1/31/20: Physical Therapy Appointment #17

Today's appointment went well. I find these weekly appointments reassuring. I like knowing that I have someone to check in with regarding anything new that might come up. Of course the ultimate goal is to be released from all these appointments, but right now, it's comforting to have them as part of my routine.

I told my physical therapist about how sometimes only the pinky and ring finger get numb and tingly on my left hand. Apparently those two fingers are related to the ulnar nerve. She gave me a new nerve glide exercise to do, but I should only do it if I continue to feel numb and tingly in just those two fingers. She said exercising the nerves too much can actually irritate the nerve and make symptoms worse.

I mentioned my theory about why I suddenly have these symptoms, and she said it's very typical for cancer patients - especially women with kids - to jump too quickly back into old routines, causing set-backs. I said I was mentally prepared for all the side effect during chemo, but didn't expect to feel so poorly even after chemo ended. She said chemo can actually advance the aging process, and regular exercise is the best way to help combat that possibility.

She worked on my cording, and again, it helped a lot! This is what it looks like now. (It's quite a bit more extensive than at first.)

The "cord" runs in a straight line from my armpit through the inside of my elbow up to my inner wrist (the same side as my thumb). I can sometimes feel a "pull" along the cord, usually near my wrist, even though that's where it's least visible. It's most palpable in the armpit, where it feels like a taut wire under the skin. Actually, in the armpit, it has kind of a webbed look, which I guess is why cording is also called axillary web syndrome.

1/30/20: My Hands Continue to Have Symptoms

Another week of paying very close attention to my hands and arms. When I wake up, I'm in 1 of 3 possible states:

• Guarded - My hands feel "puffy and tight", and it can be hard to make a fist. This state can take several hours to wear off.
• Moderate Alert - My hands feel "numb and tingly and puffy and tight" a.k.a. "weird". Sometimes only a couple fingers (usually the pinky and ring finger) feel tingly.
• High Alert - One or both hands feel like they "fell asleep". This feeling can sometimes also be limited to just a couple fingers. It's worrisome. I basically can't use my hands. 

In each state, the goal is to improve the status, or at least not make it worse. I need to get up, walk around, swing and stretch my arms. I have to avoid gripping things (e.g., cell phone, knife, toothbrush), which can trigger the next worse state.

I've started a new morning routine that includes arm and shoulder exercises (arm swings, arm circles, shoulder rolls, head rolls), the nerve glide exercises from my physical therapist, and rubbing each arm with moisturizer. My hands and arms definitely feel better after going through all that.

I have a theory about why I'm experiencing this weird arm swelling and nerve-related numbness and tingling. All the symptoms came on after school was back in session (after the holiday break), and after I started driving my dad to radiation daily. Up until then, from surgery through chemo, I was really taking it easy; Ken and the kids helped with household chores, and I only did light driving. For some reason (I think I felt like I ought to be getting back to "normal" by now), when we picked back up after the holidays, I jumped in with full pre-surgery routines, plus I'm driving my dad every day. (It's worth noting that when I drive, I still can't turn the steering wheel hand-over-hand without feeling some discomfort.) I think my arms are swelling from being over-used. Also, my chest and underarms were already feeling "weird", presumably from nerve regeneration. So maybe those two things combined - swelling causing pressure on my nerves - is what I am feeling. I don't know. Just an idea.

Unrelatedly, but for the record, I'm still losing hair. My eyebrows are almost gone, I've got just a few hairs hanging on. So weird. Interestingly, though, eyebrow hair must grow quickly, because I can already see tiny new hairs coming in.

1/24/19: Lupron + Physical Therapy Appointment #16

Since I only needed a shot today, I expected to be in and out of my nurse appointment in a matter of minutes. It turned out to be almost half an hour, in a good way.

The medical assistant took my vitals as usual, then walked me to a bay.

I had to wait a bit for my infusion nurse, and then I was pleasantly surprised when my nurse took the time to ask me for an update on my hands feeling numb, tingly, puffy, and "tight". Not sure how to summarize all that into one word, as it's really all those feelings at once; I'll just say it feels "weird".

I've been paying close attention all week. I'm most worried when it feels like it's "asleep". This feeling can last as long as 20 minutes, and I get nervous about permanent damage. Even when the "asleep" feeling wears off, the "weird" feeling can last a couple hours.

Things I've noticed this week:

• Every morning I've woken up to one or both hands feeling weird or asleep.
• If my hands feel weird, using my cell phone before getting out of bed can trigger it to feel asleep. Not sure if this is related to my elbow bending, or my hands gripping the phone.
• If my hands feel asleep, the feeling won't go away on its own. I have to get out of bed, walk around, stretch and swing my arms.
• If my hands feel weird, actions like using a knife or a spatula while making breakfast will make it worse, including feelings of pain and weakness. I have to stop and shake my hands out before being able to continue.
• If I sleep with my forearms propped up on pillows, in a "natural" position, it's possible to wake up without my hands feeling asleep. But they'll still feel weird.
• Getting out of bed immediately to walk around, stretch and swing my arms, seems to help. I feel like I'm warding off the asleep feeling. 

My nurse said walking around might be helping with my blood and/or lymph circulation. She suggested having a kind of arm exercise routine to do first thing every morning. She also suggested asking my physical therapist if I should consider wearing some kind of sleeve, not exactly a compression sleeve, but maybe something like arm warmers.

So the shot itself took only a minute, and the rest of the time was spent talking about all that.

I had my physical therapy appointment right after, and basically went over everything again with my physical therapist.

My physical therapist figured it's nerve related. She stretched each arm in three specific ways to see which positions might trigger the weird feeling. It was hard to tell because my hands were still feeling weird from this morning's episode, but definitely a couple positions made it worse. She also moved my head and neck in specific ways, but none of those positions triggered any weird feelings.

She gave me "nerve glide exercises" to help release any pressure on my nerves. Not these exactly, but along those lines.

Regarding my nurse's sleeve suggestion, she said it probably wouldn't hurt to try it, but wearing something tight on my arms, and not my hands, might actually make my hands feel worse.

It occurs to me that if these problems are nerve-related, then maybe it's a side effect of the double mastectomy, not any of my medications. But why now, 5 months later? Maybe some nerves are having trouble growing back?

Anyway, my physical therapist also worked on my cording, and it helped a lot!

I have to say, I'm kind of annoyed at this "two steps forward, one step back" kind of progress. I'm moving forward in my treatment schedule, and my cording finally seems to be improving, but now I'm hit with this very concerning numbness and tingling and swelling in my hands.

1/17/20: (1 Month Post-Chemo, 5 Months Post-DMX) Side Effects and Symptoms

Both my cancers were hormone receptor-positive, which means estrogen and progesterone fueled their growth. Chemotherapy was supposed to kill any existing cancer cells that may have escaped from the tumors, but there's always a chance that whatever conditions in my body that produced the cancer cells in the first place still remain, and so could produce a new cancer. My hormone therapy is supposed to prevent recurrence; the goal is basically to eliminate the presence of estrogen, so there won't be any estrogen to fuel any new cancer growth.

My monthy injection of Lupron is for ovarian suppression; it stops my ovaries from making estrogen (and puts me into a chemically-induced menopause). However, other parts of the body also produce estrogen. So today my medical oncologist prescribed exemestane, a daily aromatase inhibitor pill that will stop any remaining production of estrogen.

I seem to have a compulsion for tracking my side effects and symptoms. So before I take my first exemestane pill tonight, I wanted to record my current baseline of how I'm doing.

It's been about a month since my last chemo infusion, and since then, I've been on just Herceptin and Lupron.

Interestingly, even after chemo ended, I continued to lose body hair, like on my legs and in my armpits. Like the hair on my head, though, it's not complete hair loss, so a few hairs remain.

Meanwhile, the hair on my head has started to grow back. I can see tiny new hairs interspersed with the slightly longer hairs that grew from shaved hair that never fell out.

I stopped noticing blood in my nose about 2 weeks after chemo ended. My sense of taste also seems to have fully recovered.

My eyesight still feels off. The blurriness isn't quite as bad as before, but it's still there.

The acne hasn't really gone away, either, but it's improving.

My belly still feels flabby. I remember being told that menopause makes losing weight more difficult. I haven't made a conscious effort to lose weight yet, though I am about 5 pounds heavier than I was before chemo.

I'm not as tired anymore, as evidenced by my ability to stay up past 9:00 pm on a regular basis. Also, during chemo, I almost always needed to lie down at some point in the late afternoon, but I haven't been doing that lately. (Perhaps relatedly, I've started to drink coffee again, and usually have a cup in the mid-afternoon.)

At 5 months out from my DMX, my chest and right underarm still feel weird, but to an even greater extent than before. The areas are still numb, but also tingly, especially when touched, and my chest actually feels tighter. I think this is what others refer to as the "iron bra" feeling. My upper right arm, particularly around the underarm area, sometimes feels like pins and needles. I wonder if all the increased sensations means that some of the nerves are growing back. And/or maybe I need to do my stretches more frequently and/or consistently.

The cording persists. It comes and goes, but is overall worse than it was at first.

For the record, the stitch that poked out from one of my incisions is finally gone. It was significantly smaller and less noticeable about a month after I first discovered it, but it took over 2 months to fully go away. Now there is a tiny hole where the stitch used to be. I'm assuming it will close up in time.

Recently I've noticed a couple new side effects / symptoms, as I reported to my medical oncologist today. There's the leg stiffness that I first noticed a couple weeks ago, and also the numbness and tingling in my fingers and swelling of my arms (possibly fluid retention) that just started this week.

Geez. When I lay it all out like that, it's depressing. I can hardly recognize my own body. It's hard to believe that one year ago, I felt perfectly healthy. Now, is there even a single part of my body that's come through cancer treatment unscathed?

Honestly, when I think about it, I think my ears, and my sense of hearing, are literally the only things that have not been affected.

From another perspective, of course, I know I'm lucky. I'm still here, and my prognosis is good.

1/17/20: I Called My Social Worker

Since I didn't see my social worker during my visit to the Cancer Center today, I gave her a call this afternoon to thank her for calling me the other day.

It was a brief phone call, but even in that short amount of time, she helped me to feel supported.

She said she wasn't able to come by during my appointment time today, but she checked in with my infusion nurse, who told her about my dad being in active cancer treatment. She was very sympathetic about how many Big Things I am dealing with all at the same time.

I told her how not many people know the full extent of everything that's on my plate. I mean, first with the breast cancer, then with the loss of my mom, and now my father has cancer, too? It's just a bit much. Like how much more sympathy or support can I expect from people?

My social worker completely validated my feelings. Just hearing someone else say that they think I have a lot going on made me feel seen and understood. She said again that I can make an appointment with her to talk things through, if that's something I think might help. I appreciate that she was very careful to not insist on an appointment, but just wanted to remind me that that option exists. 

I told her that I am definitely aware that I need time to process everything. She, and others, have talked about how, sometimes, the hardest part of cancer treatment is when it's over. My last chemo was December 20, the last day of school before 2 weeks of school vacation, and I had been looking forward to having 2 weeks of low-key down time to focus on myself and how cancer and cancer treatment have affected me. Well, I didn't get the time that I expected, so I'm going to have to look ahead to set aside some time later. In the meantime, I just need to keep my head down, and take life one day at a time.

So I didn't schedule an appointment with her yet, but it helps just knowing that I have a kind of safety net; if I get to feeling overwhelmed, I know I can reach out to my social worker.

1/17/20: I Picked Up a Prescription

My medical oncologist prescribed a generic exemestane. To my surprise, there was no co-pay for the 3-month supply. The retail price was $1,499.99. I'll never understand drug pricing.

Total cost to date: $188,464.58

With insurance, cost to me: $4,229.43

1/17/20: Maintenance Herceptin #2 + Medical Oncologist Appointment + Physical Therapy Appointment #15

Port Access and Blood Draw Appointment

I saw my port nurse at 11:00 to get my port accessed and blood drawn. I told her about the interventional radiologist not wanting to re-open and re-suture the port incision. She nodded her head decisively and said she agreed. I mentioned how I just hope they can get a clean closure when my port comes out, and she suggested I ask about whether or not a plastic surgeon could do it. I don't know how the scheduling works for these port appointments, but I guess it wouldn't hurt to ask, when the time comes.

Medical Oncologist Appointment

After a little wait, a medical assistant took my vitals, and I was taken to an exam room to wait for the medical oncologist who was filling in for my regular oncologist, who was out sick. The substitute doctor was young and friendly.

She asked me generally how I'm doing, so I jumped into two recent concerns I've had. First, a couple weeks ago, I noticed my legs feeling tired and stiff. Literally any and every time I shift my leg position, or stretch them out in any way, I think, "Wow, that feels good, I really needed that." I mean, maybe it's just aging, but it seems a bit much for 43 years old. The doctor said she's about my age, and kind of laughed at the idea of being considered "old". But the only thought she had was that maybe I was feeling some kind of bone or muscle or joint pain from the Lupron.

Also, just within the last few days, when I wake up in the mornings, my hands feel like they've fallen "asleep". That feeling passes after a few minutes, but my fingers feel numb and tingly and "thick" for quite a while longer, sometimes as long as a couple hours. This morning I got so nervous about my wedding ring getting stuck on a swollen finger that I took it off, with difficulty. Once I'm up and moving around, my fingers feel better, but a mild tingliness and "thickness" linger kind of on and off all day. The doctor thought the swelling sounded like fluid retention, again from the Lupron. She also suggested trying a wrist brace, like something used for carpal tunnel syndrome, to see if that helps with the numb and tingly feelings.

(Back at home, a Google search told me that not only is fluid retention a possible side effect of Lupron, but it's also a possible symptom of menopause, which is relevant because Lupron puts me into a chemically-induced menopause. Even more specifically, both swollen fingers and tingling in fingers could be symptoms of menopause.)

While doing my physical exam, the doctor of course noticed the unhealed port incision. I gave her a quick run-down of the history of the incision. To my surprise, she asked if I've considered taking the port out. I told her I had mentioned it to my regular doctor, who didn't think it was a good idea. But this doctor thinks that maybe the port itself, being a foreign object so close to the wound, is what's preventing the incision from healing properly. If I took the port out, I would finish my Herceptin treatments via a regular IV inserted into a vein. She agreed that with 5 lymph nodes removed from my right arm, she would want to be cautious about preventing lymphedema and limit the use of IVs to my left arm. I guess I'll think about it, but my first instinct is to just leave it alone. The port works, after all; it's just an ugly wound.

Finally, the medical oncologist prescribed the exemestane that my regular oncologist and I discussed at my last appointment. She made sure to mention that if the price is outrageous, I shouldn't pay it; I should call the Cancer Center, and they can help figure out a way to get the price down. Apparently, if the prescription has already been picked up and paid for, it's harder for them to manage.

At this point, I figured the appointment was over, but the doctor said she had one more thing to talk about. My regular oncologist is leaving the practice! Ahhhh!!! The substitute doctor said my usual doctor really is out sick (who knows...) but she's also taken another job somewhere else as an in-patient oncologist. Sigh.

She said she could take me on as a patient, and I said that would be fine. From this one appointment, I like her well enough, and I don't know any of the other oncologists at all. Looking back on the appointment, I kind of wish she had led with the possibility of changing doctors because if I had known, I think I would have approached the appointment differently. I definitely would have answered some questions differently. I feel like I was kind of dismissive and not as thorough as I would normally be in some of my answers because I figured, "This substitute doctor doesn't really need to know everything, I'll just give her the gist of it, and catch up my regular oncologist at my next appointment." Oh, well.

At first she said our next appointment would be in 9 weeks. I hesitated a bit; she noticed, and encouraged me to say what was on my mind. I said I've had regular oncology appointments every 2-3 weeks since I started treatment, so having 9 weeks until my next appointment seemed like a long time. Without a thought, she said, "Okay, let's make it 6 weeks." Well, that really made me feel better, that she was so responsive on the spot.

Targeted Therapy Appointment

When I got to the infusion room, the usual medical assistant wasn't at the front desk. I was directed to a bay, and I got myself settled with a warm blanket.

When my infusion nurse came in, the first thing she did was sit down and say that my social worker had told her about my mom. I teared up, and she was very sympathetic. I wasn't really sure how much I wanted to talk about it, so I turned the conversation to how I was sad about losing my medical oncologist. She said she knows the doctor I saw today, and she thinks I'm a good fit with her. She went on to say that she also knows the doctor who is coming in to replace my old oncologist, and she thinks I would be a better fit with the doctor I saw today than with the new doctor. So that was reassuring.

We talked about the future appointments I need to have set up. When she started to confirm that I like my appointments in the middle of the school day, I said, "Well...." and told her about my dad's daily radiation treatments. I said early morning appointments would be better now, so I could get back in time to drive my dad to his appointments. She was immediately sympathetic again, and said she'd do her best to get me appointment times that make my life easier.

I told her about the stiff legs, and the numb and tingly fingers. She didn't have much to say about the legs, but regarding the possibly swollen fingers, she said we should ask my physical therapist to take measurements of both my arms. I guess those baseline measurements she took before will be put to use after all.

My infusion nurse also asked for an update on my port incision. I told her about my interventional radiology appointment, and also about the new medical oncologist's suggestion to remove the port. The infusion nurse took a look at my left arm - confirmed that the whole arm did look puffy - and said it "wouldn't be a breeze" to use my veins directly, but it was doable. She said it's not something that needs to be decided right away; I can think about it for a while, and re-visit the idea later as the weather gets warmer (at which time I may want to wear cooler tops that would expose the incision site).

My physical therapist came in at 12:45, just before I got started on the Herceptin.

Physical Therapy Appointment

My infusion nurse and I got my physical therapist caught up on my numb and tingly fingers. She took measurements on both arms; from my wrist to my shoulder, every 4 cm, she measured the circumference, for a total of 11 measurements on each side. She had a printout of my previous measurements, and wrote down each new measurement alongside the old one; every single measurement was bigger this time.

So we knew for sure that both arms were a bit swollen, but she also wanted to see if one arm was bigger than the other, which would be a sign of lymphedema. She went back to her office to put the numbers into her computer, and she came back to report that my right arm is now 7% bigger than my left arm. That's still within the normal range, not quite the 10% that would indicate possible lymphedema. She said she even called up a colleague who is a lymphedema expert, and they agreed that given my description of the problem, it doesn't sound like lymphedema. Most notably, lymphedema tends to get worse during the day, whereas my swelling starts first thing in the morning, and gets better during the day. She said we'd keep an eye on the swelling, and she'd continue to do measurements.

(Later at home, I realized I never asked anyone what I should do about the fluid retention. Google tells me I should drink more water, eat less salt, and keep active.)

The physical therapist also worked on my cording. During this time, she told me how she has a blood condition, and my new medical oncologist is her hematologist. (Hematology/oncology is one combined specialty.) She talked about how much she likes this doctor, and it was definitely reassuring to know that this doctor is someone her colleagues would trust to manage their own care.

The Herceptin infusion finished first, and the infusion nurse let us stay in the bay until we were done. I left at 1:30, making my visit 2 1/2 hours.

1/16/20: I Checked My Insurance Claims Online

Since we've already met our deductible, the "You Pay" amounts for these claims were all $0. The numbers listed below are the "Claim Total" amounts.

11/22/19: Medical Oncologist Appointment: $258.00
12/5/19: Medical Oncologist Appointment: $258.00
12/5/19: Medical Oncologist Hospital: $84.00
12/6/19: Chemotherapy Cycle #10 (Including Blood Work, Physical Therapy Appointment #9): $7,473.23
12/11/19: Echocardiogram Cardiologist: $240.00
12/11/19: Echocardiogram Hospital: $1,133.00

12/13/19: Chemotherapy Cycle #11 (Including Blood Work, Physical Therapy Appointment #10): $7,535.23

12/20/19: Chemotherapy Cycle #12 (Including Blood Work, Medical Oncologist Hospital, Physical Therapy Appointment #11): $7,640.23
12/26/19: Maintenance Herceptin #1 (Including Blood Work, Lupron, Physical Therapy Appointment #12): $16,323.62
1/2/20: Physical Therapy Appointment #13: $393.00

Total cost to date: $186,964.59

With insurance, cost to me: $4,229.43

1/16/20: I Called the Cancer Center

Yesterday, in preparation for my appointments tomorrow, I logged into the online patient portal to double-check the times. I noticed that my appointment with my medical oncologist was listed with a different doctor! Oh no!

I freaked out a little at the idea of losing my medical oncologist. I told myself that if my doctor is leaving the practice for whatever reason, if I have to change doctors, well, then, that's just what I'll have to do. It's not like I have a choice. I just have to accept it.

I fretted about it intermittently overnight until I was able to call the Cancer Center this morning. Turns out, my doctor has been out sick all week, and they were having a hard time re-scheduling all her patients, so to help out, some appointments are being covered by another doctor. Phew. Wishing her a quick recovery!

1/15/20: My Social Worker Called Me

My physical therapist told my social worker about my mom's passing, and my social worker called me today to offer her condolences. I missed the call, but she left a message.

Besides just really appreciating the fact that she reached out, I also appreciated how much she understood the big picture. She said she was sorry, she recognized that it was especially difficult because it happened over the holidays, and she expressed how challenging it must be to deal with the loss while going through my own cancer treatment. 

She doesn't even know about my father being in active treatment for prostate cancer.

She asked if I wanted to schedule an individual appointment, otherwise she might try to stop by to see me the next time I'm in the Cancer Center.

I am pretty phone averse, so I decided not to call her back just yet. I'll wait and see if she comes to visit me in the infusion room during my next appointment on Friday. If she doesn't, I'll give her a call.

1/10/20: Physical Therapy Appointment #14

The cording in my right arm has gotten worse. I don't mean just this week, but over the last few weeks. It used to feel like a thin, taut wire, but now it feels like thick connective tissue. And I can sometimes feel the pull all the way down to my wrist. (Previously, I could only feel it in my upper arm, half-way to my elbow.)

I didn't have the time or energy to walk for about 2 weeks over the holidays, and I just re-started walking this week. I mentioned to my physical therapist that the cording actually seems better after I re-started walking, and she said it's possible the exercise helps get the lymph fluid moving, which might help with the cording.

1/6/20: The Cancer Center Sent Me a Card

People can be so kind. It's really encouraging.

I assume it was my physical therapist who sent the card, since she's the only person I told at the Cancer Center.

1/3/20: Interventional Radiology Appointment

At this appointment, there was a chance I might have the port incision line re-opened and re-sutured. Since technically that would be a surgery, I couldn't have anything to eat or drink for 8 hours before the appointment, and I wasn't supposed to drive myself, just in case. I was glad to have Ken do the driving, since this appointment was at the main hospital in the city.

Going into the appointment, the medical assistant tried to confirm that I was there for a port placement. I explained the situation as briefly as I could, and she said she'd have a nurse check in with me.

I was taken to a bay somewhere in the radiology department. I changed into a gown, and got settled into a hospital bed. Ken sat in a nearby chair, and we did a lot of waiting.

First, very quickly, a nurse did come by and confirmed that a doctor would look at my incision and decide next steps.

After a while, a physician's assistant (PA) came by. He asked for the full history of my port incision. I told him the whole story, and even pulled out my cell phone to show him some photos.

This is what it looks like now, pretty much the same as it looked before the re-stitch, only a little redder.

3.5 months after port placement.
Entire incision not closed.

The PA listened carefully, and was very friendly, but then said the doctor would be the one to decide what to do.

When the doctor came in, he was not the same person who performed the original port placement or re-stitch. He also asked to hear the history of the port incision, but he seemed not quite as interested as the PA was. I got the feeling the PA probably already told him the highlights.

The doctor weighed the benefits of re-opening and re-suturing the line against the possible risks. The fact is, the port works, and it's not infected. Those are the two most important things. If they open up the incision to re-suture it, the risk of infection goes up. And if it gets infected, there's a chance the port would have to be removed, which means I would have to finish my treatment by getting my infusions through a regular IV, which everyone says is hard on your veins and not ideal. As ugly as the scar is, there is no medical reason to re-open the wound, so the doctor advised against it. Re-suturing the scar would be entirely for cosmetic purposes, and I would have had to ask for it against the recommendation of the doctor.

I'm disappointed about having an ugly scar for 10 more months, but as risk averse as I am, I agree with the decision to not invite an increased risk for infection.

I asked whether or not the wound could be "cleaned up" when I get the port out at the end of my treatment. The PA talked about trying to excise some of the scar tissue and using non-absorbable sutures to try to get a clean closure, but the doctor was much more circumspect and basically took a "we can't guarantee anything but will do our best" kind of line.

It's worth noting that I didn't get to choose which interventional radiologist I saw. I asked when I made this appointment, and the scheduler said I would see whoever is working at the time of my appointment. It just seems so random.

1/2/20: Physical Therapy Appointment #13

I had a physical therapy appointment scheduled for today. I thought about cancelling it, but didn't, figuring maybe it would be good to think about something else for a while -- even if it's cancer-related.

It felt a little strange to be out in the world with people who don't know about my mother's passing. This observation is somewhat ironic because, ever since I was diagnosed, it felt weird to be out in the world with people who didn't know about my cancer; going to the Cancer Center was always something of a relief because I was surrounded by people who not only knew, but really understood what I was going through.

It's funny how life can be so compartmentalized. This set of people know about you in this way, and that set of people know about you in that way.

As it turned out, it wasn't as compartmentalized as I thought. Going in, I planned to not mention my mom. But during my appointments, when my physical therapist is working on my cording, we usually pass the time talking, and last week I had mentioned that my sister was visiting because my mom wasn't doing so well. So today, being as thoughtful as she is, she asked how my mom is doing. And so I told her, and I cried, and she brought me some tissues. Then she just very naturally talked a bit about when she lost her grandparents, and how her cousin is a funeral director. It was good, and she gave me a big hug before I left.

I really do think that all the people on my medical team, every one of them, are well-suited for their careers. Presumably they are also well-trained, but they always seem to know just how to handle every situation, how to say just the right thing.

Anyway, since today's appointment was in the physical therapist's office, I was properly lying down, and the physical therapist said she could get a better angle on the cording than when I am in an infusion chair. She seemed surprised that I was not in pain at times, because she pushed pretty hard, and I said it's probably just because my underarm is still numb from surgery.

Since my cording continues to persist, she suggested I do my stretches with my arm bent at the elbow, so the cord itself doesn't get pulled when I stretch. She wasn't sure, but thought maybe we can see if it helps if I actually give the cord a break for a while.

She also mentioned that the arm measurements she took last time had my right arm at only 2% bigger than my left, which is within the normal range for a dominant arm. Maybe it was swollen at the time my nurse mentioned it, or maybe not. I'm relieved I don't have to worry about lymphedema after all, at least not now.