How are you today?

I am fine.  Really, I'm good.

On October 29th 2011 at 10 am, roughly 7 months after I was diagnosed I heard Dr. K tell me there were no traces of cancer on my last PET.  I knew it in my heart but hearing her say it made it official.  In less than a year I had:

1. Completed a half marathon
2. Been diagnosed with stage iv squamous cell carcinoma in the base of my tongue
3. Received 3 chemo treatments and 40 radiation treatments
4. Over a dozen blood draws, 2 surgeries, over 80 head x-rays
5. Drank over 150 cans of Carnation VHC
6. Lost 40 pounds
7. Lost my dad
8. Recovered and returned to the gym and gained 25 of my lost pounds back and ran a 5k.

There are still a couple of milestones to go.  To make sure the cancer doesn't come back I will have PET's every 3 months for a year, then every 4 months for a year and then one a year after that.  They are expensive so if you need your grass cut, let me know...  I still can't taste sweets very well.  I start physical therapy for some very minor swallowing issues later this month. I haven't shaved my neck since late March and it is as smooth as a baby's rear end.  I don't miss shaving my neck at all but the bad news is Robin found a couple of stray hairs on my Adam's apple last week.  I weighed 185 this morning and think I may hang around that neighborhood instead of getting back to 210 or so.

It is an incredible story but I am not incredible at all.  In fact, I am not just being modest when I tell you that I am not particularly tough, not particularly strong.  I am a very average guy.  Which means if you are reading this and you have recently been diagnosed with a cancer like mine, you can beat it too.  I am serious.  Surround yourself with friends and family that want desperately for you to succeed. Talk to SURVIVORS ( when I felt like crap, I never drew strength from talking to other people who felt like crap.  Sometimes, I felt a LOT better after helping someone who was not doing so well though.).  SURVIVORS know how you feel now and they know what got them through it.  Their suggestions may or may not work for you but they are always a great place to start.  Look for your local SPOHNC chapter and attend a meeting.  Take a pad and a pencil.  Several badasses will tell you how you can be a badass, too.  Take notes.

If this is your first time here, you have to read the posts backwards.  Here is a link to the first one:
http://iwishihadbetternews.blogspot.com/2011/09/its-really-nice-place-to-start.html
I would love to hear from you if this blog has been helpful.  Tell me if it didn't help at all, too.

God's Blessings on you all!!
chris

SPOHNC

I was continuing to struggle with what looked like everyone else to be depression.  I thought I was doing fine and really didn't understand what they were talking about.  When Robin finally told me she was going to pretty much demand I talk to someone, I knew it was serious.  I know a guy at church who is a psychologist so I gave him a call.  We know each other well enough that he couldn't be the one to see me but I thought I would give him the Cliff Notes version of things and see where he thought I should go.  He told me about the Beck Depression Inventory which is a standard testing vehicle and then told me not to bother taking it...yet.  He told me it is very common for people this close to cancer treatment to test as depressed (the fact that I had also lost my dad practically insured a positive result) and that a period of time similar to the grieving process should be allowed to pass before I get too worried.  He told me to seek help if I thought I needed it now but that what I was feeling was quite the norm.

Robin had also contacted a national body called SPOHNC which stands for Support for People with Oral, Head and Neck Cancer to ask about support group meetings.  They put her in touch with a local guy and they spoke on the phone for quite a while (I was told later. At this point she had not told me what she was up to).  She was describing the difficulties I was dealing with and he stopped her mid-sentence.  "Robin, everything you have described is perfectly normal and matches my experience to a T."  Later that day Robin told me we were going to the SPOHNC meeting Saturday morning.  I may have mentioned it before but will mention it again here, I am NOT a support group kind of guy.  I do, however, recognize my wife's wisdom and to the meeting we went.

We met in a conference room in a small hospital that is pretty quiet on weekends.  It was a smaller gathering than usual and the facilitator of the meeting asked each one around the table to introduce themselves and speak briefly about their disease and treatment.  Within a minute or two I felt like a complete and total jerk for feeling sorry for myself for even one minute.  Most of them were 10 or more years post-treatment meaning that when they were treated they didn't get the cool IMRT machine like I did.  They basically blasted away with radiation from jaw-line to collar bone.  Some of them received their radiation in two treatments PER DAY.  One guy ended up losing about 3 inches of his jaw bone on his left side and they filled the void with part of his left pectoral muscle.  The guy sitting next to me makes absolutely no saliva and has not eaten solid food in five years; he gets his nutrition solely from Ensure.  What was most amazing is the attitude of each and every one of them.  They were smiling, laughing and even cracked jokes about themselves.  I was sitting in a room full of badasses.

They were also full to the absolute brim with information that they couldn't wait to share with me.  They knew right where I was because they had been there too.  What did they tell me?  How about this...

1) I was comparing myself.. my eating, my strength, pretty much everything... to the old me.  It may be sad but it is no less true that the old me was gone for good.  There are things about me that are changed forever.  The guys at the table told me I was not the pre-cancer guy, and I was certainly not the sick guy anymore, I was this third person.  And he is not bad.  It was incredibly liberating to hear that from them.  I had a blank slate to start with as this 3rd guy.
2) I had been most depressed about the rate my swallowing was improving. It wasn't.  I found out it probably won't.  Most of the guys (and they are 10+ years further along) said eating had not been fun since completing their treatment.  After hearing that I took a long look at where I was and decided that if this was as good as my swallowing was going to get, I could live with it.  Once I made that decision and was OK with it, any improvement I do see will just be gravy.
3) I learned several things I need to keep a pretty close eye on the rest of my life.  I will need to have frequent thyroid checks as that poor organ was right in the way during radiotherapy.  If it is going to give me trouble it will be in about two years.  The carotid artery of people who have had radiation therapy in their neck can be problematic later in life.  None of this was said in a way that scared me at all, it was more like one friend telling another what to look out for during an upcoming journey.
4) This one was my favorite!  I said something about passing out in the closet and pinching the nerve in my neck.  As I described the sensation I felt when I lowered my chin to my chest one guy laughed out loud and several of them just started shaking their heads affirmitively.  "Thats called L'Hermittes Sign.  It is caused by the chemo and radiation and lasts about 18 months."  I almost started crying.  I wasn't crazy!  The guy who told me what it was called pulled up the Wiki page on his iPhone and slid it to me so I could read it.  The symptoms were incredibly familiar.

Meeting with these guys completely turned me around.  I think that day is when I started really healing.

Oops I Did It Again..

Some amazing things had been happening with my eating habits.  I was very close to maintaining the 3000 or so calorie level I kept during treatment but was adding more and more solid foods.  Lots of ice cream, milkshakes, etc.  I couldn't taste anything which really takes a lot of the fun out of meals but I could meet family and friends out on the town and share a meal.  Very, very cool.  I remember asking Dr. K when my taste buds would return and she said four weeks.  Later on, the topic came up at Dr. G's office and I asked him the same question.  His answer was 18 months to 4 years.  Ouch.

Turns out they may both be right.  Robin and I were doing something in Arlington and it got close to lunch time.  We knew there was a Pappasito's very near by and that used to be one of our favorites.  It was always possible that I would be unable to eat whatever I ordered wherever we would have gone, but I was willing to try.  The cheese enchiladas tasted like heaven.  What had tasted like black and white for close to four months now tasted like color in HD.  I still can't do hot....yet.  I miss jalapenos.  Now for the bad news, I still can't taste sweet.  People I have spoken to who would know say that the taste of sweet may be many months to years away.  I will be so happy to have it back when it does come back.

Oops, I Did It Again
I have a morning ritual that I follow almost every day.  Shower, shave my head, dry off, deodorant, walk to closet, underwear, socks, pants, sit down and put on boots, stand up and put on shirt.  Every day, the same ritual.  Well, this morning went in the same order until the "stand up and put on shirt" step.  This day, I stood up and got light headed.  I have been light headed before and I have always just waited a moment and let it pass.  When I came to, I had fallen forward, hit my head on a shelf in the closet and split the skin from the corner of my left eye across the bridge of my nose and cracked my eye orbit. My face was covered in blood by the time Robin got to me.  She had heard the crash and thought I had fallen in the shower.  I knew it wasn't good the moment I woke up.  We dressed the cut and made sure I was otherwise OK.  Then I got something to eat and went on to work.  A week or so after the fall, I noticed that when I dropped my chin to my chest I felt something like an electric shock down my buttocks all the way to my heels.  Great.  Apparently I had hit my head hard enough to pinch a nerve in my neck.  There was no way I was strong enough to deal with anything to do with my neck.  It would have to wait.

As I said a moment ago, I was eating like crazy.  I was not, however, gaining any weight.  Part of me knew that our bodies can use a large amount of calories just repairing itself.  Between the radiation and the chemo, there was plenty to be repaired.  The longer I went without gaining weight the more I started to wonder if there might be something else wrong with me.  There were a couple of other things that had started to have an impact on my attitude at the same time.  My swallowing was NOT coming along at all.  I could chew my food thoroughly and swallow and everything would make it to roughly my Adam's Apple and stop.  No amount of additional swallowing could make it move.  I had to wash every swallow down with a large gulp of water.  With the amount of food I was eating, it took 2 liters of water to get it all down.  It is also a very slow process.  I started becoming a little self conscious about how long it took me to finish a meal.  No one ever said anything but I knew it was a problem.  The ringing in my ears was at max volume and will likely not get better.  I had always accepted it but now adding that on top of everything else and I am suddenly in a pretty deep funk.

Robin had gotten to the point where she strongly urged me to speak with someone and get some help.  I am not one to readily admit I need help and definitely not one to seek it out.  It didn't take long for Robin to convince me it was time do something.  She called national group that helps people with my kind of cancer, SPOHNC.  The folks at Support for People with Oral, Head and Neck Cancer were awesome.  They directed Robin to a support group meeting on a Saturday morning.  By the way, I am also NOT a support group guy.  I went anyway and it was another major turning point in my recovery from treatment.

Well?

Time for the follow up PET.  I was all smiles because in my heart I knew I was done.  Showed up at Radialogy Associates at 7:00.  Yes, I am an early riser.  The day before I followed the same diet I had for my first PET: no sugar or carbs, nothing but protein for 24 hours.  Change into scrubs and go back to my room.  The tech finds a vein after two tries and takes a little blood from the IV to make sure my glucose level is OK before giving me the radioactive sugar.  After he pumps that into the IV, they turn out the lights and I lean back in a huge recliner for a little over an hour as the solution works it's way through my system.

An hour later, a little knock on the door and it's off to the scanner.  I don't have to use the mask any more as they are just looking for cancer this time and not using the imaging for other purposes.  There are a couple of breathing instructions, "Breathe in.  Hold it."  Stuff like that.  No biggie.  Since RA is right next door to the cancer center, I ran next door and said hi to Deb and T.  It was really good to see them.  They thought I was looking pretty good, especially my neck.  That reminds me of something I should have put in the "Odds and Ends" post....

Sometime between the second and third chemo, I had been at work and shortly after drinking my lunch had gotten sick.  I cleaned up a bit and then went and sat in my truck for about 20 minutes.  When I returned to the area I was working in I discovered that someone had stolen approximately $1,000 worth of my tools.  The worst part of this disaster was that one of the things in my stolen bag was an $800 Fluke meter of my bosses which I had to replace.  Next thing you know it is 3:00pm and time to head to Las Colinas for radiation.  When I pulled up in the parking lot I just broke down and cried.  Several minutes later I gathered myself and pasted a smile on my face and went inside.  One by one everyone I passed told me how good I looked.  If one person had said it, I would have said they were just being nice.  Two might be a coincidence.  But it was everyone!  This was crazy!  The only difference I could tell was that I was smiling.  I hadn't thought much about it but I can almost guarantee that no one in that office had seen me smile in a long time.  I made it a point to smile every day after that.

A week passes and it's time to go back to the cancer center for them to read my PET results.  Dr. K read the results and it was not at all what I expected.  "The tumor is 95% gone and all but one of the lymph nodes responded perfectly."  What the hell is this 95% crap?  I know she saw my shoulders slump and she quickly added that I was actually a little ahead of schedule.  Even this long since my last treatment the radiation was still doing it's thing.  I don't know where I got the idea that I would get a 100% clean bill of health at this reading but it was most certainly my expectation and I was bummed.  Not only that, the one lymph node concerned them.

The lymph node decision went back to my ENT, Dr. G.  He told me he wanted the radiologist that read the scan to re-read it with him so they were looking at the same thing.  Shortly after that meeting I received a call from his office setting up the surgery to remove the remaining node.  The surgery would be at Baylor Grapevine (the same place I had my tongue biopsy).  If it is possible to love a hospital, I love Baylor Grapevine.  Their out-patient setup is amazing.  Even in the operating suite it took them six sticks to get an IV going.  A little "happy juice" and I could have cared less.

The surgery was no big deal at all.  For whatever reason, I respond really well to the anesthesia.  It knocks me out when it is supposed to and when it's time to wake up and leave, I can wake up and leave.  During admissions, one of the questions they ask is if you have passed out recently.  I thought about it and then decided to tell the truth, "Yes, I have".  I got to wear a bracelet that I actually left on for several weeks afterward.  The primary meaning is obvious but I kept it on as a spiritual reminder that even though I was on a high right now, I had best be on my guard!

A week later, I went to Dr. G's office for a routine post-surgery follow up.  He walked in and was as happy and animated as I had ever seen him.  "The pathology came back on the lymph node and it was radiation damage.  That is very good news."  What else could it have been?  I had never even considered the fact that had it been cancer, I would have been in very deep doo-doo.  I never asked the question and never even considered the possibility that it could have been very bad news.  Ignorance is bliss, I guess.

Next up, another PET in 3 months.

Odds and Ends

A couple of things came to mind recently that I'm not really sure where they fit in the timeline but are worth writing about.

Water
From the second chemo on I had an obsession with water.  A very, very frequent daydream of mine (especially when the meds kicked in) was standing in the backyard with a garden hose just letting the water run over my head.  Brita or someone had a commercial running about that time that follows a drop of water over a waterfall, into a lake and then filtering down to an underground aquifier.  I was convinced it was some of the greatest footage ever placed on film and was almost moved to tears.  A friend of Robin's had suggested I spray Willard's Water on my neck (HIGHLY Recommended!) to aid in the healing process.  It is a concentrate that we diluted and placed in a spray bottle.  I would sit on the couch and periodically spray my neck and eventually even my shaved head.  It was almost a spriritual experience.  I haven't discussed this with any of my support group friends to see if they had a similar experience.  I am probably just wierd.

The Rangers
I had started treatment in March and things had started getting interesting in April which happens to be the start of baseball season.  I have been a baseball fan most of my adult life and roughly split my emotions between the Astros, the team of my youth and the Rangers, my hometown club.  Once I was unable to work, there was eating, sleeping, and baseball and that was about it.  I was always working towards seeing the next game.  If I was having a bad day, I would look at the schedule and know all I had to do was make it to 7:30 and then I could watch the game.  They didn't even know it but they helped me through some rough times.

Prayers
I know I had a post relating to a specific spiritual event during treatment but there are a few other things that happened that bear repeating.  Later in treatment when my neck was nasty and I didn't have much of a voice, I put a fly fishing rod on Craigslist.  It had gone a couple of weeks and I finally had an email wanting more info.  The guy and I swapped several email and text messages until he had gotten serious enough that he wanted to see the rod.  The appointed day arrived and as luck would have it was stormy as all get out.  Lightning everywhere and a driving rain that would come and go.  I texted the guy back and told him I was pretty sure he didn't want to wave a 10' fiberglass rod over his head in this weather.  He was committed and we agreed to meet in a Lowes parking lot.  He brought a friend who was an experienced fly fisherman (the guy I had been texting was just learning) who brought a reel and strung the rod.  He cast in the rain storm for about 10 minutes and told his friend it was a very good rod and worth my asking price.  As we were finishing the transaction, he asked "If you don't mind me asking, what is wrong with your neck?"  I told him about the cancer and treatment.  Then he says, "My friend and I are pastors at The Village Church in Lewisville.  Can we pray for you?"  So he, his friend, Robin and I held hands in a circle in a driving rain in front of a Lowe's as the two pastors prayed for us.

One day we were in a Quiktrip getting iced tea and as Robin opened her wallet to pay, several business cards fell to the floor.  I bent over and picked up a few as did a man with a small child who was in line behind us.  I thanked him in my raspy voice and we walked to the car.  As Robin reached for the door handle, I felt a tug on my sleeve.  It was the guy with the kid who had been behind us in line.  "I don't know what is wrong with your voice but I feel like I am meant to pray with you.  Would that be OK?"  Once again we are in a circle in a parking lot with people we don't know listening to them pray for Robin and I.

It made me think of how many times I had a fleeting thought of praying for someone I had seen somewhere.  I had always been too busy or too scared of being embarrassed or rejected so I just kept moving. 

Weezy
Weezy is my oldest son, Alex's dog.  When Alex moved back home from Austin, Weezy came back with him.  We are dog people.  All of us.  The last few years before the twins moved to Abilene for school, they worked at a large dog boarding house in Southlake.  Robin and I even helped out during the holidays if they were short people.  As an aside, I will forever treasure the times when my entire family was working together.  What an amazing gift!  Back to Weezy...  I don't mind if dogs sleep on my bed as long as they are on top of the covers and at my feet.  I'm asleep anyway and they dont bother me.  Well, for several weeks (months?) before my diagnosis Weezy had tried to sleep on top of my head.  Not near my head, on top of it.  He would sniff my head and neck.  It was not allowed and it was driving me crazy.  He is a very good dog and is usually very obediant.  At some point we just decided he had turned wierd.  Between my second and third chemo, he suddenly moved back to the foot of the bed.  It was several days later before Robin and I put 2 and 2 together.  Could Weezy have smelled or sensed the tumor?  We have all seen the stories on the news and it is not a particularly rare phenominon.  I am convinced that was the case.

Unfortunately, now no one wants Weezy to sleep with them.

The Rest of the Story

As fast as things had gone down hill, now they were heading right back up again.  I don't remember if it was Day 11 or Day 12 exactly, but in the same way I had felt dramatically worse every day now I was feeling stronger every morning.  In pretty short order, I decided I was done with the Fentanyl patches and just didn't put a new one on.  Ok, that didn't work out so well so I asked Deb for a script that was half the strength of the one I had been using.  I didn't even finish the half-strength box before I didn't need them at all.  I also cold-turkey quit the anti-depressants like you are not supposed to do and while it was weird for a week or so, haven't had to go back.  The goofy side effects from them continued for several months.

My neck skin was healing much better than expected and all of the docs ooh'ed and ahh'ed over the fact that I wasn't going to scar, especially in the two nasty spots on my collarbone.  I was as spritually high at this point as I have ever been in my life.  A huge crowd of friends and family had gathered around me and carried me across the finish line.  I wanted EVERYONE to know how cool that was.  As soon as I was off the pain meds, I went back to work.  I ended up missing a little over 3 weeks of work.

I should talk about that for a moment.  I may have missed 3 weeks of work but I was probably useless to them for at least two more.  The great people I worked for knew it was important to me to, as best I could, continue normal life during treatment.  When things started to get tough, they found things I could do so I could still contribute.  I know a few times I fell asleep at my desk and when I woke someone had turned the lights off.  They certainly watched out for me. They were my friends, prayer warriors and cheerleaders and played a huge part in my success.

As good as I was feeling, there were a few things that weren't progressing as fast as I would like.  My voice and swallowing ability first on that list.  I was told the follow up PET scan would be four weeks after my last treatment to allow everything to heal.  The PET picks up cellular activity and a whole area healing would light up enough to possibly hide any potential remaining cancer.  About a week before the PET, I went by the Center to let them know I wasn't healed enough for the PET.  They were very kind and assured me 1) you will NOT be 100% healed in four weeks, 2) you are on or a little ahead of schedule in the healing timetable and 3) we ARE doing the PET next week.  Come on, Chris...relax.

Release the Hounds

It had finally arrived, the last day of treatment!

I stepped up onto the scale and by the time I stopped moving the little sliding weights I had lost almost exactly 30 pounds which was the red line limit of how much they would allow me to lose before forcing me to get a stomach feeding tube.  In my head, I spun around and did an end zone dance right in front of Dr. K.           Booyah!

It was all smiles from everyone as I made my way back to the radiation suite for the 40th and last time.  I had maintained a "no photographs" policy for the duration of the treatment.  Early on when asked I had said there are some things I just dont want to remember.  Robin asked again that day if she could take a few pictures.  Things were different now and I relented.  She took one of me bolted down to the table and a couple of both the old and new masks.  I had also decided earlier if they offered me the masks I would say thanks but no thanks.  Same reason, memories I just didn't want.  I hop up on the table, get bolted down, and the remainder of the process went smoothly just like it had 99% of the time before.  The door opens, they unbolt me and thats it.

There is a bell mounted right outside the door of the treatment room.  This bell is rung by the patient after their last treatment and can be heard throughout the office.  Robin got the camera phone ready and I rang the bell three times.  Most everyone involved in my treatment was there and there was applause, a certificate and a gift box of chocolates.  They offered me the newest mask and I changed my mind on it too and accepted it.  Then they said they would see me in four weeks for the follow up PET scan. Nothing until then, no blood draws....no weigh ins. That was a good day.


Sorry for the quality, it's a picture of a picture.  This was taken Mother's Day 2010.  I think every man should pose for pictures for his wife once every 25 years...

Bell Day (a little over a year later)

**** NOTE *****  If you read the rest of this post you must PROMISE me that you will read the next post as well.  It's fixing to get ugly but the rest of the story is it gets better and you need to read the rest of the story!


Ok, if you are still reading, here we go.

Not only does the little bell signal the end of treatment, it also wakes the Hounds of Hell.  If you remember, the OJD told me my pain would peak at ten days after my last treatment.  Throughout the entire previous eight weeks I had strutted around the Cancer Center like I owned the place and acted like I was just too tough for cancer to even mess with.  Around Day 3 of 10 I started losing that cockiness.  I am guessing that Day 3 was the day I felt the first effects of the first "Boost Dose" that had been given exactly a week prior.  It wasn't just a little worse, I felt like hell.  Day 4 didn't seem like only one day worse than 3.  By Day 5 my bravado was long gone and I was scared. Five more days?!

The problem is you can't call Time Out.  What is coming is already on the way.  There is no stopping it.  In the hospital, when they check on you they ask you to rate your pain on a scale of 0 to 10.  Well, I was getting a whole new scale.

Day 6 I remember being curled up in a ball on our living room couch with my head on Robin's lap and saying "I'm not gonna make it."  I have no idea what that meant, there is nothing left to do BUT make it.  I was very diligent on keeping my Fentanyl patches fresh.  They are time release so every so often I would feel the patch kick in and would close my eyes.  I would always say a little prayer "When I open my eyes, please let it be tomorrow."  My eyes usually came open after about an hour.  I don't remember Days 7 - 10.  I can tell you OJD did not over-sell the experience.

Over the 8 week treatment period I had lost exactly 30 pounds.  Between Day 6 and Day 10 I lost 10 more.  I had started treatment at around 210 and at my lowest weighed 165.

The End! (ehhh, not so much...)

I haven't talked about Doogie much lately because there hasn't been much to say.  One time, Doogie said he was going to talk to T and make sure she was actually putting the chemo in the bag because I wasn't really showing the effects the way most do.  I was very scared of the third and final chemo because my strength was way down and the radiation was kicking my butt.  Doogie said that most of his patients had said the second chemo was the worst and I was already weeks past that one.  Well, you're not done till you've done all three. Let's do it.

It ended up taking five sticks because my veins were trashed.  Finally got a good stick in the top of my right hand.  This one took the normal four hours and there was a party atmosphere in the room.  A very sick man spent an hour or so in the suite and we tried our best to be respectful.  When he left, we had the place to ourselves and got a little rowdy.  T and the crew made the last one very special.

The next day was Thursday and my weekly meeting with Dr. K.  I guess I felt bad enough to get ornery and I had Robin with me, of course, so we were going to let her know how we felt about several things.  Fortunately for all concerned, she was on vacation and had another doctor see her patients.  I don't remember the docs name and I feel horrible about that because he gave me more information in our 30 minutes or so together than I had gotten from Dr. K in total!  Looking back, it was not entirely her fault.  I had gotten pissed off early on and was probably not a very good listener anyway.  For the sake of the blog, I will call this guy OJD (Old Jewish Doctor).

OJD walked into the patient room and introduced himself.  He explained that Dr. K was on vacation and he was seeing everyone this week.  He also said he doesn't rely on patient files so like it or not I was going to get a thorough once-over.  I didn't mind at all.  We talked about my weight.  We talked about the skin on my neck which had two pretty bad looking, oozy spots at the points of my collar bone.  He gloved-up and felt where the tumor used to be (not fun).  He asked how many treatments I had left.  I smiled and said tomorrow is my last one.  He didn't smile but asked if I was ready.

"Hell yes, I'm ready and glad this is over."

He kind of looked over the top of his glasses like you would expect an OJD to do.  "That's not what I'm talking about.  Are you ready for the next two weeks?"  He could tell by the look on my face that I had not a clue what he was talking about.  He explained:

Remember how you didn't feel any effects of the radiation for the first few weeks?  Not only are the physical effects of the radiation delayed but they are also cumulative.  They build up over time.  Your last 10 treatments will have been a "boost" dose specifically targeted at the tumor site.  Tomorrow may be your last treatment but you will not physically feel the full effect of the 40 treatments until approximately 10 days after the last treatment.  You know how microwave dinners tell you to leave them covered for several minutes after removing them from the oven because they are still cooking.  We've been cooking you for 40 days.  The next 10 days will not be pleasant.

You mean pleasant like today?

It wasn't bravery or toughness but it didn't phase me a bit.  Seriously, at this point I was very committed.  Let's do the whole thing and let's do it right so I don't have to do any of it again!  That's not to say that I knew there was more or was OK with it.  A little part of me felt defeated because tomorrow was the day circled on my calendar when I was DONE.  To find out there was more to it didn't surprise me much.  By the way, the words of OJD above may look harsh but they weren't delivered harshly at all.  He just wanted me to know what I was up against and I appreciated it greatly.