Break even

Well, another week of medical tests are behind me.  I celebrated with a trip to Bentsen to see the Ruddy Ground Dove above. Thanks to Roy and Bianca for arranging access for me!  

My CT on Monday showed no change in the tumors, while on Wednesday scales before the port flush showed my weight back up to the highest level I’ve been all year. I’ve been feeling pretty good with the odd morning where I felt nauseous. Still, no increase in tumor size is great news in these COVID times.  

So we will maintain the status quo with hormone blockers and blood thinners and add in another anti-cancer drug.  It still sounds unusual to have the positive results from the current treatment and we are going to double down and try another drug in conjunction while I’m trying to avoid hospital visits.  I’m hoping that it takes less than four calls to find out if and when they sent the prescription in. It’s likely my usual pharmacy can’t handle it but I don’t know where they will send it. 

So Happy Thanksgiving, stay home, and wear a mask. That’s what I’m doing. 

Long slow October

It's been a long slow October.  Not much going on health wise.  The heat here finally broke and the cooler temps have me feeling better.  I did an all day big day as part of the Great Texas Birding Classic dispersed team.  It was fun and frustrating as these things usually are.  Thanks to everyone who helped me out, starting with Marianna and Luciano at the National Butterfly Center and Javier and John at Estero Llano Grande State Park.  

I finally realized they never called me about my appointments for November so I called oncology.  The Doctor appointment was scheduled, but the CT not yet (though I got four letters of approval from the insurance reviewer).  Got that scheduled with their default, which I will likely have to change.   

Lots of work on the Rio Grande Valley Birding Festival and the Spring Chirp though both were cancelled this year.  The RGVBF is going virtual and I'm doing my best to make that happen.  

Successful vet visit a couple weeks ago though I got overheated trying to catch the farm owners horses.  She forgot it was float day.  Juan saved the day and caught the reluctant mares.  I still cringe from seeing the damage my old horse Dickens had happen to his teeth when he fought the speculum, so I make a point to not miss the day.  Dickens is long gone (never forgotten) but Storm and Dreamer have their own issues.  All went well, but I do worry about them more than I used to because of Dickens. Yay, all over but the bill.   

In my mind the tumor is growing.  I hope not!  I had gained weight last port flush so am cutting back on bingeing (or I'm trying to cut back).   

Reprieve!

Well, things are yet to be scheduled but it sounds like as long as everything stays constant I won't have a medical test or appointment (other than the port flush, which hardly seems to count these days) until mid November.  Blood work from a couple weeks ago stays the same, all normal and a very slightly elevated cancer marker (down from way way WAY high).  We went over the results of the ultrasound again, partial occlusion in two blood vessels but no total occlusion, definitely an improvement from the CT scan in early August.  I'm on blood thinners for the long haul.  

We've had some nice breaks in the heat and humidity, earlier than normal and cooler than normal.  It's been a wet fall and that shows no signs of changing.  All in all so far a nice fall. 

Test and retest

Well I made it back to work last week, working about two and a half days.  The heat is still a problem but I am mostly sitting in my car with the AC on.  Hard on the engine, easy on the body.  Still, ten hours is a long day.  This week I made almost full time in three and a half days.  I am looking forward to the weekend!  

I seem to be past the worst of the fuzzy headed side effects from the new meds. Friday's ultrasound showed reduced clots but some still present in smaller arteries.  At least they're gone from the jugular and other nasty places.  I'll find out what the doctor wants to do in a couple weeks, for now stay on the blood thinners for sure and maybe retest sooner rather than later.  I may still have to have the port removed, but I'd rather not expose myself to the number of humans in the hospital.  Covid19 is still severe here.  

I braved the mall and got the battery in my phone replaced.  I haven't been in that mall in years!  The phone is working great now, and I can actually go for hours without having it plugged in.  Before it would turn off every time it lost charge, and most of the time I had to warm it up on a heating pad or on the dashboard to get it to charge and turn on.  I'm glad I saved it from the landfill, and postponed getting a new one until 5G. There's still the question of whether to stay iPhone or switch with the next phone.  I have mixed feelings, not as bad now with the iPad. I can keep those Apple only apps.  

As the new job site develops I'll have to do more walking, for now it's not too bad but the site is rough.  I hope it doesn't rain!  We were fortunate to have Hurricanes Marco and Laura miss us by hundreds of miles.  

Anticipation and Frustration, August 2020

 I know I’ve talked before about the agony of waiting for test results. I had a CT last week and then had eight days waiting for results.  Somehow the weekend is worse, less going on work-wise and more time to ponder. 

Last week I went out to a field site and quickly overheated.  The first time out of the truck I forgot my cooling towel and the second I forgot my water. I ended up having to go sit in the truck in the AC.  As much as I’m feeling ok in the new normal, theoretical exercise is much easier than actual exercise(!). 

The mosquitos have been HUNGRY    I went to a local refuge with a researcher and fed them.  Bug spray kept them off until you let up on the button.  They were ferocious.  That's Hurricane Hannas lasting present.   I had a few branches lost to the hurricane, hungry skeeters, and lawn growing WAY WAY too fast.  

_______________________________________________

So my CT scan showed continued reduction (though slow) of the tumors (yay), and a blood clot (boo).  One of the drugs I was on is a risk factor for blood clots, as is the chemo port, and the tumors, so that is a triple threat for blood clots.  One of those things is readily controllable, and I have to stop the hormone therapy drugs that were working.  If not for the COVID we'd probably remove the port, but we'll wait for COVID to be less pressing before removing the port unless the blood clots persist.  Going forward we're switching to another hormone therapy and adding in a blood thinner as soon as they get the prescriptions in.  There's a chance we could go back to these drugs that worked in the future, but I have to be off them for several months.  There is optimism that I will have good results with the other drugs as well.  The nodes in the lungs are stable, that was the big worry and the reason for the quicker CT scan.  

Blood work continues to be good.  

That's the news, such as it is.   

I made it!

For a while there while going through the scary cancer diagnosis and initial treatment I wasn't sure I was going to make my 60th birthday, and then for a while I was sick enough I was scared I would.  I am feeling good now (60 does beat the alternative) and am working on stamina and energy which are still lagging.

I failed completely on my twin quests or goals, to see 800 ABA species before I hit 60, and to see 800 species in Mexico.  The ABA area is basically the USA and Canada.  I came close on both, but the twin problems of being sick and not feeling up to travel, and more recently issues with COVID 19 restricting travel kept me from making those personal goals.  Maybe I'll just re-up them for 65, we'll see.  I have made it without chasing ABA birds for several years and I want to travel elsewhere in the world, so many places to go, so many birds to see.

I even missed a potential first US record located about 40 minutes away this week.  I would have been crushed, but now I’m disappointed and no more.  I must be getting older.

I had a good day on my birthday, dipping on the Blue-and-white Swallow in the morning but visiting with good friends.  Lunch at home was followed by a lavish birthday dinner.  Food is important and my appetite is a little too good.

Hurricane Hanna came in and brought more rain and wind than forecast.  I had some damage to an non-native columnar cactus, now to get rid of it completely.  It's a good week for county listers, with coastal birds moved inland with the storm.

No news is no news (neither good nor bad)

June was busy with a tree rubbing my electric line causing me to be without power overnight.  After far too heavy pruning of trees in June and AEP splicing the line all is good for now.  Still issues with my car and my phone, and I need to schedule my AC guy who wants to check for leaks (and keep me cool).  Anything requiring action is stressful to me.  I can't explain why I'm so anxious about this crap, I just am.

Another month to the next CT to see what's going on with the nodules in my lungs as well as the tumors.  I still feel pretty good though I got seriously overheated walking in the sun yesterday.  I did get the lawn mowed without stopping today, haven't done that in a while.  Usually I take a lawn chair and sit part way through, but I made it all the way for my tiny front lawn.

Almost time for another grocery run.  Overdue for another stab at car issue diagnosis.  And I really should get a new battery in the phone after another day without it charging.  But it's easier to do nothing.  So that's what I do.

Stay tuned, no news is just no news.  COVID is taking off in the LRGV, and I'm not, I'm staying home and wearing my mask.  I get out to nearby nature sites and I should get out to the horses (but it's so hot)…

Shrinkage....

Well, I like this telephone appointment thing except when I'm having trouble understanding the doctor (Doctor #9).  He has a heavy accent, and we both have background noises to contend with.  But we got it done.  I'm happy to not be in the waiting room for hours!

The CT shows mixed results.  Both tumors are less dense according to the radiologist, with the abdominal tumor (the one that doesn't matter) shrinking in size (a very little) as well.  Less dense is a good thing.  The peritoneal nodules seem to be reduced or smaller.  But some nodules have grown.

Blood work was not nearly normal, it was freaking normal including the cancer marker.

So overall I'm happy.  We'll retest sooner and see what's up with the nodules that grew, are they still at it or not.  

Other than that it's all about the same.  It's hot.  I melt.  The birds here are pretty stock model, Arizona is racking up the rarities though!  I love having a Clay-colored Thrush singing in the yard every day, and some other resident or summer birds drift through as well.

Bird on.

And finally some migration birding!

Thanks to LP at Estero for taking me out in a tram on two days.  I saw more warblers than in the previous weeks at home.  Neither day was gangbusters, but had some nice birds.  My winter Texan friends have all migrated now, though some are still melting in place as new year-round Texans.  

Events including the Simonis reunion and the Rio Grande Valley Birding Festival are cancelled in 2020.  This is the new normal, cancel everything.  I would rather have an event cancelled than have to be too close to someone not wearing a mask.  When did that become scarier than someone wearing a mask?  A lot of the people on construction crews are wearing full masks with total neck coverage, like an overgrown buff.  

As part of my feeling more chipper I went out to see the horses last week.  It's been months.  They haven't forgotten that I'm the keeper of the carrots.  They also haven't finished shedding out, poor girls!  

Not much new or different.  Thanks for keeping tabs on me.  

Meanwhile, back on the ranch....

As I said in my last post I'm feeling better, more chipper and at least theoretically energetic.  The blood work shows a vast improvement, with most levels at or at least closer to normal.  That includes the cancer marker test, which is the lowest I've ever had.   Excellent!  We're going to keep on with the current pills (no IVs) and see how we are doing COVID and blood work wise at the end of next month.  And I'm sure there will be a CT scan in my future.  

I got to go to a private ranch again today, and though the birds were slow to come in initially (rain and lightning before sunrise) they were entertaining as always.  Bird of the Day though was a beautiful snake, two came into the blind making almost no disturbance (where were you Green Jays?).  Things really heated up later in our stay, with a quail and turkey invasion among the flocks and flocks of Northern Cardinal and Green Jays.  It's so peaceful to just go sit in a blind and see what comes in - of course my host was great at keeping food in front of the birds, if artfully hidden for her pics!  

Another couple or three weeks in isolation.

So I’m definitely feeling ok but still having allergy issues.  I’m back on drug A after two weeks on Drug B with no issues.  I have blood work and a doctor visit (or call) week, but I’m expecting we will let it all ride another month as we hope to get back to the next normal.

I normally work a few hours on Tuesday and Wednesday mornings, with no human interaction beyond one paperwork handoff.  I was invited to see a new private ranch (new to me, the ranch has been there a long time).  This photo ranch is closed for the month.  One of the guides invited me to visit, and it was a glorious day.  Nice cool weather  helped, but peacefully sitting and watching birds come to the photo pond was very relaxing.

Unfortunately I found that my car was vandalized the night before.  It must have happened at home in my driveway which doesn’t make me comfortable.  They took a hammer to my wheel well and a punch of some sort to my license plate.  Last week I found my front plate sticking way out as though someone tried to pull it off, and the same plate had several holes punches in it.  Kids I suspect but I am not happy about it and feel violated.

That's about it for now.  I slept throught he night the last two nights, for the first time in months.  I feel pretty good but wilt in the humidity.  I am still having trouble mentally with starting projects.  Once started I can complete them but starting is hard, procrastinating wins.   Getting harder to blame the chemo drugs for that.

If it wasn't cancelled the Weslaco Spring Chirp Birding Festival would be this week.  We made the right decision.

Life in CoVid Times

My Doctors appointment with Dr 8f/9 was changed from an office visit to a phone call, or to be accurate, three phone calls.  There was the phone call for billing and registration, the call with the Doctor, and the call to schedule the next appointment.   Still all in all it was worth not driving to Edinburg.  And of course it was a lot easier to maintain social distancing!   I’m feeling better still though my blood work is a mixed bag but generally a little better.   We’re going to maintain the course for a month and recheck.

I got a good load of groceries from Walmart pickup again.   Still no TP, can’t even pretend to put it in the virtual cart, but almost everything else turned up or was acceptably substituted.  3.5 rolls to go before I get worried.  The black grapes from Peru that were substituted are delicious, but very oddly shaped, like long skinny grapes.  They're very sweet and it's a joy to have fruit again.

The hot weather is keeping me down, it’s been nearly 100 most days.  One project has been cancelled (and rightly so) and another is on slowdown, right after I get started on it.  Oh well!   No one has a crystal ball for post-CoVid.  I’m still doing some construction work which involves birding but not human contact.

I'm always looking for streaming options, send suggestions to me at my email or FB messenger.  I'm staying home and looking for distractions, as are most people!

One Year in, Looking Back

My first chemo treatment was 3/21/2019.  I have been through three drugs with little to no results, positive or negative.  There is no end in sight to treatment.

I have been fighting a bug that has been elevating my white blood counts, resulting in many blood tests.  I will get the latest results next week.  I am feeling better and seem to be good on Drug A.  I'm currently on oral therapy and switching from Drug A to B every two weeks.  Drug B was a real downer last week, but either it was  something else (elevated white count) or I'll be down again in a week.

I got a bill from the hospital for services rendered in September 2018.  Yes, a year and a half ago.  Fortunately my share was small.  And in paying that one, I found a bill in the system that I haven't seen a hard copy of yet, that isn't in the online system but is dated 01/01/2020 for treatment date.  I can tell you that there wasn't any treatment going on that date.   I can't get answers until next week when they come back to work.

I continue to stay isolated and try to get essentials by pick up at Walmart.  My last order was missing 2/3 of the stuff due to out of stock, but it was nice to get some staples.  I have another order in the end of the month at a local grocery store, earliest date I could get there.  And Amazon continues to deliver some supplies.  I don't go into stores, mostly because it exhausts me too much to shop.  When I could get a perfect storm of a close parking spot and an electric cart (necessary if it was a super store) I could shop, but that doesn't happen any more.

I'm grateful to the gift of Audible, which is helping me sleep now.  It's easy to fall asleep to a book and restart it the next night to the last place I remember.  Thank you Laurie.  And I'm grateful to the gremlin that texted me after doing a hit and run on my porch, dropping off homemade pickled beets (a favorite) and a massive cookie.  My appetite remains low but treats like these make eating easier.

Bad news is that the cancer marker blood test was much MUCH higher than it's ever been last time we checked.  It was rechecked this week but we will likely have to add in a chemo drug if it stays high.  We can't do that if the white count is still high.  Trade-offs.

It's been more of a vertical drop than a roller coaster ride this year.  I started out not getting a port, but had to get one for the second round of chemo with a very caustic drug.  I continue to be disappointed in how little the port is used for CTs, blood tests, or injections.  Even though we aren't using it for anything now it still needs flushing every 6 weeks.  I have been able to get some lidocaine salve to kill the nerve endings, as accessing the port can be more painful than a regular blood test, especially when it's used frequently.  

And then there's the coronavirus.  There has been virtually no testing in south Texas, so of course there have been virtually no cases detected. Funny how that works.  We are finally hearing about tests going in so we may get a better picture in a few weeks.  I have been doing social distancing for MONTHS and continue to do so.  It's a scary time, please be smart.

Still not right even by recent standards.

I switched drugs after two weeks and had fever, nausea, and exhaustion on the new drug.  I went through a period of violent nausea and ended up with floaters only visible in my low light vision.  I finally got some blood work done Wednesday and met a new Dr (8x or 9?) on Thursday.  My blood work was out of whack so we ended up doing more blood work Thursday (9 tests).  The good news is my hemoglobin recovered a whole point, taking me from marginal (Dr considering transfusion) to fine, this over one day.  Other things stayed out of whack so we're repeating in a week.  The rest aren't back yet.

In the meanwhile I still feel out of energy and at time nauseous.  I'll start back on the first drug tomorrow.  I'm tired and cranky, and appreciate being left alone now.  I'm not up for social interaction.  Thanks.

Fortnight

The last two weeks were the first on the new drug regime - alternating drugs for 2 weeks at a time.  All drugs are oral.  Quite a difference.

So it's five weeks since the last chemo, and I was hoping for more energy as time passes.  I still pant when I walk any distance, and overheat quickly.  And it's getting hotter more regularly here.

Two weeks on Drug 1 with no obvious side effects.  I still had occasional nausea and I still didn't sleep well, though both seemed to improve with time passing from the last chemo treatment.  Two days on Drug 2 and no obvious changes.  That's all good.

I did drive up to see the White Wagtail in Austin yesterday, something like 11 hours driving for an hours birding before I decided to turn around and head home.  Was it worth it?  Um.  I wish I'd been up to carrying both my scope and the chair, but I had to elect one and that was the chair.  The flyby was great, but I couldn't get others on it because I was sitting and they were standing and the perspectives were too far off.  It was a new ABA bird, so one more closer to my 60th birthday target.  I may make it yet.  

Two weeks to the next blood check and Drs appointment.  There won't be a lot of news until then.

Three strikes

The CT on Monday was uneventful. It's so much easier to go to the Mission office where the tech Mark is on time, efficient and pleasant.  I did get a massive bruise on my hand from the IV.  The Mission offices have lab services and scans, and although parking can be a pain (walking more so) it's a good 20 minutes closer than the main hospital.

Tuesday I had a nice morning on the river (minus the drizzle that wasn’t in the forecast), and Wednesday I did a little field work nearby.

The usual anxiety about unseen test results hit on Thursday.  It only took two calls to the nurse and one to my cancer advocate to pry the results of the CT out of them before Friday’s Dr appt.  If the Dr said I couldn't have the results then I would have had to go to medical records, which I have done before.

Fever every day and still some nausea but other than shortness of breath I feel ok.

The CT showed no change, like the last several scans.  The good news is the tumors didn't grow, the bad news is they didn't shrink either.  So that's three strikes for my former Dr 7, three chemo regimes that had basically no effect.  Onwards.

I really enjoyed meeting Dr 8(d), who had much the same plan as Dr 8(c).  I like agreement.  We are going forward with the next new plan.  I learned it was Dr 8(d)s last day as a temporary oncologist at DHR, but only after my appointment.  It's back to Dr. 8(c) next month.  At some point they will get a permanent Doctor, but they haven't yet.

I am looking forward to recovering from chemo exhaustion, as much as I can; having my blood counts normalize, and getting away from injections/infustions/IVs and side effects.  And going birding.  Mostly going birding, with friends.

Yick, Uck, ugh

Well, it's been an interesting if useless week (last week).  I spent the week feeling exhausted, feverish, short of breath, and intermittently nauseous.  I ended up taking anti nausea meds for the first time.  They were prescribed back in April but I didn't need them until now.  I should have started taking them sooner, dry (or productive) heaves leave my stomach sore with muscle aches, which can make sleep hard.

Blood tests this week show the white count and platelets OK (one too high as usual, one too low as usual).  The hemoglobin is low as it was last cycle, but the Dr on call (Dr 8(d)) is not recommending transfusion.  He would prefer an injection to support production of red blood cells, but not this cycle.  So I am still tired, panting if I forget something in the kitchen and have to walk back and forth.  I have always hated not being able to breath.

I've also felt mentally slushy, though that's gotten better as of yesterday.  It is so hard to get traction to do anything, from picking up the phone to sending an email.

I'm not looking forward to this week, with a scan on Monday and results due on Friday with the same Dr 8(d).  No warm fuzzies from the phone call from the Dr, but it is the very first time any doctor in the practice - temporary or permanent - has called me personally over tasking an admin or nurse to do it.  So he gets brownie points for that.

I had hoped to go to Laredo for the Laredo Birding Festival but the nausea and fever kept me home. It was fun seeing the bird lists come in but not the same as being there.

Drug 3, Round 4... Done!

Well, it was an interesting week.  I had chemo on M/W/F after meeting with the Dr (8c) last week.

On Monday, the infusion center shifted to using the pharmacy at the main hospital while the one across the street is being expanded.  This resulted in a longer delay for meds for all the patients.  My appointment was for morning so I would have time to have a blood draw if needed.  It wasn't needed, but I kept the earlier time so I could get out earlier (ha!).

After 2 hours my chemo showed up, but the premeds hadn't.  There's a storage cabinet in every suite, so the chemo drug went into the cabinet on hold until the premed showed up.  I need the premed to keep from reacting to the chemo.  The nurse started the premed as soon as it showed up, and switched to saline to flush when it cleared the IV.  Then comes the excitement.

A big batch of drugs were brought from the pharmacy and the nurse came in with "my chemo" and hooked it up to the IV, using a different port on the multi-port line.  I was tired, but looked at it and said it wasn't right, it was much too large.  My regular chemo is 53 mls, this was a larger bag and FAT with liquid unlike mine.  The nurse went and read the name on the bag.  It wasn't me.  Good thing the drug hadn't started dripping yet.  She pulled my chemo out of the cabinet and got that started but oh my, it was so close to my getting the wrong (unknown) chemo.  Yikes.

Too much excitement.  

In contrast Wednesday and Friday were routine, which is a good thing.  The pharmacy was quicker, they trust I'm coming in and order the drugs early.  Same nurse, sharp on getting things hung up quickly and run promptly.  I was only there an hour and a half total on Friday, where Monday took over 4 hours.

Little side effects so far but not really expected.

Wait, what? And more waiting.

Dr 8(a) gave me an order for a blood test for standard counts when I saw him early January.  He wanted to check the counts a little earlier, and of course the treatment lasted a little later (and was more spread out).  I got the blood work done yesterday but no one called.  I called this morning and one nurse couldn’t get in the system.  They had the admin person call me back.  The first this she told me was my counts were fine - and why shouldn’t they be, they were fine the day before treatment!  Yikes. They weren’t fine at this point in the chemo cycle the last two cycles, in fact they were so bad they immediately started treatment with packed red blood cells once and immunity boosting shots - and wanted to (but waited too late) the other time.  But not to worry the admin tells me she will ask the new temp Dr if I need another blood test this cycle or not.  That gives me such confidence!  NOT.

I wrote that 10 days ago.  Yesterday I saw a new Dr (let's call him 8c) and was seriously disappointed that it took an hour until I got vitals taken, and was reseated in the main waiting room.  Usually it's on to an exam room.  So I went and talked to the admin person and she said there were still two ahead of me.  So another hour wait?  Seriously?  I asked her if she ever called patients to tell them the Dr was behind and she said no.  Yikes.  She asked if I wanted to see a supervisor. Stupid question.

So the supervisor came over to talk to me and offered to jump me in line!  How does that fix the issue?  If the temporary Dr needs half hour appointments instead of twenty minute appointments they should increase appointment lengths, if he's staying until 7 to finish appointments that would stop patients from waiting for hours to see a Dr.  Same amount of time, same number of appointments.  She said she needed all the appointment slots.  I said same number of appointments, less time waiting for the Dr for the patients.  All she did was maintain party line.  So they kept telling me "Miss Liz" would come talk to me.  Whoever that is, she never did.

I liked Dr. 8c a lot.  We talked about a lot of options and got the schedule down for the next month.  I won't go to see another temp Dr without calling in first.  DHR admin has never showed that they care one whit about patients.  The Drs and nurses are awesome, but the admin sucks.  Fix the problem.  It's costing you Drs.

Round 3 - Ding Ding Ding!

I made it through round 3 of the 3rd chemo drug last week with little problem.  Dr 8(a) had reduced the treatments from 5 (daily M-F) to 3 days, and listened to my request for MWF treatment.  So far so good, no fever unlike past rounds with this drug.  That could still change though last cycle I was already feeling the effects of fever every afternoon and that treatment ended on a Thursday.  Here's hoping my counts stay up, but from the bruises blossoming on my left arm I don't think that's likely to happen.  Stay tuned.

The plan was to take it easy today since I made the trek to Estero Llano Grande State Park yesterday.  That plan went out the door when a Fork-tailed Flycatcher was found in Hidalgo Co. about 45 min drive away.  I headed out the door shortly after 3 PM and enjoyed good looks at this sometimes cooperative and sometimes almost roadkill bird.  Thanks to JY for finding it and HH for keeping an eye on it until I got there.  A new Hidalgo bird is hard come to by for me! 

Happy New Year!

Good news on 1/2, all counts are up.   Finally. 

I did the Bentsen CBC in the morning on 1/3, flushing a boat load of Sprague's Pipits with the help of Laura, Rick, May, Tom and and Connie at Anzalduas before more CBC birding and of course lunch at Taco Express.  Then it was off to my Drs appointment.  Thanks to Rick and May for coming over before their (finally) sunny Butterfly Hike, and Tom, Connie and Laura for finishing off the afternoon! 

I went in and saw Dr 8(a) again, evidently his last day as a temporary doctor in the practice.  The continuity helped and our discussion was good.  We've got a plan to go ahead with treatment and try to avoid the crashing blood counts  that could make an infection all but inevitable with time.  The best thing for me was while I was checking with the chemo scheduler about the changes (warning her of the Dr orders to come) chemo nurse Jocelyn came out and talked to me about the changes and how we will monitor my blood counts for the inevitable decline afterwards.  It is great to have her looking out for me. She's awesome!

My next appointment is with yet another new temporary Dr. And I've had appointments with a couple other new Drs that got moved up or changed.   The revolving door of temporary Drs is frustrating, it's a difficult situation for the patients and the Drs.  I have to start at square one (see, I've had this fever for 3 years now so that's nothing new...) and they have to scroll  through pages of medical history to catch up (in a 20 minute appointment slot). 

Onwards.