Coffee heat rising

First-World Problems…

{grump!} How do I dare complain, growl, grump, or crab about things  like this? That is the question. Is my problem that I have to walk two miles with a pair of buckets hanging from a stick slung over my shoulders to gather water? Is my problem that we’re eating the dogs for dinner, after having run out of food? Is my problem that the water I’m about to haul back from the river contains a parasite that will cripple me and anyone who shares that fine dinner with me? Ohhhh no. No, no, no. My problem is that depositing $1344.17 worth of checks remotely took damn near 45 minutes, longer than it would have taken to make the round-trip drive to the credit union, park the car, walk across the parking lot, go inside, stand in line, and deposit the goddamn checks.

Mine is a First-World problem, no question of that.

Then I get on the phone to the Mayo, thereunto to fork over $234.45 in Medicare and Medigap reimbursements, am told the phone-tree wait will be over five minutes (horrors!), and am treated to annoying Muzak and repeated robotic announcements to the effect that it (the robot) is sorry for my inconvenience.

Really. Why AM I complaining?

The problem is, I’ve got SO many other things that need to be done today! I could have done this (pointless, overcomplicated) job faster if I’d just gotten in  my car, consumed a gallon or two of gasoline, and driven up to the credit union.

The process of uploading checks is SOOO SLOOOWWWW and SOOO FRUSTRATING that I was ready to pick up a $2,000 iMac and THROW IT ACROSS THE ROOM before all that junk got uploaded.

I don’t know if it’s the bank’s system, my router, or Cox’s notoriously slow “high-speed” internet connection — for which speed one pays extra. The iMac kept telling me it was “looking for a connection,” which usually means the connection or the router is down. Again. Up and down and up and down and up and down like a yo-yo, which has become SOP for this thing.

Don’t know whether to try a new router or to change providers.

Has anybody tried CenturyLink? They’re advertising a high-speed connection for $19.95. “Up to 40 MBPS.” That would be “40 MBPS if you’re lucky,” right? Oh, here’s the fine print: “where available.” That would mean, then, “not available wherever you happen to be.”

Cox is charging $62.99. That amount is coming out of the corporate account, because virtually all of my email and browser usage is business-related in one way or another.

But…I’m afraid that if I cancel the Internet, they’ll tell me that the phone bill is some incredible bargain because it’s “bundled” (no such thing is shown on the bill, but you can be sure they’ll pull some number like that on me) and then jack up the phone bill through the roof. And I can’t afford to have my personal land-line bill go up. Plus I have no idea whether CenturyLink is what it says it is.

Ohhhhh….waitaminit. Yelp is awash in complaints from unhappy CenturyLink customers. And helle’s belle’s, over at CityData.com, we’re reminded that CenturyLink is actually Qworst by a newer name. And over here at ConsumerAffairs.com, here are the “Top 1,119 Complaints about CenturyLink“! Qwest, the Master of Customer Disservice...

Ugh. That flyer goes in the trash.

Welp, I guess I’ll have to try a new router first and then, failing that, try to get Cox to choke up a new modem…mine is six years old and may need to be updated.

Terminal senility…or drug-induced brain fuzz?

A friend on the choir cleared up a little mystery that’s been lurking around for a while. She’s a pharmacist — has been for some decades.

She, having observed that recently I’ve been even more bat-brained than usual, remarked the drug anaesthesiologists use to knock you out causes a kind of brain fog that can last upwards of a month. Hmmm…

The Mayo’s nurses tell you not to sign any legal documents for a day or two after the surgery on the theory that you may feel confused for 24 to 48 hours. But my pharmacist friend says to extend that to several days, and not to be surprised if you can’t remember where you left your fingers for several weeks.

Insight!

That explains a lot. Since the current surgical marathon has been going  on, I’ve become as scatterbrained as Lucille Ball! I cannot remember ANYTHING. Every day I lose something, I make wrong turns, thinking I’m turning into the neighborhood but ending up in the one to the south. And I’m constantly making weird little ditzy mistakes.

She says that’s the long-term effect of the anesthetic. She advised being careful not to leave the kitchen when you’ve got a pan on the heat, and not to get upset when these little glitches happen. And also to be extra careful while driving.

LOL! The other day I had a 7 a.m. meeting in Scottsdale and a 9:30 a.m. in northwest Phoenix, way on the other side of the Valley. (The “Valley” is larger than the city of Los Angeles, which should give you an idea of what that means.) I wanted to let the dogs out between them so as to have less mess to clean up after getting back from the second meeting.

So around 8:50 I come flying in the door, rocket to the bedroom and let the pup out of her crate, shovel the two dogs into the backyard, stash my computer in the car for the 9:30 meeting and haul the stuff from the 7:00 meeting and dump it in the office, lock the dogs into the backyard with the dog door open and the bedroom door to the dog-door room closed (more mess prevention), fly back out the door, leap into the Dog Chariot, charge out of the garage, get about a half block down the road and think…hey! WHERE’S MY PURSE?

Well, it’s not in the car.

Back to the house.

Not in the kitchen. Not in my office. Not in the living room. Not in the dining room. Not on the bedroom bureau. Not even in the bathroom! Helle’s Belles! I figure I’ve left it at the restaurant.

Now I’m frantic — the Scottsdale restaurant where my bidness group meets on Thursday mornings is a half-hour drive away! And my entire life is in that thing. And it’s a breakfast joint — closes in the early afternoon. The other place I have to be is a half-hour in the other direction.

Grab the phone, look up the place’s phone number, dial it, and pace anxiously around the house waiting for someone to pick up the phone. That’s when I see an odd black mass sitting on the bed.

A short, fat zombie?

No.

I’d dropped my purse on the bed when I shot in to let the puppy out of her crate. And completely spaced it. Never would even have begun to think of looking on the bed for it. Nor would I normally drop a purse on the bed anyway.

For the past ten years or so, I’ve been deep enough into my dotage that I can’t find things unless I put them down in the same place all the time. But over the past more recent while, what with four procedures in five months, it’s gotten much more ridiculous. 😀

Cotta2Last weekend in some kind of a hurry, I took off my choir robe and cotta and tossed them on a chair in the choir room, and flew out to do something — don’t even recall what (because of course I can’t remember my name longer than about an hour these days). When I got back, someone had taken the robe and left the cotta (or at least so i think). So I get a substitute from the store of new ones. I become so preoccupied with this that I don’t realize I’m supposed to be wearing the brightly colored chant choir robe, because chant choir is singing the introit. So I throw on my white cotta and, late as usual, run to join the others at the front of the sanctuary (oh, yes…where ELSE?). Naturally, I’m the only one up there who doesn’t match. And the communications director is shooting photos. I try to hide in the back row, no doubt ineffectually.

As if that weren’t enough, shortly I manage to lose one of the church’s music books — these are lent to choir members, assigned by numbers. Between last week’s rehearsal and this morning, I search the house, I search the car, I rack my brain. Finally realize I probably left it in the choir loft (or maybe in the choir room) (or who knows where?). But since it’s nowhere to be found, I figure I’ll be purchasing and donating a new music book. Hmm… £13.95. That would be $21.92. Plus shipping.

Fortunately, the choir director found it and put it aside. Saved!

People say things in meetings. I can’t remember what was said. I don’t even remember that something was said. I write and distribute a report that makes it obvious I haven’t a clue.

I say I’ll do things. And have no memory of saying I’d do those things.

I show up at choir practice late because I’m so engrossed in grading papers I lose track of the time.

I go off and leave the space heater on.

Have you noticed that as you get older, it takes you longer to get out of the house? That you’re always running late because you’re bloody never ready to go???

That’s not a function of the drug-induced brain fuzz, but it certainly has been aggravated of late.

I started trying to figure out why it takes so long to get out the door now that I’m old, given that I never had this problem as a young pup. What has changed?

What, indeed.

  1. Computers. Back in the good old days, one didn’t fill the first moments (and the next moments, and the next moments…)  of the morning with e-mail. Now every day starts with a check of e-mail, replies, maybe another check for replies to replies.
  2. Makeup. When I was young and pretty, I didn’t need to paint my face quite so artfully. Yea verily, I didn’t really need to paint my face at all, and often didn’t. Now a good, thick layer is required to cover the brown spots and fill in the wrinkles.
  3. Lost stuff. A lost purse. A lost file. A lost list. A lost whatever.
  4. Liquids. I never used to carry a cup of water with me every where I go. Not a chance. I never fixed coffee before leaving the house so’s to pour a mugful and stash it in the car. If I wanted coffee, I bought it en route, usually at a nearby Dunkin’ Donuts, now defunct. Now I’ve taken it into my head that the car can’t leave the garage unless it’s stocked with something to drink.
  5. Locked office door. Whatever I’ve remembered that I forgot, it’s always on the other side of the goddamn deadbolt on the office.
  6. Dogs. In the olden days, dogs did not shit all over the goddamn floor. Therefore, the household livestock did not have to be wrangled into pens or herded outdoors before the human could leave the house. One could simply close the door behind one and lock it, leaving the dog inside to snooze undisturbed until one returned.
  7. Dog food. Before the melamine flap and the offshoring of everything, including dog food, to China, I fed the dogs kibble. It took all of 10 seconds to dish up a bowlful. Now I have to fiddle around with measuring out eight ounces to each dog from packages of freshly made concoctions and then storing the remainder back in the fridge.
  8. Dog competition. Dogs of yore did not try to steal each others’ food; therefore one of the dogs did not have to be tied to the oven door to keep her from chasing her betters away from their dog-food dishes…
  9. Space heaters. Back in the day, one could afford to pay to run the central heating.

So it goes.

The whiteboards with the calendars and space for daily to-do lists help a lot, especially the one that’s now installed on the back door. Lately I’ve been trying to organize stuff a day or two in advance and load it into the car, making it harder to forget things and cutting the last-minute thrash-around factor. I try to remember to put everything back in its accustomed spot (if something isn’t where I expect to find it, I’m not gonna find it). I’ve quit carrying water, tea, or coffee in the vehicle. I make lists, in hopes of not forgetting something important. But I can’t second-guess what I’m going to forget.

 Got any ideas? What do you do to avoid losing things, forgetting things, muffing things, and chronically running late?

Another Day in Dystopia

So what are we to make of lynch mob by media?

A police officer shoots an unarmed young man. One is White — the cop. And one is Black — the civilian. From there, the facts elide into contradiction, gossip, and ambiguity. The case is referred to a grand jury, and as jurors deliberate, news media predict mayhem. The President of the United States weighs in.

Nay. The news and social media urged mayhem. Reported pre-mayhem. Smelled blood in the air. Prayed for mayhem to sell papers (and website ads). Lordie!

Now we learn the grand jurors couldn’t discern enough evidence to decide, clearly and incontrovertibly, what actually happened during those violent moments. They decline to indict.

Doesn’t matter. The eighteen-year-old is in the ground. The cop has already been tried and convicted in the Court of Public Opinion, a.k.a. the Kangaroo Court of the Media.

As for due process?  Casualty of hysteria. Victim of circumstances. Lost and gone, maybe forever. Echo of the past. Wave of the future.

Plus ça change…

Boob Update: Back, Forth, and Back Again

Okay, so WonderSurgeon is at last convinced, and so am I, that the best thing to do is to have the boob OFF, and better yet, to get them both off so as to bring a stop to concerns about the other breast and so I don’t have to spend the rest of my life lopsided.

It’s taken a while to get to this point.

Last week (was it only last week?) I went in to see the radiation oncologist. By then WonderSurgeon and I had decided to keep the boob and do radiation and aromatase inhibitors. This new doctor, though, said she would do it but that the chance of recurrence was high and that the side effects I’ve heard about are real. Among them, she said, I will have scarring of the lower lobe of the right lung, which may lead to pneumonitis, which can be life-threatening. Aromatase inhibitors are not yet approved by the FDA for preventive treatment of DCIS, and so they would prescribe tamoxifen, which I have no intention of taking. She remarked in passing that if it were her, she’d have the mastectomy.

So by the time I saw WonderSurgeon, I’d changed my mind in favor of chopping off the boob. Even though I was very certain that I wanted a mastectomy, she wasn’t so sure. She felt there’s a possibility there’s no more abnormal cells in the breast, in which case it would be unnecessary surgery to remove the boob. Between the two of us, the uncertainty factor was enough to give us pause. We decided that she would order an MRI of the guilty boob, slated for next week: if any more mass appears on that, then we would amputate; if not, then we would try radiation and hormone treatment. Neither of us was thrilled with this scheme, but neither of us knew for sure which way to jump.

Well, yesterday she called me up with a new report:

Still worried, she had taken my endlessly troublesome case BACK to her colleagues for another conference. First she asked the pathologist to revisit the samples she had excised and to analyze the results more carefully. Then she asked them for their opinion. And, she said, she was careful to keep her mouth shut and just listen to them.

The consensus, she said, was overwhelmingly in favor of removing the offending boob.

Well, I was relieved.

You know how when you’re worrying about something or thinking about some major project, you’ll wake up in the middle of the night with your brain spinning on it — with no hiatus between awaking and starting to think on the issue? Well, that happened a two or three nights ago. I woke up about 4 in the morning with a perfectly formed thought in mind: Trying to save this breast is the wrong thing to do!

It seemed as perfectly obvious as the dogs sleeping on the bed next to me. I do not want my chest irradiated. I do not want my lung scarred. I do not want pneumonitis, for godsake. I do not want to run the risk of fractured ribs, new soft-tissue cancers, leukemia, and some blood disorder whose name I can’t even pronounce. I do not want my life disrupted for another four to six weeks with daily trips to the hospital for radiation treatments. I do not want to take aromatase inhibitors that will thin my hair and give me joint and muscle pains on top of the nearly crippling back pain, thank you very much. And I most certainly do not want to take tamoxifen!

Furthermore, I do not want to wait five or ten years until a new DCIS, probably harmless, is found in the other breast and then I have to go through this entire nightmare circus again! I do not want to go around lopsided, having to stuff plastic or fabric prostheses in an empty bra cup in an attempt to look normal enough not to frighten small children. And I do not care whether I have blobs of flesh hanging off my chest, because I’m not a young girl anymore and I’m not in the market for a man.

At four a.m., I could not think of how to tell WonderSurgeon about this revelation without making her think I’m crazy. So I decided to wait until the MRI revealed more mystery tissue in there, which I felt pretty sure would be the case. If it didn’t, then I’d cross that bridge when I got to it.

So, weirdly, her call to deliver what she thought would be received as bad news was really very good news.

I told her that I had quietly come to the same conclusion. She sounded relieved that I didn’t burst into tears or some such stupid thing. Then I asked if she would take both boobs off, so as I could be the same on both sides and so we could be certain that no recurrence would appear in the contralateral (medico-talk for “the other”) breast. She agreed to do so. And she even folded on the “no goddamn reconstruction” topic.

We’re keeping the MRI on the schedule, but instead examining the contralateral boob so as to see whether there’s any DCIS in there. She said there was only about a 3% chance that would be so. I reminded her that every time we’ve had positive odds, I’ve managed to defy them. Pessimists drive the poor woman nuts. 😀

Do you realize what this means?

No. more. effing. mammograms. EVER AGAIN!

And….this is the best part…

I will never, ever have to shop for a goddamn brassiere again!!!!!!!!!

WAHOOOO!

Decision Taken — At Last!

Blew the entire darned morning at the Mayo today, talking with a new radiation oncologist. I must say, she was very impressive — almost as impressive as WonderSurgeon.

She said it was within the realm of possibility to treat the boob with radiation and aromatase inhibitors. However, said she: “If it were me, I’d choose a mastectomy.”

Once again the decision is up to me. And the truth is, I’d just as soon have it off. Apparently WonderSurgeon has the idea that I’d prefer to keep the boob come what may. That’s not at all true.

I’ve been ambivalent to the ultimate degree of ambivalence. On the one hand, I would very much like NOT to have any more surgery. I do not want reconstruction because that looks like an invitation to more complications and more surgery; if we’re going to do this, I’d like to keep it as simple as possible and just effin’ get it over with. On the other, if mastectomy is not really necessary, naturally I’d just as soon keep my body intact. Especially now that WonderSurgeon magically restored the diseased boob to its former splendor…or even better.

And, as our venerable reader George likes to say, “on the other paw…” I’d just as soon do without radiation therapy and five years on a drug with potentially baleful side effects.

The choices are these:

a) leave the boob on, subject yourself to a course of radiation whose worst side effects will start to surface nine years from now and can continue to arise over the next thirty years, plus five years on an unpleasant drug, and still run the risk of invasive cancer; or
b) remove the boob, reduce the risk of invasive cancer to something under 1 percent, and moot the dangerous therapies.

I mean, really: which of these makes sense?

Yup…the answer is behind Door B.

Asked her about the potential side effects of the radiation treatment she proposed…

Bone damage? Not so much with modern treatments: an occasional fractured rib
Soft-tissue cancers? Definitely a potential
Lung cancer? Probably not; again, much less probability with newer technology
Lung damage? Scarring in a small part of a lower lobe. This can lead to pneumonitis, which is usually minor but can become life-threatening. It is treated with massive doses of Prednisone.
Lymphedema? Low risk
Fibrosis? Low risk
Hypothyroidism? Didn’t get a comment
Brachial plexopathy? Not so much
Leukemia or myelodysplastic syndrome? Very low incidence

Translations: any of these things is a possibility, although most of them pose fairly low risk.

Pneumonitis and new cancers are probably the most likely of the unpleasant side effects. I’ve had prednisone, in very low doses…and I do NOT want any more of it, thank you. Its aftereffects appear weeks or months after you’ve taken it, and they’re very unpleasant, indeed. I wouldn’t take it unless I were at risk of dying, and I wouldn’t put myself at that risk for the sake of keeping a boob hanging on my chest.

And one “not-a-cancer” has been quite traumatic enough, thank you. Don’t think I need to enjoy a real cancer sometime — anytime — in the future.

This has been going since last June! My life has been turned upside down; everything I’d planned to do business-wise and personally has been disrupted, it’s drained my checking account, the whole thing has me teetering on the edge of stark-raving-CRAZY, and I WANT IT TO STOP!

If chopping off the boob will make is stop, by all means let’s get on with it at the earliest possible moment.

For the nonce, though, I have to get back to work.

Later! 🙂

A Discovery(!) and an Insight(?)

Okay, so late Friday, the St. Joe’s oncologist called me back and listened to my sadly puzzled story about the ambiguities incidental to the latest boob surgery. I told him that Dr. P (aka WonderSurgeon) thinks the Mayo’s staff might consider radiation and tamoxifen despite her considered opinion that the 2014 standards for “clear” margins don’t suffice.

He said, “I don’t think you should take tamoxifen. There’s a better alternative for older women.” Turns out that if you’re post-menopausal, aromatase inhibitors work better at preventing recurrences in the guilty boob, are more effective at suppressing new growths in the other boob, and  have fewer dangerous side effects.

Tamoxifen is a dangerous drug. It has some very nasty side effects. Aromatase inhibitors also cause some conditions you’d prefer not to have, but fewer of ’em. Videlicet:

SideEffects

None of these are anything you would willingly bring on yourself. But then, neither is invasive breast cancer…

I’ve already got osteoporosis and don’t need a drug to make it worse. To control this effect, you have to take Drano In A Pill, aka Fosamax. It also has nasty side effects, one of them is to eat into your gut. Doesn’t that sound jolly?

With the bone thinning, I take my chances rather than taking that stuff.

So: aromatase inhibitors… My hair, which has yet to turn gray, is damned spectacular and I do not relish “thinning.” I keep the high blood pressure under control with exercise and weight maintenance, and I do not care to take a drug that will aggravate that issue and that has been shown to make me sick. I have plenty of joint pain, thank you very much, and do not need more. As for depression: well, creative types are prone to depression, and since I’m already iffy enough about riding this train to the end of the line or jumping off a bit early, it probably would be unwise to swallow a drug known to aggravate that tendency.

And tamoxifen… Holy God! Stroke? Deep vein thrombosis? Blood clots in the lung? I heard about one woman who got a blood clot on the outside of her chest — they  had to remove a rib to treat it. Uterine cancer? A dear friend of mine who was on tamoxifen had to have a hysterectomy to deal with that. Vaginal bleeding? Honest to God, I would rather die than have periods or period-like bleeding come back on me! And that is not an exaggeration.

I’ve highlighted the so-called “rare” side effects in gray. But experience has shown — consistently — that if a drug has a “rare” side effect, that is the one I’ll get. So we need not speculate that one or more of these will crop up during the five years I’ll be required to take the stuff . We know it.

So, OK. I made a discovery: there’s an alternative to tamoxifen and it is more effective in older women. It has fewer effects that are likely to be fatal. The commoner side effects appear to be even less desirable than the common side effects of Tamoxifen. Its uncommon side effects appear to be significantly less horrifying than Tamoxifen’s.

Ducky.

And over the weekend, as I was thinking about this nightmare tangle of decision-making, it occurred to me that a woman who has been told she needs treatment for DCIS after a lumpectomy has two choices and only two, with no middle ground. You can do one of two things:

a) Subject yourself to radiation treatment that has the potential for ugly, potentially fatal long-term effects, and then spend five years swallowing a drug that has side effects that may kill or cripple you; or

b) Have a mastectomy.

Doctors rarely tell women that breast radiation therapy  has effects than can crop up as long as thirty years later.  Among these are leukemia, myelodysplastic syndrome, new cancers, hypothyroidism, bone damage, lung damage, heart damage, lymphedema, restricted arm and shoulder movement, and permanent discomfort to the affected breast.

Mastectomy, as unpleasant as that prospect may be, would solve the problem. All of these matters are obviated by mastectomy, because with no cancer-prone breast tissue left, you are no longer eligible for either radiation or hormone therapy.

As far as I can tell, there’s no in-between. For example, I am no longer a candidate for radiation alone. And apparently no one suggests hormone therapy alone.

So here’s what it boils down to:

For a woman to keep a blob of damaged flesh attached to her chest, she has to accept a panoply of risks from radiation and drug therapy all of which are unpleasant and some of which are life-threatening.

Frankly, when you look hard at these issues, they make mastectomy look damn good. In fact, if I can get Dr. P to come up with some excuses to convince Medicare it’s medically necessary (the chance of new DCIS arising in the second boob is higher after it appears in the first boob, and radiation therapy increases the occurrence of new  lesions in the other breast), I may ask her to lob them both off.