Loose Strife

At last, I’ve posted some photos from December. We missed a lot of events — holiday parties, bonfire, and so on. Sometimes I just fall out of the habit. We did resurrect the video camera after months collecting dust, but transferring, editing, and posting video just takes too much time. Some day!
My favorite photos last month were taken on Christmas Eve. I was up very late as usual. Maybe waiting to hear some cloven hooves on the roof. I noticed that Santa wouldn’t be needing Rudolph because the moon was so bright that I could see everything as though it were daytime. I set up my tripod in front of the windows and after a lot of trial and error ended up with the following two photos that I really like.
The first is a familiar vantage to those of you who have looked at our other photos. It’s the view from our dining room and you can see the glow of the Connecticut River valley 20 miles away (not the sun rising). I usually don’t like the light pollution, but at 3am on a night like that I thought it was pretty cool. It’s not really as bright as you see here, but the high exposure brings out the light and colors. On the table is a pumpkin that I stubbornly didn’t throw away after Halloween and it is still today in the same spot, slowly rotting away on display. The orange from the pumpkin, almost the only color in the photo except for the orange in the sky, makes for a nice composition.
But I’m really pleased with the second. It’s looking up from the house to a line of trees. The moon shadows show in the snow, the branches look crisp in the cold, and the clouds blur across the sky due to the long exposure. The winds were whipping up clouds from over the ridge that would immediately dissipate as they drifted over the house.
There’s lots of optical noise in both photos, but I think it just adds to the character of the shots. These shots could have been so much better if I had known what I was doing, but I think they work just the same because when I look at them they evoke the sense of magic I felt staring out into the moonlight. You can see very large, full size versions by clicking on either photo.

This morning Laura and I (and Naomi) went to see the cardiologist. He listened and discussed her symptoms (lightheadedness, unsteadiness, occasional falling, fainting, low blood pressure, and lots of migraines). Like the rest of the doctors, he thought that everything except the low blood pressure was probably neurological and not symptomatic of a problem with her circulatory system. Still, he ordered another echocardiogram (fancy term for a heart sonogram) to compare to those from the time of her surgery. The echo was done right away and the cardiologist phoned with results this afternoon.
Laura’s heart function has decreased from “excellent” to the “low end” of “normal”. Damage (“toxicity”) to the heart is a well known side effect of one of her chemotherapy drugs called Adriamycin. There are standard procedures for monitoring dosage and heart response. This upcoming chemo round would have been the maximum allowable without augmenting her treatment with another drug that has been shown to protect the heart from Adriamycin’s toxicity (but isn’t administered from the beginning because it reduces the anti-tumor effectiveness of Adriamycin). After further chemos Laura would have been scheduled for a heart monitoring test similar to what she had today. The upshot of all this is that while heart damage is a well known side effect, it doesn’t usually appear so soon and with Laura’s current dosage.
Having a heart that functions at the low end of normal sounds bad, although there is that word “normal” still in there. We’re not clear yet on what it means for Laura’s long term health. But it probably means that she won’t be running any marathons and, in the long term, has an increased risk of heart failure. That risk was already present just by taking Adriamycin, but a weakened heart probably increases that risk.
This afternoon the cardiologist talked to Laura’s oncologist and we then also spoke with her onc to discuss the implications. If Laura’s CT and bone scans next Monday suggest that further chemotherapy is needed, then she would be switched to a different drug. As I mentioned in a previous post, more chemotherapy would likely be recommended if significant cancer progression or regression is observed (implying that either cancer is returning so more attack is needed or that cancer is still significantly retreating implying that more mileage can be gained by additional chemo treatments). If regression is modest, then Laura may go on a chemo break and her condition will be monitored to see if it remains stable.
In addition to the drop in heart function, the cardiologist also noticed a mass associated with the pericardium. He couldn’t say whether it was scar tissue or a blood clot from her surgery or if it was a tumor. The oncologist thinks that a tumor would be unlikely since other signs indicate cancer regression. The hope is that the so-called “contrast dye” high resolution CT scans on Monday will help resolve this question. If not, a different kind of scan called a PET may be done.
You might also be wondering about the migraine issues and possible drug interactions. Laura dropped one of her drugs, which was being prescribed primarily as an appetite stimulant, but that change had no apparent effect on the headaches, etc. She also changed her dosage of the anti-migraine drug so that she was taking two horse pills at night instead of 10 pills throughout the day. For the past three of four days she has had a return of severe migraines, frequently occurring throughout the day (once an hour and sometimes many in a single hour), and the headaches have even caused her to throw up a couple times. She changed back to her previous dosage schedule, but hasn’t seen any improvement, yet. So the dosage change may just be coincidental with the migraine recurrence.
It all takes us back to pre-hospital times last month, but Laura still says she’s feeling better than those days. She’s been in bed a lot again. I think the headache pain is fatiguing. But the temperatures have recently been up in the 40s, ice and snow have melted on the driveway and roads, and Laura took a slow walk outside for about 20 minutes yesterday. And she’s been eating a pretty normal diet.

Administrivia:
Some of you want to know when others have commented on posts — a post of particular interest or one that you have commented on.
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Neither of these is on the main page, but if you click the blog title or the comment link you’ll see a single entry blog page where you can set comment notifications.

Another installment of the Ashfield patrol log:
Dec 17 – 8:30pm – Report of a doorknob missing from residence on South Street; services rendered.

Laura’s handling this latest round of chemo extremely well so far. It’s really remarkable. None of the previous nausea/vomiting, malaise, or pain even though, or perhaps because, she’s taking no meds to treat any of these symptoms. Her appetite has returned. Many things taste different, but otherwise no trouble eating.
So now Laura’s main issues are the multiple daily migraines and dizziness, which is causing troubles for her getting around. Almost all the time Laura is quite unsteady. Sometimes she stumbles and she usually moves slowly, holding on as she goes.
To this end, we had a very good meeting with Laura’s neurologist today. He strongly suspects that it is a drug interaction that’s causing the problem because the symptom began after leaving the hospital with three new drugs. Over the next few weeks we’ll be working to eliminate and modify her drugs to try to figure out the culprit.
We’ll also be going to see a cardiologist because she’s got low blood pressure. Her chemo drug can have cardiac effects, although besides the low blood pressure she’s not showing any of the other classic signs of heart failure. Still we’ll follow up.
After reading this, many of you will probably come to the same theory as I had: that her low blood pressure is causing the dizziness. But while it may be contributing, it turns out that it’s probably not the main cause. After sitting with the neurologist for at least 20 minutes, a particular line of questions led to “Do you feel dizzy when you shake your head?” And Laura said, “Oh, I can’t do that.” And in a moment of “House” eureka, the doctor said, then it’s not low blood pressure!
It turns out that Laura feels dizzy whenever she makes any quick, sudden, or big movements. We joked about how it was a shame that she couldn’t unload the dishwasher because all the back and forth movement made her unsteady on her feet.
So it’s probably either an inner ear infection or a drug interaction.

It’s been wonderfully wintery over the holidays. I really will post some kid pics and such, but just haven’t had the time. I know some of you are experiencing withdrawal.
Lily returned to preschool today. And I’ll start accompanying Naomi to preschool for a few mornings per week starting next Monday. The staff and kids are thrilled as her reputation precedes her. (They haven’t seen her mischievous side, yet!)
We got about another 15 inches of snow over the last several days and it’s currently 1 degree outside and windy! But we’re warm and fine.

This video is a mash-up of an excerpt from Carl Sagan and various iconic movie imagery. It somehow struck me as particularly poignant right now.
Here’s to the new year!
http://media.dizz.org/palebluedot.mov

We had a very nice christmas this year without incident. (Well, let’s not dwell on the unfortunate flair up when I lost my cool after Lily turned her nose up at my christmas dinner.) The day was very easy going and the kids were adorable. I’ll post some pics and video later.
Laura had her fifth chemotherapy infusion today. She’s still just slightly anemic. No cause for alarm. So the chemo went ahead as scheduled.
In many ways, Laura is doing much better than two weeks ago when she was in the hospital. As I’ve mentioned, the chemo/cancer nausea is gone and we’re hoping it will not return after today’s chemo. She’s eating almost normally. (Proof: she wants to go get some mexican food!) She has no significant bone pain and is on no pain killers at all. The lack of narcotics and the anti-depressants perhaps kicking in seem to be reducing her fatigue. She still doesn’t have much stamina, but she looks great.
The main issues now are low blood pressure and continued migraines. The low blood pressure can be a bit scary and is probably related to her fainting episodes that I mentioned last week. It can be surprising: she’ll be sitting around talking and looking normal, then when she stands up she’ll lose her footing and become disoriented. This happened again this evening when she stood up to leave after visiting at a friend’s house. As I was walking her slowly out to the car Laura hollered back to our friend that she needs an old lady walker with tennis balls on the feet.
Low blood pressure is often associated with heart problems. Laura did have a pericardial window (surgery to poke a hole in the fluid sack around her heart) and cancer was found there, but there’s no current signs that her heart’s not working right upon physical examination. None of her drugs are associated with such a side effect, either.
I wondered whether it was related to her migraines. The oncologist said that high blood pressure is sometimes related to headaches, but not low. But we’ll discuss it with the neurologist next week.
The migraines, as I’ve previously mentioned, are less severe, but it still seems unacceptable to be experiencing such pain a dozen times per day. At this point, we don’t know whether the drug that she’s taking to control them is actually working and the migraines would otherwise be much worse and making her sick, as in the past, or maybe it’s just coincidental. We expect that the neurologist will order some additional tests. Hopefully more avenues for treatment will become available as a result.
Today we received a better sense of future plans from her oncologist. Laura’s scheduled for another set of CT scans in 2 1/2 weeks. If the result is about the same as before or modestly better, then the oncologist said she would likely recommend that Laura take a “chemo break” and experiment with a different hormone therapy than the one used before (that didn’t work). Slightly counterintuitive at first, the onc also said that if there was a big improvement then she would want to continue with chemotherapy further. If Laura is still getting significant benefit, then it’s best to continue.
Surprisingly, the oncologist is not eager to have Laura’s ovaries removed even though she has tumors on them and her cancer is hormone receptive. The doctor said that the tumors on her ovaries are “peripheral” and “negligible” with respect to her metastases. The laparoscopic surgery, although not dangerous, is invasive and has its risks. And ovarian function can be chemically turned off (using a drug called Lupron, which Laura took earlier in the year). The final argument was that since studies have shown that Tamoxifen, the hormone drug that Laura took before chemo, is about as equally effective as ovary suppression and since Tamoxifen apparently didn’t work for Laura, then there probably isn’t much to gain by disabling the ovaries.
I’m not sure I buy it. Certainly the last argument is bad logic at best. Maybe I misunderstood, but we might want a second opinion. I now know of many young metastatic BC women who have had their ovaries removed and they didn’t even have tumors present. Lupron is not always effective. And it would seem like an obvious one-time procedure to eliminate estrogen that could be feeding the cancer. (Chemotherapy also typically shuts down the ovaries, so it’s at least conceivable that this effect is contributing to Laura’s cancer regression now.)
That’s it for now.

Another installment of the Ashfield patrol log:
Dec 12 – 2:20pm – Report residential propane leak, March Rd. Determined to be stink bomb, located inside pant pocket that went through dryer.

Not much to share, but I’m wide awake. Long before Laura’s diagnosis I fell into a bad pattern. About the time I put the kids to bed I’m ready to collapse and I often fall asleep while reading stories, much to Lily and Naomi’s frustration. But they poke me and I read another line or two and finally I finish the story, tuck them in, sing a lullaby, and send them off to dreamland. If I also succumb to dreamland then I’ll sleep for maybe 2 hours and then be wide awake for hours in the middle of the night. If I fight it, I usually will fall asleep at a normal hour and get a reasonable night sleep… but sleep is a tempting siren.
Anyway, Laura and I want to wish everyone a very merry Christmas. Unlike Thanksgiving, we’re spending Christmas in Ashfield with just the four of us. It’s something we’ve never done and I hope it will be nice, although I have mixed feelings about being away from our extended family at this time. But Laura didn’t want to travel, she’s scheduled for more chemo on the 27th, and she didn’t want the stress of guests around the house.
I’m not the guy who’s ever been much involved in “putting on” Christmas, but I found the decorations in the basement, put the tree and lights up, and that sort of thing. I’ve been thinking about what to cook for Christmas. Maybe a small bird and some other conventional dishes, but planning meals is not much fun when I’m essentially cooking for one. The kids would be much happier with macaroni and cheese.
But Laura’s appetite is really improving, so I’m becoming more eager for a “real” christmas meal. Laura had a peanut butter and jelly sandwich today. Sandwich bread is the first baked good she has had in several months! So I think she’ll be up for stuffing by Tuesday.
Being far from Virginia has not kept the quantity of gifts down! Our snowy driveway has become a daily stop for UPS, Fedex, and the postman with boxes from family and online purchases. I’ve yet to get around to unpacking everything. I think the kids will be thrilled to see the tree, currently without presents, suddenly littered with pretty boxes in a day or so when i finally do unpack and wrap.
Laura is doing OK. Not feeling quite as well — her well-being closely related to the migraines. Still no cancer/chemo-related nausea and, as I said, her diet seems much better. She’s out of bed a fair amount and has begun knitting.
We had a scare a few nights ago when she suddenly fainted and became sick twice. We considered going to the ER again, but decided not to. I spoke with her oncologist who didn’t know what was going on and her neurologist is away until the new year. Luckily there haven’t been any similar episodes and we’re hoping that it was an isolated incident.
Although reluctant to go out, Laura joined me and the kids this evening and we all went to a solstice bonfire at the town common. There were songs and morris dancers and friends. We stopped at Elmer’s for a bite to eat. (I didn’t bring my camera, so these are links to pictures during summery weather. Perhaps an enticement to browse old photos.)
That’s all for now. Our best to everyone.

It’s been a winter wonderland around here over the past few weeks. Locals say that this is the sort of weather usually reserved for January or February. There’s currently 16 inches on the ground with some drifts around the barn much deeper. Low temperatures have been in the single digits and we had wind gusts to 50 miles per hour yesterday. But really it hasn’t been so bad! (My biggest anxiety about moving to New England from northern California was whether I could deal with the cold. That’s turned out to not be a problem.)
That’s not to say that the winter hasn’t been without its surprises. I belatedly bought something called a roof rake. The long icicles hanging from the house seemed so pretty at first. Then I got nervous about the gutters. And then I got really nervous about water coming into the house. I’ve already lost some of the gutter brackets, but now that I’ve cleared the snow with the rake I’m hoping it won’t get any worse. (Our 100-year-old Northampton house never had these damn ice dams because the roof is pitched more steeply and any remaining snow melts due to poor insulation.) And clearing the snow wasn’t quite as easy as I expected, either. My snow blower would barely move through the snow and I couldn’t figure out why until my neighbor told me the augers weren’t moving! That’s when I finally learned what a shear bolt was… and how to replace it. (My father-in-law kept saying something about shear bolts on the snow blower blah blah blah… I wasn’t paying attention when he was visiting.)
The kids have been having fun outside. And now that the snow is too deep for Lily and Naomi to walk through, the driveway has proven to be a perfect sledding slope. To the right is Lily on her toboggan riding behind neighbor Ella.
Former neighbors from Northampton threw an ice skating birthday party for their daughter and invited Naomi and Lily along. (Thanks, Ann and John!) Lily loved it and has been talking about skating ever since. So Santa will be bringing a pair of ice skates for some skating on our pond. (Shhh!) Naomi will get little double-bladed strap on “skates”. Naomi had fun at the rink, too, but preferred to be carried… as always. I cajoled Laura to come along to the party, too, and it was a big success. Happy birthday, Ruby!
Julia and Debra, great friends from Holyoke (near our old home in Northampton), came up this afternoon with their children to visit and the kids all decorated gingerbread houses. Naomi and Lily were thrilled to see their old friends and couldn’t wait to eat their creations. Laura had another pretty good day and I think she really enjoyed the company.
In fact, Laura’s been feeling relatively good since she left the hospital and we’re both optimistic. She still has down times and a few migraines, but the headaches aren’t usually very bad — certainly not bad enough to cause her to throw up. Incredibly, there’s been no nausea and vomiting at all for several weeks except for headache-induced troubles that ended in the hospital. Her calorie intake has been pretty good and we’ve started brewing fortified milk shakes and such to give her lots of protein and calories. With the last chemo/cancer nausea several weeks ago, the even better news is that her appetite and willingness to try foods again has definitely improved. Eggs two nights ago. Cheese pizza (shudder!) at Country Pie last night. And she asked me for a chicken pot pie tonight.
Laura is now off all daily narcotics with almost no residual back pain. She’s been out of bed for most of the day during the past week. I took her to Ashfield to do some shopping yesterday, which was the first time she’s been out of the house except to the hospital for at least three weeks. While she’s very weak — I have to open doors and bottles for her, for example — and she’s usually slow and somewhat unsteady on her feet, all in all she has more energy and is more active than she has been for some time.
Two weeks ago I was worried about leaving Laura alone and this morning I left Naomi alone with Laura! So this is all good news.
One more photo before I finish. Sunrises during this time of year are gorgeous. I snapped this pic a few days ago.