Why is it never straightforward?

We met Dr. Fisher today, the Oncology doc. A very nice and calm gentleman. He basically went through Mary's history and then gave us an information dump on how he sees the next steps for Mary. The only problem with the good doctor is that the nature of his practice apparently makes his office appointment system seem like airline schedules--lots of fiction. Our 11:30 appointment resulted in finally seeing his nurse after 1:30PM and the good doctor himself was about 2PM. Its a good thing we brought food for Mary!

Mary is set for a PET scan on Wednesday ordered by the radiologist. However, the Oncology doc needs a new high resolution CT scan as well. The equipment that does the PET scan cannot do the hi rez CT scan so that means she needs another round of tests at Stanford. They will call with proposed dates for her.

Once the radiation doc and the oncology doc have their necessary pictures, they then have a confab with the surgeon and all three of them agree on a course of action. There are two outcomes as we understand it--so far.

If the result of all these images is that no additional cancer sites are determined, then they will continue with the plan for radiation to start soon (in a week or two), followed by mild chemo after the radiation is complete. If cancer sites are detected away from the liver and area of surgery, then chemo comes first and depending on what they see, it will be "mildly aggressive" or "aggressive." After chemo, they may or may not decide to apply the radiation therapy but its likely they will do it.

In other words, the radiation therapy is specific to a location--even if its her abdominal area between the bottom of her rib cage and her belly button. Chemo therapy can attack cancers located throughout the body, hence the need for a full body, hi rez CT scan.

One good thing about Stanford. The doctor was citing recent medical publications from Europe--less than 8 weeks old--addressing some of Mary's issues. These guys are current!

The bottom line is that we have choices: bad, worse and worst. And really, there is not a choice. Frankly, the cancer free margins on the removed liver and bile duct materials were not adequate leaving Mary open for a re-occurrence. And, remember, the original confirmation was found in a lymph node which is the first proof that it has started to metastasize.

On the good side, putting her back on the Roxi has brought back her appetite, her level of activity and her general feeling that she can beat this thing. We'll do a step down over multiple weeks to help her stop the Roxi.

A quiet weekend

Its hot! Several days in a row near or over 100. The good news is that we do have whole house air conditioning so Mary is very comfortable. Normally, we have a very nice cool down during the night but it didn't really happen last night. The low temperature was about 70 instead of our normal low 60s at night. We open the bedroom door and blow the cool air into the room by use of a fan on the deck pointed into the bedroom. Fresh air is so much better than the air conditioned stuff. And, yes, in the low 60s we keep a blanket on the bed in the summer. Last night it was sheets only.

As for Mary, she is feeling better at times. We still haven't worked out the exact dosing for her various medications. The Protonix is once a day, Zofran is prescribed at 3 to 6 pills a day and we're working on the Roxicodone at or less where she was two weeks ago. Yesterday was definitely not correct as Mary had some real difficulties during the day. Today is much better with moments of uncomfortable nausea but nothing as intense as yesterday.

As things cooled a bit last evening, we were able to take a post-dinner walk to get a bit of exercise in.

My daughter, Erika, has had a change of fortune and will be staying in New York for the foreseeable future. We had expected her to relocate here by mid-July but it appears she can stay in New York as the job situation has changed. Good for her!

Mary's daughter, Lara with her husband and two daughters will make the trip up from Pasadena this weekend to celebrate the 4th with Grandma. We're working on a place to see fireworks that would allow us to easily leave (and not get caught in traffic) if Mary doesn't feel well.

Monday is the first meeting with Dr. Fisher of the oncology department. We really don't know what to expect so it will be an interesting meeting, I am sure.

Otherwise, I am home this week and will be on duty to make sure Mary has all the support she needs. I made the trip to the Los Gatos Farmers' Market this morning and picked up fresh corn, wild caught Alaskan salmon and fresh halibut. We grill the fish and by using Mary's digital thermometer, I can cook to perfection! I also brought home a supply of veggies and fruit to make sure Mary has lots of choices.

Stanford trip #1 is done

Turns out we were right but we did it wrong. Mary's symptoms are classic withdrawal. Basically, it should be done over a few weeks and not 7 or 8 days. As a result we are putting her back on the painkiller and then stepping her down over multiple weeks. The doctors were not concerned about the painkiller use because the dose is so low and because she is so committed to get off of it. We should see her appetite come back, her shaking hands go away and generally she should be in much better spirits and energy. That is good because she lost 4.5 lbs since last week as measured on the same clinic scale

We got the results of Mary's blood test from Wednesday and everything was fine. Mary was visibly relieved about that news.

The doctor said Mary and her SIADH was the subject of a complications report at Stanford Med School in the surgery department. He also shook my hand as a 'rock of calm' during the SIADH and ICU crisis. I told him I didn't think I was calm as much as I was in shock!

As for the rest of the visit, it was scheduled for 2:45PM as a fit in. Well, they did by 4:30 so it was a bit of a wait.

We had quick visits from our neighbors, Lillian and Bill and then a bit later, Janie. Lillian gave us some beautiful Armenian cucumbers and Janie delivered roasted almonds and summer squash. Summer time in California is wonderful, especially when your neighbors are gardeners!

Mary was feeling so good based on the news she joined me in the kitchen to help with dinner preparation. That is the first time in over a week that has happened!

And more trips to Stanford

The surgeon's office called and asked Mary to come in tomorrow for a quick visit. This was done before the results of the blood test could have possibly been completed because the call came while we were at the blood lab. I assume the doctor wants to see her because he doesn't like the symptoms she is reporting: shaking and nausea. So, Friday afternoon we are back at the clinic for trip #1.

On Monday, we are meeting the oncology doctor for the first time so that is trip #2.

On the 1st (Wed) is trip #3 and Mary is set for about a 4 hour session while they do the preparation for the radiation treatment. This includes making a mold of her back so she can rest comfortably and stay still during the radiation treatments. I don't know how they make the mold but its gotta be fun to watch! Will they lay her down in a large tub of plaster of paris? Maybe a large pan of hot wax? I have no idea. They are also going to take some other images simply to make sure they know what they are dealing with given Mary's post-surgery and her petite size.

My employer is shut down next week--Again, as Forrest Gump would say--so its no problem with transportation next week.

All in all, Mary continues to get stronger even with the symptomology she is reporting. We still don't know if she starts radiation on the 6th or the 13th.

Marge, Terry, Ingrid and Mary have all offered driving days for the radiation treatment. Thank you! I am building a google document (calendar) we can share to make sure we have all the trips covered. I wish we knew the schedule at the hospital so we could confirm all the help.

A long day for Mary

Mary had a long day all by herself. At noontime, she was feeling nauseous even though she has not taken the narcotic since Sunday. She called the doctor's office and they recommended that she eat small portions frequently, take a new anti-nausea medication and go back on the drug that knocks down or blocks stomach acid which ran out at the end of last week. With that under control, she seems to have recovered.

Mary did explain what we did with the step down of the narcotic and that seems fine. The office did ask if she needed more painkiller and she said no, that pain was not the issue at all. That is good news.

They also want a blood test to make sure her electrolytes are in balance so tomorrow morning its off to the lab--again. Supposedly, it is procedure because she hasn't had a draw for a month. I think its to see if her diet and fluid intake have been appropriate to keep her body chemistry in tune.

Otherwise, I spent the day at my company's office in Fairfield CA, a 1.5 hour drive with a 6AM departure from Los Gatos and a 2.5 hour return trip home at 5PM. Gotta love our California traffic! Today's meeting in Fairfield ran from 8AM to 5PM. I have to go back for an afternoon session on Wednesday. Its about 83 miles one way from the house so its a bit of a trip.

Tomorrow is a visit from The Maids and I need to go set up the house. I've got about half the rooms ready to go and need to finish before I head for bed.

Monday Evening

Ingrid and Mary had a nice lunch today and followed it with a walk. The midday heat was a bit much for Mary so they took a short walk which is just fine.

For dinner, I warmed up the prepared dinner from Gourmet Dreams: turkey cutlets, orzo, green beans and spinach salad. Mary ate a pretty good sized portion so that is a good sign. She left the table to watch TV and I was cleaning up the kitchen when I heard a crash. I turned and Devil Dog was in the process of falling off the table top, bouncing off the chair and landing on the floor. It turns out I missed one plate with some orzo on it and Devil Dog was after it. Fortunately nothing broke but DD is definitely in the doghouse!

So far, Mary had not taken the last pill of the pain medicine which gives a 0% for today. She has not had any of the withdrawal symptoms either so I think she has the painkiller licked.

Tuesday will be a long day for Mary. I have an all day meeting at our Fairfield office so I need to hit the road before 6AM and won't be home until after 7PM.

Devil Dog

I am back at work but before I left the house, I made a simple breakfast for Mary, fed the dogs and generally made sure Mary would be good for the day.

Well, while eating breakfast--and Mary takes her time eating--she had to step away from the table. When she returned, her plate was licked clean! Our older dog, Shauna, was with Mary so she knows it was Devil Dog (aka Wiggles, Ol' One Eye, Idjit Dawg or 'Why am I yelling at a deaf dog?') that had finished her breakfast. Before all this surgery, Mary and I normally eat at the high counter in the kitchen and there is no way our small dogs can get up to that height. Since surgery and to make things easier, we have been using the dinning room table. We have now confirmed that if we leave the table and the chairs are not pushed in, devil dog uses the chairs to get to the plates to eat the food.

Yesterday, I joined Lillian and two of her sons, Bill and David along with David's family for a great BBQ. Bill had smoked pork ribs and they were fantastic. Mary wasn't feeling great yesterday and didn't make it to the BBQ--lingering effects of the pain killer, we think. Lillian and Bill are neighbors so I delivered a meal to Mary along with dessert and she ate very well. The ribs were fantastic. Oh, did I say that already? Yeah, the ribs were fantastic!

Mary is on plan to stop the pain killer. Yesterday, she held it to under 20% and today she had not yet taken the one half pill that gets her to just under 10%. Hopefully, she won't have to take it if she doesn't encounter any of the withdrawal symptoms. Tylenol or Advil seem to be doing ok for the pain and those were approved by the doctor. With yesterday's low dose of the pain killer, she woke up perky this morning and feeling pretty good--well, other than having her breakfast stolen.

Marge and Terry have offered to drive some days each week for the radiation treatment. So too Ingrid when she returns from vacation. With enough volunteers, we should not have a problem.

Ingrid is due to join Mary for a good lunch today.

Terminating the Science Experiments

As Mary was in her half hour waiting period after taking her weekly dose of osteoporosis medicine, she joined me in the kitchen to terminate the ongoing science experiments.

Reenie often made meals with a little extra so Mary could use the extra for lunch. Well, those lunches should have happened some time ago! Some of them had definitely developed the patina of far too much time having passed. We also found items in the fridge that Tim and Lara bought when visiting for Easter. We found other interesting items--cheese, fruits and veggies that had all long exceeded their 'eat by' dates. The champion, however, was the goo that Mary made before her first symptoms appeared in March. The goo? We are not sure what it started as but it certainly deserved to be terminated!

This all sounds worse that it really was. These things were overlooked was because we've had several cooks in the kitchen (including me!) and we all keep adding to the inventory and no one did a systematic clean out of the odds and ends in the nooks and crannies. Its done now so we are good.

Mary stretched the pain killer interval yesterday and ended up at 25% instead of the 33% we had planned on. Hopefully, she can be under 20% today. She is doing this by extending the intervals and by splitting the pills so she is taking fractions of a dose. Even at this very low level, her system is reacting. Our girl is sensitive to drugs--that we have proven multiple times.

I return to work tomorrow and Mary will be on her own for the day. She has asked that I acquire fixing's for lunch tomorrow and Gourmet Dreams will deliver some meals for the first part of the week and they'll be great, as always. My employer is on shutdown a week later (June 29) so I'll be home again same as this last week.

We hope to hear from Dr. Chang this week. He indicated that he would be working on the radiation dose quantities, fitting Mary into the schedule for the available treatment equipment and making sure our insurance coverage was squared away. Perhaps we are optimistic that all of that can be done this week. He did say he wanted to start in two to three weeks so that would be either July 6 or 13.

Until then, we simply need to work on Mary eating, walking and getting stronger. Once we know the radiation daily schedule, we need to arrange transportation to Stanford. Marge has volunteered to help a bit, Ingrid did too after she is back from her vacation, and I am sure I can do a few runs myself working around my work calendar. It all depends on the equipment scheduling. We don't know what time of day it will be, if it is the same time of day each day or if it varies day by day. Mary may be driving by then, but we don't think she should drive after the treatment starts.

We have an invite to Lillian and Bill's BBQ this afternoon. We're hoping Mary is feeling up to it for it will be good to join the festivities.

Saturday Update

We are certainly thankful for our friends and their help. Marge has delivered two complete meals, ribs on Thursday and Lasagna today. Ingrid came over yesterday (Friday) and made a great soup as well as fixed up a supply of mashed potatoes. Mary mentioned that she seemed to be able to eat and hold mashed potatoes because they agree with her taste buds so Ingrid made sure we had enough. Of course, Marge had also prepared mashed potatoes with the ribs so we are well stocked for a few days.

Lilian and Bill have invited us over for a BBQ on Sunday afternoon with more of Lilian's offspring . We are looking forward to it but we have to see how Mary is feeling to see if she can make it.

Mary is still fighting the withdrawal symptoms resulting from the pain killer. We have stepped her down to 33% (one-third) of the daily prescribed dose she was taking a week ago. She showed some signs of withdrawal yesterday and today so we held constant at the 33% level today and will start down again tomorrow. She is much better today so we think we are on the right track. Our girl really reacts to drugs--as we know from the hospital experience.

When Lilian called yesterday, she reported that the comment function on the blog doesn't seem to work. I always sign in so I had no idea. I signed out and tried to write a comment to my last post. I was totally unsuccessful. We appreciate thoughts, prayers and good wishes! Please feel free to do so by simply sending an email to the blog. Write your email and then type this address into your regular email program without any spaces in the address:
lamey . pat . california @ blogger . com
Your message will appear on the blog in a few moments.
We do welcome and encourage comments from everyone. I didn't realize the comment function was not behaving properly.

And, I have put the email address in the "Introduction" box at the top of this page so its easy to look up at any time.

A fork in the road?

And we took it.

Turns out I had the wrong Dr Chang in my previous posting. This is the correct link for Dr. Daniel Chang. A very nice man except he graduated from Michigan. Golden Gophers have kind of a tough issue with that but I guess we'll muddle through.

The way the radiologist interprets the pathology reports takes the cyberknife out of the picture and puts in a linear accellerator treatment. LA radiation is a 5 days per week for a nominal 6 weeks procedure. In other words, its the tough, awful and nasty radiation and not the nice, easy to live with variety.

Dr. Chang was very nice and very clear. Basically, bile duct cancer is an extremely difficult cancer with little known about it--because it is so rare. The treatment he is recommending is because of the lack of adequate margins towards that 21% of the liver left after the May 11 surgery. He did say that Dr. Visser took as much as he could but he had to leave enough liver so Mary could live.

He went through the rundown of side effects. No one knows if Mary will experience any, some or all of the effects. Whatever happens, I am so sorry Mary has to go through it. I guess the worst effect is damage to intestinal tract that is now serving as her bile duct and if there is radiation damage, the fix is yet another surgery.

As for the household side of things, I have managed to cook bacon for Mary's BLT yesterday, roast potatoes as part of dinner (I'm excluding the microwaved foods), and fixed her a nice breakfast before we headed to Stanford this morning. She is not starving nor is she complaining about my food preparation. So, on that side we are doing ok. Marge is delivering a meal tonight (ribs) and Saturday (lasagna) and Ingrid is ready to prepare something as well. With friends like this, we'll do great getting Mary's strength back.

Mary continues to reduce her intake of the narcotic according to the schedule we created on Sunday so that is good news. She should be free of the narcotic by Sunday at the latest.

We're gonna miss her

We are taking Reenie to the airport in the next hour or so. And, we will miss her.

Methinks it is a big loss to the "woof-woof pack" as Mary named us in the hospital about a month ago. We don't know what that means, but it apparently applies to Reenie and me and may include Shawna and Wiggles. We don't know and Mary cannot remember.

Reenie has been wonderful, primarily for the energy and spirit she infuses into Mary. I cannot believe how positive her presence has been on Mary. Reenie is also a great cook and a fun housemate. Yeah, we are gonna miss her.

Mary is a little concerned that I will end up starving her to death but that is unfounded. I do know how to do takeout.

Frankly, I also think it will be good for Mary to spend a little time in the kitchen now and then, even if supervising her klutzy spouse. I mean, I can take instructions as long as they are simple and clear.

Introduction to the Oncologist

On June 29, Mary will meet with Dr. George Fisher of Stanford's oncology program.

From what I have read, its the radiation treatment that is going to carry the heavy load in stopping the cancer in the ducts in the liver--if the cancer is still present. Of course, I am not a doctor, but it seems to me the only way they confirmed the cancer was via biopsy samples taken during the first surgery (a lymph node grabbed during gall bladder removal) and during the second surgery (confirmed in the removed bile ducts and liver materials). I am no rocket scientist, but unless we learn something new I am concerned that there is no way to tell if the cancer is truly gone. Before surgeries were performed and even with the mass of materials in the bile ducts, none of the procedures (the ERCP, CAT scan, MRI, blood tests, etc.) could confirm the presence of a growth.

We'll learn as we go!

Radiation Doctor Introductions

We are set to meet the radiation doctor on Thursday morning. He is Dr. Daniel Chang of Stanford University Medical Center. Stanford (aka SUMC) is the inventor of the cyberknife and their website also is very informative.

You may recall that the surgeon put gold drops (fiducials) in Mary's remaining liver to allow the radiation folks to exactly target the area of interest. We'll find out on Thursday how that affects the proposed treatment.

Otherwise, Reenie has done grocery shopping and will be cooking up a storm so we don't starve after she leaves on Wednesday.

Mary is much stronger. Clearly the "cold turkey" method of quiting Roxicodone does not work for her. We have a scheduled "step down" process enabled by Reenie's pill splitter. It will be a mix of full dose and half dose pills until she is down to nothing by Saturday. While this is happening, Mary's appetite is definitely back, she walked out to get the mail with me this afternoon and her spirits are very good. The progress during the day today was magnificent.

Right now, Mary is programming our TiVo to capture the new season of "The Closer." We taped the first episode and TNT ran past the top of the hour so we are missing the last few minutes. Mary found the next showing and we're now watching the 2nd showing to see the last moments of the show. Amazingly, Reenie is heading to bed just a few minutes before we see the last moments of the mystery. So, this is not Reenie's favorite show!

Back on the good track

On Friday, the doc said Mary could drop the Roxicodone and go to either Tylenol or Advil, generic in both cases, but who can spell them? And, moderate dose of course.

So we dropped the Roxi, and Mary went into distress. Nausea, regurgitating, mentally not sharp, emotionally on the edge, etc. Reenie and I did some web surfing and found an FDA site with a 17 page write up on the use of Roxi. The bottom line is that you should not quit cold turkey. Rather, the dose should be reduced a bit day by day. If you do quit cold turkey, you get nausea, regurgitating, mental impairment...

On Sunday, we followed the instructions from the FDA info sheet and this morning, Mary is clearly back where she was. We are stepping down the daily dose and she should be free of this thing in 5 days or so. For those who are wondering, she is not addicted--she cannot stand the stuff. Rather, given the sensitive nature of her body chemistry, we need to gradually step down the dosage in her blood stream.

Her incision is looking better. Not fully scabbed over, but almost there. The doc said she only needed bandages if she was protecting her clothes so we have her wearing old scuzzy stuff so the skin and incision can dry successfully without bandages.

MaryR dropped in yesterday evening for a short visit. Mary was on the mend but not as sharp as this morning. Today, she grabbed the crossword and worked it through just like a normal activity! That is the plan. She also ate everything Reenie fixed for breakfast. Still small quantities and a bit of everything.

We are gonna miss Reenie! We have her on a plane to DaLoot on Wednesday about noontime. Heck, she was even getting goodbye hugs from the vendors at Farmers' Market on Sunday. So there are more folks than Mary and I that will miss her!

The Doc Had Great News!

Mary is definitely a solid graduate of Step 2!

The doc told her to assume 'normal' routines. She is likely to feel like she is recovering from a major surgery and so she cannot go full tilt--yet. But, he put no restrictions on her and encouraged her to resume all normal activities as soon as she feels strong enough to do so.

Mary commented that she has avoided going out in public places to minimize risk of infection. His response was that she should go shopping, to the mall, out to eat, whatever! I asked him to modify that to minimize the shopping or simply skip that part altogether--it could be expensive!

I cannot express how wonderful it is to hear the doctor say that she has successfully completed step 2. Wonderful!

We'll meet the radiation and oncology doctors in the next week or two and that will lead to radiation treatment. We won't see the surgeon for 6 weeks or so.

Happy Day, Really Happy Day!

Idjit Dawg

Mary and Reenie were out and about today on the neighborhood walk.  The most telling thing that has happened is another new name for the dog named Layla also known as Wiggles, Twinks, Little One, Ol' One Eye and "Why Am I Yelling at a Deaf Dog?"  The latest name is derived from her absolute lack of 'lead sense.'  If there is a wrong way to turn while on the 30 foot lead, Idjit Dawg will find it.  

From 2009-01-31 Garden

We acknowledge this dog is a "cuddlebug" as Mary terms it. That part is true. But the dawg is also an idjit.  She continually wrapped the lead around Reenie's legs and then couldn't figure out how to go the other direction.  As Reenie said, given she was tied up by Idjit Dawg and Shawna was resting every few paces, Mary looked like the hare in this parade! 

No real news on the medical front.  Mary is still taking the pain killers but almost on a 6 hour cycle now, way down from the original 3 hour cycle. We expect the surgeon will remove the last of the staples, give advice as to how to treat the incision and then give us the rundown on what to expect next.  They haven't ordered a blood test yet so he is clearly feeling she is on a good path. That may happen after he sees her tomorrow if there is something to be concerned about.  The fact she is making progress, the swelling is way down and she looks good may result in a decision to not perform the draw.  We'll know in the morning! 

Mary Continues to Get Stronger

Mary had another good day today. Reenie, the two dogs and Mary headed for Oak Meadow Park and had a very nice outing. This was The Maids day so all four girls had to leave for a couple of hours. Turns out that Shauna, the 15 year old dog, needed more rests on the walk than Mary did. The best part is that Mary did the walk without her walker. That is fantastic!

After the park, lunch and short naps, they headed to The Purple Onion to pick up the pulled pork and coleslaw I ordered yesterday at Mary's request. It was very good!

Mary still feels pain now and then but no where near as much as last week. She is still taking an afternoon nap but not as long as before.

All in all, the signs are good. And, we are starting to really focus on what the surgeon will say on Friday. Our amateur assessment is that she is very close to being declared successful for Step 2. We shall see.

Tuesday Evening--A Magnificent Day!

As I noted early, Mary made her first trip up and down the stairs with a dog this morning. The rest of the day was even better. Her first walk was much longer than her prior walks by a considerably amount. Using google maps, I estimate her loop has been about a quarter of a mile (I previously guessed a third of a mile). Today she added the circle which just about doubles the distant to almost a half a mile. Again, after dinner, we walked the quarter mile again.

Reenie reported Mary took a short nap today and all in all was very active and awake. That included helping us pick up the house for the bi-weekly visit of the maids tomorrow. All in all, a magnificent day!

For those who don't know our neighborhood, there is a circle road formed by Golf Links and Clara. Our house is at the top of the picture (below) and the 'Dr' of Golf Links Dr is at our driveway. For the shorter loop, she walks to the intersection of the circle and then walks back to the 2nd neighbor on the far side. The longer loop includes one lap of the circle.


View Larger Map

The Internet is Wonderful

Mary has recieved cards and flowers from so many people its too much to try and acknowledge all of them. Over time as Mary's strength improves, I am sure she'll acknowledge these wonderful acts of support and kindness.

Yesterday was special, however. Mary got a flower arrangement from Dresden Germany! Well, not really from Germany. Our friends, Ute and JoKi, used the internet to order a beautiful arrangement of flowers for our girl. Thank you!

For those who may not remember, I had the delightful task of leaving a conference in Hawaii where I was the chairman at noon on a Thursday and travel to Ute and JoKi's wedding in Germany on Saturday. This involved changing planes at SFO where Mary joined me to continue the journey. Our arrival was at risk when our plane took an unexpected detour to United's maintenance operations at Washington Dulles. That resulted in us missing our connection in Berlin. After all of that, as I recall, we arrived with a full 75 minutes to spare. As we arrived at the hotel/resort, Ute burst out of the lobby with "I am so glad you could be here! Where have you been?"

As for our patient, she is showing leaps and bounds of improvement. Last night after dinner (fresh snapper from Farmer's Market), she announced we were going for a walk. And so we did. It was the 1/3rd mile loop, her second of the day, and it was just perfect. This morning she surprised us by taking one of the dogs downstairs for the morning dog run. Mary made it down and back a flight of stairs all on her own without asking for any help from either Reenie or me. Wunderbar!

As I left for work this morning, Mary was deep into today's San Jose Mercury crossword puzzle. That is a definite sign that she is mending nicely.

The next major event is another visit with the surgeon on Friday morning. By that time, I hope, it will be a straightforward visit just to make sure she is on track. Perhaps he'll start the process to get her in the queue for radiation treatment. Perhaps not.

It may be too soon to say it, but I have this very good feeling that Mary is going to have a successful completion of Step 2! Grow that liver, grow, grow!

Monday Morning

Jake is on his way back to Portland. It was a pleasure having him visit. His Mom has him well trained as a sous chef so he spent quite a bit of time in the kitchen with her prepping the meals--although in our kitchen, he had no one to delegate to. (Me? Heck, I burn water when I try to boil it!) I enjoyed all the meals prepared for Jake except the one with the sauerkraut. Somewhere, sometime, someplace, sauerkraut became one of those foods for me that cause a gag reflex just thinking about it. I have the same issue with raw carrots but I am perfectly ok with cooked or steamed carrots. Anyway, the sausage was good and Reenie was nice enough to heat the kraut on the grill outside to minimize the aroma (forced use of the word) in the house. It was a small price to pay to have our Jake's wishes honored for a kraut and sausage meal.

Mary was most pleased to have him here for the visit. It was clear to me that she really enjoyed seeing her nephew. And, she like sauerkraut!

Ingrid came over to join us for lunch and to give Mary a back rub. Reenie went all out with yesterday's brunch, especially for Ingrid who had done the massage the day before. After lunch, Ingrid raised the ante and scrubbed the kitchen from top to bottom! Anyway, Ingrid spent so much time in the kitchen, Mary missed the backrub because she retired for her afternoon nap.

Reenie and Mary agreed to have a more 'active' day today, including a couple of walks around the neighborhood. Her single walk yesterday was about a third of a mile. We don't think the distance needs to be increased right now, but the frequency of the walks needs to increase. They do take a dog along and if its Shauna, our old dog, the pace is just right for Mary with a walker, Reenie with her bionic knees and hips and, of course, the 15 year old English Cocker. Its quite a parade!

On the medical front, Mary is clearly getting stronger and using much less of the pain killer. Reenie reports that the small opening in the incision is almost closed as of late yesterday and the large opening is quickly doing the same--just as the doc suggested.

Sunday Brunch

Ingrid brought her camera so we have pictures of Mary and Me, Wiggles (white dog), Shauna (red dog), Ingrid, Reenie and her oldest son, Jacob. Enjoy!

Saturday Morning

Friday was a great day! It even saw Mary in the kitchen tossing the salad for dinner. I think that is the first time I have seen her in the kitchen since the surgery on the 11th. Mary is no longer using the walker in the house but she does use it outside for safety. Reenie reports from the once-a-day wound care that the two remaining open areas of incision are healing nicely, with the smaller one almost being closed while the longer, deeper one will take a bit more time. It will be nice for those to be complete so Mary doesn't have to keep them in mind as she moves around.

We picked up the new blood pressure medicine and, of course, its a "brand" name with no generic substitute. Bummer, the co-pay is substantial. But, it should help Mary's electrolyte and fluid balance. Why? Her current BP med includes a diuretic that could be interfering with her body's attempts to get back to normal.

Reenie's son, Jacob aka Jake, has been a great help to his mother in the kitchen. And, is the inspiration for Reenie's menu for each meal. Breakfast today included scones made from scratch baked this morning, fresh fruit salad (strawberries, raspberries, blueberries, etc.), bacon and eggs. They went shopping yesterday and brought home fixings for a nice steak dinner with spinach salad and baked potato last night. I guess it was the abundance of wine that prevented me from posting yesterday--but who can remember?

I should note that our neighbor Bill delivered fresh raspberries from his garden and they have been the treat at each meal!

Ingrid joined us for dinner and then gave Mary a back massage in a massage chair she had brought over earlier in the day. (Mary hasn't laid on her stomach yet. In fact, she hasn't even laid on her side.) The after dinner massage was the 2nd of the day and these massages are really helping Mary. My opinion is that after all the back muscle spasms Mary suffered earlier in the week, the massages are working the latent kinks out of her muscles and she is definitely feeling better.

Ingrid also lent Mary some of her "therapy" pillows that, properly arranged, allows Mary to get very comfortable. That meant Jake has made his first venture driving on California freeways as he went to Ingrid's office to pick up the pillows. Because the pillows are here, he must have made it successfully.

As for me, I started to develop the sensation of a gout attack in my left foot. Fortunately, my prescription is still on file and valid from last fall's attack so I simply ordered a refill. My first attack of gout happened last September and I really, really, really don't want to feel that again!

Reenie is in for a treat today. She is headed to Ingrid's salon for a massage. Having personal experience with Ingrid's techniques, Reenie will really enjoy it! If you are interested in Ingrid's service, here is the link. http://www.massagerescue.com/

As I have said before, Mary is clearly on the mend. "Grow that liver, grow, grow!" is a little ditty that constantly plays in my head. She is not ready to be on her own yet but I think she will quickly get there.

One of the gifts Mary recieved was a very nice bed jacket from her buddies at Habitat for Humanity of Silicon Valley. The jacket is her constant companion. Yesterday, Reenie took it from her to wash it during her afternoon nap. The first thing she wanted when she woke up was the jacket! We were kidding her that she was a bit like Linus from the Peanuts comic strip demanding his blanket. Thanks to Jennifer and all the gang at SVHfH! You can see the jacket in this picture from last weekend. And, you can see Mary and the previous Executive Director with an award given to her by SVHfH in this picture.

That is all for now!

Mary saw the nefrologist today. I don't know why I think of people searching the ancient ruins of Egypt when I see that word, but I do.

Dr. Chertow is the head of the program at Stanford and he was extremely gracious and took his time to explain what was going on. Basically, her electrolytes are fine now and her symptoms from the end of last week are pretty much under control. They have written a new script for her blood pressure medication to eliminate the diuretic component that may interfere with what her system is trying to do. The new script is the same blood pressure component but it includes a different diuretic that is less likely to interfere with her electrolyte system.

As a result, the doc said Mary should continue to lose retained water until she is back to normal body weight.

This morning, Reenie's oldest son, Jacob, arrived from Portland after an 18 hour Amtrak trip and Amtrak delivered Jake approximately on time. That allowed me to meet the three of them at Stanford in advance of the meeting with Dr. Chertow.

Although I went back to work, Reenie, Mary and Jake headed back to the house. When I got home from work, Mary was taking a late nap and Reenie and Jake were out at the grocery store. As we prepared for dinner, Ingrid dropped in to deliver a book for Mary and to meet Jake.

The trip to Stanford and the excitement of Jake's arrival tired Mary out more than is typical. A good night's sleep will do her good.

Wednesday Evening

A nice day. Mary, Reenie and the dogs (one at a time) took a walk up and down the street. Dr. Visser did call, reported the blood tests were all nominal so we have successfully stuffed her with 'tassium. He again iterated that her progress was very positive and nominal considering what she has been through.

Tomorrow is another visit, this time with the nefrology-renal-kidney doctors. It is billed as a post-surgery follow up so we hope its straightforward.

A treat is the arrival of Reenie's oldest son, Jacob, for a visit from Portland. He arrives in the morning and has to be back in Portland on Monday. Given that Mary is so much stronger, the timing is very good.

Mary does still nap in the afternoon between 2 and 5pm. She is much more mobile now and is walking around inside the house without the walker. Outside we make sure she uses the other walker that includes a seat so she can rest if she gets tired.

I'll post more after we've heard the results of the visit with the docs.

Tuesday Evening

Mary's back spasms continued and the surgeon's office called to follow up. They sent her to a local lab to take a fresh blood draw and we have not heard back yet. We assume the silence means things are ok--or the lab didn't get the results back to the surgeon yet. Mary left a voice mail and we'll get a call back the morning.

Potassium deficiency can cause, among a bunch of other things, muscle spasms. And, given's Mary propensity for electrolyte imbalance (SIADH, for example), they want to make sure she is within normal ranges.

Otherwise, Mary and Reenie had a good day including a trip to the grocery store--to buy potassium rich items we didn't already have in the house. Reenie cooked a stir fry dinner in a wok with about every veggie and funghi known to man that has higher than average potassium.

After Dinner, Mary comfortably watched TiVo'd shows from the last four weeks.

A nice day, all in all.

A Lake Wobegon Monday

Mary had, as they say in Lake Wobegon, a pretty good day. Mary finds her strength and appetite is in the first part of the day and tapers off late afternoon and into the evening. She continues to lose the excess water and her bloated limbs are significantly less--darn near normal at times.

Reenie and Mary decided the ostomy bag was not accomplishing anything so they removed it today and replaced it with a simple bandage. That is as the surgeon predicted once she was off the 6,000mg of salt per day and is one more step towards Mary's liver carrying a full load.

The kidney-renal-nefrology doctors called to see Mary on Thursday and Mary'll set the appointment time when she calls back tomorrow. This is called a "routine post-operative visit" being held at the request of the surgeon.

Mary continues to have muscle spasms from time to time that are very uncomfortable. A heat pad and our electric massage tool helps to knock them down but not very quickly.

As for the Lake Wobegon of Prairie Home Companion reference, Garrison Keillor placed his imaginary Lake Wobegon in the very real Stearns County of Minnesota. The very same county where Mary spent four years going to college at the College of St. Benedict about a two hour drive north and a bit west of St. Paul. Her class is having a major reunion at the end of June. If this cholangiocarcinoma had not appeared, we'd probably be there enjoying the visit because it is timed during the very short season (3rd weekend in June) between the last frost and massive summer population of hungry mosquitoes.

A quick note

Sunday finished uneventfully. After her nap, Mary did have a muscle spasm in her side and back that was more than uncomfortable. It went away last evening and reappeared today so Reenie and Mary called the doctor's nurse at Stanford for guidance.

I have returned to work leaving Reenie and Mary to fend for themselves. They are probably doing a lot better than I suspect. I called at lunchtime and Mary sounded very good, showered, ostomy bag removed because it had collected almost nothing the past 48 hours. Mary's water retention is improving and our home scale shows a loss of more than a five pound (2.2kg) in just a couple of days.

All in all, a very quiet time while Mary continues to heal. That is, afterall, the main objective right now.