Merry Christmas!

Just a quick post to send out my love, gratitude, and warmest holiday wishes to all of our family and friends, near and far.  I have had a wonderful Christmas so far and it is all thanks to those around me.  

We have had a festive few days full of turkey dinner, delicious beverages and baked treats, Scott's company Christmas party, and lots of visiting with friends, and surprises galore. Loving the hugs!! The next few days will be busy too, quality time with the kids and more time with family and friends to look forward to.  Now we have quieted down for the night and we are just waiting for Santa...   :-)

I feel like I already have everything I need, and I have been feeling better health-wise than I have felt in months! Plus I got good news from the bloodwork I had done today: my calcium levels remain in good shape, so I can back off my effervescent orangey calcium stuff from three doses daily to two. Yah baby every little improvement rocks, in my books.  Thanks to my family physician for texting me last evening to tell me to go to the lab this morning.  My neck/throat is improving every day too so I don't gross people out when I see them.  All is well!

I hope everyone has a fun-filled, lovely day tomorrow... Merry Christmas to All, and to All a Good Night!

Great news...

...for once!  Score one for the fight against melanoma - I get to stay in the clinical trial!

Just got the call from Sunnybrook - it's a go.  I can plan to continue my treatment schedule of Pacmen, and have the radioactive iodine treatment in between.  If the treatment times conflict, we just skip one ipilimumab and resume in April, but at this point I have my first appointment with my new Endocrinologist on Jan. 20th, the day after my next scheduled Pacman day, which I assume means we will plan for the iodine treatment at that appointment, perhaps for early to mid February.  

Holy crap what a roller coaster.  I am also celebrating that this is my last day for antibiotics for the staph infection because tomorrow I am going to celebrate with one honkin' BIG glass of wine!!!!

How to go from crying my eyes out to busting a gut laughing in two seconds flat?  Call my Mom with this news and she says "oh great! I guess the worst that could happen if the two treatments conflict is the Pacmen would be radioactive?"  LOL !! Picture it... little yellow circle men turned glowing green, just chompin' around... oh dear I am losing it!  haha

Back into the waiting pool

Another week post-surgery, and a busy week it has been!  On Tuesday Julie took me back to Sunnybrook, sans snow storm this time. 

In the morning I saw my first surgeon, the Surgical Oncologist who removed the melanoma-infected lymph nodes from my right abdomen and groin/leg in May.  She also keeps an eye on my chart and quarterly CT scan results, knowing that I am under the care of my Medical Oncologist in the meantime.  Her physical exam reported improvement in the tissue recovery in the surgical area so she was pleased, and she booked a follow up appointment for one year out.  

I will be monitored for the rest of my life in this way, by each doctor for different parts.  I am amassing a collection of specialists as I go along this journey!

After a lengthy wait in the afternoon, I saw my Head & Neck Surgical Oncologist to check out my thyroidectomy incision and surgical report. The pathology report was hot off the press too so....

Good news is I got the staples out of my incision! My neck is feeling better already, it is to the point where I can put some vitamin E on it and start healing the skin. I am willing to be seen in public LOL.  I got a new cream from my family physician, which is helping to fix the itch that was driving me crazy.  I can turn my head now too, have almost full range of motion and the swelling has gone down quite a bit. Not perfect, but a lot better than two weeks ago at this time!

Bad news is, there is good news and bad news: they removed 37 lymph nodes from my neck in total, and ten of them were positive for thyroid cancer.  Good news is it was thyroid cancer, not melanoma. I was pretty sure that wasn't the case, based on the biopsy I had already had which gave the diagnosis of papillary thyroid cancer.  But it is good to have confirmed that the melanoma hasn't spread to my neck.

Unfortunately though, bad news is that given the high rate of spread of the thyroid cancer, I have to have radioactive iodine treatment to follow-up the surgery.  All of the lymph nodes are now gone from my neck (interesting, to say the least, and I think I will be learning more about that in the near future?), but there is risk of cancer "crumbs" remaining on the table, in the form of cancer cells, thyroid cells, and/or cancerous thyroid cells, as I understand it?  So the standard of care in this case is iodine radiation, to get rid of those cells once and for all. Check out this link if you wish?

I don't know yet where this will happen, I assume Sunnybrook but may be able to have it in Owen Sound? It is a drink or a pill that I will have to drink, a radioactive substance that attracts any remaining thyroid cancer cells in my body and destroys them - when explaining this to the girls I used the "raid" commercial as an analogy: the thyroid cells like the iodine, rush to eat it then OOPS it was poisoined bait! Raaaaaiiiid!!  And poof - gone.  :-)  Over the course of a few weeks my body would clear itself of the treatment, and thyroid cancer hopefully becomes a thing of my past.  They do a scan to be sure they got it all and sometimes have to administer a second dose of treatment, but overall it is a conclusive finding after the end of it. 

Couple of minor complications about this:

1. I have to be in isolation to drink this radioactive iodine, and I have to remain in isolation for a period of approximately a month afterward?  You drink it in the hospital then stay in isolation for 2-3 days? so as not to expose anyone else, like a walking xray or better yet.. a walking Chernobyl accident. :-/  Then home I believe, but have to stay separate from my family, no chance of sharing body cells or fluids - saliva, sweat, sneezes, coughs, hand-touching, skin cells. No sharing dishes, laundry, bathroom, towels etc, no sleeping beside, or hugging anyone. :-(  Especially the kids.

2. There is this little thing called a clinical trial in which I am participating... oh yeeaaahhh... right - I have melanoma too. Shit I almost forgot!?!  *SIGH*  I am currently waiting for a call from my Medical Oncologist to see if the idodine radiation treatment is permitted under the conditions of my clinical trial for ipilimumab. 

Yes, please feel free to re-read that and pause to try to understand... I have been doing that since Tuesday afternoon!

After all of this fuss and education and decision-making and stress and waiting and treatments for melanoma, and with the snap of some fingers somewhere just like that!  I may have to opt out of my trial for melanoma treatment.  

I find this a bit bewildering after being told that the thyroid cancer is less a worry than the melanoma, but now based on the pathology of my surgery it has flipped and I am being told that the thyroid cancer is more of a threat at this point and I need to pursue the radioactive iodine regardless of ipilimumab.

Soooooo... Tuesday afternoon my head/neck surgeon consulted my medical oncologist and thankfully she was in the building and came down to see me at the same time.  I do appreciate that so much because this is quite a unique and confusing situation!  

She explained that she is very happy I successfully received the first four of eight ipi (Pacmen) treatments, and she recommends that if I have to opt out of the trial then go for it as there are not enough statistics to prove the remaining treatments three months apart are effective enough against melanoma to risk not treating the thyroid situation.  She literally said most people don't make it that far anyway so they can't conclusively say it works.  UM, seriously!? I knew she meant stage four patients, from which I am a slim margin away, so I tried to not take offense.  I'm sure she didn't realize what she was saying right to my face?! 

I swear, it's gonna be a heart attack that gets me, long before this frigging cancer.

So at this point I have a whole bunch of questions and I am waiting for a few phone calls.  I will list them here so that you know where I'm at, and please feel free to comment if you can think of other questions to ask that I have not yet answered or can add to my list to ask. I appreciate your help and support, and I will update with a blog post once I know more information:

- When will the iodine radiation treatment be?  4-6 weeks post-surgery, so mid-to-end January? Likely at Sunnybrook, think I would prefer that even though it is farther from home, it keeps me in the forefront of my medical team's attention.

- Will they allow me to stay in the trial even if I have the radioactive iodine treatment?  Don't know... my family physician suggests that there should not be any kind of conflict between the two treatments, but we suspect perhaps the trial people won't want to administer ipi in case I have some sort of strange complication and they are responsible?  Maybe my days as their favourite guinea pig are over?  :-(

- My next melanoma/ipilimumab treatment is supposed to be Jan 19th, what will happen to that?  If I opt out of the trial, there will be no treatment, and no option for one in future (unless as a stage four patient). As for further melanoma treatment?  I don't know?

 

- What will happen with my follow up care if I opt-out of the trial? One of the reasons I opted IN was for the CT scans every three months.  So far everything else wrong with me has been found by CT scan, that is my "litmus test" and there are several things they are watching, including the unclassified lesions on my liver. Family doc assured me that I will still have the CT follow ups, just maybe every six months instead of three, I am not too cool with that.  Maybe once I have a couple - or even ONE - in a row with nothing negative on it I will be comfortable waiting six months between scans, but until then?  I think not. Scan me please!

- I am waiting for an appointment with an Endocrinologist. What is an Endocrinologist?  Not sure, think that is the specialist that looks after hormones... thyroid specifically, pituitary, all the stuff that makes the body go round. I think he will be the one to watch my blood calcium levels and thyroid hormone function etc, but he may also be the one in charge of the radiation treatment?  Not sure, will keep you posted. That will be at Sunnybrook too. 

Ok please let me know if you think of anything else, my head is nearing chemo-brain capacity!

Several people have asked... holy how are you dealing with all of this?  My answer is: I don't really know.  I am upset and confused, but it is not the first time in the last eight months that I have been hit with a brick wall to overcome.  The girls and I are hugging each other tight and taking one day at a time, as we always do.

And yes Christmas is coming but that doesn't really change anything... we are having fun despite everything - we can't not, what with all of the love and support we are receiving. Scott will be home hopefully Monday too, and then he and Paige will be here for the holidays too and we can all hang out. We have some fun plans to look forward to!  And I will be hugging everybody lots, now that staph infection is gone and before I become a contagious glow-worm. ;-)

All of the texts, emails, calls, food gifts/deliveries, treats, flowers, gifts, surprises, rides to stuff, and other helpful things our family friends and neighbours are doing are very much pulling us through.  We can't thank you enough... but we will keep trying!  Thank you.  xoxo Will keep you posted!

Hoping you are having a happy and healthy pre-Christmas holiday week - talk to you soon.

Dreaming of morning coffee on a sunny day

Just thought I'd post an update on my progress this week, I have been very tired (and hideous-looking) so no visitors... but thanks for the texts and emails checking in. Grandma Iris and I were able to fill in any spare time this week catching up on a bunch of chatting, we sure make up for lost time when we get together!  My voice seems to be back to normal and it doesn't hurt, I can talk now. yay :-)

I feel better than I did this time last week, but I still am somewhat behind the eight ball.  It seems I developed a staph infection all around/in my incision, the peak of which began Wednesday, when the itching gave way to a sizeable rashy looking thing around my neck and up my throat. My nurse took one look and said we should have my Dr. look at it. We texted a photo (EW!) of it to my Doc and she called me back with a prescription for an antibiotic. Blech! Good call H. :-) Thank you. I got great relief from the sterile dry cold compress my nurse showed me how to make, and spent the rest of the night trying to not rip my throat off.

My neck/throat has been so sore and irritated this week, it is hard to find a comfortable way to put my head on a pillow. The swelling on my left side especially, goes right up my neck to behind my ear, my neck looked like a fridge.  I have had to keep it elevated too so all week sleep has been sitting up.  The incision itself feels like a tight scarf has been stuck around my neck with pinching little barbs digging into the skin which is puffy from the interior swelling.  My drain had a crazy day on Tuesday as well, seemed to overflow for whatever reason but whatever, that was a low-light of the week.

Thursday my lovely friend calmly chauffeured me to Toronto for post-surgery consult, not even a bead of sweat poppin' on her smooth forehead as we drove south out of Grey county on a snow day. Aarrghhhh I almost chickened out, but between Julie and Iris we got me stuffed in the car, sedated with a little chill pill, and cheered up with a Timmies for the road.  I just closed my eyes and concentrated on the burning infected thorn necklace wrapped tightly around my throat and poof! we got to Sunnybrook around noon - Yay Julie!

Had a quick but good meeting with my surgeon, he assessed the incision and approved the antibiotic for the infection - oops it just occurred to me that we didn't check with my medical oncologist to see if I can take antibiotics while on the melanoma treatment... too late now.  Anyway, he explained a couple of things about the surgery but not much, we don't have the surgery report or the pathology report yet.

He said he removed ALL of the lymph nodes in the left side of my neck so that is why it is so swollen and sore.  He checked out my drain and - best part of the day - he removed it!  I go back this Tuesday to see the surgeon again to remove the rest of the staples and assess my blood for "ionized calcium serum" levels.  

I am still learning to understand what is the importance of ionized calcium serum levels?  I think this is not the same sort of calcium that we think of for bones and teeth?  

Thyroid, and more importantly parathyroid (there are four little pea-sized parathyroid - two of which I am now missing - tucked in behind the butterfly-shaped thyroid gland in your throat) regulate calcium, and I guess if it goes too low you can die?  I had no idea.  I was sent home sternly lectured to get to emergency immediately if I felt numbness or tingling in my fingertips, cheeks, lips or tongue.  Thankfully, none of that, but I certainly am motivated to take my calcium stuff!!

I thought I came home with a lot of prescriptions after my surgery in May - HA!  I have to take a truckload of stuff this time, most are temporary though phew.  

• 3x daily I have to take an effervescent orange-flavoured drink containing 1000 mg of calcium each, plus a fancier vitamin D supplement than the one I already take. These are for one month only thankfully, it feels like a full time job managing all of my medication times. Will take a regular calcium supplement for the rest of my life, but not the pricey prescription stuff after this month.
• pain meds as required, which has really backed off, usually just later in the day and bedtime for my left shoulder/neck
• antibiotics 4x daily (and of course... probiotics!)
• thyroid hormone replacement - lots of info to come on this one.  I was vaguely familiar with this little pink pill as my Mom has taken them since she had her thyroid removed in her early thirties (I'm not allowed to be specific about my age and her age when talking about stuff like that heehee - she still hasn't forgiven me for telling my grade *blank* class that she was 38 years old at the time! eeek!) ;-)

I have to complain for a second - imagine!?  The surgeon strictly explained to me that I HAVE to take this thyroid hormone supplement every morning on an empty stomach. An hour before anything else. Even coffee. For the rest of my life.  

NO COFFEE for an HOUR after I wake up EVERY DAY for the REST OF MY LIFE.  AN HOUR!?!?! 

It's the little things in life that get you... please tell me you understand the importance of my morning coffee - it's all I have left for crying out loud!! I LOVE coffee immensely, I have backed off consumption of it over the years, even went as far as trying to quit a couple of times, but my love affair with coffee is much like that of my affection for the incomparable rays of the lovely sun. Warm, strong, life-giving and never-ending... coffee, just two small cups, the thing that for me makes getting out of bed every morning bearable.   

Okay, I'm done exaggerating that for the moment, but I imagine many of you feel the same way.  Whatever little part of your morning ritual that makes your life your own, think of delaying that for an hour.  Who has time for that?? Right now I can lie in bed for an hour counting the seconds til I can stumble with my eyes closed to the keurig, but someday this cancer sabbatical will end and I will have to get up at THREE AM just to get ready for work in the morning??

Scott helpfully told me that this delay in morning coffee is a small sacrifice to make, it is a decent tradeoff for having cancer in my throat, and I should quit complaining.  He's a brave man saying that while he's in Saskatchewan!! LOL

While I am complaining, please let me elaborate a little on the one other thing that is making me a bit crazy these days: the itching.  I have a terrible rash which must have stemmed from the staples or the ointment they used or the staph infection? Pair this rash with my history of psoriasis and my current chemotherapy side-effect of itchy skin, and I am spending a lot of time applying hydrocortisone cream.  

I found myself thinking this morning that I would give just about anything (including my morning coffee - for a week!) for one half hour in the sunshine. Sun. Right now. Please!  The rash is all over my neck but now also on my face and forehead, arms, knees. I hate it.  

I know my skin well from dealing with it for so many years, and I can tell you with all certainty that one hit of real natural (or tanning bed) unadulterated UV rays would zap this irritating hot pink dry painful frigging itchy skin!!! It is a vicious circle for me, I have always used sun to cure this type of skin flare-up, but now that I can't do that I fear this rash will now stay for the winter.  Nothing helps it like the sun.

Phew thank you, I think I am exhausted of venting. 

Guess I better wrap up anyway, geez I am long-winded - lots happens while I slept the week away!

It was wonderful to have Grandma Richardson here, she was an amazing help too - I am humbled by her energy and her calm cool approach to everything.  She is one amazing Lady, that Grandma of ours (which I have always known but wow an up close reminder this week).  :-)  I was able to rest and relax while she anticipated every need the girls or I had.  I had a couple of rough patches too, not feeling well and post-surgery side-effect stuff and she calmly put up with my whining, pacing, and bitching, plus she gave me good advice when I needed it.  As always.  Thank you Iris, for everything this week and always!  I love you.  And thanks Grandpa for letting us steal Grandma away for the week. xoxo

Bon voyage Dear Warden...

The snowbirds are a little late this year; due to their loving concern for me and for my family, my Mom and stepDad Grant postponed their winter escape to sunny Florida until after my Toronto trip last week.  Despite health concerns of their own, they have put me first yet again, as they have done my entire life, and I wish to thank them and congratulate them on finally making the drive out of the Arctic and into their well-deserved holiday.

Their ailments are greatly reduced by the warm humid air in their other hometown in central gulf coastal Florida - plus they have a tonne of fun down there all winter.  Sunshine, hot tub, pool, golf courses, fresh strawberries off the vine, orange-vanilla swirl ice creams from Mixon Fruit Farms, fresh shrimp cooked in beer and peeled by hand into juicy bowls with fresh green beans, breeze blowing through open condo windows every evening, pelicans hangin' around their afternoon walks on the beach, their exploratory day trips all around the area plus longer trips to the likes of Disney resort villas and crazy Key West, salty Gulf air doing them good all winter long.  

I am so proud of them for reaching this lifelong goal and I smile every time I get a post-Margarita Sunday brunch phone call from my Mom and she tells me about their week (before snoozing off for a post-Margarita nap in the shade of the afternoon). 

Since they met when I was a kid, and Grant introduced us to his dream home in Florida, I have been fortunate to visit many times, last time being when I took the girls for a visit in February 2011. I love it there too, and though my heart is achy that they are leaving, I completely appreciate why they do.

Mom and Grant have been a fixture in my life and they are always there for me when I need them.  I do not visit them enough, but I have countless wonderful memories of our lives together, whether here, there, or wherever in between. I love them, and I appreciate them and all the thoughtful things they both do for us.

 

Here they are, in a photo from last winter, so cute and happy, married 27 years and still giggling together throughout their adventures.  See my Mom specifically?  Yes, there she is, laughing and generous, funny and loving, and don't let her fool you... a tough cookie.  A VERY tough cookie... in fact this woman has been through a war - no wonder I call her the Warden.

Since my surgery in May many of you who don't know my Mom or have/not recently met her have inadvertently come to know her as "The Warden."  I dubbed her so when she very capably became the sidekick to my cancer education and the master of my recuperation efforts when it all began earlier this year.  I tend to refer to this time in my life as some sort of sentence or penitence perhaps? Some days home feels like jail, I am the inmate in my pajamas - all of the players in this chapter have roles.  My loving Mom's being that of The Boss.  :-) 

Don't get offended Mom, I am just stating what we all already know!  And LOVE.

Mom and I are alike in so many ways, and we are often teased for having the same laugh or other similarities.  Our lives have several eerie parallels which we can usually laugh about, and we share all of our daily joys and problems with each other, from my parenting woes to her misguidedly considering me her technical support hotline.  We have had our share of rough times together as well, but our relationship always stays strong, and I think we both grow from the good and bad that we share. 

We have a pretty small family; I am Mom's only child, and I have no cousins on Mom's side. I benefitted from being the only grandchild as well, by having a close relationship to my Baba and Dido growing up with my Mom. My Mom, my Baba and I are like three peas in a pod, and we often refer to Baba-isms that have helped (or hindered) us along the way, and we value how our Baba-ness and Mama-ness wind around how we mother and grandmother my girls and eachother, and ourselves.  

Before I get us too confused, let me put some faces to names.  Mama=Mom of course, and Baba=grandmother, in Ukrainian - my Mom is Baba to Claire and Cassie (and Grant is GeeGee, which is a hybrid of the traditional Uky Dido and modern-day GrandpaGrant), as her Mom was Baba to me.

Here we are all three, around 1991, in Florida.  This photo is famous in our family, simply dubbed "the three generations."

 

My Mom is awesome for family photo opps, as evidenced by this one, our last "four generations" photo in 2002. You may recognize these players. :-) 

She's SO gonna swat me when she opens her computer after arriving home in Florida and sees this post.. Notice I have waited to post it 'til she's IN THE CAR?  Yep, I am still a little afraid of her. teehee!  

She scared lots of us around here this summer, including my well-meaning friends who would pop by to visit me in my post-surgery bedrest position in the living room, and she would in no uncertain terms limit their visits whether or not any of the rest of us thought it was necessary.  She was right I know, I was on bedrest for a reason.  It was the proper way to spend part of my sentence - in solitary confinement!!!  Just kidding Mom.. just kidding! 

I respect her.  Mom's experience and education and reasoning and common sense and genuine love of others makes her a force to be reckoned with, and I am grateful to have her on my team. Cancer doesn't stand a chance around her man, the Warden has put her foot down!

Mom had a long career as a nurse, but she also has a longer career as a woman.  A busy woman, with multiple practical skills under her belt from basketball championships and drop-dead gorgeous beast at her prom, Ukrainian culture promotion and European travels (I specifically followed in her footsteps when visiting the leaning tower of Pisa!) and professional adventures (plus the odd truck trip!) all over the northern wilds of Ontario were just the beginning of all the stuff my Mom has accomplished in her life. 

I admire her every day, and I hope that people are right when they compare us, I would be honoured to be like my Mom.

I miss her already, and I'm not sure how we'll handle everything we're going through without her being at home just a four hour drive away, she is always at the ready to drop everything and come up here to look after us (ME) in case of an emergency.  My security blankie. 

The reality is though, we still speak on the phone almost every day even in winter, so after adjusting to the actual fact that it is really two DAYS driving we are separated by, we habitually fall back into the same rhythm of talking and laughing across the phone line for hours on end. Daily.

I can't even describe how grateful I am for everything you have done Mom, and always do for me - including gracefully tolerating my unfiltered impatient patient-ism and all the evil that comes with it.  I promise I won't make any decisions without calling you seventeen times first.  I have a feeling this winter will pass by much as the summer and fall did, suddenly it will be April and time for you to come home, and your Warden duties will still be here. 

In the meantime I want you to rest and relax.  Soak up that sun for me and let it sink into your bones, enjoy your time off as it is much deserved, and much-needed, in my opinion!  Look after yourself and Grant, have fun and go to Bingo night - oh and poolside happy hour Thursdays too please.  Have fun and unwind, stretch out and sleep in, stop and smell the gardenias for nobody but yourself. 

 

Cheers to you!  Thank you!  I love you! - and I'll talk to you tomorrow!  and the next day and the next day and the next day......   Choms xo xo xo

Well... THAT happened.

Hello, I'm back!  I'm still in bed but starting to return to the land of the living.  Sorry for all the texts and emails etc I have not returned, please accept my thanks for your love and support!  I will soon be back to bugging you and blabbing on and on again.  That's a promise.

Sooo.... just for the record, I feel justified in having dreaded this thyroid surgery so much, it was certainly worth it. LOL  Does that make sense?  I may still be under the influence of some lovely prescription narcotics so writing could be sketchy..... ;-)  It was deserving of the dreading, is what I am trying to say. 

Just wanted to post a very quick synopsis of what happened in Toronto and since.  

First some great news - this morning Claire's Dad took her for her xrays for her broken ankle and YAY she can ditch the crutches and put weight on the ankle! One more week of air boot cast then a week or so of tensor bandage but overall: relief of the crutches!  

The girls' play went off without a hitch over the latter part of last week.  I am told each performance of Lion, Witch and Wardrobe presented by the Kids in the Meaford Hall group was fantastic and very fun.  Claire and Cassie the "wood nymphs" were chauffeured to and fro by Baba and GeeGee and ate and napped in between and had a blast!  I can't wait to see the dvd.  Thanks to all who attended and helped the girls enjoy their time onstage so much. :-)

As for my sorry ass, I can answer a few common questions I seem to be getting, just in quick point form, then I will be back to napping.  Major sleeping these days holy, I am so completely pooped.

• Tues. aft we saw medical oncologist for the clinical trial consult, everything still on track to go as planned, next Pacmen treatment for Melanoma is Jan. 19, 2015.  And no, unfortunately the pacmen won't go after any thyroid cancer cells possibly left behind, it is specific to melanoma only, which is why the surgeon worked so hard to remove as much thyroid area as possible so that hopefully I can avoid iodine radiation treatment which could affect my trial drug treatment schedule. Med. Onc. and Thyroid Surgeon working closely together - thankfully!
• Surgery was Wed. a.m. first thing, I spoke with surgeon before going under - I think the part I hate the worst about surgery is having to climb onto the cold operating table myself and lie there while they talk to each other and hook stuff up to me knowing that I am about to have who knows what happen while I am asleep.  It is literally terrifying.
• Surgery took 4+ hours, ended up being far more extensive than originally thought, and I now have 32 (yep, Mom counted) staples circling my throat.  Dr. Higgins told Scott that he took as much as he could so as to try to avoid having another surgery.  I have a drain in the incision as well, but it is working well so hopefully my homecare nurse can remove it tomorrow.
• Total thyroidectomy, and central and right node dissections as well, plus extensive work on the left side, in fact the left is worse for pain and swelling so I am looking forward to reading the surgery report and pathology reports to see what happened??  Also he took two of four of my parathyroid? which I am told is crucial to calcium levels so I am being  heavily supplemented and monitored for calcium. 
• Have another fistful of prescriptions, major calcium supplements to take 3x daily for a month, plus the thyroid hormone replacement for the rest of my life.  
• Night in the TEGH semi-private was better than the night in Sunnybrook short stay unit, the nursing staff was far better than I had feared they would be after the dismal pre-op appt.
• Post-op recovery not as great as last time, very heavy chest and lots of coughing even still today, which hurts. Nausea too, darn no purple tarantula this time? 
• Long story short we got home around 8pm Thursday, major traffic jams longest day ever but got home phew... and sadly Scott had to quickly pack up and head to work back downtown Toronto for Friday morning rushhour! :-(  Poor guy - don't know how he handled it all but he was amazing.  Thank you Scott!  <3
• Everything at home has been great too, the Warden mothered us all over the weekend while I primarily sleep, she has gone home now and a new Warden is coming, Iris, the girls' other Grandma, to help taxi, feed, and shuffle my adorable and busy offspring. Thanks in advance Gramma - I'm staying downstairs!! ;-)
• I am able to drink, cool liquids especially yummy, protein shakes and chicken broth with the odd coffee for good measure.  I can eat, but chewing and swallowing meat is a terrible feat right now so screw it, handy I'm not hungry anyway! It's hard to open my jaw much anyway and I still have a tonne of swelling on my left side so it's fairly painful. 
• Pain is better than I thought it would be, it is manageable which is good.. and I did figure out how to wash my hair and brush teeth this morning - nothing like a Monday morning to get you moving. I cannot get my incision wet so thankful for the handheld showers we have plus all my practice after surgery in May.
• And the incision.... yes... it is large. It is uncovered and wide open for viewing, you can't miss it, and I think it is totally GROSS. Frankenstein jokes abound LOL  and its OK, I don't mind.  The girls aren't afraid of it so that is my main concern, I freaked out when I first saw it but I am assured it will heal well and scar should be minimal.  It is disgusting, I can say it.  
• I have not had much company and honestly I just can't right now, it's too tiring and painful. AND GROSS! Kids Grandmas and nurse is all I can handle, especially 'til the drain comes out. But I am feeling better every day so should be more mobile faster than the May ordeal.  
• Post-surgery appointment is this Thursday, hoping at least some staples can come out then?  But will see.  

OK think that covers it.. thank you again for your wave of support.. I need it, and I appreciate it without measure.  xoxo

T - 24 hours

24 hours from now I will be blissfully unaware of my surroundings, which will be a vast improvement over how I am feeling now!

I hate surgery, have I mentioned that? Sorry, venting..needed a whiny moment.

It is very difficult to dread something so much but still have to keep sane plus maintain order around the house and family plus prepare for being away from home and out of condition upon return... sort of like preparing for a vacation, except not like that, no benefit of sunshine and palm tree drinks anywhere in between. :-(

The girls are settled with their lists and comforts, laundry is done, cat litter cleaned (and kitty's nails are trimmed so she is happy LOL), fridge and pantry are all set for Mom and the kids, my bed is all ready for me to snuggle in when I get home in my drug-induced haze.

Ah yes the drugs.. I am not shy with the nurses in that department, I ask for a shot as soon as I have to hand over my clothes and glasses. Yes- glasses! It is the stupid little things that freak you out when preparing for surgery, I feel very disoriented without my specs I am blind as a bat so hopefully the wait for surgery goes faster than the arrival of the panic attack.

Saying goodbye to the girls this morning was the worst.. we really hate being apart from eachother. :'-(  I am now just numb with the knowledge that we have all done everything we can to prepare, we have climbed this hill on the roller coaster and now all we can do now is whoosh down the other side.

I am reassured by the fact that the girls will be so busy with their play rehearsals and performances, though I will be missing their play (for the first time ever) - that was a tough batch of tears to choke back last night.  But their Baba and GeeGee will be there with them, plus their Dads side of the family plus our countless friends and supporters.

If you have time and happen to see the girls please give 'em a high five or a hug for me. We're just trying to repeat the mantra that this will be over before we know it.  but still... :-/

Ok enough whining, we're on our way now, Toronto-bound and down.  Sunnybrook this afternoon for clinical trial bloodwork and consultation, then staying at our fave hotel close to both hospitals.

I am to call Toronto East General this evening to get my surgery time, its looking like 9am tomorrow (Wednesday) but not sure yet.  If so then I will be without glasses by around 8am.  Wwaahhhhhh

Scott will let our close family know how it goes (and how amusingly loopy I will be in recovery hehe!) And then my buddy Crys will start the call(text) tree.  I'm practicing blogging from my mobile device so if I can tomorrow or Thursday I will.  If not, please know I am appreciating your good energy and support.

I feel very loved.. thank you. xoox

Talk to you soon! Or well..whisper, or write, or hand signals? LOL I will be a thyroid gland and some lymph nodes short of a full load if ya know what I mean. ;-)

Pre-Operative Assessment Clinic

You might think that at your Pre-op you would get a feeling for what to expect in your upcoming visit to the hospital at which your surgery will be... a feeling for the facility and the nurses and the other medical professionals that will be taking your life into their hands.  What to expect when you're under the knife, and how you will be handled afterward.  

I am here to tell you that that is not always how it goes - or at least I hope that is not why my day went the way it did yesterday!

I left the building with more confusion than I had when I went in, not very much confidence in the staff that looked after me, and with painful bruises on both of my cubital fossa! (hehe cubital fossa = the inside of your elbows, like, where they put in the needles to take blood - brutal vampire nurse yesterday, just sayin'!)

My Mom and I bombed down to Toronto East General Hospital yesterday to get the lay of the land for my surgery next week, and to provide health stats, bloodwork, and any information about my life that my surgeon may be missing; get all my ducks in a row for surgery.  Other than the bloodwork I think it could all be done by phone or skype, or fax, or smoke signals..?   But no, I had to physically trip down there to dot the i's and cross the t's.

I have done this before, I clearly remember how my pre-op was at Sunnybrook before my surgery in May, and it was no fun either - I am starting to think it may just be a symptom of pre-op visits that they are a shit-show?  You don't actually get to see the surgeon, it is all looked after by nurses and pharmacists, and sometimes the anesthesiologist, though I did not see mine yesterday. 

Overall, the visit did not provide a fantastic first impression of the hospital in which I will spend some time next week.  Maybe I have been spoiled by the excellent care I receive at Sunnybrook, or maybe I just have a bad attitude about this thyroidectomy and node dissection(S) because I hate surgery. AND because I find it truly inconvenient that I have to have parts of my precious body removed, when really I didn't ask for this in the first place! Yes, could be a slightly bad attitude, but I digress.....   

After a lengthy wait in an empty holding room (which to be fair, was nicer than Sunnybrook's pre-op hole in the wall waiting cell), I was escorted to an assessment room to have my vitals taken and my visits with various parties participating in my surgery prep. 

How my blood pressure remained lower than normal through this ordeal I do not know.  The nurse didn't even look at when introducing herself to me, and I find that inexcusable.  I cannot imagine my paperwork being so engrossing that there wasn't time for eye contact.

   

Ah well anyway, after a bunch of paper shuffling and calling of other nurses to figure out just how many vials of blood I needed to give, I was very grateful that my family physician had sent extra printouts for me to take with me in case TEGH didn't receive the faxes from Sunnybrook etc.  Turns out that was smart -yay Doc thanks so much for having my back!  Apparently there was some miscommunication from the surgeon?  Or not enough orders provided? Or..? 

Two hours later, all done, bandaid on one sore cubital fossa (now please remember I get tonnes of pokes these days and I am not fussy about it, I don't watch them do it but I don't cry or wince or bitch either, but this nurse was OUCHIE) (GRRRR), jacket on and in line at the Timmies in the lobby to get a cuppa joe for the long ride home in rush hour traffic, and I hear "hellooooo hello! Hello? Look up!" 

A voice in my head?? Is a deadly chandelier going to fall from the ceiling of this dump and end all my complaints about cancer in one quick crushing blow?  Nope. No such luck.  It was my no-eye contact vampire nurse calling from the open balcony above the lobby, asking me to please come back up - she found the paperwork and she was so glad she caught me in the lobby!  grrrrr

Two more bad pokes and five more vials of blood with two more nurses involved to confer over whether or not they had the right vial colours for my apparently fancy blood test orders (does "ionized calcium" ring a bell to anyone?) that had to be contained on ice, and another 20 minutes later I was heading back downstairs to my exasperated MotherBear who had somehow contained her obvious criticism of the situation (remember, she is a retired nurse who has many times offered to do my bloodwork for me herself! LOL). We ditched the coffee run and instead broke free for the parking lot.  Yes, we actually ran. As in, get us outta here!!!  

Overall, not a great first impression of TEGH, and I said as much to my surgeon's assistant this morning.  She apologised for the inconveniences and assured me she needed to know how things went so she can monitor their dealings with other hospitals at which her boss works.  She said that I should in no way doubt my surgeon, that despite the bad first impression of the hospital, she is completely confident that I will be well taken care of next Wednesday when directly in my surgeon's hands.  oh dear.  I hope so!!  yikes.

One of the highlights of the excitement yesterday, and the reason for my hasty call to the surgeon's office this morning, was that the nurses blithely stated that I should plan on a three day stay in the hospital - THREE DAYS IN ADDITION TO SURGERY DAY.  WHAT?? I asked several times if she was sure, if that is common, if she was sure, as the surgeon told me himself that as long as everything goes okay I will be released the next day.  

She said yes plan for three days and I asked repeatedly how I could find out for sure as this would be crucial information to know as I have a young family and we live three hours away!?  She said she didn't know but was pretty sure - I suggested that having a backup plan in case of emergency something goes wrong is far different from PLANNING for a three day stay.  Aaaarrrghhhhh 

Long story short, this morning my surgeons office confirmed that I need only plan for one nights stay, unless there should be an emergency.  They used to keep people in intensive care for three days after a thyroidectomy, due to necessary monitoring of calcium levels, but not anymore.  So... as it stands, I am expecting to come home Thursday Dec. 4.  

Lots of shuffling has happened since I got the surgery date, but we are now one week out and I think it is all organised.  Scott will be taking me to my operation, we will be in Toronto Tues. Dec. 2 through Thurs, Dec 4, and my Mom is coming to stay with the girls and taxi them to and from school, ankle x-rays, and play performances etc.  Then Scott leaves for work likely on the Friday, Mom will stay until Sunday, and Grandma Iris is coming first of the following week to help taxi and look after the girls while I rest and recuperate for a few more days.  Yes, I do expect to get some much-needed rest in my cozy master suite LOL - can I start now??  ;-) 

No confirmation of post-operative assessment date, but looks like it will be one week after surgery, on or about Dec. 11, 2014.  

In any case, I suppose I am grateful that the pre-op is over with and an accomplishment to add to my cancerous list, but I am grateful that my post-op care will continue at Sunnybrook and the whole thing will be behind me about a week from now.  I will be tired I am told, and I will have to start taking a supplement to replace my natural thyroid function, and I will have to start taking a calcium supplement, but otherwise everything is rolling along as it should. 

I am just about to the point where there is nothing else I can do to prepare for this thing, so I have to let it all go and just roll with it.  I lost control of this bus ages ago!!

I'm not supposed to look this stuff up, but if you want to know more about my diagnosis of Papillary Thyroid Cancer, this is where I would maybe start looking. Here too.  :-)  Oh and Canadian site here: http://www.thyroidcancercanada.org/

Thyroid Hormone Replacement and Papillary Thyroid Cancer?

Regardless of whether a patient has just one thyroid lobe and the isthmus removed, or the entire thyroid gland removed, most experts agree they should be placed on thyroid hormone replacement for the rest of their lives. This replaces the hormone in those who have no thyroid left, and to suppress further growth of the gland in those with some tissue left in the neck.

There is good evidence that papillary carcinoma responds to TSH secreted by the pituitary, therefore, exogenous thyroid hormone is given, which results in decreased TSH levels and a lower impetus for any remaining cancer cells to grow. Recurrence and mortality rates have been shown to be lower in patients receiving suppression.

Chemo Brain

I have recently and reluctantly discovered that I am experiencing a reasonably common but little talked about medical condition nick-named "Chemo Brain."  

Though I have always been fantastic at multi-tasking and typically have abundant energy for professional and social details, I have also been able to laugh at myself for being occasionally dippy, and I am known for forgetful little things such as over-introducing people LOL -oops so you have already met this person I am introducing you to again? Several times? at my house?  I chalk that up to social graces and making sure nobody is left feeling uncomfortable not knowing each other.  ;-) 

But in the past few months I have noticed some uncomfortable changes in myself and my patterns of thinking. A few of my close friends, and my family doctor, spoke to me about my shifts in thinking being more negative than usual, and my depressy and lackluster approach to things seemed to be overpowering my usual cheerful-laugh-in-the-face-of-danger personality traits. Turns out there is medication for that, which I have never taken before in my life, but apparently is commonly prescribed to patients receiving the type of immunotherapy treatments I am. Since taking the meds I am feeling a bit better in the depression side of things, but I am still very aware of the Chemo Brain.

Though I am not taking a traditional chemotherapy (because melanoma does not respond to chemotherapy, it was not offered as an option in my treatment plan), I am indeed taking a chemical treatment that affects the human body head to toe.  

Though I don't have the intense nasty physical side effects of what we commonly know about chemotherapy, I do have the same potential for long-term organ and tissue damage, like chemo.  It is a risk, but apparently one worth taking. We shall see. 

One of those long-term side-effects which I am already finding to be affecting my life is Chemo Brain.  For the mothers in my reading crowd, you may be able to relate if you ever had "Baby Brain" during and after pregnancy?  It's kind of like that (speaking from experience!).

I took myself to see a fantastic movie in theatres a few weeks ago, and it had an unexpected cancer twist.  Without giving away any plot I can tell you that there was one scene where the main character had to openly discuss a health issue he had been hiding from his family and the public.  This character was a highly esteemed officer of the law and he did not want to admit his challenges with mental setbacks for fear of losing credibility.  

In one scene where he was being interrogated about something very important that he could not recall whatsoever, and his cancer treatment side-effects were being blown open to the public, he easily admitted to the nausea, vomiting, exhaustion, headaches, physical weakness, etc. But when asked about his memory loss and decrease in mental sharpness he defensively exclaimed "But that doesn't apply to me!"  This scene stuck in my mind, and I could relate to his reluctance to admit a decrease in mental function.  I can tell you about my physical limitations but I don't want to admit to my feeling like I'm losing my mind! I am too strong for that!  I can handle this! 

Why do we do that?  Are we weak if we admit defeat?  Are we weak if we admit that we are struggling with something, that we are afraid of the future, if we are afraid that we may never feel back to "normal" again?  Are we perceived at losing an edge or not being "positive enough" if we admit that we are not running on full mental capacity?  I'm sure there are plenty of mental health studies on that and I don't want to elaborate on mental health at this point, except for how my experience with cancer treatment is affecting mine.  It is a real factor, and I have no choice but to be open about it.  

My kids notice it the most LOL and they just tease me and take it in stride when I can't finish a sentence without searching my brain files to spit out what I started to say... or when I intend to say one thing and an entirely different thing pops out of my mouth.  I think their favourite (beyond my mixing up their names - to their faces - a 12-year long saga of twin parenting I'm sure) is my asking them to please tidy up their broccoli! and make sure their dirty laundry goes from the hamper to the fridge!? Geez Mom you're losing it!! 

I am easily exhausted, physically but mentally as well, I find I am overly sensitive to noise, I don't like surprises as much as I did before, I like my peace and quiet alone time even more than before (my best friends all know and lovingly understand and respect what I mean when I say I'm hibernating, but they do haul me out of bed if they feel I have been hibernating too long).  I have to write everything down, and I practically carry my calendar around with me to make every note in one place, pink sticky notes and paperclips have made my "calendar" quite thick. 
Driving my beloved car is a more stressful experience than it has ever been, I have questioned my own judgement a couple of times, which scares me.  My eyes get all burny feeling when I talk too much, and I have to lie down flat when the dizzies take over, which makes me angry and frustrated therefore tired and uncommunicative. I find I don't even want to drink anymore (after all this complaining about having to keep my liver clean) I feel uncomfortable with the loss of control even a little fireball or wine causes. Eeek I never thought I would say that!?! 

I worry about this side-effect specifically as it relates to my job.  I know it has been a while since I have been there.. but believe me I am actually gainfully employed. LOL I am pretty open with my boss about how I am feeling and he seems confident that I will recover and get back my "edge" needed for my busy multi-tasking management position, though I lack that conviction right now and I fear that I will not be able to do my job with the same physical AND mental prowess I had before.  Time will tell... until then I am comfortable knowing that I just have to look after my family and their broccoli troubles. And my friends can tease me about re-telling my stories, and enjoy the fact that they can re-tell me theirs because I am largely unaware of what I have already been told. :-) 

I'm thinking this is a main reason for this blog... y'all can read about how I'm feeling, and if I repeat myself it's just because you're re-reading. ;-)  I can look back on my written word to see if I'm repeating myself. Point for self-preservation - phew! 

I found a great article about Chemo Brain and I will share some points from it, in addition to the link to it:

What is chemo brain?

Here are just a few examples of what patients call chemo brain:

• Forgetting things that they usually have no trouble recalling (memory lapses)

• Trouble concentrating (they can’t focus on what they’re doing, have a short attention span, may “space out”)

• Trouble remembering details like names, dates, and sometimes larger events

• Trouble multi-tasking, like answering the phone while cooking, without losing track of one task (they are less able to do more than one thing at a time)

• Taking longer to finish things (disorganized, slower thinking and processing)

• Trouble remembering common words (unable to find the right words to finish a sentence)

"Doctors and researchers call chemo brain many things, such as chemotherapy-induced cognitive dysfunction/impairment, cancer-therapy associated cognitive change, or post-chemotherapy cognitive impairment. Most define it as a decrease in mental “sharpness” – being unable to remember certain things and having trouble finishing tasks or learning new skills. Some doctors call it chemo brain only if it doesn’t go away or get better over time. How long it lasts is a major factor in how much it affects a person’s life. When it starts, how long it lasts, and how much trouble it causes can vary a lot. So the term “chemo brain” is not completely accurate. Still, it’s what most people call it right now.

For most people, brain effects happen quickly and only last a short time. Others have long-term mental changes. Usually the changes that patients notice are very subtle, and others around them might not even notice any changes at all. Still, the people who are having problems are well aware of the differences in their thinking. Many people don’t tell their cancer care team about this problem until it affects their everyday life."

What causes brain problems during cancer treatment?

"Studies suggest that there may be more than one cause of chemo brain, especially for the short-term symptoms. Some people with cancer have very real brain problems even though they have not had chemo. Still others notice problems when getting hormone treatments, such as estrogen blockers or androgen deprivation therapy (treatments to lower testosterone levels). For some, problems start after surgery. Along with chemo, many different things can worsen brain function.

For instance, brain function problems could be caused or worsened by any one or any combination of these factors:

•    The cancer itself

•    Other drugs used as part of treatment, such as steroids, anti-nausea, drugs used during surgery (anesthesia), or pain medicines

•    Low blood counts

•    Sleep problems

•    Infection

•    Tiredness (fatigue)

•    Hormone changes or hormone treatments

•    Other illnesses, such as diabetes or high blood pressure

•    Nutritional deficiencies

•    Patient age

•    Depression

•    Stress, anxiety, worry, or other emotional pressure

Most of these cause short-term problems, and get better as the underlying problem is treated or goes away. A few, such as depression, can cause long-lasting brain problems unless the cause is treated.

So far, there is no known way to prevent chemo brain. For some people, treating their cancer will mean trouble with thinking, memory, planning, and finding the right words."

 Source and more interesting info: http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/chemotherapyeffects/chemo-brain

Italy

OK I'm doing it... re-posting an old blog article.  Some of you may know that I used to have a blog years ago - yep, I've looonng been a blabbermouth. 

Combine that with my dreams of travel back to Italy, and the restful part of this snow day affording me some tinker-time with the computer, and here it is:  the "Maserati" part of my inspiration for this blog. Enough about the Motherhood and Melanoma for a minute... let's talk Maserati.  :-)

In 2009 I wrote about my March 2007 trip to Italy (funny, only seven-ish years ago and I happened to notice in the photos that my hair was remarkably darker then than it is now).  Here goes... as I remember it:

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Ahhh Tuscany... it even smells like purple.  I had the memorable pleasure of exploring Florence(Firenze), Italy in March 2007.  Several hundred photos remain of this trip, and I have filled a journal and two photo albums with notes and observations, but for the purpose of this blog I have included just a few of my favourites.  Another excuse to sit and daydream about my experiences there...

We flew from Toronto to Frankfurt, Germany, then on to Milan, Italy, arriving on a Sunday morning.  By early afternoon we had navigated our rental car to Pisa, in Tuscany.  While there we just HAD to see the famous tower, and of course, sample authentic pizza in Pisa, for the kids of course. After a few hours there we got to our hotel in Florence, on the Oltrarno side of the Arno river, away from the touristy downtown core.

 

Pizza in Pisa:

 

Monday we drove to Siena, found breakfast and an unforgettable morning of touring around the stone streets, savouring the pace of life there.  Laundry hung from window sills in the sun, and palm trees dotted the lush vegetation.  Siena is worth another visit, longer next time.

Siena streets:

   

                 Siena grocer:

 

 

Monday afternoon we drove into Florence downtown, and found the Duomo (you wouldn't think that such a large structure could be so hard to find), some lunch in a little ristorante (a real caprese salad!), and walked around the piazza.

  

I won't even begin to describe the food... that would take up the rest of this post.  I love to sample new foods, perhaps even more adventurous when travelling (I wouldn't try octopus in Meaford!).  To say that I have always been a fan of Italian food would be an understatement, so this trip was really a dream come true for me in the ristorante department.

 

That evening we walked from our hotel to a nearby ristorante called La Piazzetta, wonderful place, charming, cozy, hip, everything you might expect from an eatery in fashionable Europe.  We had an entertaining (and sort-of-english-speaking) server who helped us decipher the menu and order a beautiful sampling of local dishes. The pici pasta was unique, Chianti better than any I had tasted at home, and dessert was a surprise, two selections made by our server.  He seemed to know just what we would like and capped off the meal perfectly.  If you are in Florence and want a quiet but fun place to eat delicious authentic food, go to La Piazzetta.

 

We noticed this little car wash while walking off the Grappa. Perfect for their little cars:

Tuesday I was on my own, and I did some extensive walking around the city following my Lonely Planet travel guide to Florence suggested walk tours (excellent - I highly recommend those).  Found so many interesting things.  Ponte Vecchio is still my favourite!

Medieval gate to the city Florence:

Santo Spirito:

 

                    Back of Ponte Vecchio from a private balcony:

                           View Ponte Vecchio from Uffizi Gallery:

               Inside Ponte Vecchio, priceless modern day jewellery:

 

Me @ Basilica Santa Croce - to this day I can hardly believe it

Wednesday morning I spent at the Uffizi Gallery - breathtaking, indescribable, highlight of the trip for me.  In the afternoon I found the Cappelle Medicee (Medici Chapels).  After a fascinating tour of the interior of the chapels, including an incredibly close look at Michelangelo's marble sculptures 'Night/Day' and 'Dawn/Dusk' as well as some early - incomplete - sketches preserved on the walls, I dazedly wandered through the ancient jewels and treasures displayed on the lower levels.  I was glad I had taken the advice of the jewel merchant behind Ponte Vecchio to see the Medici collection.

                               Behind Medici Chapels:

 

Thursday I set out on another hike, had a few errands and another cashmere pashmina to buy, then up to Piazzale Michelangelo over-looking the city.  The weather was perfect for walking, sunny and warmer than March here, but not blistering hot like summer in Tuscany.  I walked past Fort Belvedere, along the road where Galileo lived for a time, 

<-------- Galileo lived here

and found the monks chanting at San Miniato al Monte, up on the hill above the medieval city.  This place is gorgeous!  Stephen and his Russian colleague met me up at Piazza Michalangelo, and we enjoyed the view before we descended to dinner again downtown.

                                         Fort Belvedere:

                             Exactly like in 'Under the Tuscan Sun'!

                   San Miniato al Monte - romanesque with contrast:

 

                               Remnants of medieval city walls:

 

                 View from Piazzale Michelangelo:

Friday we left Florence to spend a day in Verona before heading back to Milan to fly home early the next morning.  What a trip - as we drove north to Verona we saw incredible orchards and vineyards, unique (and new) architecture as a contrast to the historic vistas of the week.  Had lunch at a sunny caffe in Verona, then toured on foot the arena and several touristy stops.

 

Arena, Verona:

                 The famed balcony of Juliet ~ Romeo... Shakespeare:

Views from atop arena, inside it:

 

It was torture to be so close to Venice but not have enough time to go there - next time for sure. On the way back to Milan from Verona we hit a traffic jam, reminiscent of Toronto, except with way cooler vehicles - not a pick up truck to be seen.  Flights home were good as well, except that Air Canada fed us - of all things - pizza!  (yuck)      Wonderful trip overall, can't wait to go back! 

Bonus pics, love the vehicles...

                                NOT Maserati:

MASERATI:  :-)  :-)  :-)