Saturday, October 10, 2009

Margie’s own spirit that accentuates the positive

The past month has been field with variety of new encounters. Margie has had cataract surgery now in both eyes and is an the last weeks of the drops. The surgery was an immediate success and her vision in both eyes is clear and bright. She will be getting a refraction for new glasses within two weeks. This will give her great reading ability to add to her good long distance vision now.

On the cancer front, there have been downs and ups. Her valiant resilience to the difficult chemotherapy of the beginning of the year coupled with the challenge of radiation that lasted through June did not succeed in mitigating the advance of her triple negative fast growing cancer. Ceci had found a nodule in the midst of the radiation and the redoubling of the radiation effort only burned Margie’s skin. The nodules were reappearing by the end of August.

As she prepared to meet her wonderful surgeon the last week of August to attend to the nodules, an unusual rash appeared on her right side. This the surgeon intuited was the cancer reappearing in the skin. A biopsy confirmed this. In the meantime, Steve found a laboratory in Long Beach run by Dr. Nagourney that would perform tests on cancers to determine reactions to standard chemotherapies. In addition, Margie went in for a CT scan to determine if there was more than just the skin involved in the spread.

Margie’s attitude was straightforward and her daily life was unchanged. In fact she indicated that she felt fine. She continued with her personal trainer, Sabrina, twice a week as well as her active social life. And of course her positive view and her laugh prevail.

The first week of September, in combination with her first cataract surgery, Margie had a nodule removed and packed in dry ice for shipping to Dr. Nagourney Lab. The results came in the following week and showed several options. Margie’s oncologist, Dr. Greenwald, studied the results and had several options that he presented on 14 September, just before her second cataract surgery!

At this meeting we learned the first piece of good news: the CT scan showed that all her solid organs were looking good and were healthy and well. Margie’s resilience was showing here. Her daily life reflects this good news. She awakes daily felling pretty good overall, her strength is good… she can walk around the whole of her complex within 10 minutes and estimates that twice around is about one mile. With Sabirina, she scales all the stairs in her apartment complex helping the strength of her legs.

The cancer skin rash is there, but the CT scan showed no the major organs were affected. Dr. Greenwald said, at this first meeting, that we can see the source of the problem now in the skin and the strategies we could embark on will be visible. His solution would be a new round of chemotherapy, just exactly what, was yet to be fully determined. There were options based on the lab results, but the exact path was not clear. He order that we do no more surgical removal of nodule and to simply watch the skin. In the meantime, Dr. Greenwald felt he had to study the data more, and to talk with Dr. Nagourney’s lab in Long beach to clear up subtleties of the results. We scheduled a meeting for the following Monday.

Ceci arrived for a short 5 day visit over the weekend and was able to be with Margie for her next meeting with Dr. Greenwald on the 21st. Here he presented his solution. He had weighed in several options, but after clarifying details with Dr. Nagourney, Dr. Greenwald felt that he had only one really viable solution. He was anxious to move ahead immediately because, just in the intervening week, he saw the advance of the cancer bloom on Margie’s skin. He felt there was no time to waste. She would go in on Wednesday.

We were told to monitor the rash and see if there was a reaction to the new round of chemotherapy. This was a challenge, as we had reason to think there would be something positive, but did not want to bring out false hopes. To track the rash, Ceci and Anabel reviewed the situation on the 22, the day before the chemotherapy, looking at the extent, the limits, and the nodules (described by Margie not like a pea but like the head of a corsage pin!). Being dispassionate in the observations is important so that the realistic measures are monitored. It was hard. We decided on photography as a way to gauge the changes, and this was later affirmed as a great strategy by the surgeon, Dr. Grafton.

We are two and a half weeks out from the new chemotherapy. There is great news to report:
1. Margie is “tolerating” the chemotherapy very well. Daily rhythm is steady!
2. Margie’s blood work is great, no anemia, no fatigue!
3. Most significant, Margie’s cancer rash is not growing!

Combining these three factors adds up to a strategy to manage Margie’s cancer and maintain her good quality of life. She is hail and strong. Her daily activities continue unchanged, her quality of life is ever improving! One week after the chemo administration, Margie was entertaining 10 wonderful girlfriends she has traditionally lunched with. She arranged the whole event at the Vista del Monte dinning area. They made a exclusive table, decorated it specially for her, and put on nice table settings with wine glasses for her group. Not only was she looking forward to this wonderful event, but she was energized by it. She brought her group up to her apartment and Andreya, one of Margie’s helpers, had her famous Polaroid handy to document the cheer. The best part, Margie exclaimed, was there was no clean up! This past week, the thank you cards poured in acclaiming the luncheon a great success.

While all this medical intrusion weaves through Margie’s life, she has met another milestone, and this with the steadfast support of Steve. Margie’s manuscript, A Quintet in Asia Minor, is complete. Margie is going over a final reading of the nearly 300 pages of text chronically the 10 years between 1956 and 1966 where she reminiscences about our family travels in Europe and the Middle East. It is a tour de force, well written, engagingly paced, and full of her own reflections. Steve has taken his absorbing interest in our family photographs to compile them for the manuscript. He has also worked with Margie’s good friend and artist John Rindlaub to bring to life the numerous maps that help visualize the geography of her memoir. The whole compilation is to be assembled and published as a limited edition by Steve. Expect to hear of the book signing soon!

In sum, we find ourselves cheering the day on a positive note. Our recent meetings with Dr. Greenwald and Dr. Grafton conferring on the state of the cancer rash have been constructive and optimistic. Dr. Greenwald was very encouraged, agreeing with Anabel’s assessment that were not seeing any progression of the skin rash. Ceci reminds us that this is a cancer that grows at an astonishing rate. To see no change is remarkable and noteworthy, and so deemed Dr. Greenwald. We were all very relieved for this news as well as by the good lab results. All of this tallies well with Margie’s own spirit that accentuates the positive, eliminates the negative, latches onto the affirmative and never messes with Mr. in-between.

No comments: