Facing the new reality

A year ago I was told I had breast cancer. While aggressive treatment has ended, I am now faced with the reality of a life forever changed.

I had my final radiation treatment a few days ago. As I left the treatment room, the staff threw confetti and presented me with a "certificate of completion." I hated every minute of the process and I really just wanted to get the hell out of there, but the staff has been unfailingly kind and I understood their intentions were good, so I tried to be a good sport about it. 

I met with the doctor afterward and was told for sure what had been hinted at earlier: the lymphedema in my hand and arm will continue to be a problem for the rest of my life. It may not get worse, but will continue to need continual "management." This was confirmed the next day by my physical therapist.

The radiation oncologist also told me that during the next week or so my skin will continue to be inflamed and the peeling and pain will continue. And the neuropathy in my hands and feet will be with me for months more—or longer.

All in all, I am feeling depleted and depressed. Cancer treatment has been a continual assault on my body, which is forever damaged. I know that the cancer would have killed me and it has (probably) been stopped; but it is not the cancer, but rather the treatment of it, that has caused me so much physical and emotional distress over the past year. 

Add to this the aging process that has turned my skin to crepe and my hair white. And the osteoarthritis that I was already dealing with.

Knowing that robust health will never really return, no matter how many workouts I do, how many supplements I ingest, how much lymph-draining massage I get, how may ugly compression garments I wear, how many medications I take, how many anger-purging exercises I do, how much healthy food I eat—I will be struggling every day just to maintain some semblance of health. And always hanging over my head are the periodic checkups and the possibility of recurrence of cancer.

Judging by comments from other people who have gone through this post-treatment letdown, my reaction is not surprising—except to me.

I thought I would feel like celebrating when the chemo, surgery, and radiation ended, but at this point, I am just feeling exhausted. 

The slog goes on

Because I was upset about the skin burns and pain under my arm, the radiation oncologist altered my treatment plan a bit. The first 25 doses were to be aimed at an area that includes the lymph nodes that are left after six were removed during surgery. The last five doses were to be a less intense treatment of just the original tumor site. To give my underarm area some respite, he switched to  the tumor-site treatment for five days and will finish up by going back to treating the wider area for my final four treatments. 

I think the whole area looks awful and it hurts like a bad sunburn...but when I saw the doctor yesterday, he said I am tolerating the radiation well. Then today my skin started peeling. One of the nurses at the clinic applied a burn dressing made with Leptospermum honey and that relieved the pain for several hours. I dread what those last four radiation treatments might do to me.

The doctor did offer me the option of taking an extra day off from treatment, but I simply cannot bear the thought of dragging this out any longer. So we will push ahead, and my last treatment should be September 20. That evening, Rosh Hashanah, the Jewish New Year, begins and that seems symbolic, because on the 21st, it will be one year since I went in for a mammogram and was told that I likely had cancer. So, I am really focused on getting this last phase of aggressive treatment over with and putting an end to a miserable year.

The lymphedema in my hand is a bit better, according to my physical therapist. Doesn't really look better to me, but she is going by measurements. I continue to wear the ugly compression sleeve and glove all day and to do the lymphatic drainage massage daily. Today, my physical therapist taught David how to do the massage, which will be very helpful.

Meanwhile, just to make things more "interesting," I came down with a bad cold last week. So, instead of doing something pleasant over this past weekend, I was stuck  home with sneezing, streaming eyes and nose,  a slight fever, and a heavy dose of resentment.

Over the past few weeks, I have been experiencing a lot of anger about this whole experience and the seemingly endless series of side effects, setbacks, and roadblocks. Getting lymphedema especially felt like the last straw.

I have to do everything I can to support my immune system and give my body what it needs to decrease the likelihood of the cancer coming back. That includes dealing with my anger, so I've scheduled an appointment with a psychotherapist.

Maybe a witch doctor next.

Side effects redux

Last week, my physical therapist took one look at the swelling in my left hand and sent me to the hospital's breast-cancer support facility. I was fitted with a compression sleeve and glove to help reduce the lymphedema which I now have developed, thanks to the surgery and the radiation.

The compression sleeve and glove are ugly. The packaging depicts smiling young women (who obviously have nothing wrong with them) seeming to delight in wearing these beige wonders. The reality is an old lady who can barely stand to look at herself in the mirror.

Then this week, my underarm area became red and painful… the radiation burn I had been warned might happen. And I still have ten more radiation treatments to go!

The radiation oncologist assured me that the "burn" is not bad by his standards, but told me it might get worse. He wants to see me again tomorrow.

And today I see the physical therapist again—this time for manual lymphatic drainage. This is a massage technique to move fluid to where it can drain. I hope it works.

Meanwhile, my neuropathy and leg cramps continue to be a problem.

Cancer treatment is so hard on the body. I just hope that I can gradually recover from the treatment… and that it has rid me of the disease.

Halfway

Today I had my fifteenth radiation treatment… the halfway point in the process. Each treatment is short (less than ten minutes); but getting to the clinic and back pretty much takes over my late afternoons.

The biggest challenge of the treatment is getting onto and off the equipment's "table." I sometimes experience vertigo when I lie down…a remnant of the injury to my head when a bicyclist knocked me down in October 2015. And sitting back up to get off the table is quite painful, because the medication I am on suppresses estrogen, which means I've lost some protection from arthritis inflammation.

I met with a new oncologist last week, as well as with my naturopath, and they suggested curcumin and tart cherry juice, which both have anti-inflammatory properties. So, I have two new things on my chart of medications and supplements. I hope they help, because I feel like the tin man in "The Wizard of Oz."

The axillary web syndrome ("cording"), which is a side effect of surgery, also started to flare up and interfere with my left arm's range of motion, despite doing my exercises. So I had another session with the physical therapist last week, and will continue to see her for at least several more weeks.

Honestly, cancer-treatment side effects are like a game of "Whack-a-Mole." I get one under control and another one pops up… and then one I thought was gone rears up again.

What with all the medical stuff, trekking around in hot weather, and a rather demanding schedule of work (both paid and volunteer), I hit a low point last week. By the time Friday night rolled around, I was totally exhausted and depressed.

Fortunately, the weekend was very pleasant. David and I spent time with family members on Saturday and had a really nice dinner on our wedding anniversary on Sunday.

And on the plus side, what with all the travel to medical appointments, I racked up so many trips on my transit card that I earned a monthly pass. I'm also getting a lot of reading done.

Getting zapped

I have had three radiation treatments, and so far, I am not glowing in the dark.

The process is weird. I have to lie on my back in exactly the same position each time. A form-fitted "beanbag" that was made during the simulation holds my upper body in place. My hands grip handles above my ears, which is somewhat uncomfortable, because of the scar tissue under my arm. 

A machine with several panels rotates around me, and I have to hold my breath for 15-20 seconds each time radiation is beamed at me. This keeps the radiation away from my heart. 

I am scheduled for a total of 30 radiation treatments, more than I was expecting; but the doctor changed his strategy to include more of the lymphatic system.

I have been warned that radiation treatment fatigues one, and I have definitely been quite tired; but part of that may be due simply to being out and about in the very hot weather we have been having. 

Between trekking to and from various medical appointments and doing all my assigned physical-therapy exercises, I haven't had a lot of fun lately. However, David, Pixie, and I did spend last Saturday at "Canines Uncorked," a winery tour to benefit the Oregon Humane Society. Fortunately, wine is among the things I can consume on the meal plan my naturopath recommended. 

Encounter with yet another machine

Yesterday I went through the radiation "simulation,"  the planning session that comes before the actual radiation treatment, which will begin next week. 

The "sim" was definitely a weird process. It involved a CT scan in a machine that looks like a big metal donut, and getting five small tattoos so that the doctor will know where to aim the radiation. (The tattoos do not feature any butterflies or Hell's Angels emblems; they are just small dots.)

I had to lie still for about 30 minutes or so, and it took a lot of adjustment of pads and a special body-conforming "bean-bag" to enable me to do that without pain in my back from my osteoarthritis. I also had an attack of vertigo…which is a recurring problem whenever I try to lie flat, ever since a bicyclist ran me down in October 2015.

Afterward, I had a meeting with my surgeon, who answered some questions for me. She confirmed that radiation can make the "cording" in my arm worse and and lead to lymphedema. To minimize the possibility, I need to continue with physical therapy and exercise. Also a distinct possibility is  radiation burns. Because I am the "queen of side effects" I figure I better be prepared for that. The doctor advised using pure aloe vera with no perfumes or such, so I have a week to track down some of that.

On Monday, I met with my oncologist one last time (she's retiring), and she stressed the importance of staying on the anti-estrogen pill Anastrozole indefinitely. At least it's inexpensive.

If everything goes OK, I won't be seeing either the surgeon or my new oncologist for several months. 

The "C Team"

Having cancer means seeing a lot of medical professionals. The past week has involved a second visit to the physical therapist and appointments with the radiation oncologist, the surgeon, and the naturopath. 

During my second PT visit, I received targeted massage on my arm, and was taken to the medical-supply shop to be fitted with a "compression bra." This is easily the ugliest piece of underwear I have ever owned, but it supposedly will help reduce a fluid-filled area in my breast that could cause problems with radiation therapy.

When I met with the radiation oncologist this week, I learned that area is called a "seroma," which for some reason triggered the memory of the song "My Sharona," which is actually kind of a creepy song… but I digress.

The physical therapy has helped a lot with restoring the range of motion of my left arm and reducing the slight swelling. The exercises that I do four times a day are deceptively simple and cause no pain… but they are evidently quite effective. I also have been using the elliptical machine in our apartment building's fitness room. Because there is a little TV on the equipment, I get to watch reruns of "Law and Order," cooking competitions, and sometimes even the news… which is my least favorite show.

Anyway, the radiologist and surgeon decided to delay my "simulation" (radiation planning session) until next week to give the seroma more time to shrink.

It is interesting that in all the talk of radiation treatment, there has been little information volunteered about the long-term effects. The naturopath told me that since my tissues are basically "cooked" during the process, cording, lymphedema, and loss of range of motion can be a problem weeks or months afterward. The best defense against this is exercise to keep the lymph system moving. So it looks like I will be spending a lot more time watching TV in the fitness room.

I retain my title as "Queen of Side Effects"

I was evaluated by a physical therapist and learned the name for my latest cancer-treatment side effect: axillary web syndrome (AWS), also known as "cording." 

It causes pain and tightness that makes it difficult to fully extend my left arm or to raise it. This is a side effect of the surgery I had to evaluate and remove lymph nodes. 

Here's some information I gathered from the breastcancer.org website: 

Researchers are still studying what exactly makes cording happen. Some experts believe that the surgery to the underarm and chest area traumatizes the connective tissue that encases nearby bundles of blood vessels, lymph vessels, and nerves. This trauma leads to inflammation, scarring, and eventually hardening of the tissue. This hardening can spread down the fibers of the connective tissue, which causes the cords to form. 

Aside from the obvious problem with being unable to function normally, the radiation therapy I am supposed to have requires that I have mobility in that arm and shoulder. I was supposed to start the radiation-treatment process next week, but now who knows?

Treatment for AWS includes doing specific exercises four times a day, getting more exercise overall, and specialized massage of the affected arm. I will be seeing the physical therapist once a week for as many as five weeks, depending on how I respond to treatment. 

This is all getting very old. 

Ouch

I had a follow-up appointment with the surgeon today. The incisions from surgery are healing fine; but I am having some problems with pain that limits the range of motion of my left arm and fluid retention at the surgical site. This is not unusual when lymph nodes have been removed, but somehow knowing that doesn't really make me feel better about it.

The doctor assigned me some exercises to do at home and wants me to start physical therapy as soon as possible. 

If the fluid does not absorb naturally over the next two weeks, however, the doctor will have to remove it via a needle/syringe. I fervently hope that is not necessary, because despite assurances that a local anesthetic will prevent the process from being painful, I remember all too well that was not the case in some of the other procedures I've had. 

So, the threat of yet another needle being jammed into my breast should keep me motivated to do those exercises!

I also learned that radiation treatment cannot begin until this excess fluid is gone, because the fluid can cause scar tissue to form that will permanently affect my arm's range of motion.

Seems like nothing in cancer treatment ever goes without a hitch of some kind.

Good news

My surgeon's assistant just called to tell me that the pathology report from this past Monday's surgery is in. The margins are clear, which means the surgery was successful in ridding me of known cancer cells.

This surgery was less invasive than the first round, but left me with some additional pain. I had a depressing few days in which I alternated between anger and depression; so it's good to finally get some good news.

Next up: A follow-up appointment with the surgeon next week and a planning session with the radiation oncologist on the 24th. Radiation treatments will likely be five days a week for six weeks.

Someone moved the goal post

David and I had a meeting with my surgeon, and she went over the pathology report in detail. To make a long story short, microscopic cancer cells were found at the margin of the tumor that was removed. This means that some got left behind and are lurking in the wings.

Although (to put it mildly) I am not happy about it, I will go back to the hospital next Monday to have more tissue removed. With any luck, the next pathology report will not indicate the need for even more surgery. 

I asked the doctor why cancer cells get missed and she explained that there is no visual evidence of microscopic cells, so the surgeon has to rely on imaging technology and some guesswork. It also isn't currently possible to freeze and dissect breast tissue during surgery for microscopic pathology. Hence the wait for a report that takes about a week. (I hope some researchers are working on a way to get accurate pathology during surgery! It would save so much anxiety as well as the cost of follow-up surgeries.)

So, just as I was thinking I had the goal post in sight, it got moved. I will need more time for healing and radiation treatment will no doubt be delayed by a week or more. 

My main problem at this point is that I am at a low point emotionally. I steeled myself for the surgery last week and the accompanying procedures and once all that was over, I was focused on healing and rebuilding my strength before the radiation treatments. To be thrown back a step just hit me very hard. 

Once again I have been reminded that trying to make plans around a treatment schedule is just about impossible because of all the unexpected setbacks and surprises. I'm canceling out of next week's activities, renegotiating some commitments, and filling my waking hours with as much distracting activity as possible. 

On the plus side, I have received many messages of support and encouragement, and I am grateful for all the positive energy that is being sent in my direction. 

More surgery on my horizon

The pathology report is not great. 

There were cancer cells at the margin of the removed tumor, so I have to go back for more  surgery. 

When I asked about the likelihood of this beforehand I was told the chances were small. Once again I have fallen into the minority. The surgery has to be asap, before healing creates scar tissue.

There was some better news about the lymph nodes. More surgery in that area will not be needed.

After I got off the phone with the doctor I had a panic attack. I was unable to tell David anything, so he called the doctor's office to get the report himself. In the meantime l took a Valium tablet and reached a state of numb depression.

Rhymes with "witch"

The first couple days after surgery went OK, but after all the anesthetics were out of my system, I had a bad day. It started by waking from a terrifying nightmare in which I was dying. Despite the pain pills, the incision sites hurt and my left arm was alternating between stabbing pains and numbness. My throat was sore. The drainage tube from the underarm incision kept clogging up. I was in an absolutely foul mood and utterly disgusted with my body and this whole treatment process. 

I was, in a word, miserable and miserable to be around.

David managed to get me an appointment with my surgeon this morning and after evaluating the situation, she OK'd removal of the drain. What a huge relief it is to be rid of that thing! I have been using small ice packs on the most bothersome incision site, and they help a lot. The pain is much less now, and I am trying to avoid taking any more Hydrocodone. 

I was hoping we would have the pathology results by now, as was my doctor; but she said they are still not in. So, more waiting for "the other shoe to drop."

David's working this afternoon and evening and I am sure he is very happy to be away from me for a while. I plan to spend this time alone reading, watching videos, and adjusting my attitude.

Surgery went OK

My surgery went about as expected. The whole process took about 8 hours, from the time I arrived at the hospital and the time they sent me home. 

Although, I expected to be in a total panic before surgery, Valium and some meditation kept that at bay.  

The only unexpected turn of events was that the surgeon removed many more lymph nodes than she was expecting to, because the sentinel node biopsy done during surgery indicated some abnormal cells. Everything has been sent to the lab and the complete pathology report should be back later this week. Of course, I am hoping that it won't show anything that will require more surgery!

I am experiencing some pain at the incision sites, but I'm taking pain medication and using ice packs, so it's all manageable. No nausea or headache from the anesthesia. Yay!

Next week I have follow-up appointments with the surgeon, the oncologist, and the naturopath. (Too bad no one gives "frequent flyer" awards.)

Then I have a break until I go back to the radiation oncologist in July to determine the exact course of treatment based on the pathology results. (It will probably be six weeks of treatment, five days a week)

All in all, it's just a huge relief to be through this latest "medical adventure." 

Thanks for all the good wishes, prayer, or whatever good juju you send my way!

Countdown to surgery

My latest lab tests came back without all the red flags this time, so surgery on June 19 is a go. 

A lumpectomy is considered an outpatient procedure; so I will be home that same day. I expect to be pretty groggy and my surgeon prescribed some pain medication, which is also supposed to make me groggy; so it will probably be a few days after that when I update this blog.

I spent some time with the radiation oncologist this past week, getting a lot of information. I am not happy about being blasted with radiation five days a week for five to six weeks; but lumpectomy without radiation would leave me with a 40% chance of cancer coming back. The odds drop to 10% with radiation (same as if I had a mastectomy). That treatment will start a month after surgery and the exact details will be determined after the surgical pathology report. Short-term side effects are supposedly not awful…a "sunburn" on the skin and fatigue, especially toward the end of the treatment. Long-term effects can be a bit more serious, with possible lung and heart damage. The doctor is confident he can avoid heart damage with careful aiming of the rays, and says any decrease in lung capacity will be minimal and not noticeable. I sure hope he is right!

By the time I have finished treatment, I will have spent a year dealing with this cancer… which is what everyone warned me would be the case. And after that, I still have to have oral medication and twice-yearly checkups; so it's really never over. Having cancer strikes me as similar to being an alcoholic. Instead of going to AA meetings, one goes in for regular checkups and counts the months and years of being cancer-free. 

To deal with the pre-surgery anxiety, I am following my naturopath's recommendation to stay very busy. I have been filling every waking minute with activity, and I still have a long list of things to do…some of which will probably not get done. Seems like the time is going very fast, and I hope that applies to the day of surgery, too! 

Dealing with anxiety

David and I met with my surgeon last week to have blood drawn for analysis and to go over the details of my June 19 "medical adventure" when I will undergo various unpleasant procedures, culminating in surgery. 

This is assuming the date for surgery does not change. This latest blood panel came in "abnormal" on just about every test. My oncologist wants me to have another blood panel later this week to see if the results were in error or reflect real problems that would require rescheduling surgery.

Quite frankly, the more I know about what will be done to me, the more anxious I become. I had a truly terrifying nightmare last night about a gang slashing me with long knives.

I asked about taking Valium before surgery and got the OK for that. I also met with my naturopath to see if there is anything else I can do to prepare myself and deal with my anxiety. He advised me to fill every waking hour with activity…to focus on anything and everything that has nothing to do with the upcoming surgery. He also gave me a supplement that will help me heal with minimal scar tissue.

I bought a diffuser and aromatherapy oils that are supposed to relieve stress and relax me. I am also working out in our building's fitness center several days a week and am sticking with my no-grains-or grain-products and no-added-sugar diet. (I have dropped 11 of the 28 pounds I needed to lose to get to the ideal weight for my height and bone structure.) 

My hair continues to slowly grow back. There is enough of it now that I am going out without a scarf or wig… but I look forward to the day when it is more than one inch long! The color has not changed from its white and gray, but my normally straight hair is wavy now…something that is evidently common after chemo.

Mostly, I feel OK physically; but the emotional load feels heavy. I still have a lot to deal with—surgery, radiation, physical therapy, years of medication, and twice-yearly screenings. Cancer will affect the rest of my life, and that's a sobering reality. I realize how many people I know who are on the same journey, and I certainly hope that the current research will improve both the prevention and treatment of this disease for future generations. 

Ringing the bell on chemo

This past Monday was my 11th and last chemotherapy treatment. At the end, the nurse handed me a beautiful Tibetan bell to ring, which is a custom at the clinic when a person has her or his final treatment. It was a very nice feeling to ring that bell.

When I got home I was feeling a bit queasy. Up to this point, there was one chemo side effect that I had escaped. Well, forget that. I had the most horrible diarrhea all evening. Even prep for a colonoscopy wasn't as bad as this. When it finally subsided around 9 p.m., I was too exhausted to do anything but fall asleep. I was still feeling a bit sick to my stomach the next day; but seem to be OK now.

I met with my oncologist before my chemo treatment, and asked her a lot of questions about surgery and follow-up radiation and medication. She confirmed that a lumpectomy followed by radiation gives the same result as a mastectomy…reducing the chances of recurrence to 10%. We discussed the side effects and risks. I've decided to go with the lumpectomy.

My surgery is scheduled for June 19. The plan is to get me in at the crack of dawn, subject me to some unpleasant procedures, render me unconscious, remove the remnants of the tumor, check my lymph nodes and remove one or two of those, sew up the wounds, and send me home by the end of the day. If any complications arise, David will have to take me back to the hospital. God forbid that I should have professional care overnight. Might cut into the insurance company's profits.

I have a few weeks to heal and will then start radiation treatments five days a week for six weeks. That is going to be soooo convenient.

I admit to feeling some anxiety over the surgery. It seems that I am constantly running into reminders of death. I was waiting for a streetcar the other day, for example, when I noticed a newspaper box for the The Portland Mercury, which had a cover story on "How to Die in Portland." Then we saw a film in which Bill Paxton was one of the actors, and I remembered that he died this year from complications following surgery. I opened the newspaper and saw two obituaries for women who have died of breast cancer. The rational side of me says I don't have a lot to worry about, and I have been doing my best to keep a positive attitude and build up my strength. (I finally went back to the gym this past week.) But I feel that I have to take care of some things like updating my will and organizing a list of all my various financial accounts and explaining them to David.

On the other hand, I have started working on a client's newsletter that I will publish in July, organizing a silent auction that will take place in August, and thinking about where to go on a "road trip" in September so it's not like I am steeped in gloom. It's just this sense of a cloud hanging over me.

The choices all suck

This past Friday, I met with a surgeon to discuss "what comes next." She answered all my questions about the various options and gave me a lot of information.

My choices come down to a lumpectomy to remove the remnants of the tumor, some surrounding tissue, and 2-3 lymph nodes-- or a mastectomy to remove the whole breast and 2-3 lymph nodes. We also discussed the possibility of a double mastectomy and reconstructive surgery. If I have the lumpectomy, I also would get six weeks of daily radiation treatment. With a mastectomy, radiation may or not be on the agenda, depending on what is going on with the lymph nodes. 

All the options basically suck.

I asked her which option she would advise and she said the choice has to be mine, because it's really more of a psychological than a medical decision. With the kind of breast cancer I have, statistically the outcomes are about the same in regard to chances of recurrence and survival rates.

So, I jokingly told her I would get back to her after I go to medical school for four years. 

Whichever way I go, I will also be taking oral medication for the next five years … the main side effect of which is hot flashes, which I already have had too much experience with. And I will have to go in for check ups every six months. So even after all the chemo and surgery, cancer will continue to be the Sword of Damocles hanging over my head.

I have my final chemo treatment coming up on May 22, and I can't have surgery until my white blood count rebounds from that, so I have some time to mull over the various unsavory options. 

On the plus side, I feel pretty good physically, except for some lingering neuropathy and ankle/foot edema. The vegetable-intense diet, glucosamine, vitamin-B supplements, and daily walks all help me feel like I am actually doing something, rather than just having things done to me.

A birthday gift

Some good news!

Yesterday was my birthday, and I was not thrilled by having to report for a chemotherapy infusion first thing in the morning. However, my oncologist gave me a nice gift: a very encouraging report on the MRI I had last week.

The report said that the two areas that had definitely shown cancer were "no longer visualized" and "known malignancy within the left breast has resolved following neoadjuvant chemotherapy." In other words, the chemo did what is supposed to.

I was more or less stunned. My husband was so overwhelmed, he cried. 

There are two other "non-mass enhancements" that did not test positive for cancer when the needle biopsy was done last year. But continued follow-up is recommended, and that will include a consultation with a surgeon on May 12, when I will learn a lot more about what comes next.

I also will have one more chemo treatment in four weeks, finishing out the six CMF infusions.

So, this is not over, but things are definitely moving in the right direction.

The rest of my birthday was, of course, pretty darn happy.

MRI again … and adjusting to the new diet

I had my third MRI. My oncologist wants to determine how much effect the chemo has had since my last MRI three months ago and an ultrasound doesn't give her enough information. I will review the results with the doctor next Monday and we will decide whether or not to continue chemo treatments.

An MRI is a rather tedious and unpleasant experience. The noise the machine makes is loud, but I can deal with that. However, being face down for quite a while is awkward and hard on my ribs. It helped that I took a Valium beforehand. 

My new dietary regimen is paying off. I have lost several pounds in the past ten days, which should move me toward my goals: reduction of blood sugar, inflammation, chemo side-effects, and ankle-swelling; and overall improvement of my health. 

Of course, I am not thrilled with all the extra food prep that avoidance of all processed food entails, but it helps that I have stocked up on a lot of vegetables and fruits, as well as things like kefir and cheese and raw nuts. 

To help me decide what to prepare, I picked up a copy of "Good Food, Great Medicine" by Miles Hassell MD, and Mea Hassel. It has a lot of information about nutrition and also a lot of recipes. (I made a cauliflower custard that was really good.)

The biggest challenge is avoiding grain products. Eventually I can add whole grains back into my meals, but treats like cookies and muffins will be few and far between. My birthday cake this year may exist only in my imagination.