Thursday, June 30, 2011

Surgery #4

Surgery was scheduled for 3:00 Monday. I spent the morning weeding the garden, figuring I wouldn't be able to do this after surgery, before we arrived at the hospital at 1:00. Once I got into the prep area, I learned that they were running about two hours behind.

When you have four surgeries in just over two months - three of them at the same institution (the fourth, the liver surgery, was across the river on the East Bank) - you get to know the drill pretty well. I recognized all but one of the people working with me in the prep area. You also know what you dread, and for me that was the IV. For surgeries #2 and 3, it took three tries (and for one of those a fourth was placed after I was under anesthesia). Using the IV "expert." I guess I have small veins, plus they could only use the one arm. But I lucked out - the nurse got it in on the first try. Not only that, she did it so fast she was taping it in place before I even realized it was in (they use lidocaine before placing IVs). Hopefully this will be the last IV I will need for a long, long time, but if I do need one again, I am requesting her.

After the IV was in place, Scott came back to wait with me. We met the anesthesiologist, the nurse the anesthetist, the OR nurse, and finally Dr. Ogilvie finished his prior surgery and came in to discuss final details. I had scraped up my arms while weeding the garden, and when I used the antiseptic wipe on my arm, all the little scrapes flared up! Luckily, they were all superficial and the skin was not broken anywhere, so we were ok to move forward with surgery.

Finally, around 4:30 or 5, they were ready to start. The nurse anesthetist came in with a syringe of versed (an anti-anxiety med). When that made my hand and arm sting as it went through the IV, they gave me a narcotic. I was feeling loopy before we even parted with Scott.

I woke up in recovery around 7 or 8, I think. I felt pretty good. The resident working with Dr. Ogilvie came in to talk to me, but I have no recollection of what was said. I was pretty out of it, but I don't think I stayed in recovery for very long. I did have quite a long conversation with the nurse there, though. About what, I'm not sure (>8. They were fairly generous with the dilaudid, and gave me one last dose before I was taken to my room, where I would be switching to oral pain meds.

Dr. Ogilvie had given Scott an update after the surgery. The main concern had been the possible presence of residual tumor above the original tumor resection site, extending above the elbow. They located additional tumor and followed it along the tumor toward my shoulder. I guess they followed it quite a ways, as Dr. Ogilvie said he was getting frustrated as it kept going and they would have to go back and lengthen the incision. Finally, the tumor seemed to disappear. They opened the nerve and found that the tumor had actually infiltrated the nerve at this point. For this reason, they had to remove some nerve tissue, which would now probably result in some permanent loss of function in this hand. So Scott was surprised when he joined us on our way to my room and saw me using my arm, lifting my cup and spooning ice chips.

I woke up fairly early the next morning, and was waiting to hear if I could eat regular food before ordering breakfast (I hadn't eaten anything for almost 36 hours by this point!), when the resident came in at 7 to see how I was doing. I was pretty groggy, so I didn't ask many questions or retain much of what I was told. The pain was pretty manageable, with the worst of it in my arm above the incision, and he said that wasn't surprising as they were digging around a lot in the bicep.

The plan was to discharge me around noon. I ordered and ate breakfast, and they disconnected me from the IV pump but left the actual IV in. I got dressed and tried to read, but my eyes couldn't really focus on anything, so I tried to watch some tv. We learned that I didn't need any additional doses of antibiotics, so the IV was removed from my hand. By the time Scott arrived at the hospital, we were just waiting for the final discharge instructions.

I was feeling good enough that we stopped at the coop, Scott's house, and the Cake Eater Bakery before heading home, but I was fairly groggy the rest of the day and not able to focus on fine print. I felt fairly back to normal Wednesday morning.

I was able to remove the dressing Wednesday (yesterday) morning and shower. There are just steri-strips across the incision. Prior to this surgery the incision was about three inches long, and now it's been extended to about five inches, going above the elbow. Pain has been very minimal, so I haven't taken any pain meds since getting home. I took the day easy yesterday, and took an hour walk this morning. I felt just fine on the walk, so will try going back to running tomorrow morning.

The numbness in my first two fingers is definitely more pronounced. I think the thumb is about the same. I was able to cut up a watermelon and a canteloupe this morning, but I really notice the numbness in the index finger as I type. It will take a long time, maybe a year, before we learn how much of this numbness is permanent.

I will follow up with Dr. Ogilvie in two weeks, and I have an appointment with radiation oncology to get that process started on July 13th.

Monday, June 27, 2011

Lymph Node Results

Leaving for the hospital in about half an hour for surgery, but just wanted to write a brief post with some good news. Heard the results of the lymph node biopsy this morning - benign. So that means that the tumor has not spread beyond the arm.

Sunday, June 26, 2011

Surgery Tomorrow

After a lot of research last week and the creation of a laundry list of questions, I went to see my University of Minnesota surgeon, Dr. Ogilvie, on Friday. I was still trying to figure out what my gut was saying (it wasn't speaking that loudly), and why I hadn't been able to commit to having my next surgery here or at MD Anderson. I've definitely been frustrated by the slow speed of things here, and Dr. Pollock has been so helpful. Add to that the fact that at least some of my travel costs would be reimbursed, along with our non-summer weather, why was I not ready to schedule a trip to Houston?

While it's difficult to reach Dr. Ogilvie, I realized that at appointments, there aren't communication issues. He answers all questions, will pull up the MRI on the computer and explain the image (Friday he was showing the area of the tumor, and made a reference to the elbow joint. When I said "I'll take your word for it," he looked for an image where it was clearer.), and draws pictures to help explain. I have never felt rushed at an appointment, which I'm sure we've all felt with some doctors. So on Friday, we went through my long list of questions, and he answered them all, good naturedly. I think I was with him for an hour and a half. I realized that I trust him, and I feel good about having him do the next surgery. So it's scheduled - for tomorrow at 3pm (I didn't know they did planned surgeries so late!). I had known that a slot for tomorrow was available, and then nothing until July 11th, so it doesn't seem so abrupt to me.

The purpose of the surgery is to remove any residual tumor (they will lengthen the incision and look for tumor above the elbow), and to clean up the remaining tissue, in order to help ensure that they remove both all macroscopic, visible tumor, but also any cancer cells that cannot be seen. They will remove some of the surrounding muscle, but I'm told it should not impact long-term arm function. The MRI I had done on the arm on May 17th (after the last arm surgery to remove the tumor) shows possible residual tumor (especially above where they operated last time), but they cannot totally differentiate tumor from post-surgery edema on the MRI images. Dr. Ogilvie does not believe that things will have changed from the last surgery, even though it's been eight weeks.

Because the surgery is so late in the day, I'll most likely be admitted (Fairview Riverside) for tomorrow night and discharged on Tuesday. I have gotten used to having mostly normal arm function the last few weeks (although my first two fingers are still fairly numb), and not sure how far back this surgery will set me. I did learn that nerve tissue grows an average of 3cm per month. I will post an update as soon as I'm home and feeling like typing.

Wednesday, June 22, 2011

Lymph Node Biopsy

Went running early this morning (45 minutes, about 30 minutes in it started pouring!), so that I could get it done before my appointment. At 8:45 I was scheduled for the needle biopsy of the enlarged lymph node in my armpit, and I wasn't sure about how I would feel afterward.

There was a mix-up with scheduling, and the interventional radiologist and pathologist were both over on the East Bank, and I was with the ultrasound tech on the West Bank. As I'd feared, the interventional radiologist told the tech that he wasn't really sure what to biopsy (see the Frustration post - Dr. Pollock at MD Anderson had wanted an enlarged lymph node biopsied, but the University of Minnesota did not really think there was anything to worry about - the nodes looked fine, and there's only been one case of MPNST spreading to the lymph nodes without spreading to distant organs as well. But I just want to be as conservative as possible.). I'd almost cancelled this appointment in order to have it done down in Houston, but it will take two weeks to receive the paperwork that I'll need to fill out for travel reimbursement, and I didn't want to wait another two weeks.

After a discussion with me and with my orthopedic surgeon, the interventional radiologist agreed to do the needle biopsy on the lymph node in question. My other concern was that the University of Minnesota wouldn't biopsy the lymph node that concerned Dr. Pollock, but turns out there were only two nodes visible in the MRI, so I feel a little more confident that it was.

A needle biopsy is done by inserting a tiny needle multiple times into the tissue, guided by ultrasound. Cells are picked up by capillary pressure in the needle. After a few lidocaine shots to numb up my armpit, the interventional radiologist used different angles to try to access the lymph node. After inserting the needle multiple times, he handed it off to the pathologist, who verified that the cells were actually from the lymph node. The first few were not, so we kept going (I guess this is normal - even if a pathologist is not present, they collect enough cells for multiple slides, and hope they got enough of the proper type of cell). Finally, the pathologist started seeing lymphocytes. The interventional radiologist collected a few more needles of cells, and my armpit was getting a bit sore by this point, as he was pushing he needle and ultrasound transducer pretty hard, and I needed a second round of lidocaine.

Finally, they decided they had collected enough cells, a few bandaids were applied, and I was sent home. I feel like I got kicked a few times in the armpit, but not that bad in relation to other things I've had done, and I'm told it should feel back to normal tomorrow. Hopefully I will hear the results by Friday or Monday.

Turns out the pathologist was familiar with my case - both the arm tumor and the liver mass. I guess both were fairly unusual, so they made their rounds within the department. Not really the way I wanted to become famous. The arm tumor had been sent to Mayo for diagnosis verification, which I knew, but I learned today that of the 20,000 or so tissue samples read at the University of Minnesota Pathology Department each year, only about 10 are sent to outside institutions for help with diagnosis.

Monday, June 20, 2011

Today's Run

Today I went for a run. I was told that I shouldn't try running until six weeks post-surgery (tomorrow will be four weeks), that it will be uncomfortable due to the organs jostling around. But last week I ran across a busy street a few times, and that seemed ok, then I ran down the block to catch the postman and give him the letters I wanted to mail but hadn't had ready when he was at my house, and that seemed to go ok too. Then on Friday I bought a copy of the newest Runner's World, about outrunning cancer (highly recommended, by the way), and I was further inspired. So I figured I might as well try.

After walking to Como Lake, I started to run. I stopped in less than two minutes, thinking something didn't seem right. I spent the next few minutes rationalizing whether it was really organs jostling, or just a bit of anxiety about it, or maybe even just being out of shape. So I tried again, and this time it seemed ok. I did a run walk combo, and ran for about 35 minutes total. The issue was more the fact that I hadn't run consistently all year than anything to do with any recent surgery. (:

Friday, June 17, 2011

The Full Story (Part 3: MD Anderson)

Originally we'd been planning to go to New York City for a second opinion with Dr. Murray Brennan at Memorial Sloan Kettering. When we got connected with Dr. Pollock at MD Anderson, who turned out to be so responsive and helpful (in addition to being a famous expert), we decided to try to do both in one trip. Dr. Pollock's clinic day was Wednesday, and Dr. Brennan's Friday - perfect. However, once I started the process of scheduling the visit with Dr. Pollock, I learned that he was actually out of the office that day (May 16th)! When I emailed him about this, he offered to cut his trip short and see me on Thursday the 17th instead. When the visit was finally scheduled, it was at 3:30, and there was no way we could allow enough time for the visit and catch a flight to New York that evening. So we decided to meet with Dr. Pollock only - at least for now (kind of a bummer, as I'd been looking forward to spending a couple days in New York!).

Thursday afternoon Scott and I met with Dr. Pollock as planned. They had just received my records, but had not had time to review them. We discussed my case, and their approach to treating me. They also work as teams of physicians, and their conference call would be the following Tuesday. When they learned that we would be in Houston until Saturday, they made me an appointment to see the radiation oncologist the following morning. Dr. Pollock said that he would be out of town on Sunday (Sunday!), so gave me his cell number, and said that his home number was "in the book." When we seemed a bit astonished, his response was "I work for you now."

I've been a little freaked out about the thought of the sarcoma spreading to my lungs, so I asked Dr. Pollock how I can protect my lungs. He responded by saying I should just enjoy life, don't let this thing control me, don't let it take control more than it already has. None of us know what will happen tomorrow (a philosophy I have used in the past myself).

Friday morning we met with the radiation oncologist, and discussed how radiation would work. I'd actually seen the radiation oncologist at the U earlier that week, but learned some new things, like they do increasing doses of radiation in a sort of concentric circle, so that the tumor site receives a higher dose than the surrounding tissues. I will be receiving radiation five days a week for five or six weeks, so I started thinking about the logistics of how it would be to receive my treatment down in Houston (why couldn't this have happened in January?).

After that, we had a nice brief time in Houston. We found a couple of great vegan restaurants (and got vegan tamales!), drove to Galveston, took the ferry, where we saw dolphins, then went to Anahuac Wildlife Refuge, where we saw lots of alligators. I also got to see a few good birds (>8.

The Full Story (Part 2: The Liver)

Sarcomas spread to the lungs. They're not known to spread to the lymph nodes, liver, or any other organs to which you often hear about cancers metastasizing. So prior to my second arm surgery I had a CT scan of my chest, which was clear. However, it showed something suspicious in the upper left quadrant of my abdomen. For that reason, I then had an abdominal CT with contrast, which showed an atypical mass on the left side of my liver. Because I was not at risk for either primary (originating in the liver) or secondary (spreading from the arm) cancer, there was some question as to what to do next. I was sent to a liver surgeon at the U, Dr. Jensen, who did not advise an MRI, as he thought that would not provide any further information. He recommended removing the mass. Surgery would be laparoscopic (which, I learned, does not mean outpatient). However, because I was not at risk for any cancers, Dr. Pollock did not think anything further needed to be done. However, MD Anderson couldn't figure out what it was either. If someone could have told me definitively what it was and that it definitely wasn't a threat, I would have been comfortable. But no one could. So I decided to have the surgery. On May 24th I had surgery to remove the mass. When I woke up I was told that they did not believe the mass was malignant, and that it wasn't the MPNST. They still didn't know what the mass was, though, and had sent it to pathology for review.

While I was very relieved to know that the mass likely wasn't malignant, holy cow, did I underestimate what the surgery would do to me! Turns out laparoscopic also does not mean pain free. I had to learn new ways of getting in and out of bed that did not use abdominal muscles. I had three incisions in my abdomen, one in my belly button, one to the left and above, and a larger one (~3 inches) to the right. I got a pain pump with dilaudid, but I got in trouble (i.e., severe pain) a couple of times because I didn't use it enough (can you believe I'd been trying to analyze what I needed so that I didn't use too much!). I also was having a lot of anxiety, which didn't help things.

I was discharged after two days. By Saturday (two days after discharge), I was venturing out a bit. Scott's parents were in town, and we went to Linder's to buy plants. Luckily they weren't crowded. I was still on quite a bit of oral dilaudid, and I felt like everyone was standing really close to me or walking straight at me.

Things were a bit rough through that weekend, but by about 9 days post surgery I started venturing out more. Ramona came over one evening and we walked around Como Lake (all I'd done up to that point was walk up and down the block a couple times). By Saturday (11 days), I decided to get out and drive to Sherburne Wildlife Refuge to look for birds. This was the first time I'd driven since the first arm surgery over a month prior to that! It went well, I had a great time, so Sunday I went to Murphy Hanrehan Park to look for more birds. I noticed that I tired out more quickly (I had to sit down in the grass with the ticks at one point), but I decided that, while I was feeling good and driving, I should head up to the North Shore - once I had the next surgery I wouldn't be driving again so I didn't know when I'd have another chance. Monday, May 6th, I had my two week surgical follow-up, and Tuesday morning I headed north.

Knowing I wouldn't be able to be as ambitious as I usually am with my hikes, I headed to Tettegouche State Park, the best location to find Black-throated Blue Warblers. Both Wednesday and Thursday I hiked over six hours, and probably hiked a distance of 8-10 miles both days. So much for taking it easy. I was tired at the end of each day, but I felt great. I think the doctors were a bit amazed (>8.

Dr. Jensen said I shouldn't try running until about six weeks post surgery - he said I'd feel things bouncing around. So I got the idea when I was hiking that I should just focus on going on hilly walks until I can run again (~July 1). Actually, turns out walking hills uses the same muscles as running. The morning after I got back home, I walked around Como, with some "hill repeats" on the small hill leading to the picnic area. I haven't been as ambitious at finding hills since then. However, when I was out on Wednesday, I ran across Grand Avenue a few times to dodge cars. Then, yesterday, I ran down the block barefoot after the postman to give him some letters to mail. Not huge distances either time, but it felt ok. Tuesday will be four weeks, I think it's time to give actual running a try. Anyone want to go on slow runs (maybe run/walks) with me?

Thursday, June 16, 2011

The Full Story (Part 1)

Many of you know this, or at least part of this story. But if you didn't know, or want to know all the details, read on!

In early February, I noticed a large lump in my left forearm. I thought maybe it was a muscle knot, I'd had too many experiences of going to the doctor where I was told they didn't see what I was talking about (after which I always thought it was such a waste of a $20 copay), and I was busy with a job search and life in general. It made my thumb and index finger tingle when you pushed on it, and it didn't go away. So finally, on March 21 I went to the doctor. I had an x-ray, which showed nothing since it was soft tissue (but you could still see where the screws from my previous hardware for 2009's elbow fracture), and was scheduled for an ultrasound. I had an ultrasound later that week, at which point I started getting worried. I could see the mass, and when they used Doppler I could see what I thought was blood flow. The mass was around or very close to the median nerve. The ultrasound was followed by an MRI, which was followed by a referral to an orthopedic oncologist at the University of Minnesota. I saw him on Friday, April 1, at which time I was told a surgical biopsy would need to be done (in case it was malignant, they would not want to remove all of it prior to radiation or chemo that would first shrink or consolidate the tumor). However, I was traveling that Sunday to Wilmington, NC, to start my new job with two weeks of on-site training, so we scheduled the biopsy for the Monday after I got home, the 18th.

When they do the biopsy, they freeze the specimen and look at it right away, so that they know whether or not they can remove the rest of the tumor. When I woke up, I was told that the tumor was malignant. A follow-up was scheduled to check the wound and to discuss next steps, and I was sent home. However, I had a lot of pain and couldn't straighten out my fingers, so that Thursday I went back to see the doctor and to get a splint. At this time, I learned that now they thought it was not malignant: diagnosis benign cellular schwannoma (as it originated in the Schwann cells that line the nerve). A follow-up surgery to remove the entire mass was scheduled for the 28th, but I had not yet completely exhaled...

Because I'd had quite a bit of pain after the first surgery, I was surprised when I didn't have much pain after this one - just a lot of numbness. I'd had a local block in addition to the general anesthesia, so I thought maybe it was due to that. But the pain never really came, and the numbness stayed. More than six weeks later, my thumb, index finger, and middle finger are numb. I can't feel anything or do any fine work (I can't pick up a tiny pill or handle a nail clipper).

A week after the surgery, I was called and asked to come see the surgeon the following day. This didn't seem like a good omen. And, sure enough, at the appointment I was told that the tumor was, indeed, malignant. The diagnosis was Malignant Peripheral Nerve Sheath Tumor (MPNST). The pathology had been confirmed by an expert at Mayo, the tumor was high grade (i.e., aggressive), and we needed to act quickly. At this point, there were three treatment options: radiation alone, radiation plus surgery that would remove enough muscle and nerve to leave the arm essentially useless (this was my left arm, and I'm left-handed), and amputation. What I took home was the possibility of amputation.

The next day Scott and I shared the information with my family, and that's when the information and phone calls really started flying. My sister Debra did a lot of research and also put me in touch with another orthopedic oncologist at the U. We started looking for places to go for a second opinion, and a trip to New York to see someone at Memorial Sloan Kettering started to materialize. My cousin offered to find out who treated a friend of his that had also had a sarcoma, this one in his stomach. This is how I got connected with Dr. Pollock at MD Anderson in Houston. In the email chain, I could see how quickly Dr. Pollock responded to my cousin's friend, so I was hopeful when I emailed him to introduce myself...

Sarcomas (and maybe most cancers) are treated by a team of physicians. The team following my case consisted of three orthopedic surgeons (including the one who had done my two surgeries and also the doctor with whom my sister had connected me), an oncologist, two radiation oncologists, a pathologist, and a doctor from the cancer survivor long-term follow-up clinic. I discussed my diagnosis with the doctor from the long-term follow-up clinic, who didn't think it was a good idea to receive further radiation, and suggested I meet a doctor who specializes in neurofibromatosis, a genetic condition associated with roughly 50% of MPNST cases.

In the meantime, Dr. Pollock had responded to my email (about 30 minutes after I sent it) and suggested we set up a time to talk on the phone. During that call, he told me that amputation would likely not be necessary - depending on whether the previous surgery had removed all traces of the tumor plus the surrounding tissue, I would either require follow-up alone (regular MRIs of my arm and chest), or radiation plus follow-up. We started to tentatively plan a visit to both New York and Houston.

My next appointment was back with the orthopedic surgeon at the University of Minnesota. I discussed my conversation with Dr. Pollock with him, and he agreed that he did not think that amputation would be necessary. In the case that nerve or functional muscle would need to be removed, there were options of nerve and/or tendon grafts (from the legs - I guess we just carry a lot of extraneous tissues there!) that could help with arm function. However, radiation impairs the healing process, so it might impact how well the graft would "take."

I was again feeling more encouraged at this point, but we were late for our next appointment, with the neurofibromatosis specialist. We had to wait quite a while for this appointment, and we were in a pediatric oncology clinic. To see all those kids suffering with cancer and treatment...well, things didn't seem so bad any more.

Imagine my surprise when the neurofibromatosis specialist told me that amputation is standard of care for MPNST! Just as I'd been starting to feel better about things, the emotional roller coaster plunged down again. I also learned that I did not have neurofibromatosis (based on the clinical exam they did not need to do a genetic test). Anyway, as soon as I got home I emailed Dr. Pollock, whose response was that amputation was "definitely not" standard of care.

Enough for now! More later...

Frustration...

Current status: waiting to schedule third arm surgery (fourth surgery in all). Waiting has been a common activity for the last six weeks.

In mid-May I had an arm and shoulder MRI that showed an enlarged lymph node in the armpit, and probable residual tumor in the left forearm. This was pointed out by Dr. Pollock at MD Anderson Cancer Center in Houston, who had received a copy of the MRI when we went there for a second opinion. When I mentioned it to my orthopedic surgeon here, he discussed another surgery to remove any remaining tumor (but that the abnormality seen in the MRI could also be post-surgical edema), and to "clean up" around the tumor. While this would involve removal of muscle tissue around the nerve and perhaps the nerve lining (I'm still unclear as to whether there's a separate lining that's not the sheath cells), it should not impact long-term function. He also pointed out the enlarged lymph node (which he said could very well be due to the previous arm surgery) and suggested we see another doctor to see about a lymph node dissection done at the same time as the next arm surgery (the orthopedic surgeon doesn't work on lymph nodes). So last Friday, I saw the lymph node doctor, who said he didn't see any abnormal lymph nodes and that nothing further needed to be done. I should be relieved. But I only felt frustrated and confused. It's true that it's extremely rare for MPNST to spread to the lymph nodes, especially in the absence of spreading to distant organs, but I would rather err on the conservative side! So Friday afternoon I emailed Dr. Pollock, who of course responded within a half hour - but he was in the OR so gave me his cell and asked for me to call that evening or the next (Saturday!) morning.

Saturday I talked to Dr. Pollock, who suggested an ultrasound of the lymph nodes, with an ultrasound-guided needle biopsy of the enlarged lymph node if it was still present. Regarding the arm surgery, Dr. Pollock himself would do it, but he would have a reconstructive surgeon on hand in case removal of additional nerve or muscle was needed, necessitating a nerve or tendon graft, and also a neurosurgeon, in case microsurgery of the nerve was required. They would also want another arm MRI shortly before the surgery. This sense of coordination and pro-activeness, on top of Dr. Pollock's responsiveness, got me thinking more about going to MD Anderson for the surgery. Unfortunately, Dr. Pollock will be out of the country from the 19th June until 2nd July, pushing everything back even more.

I still wanted to talk to my doctor here in order to help me make the decision. I paged his nurse, who is usually very good about getting back to me, on Monday afternoon. No response. Paged her again on Tuesday, after which she called me. I updated her on the above, and asked 1) if they would consider moving forward with an ultrasound even if the lymph node expert said there's nothing to worry about, and 2) are additional surgeons on hand in case they are needed (she did say that this doctor does his own reconstructive surgery (which makes sense since he's an orthopedic surgeon and Dr. Pollock is a surgical oncologist specializing in sarcomas), but that sometimes he does have a plastic surgeon available - but that this would not likely be necessary in my case), in order to prevent needing a fourth arm surgery. I didn't ask about 3) what happens to my care at the University if I choose to have the surgery in Houston - where do I go for follow-ups, will they still see me? And can I still do the radiation here (I'd really prefer not to spend 5-6 weeks in Houston this summer!)? Anyway, I was told she'd discuss with the doctor during clinic the following day, and either she or the doctor would get back to me toward the end of the day. So yesterday, my phone rang around 5:30, and it was the nurse, telling me she hadn't had the opportunity to discuss it with him, and that she would be in training all day today (Thursday), but that it would be first priority Friday morning.

I'd been hoping to talk to the doctor early in the week so that I could make a decision this week. Hmm. It is, however, yet another example of why I'm so frustrated by the U and so impressed by MD Anderson...

To My Family and Friends:

Tuesday morning I went to an orientation at Pathways (pathwaysminneapolis.org), a non-profit organization that offers complementary healing services for people affected by health crises. There was a video shown, in which participants discussed their experiences at Pathways. One participant mentioned that when she was diagnosed with her brain tumor, all her friends just disappeared.

I feel so lucky that that has not been the case for me, either now or way back in 1989. In fact, it has always made me realize how lucky I am to have the wonderful friends and family I have, and how good people are (sometimes we need a little reminder of this, when we're always hearing about the bad things that people do).

Yesterday I went out for breakfast with my friends Misty, Katie, and Maria. I ate sugar and drank coffee, and didn't drink any green tea, but I laughed for two hours, so I figure that more than made up for my dietary lapse.

I've received so many well wishes and offers of assistance, but at least at this moment, there's not really much with which I need help at this time (unless you really want to scrub my bathtub). So thank you, everyone, for your offers. I guess the best thing right now is to just keep me laughing. (>8