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.