Happy Halloween

Well, it's Halloween. I'm trying to be on the ball with this sort of thing so I carved pumpkins for the front of my house. I think they came out pretty well this year. I'll include a photo of them all assembled side by side. It's not ideal but it's the best I could get yesterday evening.

This has been an OK week. I thought I was getting sick with a cold and that had me worried. I don't want anything to come up that might make the schedule change. It seems to be going away, though. That's a break.

I'm having a little trouble concentrating on stuff that I really need to get done at work. I think I'll have enough pulled together so that I won't leave anything huge hanging undone. I hope so anyway.

Well, happy Halloween everyone.

Passed my pre-op physical - pretty much

I had my pre-op physical today. I passed - unless my blood tests come back with some surprises which I don't think will be the case. My primary care doctor is truly a kind man. I'm grateful to him. If he hadn't pressed for a CT scan for me earlier this summer my tumor never would have been spotted. When in his waiting room I have often noticed how he took extra steps to confront insurance companies and bureaucracies to make sure that his patients got the care that they needed. This impressed me but I never thought that I would be one of those people. Today I thanked him - more than once - for having done that for me as well. I was surprised at his reaction. He brushed it off as being part of his job. Not unkindly, but in a self-effacing manner. I have taken care not to identify anyone by name in the posts I've made here. Internet-o-phobia and respect for people's privacy are the motivations there. But call me if you're looking for a doctor. I have one to recommend.

Oh, by the way, it seems I have some old-guy issues that will need to be addressed at some point after all this is done. I have a hernia. Grrr. Not a big one. I think it developed from being more than a little overweight combined with all the coughing I did this summer. Yippee. As if this surgery isn't enough. I get to have something much more minor to look forward to some time in the future.

On another note.........

This has been an odd day. I keep a spiral notebook so that I can write down whatever I might have to remember when I'm in assorted doctors' offices. I was really on the ball at work this morning and congratulated myself on my efficiency. When I arrived at the doctor's office for the physical I realized that I left my illness notebook at work and my mobile phone at home. I just might be over the top with things to remember to do. Luckily I have lists in my currently-at-large-but-I-hope-is-in-my-office notebook that should keep me from missing anything too critical.

And one other thing.....

The people in my department at work have been great. They have been very quiet about it but today I finally realized that they had been quietly anticipating things that are likely to come up while I'm away. I wouldn't have such a clear mind about skipping out for survery if I didn't know that they were ready to step up and handle whatever might develop in my absence. I am very grateful for that. When I think about it, things usually go more smoothly in the department when I'm not there. Hmmm..........

Two weeks to go - denial or a reasonable approach?

Two weeks from now, if all goes according to plan, I should be out of surgery. It seems as if this has begun to loom all of a sudden.

A couple of people have commented on my positive outlook and have asked me if I'm in denial over this. I've thought about this a bit and I really don't think that's the case. But for the record, let me just say that I really don't want to do this and I wish it would go away. Every now and then I imagine that I'll get a call saying that the test results were a mistake and I'm off the hook.

When I first heard the words "abnormal CT scan" I think I did go through a lot of those typical stages of denial, bargaining, etc. As soon as I got home I started cleaning out drawers, thinking that if I was going to pop off shortly I didn't want anyone else to have to do that. Even as I was doing it I knew it weird. Still, it was a lot less weird than some things I could have been doing and it made me feel better so I kept at it for a while. Not long, though. Most of the drawers in my house are still crammed with who-knows-what!

Since then I've been trying to get ready as best I can. By all reports, the time after the surgery is supposed to be very painful but honestly there isn't a whole lot I can do about that. I'm doing what I can, though. Every morning I take a long walk like my surgeon recommended so that I can improve my lung capacity and general fitness. I've laid in a supply of warm shirts that zip up the front so I won't have to work with my usual pullover sweatshirts. I'm in the process of cleaning up the house, weeding down my work email inbox and trying to get my projects at work in order so that I can pass them along. I'm also reading up on wills, living wills, advance directives and that sort of thing with the goal of having all that in place before I go into the hospital. (In my experience, the more prepared you are for something the less likely it is to happen so this may be a bit of a defense mechanism, too.) And finally, I did buy a new, bigger refrigerator. That was an indulgence. My old one was small and rust was coming through the paint. I thought I'd get a larger new one so that I'd be able to accept all the fabulous and appetizing things that my family, friends and neighbors just may be sending my way while I'm laid up.

One last thing about my situation in comparison to ones that others have faced. I count myself lucky because, if all turns out as expected, I am very likely to be clear of this after the surgery and not face recurrence, chemotherapy, radiation or some other form of follow-up therapy. That makes this much easier for me. I have friends who have had cancers that require much less dramatic surgery but who have had to face the looming threat of recurrence, spread of the disease, etc. At least so far I haven't had to deal with that. I had some very dark times in the days before my biopsy results came in - and I'll probably have more scary moments when my post-op biopsy results are looming. But that will have to wait for later. I'll work in the meantime on the things over which I have some control. That helps a lot.

Oop, OK, one more thing. I took my car in for maintenance this morning and was on the road as the sun was coming up. It was a spectacular sunrise today. That certainly made it easier to cough up the $$ for the work on the car!

Being the sick person

More than once I've been in the situation where I was one of the main caregivers to someone who had a serious illness. When I found out that I had this tumor, I realized how unprepared I was to be the patient instead. It wasn't really more scary but it seemed much more difficult and complex. Recently, though, a few people very dear to me began to face health problems that could turn out to be serious. What a feeling of helplessness that brings on. It can be much harder to be the person who's trying to help when you don't know what to do or when there isn't really much you can do. When you're the sick person you're in a position of some power. Within your physical limits, you have the ability to make things easier - or harder - for yourself and for those around you. I hope I'm doing and OK job of that.

Reflection and the pervasiveness of love

After the frantic pace of the last few weeks I’ve been trying to level off in preparation for my big surgery day and the recovery to follow. When all this started I was determined to devote at least a bit of my time to prayer and reflection. I haven’t been so good at that lately so I’m working to get back on track – with thinking about things and with living life a bit more fully. While pursuing that goal this morning I had a realization that took me by surprise. Prepare yourself. This may be my most sappy post so far.

I have said many times here that I have been very lucky to have such a wonderful group of family, friends and co-workers who have been on hand to help me through all of this. When I was thinking about that this morning it occurred to me that this has always been the case for me. Remembering back as far as I can (which is pretty far at this now-advanced age) I can’t think of any time in my life where I doubted that I was loved. I can't say that I took this for granted but I never had cause to doubt it. It never occurred to me that everyone else might not have had the same experience or background. I see now how profound an influence it has been. It lets me move forward into things with confidence. More important, I believe that what good I have been able to do in this world was made possible by that foundation.

So, thank you once again to everyone for giving me this greatest of gifts. I will do my best to deserve it and return it back to you.

"Why me?", fatigue, and a great birthday surprise

Yesterday morning really for the first time I had a big attack of wondering why this happened to me. It didn't last long but it took me by surprise. I had been very busy for the last few weeks and I think it was the fatigue talking. It doesn't take long to realize how pointless thinking like this can be. It did happen and it's not going to go away by itself (although I've daydreamed about that.) The only thing I can do is take it on and do the best job I can. The woe-is-me attitude dissolves away pretty quickly when I'm reminded of how much worse it could be and how lucky I am to have such legions of supportive people around me. This came in loud and clear last night. One of my book groups got together and had a birthday event for me along with our meeting. This year has been the birthday party that never ends. They had wonderful food, a cool giant chocolate chip cookie (home made) with candles and they gave me a snappy gift card and catalog for the Sharper Image. I'm going to have fun with that. So, after a bit of a dip I'm back on track. Thanks everyone!

The word from the surgeon

Well, I had my meeting with the surgeon this afternoon. It went better than I had expected. He’s a very nice man and seemed very confident and considerate at the same time. That seems like a good combination .He also said that he saw lung carcinoid tumors like mine about once a month so he has some experience with them.

Here’s what I learned…

The surgeon will do a bronchoscopy to see how things look from the inside. If possible he will do something called a sleeve resection. That’s where they take a section of the airway and re-attach the ends of the pieces. This is preferred because it preserves all the lobes of the lung. Whether or not they can do that depends on the position of the tumor. From what I’ve heard about the position of my tumor, I probably won’t be a candidate for this but I’m very glad that it will be considered. My tumor, it turns out, is about the size of a marble. If a sleeve resection isn’t an option, then he’ll need to remove one or two of the lobes of the lung. The primary goal is to make sure that the ‘margins are clear’ – meaning that all the malignant cells have been removed. They’ll test lymph nodes during the procedure to make sure that there has been no spread. The surgery could take two to four hours. The American Cancer Society has a good web page about carcinoid lung surgery You can also look up “sleeve resection on YouTube but the video looked too unpleasantly detailed for me to want to watch!

The surgery incision will be horizontal along the line of ribs under my right arm. He’ll need to cut through one muscle and some assorted other tissues and then he’ll spread the ribs open. He said that they try not to break any but that it might happen. This sounds unpleasant but it is much better than what I was imagining. I thought he would need to cut vertically and spread the cut ribs open like a rack of lamb.

I’ll be in the hospital for three to five days. The first day will be in the intensive care and then I’ll be home recovering for three or four more weeks. I thought it would be worse than that so this seems like good news to me. I won’t need help doing any sort of personal care stuff, which is also happy news. I’m encouraged to be as active as possible during this point without lifting anything heavy or doing anything too strenuous. I’ll stick to this. I want to be mobile but I don’t want to pop a seam. By all reports this will be a painful process but I’m assured that I’ll get enough pain pills to get me through it.

The pathology report on the tumor will be back in about a week after the surgery. There’s a good probability that surgery will be all I’ll need to have. It’s unlikely but if other treatment is needed it would most likely be chemotherapy. I’ll go for a follow-up appointment in three weeks after the surgery. After that I’ll go every month for a while, then every three months and finally every six months until five years has passed.

So, I have just over a month until November 6 when the show really starts.

Initial surgeon appointment changed

I had a call from the surgeon's office this morning. My initial appointment has been changed to Tuesday, Oct. 2 in the early evening. That's a few days earlier than had been originally planned. I'll need to start writing down my questions now so I don't forget to ask anything.

A day in the mountains

We had a spectacular day yesterday. We started the day in Rocky Mountain National Park hiking a trail that begins at Bear Lake, passes Nymph Lake and Dream Lake and ends at Emerald Lake. The weather was perfect and this happens to have been the best weekend for viewing the yellow aspen leaves. The hike was several miles. We started high up and climbed a total of about 600 feet to somewhere around 10,000 feet. The air was beautifully clear and the views were amazing. After that we took a drive up the Old Fall River Road to the visitors center at 12,000 feet and then drove back down Trail Ridge Road to Estes Park for dinner. A great day. I'm including two photos.

One is a picture of Long's Peak from the Trail. This was the first 'fourteener' that I ever climbed in Colorado. That was several years ago.


The other is a picture of all of us sitting in front of Bear Lake at the end of the hike.


This is being a great trip.

A wonderful day

What a wonderful birthday. The trip to Denver went without a hitch. When we got here they surprised me with lunch and a fabulous present - a hammered dulcimer. I couldn't believe it. I've always wanted to learn to play one. It's beautiful. I was thunderstruck. I cannot describe how lucky I am to have been given the family I have. We're off to dinner now. What a day!

Happy birthday to me

OK, it's official. Midnight has arrived and I am now 50 years old. I'm including a picture that Sharyn sent to me today. Cool, huh?

I'm leaving tomorrow for a trip to Colorado. It's a work trip but I've added some days in advance to visit my sister and brother-in-law who live outside Denver. My two brothers and sister-in-law are coming along to make a birthday celebration out of it. I'm looking forward to it a lot. It will surprise nobody that I'm up late packing, catching up on email, etc. I just finished laundry and should be done with the whole packing chore in another hour or so. There was a birthday surprise gathering for me today at work, too. This has been a great stretch of days! OK, off to polish shoes, fold clothes, check the pack list, write up cat care instructions, blah blah blah. Can't wait until I'm on that plane!

Many kind surprises

Just in case I haven't mentioned it a bazillion times already, my birthday is coming up shortly. I will be 50. I'm OK with this since I don't have to say that I'm OVER 50 until next year. This past weekend I went to a meeting of one of my book groups and also to a small fund-raising dinner for the Maryland Library Association. At both of those I was surprised with cake, wine, and all manner of good wishes. I continue to be astonished by the warmth and kindness of those around me. Knowing these people as I do, this shouldn't have surprised me in the least. Still, the fact that I didn't see it coming made it all the more wonderful.

Surgery scheduled - November 6

OK, I got the call from the surgeon's office first thing this morning. Things are a bit farther in the future than I had hoped but at least it's on the books. Here's the scoop...

I have a clinic appointment with the surgeon on October 5 and the surgery itself is scheduled for November 6. I'll have to have some pre-op testing done but I'll need to work that out through my primary care physician. So, there we have it. There's a possibility that the surgery will be moved up if someone cancels but I can plan for November 6 in the meantime. I'm glad to have this all set up! I'll get more information about the surgery, what's involved and how long the recovery will be when I go in for that October 5 appointment.

Birthday dinner

Mary Lou, Cindy and Sue took me out to dinner last night for my impending 50th birthday. I had a wonderful time - and raked in some good gifts, too. Among other things, they gave me a portable DVD player which was a very welcome present. I'm sure I'll be able to use it. I have already played with it, of course, and it's really cool. Yesterday had been a challenging day at work so this came at a great time. I'm very grateful to them. I'm looking forward to playing with all my new stuff as well!

A positive attitude and two poems about hills

They say that having a positive attitude is important when dealing with this sort of thing. I'm generally fairly good at that. I can tell that it's important for the people around me as well so I'm making an effort to be as positive about this as possible. Some times are more challenging than others. I suppose that's typical.

I was talking yesterday with a friend who has had something similar. We agreed that even the potential for scary news causes you to look at everything with more appreciation and perspective. That is certainly true.

All of this made me think about two poems with similar themes but very different attitudes. I'll include them below. The first is Up-Hill by Christina Rossetti. I learned this one years ago from my friend Kay who recited it from memory. It has a resolute and positive tone. The other is The Long Hill by Sara Teasdale and carries a feeling of fatigue and capitulation. I learned of Sara Teasdale when my friend Nancy recited her poem Wisdom to me from memory. I think I'm doing a good job of it so far but I'm going to work to keep on the Rossetti side of things and keep those Teasdale times to a minimum.

Up-Hill

Does the road wind up-hill all the way?
        Yes, to the very end.
Will the day's journey take the whole long day?
        From morn to night, my friend.

But is there for the night a resting-place?
        A roof for when the slow dark hours begin.
May not the darkness hide it from my face?
        You cannot miss that inn.

Shall I meet other wayfarers at night?
        Those who have gone before.
Then must I knock, or call when 'ust in sight?
        They will not keep you standing at that door.

Shall I find comfort, travel-sore and weak?
        Of labor you shall find the sum.
Will there be beds for me and all who seek?
        Yea, beds for all who come.

- Christina Rossetti

The Long Hill

I must have passed the crest a while ago
And now I am going down--
Strange to have crossed the crest and not to know,
But the brambles were always catching the hem of my gown.

All the morning I thought how proud I should be
To stand there straight as a queen,
Wrapped in the wind and the sun with the world under me--
But the air was dull, there was little I could have seen.

It was nearly level along the beaten track
And the brambles caught in my gown--
But it's no use now to think of turning back,
The rest of the way will be only going down.

- Sara Teasdale

Chest CT scan video

This is probaby in bad taste but I'm doing it anyway. I had the CD with images of my CT scan and I was curious if I could make them into some sort of animation. I did that this afternoon. I was just going to post an animated image but then it would be playing whenever people loaded this page. Some people might prefer not to see that so the video link seems better. Still, I had never seen one of these and I thought it was interesting.

Anyway. Here's one of the three views of the chest CT scan I had at the end of July. It shows views going from my sternum down through my backbone and my flabby, I mean well-muscled, back.

At this quality it doesn't show any evidence of the tumor. Still, I thought it might be interesting to some. Click the play button if you'd like to view it. Or skip it if you aren't intrested in this level or type of info.!

Document Delivery

I picked up the films yesterday and dropped them off down at Hopkins today. They told me that I should hear something from them Monday or Tuesday. Another Friday arrives and I can go into the weekend knowing that I've made some progress. That's a very good feeling.

On several occasions I've been in places where people have been picking up, carrying or delivering their radiology films. I've sometimes accompanied people who were doing that. It has always struck me to see them forging along to someone that might help them. They seem brave, resolute. They bring out a feeling that's both hopeful and forlorn. Now I'm in the club, too, and from this side it feels pretty much the same way.

On a brighter note. Seton Imaging was able to put my CT scan images on a CD. Of course, I made myself a copy. If I get a chance, I'll see if I can find a way to post some sort of "3-D trip through Jim's torso" animated image. That would be an interesting challenge.

Records roundup

No more news.

Yesterday and today I talked to assorted people trying to get the records that are needed sent to the people who need them in the format that is required. Hopkins needs my medical reports plus my CT scan results. The reports were faxed once but didn't seem to make it. They're being sent again today, I hope. I'll pick up the films tomorrow afternoon and will deliver them to Hopkins on Friday morning. The films will be on CD - I hope - but Seton Imaging couldn't verify for me whether or not they'd be in DICOM format. That would be compatible with the system that Hopkins uses in their operating rooms. So far all the appointments, discussions, tests and reports might not have been good news but they all went well. This is the first red-tape style roadblock I've hit. I guess that's better luck than average.

Some progress

I have been referred by a friend who is an associate professor at Johns Hopkins School of Medicine to a thoracic surgeon at Hopkins. My medical records and information are being sent to him. He'll review the information and will suggest a course of action.

It is good to be going into the weekend having made this progress. Whew!

No surgery news yet

OK, this post will be labeled 'medical update' but the only news is that there isn't any news. I'm waiting for recommendations for how to proceed with the surgery. I do have two surgeons available who can do this but want to get a little expert advice from a friend who is very much in the know about this sort of thing. If I haven't heard by tomorrow then I'll call and see what I can find out. I'm a little tired of thinking about this at the moment so I'm letting myself off the hook until then.