Health update, 9/27/07

Yesterday, I made a brief visit to Dr. Grapski's office to pick up some prescriptions. While there, I had the opportunity to check on my ca19-9 levels, measured a week ago. The news is not good, I'm afraid: after my first cycle of Xeloda, my ca19-9 came in at 307. Three weeks later, after a second cycle, it measured 390. You'll remember that "normal" is at or below 35. Now, this could mean nothing. When I first took the carboplatin/taxol combo, starting in June of 2005, I had a similar spike after the first cycle, going from 240 to 420, before it started a steady decline to "normal". However, that spike was accompanied by a series of other effects suggesting the treatment was working. Primarily, the pain I'd been feeling dropped considerably, as I went from needing the suggested maximum daily dose of ibuprofin, to needing no pain relievers at all. This time, however, I've noticed no change (or if anything, a slight increase) in my pain levels.

We'll go for at least one more cycle before making any decisions on what to do next. I'll get a CT scan after this cycle, then we'll also do more blood tests, to see if my ca19-9 continues to rise. If it is determined that Xeloda is not working, it will be time to get creative. We have reached the end of using chemotherapy alone. We note, for example, that while the carboplain/taxol combo had stopped working in my liver, it was still working everywhere else. It is possible that we could return to that chemotherapy while using radiation on the tumors in my liver. That, anyway, is one option among those that will be considered once the results are in from the CT scan and next blood test. More to come on this by late October...

Fantasy football!

Another week, another tough loss for Monkey Knife Fight, this time 161 - 139 to the EighteenGrands. Now in this league, 130 points is a really good score. Though it should be good enough for a win, MKF has found themselves on the losing end two consecutive weeks with such a score. We now find ourselves at 1 - 2, entering into the dreaded byes. It's early in the season, too early to call any week a "must win"...but this coming week vs. the first place Sunrise Stingers is a must win. With week 6 looming as a likely loss, with half the blade wielding chimps taking the week off, a run of wins is necessary to keep our play-off hopes alive.

Meanwhile, the Rodents are delighted. Seemingly putting it all together, Rodent Passion took league scoring honors for the week with its 130 - 68 victory over Gametime Decision. A strong performance by QB Philip Rivers complimented the continued stellar performance of our mighty receiving corps, which over-came the loss of Andre Johnson through the sensational play of Roy Williams, Anquan Boldin, and Deion Branch. In a daring pre-season move, RP traded perennial fantasy football standout Rudi Johnson for promising young runner DeAngelo Williams and the aforementioned Branch. Key to that deal, at the time, was the hope we have that Williams will develop into a stud in the NFL. In the short term, the play of Mr. Branch has been a key to consecutive wins. An important intra-divisional match-up awaits this weekend with Corporeal Punishment. At the moment, RP finds itself alone in first place in the Beatles Division of the Rock 'n' Roll Fantasy Football League. With Corporeal Punishment alone in the division in second at 2 - 1, a victory would give RP a daunting 2 game advantage, and would make them the clear front-runners for that all-important first-round bye in the play-offs.

Update, 9/25/07

Just a quick word since my transfusion: had that on Saturday, and I was feeling the positive effects almost immediately. "Go juice," as my uncle called it when he was getting 'em (also during chemo).

Z asked about talking with my docs about "rhEPO". Actually, this was the first I'd heard of the term. However, I had been getting a red cell booster (starts with an "a"...can't remember the name of it at the moment) since the Spring. We'd taken me off it for a while, but with the recent happenings, we'll put me back on it.

Before this Spring, I'd never needed any help with my blood levels. I'd never needed a break from treatments, never felt unusually fatigued. Now, I suppose with the cancer moving to my bones, it's that much tougher for my body to reproduce the cells as I need them.

All those years of giving blood...I think I've still given more than I've taken, so I feel good about that. :)

Meet Sebastian

He's my new roommate -- at least for a short while, perhaps permanently, depending on circumstances. Seems my neighbor's new-born little girl, Sierra, has developed a fairly serious allergy to something. Just what, we're not yet sure. But as a precaution, while we're still waiting for the test results, Sebastian is moving in with me. If Sierra's allergies are of something other than cats, he'll head back next door. Otherwise, I'll have a buddy to watch football with. :)

St. Sebastian is an early Christian martyr, about whom very little is known. He is traditionally depicted as a young man bound to a tree, pierced by many arrows. Some time ago, my buddy Dave, moved by the appeal for the virtue of fortitude, gave me a prayer card of St. Sebastian, who is often invoked for healing from physical and spiritual wounds:

O Lord, grant us the spirit of fortitude, so that guided by the example of the martyr St. Sebastian, we may learn to bear witness to the Christian Faith and patiently support the sufferings of life.

God willing, my new roomie can act as a reminder of my need for virtue in general, for fortitude in particular. Trying to paraphrase St. Thomas Aquinas (and I invite the correction of those who understand the great saint better than I), fortitude is that habit of the soul which allows us to overcome the fear of death that disables our reason, leading us to despair of our fate. By the willful application of reason against the passivity of my flesh which leads to fear and despair, I am reminded that by faith I believe in the God Who overcame death, and have hope that He will provide for me at my own.

Health update, September 20, 2007

I met this morning with my oncologist, Dr. Grapski, of the Thomson Cancer Survival Center (link to the right). Blood tests showed I'm in good shape to start cycle three of Xeloda -- took a first dose after leaving his office, and the second just minutes ago. We've begun tracking my tumor marker, ca 19-9, the levels of which have proven to be a solid indicator of the activity and growth of my cancer. My ca 19-9 from 3 weeks ago was at around 300. While this is high (normal is below 35 or so), it doesn't mean much by itself -- when we can compare it to today's number, that's when it'll be significant. We'll see...I don't have a feeling either way. I've had it as high as in the 400s...I've had periods where I've been happily "normal". Right now, we just hope to see it go down.

We set up a CT scan for mid-October, after this present cycle is finished. I'll meet with Dr. Grapski two days later. By then, we'll have our first indications concerning the effectiveness of this treatment.

In the meantime, I'll be getting a blood transfusion this Saturday. My hemoglobin is at 8.8 g/dl -- "normal" is between 13.8 and 17.2 g/dl. A transfusion should push me up to around 11, then hopefully my body takes care of the rest. Why am I so low? I don't really know. I've been low (but not this low) since coming off the irinotecan/erbitux I'd been taking through the spring. I suppose the Xeloda takes out some...maybe the cancer in my bones is doing bad stuff, too. Plus, I was losing some blood due to those digestive/urinary tract infection issues I believe I'd mentioned. In combination, I suppose it's easy enough to believe my red cells would be low. Hopefully, a transfusion helps me out -- gives me more energy, helps the body recover a bit better, stuff like that.

Edit (9/21): I'd confused my hemoglobin with my hematocrit. The first is "the iron containing oxygen-transport metalloprotein in the red blood cells", and is quantified by mass per volume of blood. The second is a "measure of the proportion of blood volume occupied by red blood cells" and is reported as a percent. For men, it is typically between 38% and 52%. My hemoglobin is at 8.8 g/dl. I don't recall the hematocrit...but when I've needed a transfusion in the past, it's been around 24% to 27%.

Fantasy football!

Half a point to Gigi for getting that Monkey Knife Fight is a Simpsons reference. Of course, how hard would that be to guess for anyone that knows me fairly well at all? I've got to admit, though, I was disappointed no one gave me a Tyson v. Secretariat ("They were so drunk" -- Moe) or anything. Perhaps stung by the lack of recognition, MKF could not pull out the nail biter versus the Maroon Tigers, falling 132 - 129. MKF continues to get balanced scoring, however, and remains a legitimate title contender.

In Rock 'n' Roll Fantasy Football League action, Rodent Passion remains undefeated, carried by a super-powered wide receiver core. We put the smack down on KC Masterpiece, 104 - 72, despite another poor showing by Rex Grossman. I've got to admit, I haven't the patience of Lovie Smith for Rex's lackluster efforts. He's taking a seat this weekend.

Health updates

I can't seem to find a good way to archive all the health updates in a convenient place. So I'll make this list of links to all of them, updating it whenever there's a new posting. I'll keep the link to this post on the "links" list on the right.

1. Chronology
2. June 30, 2007
3. July 14, 2007
4. Xeloda (August 8, 2007)
   
5. First cycle down (August 23, 2007)
6. Round two in the books (September 14, 2007)

A better idea, from Z in the comments -- I'll make a permanent list of links on the right, so you don't have to click twice to get to any of the past updates.

Quote of the day

God has created me to do him some definite service; he has committed some work to me which he has not committed to another. I have my mission; I may never know it in this life, but I shall be told it in the next. I have a part in a great work; I am a link in a chain, a bond of connection between persons. He has not created me for naught. I shall do good, I shall do his work; I shall be an angel of peace, a preacher of truth in my own place, while not intending it, if I do but keep his commandments and serve him in my calling.

Therefore I will trust him. Whatever, wherever I am, I can never be thrown away. If I am in sickness, my sickness may serve him; in perplexity, my perplexity may serve him; if I am in sorrow, my sorrow may serve him. My sickness, or perplexity, or sorrow may be necessary causes of some great end, which is quite beyond us. He does nothing in vain; he may prolong my life, he may shorten it; he knows what he is about. He may take away my friends, he may throw me among strangers, he may make me feel desolate, make my spirits sink, hide the future from me -- still he knows what he is about.

John Henry Newman, Meditations and Devotions, III, 1855

Round 2 in the books

As of yesterday, I am through two rounds of Xeloda. I wish I had something more to say about it. No noticeable change in the levels of my pain meds. Still around the same level of side effects -- meaning, virtually no side effects. I'd guess the nausea and fatigue I feel is more a consequence of the pain meds than of the chemo. One disturbing sign -- my vertical scar is getting a bit tight. I've been feeling this coming on over the last several days. There is a noticeable hard spot, right near where my belly-button used to be, which had not been there until recently. I don't want to get ahead of myself on what this might mean...certainly something to discuss with Dr. Grapski when I see him next week.

Fantasy football!

So, the rule goes, nobody except you (meaning me) really cares about your (meaning my) fantasy football team. But this is my blog and I'll do what I want. You don't like it, you can start your own blog and criticize me mercilessly (which is how I gather much of the "blogosphere" works). And even though you don't really care, I'll be posting news on both my fantasy football teams on a weekly basis. Happily, in Great Pigskin Experiment action, Monkey Knife Fight (who can guess the reference first? And be specific...) starts at 1-0, getting balanced scoring across the line-up: Matt Hasselbeck, Travis Henry, Joseph Addai, and Antonio Gates doing the heavy lifting in a 132 - 105 win over the Lazerphiles.

I'm told today by Dan Shanoff that there's no shame in winning your fantasy football game while being the lowest-scoring team in your league to do so. So I can proudly say Rodent Passion completely destroyed the under-manned Popeye's Nephews by a score of 73 - 51. They, too, are 1-0 in the Rock 'n' Roll Fantasy Football League to start the year. (Note: due to different roster sizes and scoring systems, the scores in the Rock 'n' Roll Fantasy Football League will be consistently lower than those for the Great Pigskin Experiment).

Now the name Rodent Passion stems from a Dave Barry article of many years ago, the gist of which I can't recall. There was something about squirrels making sweet, sweet, squirrel love, which he referred to as "rodent passion", which he then remarked would make a great name for a rock band. I don't know about that, but it's been a great name for a modestly successful (1-time Super Bowl runner-up, 2-time play-off participant, in its 3-year existence) fantasy football team.

In contemporary times, we have a rather limited view of "passion", typically confined in our thoughts to purely sexual matters. Classically, however, "the passions" suggest something akin to our emotions, that part of our soul that is moved by events outside of us, "passively" as it were. They are neither good nor evil in themselves, but can lead to either good or evil. The aim of the good man is to train, or tame, the animal within, so that one's passions can aid in the performance of good and noble deeds.

In the past week, the Rodents have been moved to anger and sorrow in various parts because of Chris Brown of the Tennessee Titans. For nearly 3 years, he's been a waste of space on our roster, and one week after we finally wash our hands of him, he produces his best game as a pro. Were I compelled to act purely from my passions, untempered by reason, I might act in a malicious way (either by thought or deed) toward Mr. Brown or the good owner of Popeye's Nephews (shrewd enough to select Mr. Brown in our recent rookie/free agent draft). The inner man, the Dennis who longs to be good, however, takes this opportunity to forgive Mr. Brown, delighting in his resurgence, and congratulate the Nephews for their astute acquisition (even as I totally destroyed them on the field). A good man would never gloat over a fallen opponent. I'm still working on this, people.

Far From Home

Reminiscing again over my time in Munich...

Here's a picture of my band, Far From Home -- Southern Germany's best honky tonk! It was great fun, and the folks in and around the band were among my best friends in Germany. John (the drummer) and I have since moved to the US, but Michelle (vocals, acoustic guitar) and Robert (lead guitar, vocals) have been joined by Wolfgang (bass) and Fritz (drums) and have been doing really well. Mary Beth left the band late last year to pursue a solo career, has put together her own band, and will be touring Holland soon. Look her up if you're there! She's a heck of a song-writer -- you check out her stuff here.

First cycle down...

On Wednesday I took the last dose of my first cycle of Xeloda. I wish I could say something...anything...about if or how much it's working. But the nature of the business is that it takes time. The first obvious sign that things are working would be a decrease in my aches and pains...unfortunately, there's been none of that. No increases though, and since during the weeks leading up to beginning Xeloda my pain had been rising, I suppose we can take this as a modest positive.

I get a week off before seeing Dr. Grapski again next week. We'll probably start looking at my ca19-9 (my tumor markers) with some regularity, but it will take 2 measurements to have any kind of indications as to what's happening there. This will take, from today, 7 weeks, and by then I'll be about due for another CT scan. All of which is to say that the only "news" on the effectiveness of this treatment can come from an improvement in my pain. Here's hoping for the best there...

At the very least, this has to be the easiest chemo I've ever taken. I had some mild nausea over the past week, but it's been easily managed. Nothing even approaching what I've experienced on other regimens. I was told to watch for a reddening or blistering of the hands and feet -- something on the level of 2nd-degree burns at its worst -- which can be a common side effect of the Xeloda. Good news here -- I saw nothing like this. I suppose this is probably something to watch for as the treatment continues, though.

Xeloda

And so it begins. This evening I start my new chemotherapy regimen, with 3 500 mg tablets of Xeloda. I'll take 3 tablets every morning and evening for the next 2 weeks, then I'll get a week off before starting again. Repeat till (1) we know it doesn't work or (2) we're fairly confident that my disease has stabilized. According the link, xeloda "is a prodrug that is enzymatically converted to 5-fluorouacil in the tumor by the tumor-specific enzyme PynPase, where it inhibits DNA synthesis and slows growth of tumor tissue." I've had 5-fluorouacil (5-FU) as part of the very first chemo regimen I took back in the Spring of '04. It's really hard to say how effective it was -- we know that there was no visible growth on my CT scans during that Spring, and that my ca19-9 (the best tumor marker we've got) was at a reasonably low 80 ("normal" is less than 35 or so...right now, my level is somewhere around 250) when I finished. We weren't tracking the ca19-9 during those months of treatment, not knowing till the first Sugarbaker surgery that this was a viable indicator of the level of cancer in my body. The main difference with xeloda is that the poison is activated in the tumor -- the highest concentrations, if I'm understanding things right, will be in the tumors themselves. I can imagine that this might lessen the over-all side effects, though I'll experience to some degree or other the "usual" -- fatigue, nausea, etc.

I'm always a bit anxious at the start of a new regimen. Never quite sure how well it's going to work...hoping that it works well, shrinking tumors and otherwise halting their growth for an extended period...fearing that it won't work at all, leaving me in 3 months with still larger tumors. And big questions about where exactly we might head next.

A chronology

If you'd have asked me on January 4, 2004, I'd have told you I was in the best shape of my life. I'd spent the previous several months living cheap, and eating well (in quality if not quantity). In August of '03, I'd started graduate studies in philosophy at the Catholic University of America (CUA). I'd secured a stipend from the physics department, doing bits of analysis with the nuclear physics group, but $1000/mo (before taxes) doesn't go that far in Washington, DC. I was walking everywhere, playing ultimate frisbee twice per week (football when the weather turned), eating low fat (pasta and rice are cheap) with lots of fresh fruits and veggies (surprisingly cheap, certainly compared to frozen entrees and the like). I'd lost a few pounds, could run non-stop for a week, and was feeling great. Then everything changed, literally overnight.

During the night of January 4, I'd started feeling sick -- pains in my lower right side, combined with a nasty queezyness. As things got worse during the day on the 5th, I called 911. As they brought me to the hospital, it became clear that I had appendicitis. I'd wake up in a few hours after a routine surgery, spend maybe 2 days in the hospital, then go home to continue studying. I woke up early morning on the 6th -- much later than the couple hours I'd expected -- and was told I had adenocarcinoma of the appendix. My cancer started in my appendix, but by the time we'd discovered it, had spread throughout my abdominal cavity, growing on the surfaces of my organs. They could remove the primary tumor and several of the larger chunks, but there were too many smaller tumors (not to mention the unseen microscopic elements) to hope that the emergency room surgery could leave me cancer free.

From here I'll just hit the highlights: in mid-February, I started a chemotherapy regimen called FOLFOX. I took three months of this, with a one-month break before undergoing cytoreductive surgery with hyperthermic intraoperative intraperitoneal chemotherapy with Dr. Paul Sugarbaker of the Washington Cancer Institute (coincidentally, just down the street from CUA) on June 30, 2004. The short of it is, Dr. Sugarbaker cut me open, then spent approximately 8 hours over my wide-open abdomen, meticulously stripping my abdominal lining (the peritoneum) of any visible aspects of cancer. Then, before sewing me up, he poured chemotherapy into my open abdomen, heating it so that it might penetrate more deeply into my organs. In this way -- and only in this way, according to what was then (and presently) known -- was there some hope that my cancer could be completely wiped clean.

In August of '04, as I recovered from this surgery, I began a second chemotherapy regimen, with a drug called irinotecan. I took this for three months, before seeing Dr. Sugarbaker again in mid-December for a "second look". After this "second look" surgery, all signs looked good -- in Dr. Sugarbaker's experience, I should have had something like an 80% chance of full cure.

In September of '04, I interviewed for a position in Munich, Germany. A return to philosophy was out of the question, as I needed work that would provide insurance to cover future medical expenses, and would also likely finish '04 with extensive medical bills. When given a positive outlook for recovery, after the struggles of '04, I figured a European adventure would be fun, while also getting myself back on a career track. I left for Germany at the end of February '05.

In May of '05, during a routine staging/check-up (consisting of blood work and a CT scan) we discovered that my cancer had returned. This time, inside my liver and lung -- once the cancer appears inside the organs, we are beyond the reach of surgery. And for that matter, beyond the reach of a known cure. From this point, I take chemotherapy and seek other treatments to keep the cancer at bay, to maintain some quality of life, and hope, in the meantime, that a cure presents itself (and, as a man of faith, I welcome a cure either by natural or supernatural means). Starting in June '05, I began a chemotherapy regimen in Munich with the drugs carboplatin and taxol. I took this regimen through November of '05. My disease stabilized, and I was went till June of '06 before any new growth appeared.

In August of '06, I underwent a 4th abdominal surgery to clean out some particularly troubling tumors, then began chemotherapy again, with irinotecan plus the anti-body erbitux. In January '07, I returned to the US, beginning work outside of Washington, DC. Through April of '07, I continued with this same chemotherapy regimen. A mid-April staging suggested that my tumors were again growing, motivating a return to the carboplatin/taxol regimen. Shortly after beginning this new/old regimen, I made the move to Knoxville, where I am today. A recent (June) staging suggested that, while the treatment was working on some of my tumors, it was not working on others -- in particular, the tumors in my liver (the more dangerous of my tumors) were still growing.

And that brings us up to date. There remains one last untried "standard" treatment option (xeloda), which I expect to begin in the next week. There's really no telling how well it will work. While I hope that it can arrest the growth of my cancer, perhaps even stabilizing it to where I can get an extended break away from treatment, there are no guarantees. Regardless, my personal ambitions really don't (or at least, they shouldn't) change. That is to be a good man, a virtuous man, a man of constant, humble, prayer. I'm far from being such a man, but I'm giving it a shot, so long as I have one.

A picture from Lucerne

Just wanted to post a picture from my time in Europe. This one is at Lake Lucerne. Last June, I took a long weekend to visit my good friend Zema, living at the time outside of Zürich. We got a day-pass for the rail, and managed to see bits of Zürich, Lucerne, and Bern in one day. Very cool. (And thanks, Z, for taking the pic!)

Barista love

None of my baristas in Munich ever called me "sweetie". But they were totally hot for me, this I know. Unlike this poor guy.

I'm Superman...

...or is it Spiderman?

Which superhero are you?

Quote for the day

My soul proclaims the greatness of the Lord,
my spirit rejoices in God my Savior
for he has looked with favor on his lowly servant.

From Mary's prayer of praise (the Magnificat), during her visit to see her cousin Elizabeth, then carrying the unborn John the Baptist in her womb. One suspects that she knew -- if not specifically, at least in a general way -- that her "yes" to God, her agreement ("let it be done to me according to your word") to carry and raise the salvation of the world -- would be a great struggle. She accepted such responsibility and considered it a favor -- knowing that faithfulness to God offers its own reward, though as yet unseen.

I don't claim to have the faith or courage of Mary, but I use this as my sig to remind myself of my ideal. I can, in more reflective moments, see my cancer as a "favor". Virtue is both brought into being and revealed through struggle. In my struggles with cancer, I can see a little more clearly just who I am, while I approach (God willing) what I wish to be.

E-mail update from July 14, 2007

Just wanted to pass along the latest news from my recent CT scan and blood work. As I mentioned in the last e-mail, we were expecting good news -- the near-the-surface tumors were clearly smaller, I was cutting back on my pain killers (suggesting improvement in the bones), and had the experience of this treatment working previously. I was feeling pretty good, too, for the most part.

Anyways, I had a CT scan a week ago, and got the results on Wednesday, when I went in for what should have been a treatment. In something of a surprise, given how good things were looking, it turns out the tumors in my liver have been growing. I guess they've adapted to and are no longer responding to the treatment. These are, of course, the dangerous ones...the ones that really dictate when a change is in order.

So, what's next? We've got one (maybe 1.5...depending on what kinds of drugs we can add to the supplement one) more standard and approved treatment option to try. It's a pill form of a drug I'd taken back in the Spring of '04 at Northwestern. We have no way of really guessing how well that regimen worked -- we weren't yet checking my one good tumor marker (that showed up as a good marker with the first Sugarbaker surgery), though we can say that there wasn't great growth during the months I took it (nothing was popping up bigger on the CT scans during those months). I suppose taking it orally allows it to be absorbed into the system in a different way...not sure how that might make it more effective, but I suppose it could.

Beyond that, we're looking at clinical trials. Given that my cancer is pretty rare, I'm not gonna qualify for many of the experimental options out there -- at the "trials" stage they're looking to accumulate data on how well a given treatment may take out a particular kind of cancer. There just aren't enough folks with appendix cancer to warrant a full scale study of treatment options specific to it. This means that my "experimental" options are mostly going to be limited to very early trials...where they're still looking to establish the dose levels and things like that they'll use for a bigger and more specific trial. I've called the folks at Vanderbilt University, in Nashville, and they said they've got 5 or 6 such trials happening right now that I'd qualify for. We're not running there next week -- we'll give this last "approved" option every opportunity first -- but it's worthwhile to start asking around and seeing what's available.

We've actually decided to take a short break from treatment. Dr. Grapski (my guy here in Knoxville) is going to call Dr. Marshall (my guy at Georgetown) and see if he's got other ideas besides Xeloda (that pill treatment I'd mentioned). In the meantime, we'll take a couple of weeks and see if we can't do something about those cryptic "issues" I'd mentioned...problems in the lining of my digestive tract and bladder that have arisen since the surgery in Munich last August. If we can do something to get this to heal up, we open up one possible option to add to the Xeloda (a drug called Avastin, which I'd taken a bit at Northwestern. It gets in the way of the cancer cell's ability to create new avenues of blood supply. One possible side effect is the creation of or making worse of such problems as I've already got -- the issues I'm having would potentially go from mild nuisance to a big deal).

I'll probably be starting up on Xeloda (and whatever else) come the start of August.

No sugar coating this, folks -- this is bad. But we'll do what we always do when we get punched in the gut. We'll get back up, catch our breath, and resume the fight. And we'll pray. Lots.

Thanks as always for all your prayers and support.

E-mail update from June 30, 2007

In health news, recent complications arising from the surgery of last August notwithstanding (more an annoyance than anything life threatening, and it's something that hopefully is readily fixable...but in the meantime it's making life uncomfortable), things are going well. I've got a CT scan scheduled for next Friday which should confirm what we already know -- the new/old treatment is working, with the tumors near the surface (which I can feel, just beneath the skin) clearly smaller. This 4 treatments in -- if I remember right, when I took the same stuff during the fall of '05 in Germany, I took about 8 before getting my extended (6 month) break with no growth. If all goes well, I may get to enjoy the fall without treatment. No expectations here, just a modest hope.

This treatment, as I probably mentioned before, is a bit easier to take than the last, too. It comes every 3 weeks, and while that first week is probably tougher than the worst days of the last treatment, I then get 2 weeks to feel like a normal human being. I suppose back in the day, I'd be complaining about feeling like crap 1 out of every 3 weeks...these days, I'm happy to enjoy feeling good 2 out of every 3. Nice what a little struggle can do for the attitude...