Spring approaches.

The other day, I noticed that something had dragged one of the pillows off the chairs in the front yard and ripped it wide open. But before I could collect it to throw it away, I saw a squirrel pulling a mouthful of foam from it and dashing off up a tree. Aww - getting a nest ready for a spring crop of baby squirrels! So guess who is leaving the pillow right where it is for now?

There are other signs of spring. My trusty hellebores have been blooming since mid-winter, but are absolutely full of flowers right now.

I've got crocuses up all over, looking very cheery.

And beautiful little dwarf irises, also in the front yard. All that rain has helped them.

But enough is enough. Our region has gotten so much water that the ground is saturated and many areas are flooded. The home of our friends on the street got three feet of water in the basement and their sump pump gave up the ghost in response. It was the rainiest February in this state since 1883.

[Note: Not my photo. This was on the local news channel's website.]
This is a street off the main thoroughfare in my part of town. My husband was going to the grocery store at the time and as he was headed out I warned him not to take that side street because it floods when it rains hard. I was right. Apparently one of our firetrucks went in to rescue a trapped person, and the edge of the road collapsed under the weight of the truck, tipping it over.

There is a four-foot chainlink fence separating these two yards in our neighborhood, and you can see that part of it is completely submerged. You could swim over it if you wanted to.

There were similar scenes on the drive into work, with one neighborhood submerged up above the houses' foundations.  I tried to drive in a little ways to explore, but soon ran out of dry road.

When we went to Aruba right before my mastectomy, we made a vow that we'd return to the ocean when my active treatment was over. Now that my incision from my port removal is closed up, it's time. A bigger trip will have to wait, but we're headed out now for a few days in the Florida Keys. Navy brat that I am, I believe the ocean air to be healing. So I'm leaving our soggy town behind for a bit and going to soak in the sun and the salt breeze instead.

Local Music.

One of the things that most makes me feel like life is gradually returning to normal is getting out to listen to music. Last weekend it was a free event at the Cancer Support Community. Bonus - I wasn't the only one there recently out of chemo. This was jazz by Frog and Toad, and there was also a pretty good brunch spread provided for us.

I texted my older son this photo since he'd played saxophone in high school and community band. My son told me they have to close the entire brass instrument factory for a month or more to create a contrabass saxophone because it takes all the workers to build one, and that they cost $30,000 to $100,00 new. This one is a bass sax (third to deepest), from 1914. The saxophonist also played a baritone sax, and a small silver soprano sax from 1924.

This weekend, we went to the 50th Jubilee Festival at the theater/former church where we got married. Note that the tapestry says both "AMEN" and "AWOMEN." There were seven bands in the line-up, plus warm-up music by a group of harp singers.

The musicians were all from this area, and the focus was on Appalachian music. The Lonetones I've seen at a number of places - we tend to show up at the same hippie crowd events. The man in the group used to do children's shows and I took my boys to see him at this very theater when they were little.

David Lovett and Dale Stansberry and a guitarist who wasn't listed played music that wasn't far off what we heard in pubs in Ireland. They made me want a whiskey.

By this point, there were some overeager cloggers immediately behind us, so we moved up to the front row so we could hear better.

John Alvis and friends are basically the house band for the Museum of Appalachia. This is what I have in mind when I think of mountain music.

I sent my older son a photo of this couple and he responded, "Ha ha! They look like that Rucker couple who perform together!" I texted back, "They ARE that Rucker couple who perform together." Turns out they are the parents of his freshman year college roommate. So I went to introduce myself after their set.

We saw the Tennessee Stifflegs (named for the goats also referred to as fainting goats) at a high grav brewery downtown a couple of years ago and really enjoyed them. They call their music style Western Swing. The fiddler/singer is a second generation performer at the Jubilee.

The last group included a mandolin player who has performed at every single one of the 50 Jubilees! We left at 11pm, and although I was tired, I was doing okay. We decided we definitely want to do this sort of thing more often.

My bitter pill to swallow.

Note: So, I talked with my breast surgeon about the bruising on my tongue. She said she'd watched the anesthesiologist, who had some trouble getting the breathing tube seated properly, and he'd used his finger under my tongue to maneuver my jaw into place. Hence the bruises. Mystery solved. Now, back to our regularly scheduled programming...

With hormone receptor positive breast cancers, cancer growth is driven, at least in part, by the presence of estrogen. Any long-term treatment, then, virtually always includes endocrine therapy. At this point, there are two classes. One is the old standby, tamoxifen, a selective estrogen receptor modulator. It acts by mimicking estrogen and taking up the estrogen receptors in cancer cells. Sort of like getting dummy keys made for all your locks and then sticking them into the keyholes so that you can't use the real keys. A new drug, more often prescribed these days for post-menopausal women, is a class of drugs called aromatase inhibitors (AIs). These work by preventing the conversion of androgen to estrogen in various sites in the body (like the adrenal glands). But the choice is not as clear-cut as it might sound. AIs have a couple of ugly side effects, including joint paint and acceleration of bone loss. I already have osteopenia and I was not keen on worsening that or on risking jaw bone necrosis with a bone-building bisphosphenate. On the other hand, tamoxifen also carries risks, most notably blood clots and endometrial and uterine cancers. But I had already forfeited my uterus to cervical cancer and as a thin nonsmoker, my clotting risk is minimal. After a discussion with my medical oncologist, we decided to go with tamoxifen. He didn't like the bone loss risk for me and felt an AI offered only a very minimal advantage otherwise.  I asked if the plan was to switch to an AI at some point,  but the oncologist said he wanted me on tamoxifen for ten years and then we could talk about what next. Ten years! If I'm here in a decade to talk about what next, I'll be thankful.

Still, after much research, I started taking a baby aspirin daily with my tamoxifen, both to decrease the clotting risk and because there is some early evidence, per the NIH, that aspirin may lower the risk of metastases for a variety of possible reasons - because it acts as a weak aromatase inhibitor, it may interfere with stem cell formation, it has an anti-inflammatory effect, or maybe something else entirely. Whatever the reason for the finding, it seemed prudent to me to start taking aspirin. And melatonin, which NIH studies have shown to reduce the risk of cancer becoming tamoxifen-resistant. I've been taking tamoxifen for about ten weeks now, with no serious side effects that I can discern. Except mild wooziness. I feel constantly like I've very slightly drunk.

At my first post-chemo oncology visit last Friday, I had my port accessed for the last time. I asked my oncologist to add a cholesterol check while he was at it. One positive side effect is that tamoxifen cal actually lower cholesterol, an average of 13% in some studies. Mine had been steadily creeping up, and was 218 a year ago. My PCP said all my other risk factors were low so he didn't want to prescribe a statin for me. Yet. I was hoping for a decrease, but was shocked to get my labs back. 166! That's almost a 25% decrease! I told my breast surgeon when I saw her and she high-fived me.  The decrease was so impressive that I can't help but think it's a combination of the tamoxifen and my mostly plant-based diet since chemo ended. For instance, every single day I eat a bowl of oatmeal with dried fruit, nuts, cinnamon, and flax seed. I make up a dozen packets and keep them at work, then bring the bags home to refill.

In a comment, Sabine recommended a two-soup combo made with carrots and Brussels sprouts. I'm constitutionally incapable of sticking to a recipe even when there are measurements given, but I went a little nuts with this one. I thought about it and said to myself, "Ooh, you know what other color would be pretty?" Beets it was. I made each soup with a little white wine, vegetable broth, and yogurt, with a patch of yogurt added at the end. It was almost two pretty to stir it all together. But so good. We had a lettuce, red cabbage, dates, and almonds salad with it. And some whole wheat sourdough bread. I have to say, I was a little disappointed when I saw my PCP this morning that he wasn't more impressed with my results. But I am.

More from the Cancerland Diaries.

Surgery 5 is now behind me. My last three surgeries were at the day surgery center rather than in the main hospital building. I was a little thrown to find out a couple of days ago I'd be back at the main hospital because they last time I was there I had very painful nuclear medicine injections and then was in surgery for 7 hours. I just didn't want to go back there. But this whole journey has been filled with steps I didn't want to take, so I arrived at registration a little before 6 am yesterday, as instructed. Fortunately, everyone was (as they have been through all of this) very kind. I asked the nurse in pre-op for a numbing shot in my hand before my IV and she said it had already been ordered. Once that was done, I relaxed - the worst part for me was over.

The hospital blankets have gone high tech - they have these weird inflatable space blankets instead of the warmed cotton blankets. No like. For one thing, the range between settings was pretty big, so I had to toggle between too warm and too cold. I had a little bit of a wait before surgery, so I curled up and slept for a bit while my husband snoozed n the chair next to me.

I went to see my breast surgeon give a talk last week about advances in breast cancer treatment. She teared up as she talked about her passion for working with breast cancer patients and again when she talked about her role in getting a clinical trial going in partnership with MD Anderson and Memorial Sloan Kettering, bringing top tier research to East Tennessee. After the talk I stopped to say hello and she hugged me and told me I looked great. She's incredibly skilled, which is obviously important, but also huge-hearted. So when she ambled in yesterday morning, putting her mug of coffee on the table saying, "brain fuel," and said it was good to see me at the talk, I felt immediately at ease. She explained the removal surgery including something I didn't know - that a tube of scar tissue forms around the catheter feeding into my jugular vein and that she would have to stitch it shut to keep it from being a tube blood could flow through. I've gotten used to surgeons scribbling on me with a marker in pre-op, but this time my surgeon initialed and dated where she marked the incision site. My older son said I should get it tattooed. As much as I love my breast surgeon, I'm settling for this photo to remember.

Yesterday evening, we went out for sushi and edamame to celebrate. We did the same thing the evening of my port placement surgery, so it seemed fitting. The numbing injections were starting to wear off and I was hurting. I was ready by the end of the meal to get some sleep. Except that when I went to brush my teeth, I saw that I had dark bruises on the edges and underside of my tongue. Because I'm the queen of weird surgery side effects. Naturally, I stayed up late googling "tongue bruises" and "lymphoma symptoms." It's difficult with cancer not to immediately fear that any symptom is a very bad sign. But I sent my surgeon a message and I'm going in to work this afternoon - aching former port site, purple tongue, and all.

Yeah, that whole Polar Vortex thing...

But this is the South. So what it meant for us was a few days of very chilly weather and even snow flurries one day. Naturally, the schools closed for two days because of it.

After some freezing days, however, the warmth returned and on Friday we drove up to a wildlife management area, on my younger son's recommendation, to see the re-introduced elk herd. The hike was up a partially-graveled road. We missed the shortcut, because the sign was a little less than helpful.

Fortunately, the herd was grazing close to the observation area, so no problem finding them. I tried to count - I think there were about 70 elk.

The landscape is a little barren this time of year, but they did have a watering hole.

There were a few bulls in the herd. Seems like it would be awkward to have heavy antlers on your head.

We stayed for a while, just watching them graze, then hiked back to our car.

Yesterday we drove to a bird sanctuary for another hike. This one wound down by the river. I didn't get a photo of it, but we did see a beaver swimming by.

The sanctuary used to be a farm. We stopped to look through the old farm house and take a breather on the porch. Incidentally, I'm not covering my head even at work any more. Just doesn't seem necessary.

Today was warmer still and we headed over to a nearby park for another long walk. By the end it was so warm, in fact, that I was down to a t-shirt. And then I came home and did some yard work! I know we've got lots of winter ahead, but I am enjoying the little warm spell while it's here.