Tuesday, September 18, 2018

Next steps - the Kobayashi Maru

Since my last post, I've made one more trip to Sloan Kettering in NYC.  To be honest, I don't like how things are going right now.

The surgeon that I saw in early August doesn't really want to operate, and he's one of the more aggressive surgeons out there for liposarcoma.  He will operate when others don't want to operate.  He's the guy that people go to see when their local surgeon doesn't want to do any more surgery.

He sent me to a radiation oncologist instead.  I was mostly disappointed in that visit, because it seemed that the radiation oncologist wasn't really prepared when I got there.  It seemed like he was making stuff up while I was sitting there.

Essentially, he didn't want to do conventional radiation, because the beam of radiation would pass though a spot where my bowel has been re-constructed.  He is worried that the radiation could burn a hole in the bowel, and because of prior radiation, it could be very difficult to get in there and do the surgery to repair the hole in the bowel if it occurred.  It would be an emergency surgery, full of risks.

But, he did have an alternative idea - proton beam radiation.  Proton beam radiation, unlike normal photon beams, can he halted at a particular depth.  So, it was his reasoning that we could make the beam go far enough to reach two tumors, but not go so far that it would damage my bowel.  Of course, he said there were still risks, but he thought that this was the way to go.

He also warned me that proton beam radiation is very expensive and insurance companies tend to fight it as a treatment option.  While I was still at the hospital, he talked briefly to the surgeon and they agreed to take my case to their tumor board to discuss options.  This was on 8/22.  Then, for weeks, I heard nothing.  I thought that perhaps they were fighting my insurance company.  I finally heard from my surgeon on 9/14.  They had finally agreed to a plan.

I have four total tumors right now.  One of them could easily be operated on.  The other 3 are not great candidates for surgery.  So, the plan is to attack those 3 tumors with proton beam radiation and then enroll me in a clinical trial to try an immunotherapy drug to target the 4th tumor after radiation.

They are allegedly working on the insurance approval right now.

I checked my insurance company's web site yesterday, and found nothing about the pre-approval for the radiation.  Perhaps they don't list items until a decision has been made, but it just seems to be taking forever.

While this process drags on, three things have been occurring.  First, the pain I'm dealing with is getting worse.  We increased my oxycodone prescription a couple months ago, and the next time I need to increase the dose, I need to see a pain specialist rather than my primary care doc.  I'm at the limit that VT law allows my PCP to prescribe.  The next step is likely to be something like a morphine pump, something I've been hoping to avoid.

I'm also dealing with increasing fatigue.  I am napping all of the time.  I fall asleep in the car on the way to work.  I fall asleep on the way home.  I fall asleep on the couch as soon as I get home.

Yesterday was all of those things.  I slept on the way to work and on the way home.  We skipped the gym on squat day, a day that I hate to miss, because I was so tired.  As soon as I got home, I fell asleep on the couch.  I woke up about 8:00 and ate a sandwich for dinner.  And then, I fell asleep again.  At 10:00, my wife woke me up to go to bed.  And, at 6:45 this morning, having seemingly slept for most of the past 24 hours, I could barely drag myself out of bed.

Lastly, I have zero appetite.  I never eat breakfast.  I rarely eat lunch, or I eat something very small for lunch.  On the weekends, I never bother to eat breakfast or lunch.  And then at dinner, even with the medical marijuana, I still don't feel hungry.  My weight is gradually decreasing.  I think it's been my fairly regular attendance at the gym that's been stopping it from dropping faster, but if the fatigue starts to mess with my gym attendance, I'm afraid that my weight will plummet.  I'm certainly not skinny.  But, to be honest, I don't want to lose any weight right now.  I need to keep as much muscle mass on my body as possible, to be ready to handle the rigors of radiation and immunotherapy.

For the first time since this ordeal started about 3.5 years ago, I feel like I'm starting to fall behind.  Previously, it felt like we always had answers, another treatment option, I had the gym and my training to focus on, and I had a focus for taking on this disease.  Right now, it feels like I'm starting to lose some of that.

I'm also somewhat depressed by something my employer did to me recently.  I will admit that during my last chemo, I was far from 100%.  I tried hard to keep up, to do a good job, and I was even working up to 60 hours per week during chemo.  But, it wasn't good enough for my employer.

The Friday before Labor Day, my employer presented me with an "offer".  Basically, they were planning to demote me for poor performance, to decrease my salary by 35%, and they asked me to sign a form that admitted I was incompetent at my job.

I spent the weekend trying to chase down an attorney to see what my options were.  What I discovered is that despite my cancer, at-will employment seems to trump the ADA and EEOC laws, and I really had no means to avoid the situation.  Two attorneys suggested that I not sign the form, but I was told that they could impose the job and salary on me at will.  So, I did refuse to sign the form, and the company imposed the new job and new salary on me.  So, now my wife and I are staring at bankruptcy on top of everything else that is going on.

If they had fired me, I would have been eligible for unemployment, I would have filed for bankruptcy immediately, and I would have started the waiting period to collect social security disability insurance.  Instead, they left me with some income, but not enough.  So now, we will struggle for 3-12 months (it's hard to predict how long we can hold out) and then we will have to file for bankruptcy.

Another hope that I was holding onto was that I'd be able to go onto disability insurance when I'd reached the one year mark at work.  That insurance basically pays 2/3 of your salary.  At my old salary, again, we could have gotten by for a while on that level of income.  But, 2/3 of my new salary is now less than half of my old salary, and while we may still take that option, it would again mean bankruptcy.

All in all, I think we've held up pretty well for the past 3.5 years.  If you count my prostate cancer before that and the rare form of melanoma that my wife had, it's been five years of dealing with cancer.  But, we are now approaching the point where we are not going to be able to make it on our own any more.

My daughter is currently doing a semester in Spain.  She sent me a WhatsApp message last night, asking if my wife and I might be interested in meeting her in Spain for a long weekend in Bilbao.  We would love to do that, but it's simply not possible given this turn of events.  I was almost in tears as I read her invitation and thought about how impossible it was.

Oh yeah, two different attorneys have looked at what my employer has done to me.  Both of them described it as the most unethical thing that they've ever seen an employer do.  At the same time, they said that it appeared to be completely legal.

What kind of system do we have in this country where someone's life can just be destroyed because you were unlucky enough to contract a rare cancer?  I know I'm not alone in this situation, but for a while, it seemed like we'd be OK.

Now, I'm left wondering if we are going to be able to afford to eat, or to even feed our pets.

Please don't feel sorry for me.  I've had a great life.  I have an amazing family and support system.  I'll get through this somehow.  I'm sure that many others have been put in worse situations than mine.

But, it's certainly not how I expected that the final years of my life would go down.

Monday, August 13, 2018

What a waste of time and resources

I was at Sloan Kettering last week, getting a CT scan after 3 months of chemotherapy.  This was a rough round of chemo and I dropped 17 pounds in 3 months despite exercising very little.  To be honest, a lot of the lost weight was probably muscle mass.  I am really struggling in the gym these days, from both a strength and an aerobic perspective.  I honestly think my fitness right now might be the worst it's been since 1998.

So, after all of those side effects, at least I knew I'd been taking a chemo that has worked for me in the past and I was optimistic that I'd get good news.  Regretfully, my optimism was unfounded, and the tumors continued to grow right through the chemo.

I have four tumors right now, and three of them grew.  Two of them are in a spot that is tough to operate, because it would require an extensive resection of my liver, and it would require a liver specialist as a second surgeon.  My surgeon was not crazy about that option.

The chemo that I could try next doesn't have a great success rate.  Clinical trials would require me to be in NYC one day every other week - something I can't pull off right now.

But, my surgeon, remembering the good success I had with high dose Image Guided Radiation Therapy (IGRT), suggested we try that again for the two tumors near my liver.  The radiation oncologist agreed that this makes sense, so that is the next treatment for me.

The bad thing is that only 2 of my 4 tumors will be targeted, although one of the tumors that won't be targeted is well differentiated, small and growing very slowly.  But, the radiation will not go after one of the other major tumors, meaning I might need surgery after radiation.

The bosses here at work are being supportive, but I know they aren't really happy.  They would prefer to have me in the office full time rather than being out getting treatments.  For this next treatment, I have a consult with the radiation oncologist next week in NYC, then a day to fit a mold around my body to hold me in place during radiation, and then finally, five straight days of treatment.  I'll need to be out of the office for all of those days, although I hope to work from NYC during the radiation itself.

I'm afraid of what my travel costs are going to be as well.  Finances are pretty tight right now and the cost of a week in NYC, plus the train for 3 trips to the city will be expensive.  I'll do my best to figure it out, but things are going to be tight for a while.

So, after three months of a rough chemo, the news wasn't good.  But, the doctors have a plan and I'm going to listen to them and continue with the treatment.  The side effects from the radiation aren't great, but they are less intense than chemo.  It's mostly nausea and fatigue that I'll have to deal with.

I was looking forward to the arrival of fall and hopefully some rain so I could get out fly fishing again.  I've hardly fished at all this year due to the high temperatures and the drought we've been dealing with, and now, by the time conditions improve, I'll be dealing with the side effects from radiation.

My next scan will be in late November, and that will determine whether or not I can teach skiing this coming winter.


Wednesday, July 4, 2018

On to round 3

It seemed to take forever, but my white blood cell counts finally rebounded enough that we could finish round 2 of the chemo.  It's supposed to be a 21 day cycle, with treatments on days 1 and 8, but my day 8 treatment didn't happen until day 20 in the second round.

Even then, my white blood cell counts, although high enough to give me the treatment, were still less than 10% of normal.  So, the third cycle was delayed by an additional week and it's scheduled to start on Friday.

The second round ended up taking a lot out of me.  I'm going to see if there's any way to use Neulasta or Neupogen to speed along my immune system recovery in this next round.  I don't want all of the rounds stretching out to 4 weeks.

By adding a week to the process, it now means that all of the concerts I have tickets for in July happen on the same weekend as Day 1 of the chemo cycle.  This is when I feel the worst from the chemo, although the "down period" from the Day 1 treatment lasted a full 10 days in this past round.  I also went 22 days without going to the gym - something I really hate.  In July, I'm hopeful that I'll feel OK at all the concerts (4 total) that I'm going to see.  My biggest concern is three straight days of shows at the end of the month - a Thursday night (we will likely do chemo that day), and then Friday and Saturday in Camden, NJ.

So, on Friday, I will talk to the doctor about options to keep my immune system functioning at its best as we start this next round.

I have to admit that work has really been a challenge, and I'm guessing it showed to some extent.  I met with my boss yesterday, and she is going to temporarily take a few projects off my plate.  She warned me that she still had high expectations for my work, but she wanted to reduce my stress level a little bit as I go through the rest of chemo.

In some ways, I'm thrilled.  I have felt like I'm drowning at work and I can never catch up.  I'm still going to have a lot to do, but it's going to be more of what I was hired to do and less of the project work that was outside my core skill set.

On the other hand, I worry a bit that the work was removed from my plate because I wasn't doing it well enough.  Anyone who knows me knows that I'm a perfectionist about the work I do, and I'm my own harshest critic.  Although, and I say this with no ill will at all, my current boss is also a tough critic and she has high expectations.  I'm hopeful that the work that was removed from my plate was removed for the reasons stated, and not because I was doing a poor job at some of it.  But I'll probably never know for sure.

My primary goal now is to excel at the core work I was hired to do, and then, in a few months, I'll hopefully be feeling better and I'll ask to be re-assigned some of the project work that was taken away earlier this week.

In the interim, life is simple.  Work hard and do a good job at work.  Reduce my stress levels a bit and get my treatments done.  Try to have fun with my concerts, the gym, and some fly fishing.  And, hope that the chemo is doing its job so that I can enter a period of no treatments later this summer.  Or, at the very least, hope that I'll continue with just one of the current chemo agents - the one with very few side effects.

And, I have to hope that my immune system can handle the treatments.  Apparently, every time I have had a cytotoxic chemo in the past, it has done a little bit of damage to my bone marrow.  Over time, the bone marrow simply doesn't work as well after the beatings it's taken, and the risk of neutropenia goes up with repeated treatments.  Hopefully, we can find a way to avoid that issue in this next round and in the future.  The last thing I need is to be hospitalized with some sort of opportunistic infection.  I trust that my docs are doing everything that they can for me, but I'd prefer to see them a little bit less often, if possible.  Being hospitalized for an infection would mean seeing them more, not less.

Friday, June 15, 2018

Climbing out of the abyss

I started my second cycle of chemo last Friday.  Regretfully, this round hit me harder than the first time through, and it's been a tough week.  Part of the problem was that I had concert tickets for this past Monday night, and on a night where I should have been resting, I was at SPAC in Saratoga, NY seeing Dead and Company.

Ever since then, I've been playing catch-up on my sleep, and struggling to get by at work.  But, day by day, things have been getting better.  Today is the first day I've even considered going to the gym in the past week, although I'm guessing I'm going to opt for rest instead.

I was due for another infusion today - the less toxic drug only.  But, somehow the hospital screwed up and didn't get the drug in stock, so they had to delay things until Monday.  That means I don't get the weekend to rest and recover right after the chemo.  But, because it's the less toxic drug, I'm hoping I'll feel pretty decent next week, even with the infusion on Monday rather than Friday.

I did talk to the hospital a few times this week.  I've honestly felt so bad that I barely made it to work a few days this week.  I was hoping there was something that could be done to alleviate the fatigue and nausea.  They couldn't really help for this round, but they have some ideas going forward.

Today, the hospital finally got back to me on those issues, and they want me to really focus on taking more of a steroid next round, plus more medical marijuana.  I've been nauseated, unable to eat, and not sleeping well despite being tired.  My doctor is convinced that the medical MJ will make a big difference if I can just get that down the next time around.  So, we have a plan for the next round.  This is the first time ever that my doctor has actively advised using marijuana.  She never flinches when it's time to sign for my medical MJ card, but she's never really advocated for its use either.  This time, she is actively suggesting that I use it more.  So, I will.

Hopefully, by not having chemo today, I'll feel better this weekend.  It's supposed to be a beautiful weekend, and I'm hoping my wife and I will get out and do some fishing.  Plus, we have our normal weekend trip to the farmers' market and some lawn work to do.

Other than that, life moves on.  I'm just trying to have as much fun as possible, take care of my body, and make sure I can handle the demands of work.  It's been a tough week, but I made it through.  Hopefully the next two weeks will be much better.

Here's a link to an interesting article that I read this week.  While the author has a completely different illness than I have, I really identified with the article.

Thursday, June 7, 2018

First chemo cycle done

Each of my four scheduled chemo cycles lasts 21 days.  Today is day number 21 of the first cycle, which means that I start the next cycle tomorrow.

Just as with all the other chemo I've done in the past, it seems that just as you start to feel almost human again, it's time to start all over again.

On Monday and Tuesday of this week, I had the best workouts I've had since the chemo started.  For the most part, my strength, while reduced, hasn't been too bad.  It's been my aerobic capacity that's taken a big hit.  I'm not anemic, but I just seem to have no aerobic capacity.  On Monday and Tuesday, I finally felt like I could push a bit.

On Monday night, I ate what I would consider my first truly normal dinner since the chemo started.  My appetite is finally returning.  Yesterday was my wife's birthday (last year, we had dinner at db Bistro Moderne in NYC on her birthday, so this year's local restaurant was a bit of a letdown), and I felt good enough to take her out for dinner to celebrate.  I even had a martini - my first alcoholic beverage since the chemo started.  But, again, I didn't eat very much and I was in bed by 9:15.  Not my best effort for my wife's birthday, but in her infinite patience for my medical situation, she said she was just happy to have the whole family together for dinner.

So, tonight I'll get in one more CrossFit workout before the next round begins.

And then tomorrow morning, it all starts again.  I am hopeful that everything goes better at the hospital this time.  Last time around, they seemed a bit confused by all of the drugs, any potential drug-drug interactions, my sensitivity to dexamethasone (I need to have it infused over an hour instead of the normal 10-15 minutes), etc.  I think that my cancer is so rare that the nurses had never even given one of the meds before.  It is a fairly new drug, only given to liposarcoma patients at a particular stage in the disease, and usually in conjunction with another particular drug.  They were very concerned about the possibility of allergic reactions with that drug, hence the need for the dexamethasone and also Benadryl.  All in all, I didn't get out of the infusion clinic until after 7:00 p.m. last time around.

Tomorrow, we are starting earlier and hoping to finish much earlier.  I'm sure that none of the nurses wanted to be in the clinic with me that late on a Friday last time around.  I'm sure they had better things to be doing on a Friday evening.

This weekend, I'm scheduled to fish in a fly fishing tournament.  I'm a bit skeptical that I'll feel up to it, but as long as I'm taking dexamethasone, which helps with my energy levels in the days after the infusion, I have a chance that I'll make it out.

I have to admit that I've been sleeping in most weekends, and if I'm going to fish the tournament, I would want to be on water close to 5:00 a.m. on Saturday morning.  So, we will see if I can do it or not.  I can always start (if I can get out of bed) and then bail if necessary.

I'm going to load up on Ensure and ice cream this weekend.  In the first chemo round, my weight dropped almost 10 pounds in the first week after the infusion, although it has stabilized in the last two weeks.  I always seem be carrying some extra pounds, but I really want to limit how much weight I lose.  I certainly don't want to be losing muscle mass, which I think is important for me to remain active through the treatments.

So, no exciting updates.  The first round was tough - tougher than I expected, to be honest.  Last time I had doxorubicin, each round got worse than the one before it.  I'm hoping that doesn't happen this time around.  I've been able to work every scheduled work day since treatment started.  I had one day where I was really exhausted, but I managed to make it to work.  I've already lost my hair, so that won't change this next time around.

One round down, and three to go.

Thanks to all of you who read this blog and send me words of encouragement.  It's very much appreciated.  When I started this blog about a decade ago, it was all about ultra-running and skiing.  i certainly never imagined that it would end up being a cancer blog.  But, I imagine that most cancer patients never really expected their diagnosis right up until the moment it happened.  None of us are immune.  Eventually, whether through a friend or a family member or even yourself, cancer will touch your life.  Let's all hope that science eventually finds a cure for the plethora of diseases that we collectively call cancer.  Nobody should have to go through the process of being poisoned right up to the limits of what the body can handle, or radiated so extensively that secondary cancers are spawned.

I sometimes think of the movie Star Trek IV: The Voyage Home.  The crew of the Enterprise finds itself in a Bay are hospital in the 1980s.  Dr. McCoy encounters a patient on dialysis.  His response is "What is this, the Dark Ages?"  He gives the woman a pill, and if I recall correctly, her body generates a new kidney.  The interns are shocked at what they find.

Yes, we are a long way from those kind of medical solutions.  But, in many ways, we are living in the Dark Ages, and I'd rather be a patient in an era where medicine guesses less and actually knows how to solve problems.  Who knows how many years/decades/centuries might pass before we reach that point?

Tuesday, May 22, 2018

Chemo just plain sucks

On the way in to work this morning, I heard the J. Geils Band's song "Love Stinks".  All I could think as I heard those words sung over and over was "Chemo sucks".

In some ways, maybe I could even call it luck, it's been a couple years since I've been on a truly cytotoxic chemo regimen.  I did gemcitabine and taxotere about 15 months ago, but the side effects there are just nothing compared to doxorubicin, which is what I'm doing now.

I think I was in the infusion clinic for close to 7 hours last Friday.  First, I had lab-work done.  Then, met with my doctor.  Then, the endless infusions of medications.  Benadryl.  One to protect my heart from the doxorubicin.  Then, two different long acting anti-nausea meds.  Then, dexamethasone, which I need to take slowly due to a sensitivity to the that one.  I basically passed out the first time I had IV dex, and they've since discovered that I'm OK if infused over an hour rather than 10-15 minutes.  And then finally, one chemo drug and then another.

I spent most of the weekend flat on my back on the couch, with no appetite at all.  I managed to get down a milk shake each day as my only source of calories, plus I tried to get plenty of fluids.  I wanted to get out and go fly fishing but it just wasn't in the cards.

I have three different medications for nausea at my disposal - Zofran, compazine and lorazepam.  Of those three drugs, two are known to cause hiccups in some people, while the third, compazine, is sometimes used to try to alleviate hiccups.  Yet, I seem to be getting hours-long hiccup attacks (every six seconds for hours at a time) while on the compazine, which seems completely backwards to me.  My last two nights of sleep have been interrupted by hours of hiccups.

I'm still feeling pretty rough mentally.  If you've never heard to term "chemo brain", let me assure you that it's a real phenomenon, and working in IT, it makes the work day difficult.  I have two meds to help with the fatigue and chemo brain and they help, but I'm just not quite my normal sharp self.

I did have an appointment with a specialist on Monday due to persistent concerns about my one remaining kidney.  I lost a kidney when my original liposarcoma tumor was removed, and about 15 months ago, my kidney health readings (a test known as eGFR) started to decline.  The number should ideally be about 90, although with one lost kidney, it's rare to see numbers above 70.  But, mine have been ranging from 36-43 for the past 15 months.  Higher scores are better with this lab test, as it's an estimate of how fast your body can excrete excess creatinine in the blood.

Amazingly, last Friday, before chemo started, my eGFR was at 56 - the highest it's been in those last 15 months.  Yesterday, I saw a nephrologist.  He had mapped my eGFR scores against my various cancer drugs for the past 15 months.  What he saw was a pattern of two drugs negatively influencing my kidney function.  If he was right, he said my kidney function should be rebounding, which is exactly what we'd seen the previous Friday.  So, for now, that is one less thing to worry about.  He said he thinks I'm fine and I don't need to return to see him unless the scores become depressed again.

I did manage to make it to the gym last night.  I had to scale the workout somewhat, mostly to keep nausea at bay, but I was able to do the workout at about 75% of my normal capacity.  I was able to eat some solid food when I got home last night.

Today, my thought patterns are still a little bit scrambled.  It's like I'm living underwater - everything just happens slowly and I can't seem to operate at full speed.  But, it will get better day after day, I should soon be back to normal.

This coming Friday, I still have chemo, but not the doxorubicin.  Hopefully, I'll feel a lot better this coming weekend than I felt last weekend.  And maybe, no hiccup attacks.

If the weather holds, maybe I'll even get the lawn mowed and get in some fly fishing over the holiday weekend.


Tuesday, May 8, 2018

A Change in Direction

I was at Sloan Kettering this past Tuesday.  Regretfully, a CT scan showed that the two tiny tumors in my abdomen have grown in the past three months.  The verdict was that the growth is statistically significant, and that the Ibrance is no longer working.  I'd been on Ibrance for six months, and it has a median progression free survival period of 18 weeks.  So, I got about that much time out of the medication before the tumors resumed their growth.

I did complain to the doctors that my pain level has increased in the past few weeks.  They believe it's because one of the tumors, which is sitting against my rear rib-cage, is probably pushing on a nerve.  They suggested two options to deal with the pain, and left it up to my primary care provider and I to decide.

I sent an email to my PCP and she immediately agreed with my preferred option.  The change has worked well and the pain is not bothering me as much as it had the few previous weeks.

The doctors at Sloan Kettering described this entire ordeal as a marathon.  They said that I am literally not sick right now.  I'm in good health, I feel good, I'm training reasonably well, and the disease is not impeding my life at all.  At the same time, it's important to prevent those two tumors from growing further.

The tumors are so small that surgery was not the recommended option.  Instead, they want to try a 12 week run of chemotherapy.  This time, it will be a combo of Doxorubicin (the first chemo agent I had, and I responded very well to it) combined with Lartruvo.  Lartruvo is in a category of drugs known as biologics, and when paired with Doxorubicin, it seems to amplify the effects of that drug.  Patients who take the combination of the two drugs statistically lived twice as long after treatment as though who got Doxorubicin without the Lartruvo.

The doctors described the current state of my disease as being in the early stages of a marathon.  Yes, we've used up one magic bullet with Ibrance.  After four more rounds of Doxorubicin, I will be at my lifetime limit for that drug.  But, there are still many more options out there, plus I'm sure we will do surgery again in the future.

I am hopeful that the combo of the two drugs will substantially shrink, or perhaps kill, the two small tumors that I have.  Doxorubicin worked very well last time, and if Lartruvo makes it work even better, I should experience significant shrinkage in two tumors that are already small.  If that happens, I will hopefully enter a period of time where I won't have any treatments at all.  Also, shrinking the tumor in the back will hopefully reduce my pain level.

So, while this was a setback, it's not a huge issue.  Yes, it would have been nice to be one of the lucky few for whom Ibrance works a long time.  But, that didn't happen.   At the same time, my tumor load is small and I'm fairly healthy.

On the downside, Doxorubicin is a nasty true cytotoxic chemo.  My hair will fall out.  I will be nauseous and tired.

On top of this, I started a new job in February, and I had to tell my employers about the cancer because of the chemo.  So far, I've been overwhelmed by the support I've gotten at work, the response to my plan to minimize the impact on work (I'm going to do chemo on Fridays so that I can rest on the weekends, maybe work from home on Mondays, and otherwise hopefully feel pretty good throughout the process), and just the good will I've felt from the senior management in the company.

I was very concerned about telling people here, considering that I'm still the new guy, but I think that things are going to be OK.  My biggest concern is that I'll be be too tired on the weekends to do much fly fishing.  Our season is off to a terrible start, with a cold April, rivers running high, and I haven't fished even once yet.  The forecast for this coming Saturday is looking dismal and I might not get out again this weekend.  But, I'll get out pretty soon.

So, on to a new chapter.  I'm not thrilled at taking this drug again, but it's what I need to do.  So, I'll muddle through.  Life goes on.

On the fun side of life, concert season is starting.  I saw They Might Be Giants three weeks ago.  I saw Peter Hook and the Light two weekends ago.  And, next week, I'll be seeing The Editors, a band I've wanted to see for a long time.

After that, I still have tickets for five other shows through the summer and the fall.  Unlike last summer, when I was recovering from surgery, I'm hoping to feel better at the shows this summer.  I'll be tired, but I won't be recovering from surgery.

And, I'll be saving money on haircuts over the next six or more months.