What's New Pussycatt?

What's New Pussycat?  Dates us, doesn't it!!

Anyway, what's new? Let' start with the not so fun stuff.

When I last got my shots, it turns out one of the ladies may have nicked a nerve. My right bum and upper thigh hurt ... bad. The doctor told me to take 800 mg of Ibubropen every six hours for two to three days and hope it goes away. Great! Icy Hot helps at night. 

My grandsons and I cooked dinner and dessert together Tuesday night via Zoom. I took the ingredients and recipes to my daughter on Sunday. We both fixed a simple chicken casserole and the staple, Apple Crisp, for dessert. Fun was had by all. We decided we need to do this again soon. Next time, David will cook the main course;  AJ and I will do what we do .... try a new cookie recipe. Sometimes we have a hit, sometimes not so much. It's a crap shoot, but we love it! Can't wait for next time. 

Confession. I hugged my granddaughter Hazel for the first time in months when I dorpped off the ingredients for our virtual cooking session. I picked her up, she snuggled in, and I hugged her tight for ten minutes or so, crying for five of those ten minutes. This is the hardest part about social distancing .... hugging my babies, big and small. I need to find a creative way to safely hug my grandsons, too.

Packages continue to arrive at a steady clip at the Bishop house. What has been delivered so 

far this week?

• Bark Box for the pups
• More coffee and a mug for me (late mother's day present)
• My new laptop (whoop!)
•  Art
• Comic Books
• Meat
• Dinner (Bacon wrapped stuffed chicken) from Bow Ties 2 Blue Jeans (YUM!)

And the week isn't over yet!!  Most of this was ordered by hubby or my son. I ordered the artwork. It's a canvas Picasso print. I love it! Hubby is going to hang it by our bedroom door this weekend. 

I am taking off Friday so I will have a long weekend! On my to do list is hang tons of pictures, placques, and my fun stuff in my office. I will post picture(s) when I am done. I've only had this on my plate for about three months. Can we say "procrastinate"?

What else? Oh yeah. I think my thyroid is on vacay! We are having issues getting thyroid levels under control. I've gained 5 pounds in a week. I feel like a beached whale about now. What to do? Well, I walked to the lake at lunch; its a three mile round trip. I will continue to do that every day, weather permitting. 

Rant time! So I go on a 3-mile walk around the lake today, wearing my mask. Is it hot? Yes! Did I want to take it off? Yes! Did I? No! But everyone I came across, runners, cyclists, people at the playground, people walking their dogs, not one had on a mask! Do they not understand that even when you talk, droplets can linger for up to 8 minutes!

I don't wear the mask to protect me but to protect others. I wish my neighbors were as courteous! So frustrating! I am re-thinking this lake walk thing because of the number of inconsiderate people I run into. This could put me at risk.

I am suppose to start my beginner Yoga class on Saturday the 6th. I am a little anxious but prcautions are in place. I have to order a Yoga mat. Oh Good! Another package for the Bishop house!!

Hit Me Baby, One More Time

Hit Me Baby One More Time

Great PET results, right? RIGHT! Don't get too comfortable in that happy place. You are about to get another gut punch!

About a week after my telemedicine call with Dr. Kocs, I get a call from Super Nurse (Stephanie). Dr. Kocs wants me to come back in for more blood work. WHAT?! I'm on a "once a month" track right now for meds, shots, and blood work. What's up?

It turns out that some of the cancer markers are up. Now, before you say … awww, no big deal.... remember this: my cancer has NEVER, I repeat, NEVER shown up in cancer markers in my blood work. So now what are we dealing with? Is this a new cancer? A false positive (it happens)?  Who knows. This cancer crap is getting old!! Did I tell you I hate cancer? Well, I HATE CANCER!! I wanted to leave no doubt on my feelings about cancer.

I go in Friday afternoon for the blood test. Scheduling that was a ride in itself. Stephanie scheduled it for this Friday afternoon when she called me. Fast forward to this week. I get no less than three … count em …. three calls from Dr. Kocs office to schedule the blood work. One nurse even scheduled an appointment for next Friday. When I called the nurse back and told her I already had an appointment for this week, she told me there was no appointment for this week and Dr. Kocs' orders read to schedule the blood work for two weeks from 5/13, which would be 5/29. She said the notes in the chart showed conversations back and forth between Stephanie and Dr. Kocs on how quickly to get me back in. I told the nurse, "Fine, schedule the appointment for the 29th, but please go talk to Stephanie and confirm with her, because what you are telling me is different than what we discussed". Ten minutes later I get a call back from the nurse. My appointment for this Friday stands. Guess Stephanie won that battle on timing!

Truth be told, I think Stephanie is probably the one that found that cancer markers in the first place. It wouldn't be the first time Stephanie picked up on something and pushed the doctors into action. The first time this happened was post surgery while I was in the process of reconstruction. She called to ask what are we going to do about the close margin. What close margin? Next thing I know, I am sitting in my plastic surgeon's office, he gets a call from Dr. Kocs, then they conference in my surgeon, and the boys start talking close margins and what are our options, the whole time I am sitting on the table, waiting on my next "tissue expander fill". In hindsight, it was quite comical. Turns out any further treatment posed more risks than benefits, but then again I may not be in this situation had we done radiation then. Oh well. Can't second guess medical decisions.

Stephanie caught it again when she noticed the January 31 CT scan results were being compared to the first CT I had when I was first diagnosed with MBC; that was October!! The more Stephanie looked the more concern she had. That's when we found out that they read the scans incorrectly. Instead of everything being stable, the chemo quit working somewhere between 12/1 and 1/31; my tumors were back to their original size or bigger.

The point is, Stephanie is my guardian angel. She looks out for me. Always has since I was first diagnosed with breast cancer. God only knows where I'd be without Stephanie!

Anyway, I go in Friday, they do the blood work, and then I wait. I don't expect results until Tuesday because of the holiday. It's going to be a very long 4.5 days. So what to do while I wait? What any PM would do …. download all the blood work results, pop it into a spreadsheet, highlight the tests that could indicate cancer, and start comparing them beginning 12/6 to present. At a minimum, I will highlight those things to discuss with Dr. Kocs or Stephanie when they call with the results.

For now, we stay the course. If they don't like what they see? I'm not sure. Take a wait and see approach? I'm ot much of a "wait and see" kinda girl! Change the protocol? Possible. I know we have about 20 or so in our pocket now, not including new stuff coming up all the time. But, if we do start a new protocol, that's 3 in 9 months that we've burned through, roughly one every three months or averaging one a quarter. Hmmm. My prefence is we stay on a protocol for 6 months, a year, before switching, if possible. We all know cancer could care less about my "preference"!

Dr. Kocs and PET results discussion

I had a brief telemedicine visit with Dr. Kocs during lunch on Wednesday to discuss the PET results.

Overall, the results are good. Lymph nodes in neck and chest have been shrinking. The liver is larger; more on that later. There are possibly two new problematic lymph nodes in my right upper abdomen. The larger liver and new areas of concern triggered a brief panic and pity party. Then I talked to nurse Stephanie; she always helps "cool my jets". This was all pre-Dr. Kocs conversation.

The real story here is the overall drop in metabolic activity, some dramatically so. Dr. Kocs and I discussed this, but it wasn't until I was updating my spreadsheet today that I realized just how much has improved. Regarding the two new lymph nodes that showed up? Dr. Kocs is not convinced these are new, mainly because of the misreading of the last CT results and the timing of the previous scan. We are taking a wait and see approach on the newbies. The liver? Yes, it has increased, but the drop in metabolic rate is indicating this sucker is dying.

Some think I am a bit "cray-cray" for tracking bloodwork and scan results on my spreadsheets, including members of my own family. HA! Seeing the changes in the suv rate side by side is what made it real for me. I love my spreadsheets. I am a very, very happy girl today.

Here is the comparison:

Description/Location	12/02/19 - CT/PET	2/13/20 - CT/PET	5/1/20 - CT/PET
IIa Lymph Node	8 x 13 suv max 3.4	9x15 mm suv max 9.2	suv max 9.0
Iib Lymph Node		suv max 8.4	suv max 2.6
Left supraclavicular bulky adenopathy	25 x 32 suv max 8.9	32 x 27 suv max 14.4	suv max 6.6
Left axillary node - Voldemort	8 x 13 suv max 4.3	9 x 18 suv max 11.3	suv max 2.7
Left pectoralis intramuscular lesion	13 x 10 mm
Nasal Thing (inflamed thornwaldt cyst?	11x11 suv max 3.6	11x11 suv max 6.4	decreased suv max 3.7
Liver		1.1 x 1.3 max suv 16.3	20 x 19 max suv 10.9
Right Axillary node (Abdomen and Pelvis)	Previously normal	7 x 10  suv max 8.5	suv max 1.7
New bilateral metabolically active axillary and internal mammary lymph nodes		Increased in size, number, and activity	No mention
New metabolically active cardiophrenic lymph node		From this scan	No mention
New porta hepatis node right upper abdomen			max suv 9.9
Preval node right upper abdomen			max suv 4.5

So .... we stay the course! Whoop!!

PET/CT Scan Results

PET/CT Results from 5/1 PET/CT scan. I highlighted changes in red; bolded the final results. Discussion and other ramblings in the next post. Stay tuned!

Exam: PET - TUMOR IMAGING W/ CONCURRENT CT, SKULL BASE - MID THIGH Patient: BISHOP, VICKI Exam Date: 05/01/2020 DOB: 12/06/1956 At the Request of: Patient Age: 63 DARREN KOCS MD Patient Sex: F 2410 ROUND ROCK AVE ARA MR #: 2113432 SUITE 150 Exam Status: Routine ROUND ROCK, TX 78681 Accession #: 30634097 PET - TUMOR IMAGING W/ CONCURRENT CT, SKULL BASE - MID THIGH: 5/1/2020 SKULL BASE TO MID THIGH PET/CT - CLINICAL HISTORY: Left breast cancer, subsequent treatment strategy. RADIOPHARMACEUTICAL: 12.0 mCi F-18 FDG was administered intravenously. The blood glucose level was 105 mg/dl. TECHNIQUE: The F-18 FDG injection was followed by an uptake period of 52 minutes. CT was then performed from the skull base through the mid thighs for attenuation correction, followed by positron emission tomography (PET) imaging in the same distribution. PET images were viewed in axial, coronal, and sagittal planes, along with reformatted CT images for anatomic correlation. COMPARISON: 12/13/2020, 12/02/2019. FINDINGS: NECK: Visualized portions of the brain show normal metabolic activity. Brain parenchyma is normal in appearance. The orbits, intra and extraocular structures are normal. Visualized sinuses are well aerated, with no air fluid levels or abnormal activity. The salivary glands are symmetric, and have physiologic uptake. Focal nasopharyngeal uptake has dramatically decreased. SUV max 3.7; previously 6.4. Larynx is normal, and has physiologic uptake. The thyroid has normal parenchyma and normal physiologic uptake. CHEST: New left upper lobe nodular airspace opacity demonstrating low level uptake, likely infectious/inflammatory. * Left upper lobe nodular airspace opacity: 14 mm, SUV max 1.5. Stable apical pulmonary scarring. No abnormal uptake. No pleural effusion, pleural mass, or pneumothorax is noted. No abnormal FDG activity is seen in the pleura. Esophagus is normal, and has physiologic uptake. The heart has normal metabolic activity. No evidence of pericardial effusion. Reference background activity (mediastinal blood pool): mean SUV is 2.3. ABDOMEN AND PELVIS: Medial segment left lobe hepatic metastasis is larger, although uptake has decreased. * Medial segment left lobe hepatic metastasis: 20 x 19 mm, SUV max 10.9; previously 13 x 11 mm, SUV maximum 16.3. The pancreas is normal in appearance and has physiologic uptake, without mass or inflammatory change. The spleen demonstrates physiologic activity without splenomegaly or mass. The adrenals are normal, and have physiologic uptake. Physiologic FDG excretion is seen in the kidneys. Atrophic left kidney redemonstrated. Normal physiologic activity is seen in the bowel. No evidence of bowel obstruction. The reproductive organs are normal in appearance and activity. The bladder is normal. Reference background activity (liver): mean SUV is 2.8. LYMPH NODES: Lymph nodes in the neck, chest, abdomen and pelvis are normal in size. No abnormal radiotracer accumulation in the lymph nodes. BONES AND SURROUNDING SOFT TISSUES: Most neck lymph nodes demonstrate decreased activity. Axillary and supraclavicular adenopathy has improved. Significant misregistration of activity is present, although new foci FDG activity in the porta hepatis region appear to be related to new lymphadenopathy. * Left submandibular nodule: SUV max 8.1; prior SUV max 9.5. * Left cervical level 2A node: SUV max 9.0; prior SUV max 9.2. * Left cervical level 2B node: SUV max 2.6; prior SUV max 8.4. * Left supraclavicular adenopathy: SUV max 6.6; prior SUV max 14.4. * Right axillary node: SUV max 1.7; prior SUV max 8.5. * Left axillary node: SUV max 2.7; prior SUV max 11.3. * New porta hepatis node: SUV max 9.9. * Precaval node: SUV max 4.5. PET/CT IMPRESSION: 1. Although neck and chest adenopathy has improved, a couple of new lymph node metastasis are seen in the right upper abdomen. 2. The left lobe hepatic metastasis is larger, although uptake is lower. This could be explained by inconspicuous necrosis. 3. New nodular left upper lobe pulmonary airspace opacity demonstrating low level FDG uptake, likely infectious/inflammatory. Follow-up recommended. 4. Decreased focal uptake in the nasopharynx.

New Horizons .... Literally!

My oldest son, Tyson,  has wanted to get into the wind industry for quite some time. Life kept getting in the way. I am happy to say he starts his new job in June! Tyson and his wife are beyond excited!

Tyson isn't really sure what he will be doing, but he doesn't care. He wants to do it all .... and he is smart enough to do it all!  He loves the serenity .... and the gorgeous views .... of climbing up a wind tower to do his thing. He can see for miles, hence the new horizons.

Most wind farms are in remote locations. He is hoping to buy a truck and a 16 ft trailer to haul around from job to job. He will most likely work 6 wks on with one wk off, up to 70 hours per week. But when you are doing something you love, it doesnt' feel like work, right?

The ultimate goal? To move closer to his wife's family and live on the waterfront, river or lake. He has been checking out lake front property in New York. It is amazing how affortable it is. He has shared some of the properties he is looking out .... definity a chill vacation destination!! I am not sure I could handle the cold winters, but the fall? Make room! I'm coming!

Dad and I are so proud and so excited for this new chapter in his life!!

Congrats #1 son!!

Chick Comes Home to Roost

Matthew finished his doctorate in Health Education from the University of Cincinnati. He won't officially be Dr. Bishop until he receives the official paperwork later this month. He is still working for the University of Cincinnati, teaching several online classes. The Spring semester classes are over. Next week, he starts teaching summer online classes.

Matthew has a job lined up at James Madison University as a tenure track professor. But he does not report to work until August 5th, That, coupled with the fact that his lease was up in late April, prompted us to help move him back home until the end of July. No small feat in the coronavirus pandemic!

Once the boys got back from their two-day trek from Cincinnati, I told my son he could be a "guest" for the rest of the weekend. After that, he is a resident. Momma spoiling him stops there (yeah right .... who is kidding who?).

Anyway, it has been a delight having Matt and his girl Sadie home for a few months. The boys trade off cooking (notice I am not in the mix? there is a reason for that), I clean up the cooking mess. I have the better end of things!

Sam is thrilled to have Sadie here. He could barely contain his excitement when he saw her come in the door. We  expected a scuffle or two, but it hasn't happened. Besties for life, now! They both go to doggie day care on Wednesdays and come home happy and exhausted. Here is Sam and Sadie on the first day back at Action Pack Dogs:

Sam looks bored but he is waiting on a treat. He thinks sitting long enough for a picture is deserving of a treat. He is wrong, but it doens't stop the anticipation.

Sadie is smiling. Some may think she is growling, but that is her happy face!

The staff said Sam was so happy to have Sadie with him at doggie day care.They played hard all day!

Matthew and Sadie are planning on moving to the Shenandoah Valley (Virginia) in late July. That could change.





Univerisities across the country will be deciding soon if they will reopen in the fall or not. Matthew expects that decision to come down sometime in June. One or tlwo major universities will announce their intention to open or not and the rest of the universities will probably follow suit. If schools choose to stick with online courses in September, odds are Matthew will stay and teach from here. He can set up and teach online courses anywhere. Of course that depends on James Madison.

We are already planning on making the 20-hour drive to Virginia the last week in July. Matthew will have to rent an apartment or house site unseen. Scary, huh? He donated all of his furniture when he moved here, so he will shop and order furniture online for delivery the day after we get there. Dad and I will then probably fly back home.

Anyway, the situation is a little fluid right now, but isn't everything. We will roll with whatever comes.

Hair? Where? There!

When I was first diagnosed with metastatic breast cancer and started on my chemo treatment, I was told I would lose my hair. As many of you know, I took matters into my own hands and shaved my head …. three times. My hair has thinned out a bit, but I have never been bald except after I went to the barber (which is a cool experience, if you are so inclined to shave your head).

I have lost most of my eyebrows and my eyelashes. They look weird. I can pencil in the brows (ha! I can't wait to see how bad I botch that!!) and I can buy fake lashes. Problem solved on the eye front.

But …. my hair is growing back. With a vengeance! And the strangest thing? It is coming in dark! I look like a reversed skunk … white with a dark stripe down the middle of my head.

I feel like an old man with a comb over!

Even though my hair is growing fast, it isn't long enough for a cut or even shaping. But it's getting there! Can't wait to see my favorite hair stylist Amy Salas! Maybe a couple of months? We'll do something fun. I see pinks, purples or blue in my future!!

Can you see the hair sticking out from my neck or behind my ears in this next picture? Sometimes is sticks out everywhere. It is out of control. Patience ….

I look like a turtle!