Thursday, September 29, 2016

Global Entry Program

The beginning of July Jim and I applied for the Global Entry Program, which is offered by the Department of Homeland Security in the United States. The goal is to enhance security and increase system-wide efficiencies while improving the passenger experience. They offer different levels of programs, but because we travel within the U.S. as well as abroad, we chose the Global Entry selection. The bottom line for us as travelers is that we will always get TSA Pre-check when flying in this country (no more removing shoes, light jackets, laptops from bags, or small liquids from carry-on bags), as well as expedited processing through Customs at airports and land borders when we return to the United States following international travel.

The process begins with online enrollment in the program, and the payment of $100. They keep the money if you are not approved for the program, but if you are successful then your membership is good for 5 years. On July 8th we received notification that we had been preliminarily approved, and that the next step was to set up an interview at one of their enrollment centers. You must set up the appointment within 30 days of the date of the notification letter, though the interview does not have to take place within that time period. And that is a very good thing because the enrollment center in St. Louis, which is located at Lambert Airport, had no openings until late November!

At the time we applied we thought (wrongly, as it ends up) that we were going to be spending November in Australia, thus the desire to get into this program. I checked other locations to see of we could get an earlier interview and the only place I could find within a reasonable driving distance was Peoria, IL, which had openings on September 21st. Knowing that it would take us nearly three hours to get there, I set our appointments up for 11:15 and 11:30 in the morning. A caveat is that the confirmation letter we received stated that the agent has other responsibilities, and thus might not be available when you arrive. For that, they apologize. No big deal if you are from the area, but a pretty big consideration when you are traveling a distance. We decided to go for it.

We arrived at 10:45, and were relieved to see a Department of Homeland Security vehicle in the parking lot. The agent was all alone when we entered the building. I explained that we were early, and he asked what time our appointments were scheduled. After I told him, he said "Well let's get this done before 11." He no sooner uttered those words when his 11:00 appointment came in the door. He told her he would be with her after he finished with us.

For the appointment you were asked to bring a copy of the preliminary approval letter, your passport, a driver's license, and a utility or other bill showing your address. He asked to see all but the last item, and asked us both questions that had been answered on the original application. I think they want to make sure you answer the same way. I had read that they ask you where you have traveled in the past, whether you have ever been stopped by customs, if you have ever brought anything illegal back into the country, etc. I prepared a detailed list of all of our international travel, just in case. Our agent only asked where we were planning to travel in the near future. Again, we had answered this on the application. We had to place our fingers and then our thumbs on an electronic device, which took our fingerprints. No more paper and ink! When the results came back with no red flags, he aimed a hand held camera across the counter at my face and snapped a picture. All with less warning than the driver's license office. You can imagine how it turned out. It makes my license look like a Glamour Shot in comparison. Nevertheless, we were both approved and finished just before 11:00. The lady after us drove there from the Quad Cities, so we weren't the only ones traveling a distance to get this done.

Caterpillar Museum in Peoria
Since we had made the drive, we decided to see a little of Peoria. On the recommendation of the agent, we first had lunch at Thyme, a fun restaurant with an interesting menu and a decor to match. Jim said it looked like Pinterest had exploded inside the building. It was quite good, and we enjoyed our food. From there we headed down the street to see the Sculpture Walk, a series of 16 sculptures that are on display for a year. This led us to the Caterpillar Museum, and we decided to go inside. We had purchased several pieces of their equipment during our time of owning the composting facility. It is an excellent museum, and the docents are friendly and knowledgeable. All the ones that we talked with were former Caterpillar employees.

the tire is 14 feet tall
largest piece of equipment
made by Caterpillar
By the time we got out of the museum a storm was blowing in so we were unable to see the sculptures on the other side of the street. That was too bad, but we were happy to get out of town before the storm hit. The weather cleared as we drove back home, which gave us an opportunity to stop and see this roadside attraction. We had driven past many times on our way to Chicago, and always thought it would be interesting to experience. You can get your kitsch on Route 66 here! We had dinner at the diner, which certainly took us back in time. The chocolate ice cream machine was broken, but that was the only negative to the visit. What a fun day!
Livingston, IL

Tuesday, September 27, 2016

Update on Kirby's Cancer

Kirby at the clinic
On Thursday the 22nd we took Kirby to see the oncologist, Dr. S. It was our first visit to Veterinary Specialty Services, a clinic filled with board-certified veterinary specialists. So basically every animal that comes in there is in some sort of a crisis situation. I filled out the paperwork, and we had a short wait before the vet could see us. We found Dr. S. to be a no nonsense type of person, but with a wonderful bedside manner. We discussed Kirby's surgery and the pathology reports, and she suggested doing an ultrasound to see if there were any additional tumors in the belly area. If he was loaded with tumors then followup treatments would not make sense. We agreed that was a good starting point.

They took him in the back, shaved his tummy and did the test. It was questionable whether they would have to put him under for the ultrasound, but in the end a muzzle took care of the issue. We met again with Dr. S., who said that the good news was she did not see any new growths. She also did a needle aspiration on a lump on his leg, and that was just one of the many fatty growths he has on his body. Her recommendation was to do chemotherapy, whether through pill form or IV. That would be up to us. She explained that she hates mast cell cancer because it is so unpredictable, and the fact that he had it in a lymph node was very troublesome. We discussed the pros and cons of the pill versus IV therapy, and honestly my biggest concern at the time was that the pills are very dangerous to humans. You have to wear special gloves when you handle them. It makes sense to me to have them administer the IV in a controlled setting where they know what they are doing. The treatment would involve going in once a week for four weeks, and then every other week for four additional treatments. So three months, essentially. The pills, on the other hand, would be administered every other day for three months. Whichever way we go, Kirby's saliva, urine and feces will be toxic to us and other animals, so we'll need to exercise caution with that. His immune system would be compromised either way, and he would not be allowed around any other animals. Not even at the groomers.  After further discussion, we set up the first IV treatment for the next day, Friday the 23rd.

At 4:00 in the morning on Friday, Jim and I were both wide awake and fretting. I could not stop crying, worrying about whether or not we were making the right decision. We finally decided that if we were both concerned, then we should listen to our guts. We are not impulsive people who make major decisions without looking at all the facts and options, and I think that was part of the problem for us both. I called and cancelled the appointment, and asked for Dr. S. to call me. She returned my call a few hours later and answered all of my questions to the best of her ability. Basically, mast cell cancer cannot be cured. It will come back in Kirby, so it's not an "if" but a "when" situation. What you are hoping to accomplish with chemo is to destroy or disrupt the mast cells that have gone rogue in his system. Unfortunately there are no good statistics to help with the decision. It's not like she can say if you give him chemo, he can live for another 2-3 years. Or if he doesn't get chemo he will die in 3 months.  If he was five instead of going on eleven, that would make the decision easier.

We have since talked to a couple of people that worked in clinics that treated dogs with cancer, and they both said most dogs handle the chemo better than a people do. But all I can think is, if he is one that gets really sick, how in the world do I get his toxic waste out of hardwood floors and tile grout? Would he have to be kept in a kennel? Can we even take him on any walks if his waste is hazardous to other animals?

Lots of questions and no easy answers. At the moment, we are doing nothing other than keeping him on the medications he has been on since surgery - Benadryl twice a day, a Pepcid AC cut in half twice a day, and an Apoquel once a day. The mast cells release too many histamines in the body, causing itching and a chance of damage to the stomach lining, so these drugs help to keep that in check. I am taking him tomorrow for his grooming, which we do every two months and he is due for that. And Jim's parents want to see Kirby while he is still feeling good, so the two of them are going to do a road trip soon. Then we'll have to make an executive decision on which was to go. It is hard because Kirby has no say in this whatsoever. What decision would he make???

Friday, September 23, 2016

Skin Cancer Strikes Again!

When I saw my dermatologist (Dr. S.) in late July for my normal (if anything about my skin can be considered normal) six month check-up, I mention that a spot on my upper right chest had not responded well to the cryosurgery he had been doing on it each time I came in. He said it was time for me to see the plastic surgeon again. I would say it was past time, actually. I rely on him to tell me when it is time to get things surgically removed, but in light of recent developments I can see that I will have to be more assertive. Dr. S. then proceeded to burn about 13 spots on my head, chest (including two above the spot I believed to be skin cancer), back, shoulders and arms, and I booked an appointment with the plastic surgeon (Dr. R.) Between his schedule and the trip we had planned to Seattle, I could not get the surgery done until September 16th.

When I arrived at Dr. R.'s office, I also asked him about a tiny spot on my shoulder that had also not responded to the liquid nitrogen. Typically, a benign area will crust over and peel following treatment, whereas skin cancer spots essentially stick their tongues out at the doctor and do nothing. Dr. R. agreed that the small spot looked like a basal cell to him. But he was also concerned about two other spots above the growth on my chest that he was going to remove. He referred to it as a multi focal cancer, meaning the additional two had popped out as a result of the first one. He did not use the word "metastasis", which was somewhat comforting. But this was certainly a first for me. He decided to take all three of the spots in one incision. Needless to say, that was a little more involved than I was expecting, and will result in a longer scar. After that procedure, removing the one on my shoulder was a piece of cake. That made me realize I need to get into the plastic surgeon much sooner than my dermatologist is referring me. Dr. R. also suggested that I might need to go see Dr. S. more often than every six months. Yippee...

There was some pain that afternoon and a little on Saturday, but nothing like when I had the two removed from my forehead earlier this year. In fact, I felt good enough to go and photograph migrating pelicans with my friend Sunday morning.



Unlike any incisions Dr. R. makes on my forehead, these two incisions were covered with bandages so I didn't need to worry about clothes rubbing on them or dirt blowing in them. I have to wait for the bandages to come off on their own, and am not supposed to be doing any exercise or movement that may stretch the incisions. The biopsy reports came back that the ones on my chest were basal cells, but the small one on my shoulder was just a mole. That surprised me, as I have many moles and none of them look like that one did. But I would rather err on the side of caution at this point.

Silver Games pickleball
In light of the exercise restrictions, it was a good thing that I scheduled my surgery for after the Silver Games in Washington, MO. I played in my first pickleball tournament on September 14th, playing ladies doubles with my friend Audrey and mixed doubles with my friend Leon. In both cases we only won one game out of three, but we had a lot of fun despite the disorganization of the tournament. We arrived at the sports center at 12:00, and games were supposed to begin at 12:30. In fact, they did not begin until 1:00, and Leon and I did not finish our last game until 10:00 that night. Frankly, by then we did not really care if we won or loss. But it was still pretty fun to hang out with many of my pickleball friends for the day.

me & Leon

Audrey & me