Amygdala, Medula and the Frontal Lobe (it's about a dog)

[Parts of the brain are important in this blog post.  I mean, not in the way we  read, understand and laugh, which is the usual way but in a more basic way.  To this end, please remember that the frontal lobe is part of the cerebral cortex involved in, among other things, making plans and judgments.]

In one way, my daughter is a chip off the old block.  Sure, she’s smarter and cuter and more motivated than I am, but she does have the same dark humor, so when she Face Booked this story about her dog, I asked her if she would guest post it for me.  I need to tell you that my darling girl is a neuroscientist.  (I mentioned she was smarter than me, right?)  Yes, she’s a clever thing, so while the amydala is the part of the brain linked to emotion, more importantly, it can conveniently morph into a FB handle.  This story is written by Amy G Dala or, as I like to call her, Dr. Smartie Pants.

So Amy G.'s family recently got a puppy that is the spit and image of the RCA Victor dog.  Anyone remember good ol' Nipper?  Being into Mom’s neuroscience stuff, the family. named their dog Medulla which is the part of the brain that controls heartbeat and breathing  It was an apt name as the puppy excels at these things; no training needed. They are training him for the harder things like sit and stay and off.  All training, though, is subject to mishaps, so let’s begin by saying the dog is okay.  The dog is fine.  The story goes like this.

My 6-month old puppy, Medulla, is still house-training.  I took him outside where he pulled away from me Sunday morning and ran straight into traffic on the highway, where he was instantly hit. Twice. By two different cars.

By the time I ran out onto the road, the man (car 2) who had hit him was standing over him crying, "I'm sorry, I'm so sorry" and sobbing. Cars were whizzing by us and I realized we were going to get hit. I tried to lift my dog, but he fell out of my arms (me imagining torn organs, broken spine - collapsing and stressing and tearing), and I half dropped him.

 "Help me lift him, please" I gasped, and the flapping man did as asked (still babbling at me). We lowered Medulla onto the grass in front of my house. Blood was gushing from his mouth, his nose, everywhere, and he gurgled with every breath.  (I was imagining his lungs collapsing, throat crushed, jaw broken).  He lay there, breathing and gurgling, as the man flapped around "I'm SO sorry, I'm sorry."

This is his last breath, I thought, petting my dog. No, this one. ("I'm sorry" sobs the man, "gurgle gurgle" bubbles the dog). No, this one.

And then, know what? The dog raises his head, licks his face with his bloody tongue, and looks around with interest and tries to stand up.  I just   about   killed    him.

So we got away with a VERY broken femur in a hind leg, which meant a surgery, and broken toes all on his front leg, which means a cast, and a broken tooth and bruised mouth and his neuter stitches torn open, BUT - the dog is home. The dog is fine. The children are Thrilled. We are reeling but okay. 

My husband is absolutely right, though: we should have named him Frontal Lobe.

Medulla associated beginning to piddle 

in the house with getting hit by a car.  

He is now completely house-trained

Boys: good grief!

What is it with boys?  In heaven's name, what are they thinking?

We are one of four houses off a pipe stem driveway.  Our front yard ends in a 50 degree slope composed of sand and ruts and roots.  As the person who planted over a dozen flats of ground cover to prevent its erosion, I’ve had the experience almost spraining an ankle when preventing a slide toward the street.   Kids in the area know they’re not allowed to climb on the slope.  They’ve never been allowed to climb on it.  The slope is treacherous. 

Last summer the number of boys in the cul-de-sac climbed to six.  The average age declined to 9.   After several rampages onto our flower beds and my across-the-pipe-stem neighbor’s bushes, one sorry day, at the urging of Pipe Stem Neighbor, I informed the gaggle of boys I had to ask them not to play in our or Pipe Stem’s yard any more.  This should not have proved a terrible hardship.  They have three huge, adjoining back yards of their own that adjoin parkland.  I reminded them that the slope was dangerous and forbidden, but in the excitement of new playmates, old rules were forgotten  The slope was a temptation beyond resistance. 

I rounded up the gaggle and wash, rinse, repeat.  Boys!  No going on the slope! 

Boys on the slope.

No boy is that stupid that he's forgotten.  I sighed and visited parents, awkward for all involved, but I don’t want anyone getting hurt.  I’d only spoken to the new neighbors when I brought welcome cupcakes.  What a way to have a second conversation.  However, what were they going to say?  That they wanted their sons to fall onto their heads on the pavement?  Another mom, a long-time neighbor, was really upset, saying “There’s roots.  They’ll get caught and fall!”  Um, yesss.

A couple of weeks later, Pipe Stem caught boys in their bushes and told them that was not a good idea.  The boys needed to stay out of their yard.  They’ve got double jeopardy because they’re trying to sell their house, and they work hard to keep everything in pristine condition.       Bushes askew with broken branches does not raise the property value.                                                     

The next week, there's the eight-year-old running across my yard.  His friend, who’s known me since he was born, was being extraordinarily self-controlled, shadowing his cohort from the street. Okay, I’m not going to lose my mind.  Ol’ Ace was passing through, not cruising in the flower beds or crashing into shrubbery, but later that day, Pipe Stem reported seeing Ace climb up my erosion channel. 

As mentioned, our slope is quite sandy.  I’ve worked hard for 20 years to prevent erosion.  One spot, however, has been a lost cause, and last summer we had two workmen put in a drain and an erosion channel covered with river rock.  It was a day’s hard labor and cost many hundreds of dollars.  The next morning when I went down to get the paper, I checked, and there were rocks strewn in the ground cover.  *Sigh*  I replaced them as best I could, slipping and sliding up the sides of the channel. 

About an hour later, the boys were out with their scooters.  Fortunately I had gotten dressed, as a grandma in her ‘jammies is far less authoritative than a grandma in her jeans.  I steeled myself as Ace’s brother and friend were bound to give him avid support.  Um, not quite.

By the time I walked to the street, they were headed toward one of their garages.  “Boys, come here a minute.  I want to talk to you.”  One glance back, but hoping to avoid me, they kept going.  Un uh,

This is our slope.  Stay off it!

not on my watch.  “Boys, come here.  I want to talk to you for a minute.”  Glances all around as they gathered in front of me.

“You boys know you are not allowed in our yard.  Ace you know you’re not allowed anywhere on the slope.”

Did brother and older friend offer defenses and rationalizations?  Oh, no.  The two bigger boys threw Ace under the bus as fast as they could talk.   Brother and friend denied any and all involvement, brother going so far as to point a straight arm replete outstretched finger.  “I didn't do it; it was him!”  Boys, boys, boys, this is no way to help your friend.  It was all I could do to supress a wide grin and form a serious expression.

Ace hangs his head.  

The others continue gabbling away.  “I only went up there,” said the friend, “to get my drone when it crashed.”

“Well, I appreciate that.  It's fine to go up there to get a toy, but Ace, you were climbing up the rocks.”  I explained the effort and cost that went into their placement.  “Why did you do that?”

Now the two other boys are  speaking so quickly and feverishly that I can’t understand a word they say. 

“No, don’t answer for him.  He’s a person; he has a voice.”

All Ace has right now is a sniff.  Oh, no, Ace my boy, I have been a school teacher.  Easy tears will not get you off the hook.  “Why did you do it?”

The other continue with all their might.  They are reassuring me that they would never, EVER set foot on my yard.   I reiterate, "Don't answer for him.  He's a person; he has a voice."  

Ace’s is searching his mind for an acceptable answer.  He is coming up short. 

Finally, after a few moment’s torture, I take pity on him.  “Were you playin’?”

A nod.

“All right,” I say at my strictest, “I believe this will not happen again.  If it does happen again, we will be marching to your parents to discuss consequences.  And, boys, Pipe Stem is trying to sell her house.  You can't go playing in her bushes.”

“We needed sticks for a fort.”

“Well, I understand that is important, but you know where there are plenty of sticks?  In the woods behind your house!  Okay, go on and play.” 

The two bigger boys are still telling me how good they are as they skedaddle out of there as fast as they can go. 

I managed to make it into the house before I burst out laughing.  

The Plan

If we were to move, it would be so hard. There is tons that has to be done, and, well, only us to do it. You can't just plop a house on the market, at least not where we live.  You have to prepare it and stage it.  It is supposed to gleam and glisten and sparkle.  For heavens sake, it must not look lived in!

For 35 years, the woodpeckers and squirrels have had their way with the back deck, and so we did get that re-built last summer. Check.  And we got the erosion channel on the front slope seen to. Check. What could possibly be left?  *Sigh*

If we were to move, what would we do about the downstairs bookcases, the ones with those runners mounted directly into the wall. Do they have to come down? If they do, the room will have to be patched and painted. All the articles say the front door should be painted, too, but what else? And how many pictures can you leave up on one wall when you show a place, anyway, 'cause I'm pretty sure we have too many. If we take them down, well, then that wall will have to be painted. Do we have to paint the entire house?

If we were to move, we wouldn't want all this furniture. Is it worth the hassle of selling it, or does it all just get donated? Can I deal with the annoyance of a garage sale?

If we move, can my husband and I possibly agree on what to keep and what to get rid of? He really wants to downsize, but if I hold up any single item and ask should we get rid of this, he doesn't want to let it go. Not one thing

If we move, we won't have to spend so much time traveling to our grandchildren.  We could help our daughter and son-in-law with child care emergencies; they could wipe the drool off our ever-aging chins. We could catch some of the grandchildren's activities before they grow all the way up. (Suzie's already in middle school!) They could join us for movies and parade-viewing and afternoon tea. We could enjoy our son-in-law's cooking.

If we move, we'll have to interview agents, and keep the house and yard immaculate. We will have to, you know, actually organize the endeavor. We will doubtless have arguments, er, I mean discussions. And it's been 23 years. I think we have roots we don't even know about that will hurt when they are pulled.

If we move, what would be the Master Plan?  Yeah, right. We never have a Master Plan; we never even have a Minor Plan. To have a plan takes making Big Decisions. I am not one for Big Decisions; I prefer to get positioned and let them make themselves. Steve is quite willing to make Big Decisions provided he can re-make them at any given time. No, there is no Master Plan. However, we do have the kind of plan that works for us, the Wishy-Washy Plan.

The plan is to jump around and do everything we need to do to sell this house, but, aha!  here's the genius, but not buy a new place. We'd rent. We'd rent and give ourselves a year to discover, explore, try it out. If it works, hooray!, we'll buy a home in the neighborhood. If not, OMG, what will we do? Who knows? We'll come up with a new plan.

Meanwhile, if we were to move, would I need every scrap of quilting fabric I own. Yes! Yes, I would! Steve would have to get rid of some golf stuff instead. That is, if we were to move.

How Do You Know You're Alive?

There's sky diving and bungee jumping and motorcycle racing. There's that thing where you hold your breath and try to go deeper underwater than anyone else has without dying. There's bull riding and bull racing (you know, the men running in front of the bulls in Pamplona, the idiots). There's Parkour, every seven-year-old boy's dream. Don't forget hang gliding and hurricane chasing. Does the adrenaline rush verify existence? What's it take?

I have a young friend who is a record-holding slack-liner. There she walks between mountain peaks, wind buffeting her, rope swaying under her feet. She'll take a little bounce on the line; for heaven's sake, is she bored? She climbs sheer rock with nothing but pitons and boots. I can't even make it to the top of a climbing wall. She says no one else can say how much risk is too much for her. For her, the exhilaration outweighs the danger.

Allow me to digress. I promise to return to the question.

Have you ever felt exasperated with your computer? I mean, are you human? My computer crashed a few weeks ago, but is that aggravating enough? Noooo. Nope. It turns out my back-up drive failed last December. Oopsie. To add insult to injury, when they transferred my stuff to a new hard drive, oh, well, Microsoft Office – originally installed from a no-longer-to-be-found disc – was lost. My docs transferred to the new drive, but there was no Word to read them. (I was saved a heart attack as all my blogs were saved to Dropbox.) Microsoft had a two hour wait in their phone queue, so I sent them an e-mail. Fortunately I did not expect a response so I was not disappointed. I was NOT going to buy a new Office Suite for an old computer, so what to do? Hello, Open Office, you beauty, you!

A week after fussing with my documents, I went to transfer a CD onto my drive, and, oh, iTunes was gone. The tech thought my music had also disappeared, but I showed him where I'd seen it. He reinstalled i-tunes and my own tunes. It took me two weeks to get close to the starting point, TWO WEEKS of thorough, time-wasting exasperation. Now everything is saved to the lovely Clouououd. (I have a metaphor as the Cloud as God, but perhaps that's a topic for another Post.)

Let's talk about the bank. We are so spoiled. Gone are the days when a bank drive-through window was the great convenience. (Of course, also gone are the days when I walked into my bank, and the teller said, “Good morning, Mrs. Simon.”) Do you need cash? Pull over to the nearest ATM. Easier still, get some back at the grocery store. But if someone sends you a big check (you can only hope), or you need a to your bank. We put the errand off. We think, it will be easier to do it tomorrow. It niggles away at the the back of the brain, I have to go to the bank. How can one errand so irritating? What has the bank ever done to us that we find it so annoying?

Oho, then make a phone call, any call to any institution. Listen to the menu, push a button. Listen, push. Listen, push. By the time you're put on hold, you're so ticked off, you are screaming at the muzak. When a person finally answers, you are so fed up and grateful at the same time, you almost forget why you called.

Traffic. Need I say more? What are all those people doing out on the road? Don't they know I want to go somewhere? Don't they know I have to park? Don't they know I'm in a hurry?

Now, remember our original question? You don't have to be an adrenaline junkie to know you're alive. You don't have to do anything at all. Every daily irritation is existential proof. You know you're alive because you're annoyed.

Cancer: Genetic Testing

The instructions I received before (free) genetic counseling (and my insurance covered the testing) was that there would be no drinking water, eating anything or chewing gum during the hour to hour and a half appointment? What?  I mean, first off, would you NEED to eat and drink during an hour and a half?  And second, WHY NOT?

One also has to fill out an extensive family history form. I left a lot of blanks. My folks didn't report to children about causes of death much, even if they knew them. I thought my form was sparse, but the counselor said it was pretty good. What I particularly noted was that while there wasn't a ton of cancer in my family, people were dropping like flies from heart attacks! All that tasty pastrami, liver pate and tongue took their toll.

The reason my doctors strongly recommended genetic testing is that I am of Ashkenazi (eastern European Jewish) decent. One in 40 Ashkenazi Jews carry the BRAC 1 or BRAC 2 (breast cancer) marker. This figure is somewhat higher than the general population.  Okay, I took notes as fast as I could, but the exact percentage difference fell through the cracks.  Gimme a break!  

The counselor noticed on my family history is that we don’t have a lot of girls which may be the reason why we don’t have a lot of breast cancer.. The other thing was that breast cancer in the 30s and 40s tends to indicate presence of breast cancer genes.  Our instances of breast cancer had later onset.  One mark for me on the positive side of the ledger.  (Or, hmmm, the negative side, depending on how you read it.  Oh, never mind!)  

While BRAC 1 and BRAC 2 are the most common genes, there are a total of 24 genetic markers!    Yikes!  They’re not really genes, though, they’re genetic mutations, and they’re discovering more all the time!  Is this a Darwinian way of winnowing the human herd?  That seems harsh.  

Should I have one of the high risk cancer genes, my direct blood relatives would each have a 50% chance of being carriers.  Along with breast cancer, these genes indicate a higher risk of ovarian (but not cervical) cancer. Not many males get breast cancer, but they would be at a 20%-50% higher risk of prostate cancer.  

A lot of research has been done on the four highest-risk cancer genes. Less is known about the others. Whether you choose to be tested for any or all, it's done at the same time with the same sample, no further fuss for you. I choose to be tested for only the top four:

             Gene                                            Associated Cancer

BRAC 1 and BRAC 2          45%-87% increase in breast, ovarian, pancreatic, prostate and                                               male breast cancer

CDH1 breast,                       39%-52% increase in breast, gastric and colorectal

PTEN                                   Up to 50% increase in breast, thyroid, uterine, colorectal, kidney

TP53                                    no % assigned, significant increase in breast, sarcoma, brain (!),                                              adrenocortical, and others (and OTHERS?!!) 

The most surprising thing I learned during counseling was that even if you carry the BRAC 1 and 2 genes, there are two methods of treatment with EQUAL OUTCOMES. Yes, if you are young and want to be sure you don’t have a lifetime of worry ahead of you, you may opt for a mastectomy. That removes absolutely all risk of breast cancer and, obviously, metastasis. However, you can also opt for twice-a-year mammograms, MRIs and clinical exams, keeping on top of the beginning of any cancer. The outcome to your health and life-expectancy are the same. Wow, I did not know that.  I was surprised at what a relief that was.

You will receive one of three possible results.

Guess what? Testing is not about blood at all. Now my veins like to play roll-away from a needle, and no blood flows out. Sometimes the needle hits the vein wall which hurts, and no blood flows out. If I’m pretty well hydrated, a skilled phlebotomist with a pediatric needle can zoop right in there, but otherwise, I’m in for a prolonged, multi-stick session. Score! They don’t take blood for genetic testing.

They don’t take a cheek swab either. This is not a crime show. Nope, instead the counselor opened up a compact case to reveal two small tubes with mouth pieces. You have to fill each one with spit. At least now the no-gum/water/food rule makes sense: they don’t want anything to taint the results.

You spit and you spit and you spit. Although I’m sure this would be quite a treat for the counselor to watch, she turned to her computer. My job is to fill about a ¼ inch space in each tube with saliva. It takes a while, and it’s messy. The box of Kleenex I thought was for weepy patients (and it might well be) was what I used to keep spittle from running down my chin. Not much did, though. The task was daunting enough for me to make sure that no drop is wasted.

The first line is just above the white label area.

You have to fill it to the black line.  

The counselor showed me how to seal each tube as it was completed. Now I wait.

There are three possible results.

          Positive: a clear genetic mutation with associated cancer risk.

          Negative and winner of the prize: no genetic mutation.

          Variant (under 10% of the results, and the one most likely to make you crazy): This is           not the basis for a movie plot. It means they found some weird genetic change,  

          something they’ve never seen before and don’t know what it means. I have already

          decided that if I get a Variant result, I am totally blowing it off.

And wait.

Still waiting -- for two to three weeks.

But I am not going to make you wait because that’s just the kind of person I am. In any case, my results came in early, and I only had to wait two weeks.  I am not a mutant 

Most of my relief is that I don’t have cancer-related genes. The rest of my relief is that I won’t have 50 million more medical appointments to deal with! Yay!

Have I been bored in the weeks between completing radiation and getting my genetic test results? Oh, no, I have not been bored. During that time a very dear friend, one for whom I hold Powers of Attorney, climbed up on the railing of the Good Ship Sanity and fell overboard into the sea of massive infection and mental confusion. You know, just so I don’t run out of material to blog about. Oh, yeah, that’ll be next.

Cancer: Radiation

 Each day is a calendar square, each square empty except for my afternoon appointment written neatly in purple, the occasional lunch date added in black.  Dance classes are marked at the top of the day columns.  Nineteen carefully blocked days with 15 minutes extra noted every Thursday.  Thursday is the day I meet with the radiologist.

Is it a Space Pod?

Today’s Science Lesson: (there will be a quiz later, so listen up).  The Space Pod is the machine that effects radiation treatments.  Right, right, it isn’t really a Space Pod (in case you were in any doubt), or a Radiator or a Zapper (I’m just sayin’).  It’s a linear accelerator.  Electrons from an energy source shoot (accelerate) down a tube where they impact an angled metal plate.  98% split away as heat; the other 2% radiate photons (radiation) down the adjoining tube and spray them at my breast.  You can also send the un-split electrons down the tube.  Electrons kill cells really well, too, but they don’t penetrate very deeply and so don’t need a metal plate to catch them on the other side of their target.  Radiation hits any stray cancer cells that might have avoided surgery and damages their ability to repair themselves or to multiply.  It hits normal cells, too, but they are better able to repair themselves and so heal afterwards

The linear accelerator is HEAVY and so is located in the basement of the Cancer Care Center, but  there are faux skylights in the Rad room so it always seems airy and pleasant.  In fact the Rad area is about the most pleasant place on earth. The staff learns my name, respectfully Mrs. Simon and never Ann.  There’s never more than a few minutes wait for treatment.  The changing room (I remove my top and bra and put on a short hospital gown) and waiting room are quiet and comfortable.  There is hard candy in the outer office, but in the inner sanctum of the radiation anti-chamber, there are Dove chocolates.  All questions are answered.  Everyone strives to make me comfortable.  It’s like a spa -- well, almost. 

This skylight has dogwoods.  The other one has cherry blossoms.

  

When I’m called into the anti-chamber, the merest possibility of radiating some extraneous body part is prevented as they check my face against the picture taken during preparation.  (They promised not to put it on the Internet.)  While I eye the bowl of chocolates, I state my name and birth date and identify the left breast for treatment.  They’re thorough in all things so measurements and body placement are precise and are adjusted every week as needed. 

When I lay back on the oh-so-narrow table, the nurse and assistant help me remove my gown and drape it modestly over my right side.  I place my arms in the brackets.  If I like, the technicians wrap my arms in heated towels although I've declined since the temperature hit the high 80s.  The technician and nurse carefully align my tattoos with the sensors.  Once in position, I must not move.  I am an itchy, twitchy person, but they are strict!  They tape the funny black plastic box over the stickers on my tummy.  Everyone leaves the room (but me), and the gurney slides me  into the Radiator, er, linear accelerator.   

The space wings rotate around me and lock into position.  The square wing seen on your right swivels out of the way.  It can be used as a soft-tissue CAT scan.  The rounded wing on your left, is the one that will fry my cells.  It is angled so the rays travel through my breast and hit a metal plate beyond.  It has a rectangular screen with a smaller screen inset, and it if from there that the photons whoosh out.  

I hear a mechanical hum; the nurse’s voice through the speaker directs, “When you’re ready, inhale and hold your breath.”  Holding my breath pulls my heart millimeters out of the radiation beam.  If I exhale before directed, the sensors in the black box detect the movement, and the radiation automatically stops. The first zap is 21 seconds (not that I’m counting, but 21 seconds is a bit of time to hold your breath, I can tell you); the second discharge is seven.  The wings rotate to a new angle.  I hold for 12 seconds and then eight.  The gurney slides out of the Radiator.  Repeat once a day for 18 more weekdays.

2^nd Treatment:   I can feel occasional sparks along the surgical lines where the nerves were cut.  They are trying to re-grow, but the radiation keeps killing them off.  The little twitches tell me the invisible, unsensed rays are working. 

6^th Treatment:  My consultation with the doctor goes well.  My breast is sometimes sore, but there is as yet almost no reddening of the skin.  Depression hits on and off.  Today I probably feel down  because I slept badly last night.  I have been obsessing over the oncotype test which showed an 8% chance of metastasization years down the road.  This weighs on me.  For the first time I get why they call it the Life with Cancer Center.  I had thought it a horrible name, stressing that cancer would always be part of your life, but I am constantly aware that death shadows me. 

(Later that day)  I had lunch with my neighbor, a nurse and another breast cancer survivor.  She told me that breast cancer migrates to particular places.  They will regularly check liver and lungs.  Should the cancer metastasize, they will catch it early.  I feel the black cloud lifting.

9^th Treatment:  It takes me five minutes to drive from my garage to the hospital parking lot, seven if the traffic’s bad.  How great is that?  I’m fine in the mornings and still happily flail my way through ballet class, but I've been pretty tired after the last couple of treatments.  I’m very tired of the whole cancer thing.  I’d like to do something else now, please.

11^th Treatment:  Today the nurses attached a cone to the accelerator.  (Well, they called it a cone; it’s an open-sided box with a metal ring set in the side that points at you.) They positioned it a couple of inches from the lumpectomy site.  They drew a new target on me and put on a new sticker (new sticker, yay!) in preparation for my last three sessions.  These are called booster treatments and will consist of electrons (rather than photons) bombing right up against the lumpectomy site, the area of greatest risk.  (Remember how the linear accelerator works?  I told you there would be a quiz.)   Yesterday and today I have not been at all tired.

After my treatment, I asked the nurse more about the oncotype test.  I didn't take notes, but I believe this is the gist:  stray cancer cells can be in our bodies.  They just float around suppressed by the immune system until or unless something triggers them to multiply.  More relief!  It’s a coulda, sorta, maybe scenario rather than a screaming you’re gonna die! scenario.  I no longer feel doomed.

12^th Treatment:  The effects of radiation are cumulative, and I feel the burn.

13^th Treatment:   While I’m in the Zapper, I think, hey, I’d like an end-of-treatment, sticker-off ritual.  I think of wearing gauzy scarves, skipping through a field of daisies a la Isadora Duncan, stripping off the stickers and strewing them to the wind.  I shout, "Sticker off!  Sticker off!" and move in slow motion.

15^th Treatment:  My fatigue level is up and down.  This morning was the first time I did not finish dance class which was sad for me.   After class I had a phone call, and I would just like to say that my friends should put off having crises until I’m done with mine.  I mean, what’s up with that?!

17^th Treatment:  I've been quite fatigued (as opposed to sleepy) for the past three days. Today, aha!, was the first of my Booster treatments.  They fitted the “cone” onto the Radiator, snugged it up close to my lumpectomy scar, and the big, dopey electrons dripped out.  (You know that’s a metaphor, right?  The electrons are tiny, they don’t drip, and if they did drip, they’d fall right on the floor since the cone is targeted from the side.)  Anyway, the important thing here is that it signals the beginning of the end.  I have the weekend to rest (except the Perfect Grandchildren and their attendants are coming to town, and my sister is having a big anniversary party and then brunch the next day), and then I’m in for my last two treatments.  The skin right under my nipple is really red and sore. I have gotten no further in creating a plausible sticker-off celebration. 

I’ve been tired all weekend.  Like really tired.  Like napping tired, and Inever nap!  I am tired of being tired, and now my lumpectomy site is stinging a lot.  I say Bleh! 

19^th Treatment:  I was stoked all day because this is my LAST treatment!  Then driving to the hospital, I was a little sad, maybe because I will no longer be actively fighting the cancer.  Anyway, I was over it as soon as the treatment was over.  The nurse gave me a certificate of completion almost as if I’d actually done something!  I got instructions for follow-up care (continue the same breast care for a couple of weeks) and will make a follow-up appointment in two months. 

We grilled steaks tonight in celebration. My private celebration was in the bathroom (alas, no Isadora Duncan) as I unpeeled stickers and chortled, “Sticker off!  Sticker off!”  The newest sticker will have to wait a bit as tugging at it pulls the sore skin.  However, its day is coming.

Next week I enter the black hole of genetic counseling.  There seems to be very little to available about that in advance.  One quirky thing about it is that the genetic counselor got her masters degree at my old college.  What do you think of that?  She will probably test, and I hope they are able to take the blood right then.  It is so hard to go back and back and back some more.  Once they draw the blood, I guess, deducing from the oncotype test, it will take about 10 days to get results back.  We’ll see, or rather I’ll see and report back to you. 

Sticker off!

Cancer: Preparing for Radiation (the simulation)

They TATTOO you!  Yes, tattoos.  And it hurts!  I asked for a kitty, but they only do dots.

Then they put stickers on your tummy.  It’s a three-year-old’s dream.  

You lie back on the CAT scanner gurney, hands secured in brackets overhead a la Fifty Shades of Gray.  When you are positioned just so, they draw arcane lines and dots on you with black and red magic markers. Who knew the preparations for radiation involved so much body art?    

After the radiologist approves the signs and symbols, the technician tattoos all-but-invisible guideline dots, one under each arm, one on the sternum.  How do people bear those beautiful tattoo sleeves?  Yikes! 

Next comes the black box which is positioned on the tummy stickers.  Of all the strange things that diagnosis and treatment entail, having a black plastic box taped to my belly is right up there.  Will I disappear inside the machine so they have to use the black box to find me?

The gurney slides into the CAT scan.  This time a nurse, rather than a robot, tells me when to breathe. She takes x-rays while I hold my breath, and some while I don’t.  The radiologist will analyze these to determine if holding my breath also pulls my heart out of the radiation beam.  That is worth knowing!  I breathe -- or not -- on command.  I do not move no matter how itchy the corner of my eye gets.  For once in my life, I am more than willing to be perfectly obedient. 

This appointment is called a radiation simulation. It’s not a simulation as far as I can tell, since the radiation does not take place in the CAT scan or even in the same room.  The process is rather a graphing and mechanical preparation.  The red rectangle they drew around my breast shows exactly where the x-rays will redden and burn.  There is no guessing, and there will be no stray radiation.

Once I’m up and dressed, I’m shown to an ordinary exam room where the nurse gives me “the talk.”  No, not that talk.  It is a talk about rules.  There are always rules once you are plugged into the medical world.  In this case, there are creams and powders and when to use each.  Vitamin C and Co-Q10 and high C multivitamins are prohibited during and for six weeks after treatment (antioxidants feed cancer cells).  I’m not permitted an underwire bra.  She says to wear a cami or a sports bra.  A cami?  She's kidding, right?  I’d expire from bouncing!  But, see, this is why god created catalogues.  

I discovered a soft, cotton bra which has both darts and front gatherings (lots of support) with a front clasp of four hooks and eyes.  I also learned that sports bras have come a long way since I last tried one. 

Stretched out, tested, prepped, and shopped.  I’ve cleared my calendar for the month.  I will back out of activities if I suffer the vaguely warned-about fatigue (which will also, you know, be a good excuse if I just don’t want to do something.)  I will show up five days a week for 19 treatments.  

I’m more than ready; I’m eager.  Nuke the damn cells; nuke 'em all!