Monday, June 30, 2008

A Plump 121#


Over the last week, my weight plunged to 114# after I developed a fever and had bouts with nausea and vomitting. It is pretty hard to drink of your own volition if your stomach feels bad. So I was not doing a very good job of keeping myself hydrated and consequently I couldn't eat either. But today I drank not 1, not 2, but 3 carnation instant breakfast drinks and then came to my weigh in here at the clinic. To my surprise my weight is back up to 121#. Yeah! That means I am slowly getting back the weight I lost from the chemo regimen and all the nausea.

My Dad and Lynn arrived last night after traveling up from Charleston. Dad was up first thing this morning making fried eggs and potatoes for breakfast. Tonight he is going to cook a fish dinner with green beans and cooked carrots. He's a great cook so I should be able to continue this upward trend on my weight during this week.

We had a great thunderstorm last evening with plenty of rain. Everything is so fresh and clean this morning. The plants look great too. Quig and I took a walk spying on the bluebirds and goldfinches and purple finches lighting in the field behind the house. The workers were out in full force this morning building, building, building on the new homes going up in the neighborhood.

Today my energy level is good, and I feel very rested, hopeful, and positive. I 've seen my woodpecker at the suet with his bright little red cap this morning. So I've had my highlight for the day.

Sunday, June 29, 2008

IN Remission!


Today's biggest news is that my bone marrow biopsy came back with a hypocellular marrow, i.e. I am in remission. And today the white count was just a bit higher than yesterday also suggesting that my body is starting to repair after the chemo. Both are terrific news, of course. Holly and I are very happy. :-)

Follow up from the fever earlier in the week: I did grow out a bacteria from both of my blood cultures that were taken on thursday after my fever spiked. The bacteria is a type of staphylococcus which is one of the common skin bugs that we carry on our body. Most of the time, this is not a problem. But then most of the time, people have infection fighting cells to combat them, and I don't. I will remain on these antibiotics for a total of 10-14 days to completely get rid of the infection and prevent it from getting onto or into my catheter line. I did get some more blood today too since my hemoglobin level was back down to 8.3. Today's picture is of me and my nurse Dana, hooking up some juju juice through my catheter.

This morning we visited with Kristen (a little bit) before we had to leave to head to the clinic for my appt time. She was too kind and came over to mow our grass for us. Thank you Kristen; you did a great job! I wish I could do it myself and didn't have to accept the help. But I am getting a bit better at accepting that sometimes you just do-need help that is. Thanks again for driving all the way over here to do that for us and to chat a bit about your life. Sorry we had to miss Jana.

It's a late entry today, and I should have more to say, but it's been a very emotional week. I'm tired and need to gear up a bit for my Dad and his wife Lynn who will be arriving for the week in about 2 hours. Tomorrow is the start of a new week...looking forward

Saturday, June 28, 2008

Things That Matter


I had my second day of antibiotics yesterday for the fever I developed on thursday. No wrinkles, smooth as glass, just took a while for us to get in to the clinic, get all three abx, my platelets, and a bag of fluid. But I started feeling better about half-way in there so yesterday turned out to be a good day.I was even able to eat a real dinner with chicken, peas, gumbo soup (my fave), and peaches.

After dinner, we watched the movie "Sliding Doors" with Gwynnth Paltrow where she misses the subway and hence does not catch her boyfriend having an affair with his ex-girlfriend, and in another version she makes the subway and does catch him. The movie shows lots of little takes on how small things, esp timing, can make all the difference in the world. It was done in 1999, but I really liked it. I usually enjoy those movies with the whole time traveler thing-you know the Bostonians, the Lake house, etc. I can't wait for them to make that excellent book, "The Time Traveler's Wife" into a movie. Maybe that got derailed since I haven't heard anything more about it. In my version, Tom Hanks plays the guy who keeps getting bumped up and back in time. And yes, Gwynnth Paltrow is my choice for the woman. The daughter would be played by Dakota Fanning.

For the first time in I don't know how long, I slept all the way through the night (some of you would question that statement since I am up at 5:37a on a Saturday writing this, but that used to be my normal wake up time so it isn't odd for me). The first thing I thought of was how much better I felt already than the day before, and certainly than the day before that. Thursday when I had fever and chills, I was so weak and out of it. I'd never felt that bad (and you know I have chemo to compare to). One thing I realize in all of this is that as you go down and feel bad, you think this is the worst you ever have or could feel and then another day proves you wrong. No that day is the worst you've ever felt, etc., etc., etc. But then when you start coming back to normal, those same kinds of days are better than what you experienced yesterday, they are an improvement even though you're weak. So you see it really is relative. What would have been a bad day gets turned into a good day because there is less suffering than the one you just experienced. I call that the cancer gift. The ability to recognize that suffering is a part of life but not to get too tangled up in it.

When I woke up this morning, I was thinking about this concept, and about all the things I am thankful for. It is a long list, of course, and I won't bore anyone with it here. But I do think it helps to take stock from time to time of the things that matter. I do want to share that list, see below.

Teresa's List of Things That Matter Most (a partial list I am sure)

friends, family, lovers

pets

a good job with supportive co-workers

books

time for conversation

birds at birdfeeders

a beautiful garden that you, your neighbors and the birds/butterflies can enjoy

generosity

smiles

time to be alone to figure out what you think and who you are
time to be with others to show them who you are and share who they are

mean something to the community where you live

handwritten letters of thank you or general news

humor (I have Quigley the miniature Dachshund expressly for this purpose)

tell people how important they are to you and how much you love them

hugs

our society is going so fast; do what you can to slow down to a more natural pace at least once each week

travel-to see other places, experience other cultures, and realize there are many different "right" ways to do things

be quick to experience delight and slow to experience anger

treat your body well since it's the one that has to last your whole lifetime-if that means massages and manicures to you, so be it

love things so that your capacity for love just gets bigger and bigger; when you die, you can take all that love with you (I don't have that one on authority, but I am pretty sure it's true)


Okay, enough serious stuff for an early Saturday morning. I need to go enjoy some coffee time with my gf while I watch the birds at the feeder hovering over the butterfly bushes and purple coneflowers. See, it's already a great day! -tree

Friday, June 27, 2008

My Five Donors


We are here at the the clinic getting my antibiotics for the fever I had yesterday. I was up with fevers of 103.5F and 102.0F last night that wore me out. I feel lots better today since my temp is back down to the normal range. My platelets are low again at 6000 so the nurse is hanging a platelet pack as we speak.

I met with Tanya Helms, the Physician Assistant for my doctor to go over the donor typing for my sisters. They are a perfect match to each other but not to me. (The chances are 1 in 4 for a sibling match). However, they have identified 5 donors in the registry who match my profile. Over the next month, they will contact those 5 donors, ask them to be re-tested, and determine who could be lined up for the transplant in the time frame we will need.

Right now the transplant feels so far off since I am barely keeping my own with the fever I had yesterday. My weight was better yesterday (up to 117#) but today I am back down to 114#. When I have a bad night or bad day, I seem to slip since I can't keep anything down.

I woke from my benadryl haze at one point to see Ms. Karen Pieper seated near my recliner. What a long time it's been! She works in another part of this building and I guess she knew I was here. It was so good to see her and hear about her Brazil trip, her family, and all the great dog stories (she keeps the dogs for one of the Cardiology fellows who has some kind of small dog called a Havanese). I'll have to look them up because I've never heard of them.

The most beautiful pair of goldfinches were at the feeder this morning. The male was brilliant yellow and the female just a touch less so. They were so delightful to watch while I ate my breakfast.

Thursday, June 26, 2008

Today's Excitement

So no sooner had I eaten my lunch that I started to feel cool and shiverrey. I went to put on a second shirt even though it is 95 degrees outside, and the house is 76-77 degrees. So I took my temp. 101.1F Dang! That is a real fever. I called the clinic and they told me to come in immediately. No sooner had my butt hit the chair than they were coming at me with needles for blood cultures and blood pressure checks and urine cultures. A retake of my temp showed 102.0 F. That is a real fever for sure.

I am getting what we call in medicine a "febrile neutropenic" work-up. Febrile just means fever. Neutropenic means the infection fighting cells count is low. In medicine, we treat this as an urgency with blood culture tests for infection, urine culture tests for infection, a chest X-ray to rule out pneumonia and then 3 days of antibiotics until the tests come back to indicate what, if any, the bug or bacteria is. Right now I am taking Ceftriaxone, Tobramycin, and Vancomycin, all through my catheter. Those are big gun antibiotics that can fight many, many different infections. If nothing grows out of the urine or blood, they will stop the antibiotics and let me go back to my other oral meds. You non-medical people are wondering why this is such a big deal. Well the issue is something we call sepsis. Sepsis is when the infection in your body gets widespread and bad things happen. The blood pressure drops, the kidneys fail, the heart can fail, blood clots can form and fill the small vessels everywhere. It is bad news bears. We are very conservative with infection & fever in people with neutropenia because they just can't fight anything off.

We'll be here at the clinic for a while this afternoon but I bet we'll be home by 5pm. That is the beauty of living so close. Thank Goodness for that. They have been so efficient getting me in and getting me treated. The nursing staff here really is top notch.

A Deep Sleep


I woke up this morning with Holly at our usual time (6:30a) and had my carnation instant breakfast drink. But I felt tired and low energy so Holly suggested I try to take nap when she left at 8am. The last thing I remember is her pulling the bedroom door closed and the next thing was waking up at 11:30am. Hmmmm, maybe I need more sleep right now too. I am starting to have that part of the body ache thing they told me I'd have-where you feel like you have the flu. Last night my back and feet and stomach hurt. I had to take tylenol to get comfortable enough to go to sleep. If you've ever had the flu, you know how achey and tired and slow you feel. Just getting up to go brush your teeth seems like a chore. So that is the stage I'm at today.

That being said, my mom is on her way to get us a Frosty from Wendy's. ;-)

The birds have been very nice today with a pair of little woodpeckers and many purple finches. The purple coneflowers look great from my bedroom window and the hydrangeas look great from the LR.

We watched a cute movie last night about Burt Munro, a NZ motorcycle guy who travelled all the way around the world to test his Indian motorbike on the Bonneville Salt Flats in 1967. It is a true story and there is footage of the real Burt in the special features. It was cute and sweet. He was a determined guy and it was cool to see how much her did to realize his dream of getting a real time trail for his bike. I think the name of the movie is the World's Fastest Indian, which by the way, was built way back in 1920. Amazing that he could tinker with that thing to get it to reach over 200 mph top speed.-teresa

Wednesday, June 25, 2008

Same Rump, a few new holes

They were helping me out in the clinic giving me IV fluids to combat some of this wt loss and lack of energy. Peggy the Nurse Practitioner has to be out of the clinic for the next 2 days so she went ahead and did my bone marrow biopsy. This was the 3rd one-probably the one that was the most uncomfortable despite getting a pre-dose of 1 mg ativan. They did need 6 tubes to do lots of cytogenetic tests so maybe some of the discomfort was from pulling so much to get those spicules out. I won't likely hear anything from the testing until the middle of next week. They will need to look at the % blasts as well as the chromosomal abnormalities. My leukemia has an inversion of chromosome 16 so it will be interesting to see what else turns up.

I came home after the biopsy and took a 2 hr nap. I feel beat. I am going to try a new nutrition regimen to see if I can reverse this weight loss. The regimen will be a fluid drink in my hand or nearby at all times (think Karen and Freddie with their water bottle) and a snack or solid meal every 2 hours. Obviously I can't wait on my appetite to kick in (that just isn't happening) so I will have to force myself to eat on a timed schedule. You know food is not as fun when you have to make yourself eat it. It's a whole lot better to actually want to eat. I am going to get some protein powder to add to foods too.

Feeling a little tired


Not sure why, but I woke up a little tired and down this morning. My stomach is a bit queasy today so maybe that is it. Sometime in the night I had those bad dreams that make you scared and angry. Sometimes if I think about the fact that my chemo from breast cancer caused this leukemia, I get angry. I wonder why my doctor used such an aggressive regimen, every other week when every 3 weeks was the standard of care. I remember that once Holly and I questioned her on it (as well as the need for 2 different chemo regimens) and her response was that she wanted to be very aggressive so that I would live a long time w/o a breast cancer recurrence. I don't usually let myself ask what if questions or let myself be angry about all of this. The risk of leukemia is 1 in 100 people treated with chemo, and there is no way to know if you will be the 1 or the 99 who slipped by. But today I am down because it is a hard day. This is alot to go through and sometimes I wonder what would have happened if I had been treated differently 2 years ago.

I am currently sitting in the recliner at the Outpt clinic while I write this. I am getting a liter of fluid to help with the nausea. I have to weigh in each time I am here, and it has been nothing but down. Today I am down to 115# from 117# last time from 120# in the hospital from my usual baseline of 125#. So I am 10# down. Ouch! And I am doing carnation instant breakfast, ice cream and soup. This is a helluva diet. If anyone wants to lose wt, I think I could give them the recipe.

Tomorrow I have to get my day 14 bone marrow biopsy to look for remission. Hopefully we will get good news there. I think subconsciously (or not so subconsciously) it is weighing on me. If I am not in remission then I have to go back into the hospital for an even higher dose of chemo to try to get me into remission. The bone marrow transplant would occur after all of that.

Some of our pals are heading west to week of rivers. I am so envious of you guys getting to go out to asheville and beyond. I so look forward to the day we can head to the mtns to enjoy our Aville house. You guys be careful and don't go exposing any ribs. Marty has already done that for all of us.

Speaking of Marty, we got the news from Marty and Deb about the next grandchild due Jan 10th. I think I was as excited as they were (something about cancer treatment that makes one embrace new life like never before). We will have to plan a big party for January. And for their sake, I hope it's a girl. Those Riley's seem to have a bunch of boys. I am sure Jason and Lee Anne are very excited.

Well that's all I have for now. Sorry for the mopey tails today. I'll be better again when I feel better.-tree

Tuesday, June 24, 2008

A Journey With Friends


Holly picked me up after my clinic appt yesterday and we headed home for a short walk around the neighborhood. I spent a good while at the Outpt Clinic since my appt was at 10am but didn't get seen by the Practitioner until almost 2pm. Mondays are very busy evidently. I didn't mind though because I had my book and snacks and slept a bit after the benadryl they gave me for my platelet infusion. My platelets had dropped to 6,000 (ouch! less than 10,000 can be associated with spontaneous bleeding) so they gave me a platelet pack-donor matched bag with my same blood type (O+). Afterwards, they checked the level and it had bumped to 32,000. Hey I fill all juicy now. Still I need to be careful to avoid cuts or scrapes or bumps. As Holly put it, I won't bleed out immediately but I shouldn't take any chances.

I saw a woman at the clinic who was a resident at Duke when I was a med student. She is now an Attending doc on the bone marrow service. I introduced myself to her after she came in to tell me that she was the head doc for the week. Her name is Cristina Gasperetta (from Italy) - tall & stylish with gorgeous long brown hair. She asked me what I was doing there, so I explained that I had just had 7 and 3 chemo for induction and that I was the one who'd had breast cancer 2 yrs ago with chemo-induced leukemia. She said in her beautiful Italian accent, "Teresa, you are the one with secondary AML? We must fix you with a bone marrow transplant." Well yeah that was my plan too. Somehow when you hear her say it, it seems a lot more glamorous than it has been so far.

I got to see Gail after my appt as we visited a bit. Her office is in a different part of the building where my clinic is. She made us a big batch of spinach lasagne. Yum, yum, thanks Gail. Now I won't die of scurvy, at least.

As I said above, Holly and I did a walk with Quig when we got home. Waiting for us on our porch was a slim cardboard package from Blurb. What is it? We opened the package to find a slim book that Marty put together with photos of friends. It is beautiful. Photos of Jason's wedding, hiking Max Patch, Quig, Hiking Roan mtn, etc. It is gorgeous. You guys would all love to have your own copy; it's so well done. Thanks Marty. It is a cool idea and one I'd like to use in the future to make a photo memory book after our travels. I took a photo of it to put here. It won't do it justice but you'll get the idea at least.

Well my mom is one her way back up. We'll be safe now and Holly won't have to miss so much work. Thanks to everyone for offering rides and all manner of help. More later...tree

Monday, June 23, 2008

Monday, Monday

It rained so nicely here yesterday afternoon. It felt good to see the garden get some much needed rain and nourishment. It makes me hopeful that today will be a better day. Everything feels so clean and new. I've been able to keep down some carnation instant breakfast mixed with milk so just that is an improvement over yesterday. I slept well and woke rested. I just need to bulk up the calories to get my stamina improving.

My mom called first thing and she is driving back up here tomorrow. I think she worries about Holly having to miss so much work as I get seen in the clinic. Today's appt is at 10am and Sandi is going to drive me to the appt since Holly has a 9am meeting. I can only imagine how hard it must be for Holly to do her regular work and tend to me. I keep needing meds and clean clothes and food and then every once in a while I throw up too. Must be awful to have so much on her shoulders. I will try to do as much as I can as I get my strength back. I hate sitting around but right now I am not strong enough to do much.

I got a couple of emails from my Asheville pals who did the Hazel Creek trip this w-e. Sounds like it was fabulous. They saw beavers, bald eagle, other birds and toasted us with brownies. I do wish we could have joined in. Next time...

I finally got the chance to go through all the cards my co-workers sent from the Drew Clinic in Burlington. Thank you all for your kind wishes, words of encouragement, and sweet messages. I do miss you very much.

I'll write more later...

Sunday, June 22, 2008

It Can Only Get Better From Here


Well the best laid plans of mice and men and all the optimism in the world were not enough to keep me from feeling horrible today. I was really tired this morning despite good sleep last night. I made myself have a bowl of Miriam's most excellent soup thinking it would buffer all the nastiness going on in my belly. To no avail. At the clinic I had wave after wave of nausea and was diagnosed with a yeast infection in my mouth and esophagus (you ought to see how white all of that is-it's impressive). They added medicine for the candida as well as another medicine to help with the nausea & reflux symptoms. Every time I swallow I feel like I've been jabbed with the sharp point of a shovel in my solar plexus area. Then, in between swallows, it feels like an elephant has his foot pressing there. As you can imagine, it is not very conducive to eating.

When we got home from the clinic visit about noon (all I needed was some potassium supplementation but tomorrow I'll need platelets as I only have 13,000), I promptly threw up 6 or 7 times. There went all of that great chicken soup I had at 6am. Oh bother! So I cleaned up and just went to sleep for 3 hours until it started to rain this afternoon. I watched the birds outside for a bit then fell asleep again. Must need that million dollar sleep right now. I finally woke up at 6pm, and Holly just fixed me a small bowl of her chicken gumbo. Two years ago when I had chemo, Marty and Deb brought me gumbo, and it was a very helpful concoction. It seems to be good this time too. Maybe okra has some kind of special healing properties. Dunno. If it stays down, I'll try a little more later because I can feel myself getting weak from lack of fluids and calories. It's really weird to have to tell myself to eat and drink when I've always been such a chow hound. Cancer sucks that way.

Holly has run off to Weaver St Market to get us some bread and check out the new store. I haven't been yet but I'll get there in time.

Thankful for the rain and all the pretty birds I got to see this afternoon-2 male gold finches, lady bluebird, some purple finches, some cardinals. Where are my woodpeckers???
Hope the Asheville gang had good weather and fun on Hazel Creek/Fontana this w-e. Write in and let us know how it went guys.

A Bounceback...almost


Yesterday was my first full day home after being an inpt for 7 days. I can't say that I felt great but I muddled through. Seemed to have a great deal of reflux and nausea. However, despite all of that I did get to have some fun visiting Sandi and Amy to check out the special Juliana bike that Sandi configured. Also got to see my boss from the Clinic when she dropped by to bring me some cards from my co-workers. It was nice to catch up and think abut work or anything that is not related to leukemia or chemo or hospitals. Miriam and Alex came over for a short visit too bearing an incredible pot of chicken soup. Miriam made me chicken soup 2 years ago when I had breast cancer treatment and it was a highlight then. This batch did not disappoint either. Although my stomach hurts and I feel like I have an elephant's paw pressing at my sternum, the soup actually made the symptoms lessen. So I got up first thing this morning (6am) to have a little bowl. Putting something in there seems to help at least a little.

For all of you medical folks out there, I was almost a bounceback to the Bone Marrow Unit last night. I started feeling achey, cool, and tired. We took my temp which was 100.4. I was told by the discharge nurses that I have to come in for an eval either in clinic or the unit if my temp is above 100.4. We rechecked it after an hour-still 100.4. I took all of my meds and went to bed. I had deep, restorative sleep fortunately until 3am when I had to get up and take more nausea meds. This am my temp is 99.4 but I do feel like I am coming down with something. Hopfeully they won't send me to the Unit from my clinic appt this morning at 9:15am. I am already on antibiotics to prevent several kinds of infections (Cipro).

I am definitely at the stage where the chemo is killing the lining of my mucosal surfaces. My tongue is sloughing off; my GI tract is coming out too. I know that is why it is so hard to eat and drink right now. I just have to make myself do it. Thank goodness for apple juice which seems to be my friend right now.

Well I'll add more later as we get info at the clinic. Thanks again to all of our friends here and in the mtns, co-workers, and others who have made this difficult process easier. Have a terrific Sunday. -tree

Saturday, June 21, 2008

Home on Saturday Night



From Holly: We've just had a beautiful downpour here in Hillsborough that has cooled things off and watered the yard nicely. Might have put a damper on the Annual Hillsborough Hog Day festivities though. It's a BBQ festival--games, entertainment, vendors and Q. We weren't able to attend, but had a pretty active day nonetheless--talked or visited with family, friends, and colleagues. We even went on an outing to Sandi and Amy's to look at Sandi's most awesome mt. bike and to get ideas for Teresa's future mt. bike. Sandi's bike is custom-made and only 25 lbs.--about the same weight as our two cats together (Henry and Gracie--or one Petey cat! :)). By this evening, Teresa was pretty uncomfortable and unhappy with the wonderful g-i effects of chemo, though Miriam's outstanding chicken soup dinner seems to have had curative properties. Her health status is like the weather--one minute sunny, the next minute roiling. Jeanne, one of the nurses at the transplant center recommended a little judicious aroma therapy (peppermint, lavender or chamomile essential oil).

We've both been listening Pandora.com quite a bit on the computer lately--does anyone have anything they would recommend we listen to?

Never Been Around this Corner Before



So this is the first blog entry from home. I got home yesterday about 4pm and it was heavenly. I had good energy and even an appetite for the Kashi pizza my mom had bought for us. I did have trouble getting to sleep since my schedule had gotten later and later at the hospital. When they come in at 12 noon, 4p, 8p, 12 midnight, and 4 am to get you up, weigh you, draw blood, and measure all of your vitals, it's hard to have a regular bedtime schedule. So last night I went to bed at 12 mdnt but couldn't get to sleep. I read some, wrote thank you notes, looked through several bike shop websites to peruse the bicycles, and eventually crawled back into bed at 2am. I woke up with horrible nausea and queasiness at 4:22am when the nausea meds ran out. So the lesson of the day is to stay on top of the nausea while I'm here at home. I'll take the pills regardless of how I feel. That should help alot.

As I was lying in bed trying to fall asleep I realized that this situation is very different from the breast cancer chemo. I haven't been around this corner to know what to expect. So I have to be gentle with myself not to do too much, to eat better, to be extra fastidious about hand washing and avoiding germs. Those 92 measly white blood cells won't do much to protect me against the big dirty world out there.

Tomorrow I will head back to the outpt clinic to have my counts drawn, get blood cells and platelets if I need them and to be examined. It was so nice of them to give me a reprieve today. After being in Duke hospital for 7 days, I am ready to see some normal life stuff for a change.

My mom just left to head back South to Charleston. She was so helpful being here-cooking, cleaning, grocery shopping, even got us a new dishwasher since the old one went on the blink. She is such a delight to be with these days, now that we relate as adults and now that she has given up drinking for good.

Well if we have the energy today we are going to look at women's mtn bikes. My birthday is a little over a month off so I want to get myself a special treat. It's time.
Hope everyone enjoys the weekend as much as I will and check back with us here. Warm wishes to you all, tree

Friday, June 20, 2008

Bon Voyage ...for now


So today is the day I get to go home as soon as I finish the last few punishing drops of Ara-C, my 7 day chemo. I was so excited last night about leaving today that I had trouble falling asleep. Did finish my latest book in that time (Predictably Irrational by Dan Ariely). I think it's great that they are letting me go home and just return to clinic, on Sunday at that. The attending doctor Dr Rizzieri said that I will probably need more blood and platelets by Sunday. They gave me 2 units of red cells last night so my color is better and so is my energy level. Todays counts are pretty ridiculous though, I have to say. My HgB is 9.4 (hct 26%) and my platelets are down to 20K (normal is greater than 150,000; spontaneous bleeding starts at 10,000, just an fyi for all you non-medical folks). But get this my total white cell count is a measely 92. That's it. That number is supposed to be 4000-8000. So I figure my 92 white cells are all that is standing between me and infection. Feels like a flimsy paper gown-No a flimsy paper gown would provide more protection than that. Anyway, it is what it is. Wash my hands and eat only the cleanest foods, yada, yada, yada.


When I get home I can publish the photos from today-1 with Holly and 1 with my mom. Just so you far away people can see I am still standing.

The new Weaver St opened in Hillsborough yesterday so that will be top on my list to try out once we are home. Holly brought me a locopop last night, since we now have a store of our own behind the coop. Man, Hillsborough is getting to be a cool place. We also have a killer library that I love to frequent. Aren't libraries just the best, most amazing places? I mean where else can you get a card to check out stuff free. Good stuff. My reading has certainly increased lately. It's easier to do with all this down time. I have to admit, though, that I haven't written in my own personal journal since I've been in here. Just not enough energy. Guess the blog will have to do.

Thursday, June 19, 2008

Thanksgiving Day


When I was awake this AM at 2 trying desperately to get back to sleep I was doing my pleasant thought thing (-I have always thought about bicycles since I was a kid. My mom would send me back to my own bed after a nightmare, to think of pleasant things. It always worked to think of bicycles. They are calming, fun to fantasize about, fun to imagine riding etc.)

Anyway, my point is that I was going over different times of the year and thinking about my upcoming birthday (July 25, 1962-Christmas in July) and special holidays. I want to tell you about Thanksgiving which is hands down my favorite holiday. First the point is to get together with friends and family. Second there is a big special meal involved. Third there are many desserts including pecan pie, my favorite. And the whole idea of the day is FELLOWSHIP. No gift giving or over-commercialization like Christmas. It's all about hanging out, maybe doing a hike or a walk, maybe watch some tv like a parade. Bu the big thing is to just be together. That is the greatest gift and I feel it ever more insistently now.

So I've enclosed a phto from Thanksgiving last year at Susan and Donna's house. We had such a lovely time. The kitchen addition got put to terrific use and everyone had a great time. It was chilly and a few folks balked at doing the traditional hike (you balkers know who you are...) but that part was good too. Can't wait to do Thanksgiving 2008 months from now. love to everyone who made that day special-taf

ANOTHER GOOD DAY-LEAVING TOMORROW

WELL MY TEAM JUST ROUNDED AND IF ALL GOES WELL THEY WILL LET ME LEAVE TOMORROW AFTERNOON. I WILL FINISH UP THE 7 DAY PORTION OF THE 3 AND 7 AND THEN POOF, LIKE THE WIND BE OUT OF HERE. TODAY THEY ARE GOING TO GIVE ME 2 UNITS OF RBC'S SINCE MY BLOOD COUNT HAS DROPPED TO 24% (HGB 8.3). THAT WILL HELP ME HAVE MORE ENERGY I AM SURE. THOSE RED CELLS ARE PRETTY DARN CRITICAL TO GETTING UP AND MOVING AROUND.

WHICH BRINGS ME TO A REQUEST FOR ALL OF YOU OUT THERE ITCHING TO DO SOMETHING TO HELP ME. DONATE BLOOD. I AM O+ SO THE UNIVERSAL DONOR BUT NOT THE UNIVERSAL ACCEPTOR. I AM GOING TO NEED BLOOD TRANSFUSIONS ON AND OFF STARTING TODAY. SO EVEN IF YOU'RE TYPE DOESN'T MATCH MINE, CONSIDER HEADING TO THE RED CROSS OR ELSEWHERE TO SAVE SOMEONE ELSE'S LIFE WITH LEUKEMIA.

STARTING READING MY NEW BOOK "PREDICTABLY IRRATIONAL" AT 2AM LAST NIGHT WHEN I COULDN'T SLEEP. COOL STUDIES OG PEOPLE'S BEHAVIOUR. WE'LL DRIVE ACROSS TOWN TO SAVE $7 OF A FANCY PEN TO GIVE AS A GIFT. BUT WON'T DRIVE ACROSS TOWN TO SAVE $7 ON A FANCY SUIT THAT COSTS $289, EVEN WHEN WE KNOW WE CAN PURCHASE IT ELSEWHERE FOR $282. DOEN'T MAKE SENSE DOES IT?

SO MANY NICE PEOPLE HAVE CALLED OR COME BY OR EMAILED OR JOIN THE BLOG. IT REALLY HAS MADE THE DIFFERENCE FOR ME. THE ROOM HERE ON 9202 IS QUITE SMALL AND ALL OF YOU HAVE ENLARGED IT IMMENSELY BY BEING IN THE LOOP.
THANKS FOR THAT. -TAF

Wednesday, June 18, 2008

Clarification


I didn't mean to send the wrong message with my last post to the blog. I read that book "3 Cups of tea" and I was inspired by how the guy in the book made it his mission to build schools for girls in Pakastan. he had been in the area to Mtn Clim and he missed the mtn he hoped to ascent (K2). But he turned his life into a mission to make the world a better place, starting there. Despite the politics of the Iraq war and Afghanistan, I think it is a noble thing to identify a cause in that tough part of the world and help the real people. The girls deserve schools, advancement, a chance to change their future. Indeed that is why our Army is over there fighting-to bring freedom and democracy to that part of the world. Education will go a long way to achieve those ends. At the back of the book he points out that a penny buys a pencil and a $1 buys a teacher. I just want some of my hard earned money to go there instead of Fidelity Investments. I feel sure that Holly and I will have enough to retire on. Our needs are simple. We aren't clothes hounds or big gear heads (even if we were, it's not like drugs or mid-life crisis cars).

So I wasn't trying to be pessimistic. Just realistic that I might not live to see all those $$$ squandered away for later. And who knows much of it may go to the treatment at hand-also a useful outlet for those yrs of saving. Because just as they say, you can't take it with you. ;-)

The beauty of the Anti-Nausea Cocktail


Well sometimes you have to hit bottom to bounce back up. That happened to me yestereday. I threw up 6 or 7 times during the day. Just never could get relief. At 4 am when they did my vitals, weight, labs and administer meds (they always do this whol rig-a-ma-roll at 4am so the labs and reports are back in time for morning rounds with the doctors ~8am). Anyway, I stodd up the be weighed and promptly proceed to vomit into the trashcan. So much for easing into the day. But that was a call to arms for us all and now I have decadron, more zofran, IV ativan and a scopolamine patch on board (I'm pretending I'm on one of those chic cruises where everyone has their scope patch behind their ear. I'm seeing Scandanavia in case you want to know. Brillant fjords and icebergs and a big ship and birds everywhere. )

So I have made some progress today. I finished the "Three Cups of Tea" book that Deb lent me. Excellent. I'll send them lots of money to build schools for girls in Pakistan. Only a $1 buys a teacher. Seems better than squandering it away for some retirement later. I've got plenty enough for that now and I'll be surprised as it is if I get to use it for retirement anyway. I'm not being sad or pessimistic, just realistic that again my priorities are changing and saving every spare dollar for age 65 probably doesn't make sense in my life. But I will be turning 46 on July 25, 2008 and I plan to buy myself a nice new mtn bike. Sandi is going to help me find the right one. Hopefully something fun, light, fits like a woman's bike should, and is easy to ride.

I feel I owe an incredible debt of gratitude to anyone and everyone who is reading this. You are keeping me and Holly well nurtured. I appreciate all of the energy and well wishes from everyone out there. I miss seeing you all in person. Soon enough.

Wednesday Morning: Step Backwards

From Holly: It is a lovely morning outside here in Durham. Inside room 9202 it's not so sunny. The nausea has gotten the better of Teresa. She had a rough night and feels crummy this morning. They have boosted the Atavan and added a scopalamne patch which should start to help by the afternoon. She's lying quietly at the moment. All the great comments, thoughts and prayers have really kept us both going. The infusion will end during the day on Friday--something to aim for now. After it stops, she should start to feel better--the nausea should ease, though she will be fatigued for quite a while. Ah, the doctors are here. Later, all. Thinking of you all and holding you in our hearts

Not A Home Run

Tuesday, June 17, 2008

Not So Fast

From Holly: Guess this is the nature of the disease--and the treatment--to have ups and downs from day-to- day and even within the same day. Teresa was pretty uncomfortable this afternoon so they gave her a heady dose of Atavan to stem the nausea and now she is very very asleep (8pm). Which is good. I'm hopeful she will have another morning like she did today. The sunset out her window is rosy and clear. From this top floor of the hospital there is a nice view of Duke Chapel. It's lovely this time of evening.

She is getting very good care from the nurses here. They are kind, attentive, and funny. They are exceptional people. The doctors, nurse practitioners and PA's have been great. Nonetheless, we're really looking forward to getting to go home Friday if all goes as planned.

Turned A Corner?


Yesterday was a hard day because I had the swelling thing in the morning (and hence the Lasix-induced going to the bathroom the rest of the day) and I had many hours of shakes and shivers. The PA who was on switched one of my nausea meds to ativan. Almost immediately I had relief and could get some sleep. It was so good to rest comfortably and not shiver and not be rocked about with bout after bout of nausea.

So today I feel better than I have in days. I've already been up walking the treadmill, ate a half of a popsicle, and now back in my room with the light on. I think the light thing is a good indicator of energy. Hopefully this will last for a while and I can make some good progress. It's always good days and bad days with this thing. But this one feels like a good one.

So the word of the day is hopeful....

Monday, June 16, 2008

Today's Cross to Bear


Seems everyday there is some symptom to put up with. Some of the old ones drop out or lessen only to be replaced by new ones. Today's version is shaking chills and tremors from the Ara-C. Apparently it is to be expected but it sure has made it tough to sleep. But I am feeling a bit less nausea- a thing to celebrate!!!

My mom is here now so everything will be okay. I will draw much love and comfort and fortitude from her. She is the strongest woman I know. And I really appreciate her leaving her husband who just had surgery of his own to be here with me.

Best thought for today: being on that rhodo walk with Susan and Donna, seeing the flame azaleas and pinkey purple blooms all over that mtnside; thanks for the photos guys!

3 down

Yesterday was a really rough day. I was very tired, low energy and the extra fluid made me feel bloated all day. They did pull some off with the Lasix but will be giving me more today. I just finished some time on the treadmill. What I wouldn't give for a day to feel normal again. I hope I have that when all of this is over. That is my biggest fear, that I will do all of this and it won't work or I'll still feel like crap. I decided this AM l like solid tumors better. The treatment and lack of treatment results seem much less bothersome.

So yesterday I finished the last of the 3 daunorubicin. Maybe the nausea and tiredness will improve some now.

My dad called this AM from Russia. It was good to hear his voice. And my mom comes today to stay and watch Quigley and take her back to Chas to keep. That will be great too.

Well tata for now-taf

Sunday, June 15, 2008

Father's Day

From Holly: Teresa is feeling really tired today. She's just received her last dose of daunorubicin which is good as it leaves only the cytarabine. This will be given until Friday. Despite the edema and fatigue, she did a total of 1 mile walking on the treadmill. After the Lasix, she's shed about 6 lb. and is much less puffy. Her nausea fluctuates, so no, she hasn't eaten much. The main thing is fatigue. She wanted me to apologize to folks who came or called about visiting. She just wasn't up to company, but really appreciates the thoughts and hopes to feel better tomorrow. While she was semi-awake, we finished watching the movie about Bob Dylan (loosely), I'm Not There. Can anyone explain it to me? I don't think she missed much by semi-asleep during it. But then, I was never a big Dylan fan or Sixties scholar. Now, Cate Blanchette--that's someone worth watching.

We both want to wish our dads a Happy Father's Day. We had planned to visit my family in Lawrence, KS for Father's Day, but will postpone it until all those tornados stop whirling about in the midwest (and in Teresa's stomach!). I miss you, Dad, and love you very much. Yes, I will call later. Happy Father's Day, Henry. We're thinking of you.

Puffy Eyes

Well every morning in anticipation of when the doctors round on the pts, they get us up for blood tests, temperature readings, blood pressure checks and to weigh us. This morning when they did that my weight was up 12#-ouch. No wonder I feel so bloated. Then when I woke up I couldn't open my eyes since there was so much swelling around my eyes.

They give lots of fluids to flush the kidneys and protect them from sludge of the cells breaking apart. At this point there aren't as many to break apart so they are willing to give me some Lasix, a diuretic, to push out some of the fluid today. He wants me down 2# by afternoon. Hope it all comes from my eyes because they are really tough to open still. If I had a way to capture it to put as the photo I would but it's better this way.

Okay guys go out and have a god Sunday for me. See some nature, commune with some birds. And hug the people most important to you. love to my friends-taf

Saturday, June 14, 2008

Holly's Post

This is my first foray into blogging.  Teresa is sitting next to me on her plush hospital bed giving me instructions between zzzz's.  She slept well last night--even woke up at a late time for her--8am.  Her blood counts are lower as expected with the chemotx and fluids she's on.  So she's more tired today.  Amy and Sandi stopped by to chat--great to see them.  The Transplant staff is very accommodating with visitors.  All the calls and emails are very much appreciated.  We have such wonderful families, friends and colleagues. I'm thinking of you.

Did anyone participate in the Race for the Cure today?

Don't Put Off Until to Tomorrow...


Maybe the next part of the phrase should read "what you can do today." Or maybe it should read fun that you can enjoy today. Or maybe it should read change that will make you happier. Or the trip you've always wanted to take or the bike you've always wanted to buy.

Anyway, I mention it because my labs came back yesterday with much lower values. My neutrophil count was down to 84 (from 300 on Monday while 1800-7800 is normal). My platelets and hemoglobin are significantly lower too at 71, 000 and 10.o (from 107,000 and 11.0). So I am very grateful to Dr Gwynn Long for seeing me in his clinic at Duke on Tuesday instead of Thursday and motoring to get me into the hospital. Now I have had my chemo started, and I am well on my way with this 7 and 3 regimen. Had my first dose of the daunorubin last night, and I am just starting to experience a tiny bit of nausea at the pit of my stomach. But I had the nurse give me medicine for it so it should lessen some in a while.
I've just done 30 mins on the treadmill in the exercise room across the hall from my hospital room. That felt good because they are giving me lots of IV fluids to wash out the breakdown products of the leukemia cells. My hands and feet are a little puffy. Walking on the treadmill helps a bunch with that.

At 5:30p or so I will get the next dose of daunorubicin (# 2 of 3) so that feel like progress.

I miss my little puppy dog Quigley and seeing the sweet view from our bedroom. Watching the small woodpeckers light on my suet cake or the goldfinches peck away at the thistle. But I can imagine it and that counts for alot. And of course I miss Zippy the most of all.

I'll write more later if anything worth reporting happens. If you want to come visit, Room 9202 or call 681-9202. Thanks to everyone who has stopped by. And thanks to Pam & Cindy for the big burly Teddy bear and balloons. Beautiful and cuddly, right by my bed.

Friday, June 13, 2008

Today's Schedule

Just met my doctor for the hospital portion of my leukemia treatment. His name is Dave Rizzieri and he does research into this type of cancer as well as other hematologic malignancies. He is very interested in people like me who develop leukemia after treatment for another type of cancer (breast cancer in my case).

Later this morning I'll go downstairs for a cardiac echocardiogram to evaluate the effectiveness of my heart pump. One of the chemo drugs can injure the heart and it is best to see the level of function now before any of the medicines are infused. Then later today I will get a whole bunch of fluid through my catheter followed by the start of my chemo drugs. The regimen I am taking is called "7 and 3" because one of the drugs (Ara-c) is given continuously for 7 days while the other one is given once daily for 3 days (daunorubicin).

I'll be hanging out here in Room 9202, looking west out my hospital room window, or reading, working on the computer, or giving the treadmill and stationary bike a good workout.

New Book I'm Reading: Three Cups of Tea by Greg Mortenson (loaned to me by my good pal Deb Reilly)

Word for Today: Breathe ...take a big life giving gulp of air and relax. Everything will happen on its own time.

 

Haircut


Well things started happening yesterday. I got a call from the PA at the clinic (Tanya Helms) who works with my Bone Marrow doc (Dr Gwynn Long). She had arranged for me to have my catheter placed at Duke in the Vascular Radiology department, but first she need me to "drop by the clinic" for another bone marrow biopsy. These guys don't do anything for you or to you without sticking a needle somewhere. The day before it was my arm. Yesterday, my buttbone. So far today, no needles. Now that I have this big, juicy catheter sticking out of my chest to make things easier, no one wants any blood. Go figure.

So when I talked to Tanya yesterday about getting the catheter and the bone marrow biopsy, I relayed to here that my sister had arrived from Atlanta to be tested. Becky also gave me a very nice short haircut to commemorate my upcoming baldness. Once the chemo kills those hair cells, the hair just falls out in clumps. It is a little disconcerting to see so much hair on the pillow, in the bathtub, and falling out in the brush. So I had Becky give me a really short trim-maybe an inch or so in length now. And dang, I had just grown it long enough to pull into a pony tail. But what I learned last time is that though we are all more vain than we think, it grows back pretty quickly.

Tuesday, June 10, 2008

Bad Luck, Twice


I remember how shocked I was two years ago when I learned that I had breast cancer. We had consulted one of my former residency professors, a general surgeon whom I knew to be especially kind and thoughtful with patients and their families, to do the needle biopsy of a hard lump near my right breastbone area (breast tissue goes from your collarbone down to your actual breast and under your armpit; my lump was actually pretty high on the chestwall in what we call the tail area of the breast). After several days, we had a follow up appointment in his office to go over the results. I had barely touched the seat before he said that I had breast cancer. No matter how much you are prepared to hear those words (and I was prepared because my lump was hard and fixed against the chest wall, both bad characteristics for breast lumps), they come as a shock. The world spins a little, and in an instant, everything you thought you knew about the world & your future is different. I think I remained in shock for several days as I continued to go to work and focus on other things. But then I had one weekend of sadness, tears, and "what if" questions - dealing with a future that didn't seem so certain and planned out anymore.

We struggled with whether to do just surgery & radiation or chemo too as the specialist was recommending. (If you think doctors are any better at deciding what treatment course to take, you are wrong. We read the medical literature and second guess ourselves as well as our doctors). We struggled with where I should get treatment-in the Asheville area where I was living at the time or in the Durham area where my partner lived. In the end, we decided to do the surgery, a lumpectomy and lymph node biopsy, in Asheville followed by chemo at Duke and daily radiation treatments (for 7 weeks) in Asheville. Work was incredibly flexible with my schedule and everyone, I mean everyone, was extremely supportive. I got flowers, gift baskets, cards, hand knitted scarves, hats, and a personalized quilt that many folks sewed together to keep me comfortable during chemo. Ultimately I had 6 chemo treatments, every other Friday. I was pretty nauseated after each treatment, but we got through it. As the chemo left my bloodstream every other week, I felt better and better. Once I could drive, I'd slap on a scopolamine patch, to get rid of any remaining motion sickness, and drive back to Asheville to work until the next treatment. Friends and co-workers got used to the schedule and would stop me in the hall to ask which week it was-a treatment week or a non-treatment week. Even my patients took to looking after me, offering to mow my grass or cook me a tasty meal. 

I was so happy to be working during the "off " weeks, and I got closer to many of my friends, co-workers and family members. I was very fortunate to have so many great people in my life and thrilled to be able to do something for other people, too, on the days I was allowed to work in the clinic. Seeing patients during my treatment allowed me to keep some semblance of normalcy during a difficult time. Running, too, helped in that regard. When you have been as active as I have, it really feels good to get outside and run or walk. Even when I felt tired or fatigued, it was great to push myself to exercise just as I'd been doing since age 16.

I found a poem at one of the UNC breast cancer sites that described cancer in a very interesting way. The gist of it was that in the beginning, cancer fills your whole life. It's there in every room of your house-your kitchen, your living room, your bedroom. But eventually as you move through treatment and follow-ups, the cancer, and its importance, shrinks in your life. In the poem, the author says that eventually it occupies only a shoebox. I thought that was a good metaphor for the cancer journey. Cancer goes from being something you negotiate in front of you, to something you spy through the rearview mirror. And with time, the cancer gets smaller and smaller, as you leave it behind you and move away from the day you were diagnosed.

Until you have bad luck again like I did. On some routine blood work a few weeks ago, my neutrophil count was very low (900 instead of 1800-7800).  Several tests later it had dropped to 200. Neutrophils are the kind of white blood cells that help us fight infection, especially bacterial infections like pneumonia. I saw a hematologist who ordered more lab tests including a bone marrow biopsy. A long, fairly thick needle was inserted into my sacrum or buttbone to collect fluid from the marrow as well a piece of bone to analyze under the microscope. A few days later, we went to see the hematologist to find out my test results. I had a large number of atypical white blood cells, in my case leukemia cells, as well as lower numbers of red blood cells and platelets than I should have. It's rare, but it turns out that 1 in 100 people who have chemo and radiation will develop a second malignancy, often a blood disorder like mine (AML or adult myelogenous leukemia). Fabulous luck, a second time. I think the odds for women developing breast cancer are somewhere between 1 in 8 to 1 in 13. And the odds of getting a second malignancy are 1 in 100; so I am really special, as they say. I think of it as getting hit twice with lightening.

So in the past few weeks, that big bad cancer that had been confined to a shoebox was let out again (just like the Dementors from Harry Potter) into the living room, the kitchen and the bedroom. But we will get through with it, and eventually, cancer will be something we check in the rearview mirror again.

The schedule for the next few days will be jam packed. Tomorrow (6/12) I'll have another catheter placed in the upper part of my chest to access the big vessels near my heart that will accept my chemo, blood transfusions and other medicines. Then Friday (6/13), I'll report to the hospital to be admitted and start 7 days of continuous chemo. Meanwhile my sisters will be tested to determine if they can be donors for my bone marrow transplant. Hopefully the chemo I get starting Friday will kill all of the leukemia in my bone marrow, and I'll be in remission. I'll need another bone marrow biopsy on day 15 to check that. If it looks good and one of my sisters can be a donor, I'll go on to the bone marrow transplant. That involves a month in the hospital since they will kill all of my bone marrow, infuse that of my donor, and wait for it to make white cells, red cells and platelets for me. I'm not too worried about all of the "what if's" this time because I have to get through this first part with 7 days of chemo first. One day at a time, one week at a time, ...I'm just happy to be here feeling good, feeling strong and hopeful and blessed with everyone's help.

Word of the day: resilience...makes me think of all the ways we adapt to hardship or suffering to emerge vibrant on the other side

Listening to Alison Kraus& Robert Plant




A Duke Consult

It's Tuesday 6/10/2008, and today I have my first consult with the Duke docs at the Bone Marrow Transplant group. Due to insurance issues, my transplant has to be done at Duke instead of UNC where I was first diagnosed with leukemia. Bone Marrow Transplants cost upwards of $150,000 so the insurance company gets a big say in where that happens. I suspect they negotiate a price with a particular medical center and then require all of their enrollees to use that center.

I saw my leukemia doctor at UNC yesterday just to check in and get my blood counts redone. Fortunately, they were about the same as last week when I had them checked. Last week at the clinic, I also had a bone marrow biopsy done by a terrific PA named John Strader. He pre-medicates with a little IV morphine and ativan to make the procedure more comfortable. I've never had a bone marrow biopsy before, but I think it certainly helped me be more relaxed. I mean they do stick a big needle into your pelvis bone and suck out the marrow for testing.  I was a little anxious about it I have to admit. I've seen them done during residency and they looked painful. It left me a little bruised and sore at the puncture spot, but it wasn't bad overall.

My sister Beth is coming up today from Ga and Becky arrives by plane tomorrow. They are coming to be supportive and to be tested to see if their bone marrow matches mine for the transplant. There are 6-8 markers on our blood cells that help our bodies decide if something we encounter is foreign or part of us. I need to get bone marrow or stem cells that match mine so that my immune system doesn't reject the transplant. Since we inherit the antigen markers from both parents, the best match is most likely to come from one of my sisters. Each one of them has a 1 in 4 chance of being a match for me. (Makes you want to be from a big family-more options for a potential match.) If neither of them is a match, then my doctors will search the bone marrow registry/database for a donor who is a close match. Of course, it would be a lot simpler if one of my sisters is a match. They live nearby and are willing to help out. I can only imagine what it would feel like to donate life-giving cells to your sister. Altruism of the first degree. Fortunately they now use stem cells instead of actual bone marrow cells so the donor doesn't have to have a bone marrow biopsy or harvesting anymore. They sit in a chair as if they are giving blood and a large apheresis machine separates out the stem cells, returning the other blood cells to the donor. So I imagine it to be a little like giving blood, just a lot more complicated than filling a pint bag at the Red Cross.

Word of the day: Peace... brings to mind quietude, internal tranquility, forgiveness, self-soothing

Book I'm Reading: The Post-American World by Fareed Zakaria

Best Book I've Read Recently: the World is Flat by Thomas Friedman

Thing I'm Most Thankful for Today: The deep shade of a large tree. It has been 100 degrees in the Triangle the past few days, and I am struck anew at the pleasure of stopping below a big tree to cool off.