Bullet Proof

"Bullet Proof"

Pam's recovery from the second round of chemo could not have gone better so far.  Dr. Weinstein said that he and Dr. Segal were debating about whether or not to let Pam do the chemo as an outpatient instead of sticking her back in the hospital.   Dr. Weinstein was gloating just a little, because he is so pleased... he said to Pam  "You are bullet proof.  Dr. Segal was worried about letting you do this as an outpatient, but he is a little compulsive. I kept telling him it would be OK."

Blood counts are now beginning to recover.  Platetlets and white cell counts are increasing rapidly, red cells will be following shortly.  As her white count improves, she will be less prone to infection; as the platelets continue to improve, she will be less prone to uncontrolled bleeding; and as the red count improves, she will begin to have more energy and endurance. She hasn't felt very ill at all during all of this, so, again, we are very lucky.

Remission vs. Cure

I caused a bit of a stir with some of the recent blog articles.  I think I gave some readers the impression that Pam is cured.  Not yet.  Her leukemia is being kept in remission with chemotherapy.  She is in remission because there are no detectable cancer cells at the moment.  I don't think I made that point clearly in earlier posts.  The first paragraph of ths article in wikipedia explains the difference.  Remission vs. Cure

Unfortunately, her genetic tests have shown that the leukemia will come back without a bone marrow transplant. She will be seen by leukemia specialists at OHSU for an allogeneic bone marrow transplant.

Stem Cell Transplants

I am sure we will learn a lot more about this very soon, but here is my current understanding of how bone marrow stem cells can be matched and donated:

• Pam and her brothers, Mike and Mark, come from the same pool of genes, courtesy of Don and Bonne.
• Mike and Mark can donate to Pam directly, and it is the best chance of a good match and a cure.
• If Mike and Mark turn out to be a poor match, she will have to use matched stem cells from a bone marrow bank and chances of a cure are slightly worse. 
• There has also been a lot of confusion around donation of stem cells from baby Austin's umbilical cord blood.  Here is what I understand about that:
• Alyssa and Jason can't donate Austin's cord blood cells directly to Pam.
• They can "bank" cord blood cells for the future use of the immediate family. (Austin, Jason or Alyssa)
• In any event, the baby Austin stem cells are not necessarily a great match:  
• Half of the genetic makeup of Baby Austin comes from Jason
• Half of Austin's genetic makeup comes from Alyssa
• Only half of Allysa's genetic makeup comes from Pam.

This is just my understanding of the situation right now, and I could be mistaken. I don't even play a doctor on TV. I will correct the above if I find out it isn't accurate.

 

So, brothers Mike and Mark are going to get tested soon as potential bone marrow donors, and we will be hoping that one of them is a good match.

Make sense, sort of?

OHSU on Monday

Pam has her first appointment for an orientation at the Hematology Clinic at OHSU on Monday with  Dr. Shernan Holtan.  I am sure we will learn a lot more about next steps on Monday and I will share what we learn here.

With my keen skills of observation, I can tell Pam is a little anxious about Monday.  She is very distractable (yes, more than normal) and has suddenly taken to organizing tupperware lids. We all have our own ways of coping with stress:  I get irritable and cranky; she organizes.

I'll write another article after the appointment on Monday. Thanks again to everyone.

Topping Off the Fluids

Last Friday turned out "interesting".  As expected, Pam's red blood, white blood, and platelet counts have all decreased since the second round of chemo ended on September 7th.  She was scheduled to receive a unit of platelets this past Friday.  After getting the platelet transfusion at the hospital, we went to the outpatient clinic for another check up.  Another blood count was done at the clinic, and her red count was very low, so we were sent right back to the hospital so she could get 2 units of red cells. As usual, the staff at the Compass Oncology and at Good Sam "got 'er done", and Pam had all of her fluid levels topped off by the end of the day.



Don wearing one of Pam's snazzy hats

On Friday evening, we went to Manzanita with brother Mark and parents Don and Bonnie, and had a nice relaxing weekend. 

Bonnie giving Pam a trim

Her white count is now very low, so she is now in the "danger zone", she can get an infection very easily, so we have to be careful.  Her energy level is OK, although she has noticed a little shortness of breath today, so I'm assuming she will need another unit of red cells pretty soon.

She is scheduled for her first appointment at OHSU in prepraration for the stem cell transplant on Monday, October 1.  As part of the procedure, they will completely eradicate her white blood cells, then transfer the donor cells to her.  There is a rejection risk, as there would be with any transplant, but the transplant offers her the best chance of an ultimate cure, so it is a bit of a no brainer.

So it goes...

A Plan, Finally

I just returned from a business trip to San Diego.  While I was away, Pam had an appointment with Dr. Segal. The final genetic test results are finally done, and Pam will definitely need an allogeneic bone marrow transplant to achieve a cure.  The bone marrow would most likely come from one of her brothers, assuming they are a good match. There is about a 60% cure rate for for a bone marrow transplant patient with a good donor match.

So, going back to Dr. Weinstein's original drawing of the treatment plan, we are at the least desirable of the three treatment paths he outlined when Pam was first hospitalized.  The bone marrow procedures will be done at OHSU, and she will get her first consultation with the team there within a couple of weeks.

In the meantime, her blood counts are decreasing rapidly from the last round of chemo, as would be expected.  She is becoming more fatigued and her white count is low enough that we have to be super careful to keep her away from anyone who is ill.  Her platelet count has gotten especially low, so she is going to get a unit of platelets at Good Sam today.  Other than the fatigue, she is feeling fine, and has taken the bad news on the genetic tests in stride.

End of Round 2

Chemo

The first week of chemo as an outpatient has been, thankfully, pretty uneventful.

Pam had chemo treatments with Cytarabine (one of the two chemo agents she had in the hospital) on Monday, Wednesday, and Friday at the clinic.  Following each treatment, she was fitted with a small pump that gives her another dose of chemo overnight, complete with whirring and clicking noises. When the pump is done, it wakes you up with a series of beeps.  I jumped out of bed every time.  (Pam doesn't jump out of bed, it is against her general principles; or policy; or religion; or something.)

Good news is that she hasn't had any nausea since restarting chemo this week.  The mysterious rash in her groin is returning, so we will need to get that checked out.

Treatment Plan

The final genetic test results finally came back.  They were "mixed", meaning it is likely that Pam will need treatment beyond just chemo, either an Autologous (stem cells from her own marrow) or Allogeneic (stem cells from someone else) transplant.  We will be going up to OHSU for a consultation fairly soon.

See Dr. Weinstein's original treatment plan drawing.

No chemo next week, but she will need to go in for three visits in the coming week to have her blood counts and chem panel monitored to make sure her liver is OK.  She will more than likely need some transfusions soon.  For right now, her white blood count is good, so we can mix and mingle with all of the germs out there with no risk.

Crosby, Still and Nash are OLD....

Stephen Stills

We had tickets to Crosby, Stills and Nash for this past Wednesday. When I bought the tickets, I forgot that I had to go to Salem that evening for a work commitment.  So, Pam took her brother Mark.  Reports are that it was a great concert, that David Crosby has lost a lot of weight and looks like an old grand dad, and Steven Stills looks like he pulls green chain at a lumber mill.




David Crosby

 

 

 

 

 

 

... but, so is The News

We have decided that we should not try to plan things much ahead of time, since we really will not know how Pam is feeling from one day to the next.  So, yesterday we bought tickets to Huey Lewis and the News at the Maryhill Winery for today. Bought them from some guy on Craigslist. And, after some effort, we found a motel room not far away in Rufus (yes, there is a town named Rufus) so we don't have to drive home after the concert. Should be fun.

Round 2

Pam started on Round 2 of chemo today as an outpatient.  She will have infusions Monday, Wednesday, and Friday this week in the oncology clinic.  After each infusion, she will be fitted with a pump and get another dose of chemo overnight at home.

Right now, she is feeling fine.  She may have some nausea and will certainly need blood transfusions, but she won't be nearly as sick as she was during the first round.

After Pam got out of the clinic today, we met with friends Steve and Debbie Wilkins and Brian and Tina West at the Pyramid Brewery in Northwest Portland.  Had a great time.

Back from Gotham

New York

My Buddy, Creta
at the US Open

I returned yesterday from a whirlwind business trip to New York, working with Metro Sports Med in their main office in a nice area in Brooklyn called Park Slope.  My old friend (scratch that... and replace with "my friend I have known for a long time"), Creta Chandler, is now the COO for the company.  It was great seeing her. She has adapted to life in New York well, she looks great, and is generally kicking butt and taking names in her new position.

View from our seats at Arthur Ashe Court
US Tennis Center

I didn't have much time to really play tourist, but the owner of Metro Sports, Dr. Dave Menche, has great tickets to the US Open Tennis Tournament, and invited Creta and I to go on Thursday evening.  We took a train to Manhattan and transferred to the "7 Train" to Flushing.  The tennis center is right by Mets stadium and it is an awesome venue.  We watched both Roger Federer and Venus Williams play opponents I have never heard of at Arthur Ashe court.  Quite an experience, but I was so tired that night, we had to leave before the Venus Williams match was over.




Caprese Salad Appetizer
Italian Restaurant

Food

There are nice small restaurants with good food everywhere you turn in New York, and it is not necessarily expensive. We ate lunch at a couple of neighborhood restaurants in between the training sessions I was teaching:

Grilled Chicken and Flatbread
Turkish Restaurant










Back Home

Sporty
GLH

Before Pam got sick, I was going to take her to New York with me for her birthday, and we would have stayed a few extra days seeing the sights. We will have to do that later.

Pam had her Groshong Catheter placed at the hospital while I was in New York.  Her son Nate took her to the hospital and helped her out.

I didn't sleep much while I was over there, so I was pretty exhuasted last evening after Pam picked me up at the airport. So, we walked to a local restaurant for a nice dinner. I have been talking about what I call the "Goofy Little Hat" trend in fashion.  (I think they look Goofy on men, sorry, see Howie Mandel.)

 In fact, I have abbreviated it to GLH.  Well, now Pam has a whole collection of them, and she looks cute in them.  She wore one of her new GLHs to dinner.




Grilled Octopus
at Jamison in Portland

More Food

I don't mean to turn this into a food blog, but highly recommend the Jamison.  It is only half a block from our place.  Yum.

Austin

While I was away, Pam stayed with Alyssa and helping out with baby Austin.  She was in heaven... she really enjoyed being able to spend some quiet time with Alyssa and the baby.

The Beach

Today, we are heading to Manzanita and will come back on Tuesday.  Should be nice.

Back to Treatment

Still no final word on the treatment plan, waiting for more genetic tests on Pam's original blood sample to be analyzed.  She will start chemo again on September 10th as an outpatient on a Monday, Wednesday, Friday schedule to keep the leukemia in remission in the meantime.

Thanks!

Thanks to Creta, Dr. Menche, and all of her team at Metro Sports Med. And a special thanks to Nate for helping out in my absence.  Much appreciated!

Hats R Us

Hats Galore

Had dinner with our good friends Mort and Tina and had a GREAT time. Nice to do normal things again. Tina had a vintage hat collection for Pam to check out.

No Hospital Food

Dinner was great!!  Planked salmon, greek salad, blackberry pie, and corn on the cob.

 Cheers!

Tina and I celebrating. 

Pam isn't drinking alcohol while her liver recovers from chemo, so she missed a very nice wine.

To Come

Appointment with Dr. Weinstein tomorrow to check blood levels and discuss next phase of treatment.  I am leaving for New York on Wednesday and back on Saturday.  Pam's Mom, Bonnie, will take her to the hospital to have her Groshong Catheter placed for future chemo.

Baby Day

 Baby!

 Little Austin was finally born last night. He is a beautiful baby boy. Alyssa had a hard time and was in labor for over 24 hours, but everything turned out great. Both of us are thrilled, but Pam is really way beyond thrilled.

Here are some more pictures, not all the greatest quality because the hospital room was dim and I didn't want to use a flash:  Baby Austin Pics

 

Whew!

It has been a whirlwind of activity for the past couple of days. Alyssa started having labor pains Wednesday morning and went to the hospital late that evening. Naturally, we beat Jason and Alyssa to the hospital. While Alyssa, Jason and Austin did their thing, we waited... and waited until about 3 AM Thursday morning, then went home and caught a little sleep. I had a 7 AM phone meeting that morning, then went to the office and Pam went back to the hospital about 10 AM. Pam had a consultation with another oncologist, Dr. Segal, at 4 PM (more on that below), then we went back to the hospital for more waiting, and, finally, Austin decided to join the outside world about 9 PM last night.

Treatment Plan Continued

Dr. Segal turned out to be congenial and empathetic. Introduced himself as "Jerry Segal", which I appreciate.* When reviewing Pam's history, he commented "you were really sick!"... seems obvious, of course, but in an odd way it felt like an accomplishment when he said that.  Pam was so critically ill, and, for now, she is out of the woods.

He was very thorough in reviewing Pam's history, and concluded that he would not recommend an Allogeneic Transplant.  That is generally more successful with younger patients.  Based on the genetic testing that will be forthcoming, he and Dr. Weinstein will likely recommend either more Chemo or more Chemo, then an Autologous transplant.

Pam's liver is still recovering from Round 1, and they will not start the second round of chemo until the liver numbers are normal.

We have an appointment with Dr. Weinstein later this morning and should know the plan very soon.

Melt Down

After getting back from the hospital last night, Pam melted down and had a good cry. Partly because she was very tired, partly because she was thinking about Alyssa's pain during the delivery, partly because the timing sucks:

She is, of course, simultaneously happy about baby Austin but sad that she has been so sick, especially right now of all times in her life.

For as long as I have known Pam, she has dreamed about helping Jason and Alyssa and the baby during this time. In fact, she mentioned it to me on our first date (4 years ago?).  As it turned out, she has been so sick that she hasn't been able to help much at all.

*I know this is petty, but I can't help it:  I have a problem with physicians who expect to be addressed as "Dr.", but feel perfectly OK addressing me by my first name. "Hi Jerry, my name is Dr. Smith" makes me grit my teeth, just a little. 

 

It should be either, "Hi Mr. Henderson, I am Dr. Smith", or, "Nice to meet you Jerry, I am John Smith". 

 

I am not proud of myself for letting such a petty thing bother me, but it does.  There, I said it.

Remission!

Great news

Pam is in remission.  Her blood counts are all normal and her bone marrow biopsy came back looking great.

This doesn't mean her treatment is over, far from it, but it does mean we can to onto the next phase. 

Here is how Dr. Weinstein drew it out:

We are done with the Induction Chemo now that Pam is in remission.  Remission is not the same as a cure.  To cure the leukemia, there are 3 options:

• More Chemo for at least 3 more sessions
• Autologous Stem Cell Transplant:  re injection of her own bone marrow cells
• Allogeneic Stem Cell Transplant:  replacement of Pam's bone marrow with someone else's.  The marrow could come from a close relative, or could come from a bone marrow bank.  Obviously, the better match the more likely she would have a successful outcome.

All 3 options involve more chemo.  The Allogeneic Transplant has the best chance of success in the long run, but it also requires treatment for a longer time.  She has an appointment with another oncologist who is the bone marrow transplant expert this coming Thursday to discuss our options.

So, we are not even close to being out of the woods, but at least we have a compass.

Pam is not feeling red-hot, but I expect she will continue to gain strength over the next few days.  Her hair is falling out pretty steadily, but she doesn't look ill.  She is not eating much and she is losing weight with the "toughest diet program ever!"

On to much more trivial matters:  I cancelled a cruise we had planned for November.  Things are just too unpredictable right now.  Luckily, we are going to get a full refund. I am getting back into the swing of things a bit more at work, going into the office every day now.  I have periods of time where I am super productive, others where I can't concentrate at all. I have business trips scheduled to New York and San Diego coming up soon. I had planned on taking Pam to New York with me for her birthday. We are both disappointed about that.  I will be working with our good friend, Creta, in New York, and I was going to take a couple of extra days, but it just won't work out.

Long Awaited Biopsy

Went to the hospital early this morning and the bone marrow biopsy was finally completed under CT guidance.  Easy peasy.  I tried to catch up on some work while waiting in the hospital cafeteria, but the procedure was so quick, I didn't have much of a chance to get anything done. Results on Monday.

Jason's birthday party at the Lucky Lab this evening.

Pam and I are going to sneak away for the weekend and relax a bit. No IVs, no procedures, no hospitals and no appointments. Weeeee!

Why Start Now?

So, another interesting day... at least to me.

Most importantly, Pam is feeling pretty good.  It is still amazing that a person's condition can change this quickly. She was suffering tremendously last week, feeling pretty close to normal this week.  In fact, I think her leukemia may have cured her snoring... she is sleeping soundly and not snoring at all.  Amazing.

She had he first outpatient appointment today to get a bone marrow biopsy.  Since having a biopsy wasn't trying enough, she thought it would be a marvelous idea to go to the DMV to get her driver's license renewed today before her appointment.  She explained to the nice folks at the DMV that she wanted her picture taken with her hat on, because she is self conscious about losing her hair, and, surprisingly, they let her do it.

To prepare for the bone marrow biopsy Dr. Weinstein gave her a prescription for anxiety. She needed it.  She was little Miss Chatty Cathy before we got to the clinic. I have never heard her talk so much about nothing... I finally asked her to take a few deep breaths and take one of those magic pills.  Immediately. I was tempted to ask her to take two pills, but that probably wouldn't have been prudent.

When we arrived at the clinic, Dr. Weinstein was his usual gentle, affable self.  He explained what he was going to do, made sure we both understood, and, after he made sure I wasn't going to feint or something, he allowed me to watch.

The procedure involves numbing a spot over the backside of the pelvic brim, then inserting a large bore needle in to the pelvis to retrieve some bone marrow.  It didn't go well.  In fact, it didn't go. Pam's iliac crest was so tough he couldn't get the needle through it.  He was literally sweating trying to break through and he could not.  His nurse had never seen this happen before.  All Pam got for it was a sore bum.

So, we now have to go to the hospital early tomorrow morning and have the procedure done under guided CT. It is important to get the test done right away.

I told Pam that we shouldn't expect this to go as expected, nothing else has so far.

Looking Sporty

Pam had her first night at home and slept well.  Prior to last night, had not slept well for over a month.  She was very sick before she was finally diagnosed, and no one sleeps well in  a hospital, even if they feel OK.

Sis in law Sandra took her to her first outpatient appointment today and she was very pleased that Dr. Morich was there to greet her.  He was one of our favorite residents in the hospital, and Pam didn't expect to see him again as an outpatient.

She will be having her bone marrow biopsy (finally) tomorrow, and after we get the results, they will decide on the next course of treatment.

New Haircut

My favorite hat

While I was at work today, she decided to cut her hair very short.  It is falling out very rapidly now, so it will make less of a mess.

She tried a few hats on for size.  She has a white Mariner's cap that makes her look sporty instead of sick.

Our little condo is cluttered with all of the stuff that we brought from the hospital.

I have been surprised by well wishes from people that I haven't seen in years.  Very touching.

Home Run

The mystery of Pam feeling so poorly over the past two days has been solved.  She was simply having withdrawl symptoms from the Dilaudid.  She went from having severe, unremitting pain to almost no pain within a day.  As a result, she went from lots of narcotic pain medication to none. So, today, they put her on a very small dose of oxycodone, and she will taper off over the next couple of days.

So, big news:  Home at last!  Discharged from the hospital today.  26 days is a long time.

She will go in for her first outpatient treatment tomorrow, so the second phase of treatment will begin shortly.  Soon, she will get a central venous catheter inserted under her collar bone.  It is a surgical procedure, but it will make future chemotherapy much easier.

A big thank you to all of our good friends and family.  Your prayers, well wishes, card, and phone calls mean a lot to both of us.  Your free beer means a lot to me.  Thank you so much.

Curveball

8 AM

Came to the hospital this morning expecting Pam would tell me how much better she was feeling.  Sadly, that wasn't the case.  She was miserable all night long with diarrhea and she wasn't able to keep her breakfast down this morning.

While we were talking, she had a bit of an emotional melt down. Everything is catching up with her: she is discouraged that she went from OK to miserable again, she is anxious about going home, she doesn't want to feel dependent on anyone for help, but still afraid that she won't get the help she needs after she is discharged. Mostly, she is just exhausted after the rough night.

She also said she is afraid she won't be able to hold her grandbaby.  I melted down myself when she said that.

Medically, everything is looking up. Blood counts are all approaching normal.  She is only on IVs intermittently for antibiotics.  She is eating better and she is not taking any pain medication at all. The diarrhea is probably from the antibiotics and will resolve soon. Her hair is coming out more rapidly now... very minor issue in the scheme of things.  It is just part of the whole journey.

6 PM

She has been sleeping comfortably most of the day now.  Jason and Alyssa will be visiting this evening, and I'm sure she will feel rested by then and seeing them will boost her spirits.

Outside!

Great Day

I slept in until 9 this morning and called Pam at the hospital.  She had a good night!

She was able to eat some cream of wheat with a pat of butter (ick) for breakfast and she was able to eat a bit of lunch today.  Since she is now able to eat and can supplement with Boost, they took her off of the TPN at mid day today.  They also removed the PCA (patient controlled analgesia).  The only IVs left are for antibiotics.

Everyone seems happy that Pam is finally better.   One of her nurses, Danni, at the front desk:




I went to a local bakery and got the nursing staff some cookies this afternoon.  They all thanked me so profusely, it was a little embarassing.  (The great care they gave Pam vs. some fancy cookies doesn't seem like an even trade to me.)


Late this afternoon, she was totally "unhooked" for a while and we took a walk OUTSIDE on the hospital grounds. Per usual, Pam noticed some things that I never would have noticed by myself.



Vertical Garden

There was a vertical garden against one wall that had strawberries, rhubarb, and tomato plants.  There is a hardwood frame, hogwire and landscape felt inside. Make a little X in the landscape felt for your plants.  Very cool.

There are also a bunch of creative bird houses:

So, we are looking on track for getting discharged on Monday. 

More adventures to come.

A Sure Sign

I received a sure sign that Pam is getting better. She called me at work and asked if I could pick up her makeup at home before coming to the hospital this evening. "It would make me feel better" she says.  I can't imagine how or why, but I stopped by the condo on the way back to the hospital and got her makeup as requested.

On to significant, but less reliable signs of her recovery:  Her platelets and red blood cell count are normal.  By tomorrow, her white blood count will more than likely be normal and she will no longer be neutropenic, meaning we will no longer have to wear these silly masks in the hospital room.

She may get out of the hospital within a couple of days.  Possibly Sunday, more likely Monday.  She is both excited and apprehensive.  After all of the rough nights she has had, it is difficult for her to believe that she will improve enough in just a couple of days to be ready to live at home without constant medical care.

She is obviously better... more energetic and less pain..  She is still not eating very much, but she is at least eating a little. She had a little bowl of cream of wheat this morning, 2/3 of a boiled egg and a Boost, some canned pear for lunch, a Boost and a tablespoon of tuna salad for dinner.  Because of her ravenous appetite, they are going to begin to taper her TPN (food in her IV).

They are also going to see if they can begin to decrease her pain meds so she is no longer reliant on the PCA (patient controlled pain medication with a "magic button").  If she can eat a little solid food and supplement her diet with Boost, she should be fine.

We still don't really know about next steps.  She will, finally, get her bone marrow biopsy as an outpatient, and her oncologist will decide on a treatment plan from there.

Some of the great nurses:

Kris

 

Kris is 6 foot 3, played college volleyball.  Great sense of humor.








Carla

Carla is one of the daytime charge nurses.  Never really finishes a sentence, because she is running off to another room to do something.

Sydney

 Sydney came down to take care of Pam when she was in ICU and spilled stuff all over the place when she was changing out Pam's chemo... she always announced herself as "the clumsy nurse" every time we saw her from that time on.






Carly

Carly is her nurse this evening... took care of Pam last night when she had a bad night with all kinds of "bathroom issues". 

Did it all in good humor.

Long Walk

Pam and I took a long walk about 10:30 PM.  Everything was nice and quiet.

The oncology ward, where she has spend most of her time, is on the fourth floor of the hospital.  We walked around the wings on the fourth floor, then went down to the third floor and visited the little chapel. I also showed her the ICU waiting room on the third floor where I spent a lot of time.  We walked the length of the hospital on the third floor, down the elevator to the first floor where I showed her the cafeteria and where I park my bike.

The cafeteria was closed, but one of the hospital workers passing us in the hall thought we were looking for something to eat.  "Are you looking for the cafeteria?"  When we answered no, we were just walking, she said... "Oh, I was just wondering, I just went to the store across the street and I have a banana."  Very touching.

I know this is the most boring travelogue you have ever heard, but it was exiciting to us.

So, she is walking and eating, a little.  Blood counts are improving and are almost normal.  We just need to get adequate white blood cells and her pain under control and she can come home.

Turned a Corner?

I hate to say it, but I think we may have turned a corner. Pam's blood counts are coming back, and it is obvious that she has more energy.

Her hair is beginning to fall out pretty rapidly now, but Alyssa came in and cut her Mom's hair, so it won't be so much of a mess. I hate to admit it, because I love long hair, but it is very cute.

Here is Pam hamming it up with her oldest friend, Joni.  I don't really understand the hand gestures.

Two Score Days

20 days since being admitted
10 days since the end of Round 1 of Chemo

Pam's blood count may be starting to improve.  Her white blood cell count nudged up today just slightly.  After the chemo, her lowest level was .1 and she is now up to .3.  This is a very small change, and it might not even be significant, time will tell.

No blood or platelets today.  3 walks: One with son Nate, another with daughter Alyssa, and once this evening with me.

Her mouth and throat pain are still the biggest problem symptomatically.  The dilaudid helps, but there are times when even that isn't enough.  As her white count begins to improve, the mouth and throat pain will resolve.

Charlotte, CNA

Sara, RN

Pam wants me to take pictures of all of the people that are taking care of her.  This is Sara and Charlotte:

Brother Mike
Dad Don

Sis In Law Sandra

Mike, Sandra and Don visited this evening.











Pam Reviewing the Blog

Pam was feeling good enough after everyone left for the evening that she took a look at this blog herself.

She didn't think my photography was very flattering.  I reminded her that she has cancer, and everyone tells me how good she looks in the pictures.