Squeamish over Squamous

squamous cell carcinoma

My biopsy report came back Wednesday, and as expected the spot on my arm was positive for cancer. This time it is another squamous cell. Of my 19 skin cancer diagnoses, 4 have been squamous cell and the rest have been basal cell.

Dr. Seminara offered me two choices for taking care of this spot. The first is to do an ED&C like she did to the two basal cells on my neck in April of last year. That was no fun since the cells are just scraped off and no stitches are given. They took quite a while to heal, and as I am allergic to the adhesive in bandages that made dealing with open wounds problematic. The second choice is to do a deep burn on the spot with liquid nitrogen followed by a topical skin cancer cream. The success rate is in the 96th percentile with the first option and in the 84th percentile with the second. 

On one other occasion I was prescribed a topical cancer cream to use on my forehead. Let alone making my forehead swell so much I could barely see, it burned a lot and made me sicker than a dog. I thought I had the flu until my husband pointed out that I was sick on each day I used the cream, but started feeling better on the off days of usage. Based on that experience, I am opting to go with the ED&C again. I am waiting on the dermatology scheduling department to call me and set the appointment.

In the meantime, I'm just going to enjoy watching the sun from the shade of my back porch.

Mountain Island Lake

More Skin Cancer

Because of the two basal cell carcinomas found in my scalp last November, the dermatologist wanted to see me three months following the Mohs surgery. I went in the end of February, where she did an all body scan. She asked about a spot on my left neck, and I reminded her that she had put liquid nitrogen on it the last time I was in. She decided to biopsy the spot, along with one a few inches behind it. They put bandages on both before I left due to bleeding. I left those on overnight as I didn't want to get blood on my pillowcase.

Unfortunately, I have an allergy to latex - specifically bandages, oddly enough. By the next morning the spots on my neck had angry red welts, and they itched like crazy. I put an antibiotic ointment on them, and recovered them with bandages that have paper tape on them. That was also a mistake, as the welts and itching got worse. So I had to leave them uncovered, and used Benadryl cream on the welts.

Both the biopsies came back positive for basal cells, but apparently they are in the very early stages. So instead of having the plastic surgeon in the office do Mohs surgery, she is going to do an ED&C on them. I wasn't sure what that meant, so I had to ask Dr. Google. It stands for electrodesiccation and curettage, and is a procedure where they basically scrape off the cancerous cells. I have not had this done before, despite being on cancer spots number 17 & 18. I'm not sure exactly how they will know if they have gotten all the cells. With Mohs they examine each removal in the lab to make sure that they have gotten clean margins in the piece. If not, they go back and take more. Apparently with the ED&C, they will make three passes over each of the basal cells to try to remove all the cancerous tissue. The procedure has a 95% success rate, so hopefully I will fall into that category. I'm not scheduled until next month, so I'll report back on how it goes.

I'm not sure I followed up here regarding the infection in my scalp. Two weeks after they took a scraping to check for infection, it ended up that my one wound had a MRSA infection. This was definitely a surprise to me, as the most common way you get this type of infection is from a hospital or other health care setting. My guess is I got it when they removed my staples back in December. I opted to continue with the topical antibiotic rather than taking an oral antibiotic. Fortunately after another week of use the infection went away, and was cleared up before we went to Africa. I'm praying the next surgeries will not have any surprises coming out of them. 

Monday morning I got up early and walked down to a nearby point on the lake. It was cold, and fog was rising off the water. I'm reminded that beauty is all around us if we only look for it.

Mountain Island Lake

More Mohs Surgery

two grinches

Last Thursday I went to the plastic surgeon's office. I wore my grinch face mask as it mirrored my mood at having more skin cancer. It was ironic that the grinch greeted me in the waiting room. I was scheduled for Mohs surgery to remove the two basal cell carcinomas they found on my scalp. I had a tiny one in my hair on the left-hand side towards my forehead, and a larger one further back in my hair on the right-hand side. 

Dr. Mu was my surgeon again - she removed the squamous cell and the basal cell hiding below it from my nose in December of 2019. While she was unable to get clear margins on either of these after the first excisions, at least she was able to get all of them in the second cut. The one on my nose took five tries!

After she was done Dr. Freeman came in to do the closings. He discussed the pros and cons of stitches versus staples, and we decided to do the staples this time. I have not had them before, and it sounds just like you think it would. Imagine someone holding a staple gun up to your head and firing away. It took 8 staples to close the one on the left and 14 to close the one on the right. 

Mohs followed by staples

hair loss

I was able to manage the pain with Tylenol, which is good as stronger drugs make me sick. The larger wound did bleed a bit that night, so I covered it with Neosporin and a gauze pad. Though I was advised I could wash my hair after 24 hours, I chose to wait an extra day to do so. A large chunk of my hair came out, I'm guessing from the area of the large incision. I'm not sure why they didn't just go ahead and cut the hair in that spot. While the dried blood came out with the double shampooing, the solution Dr. Freeman used to clean my head before closing up the incisions did not all come out. I can still feel it caked on my scalp. I guess I'll need to pick on it a bit before the next shampoo.

Next week I go back in to have the staples removed. Hopefully that won't be too bad.

Skin Scan

Tuesday was my annual skin check with my dermatologist. It had been three years since any skin cancer was detected, and I had graduated to only having to come in once a year. Well, my lucky streak has probably come to an end. There were a couple of spots in my hair that I wanted the doctor to take a look at, and she decided that both of them needed to be biopsied. As they gave me the shots to numb the area, I kept feeling it when they would stick me to see if it was numb. After three shots in each location, the technician had the doctor come in to give it a try. I still felt her stick as well.

As it ends up, people who have red hair or highlights (that's me with the red highlights and my mom was a redhead) need more lidocaine when having procedures done. This certainly has always been true for me. The doctor said there is a world-wide shortage of lidocaine right now, and it's been hard to get their hands on the higher dosage shots. She went from room to room in the clinic until she located one for me. And sure enough, the extra dosage worked like a charm and she was able to snip the samples she needed.

Now I just have to wait to see what the lab results say. That may take up to two weeks. With my history, I'm fairly certain that it will not be good news. But at least this time the scars will be hidden by my hair. Red highlights and all.

More Skin Cancer

skin cancer removal

To add to the list of medical procedures I'm having done this week, yesterday I went to my plastic surgeon to have yet another suspicious spot removed from my forehead. It's one we have been watching for a bit, but as it has not responded to liquid nitrogen (it should blister and then peel, but it does nothing), the dermatologist said to was time to have it removed.

In checking my records I realized that I had not been to the plastic surgeon since September of 2016, so that actually is not too bad for me. Unfortunately this is my 14th skin cancer, if indeed the biopsy comes back positive. I have resigned myself to the fact that this is my life from now on, but I have been taking extra precautions with my skin so hopefully I won't have too many more that will need to be surgically removed.

I did not sleep well last night as the doctor told me to keep my head elevated to lesson the risk of bleeding. It hurts today, but not as much as yesterday. It should feel much better by tomorrow, which is good because I am volunteering at the Michelob Ultra Pickleball Tournament in the morning. It was supposed to be outside at Forest Park, but because rain from the hurricane is headed our way, it has been moved indoors. Unfortunately that means a 45 minute drive for me in the morning, and I have to be there by 7:00 a.m. It is the first sanctioned tournament to be held in St. Louis, so I am eager to see the 4.0 and 5.0 players in action once my volunteer work is finished.

On a more fun note, last weekend was Paint Louis 2018. This was an organized event allowing graffiti artists to legally spray paint the flood wall that runs along the Mississippi River in downtown St. Louis. Hundreds of artists came from mostly around the Midwest, with live hip hop music adding to the party atmosphere. By the time we got down there Monday morning, most of the artists had packed up and left. But there were a few remaining, and it was interesting to talk to them about their work and the process they use in creating art to cover such a large space. Sadly, it won't last for long as other graffiti artists will come along and paint over what is already there. It is a constantly evolving work of art.

Paint Louis 2018

Breast Biopsy Results

Early this afternoon the home phone rang, and caller ID revealed that it was St. Anthony's calling me. I thought that was odd as I had the mammograms and biopsy done at Missouri Baptist. I picked it up anyway, and it was my primary care doctor's office. She asked if I had been given my pathology results yet, and I said I hadn't heard a word yet. She said they had just gotten them, and that the results were BENIGN!!!! What a huge relief, and a blessing not to have that hanging over me the whole weekend. She asked that I call their office back after I heard from Missouri Baptist regarding what kind of follow-up they were recommending.

About a half hour later, Missouri Baptist called me with the same report. She said the biopsy had come back with the cells being identified as stromal fibrosis. Fibrosis refers to an increase in dense connective breast tissue. It is a very common finding, occuring in up to 7% of suspicious breast lesions examined by biopsy. According to the American Cancer Society, fibrosis does not increase your risk of developing breast cancer later on. More good news.

They do want me to come back in six months for a repeat mammogram and ultrasound of the right breast. When I asked why, since the biopsy came back negative, I was told it was to make sure nothing had changed. I have to admit that I am a little concerned about all the x-ray exposures on this one breast. There were the two views at the routine mammogram, three views at the screening mammogram, and two more views following the biopsy. It is something I will be asking questions about, especially since they established a baseline mammogram after the biopsy was performed.

But setting all that aside for the moment, I am one lucky lady!

Breast Biopsy

flowers from the breast care center

Yesterday morning I left the house at 6:35 a.m. to get to Missouri Baptist Hospital by the 7:00 requested arrival time. My biopsy was scheduled for 7:30, but they needed to check me in and all that. Due to it being a holiday week, traffic was light and I got there at 6:50. More time to wait - yippee...

The front desk gal checked me in shortly after 7:00, and I went back to a room for the nurse to go over my information again, and to repeat what was going to occur. Then I slipped on my beautiful pink ball gown, and waited for the radiologist to come in. We have known each other for many years as our kids went to school together. He is the same doctor who drained a couple of breast cysts, and he has been reading my mammograms through the years. I was grateful that he was scheduled for July 5th, and that he had an opening for my procedure.

Dr. H. stated that he wanted to do another ultrasound himself as he wanted to see exactly what the spot looked like. At that point I think he was still hopeful that it would turn out to be nothing, or that perhaps an MRI would do the trick instead of putting me through a biopsy. I didn't realize that was even a possibility, and it was probably just as well.

Once in the procedure room, the nurse and technician went over my name, date of birth and which breast we were looking at - for the third time that morning. As someone who was once Vice President of Marketing and Risk Management for a medical malpractice insurance company, I appreciated all their efforts to make sure they were a) treating the right patient and b) treating the correct body part on the patient. The doctor then came in and performed the ultrasound, and decided he need to go in after all.

While I was told that the local anesthetic could be likened to what you get in a dental chair, that it not exactly accurate. This one went much deeper into the tissue. I am used to needles and anesthesia due to all my skin cancers, but I'll just say that this smarted more than any of those have. On the plus side, it was not as bad as a cortisone shot, so there is that.

Under the guidance of the ultrasound, Dr. H. guided an instrument through the side of the breast to get to the area of distortion. He warned me that I would feel pressure, but should feel no pain. That was the case. Then he said I would hear a sharp noise, so I shouldn't be startled. I took that to mean, don't move. What he didn't say is that I would hear four sharp noises - one for each of the tissue samples that he removed. The sound reminded me of what the ear piercing gun sounded like.

After the tissue was removed, a ceramic marker was inserted into the breast so that any radiologist who reads my mammograms in the future would know that the area had been biopsied. Normally they would put a metal marker in, but since I have had allergic reaction to different metals in my earrings, they decided to be safe and go with ceramic. Then the nurse kept pressure on the entrance site for ten minutes to minimize bleeding. She said that I hadn't bled much during the procedure. Then she said I needed to go and have more mammograms taken. While they had told me I would have a followup mammogram, I presumed it would be after the biopsy site had healed. Not right after it was done! They assured me that rarely does anyone bleed nor does it dislodge the marker they had put in.

The mammography technician reassured me that she would not be putting as much pressure on the breast as she would do during a normal screening, and said this was just to give everyone a baseline of where the biopsy had been done and where the marker was located. While I was in there, I asked her to explain the difference between the 2D and 3D tests as it seems like they are done by the same machine. She explained that a 2D mammogram was like taking a picture of a lump of bread that had been squished. You might see something, but you don't know exactly where in the loaf to go and look for it. A 3D, on the other hand, offers slices of the loaf of bread, so if something appears they can go and look at that slice. I thought it was an interesting way to describe the difference. I had asked Dr. H. if he thought a 2D mammogram would have picked up the architectural distortion. He said, "No way." At any rate, the technician was correct. The squishing in two directions wasn't bad, and did not hurt.

The entrance wound was dressed with steri-strips and then topped with a gauze pad covered in tape. My instructions were to leave the dressing on for 24 hours, with no shower until it came off. They sent me home with two small ice packs to place inside my bra over the wound, 20 minutes on and 20 minutes off to minimize swelling and bruising. The nurse told me to take it easy and load up on Netflix for the rest of the day. Sort of lends a whole new meaning to the phrase "watching the boob tube", doesn't it?

ice pack

dressing

I slept pretty well last night, and removed the bandage this morning. There is a small bruise but no swelling, and not even a drop of blood on the dressing. I continued to use the ice packs off and on today as well since they seemed to help. I took it pretty easy, and should be back to most activities tomorrow.

They said two to three days to receive the results from pathology, and they will call me once they get them. I'm hoping since my test was so early in the morning, that Friday I will hear something. Otherwise, it will be a long weekend. I'm trying to stay off of Doc Google and relying on Doc H. instead.

Say Yes Ma'am to the Mammogram

A week ago Tuesday I had my annual mammogram done at Missouri Baptist, where I have been going for many years. I was given the option of a 3D mammogram versus the traditional screening. It is supposed to give better readings, especially for women who have dense breast tissue, which I apparently do. I was warned, however, that my insurance company may not pay the additional expense of the 3D test. The difference in cost? $60. That seems a small price to pay, and so absurd that the insurance companies do not feel it is worth that amount to catch breast irregularities early. I opted for the 3D test, though I can't say I noticed any difference in how the mammogram was done. The boobs still got smooshed two different ways.

The mammography office called me on Monday, which I knew was not a good thing. Normally they just send me a letter in the mail. The gal told me that they noticed a distortion in the right breast, which they felt needed to be looked at further. She scheduled me for a diagnostic mammogram, which possibly could be followed by an ultrasound. I have had fluid filled cysts in the past, so I've had the diagnostic test and ultrasound done before.

Later that day I received a letter regarding my mammogram results. It just said that the exam showed "an abnormality that requires further evaluation." Had I received the letter before the phone call, I would have seriously freaked out. I'm glad the office called so I could have the explanation to go along with the words.

Missouri Baptist Breast Health Care Center

This afternoon I went to Missouri Baptist Hospital (I have the annual mammograms done at one of their satellite offices much closer to my house) for the additional tests. The technician was hoping that the distortion would not show up with the mammograms she performed, but no such luck. The radiologist then requested the ultrasound. After reading those films (if they are even called that anymore since everything goes into a computer), the doctor came in to talk to me. She wanted to know if I had ever had breast surgery or experienced any trauma to the breast. No to both questions. She asked me if I felt a lump and I said no, and she said she didn't feel any either.

She then requested two more mammograms to try to get a better look at where the distortion had been pinpointed. Upon reviewing everything, she felt it was best to schedule a biopsy to see what we are dealing with just to make sure it is not a very early cancer growth. Three plus hours of multiple boob squishes, having it pressed upon by the transducer for 20 minutes, and lots of time sitting around pondering the "What ifs?" My biopsy is scheduled for July 5th, and then it will be 2-3 days before the pathology report comes back. More time to ponder.

With all the people you hear about getting diagnosed with cancer, do you ever feel like you are a ticking time bomb?

Our New Normal

last picture together December 4, 2016

It's been a little over a week since we had Kirby put to sleep. We are still trying to adjust to our new normal. I knew that Jim would have a hard time because Kirby was his little buddy - they had a mutual love affair going on. I loved Kirby as well, and I know he loved me, too. But I played second fiddle if Jim was around, despite me being the one who was in the house with Kirby all day. But I underestimated how much I would miss the little guy. Everything in the house reminds me of him, especially when I am cooking. I got the can opener out to open some tomatoes. He would have dashed to my side, hoping I was preparing some tuna or canned chicken. The cutting board? He was always right there in the hopes that I was cutting up ham or chicken. It will be a long time before I can buy ham at the deli, as that is what I wrapped all of his pills in so that he would eat them. And I don't think Jim or I will be able to eat a hard boiled egg for quite a while. Kirby loved those, and he and Jim shared one each morning.

Last Wednesday the trash bins did not get rolled back to the house because I always grabbed them after our afternoon walk. And the W-K Times didn't get picked up Friday morning because Jim and Kirby would get it after their morning walk. We both find ourselves leaving a last bite of meat on our plates because we would save Kirby a treat each meal.

Friday I came home to a message on the answering machine from the emergency clinic with "some information about Kirby". I almost didn't return the call, but I knew it would be hard for Jim to do it as well so I just got it over with. As I suspected, they wanted to let us know that Kirby's ashes were ready to be picked up. Jim had requested that he be cremated. I confirmed that they would hold the ashes until we were ready to come and get them. When is one ever ready for that? I am still traumatized over my dad making me go to the vet to pick up the collar and leash of our German Shepherd after he died on the operating table when I was in college.

But Jim was out yesterday afternoon, so he did stop and pick up the remains and settled our bill. He said it was terrible. He felt the eyes of the other pet owners on him as they sat in the waiting room with their pets on a leash while his was in a box. When he got home, he told me not to freak out, but that Kirby was in his favorite spot. I peered into the conservatory, and sure enough Jim had set the box on the couch where Kirby had spent most of his time. He loved sitting in the corner of that couch (or on top of the cushion) so that he could watch for Beloved (as I referred to Jim) come home from work. It was a jolt to see the box in his corner. One surprise is that the emergency clinic had made a cast of Kirby's foot to give to us. It was a nice gesture that I am sure we will appreciate at some point. For right now it is another reminder of what we are missing.

all that remains

We received sympathy cards from our new vet as well as the emergency clinic. A couple of friends have sent cards as well. My Facebook post about Kirby's death received over 100 comments in addition to all the emoticons people tagged on it. It is comforting to know that he touched so many people in his ten years with us. I know that we gave him a great life, and he in turn graced us with much love and happiness. But right now our new normal doesn't feel very normal at all.

Our Hearts are Broken

Late yesterday afternoon we had Kirby put to sleep. In the past few days he had seemed more restless, particularly at night. He spent a lot of time on the tile floor of the conservatory, despite the cold temperature. The conservatory was definitely his room, with the couch serving as his throne where he could observe his subjects - the birds, bunnies and cats who traversed through our yard. And where he could watch for his most loyal subject (Jim) to arrive home. It was unusual for him to be spending so much time on the hard floor.

His tumor had continued to grow, but did not appear to be bothering him until yesterday. He had eaten well in the morning and taken his pills nicely for me. He and Jim took their normal long morning walk, and then we went out to do some Christmas shopping. Kirby still seemed fine, and Jim went to the office to do some work, and I headed upstairs to try to look at a website issue I've had ever since some cretins hacked into my web host and ruined four of my sites. Jim got home a little after four, and called up to me that Kirby was bleeding. He must have just been licking the tumor nonstop while we weren't watching. He was bleeding quite a bit, and his muzzle and feet were covered in blood. I knew what that meant as I had discussed this with the doctor a couple weeks ago when he aspirated this latest lump. Mast cell cancer is incurable, and he would continue to get these tumors. It was time to let him go. I called the emergency clinic while Jim was cleaning things up to let them know what was going on. It was the same facility where we had met with the oncologist, so they had a file on Kirby.

We wrapped Kirby up in towels and headed to the clinic. They immediately took us to a private room, which we very much appreciated. We spoke first with a technician, and she took Kirby away to insert a catheter into his leg in preparation for the medication. The vet took a look at him at the same time, and then the tech returned Kirby to Jim's lap. The very young vet then came in to talk to us. She confirmed that we wanted him put to sleep, and then said in light of all that was going on with him she felt this was the best decision. I told her it was hard to let him go though, as he was still eating and playing and wanting his daily walks. She said that it was a blessing that he did not have to go through all the really bad stuff that this cancer can cause. It was just the right thing to say to us. She asked if we wanted more time with him, and we said no because he was really agitated at the point. So she injected medicine to make him go to sleep, and then the final dose for his permanent rest. It was all very quick though he did take one last inhale that was a little disconcerting. She continued to listen for a heartbeat until there was none. 5:45 p.m. It was all over but the crying. Truer words...

After we got home I washed up the bloody towels and Jim's bloody clothes. I texted or emailed close family members to give them the news, asking them not to call us last night. We couldn't handle talking to anyone. Neither one of us ate dinner, or slept much last night. We were missing our bed buddy. When I went downstairs this morning, the first thing I did was check to see if Kirby's water bowl was filled. The pill bottles lined up on the counter made me cry. I woke up my computer only to see the website of the emergency clinic staring me in the eyes. The first email I read was from Merial, reminding me to apply Kirby's flea treatment.

Since I was bawling anyway, I went ahead and packed up all of his toys, leashes, food, etc. I discarded what needed to be thrown away, and hope to donate a couple of unused leashes and poop bags to someone who can use them. I also have an unopened box of flea treatment and sealed Heart Guard pills that I am hoping a shelter can use. We'll see...I can't deal with that yet, but at least it is all out of site. None of it will be out of mind, however.

A Dog's Life

Kirby

In October we found another lump on Kirby's belly, very near the site of the original tumor. We kept a close eye on it, and it began to change so on November 14th I took him back in to the vet. He performed a needle biopsy on the lump, and to no one's surprise it tested positive for mast cell cancer. This is very dismaying as it has only been three months since the last tumors were removed. The vet said that he can remove it, and in fact it would be a little easier than the last one as it is over a bit from his private parts. But he said we have to face the reality that it can and will come back. How many surgeries do we want to put him through? How many surgeries do we want to put ourselves through, not to mention the expense? This type of cancer is incurable, and I honestly don't think the chemotherapy would have made a difference so I am glad we didn't put him through that.

After some discussion, we decided to try putting him on prednisone in addition to the Benadryl and Pepcid AC that he currently takes. The hope is that the prednisone will keep the cancer cells from irritating Kirby to the point that he licks the tumor and forces it into ulcerating like it did last time. This drug can make dogs very hungry and thirsty, and some dogs urinate in the house because they can't control their bladders. We started with a dosage of three pills at a time once a day, which would be modified if he ended up peeing all over the place.

Fortunately, he has tolerated the medicine well. He is drinking and eating more, and also pants a lot. That, too, is a known side effect. Unfortunately, the tumor continued to grow a bit. His prescription was going to run out on the 23rd, the day we were leaving for Washington, DC to be with our kids for Thanksgiving. So I called the vet again to see about refilling the prednisone. He said that drug should have caused the tumor to shrink some, and that it is a bad sign that it grew even while he was on the medication. But I feel it is great that the tumor didn't go crazy in a 48 hour time period like the last one did, so he agreed to renew the prescription to get us through the seven days we would be gone.

The dog sitter called us the night of the 23rd, and she felt the tumor had grown more and was very red. She wanted to let me know that she had called the vet, and he had her adjust the timing of the pills, giving him one in the morning and two at dinner, along with an additional Benadryl mid-afternoon. She felt we would want to know. None of us slept well that night. Jim was even looking into flights to head back home on Thanksgiving Day in case Kirby needed to be hospitalized - or worse. But when I called the sitter the next morning, she was pleased with the change as the tumor didn't look nearly as red as before. She kept him on the new regimen while we were gone, and fortunately that worked out okay.

I honestly did not know if I would get to see Kirby again. I thought for sure based on how the last tumor went that it would ulcerate while we were away, and we would be faced with tough decisions from far away. It was a horrible feeling, and cast a damper on our visit with the kids. The five of us had not been together since last Christmas, so it is a shame that we had this hanging over all of us. But in the end it all worked out and we will just take each day as it comes. For now he is eating and sleeping well, and still wants to go on his daily walks. I don't know how much more time he has to be with us, but I intend to enjoy each and every day we get.

Family Affair

My sister and I drove to Cincinnati last weekend for the Crusham family reunion. Once held every other year (sort of) at a park in the heat of August, one of the female cousins took charge several years ago and secured a room at Price Hill Chili in the fall. For three years in a row we have not had to endure heat, humidity, rain or bugs. It is also easier for the elders in the family to get in and out of this location, the bathrooms are clean and the chairs are more comfortable. Genius! The added bonus is that the restaurant serves breakfast all day, so I can get my Goetta fix taken care of at the same time.

Kubler family

But our first stop upon arrival Friday night was a German restaurant in Newport, Kentucky to meet with the last surviving sibling of my dad along with her three children. It is always nice to see them and catch up on their lives. I had a bit of trouble locating the restaurant as my GPS did not recognize the address. This led to us hitting street closures, roads that did not connect between Covington and Newport, and an unexpected trip over the river into downtown Cincinnati during rush hour and a Reds game. To top it off, my sister's phone had frozen, and she had the cell number of the cousin who had arranged the meeting place. We were like the Keystone Cops, and felt every bit as incompetent as the bumbling police in the show. We finally arrived at the restaurant 20 minutes late. I guess it could have been worse. The conversation was good as was the food. When the German band began to play, however, it was time to head out as the sound was deafening.

From there we drove to a Crusham cousin G's house, where we would be spending the weekend. Unfortunately, he became extremely dizzy soon after our arrival, and he had to be taken to the hospital via ambulance. My sister jokingly told him that if he didn't want us to come he should have just said so! He ended up spending two nights in the hospital with a diagnosis of severe vertigo. As he was concerned he was having a stroke, this was good news indeed.

Saturday morning I met a female cousin for breakfast, and then my sister and I went to the hospital to check on G. We stayed there until it was time for Mass at St. Theresa's, which is located across from Price Hill Chili. The proximity meant we were the first to arrive for the reunion, so we settled in with a drink and some popcorn while we waited. A number of our relatives were out of town or had other plans that night, but we still ended up with 29 people. The oldest in the group was my mom's first cousin, who is 97 and enjoyed a Bloody Mary. There are only two girls left in my mom's immediate family, and they are 94 and 89 years old. Longevity is pretty good in the clan. We had a great time, as always.

Sunday afternoon we went and visited with our 94 year old aunt for awhile as it is difficult to catch up when there is a big crowd. Then we took her to a steakhouse, where we met up with her daughter and granddaughter. That pretty much wrapped up the weekend, and we headed home on Monday.

While I was gone, Jim took Kirby up to Iowa. His parents wanted to see Kirby while he is still feeling good. We were cherishing memories in both Ohio and Iowa this weekend.

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???

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

Floating Away

float trip

My husband's office has a float trip each summer, and we were back on the Huzzah River again this year. We shared an A-frame cabin with Jim's business partner (whose wife got sick at the last minute and wasn't able to go.) There were 23 of us altogether, and most of the others set up tents, with the exception of a couple who had just purchased a nice-sized camper. While I don't really mind tent camping, doing so in August is not my idea of a good time. I was happy to have the air conditioning as well as indoor plumbing. It worked out well because the A-frame had a kitchen, and the refrigerator and running water made it easier to prepare the Saturday evening meal.

A-frame cabins

The forecast for the weekend was not good, calling for temperatures in the 90's and rain, but we actually lucked out. It was overcast for much of the day on Saturday, and we had a slight breeze out on the water. The river was not too crowded - perhaps the forecast kept people away. It ended up being a lot of fun, and it was nice for me to be able to meet the new employees as well as this year's batch of interns. One of the interns is from the Cincinnati area, so we sure had a lot to talk about.

Huzzah horses

Saturday night was not restful as there was a huge party going on until all hours of the morning in the area where the cabins were located. But we awoke to some low lying clouds, and Jim captured this nice picture of the horses in the pasture.

We had a light breakfast and enjoyed coffee/tea on the deck of the cabin before packing up and heading out. Jim and I stopped in Cuba, Missouri on the way back to see the murals in town. There are 12 outdoor murals that tell the history of Cuba, which was founded in 1857. We did not have a map depicting the locations of the murals, but we were still able to find all of them. Below are pictures of a few of them. They are beautifully done, and it is well worth a stop if you are heading down Interstate 44.

Cuba, Missouri murals

While we were gone Kirby was in the capable hands of the friend who always stays with him, and he was just fine without us. We left his cone of shame on, and Caren commented that he wears the cone like a fashion accessory! She was amazed at how well he has adapted to life with the collar. We actually removed it last night as the vet said to wait 3-4 days post stitch removal to take it off. He did a little licking at the surgery site, but not too bad. He has behaved himself pretty well today, so I am hoping that we can leave the cone off. He sure does like to snuggle, and it is pretty hard with that large thing around his head.  With all the uncertainty, we want to get in as many snuggles as possible.

The Stitches are Out!

Kirby August 25

Three weeks post-surgery, Kirby finally got his stitches out today. Unfortunately, while the stitches were ready to come out, there is some seepage from one of the surgical sites. It could be that there is an infection because somehow our contortionist has managed to lick the wounds this past week despite the cone of shame (which is actually called an econe, by the way). But Dr. M. is more concerned that it might be an indication that the cancer is still in there. Wow - that was not something we wanted to hear! Kirby's weight is also down two pounds from pre-surgery, and that is pretty significant on a dog his size. I imagine they will be monitoring that as well, though I do think some of the medications affected his appetite.

For now the vet prescribed more antibiotics and prednisone to hopefully help with the itching, though I would have thought the Benadryl would have done the trick. We also put a larger cone on him, so there is no way for him to reach the incisions now. On the plus side, this cone is clear and he seems more comfortable with being able to see better than he could with the opaque cone. With any luck, it will only take a few days to clear things up and we can remove the cone. They want to see Kirby again in two weeks, or sooner if we see any problems. We got the name of the oncologists, so we'll be scheduling an appointment with them after Labor Day as our schedule is pretty booked until then.

A new pickleball friend of mine had asked me last week if I minded if she added Kirby's name to a Facebook group called Fur Angel Blessing Blanketeers whose members pray for pets in need. Of course I said it was fine. She also asked for my address, and I thought it was because she wanted to mail us a card. Imagine my surprise when a package arrived in the mail yesterday, addressed to Kirby. Inside was a note and a blanket with a  matching toy, telling Kirby that they hoped the blanket would bring him comfort as he heals. It was postmarked from a woman I do not know in North Carolina. How amazing is that? Even more incredible was the fact that Kirby sniffed it all over, and then laid down on it. He usually shies away from something he hasn't seen before. It was as if he could feel the love coming from the blanket. Puppy love from 600 miles away! Maybe I'll curl up on it too - I could use some comfort right now as well.

Kirby's new blanket

Kirby Update

Kirby August 16

It's been over two weeks since Kirby had surgery to remove his tumors. Until the diagnosis of cancer, it was intended that his stitches would be removed on the 18th. Because of the type of cancer he has, the vet wanted to leave the stitches in for an additional week, so they will be removed on the 25th. Dr. M. said we could try taking the cone off to see how Kirby would do, and we removed it after dinner on the 18th. He was such a happy boy! He could finally rub his ears, and get around without running into things.

Unfortunately, it also meant he could get to the two incisions. He went and hid behind a chair and licked them until they were all red and swollen. Man, he is so much like a toddler sometimes. So the cone went back on, and it will remain in place until the vet removes it on Thursday.

Other than that, he is doing quite well. We are taking two walks a day, and could probably add back in his third now that the weather has cooled a bit. He is done with his antibiotics and his pain pills, so that just leaves giving him Benadryl. I think he will have to take those the rest of his life, but I will ask the vet about it on Thursday. His appetite is pretty much back to normal. I'm thinking that his post-surgical medications probably acted as an appetite suppressant. All in all, things are okay for now.

We celebrated our 38th wedding anniversary Friday night at Annie Gunn's with Jim's business partner and his wife. They were also celebrating special birthdays, so it was a big night. We we seated in one of their special booths that has a sliding door for privacy, and they brought us each a complimentary shot glass of sparkling moscato. It was very good. Then after dinner they gave us two pieces of warm apple pie ala mode to share, complete with a candle in them. How nice was that? The best part is that both couples had gift cards, so the entire deal only cost us $10 out of pocket. Nice!

Sunday was so gorgeous that Jim went for a motorcycle ride, and I headed off to the Missouri Botanical Garden with a friend. It was such a treat to have a day in August that began in the low sixties with even lower humidity. Here are a few of my favorite photos from the day.

Missouri Botanical Garden August 21

Stupid Cancer

Kirby June 2016

When the new vet called me late last week, I did not immediately think the worst. He was asking how Kirby was doing, and truly the dog is doing well. He bounds up and down the stairs, jumps off the couch and bed, and does not seem to be in any pain. He has adjusted to his new normal of wearing the cone of shame. The only thing that has given me a little concern is the fact that his appetite seems to be off. Fortunately he still will take a bite of ham from me, which is great as that is how I disguise the pills he has to take. And he will normally eat the hard boiled egg that he and Jim share each morning, but he has not eaten much of his dry food. I suspect that he may be playing me a little, hoping he can hold out for more ham.

But then Dr. M. mentioned that the pathology report came back, and that is when my heart dropped. I figured it was probably bad news if he was calling me himself. The report stated that Kirby has mast cell cancer. Mast cells are present in all dogs, and they help other cells get to where they need to be to fight an infection. The mast cells release histamine, which causes tissue swelling so the white cells can travel through the tissue to reach the infection. But when a dog has mast cell cancer, the amount of histamines being released can be dangerous. A tumor is formed when the mast cells reproduce out of control. Mast cell tumors are the most common form of skin cancer in dogs. Certain breeds are at increased risk to get this type of cancer, including the Boston terrier, Boxer, English Bulldog, Bullmastiff, Labrador retriever, and other bull breeds. As a cockapoo, Kirby does not fall into any of those, so it is certainly odd that he got this.

Because Dr. M. found a second tumor when operating on Kirby, and that tumor involved a lymph node, Kirby's cancer is considered a Grade II out of III, and he has been given a "guarded" prognosis. I was advised to start him on 25mg of Benadryl twice a day to help combat all the histamines that the cancer is pouring into his system. And removal of the stitches was pushed back one week as this type of tumor has a tendency to come "unzipped". When asked if this means Kirby has to wear the cone for an additional week, the vet said that was up to us. He said we can remove it and see if Kirby leaves the stitches alone. My plan is to keep it on for the full two weeks, and then remove it to see how he does. I don't want to take if off and then have to put it back on.

Dr. M. said at this point he can recommend some veterinarian cancer specialists in St. Louis if we want to go that route. I have been reading up on mast cell cancer, and it sounds as if the first six months following surgery will be crucial. If Kirby doesn't have a recurrence of the cancer in that time period, studies show that 44% of dogs survived over four years following surgery. Since he is already over ten years old, that would be a good run.

Jim & Kirby

Jim was out of town for work when I got the call, so I waited until he got back home to tell him about
Kirby. He wasn't going to be able to do anything from where he was at, and I certainly didn't want him driving home alone with this weighing on him. We both love Kirby, but Jim is number one in Kirby's eyes. They are best buds. Jim and I are on the same page as far as thinking that we'd like to meet with a specialist if only to learn what to expect with this disease. We certainly would not be in favor of doing anything that would cause Kirby unnecessary pain, or make him extremely ill for whatever time he has left with us. But if there is something that can give us more time together without hurting him, we'd like to explore the options.

Skin cancer on both me and my dog - what are the odds?

Memories, Light the Corners of My Mind...

This morning I attended a memorial service for a friend of mine, someone who was almost exactly two months younger than me. I first met Mary at the elementary school, where her son and my daughter were in the same grade. She had lost her husband when her children were 2 and 5, and despite the challenges of being a single mom, she was an active volunteer at the school. When our kids were freshmen in high school, she was diagnosed with breast cancer. She fought long and hard to beat it, and for awhile it seemed she had succeeded.

Unfortunately the cancer metastasized, and it went everywhere. But she did not give up hope, or her fight to be there for her kids. I would see her out and about when she felt well enough, and after she could no longer drive she still walked to the places and events she wanted to attend. And she kept going to our local fitness center up through November. She became the inspiration for those of us in my small group training. By God, if Mary could undergo chemotherapy and still come to work out, there was no reason for us not to be there!

She was genuinely the nicest person I have ever known - inside and out. And that was reflected in the turnout today. The church was packed with those whose lives Mary had touched. The minister encouraged us to attend a reception after the service to share our stories with the family and each other. I took the opportunity to tell her son a couple of things. I reminded him of the time my daughter invited him to her birthday party. "Yes, I was like five or six," he said. I told him I had asked his mom if it would bother him that he would be the only boy there - he was the only boy that had been invited. "Oh no," Mary said to me, "he gets invited to all the girls' parties." All the girls liked Paul. I also let him know what she meant to all of us at the recreation center. The big, burly guys that worked out when she did all rushed to see if she needed help with anything. And they all asked about her when she could no longer come in.

I will never be able to understand why someone so wonderful has to face the many challenges that Mary faced. Or why these two young people have to go through their lives without any parents. But I am grateful that she is finally without pain, and feel so blessed that I was able to know her.

Gone Too Soon

This morning my sister and I attended a memorial Mass for a woman we had met only once, some 25 years ago. Why, you ask, would we go to such a Mass? Robbie was married to our cousin, Jeff. We are originally from Cincinnati, but our family was the only one to move away. All of the aunts, uncles and cousins still reside in Cincinnati. Except for Jeff. He did a stint in St. Louis in the early 80's, which is where he met Robbie. She had grown up here, but Jeff's job took them many places over the years. Shortly before Robbie died, they had moved to Las Vegas, where they hoped to stay for quite some time. Cancer had other plans for Robbie, who battled breast cancer for the past couple of years. The cancer spread to her lungs, and at age 52 she passed away. Her wish was to be cremated, and Jeff complied with that wish. A memorial Mass was held in Cincinnati earlier this week so that Jeff's family could give their support to him, but he also wanted to have one here so that her childhood and early work friends could say good-bye. As the only family in attendance, he asked that we sit in the front pew with him. It was rough, and sitting next to Jeff I could feel him fighting his tears. The priest made a wonderful analogy during his sermon, as he was following up on the reading of how Jesus will be waiting for us to take us home. He asked us to imagine a child in the womb. If that child could talk and ask the question about what life was like on the outside, you might answer that there is a beautiful blue sky overhead. The child would have no way of understanding what a blue sky is. Or you might say that there are majestic mountains here, and again the child would have no concept of what a mountain looks like. So it is that Jesus cannot explain to you what life is like in heaven - we simply don't have the capacity to understand what it will look like. Very nicely put...

Because my sister and I didn't really know Robbie, we did okay during the service until the very end when a man went up to do a last reading. Jeff whispered to me that "now comes the hard part". What the man read was a tribute to Robbie written by Jeff. I put my arm around him as it the words expressed to all of us the depth of his love for his wife, and the tears streamed down his face and mine. The service ended with the song "On Eagle's Wings", which had also been sung at my beloved mother's funeral. Well, that was it for my sister and me. I clung tightly to her hand, and Jeff's arm embraced us both.

I'm saddened now that I did not have the opportunity to get to know this courageous, loving woman who brought such joy to those lucky enough to know her. My heart aches for my cousin who must try to rebuild his life without her. My brother also lost his wife to cancer at the age of 47, leaving him to raise three small children on his own. I understand to a certain extent what lies ahead for Jeff, though he and Robbie did not have any children. I hope the vision of Jesus walking Robbie to a better place helps him deal with a future of her no longer walking by his side.