Bone Mass Density & First Annual CT Scan Results

I blame the coronavirus pandemic. In compliance with our governor’s social distancing order, our retirement resort’s administration building was closed to all but necessary people. I can’t access my favorite computer. This blog update was generated in my smart phone.

The pandemic for sure cramps my style. Whenever I step out of my house, I wear a mask. All of a sudden my ears are carrying several gadgets – eyeglasses, hearing aids, earrings, mask. Shit! I’m a petite senior babe with petite outer ears. The head appliance overload sends my face dangling forward.

Okay…on with the report.

Boniva. After taking Boniva once a month for one year, the bone mass density scan image of my skeleton, compared to those of the last two years, showed stability. My poor aging bones’ osteopenia did not worsen into osteoporosis. By golly, Dr PCP is right. He insists, You did not lose. That means you are winning. Carry on with the Boniva. I don’t argue.

Tagrisso. Tagrisso has been great. I have been on it for 39 months. It has maintained the stability of the sole nodule at the bottom of my left lung, which started my non-small cell lung cancer journey 8 years ago. Onc Dr Smiley put me on 4-month scan, then 8-month, then, early March, after much confusion, as in Dr Smiley posting a glowing CT scan report before I’d had the CT scan, my first 12-month scan finally happened. I have remained asymptomatic – no cough, no fatigue, no loss of appetite, no pain, no lumps. Nothing. Nada. I feel great.

Having had no scans for a whole year, I noticed changes in the process. I had to make 2 trips to the hospital’s spanking new cancer building named after the wealthy couple who donated it. The first trip was the day before scan day to pick up the 2 bottles of chalky raspberry flavored barium drink. I was instructed to drink all but one fourth of the liquid at home. The following day – scan day – I drank the remaining liquid just before scan time. Another change: I was not given the intravenous liquid that gives the warm sensation and the feeling of wanting to go potty. So my body’s horizontal trip through the scanning machine tunnel was all there was to it – very quick and painless.

The CT scan result report in the patient portal started awesome. The innards were unremarkable. No lymph node issues. No metastases anywhere. Stable sole nodule at the bottom of the left lobe. Seen again was the Milky Way – the tons of tiny nodules too numerous to count but all under one centimeter the largest one being 6 mm, which is now 12mm. Clueless, I thought, That would be me, Celia the Gambler double or nothing. And then it hit me. Twelve millimeters! That’s 1.2 centimeters equal to 1/2 inch! If the nodule was solid and had clear margins it would resemble a green grape. At the end of the report, Dr Smiley added a recommendation: SBRT, short for stereotactic body radiation therapy. He wrote he had called Dr so-and-so (Dr SS, a Radiation Oncologist) but no answer. End of Report.

I assumed Dr Smiley would contact me after he got the return call from Dr SS but I did not hear from him again by phone or through the patient portal. Fortunately, I had an appointment with Dr PCP for our semi-annual what’s-wrong-with-Celia session. First thing he said to me was, Have you read your latest report from Dr Smiley? Are you not going to ask for a biopsy before SBRT?

I said, He will call me back.

Dr PCP was adamant. No, you call him. I will write a script for you to follow.

A script? I thanked him although I had my own script in my head. After all I’ve been researching and blogging about cancer treatments for 6 years. I accepted his handwritten script, which I had no intention of following word for word.

As soon as I got home, I sent Dr Smiley a message through the patient portal.

Me: Dr Smiley, I haven’t heard from you. Has Dr SS returned your call? Or can this wait until our next meeting in July? Don’t we need a biopsy?

Within a minute he responded with what seemed like a horrified reaction over my mention of July. Sure got his attention!

Him: NO! This has to be taken care of now, this month, March 2020. No need for a biopsy.

Me: Give me the phone number of Dr SS and I’ll ask for an appointment.

Him: For your information Dr PCP and I have been discussing you, my basis for no biopsy, Dr PCP’s justifications, Dr SS’s two cents, etc.

I did not argue with Dr Smiley. I was saving it for my one on one with Dr SS. After all the radiation oncologist would know more than the cupboard oncologist, who only deals with approved drugs like Tarceva, Afatinib, Tagrisso, etc.

Well! How about that? Suddenly 3 doctors are involved in my 12mm nodule. Why don’t I add a 4th one? And I did!

I contacted my buddy, my Onc’s Onc, the Lord of Lung Cansah in Denver. The last time we talked was 3 -1/2 years ago in Maryland where I was flown to implore the FDA to approve the CO-1686 trial drug, which was eventually orphaned.

Those who have followed this blog from day 1 will remember that my first onc in Albuquerque has cancer. He introduced me to his own onc in Denver for a clinical trial possibility in case Tarceva, the drug I was on at the time, lost its potency against my EGFR cancer mutation. Thus the moniker my Onc’s Onc.

I texted my Onc’s Onc. Within a couple of minutes, he responded! Here’s how the exchange went:

Me: Hello my Onc’s Onc! Just to say Hi and inquire big time. How’ve you been? It appears my run on Tagrisso has hit the skids. I was doing so good the last 3 years that my CA Onc decided to go to once-a-year scan. I had one last week. Everything is fine except one 6mm nodule in the left upper lung (LUL) doubled in size, now 12mm. I remain asymptomatic. Do you know of any post-Tagrisso clinical trials I might qualify for? Thanks, the Diva

Within minutes he replied.

Onc’s Onc: I’d wonder, if only one site is growing, if you can zap with SBRT and stay on drug. YOO (Your Onc’s Onc)

Me: Thank you for your super quick response. Really appreciate it. Just thinking ahead. SBRT was the immediate reaction here, too. Carry on!

Dr SS, the Radiation Oncologist

Dr SS, of Chinese ethnicity, marched into the examination room with the Kung Fu swagger of a warrior who has successfully conquered a battalion of nodules in his young mid-40’s existence.

Dr SS: I read your medical history. You look good!

I liked him instantly. I guess he was expecting to see a despondent wrinkly little old lady in tennis shoes.

Dr SS turned on the computer and showed me the CT scan image of the 12mm nodule in my LUL. Against the black background, the CT exaggerated picture of the nodule resembled a dandelion flower. It was the first time in my over 3 years outside of the university hospital scene that I’d seen a picture of my lungs. The Oncs in the one-man-band cupboard sector are not big on picture sharing.

Dr SS explained the SBRT procedure. Then he asked, Do you have a Pulmonologist? We will need one to prepare you.

Me: Whoa! Whoa! Before we start bombarding this body with radiation, I think we should investigate that nodule. It could be benign, it could be malignant. In the six years that I’ve been blogging, things have come – then mysteriously disappeared – in my lungs and other parts of my body.

Dr SS: We can do a biopsy but I’d suggest something safer: a CT/Pet scan. Have you had it already?

I couldn’t believe what I heard. He should have noticed it during his review of my medical history, which showed no record of a recent Pet scan.

We agreed on the CT/Pet scan as the next course of action.

And so I went through the CT/Pet scan, which can provide more information about the cancer like size and SUV that CT alone or Pet alone can’t do. SUV stands for Standardized Uptake Value, the rate of glucose absorption by the malignant tumor as compared to the rest of the neighboring non-cancer cells. Radiation oncologists look for a nodule of 8mm maximum in size and SUV of 2.5 before they get excited about doing SBRT.

The result: My nodule is 10mm in size and its SUV is 1.4. It’s big enough but its appetite is less than voracious. Dr SS and I decided to go for the SBRT. But first, he had to ask his favorite Pulmonologist to do the honor of giving me a Bronchoscopy – a procedure that involves shoving a small camera through my throat to enable him to examine my passage ways from north to south, take pictures and gather tissue samples if necessary. I’m pretty sure anesthesia would be involved, just like when I had colonoscopy where the small camera went cruising from south to north.

Dr P, the Pulmonologist

Dr P, and his sidekick a female nurse strode into the examination room where I was waiting. They were both wearing masks, like my plus one, BT, and I were.

I could tell Dr P is a tall handsome devil of a middle east persuasion, wearing a cloth head covering. He said he was not going to examine me because I look good. He explained his role. He would drop tiny gold stuff on the tumor area to guide Dr SS when working on the focusing of the SBRT equipment.

We scheduled the gold-dropping event on April 3rd.

So until then, I keep the energy level high, the stress level low.

And with the new knowledge about the tumor, we can make room for a little happy dance!

Boniva, First Annual CT Scans, Etc.

A few days after my entry into the world of retirement in 2008, a younger friend asked me, What’s the secret of looking like you have always been retired? As usual, I was tempted to claim I am a genius gifted with an amazing personality that just latches on to the wave and goes with the flow.  But I could not say that.  Truth is, I ran into a secret:  Set ONE and only ONE task each day and make sure to accomplish it.

One day last month, the only task on my calendar was an appointment with Dr PCP and his osteoporosis clinical trial group. The clinical trial technicians were going to measure my bone density. Twenty (20) minutes later, I’d meet with Dr PCP and we’d discuss the bone density results – whether my ingesting Boniva once a month for ten months has made my bone more youthful, less like honeycomb.

I so looked forward to the appointment. If the bone density test result would everything is fine, it would debunk my colleague’s assertion that the vehicle/pedestrian collision accident did not break any of my bones because I was only hit by the car’s rear-view mirror. I subscribe to the imaginative account that had me surviving after the car hit me and tossed me 80 feet up in the air.

I got dressed up early, anxious to execute the task. After completing all the primping motions to live up to the appearance of a gorgeous senior babe, I looked at my watch. I still had an hour to kill. Since Dr PCP’s clinic is only walking distance from my manor, I thought I might as well do some of the yoga poses that are good for my left knee. And I did and the poses relaxed me so much. Next thing I knew I was waking up from a nap! OMG! I’ve just risen from the dead! I looked at my smartphone, which is always on mute, and saw it was past my appointed hour. In addition, a transcribed voice message from Dr PCP’s medical tech greeted my eyeballs: “You had an appointment with us this morning and you called and you left a message you were coming blah blah blah.” I called back immediately and recited to her my alibi.

Me: I’m all dressed up. May I come now?

She: (pretending to sound stern) You had the opportunity. You lost your chance.

Me: (concern in my voice) Oh dear! Let’s re-schedule it then. Any day within the next two years will work for me.

We re-scheduled the bone density test March 8th this year.

That’s my Boniva story and I stand by it. The medical fact story will be for another day.

Fortunately, there are other developments I could write about. My first annual CT scan was up last month. On February 20th, I met with my oncologist Dr Smiley. He told me happily the result of the cancer blood test I had taken a week before: Carcinoembrionic Antigen (CEA) tumor marker level is stable. The he went through his physical activity of kneading my neck and belly, searching for suspicious lumps. He dictated to his medical flunky his findings: None. With the contagious built-in smile on his face, he told me to get my first annual CT scan. I smiled back and said, I have not had a CT scan in a year. Please run by me again the procedure. He responded, I will request approval from your insurance company. As soon as it’s approved, my staff will contact you and give you the telephone number of the imaging entity, which you will call to schedule your CT scan. Perfect, I acknowledged his clear instructions.

Day after day I waited. Of course I did other cup-filling activities. I played the slot machines at an Indian Casino in San Diego, shared a foodie lunch with a friend, sauntered in my bikini at the hot spa.

It was already February 27th – one whole week- and I still hadn’t heard from Dr Smiley’s staff. I checked the patient’s portal to see if I might have missed a message. There was none. Instead I saw his latest chronological assessment of my condition. What I read shocked me! On the 2/20/2020 entry, he discussed our visit. On 2/21/2020, he discussed a detailed CT scan report. There was already A CT SCAN REPORT! I read it with great enthusiasm. It was great! It would make a perfect cheating document. If I were running for president of the United States and my opponents demand full disclosure on my health, I’d flash that report! Then I thought, OMG! Whose lungs are these? Whose innards do these belong to? Someone out there likes me and impersonates me! Okay wishful thinking. But I had done enough sleuthing for the day. The important thing was to get on with the program.

I sent a message through the portal: Hi Doc! I haven’t heard from your office that your order for a CT scan for me at Mission Hospital has been approved and I should make my appointment for it. Please advise.

As soon as I pressed “SEND” a response came from Dr Smiley: Celia, didn’t you have your CT scan earlier this week already?

My response: No, not yet! But I did read your report in the portal. I liked it but it made me wonder!

His response: I will look into it with my staff and see what the hold up is.

Moments later, a message from him: Yes your order has been approved by the insurance, and the number is …

My response an hour later: I got your message. I made the appointment for March 2nd. FYI I was told your order was approved on February 21st.

So there’s another hanging story! Story about the results will be for another day.

But wait! There’s more. I want a complete story to cap this blog update. Here it goes:

The word PERFECT has eluded my list of personal attributes. When I was young I thought I’d be a perfect candidate for Miss Philippines. But No! My older sister said beauty is a prerequisite for such title. Later I thought I’d be a perfect candidate for City Engineer. But No! I was two decades ahead of my time. So I gave up on the PERFECT adjective.

One day three weeks ago I received an e-mail from a clinical research coordinator. It said: Celia, your urologist referred you to our office. She said you’d be a PERFECT candidate for a urinary Tract Infection (UTI) clinical trial. She said you have a “colonization of the lower urinary tract by E. Coli bacteria and you are over 18 years old.”

The email message moved me. The word PERFECT was clearly mentioned. In my twilight years, I finally had a match! A guinea pig babe in a UTI clinical trial!

I emailed back, Send me the trial material and I’ll be the judge if we are prefect for each other. And she did.

The material said there will be a screening for 21 days. Qualified candidates will get into the rest of 35-day trial, which is randomized and involving a placebo or an investigative drug while staying in one of 8 trial sites. There will be a top payment of $350 per day for 7 days stay in a facility. All other pays range from $30 to $100. I liked it! I said I’m in.

The candidate must have worn a catheter in the past or is currently using a catheter. A new catheter will be installed for the trial. There was one problem. I have never experienced a catheter and hope I never experience it. I informed the trial coordinator. She checked with the powers that be for exemption. She reported back: Nope, no exception.

I am still not perfect after all!

Now there’s a finished story.

That calls for a happy dance.

Oh the Aging Bones!

So the first part of the new year came and went like a ship that docked and sailed. Gone with the waves and the wind. Only memories linger now.  But the events in it were germane for events of months yet to come.  Am I waxing poetic or what!

January opened with a big swallow of the pill Boniva, a once-a-month drug prescribed by my primary care physician, Dr PCP. There’s a story behind Boniva. Yes, indeed, there’s always a story.

One day in In 2018 during my physical therapy sessions after having been smacked from behind by a full-size sedan, Dr PCP got this wild-hair notion to prescribe a drug for me to fight osteoporosis. Our conversation went like this:

Him: I’ll give you a prescription to combat osteoporosis. It’s the best and latest in the market. It’s called Prolia.

Me: But I don’t have osteoporosis. Remember a car hit me and hurled me 80 feet in the air, according to someone who never saw the accident, and I sashayed out of the scene with zero broken bones? I just got tossed around like a rag doll. That’s all. I was not reduced into a pile of broken bones even after bouncing on the street pavement twice.

Of course I did not tell him I was wearing a floor-length coat as thick as a sleeping bag during the accident.

Him: Your bone density test results showed you have osteopenia, which could lead to osteoporosis, if left unchecked.

Me: Okay. Tell me more about Prolia.

Him: You’ll get an injection only once every 6 months. And you will immediately see the improvement. The only problem is you can’t stop taking it.

Me: (inscrutable eyes widened) Why would I start taking something that I can’t stop taking?

Of course I did not launch into a discourse about my decisiveness in reducing dosages or stopping prescribed pills if they didn’t seem to do anything.

He had no answer but continued to try to talk me into taking Prolia. He failed and we parted with the osteoporosis prevention issue unresolved.

One evening Dr PCP phoned me at night at home. It took me by surprise. He is a busy doctor. He usually only sees me on appointed dates and times. When I had a rare problem between appointments, his assistant answered the phone, asked me several questions, discussed the answers with him, and got back to me. I wondered about the phone call at home at night. Is he really such an awesome doctor that he cares so much about me and/or my future osteoporosis? Does he own stock in Prolia? I found the answer on the new sign outside his office: “Senior Clinical Trials – The Osteoporosis Diagnosis Center!”

Him: I really want you to consider doing something about your osteopenia.

Me: Dr Google gave me the literature on Prolia. I am not qualified to take Prolia. The literature said it should only be taken by people who have thyroids. One of my 4 parathyroids was removed years ago when I had surgery for goiter.

Dr PCP surprised me again. He had a new pitch.

Him: Oh no, I’m not going to give you Prolia. I’ll give you Boniva. It’s a pill you take only once a month.

Me: Can quit Boniva any time unlike Prolia?

Him: Yes you can.

Me: Okay! That’s better. But I’m not going to start taking it until my accident lawsuit is settled. I don’t want to introduce new substance in the blood coursing through my veins that could complicate the settlement discussion.

He caved in.

In March 2019, the pain-and-suffering lawsuit was settled. On April 2, 2019, I started taking Boniva. What’s with April 2 and not April 1? April 2 does seem unusual. Well, it’s because I totally forgot about it on April 1. The first of the month is Inspire Branastasia’s Rabbit, Rabbit day and my blog update post day. Priorities!

This February will mark the moment of truth for Boniva. We’ll see if 10 months of the drug has improved my bone density. I did follow the strict instructions faithfully. I took the pill only with water. For one hour after taking Boniva, I ate no food, drank no beverage other than water, and stayed upright. Staying upright during that hour is extremely important. On the first swallow day, I became curious and wanted to check what would happen if I went horizontal? Would my bones snap and crackle? Should Boniva be a certain height from the floor for any reason otherwise it will get upset and cancel out the effect of Tagrisso? Then I thought I better not tempt the fates! I turned to my buddy. Please answer the question, Dr Google.

Dr Google and I should be on first-name basis already after all these years but he is so secretive about his first name.

Dr Google said Boniva can cause serious problems in the stomach or esophagus of the patient. That’s why anyone who can not be upright for at least one hour after taking Boniva should never take it.

In other words, I figured a person throwing up while on her back could drown in her own vomit. The instruction could have just said that and I would not have had to bother the good doctor.

Dr Google continued. Boniva works by slowing bone loss to help maintain strong bones and reduce risk of broken bones or fractures.

Talk about bones! The pain in my left knee returned. I finally asked Dr PCP to refer me again to the orthopedist Dr O, who attended to my left shoulder that had been hurt from its collision with the sedan. It was a moment of truth, a time for Dr PCP and me to let the real damaged-bone specialist do the diagnosis!

Time came for my meeting with Dr O. He told me to walk from point A to point B in his office. I did as told.

Dr O: You do have a limp.

Me: That’s why I’m here.

He told me to sit on the examination table. He poked here and there.

Dr O: (Looking me in the eye) Did you recently exercise more than you normally do?

I thought, wow! How could he be so dead on? Dr PCP and I were right after all.

He gave me a cortisone shot on the knee and prescribed an non-steroidal anti-inflammatory drug (NSAID).

Me: I already took NSAID.

Dr O: How long?

Me: Couple of days.

Dr O: You need to take NSAID one week on, one week off until the inflammation is gone which should not take long. And don’t be entering marathons anytime soon.

The conversation was a perfect example why I shouldn’t be stopping prescribed pills without doctor’s blessings – the perfect reason I don’t give medical advice here.

Between the cortisone shot and obeying doctor’s orders, my left knee has almost healed. Dr O also prescribed 8 hours of 15-minute insurance-covered physical therapy sessions. I don’t think they’re necessary because I can do somersaults now. But why not? I’m retired. I enjoy keeping busy and learning something new everyday.

Happy dance!

A New Ailment

Happy New Year!!!

Whoo Hoo! I discovered an unpleasant new health issue.  It’s new to me anyway, and I’m flaunting it like a new string bikini.  I’m sharing the story because it is a one-size-fits-all kind of thing.  It involves the mechanics of the human body, which is  a machine, the  mother of all machines. 

As I’ve written before, based on my observation, the normal human body is a perfectly designed machine.  Each and every part of it is located where it makes sense.  For example, the nose is on the face, not on top of the head.  Otherwise, we’d drown when it rains.  The arm bends at the elbow, the hand toward the mouth, so we don’t eat like pigs and other lower class mammals.  The leg bends at the knee, the foot toward the back so we can kick ourselves when we have knowingly allowed an opportunity to pass us by.  Maybe that’s just an expression.  I’m  tempted to cite more wowzy examples but I think you get the drift.

Now  to my earth-shattering discovery but first, I must confess, sometimes I’m always the last one to know.

I blame my Apple smartphone.

My smartphone is an integral part of my fingers.  It’s my go-to when I’m alone or waiting for my turn in line, for blood test for example.  I play Scrabble with my sister, sister-in-law, and one “random guest.”  One day I’ll try to figure out who that is.  I email, text, google, do online shopping, news reading, blogging, banking, some phoning, etc. etc..  One day I inadvertently hit something on the screen.  Suddenly out of nowhere appeared that day’s date, an ongoing count of steps, and miles covered by the steps.  There was even the number of flights of stairs climbed.  I thought OMG.  Siri follows my every move!  I know she occasionally injects herself into my life.  One time I burst into a karaoke song and she barged in, I did not understand what you said.

I closed the page on the phone and voila:  A step-counting app appeared!

Step counters had been all the rage but I refuse to buy apps or Fitbit.  I only do free apps.  Walmart.  Banks.  Amazon.  WordPress.  I noticed the app in front of my face is part of Apple’s smartphone package and therefore free.  Oh boy oh boy!  I showed it to my Plus-One, BT.  I told him, Now we can count our steps and keep up with the gang of old people who brag about their daily thousands of steps!  He got as excited as I was and responded, But I have Android in a cheap phone from Walmart.  I need my own step counter app.  No problem.  I downloaded a compatible free one in his smartphone.  I like to think I’m the tech-savvy one.

That was early September 2019.  Henceforth we established in the retirement resort a step-counting route, on which we walked religiously daily.  We raised the statistically normal person’s average of 4,000 steps to a minimum of 10,000 every day, no days off.  Sometimes we even made 20,000. We competed against each other.  When we went to separate destinations, we compared numbers at the end of the day.  If one did not have the minimum 10,000,  the laggard took off and walked some more to make up the deficit.  At the pool at night, we crowed about meeting our challenges to the other crowers.  Life is good in the retirement resort, where crowing about health habits – eating plant-based foods, gym routines –  is a favorite pastime.   

Two months later, in the beginning of November, BT and I traveled one way by train for a relaxing ride to Albuquerque to root for my Son the Sculptor at the dedication of his commissioned public art sculpture.  The train ride inside a first-class roomette was anything but relaxing.  After the art dedication, our bodies were not in a train-riding mode.  Fortunately we had a pre-arranged 900-mile road trip back from Albuquerque to South Orange County, CA, courtesy of my brother-in-law and his wife, Phoenix residents who had also attended the art event.  NO spring chickens, all four of us seniors who’ve convinced ourselves we can still do the limbo rock.  Okay, I just speak for myself.  But we all believe in step counting gadgets.  

During the trip, we drove for about 4 hours before taking a break for the first time to stretch our legs.  I noticed a pain on my left knee as I tried to stand up.  The pain showed up at each stretch break on the drive.  I blamed my sitting position.    

Upon arrival at the retirement resort, I took the blood test ordered by my primary care physician Dr PCP.  He would compare the result with the one I had a month ago.  He was monitoring my elevated liver enzyme count, which had fluctuated while I was on the CO-1686 clinical trial.  Maybe the high liver enzyme count was only caused by all the antibiotics I had taken during the seemingly endless urinary tract infections.  A couple of days later, my smart phone vibrated.  It showed an incoming call from Dr PCP’s office.  I thought, the blood test result must have alarmed him.  Maybe my liver enzyme count had doubled!  

I answered the phone.  

Celia, do you have any pains in your body?  The voice at the end of the line was that of PCP’s registered nurse, RN.  I answered, No, Why?  She responded, Your muscle enzyme count is elevated.  MUSCLE enzymes? I asked her.  What happened to LIVER enzymes?  Why does my body have more enzymes than the law allows?  She said if I did, Dr PCP would give me something to take.

After hanging up, I immediately consulted my colleague, Dr Google, who’s at my beck and call 24/7.  He said elevated muscle enzymes can be caused by trauma, arthritis, muscular dystrophy, Parkinson’s disease, heart attack, etc.  HEART ATTACK? 

I focused on trauma.  Trauma seemed more manageable and less scary.  I remembered the pain when I stood up after long periods of sitting.  I decided my left knee was traumatized by the awkward sitting position for hours.  I called RN and told her about the circumstances that traumatized knee.  She agreed it could elevate muscle enzyme count and passed the info on to Dr PCP.

Dr PCP is cool.  He was not automatically convinced.  He asked RN to mail me an order to repeat the blood test after a week.  I could imagine Dr PCP wanting to examine me again then refer me to a vascular specialist if my muscle enzyme count did not normalize.  I must hand it to Dr PCP.  He is a conscientious primary care physician.  He also loves the way referrers are made happy by the specialist doctors.  

I waited two weeks before I took the follow-up blood test.  The results came back and RN phoned me the news with a smile in her voice:  Your muscle enzymes back to normal!  She made no mention about the liver enzymes.  I was glad there was nothing to worry about. 

Days went by.  My left knee pain worsened.  Each time I stood up I felt like falling on my face.  Fortunately, it just so happened that I was scheduled to see Dr Paa, my podiatrist.  He does my big toe nails every three months.  The knee is part of the foot so I’d ask him. I was not optimistic because long ago when I asked Dr Google if the knees were too high for podiatrists, he responded:   orthopedic specialists for pain from diseases that affect the knee, physiotherapists, osteopathic or rehab physicians for pain from injuries, the list went  on and on.  OMG information overload!  All I wanted was a simple yes or no.  Sure enough, when I saw Dr Paa, he told me to see Dr PCP.  

Dr Paa and Dr PCP share offices.  I went to Dr PCP’s medical tech and tried to make an appointment.  Instead of making an appointment, she asked me all sorts of questions, with a view toward discussing my situation with Dr PCP and said she’d call me back. 

The following day, she phoned me.  She said, Dr PCP wants to know if the pain is in the back of the knee.  I answered, No why?  She responded, Dr PCP is thinking blood clot. I said, No way.  My blood flows continuously like the Niagara Falls.  It clots quickly but only when necessary like after a blood draw.  She said, Okay, then, Dr PCP said, take NSAID like Ibuprofen for one week and don’t exercise for one month.

After the phone conversation ended, it dawned on me:  I had bragged about my arterial blood.  When it comes to health, things can change rapidly.  No crowing be allowed about glowing health.  I remembered my late husband Octo, the second in the widowhood series.  He had enjoyed excellent health and one day laid out his plan to live to be a hundred.  Three weeks later his remains were cremated.  Leukemia got him.

So back to Dr Google I shuffled to ask about symptoms of blood clot in the leg.  He said, warmth and swelling on the affected area.  I looked.  Nope. None.  Another symptom: vomiting.  I had not vomited since my last post nasal drip.  Another symptom: Chest pain. None.  The last time I had chest pain was years ago when I became voluptuous and needed to move on to the next size bra.  And so with all the other symptoms.  Nada.  Blood clot was not the cause.   So back to sleuthing with the good doctor Dr Google.

Finally, we found the ailment that appeared to fit my symptoms.  It’s called patella femoral pain syndrome or PFPS for short.  Dr Google said, it is also called Moviegoer’s knee or Runner’s knee and is the most common cause of knee pain.  It comes from muscle overuse.  Obviously the daily 10,000+ steps for two straight months with zero break or rest were just too much for my aging legs and the knees took the brunt of the over exertion.  Sitting during the long drive exacerbated the problem.  The cure, among others listed, is RICE: Rest, Ice, Compression, and Elevation.  As always, here and now, I recite my disclaimer.  This post is not meant to give medical advice.  Check with your doctor.   I am not a doctor, a nurse, a therapist, or anything within miles of the medical profession.  I am a retired professional engineer, a civil engineer who delights in analyzing water puddles on the paved street after a rain and blaming the current young civil engineers for bad street design.

Dr PCP agreed with me. 

The new ailment is under control now.   My left knee hurts only when I stand up after sitting for a long time.  Once I start walking, everything is fine as long as I keep walking.  I can even do 10,000 steps no problem.  But what kind of a deal is that?  I need to rest sometime.  So the answer is moderation in sitting, standing, and exercising.  

I believe sauntering on the beach in my string bikini qualifies as moderate exercise.

The Sculptor’s Art Dedication

OMG! I was so excited! I just couldn’t hide it!

Remember? Almost one year ago I updated my blog with a post about the Sculptor’s Mother?  Well, that came to pass.  The County art board did commission my Son the Sculptor to design and build the art piece, which he consequently completed within budget and in time.  Then the County politicians got a marvelous idea to set aside a special day to dedicate the artwork – an opportunity for them to make points with the  Bernalillo County and Albuquerque, NM voters.   The notion got me excited anew!

Why the excitement for me?  Why not!  In 2012 I was diagnosed with Stage 4 Non-Small Cell Lung Cancer and sentenced to 8 months to live if no treatment, 11 months maybe 12 with treatment.  I had already resigned myself to say Bueno Bye world and tiptoe through the tulips at the Pearly Gates.  Now 7 years later, alive and kicking, bunion and all, I was presented the opportunity to see my Son the Sculptor, the once starving artist, ARRIVE as a professional sculptor.

So I concocted a plan to throw a major shindig honoring the celebrant artist, complete with caprese, burritos, champagne, and music – zumba, rock, whatever the DJ desired to spin.  I compiled a long list of friends and relatives from as far away as Washington DC and Georgia to be invited to the ribbon-cutting ceremony.  Okay, I must confess.  It was all about me.  That’s what insufferable proud stage mothers do.

Unfortunately,  the powers-that-be scheduled a date too soon and a time too early not conducive to effective event planning.  The county’s formal invitation showed the art dedication event to be less than 2 weeks away on a Saturday at 10:30a.m.  It would not be fair for my proposed invitees, who are mostly seniors, to plan their foreseeable future in less than 14 days.   The hoopla immediately after 10:30a.m. in November?  I’m retired.  It would be too early and too cold for me to be in my tutus and dancing shoes.  So my son and I scrapped the plans.

The only thing Drama Mama could do was to show up at the ribbon-cutting event, tell anyone who cared to listen: I’m the Sculptor’s Mother, and make the loudest noise.

So my Plus One (BT) and I decided to take an overnight train from Los Angeles to Albuquerque, something neither of us had ever experienced.  The trip would be a dry run for the same train ride we had reserved for the coming Thanksgiving – an accommodation called a “roomette first class” ensuring a more relaxing journey. 

We did not know the roomette was the size of a closet.  The seats that turn into a bed could only hold one small person, who would be me.  BT, who weighs 220 pounds, nicknamed “Killer” by his water polo team mates in his high school years, had no choice but to sleep on the upper bunk contraption.  I laid awake all night, hallucinating on a train wreck, the cantilevered bed unhinged with its content dropping on me and squashing me like a bug.  Not a pretty picture.  At 1:00 a.m., BT tried to go down to visit the restroom outside the roomette.  It was dark, neither of us could locate the light switch, and he could not see the way down.  His big foot missed the tiny support next to my head.  He valiantly tried to hold on and broke a rib in the process.  OMG, it was so hilarious I could not stop laughing.  What a morbid sense of humor!  He was not amused.  

Broken-rib BT and sleepless Celia made it to Albuquerque.

Fortunately, the dedication event proceeded smoothly. 

At exactly 10:30a.m., the television cameras started to grind.  The art board’s Big Kahuna thanked the audience then waxed poetic about the beauty of the sculpture and its significance.  Titled “Sanctuary” by its creator, the public art is located at the Bernalillo County Animal Care and Resource Facility, a place of safety and healing for all animals.  The sculpture, a steel structure with concrete base within a 24′ diameter circular landscaped site, embodies the spirit of the building it adorns.  In the best circumstances, the unwell animals are just temporary guests in the facility, a transitional space that is simply a pass-through.

If my description of the sculpture sounds impressive, it’s because it’s not original.  It came from the website of my Son the Sculptor.  What do I know about the depths of the meaning of a piece of fine art?  I am slow on profound stuff.  Even cowboy movies have to be explained to me. 

The art board’s Big Kahuna recognized everyone involved in the project.  Then on cue, the honored sculptor wielded a giant pair of scissors and cut the ceremonial ribbon and voila!  Applause erupted.  Smartphone cameras clicked away.  Soon it was over.  Parents and their children went in and out of the sculpture, admiring its abstract animals and vibrant colors.  Drama Mama did not make the loudest noise.  Quite the contrary.  For once she was quiet, in total AWE of her son’s accomplishment.  

BT and I returned to South Orange County, California by car courtesy of my brother-in-law and his wife and kept busy fighting Amtrak for a full refund of the Thanksgiving train tickets that we could obviously not use.  We bought airplane tickets instead.  Don’t get me wrong.  We did enjoy the train’s gourmet food, the observation deck, and the leisurely pace of travel.  We’d do the train again but only one person per roomette. 

And so, as one of my proposed invitees said in an email congratulatory note, my life goes on like the aquatic spiders that race over the water surface on long spindly legs, never slipping into depths.  Except they don’t laugh like I do!

Happy dance!!

The Foray into the World of Incontinence

Before finalizing the title of this blog update, I wanted to make sure “FORAY” fits the story.  So I asked my language consultant Ms Google.

I am so proud of being networked with the Googles, a family of awesome experts in various fields of knowledge.  I have consulted with Dr Google and Atty Google. Now it’s Ms Google, the know-it-all language chick. She advised me “foray” is the word if I am making a sudden attack or incursion into enemy territory, especially to obtain something, a raid. Her response got me all excited!  It doesn’t take much to get me so excited in old age.  My word choice is right. Foray is the word.

A couple of months ago a medical problem I couldn’t blame on Non-Small Cell Lung Cancer Stage 4 suddenly popped into my existence.  The issue: I was putting out copious amounts of urine.  On referrals of my primary care physician Dr PCP, I saw in quick succession a urologist, a gynecologist, back to urologist, back to PCP.  Urologist gave me a prescription for antidepressant pills that also treat bed wetting kids.  I did not comply because I was neither depressed nor a bed wetting kid. The gynecologist did nothing.  Instead, he gave me an insight to state-of-the-art treatments for Overactive Bladder and suggested I return to the urologist and bug her.  She might just try any of the new techniques.  On my revisit, the urologist floated an idea of sending me to a physical therapist. I ended up more baffled and less relieved.

As it turned out, the urine test at the urologist’s office revealed a severe urinary tract infection (UTI).  It was the mother of all UTI’s!  Treatment of the UTI eliminated everything that was ailing me. But until I started feeling better and convinced Overactive Bladder was not the cause of the tremendous amounts of urine I was dumping into sanitary sewer systems everywhere, I had no choice but to get a grip on what I thought was permanent incontinence.  Thus the word foray.  I forayed into the land of adult diapers.  I had the crying need to know.  Here and now, I share with those who give a hoot what I learned.

If incontinence is in fact in the cards,  I discovered there is nothing to worry about.  According to Dr Google, 13 studies revealed that 30% to 50% of adult women in the United Stated are incontinent.  That’s quite a big spread.  I decided 50% is the more accurate number because I was adding myself to it.  It’s more reassuring that incontinence is normal.  He also said there had been stigma about incontinence until adult diaper manufacturer Depends used  June Allison, the fabulous movie star of the 40’s and 50’s in adult diaper television commercials.  For me, personally, stigma means zip, nothing, nada.  As long as I’m not hurting anyone, I go ahead and do my thing.

I went shopping for adult diapers in brick-and-mortar stores and online.  What a world to behold!  All kinds and brands of incontinent products in existence greeted my eyeballs.  I saw absorbent pads of various thicknesses, pull-up diapers that resemble panties for all sizes, for day time use, night time use, and everything in between.  In my opinion, the biggest, most effective adult diapers come from Denmark.  Each piece has the dimensions of a thick rectangular kitchen cutting board.  I guess it is for a woman or man with a square crotch.  Okay, just kidding.  The diaper is not ideal for wearing under a skirt or pants and walking around but it is perfect for night time use.  I know.  I used it one night when I had no intentions of getting up to go potty.  I just let ‘er rip!  

I wish I had known about adult diapers when I was younger.  I could have used them a year after I became a widow the first time.  I was one of the women CEO’s invited to a camp with young California girls who wanted to learn about us CEO’s who were not men.  The camp took place in a forest outside San Francisco.  I flew in from New Mexico.  I remember the girls slept in tents outdoors in while the CEO’s enjoyed beds in a permanent rustic building.  But the plumbed toilet was located half the length of a  football field.  I remember clearly how I wished I was in a tent among the girls so I could just get out of the tent and go pee-pee.  Imagine walking in the dark on a woody rolling hill from the CEO quarters to the toilet!  Who knew what nocturnal animals lurked in the pitch dark?  I was not a seasoned camper and the thought of bringing a flashlight never occurred to me.  Those Danish adult diapers would certainly have guaranteed nice restful sleep nights for the camping duration.

The engineer in me told me to dismantle one of the best adult diapers to see how and why it works.   How can it hold a whole night of piss?  I found the answer.  Inside the pad is silica gel, the same material commercial plant nursery owners add to the soil to minimize frequency of watering for certain plants leased to offices.

Then I thought why should diapers have to be worn like panties? Why don’t manufacturers make a wide rectangular pad using the same material and the incontinent person just lie naked on top of it and let ‘er rip?  Then it dawned on me: Maybe I’m reinventing the wheel.  Maybe there is already such a product.  So back to online shopping I went and voila!  I chanced upon a bed pad advertised next to the pull-up diapers.  It promoted comfort, freedom from accidental spill, never having to worry ever again about lost sleep, yada yada.  Like a true red-blooded diaper warrior, I ordered one.

With great anticipation, I opened the package delivered by Fedex.  I used the bed pad that night.  Boy howdy! Was I in for a rude awakening from untruthful advertising!  Sure, the bed did not get wet but a cold dampness on my back woke me up in the middle of the night.  I was up to my neck in my unwanted body fluid.  I jumped up and yanked the pad out and tossed it in the trash can.

I continued my knowledge acquisition.  I found a group of men and women who do have diaper fetish!  They talk about loving the soft caress of the dry pad, the joy of being all dressed up, appearing normal, smiling demurely, and carrying on a delightful conversation while urinating in their diapers, unbeknownst to the party across the table and everybody else in the room.

Now I know I’m still in control of my bladder.  But I’m not jumping up and down in celebration.  Etched in my mind is a fine line that divides mature women into 50% continent and 50% incontinent.  I am the dot clinging precariously on that statistical line.   Fortunes do change rapidly.  If or when incontinence happens, my inner Mehitabel will simply tell me, You’re in the company of distinguished high-level folks, Ms Senior Babe!  The astronauts wear diapers in space.  Even on earth!  I know for a fact because I followed a True Crime story.  One female astronaut drove far to try to eliminate the competition for her male astronaut-lover’s affection.  But first she outfitted herself with a heavy-duty, super absorbent diaper.   It sure eliminated the need for a rest stop which would only have delayed her diabolical mission.     

I think my inclination would be more toward the positive and joyful applications of diapers — like what the diaper fetishists say and do.

Happy dance!

Annual Physical and CT Scan

Before my number’s up, I’m gonna fill my cup
I’m gonna live, live, live until I die

That’s the best part of my theme song.  I love its lyrics and conduct myself accordingly.  However in early September, instead of filling my cup, I kept the laboratory phlebotomists busy filling vials with my blood for tests ordered by Oncologist Dr Smiley and Primary Care Physician Dr PCP.  Dr Smiley needed them prior to my every-8-month CT scans while Dr PCP wanted them for my annual checkup.  The results help Dr PCP to determine everything or anything medically wrong with me so he can refer me to specialists, an activity that really sends him!

First up for eyeball-to-eyeball consultation was Dr Smiley.  He hasn’t changed much in the three years that we have been seeing each other.  His facial expression still looks like he’s going to burst into laughter any moment.  He gladly informed me the blood test results showed a low number of carcinoembryonic antigen (CEA) for blood proteins, which Oncs consider to gauge the efficacy of a cancer drug.  Tagrisso is working, he declared.  Then he moved on to his normal gyrations, letting his fingers do the walking.  He dug them deep into my armpits and searched for swollen lymph nodes.  Nothing there, he dictated to the 20-something male Asian sidekick who consequently clicked away the information on the laptop in front of him.  Next Dr Smiley kneaded my neck; maybe the nasties were hiding there.  Nothing there either, he told the typist.  Then he instructed me to lie on my back.  Using the palm of his hand he applied pressure all over the tummy.  Any pain? Coughs?  None.  Finally, he did the stethoscope motions on my chest and back.  Everything is good, permanent smile on his face.  We will not do a CT scan this time.  We’ll do it one year from February 2019, which would make it February 2020.  Congratulations! You have moved to the once-a-year CT scans.

Two days later, it was Dr PCP’s turn for the face-to-face meeting. 

My camo shorts and jungle hat caught Dr PCP’s attention.  Love the hat! He exclaimed.  Thus our friendly banter took off.

PCP:  May I take a picture of you?

Me:  Sure!  Do you take pictures of all your patients?

PCP:  No, just the hep and interesting ones.  That’s you.

Me:  Thank you.  I like it. 

With that our smart phones clicked away.  I just assumed it was okay for me to take his picture too. 

PCP:  Do you still wear string bikini swimsuits?

Me:  Yes, I do.  That’s why you should never refer me to a medical specialist who accesses innards by cutting the tummy below the belly button.  Dr Google told me there are all sorts of access through the pelvic floor.

And we laughed.  Dr PCP and I go back a little more than 3 years now.  I remember commenting on the photo of his beautiful wife on top of his desk at our first meeting: Is she also a doctor?  He answered, No, she is an RN and she owns a hospice business.  I said, Whoa! You guys have a conflict of interest.  He seemed to enjoy the irreverence.  

Back to the annual physical.  He reviewed the blood test results with me.  Everything is fine, he said except the liver function numbers are abnormal.  I explained: They should be.  I was on antibiotics for urinary tract infection (UTI) for half a year.  He decided, You should repeat the liver tests in November to see if the numbers improve.  Otherwise, I’ll refer you to a specialist.  I gasped in feigned horror:  Oh dear.  Here we go again.  Next, he did the stethoscope motions.  Everything sounds good, he concluded.  

Dr PCP’s registered nurse gave me the flu shot and recited a list of things to do: second shingles shot in October; blood test with fasting, another blood test without fasting, and bone density test in November,  gynecology RN in December.  What makes you think I’ll remember all those? I asked.  Don’t worry, she responded.  You’ll take home reminders. With that, I sashayed.

Gonna dance, gonna fly, I’ll take a chance riding high, Before my number’s up….