It's Puzzling

When I'm sitting in the cancer treatment center, I find it hard to concentrate enough to read a book. Each week when I go for treatment, I take a crossword puzzle book along as well as my iPod Touch, and that usually gives me enough to work on if I don't fall asleep in the recliner. However, my sister recently reminded me of fun word puzzle we have had a friendly competition over the past few winters.  (I should say that while I'm enduring real winter, my sister lives in the Virgin Islands.) We give ourselves a week to work on our lists and then get in touch and compare words. Invariably, we each come up with a few the other has missed. The puzzle is printed in the daily Halifax, Nova Scotia newspaper, The Chronicle-Herald, although I haven't ever found it on their web site.  I just have little clippings, which a friend was kind enough to collect for us several years ago. It's a great puzzle to do while on a flight, over breakfast, during a coffee break, or when waiting for an appointment -- anytime you have some moments to fill and want to challenge your mind.  All you need are a pen or pencil and a sheet of paper. 

This is the way the puzzle works:

You are given 9 letters in a 3x3 grid and are asked to see how many words of 4 letters or more you can make from the letters shown. There is at least one valid 9-letter word that can be formed using the letters given.

The rules are:

*In making a word, each letter may be used only once. 

*Each word must contain the center letter.  (CAUTION: it is easy to lose sight of this rule and get off track, only to discover that you stopped using the center letter 15 words ago!)

*There are no plurals or verb forms ending in s.

*No proper names are permitted.

*No words with a hyphen or apostrophe are permitted.

Depending on the word, the paper tells you what you're aiming for, or what the "word target" is. They note what they consider to be good, very good and excellent scores. You get 1 point for each valid word you come up with. 

Here's the one we're working on this week, in case you want to join in the friendly competition.  I'll start working on my list tomorrow at the hospital, and will compare my words with my sister's next weekend. I'll print the words we both came up with sometime next week.  This week the letters are:

Don't forget that each word must use the R.

Scoring:

You've done a good job if you come up with 14 words

Very good:  21 words

Excellent: 27 words or more

Good luck!

The Element of Surprise – Bumping into People

I have been living in self-enforced semi-seclusion these past few months, avoiding being out in public as much as possible, except for a few special events, in an effort to steer clear of the germs that are so prevalent this time of year.  I go from home to the small office where I work part-time and only run the occasional errand, as quickly as possible, avoiding interaction with the general public.  As a season subscriber to the local repertory theater, I have been to a couple of performances, and I did go to one or two holiday events, but if I interact with friends, I prefer to have people come to my home for a visit.  If someone’s coming for a bite, I like to make it simple, so we’ll pick up some take out food and bring it in. That way there’s very little fuss, beyond tidying up the place a bit. 

So, not being out in public, I haven’t run into too many people I know unexpectedly.  When I have, I have found myself unprepared for the awkwardness of having someone I know look at me and try to assess what is going on and what to say.  This is, admittedly, in part a result of my own choices.  In the end, I have chosen not to wear a wig, which might have helped make it much less obvious that there is anything awry. 

My first encounter where I caught someone off guard really took me by surprise.  I was at one of the holiday functions I felt compelled to attend this year and someone came up to me and asked me about the fashion statement I was making, wearing a scarf.  I was a bit dumbfounded, particularly because the gentleman in question had lost his wife to cancer just a few years ago, so although he didn’t know of my health status, I would have expected him to assess the situation a little better without my having to search for my tongue and blurt out that I was undergoing chemo for breast cancer. The poor man clearly felt awkward, as did I, and he retreated before either of us could gather our wits and make a graceful transition from there.

My next unexpected encounter was just after the holidays when I ran into a woman I used to work with years ago.  We were both in a small shop, a rare event for me these days, and I saw her out of the corner of my eye.  I hesitated before going over to greet her, not sure what to do or say.  Finally, I exhaled and went to say hello.  I felt compelled to point out my condition rather than let her wonder, although I didn’t do it as gracefully as I would have liked.  I think I told her rather more than she needed or wanted to know, so I made a mental note to just give a quick summary in the future, and wait to see if there are any questions from the other side.

On Monday, before my weekly Herceptin infusion, I went with Lydia to the Garden, where I used to work, to sit in on some presentations before we headed to the hospital.  It was something she needed to do, and it was far more convenient for me to join her than for her to come all the way back to the house to pick me up when the Garden is relatively close to the hospital. Donning a headscarf, there is no easy way for me to be totally inconspicuous, although we snuck into the back of the auditorium and took seats way off to the side.  As I was leaving to prepare for my treatment (I had to apply lidocaine to the site of my port in advance of arriving at the hospital), I again encountered an old acquaintance who, after a moment of not recognizing me, followed me to the lobby to catch up.  His first comment was a plain and simple statement:  “You’ve been ill.”  What a straightforward, cut-to-the-chase observation! It paved the way for me to give him the quick rundown and then move on to other topics. I was so grateful for his candor, and for making it easy on both of us.  I didn’t feel the awkwardness I had felt in the other two encounters. There was no sense of avoiding the elephant in the room, or who blinks first.  It was just a simple statement of fact, and it provided an opening to a normal conversation of friends catching up.  It was refreshing and taught me a lot about communicating with people who clearly are coping with some issue.  From my vantage point, I have come to realize that it’s best to acknowledge it and then allow the person to fill in the blanks as they see fit.  Will it be as easy for me to do as it was for my acquaintance?  That remains to be seen, but I will certainly try!

The Afterglow

For posterity – or at least for my own recollection, I wanted a picture of myself in my nearly bald state.  However, soon after round 3 of chemo, I seemed to look more like a cancer patient than I had previously, with my skin looking a little sallow and circles under my eyes.  So I brushed that thought aside, until this morning when I awoke with one of the brief side effects that occurs in the first day or two after my chemo – a healthy looking flush to the face.  So here I am without any hair or makeup. But do take note: I still have eyebrows!  

Cleared for Takeoff

It's a Monday, so here I am, back at the hospital. My platelets rebounded from last week's low and are well over 100,000, well over the threshold for chemo, so I have been cleared for takeoff!

The routine this morning was just that -- very routine. Lab work at 9:30, doctor at 10:20 and treatment center at 11:30. The doctor, as always, was delightful and willing to answer my every question. She did point out that my hemoglobin is quite low and I'm likely to need a blood transfusion next week. In the meantime lots of red meat and spinach for me, and perhaps some chicken liver too. She also called me a model patient because I'm coping so well with the chemo! I have always aimed to please!

I'm hooked up and underway. I'm getting a benadryl drip as I type this, so I expect to fade off shortly. More later, perhaps!

3:15 p.m.

Awake again, albeit a bit groggy, after the Benadryl/Lorazepam induced sleep.  Each nurse does things a little differently and I received my Bendaryl first, to be followed by two bags of anti-nausea meds.  They weren't going to give me the Lorazepam until after that, but my legs were already bouncing around in reaction to the Benadryl, making sleep impossible, so I asked them to give me the lorazepam next.  My legs quickly settled and I fell into a much more peaceful sleep for an hour or hour and half.  During that time, I apparently went through all my pre-medications and was put on the first of the chemo drugs.  Now I'm partway through my second drug, Taxotere, and will end with a chase of Herceptin. 

The taxotere is what causes me some side effects I'd rather do without: very teary eyes, especially for the first couple of hours in the morning; skin rashes, leading to toughening skin and eventual peeling, particularly on my hands, constipation and then, possibly diarrhea.  My tongue loses its coating and then foods taste really blah for a week or so, and the newest one is muscle aches, particularly in the thighs.  Fortunately, the taste buds have come back each time, so by the 3rd week, I have gone back to enjoying food.

Ah, the home stretch.  We finished drug #2 and are on the final one of the day, Herceptin.  Herceptin takes a half hour or so to be infused, so I may actually be gone by close to 4:00.  With enough Benadryl/Lorazepam in my system, I anticipate a nice stretch out on the couch once I get there and perhaps another short snooze.  It sounds like heaven to me!

I Want My Chemo!

It is already January 10th, and I have yet to write a piece for this blog in 2011. That is partly because there is not a lot to report.  Last week was, after all, the third week in my three-week chemo cycle, and except for some relatively minor issues, I have been feeling remarkably well.  My energy level has been good, and I worked three solid days last week – one of them was even a seven-hour day, and when I got home I wasn’t exhausted.  As a matter of fact, I am a little puzzled, although not ungrateful, about why I am not more tired.  Everything I’ve read has talked about the major fatigue chemo patients face. Not me, or at least not yet.

So, with the third round of chemo under my belt and a three-week interval, I started preparations this weekend for round 4.  I attempted to drink 64 ounces of water each day, although that is challenging for me to do in the best of times, but more so in the winter.  I also sought out foods with more fiber, to help offset one of the more common side effects of chemo. Last night I prepared my bag of items to take along for the 7 hours or so I would be at the hospital, and Lydia gathered an array of snacks to keep us both satisfied.

My lab work was scheduled for 9:45, which is a couple of hours later than it has been.  It was nice to have a more leisurely morning of it; getting up later, taking time over breakfast, checking e-mails and doing some other things on the computer before leaving at 9:20.  The only downside to the later start was that it meant getting out of the hospital in the very late afternoon and dealing with rush hour traffic.

The 7th floor of the cancer center was a hive of activity. There seemed to be more people there than usual, though perhaps it seemed that way only because I am often in with the doctor or having treatment by that time of the morning, and I don’t usually see the later morning crowds amassing.  First up, as always, was my lab work. The nurse made quick work of drawing blood, and then she left my port accessible for the chemotherapy later on.  I moved across the way to the doctor’s area, which was exceptionally crowded.  They were so busy that medical assistants were calling patients into the examination area to take vital signs and then sending them back out to the waiting area until a room was available.  Uncharacteristically, I was called in at 11:15, nearly an hour after my scheduled time.  After having my weight (up a pound or two) blood pressure (wonderfully low at 108/74 despite my use of salt), pulse, oxygen level and temperature taken and recorded in the computer system, I waited in the wings for a room.  My chemo was supposed to start at 11:30, so I knew that even if I had only a short visit with the doctor, we were doomed to a later treatment start and finish than anticipated.  They were so busy that I also expected a long delay in the treatment center while waiting for the pharmacy to process all the orders for treatments.

Finally a room opened up and I expected that I would see the very punctual doctor almost immediately.  Not so, this time.  We waited and waited and had a snack of almonds and then a banana to stave off hunger -- it was nearly lunchtime.  Finally, a knock on the door, and in came the doctor.  Only it wasn’t my doctor.  It was a fellow, who introduced himself and said he was working with my doctor.  Now this is a teaching hospital, and I am used to all sorts of medical students and residents accompanying my doctor during our visits, but this was the first time that another doctor came along and saw me first.  And he came bearing news I didn’t want to hear:  I couldn’t have chemo today after all.  Not because of delays and overcrowding, but because of my own blood work!  The platelet level in my blood was too low for treatment.  If you are like me and are a little rusty on the role of different elements of your blood, platelets are important because their function is to prevent bleeding.  Normal platelets levels are in the range of 140,000 to 440,000 per microliter of blood.  My reading was 68, or 68,000/mcL.  The threshold for chemotherapy is 75,000/mcL and above.  My reaction to this was an out loud “oh, crap!”  Not because I was scared, because I wasn’t -- they can provide you with more platelets through a transfusion if your numbers get way too low.   My “oh crap” was uttered with a great sense of disappointment because I really truly wanted to have my chemotherapy today in order to stay on schedule and be done with my treatments on February 21st as planned. 

Unfortunately, there was not a thing I could do to change what was, and wanting it wasn’t going to make it happen.  Instead, I was examined by the fellow and then was left in the exam room while he tracked down my doctor and they consulted with the study coordinators to see whether the study protocol was for me to get my weekly infusion of herceptin or to just go home.  In the end, I was given a pass, so we packed up all our bags full of books and puzzles, knitting, a laptop, lunch and snacks and made our way out to the car, then home where we ate our picnic lunch instead of in the treatment center.  Now I am slated to go back in next Monday, and, if my platelet counts are back up above 75, I’ll be good to go for a postponed round 4.  I can’t wait.  Really, I mean it!