Here we go again!

It has been a little while since I wrote anything and much has happened in that relatively short amount of time.  I thought I should get an entry in the books as we have a plan in place moving forward towards a sea of uncertainty.
The first major decision to come out of this latest recurrence is that I will no longer continue my futile attempts at working full time (actually working at all).  That opens a huge door to the uncertain times ahead, but I felt like this time I needed to take that step.  This will give me the opportunity to spend more time at home with Bowen and A.J. as I continue to fight for more time in this world.  It should make for an interesting transition and I am not exactly sure how I am going to pull it off, but it feels like the right move for us right now.  There are a number of pieces that I need to fall in place in the coming months, so hopefully everything works out for the best.
Treatment-wise, I have started a chemotherapy cycle, this week will be infusion #3.  The first infusion was the big one and it was a couple of Thursdays ago.  It involved Erbitux, Docetaxel and Carboplatin...all drugs that I have had before.  This one hit me hard this time.  I spent the better part of a week in bed feeling like absolute crap.  I don't remember a time in my past chemo history where I reacted a badly as I did this time.  Luckily, after about a week, I began feeling slightly better and could stay out of bed for a good portion of the day.  Now I just get Erbitux every week and that doesn't knock me down like the big 3 did.  The Erbitux is an immunotherapy drug that stimulates my immune system to fight the tumor.  It's actually a monoclonal antibody derived from something found in mice, I believe.  The down side to this treatment is a rather nasty rash that covers my head, face, chest and back that is not pleasant.  It's somewhat itchy, somewhat painful and my skin seems to dry out rather severely along with the rash.  I am told that the severity of the rash usually indicates a positive result on the tumor, so hopefully this stuff is making my tumor shrink.  Overall, the goal is to limit growth of this tumor prior to surgery #5.
Surgery #5 is to happen on May 22nd.  This is another non-standard procedure that is somewhat of a hail-Mary attempt at getting this cancer out of my body.  There is nothing easy about it and there are lots of surgeons that will be involved.  It will not be a pleasant surgery and I try not to think about the details too much as it tends to up my level of apprehension about it substantially.  I will have another CT scan about a week before the surgery date and then talk one last time with everybody prior to the surgery.  I shall report on the 22nd and once again put my life in their capable hands.  I don't know the length of the hospital stay and we have no guarantees as to the outcome of this surgery, but all I am asking for is a chance...and a chance I have been given.  Strap in, I feel like it's going to be a bumpy ride but better times are ahead.

On the verge of something big

Here I sit, two full weeks after the fateful scan, still not knowing what the exact course of action will be, but eternally more hopeful than I was the day they told me it was back.  The PET scan AGAIN indicates that this is the only spot of note in my entire body.  This first image is from my PET scan and shows where the tumor is.  

The glowing yellowish area is the tumor and all the reddish hues are normal tissue and the white is bone.  My goodness, this little guy has proved elusive to get rid of!  Seems so simple, just cut it out and move on with your life.  Yet here we are, 4 major surgeries and and the 5th instance of cancerous growth.  The hope has yet to fade that I can actually rid myself of this disease and the wheels are slowly but surely turning in that direction.  

The past two weeks have seen me in Houston a lot seeing A LOT of doctors.  Last week I saw one doctor who is running some clinical trial, one of which my medical oncologist recommended me for.  The feeling coming out of that meeting was that the clinical trials are a last resort and we possibly have more options in my case.  Ok, that is a step in the right direction, but kind of a 180 from what I got the week before.  The next appointment was with a cardio-thoracic surgeon who would be involved if there were to be a surgical option.  He talked about the surgery and stated that it was not impossible, but what is the end goal that we are trying to achieve?  SOME LIFE, is what I am thinking.  I would take two years at this point versus the year that has been prognosticated at this point.  Give me a chance.  That is all I ask and that is what I tell these doctors.  I understand the risks, I understand the odds.  Give me a chance for survival and I will take it in a heartbeat.  I do not care how many surgeries, nor the extent of disfigurement that I must endure.  Give me a chance at life.  After seeing the surgeon, I met with my old radiation oncologist who I requested to see that morning and he happily obliged.  I wanted to get his opinion on everything and hear from him if radiation would possibly be an option.  He furthered our hope and asked me to come back this week to meek with his team of radiation oncologists at the main campus during their planning conference where they look at individual cases and make recommendations.  That was Tuesday and the result was that they would indeed radiate me again if there were no other viable options.  Great, another step in a positive direction...we have further options.  During this time, it became evident that I would need to stick around in Houston into Wednesday to have a biopsy performed on the chest mass in question.  That was done this morning and was not overly pleasant, but I made it through yet another fine needle biopsy.  If you want particulars, search the blog for biopsy and I think I have chronicled the procedure in the past.  It was while I was there that I got the most jarring news to date.  My radiation oncologist had called Jessica and didn't divulge much, but did say they were moving forward with a surgical option sooner rather than later.  My past treatments had involved a lengthy chemo waiting period prior to surgery to see how the tumor responds to that path.  It appears that they are indeed listening to my pleas to fight this things as aggressively as we can and want to perform this surgery as soon as possible.  I don't have the official word, but the schedulers have been calling trying to set things up for 2-3 weeks out.  Looks like we are on the fast track for surgery number 5.  

Things just got real people, and in the morning I will find out just how real they are.  That's all I have right now, but much more to follow when I finally get official word on the path forward.

...and it all comes crashing down (yet again)...

Man, I have felt good over the past three months.  I have been getting used to my new body modifications and learning the nuances of what it means to be a neck breather and electrolarynx talker.  The boys have been playing basketball and recently transitioned into baseball for the duration of the spring and all has been right with the world.  Well that all came to a screeching halt on Thursday morning about 8 am when my doctor walked in and said "It's in your bone."  I had prepared myself for a lot of things that morning, but to hear that the cancer has now spread into the bone of my sternum was NOT something that I was ready to hear.  I think both Jessica and I nearly passed out and there was a rush of activity as we tried to come to grips with what we just heard.  In my bone.  That is just so deflating, crushing, maddening, etc...to hear that I didn't know (and still really don't) what to do or think or say.  I have always held out hope that I could somehow beat this against all the insurmountable odds, but being told that it's in my bone just about popped any and all thoughts I had of my life extending beyond the next year or so.  Damn the bad luck.
So after the initial shock of the news, we settled back in to what needs to happen next.  There was to be a PET scan that afternoon to determine where else in my body it has spread (because it is in the bone, the felt it very likely to be in other places) and the results of the PET would help determine the next course of action.  I had the PET scan at 1 pm and went about my day.  We had a wonderful meal at our favorite German restaurant in Houston and prepared for the next day.  I guess I convinced myself that my best chance would be for it to still be localized in the area I have been dealing with and not to have spread elsewhere in my body.  Appointments yesterday were with my surgeon and the medical oncologist that I see at MD Anderson.  Once again, they only see the cancer in this one area, and once again there is no evidence that it is anywhere else.  Oh how I wish I could get rid of it, but it just will not go away.  Anyway, this development means that I at least have some decent options going forward.  It will again all depend on what happens in the next 3 to 6 months, but there are options and I have expressed to them my desire to continue fighting and do whatever I have to do to give myself a chance for survival.  They were very happy to hear that I am still willing to continue the fight and their demeanor changed the minute I said that I am all in.  I really do have a special place in my heart for this surgeon and her PA, they bring such a dynamic human element into this dark, bitter place and it has been and continues to be refreshing to me in such a depressing clinical setting.  The option going forward is going to be 3 to 6 months of chemo (more on that later) while tracking the tumor progress and hoping for minimal growth or even better would be some shrinkage of the tumor itself.  At the end of this time-frame, if things look favorable I could have YET ANOTHER surgery to remove the section of my sternum and surrounding tissue that contains the offending cancerous growth.  This would be done by a separate team of surgeons, this time cariothoracic specialists.  I don't know the details about this surgery, but it would be dangerous and leave me with not very adequate protection for my heart and other sensitive structures in the center of my chest.  There are ways around that and still many concerns and hurdles to overcome, but it is an option out there in the not too distant future.  I have lots to think about in the coming months and many very important decisions to make regarding my future and the future for my sweet little family.  I can only hope to handle this process as gracefully as I can, but I will go down fighting to the bitter end.  I will not give up on myself or my family and I will put myself through whatever I have to in order to get as much time with them as I can.
I am scheduled to meet with some additional MD Anderson personnel late next week.  On Thursday, I meet with the head of a clinical trial that my medical oncologist is recommending me for and this will likely be the road I go down for chemotherapy this time.  It is a trial of a combination of standard chemo treatment with a new immunotherapy agent that shows promise in advanced metastatic head and neck cancers.  I don't know the details yet, but I should find out more in the next week.  That seems to be the teams advice for the best course of action.  Get me in this clinical trial and see how I respond to treatment and then reassess and go from there.  It's not the greatest option, but it is what I have and what I will do.  I have told them that I will see my 40th birthday, so that is the goal.  Get me two and a half more years minimum here with my kids and I will consider myself a lucky man.  On Friday of next week I will meet with a cardiothoracic surgeon to just talk about what that surgery would be like and what my options are with that approach, should it become viable down the road.
That's about it, I just wanted to throw out a quick note about the recent developments to any who are interested.  As long as I continue to draw breaths in this world, I remain ever hopeful that I can overcome the challenges before me.  Thank you for the support you have given me and my family throughout this entire process.  And so it continues...

4 weeks out

We are rapidly approaching 4 weeks since I had the latest surgery.  Everything continues to progress nicely, I suppose.  I had a days worth of appointments last Monday, the 22nd of December in Houston at MD Anderson.  There were three appointments on the schedule, first was speech pathology, followed by the plastic surgeon and finished with my ENT surgeon.  The speech pathologist set me up with a new type of HME filter holders, this kind was adhesive backed and doesn't require a neck strap.  For those unfamiliar, I no longer breathe through my nose/mouth combo, instead I draw my breaths through a hole in my neck that leads directly to my lungs (the opening is called a stoma).  I am what is know as a neck breather now.  The nose has a couple of important functions that I no longer get the benefit of.  It filters the air that is headed towards the lungs and provides moisture for that air as it travels into the body.  I no longer have any natural means of filtration or humidification, therefore, I must replace that with an artificial means to accomplish these functions.  Until last Monday, I used a larytube, held in place with a cloth strap that wrapped around my neck.  The opening of the larytube holds a small, round filter/humidification insert that I change every day.  The adhesive pad simply sticks to my neck around the stoma and a filter cartridge is inserted and I can go about my day.  I like it much better than the tube/necklace combination as I barely notice that it is there during my daily activities.  The tube annoys my airway and makes me feel like there is always something in my trachea about two inches in and I feel like I need to cough much more often.  I still have to use the larytube when I sleep, but at least I have some options as I get used to daily life as a dumb neck breather.

My boys on their new trampoline

We went to one of the restaurants in the complex so that Jessica could have breakfast and got a call soon that my swallow study was scheduled shortly and we needed to head back over to one of the imaging areas in the main campus.  The swallow study was pretty cool and I was able to see a lot of the action in real time.  It involves sitting in an x-ray booth and swallowing a barium solution while the technician records video of my upper body as I chew and swallow.  There were two concentrations of barium solutions, one very liquid and the other the consistency of pudding.  Neither tasted good at all, but the pudding was revolting enough to cause some gagging, but I did swallow it.  Swallowing was deemed good enough to let me start eating food, but I was advised that I should take it easy and start slow.  Soft foods and liquids.  No cheeseburgers.  One step closer, but not quite there yet!
The visit with the plastic surgeon went well and they were able to remove the stitches.  They really did a number on my neck this time and I don't think having the stitches in for three weeks did me any favors.  The stitches came out easy enough and other than it taking an hour longer than it should have, the visit was uneventful.
From the medical center, we raced out to the Memorial City office to meet with my ENT surgeon.  This was our first visit to this office and it took some time to find it, but we made it and the entire visit didn't take too long.  Overall, the visit was good.  I got to talk with the surgeon and her PA, both of which I have known for too long now.  My surgeon reiterated how good she feels about the outcome of the surgery and the results of the pathology that we got back recently.  She always likes to give me warnings that I usually just shrug off but this time she actually chuckled a little and said "you aren't going to listen to me at all, are you?" as she gave me some of her guidelines on what I should and should not eat.  She talked a little about me being near water and I held my hand to my upper chest and said I would only get in the water that deep, to which she held her hand at her knee and recommended that I not get in deeper than that.  Somewhere in between is probably where I will end up, although I don't have to worry about that for a while.  I found out also that the voice prosthesis is not a done deal yet.  They need to see in the next CT scan results what the inside of my neck actually looks like and where everything is in order to know if they can punch the hole or not.  The problem is my pectoral flap that they moved and stretched in this procedure and it's location relative to the spot where they will have to punch the hole between my trachea and esophagus.  If it is in the way, I might not be able to have the prosthesis, but we will have to wait and see.  My official followup plan is to have a CT scan roughly 8 weeks out from surgery.  That will be the new baseline and will tell them more about the TEP procedure that I can hopefully have.  After the baseline CT, I will have a CT every 3 months to look for new tumor growth or trouble spots.  Other than that, it is just rest and recover.  
Still trying to get used to my inability to speak.  I get frustrated very easily.  Very, very easily.  I hate the electrolarynx, but I guess I need to get some practice with it.  I am reading a lot about esophageal speech, but it appears to be tough to master and take a long time to get good at.  There are options, but nothing will happen overnight.  I need to start doing some physical therapy and learn to massage out the fluid that builds up on the right side of my neck, but I am still just focusing on resting and getting used to my new life.  That seems to be enough right now.

Dumb guy problems.

This is just a quick entry to complain about my two main problems, me being dumb is number one and my inability to eat is the second.  I am currently living in this world as the definition of the word dumb.  One of them, at least.  It continues to be very interesting going about daily activities with a complete inability to speak.  My current solution is to use an app on my phone and type anything I need to say and then either use the phone speaker or any one of the 12 bluetooth speakers that I have.  My favorite has to be using BROCK.  To those unfamiliar, BROCK is the 5th member or our tiny family.  He came into our lives almost one year ago and has brought immeasurable joy to not just the four of us, but to countless others that happen to cross paths with him.  You have probably guessed by now that BROCK is actually my suitcase-sized rolling bluetooth speaker officially named The Block Rocker.  Paired with my phone, I can be in my room and I can yell at the boys on the other side of the house.  When I was in the hospital, the default voice that my phone spoke in was an unbelievably dissatisfying voice that Jessica called Linda.  Very female and very much not what I wanted to sound like when I was trying to argue with the nurse.  And when things got really heated, I don't think my anger came through on the white board that I was trying to communicate with.  On the drive back to Lago Vista, as Jessica expertly chauffeured me towards home, I downloaded my new voice.  Officially it is called The Dark Lord, but it is now the voice that embodies all that is Bryce.  The downside to all of this technological communication is that it happens at the speed of texting.  By the time I have something typed out in a normal conversation, things have progressed four or five thoughts past where we were when I started typing.  Unless those involved patiently wait for the dumb guy to finish typing before continuing the conversation.  It is incredibly frustrating.  Frustration is my new go to emotion.  In the long run, I feel like this will help me as a person, especially with my patience...which was severely lacking to begin with.  SOME patience is way better than absolutely none at all.  Currently, I am learning to be an observer, interjecting myself when I need to and the situation demands it.
The second problem is one I struggle with every day.  I have been hungry since I woke up immediately after surgery.  These tube feeding just don't cut it and it still feels like I am constantly messing with these "feedings".  I started juicing this week again and putting the vegetable juice through my tube and that has led to some interesting sensations.  It is very interesting how much I can actually taste when I put liquid directly into my stomach.  I suppose it has something to do with gas released during digestion travelling up my esophagus and then being expelled as a burp.  It is almost immediate, however, and I didn't notice it until I started pouring in kale-spinach-carrot-beet juice.  I was looking forward to NOT having to taste it, but as is so often the case in my life, it didn't work out the way that I was hoping.  At least I am getting something in my belly other than baby formula, a little diversity is good for my tummy.  Still looking forward to that glorious first cheeseburger, although I am a bit concerned with my chewing ability now that I have had so much time without really working out my jaw.  The left side of my jaw is still mobility impaired and painful from the second surgery and first round of radiation that focused treatment in that area.  The muscles are always tight over there and they get stiff and crampy when I haven't used them in awhile.  Any pain will be well worth it to once again get the pleasure of eating normally again.  I will likely make myself sick the first day back on the eating wagon, but I have already prepared myself for that and will gladly accept my punishment.  I can't be around people who are eating anymore, so I spend family dinner time laying in bed listening to the frivolity happening at the dinner table.  That is much better for everyone.  Who needs the dumb guy sitting at the table drooling over the meal of the day and getting increasingly annoyed by the sounds of people eating? Nobody living on Rockefeller Cove, of that I am sure.

I was discharged from the home health service yesterday, so that is a step in the right direction, I suppose.  I report next Monday to have the stitches removed and visit the surgeon for the first time since surgery.  Should be fairly routine and I am not expecting much to come of it at all.  That is the day, however, that I have my best chance of eating normally for the first time.  They will do a barium swallow study to see how my swallow function is post surgery.  I really hope that I ace that test.  I don't know how much more of this I can take.  Monday shall either be a very good day or a very bad day.  Again, time will tell.

A full week at home!

It is now Monday, December 15th, 2014 and I have been recovering at my house on the 17th hole of the Highland Lakes Golf Course for exactly one week.  The time has flown by and I continue to improve every day.  I probably mentioned this before, but this time feels totally different for whatever reason.  Physically I am able to do much, much more than I have in the past and mentally I am filled with much needed hope and feelings of finally being able to put all of this behind me and a vision for the future.  It has now officially been almost 3 years since I first was diagnosed with squamous cell carcinoma and SO much has happened in that time.  It feels like I have been fighting this my whole life, or at least a good portion of it...but it has only been 3 years.  That seems like such a short amount of time when I think about the rest of my life, but it also feels like an eternity to me.  It is crazy how the mind works (my mind, at least).  I don't have the greatest memory in the world (just ask Jessica about that), but I usually remember the big things.  My mind has erased a good portion of the events leading up to the surgery on December 2nd.  Just the normal everyday stuff.  We had a great Thanksgiving day with my entire family.  My mom and dad were at their house up here, along with my sister and her family and then my brother and his brood arrived on Thanksgiving day.  I don't really remember any of it.  We had family pictures made that Saturday along with a birthday party celebrating AJ's 8th and my brothers youngest daughters 1st.  I couldn't tell you what happened that day if I had to.  Nothing.  Erased completely.  Pretty sure I went to work during that week, but I don't know when or what I did.  The one thing that sticks out in my mind is immediately prior to surgery, after I made my way on to the surgical table in the operating room, surrounded by a team of medical professionals and hooked up to the gas they always give me to relax me and begin the knock-out process.  I reached out for my ENT surgeon, Dr. Pytynia, and told her that my name was Bryce and to stop calling me Mr. Stobb.  That's it.  Apparently that is the one important thing that I needed to remember about this whole ordeal.
Liquid feedings suck.  They say that it is a great way to recover.  No need to worry about eating, just hook your tube up to a bag filled with formula, let it drain into your stomach and get on with your day.  On one hand, yes, it is a very simple process.  I understand exactly what they mean, as eating has been very difficult after most of the surgeries I have had.  What they don't tell you (and maybe it is just me) is how incredibly unsatisfying it is to be fed in this manner.  Sure, I get my calories in and the nutrition I am getting fills me up.  It fills me up, but it is, in NO way satisfying.  I want a freaking cheeseburger.  I want to smell it (which, interestingly enough, I probably won't be able to do as I don't really smell anything anymore), I want to bite into it and taste it, i want to chew it up.  All those sensations are lost when you pour liquid directly into your stomach, bypassing the best part, the sensory delights that accompany the act of eating.  It is absolutely maddening having to watch everyone around me eat while I sit there hooked up to a bag on an IV pole and fluid slowly drips directly into my stomach.  I have one more week until my stitches come out and I have my swallow study to make sure I am capable of eating.  I can assure you right now that I am capable.  I drank some water yesterday to test out the function of my throat and esophagus.  Although very strange feeling, I can definitely ingest a mouth full of water.  The strangeness has to do with a lack of feeling in my throat and upper esophagus, I think.  I feel the liquid in my mouth and then I swallow and it is gone.  I don't feel it go anywhere, but it is undoubtedly not in my mouth anymore.  I guess I don't have feeling back there where they stitched me up anymore, which could pose a threat to someone who breathes normally.  That could be a choking hazard, but when you breathe through a hole in your neck, I doubt that it is really a big deal.  Speaking of eating, I think it is now time for my breakfast.  Two cans of formula, some water and a bunch of medicine.  Try not to be jealous.

Recovery continues to go very well.  I received great news on Friday in the form of a pathology report from surgery that is very promising.  For once, the surgery yielded no surprises and the results lined up with expectations going in.  Basically, they got all the cancer out that they knew about, and the suspicious spots they took out were not cancerous.  While this does not mean I am completely out of the woods yet, it is a big step in the right direction.  Time will tell what the final outcome is, but for now it feels so good feeling good again.

Back to it.

Greetings, everybody!  It is I, Bryce, back from the brink of insanity and here to regale you with stories from the edge.  OK, so that is probably a bit much...but I am here to update everyone in my own words the major events of the last week or so.  Jessica did a fantastic job updating in my absence, in addition to doing an amazing job taking care of me and watching over me during my hospital stay.

Speaking of the hospital, let's talk a bit about that.  I really like my surgeon and the team of people that perform my surgeries there at MD Anderson.  I like them a lot and I think they do an incredible job doing what they do and feel like they have done amazing work on me, especially this time around.  This surgery could have been so much worse, but they did everything they could to take it easy on my and make the impact to my body (and consequently, my life) much less severe, I think.  The big changes to my body are that my trachea now exits  my chest at the base of my neck, so I have a large hole there now and I have no ability to talk whatsoever.  Time will tell if they got everything and my body is now rid of the cancer, but if it is, I will gladly take that trade off.  They were able to fill the newly created voids in my neck with the existing flap that I got in the last surgery (my former right pectoral muscle) and did not have to re-purpose my left pectoral and for that, I am very glad.  I still have a lot of swelling in my right neck, so that looks kind of funky, but I can honestly tell you that I am extremely happy to be alive right now and considering the scenarios that I had running through my mind in the weeks before surgery, I am amazed at the outcome of this surgery and how well I have recovered to this point.  So that is the good, let's talk a bit about the bad.  The hospital stay there was, again, a complete nightmare.  The nice thing about living in my body for the last 37 years is that I kind of know it.  Even through all the changes, I know what it feels like when I have a full bladder and need to pee.  I have always had issues using the bathroom after these surgeries, especially after they remove the Foley catheter...but I can do it when my body has enough fluid in it to need to do so.  The motto of the MD Anderson nursing manual must be: "Force a catheter up their pee-hole, ask questions later".  They again evacuated my bladder by using a straight catheter because they felt I was not outputting enough, ignoring the fact, in my opinion, that I was not getting very much in the way of fluids at that point.  The straight catheter, in addition to relieving me of piss, also greatly pisses me off.  I argued with them relentlessly, which is EXTREMELY hard to do when you do not have the ability to talk.  I was mad.  Even after the first straight catheter, they were about to try it a second time and this time I was not going to let them do it.  I gave them mathematical representations of my input versus output, I pleaded with them.  I know my body, I know what it feels like when there is fluid in my bladder, I know how to use the bathroom in a way that I can comfortably do it even after these surgeries.  They did not listen to me at all.  They never do.  They brought in the first (of 2) ultrasound machines to see how much fluid was in me.  None.  Couldn't find any.  At that point, they could have believed me when I said I didn't have anything in there, but they didn't.  They went and got ANOTHER ultrasound machine.  The results from the second machine?  Nothing.  There was absolutely nothing in my bladder.  SHOCKING.  They left dejected, and I was the happiest I had been in a long while.  It was such a satisfying feeling when they came back in to let me know they consulted with my surgeon's fellow and he said I might be dehydrated and to give me a liter of fluids.  The happiness was short lived, however, as their insatiable desire to put things in the many output only orifices of the body once again reared its ugly head and they turned their attention to the movement of my bowels.  I won't go in to detail on that one, but lets just say they won that battle.  After just a short 6 night stay in the hospital, I was discharged on Sunday and we made the 3 hour drive back to Lago Vista and settled back in to the comforts of home and things got much, much better.

Now that the surgery is behind me, I can definitely say that the build up to it was far worse than the actual event itself.  Prior to surgery, one of my biggest fears was feeling trapped inside my body with no way to communicate my thoughts since I didn't have a voice.  Some of that was realized and I still struggle with communication now, but those first few days it was maddening.  It is an incredibly frustrating experience to suddenly not have the ability to talk, and I will have to work on my patience in the coming months.  Overall, however, I am feeling better than I have in months.  There is no longer the stress of the unknown from a radical surgery, I now know what I am faced with and can adjust accordingly.  For now, I am at home resting and recovering.  I am recovering remarkably well for what I have been through, I think.  This surgery was one of the more invasive and yet I am recovering better from this one than I have from any of the previous.  Blind optimism says that I am recovering so well because they got everything out and my body is now free to heal itself minus any cancerous cell growth, so let's go with that.  I have more to say, but Jessica really wants me to post something, so this is it for now.  I have until the 22nd before my next appointment, so I have some time to rest.