Infusion #2

Things went much faster this time around, largely because this wasn't a set of appointments wedged into already full-up schedules less than 24 hours ahead of time. We checked in about 1:30, and Rob was called in for his first stop (blood draw) at just a smidge after 2:30, which was his actual appointment time. We got out of that, were called back for the appointment with Dr. Puzanov less than five minutes later, filled out the various forms they make Rob do every time. Spent some time with Dr. Puzanov going over the symptoms from last week, which he opines might actually have been a straight-up reaction to the MPDL drug, rather than an interaction of drug and virus. He also firmly agrees that the increase in tumor size is inflammation and a good sign. Actually much of his visit could be summarized as "Please, please, please don't panic and leave the study! It's fine, I promise!" Rob and I found this pretty funny, because we weren't even considering leaving the study as an option at this point.

After Puzanov it was time to go up to the infusion clinic. Again, things were much quicker this time, because we were part of the original schedule, rather than wedged in at at the last second. Infusion time is still an hour (plus 15 minutes either side for IV fussing), but we only had to wait an hour before they did the final blood draw and let us go this time. I was also able to run over to the hospital cafeteria and grab some food for both of us, since Rob had been fasting for the first blood draw, and I hadn't had much because it seemed cruel to be munching in front of him if he couldn't eat. The cafeteria is pretty decent as hospital cafeterias go, and actually had decent sushi in their refridgerator case (cooked sushi, I'm not that much of a daredevil!)

The whole thing finished about 7pm, and we were able to hit the road home in time to get home before midnight. The hour time change here to there is really nice in the morning when heading down, less so coming back home.

So far no side-effects once again. If last week is a repeating side effect, I guess we'll find out in nine days or so.

In other news, the kids have now had their first two days of school. Aaron is really liking his classes and teachers so far, and doesn't seem to share any classes with the kids who were pestering him last year (Yay!). Robbie has no complaints, but I've already gotten an e-mail from his math teacher about him sleeping in class. Their friend Samuel will be able to drop by tomorrow and play for the first time in over a year (he lives 2 hours away), so both of them are very excited for this weekend.

That was the week that was

It was the last week before school starts again. It was also pretty much a dead loss. Rob caught a virus, and his hyped-up immune system decided to go full nuclear option. Fever, shakes, sweats, sore throat, swollen lymph nodes, inflamed spleen, throwing up - you name the symptom, he had it. This culminated in a nine hour day spent in the ER, because we couldn't keep the hydration up with the fluid loss. They put in 2 1/2 litres of fluid, which is probably the biggest reason for why he felt better, but while he was there they also ran him through a massive series of tests, because they really didn't want to think that this was just some random virus. So there was blood and urine analysis, a mono test, strep test, chest X-ray (in case of pneumonia), CT scan (in case his adrenal gland had ruptured), and then when they discovered his bilirubin was elevated (which made his urine an amazing shade of neon orange), a set of liver function tests.

The upshot of all this? He had a virus, his immune system freaked out, and then the dehydration spiral got him. They sent him home rehydrated with an anti-nausea pill and some pain-killers (after much back and forth with Vanderbilt about which drugs won't interfere with the trial protocol).

We did find out two interesting things though.

#1 - Rob has a benign condition called Gilbert's Syndrome. It apparently causes his liver to produce excess amounts of bilirubin when stressed (E.g. - when he has an infection and is dehydrated). It's otherwise harmless, but does make him a little yellow when he's sick, and occasionally scare ER workers.

#2 - The CT scan showed that in the three weeks since his last CT, the adrenal tumor has increased from 2.8cm to 3.3cm. The doctor at the ER was very unhappy about this, but when he called in Dr. Rez, our local oncologist, Dr. Rez was very nearly giddy with excitement (for his own personal levels of giddy - he's a really lovely person, but not exactly highly excitable). According to Dr. Rez, it is basically impossible that the tumor could have started growing that fast, which means the tumor is inflamed - which means that Rob's immune system has found it and started attacking it. He's quite adamant that it's the best possible sign, and that we should start seeing shrinkage within the next couple of months. (Please, please, please let him be right!)

Anyway at this point, Rob is feeling better, if still easily exhausted. The first day of school is Thursday, and Rob's next infusion is Wednesday, which gives us Monday and Tuesday to get all the school supplies, hair cuts, and generally get things ready to go for school. Gonna be a close one!

Where We Wait

I was going to call this post "Where We Stand", but honestly our lives are mostly waiting right now, so that seemed more apropos.

I had a grand time in Okinawa. Shimabuku-sensei and Tokumura-sensei both kicked my butt, if in somewhat metaphorical fashion. I learned a ton about bo, tekko and tetchu, had my front snap kick absolutely dissected, and generally had an awesome but exhausting time at the two dojo. My broken foot is definitely healed - Shimabuku-sensei opened each class with about 15 minutes of running laps of the dojo barefoot, and then followed that up with technique drills, including kicks to focus bags in batches of 50. So if there were anything still wrong with the foot, it would have showed.

In between the training portions of the trip, we visited the Budokan - a giant dojo/martial arts convention center, Shurijo (Shuri castle), Katsuranjo (Katsuran castle - in ruins), went to Kokusaidori, which is the main Okinawan shopping area and tried several different kinds of foods. Went to Shureido (martial arts equipment store) and bought a gi, dojo bag, and several other random items. Went out to Hamahiga Island. Stayed in a traditional Japanese-style hotel room, complete with tatami mats, futon for sleeping, low table with cushions instead of chairs, and a set of toilet/bathing rooms that has to be seen to be believed.

 Skype is awesome, as Rob and I were able to talk daily, and able to see each other any time he wasn't at work (the work data protocols muck with Skype's video).

My hard-won Japanese seems to be just enough to get me into trouble. Apparently, while my vocabulary and grammar are still limited, my pronunciation is excellent, leading people to think I speak and understand much more than I do. And since disclaiming any ability is only polite in Japan, no matter how good you are, me saying "No, no! I'm still very bad." is just taken as proper modesty. So people kept exchanging a couple of sentences with me, and then launching in to full-on, full-speed Japanese, and being surprised when I would get lost half a sentence in.

I'll probably say more about the Okinawa trip in later posts as things occur to me, but for now, onto the Rob update.

It took a while to finalize everything, but as of last week, Rob is officially in the Vanderbilt study on MPDL3280A/Bevacizumab. He's in the study cohort that receives the PDL-1 drug by itself, rather than the combined medications, which is right where we were hoping he would land. He had the first dose a week ago, and will continue to get doses every third week for the next year, provided the cancer responds in some positive way. If it doesn't then he'll be moved into the dual drug cohort, and if that still doesn't work, it's out of the study and on to conventional treatments.

In unhappy news, the CT scan they did to finalize his acceptance into the study - the first we've had since March 10, when we first found the tumors - showed about 30% growth in the right adrenal tumor. There are still no other metastases showing, which is good, but 30% over four months is a lot more aggressive than we were hoping for.

The actual first infusion was fine, though I hope future visits are a little more smoothly planned out. This time we didn't get our go ahead and appointment time until less than twelve hours before we had to leave to get there. Then once we did get there, there was a lot of waiting around between portions, because he'd been wedged in at the last second. Entirely understandable under the circumstances, but I hope it gets more predictable when they have more lead time.

The day started out with drawing 18 vials of blood for the baseline blood work. Rob seems to have excellent blood chemistry, with the only complaint being that he's mildly anemic - which the 18 vials of blood is hardly going to help, unfortunately. From there we went to the intake interview and final signings of papers - which included the study nurse having to chase the doctor around room to room trying to find him so he could sign the last bit of permission. While she did this, Rob filled out the various "How are you feeling today?" forms, which he'll have to do with each visit, and then we were off to the infusion.

The infusion takes about 90 minutes all-told, with about an hour of the drug running, plus set-up time and time at the end. Then we have to hang around for another two hours, while the nurses stop by and check things like pulse and blood pressure every 20 minutes or so. Fortunately, he's allowed to eat and snacks are available, and we're never short on reading material. After the infusion they draw another two vials to check for drug levels in his blood, and then after the 2 hours are up, we're allowed to go. This first time, we finished right at five, so we went out to dinner first rather than fight Nashville traffic running north (one advantage to having lived in Nashville before, we know when and where traffic is likely to be bad).

Future visits, we can skip the intake interview and chasing around for signatures, plus they will apparently gradually increase the rate of the infusion if he tolerates it well (which he did this first time), so we should be able to get through the whole process a little faster. With any luck, we should be able to see the kids off to school, hit the road, make Vanderbilt by about 11am, and be home again by about 10pm. A long day, but manageable.

Oh - and the next infusion date is also the first day of school - so I really hope they can schedule us in such that we can get the kids off to their respective buses. It would really suck to have to leave the boys to see themselves off for the first day of school. Bad enough that we'll be coming home just about in time to say "Good night".

No noticeable drug side effects thus far. Rob was pretty tired the next day, but not in any way that was distinguishable from the normal tired you'd expect from driving six hours and having seven hours of hospital time in one day. The only day-to-day discomfort he's having at this point is a chronic upper-backache, which seems to be nothing directly cancer related, but rather a combination of his horrible posture, and a tendency to have tension backaches rather than tension headaches. So far we're keeping it down to a dull roar with Tylenol, massage, and Tiger's Balm.

And now we wait. We have another infusion in two weeks, and then a repeat CT scan the visit after that. Until then, all we can do is be as healthy as we can, and hope that all of this is doing some good.

I Pronounce It "Eye-gore"

Well, not actually. The doctor's name down in Vanderbilt is Igor, pronounced the usual way. We're still getting a kick out of Rob potentially getting experimented on by an Igor, though.

The trip to Vandy was very good for our psyches. Firstly, Rob has been declared an excellent candidate for the trial. He needs to get a new CT scan, but unless it shows regression, he's in. If he does show regression, we don't want to mess with it anyway. Igor (actually Dr. Puzanov, but it's too much fun calling him Igor) was very informative, and was able to reassure us on what would happen if he ended up in the control group, and how they dealt with patients who weren't responding well to the treatment.

The trial has three branches: One gets the trial drug (MPDL4280A, or PD-1 for shorthand) alone. One gets PD-1 combined with bevacizumab, which is a TKI, or anti-angiogenic drug. One gets Sutent alone - which is the most commonly used of the TKIs in current therapy. Or in other words, branches A&B are the experimental groups, and C is the control. Thankfully these days cancer trials are run vs. the standard of care, rather than vs. a placebo.

Additionally, if the patient doesn't respond to the Sutent, they can be moved into the A group, since at that point they would be stopping Sutent therapy under the standard of care anyway. As to another concern of ours - that TKI therapy can inhibit later IL2 therapy by causing heart toxicity, Dr. P said that they had noted that, and had developed an in-house protocol for doing IL2 specifically for patients coming off of TKIs that has been working well for them.

So we came home with a pile of paperwork for Rob to read through and sign, and he should be getting his repeat CT within the next week or so. Entry into the trial won't be before I get back from Okinawa at the earliest.

The other exciting bit of news was from Dr. R - our local guy. He spent the weekend at the ASOCO annual meeting, and went to the presentation of results from the first trials of PD-1. Results are incredibly promising - 26% of patients with durable remission. Keep in mind, the durable remission numbers for IL2 are something like 4%, with another 15-20% getting a durable partial remission. PD-1 trials for melanoma were also presented, and apparently it's the first drug to show real life extension with advanced melanoma cases. He thinks that with numbers like those, it should be FDA approved for renal cell carcinoma and melanoma before the end of 2015. Knowing the FDA, I'm a little more dubious, but since it's already approved for some other cancers, it's possible.

In other random good bits, Dr. P commented that Rob's expected untreated lifespan wasn't "average of three years", which had been told to us a couple of times as the usual for stage IV RCC, but that given his blood markers and the nature of the spread, he would say "minimum of three years" if untreated. Which sounds a heck of a lot better to us. Particularly the "if untreated" part, since we're hardly going to leave this untreated. Not as good as "durable remission", but still a more upbeat take.

Three days to Okinawa! Packing! Last day of school! - busy, busy the rest of the week.

OMG/110

We've survived Dad W's first chemo procedure. Actually, he tolerated the procedure really, really well, without any of the pain and nausea we were told to expect. The side effects from the chemo itself have just started cropping up today (48 hours later), and thus far aren't too horrible - some abdominal pain, some nausea - both controllable with medication - and a lot of fatigue.

In another eight days we do the same thing again (1-day admit for a procedure, then home) only this time the microspheres will be radioactive instead of impregnated with chemotherapy drugs.

Yesterday, naturally, the hospital released Dad W at exactly the wrong moment for our schedules. I had Dad-sitting duties until 2, when I was supposed to leave to go to my annual gyne visit, and then pick up the boys. If he was released before 2, then I would take him home. If he was released after 2, then Rob would get off work early and come get him ASAP - which would be 3:30, approximately. Well, they told me at 1 that they were releasing Dad W. By the time they got the paperwork processed, walked us through the release orders, got him dressed and all his stuff together, and got the wheelchair transport, it was 2:05 - and instead of going straight to my appointment, I had to go home and get him settled first. I showed up 15 minutes late, and with an absolutely sky-high blood pressure - 185/110. My blood-pressure occasionally runs the high side of normal, but nothing like this. But half an hour later it had only dropped to 172/105, still waaay too high. So now I'm under instructions to take my BP daily for the next week and go see my PCP with the results (had an appointment with her before I left the building).

Why do I feel like my BP would have been better if I had been able to make karate class on Tuesday night? But that was the procedure day, and it just wasn't happening. And tonight class is cancelled because of snow. Only two classes missed so far, and I'm already feeling a bit bereft. And I'm likely to miss Thursday of next week because of that procedure. Glah - I need to go hit stuff! This no yoga, no karate thing that's been happening for the last month is just not on.

In good news, Sensei is supposed to be starting back at work in about 2 weeks. His knee is apparently healing well from his surgery. Missing this much work has been a big concern for him, so I'm glad he's getting back to it.

A Deep Breath

Some good news - Dad W has no metastases. We have only the primary tumor to deal with. The oncologist sounded downright optimistic at the latest visit. Granted, we still have a big honking, fast-growing liver tumor, but we have a plan of action and some hope.

I just realized I was talking about Dad W's cancer the way some husbands talk about pregnancies - as "our" tumor. It's really feeling that way. I track the appointments, take Dad W to them, and provide doctor interface and translation when he gets confused. Though I feel a little guilty because along with everything else I feel, I'm also absolutely fascinated with the actual treatments being planned.

We'll be starting targeted chemo and radiation therapy in January, both supplied through polymer microspheres fed directly into the artery that supplies the tumor. Between now and then our instructions are to feed him up, and chase him out of the house to get some exercise - basically to try to build him up both physically and mentally before treatments actually begin. So for now, it's time to catch our breath, enjoy the holidays and get ready to hit the ground running.

Other news: The Saturn having been successfully turned into a large paperweight (cracked engine block), I now have a 1997 Nissan Maxima to play with. It's a year older, but with 100,000 fewer miles than the Saturn. We now look like a family of government agents, with two black cars with black interiors and tinted windows.

Our church organist is taking a leave of absence for January and February, so I will be sharing duties with one of the other choir members (a composer and phenomenal pianist) to provide coverage. Eeep! That's a lot of playing given the size (miniscule) of my organ repertoire. Also, said composer has written a duet for two sopranos and has asked me if I would debut it, singing with M (a professional singer/voice teacher), which is terribly flattering. I've heard M sing, and she's got a fabulous voice, though very different from mine. To have a professional composer think I'm a good match for a duet with her just made my whole day.

Full speed ahead!

My crystal ball is broken, because treatment for Dad W. will be proceeding under full steam. Apparently we're dealing with a cancer originating in the common bile duct (surprise, surprise, the doctors here are better at identifying odd cancers). This is good, in that it means that this is the primary tumor we're dealing with, bad inasmuch as it's a notably aggressive form of cancer.

Targeted chemotherapy with supplemental radiation will be commencing practically immediately - they literally wouldn't let us out of the exam room until they had lined up Dad W's appointments with the radio-therapy people and the chemo specialist.

All the knitting stuff I got will definitely come in handy. I got 2" done on a leg warmer this afternoon alone, and this was a relatively short appointment.

It feels really weird, though. I'm getting all but blasted with approval from my in-laws (all three), all for doing stuff it would never occur to me not to do. What, am I going to tell Dad to get his own butt to and from appointments? Leave him to flounder through the medical explanations, when I have the training to understand them and he doesn't? Yell at him for being lazy because he's anemic and depressed? This is all stuff I would do for my next-door neighbor, did he need it, doing it for my father-in-law seems like no special merit. I wonder why it seems to look so different to them.

In other news, the car is good - it was just suffering from excessive cold (like my younger son, who had much to say about walking to school in the snow because the car wouldn't start).

I'm cantoring for church this coming Sunday, which will be a new experience. The singing itself is easy-peasy, but leading the congregation through the psalm is new for me. The week after is Mary's Sunday, and I'm doing a solo bit. It was originally supposed to be all the women, but apparently it's too high for even the other sopranos to sing. So, naturally if you want someone to sing in the stratosphere, I'm your girl.

Robbie has his first band concert this Thursday. He's really happy right now, because the conductor has moved him up from last chair to 4th chair within his section. He's been practicing assiduously, and is amazingly good for having been at it such a short time. Unfortunately his Dad will still be in Brazil, but Grandpa and I will be there to cheer him on.

Last but not least, Sensei's knee surgery appears to have gone well. He should start PT sometime this week, though I haven't heard exactly when. He's bored with sitting around, though - I should make him learn to knit!

ps - happy 50th Robert! I hope your party was a blast!

Pathetic Self Care

One of these days I will actually learn to take care of an injury rather than plowing through it.

No, I don't have any new injuries at the moment, thank goodness. The knee has settled back down and is behaving itself, though it does have a new, and very loud, click when bent deeply.

What's annoying is my back, which I sprained back in December, and which stills acts up occassionally. It's how frequently it acts up vs. how much it should act up that is making me annoyed with myself. You see there are three things I can do, any of which by themselves will prevent my back from hurting.

1) I can take ibuprofen at inflammation-reducing levels (I.e. every 4-6 hours whether my back hurts or not).

2) I can lie down and put my feet up, once with ice, or 2-3 times without ice, for 15 minutes each day.

3) I can do back exercises: 1 hour class, 4x a week. This prevents pain after about 3 weeks to a month of consistent exercise, and continues to work until I drop off significantly, defined as missing more than 2 classes/week for more than 1 week.

It says something about me that #3 was the first thing I discovered that worked, and that I figured it out more than six months before I realized that rest and/or taking ibuprofen also worked. In fact, I didn't even try them until a chiropractor pretty much forced me to.

It also says something that once I had worked up the exercise schedule I only fell off the exercise enough to have a recurrence twice between December and mid-May, both times during vacation weeks. On the other hand, now that summer's here and I can't fit the back classes into my schedule, I'm failing to follow through on rest or ibuprofen to the point where my back hurts more days than not - even though 15 minutes of rest/day is sufficient to prevent pain for that entire day. Mind you, I'm not someone who considers sitting (or lying) still a punishment. I can happily lie on the couch for hours reading, if I'll allow myself to do it.

But apparently I'm only permitting myself to actually take care of an injury if it is in some way a punishment for me. Lying around with an ice pack, reading a book is insufficiently difficult or something. Which is getting deeply annoying as I keep hitting evenings, when I pretty much can't go lie down - dinner, karate, baths, bedtimes, etc. - and discovering that oh crap, my back is going to make me miserable tonight, isn't it?

My subconscious is apparently a weird and masochistic place and I'm getting a little tired of it.

Medical, Medical

We've been spending this last week at my in-laws. Rob's Mom is sick, and has been for a while, so we went down to help for a while. We got there to discover that my MIL, who was already underweight at 105, had dropped to 90 pounds. She's been sick for 4-6 weeks (intestinal), but only saw a doctor for the first time about 10 days ago. Our being there helped, but she was already in such poor shape that her internist admitted her Friday - official weight at intake was 86 pounds. At least at the hospital they can sit on her - give her food she should be eating (she designs meals around Dad's dietary requirements and ignores her own), supplement her food and fluids with IV's as necessary, and keep her from trying to do things she shouldn't. She already sounds better just having had intrevenous fluids - she was so dehydrated going in that they had to use a chest vein to start an IV - and that was after a week of us pushing fluids on her! We don't have a diagnosis yet, but the doctors appear to think she'll recover, as long as we can convince her to take care of herself.

I had my own check-up this week (had to scoot up to Louisville from Nashville and then back down again, but they had no open slots for rescheduling). The Crestor has done wonders, my cholesterol is down 70 points. Liver and kidney functions are both fine. I've lost an official 16 pounds since Febuary (total of 29 since last Sept.), and my blood sugar levels are fine. The lab forgot to check insulin levels though, so I'm now in possession of the funniest lab order I've ever seen. All the usual things are checked off, but on the line for other tests, "Check insulin levels" is written in all caps, underlined, exclamation pointed, and starred. Rob took a look at it, and said "I'm surprised they didn't tattoo it on your arm!"

The MRI showed no changes in the adenoma since January (yay!). cortisol was normal, though it bops all over the map, so one normal reading is pretty meaningless. The only real change was that TSH (thyroid stimulating hormone) levels have risen, though thyroid levels remain the same. Because of this, I've been put on Synthroid. Which has been an experience. I started yesterday. Today I was sweeping the kitchen floor, and suddenly stopped dead. I had realized that thus far I had unpacked from Tennessee, done some laundry, done a load of dishes, unloaded a storage crate, gathered together our school supplies and checked them off the list to see what we still needed to get. It was about 2pm, and I wasn't tired.

Now you have to understand - I'm always tired. I don't wake up in the morning bright-eyed and bushy-tailed. I'm already tired when I wake up, and it doesn't get better. There is never a moment in my life where, if someone presented me with a bed and said "I'll take care of everything, just rest", I wouldn't happily crawl into said bed and take a nap. I've been this way, not only my entire adult life, but for as long as I can remember. I know what bright-eyed and bushy-tailed feels like because it's happened to me twice. One day in the spring of 1997, and once in sophomore year of high school, I actually woke of feeling energetic and rested. That's it - my entire life experience of not being tired.

Until today. I accomplished approximately three times as much today as I usually do - and I'm not even feeling energetic - just not tired. It's a really strange and subtle thing to experience. I hope to God that it sticks and that it's not just an effect of adjusting to the Synthroid - 'cause I could get used to this really easily.

The Joys of Transparency

Yet one more chronic condition to add to the list. Quite possibly the first time in my life I'm overjoyed to be so pale as to be practically transparent.

Apparently I've developed vitiligo (pronounced vittle-I-go) - or more to the point, have had it for at least a year or so. Vitiligo causes patches of skin to lose their melanocytes, and turn pale - for all intents and purposes, you break out in albino spots. It's highly associated with Hashimoto's (about 21% of all Hashimoto's patients develop it sooner or later), so not exactly a stunning surprise there. (Though it would be nice if the Hashimoto's information sites (or my endocrinologist) had mentioned the connection.) There are a few treatments, all for the cosmetic issues rather than for the source. Fortunately for me, I'm so pale the only one who can even find the lighter patches without a strong light and having it pointed out, is me. So not exactly a major cosmetic problem. Even a massive outbreak of demelanization would only mean I start wearing foundation. Well, plus any patches on my scalp would grow gray hair, but my mother started going gray in her twenties while I'm 38 with no gray at all, so that wouldn't exactly be a tragedy.

This feels very tree-in-the-forest. If I have a condition whose only negative aspect is cosmetic, and the cosmetic doesn't affect me, does it count?

The BBM Diet & Exercise Program

To open with, I'll post a picture of the boys. This is Robbie and Aaron in their tuxes, just before their stint as ring-bearers in my friend A's wedding. You can get a good idea of how strong the resemblence is here. (Robbie is the taller one on the left.) I get asked if they're twins an average of twice a week.

Sorry for the long wait between posts. Brochitis has been kicking my butt for the last week and a half. I haven't even been to karate, which is unusual for me. I did try on Friday, but was foiled by Sensei craftily having to work and cancelling class. Just as well I suppose, since I'm still getting coughing fits bad enough to make me hyperventilate. Passing out in class would probably not go over well. On the good side, as Black Belt Mama reports, a good round of bronchitis leads to both weight loss and strong abs. The weight loss is enhanced when you combine a deep chest cough with nausea-inducing medication (I leave the resultant synergy to the reader's imagination.).

Just to add to the fun of this last week, the boys' last day of school was Tuesday. Plus Rob was out of town, so I had two kids wanting Mommy attention, when all Mommy wanted to do was crawl into bed and hack her lungs up in peace. Both boys did well. Robbie made the A/B honor roll (B in Language) for the year. Nobody in the entire third grade made the A honor roll. The grading at Parkwood is really tough. An A is 93% and up, rather than the 90 or 91 I'm used to. That means that on a 10 question test, which would be about half of their tests at this age, even one question wrong means a B. Aaron was S's (Satisfactory, the highest Kindergarten rating) across the board except in Writing Mechanics (how he holds his pencil), and Identifying Information (He can't seem to remember our phone number). I'm not sure about the number, but given that he gets 15-30 minutes of special help daily on how to use his pencil and manipulate things manually (scissors, glue, etc.), it would be shocking, delightful but shocking, if he did manage to get an S.

Keeping our fingers crossed for 1st grade and 4th grade respectively. If we get our teacher request for Aaron, I'm pretty sure he'll have a great year. Robbie is more of a crap shoot, since we don't know any of the fourth grade teachers. Unfortunately, Robbie is actually the fussier child when it comes to teacher matching. A great teacher means a fabulous year (THANK YOU MS. EDDINGS!), whereas a bad match, not even a bad teacher, just a poor match for Robbie, spells universal disaster. A nine-week stint with a new math teacher in 2nd grade nearly had him suspended by the end of it, and the behavior problems weren't just in math class either. We had notes home from music, gym, English, everything, for as long as he had that teacher for math. When the math class rotated, the problems vanished within a week. So heavy finger crossing there.

I'm starting a new sweater from knitty. I just cast on today. I'll post about it sometime later.

School! and stuff

Four more days of school left. Starting next Wed. I have to figure out what to do with my crew all day, every day. Rob, the stinker, is out of town all next week (and part of the week after), so I'm on my own for the first several schoolless days. In the effort to get a head-start on things, I've made both boys an offer: If, working together, we can get their rooms actually clean and organized, then I will help them to redo/decorate them as they see fit. This is up to repainting, new curtains, painting a mural, or putting up posters, but does not include new flooring or furniture. Since Robbie's room most recently belonged to a little girl, while Aaron's room belonged to a sports nut teenager, the offer intrigues them. Whether they'll follow through with actual cleaning effort? Who knows?

All the exercise time is really beginning to pay off. Exercise sessions at the beginning of karate, which used to be doable but strenuous, are becoming easy. I can grab the balls of my feet on a straddle stretch now, which is further than I could get when I was 12 and in gymnastics! My hamstrings have always been my tightest muscle, but the yoga seems to be getting to them. Plus muscles are starting to pop up all over. I'm ready for next week when the dojo switches to summer casual - no air-conditioning, so we can ditch the jacket and wear gi pants, t-shirt and belt.

As expected my PCP put me on a statin (Crestor to be precise). This caused a rapid weight-loss in the short term, as I was one of the lucky 5% who ends up with nausea from Crestor. After several days of diddling around and trying various things, a simple suggestion from a friend proved the key. A, who takes multiple medications and so is wise to their ways, suggested that I time when the nausea occurred, and then time swallowing the Crestor such that the nausea is happening while I'm asleep. Presto! As long as I don't have to get up in the middle of the night, I'm set. Thanks, A!

Fortunately for future midnight emergencies, the nausea is supposed to fade out over time, so mainly I need to get through the first month or two.

Nicky is completely fine again, having mystified two vets. His recovery was too fast for spinal injury, too slow for a pinched nerve, epileptic fit or blood clot. TIA is possible, barely, but there's no evidence of such a thing. Plus the progression really doesn't fit any neurological condition either vet can think of. Timing would be about right for a toxin, but the only toxin with a front-to-back progression of paralysis is ethylene glycol (antifreeze), and if he'd gotten enough of that to paralyze him, he'd be dead. Paralysis tick might work, but a) no ticks in our yard that we've ever found; b) Nicky has a monthly tick treatment; c) the paralysis progression should go the other direction with a paralysis tick; d) the emergency people checked for ticks and didn't find any. In the end they shrugged and said "If it happens again, maybe we'll be able to compare and figure it out." Thanks, but I'll skip if I can.

Quickie Update

I was waiting until my most recent endocrinology appointment to do an update, but since the office just called and put off the appointment until Friday (lab work not back yet), I'll give the short version here.

The summary of what we have thus far:
MRI showing a 2mm adenoma, low and central in the anterior lobe of the pituitary.
Blood workup #1: Normal GH, borderline cortisol, high TSH (thyroid stimulating hormone)
Blood workup #2: Normal GH, Normal IGF-1, high cortisol, borderline TSH, low thyroid
Blood workup #3 (with cortisol suppresion): Cortisol not suppressed.

Because the suppression test didn't suppress my cortisol levels, we did the more formal test for Cushing's (24-hour urinalysis, whee!), and yet another more generalized blood panel. That's what the lab is slow getting back with. I should get those results on Friday morning when I go in.

Given the low thyroid and high cortisol, I'm suddenly not feeling as guilty about the 40 lbs. I've put on in the last decade. With both of those going on, weight gain is pretty much inevitable. It also explains the great exercise mystery of three years ago - to wit: how could I train for a triathlon for six months and lose a total of three pounds?