Update details

My last update was oversimplified. I was surprised to learn from the oncologist that the cancer develops a resistance to chemo over time. (To be honest, I was a bit annoyed that he'd never mentioned this before.) Furthermore, he says, the worst thing to do is to take a break and then restart it; apparently this only helps the cancer cells to regroup and defeat the cisplatin/gemcitabine. But restarting the chemo sooner is also of dubious value, so I saw no need to do so, and he didn't argue. But he was adamant that it would be pointless to return to chemo after the next scan in three months. The upshot, in other words, is that I am now done with the chemo but not with the cancer. It looks like I have two options left.

The first is the atezolizumab immunotherapy discussed in an earlier post. Contrary to what I thought, I would definitely be eligible for this. Regarding the nasty side-effects, he said that urinary tract infection, described as occuring in fifty percent of patients in some of the online literature, has nothing to do with the therapy and is (unsurprisingly) caused by the bladder cancer itself. The one side-effect he emphasized was colitis, which can be serious and occurs in ten percent of patients. There is no guarantee that the therapy will work, or if does work, for how long.

If it doesn't work, the possible remaining option is (as I understand it) to join a different research study with another immunotherapy agent. This is the one that is only an option if I have the right PDL's or something like that. If I don't, I guess it's on to voodoo or snake-handling.
I remain optimistic, and don't worry about any of this. But at the same time, I can't avoid being realistic. I find it much easier, almost comforting in a perhaps strange way, to face the facts directly. The tumor in the bladder is still there, and in view of what happened last winter leading up to the TURBT in spring, it seems unlikely that it is going to just go away. Whether it is in three months or six months, or whatever, I expect further treatment will be required. If the atezolizumab yields a so-called ``complete response'', a misleading term that in no way implies a permanent cure, great. It is possible, although apparently rare, for it to achieve a complete cure. If it doesn't work, and the third option doesn't pan out, I may have reached the end of the line. But why worry? We all reach the end of the line, sooner or later.

It was also stressed that if I have any symptoms before the next scan, I should report them immediately. Duh. But I still don't have any. I'm asked regularly: ``Do you have any pain? Do you have any pain?'' Sometimes I get the impression they're surprised I'm still alive. No, I do not have any pain. Never have. Yesterday a nurse wanted me to come in for yet another blood draw. But why?
I'm done with the chemo. Maybe my platelets are still low, so I should avoid stabbing myself with sharp objects. But I've never had any problem with it. Yesterday, in this oddly warm weather, I did my beloved bike-and-hike and felt great. Clearly the other red blood cells are back, why not the platelets? Besides, my platelets are of exceptional quality. Seriously, I think it's been proven.
So I'm not going in for the draw, although I will have to have the old chest port flushed once a month. (Taking it out is a major project, and so isn't worth doing as I may need it again.)

In short, the future is still very uncertain. But that's always true, is it not?

There's a Chinese student in my class who in his first email to me addressed me as ``Dear Old Steve''. Maybe I already mentioned this. In a more recent email he said ``You are the cute and affable professor''. That's not a comment I get often!

A dark day for America

It's official: Our country has declared to the world that it represents hatred, bigotry, racism, sexism, xenophobia, and most of all, ignorance. The know-nothings have finally succeeded in electing a candidate who knows even less than they do. Early attempts---Reagan, George W.---came close, but now we have a president who knows absolutely nothing about government, foreign affairs, and the world beyond Trump Towers. The bigger difference is that in Reagan and George W. one could, under close examination, detect a core of decency. Trump, on the other hand, is nothing but a con man---a self-centered, egotistical, greedy, vulgar con man who cares for no one but himself, tells nothing but lies and will likely betray even the poor suckers who voted for him.

With congress too under their control, the Republicans will now set about gleefully destroying America: attacking a woman's right to choose, ensuring that health care in America remains astronomically high, screwing the poor, destroying the environment, wreaking havoc around the world and all the while pursuing what has always been their highest priority: cutting taxes for the rich. As always under Republican administrations, spending will meanwhile be increased, preferably on a war such as George W.'s on which their rich friends (Haliburton, e.g.) can shamelessly profit. Then they will act surprised that the deficit has gone up.

The grotesque hypocrisy exposed by Trump's campaign will continue. ``Character matters'', a favorite maxim of conservatives, is now seen for what it is: a lie. Character, apparently, doesn't matter at all. The hypocrisy of the Christian right, including especially Pence, is now laid bare for all to see. If one were to seek the anti-Christ personified, one can scarcely imagine a person more antithetical to the Christ portrayed in the gospels than Trump. In Trump we have a serial adulterer who denigrates and abuses women, incites violence, openly insults entire nations, peoples and religions, mocks war veterans and the handicapped, cheats, lies almost every time he opens his mouth, and has never in his life lifted a finger to help the less fortunate. Yes, character matters.

I don't like to make facile comparisons with Hitler, but he and Trump do have one characteristic in common--that of being a petty, mediocre person who discovered relatively late in life his true talent: rabble-rousing. Trump is the classic demagogue, that is, to quote the dictionary, ``a politician who gains power and popularity by arousing the emotions, passions and prejudices of the people''. We like to think that ``it couldn't happen here'', and I'm not saying it will. But ``it'' definitely could. One can only hope that enough decent Republicans are left to rein in Trump's worst excesses.

My cancer is of no significance, compared to the cancer now metastasizing in the United States of America. I don't really even want to talk about it. I'll just say that the CT-scan results were what I expected, namely that the cancer in the liver has been slightly reduced, that of the lymph nodes is either reduced or stable, and in the bladder itself the tumor is also stable. I won't be getting any treatments for at least three months, so I'm happy about that. Maybe later I'll post a more complete run-down, but in the big scheme of things none of this matters.

To end on a more positive note: In the main lobby of the Med Center there's a piano, and as I was leaving a young woman was playing Debussy's famous Arabesque, which to me is one of the most hauntingly beautiful piano pieces ever written. Despite having an important party to get to (see below), I had to stop for five minutes and listen. I don't know why, but it gave me hope.

As to the party, Kaia turned seven today! A splendid time was had by all. Her little brother, who is not known for his patience when it comes to such things as birthday cake, ice cream and presents (even his sister's), came out with many memorable lines. As dinner  plates were being cleared, cake was being readied, and the adults were vainly attempting to have an adult conversation, Finley interrupted with ``Guys, guys!! Would you please stop talking so we can get on with the birthday party?''

Life goes on.

Brief update

The latest (and tenth) cycle of chemo was the worst I've had yet. I was definitely not a happy camper, and even cancelled my classes on the post-Cisplatin Monday. You don't want to know the details.
As the last day or two I'm finally on the upswing, and it is a great feeling! Today's blood draw, however, showed I am at my lowest hematocrit level ever (no wonder I've been tired). Platelets very low too, prompting the nurse to give the canonical warning--no sword juggling, alligator wrestling, etc. But the counts can only go up from here. There is another suite of lab results involving potassium, sodium, creatinine etc. and on these my results prompted superlatives such as ``stellar'', ``perfect'' etc. I think I'll post them on the refrigerator with a big gold star. Then again, maybe she's an easy grader.

Speaking of grading, while waiting around for the lab results I graded the first problem on today's topology midterm. The results were disappointing, even depressing. This was the easiest exam I've ever given at this level, and the first problem in particular was supposed to be a freebie. Only 8 out of 45 students got it right (including of course that sophomore they wouldn't let register for
the class). This was the one problem where they didn't have to prove anything but could just give the answer. These are senior math majors, but some of them couldn't even draw/visualize the graph of a simple function appearing in the problem, and even those that could seemed to have almost no intuition for the concept of ``limit point'' that we've been studying all quarter and
is not even a new concept; they see it in a simpler context in earlier courses. In the worst cases they wrote total nonsense.

What do I do? I'm really at a loss. Maybe they'll do better on the other problems, which I'll start grading tomorrow. But I'm not optimistic. I suspect I'm going to have to suggest to a large number of students that they drop the course, as they are headed for the D/F range. I'm an easy grader up to a point, but this is ridiculous. As I keep saying to the department, we need to raise the standards for the math degree.

 On a happier note, I had fun visiting Finley's preschool yesterday. They speak Spanish for much of the class, which is fun for me; I can compare vocabulary and grammar points with Italian. I understand Spanish more than I used to, but there's plenty of vocabulary that's completely different. Finley seemed to get a big kick out of having grandpa in his class.

 And finally, Kaia is about to turn seven! We have the ``kid party'' on Sunday at a gymnastics venue, then the ``family party'' on the actual day, Wednesday. Fun!!

  

Programmed cell-death ligands: the trailer

I won't know until mid-November whether or not immunotherapy is recommended in my case. That makes it a little hard to get motivated to research the subject, but I don't want to be doing it at the last minute either. So I've started looking into it. The idea is that I would ``join a research study'' on atezolizumab (trade name Tecentriq, approved for bladder cancer by the FDA last May), assuming certain conditions are met as discussed below. Anyone who is interested can easily find details online, so I'm just going to give the short version.

There is a lovely term ``programmed cell death protein'' or ``''death-ligand'' PD-L1 blocking antibody. The idea seems to be
(this is all based on a cursory survey of the web, and a preliminary conversation with the onc) that PD-L1 is bad because it interferes with good guy immune cells that would like to attack the cancer.  Atezolizumab blocks or inhibits the PD-L1 so that the good guys can do their job.
In bladder cancer patients, this therapy is approved for patients who have had ``platinum-based chemotherapy'' (i.e the cisplatin), yet the disease has still progressed. That is possibly true in my case, but we will wait to see the results of the latest round of chemo.
If the cancer in the liver has been reduced or at least hasn't progressed, my understanding is that the chemo is declared a success and we don't do the immunotherapy. Of course ``success'' in this business seems to mean temporary success, apart from a few rare cases where a complete cure is obtained. One often sees the abbreviation DoR, which at first makes me think of ``dead on arrival'', but actually stands for ``duration of response''. This refers to the length of time before the bad guys start up again. By the way, a key point to be aware of when evaluating statistics is that there is a group of patients who get the immunotherapy because they are too old or in too bad of health to tolerate the platinum-based chemo. Keep this in mind if you come across gloomy death statistics; some of these people were already in bad shape for other reasons.

The second criterion for proceeding with the immunotherapy (according to the onc; the online literature is less clear on this point) is that PL-1 should be (sufficiently ``highly expressed'' on the tumor.  I think the idea is that if it isn't highly expressed, then the success rate is too low to risk the side-effects (see below) or to justify the cost. This is why they first have to send a sample of my original tumor to a lab. (Didn't know they still had it; maybe they keep it in a refrigerator in the lunchroom. Anybody ever see the movie ``The Loved One'' with Jonathan Winters? If so, you'll get the reference.)

In theory, the process of getting the immunotherapy is simpler than the chemo: one 30-60 minute infusion every three weeks (for how long, I don't know). But I assume that many more visits to the clinic are required, for check-ups and so on.

This leaves the big question: side-effects. Some people have died from atezolizumab therapy, but it's a small percentage and I suspect they're generally people who were in bad shape to begin with. On the other hand, there is the usual list of fairly common side-effects: fatigue, nausea, constipation, decreased appetite, and especially urinary tract infection. Plus a host of gruesome but less common side-effects including thyroid problems and eye problems. That last one is a potential game-changer for me. If any kind of permanent eye damage is even remotely possible, I would not do it. Even temporary problems (blurred vision, double vision and redness are all mentioned) might be enough for me to say ``no thanks''.

But it's all up in the air at this point, so I'll just wait and see. Programmed cell-death ligands, watch your step!

Date night in the infusion ward

Yesterday being a cisplatin appointment, I was in the infusion ward from 2 to 9:30. But what better place for a Friday night date?

As I had been unable to eat the dinner I ordered (explanation below), Wendy, who was already on her way, stopped at a convenience store and brought me Cheerios and milk at 7 or so. Perfect! She is a lifesaver. We could chat, or could have watched TV but there is really nothing on. Still, we had our books to read, and being in the Luxury Suite I had a bed on which I could and did fall asleep. It was almost too much excitement for one date. To sum up, with apologies to Omar Khayyam and his first English translator, Edward Fitzgerald (see the wikipedia article for a discussion of Fitzgerald's highly non-literal translation and his own interesting justification thereof):

A cup of cheerios, a touch of milk, and Thou
listening to me snore in the infusion ward,
ah, this day, this moment is paradise enow!

Now, as to why I couldn't eat: It wasn't because of the chemo; I was feeling nauseous long before that kicked in. It's the pyschosomatic reaction I've mentioned earlier. I asked Tom about it and he said oh yeah, that is a real phenomenon
they see often. Their worst case was a guy who couldn't even set foot in the medical center without throwing up; they had to move his infusions to a different hospital. Another person would react to seeing an infusion nurse in the grocery store. (Hey Tom...you don't shop at the QFC on Juanita Drive, do you?) I've noticed that even looking at the hospital menu (which actually has some good food) makes me feel queasy. In fact just typing the words gave me a twinge. It's interesting how the brain and the digestive tract are linked in that way: seasickness, for example, and as I understand it the highest concentrations of the neurotransmitter serotonin are in the brain and the digestive tract. Before your first chemo, they warn you that ``you cannot control nausea and vomiting by willpower''. Okay, but surely this reaction to simply being in the ward can be defeated? I need to get more serious
about a mental imagery/self-hypnosis approach and see if it works. Meanwhile, thank goodness my wonderful wife brings me cheerios on a Friday evening!

On the afternoon half of my stay I had Molly again, and learned something new about her. Very few people read ``classic literature''---after high school I read almost none until I got on this literature kick a few years back. At the moment I'm reading Anna Karenina, and as I had it with me, I asked her if she'd read it. ``I didn't care for it that much; too gossipy. I like Dostoevsky more, especially The Brothers Karamazov.'' Cool! I think by ``too gossipy'' she means in a soap opera-ish way. But if it's a soap opera it's a darn good one. In fact I'd like to announce this breaking news to the world: Tolstoy was a great writer!  I have the famous Karamazov brothers on my future reading list, but I think it's over a thousand pages (Anna is a mere 900) and it may be a while before I atttempt it. In any case, Molly's interest in literature was a pleasant surprise.

I have to start my infusions at 2 because my topology class gets out at 1:20. When I learned I would have to start chemo again this summer, I made up my mind I would not give up the class, and fortunately I was able to work it out with the Med people (who honestly bend over backward to accomodate my schedule; they're awesome). I am so glad it worked, because my class is just fantastic. This was unexpected because I thought with 50 students (now down to about 47)  it would be very difficult to get students engaged, speaking up etc. On the contrary, it might be the most engaged, lively class I've ever had. At last count I could
list 19 different students who've had questions or comments, and often it turns into a real dialogue. I wish I could learn more names---so far I know maybe 20---but the students seem quite impressed that I even have that many. Now I'm determined to get them all.

  My system of secret mnemonic nicknames works pretty well. It's unlikely but theoretically possible that one of my students could find this blog, so if you are such a student and recognize yourself below, please know that even when silly, the names are chosen with respect and affection. It's just a way to help me memorize. A few examples: Rasputin, Kate Winslet, Wagnerian opera guy (Tristan, as in Tristan und Isolde), Stylin', Jesse James, the fake Italian (third generation; doesn't speak the language), the Norwegian (his name isn't Norwegian, but somehow he looks Scandinavian and has the same first name as Jay's Norwegian friend), Canadian mountain man (Jasper), Punk-rocker, Compact Disc (first name Qidi, pronounced like the Italian for CD),
Mathematical Bakery woman, the Twins (two Chinese women who hang out together and thankfully use English first names here, as many of them do; they don't look at all alike), and more. Then there are the ones who don't need a nickname; there's a ``Ken'', well, two in fact, but only one ever speaks up; and a female Jordan who is the lone math grad student in the class. Also a Chinese student who has what appear to be serious burn scars on his neck and part of his face. It's unfortunate, but inevitable, that this immediately becomes the recognition clue. He's a great student.

The main problem is getting the women to speak up (there are only nine, alas). I've never come up with a good way to encourage them, because any way you do it, it risks putting even more pressure on them, as though they're obligated to speak up for the good of all. One way that sometimes works is to put encouraging notes on homeworks, but I have a grader since the course is so big. Or if any of the silent types, male or female, ask a question after class, I try to compliment them on a good question and say Hey, you should ask questions in class. Wednesday this finally worked; Kate Winslet asked a great question in class!

I was getting to the point that I thought there was only one solution: Bring in the formidable Maddie as an undergrad in disguise, to set an example. She's the lone female in my algebraic topology reading course with three males (the Italian student, an undergrad, and one other), plus me. Maddie is awesome. She immediately established herself as the leader of the pack, and pretty much runs the show. Now that I've had a chance to hear her present ideas at the board, it's clear that she really is good. Great geometric intuition combined with computational skill and precision.

By the way a high school student visited my topology class on Wednesday. Took calculus in 9th grade and moved on to other things, including topology. These prodigy types grow like weeds around here, I tell ya. I hope he comes to the UW, but if he's as good as he sounds he'll probably go to someplace like Stanford or the Stanford of the East, you know, what's that place called? Oh right, Harvard.

Well, enough dex-fueled babbling for now, but it sure helps take my mind off the chemo! Oh darn...
I made it to 7:30 pm without the hiccups (a record), but they have just started...

Revenge of the neutrophils

The rash finally went away, my neutrophils have bounced back big time (told you so!) and today's infusion went ahead as planned. 

My nurse this time was Molly, who I think I've seen before although she didn't seem to recognize me. As they always do, she emphasized that ``it's important to drink'', then felt compelled to clarify that she didn't mean alchohol. What?! You mean all this time I've been misinformed? Every infusion weekend I've been dutifully knocking off three cases of beer, five with cisplatin.

Molly is very nice, but when her shift ended at 4:30 I was happy that Dana took over. She's the one with the quirky sense of humor; we exchange movie reviews too. I recommended ``The man who knew infinity'', about self-taught Indian mathematical genius
Ramanujan and his ``discovery'' by Cambridge mathematician G.H. Hardy.  The book is fascinating, and hard to capture in a movie. But they did a pretty good job I think. Jeremy Irons is well-cast as Hardy (``I love him!'' says Dana), and Dev Patel as Ramanujan. ``Dev Patel,'' Dana sighs, ``he's so cute!'' and pretends to run off to get the movie right away. She's a nut.
She recommended ``Genius'', the movie about Thomas Wolfe (author of ``Look homeward, angel'', not to be confused with the later Tom Wolfe, author of ``Bonfire of the vanities'') and his editor Maxwell Perkins. The cast is certainly great, including Colin Firth, Jude Law, Nicole Kidman and Laura Linney. So far we've loved the movies Dana recommends, so we'll be sure to try it. 

A random oddity: While waiting a few minutes outside the infusion ward, I was surprised to find on their magazine rack a 1991 volume entitled ``What every first-grader needs to know''. Odd choice for a chemo ward, but clearly something I needed to read up on, as next Thursday I'm visiting Kaia's class during math period (don't tell my chemo team; they would be horrified). I was able to do all the math problems in the book, but was taken aback by the paragraph on the Aztecs that mentioned human sacrifice. For first-graders?

One good thing about last week's infusion postponement is that next weekend is now an off week. This means we can go to the opera: Hansel and Gretel, by Engelbert Humperdinck. Anyone of my generation tends to associate that name with the British pop singer, but that was just a stage name stolen from the real Humperdinck (1854-1921). Initially Humperdinck just wrote a few songs to be performed in a puppet show by his nieces, eventually expanding it to a full opera, with libretto written by his sister. The opening performance was conducted by Richard Strauss, who considered it a masterpiece. Wendy and I have just listened to a recording of it, and the music is indeed beautiful, with much elaborate orchestration a la Strauss. Seattle Opera is staging it in a modern setting, a practice I generally dislike, but still it should be fun.

Usually Wendy drives me to the infusions, a practice we'll probably continue for the cisplatin weekends. But it really isn't necessary on the single-dose weekends, and it requires two trips for Wendy, so yesterday I drove myself. I can't say that I felt at the top of my game on the drive home, but it isn't bad. Besides, I now have Anna Karenina to keep me company for my next 39 hours of driving.

Quarter is still off to a good start. I got the Turkish exchange student into my class, as well as a university employee who's been wanting to take topology for years. But the powers that be wouldn't budge on that sophomore Haim Grebnev. ``If we let in a student who doesn't have the prerequisites, other students will be clamoring to do the same thing''. So? The whole point is that
it should be at the discretion of the instructor. If other students come a-clamorin', I would just say great, show me that you're at Grebnev's level and I'll let you in. This guy not only was asking on day 2 ``How many distinct topologies are there on a finite set with n elements?''; when I came in yesterday he had written on the board what he claimed was a recursion formula for the number in question. A recursion formula is something weaker than an actual formula, and his formula looked too good to be true to me, but who knows? I've asked him to write up a proof, which I will then ruthlessly critique to see if it's right. It doesn't matter though if it turns out to be wrong; the point is that only a tiny handful of students would even think of the question, let  alone try to solve it. I checked around and I was right about what I said earlier: at the moment, no one knows the answer to the question.

Did a nice walk this morning (it's the day after chemo) and felt remarkably good!

The further adventures of ChemoMan

A week ago Friday, I had the pleasure of being at the med center from 8 in the morning until 7 at night. First on the agenda
was installation of the ``chest-port''. I must say that this was one of the most pleasant medical procedures I have ever experienced. Narcotics are involved, as well as a local anesthetic. The procedure is done by an ``interventional radiologist'' and takes about an
hour. I was feeling very comfortable indeed just lying there, vaguely aware that someone was fooling around with the right side
of my chest. In fact when it was over, and they announced I could go up to the infusion ward, I really didn't want to leave. Hey,
it's so nice here! Can't I just lie here for another hour?

Next up was the usual 8 hour session for the double infusion, in the luxury suite. As always, I came armed with an array of mathematics, novels and audiobooks. It's not bad really; in the luxury suite there's a bed and a sliding door you can close. The one big disappointment was missing Finley's ``kid birthday party'' at Denny Creek Park. We'd already had the ``family birthday party'', which I absolutely would not have missed for anything, and certainly not for chemo. The next day Jessie texted me that she and the kids were dropping by for a ``special delivery'' from Kaia. I've talked to Kaia and Finley about having a funny bladder problem, without using the word cancer, so they know about these hospital stays and why I wasn't at the party. Anyway, Kaia brought me a cupcake from the party, and a big apple. So cute.

But alas, it's always sumthin. For the port procedure they use the common technique of painting around the area with betadyne, if that's the right spelling, and it turns out I'm allergic to it. So that whole side of my chest, up onto the neck and shoulder, looks like a case of poison oak and periodically itches like crazy. So far, nothing has worked to reduce it (at this moment it feels better, but I've been fooled before...).

Yesterday I went in for the week 2 infusion, and further complications ensued. The infusion nurse was reluctant to even use the
port, because of my skin condition. Dammit, I went to all the trouble of getting the stupid thing and you're not going to use it?
The big concern is infection, since it's so close to the heart. Okay, let's just do it peripherally, as they say in the biz. Then my labs
come back and it turns out my neutrophil count was down to 1.2, with 1.5 being the minimum to go ahead with the chemo.
Yeah, but my neutrophils have a family motto: ``Few, but strong''. We've done it before below the minimum, with approval from the onc, with no problems whatsoever. My neutrophils can kick ass! On the other hand, the combination of skin rash + infection risk + low neutrophils led the onc to nix the infusion for the day. Two and a half hours in the ward for nothin'. Meanwhile the NP suggested dexamethosone to treat the rash (wonderful, the hiccup drug), only to be countered by the onc because, for reasons I didn't quite get, the dex can also have an adverse affect on my long-suffering neutrophils. Ultimately it was decided that I should take antibiotics prophylactically for a week, and very small doses of dex but only if ``the rash gets worse''. Otherwise I just wait and time is supposed to cure it. Then I'll do the week 2 cycle next Friday.

Further entertainment was provided by the big Husky-Stanford game. The med center is just across the street from Husky Stadium,
and game time more or less coincided with the end of my session. No way would I ask Wendy to pick me up at the hospital or anywhere near campus; it would be a nightmare. Here you have to understand that on game days, mere professors can't even park on campus; everything is reserved for the convenience of football fans. I would've ridden my bike if I had known there would be no chemo, but oh well. I considered swimming across the lake, but my pack was too heavy. So we had devised a strategy: I would start walking north on the Burke-Gilman trail, while she was driving south, and we'd meet somewhere along Sand Point Way. 
It was a beautiful fall day, like almost every day this September. Near the stadium there was much hooplah as fans were streaming in for the 6 o'clock kickoff. Fundamentalist nut-cases were marching along with them, carrying big signs and ranting mindlessly on megaphones about the wages of sin, Jesus this and Jesus that ad nauseam. Others seemed more concerned about getting tickets to the game, or scalping some, than about the afterlife. After a mile or so the noise died out, and a couple of miles later I met my lovely wife at a very nice, quiet little park: the Burke-Gilman, which oddly I'd never been to.

Meanwhile, the fall quarter has begun. My senior topology class has fifty students with more trying to get in. It's a ridiculous number, due largely to the massive influx of Chinese students the last few years. Of course students of all nationalities are very welcome in my course, as long as they really want to study topology. The problem is that there are many who do not, and I'm doing my best to weed out the non-serious ones as soon as possible. On the plus side, there are already at least half a dozen students who have been very vocal and involved in class, and that's all it takes to make teaching really fun. On the other hand, the sheer size of our bloated program (600+ math majors) brings the Bureaucratic Law of Large Numbers into play: the bigger any organization gets, the more it succumbs to bureaucracatic rules. So I have to battle my own department to enroll highly qualified, motivated students who don't technically meet the requirements. A Turkish exchange student, for example. Or a sophomore who doesn't have the prerequisites and isn't even a math major yet, but was the top student in honors calculus last year. We have amazing, world-class students in the honors program, so this kid is sure to be phenomenal. Why hold him back?
He sits in the front row, asks persistent, interesting questions, and in fact when I came into class yesterday he was at the board
holding forth on some topological problem. Great, a guest lecturer! I can take a seat. ``We have a challenge problem for you,''
he says. His question showed tremendous insight and creativity. I didn't know the answer, and I suspect no one does.
He's the ideal student! How can we not let him in? I'll continue the battle over the weekend.

Wednesday I met my two new ``preliminary advisees''. One of them is Italian! In fact Alessandro and I had already been corresponding for some time, but I hadn't met him yet. We had our entire meeting in Italian, including the mathematical part.
A very nice guy. He was assigned to me based on his interest in algebraic topology, not his language! The other is Jasmine, an African-American young lady who I may have mentioned in some earlier post. She's the granddaughter of a friend of the husband of Wendy's friend Karen (got it?), who I first heard about from the grandma at Karen's 60th birthday party. Since then
I've been encouraging Jasmine to apply to grad school at the UW, and she's been admitted to the Masters program. It is sad but true that African-American math grad students are exceedingly rare, and an African-American woman is unheard of around here.
I'm excited she was accepted and will be rooting for her to succeed. She definitely has the enthusiasm and the initiative required, and obviously her file must have looked good to the admissions committee.

Supposedly I'm cutting back on my total activity during the chemo. For instance, I've again bowed out of committee duties, by
agreement with the chair. But it's hard to resist grad students who want to do reading courses in algebraic topology. It looks like I'll have a reading course with three students (including one of those brilliant undergrads I alluded to), plus possibly Alessandro although he may be too far ahead (he has a Masters already from a top school in Switzerland). The ringleader is a young woman
named Maddie. Talk about a ``take-charge'' kind of person! Before I knew what hit me, she'd already recruited these other students, worked out a time we could all meet and reserved one of our local rooms in Padelford (not easy to do). How could I say no?

Well, enough babbling. It's therapeutic though. Thursday we had the Brown family over for dinner, and opened our bottle
of Casa Aiva wine! Enjoyed by all, although Kaia and Finley much preferred the homemade chocolate chip cookies.

Huskies are on a roll. Jury still out on the Seahawks. And will the Mariners make the playoffs? With that, I shall take my leave.

Medical update

Just a brief update on the plan going forward. Friday I restart chemo. Groan. Before that I have to get a chest-port put in, so I'm going to be spending a lot of time at the med center. In November, after two cycles of chemo, there will be another scan. If the metastatic cancer hasn't been reduced, we will turn to alternate methods. The doc suggests participating in a research study on a new immunotherapy approach. Whether this will be more or less of a pain than chemo is unclear, nor is there any guarantee it will work. But that's a couple of months away, which in my current way of thinking is the distant, remote future. When it gets closer I'll do some research into it, but for now...one day at a time is the only way.

Today Finley turned five!!!

Italy report

Our vacation in Italy was simply wonderful. In almost every detail it lived up to or exceeded my expectations; the itinerary worked out perfectly. Above all it was wonderful to spend eight days with Wendy, Jessie and Abby, then eight days with just the two of us. It's been a long time since we've done either of those.

I would love to have written a much longer report (you will probably find this one long enough!), but with the quarter starting soon and all the upcoming medical issues (details in a later blog), I've limited myself to a few highlights and miscellaneous amusing episodes. Plenty has been left out.

Some comments before I start the travelogue:

 1. I didn't take a single picture. Never do. That's just me; although in principle it would be great to have pictures to show, I find that stopping to take them interferes with the experience.

2. On most of our trips I'm the designated navigator, which makes Wendy the designated driver. She earned her European driving-stripes long ago in England, Wales, Spain, France and Italy, and is fearless! I drove mainly on sections where little navigation is required. We make a great team.

3. For me, one of the highlights was just talking in Italian with Italians. It's become very easy, it's fun, and besides, many Italians don't speak English. Even when they do, my Italian was usually much better than their English. For example, it was often better to get directions in Italian. I do still have an oddly skewed knowledge of the language, e.g. I'm better at discussing 19th century Italian literature than at translating menu items (gotta work on that). Anyway, all of the conversations I mention took place in Italian, but for obvious reasons are given below in English.

I. Stresa.

Wendy, Jessie and I arrived at Milan's Malpensa airport around 11am. Abby arrived from New York about an hour later. The four of us with luggage barely crammed into our little ``Smart Car'', but it would soon become clear we made the right decision not to upgrade to a larger one.

Our apartment was in the hills above the town of Stresa, overlooking the beautiful Lago Maggiore (the westernmost of Italy's three big northern lakes). The shortest route to it appeared to be coming down from above, rather than up from Stresa, but here I failed as navigator and we got a bit lost. (Incidentally, we were instructed NOT to use a gps, as it would take us onto impossibly narrow streets. Of course I would never use one anyway.) I had to call the housekeeper Elisabeth (German by birth, fluent in Italian), who came and found us. Elisabeth led us into ever more narrow streets bordered by stone houses, to the point that we had to fold in the side mirrors so they didn't get torn off. At one point, she stops, gets out, and sizes up the dimensions of our car. ``After this the street gets a bit narrow,'' she says. Ha! For Wendy, it is mere child's play.

The apartment was on the third floor, with two bedrooms, kitchen and a nice little living room. The bedrooms and kitchen each had a tiny balcony, all facing the same way with a beautiful view of the lake and surrounding hills and mountains. The mountains are pretty high, but not enough to have year-round snow.

Our first excursion was to two of the Borromean islands: L'isola dei pescatori (fisherman's island) and L'isola bella. These tiny islands---you can walk from one end to the other in fifteen minutes---were originally nothing but rock, then were developed by the Borromean family and others beginning in the early 17th century. L'isola dei pescatori today consists mainly of picturesque narrow streets with shops, restaurants, gelaterie etc. L'isola bella has a few shops too, but is mainly occupied by a 17th century summer palace and a beautiful terraced garden with plants and trees from all over the world. We needed Victoria here as botanical consultant! The palace has an amazing ballroom with a 50 (?) foot high ceiling and balconies looking down to the dance floor, but other than that is filled mainly with gloomy paintings of assorted saints being martyred in assorted gruesome ways. The garden was much more to my liking.

The second day we drove up the west side of the lake, toward Switzerland, stopping short of the border at the little town of Cannobio, or rather in the Val Cannobio above it. Did a nice walk along the river, then went swimming in it, at an unusual deep pool where the river doesn't seem to move at all. How deep, I don't know, although the strange bubbles coming to the surface turned out to be from scuba divers. From there you can swim upstream into a narrow, deep gorge with vertical rock walls. The girls and I went a short ways into it. I was hesitant to go far, as there is no way to get out as far upstream as one could see. It would be a boatload, ha ha, of fun to come back with inflatable kayaks. Another interesting feature of the swimming is that Italians don't so much as go behind a rock to change into a suit; everyone just does it right out in the open. When in Rome...

In retrospect, I wished we had stopped in the town of Verbania along the way. The main attraction is the Villa Taranto, a very elaborate garden built by a Scotsman in the 1930's. Maybe I was thinking that the Scottish component made it ``non-Italian'', but to judge from internet photos it's a pretty amazing place. And had I done my research, I would surely have visited the tiny islet of San Giovanni, where Toscanini lived for a couple of decades. Too much to see!

The third day we went west to the nearby and much smaller Lago di Orta and its picturesque town, Orta San Giulio. The Lago di Orta has its own little island of San Giulio, named after the saint who rid it of dragons and serpents in AD 390. By the way, although I suffer from a rare form of shopaphobia, I loved shopping with Wendy and the girls in Italy because I could act as interpreter. I don't think the little old lady on the island who showed us some tablecloths had even a word of English. At the end of the day, Jessie and I took a different route back to the parking lot, going up and over the Sacre Monte di San Francesco. On the Monte there are 21 chapels illustrating the life of St. Francis of Assisi (why in this particular location, I'm not sure): his first followers, his first miracles, his renouncement of material possessions. What would the saint himself think of all these expensive material monuments built in his honor? It's a glaring contradiction, just one example of the massive self-contradiction known as the Catholic Church.

II. Val di Rhemes.

For those unfamiliar with Italy, the ``regions'' of the country are analogous to our states. The most familiar examples include Toscana, Umbria, and Sicilia. In the extreme northwest, up against the Alps on the border with France, is the region ``Valle d'Aosta'' whose main city is ``Aosta''. Don't confuse the region with the city! There are many French place names in Valle d'Aosta, and in fact many citizens whose primary language is French. Our next apartment was in the Val di Rhemes, a mountain valley outside of Aosta.

Getting from Stresa to Aosta was easy, almost entirely on the autostrada. From there we set off up the Val di Rhemes, which is another story entirely. The hairpin turns begin! We did hundreds of them over the course of the vacation. I underestimated how far up the valley we had to go, but this was a good thing: wonderfully cool at 5000 feet, quiet, less populated, beautiful. In fact, apart from its Roman history, the city of Aosta has little to recommend it; our mountain retreat was by far the better choice.

Our cabin (for lack of a better word) was very small---no living room, just a kitchen and two bedrooms---but quite comfortable. It was in a small, isolated group of houses consisting of a few rental units (used as ski chalets in winter) and at least one home whose occupants apparently were mainly cow-herders. As anyone who has spent time in the European mountains knows, every grassy slope, no matter how steep and how high, has its contingent of cows. The hills are alive, with the sound of cowbells. Our bedroom windowsill was at the street level of a cobbled lane running behind the house, and one morning Wendy was startled to see a passing cow practically poke its head through the window. 

How wonderful though to just step out the door and be in this beautiful valley, with peaks rising thousands of feet above it and a river running down its center. The river was a gray, muddy color, but from natural causes: glacial silt and mud carried down from far above. Best of all there were hiking trails that started right from our doorstep. On our first full day, the girls and I went up a very steep trail that gained well over three thousand feet, maybe four, to a tiny lake. A classic alpine cascade from on high bisected the route, the early switchbacks were shaded by trees...lovely. Eventually, though, the altitude was really getting to me; only a sense of honor kept me from quitting before the lake. The upper slopes were completely exposed to the sun, too, but
what saved the day was a continuous cool breeze. Of course Jessie bounced on ahead and left me in the dust; Abby too beat me but not by as much.

I expected that I wouldn't even be able to walk the next day, but surprisingly wasn't that sore. So I think it really was the altitude and the lungs that slowed me down, not the legs. Jessie of course got up early and went for a run. Now while the three of us were hiking, Wendy had set out on a walk of her own up the river. It's a beautiful walk, and she discovered a lovely ``parc Pique-Nique'' up at the next little village. So around mid-day we all walked up to the Pique-Nique, where we had lunch, sat on benches to chat or read, or just lay down on the grass looking up at the beautiful blue sky above the high ridges. Later we drove up to the end of the road, at the head of the valley where trails take off into the highest of the high country. The girls and I went a short way up one of the trails, stopping on a rocky promontory with more views.

The original plan for this day was to drive down to Aosta and then up the road to Mt. Blanc, where a cable car takes you very high up the mountain. But given that (a) the drive was much longer than I thought, and (b) our little home in the Val di Rhemes
was such a nice place to be, we decided not to spend more time in the car and just enjoy our valley. Meno male! (It's a good thing!) The next day we found out that the cable car broke down and 100 people were stranded at the top, where they had to spend the night before being rescued by helicopter.

We would like to have done a longer version of the valley's-end hike the following day, but it turned out that in order to make their flight out of Milan the girls needed to leave a day early, by bus, and spend the night at an airport hotel. So we just enjoyed the morning along the river, then drove down to the bus station in Aosta. But it wasn't quite that simple. At one point on the winding steep road, a bridge that looks like it was built by Napolean crosses a deep gorge. Earlier I'd seen signs saying that the bridge would be closed for repair work all day on Friday, the day the girls needed to leave. Not believing that they would block in hundreds of valley residents, I had asked the kindly elderly proprietor of a hotel restaurant what he knew about it. No worries, says he, cars can get through on the old road. The old road?? How much older can it be than the one we came up? A lot older, it turns out. A worker directed us onto the detour, and we all burst into nervous laughter at the first turn: A very narrow road between rock walls makes such a sharp right into an equally narrow road that it seemed impossible even our little car could manage it. Fold back those side-mirrors, folks! With Wendy at the wheel, we ace the turn and then burst into even more hysterical laughter: next is a stone bridge that looks like it was built by Julius Caesar, and if anything is narrower yet, stretching precariously across a gorge hundreds of feet deep. Maybe we should have ferried one person across at a time, but somehow it held our weight.

After seeing off the girls at the bus station---it was sad to see them go---it was time to start some shopping of my own: Italian books. The first bookstore I found had a limited selection, and I came away with only two. Down the street was a tiny little used bookstore where I found three more for three euros each. Five books in Aosta, a good start.

III. Across the Alps and back, to Susa.
From Aosta to Susa is only about 120 miles. But the route crosses the alps into France, via the Col du St.Bernard, descends to Val d'Isere, up again to the Col de l'Iseran, down again, back up to the Col du Mont Cenis (where Hannibal is said to have crossed with his elephants, in the Second Punic War), and finally down into Italy and the town of Susa. I guessed that in this terrain it would take us four hours to do 120 miles. It took six.

Endless switchbacks climb about 4000 feet up to the Col du St. Bernard, or rather the Col du Petit St. Bernard (its ``Grand'' cousin is in Switzerland). The hairpin turns are marked with signs indicating the sharpness of the turn in degrees (mainly for trucks and buses, I suppose). The angle is measured from the negative x-axis, so to speak, e.g. zero degrees would be an impossible 180-degree turn. Thus successive turns might be marked as 8 degrees, 7, 6; I think there was even a 5. Our little car sure got a workout. At the Col there are various signs and monuments celebrating the St. Bernard dog-breed.
Now the road descends 4000 feet (Hannibal was wise not to have chosen this pass). It is white-knuckle time for whoever happens to be in the passenger seat---in this instance, me. There is no shoulder and there are no guard-rails whatsoever. If the car goes two feet off the pavement, it's going to roll down a steep slope for a thousand feet or more. Here the downhill slope is most often on the right, so it's much worse for the passenger. I offered to switch places with Wendy and drive, but she refused.

The Col de l'Iseran is at an altitude of over 9,000 feet, and is the highest paved road in the Alps. Both these Col's have been featured as stages in the Tour de France, which is pretty amazing. As one would expect for a pass once crossed by elephants, the Col du Mont Cenis is a bit tamer. At the top it flattens out and runs along a large lake, then descends into Italy.

Near Susa the road was blocked by police who were turning traffic away onto another road. What's going on? I asked an officer. ``Susa e` chiusa'' (``Susa is closed''; in Italian it rhymes). What do you mean, closed? It's the festival of the Alpini, she replies.
But we have a hotel reservation! What hotel? she asks. After some discussion I realized that what she meant was that the center of town was closed to traffic, and after a slight detour we had no problem getting to our hotel. 

The ``Alpini'' were an Italian military unit of mountain troops that (I thought) were associated with the two world wars. But in fact they are still active, and veterans of the Alpini have a special comraderie and annual festivals. This one was for the Alpini of the Valle d'Aosta, Piemonte and Liguria regions of northwest Italy. We had no inkling that the festival would be going on, so it
was a fun surprise. In the evening we walked into the center and watched the festivities while having dinner at an outdoor restaurant. There was a small parade of Alpini in their distinctive hats with a feather, accompanied by a band consisting of accordion, miscellaneous woodwinds and drums. People were singing in the streets, and of course there was much drinking---although almost exclusively beer. Still, it seemed like a rather small party.

Driving out the next morning (a Sunday), we realized that Saturday evening was just a warm-up. People were streaming into town by the busload, with many of the buses having to park a mile away. It might have been fun to stick around for the real party, but we had bigger and better things to do.

IV. The road to Pinerolo

Our next and final destination was Pinerolo, about 25 miles southwest of Torino (the main city of the Piemonte region), or more precisely an apartment in the hills a few miles outside the town. The route we chose was certainly not the fastest, as it loops south and west staying close to the French border before finally heading back east toward Torino. But it's certainly the most interesting. Not far from Susa we stopped at the massive fort of Exilles. Fortifications at this site date back to early medieval times, and changed hands numerous times between the French and the kingdom of Savoy. Napoleon destroyed it after his conquest of Italy. It was rebuilt in the mid-1800's in the form that exists today. It's a steep hike from the parking lot up to the highest level of the fort, with beautiful views. Surprisingly, there is also an elevator, whose shaft seems to have been cut directly into the rock of the outer walls. Throughout the trip I tried to strike up conversations with Italians whenever I could. The lady working the small cafe at the top of the fort was especially chatty and told me quite a bit about her family. I asked her about the third local language, Occitana, which is spoken in parts of the Valle d'Aosta and Piemonte regions, as well as in nearby France.
She said she can understand it but doesn't speak it, and that it's dying out. There was a poster on the wall written entirely in Occitana; it reminds me very much of Catalan (the lady agreed), as a sort of cross between French and Spanish.

Then we were back into hairpin-turn land, up and up and up to the ski resort town of Sestriere. Our cousin Barbara once stayed here for a while, and loved it.

Further down the road is the bizarre fort of Fenestrelle. We didn't have time to visit it, but from the road you can see it spread up and along the mountainside in a series of strange blocks, like a structure constructed by aliens from giant legos. In fact it was built by Savoy, over a long period of the 18th and 19th centuries. The elevation gain from the bottom of the fort to the top is around 2000 feet. A must-do for my next visit to the area! There are also many interesting rock formations and rock-climbing possibilities in the general area.

V. Pinerolo and Casa Aiva

Casa Aiva is the name of the house/apartment we stayed in near Pinerolo; Aiva is an acronym standing for ``aria, incanto, vacanza, agricoltura'' (air, enchantment, vacation, agriculture). I'd been corresponding for months with Barbara, the lady of the house, and had high hopes for lots of Italian conversation during our stay. It was a spectacular success in every way. But first, a little description of the house and property:

We had actually reserved the so-called ``romantic cottage'', adjacent to the main house. We knew it would be small, but it was really, really tiny, with minimal furnishings and no comfortable space to just hang out. Barbara no doubt could see from the look on our faces that we were disappointed. The big house is available too, she said, for just ten euros a night more. What a stroke of luck! The other house (or rather apartment, attached to the family home) was wonderful, with a spacious living room, nice kitchen, dining room table that seats eight, spacious bathroom etc.

Casa Aiva is situated up the hill from the little town of San Secondo, which is across the (mostly dried-up) river from the much larger town of Pinerolo. It is surrounded by vinyards, a beautiful swimming pool and a big lawn; the grapes were almost ready for harvest and looked perfect, like a picture you'd see in a magazine. They make wine just for themselves and friends, not for sale. The hills behind the house rise up several hundred feet higher than the property, and made for good early morning, steep walks, partly on the road and then on trails. The house also came equipped with a young, very friendly orange cat named Alfie, who would follow us around and get into mischief at every opportunity.

I was surprised and touched that on arrival, Barbara gave me a novel by a local author, with a little note from the family on the front page. (Book count is now 6!) Later I found out that she was about to finish the four-volume ``Napoli'' series by Elena Ferrante, that both Wendy and I had read and liked. By chance I had finished an earlier Ferrante novel that Barbara hadn't read on the plane, so it was nice to be able to pass it on to her.

Now, the family: Barbara's husband Gianmassimo works as a financial consultant, and is able to set his own hours to a large extent. So he spends a lot of time at home too. (They must have a lot of money, as they bought this place outright ten years ago). Their son Tommaso is 16 and in roughly the equivalent of our tenth grade. One disappointment was that Agnese, the 18-year old daughter, was off working at a hotel in Scotland for a month (a job that came up at the last minute) before starting at the University of Torino. They showed us a picture of Agnese, a petite Italian girl with wild curly hair, posing next to a gigantic bearded Scotsman in traditional dress (at some Scottish games event; this guy must have been the caber toss champion).

On the second day they had us over for a three-hour lunch, and got Agnese on Skype to talk with us a bit. It was by cellphone and a bad connection, but at least we got to meet her that way. Another day we were invited over for tea in late afternoon, and Gianmassimo's father showed up to take Tommaso to soccer practice. I've forgotten his name so I'll just call him the grandpa. He had the day mixed up: there was no soccer practice, but this too was lucky because I got a chance to chat with him as well. He's an interesting character, 84, who worked for Fiat in Italy, Chicago, and even a few months in Patagonia where they were testing performance under extreme cold. He and Gianmassimo are passionate fans of the Torino soccer club, which is not to be confused with the more well-known rival Torino team called Juventus. ``Juventus, no!'' he cautioned me, wagging a finger.

The grandpa and Gianmassimo speak the Piemontese dialect (as well as standard Italian), and I encouraged them to demonstrate. I could recognize just a few words. Interesting sound to it.

The topic of mathematics came up, of course. According to the family, high school math teachers in Italy, or at least those at the local liceo, are terrible. They can't explain anything, says Gianmassimo. They can't even talk! adds Tommaso. They don't even face the class, they just talk to the board while they write on it. All too common, I'm afraid. I mentioned my fantasy of getting a visiting position at an Italian university. Barbara said they knew two math professors at the University of Torino, and would look into it. I think she was serious, so I didn't want to spoil her enthusiasm by pointing out that universities don't just hand out visiting positions to random professors who want to visit the area. Reciprocally, I promised to look into athletic scholarships at the UW that could potentially be available to Tommaso (soccer) or Agnese (track and field). Such things are very competitive at the UW, and I have no influence on the matter whatsoever, but I'm certainly happy to help if I can.

At the risk of revealing my ignorance, I'll mention a surprising (to me) historical detail of the region. I'd noticed a number of signs indicating ``Chiesa cattolica'', ``Catholic church'' which seems a tad redundant in Italy. Then in the novel Barbara gave me (which takes place in the Pinerolo area) one of the major plot points is that the protagonist Eglantine wants to marry a certain Franco, but her mother is bitterly opposed because ``he's catholic''. Through Barbara I learned that this was the one part of Italy with a major Protestant population. They call themselves the ``Valdese'', and not surprisingly have a long history of persecution, exile and return. But it was only after coming home that I realized the Valdese are the same group known in English as the Waldensians. Maybe some of you already guessed that, but it was news to me.

 In the Casa Aiva guestbook one guest raved about the ``libreria Volare'' in Pinerolo (libreria=bookstore, Volare=to fly). Obviously a trip to the Volare was obligatory and I spent two hours there, buying seven books (raising my total count to 13). 

The author of ``Eglantine'', the late Laura Trossarelli, was a highschool teacher born in Torre Pellice, the local center of the Valdesian church. The whole valley of the Pellice, west of Pinerolo, is interesting to explore. We drove all the way to the end of the road---more narrow roads with no shoulder, no guardrails of any kind and vertical drops to the side. Wendy was once again the fearless driver! Terrrifying on the passenger side though. From road's end (very close to the French border) a number of trails take off into the higher mountains, including one highly recommended by Gianmassimo that I'll come back to do some day.

On the way back we had dinner in Torre Pellice (tagliolini al granchio for me, very good). Torre Pellice also had a nice little bookstore, and although I had sworn not to buy any more I had to go in. Came out with two; total count 15. I could not find, however, a Sicilian novel recommended by Barbara. In general I was buying a combination of novels by Italian authors and some French (Balzac, Maupassant, Zola). I'm also interested in the history of the Italian resistance in WWII, especially that of the women partisan fighters. One great find that I've never seen online was a collection of twelve autobiographical accounts by women partisans.

We did go into Torino one day, but this proved to be a mistake on my part. The fact is that I just don't like big cities, and in many respects Torino is just a big city like any other: crowded, noisy, hot, heavy traffic etc. I'm sure it has a lot to recommend it, but I hadn't done enough advance research. While resting in the shade on a bench surrounded by a carpet of cigarette butts, Wendy and I looked at each other and knew we were thinking the same thing. What the heck are we doing here, when we could be back in the beautiful vineyard country, swimming in the pool and enjoying the view? We cut our losses and went back to our wonderful vineyard home, where we should have stayed in the first place.

It was a good thing I didn't find that Sicilian novel, because when we got back Barbara gave me a copy. (Book count 16!)

We were very sad to leave, but promised to stay in touch with Barbara and family.  On the way back to the Milan airport we stopped in the town of Alba, which has an extensive, attractive pedestrian-only zone. In a 2-block stretch there were three bookstores, but I showed self-restraint and didn't go in. Okay, so two of them were closed for the afternoon siesta, but still... We didn't have much time, but since Alba had been highly recommended by Roberta (one of the teachers at Percorso Italiano) I wanted to at least be able to say we'd been there.

So what's next? We still want to go to Sardinia, but now we also want to go back to Casa Aiva.
Eight people could stay there, with two using the "romantic cottage" just as a bedroom, while sharing the house. There's so much more to explore!

Good to go!

The scan report was more or less what I expected: no change. That's good; it means the "lesion" in the liver hasn't gotten any bigger. They do want me to continue chemo when I get back, which I can't say I'm looking forward to...but I'm not going to worry about that at this point.  I'll post more details in a couple of weeks, but there's no time for such nonsense now, because tomorrow

WE'RE OFF TO ITALY!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Italy or bust

I haven't done so well with posting to the blog, partly due to being busy and partly that it's really just more of the same old stuff,
as far as the chemo goes. But here's a brief synopsis of current issues and problems, followed (by popular demand) by our Italy itinerary!

I regret to report that my grand plans to push my physical activity further during chemo have fallen short of the mark.
The fact is that the cisplatin weekends are, as I said (insert British accent here), not inconsiderably unpleasant. It's about all I can do to drag myself out for a single-hill walk in the park. The second week, gemcitabine only, is definitely better but my thought that I'd get out on a hike was overly optimistic. For one thing, one certainly doesn't feel like doing the drive. The actual hiking wouldn't be much fun either. So I just kept doing my single-hill walks every day in the morning, then a couple of days after the gemcitabine
did a double-hill, then another, and things get better from there as you enter the ``off week''. It takes quite a while to get rid of the gross stomach issues. For instance in normal life I eat a lot of wheat thins, probably too many, whereas during chemo I can't even look at one. Only in the last couple of days have I returned to wheat thin munching. The real indicator of full recovery, though, is when a beer starts to sound appealing again. I'm still not quite there, but I have one Inversion IPA in the frig with my name on it and hope to try it this weekend, maybe even tonight!

Meanwhile I'm a couple of quarts low on hemoglobin, hematocrit, platelets and whatnot.
So I get tired pretty easily. Rode my bike in for Wednesday's blood draw and man, did that take it out of me. But within a week or so the old cells should be coming back.

On Wednesday, the day before we leave, I have a CT-scan in the morning and consult with the NP and the oncologist in the afternoon, so pretty much all day at the Med center (the cafeteria is a nice place to work on math though, so it's not too bad). Susan, the NP, says that they will also ``evaluate me'' for that Porta-Cath idea, the thing that goes in your chest. The main issue, however, is the result of the scan. Re-thinking what I last wrote about this, it's very hard to imagine that the doc is going to tell me not to go to Italy on the day before we fly out. Furthermore the result would have to be really bad for me to go along with such a recommendation. My theory is that if things are so bad that three weeks off of chemo is a risk, then it's going to get me anyway so why not just eat, drink, and be merry, and so much the better in Italy. Or taking the optimist viewpoint, my preferred theory is that the two cycles I've done already will have eliminated the ``ill-defined segment'' in the liver, and I won't even have to continue the chemo when I return. But then why do they want to do a scan before the trip? That's the one impediment to my ``take it one day at a time'' approach, the possibility that I'll have to make a difficult decision literally overnight. Hard not to think about that. Ah well, maybe this whole metastatic cancer thing is just a mirage. I sure don't have any symptoms of it. I'll post to the blog Wednesday eve.

So, onward to Italia! While organizing our trip info, I've been getting more and more excited about this. Here's the plan:

1. We leave at 11am Thursday the 1st. Remarkably, the trip takes only ten minutes, as we (Wendy, Jessie, and I) arrive at Milan's Malpensa airport at 11:10am. Oh wait, that's Friday the 2nd. Darn. There we collect Abby, who will arrive from NYC, get our rental car and off we go.

2. It's only 30 miles or so to our first stop: Stresa, on the Lago Maggiore north of Milan. Lago Maggiore is the westernmost of the three big northern lakes (Como and Garda are the others), and the only one I haven't been too yet. We stay there for 4 nights, in what promises to be a cute little apartment in the hills overlooking the lake. Likely excursions include the Borrommean Islands, with their palaces and gardens dating back to the 1600's, and north along the lakeshore, almost to Switzerland, and a walk upstream along a little river that sounds interesting. And of course, just mingling with the natives in Stresa or enjoying the view from our balcony.

3. On Tuesday the 6th we drive West into Valle d'Aosta, probably Italy's least known province (I've yet to meet an American who's even heard of it). It's in the extreme northwest, bordering the French Alps, or rather the French-Italian alps. Many of the place names are French; in particular the place we're staying for four nights is in Rhemes-St. George (circumflex over that first e). It's not too far from the main city of the region, Aosta, but it's up a beautiful mountain valley. I think our place there doubles a ski chalet in Winter.
Mountains, mountains everywhere; as you can imagine this is not a coincidence, given who planned the itinerary. Back in the day, way back, Aosta was a major Roman outpost and has the usual quota of ruins. A little ways to the east there's a classic medieval castle at Fenis. Then there's a big national park just to the south (mountains, mountains...), Mont Blanc is just to the northwest...

4. Saturday the 10th Jessie and Abby (ahime'...that's Italian for ``alas'') take the train back to Malpensa to return home.
Wendy and I do what will probably be our longest driving day, over into France and through the Alps, re-entering Italy further to the south where we'll stay in the interesting town of Susa (in the province Piemonte, whose main city is Torino) for one night at a hotel. The distance isn't that great (none of the distances are), but it's on winding mountain roads that can be blocked by herds of sheep. Still, I suspect we could easily reach our next destination (item 5) in a day; we just don't want to rush, and there are interesting things to see in Susa and vicinity.

5. Sunday the 11th we have what looks to be an interesting drive to Pinerolo, south of Torino. There we stay 4 nights in the ``romantic cottage'', whose original tenants were goats. This is the place whose owner Barbara I've been corresponding with, so voluminously that I fear we'll have nothing left to talk about. (The latest news is that the two kids, 16 and 19, did very well on their exams. Agnese, the 19-year old, wants to go to university in Torino, but is frustrated that it's very hard in Italy to combine academic and athletic ambitions in college. They don't have the athletic scholarships we have here, and indeed don't even have athletic facilities at many universities. According to Barbara this is why Italy has had such a poor showing in the Olympics in past years, although I pointed out that in Rio, Italy didn't do so badly if you look at the medal counts.)
Anyway Pinerolo is in hilly vinyard country (still more mountains in the background!) and we'll probably spend some of our time just hanging out there, going for walks in the vinyards and using their beautiful pool. But of course we'll also go in to see Torino,
and probably work in a trip to the picturesque town of Alba off to the east.

6. Thursday the 15th we drive back to Malpensa and spend the night in an airport Hotel. Our flight home Friday is at the crack of dawn. Get back to Seattle around noon, Friday the 16th. Just in time for Finley's birthday weekend!

The need to vent

I do try to keep a positive attitude, but sometimes it is necessary to vent. I would therefore like to
state for the record that chemo really, totally sucks.

Thanks for listening, and a wonderful week to all!

One more ride on the roller coaster

Same old same old. Wednesday rode my bike into campus, felt fantastic. Met with my student James who's back from a conference
in Vancouver, and as I hoped it was a great success. He's energized, and that energizes me too. Thursday morning Wendy made some delicious blueberry pancakes! That's the top of the roller coaster.
Then back to the infusion ward by noon for 8 hours and a steep descent to make myself feel miserable. Ah well, you just make the most of it.

I thought I'd have met all the nurses in the infusion ward by now, but not so. This time I was assigned Mark, a nice guy but not as personable and funny as Tom. When he left for his four hour commute to Squim (he does double shifts, spending the night
in Seattle), a female nurse I hadn't met took his place. Much less personality than Dana and co., but then I learned her name is Jessica and she has a four-year old girl and a two-year old boy, which certainly gives her bonus points! I pointed out to her that
her job description specifically states that she has to look at pictures of her patients' grandkids. A couple of other nurses joined the viewing, with suitable gushing of ``awww, aren't they cute''. Well duh.

Dana was around and continues to crack me up. At one point my IV beeper was going off and she stopped in to check. ``Mark seems to have abbandoned me,'' I said. Without missing a beat she replied ``well can you really blame him?'' Or when I'm heading out to the hall for one of my many trips to the bathroom, if she's walking by she'll make some crack like ``where do you think you're going?''

For the first few hours I still felt fine, and as usual got a fair bit of work done. Like how maximal associated primes in a group cohomology ring are annihilators of primitive elements. This was in an old paper I was looking at in connection with Charlie's thesis project, and I suddenly realized it applies in James' situation too. It's really cool; beautiful stuff. If only I could channel my mathematical hero, the late Dan Quillen...he was about ten thousand times smarter than me, and I'm sure would have some beautiful, suprising approach to the problem James and I are working on with limited success. (I know the technical words don't mean anything to y'all, but I just want to get across how much fun I'm having with math, chemo or no chemo!)

Here's a question for the North Kirkland Philosophical Society (anyone reading this is automatically an honorary member): Can a man write a novel about a woman? Wendy says no. Having finished Capuana's ``Il marchese di Roccaverdina'', which I found very well-written, I got his first novel ``Giacinta'' from the library. Capuana seemed to fancy himself a student of female pyschology,
and this is another 19th-century novel whose main and title character is female, in the vein of Madame Bovary, Therese Raquin, Anna Karenina et. al. Although Giacinta was well-written and a fast, interesting read, I didn't find Giacinta very convincing. And why do these authors always have their heroines commit suicide? Giacinta does it creatively, with a curare-tipped needle. After first testing it on her canary, which seems rather mean. So what say ye, philosophers?

Or can a woman write a novel about a man? Currently I'm reading ``La via del male'' by Grazia Deledda, another 19th century author I may have mentioned before. She was Sardinian, and I love her vivid depiction of life on that intriguing island. Now ``La via del male'' has a young man as protagonist. The jury is still out on whether it works, so we'll see. The cultural context, so foreign to us, makes it difficult to judge. By the way, the title means ``The way of evil''. So ``male'' means ``a man'' in English and ``evil'' in Italian (when used as a noun). Make of it what you will.
This time around I planned to cut the dex even further, from 3 pills to 2 (the instructions are to take 6). You get a dose of it intravenously in the ward, and this morning the (expletive-deleted) hiccups had already begun. So I decided to go all in and cut the dex completely. I even went for a walk in the park, on the theory that if need be I could always puke discretely in the bushes. No nausea, just the usual crappy feeling, so although too soon to tell, it was looking like I could pull it off.  Then Susan the nurse practioner called just to check on me, probably because I'd been talking to her in the ward about my ambition of going dex-less.
And I did learn something; the other anti-nausea drug they give intravenously during the infusion only works when taken together with the dex. So, after some pleading on her part I agreed to take half a pill today and half a pill tomorrow. I'm hiccuping as I write this. However, I do keep a large supply of dex on hand in the TV room, in case Donald Trump comes on.

With perfect timing my latest Italian book order arrived today! It always feels like Christmas, and cheers me up. As of course do the little ones, and not only mine: On the trail as I was passing a day camp group, I overheard a little boy telling his camp counselor: ``Once I walked to San Diego.'' ``From here?'' Nod. I think he was about four, and probably, in his own little brain, telling the truth. He may have vacationed there and walked on the beach, who knows?

The other night while baby-sitting we had ice cream bars for dessert (the mere thought of which nauseates me at the moment)
and Finley came out with ``What if I ate two million ice cream bars?'', then immediately re-calibrated ``no, what if I ate a hundred?'' Good to see he has some self-restraint. I said that I thought he would expand into a giant round ball that had to roll instead of walk, that we'd have to take out a wall for him to get out of the house, and that he'd go rolling down the street while the neighbors exclaimed ``what the heck is that giant ball? Oh my gosh, it's Finley!''  All this to the great amusement of Finley and his sis.

Okay, time to attack these hiccups again. Then see if there's anything to eat I can successfully stare down. Wendy, who is a wonderful big sister, is taking Warren and Shirley out for birthday dinner. Normally I go too, but tonight is out of the question.
Don't even bother bringing back a piece of pie, I said. Maybe I'll have some more cantaloupe. But the big question is:
Can the Mariners make it seven in a row?

Off week!

Ah, so nice to be in an off week! Rode my bike in yesterday for the off week appointment, which formerly involved changing the Picc dressing but this time was just for a blood draw and to have them look at my arm. It's much better but still itches and hurts a bit. Apparently I'm the worst Picc patient in the history of Picc-dom.

I got the results of the blood draw while I was there (it's amazing they can analyze twenty or thirty variables so quickly), and was a bit shocked that my poor little platelets are already down to 86, normal being 150 or higher. Don't recall it happening so fast last time. Guess I'll have to give up knife juggling yet again. At 50 you have to be very careful, and at 10-20 they do a transfusion. But it was never even close to that last time. "Be careful on your bike; don't fall off" they cautioned me. It's a totally flat trail, for heaven's sake! I think the only time I've fallen as an adult was on the Sammamish river trail a few years ago, while making a hasty U-turn to go back and look at a snake in the grass. So as long as I avoid snakes, I'm fine.

Meanwhile the red blood cells are already down to the minimal "normal" level, while my white blood cells are higher than normal--but that's just because they give you a white-cell booster in week 2 of each cycle. Anyway, studying these lab reports helps keep it interesting.

Nothing more to say, except that it really is a beautiful day!

Double off the left-field wall scores nine

That might seem impossible, but I'm playing by the Finley rules. There could be nine bases, for example, plus home. Or the bases could be loaded with three runners to a base. With the Finley rules, all things are possible. The final score was Stevie Boy 9, Chemo 0. The chemo had no chance of hitting my two out pitches: the quantum slider, which exploits wave-particle duality and splits into two balls halfway to the plate, and the Heisenberg knuckleball, which is unhittable as batters cannot determine the position of the ball and its velocity simultaneously. In short, I realized my plan of riding my bike ten and a half miles to the Med Center for chemo, then riding back. Yeah! Fist pump etc. understood here.

I've heard of a person on chemo running a marathon, compared with which my little bike ride is like a five-minute shuffleboard game played from lawn chairs. And I must confess there was no great triumph over adversity; I felt great and there was nothing to overcome. But you have to imagine what a psychological boost it is to carry this through. Exercise is good; pushing it harder is even better. It helps the entire system, in many ways. So I'm determined to to up the ante compared to the last round. It gets worse as you get to later cycles, due to the cumulative effect and vanishing blood cells. Still, my goal is to push the limits.

The only really bad effect so far is the Picc, which has left my skin looking like crazed wombats have gnawed on it. Today we
reached a consensus: The Picc must go, and it has. Hooray! The next two infusions will be done by direct intravenous injection, which as you might recall from earlier posts has its own problems, but the Picc is impossible. Then after returning from Italy, they will put in a ``chest port'', pretty much what it sounds like, that goes under the skin. The oncologist counseled against this option last time, but Susan the NP thinks it's the best for me. If he okays it (he's not around at the moment), that's what we'll do.

After they pulled the Picc and wrapped the arm in temporary bandages, both nurses were aghast at my plan to ride home in 85+ degree heat, because of sweating (it's a yeast infection and needs to be kept dry). I get it, but not completing the ride would be much worse. It's all a mind game, you know. ``Can you at least ride really slow?'' Oh yeah, I can do slow.

The pre-Italy plan has now been finalized, and it's not what I wanted but appears to be the only option. My CT-scan and oncologist consult will take place the day before we fly (for best scan results they like to wait two and a half weeks after the last infusion). They assure me this can be done with a ``stat read'' i.e. they will have the radiologist look at it immediately. So why not just do it when we get back? Well, if the cancer has progressed I could be advised to cancel the trip and continue chemo. At least I got a straight answer on this out of Susan. Canceling just before we fly...wow, that would be grim. I'm going to assume this won't happen. But at the same time, I have to be psychologically prepared; if things really looked that bad I'd probably go with the doc's recommendation. The interesting data point is that is that if I go to Italy, it means just a one month gap in treatment. So they seem to be pretty serious about the aggressive nature of this kind of cancer. That said, I'll return to the optimist view: Andiamo in Italia!
In general the chemo has gone really well. The cisplatin week, week one, oscillated between feeling pretty good and feeling like merda. But in the down periods, at home, one can just lie down for a while and wait it out. Appetite has been very good, thanks to the exercise. I've been taking in more water than the Titanic. Shipped my two students off to a conference in Vancouver, so I've got a couple of weeks do hang out at home and work uninterrupted on math. Not a bad place to work!

Well, now I really have hit the wall. Neurons fading, synapses lapsing into dream mode...Buona notte a tutti!

Chemo party; Super-Grandpa vs. Santa Claus

It was downright festive yesterday at the infusion ward, like being reunited with old friends. Hey, great to see you again!

The primary nurse assigned to me was Dana, the one I exchanged many movie reviews with. She's quite a character, with a quirky sense of humor, delivered in a deadpan style. At times it takes me a while to realize it was a joke; you have to be on your toes. She just celebrated her 60th birthday by running a half-marathon. Around mile ten, she said, she remembered why she stopped doing these. Tom is a great guy I've been assigned often. He's the one who complimented me so highly on my veins (actually I get this a lot around people whose job it is to stick needles into you). He said his wife gets mad when they're holding hands and he starts running a finger over her forearms, looking for a good vein. Rose just got back from a trip to Italy, but I didn't have much chance to talk to her yet. A great vacation Venice to Florence (well, da Venizia a Firenze) is all I know so far.

On Wednesday I'd done my bike-and-hike on a beautiful day, feeling great and in fact more energetic on both the bike and the steep hill-walking than ever. It makes it soooooooooo frustrating to go in and deliberately destroy that feeling. But dying would also be very annoying, so what can you do.
Day 1 is easy though. Get the PICC in, order a pot of coffee in the luxury suite and get out my math and Italian: complex cobordism of classifying spaces; Il marchese di Roccaverdina by Luigi Capuana. Very interesting so far and with lots of dialogue, (in the Italian novel I mean, not the cobordism!) which makes an easier read. It was written in 1901 so in effect a 19th century novel; I've found I tend to like this period, which includes also a surprising number of female authors. Also brought with me and finished the audiobook of ``Una stanza tutta per se''' by Virginia Woolf (it was 8 and a half hours in the ward, so lots of time to kill), a well-read translation of ``A room of one's own''. Never having read anything by her, it seemed appropriate to get the original English version too from the library. She certainly has a style of her own. It is a fiery feminist lament and call to action, written in 1928 (well, many of you have probably read it; odd that it took me so long!). Highly recommended, and short as it based on two lectures she gave on ``Women and fiction''.

Last night I went to bed not feeling all that great, then gradually felt better and better, was wide awake and thinking about math.
Finally got up at 1 and worked a bit on math and also on a short review of Woolf's essay for my Italian book reviews. The ondansetron effect has kicked in already! Went back to bed at 2:30 but still wasn't sleepy.

Today my body has reminded me that chemo is not inconsiderably unpleasant. Hiccups have started too, although at least those only come in week 1 of the cycle, from the dex. I'm not doing too bad though. While I'm typing, two young coyotes have been crashing around in the bushes right outside my window. If they're hunting, their parents ought to offer some advice; any rabbit within a hundred yards will hear them. Or maybe it's a strategy to flush out little critters. Or maybe they're just playing!

I'm very disappointed to miss Rebecca's wedding in California, but I made the right decision. Both the plane trip and the event would have been pretty miserable both for me and anyone around me. I insisted that Wendy go however (notice that English DOES have a subjunctive, albeit a pretty pathetic one) because there's really nothing anyone can do, not even my amazingly supportive wife. Enjoy the rehearsal dinner tonight! (I doubt I would. That reminds me, I need to talk to the med center about their choice of words on the dinner menu: ``vegetables infused with Thai flavor''.)

On another topic, I always feel vaguely bad about lying to children about Santa Claus, not to mention the Easter Bunny and the Tooth Fairy. Jessie and Abby seem to have gotten over it and forgiven us, I think, but I still get that feeling now with my grandkids.
The issue came up on our Sunriver trip, in a way that surprised me. I was joking around about being Super-Grandpa, making a muscle with my biceps, to the extent that I have any left. I'm so strong I can pull a cloud down from the sky! I boasted, assuming this would be met with laughter and derision. Finley (all who know him can picture his wide-eyed expression) grabbed my arm and exclaimed, ``For real? In REAL LIFE?'' Rashly seizing the moment, I said yes, in real life! Super-Grandpa can even walk upsidedown on the ceiling! To my surprise even Kaia got in on this, i.e. instead of laughing ``no you can't'', both seriously wanted me to go out on the deck and pull down a cloud. Oh boy, now I'd gotten myself in a pickle. I invented a series of excuses to get out of it,
saying I'd do it the next morning---by which time, I thought, they'd have forgotten all about it.
 Not so. They came running up to the kitchen the next morning: ``Grandpa, we want to you to pull a cloud down from the sky!''
 Finley helpfully pointed out that several clouds were conveniently available, right above us.  Well, the jig was up. I had to confess that I made it all up. But as I said to Kaia, you didn't really think I could do it, did you? Do you really think someone could pull a cloud down from the sky, or walk upside down on the ceiling? Her reply:

 ``Well, a man couldn't really fly around at Christmas delivering toys to all the children in the world. There would have to be magic.''

 Oh dear. I have disillusioned her. She thought I had the magic too? And then:

 ``But even if you're not Super-Grandpa and can't walk upside down on the ceiling, you're still a super grandpa because you do super things.''

 If that doesn't melt your heart, I don't know what will.

Gearing up for round two

Now that I'm starting up chemo again, I intend to post more regularly to the blog.  I imagine I'll be saying a lot of the same old things, but it's definitely good therapy for me to talk about it. To those who take the time to read my muddled and often repetitive thoughts, thank you!
As always, it doesn't bother me to talk about the worst case scenarios, including death. Indeed it does me no good at all to ignore such grim realities. I don't dwell on it. I don't worry about it. I don't give in. But to pretend that it couldn't happen serves no purpose. So I'll briefly report on the negative side, and move on.

I saw the radiology report before we went on our Sunriver vacation, but didn't see the oncologist until after. So I knew about the possible metastasis to the liver. I'm well aware, of course, that this is a bad sign. But I can honestly say I didn't worry about it one bit. Thought about it, sure, but didn't worry. It didn't detract at all from a fabulous vacation. My standard mantra has been very effective: I'm here now. It's a beautiful day along the Deschutes river. I'm riding bikes with my two amazing little grandchildren. What happens next week, or  next month, or next year, is irrelevant.
Yesterday I had a ``refresher chemo course'', if you will, with nurse practioner Susan. Since the oncologist has said that untreated bladder cancer can kill you in three to six months, but never gives examples, I asked Susan point-blank if she had personal experience with such cases. She said yes, but gave only one example of someone who refused chemo and within six months was in terminal hospice care (okay, so the guy didn't actually die within six months, but close enough). One can also judge the seriousness of the situation from the fact that not only did the oncologist think postponing the chemo until after Italy (i.e. 2 months) was too risky, but also Susan seemed dubious about taking even the three-week chemo break that our planned trip would entail (it's only a two week trip, but I need some recovery time ahead of it). However, there's no point in worrying about this now. After the first two cycles of chemo, i.e. in late August, they'll do another scan and we'll re-evaluate the situation then.

Well, enough of that! The fact is I'm feeling very relieved, now that the chemo decision is final. I did pretty well with the chemo last time, but I'm making it my goal do even better with the second go-around. At least now I know what to expect. I'm even looking forward to seeing all the nice folks of 8th floor southeast (the infusion ward) again!

I'm a little disappointed that I don't have Sarah, the opera nurse practitioner. According to Susan, Sarah said ``I hate to give up Steve'' but had to for scheduling reasons. (Or maybe she really said ``thank goodness I can pawn off that Mitchell character on Susan''.)  During the ``refresher'' another nurse poked her head in and said ``oh, you're the opera guy!''.

The doc thinks the chemo will help my exasperating bladder symptoms, which have gotten even worse of late. That alone will make it worthwhile. Meanwhile Susan suggested the use of a ``condom catheter'', a term that is, I hope, self-explanatory. She proceeded to get out some samples and asked me whether I needed a small, a medium or a large. Are you kidding me? Obviously I need the extra-large, the ``Trump special''.  ``Deanna can show you how to use it,'' says Susan cheerfully. Now Deanna is a nurse I hadn't met yet, although she happened to be on duty at a time I was sending irate emails about UW Med's god-awful appointments system. Too late, I realized that if a nurse is going to give you hands-on condom catheter instruction, it's probably best to stay on her good side. Of course I never blamed the urology clinic, and certainly not the nurses. ``That's okay,'' Deanna reassures me, ``your emails always had a sense of humor.'' As it turned out, no rooms were available for the instruction, and I was relieved to postpone it to a future date. In any case, it's good to know it's an option, especially for a transatlantic flight.

I'm psyched up for Thursday, then, which will be a long day since not only is it the double-dose but they have to place the PICC. I've got my math ready. I've got my Italian ready.  It should be a productive session in the old infusion ward!

Decision made

Just a brief update to say I've decided to follow the doc's advice and start chemo next Thursday.
I still hope to make the Italy trip work, and in fact I may have a better shot at it with the chemo than
without; the doc thinks the chemo may improve my exasperating bladder symptoms (which have not
improved much at all in the two months since surgery).

For me, by far the most anxiety-producing part of this experience is making such decisions. Once
the decision is made, however, it's back to full steam ahead!

I'll need plenty of steam to keep up with the munchkins. In a baseball game (I use the term loosely) with Finley and Kaia yesterday evening, almost any hit was declared by Finley to be a "ten-run homer" and my one bunt was decreed to be a "grand slam", surely a first in the history of baseball. The one hitch was that I was supposed to "run around the bases ten times". Uh, grandpa's kinda tired right now. "That's okay," says Finley, "you can just run slow."

Decision point

I might as well get straight to the bad news: it appears that the cancer has metastasized to the liver.
I knew this before even seeing the oncologist, since radiology sends the report to me directly via email. (The oncologist hates that they do this, but I like it because I'd rather have an inkling ahead of time rather than be blindsided by the news at the clinic.) The radiologist report reads (referring to the liver):

Interval development ill-defined segment 7 hypodensity (3/106), measuring 1.6
cm this concerning for metastasis.

(That's a copy, complete with missing verbs and punctuation.) To be certain that the "ill-defined segment" is cancer would require a biopsy, but based on my history and the scan, the oncologist seems to have little doubt. He thinks I should begin "therapy" immediately, which brings me to the decision point.

The easier decision is what form of therapy to choose. Although there are some newer options that I've mentioned before, I would go with the devil I know, namely the delicious cisplatinum-gemcitabine cocktail, the Nectar of the Gods, served on 8th floor Southeast. The oncologist agrees. The hard decision is whether to do it at all, and if so, when.

One frequently sees obituaries of so-and-so who died "after a long, courageous battle with cancer".
While I have great admiration for such courage, I'm not sure I have it and in any case a "long battle" may not be the path for me. One side of me wants to say screw it, let's forget chemo entirely.
If I had a crystal ball and knew that to a high probability the cancer would get me in a couple of years no matter what, I would definitely forgo therapy and focus on enjoying life while I still feel good, rather than eke out a bit more time at the cost of feeling miserable. I don't know that I have the guts, though, for this all-or-nothing gamble.

On the other hand, the thought of spending the rest of my summer on chemo is not very appealing. In fall at least I could use it as an excuse to get out of committee meetings. My idea would be to
wait until we're back from Italy, but the oncologist is strongly against waiting that long. He has
emphasized on several occasions that bladder cancer can be very aggressive, so I understand his point, but we're talking two months and a patient who (if I do say so myself) has consistently defied the norms. Naturally, the oncologist is going to be conservative and thinks of worst-case scenarios.

At any rate, for the moment I am scheduled to begin chemo next Thursday. The theory is that I would squeeze in two 3-week cycles before leaving for Italy, then take a break. But I've told them that I'm not yet committed to doing this, and may cancel. It's a gamble, yes. That's the decision I have to make. Curse you, ill-defined segments!

Well, enough of that. Apart from my annoying bladder symptoms, I still feel perfectly fine. We just got back from a wonderful vacation in Sunriver with Jessie and family: Hiking, biking, waterslides, bumper-cars, mini-golf, climbing walls, watching the Mariners (if you miss an inning, Kaia can fill you in with an accurate blow-by-blow summary). Anyway, to stay grounded I always like to end with a kid-quote:

I was about to tell Kaia and Finley the latest episode of a series of stories about them, in which they
usually rescue mischievous kittens Fluffy and Tuffy from various evil-doers such as the Three-headed Wafflesnort and the nefarious Dr. Drooly Trashit. The title of this one was "Kaia and Finley build a time machine". I began with a preview, knowing that they'll want to add lots of details.

Me: You'll go way back in time, to the days of the wooly mammoths.
Kaia: The Ice Age!
Me: Yes, and then you'll go back even further, to when dinosaurs roamed the earth.
Kaia: And men first walked on the moon!
Me: Now wait a minute, when men first walked on the moon I was just out of high school.
Kaia: Well, that WAS a long time ago.

Until the next post this is Herr Professor Doctor "Steve-asaurus" Mitchell signing off...