I am getting a new MediPort today, on the left side of my chest, because my previous port was on the right side, before it was removed last month during my blood infection.

I actually prefer my PICC line but I am hoping that I won’t need daily hydration IVs. The port will leave a bump in my chest, and if I could not have the needle access all the time, it would be less bulky and painful. I could maybe even have somewhat of a normal summer if my symptoms stay away. I keep campaigning to end the IV fluids.

Right after a pep talk I gave myself yesterday to embark on a new life, I promptly fell down the stairs while wrestling with some bags. (I have been staying away from my apartment for most of his packing.) It happened in extreme slow motion, so I miraculously didn’t break anything. I ended up with scraped up legs and knees and a twisted ankle as I sat dazed on the steps that smell of urine. (It’s urine season.) I hope they can fix my ankle while I am out for this procedure.

On a more serious note, I feel really bad when I have to come in for procedures. I feel so abandoned and alone, even though he wasn’t always here. I cry the whole time the nurses ask me questions. It’s so silly. It will get better. There is something so lonely about having this stuff done now.

I am looking forward to hopefully a summer of more normalcy and fewer infections. In the meantime, I am going to watch this in depth discussion of Gigi Hadid and Zayne and the Lee family and ponder how you get a gig commenting on celebrity gossip.

On Monday, I had a Mediport put in. I was supposed to get one about four years ago, when I was doing Brentuximab after the ABVD chemo didn’t get rid of all the Hodgkin’s lymphoma, but I thought I’d have only a few more months of chemo at the time. Now that it looks as if I’m going to be getting chemo and intravenous fluids indefinitely, I need something a little more permanent than a PICC line. This should make things easier. My veins are pretty beat up. Whenever I need an IV these days, it ends up being a small needle in my hand.

The port placement was an outpatient procedure, and I rested the remainder of the day. Since they didn’t really think about how I use my PICC line every day for fluids, they left the PICC line in too. I’ll probably get that out next week, when I go in for chemo. I’ll need to learn how to do an IV through my port.

No lifting more than 10 pounds for five days. After that, I am supposed to be able to resume normal activities, though I can’t play contact sports probably ever again. Since the last time I played contact sports of any time were miserable days of gym class in 9th grade, I can probably live with this. I do miss working out, but with my energy levels and sickness, that might be a long way off, if ever.

It’s been a disappointing several weeks, with the tumor-related side effects coming back with a vengeance after my first chemo treatment. I’m now giving myself three shots of short-acting octreotide (Sandostatin) every day, in addition to the long-acting shots that I get every month. After some desperate Googling, I had hoped one drug might work for the side effects, but it turns out that my tumors make VIPoma, not seratonin of carcinoid syndrome, so that treatment wouldn’t work. VIPoma is rare, and happens in 1 in 10 million cases per year.

I read that and bought a lottery ticket. I didn’t win.

The tincture of opium isn’t approved by my health insurance, but I’m not sure that it would help anyway. No one has officially said this, but it seems like the options are running out. The octreotide was the first step, and the doctors really thought the radiation would work. Now that the chemo isn’t working, I think things are looking grim. It’s a rare cancer without a lot of treatment options—and I’ve already done the surgery, ablation and radiation. Though the only tumors showing up on the scan are in the pancreas, they are inoperable, but the thought is that there is microscopic disease that is also producing VIPoma, which is making me so sick.

My last hope is PRRT (Peptide Receptor Radionuclide Therapy), which goes by Lutathera and was just approved by the FDA in January. Radiopeptides are delivered to the NET cells, which are hopefully killed and shrink the tumors. Both Mount Sinai and Memorial Sloan-Kettering are supposed to have this treatment available in April. I’m hoping my health insurance covers this, because it would be only four treatments as opposed to the Dacarbazine, which I would get every three months forever. Also, I think the Dacarbazine is what is worsening my symptoms, and this reminds me of last year, when the chemo would make me sick for a week and ultimately did nothing to stop the growth of the tumors. From what I’ve read, Lutathera could stop or shrink the tumors and buy me a few more years, but mainly I’m concerned about quality of life. I’m a little concerned since the octreotide hasn’t worked very well, that the Lutathera won’t work.

If the Lutathera doesn’t work, then…well, I think that’s it. The effects of the VIPoma haven’t been able to be controlled. I still do daily IV fluids for three to four hours and take a lot of supplements and give myself those three shots a day, but eventually, the dehydration and electrolyte imbalance take a toll on your heart. Sometimes you more or less starve to death or your liver fails or you might have some kind of attack.

I’m OK with letting go. I’m tired of the IVs and the procedures and the shots and wearing diapers and the feeling that something is always hurting all the time. As Leonard Cohen said, “I am ready to die. I hope it’s not too uncomfortable.” I’m aware it’s only been five years, and people live through many more challenges than this. Maybe I’m just tired.

Even though it was tough, I find myself looking back fondly on my recoveries after the stem cell transplant and after the Whipple procedure and after last year’s liver ablation. I think it’s because I had hope. I wonder if I’ll look back at this time with nostalgia, as a time when I hoped that this one thing would buy me some more quality time.

I couldn’t sleep. I started this blog around 5:30 am, when I finally realized I wan’t going to be able to go back to bed. One of the strange side effects of the peripheral neuropathy is that sometimes I feel buzzy and kind of manic in the middle of the night. I actually haven’t been taking Gabapentin for weeks, but tonight, my feet, ankles and calves started cramping up, so I took it again. It’s been a long, kind of strange day. I started chemo again and have been reunited with my old companion Dacarbazine, the D in the ABVD treatment for my Hodgkin’s lymphoma about five years ago.

I headed to see the doctor at Sloan-Kettering today, hoping there was a plan B in place. The radiation only slowed down the side effects of the tumors (namely, the diarrhea), but it’s still pretty bad. I’m on potassium, sodium bicarbonate, phosphorus and magnesium, as well as the daily saline bags, just to keep me stable and out of the hospital. Plus I take atropine and imodium to try to slow things down. In the hospital, I took tincture of opium but my insurance company didn’t approve it for outpatient use. If it sounds like something you’d see an ad for in a Victorian newspaper, laudanum was a tincture of opium; if you’ve read The Alienist, it should also sound familiar. It was used by poets and writers Elizabeth Barrett Browning, Charles Dickens, Bram Stoker and Thomas Coleridge. Laudanum is not the same drug that I received, and that’s probably why I produced no brilliant poetry or literature while in the hospital, only a few blogs and some drool as I fell asleep for about a day after the first dose. After that, I received a half-dose, some bitter drops from a bottle that were placed in a syringe.

As I suspected, the radiation worked a little bit, but it’s not what we all hoped for. Scans show only the tumors in my pancreas and lymph nodes, but the oncologist thinks that there is microscopic disease and that small undetectable tumors are also producing the VIP hormone that is making me so sick. I got an increased dose of subcutaneous injections of octreotide, which is also supposed to fight off the renegade hormone, so I’m a little sore.

So it’s time for Plan B, which is Dacarbazine, every three weeks, probably forever. I looked it up on my older blogs and realized it was my least favorite chemo drug. There’s another drug that just got approved by the FDA, but then the hospital has to approve it and the insurance companies also have to agree to pay for it, as it has a $50,000 per treatment price tag. But that drug is something I would receive only four times and then be done, so I’m hoping it’s something that insurance approves and that I can afford. I’m not hopeful as the insurance company does not want to pay for the last day in the hospital, because they deemed it unnecessary. The hospital was trying to prepare me for life on the outside, where I wouldn’t have a steady drip of fluids and drugs, and where nurses don’t check my vitals and blood several times a day and feed me cups of medicine on a regular basis. I was feeling a little better, but not great. I actually would have been OK staying through Friday to finish my radiation, but I knew the meter was running on my hospital stay. I still had to poop in a bucket until I left. I would like to send the insurance company a full bucket to show my displeasure, so hopefully we can straighten it out.

(An aside: I picture someone at the insurance company looking through my bills, stroking his horns. He leans into his computer screen, smiling, typing a few notes and checking a box. Then he sits back in his chair, wrapping his pointy tail around the base of his desk chair, a habit he developed as a display of satisfaction when he found something the company could argue wasn’t necessary. He picks up his pitchfork, which he uses to eat lunch, and heads to the cafeteria to eat from a warm/cold buffet with offerings like candy stolen from babies, heapings of human despair of the sick, and the fruits and vegetables no longer in the SNAP plan with “harvest boxes”.)

Yesterday, I stayed at the MSKCC outpost for the rest of the day, got my octreotide shots and then zipped upstairs for a bone density test because I have osteopenia, a long-term side effect from my lymphoma treatments. I’m oddly not worried about those results as it seems my long-term is becoming much shorter. Then I went to one of the chemo stations. I got a little bag of some type of steroid to ward off nausea, since Dacarbazine causes nausea for a few days. I suddenly felt an itchiness that spread from my legs to my back and asked the nurse about it. She said it would last only for a few minutes. It’s usually in a more diluted form but a hospital supplier was affected by the hurricane in Puerto Rice, so this one is what’s available. It was fine, but a little weird. (I also have to take Dexamethasone for two days afterward, as well as Zofran, for nausea.) Then I received my Dacarbazine, which take a little over a half-hour, and potassium, because I was a little low at 3.1 instead of last week’s 3.7. It was diluted in a bag of saline, but with my PICC line, it’s much easier to do the chemo and the potassium, both of which sting and ache through an IV.

That brings me to my next bit of news: I’m finally getting a Mediport implant. About four years ago, when I was on a Brentuximab trial, I was scheduled to get one but I changed my mind, since I had only about six to nine treatments left. Since then, I’ve thought that maybe I should have gotten a port. One of the nurses at one of my most recent hospital stays (before the PICC placement) asked about my chemo history as she searched for a vein for an IV, and I rattled off: six months of ABVD, three months of Brentuximab, two rounds of ICE, and a stem cell transplant (though by then, I had a leukapheresis catheter in my chest). “It looks like it,” the nurse responded. Getting a Mediport seemed like admitting defeat before, but now I think I will need it for the rest of my life, and it will make things so much easier. It’s a permanent marker of sickness. The big Whipple scar running down my abdomen doesn’t bother me so much, nor do the 10 radiation tattoos. (In fact, I love saying that I have 11 tattoos. Only one is “real,” a small Libra symbol on my upper shoulder that a friend got for me as a present when we were 20. After these latest tattoos, someone told me, “You’re like Tommy Lee now.”) But the port for me will likely be as forever as my tattoos. I am scheduled to get it not next Monday, but the following Monday.

I was hopeful the Dacarbazine would work, but I’ve gone from declining to taking a considerable turn for the worse. I’m back to wearing night diapers, and my neuropathy is back with a vengeance. This evening, I became snuffly and my throat started hurting, along with my lower back. I was worried to take my temperature, because a fever would send me to the MSKCC Urgent Care, but I thankfully have no fever. My cheeks were flushed when I went to bed, so I’m thinking it was chemo side effects. For now, after talking to one of the oncology nurses, we’re going to keep an eye on things and see how I feel.

I’m getting really discouraged that nothing seems to be working. At first, the doctors said I could have years or even decades. Steve Jobs had eight years. I know I’ve had the tumors for at least five years, and I’ve known they have been active for two. When I found out in July that I was always going to have cancer and that it would be treated as a chronic disease, I thought I still had some quality time left, and I’m surprised that I declined so quickly. I can’t continue living like this, and I’m a little worried it’s going to be downhill from here. This life of saline and diapers could be as good as it gets. When I was in the hospital, it felt like it was the beginning of the end. I was coming to terms with big life things I wouldn’t accomplish, but now I’ve had to cancel some short-term plans.

If all my fluid and electrolyte loss doesn’t get under control soon, then I’m going to have to give myself daily octreotide shots. The focus is trying to keep me out of the hospital.

I can’t be out for too long. I haven’t been able to work out or go to my beloved metal and goth cycling classes or in-office building yoga. I haven’t had any alcohol or caffeine since New Year’s Eve. (That’s why I’m against dry Januarys and cleanses. As someone who has not been able to eat for weeks or drink for long periods of time, I say you should eat, drink and be merry while you can. Then again, I’ve always been a hedonist, so I’ve always eaten the cake or whatever memes tell you to do to indulge in small pleasures during your short life.) But I’m trying to focus on what I can do and not what I can’t. I can have friends over and do some low-key things. I caught up on some TV. I have spent a lot of time with the cats. There lots of good things, but I’m not sure what the future holds. I found out I had cancer five years ago on February 18, and sometimes I’m just tired.

That’s a sad note to end on, so enjoy these photos of cats I’ve taken during my post-hospital life.

 

Cat with her paw on someone's hand

Lulu held my hand.

Cuddling cats

All cats love Lux.

A cat on a a table with roses and wine.

Handsome Ziggy on Valentine’s Day.

Three sleeping cats on someone's legs.

I was trapped under a pile of cats.

A cat in a u-pet carrier with stickers on it.

Lulu inside the space-age u-pet carrrier.

A cat wearing a tie behind a laptop

Ziggy wears a tie to help me with work.

My doctor’s advice to take it easy has really been stressing me out. That’s not a good sign. In fact, I didn’t even think to ask if she meant physically or mentally because I was already planning to ignore her advice and wondering how I could make my boyfriend un-hear what my oncologist had just said.

He comes with me to my appointments to make sure I don’t ignore my doctor’s advice.

I got the results of my PET scan today, and I had asked if there was anything I should be doing to get better. I should have known that it would be the one thing I feel I can’t do, but that I definitely should do.

The doctor showed me the PET scan, starting with the first, taken in April, that showed the lymphoma as black splotches. There were quite a few of them—the large mass in my chest and neck, and a bunch of dots through my upper chest, as well as one big spot near my belly. The later scan shows just two spots—the one that had pushed my ribs out in my chest and the belly spot. It’s good news—they’re still shrinking and I won’t be getting stronger treatment, just the remaining four (now three, as of yesterday) ABVD treatments.

But whereas the first PET scan after four treatments showed dramatic improvement, the scan after eight shows moderate improvement. It’s slowing down, while I am getting impatient. So there might be some cancer left after all this is done. Maybe.

Since that second optimistic scan in late May, I feel like my life has been falling apart, mostly with the stress of finding a new job and new insurance. I can’t relax. Since June, it feels like I’ve had a heavy leaden pot of worry in the center of my being, roiling with a big worry and stress stew. I understand my TV cancer companion Walter White more than ever. I want control. But I feel like I have very little right now—not over my body, my finances, my emotions. The latter I can do something about. I still need to work on my attitude.

I don’t cry over hair, no matter what. I’ve cried over test results my whole life. I’ve always beaten myself up about not doing my best. One day In kindergarten, the teacher gave out little awards for being able to recite your address. I knew my address. I was so excited when it was my turn. And then, when all those expectant faces were turned toward me, I blanked. This type of performance anxiety still haunts me today. We had another chance the next day and I got my award. In the end, everyone got one, of course. It was a round piece of orange posterboard that said “AWARD” with a gold star and ribbons that the teacher had stapled to the bottom. I was extremely disappointed in myself for having to use my second chance. I felt as if I didn’t deserve it.

It was the only award non-sporty me ever received until my high school decided to give out letters for academic achievements, and I lettered in academics. I sat near one of my friends who was a star swimmer and track athlete and was in my AP and honors classes. She was really nice, so I know she thought I was also against the academic letters when she said, “What am I going to put on the back of my jacket? Nerd?”

I was secretly kind of proud, but I obviously didn’t have a letter jacket. I wondered if it was too late to join a sports team so I could wear my academic letter. I don’t care about sports much, though, and who gets the ball to wherever it’s supposed to be. I’d rather work myself up into a frenzy about grades and what people may think of me professionally. I really do need a nerd letter jacket. I still have the letter somewhere. The little symbol, instead of a football or volleyball, is a torch. Presumably to fend off the cool people with letter jackets who want to give you wedgies and shove you into lockers.

And so now I have test results that disappoint me a little bit. Today was like getting a B or C when you expected an A. Or not getting a tiny paper award when you expected one.

Yet the remaining spot near my belly is also a glaring example of how useless my previous worrying has been. I knew there was a spot below my diaphragm that was considered cancerous—it’s what put me in the Stage 3 Hogdkin’s lymphoma category instead of 2. But until I saw the scan, I had no idea where it was, and I assumed that it was a smaller area, late to the cancer party that had been going on in my chest and neck. I didn’t realize it was one of the bigger infected nodes.

For the past months during treatment, I’ve had pain pangs in my abdomen that I’ve assigned various possible causes in my mind, from liver failure to intestinal distress. It’s the cancer, probably (hopefully) shrinking —a variation on the same twinges I feel in my upper chest from time to time.  I picture it going down like this. Maybe the black dot on my PET scan is my heavy cauldron of useless anxiety.

I’m struggling now more than ever. Everything just got real. Before this week, I could still kind of pretend like this wasn’t affecting me. I had hair. I had insurance, which runs out at the end of the month.

I didn’t realize my veins were in such sorry shape. I have a little bump on my left arm where part of a vein has hardened. There’s been talk of a Medi-Port, which typically stays in for a year and gives me the heebie-jeebies, though it looks a tiny version of Tony Stark’s Iron Man implant. My other option is the PICC line, which also gives me the heebie-jeebies, but stays in for less time.

Tons of people have had this done, so I need to admit to myself that if I need one, I need one, despite 100 percent chance of the heebie-jeebies. I need to stop trying so hard to stay “normal,” whatever that is. I don’t mind the baldness. I wear my wig only for other people, so I don’t freak them out. The same with the headcovers—that and to shield my head from the sun. (The pork pie hat, I just ordered, though—that’s for me.)

I’m hoping that since I have only three treatments left, my veins will hold out. The nurse yesterday, when she saw my tiny veins, told me she didn’t see how I got away with not having a port. My left arm just wasn’t accepting an IV, so we used my right again—for the third time in a row. When she was giving me the first round of drugs, though, she seemed more optimistic and said I probably have at least three good veins left. That’s all I need—for now!

I’m a little disappointed in my left arm for giving out on me. My left side, where this started and where the lymphoma remains. Side of my spare rib, my weaker eye and the ear that sticks out like the handle of a pitcher. A new study shows that there may not be such a thing as left-brained or right-brained thinking, so at least my creative and thoughtful right brain doesn’t have to forgive the left brain for those shortcomings. It turns out I’m just bad at math. I have a hard time distinguishing my right from my left anyway. I always make that “L” with my thumb and forefinger, no matter what—in the middle of yoga class, while giving directions to people who visibly look alarmed and doubtful (as they should be) when they see me do the hand “L.” Oh, well. It’s about body teamwork at this point, I suppose.

I also talked to a social worker yesterday, about what I would be eligible for now that my income has decreased. That helped—at first because I had to pull it together to talk to her. It’s the first time I cried while I was at chemotherapy. And it wasn’t even about bad news, just OK news. I really need to take a lesson from my veins and toughen up.

Plus, the social worker reminded me of some of the programs MSKCC has in place that I should take advantage of, including the Visible Ink writing program and the Look Good Feel Better program. I told her I’m not really into wigs, but she said there’s also makeup application tips. I haven’t been wearing much since my recurring eye infections, not that I wore that much makeup to begin with. But I think the social worker stressed the “feel better” part of the program, probably because I was still a little teary when she walked in. I put about as much effort into my beauty routine as ever—very little.

I prefer to spend my time working out—at first, in my early twenties, it was always to stay thin or lose weight. It wasn’t until later that I realized I worked out because I truly enjoyed it. It’s odd that after years of not caring about sports (and I still don’t), I’ve found what keeps me grounded is physical activity. It balances me out.

I’m eager to get back to my classes and yoga. Yet how many times have I heard that yoga isn’t just the poses? It gave me balance and sanity, and now that I’ve been told to take it easy, I’m going to have to practice less vigorously, but no less mindfully. But that’s another post completely. I’m eager to get back to working out, but this new “take it easy” advice probably doesn’t include kickboxing. And a Medi-port or PICC might limit my mobility for a bit.

I was beating myself up about something last week, and one of my former writers said, “Time to practice some self-compassion!” She’s right. I need to update my to-do list. It still will have jobs to apply for and deadlines to meet. But I’ve added three more reminders: Self-compassion, take it easy and stop worrying.