Loose Strife

Hi, all. Laura had a pretty good day today. (A good day means only one prayer at the porcelain alter this morning!) She spent a lot of time up, got outside with the kids, ate fairly normally, etc. The esophagus pain from the radiation treatment seems to be lessening, too. Back pain is still present — which is a worry that we’ll have to follow up on because the radiation treatment was supposed to kill the cancer deposit in the spine and relieve the pain. But there’s reason to be hopeful that even that may still improve. Laura is managing with a slightly reduced amount of pain killers, suggesting some progress.
Tomorrow I’ll be taking her to the hospital for a test in which an xray movie is made of her throat, windpipe, etc. as she swallows a chalky radioactive drink. Then she ingests more radioactive juice for a new CAT scan. The last scan was almost two months ago and Laura has been on hormone therapy for 6 weeks, so this will be an important indicator of the cancer regression. Results won’t probably be available until next week. Laura will be back in the hospital Friday for a minor surgery to have a “port” installed — which is basically a tap directly into a major vein so that future IVs and blood draws are easy.
Yesterday evening I dragged Laura out of the house to visit an organic farm in the neighboring town of Conway that uses only draught horses. No tractors. Beautiful fields of long narrow rows along a riverbottom. You have to walk across a swinging suspension bridge to get to the fields. On the way across my mother snapped this rare family photo that turned out pretty well!

There are a few new photos in a September photo album.

(No improvement for Laura, yet. She’s having worse trouble throughout the day with vomiting. Will be talking to oncologist tomorrow for coping tips.)

Just a quick update to say that Laura’s not feeling very well. She’s a heap of compounded side effects. She’s got nausea, throws up like clock work every morning, has no appetite, has acid reflux, is fatigued, her esophagus has been burned up by the radiation so she can’t swallow, and the narcotics — well, let’s just say they don’t leave you feeling so great.
So what’s upsetting is that side effects are getting worse, but the primary symptoms of back pain and cough aren’t getting better either. Not fair. But we talked with her radiation oncologist this afternoon. Tomorrow is her last radiation treatment and hopefully over the next week we’ll see good effects from the radiation (although side effects are likely to get still worse, first). But eventually Laura will be able to reduce her pain meds and the combined side-effects from rads and pain meds will be eliminated.

We had a black bear pull down the cherry tree in our front yard recently. But that’s nothing compared to what grizzlies can do. I did put the word “whimsy” in the title of this blog — because, um, I was looking for another short “w” word that wasn’t a downer. So, without further ado.

One way of tracking the progression of cancer and the efficacy of treatment is the measurement of various quantities in blood samples that are statistically associated with cancer growth. There is some controversy about these, but taken along with other indicators are useful.
Laura received the results of her second measurement of “CA 27-29” today and it was higher than a month ago at the time of her diagnosis. This isn’t a cause for concern yet because Tamoxifen is slower acting than chemo and the trend over several months is more important.
In fact, there’s a lot of reason to be optimistic at this stage. It’s quite possible that Laura could ride a wave of new cancer treatments. First, women with hormone receptive breast cancer respond better to treatment because of the availability of multiple hormone therapies. Second, while the published median statistics on “BC mets” (metastatic breast cancer) are poor, it’s important to realize that they are based on all breast cancers (hormone receptive or not) over the last 40 years. Many new hormone therapies have been developed during the last 10-15 years and it’s likely that more will become available in the next decade. (It’s typical for someone with mets to change to a new treatment when an old one stops working after months or years, but usually not more than five years for any one drug.)
Another reason for optimism is that the usual statistics are based on all mets cases, regardless of previous history. Someone with mets due to recurrence or because of a failure of treatment for earlier stage breast cancer is likely to have a worse prognosis than someone in Laura’s situation who was diagnosed with mets from the get go. In other words, Laura has a better chance of responding to therapy than other stage IV patients who may have been battling cancer for a long time. In our case, it’s just the beginning and there are many treatment options to try.
The last reason for optimism is that Laura is under excellent care, has a strong reason to fight, and has lots of support from family and friends. These factors cannot be underestimated and should help to place her in the “positive tail” of the distribution.
Stephen Jay Gould is a famous evolutionary biologist who had a very rare type of cancer called abdominal mesothelioma, which he managed to keep at bay for tens of years longer than the median estimate. He wrote an excellent article called “The Median Isn’t the Message” that explains both the importance of statistics and the reasons for optimism given the statistics.

The Greenfield Recorder today had a brief article about a classic post and beam barn raising at Sangha Farm, which is run by folks we know in town.  Their son goes to our little town’s preschool — same as Lily.

After a week of messing around, I’m sending out a link to this website — yet another excuse for me to obsess about breast cancer and procrastinate.  I figure this is a better way of keeping folks informed about what’s going on up our way.  You can either read this website or put your email address in the box to the right, which will send at most one email per day if anything new shows up on this site.
Feel free to leave comments if you want.
The “About” page will contain Laura’s latest status.
-d

The 2nd chest xray showed no change from the one last week.  That means no evidence of increased pleura effusion.
In other news, Natalie and Joe, Laura’s parents, are returning tomorrow to Virginia after almost a month here.  It would have been a tough slog without them!  And Naomi begins daycare in Shelburne Falls tomorrow, which should help Laura focus on good health, rest, doctor’s appointments, etc.

We met with the onc this afternoon for a follow-up because the doctor was concerned about Laura on Friday being so uncomfortable.  But the anti-nausea drug seems to be working OK.
The onc noticed that Laura’s cough is back and she detected more fluid in her lungs.  So Laura went back to the hospital this afternoon for another chest xray to compare with the one from last week.  She’ll discuss with one of her surgeons tomorrow, when she happens to have a post-op appointment.  If there’s a lot more fluid, then they might consider putting in a catheter drain.
Laura’s exhausted again.  I’m pretty sure the radiation is causing the fatigue.  She’s back in bed — actually back in the recliner.  She’s been sleeping in the recliner for over a week because of back pain.

Our Ashfield farmers market was hopping this morning. I’ve read that, ironically, as the harvest really starts to increase in the late summer and early fall, many shoppers start to get farmers market fatigue, but our town seems to have remained committed.
With a 60% chance of rain, I was up early. Joe and I messed with the sickle bar a little more, shook our heads, and I decided to give it a try mowing down the buckwheat. Well, it sort of worked, except it kept getting clogged and the teeth would stop and then a tooth assembly came loose and the whole thing stopped. A valiant attempt to use what seemed like a perfect tool, but it’s time to send it to craigslist.
I then tried putting the tiller on the old International, but there are problems with the hydraulics and I would almost stall the tractor as I pulled it across the field. I switched to the Massey (my new sub-compact) and I moved through the 1/2 acre like cutting butter. It hasn’t rained in a month, so it was dry as hell. The dust was fierce and I put on a mask. With the tiller I can’t turn in all of the organic matter, but I probably get 75%, which seems good enough for seeding the next crop.
Not moving quite fast enough, I got the broadcaster attached and a roughly half-and-half mix of hairy vetch and winter rye loaded just as the winds whipped up and the lightening flashed. I didn’t quite get the seed down before the rain, but it turned out to be a relatively light shower, so I still managed to spread the seed afterwards in wet dirt.
Broadcast seeders are a pain! The documentation will have a chart that will tell me to do something like set the opening at 1/2″ for oats when traveling at 7 mph. So what do I do with vetch and rye when there’s not even a speedometer on the tractor? My answer was to set at the smallest opening that still allows flow and then hope. Which wasn’t such a great solution. I managed to go through almost twice as much seed as I had intended after just one pass — and vetch is expensive! Oh well. Live and learn.
After all that, it was late, so I held off discing the seed in. Instead I took the girls for a swim at the lake and some chow at the Lake House. Laura had her first real meal in a couple days.
A busy hot day. Finally some much needed rain. More possible every day for the next week.