Monday, November 17, 2014

Getting a Second Opinion

Today we met with Dr. William Gradishar at Northwestern Memorial to get a second opinion on my course of treatment. By all accounts, he's the leading breast cancer specialist in the Chicago area and one of the top breast oncologists in the nation (just check out this publications list). My oncologist recommended I see him simply because my case is such a borderline situation. So it isn't that I don't trust or agree with my oncologist; he's smart enough to recognize the value of additional input and referred me to bigwig in the field (part of why I like this guy).

Anyway, Dr. Gradishar agreed with our treatment plan and said he would recommend the exact same thing: chemo with a 4-round course of TC, radiation, and Tamoxifen (hormone therapy since the tumor was hormone responsive). This was very reassuring, obviously! On the one hand, it's good to hear from the top expert in your particular health issue that he/she would do the same thing you're planning. It's also nice to not have the waters muddied, so to speak, by that person recommending something else or casting doubt on the course of treatment. All in all, I was hoping for confirmation from this meeting, and that's exactly what I got!

Another bright spot was that the word "cured" was used in the conversation, and it's a relief just to hear it. According to the doctor, for all intents and purposes I am "cured" right now since the tumor was removed cleanly and entirely, and my lymph nodes were negative. Of course, systemic treatment is still crucial to prevent any microscopic cells anywhere in the body from growing, but he said I'm at "the good end" of the scale, and this is likely "a bump in the road." Always a nice thing to hear!

Thursday, November 13, 2014

Cancer Update!

OK, so this is a way for me to keep everyone up to date on the latest cancer news. Please feel free to comment (I get notifications), but if you'd rather text, call, send a carrier pigeon, whatever, that's fine too. My apologies to those of you who know some/all of this info...skip whatever you already know!

Where things stand right now: I am done with surgery and will be starting chemotherapy the second week of December. My lumpectomy was a success, they biopsied three lymph nodes, which were all negative for cancer cells, and radiation will come later on. Many of you know I was on the fence about chemo, but in light of my latest test results I feel it's safest to just do it.

What changed? Well, my Oncotype score was "intermediate" risk for recurrence, but very close to the "low" risk part of the scale. Needless to say, it was inconclusive. So my oncologist ordered a MammaPrint test, which is a more comprehensive test of genes from the tumor tissue. That test only has "high" and "low" risk of recurrence. My results were high-risk, but just on the line between low and high. Literally. On the line.
My surgeon's response: "You've gotta be kidding me."

Unfortunately these results are rather inconclusive too. However, if that high-risk categorization is accurate (and the testing company itself says it's got >10%  chance of being wrong), then I would benefit notably from chemotherapy. Basically chemo will substantially help prevent cancer cells from recurring in another organ. Of course, the cancer could still pop up in another organ even with chemo, but the treatment will lower that risk in a numerically significant way.

So, I'm going to suck it up and do a chemo regimen for three months. I'm concerned that if it recurred in my liver, kidneys, what have you, in a few years and I hadn't done chemo now, I wouldn't be able to live with myself. I feel I need to do everything I can to beat this NOW and ensure my best chances for long-term survival. If it does come back in a different organ in a few years, at least I'll know that I did all I could. I'll get four infusions of two chemo drugs (cytoxan and taxotere for those of you keeping score at home), on a three-week cycle. This is set to begin 12/8, with the last one around mid-February.

Once I've had a few weeks to recover from that, I'll start radiation. What is the point of that, you ask? Radiation is to kill any latent cancer cells in the breast tissue itself. Since I didn't have a mastectomy we need to blast the shit out of the breast with radiation. That will be about two months but less intense side effects than chemo (i.e., a bad sunburn and fatigue). In total, this crap is going to be about six months.

On the bright side! Bryce and I are taking a much-needed, much-deserved vacation to the Dominican Republic to celebrate our 10-year wedding anniversary! We'll be spending five days at an all-inclusive resort where Umphrey's McGee is playing a music festival exclusively for resort guests. We've been planning this for months and are so relieved that the cancer didn't ruin the trip (it seemed that it would at a couple points). Then I have my first chemo infusion less than 12 hours after we're back.

You may wonder how I'm handling things, and that answer changes hour to hour. I feel satisfied with my choice to have a lumpectomy and radiation (the survival rate for women choosing that option is exactly the same as it is for women who choose a mastectomy). If a breast tumor comes back, mastectomy is still a tool in the toolbox. I am at peace with the decision to do chemotherapy. I'm terrified, angry, saddened, and all those other things that come with a cancer diagnosis. I'm grateful I have amazing doctors and a good prognosis. I'm relieved I have quality health insurance. I am paranoid it will come back. I am human.

What's next? We're meeting with another oncologist on Monday to get a second opinion. I doubt he's going to say much of anything different, given the latest test results, but he's a breast cancer specialist and I'm looking forward to getting confirmation that I'm taking the right path, or to hear of some amazing new study that could brighten my outlook. I'll post again with an update from that meeting...stay tuned!

Monday, October 20, 2014

Fall Clean-up: The Annual Debate

I am of the gardening school of thought that advocates leaving spent perennial foliage through the winter and cutting it back in the early spring. There are number of reasons for this—providing food and shelter for birds and other wildlife, maintaining some color in the garden once flowers are done blooming, having a landing place for snowflakes as well as brown matter to contrast with those snowflakes, in the hope of achieving that elusive "winter interest" in the garden, etc.

Joe-Pye weed (Eupatorium maculatum) seedheads stand 6' tall...when dusted in snow they exemplify "winter interest"
Personally, I have rarely seen birds eating the seeds of my spent plants, although in late summer the goldfinches were feasting on purple hyssop seeds. But I also get the sense that old foliage protects plants through the winter, maybe helping to prevent frost heave and shielding the plant from freeze/thaw cycles. I don't know, it's just a hunch.
'Purple Emperor' sedums with prairie dropseed (Sporobolus heterolepis) photobombing

However, all those good reasons/intentions do not supersede the reality of dealing with straight-up ugliness in my garden. Essentially, if spent foliage just looks awful, I'm getting rid of it in the fall. Yes, it will all look awful by February, but if it's sad and dilapidated in October there's no chance I want to keep looking at it as it gets soaked, frozen, and increasingly beat down by winter.
Purple hyssop (Agastache foeniculum) with vine-whose-name-I-can't-remember look good in fall and so get to stay

So today I cut back some barren sticks that used to be purple hyssop (I think the finches were done with them, guessing by the looks of them), some flopping stems of brown-eyed susans, and nameless hostas. 'Halcyon', 'Touch of Class' and 'June' all look good, or at least they're on the spectrum between not terrible and still got it. The nameless ones were riddled with holes and yellowing, but not in a good-festive-fallish way. They were feeding nothing but any slugs still lurking around.

'Halcyon' still hanging in there

Am I prioritizing good looks over ecological utility? Maybe so, but overall there are still plenty of food sources, shelter materials, root protectors, etc., still left in my garden. Plus, is it really a bad think to cut back monarda and peony foliage swamped with powdery mildew? Doubtful. Mildew will always be in the soil here, but letting more knowingly incubate under the fall blanket of leaves seems unwise. It's a debate each year about what stays and what goes!
Zizia aurea (left) and Coreopsis tripteris (right)

Wednesday, October 15, 2014

Garden Blogger's Bloom Day—October 2014

Forgive me garden, for I have sinned. It has been two years since my last blog post.

Garden Blogger's Bloom Day seemed like an auspicious day to get back to it, so here I am! Although admittedly there isn't much still in bloom. However...

Aster shortii
These short's asters are making a hesitant comeback after being voraciously mowed down by rabbits (and likely other animals) during a drought a few years ago. I'm not sure what made them so appealing, but their wholesale destruction at the time led me to believe they were done for. But, like so many garden surprises, a few seeds or runners must have survived because they've been shyly appearing the last two years. Much smaller than before, they hide amongst the spent plants and the fence in this prairie border as if to say, "Are the rabbits gone yet?" (Spoiler: they're not gone, they've multiplied but seem to have plenty of other food sources.)

I'm relieved and happy to have these late-season blooms with their cool blue-violet color back. With all the rain we've had the last two years, it's hard to imagine a time when conditions were so dry that animals needed to devour any and all stems and leaves that might be holding moisture.

Solidago ulmifolia
 A few elm-leaved goldenrods are still blooming. I'm a huge fan of these plants because they flower profusely in dry shade, but I would have to warn you that they are aggressive, bordering on invasive. For me that's no problem because the dry clay in shade kills almost everything I try to grow, or at least causes it to grow weakly, so if a plant can colonize in those conditions, be my guest!
Every one of those little yellow florets becomes a puffball of seeds

And indeed, they've spread to become the major feature in the dry shady section of my front border. For those who would prefer to check their spread, deadhead the plumes as they go to seed. I'm pretty sure the prodigious seeds production is what allows these plants to spread so extensively.

Ruellia humilis
Speaking of seedheads, check out these wild petunias that have gone to seed! No they're not a bloom technically, but I had never seen these go to seed before and it's delightful, reminiscent of another low-growing prairie favorite of mine, Prairie Smoke (Geum triflorum).

And for good measure, here's some colorful foliage of Solomon's seal:
Polygonatum oderatum

While also not a bloom, these beautiful yellowing leaves capture where the garden is at right now, in mid-October. Happy Bloom Day!

Saturday, October 13, 2012

When Will I Learn?

Every fall I say never again, and a year later I'm right back in the same place. Every spring I swear I won't put myself through the heartbreak, and seven months later I've convinced myself it will never happen again. I'm talking about spring bulbs, notably tulips, which I've fallen hopelessly and stupidly in love with over the last few years.

But planting bulbs six inches down in rocky clay is absolute hell. Or, more accurately, digging to plant those bulbs is hell. And while the flowers thrive admirably in the terrible soil (part of why I keep putting myself through the misery), they are all too often cut down just as they're about to burst into bloom, thanks to the abundance of rabbits and other rodents around here.

And then there's the forced bulbs. Potted hyacinths are intoxicating, in both form and fragrance. Beloved tulips, the finicky Triumph varieties that are drool-inducing in catalogs but really just high-effort annuals in the garden, are ideal for potting and forcing, which is by its nature a one-time deal, an excuse for palette-defying colors and experimentation that is only justifiable in the depths of winter.

But the fungus gnats! Every year they grow in intensity! I have no choice but to let the pots overwinter in the musty garage...there is no greenhouse, cold frame, basement, or cool closet where they could possibly go. And in that same vein of helplessness, I cannot banish the fungus gnats from the garage, even when I leave the potted bulbs almost completely dry throughout the winter, as I did last year.

So what is to be done? Well, in terms of the potted bulbs, it's to re-focus and go small. I potted only five 'Brown Sugar' and five 'Gavota' tulips and am taking a year off from hyacinths (having to throw them in the compost after the house became infested was so painful anyway that a break is good to heal that wound).

I developed the above contraption so that the pots can dry out on the patio, not in the garage where the fungus infestation would surely begin. And the wire mesh (held down unattractively but effectively by a hose and doormat) will hopefully keep out the rodent life until the soil dries up. At that point, the plan is to move the pots to the garage so they don't get destroyed by the cold temperatures, spray the top of the soil with chamomile tea (recommended by many gardeners for keeping fungus gnats at bay), and then displaying these pots outdoors in April, so even if they are infested with the damn gnats, the chilly spring air can take care of it.

As for toiling in the clay, I did it again but on a smaller scale than the last three years. I planted only 10 more 'Dordogne' and 10 'Cum Laude'. The former are so beautiful that I couldn't resist adding more, and the latter are a seductive purple that will offset the yellow-pinkish-ness of the 'Dordognes' at the end of the tulip season. It was hard work, but I've accepted the risks involved and plan to arm myself with hideous-smelling Liquid Fence again and hope for the best. I guess it's that "try again next year" attitude that is inherent to gardeners!

Wednesday, June 13, 2012

Not Cool

So far it's been a rather dismal year for cool-season edibles. We went from winter straight to mid-80s summer conditions (which was tough on my seedlings), back to rain and cold (which they survived, but it inhibited their growth), back again to hot, humid summer.
 Most of my lettuce seedlings fizzled, and the broccolis aren't going anywhere. I did get a couple small heads of Tom Thumb butterhead and a few Rough D'Hiver romaines may make it. But most will bolt or wilt before reaching full size. What's worse, my cilantros are stunted by all the heat and may be too small to bolt into the pretty white umbels that give them their second life in the garden.

On the bright side, I'm hoping for a banner year for heat-loving vegetables, like tomatoes, chili peppers, and squash. How have your cool-season veggies done?

Friday, May 18, 2012

Belated Bloom Day

Traveling caused me to miss the official Garden Blogger's Bloom Day for May, hosted by Carol at May Dreams Gardens. But like gardeners all across America, I am enjoying the explosion of spring blooms! Without further ado...
My spring stalwarts, native columbines, are blooming... are golden alexanders (Zizia aurea)
And fellow carrot-family member, Taenidia integerrima. See how similar they look with their yellow umbels? The latter likes shade and can tolerate dryness, however, while the former likes moist sun.
Some prairie smoke (Geum triflorum) is still in its "flower" stage, prior to forming the "smoky" seedhead.
Salvias are starting to bloom too...
...but best of all is saved for last! Proving the old adage about good things and those who wait, after three long years my 'Twilite' Prairieblues baptisias are blooming!
Ahhh, worth the wait! Also blooming: Peonies; Heucheras; Chives; Camassia (mostly finished)

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