What I Learned Today

Deb and I had an appointment with my E/N/T doc today so that he could size up my squamous cell carcinoma in preparation for tomorrow's operation and give us a chance to ask questions.

He seemed to like the way the carcinoma was looking -- as if it should be an easy operation tomorrow. He had expressed some concern about it being too close to a branch of the facial nerve, but seems confident now that he has room to spare between the extent of the excision and the nerve. Yay!!

I asked him about how and why, after the recent bouts of chemo and radiation, a tumor could show up so quickly. He explained that the therapeutic radiation beam is now so carefully aimed, that it probably didn't affect that area that much -- and I know that the radiation doc was working hard to keep the radiation beam away from my right parotid salivary gland (since the function of the left parotid was going to be inevatably lost because of its proximity to the location of the primary tumor). He (the radiation doc) felt this would not interfere with the overall efficacy treatment, since the flow of metastatic particles should be down and away from that area. So my neck got clobbered, but my chin got a fairly light dosage.

And I know that that particular area of my right chin got a light dosage, since it's still growing some hair.

So all that makes sense about the radiation.

As far as the chemo goes, my E/N/T guy explained that the different forms of chemo (and there are well over a hundred, if I recall correctly) attack cancer cells in a number of different ways. Some of them disrupt the DNA chains, so that the cancer cell functions "normally" until it goes to reproduce, at which time both daughter cells die. Other treatment options disrupt the external cell membrane and kill the cell then and there.

The point being that chemo for a salivary gland duct cancer might attack cells in a totally different way from chemo for a squamous skin cell cancer.

And the doc also pointed out that most people carry latent patches of cancer cells that simply need a trigger to begin growing and misbehaving. And disrupting the body's immune surveillance system (which my treatment has certainly done!) can be one of those triggers. And goodness knows, the amount of sunburn my face endured when I was a blue-eyed, blond-haired kid (decades before the term "sunblock" entered the common vocabulary), there could easily be such patches lurking beneath my visage.

So that's what I've been told. And it all makes sense.

Whew.

Health Update: 8/30/09 -- The Next Two Days

Some of this I've already covered in a previous blog, but all of it fits with the story of this posting:

Monday, August 31, Deb and I visit my E/N/T guy to talk about the excision (i.e., removal) of the squamous cell carcinoma on my right chin line. As mentioned before, this is a very common cancer, and one that is normally easily handled -- especially when caught early, which this one certainly was. On the surface, it's a little bigger than the diameter of a pencil, but I have no idea how deep it may be.

Several questions have arisen in regards to this tumor -- which is a considerably different type of cancer from the one I've just been treated for. Question #1, which came from a dear friend recently, is: "How can I be just recovering from radiation and chemo for this one kind of cancer and have another type show up so quickly? Why didn't the radiation and chemo kill whatever cancer cells were there?" Follow-on questions include: Is it possible that the two cancers are related? That one may have triggered the other? Or did the treatment for the first cancer trigger the new one? and Should I expect to have other squamous cell cancers show up any time soon?

It was such a relief to find out that this cancer was not like the other one that I'm afraid I just didn't extend my thinking far enough: if it isn't like Cancer A, what the heck is it doing on my face now?

(Anyone out there with some experience that might shed light on this is more than welcome to chime in at this point!!)

Needless to say, I'm hoping that my doc has some good solid answers backed up by lots of experience and maybe even some data...

Anyway, that's how Monday should go. And then Tuesday is the actual operation, which is an outpatient procedure. (And that's encouraging!)

Stuck in the middle of all this is the issue of the blood-thinning medication (Coumadin) that I've been taking for over a month for the blood clot in my leg. There is some discrepancy between my docs as to the best way to handle this: (obviously, having blood that doesn't clot normally isn't a great condition in which to undergo any surgery...) so they've taken me off the Coumadin for a couple of days (exact time to be decided later...) and put me back on the Lovenox -- which I self-inject with a hypodermic twice a day.

So I'm back to shooting myself.

As always, prayers and kind thoughts are more than welcome!!

I Can Drink Tap Water!!

This announcement probably doesn't amaze or thrill you much on first hearing it. It's kind of like saying. "I can walk across the room!" Or, "I can read a magazine!"

Well, the ability to drink tap water was one of the things that this tongue issue had robbed me of for months. I had been informed all along by my medical support team that certain fruit juices -- especially citrus juices -- would cause tongue and/or throat pain for a while, and that I should stay away from them, but they didn't mention anything about plain old water. And when I told them about the problem, they just shrugged their collective shoulders. No answers or suggestions.

But just a few drops of water would cause a level-six-out-of-ten shot of pain that focused on a single spot on the left edge of my tongue. So for months, I have been cleansing my mouth of mucus with a weak solution of salt and baking soda, which solved the problem completely. And if I poured a bit of that solution into a glass of fruit juice or Gatorade, I could drink that with absolutely no difficulty. Except it tasted yucky.

But a couple of days ago, in a moment of forgetfulness (I have a lot of them lately...), I tossed back a small glass of water without any pain at all. And when I realized what I'd just done, I stood staring at the empty glass in amazement.

There are a number of consequences to this recovery. Most importantly, that I can hydrate myself anytime I want without uncoiling and uncorking my PEG tube, tracking down a syringe, etc. Just drink the water! And the taste of that water is now both subtle and complex and wonderful in ways I never would have guessed possible. Just. Plain. Water.

And looking back at the first paragraph of this posting, I can see that -- YES! -- walking across the room would be cause for celebration for many people. And being able to read a magazine likewise. And I'll let you make up your own scenarios for why this would be true.

So it's another important step back towards normalcy. And another reason to be deeply astonished grateful for the healing capabililties of the human body.

The gifts of my disease have sometimes been hard to discern, but this one -- a new appreciation of something as simple as drinking tap water -- was as clear and easy to understand as a fancy wrapped box on Christmas morning.

Reclaiming my Life -- Bit by Bit

Or should that be "Bite by Bite"?

I had scrambled eggs for breakfast this morning.

......

Ahem.

I said I had scrambled eggs for breakfast this morning!

Okay, A Brief Description of What This Means In Case You Missed Something Along the Way:

For the first time in two months, I had a complete serving of solid food that I ingested with my mouth and tongue and teeth and stuff. And I ate all of it.

It wasn't yummy-wonderful, but it didn't have the metallic taste I'd been warned about. My tongue, while still not completely recovered from the radiation, had no problems in positioning the eggs to the proper places within my mouth. (And I didn't bite my tongue, thank goodness!)

I decided not to push things by trying toast, as generating saliva is still an issue -- and may be for the rest of my life. (The radiation treatment necessarily and permanently deactivated the parotid saliva gland in my left cheek. But the doc tells me that the right parotid may figure this out and produce even more saliva than it normally would. How do you set up a cheer for a saliva gland?)

We followed up this repast shortly afterwards with a can of Jevity, as one of our goals is to regain 5 or 10 of the pounds I'd lost recently.

And afterwards, I went out to to the garage to do some work I'd been meaning to do for weeks and weeks.

And somehow, I feel, y'know... just bigger. With more Randy expressing itself. I like it.

All this from one dish of scrambled eggs...

My Music Lesson

Well, dear friends, today was scheduled to be my first formal lesson on my brand new musical keyboard. And it was. A lesson. Sort of...

I was at the music shop promptly at 11:00 -- my scheduled start time, with a collection of books and sheet music I was interested in learning how to play. To give my teacher an idea as to where I wanted to go with the lessons. You know...

Turns out he forgot I was coming. And he had a student pounding away at a piano in his studio until 11:15. When he opened the studio door and saw me sitting there, he apologized profusely for the oversight -- the student was having a make-up session and my appointment just hadn't made it to his calendar, so he thought he was filling an empty slot in his schedule. Yadda yadda.

But actually, I was quite pleased: "Aha! [I thought to myself] this guy must be a real musician if he'd foul up an appointment like this!" Doctors and dentists put their framed diplomas on the wall. Musicians forget things like gig appointments. Same same.

Anyway, he offered a free lesson for the day, and I told him I would have to leave by 11:30, but by all means let's see what we can get done in the 15 minutes we had available.

He left to find a keyboard exactly like mine, and was back and had it ready to go in two minutes flat. Then he looked expectantly at me and my satchel of music, as if to say, "So, what did you bring me?"

I fished out my laminated copy of "Fur Elise" and put it on the music stand. I almost had a chance to show him that I had been practicing the piece furiously for days in preparation for the lesson, but he stopped me just as my hands were reaching for the keys. He asked me what seemed to me to be a fully remarkable question: "If you're interested in music like this, then you're probably more interested in learning to play the piano rather than the keyboard. Is that right?" (So I'm thinking, "Is this some kind of Zen koan or something? A simple question without a simple, reasonable answer?")

I assured him I hadn't the slightest idea what he was talking about. So he said, "Well, if you were playing this piece as a piano, it would sound like this." And he played the song beautifully. Beethoven would have been delighted.

Then he said, "But if you were interested in playing the keyboard instead... hmmmm... let's try 'Has Anybody Seen My Gal?'" (Which is a fine old pop song from the 20's or 30's.) He then punched up a half-dozen buttons on the keyboard, explaining himself in presto tempo, and then started to play.

Good grief! In 10 seconds or so, he had created an entire small orchestra inside the keyboard which automatically backed up his melody line for the song absolutely perfectly. The orchestration had separate opening and closing sections and changed keys throughout the song to fit the song exactly.

It was scary.

I assured him that, although the keyboard support functions were certainly impressive, I was looking for the discipline of learning the piano -- and learning it the right way. Treble clef, bass clef, right hand, left hand, the whole nine yards. I then blurted out what might be my most important motivation for learning the piano -- an idea that had never occurred to me: my mother (who passed away several years ago) played and taught piano for decades, and none of the five of her children ever took up the golden opportunity to learn to play the piano the right way. Formal. Disciplined. The kind of background you can grow into a full mastery of the instrument. I think the fact that none of us took her up on this was a major disappointment to her.

But I digress. I wanted the piano.

My teacher looked at me as if I had grown a second head. Why would anyone pass up all the musical firepower that the keyboard offered for learning piano? The basic techniques of learning and playing probably hadn't changed in centuries? (If that was his unasked question, he actully got his own answer, whether he knew it or not.)

Anyway, so far the lesson had been informative and useful. My teach then asked me if I could find Middle C. Which I got first try. Plunk! He then showed me the basic technique for hand position: curled fingers, thumb over Middle C.

Then (I thought this was cool), he asked me to find A-flat. It took a few seconds to for me to make sure, and then I plunked the right note. So my first piano lesson was comprised of playing two notes.

And from this (and answers to several questions he asked), he verbally summarized almost exactly what my goals were for taking lessons. I think he'll do just fine as a teacher.

He had me purchase his favorite "My First Piano Book" (not its real name, but might as well be) theory/technique/song book and a manuscript book for taking notes. He then assigned me the first 24 pages in the book -- which shouldn't be that hard to master by next week.

So I'm off and running. And I think my mom would be pleased.

The Biopsy Report

My E/N/T/ doc called me late this morning with the results of the biopsy of the bump on my jaw.

It's been analyzed as a squamous cell cancer which is, as I understand it, totally unrelated to the salivary duct cancer that started all this. (I will ask the doc about a possible relationship between the two when I see him next.)

Squamous cell skin cancer, according to my doc, is the second-most common type of cancer and is easily treated -- especially when discovered early, which this one certainly was.

I have an appointment to see my doc on Monday to talk over the procedure for the removal of the cancer. And he's set up an appointment on Tuesday morning for the actual operation. Local anaesthesia at the local surgery center. Probably a couple of stitches (which this guy is really good at!). No need for a visit to the hospital.

It sounds like we can chalk this one up as simply being a small bump on the road to recovery...

(And many thanks to all of you who posted your own anxieties, good wishes, excellent suggestions and offers to come and sleep on our front porch.)

The Reason Why...

I haven't been posting for the last several days.

You may recall that my last posting, "Health Update 8/21/09" mentioned a bump on my right chin that my E/N/T doc -- just to be sure -- should be biopsied. Which he did last Friday. And, he said, the results shold be available sometime early this week.

Since my cancer had been centered on the left side of my face and neck, anything showing up on the right side is:

-- if found to be benign, no great surprise and no big deal. It would be just another bump.

-- if found to be malignant, possibly a major setback in my therapy. With serious consequences.

Although my doc is on vacation, he left instructions that the lab should call him as soon as the biopsy results were known. So he could call me. He didn't call today.

So I have spent the last three days trying to place myself in God's hands and recognize that I have absolutely no control over what will happen. I've gone through the completely pointless exercise of trying to imagine how I would respond if the call comes and the doc tells me "A" or if the call comes and the doc tells me "B."

I've sat in front of the computer trying to write something for the blog -- anything for the blog -- and haven't been able to do it.

I'm simply terrified.

And as deeply as I appreciate all the love and caring, the thoughts and prayers that have been showered over me for the last few months, there are times when this experience is inevitably a lonely one.

I will let you know immediately what I hear from the doc. As soon as he calls.

(By the way, the keyboard playing is going well. I'll tell you more about that later.)

Health Update: 8/21/09

First, what's going right:
As indicated in the previous posting, there are a lot of facets to my recuperation that have made life either a little easier or a lot easier. And it's clear to me that whatever burdens I may be carrying now -- trying to get back to normal -- are manageable and will remain so. (Deepest thanks to "Anonymous" on the last posting for reminding me of this!)

Some of the burdens (like this mucus stuff) are downright annoying, but nothing worse. I am not in any noticeable pain, nor am I taking any drugs to suppress pain.

I'm now drinking fruit juices whenever I want, with only the slightest complaint from my poor, battered tongue. So I can now swallow my collection of pills in mango juice or papaya juice rather than burying them in applesauce or yogurt. It's been explained to me that the more I use my mouth for ingesting nourishment, the sooner it will "remember" what it's supposed to be doing and accelerate its return to regular service.

Deb and I have a plan in place to substitute a different meal (Instant Breakfast or other protein beverage) each day for a Jevity meal. And work our way out of that to Moo Shu Pork.

On the flip side of going right:
Over the last two days, I have been diagnosed with a yeast infection of the mouth known as "thrush." This may have come about because of the chemotherapy or something else -- not sure. I have lozenges I'm supposed to allow to dissolve in my mouth to suppress this. (I think the lozenges are made of the same material as poker chips. They really don't want to melt in you rmouth.) It's not painful or dangerous, but needs to be dealt with.

And then there's this bump showed up on the right side of my jaw -- the other side from where the cancer was detected. It may just be an infected bug bite -- but it looks strange for that. My E/N/T doc described at length why there's no good reason it should be related directly to my cancer, but he's taken a biopsy just in case. He tells me he may have the result by Monday. (So what are you doing this weekend?)

And y'know, that's one of the big deals about cancer: you undergo these punishing procedures (surgery, chemo, and/or radiation) and hope for nothing. Nothing on the scans. No new bumps. No new discolorations anywhere. No disruption in your breathing or digestion. No new troubling symptoms anywhere. And you spend years continuing to hope for nothing.

It's my sister's roller coaster analogy, and you've got a ticket to ride. You just don't have a ticket to get off...

Counting My Blessings

As I sit here fulminating about not being healed right now and being deprived of my moo shu pork and Pinot Noir, I thought it would make sense to list all that I have to be thankful for. Things surrounding my medical condition:

The Weather: Given where we live (i.e., the mid-Atlantic states) we had every reason to expect hot, hazy, humid weather throughout July and August. Even without Global Warming. But the weather, as a rule, has been delightfully cool. We don't have air conditioning in our fine old house, and so we open every window at 4:00 or so in the morning to flush out the residual warmth from yesterday and start again with fresh, cool morning air. This morning, for example, the air outisde is 70 degF while the air inside is 78 degF. We have two fans assisting the natural flow of air up the stairs and out the upstairs windows. Closing our fancy new windows around 9:30 or 10AM (when the outside air climbs to the same temperature as the inside air), we will remain comfortable until we can open the windows again this evening.

This approach works wonderfully well -- assuming the outside air doesn't jump into the 90's and stay there. And it simply hasn't done that at any time this summer.

A blessing.

The Season. I am told that dealing with the throat-related issues I've blogged about is much tougher in the winter, when the dryness of the weather makes staying properly hydrated much more difficult. The mucus is even heavier and the dry mouth phenomenon is more pronounced.

Also, having daily access to the porch has been a blessing for me -- and especially for Deb, who uses the porch for rest and rejuvination on an almost daily basis. (See the posting in May titled "Porch Lessons" which extols the manifold virtues of our wonderful porch.)

Another blessing.

My Age. There is no good age to get cancer, I suppose... but if I had contracted the disease 15 years ago, I would be in the middle of my career as an independent consultant quite possibly with no health insurance at all. (In addition, I would like to think that I've grown spiritually and mentally since then and am far better prepared to handle the required activities and attitudes to get through this thing successfully.)

If I contracted the disease 15 years from now, I would likely not have the energy and recuperative powers that have impressed many of the medical staff that have taken care of me.

Yet another blessing.

The Nearness of our Medical Facilities. As mentioned in previous postings, it's a 15-minute drive to the radiation center, and the same distance to our Ear/Nose/Throat guy (whose office is in the same complex of buildings). And it's a 10-minute drive to the chemo center, which is right across the street from the Chester County Hospital. It's been tough enough trying to ingest six cans of Jevity in a day without any doctor visits at all -- given the length of each individual feeding and the requisite timing between feedings. And having to drive to Philadelphia or farther for appointments would toss that schedule that much farther out of kilter. Disrupt the schedule and lose another pound.

AND, it should go without saying, Deb and I have been perfectly comfortable with the medical advice and procedures which we've experienced here locally. I honestly don't think we could have done better by linking up with more prestigious institutions an hour or two away (i.e., Penn, Fox Chase, etc.).

One more blessing.

The Blog. The Blog has been an opportunity to express myself about some of the most trying things that have ever happened to me. Expressing myself to myself. To my friends and family. To the world at large. If no one had ever written a "Comment" response, the Blog would still have been a wonderful tool for me.

BUT, over a dozen people have taken the time to respond, and what they have told me has touched my heart again and again. I am astonished at how many people have responded and what they have said. I am often in tears after reading the beauty, the compassion, the understanding, the enthusiastic support, the gentle good humor (did somebody say monkeys?), and the gratitude that people have expressed that I would take the time to write this.

I hope all of you understand how vital this document has been to my well-being. And having you respond with "Yes, we hear you." said a dozen different ways makes the writing -- yours and mine -- all the more precious to me.

One more blessing.

You. Not only in your comments on the blog, but in your wonderful cards, and our conversations face-to-face or on the telephone, you tell me over and over again something that had not been at all apparent to me before I was diagnosed with cancer: There are so many people on this planet who care very deeply about me and my welfare.

I've led something of an insular life. And I've always known that I was surrounded by nice people. But, by your attitudes, your words, the compassion in your faces and voices, I now see how completely inadequate the word "nice" is.

You have completely changed the way I see the world around me.

An immense blessing.

Deb. Does it make sense to you that I can't even begin to blog about her in this context? Deb has done everything imaginable to make this experience tolerable for me. She has been unfailingly upbeat, cheerful and helpful in ways that I can't even begin to enumerate here.

I shudder to think what this experience would have been like without her.

She is the most wonderful of all blessings.

There's more to be said, but the day beckons. And the moo shu pork can wait for a week or two. Or a month or two. That's okay now.

But when I stare down at that plate of moo shu pork, I will count it as -- another blessing.

Sharing the Blog

Those of you with a high degree of technological savvy have probably noticed that, at the end of each posting, there is an icon of an envelope with an arrow in it. (As an indication of my savviness, it only took me five months to see the icon for what it was...)

If you find a blog posting that you would like to share with a friend, all you need to do is to click in that posting's envelope icon, which will take you to a screen that enables you to type in the information about who you are and whom you wish to send the posting to. There is also a field on this screen display that will allow you to type in an additional message to the person to whom you're sending the posting. It's pretty easy to do. (You will also have to do one of those "type in these wavy letters in that box" dealies, but do it in remembrance of Woodstock!)

The recipient will receive an e-mail with a link back to the particular posting on the blog. The recipient may have to cut and paste the link out of the e-mail and into his/her address line, but most everyone knows how to do that now. I think...

So this posting is an invitation to do just that -- and a brief explanation as to how to do it. (If you wish to let me know that you've done such a thing, that would be a thoughtful thing to do. If not, that's certainly okay. But it would be nice to know that it's working for you or a complete mystery...)

The Roller Coaster Climbs the Hill

Many of you may recall that my charmng sister Martha (whose husband is a cancer survivor) informed me months ago that living through cancer treatment with the possibility of the disease returning was like a roller coaster: that a set of good test results allows the coaster car to climb the hill, only to go dashing down again on the other side when the next medical person says something like, "We weren't expecting to see..." But also (and this it vitally important!) that when the car is speeding down the track, that there will be an uptick coming soon.

Yesterday was like that for me.

In my last post, I mentioned a variety of issues were continuing for me that I would have hoped would be visible only in the rear-view mirror by this time. Well, guess what just showed up in that mirror?

One of the primary concerns I mentioned was the loss of three pounds -- and that my weight dipped beneath 160 for the first time in probably 30 years. And, perhaps understadably, Deb and I assumed that we simply hadn't been assiduous enough with our Jevity feedings. (If and when Guilt becomes an Olympic sport, Deb and I are trying out for the team!)

Another concern: I was in danger of choking as I slept on this heavy mucus build-up that refuses to relent.

And I responded to these issues with a chorus of "Geez-es" in that posting.

What you may not recall is that, in early July, I posted something rather cryptic entitled "So Much Depends on Where You Focus." Pay attention, dear friends, there's an important lesson coming up here!! Deb and I had assumed that we were responsible for finding answers to these problems on our own, because the docs and nurses that we had talked to about these issues basically shrugged their shoulders.

But we hadn't yet talked to Doc Och -- the guy who recognized my hobbling on crutches some time ago as possibly being a serious blood clot and got me seen at the local hospital in record time.

Doc Och (whom we saw yesterday because my regular radiology doc was away), suggested a pharmaceutical response to the mucus. It's called "Robitussin DM." And it's considerably cheaper and more readily available than any of the prescription drugs that are collecting on a shelf in our kitchen (one of whom lists a non-insured cost of over $600 for 30 or so tiny little pills). And we had the Robitussin on-hand anyway.

Doc Och also recognized that I was "drying out," which would make the mucus situation worse. So (as mentioned yesterday) he arranged a 1.5-liter IV treatment for me at the chemo center. Which did, in truth, make me feel better, more alive.

This morning, there were two wonderful events to report: first of all, I had slept for over five uninterrupted hours last night. Now, I had not slept for three uninterrupted hours for two months. The Robitussin had, in fact, lessened the impact of the mucus to allow me to sleep.

And, when I stood on the bathroom scale, I had regained, not one, not two, but all three of the pounds I had lost over the week.

You see? Deb and I had been assuming that the lost weight was due to an insufficiency of Jevity. Because that is where Deb and I had focused. In fact, it was an insufficiency of water.

Off-the-shelf cough medicine. Drinking enough fluids. When you're thinking too fast and you're too close to the problem and you think it's your fault and your responsibility and you're too ready to put up with discomfort and you haven't exhausted your readily available sources of help, well, this is the kind of thing that happens.

Slowing down. Meditating. Pulling back from the front-lines of the problem. Asking for help -- human and otherwise. Trusting that there is a better answer. Well, these are the ways that you put problems in the rear-view mirror.

Whaddaya Mean...

... I'm not "out of the woods" yet?

Geez, things people don't tell you.

Three weeks ago, I had this very clear image as to what I would be doing by the end of this week -- the last week of chemo and radiation therapy sessions. And that image involved chowing down on moo shu pork and swilling a fine Pinot Noir.

Hmmph. Not even close.

I'm still waiting for my tongue to heal up. (Every day it's just a little bit better, but note the use of the term "just a little.") And this heavy mucus deposition in my mouth refuses to stop. And that started to get downright scary several nights ago, when I would wake up with a mouth half-full of this gunk and feeling like if I moved the wrong way, I would start to choke on it. So I would rocket off to the bathroom and spend five minutes clearing my mouth.

And I'm still almost totally dependent on this Jevity nourishment-in-a-can stuff (although I did polish off a vanilla milk shake the other day, but that wound up being as much work as pleasure). But I'm holding off on trying solid food until I can depend on my tongue not giving me fits and feeling worse the next day for the efforts involved. Timing on the Jevity is a lot trickier than it may sound, and there were several days this week when we couldn't get in the suggested six cans. As a result of that and being somewhat dehydrated, I've lost another three pounds this week.

I mean, geez.

A hastily arranged visit to the radiation center for advice today resulted in a trip to the chemo center for an IV injection of 1.5 liters of saline solution to get me re-hydrated. And the doc -- an associate of my radiation doc, and the guy who arranged the IV session -- gave me the following advice: "This may sound strange, but it's not unusual that your first week after therapy sessions is the worst week of all." (I'm guessing that's because my body has become accustomed to the therapy sessions, and is now having a bit of trouble making the trip back to normalcy. Or maybe it's just the frustration of thwarted expectations. Who knows? It just is what it is.) But the doc continued by saying, "So next week is the first week that you should experience some real healing and return to normalcy. But this weekend might still be a problem." Ah.

So the radiation doc had some other sensible suggestions that we plan to follow pretty carefully.

And at the chemo center, it was pointed out to Deb and me that keeping my weight up probably depended on getting enough water at least as much as getting the recommended six cans of Jevity inside me. Hmmm, hadn't thought about that, but it makes sense. Water is pretty heavy.

...

I mean, geez.

Did I Mention My Fingernails?

My last post listed a series of reasons why I thought an electronic keyboard would be a sensible next musical instrument for me. But I forgot one of the most important reasons:

-- while my keyboard will not require any "lip service" (see previous postings about My Dick Cheney Smile), it's also true that I can keep the nails of my left- and right-hand index fingers a bit long and pointed. It's extremely helpful to have those points available for spinning balls and plates in my juggling act. And the cello (or guitar or banjo or...) would, undoubtedly, require me to trim all my left-hand nails short.

There. I felt I needed to say all that.

And the Winner is...

So many of you were good enough to make recommendations for a new musical instrument for me -- since my lower lip isn't co-operating for my flutes and/or harmonicas. (No decent pucker, if you'll recall... See "A Remarkably Short Cello Career" posting from earlier this month.)

I'm still so pleased to think about all your wonderful suggestions. (And special thanks to Adam who, at a recent practice session of the Turks Head Jugglers made a face-to-face appeal to consider building a Theremin!)

Anyway, I've come to a decision, and felt it only fair to share it with you. The winner is: an electronic keyboard.

What's that you say? Dull, prosaic, and unimaginative? Yeah, I kind of feel the same way. But here are the "plusses":

-- I don't have to tune it.
-- I won't have to fret about humidity and the instrument splitting in the dryness of winter. (Did somebody say "fret"? Is that like "worry"?)
-- There are lots of styles with different features -- and the price of a reasonably sophisticated keyboard is roughly equivalent to 4 month's rent of a cello.
-- It won't take up a lot of room around the house.
-- It's highly portable.
-- There are tons of sheet music available -- of the widest variety imaginable.
-- It will help me learn more about musical theory.
-- There are a bundle of teachers readily available nearby.
-- I can plug in a set of headphones and practice -- without driving Ms Debbie crazy.
-- It will be equally suitable for solo work or playing with others.
-- I can ask serious keyboard musicians to show me stuff on my instrument.

And, for reasons most of you will understand immediately, I would ask you never to ask me to play. For at least six months. Or longer. Probably longer. Maybe much longer.

We'll see...

Debbie's Bunnies

(One item in the very long list of nice things about having Deb as a spouse is that she came equipped with three different names: "Deb," "Debbie" and "Deborah." And each of them get used often in this household. However, when it comes to the lady in question and bunnies, the clear choice name is "Debbie.")

And oh, make no mistake about this! These are Debbie's Bunnies!

Debbie spotted them first. She makes sure that the back yard gates are closed -- keeping out the dogs and cats. She puts messages on the back stairs, imploring our tenants to keep their cat inside. (Tibbi -- the cat in question -- is well past actually doing any damage to the bunnies, but could certainly frighten the little guys and mom...) Debbie's the one who scans the back yard with binoculars several times a day to check on things. And she's the one who saw the little guys yesterday afternoon -- out from under the butterfly bushes for a late-day stroll and a snack. (Please note that we caught the little guy on the left mid-munch.)

Mommie bunny certainly did -- and continues to do -- her part, but it's Debbie that keeps the larger world as safe as possible for two impossibly cute tiny rabbits.

At 419 W. Union Street in West Chester, PA, bunnies may safely graze.

Partings

As Ellen observed in a previous post, today was, in fact, the last radiation session in the schedule. Something of a bittersweet occasion: Deb and I have been to the radiation facility well over thirty times (as opposed to six for the chemo center), and every time met with caring, compassion, and a high level of competence and confidence. It's a bit tough to walk away from that...

And we had a chance today to say "Goodbye" to Gene and John -- two fellow patients who travel together from southern Chester County to the facility for treatment. They were normally scheduled for radiation right before my session, but they'd almost always stay around in the waiting room area to talk with Deb while I was getting my treatment. Gentlemen of the old school. I don't know what Gene (a white guy) does or did for a living, but John is a preacher in a small African-American independent church. And John wants to continually praise the Lord and bless everyone on the planet -- in the nicest possible way. These two fellows could not be more different in so many ways, but fit together so tightly. You just had to smile when Gene and John were in the room. When we told them that today was our last session, we were congratulated with big smiles from the two of them and the warmest of handshakes. And John told us that he knew from the moment he first saw us that we were both very special people, and that he would carry memories of us in his heart. John asked us to write our names on a slip of paper, and that he would place the paper in a small model of a church which lives in his full-sized church back home. The congregation prays for everyone whose name is written down and placed in that model church. And it was a bit tough to walk away from them...

And I had a chance to put on a special juggling show for Joan, a nurse who has been especially helpful to us, but was off-duty last Friday. She was thrilled at the juggling. I was grateful for the opportunity to say "Thank you" in this special way.

After the show (notice: juggling first, talk later!), Joan gave us kind of a wrap-up talk and a chance to ask questions. She told both of us how well we had done. She said if we ever had any questions at any time about any facet of the treatment or my condition, call immediately. Joan said, "The farther away from this treatment you get, the better you're going to feel."

And Joan and the radiation doc (who chatted with us after Joan left) gave us some perspective about timing. They both said I need to think of a complete return to health -- not in terms of days or weeks, but in terms of months. In my mind's eye, I can still see Joan shaking her head and saying something along the lines of: "The punishment we've given your body over the last month and a half..."

I don't understand what any of this really means. (If anyone does, it may well be John, who tried to help us see that we're all in God's hands, and therefore perfectly safe.) But I do know that I have been to very special places -- physically and spiritually -- with people I would never have met under any other circumstances. And I am deeply enriched by the experience.

Feeling Healing

I think it happens to everyone. And probably pretty often. You've had a bad cut or bruise, a broken arm, a case of poison ivy, a lousy head cold -- something that throws you seriously off your normal stride. Something that demands extra attention and inconveniences you in the most inconvenient way.

But then one day-- in just a moment -- you just know that the injury or illness will resolve itself. You may still be suffering the effects, but something 'way down deep inside gives you a promise that the time is coming soon that the suffering will be over. And that changes everything. A new energy blossoms from that promise. A new confidence in today and tomorrow. Another reason to rejoice at being alive. Another reason to be thankful.

Well, that moment came to me this morning concerning my cancer treatments. I knew I was getting better, and I've mapped out in a recent blog posting the steps to recovery. And that was all fine and well, but kind of "out there." Clinical. Almost impersonal.

But what came to me (around 3:30 AM...) was that internal confirmation that means everything. Yes, my tongue still hurts. Yes I still need to wear a compression stocking to keep my leg blood clot under control. Yes, I still need to eat using a plastic tube to my stomach. Yes, my mouth still fills with heavy mucus from time to time. Yes, my neck still needs time to heal. Yes, I'm still woozy and shaky from the chemo. And on and on.

But none of that matters nearly so much now. These things had been in the forefront of my awareness: taking special care of my tongue and mouth, trying to schedule in all six cans of Jevity, trying to get some daytime sleep since I'm still waking up every two hours at night, slathering a thick ointment on my neck and getting it all over my shirts...

But now these are background issues. They're okay, and they're fading. And now space opens up for revisiting and reopening parts of my life that have been on hold. And exploring to see what else has opened to me over the last several months.

I am returnng to normal, but I will never be the same.

A Gig to Remember

Somewhere along the way of my 36 radiation sessions, I mentioned that I was a professional juggler to one of the nurses or technicians. I forget who or when or where. But the word got around through the rest of the staff. And staff members would come up to me and share juggling stories, which was really quite nice.

(Among other things, it seems there is an ex-patient -- fully cured of her cancer now -- who comes to the facility every year on the day before they close for the Christmas break. She sits in the waiting room and plays the accordion for an hour or so and then leaves. And she's been doing this for 10 years or more. One year, she came and promised the staff that the next year she would come back and play the accordion and juggle -- without the accordion, of course. Next year, she came back and apologized for not having mastered the juggling bit. Said she was getting oh-so-close. Said the same thing the following year. I want to talk with this lady and help get her pattern going!!)

Anyway, Deb and I handed out a few "Randini the Remarkable" business cards which directed staff members to our website, which in turn took them to my uploaded DVD. (If you're interested in watching the DVD and have a high-speed internet link, just go to: http://www.toucanenterprises.com/ and follow the prompts. It's really a good 6-minute show! And I'll wait here for you if you'd like to head over there now. Up to you... Back again? Great! Here's the story about the Gig to Remember.)

As reported in previous postings, Deb and I have been at times overwhelmed with the caring and positive attitude of the staff at the radiation facility. You may recall they were once set to drive over to Chester County Hospital to retrieve me, as we couldn't find a doctor at the hospital to sign a release form to allow me to get off to my radiation treatment. On another occasion, our schedule at the chemo center looked as if we would not be able to get to the radiation center until after they were scheduled to close, and they said, "Just get here whenever you can. We'll be here for you."

And serendipity had set up the perfect occasion for me to say "Thank you for all you've done for me!" Since my two next-to-last radiation treatments were scheduled for late in the day (to follow immediately after the chemo sessions), there would be few if any patients waiting for treatment, and the staff had little to do but catch up on some paperwork. So I told a few staff members on Thursday that I would return on Friday with juggling props and put on a bit of a show for any staff that were available.

I was hoping for 4 or 5 staff members for an audience, but word had gotten around through the entire facility, and everyone showed up! They closed down the telephone switchboard and put all incoming calls through to the answering machine. Must have been over a dozen people -- several of whom I had never seen before. Several folks showed up a bit early, and looking anxious, asked if they had missed the show. And were visibly relieved to hear that we hadn't started yet. And they extracted a promise from me that I wouldn't start until they returned.

And, although I hadn't seen my radiology doc in the facility for several days, he was there in the audience too! Yay!!

Before I started the act, I explained that anything that I dropped could be blamed on the chemo treatment that I had just completed. And all these lovely radiology people seemed comfortable with that. Couldn't blame them! And the notification had some meaning to it: my hands were shaking from the chemo and my brain was a bit foggy, and I wasn't that sure how ready I was to perform...

And sure enough, halfway through my four-ball routine, I dropped. And a chorus of staff members all called out -- in unison -- "Chemo!!" Nice to have the audience firmly on your side. (Although later in the act, after I dropped something else, I did hear a staff member jokingly tell Deb, "You know, if it weren't for the chemo, he'd probably be pretty good!" Okay...)

And the balance of the act went just fine. We all got a bit nervous when I did the spinning-plate-on-a-stick-on-another-stick routine, as it looked like I was imperiling the health and well being of several audience members, but no one came out the worse for wear.

Towards the end of the act, I called one of the technicians out of the audience and placed a spinning plate on her finger. She looked over at the radiology doc and announced, plate still spinning on her finger, that "I don't need this job any more!" Several of us suggested she should keep the day job for a little longer.

At the end of the act, I realized that the end of my food tube had come loose from its holder and was clearly visible bobbing back and forth from under my shirt. My radiation doc asked if I juggled cans of Jevity -- the food replacement liquid that's kept me going for the last several weeks. The idea opened up an interesting line to a new act, but I think I'll just let that one go. I'm grateful to the Jevity people for producing such a fine product, but will be happy to see the last can of Jevity leave our house and my life.

One of the nurses, before the act but after she had seen the internet version of my DVD, looked at me very seriously and said, "Randy, you need to get back to your juggling as soon as you possibly can." I think she saw how much my performing means to me -- and what I can provide for my audiences.

Funny where your inspiration and confirmation can come from.

Healing

Well, we had our last chemo session today -- and followed it up with our next-to-last radiation session. (See "Double Whammy" in previous blog postings.) Monday is the finale for the radiation sessions. I like using the first-person-plural "we" for this description, because Deb has been so intimately caught up in every phase of this -- from driving me to and from sessions, to retrieving medications, to acting as secretary for upcoming visits and procedures, to feeding me via the food tube and on and on. So we're coming to the end of... something.

Clearly, the overall quest to confirm that my body has totally rid itself of cancer (with the help of these wonderful technologies) is still ongoing and will be for years. But it is time now to celebrate this penultimate treatment -- about which I will blog a bit more, I hope, tomorrow. It was a rather special day at the radiation therapy facility.

As posted earlier, we will start scheduling one or more scans sometime soon for a month or so from Monday -- and MRI and/or PET and/or CT scans, all have been mentioned and I will be asking for clarity when the subject comes up with a doc. At this point, I'm not even sure which doc...

Anyway, there are signposts -- or checkpoints, or something -- between "here" and "healthy." I e-mailed my classmates about this yesterday in a context that only affected my work with them, but thought I would share these with you. The steps, in order, look like this:

1. My tongue needs to heal. It got a bit better, then a bit worse over the last week or so. Yesterday, I carried on several extended conversations with folks that taxed the damaged tissue excessively. So a minor setback...
2. Once my tongue repairs itself, I will work to move to solid food taken orally and run the daily Jevity liquid nourishment count from six cans a day to zero. (My fantasies about eating pizza or moo shu pork still haunt me, but they have been joined by more prosaic desires. Like toast. Rye toast with butter and jam. And raisin bran. With almonds sprinkled on top. And coffee! Or even herbal tea! Oh, the ecstasy of it all!) Over the last couple of days, I've managed to ingest half of a root beer float one evening and a half can of chicken-and-wild-rice soup yesterday. So swallowing is not a problem, it's just the pain from the ulcer that eventually tells me, "Okay Randy, that's all we can handle just now..." So this is all quite promising, but whether this will take two days or two weeks has yet to be determined.
3. Once I don't need the PEG food tube anymore, I can schedule a date to have the surgeon remove it. I recall he outlined briefly how this extraction will take place, but I don't recall the details. (Do I need stitches in my stomach wall? How to you put them in, and do you need to go back in and take them out?) But it sounds like there will be some serious "lay down and take it easy" time after this procedure. Once again, two days? Two weeks?
4. Hey! But after that is done and the recovery from the tube extraction surgery is in the rear-view mirror, I can start working out at the gym again -- trying to regain some of the 15 or so pounds of muscle that I've lost during these procedures. And lose some of the fat that's been kind enough to hang around with me (quite literally "hang around") for the last several months. But when I get to that stage, darn it, I'm healed. And then, chapters in my life that have been placed on hold for a couple of months open up again.

And it's delightful to think about how many of you will be important parts of those chapters. Just as you have been such important parts of these chapters that should be closing soon...

Bunnies in the Back Yard

We've had rabbits in our back yard for years. I'd like to think they enjoy our grass more than the neighbors because we don't use any fertilizer or weed killer.

In addition, several years ago, we converted half the back yard lawn to a planting space for native trees and other flowering plants. The idea is that native plants have been dealing with this soil and these insect pests for thousands of years, and are adjusted to the yearly cycles of temperature and precipitation. In short. they don't need anything but a plot of ground and sunshine. (We chose our plants to provide berries for the birds. And, as it turns out, the rabbits as well.)

The lady who sold us the plants told us how large each should grow. And each of our plants has beaten the estimate by at least 30%. That "8-foot bush at maturity" is now over 12 feet tall. The domestic dogwood insists on taking over the back entrance to the yard. The serviceberry bushes are eyeing up the telephone lines to the house. The Joe Pye Weed plants are all taller than I am. And we've taken to calling that whole area either "the forest" when we like it or "the jungle" when it gets a bit scary.

But in any case, the birds and rabbits like it a lot. And that was the basic plan anyway.

So we're used to seeing rabbits small and large prowling around the back yard. They probably also feel a bit safer since the yard is completely fenced in and therefore safe from dogs. And, as the summer goes by, we appreciate seeing the small rabbits become big ones. (If you're never seen a rabbit eat a dandelion flower, starting at the base of the stem and proceeding to the blossom -- then eating the blossom as well, you have missed one of life's great little pleasures.)

But this year, Mother Nature upped the ante on us. A girl rabbit "in the family way" decided that our yard was a perfect place to start a family. She and her tiny brood spend a lot of time sheltered behind the butterfly bushes, but she ventures out to stock up on grass and weeds to feed the kids. I imagine they go on the occasional foray to "the forest," as it provides excellent protection and the occasional blueberry or serviceberry on the ground.

We've seen the kids on occasion -- Deb actually saw one of the little guys before it had hair. But mom is pretty careful about keeping the kids out of sight. We may not have dogs in the yard, but we do get the occasional hawk... And at this point, they're still so small you could place two of them on a single hand.

New life. Unexpected pleasures. Nature fulfilling itself. New wonders.

The challenges in life for tiny bunnies are many and huge. Much bigger in many ways than the challenges that we face ourselves. Perhaps we can draw inspiration and courage -- even from a tiny bunny.

Repaving the Path Ahead...

Y'know, I had a hunch this might happen. And I thought that if I blogged about "The Path Ahead" and laid it all out there in cyberworld as The Plan of What Was to Happen in the Near Future for Randy... that things would change. And they did. And no, this repaving is not a "shovel-ready" part of the Stimulus Package. Here's the scoop:

Okay, I talked in a previous posting about how the radiology doc felt he could proceed with my rad treatments since they would not further decrease my white blood cell count -- but that the chemo doc had reservations about doing so, since the chemo would definitely decrease the white blood cell count.

But today, the chemo doc outlined the reasons he felt we could proceed. So I am scheduled for the third pair of chemo sessions this coming Thursday and Friday, the 6th and 7th. Chemo in the morning, radiation in the afternoon. The "double whammy" is back in business.

I will be getting blood tests on Thursday morning, and if my white blood cell count doesn't show the continued improvement that the previous week has shown, the doc can still "pull the plug." But that doesn't sound likely.

Although the white blood cell count is still marginal at best, the chemo doc likes all the other facets of the blood work. My kidneys and liver are functioning well and are ready for the stresses that the chemo will impose on them. And the number for "neutrophil" (I think I've got that right) is okay as well. Finally, there is a fairly new drug called Neulasta, which is supposed to support the white blood cell count after strong chemo doses -- like the ones I'll be getting on Thursday and Friday. So a shot of Neulasta on Sunday morning should keep the one parameter that has the chemo doc concerned from falling too far.

I think that my overall good health and consistently good recovery from previous treatments also played into the chemo doc's decision to proceed. Plus it was obvious to him that I wanted the treatments.

The chemo doc explained that cancer treatment was a matter of pushing the patient's capacities as far as seemed reasonable (i.e., staying this side of life-threatening) in an effort to eradicate the cancer cells completely. The stronger the patient, the harder the treatment regimen can push. If the treatment winds up creating short-term issues for the patient, but successfully eliminates the cancer, that's a good trade-off. And who could argue with that?

So the chemo doc would probably like to have postponed his pair of treatments for another week or two, but the radiation treatments wind up on Monday. So it's kind of a "now or never" situation.

Sometimes, you just get the feeling that yes, prayers are answered. And I thank you, dear reader, for that.

Calibrating the Search for a Musical Instrument -- and...

... guess what? This is the 100th posting on Randy Lyons' Health Blog!! This has become someting totally wonderful and a great source of comfort, inspiration, and peace. Thank you all -- posters and non-posters alike -- for making this blog come alive. (Just the idea that our dino buddy from Australia can exchange thoughts with our dear friend the nun in Emmitsburg, Maryland OR that a museum curator in Alberta, Canada can read what my sister in Baltimore has to contribute through this medium is so intoxicating!!)

And nothing we've chatted about on the blog has been as much fun as the wonderful suggestions for a musical instrument. Which is what the rest of this posting is all about. Given the wide variety of suggestions (yowza!), I'd like to add a few parameters and some additional information to the search to help things along:

-- first, I've never been any good at tuning a stringed musical instrument. I find it terribly frustrating. And that goes for the 5-string banjo that's been sitting in my closet for years. Right next to the guitar. So the idea of the hammer dulcimer -- which has a beautiful sound but a bazillion strings -- I think doesn't make the final list of possibilities.

-- second, I'd like to work on an instrument that I can play all by itself or with others. And my collection of percussion instruments -- which includes two dumbeks, a djimbe, and a home-made bodhran (an Irish frame drum) -- sits idle, waiting for someone to play along with. I guess this is my lack of imagination or commitment or something...

-- third, I'd like it to be a reasonably serious instrument, which will help me learn something academic about music theory. (One of the nicest parts of my Indian music lessons was learning what ragas really are -- and why it's so hard for so many Westerners to grab hold of this concept.) Anyway, this precludes adding to my "fou-fou" collection of musical instruments, which includes a slide whistle, a set of wooden spoons, several nose whistles (please don't ask about these...), two kalimbas, and on and on...

So my plan is to check with a cello teacher -- which I hope to track down by way of my local music store -- to confirm or correct the idea that I would need to keep my fingernails short. And if that is a requirement, to talk about an electronic keyboard and some reasonably serious lessons in musical theory and proper keyboard fingering. Goodness knows that a keyboard gizmo is easier to cart around than a cello! And is not affected by the weather. And can be played with earphones so as not to bother the neighborhood cats.

So thanks to all of you for your wonderful suggestions. Please keep them coming!

The Path Ahead...

...is a lot clearer this afternoon than it was when the day started.

On each of the last five Mondays, I've gotten a variety of blood tests. The results of some are available almost immediately, some later in the day, and some take a day or so to get evaluated and reported.

One of the immediate-return tests showed that my white blood cell count was recovering nicely and had almost doubled since last Tuesday -- from 1.3 (whatever that means) to 2.4 today. That number was high enough that the radiology doc started up the radiation treatements again. But the chemo doc said a week ago he wants to see 4.0 before resuming chemo.

(This makes a lot of sense. It's the chemo sessions that kill off the white blood cells along with the cancer cells, so the chemo doc wants to make sure I have an adequate reservoir of white blood cells that I can afford to lose a bunch of them to a high-dosage Cisplatin chemo treatment. The radiation sessions don't kill the white blood cells per se, but they do damage the skin and cause the ulcer on my tongue. So his concern is: Does Randy have enough white blood cells to assure that his body can fight off any infection that may occur at the site of damaged tissue?)

Anyway, I got a radiation treatment today, and should be able to finish off the other five sessions wihout interruption. That would mean that the last rad session would be next Monday, August 10.

The chemo doc doesn't want to make any commitments to continuing and/or scheduling the third chemo session until after he sees the results of all the other blood tests -- including the ones for which the results won't be available until later today or tomorrow.

AND the two docs may decide to adjust the schedule and link the chemo and rad sessions to allow each to take advantage of the other. Time will tell -- and soon!
So I've had six days in a row of no treatments whatsoever. And my body deeply appreciated the "time off." The respite gave me a chance to understand what the timing might be like for complete healing after the last chemo and rad sessions are done. Whenever that is.

The first four of these six days-off did not supply any hints of healing. The skin on my neck continued to look horrible and my tongue continued to feel horrible and swallowing continued to be painful. But the last two days gave the promise of alleviated symptoms -- and the rad doc this morning told me how good the neck and tongue looked. So my guess is complete recovery in two to three weeks after the last session.

And given that the radiation treatments are much lighter for the last seven sessions compared to the first thirty sessions, the amount of damage revisited to my neck and tongue should be considerably less in the remaining five rad sessions. So that the timing for full recovery may be even less than a couple of weeks. We will see.

As always, your thoughts and prayers are gratefully acknowledged. Thank you again for sharing this journey with me.

A Remarkably Short Cello Career...

So I had figured, if the harmonica and Indian Flute are denied to me due to my Dick Cheney smile and inability to control my lower lip completely, why not pick up a musical instrument that has always held an appeal for me? Like the cello...

But it occurred to me the other day that, to play the cello, one needs to keep one's fingernails short. At least the ones on one's left hand (the hand that frets the strings). I know that's true for guitar and banjo.

And I really need pointed fingernails on both my index fingers for ball spinning and plate spinning in my juggling act.

And since I have to choose either pointed fingernails or short, flat ones, I think I need to go with the points.

Which means I'm back in the market for a new musical instrument. Suggestions are encouraged!

Feeding the Birds -- and Randy

The best place in the house for Randy to take a tube feeding is at the breakfast table in our kitchen. One reason is that the feeding doesn't always go smoothly, resulting in liquids being splashed here and there. And the kitchen floor is the easiest to clean up.

Equally important, the breakfast table gives us a look out onto our side yard, where we have five bird feeders set up. And watching the birds chowing down gives us something pleasant to do for the half hour or so that a tube feeding normally takes. ("Why five feeders? Won't one suffice?" asks the non-birder. "Because birds' beaks differ considerably, enough so that different kinds of birds are attracted to different kinds of seeds, and different seeds require different kinds of feeders" says the seasoned pro.)

Anyway, the following description requires a careful look-see of the attached photo, which was taken from my seat at the breakfast table. I'll wait here while you click on the image, get a clear idea of what's there, and come back to the text. Dum de doom de dumm...

Ah! Back already? Good! Here's what's going on:

The enormous-looking thing in the upper left-hand corner is a feeder attached to the window. (Right now, it needs a cleaning and refilling.) All kinds of birds are perfectly comfortable in flying right into the feeder and chowing down while we watch them. The house finches enjoy playing "King of the Feeder" in here -- they don't bother eating, they just sit glaring out at the world and daring anyone else to try and enter the feeder. Anyone else trying to land inside the feeder results in a wonderful fuss!

The dark cylinder and cone in the lower-right corner will be recognized by birders everywhere as baffles to keep the squirrels off the feeder support pole -- which is roughly 8 feet from the house. Young squirrels are light and agile enough to beat the current arrangement of baffles and they need to be chased away with a squirt gun, but after a month or so, they put on enough weight that they can no longer jump to the feeders directly.

The two transparent hemispheres in the middle of the photo are "umbrellas" for feeders. They not only present yet one more obstacle for the truly inventive and determined squirrels, but they keep the seed remarkably dry in wet weather.

The feeder under the "umbrella" on the right is filled with sunflower seed. It is pretty much the province of house finches and a variety of brownish finches and chickadees, although the occasional goldfinch will find his/her way to this feeder. (Find his/her way from the niger seed sock feeder in the back yard. Which you can't see from the breakfast table.) Since this is the season of new finches, we have a fairly constant show of baby finches fluttering wildly to convince mom and/or dad that they are about to die of starvation if not fed immediately. The show is a put-on and doesn't work all that well, which means that the baby finches simply try harder. (Everything I need to know about human behavior, I think I can learn from watching house finches.) Anyway, the cardinals are simply too large to use the small perches on the feeder and small openings for access to the seeds. So that's why we have a larger feeder with easier access to sunflower seed just off to the right of the feeders in the photo.

The really wonderful feeder right now, though is the one under the umbrella on the left. It is filled with a variety of nuts -- a highly desirable food for almost any songbird. But the green cage around the feeder makes it impossible for starlings, doves, jays and other undesirable birds to get access to the food. So it is a safe feeding location for the little guys. The cute ones. The ones we're trying to attract in the first place!

So, as I'm sitting waiting for the Jevity liquid to drain slowly into my tummy, Deb and I are royally entertained by chickadees (I think we're getting black-capped and Carolina chickadees), titmice (or is it "titmouses"?), two kinds of woodpecker (downy and hairy), house sparrows, song sparrows, Carolina wrens, and, of course, yet more house finches. And, as mentioned above, the kids (of all species!) are the stars of the show.

And you never know what will happen next or who will show up. Kind of like sitting in your favorite tavern...

A Sign I Saw Someplace

... a year or two ago. Can't remember where I saw it, but I did take a photo of it. Seems more appropriate than ever lately...

Serenity: Life isn't about waiting for the storm to pass. It's about learning to dance in the rain.

My Dick Cheney Smile Revisited

Well, I won't know anything about wrapping up my chemo and radiation therapies until Monday. Deb and I will drive to the chemo center for some blood tests as early as possible on Monday, and the results of those tests will likely determine what -- if anything -- happens next. My white blood cell count needs to be significantly higher if my chemo doc will even consider a third and final pair of chemo sessions. And my radiation doc wants to see the results of these tests before he determines when to start up the last several radiation treatments (I have six sessions left on the schedule).

Given the state of the skin on my neck (it's quite fragile and is bleeding just a bit in a couple of spots), he may decide to wait even longer. I believe the two docs want to co-ordinate their decisions. But all will be revealed (we hope!) on Monday.

In the meantime, I should document something that my Ear/Nose/Throat doc (who performed the major surgery on my neck) told me several weeks ago. Back in May, I posted under the title "My Dick Cheney Smile" that the left side of my lower lip didn't respond the way it had before the operation. So that when I put on a big smile, my lower lip draws a diagonal line across my teeth.

So I asked the E/N/T doc during a recent visit what was going on, and when -- if ever -- would my lower lip respond the way it used to. He asked me to pucker my lips, then try to whistle and a few other activities. He asked if there had been any change in the smile since the operation, and I told him no.

Then he explained that the facial nerve (which exits from the brain through a hole in the skull be the ear) fans out across the cheek, with each fanned-out sub-section carrying out a specific function. The lowest of these fanned nerves drops down to the chin and then comes back up to control the lower lip. And this section of nerve was damaged during the operation.

He said that normally, it might take a year for this nerve to repair itself -- if it ever would. (And Hal had mentioned in an e-mail that nerve repair might take an extended period, so I was not surprised to hear this from the doc.) However, since that area of my neck has been heavily bombarded with radiation during my treatments, it might be two years -- if ever -- for complete articulation to return.

I don't really mind the Dick Cheney smile, although I don't know how other people looking at me respond internally to seeing the crooked smile. But I'm sad that, because I can't pucker the way most people can, that my harmonica playing and Indian flute playing may be done forever. Maybe I can work out some alternative lip positioning, but I haven't had any success so far...

Time will tell.