FINAL FOUR OR BUST

Blogs are like a newspaper.  Sometimes you have a big headline and other times you just have to embellish something not so newsworthy.  Mr. FOG thought this was going to slow blog day with only test stuff to report, but things picked up with a call from Mario’s oncologist and our interview with Mario about his goals.    

Chemotherapy Protocol and Scheduling

A conversation with Mario’s oncologist was perhaps the more interesting development of the day.  She explained why she modified the standard Ewing’s Sarcoma protocol (a protocol is the mix of drugs given during chemotherapy).  The mix of drugs was changed somewhat, eliminating, for the time being, cyclophosphamide, but could this drug could be added later if needed.  The mix of drugs was changed as a result of her conversations with colleagues at MD Anderson Cancer Center in Houston and the Winship Cancer Center at Emory.  Mr. FOG thinks that during our initial consultation Mario was to be given the national standard for treating Ewing’s Sarcoma, but based on her discussion with fellow oncologists, a modification to the protocol was made.  Mario will get what MD Anderson Cancer Center in Houston is currently using for Ewing's Sarcoma. 

The scheduling of chemo treatments was also different from what we first understood. The drugs will be administered in the hospital during five consecutive days, three weeks apart, for perhaps 6 to 8 cycles (18 to 24 weeks).  Initially Mario was to receive an intense dose on one day in the odd numbered cycles and five days of doses on the even numbered cycles.  Given the toxicity of one drug, Doxorubicin, that is on both the old and new protocols; his oncologist said that Mario will have to receive these medications in the hospital and not as an out- patient. If delivered improperly serious health issues could result and he could be much better monitored in the hospital.

 As out-patient, Mario would have gone to the nice cancer center with the soft chairs and spectacular views of downtown Atlanta.  Will he now have a drab hospital room? .  We shall see.  Hopefully Nurse Sherry and Mr. FOG will still be allowed to go the Wellness Center at the Cancer Center for the support programs.  They even had yoga classes for Mr. FOG, but did not see spa treatments for Nurse Sherry. Perhaps if we ask??  The trio is still processing how the scheduling changes will affect them.

A Lofty Goal

Mario has set the goal of being well-enough to make the Final Four.  Given the scheduling, this is around Chemo session 4, 12 weeks away and coincidentally his problems started about 12 weeks ago.  Having the NCAA FINAL FOUR as a goal will surely help Mario beat the cancer.  He wants very much to be well enough to go.   It is a lofty goal given the chemo treatments ahead of him and the health issues he is dealing with.

Of course Mario will still need Mr. FOG, Nurse Sherry, or perhaps both in New Orleans with him.  Mr. FOG loves New Orleans and is eager to return especially with a free hotel room, locker room passes, cocktail receptions, and beaucoup perks.  Let’s root that Mario is well enough to go, so that Mr. FOG (or Nurse Sherry) also get to go.  laissez les bon temps rouler  . 

 http://www.ncaa.com/championships/basketball-men/d1

Tests

This morning Mario had a test to see if the swelling in his right leg was due to a blot clot.  The preliminary result is that there is not a blot clot, just a slightly swollen leg.  Hard to say why.  It is the leg with the operation and tumor, so there is a lot happening in the poor leg.  .

After his test Mario stopped off at work, then headed home and had lunch with Sherry.  Afterwards Mr. FOG settled in for a nap.  He had slept well the night before, but a nap is always nice, and you take it when you can.

Tomorrow we have an echocardiogram.  An echocardiogram (sometimes called an ECHO) is a heart test procedure that uses a probe (called a transducer) to send high frequency sound waves into your chest. These sound waves bounce (or, echo) off of your heart. A computer uses the "echo" sound waves to create a moving picture of your heart. This procedure is painless.  Because Mario’s chemotherapy will be delivered directly into the vena cava via a port place in his chest—this happens on Friday-- it is important that Mario has a healthy heart. Here is a long slightly boring video web link, but effective in showing the test.

http://www.youtube.com/watch?v=TwA0LM5_1dE

Later that morning we have a PET scan..  The test uses a radioactive marker injected into the blood stream.  Parts of the body that use more blood, such as the heart will show up more clearly. Also cancerous tumors requiring more blood (hyper vascular) should also show up.  Following are two links that give more information about the test.

 http://my.clevelandclinic.org/services/pet_scan/hic_pet_scan.aspx

http://www.youtube.com/watch?v=QZQq7chGoO4

Nurse Sherry is fighting a cold, but was doing better in the afternooon after a rest. 

Drilling for Bone Marrow

Sherry went to work early, and Mario stayed home.  He was in more pain today than the day before. He did a bit of work and wished he could have been in New Orleans for the LSU vs Alabama game. Mario could not eat anything before his procedure, so Mr. FOG could not share the last of the pasta dish Ann and Fritz had brought over.  Mario had said the pasta when excellent when he ate it on Friday, and it was still very good on Monday. 

Mario’s bone marrow biopsy had more pain than anticipated, or perhaps it was a combination of everything—the foot pain from the tumor, the leg pain from the surgery, and now the two holes in the pelvis at the base of the spine. 

The following web links will give our gentle readers what is involved.  The first web link is animated and likely propaganda produced by the manufacturers of the tool used to drill and extract bone marrow.  Watch this one if you do not want to see blood.

http://www.youtube.com/watch?v=UVWKKFyz9zM&feature=related

The second is an actual procedure, and probably more similar to what Mario had.  Two penetrations were needed, since not enough bone marrow fluid was obtained from the first penetration into Mario’s pelvic bone.

http://www.youtube.com/watch?v=946xFHu0Rpo&feature=related

It looks simple in the video, but Mr. FOG is not so sure.

Our star reporter Sherry Lane learned a few things during Mario’s biopsy.  Mario's oncologist  has been in contact with colleagues at the Anderson Cancer center in Houston, Emory University here in Atlanta, and another cancer facility in Florida, perhaps the Moffitt Cancer Center in Tampa.  Since Mario has a rare juvenile cancer and there are not many cases involving in adults, learning what has worked is important.  His oncologist is consulting with colleagues who may have had similar cases to see what has worked best.   As a result of these discussions, she will be adjusting the national standard chemotherapy protocol for Ewing’s Sarcoma.  We will talk to her again, but the change may be to adapt the juvenile treatment to an adult or to take advantage of new approaches being her used.  We will get back to you on this.

Sherry Lane also learned from the oncologist that Mario’s treatment may be chemotherapy and radiation only, excluding surgery.  If needed, there is a fine surgeon specializing in sarcoma tumors here in Atlanta.   It is still early to tell, but surgery may not be needed if the cancer responds well to the chemotherapy.   Again as we know more we will share.

Mario’s Tuesday has also changed.   He had been complaining of swelling in the operated leg and we are headed to Piedmont Hospital for another test to make sure there is no blood clot in the leg.

Finally a quiet evening at home for Lord, Nurse and Butler.   Lee Zell from Turner sports ,a friend of Mario and Sherry’s, brought over a most excellent meal.  A great salad, beef stroganoff, a pie, wine, plus more.  Many thanks.  More importantly Mario changed when Lee came.  He is a social being and these visits from friends are good for him.  Thanks to all.  Mario and Sherry are doing OK

Mr. FOG’s Weekend

Mr. FOG was tired.  He is over 50; actually well over 50, and needs his rest.  The weekends, be they in Atlanta or Asheville, are rejuvenating and he needs to stay in top form to serve the Laird during the hard fight ahead.

Mr. FOG stayed at a friend’s house who was out of town. Fortunately Mr. FOG has many friends in Atlanta who have opened their homes to him. 

In any event, this friend was on a business/pleasure trip, and made this the perfect place to crash for the weekend, except perhaps for his own home in Asheville.  Of course Mr. FOG pilfered the friend’s wine and food while he was away.  What are friends for?  While friends let friends pilfer their spirits and food, they usually draw the line at cars.

 A bachelor, the friend’s booze selection was good, but the food was not as good, but OK if you looked hard.  Mr. FOG however was lucky and by chance selected a most excellent Tilapia breaded frozen fillet. It was so good that after having the first fillet he had a second and threw away the empty box to destroy the evidence.  Before doing so however, he jotted down the name of the brand for future reference.  Perhaps the friend will not even notice the fish is missing.  If accused, he could blame Dame Bess the cat. A hungry cat wanting a piece of fish can be a compelling and possibly believable story.  Mr. FOG took good care of Dame Bess the elderly cat who likes baby food.  Mr. FOG was generous with Dame Bess to hopefully buy her silence.  It is hard to tell what cats will do. Mr. Fog will make it up to his friend. 

On Sunday, he decided to see son number two.  Actually both sons are number one they just trade places depending on what is happening in their lives.  All was well with Mr. FOG’s other son.  Mr. FOG had a nice Sunday dinner with friends.  They shared a Ropa Vieja, a Cuban Dish,  translated as old clothes.  Ropa Vieja is shredded beef in a seasoned tomato sauce served over rice.  On Sunday night, a semi-rejuvenated Mr. FOG reported back to the Vinings Mountain Castle for duty.  Tomorrow is the bone marrow test.  

Sherry Lane our texter reported a quiet, restful  weekend at the Vinings Mountain Castle.  The Christmas decorations were taken down and stored away until next year. 

Cancer versus Chemo Fight Set for January 16

A lot happened on Friday, January 6 and very quickly.  The day started out slow and ended in a flurry of activity.  Both Mario and Sherry got up later than normal.  Mario as usual had Cheerios with milk in a plastic cup.  Mr. FOG suggested an egg, toast and fruit to make his breakfast more complete.  This was accepted.

Mr. FOG sometimes offers , but generally leaves Sherry alone in her food choices. She makes much better choices than Mario and does not need Mr. FOG’s input.  She likely had her Greek yogurt.

Both Lord and Nurse went to work  most of the morning on their computers to keep their employers happy and the pay checks coming in.  Mario had a couple of conference calls.  Mr. FOG was in his room working studying cancers, backgrounds of doctors, etc. 

On the agenda today is another doctor’s appointment.  It is probably the one that we should have had yesterday, but yesterday’s appointment was also helpful --so no regrets—since we learned a bit about what radiation oncology can and can’t do for Mario.  As you may recall, the radiation oncologist we saw yesterday facilitated the appointment we have today with a hematology oncologist.  But before we get to this, it might be good to discuss the history of this cancer saga.

Timeline

We are now at about week 12 of this odyssey.  Below is my best recollection of what happened and when.  Mario and Sherry know best the first eight weeks of this saga, since Mr. FOG was in Asheville.  In any event these first 8 weeks were mainly a blur of pain, increasing impairment of motor skills, ineffective injections, three different doctors, misdiagnoses, etc. trying to determine why a healthy 35 year old man, with no  injury or prior history of back or leg pain issues was having severe leg pain and motor skills issue.   In hindsight as usual, the answer is clearer. But this was not an easy diagnosis of a rare condition.

Dates	What Was Going on	Comments
Week 0	The Wedding.	A good time was had by all.
Week 1	Drive home and Honey moon	Symptoms begin but very slowly.  A slight discomfort, a little odd walk, etc
Week 2	Back to Work	Pain begins but not too bad
Week 3	Back to Work	Pain increases, Mario sees primary care doctor injections given
Week 4	Back to Work	Pain continues, more injections, pain pills
Week 5	Back to Work	Pain continues, motor skills affected
Week 6	Thanksgiving	Mr. FOG sees Mario, Sherry and the Duffys.  Mario is limping and in pain but goes fishing.
Week 7	Back to Work	Pain is still there
Week 8	Spinal Surgery Planned	Mario gets pre spinal surgery tests, tumor found
Week 9	Diagnosis of Schwannoma	Spinal surgery cancelled.  Decide to go to Miami for tumor operation with specailist.  More pre-operative tests
Week 10	Miami Surgery (12/21)	Mario and Dad go to Miami, More pre-operative tests.  Surgery, Find that tumor is likely malignant.  Biopsy taken.  Lots of tears
Week 11	Christmas, Recovery from Surgery and Drive Home	A blue Christmas, Nurse Sherry arrives, Miami hotels, Filling prescriptions, Aunt Julia, St. Simmons Island and Family, A Gator Hope Chest, Drive home Cleopatra-style in our Honda Element turned into an ambulance
Week 12	Atlanta Doctors, Tests, and Chemo decision	New Years break, Mr. FOG starts his new job,  more doctors, and a treatment decision is made
Week 13	Pre-Chemo Tests	To be written
Week 14	Chemo Begins (1/16)	To be written

A Decision

Events during our afternoon visit with the Atlanta hematology oncologist moved quickly, and perhaps rightfully so.  The Lord was making the decision.  Nurse and Butler were in agreement.  The trio decided to go forward with chemotherapy and the sooner the better. 

Chemotherapy protocols (the mix, frequency, and strength of the medicines/poisons given) is fairly standard for the cancer being treated.  Stated differently, the chemotherapy received would probably vary little from one hospital to another.  An exception to this would be if one is in a clinical trial.   While Mario’s results may be better at a hospital having more experience on Ewing Sarcomas, there are drawbacks.  The biggest one is that it is rare cancer, so while there is research there was no clear place that had an "expertise" on this cancer.  Also, It would be difficult to get chemo therapy at the Mayo Clinic in Rochester, Minnesota or Cleveland Clinic in Ohio or Sloan-Kettering in New York and still maintain a normal life.  Nor is there any real assurance that going toone of these facilites would in fact be better or any different treatment than what Piedmont Hospital would provide.  For sure we would have lost another couple of weeks following up on these options.  Time is an important factor for us.  The oncologist confirmed what Jane, Mario's Mom had said, Ewing's Sarcoma is a fast growing cancer.

Mr. FOG’s friend is being treated at Piedmont, went for a consult visit to the Anderson Cancer Center in Houston, a world leader in cancer treatment.  During her visit she found that the treatment she was getting in Atlanta for her lung cancer was the same treatment she would get at Houston.  Hence it made no sense to leave home for the same treatment she was getting at home.

Mario and Sherry have a support base in Atlanta.  Besides getting a paycheck, having a near normal work and social life as possible should help Mario (and Sherry) deal with the many challenges ahead. 

The oncology practice selected is affiliated with Piedmont Hospital and is the one used by Mr. FOG’s friend of who is battling lung cancer.  The practice is also a part of the hospital system of Mario’s Atlanta neurosurgeon.  While the oncologist treating Mr. FOG’s friend was highly recommended, he was not the one with whom the radiation oncologist had been able to set us up with.  Our hematology oncologist did her residency at the Winship Cancer Center at Emory.  This is the center that had two oncologists that had done some work on Ewing Sarcomas identified by one of Sherry’s friends, a cancer survivor.  A special thanks to her.  Although Mario decided to get treatment at Piedmont and not Winship, the information she provided helped us.  Mario’s oncologist had already discussed his case, since it is rare, with one of the Emory (Winship) specialists recommended by Sherry’s friend.  Thanks.  Also we are not locked in to this choice, if we find something better.

Mr. FOG was more concerned about time.  Too much time had already elapsed and we needed to attack the cancer quickly.  It is only getting stronger and making Mario’s recovery of his motor skills more difficult.  Or least this is what Mr. FOG believes.  More searching would probably not give us a better decision, but delaying would likely risk having a favorable outcome. 

For the most part Mr. FOG kept his mouth shut during the appointment, only asking a couple of questions to see if the oncologist was worthy.  There was no need for him to talk, Mario did well on his own.  Funny how we still think of our children as when they were small and not all grown up. 

Mr. FOG liked Mario’s oncologist, a young but not too young, Asian American woman. Mr. FOG observed that with only 24 hours lead time she had studied Mario’s case before our appointment; was familiar with Ewing’s sarcoma, knowing the difference between an EES and PNET; consulted with the senior oncologist in the same group used by Mr. FOG’s friend; and had already contacted her colleagues at Emory having a background or research interest on Ewing’s Sarcoma.  She also asked about for any clinical studies that Emory may have, but there were none.  In Mr. FOG’s opinion she passed her job interview with high marks and will do her best and work hard in Mario’s behalf

Mr. FOG foolishly did get involved discussing the date that the chemotherapy should start and lost sight of priorities.  Fortunately Hot Lips Houlihan was there, and true to her character stepped into the fray. Mario wanted to minimize the impact on his work schedule and start chemo on a Thursday.  Mr. FOG and Mario had previously discussed this, reasoning that this might be better for him since the worst symptoms would happen over the weekend while he was at home.  Mr. FOG was lured into this argument, but fortunately Nurse Sherry was there with the obvious, “the treatment should start as soon as possible.  Mario’s health is more important than work.”  That simple true statement settled the matter.  As we know more how the chemo affects Mario the day that it is given can be adjusted so that the impact to his work is minimized..

While the trio is not happy about what will come ahead and the changes to their lives, especially Mario, they are comfortable with the decision.  Mr. FOG will try his best to balance Mario’s health needs with work, and other commitments of the couple.  However, sometimes when the tire hits road you got to make hard choices and Mario’s health comes first. 

West Piedmont, as the building is called since it is west (and also north) of Piedmont Hospital, is well situated for Mario and Sherry. The facilites are almost spa-like and patients have nice vies of the city, telivision and other comforts while receiving chemotherapy (really poisons). The facility is at the intersection of Howell Mill Road and I-75 for those of you who know Atlanta and convenient to the work places of the couple and their home on Vinings Mountain.  Likewise for those of you with a military interest, since this will likely be a long war and not a quick battle, having short reliable supply lines between home, work sites and cancer  treatment center is important to keep morale up and keep our cancer warriors strong during a long campaign.   

Many, many more things were learned during this visit but these will have to wait and will be shared soon. 

The day ended with Sherry and Mario having a nice evening at home with close friends.   Although tempted by the food, Mr. FOG decided it best to leave for the weekend so that the newlyweds could have their own space.

 Mr. FOG also needed his own downtime and will be staying at a friend’s house in Atlanta.  The friend is out of town, but Mr. FOG will have a feline, named Bess to attend to.  She is an elderly cat and perhaps Dame Bess is a more appropriate name should Mr. FOG need to embellish his resume. Lord Mario, Dame Bess, perhaps Queen Elizabeth is next?????  We need to show progress on our resume.

Cancer Research Materials Are Not Good Bedtime Reading

Reading about Ewing’s Sarcoma just before going to bed is not a good idea.  If one is a pathologist or a student studying for a test, then this type of reading is fine.  One is detached from the disease, and reading about the trials and adventures of Ewing’s Sarcoma as it attacks humanity may actually put one to sleep and give you sweet dreams.  However, if one is a father as Mr. FOG is, and reads about the adventures of his son’s cancer on other people, it is clearly not good reading and certainly not at bedtime. 

Please gentle readers, consider very carefully before reading about these mean cancers.  Also given very limited research, applicability of mainly juvenile research to Mario's case only help only so much.  Perhaps before bedtime, it is better to read about Ms. Lopez’s relationships, or watch a TV show to see which supposed stars is the better dancer or who is the better chef.

Yesterday’s meeting with the radiation oncologist was good because it actually gave us more specific information about the cancer.  However these things also raise more questions.  Besides the scary cancer stories, Mr, FOG did not sleep well because It may be important to identify if Mario has an extraosseous (not of the bone) Ewing’s Sarcoma (EES) or a primitive neuro ectodermal tumor (PNET).  The research literature suggests that the treatment is the same, but knowing the specific Ewing cancer subset may be important for the chemotherapy to have its maximum effect.  Mr. FOG knows that the doctors will have this covered, but he wants to know and make sure.  

Jane was able to help yesterday with Oxycodone and has a medical technology background.  He will ask for her to help on what kept Mr. FOG awake.  The only thing that is greater than a father’s love is the love a mother has for her children.  The love between wife and husband is also right up there.

Tonight I will ask Mario or Sherry read to me Dr. Seuss book before going to bed, be tucked in, and ask that they leave the closet light on.

Meet the Cancer

Today was a mix of work, research, filling prescriptions and a visit to another doctor. 

Off to a late start, Mario and Sherry both went to work. Mr. FOG was up early and decided not to wake them up.  A late start is not all bad.  They both got some good sleep. 

 Mr. FOG was Mario’s chauffer and after dropping Mario off at work went to Starbucks.  He researched suggested oncologists, developed a list of questions about the cancer and treatment options, and had to track down where we might be able to buy Mario’s Oxycodone.

Oxycodone is almost as scarce as hen’s teeth.  Only some pharmacies carry it.  The prescription cannot be phoned in.  And usually pharmacies require that the patient pick up the medicine him/herself.  Most annoying is that pharmacists often do not want to tell you over the phone if they even have Oxycodone in stock.  Fortunately Jane took over the Oxycodone search and her first guess was correct.  The Walgreens Pharmacy at Piedmont Hospital had the precious Oxycodone. 

Cancer Weapons:  As a primer, there are three ways to fight cancer, well perhaps four or five.  The first is surgery.  You can cut the bad stuff out. Mario’s Atlanta and Miami doctors are neuro surgeons and offer this specialty.  Secondly one can kill the cancer with poison injected into the blood stream.  This is done through chemotherapy provided by oncologists usually having a background in hematology.  Radiation also can be a very good way to kill a cancer and this is done by radiation oncologists.  The fourth way is a holistic approach that uses the body’s own defenses to overcome the cancer. Many would also say prayer is a powerful force and deserve a high place in our arsenal. 

Each approach has pluses and minuses.  Likely Mario will use two or more of these methods to overcome his cancer, and chemotherapy is probably the first weapon he will use since his cancer is probably not localized.

The Cancer:  In the afternoon Mario, Sherry and Mr. FOG met with a radiation oncologist.  This was the doctor that had been referred by Mario’s Atlanta neurosurgeon.  While he is not the specialist we need right now, he had some answers for us and paved the way for tomorrow’s appointment with a hematology oncologist.   We may need a radiation oncologist but probably not just right now.  It was a good meeting and he provided answers to many of our questions. 

The pathology report found that Mario has a Ewing’s Sarcoma, which is a rare cancer, mostly occurring in juveniles, and often of the bones.  Mario’s is the even less common an extraosseous (not of the bone) Ewing’s Sarcoma (EES)  Mario’s radiation oncologist confirmed that he has the rarer ewing's sarcoma that is not in the bone.  We will know more when we talk to the other oncologist tomorrow.  Another uncommon ewing's sarcoma is a perpheral neuro ectodermal tumor (PNET) .  While there are some differences between EES and PNET the treatment is similar.  While probably not its best picture, Ewing's Sarcoma had this publicity picture for our use.

photo courtesy of cancer facebook. com 

With about 4,000 cases a year mostly in juveniles, Ewing’s sarcoma is a rare cancer, and the none bone is a subset, making it even more unusual.   The research on treatment especially for adults is nil to none   The doctor stressed that this is a curable cancer.  Also Mario is young and strong which will help him fight the cancer.

Mario likely has had the cancer from a few months to 18 months, but not much longer.  The tumor grew to a point where it affected a nerve and caused pain.  Doctors do not know what causes this cancer, but it is due to a chromosomal mutation.

Cancer Treatment  We need to move quickly on fighting the cancer.  Waiting will not help Mario. .  For Mario, the treatment that is provided to juveniles will likely be modified for him.  Since Mario has lesions on his liver, the cancer has spread.   This fact means that he should do chemotherapy to hopefully kill the cancer cells in his system.  Chemotherapy should also reduce the size of the tumor in the leg which should in turn alleviate the pain.  Depending on the cancer’s reaction to chemotherapy, next steps would be decided then.   Also with so little data on this cancer and especially in adults, it is almost impossible to give odds on beating the cancer.  But again, it is a curable cancer according tothe doctor.  Location of the tumor, the degree to which it has spread, and how soon it is treated determine the outcome.

Tomorrow afternoon we meet with the oncologist who specializes in chemotherapy.  Also at Emory there are some doctors who have done some research on Ewing’s Sarcoma and we plan to schedule a conference with them soon.  Additional imaging was also requested and will have to done.  We are moving with prudent haste.

Wednesday, January 4

Wednesday, January 04, 2012

Our agenda for today is

·         a morning appointment with our Atlanta neurologist,

·         Mario goes to work and gets back his computer,

·         Sherry and Mr. FOG are running a couple of errands, and

·         The day ends with a nice evening with Dan, Anna, Tom, Banks and Charley. 

Wow! It sounds like a full day, and mostly it worked out that way.

THE DRIVE:  Lord, Butler and Nurse got on the road by about 8:00 for a 9:00 am appointment with our Atlanta neurologist.  A brief discussion on the choice of route, recriminations about traffic conditions, subsequent apologies, and intense sunlight; made an otherwise dull drive more memorable.  Regarding the choice of route and recriminations, the trio agreed that these discussions are not worthy of a Lord, Nurse and Butler.  We need to lighten up, especially on such petty matters, and save our energies for the more important issues.  We agreed that the driver would entertain counsel, but he or she, would be in select the route and passengers would remain silent and focus on other things, absent an emergency.  The sunlight issue was more interesting; twice during our route it took the three of us to discern when a traffic light turned green.  We found that if a traffic light is directly in front of a very bright sun, it is impossible to see the light’s color.  Only Mario’s super expensive sunglasses helped him to see a little.  Mr. FOG listened to him and observed for other signs that it was safe to proceed.  Perhaps Mr.FOG needs to buy a pair of these fancy sunglasses.

We tuned to Hot Lips Houlihan’s favorite morning radio station.  We learned that Jennifer Lopez was seen at a Miami McDonald’s with a much younger man.  Ms. Lopez is about 42 and the man is about 24.  Ms. Lopez was on the rebound from another failed relationship.  According to the commentator, the scene turned ugly when the McDonald’s server assumed Ms. Lopez was the man’s mother, and the diva left the establishment in a huff.  Mr. Fog thought that perhaps the most incredible part of the story was that Ms. Lopez would even set foot in a McDonalds.   Also, how often do McDonald’s servers ask “may I super-size your order and by the way, how is your mother”?  This farce is likely all made up paparazzi gossip.  Mr. FOG is not used to wasting his valuable radio time on such dribble, but was none the less intrigued by it, and may want to listen again.  They entertain and we listen.

THE APPOINTMENT:  Complaining after a long wait; the trio apparently forgot what they had learned on the drive.  Our appointment with the Atlanta neurosurgeon was not what we had expected.  Yes, the wound was healing nicely, but the second scan of the liver with contrast showed that the spots first detected in the Miami CT scan were in fact lesions and probably cancerous.  There are two spots (lesions) on the liver, one 0 .7 x 0.7 cm and another 2.4 x 1.7 cm.  No, Mario does not have liver cancer, but some cancer cells have decided to colonize the liver.    Disheartened by this news, the trio was glum.

On the positive side, further review of the report showed that this cancerous invasion was limited to the surface of the liver and was not hyper-vascular, i.e. drawing a lot of blood that a cancer needs to grow.  Also the leg MRI that was done yesterday showed no issues.  The Atlanta neurosurgeon ordered a scan of the left kidney to follow up on the Miami CT scan that found a small cyst on the left kidney.  Mario obtained a copy of the various diagnostic reports and to have them for the oncologist(s). The doctors are following up with more detailed tests on areas that appear suspicious; hence we found the liver lesions.  This is good.  We need to know all we can, good or bad, to decide how best to fight the cancer and win.

WORK, ERRANDS AND SHOPPING:  Mario made it to work around 11:00 am and hopefully his computer has been fixed.  Mr. FOG invited Sherry for a Starbucks coffee, free Wi-Fi access and her work email.  This Starbucks break was needed down time to process the health news.

Things were still going slow on the computer repair and Mr. FOG and Sherry decided to make best use of their time.  They went to Mr. FOG’s broker to pay a bill, next was a visit to Sherry’s gym to pick up a check, and lastly they searched Barnes and Noble, Target and Staples for a padded cover to protect the very popular Kindle Fire they received from Chaney and Ryan.  Although lured by a red cover that reminded her of the University of Georgia days, Hot Lips  settle on a neutral black cover.  Mr.  FOG thought the cover was expensive at $30 but that is what they are charging for these things.  We also looked for new shoes for Mario without luck.  Sherry treated Mr. FOG to a Pink Berry yogurt.  Mr. FOG picked the pomegranate flavor and Sherry went with peppermint.  Mr. FOG liked the Pink Berry treat.  Pink Berry looked like girl type of place.  He wondered if he and Hot Lips Houlihan decided to hang out together as friends perhaps pedicures would be next.

Finally at 2:30 pm Mario’s computer was ready and the trio headed home after an exhausting day.  Without lunch, Mario had leftovers from last night’s Cunningham family dinner and the trio took a much needed nap.

A NICE EVENING AT HOME:  Tom, Dan, Anna, Banks and Charley came over for dinner.  Again the Cunningham family dinner stepped up to the plate. The meal was almost like the miracle of loaves and fish.  The last of chicken kabobs were a snack for Anna, the salad was a Mr. Fog favorite.  Hot Lips Houlihan made a wonderful pasta and meat sauce.  The piece de resistance was the Trader Joes chicken meatballs.  A most excellent meal was had by all.  Mr. FOG still had a salad for tomorrow.

Dan, Tom and Anna brought over the hope chest.  Sherry will find a nice “man nook” for the chest.  Here is a picture of the group.

 MEDICAL:  On the medical front, Mario has an appointment with a referred oncologist for tomorrow Thursday at 3:00 pm and a prescription to fill for pain medicine, Oxycodone.  While filling a prescription sounds simple, Oxycodone has been very hard to find and Mario has to be there himself to have the prescription dispensed.  Friends of Sherry and Mr. FOG also provided names of possible oncologists.  The thinking of the trio is that they will talk to a couple more oncologist, discuss treatment options and then make decision on treatment fairly quickly.  Thanks go out to friends who have shared names of oncologists and advice. 

AS THE FOG LIFTS:  First of all Mario and Sherry are holding up well.  Mario is in a lot of pain, but treats everybody nice and does not complain. I am very proud the way he is managing this and not sure I could do as well.  Sherry is holding up and helping Mario through this, and Mario is helping her.  Perhaps better stated they are helping each other through what could be a very difficult time in their lives.  I know that the support of family and friends is a great source of strength for them.  Mr. FOG is having a hard time keeping his mouth shut.  Fortunately Nurse Sherry often says what Mr. FOG would have said had he spoken, so there is no need for Mr. FOG to say anything.