First day of prep

Now I really feel that things have started moving (darn it; considering tomorrow, that's not what I mean). But the countdown has definitely started. Today I'm on what Jerry is calling the Trailer Trash diet: no fruit, veggies, or complex carbs, just fish, poultry and eggs, dairy, and white bread and pasta with no tomato sauce. I'm thinking of an aioli to go on the pasta. Garlic isn't a veggie, is it? Tomorrow is clear liquids and the trip to Lebanon.

So here's how I'm visualizing things:
Laydeez and gentlemen, in this corner we have Pancreatic Cancer. Big, mean, nasty, seldom loses a fight. You may think you have it beaten, but it'll pop back up for more. Full of dirty tricks. Its reputation is enough to terrorize the unwary.

In the other corner... Lucie, looking pretty wimpy in comparison.
But that's if you don't look at what she has on her side. I know I've posted lists like this before, but this bears repeating, especially right now.
*Otherwise good health. No problems with diabetes, cholesterol, blood pressure, or anything else I can think of, except for a touch of hypermobility syndrome. Normal weight (haven't gained over the past few weeks, but haven't lost, either) Healthy diet, recent exercise program (back up to 1/2 hour swimming or on the exercise bike). Regular meditation. Basically, I feel as healthy as I have for years.
*Top medical care which I trust. Logistical and financial access, no worries about getting the care. I went through the chemo/radiation, special protocol, with no problems. (Dartmouth-Hitchcock research shows that doing the chemo and radiation before surgery increases chances that the cancer won't come back) Stent inserted and replaced twice without trouble. The surgeon at DHMC has done over 250 Whipples; when we talked with him at the beginning of this month he'd already done 16 this year. (Success of the procedure is directly correlated with number the surgeon has done) A nurse in his OR said he has a reputation for being meticulous and insisting on total competence from everyone in the OR.
*I can never say it too many times. Support from family, friends, people I don't even know but wish I did. Your good wishes, prayers, thoughts. I feel as though I'm going down some scary rapids, but cradled in your hands.
*Jerry, always in a category of his own.
*Attitude. This is a hard one to talk about, because sometimes I feel as though I'm walking a narrow line between Pollyanna/denial and an honest appreciation of all of the above.

When you look at it closely, it doesn't seem like a fair fight, does it? Now imagine Pancreatic Cancer slinking back to its lair, defeated, while we all cheer and John Williams's music rises in the background.

Great weekend, but back to the real world

In fact, it would be hard to think of a better weekend as we look forward to the next week. We went to our favorite inn in VT, Abbott's Glen: it was peaceful and beautiful, and as usual we were spoiled with delicious food, interesting fellow guests, a great massage, and beautiful weather during the day. Saturday night there was a dramatic thunderstorm which I enjoyed from the comfort of our room, sparing some sympathy for the campers out in the middle of it.
It was a time away from time, but now we're back, and what a moment ago was three weeks is now down to three days. The surgery is on Friday, but Thursday we'll go up to Lebanon in plenty of time for me to do the bowel cleanse (yuck)without having to stop by the side of the highway.
For anyone who doesn't know DH-Lebanon, it's a major teaching hospital connected to Dartmouth College. Here's how it looks from the outside:

From the inside, it looks like a hospital, except that there are several grand pianos scattered around. To Jerry's annoyance they all are locked, but on the other hand, he's going to have plenty of time on Friday. I have faith in him.
I'm busy with my list-making (hand cream, dental floss; check to see if the wifi works on the laptop; borrow the complete Number One Ladies' Detective Agency and the last Harry Potter) and with worrying about Jerry. He asked me rather wistfully if I'd show him how to run the washing machine.
And what will he eat? He's a wonderful cook, but just isn't inspired when he's alone. I guess he could get takeout from the sushi place down the hill, but then I'll worry about his getting scurvy or weird intestinal parasites from all that raw fish.
What it comes down to is that it's easier to worry about him than me.

Cancer and Heart Disease

I've read that cancer has now overtaken heart disease as the leading cause of death in younger people. Of course, the article defined "younger people" as those under 85, which is encouraging to some of us. But up until recently, most of you reading this would have been more likely to die of heart disease than cancer.
So why is cancer so much more frightening? Just look at popular entertainment. Once you're past the testosterone flicks, where people die of car crashes or being blown up in various imaginative ways, it's always cancer, with Alzheimers and AIDS a distant second. In chickbooks or flicks, cancer is the disease of choice to off spunky middle-aged women who might otherwise take over the plot. People only die of heart attacks in books when the author wants to get rid of them quickly.
Do I sound paranoid? Jerry is used to my suddenly screaming obscenities and throwing my book across the room, and just asks with mild interest, "Another one?"
I was talking about this cancer bias with another survivor, and we agreed that part of the reason is that heart attacks are just that: attacks that can come without warning. Boom. "I didn't even know he was sick." We're all aware of heart disease, but we have an illusion of control: we get our cholesterol checked, maybe take statins and low-dose aspirin, try to remember to get some aerobic exercise regularly and we'll probably be okay.
Cancer, on the other hand, sneaks up on you. In the popular medical literature, though thankfully not among my friends, there is a kind of blaming the victim. "Most cancers are due to lifestyle" -- and let me tell you, considering what my lifestyle has been, there are a lot of people out there who by rights ought to be toast by now.
Besides, it takes a long time to get treatment, and the treatments can be costly and nasty, leaving the person bald and sickly-looking. Someone on a treatment regimen for heart disease, on the other hand, loses weight, quits smoking, and quickly starts looking better. Even the surgical options are unfair. A mastectomy is a lot more disfiguring than a by-pass.
So it's no wonder that cancer scares people more than heart disease. It sneaks up and is suddenly in your face. People hearing about it don't quite know what to say.
But once you're in it and have accepted your lot--whatever it is--it's just what is, and you deal with it. Fortunately, I have a dedicated group of friends and relatives to help me. And their support has made the journey,so far, doable.

Things continue well. Recipe.

Saw the oncologist today, and he continues to be upbeat about my status. Among the big, serious questions we had for him was whether I could eat sushi, and he said that my white blood count is so high that there wouldn't be any danger in it, though he had the look on his face as though he wondered why on earth I'd want to. I've only lost half a pound over the past few weeks (more ice cream needed), and the oncologist seems to think that I'm in as good shape as we could ask for going in for the surgery. So Jerry and I are encouraged (not to mention scared shitless at the thought of the surgery, but This is a Good Thing, considering that the prep for the Whipple is like the prep for a colonoscopy).
Leaving those thoughts aside, I am following the advice of a Whipple survivor on one of the pancreatic cancer forums: he said that it's all well and good to eat healthy food as I prepare, but that for the next two weeks I should include all the foods I love, since I'm sure not going to love them for a while post-surgery, and it's good to have good memories.
That being the case, I cooked (and ate some of) a lamb roast for Jerry, Max, and Anya yesterday. Jerry kept wondering why we ever became partial vegetarians and Anya said she loved the sauce. So, this is for Anya:
Mouton Moutarde
Preheat oven to 325

leg of lamb, 3-5 pounds
good mustard
dark brown sugar

Spice mixture:
1/2- 2 t each of ground ginger and cinnamon
1/4- 1/2 t each of nutmeg, ground coriander, ground cardamom
pinch allspice

for basting:
1 - 2 c coffee

for sauce:
2 t cornstarch dissolved in 2 t water
about 1/2 c currant jelly (or grape)

Spread the lamb thickly with first the mustard, then the brown sugar. Mix the spices and sprinkle all over the lamb. Put the pan uncovered in the preheated oven. After about 15 minutes, baste with the coffee, and after that baste every 15 minutes or so with the pan juices. Roast the lamb until it's to your taste (we like it rare, at 135 internal temp, about 30 min/pound).
While it rests, thicken the pan juices with the cornstarch-water mixture, then add the jelly. If you don't have currant jelly and have to use the grape, you might want to add a squirt of lemon juice. Serve the sauce separately.
Recipe adapted from Elsie Lee's Second Easy Gourmet Cookbook, 1968 and probably long out of print.

Getting information

I guess it's my Control Mode reaction, but I need to know as much as possible about what's going to happen. It probably started with all the traveling I did when I was young. As soon as we knew where we were going next, the family began reading travel books and novels set in the place, and finding people from there or who had at least passed through in order to grill them about their experiences. That's how at a very young age I knew about the canals of Holland, the escolas de samba of Rio de Janeiro, and the reforms of Mustafa Kemal Ataturk in Turkey.
It's the same with medical procedures. Jerry says that I just want to know everything so that if the surgeon keels over with a heart attack in the middle of the procedure I can take over and finish up for him. Or maybe it's just that if I know what's going to happen, I have faith that that's what will happen, and everything will go right.
Google Whipple Surgery and you'll get more than you probably want to know about it. Fascinating stuff. They need to get part of the stomach, the affected part of the pancreas, the gall bladder (if it's still there; mine isn't), and part of the duodenum. Then they have to sew everything back together so there are no loose ends.
Today I was lucky enough to talk with a friend who had the Whipple at DH-Lebanon in January. She looks good and apparently feels good, though she said that she'd lost over 20 pounds and was having trouble gaining any back. She told me what to expect after the procedure (a lot of feeling fuzzy and unwilling to move around). She said that I'll be on nothing but IVs for several days, moving up to clear liquids for several more, and finally real food just before I leave the hospital. She warned that I probably won't be able to wear anything around the waist for several weeks because of the incision. She also warned about the various drains and tubes which will still be coming out of me when I come home. And more.
Just seeing her and talking with her was encouraging. Besides, now I have just a little bit more control.

A good time/place to be in

No matter what else is going on, I love this time of year. The strawberries are past, but our blueberries are just about to come on; the question is whether the wild turkeys will leave us any. We're eating lettuce, greens, and summer squash from the garden, and keeping watch on the first tomato as it turns orange and then red. It's hot enough for occasional trips to Stone Pond to lie on the beach and swim. Life doesn't get much better than this.
Besides that, physically I feel completely normal. I can eat about anything I want, though not a lot at a time. Seems like I'm always eating. Jerry does his bit, hovering over me like a mama bird and suggesting ice cream at frequent intervals.
The exercise program, which sounds more strenuous than it really is, is going pretty well (reminder to self: next time you plan swimming, check to see if the pool is actually open before you arrive), and I feel less saggy and withered than I did a couple of weeks ago.
And my hair is growing. I can go out in public without a headwrap now, though I think I look like a cross between a Buddhist monk and my bald uncle, though neither of them would wear earrings.
Speaking of Buddhist monks, my mantra these days is a variation of a Thich Nhat Han one: Breathing in, I smile. Breathing out, I am content. Breathing in, I am here and now. Breathing out, it is wonderful.

Suggestions for the hospital stay?

As part of getting all the ducks lined up for my stay in the hospital, I'd appreciate your suggestions on what to take, what to plan for, what to read, and what to do while I'm there.
Jerry remembers his stay in the hospital after his heart valve surgery as being incredibly boring. The high points were when I played Scrabble with him (well, of course), and a low point was when he listened to "Glitter and be Gay" from Candide and it became an earworm that repeated itself endlessly through a very long night. After that I plan to take nothing but forgettable music along.
But what else? I want something to read that will keep me busy and my mind occupied but that won't challenge me too much (not too many plot twists or characters to keep straight). This is complicated by my being a speed-reader (literally. I once got a job teaching speed reading and went through their training just before the outfit went bankrupt), and even on painkillers I can get through thick books quickly.
But what else? Like taking Miles-the-grandson on a trip, I'd rather have too many toys than lie around whining, "Are we the-e-e-re yet?"

And a quick story from Jerry's surgery: we were in asking the last pre-op questions, and Jerry said, "So, doctor, how soon afterwards will I be able to -- "
He paused, the doctor looked over at me with a knowing smile, and Jerry continued, "Play the bassoon?"
Without missing a beat the doctor said, "Two weeks." But after the surgery, during rounds when all the residents follow the doctor in they'd check their notes and instead of identifying him as "the valve job" they'd mutter to each other, "Oh, yes, the bassoon player."