Month: July 2023

31 July 2023

Hallelujah! Dr. Burgers removed the drain! Tomorrow I can shower again. After 17 days, I still find myself habituated to the drain even though it is gone. I put things in a different pocket, check to see if I am snagging the tubing, thinking about checking the blood level in the bulb. It’ll take a while before I quit doing that.

The actual removal of the drain was simple. A couple of snips at the sutures and it pulled right out without pain. Then it was injections with lidocaine to numb me for aspiration.

She tried to aspirate the hematoma again to no effect. I’m scheduled another post-0p with her on Friday and if the hematoma and swelling over the former left breast hasn’t gone down, she’ll schedule me for a quick surgery on the following Monday or Tuesday to remove any other congealed blood in those areas. She said it would be about a 30 minute surgery with a small incision where she would suction the congealed blood out.

There is no danger of the hematoma in place. It would gradually resolve itself in a few months but she’s concerned about the pain associated with it – as am I. Of course, there’s no such thing as a 30 minute surgery because of the prep that is required and the post-op. In some ways, I wish she would go ahead and remove the hematoma surgically.

She put a bandaid over the opening for the drain and said it would probably drain some more but not to worry about it. She and the nurse also put a compression wrap around my chest in hopes of forcing the fluids into the lymph system and get it out of the area of swelling. It’s like having that bra on again.

Everyone at the cancer institute keeps asking me how I’m feeling. To be honest, depressed. The antibiotic keeps me on the toilet until the Lomotil kicks in. I’m sore and puffy near the surgery site and until today had to deal with that damned drain. I didn’t take the anti-anxiety medicine last night. Apparently, the trade name is Xanax (thanks Jimmie) and I guess I’ll start taking it again. I took it one night and not the next. Maybe I need to be on it for a while.

She also keeps commenting on the bruising. I finally told her it was because she was so mean to me during the original surgery. She didn’t laugh at that one. Then I told her that 74 year olds tend to bruise quite a bit for just about any reason.

It’s getting close to lunch time so I think I’ll partake of a couple of Duncan Donuts and a coke for lunch. When I was in junior high school, that was my breakfast. I would walk to the Gulf Cafe in Morton and sit at the counter and order a single donut and a coke. It was all I could afford for breakfast. Mom was either in her cups or missing in action so there was no breakfast at home. At the cafe, it got to be so regular that whoever was waiting tables would just go ahead and plop down my donut and coke without asking what I wanted. No, it wasn’t particularly nutritious but it got me to lunch time at the cafeteria at school. Back in those days, I think lunch was 25 cents and milk was two pints for a nickel. That way I got at least two meals a day.

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No plants to bore you with today. I just don’t feel like it. I’ll try again tomorrow. Stay tuned!

28 July 2023

I was supposed to have two doctors’ appointments today but Dr. Burgers rescheduled for Monday. Instead, I met with Dr. Velez’ nurse, Danielle, and then later with Dr. Velez.

Danielle pretty much answered all my questions and by the time Dr. Velez came in, I had to come up with some new ones.

I cleared up the 9 weeks question I had. Even Danielle had it wrong. Dr. Velez follows the Dana-Farber protocol of using Herceptin and Taxol but he decided to modify the protocol, particularly for me since I’ve already had one chemotherapy that included Herceptin when I did the four drug regimen.

In essence, I’ll start chemo on August 21 at 9:30 am and will have it every Monday for 9 weeks. I will get 80 mg/l of Taxol for each of those Mondays. I also thought I would be getting Herceptin at the same rate but Dr. Velez will put me on the every-three-weeks regimen immediately for Herceptin so there will be only three times during the nine weeks that I get the Herceptin.

After the nine weeks, I’ll continue Herceptin alone, every three weeks for one year (or 14 sessions). Once my year of Herceptin is up, I’ll be on Tamoxifen for 10 years. The 10 years is based on research with people with the same genetic markers I have for my cancer.

Every infusion date, they will test my blood and pay particular attention to my white blood cell (WBC) count. If all normal, I will not need the next day injection to boost my immune system required with the old protocol. Apparently the two drugs they will give me during each infusion doesn’t destroy the bone marrow like the four drug regimen did.

Because Herceptin has effects on the heart, every two or three weeks I will undergo an echocardiogram – for a year.

Taxol, of course, has side effects. One is bone pain. They will preemptively work on that by administering Decodron before each treatment. It’s for arthritis (yes) allergenic reactions (yes) blood/hormone disorders (no) skin diseases (maybe) eye problems (no) breathing problems (no) bowel disorders (boy howdy!) cancer (yes) and immune diseases (no). Another issue with Taxol is peripheral neuropathy but unless it gets severe, and they don’t anticipate it to do so, they’ll stay the course on the dosage. Otherwise, they’ll cut back on the dose.

Taxol does cause diarrhea but Dr. Velez feels confident my low dosage for 9 weeks will allow me to skip that problem.

So, in summary, I’ll get 16 doses of Herceptin (one dose every three weeks) and 9 straight weeks of Taxol. That leads to a 97% survivability rate after 10 years.

I will still be able to eat fresh fruit and be around flowers. I must avoid crowds and sick people. Dr. Velez feels this Dana-Farber protocol is doable for me. I told him I was willing to try it but if it got to the point where I was with the four drug protocol, I would stop chemo.

I mentioned my episodes of depression and he has prescribed me Alprazolam 0.5mg tablets which should even out my mood swings. It’s actually an anti-anxiety medication that produces a calming effect. I told him antidepressants don’t work well on me and he says this will help. Of course, the pharmacy is having trouble with my insurance company on filling the prescription.

I also asked about skin tears and bruising. The four drug routine I was on previously had that as a side effect to the point they recommended you not use rectal thermometers because it might cause damage to the colon. Not to worry. I don’t use a rectal thermometer but it’s nice to know I don’t have to worry about excess bleeding and tears.

They want me to eat a protein rich diet. I really don’t have much of an appetite and haven’t been able to finish any meals lately. I did stop at the HoneyBaked ham store and got a BOLO sandwich, so two meals in one. I also purchased 2 lbs of HB Ham and froze one. I found out last week I can eat that.

I’ll also need to drink at least 2 quarts of water in a 24 hour period to flush the chemo out of my system. Neither of the two drugs seem to affect the kidneys as bad as the four drug regimen.

On the four drug regimen, I would not have been able to receive flu shots, Covid shots or when approved, RSV immunizations. I asked about that and he said it was perfectly fine to get the injections when they become available in the fall.

One handout said no ibuprofen and in the same handout, said it was OK. I checked and I can use Advil without any problem.

I asked once we are on infusions every 3 weeks, could I camp and hike. He said absolutely!

I feel this was as positive of a situation as I can possibly expect. I’ll give it a try. Now if I can get that damn drain removed!

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This plant is considered to be a stage 2 invasive in Florida which means its on the increase but has not affected native plant communities – yet. It’s a tropical and subtropical vine and is planted in Asia, Africa and the Caribbean for its edible, albeit bitter fruit. Here, it’s a pest.

Every time I find it in my yard growing along the fence row I rip it out. When I do, the air around and my hands have this very pungent aroma from the vine. It’s not unpleasant but it certainly isn’t good smelling either.

Most people like it for the colorful orange fruit. The flowers are very much like flowers of the cucumber, cantelope and watermelon.

I digress but there was a meme several years ago on Facebook about how to tell the ripeness of the watermelon and explained that male flowers produced a poor tasting melon and female flowers produced a good tasting melon. Tommyrot. Only the female flowers produce the fruit.

However, Momordica belongs in the same family as watermelons, cucumbers, and cantelope: the Cucurbitaceae.

The Biota of North America Program (BNAP) reports 25 genera in the United States.

Genus/Species	Common Name	Location
Marah oreganus	Manroot	Muir Woods National Monument
Marah fabacea	Manroot	Muir Woods National Monument; Pinnacles National Park; Santa Rosa Island, Channel Islands National Park

Stay tuned!

26 July 2023

Depression runs in my mother’s side of the family: aunts, uncles, cousins, mother, and me. In some members it’s more pronounced than in others. For example, my mother was committed and underwent shock treatments. What intrigues me is what small, inconsequential events trigger my depressions. It can be something as simple as breaking something around the house or when I was teaching a student saying something they didn’t realize was hurtful. Last night it was a text.

Strangely, the cancer diagnosis has not triggered any depression episodes or it could be that there has been an accumulation of things that a late night text triggered. I’ll do what I always do and withdraw and hunker down until things get better.

It’s been a gray morning (literally and figuratively) and added to that was my unexpected appointment with the surgeon, Dr. Burgers. Two nights ago was rough with burning pain, a rash, and soreness under the left axilla. Dr. Burgers worked me in this morning.

She kept saying “Your poor skin” where we think the tape that held the gauze in place over the drain insertion caused an allergic reaction. She recommended continuing the cortisone cream on the rash.

Next she addressed the soreness in the axilla which is apparently due to the hematoma. She numbed the region with lidocaine and attempted to aspirate the hematoma. Unfortunately, the blood in it had coagulated and she was having a hard time getting any blood out. She then injected some fluid into the hematoma to try to loosen up the clot and was a little more successful with the aspiration. There’s still about a half tennis ball size hematoma under the arm pit and it’s still sore but at least it’s smaller than it was. I was amazed she spent as much time as she did trying to loosen up the hematoma, particularly for a spur of the moment appointment.

She also removed the glue that covered the incision (relief!) and has prescribed an antibiotic from where she messed around the hematoma and drain insertion with needles. I’m to keep the Friday appointment with her and she mentioned she might remove the drain and let my body naturally acclimate.

I’m back to no showers (the semi-water proof tape may have been the cause of the rash) and I’m back to using bath wipes.

I’m not looking forward to the chemotherapy. I’m still unsure about how many times and with what drugs but I’ll find out more about that on Friday when I meet with Dr. Velez after my Dr. Burgers appointment. If it gets too much I may opt for my 10 year 75% chance as opposed to the 95%.

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Wikipedia reports this native to Panama, Columbia and Venezuela. What is interesting to me are the leaves. Botanically, the term is obovate which means they are wider at the tip than at the base. Wikipedia suggests they are like the hood of a cobra. Not sure I agree so I’ll stick with obovate. However, they certainly stand out.

The plant belongs in the dogbane family or Apocyanaceae. The family has undergone a significant revision since DNA analysis and there are a lot of species that have been added to the family since I was a graduate student.

As a member of this family, Plumeria is related to frangipani from which leis are made. It seems to be quite common in my neighborhood and it’s a pretty consistent bloomer.

Biota of North American Plants (BNAP) reports 24 genera in the U.S. I’ve photographed 7 genera and 13 species of the family in my travels. Click on links to see an image of the plant.

Genus/Species	Common Name	Location
Amsonia tabernaemontana	Willow Amsonia	South Mountains State Park, North Carolina
Asclepias curassavica	Tropical Milkweed	Fred’s Back Yard, Fort Lauderdale
Asclepias curtissii	Curtis’ Milkweed	Silver Springs State Park, Florida
Asclepais exaltata	Poke Milkweed	Linville Falls, North Carolina; Shenandoah National Park
Asclepias humistrata	Purple Milkweed	Manatee Springs State Park, Florida; Reed Bingham State Park, Georgia
Asclepias pumila	Plains Milkweed	Devil’s Tower National Monument
Asclepias speciosa	Showy Milkweed	Theodore Roosevelt National Park; Devil’s Tower National Monument
Asclepias variegata	Redwing Milkweed	Wakulla Springs State Park, Florida
Cynanchum northropiae	Fragrant Swallowort	Bahia Honda State Park, Florida
Mandevilla macrosiphon	Plateau Rocktrumpet	Big Bend National Park
Pentalinon luteum	Wild Allamanda	Bahia Honda State Park, Florida
Rhabdadenia biflora	Mangrove Rubber Vine	Secret Woods Nature Center, Fort Lauderdale
Sarcostemma clausum	White Milkweed Vine	Shark Valley, Everglades National Park

Stay tuned!

25 July 2023

It was a miserable night. I couldn’t get comfortable with the drain insertion point. It felt like I had burned myself in that area. Not only that but I’m still very sore in the axillary region. There seems to be a lump there in the muscle tissue.

I finally couldn’t stand it any more so I removed the bandage from around the drain insertion.

I seem to have developed a rash around the drain area. In the photo above you can see the sutures that hold the drain in. I’m still bloodying tee shirts every day. I cleaned the area with rubbing alcohol and then put Neosporin on the rash and replaced the gauze and tape. I then covered it with Press and Seal to semi-waterproof it. It already feels much better.

I’m still donating 30 milliliters of blood every morning. It’s still dark red with no indication that it’s clearing. Looks like I’ll be forced to have the drain for a third week unless something drastically changes in the next few days.

I’ll call the Nurse Navigator later today and ask if they want me to come in and let them check out the rash. If not, I may go back to bed and sleep awhile since I was up at 4 am this morning with the burning.

Since I was up, I ate breakfast (bananas, strawberries, blueberries, and yogurt) and then was out the door for my morning walk at 6 am. It was still pitch black outside. This was the first time I got to photograph Riverland Road in the dark since the re-vamping of the road. It’s taken a couple of years but the wait was worth it.

Riverland now has two bike lanes (left and right side) and even better, reflectors have been spaced all along the road bed. The reflectors light up from either car headlights or from street lights and show you the edge of the bike lane.

Even better, although not shown in the photograph, is the center line has yellow reflectors. Where you find a fire hydrant, the center line has a blue reflector so the fire department can easily determine the location of fire hydrants.

Even with street lights, Riverland used to be a very dark street at night. With new street lights, bike lane reflectors and center lane reflectors, there’s no reason for anyone to accidentally drive up on the swale. However, if you look at the front center of the above photograph, you can see where someone did manage to do that.

I don’t typically drive Riverland at night (nor anywhere else that much) but it certainly makes it a pleasant experience when I do. You tax dollars at work!

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This plant belongs to my favorite group of plants, the cycads. They are considered extremely primitive and are related to the gymnosperms (think pine trees). They have fern-like characteristics (look at the fronds) but unlike ferns, produce seeds, not spores.

Cycads are dioecious which means there are male and female plants. Both produce cones. The male cones produce pollen and the female cones produce seeds when fertilized by the pollen from males.

Dioon is a native of Mexico and Central America and is often planted as an ornamental in South Florida. A lot of people confuse them with palm trees, and indeed, one cycad commonly found down here is misnomered the Sago Palm (the species Cycas revoluta).

At one time, scientists considered the cycads to be wind pollinated, a very primitive form of pollination. Let’s face it, if the wind is blowing the wrong direction the day you start releasing pollen, your genes aren’t getting passed on that year.

It was Fairchild Tropical Garden in Miami that clued the world in on insect pollination of cycads. One of the grounds keepers noticed the native coontie (Zamia integrifolia) had beetles crawling all over the female cones. The Garden was later able to demonstrate that indeed, some cycads are pollinated by insects – considered a more advanced trait in plants.

You find most cycads in South Africa and Australia although there are some in the Americas. Our only native species in the U.S. is coontie (Zamia integrifolia). Native Americans and then early settlers used the corms (short, vertical, underground stems) as a flour substitute.

The female cones of Zamia produce seeds with a fleshy covering that is carcinogenic so you have to be careful when handling the female cones. The red covering of the seeds can be quite striking.

The rarest plant in the world is a cycad of the species Encephalotos woodii. There is only one known plant in the wild in South Africa and it’s a male. Good luck with passes on those genes! All others of the species are simply clones.

The cardboard palm pictured above is a little misleading. It can grow quite large – to the point of over 6 feet tall. I purchased one when I first moved to Florida and kept moving the potted plant with me where ever I moved. When I finally settled, I planted it in the ground. It took over the area in front of my front window. I finally had to remove it (no easy task) so I’m glad to have this one growing in my back yard.

Stay tuned!

23 July 2023

I’m still recovering from the surgery. I seem to need to sleep a lot. Nap time has taken on a totally meaning in my life. I can get out and around (I did grocery shopping this morning) but feel kind of blah. No bad but not good. The hematoma from the surgery seems to be going down a little and I’m not nearly as bruised as before but I still drain about 30 ml of very dark red blood every 24 hours. I am still quite sore from the biopsy of the axillary lymph nodes but I have a good range of movement. I can now put on a tee shirt without grimacing.

I looked up how long you can keep a drain in and one cancer website said three weeks. After that, you are prone to infection. I seem to be heading to the three week time frame. I go back to the surgeon on Friday but I can’t believe my drainage will lighten in color much less turn straw colored or clear so I’m sure she’ll tell me it stays in. I still have to sleep on my right side because of the drain on the left.

A friend who had a hysterectomy also had a drain. I commented I was afraid I would scare little children with my bloody bulb pinned to the outside of my shorts and she said she wore hers on the inside of her underwear. A lightbulb went off and I realized my shorts have pockets!

I’m a creature of habit. My wallet goes into my left back pocket, my house keys and car fob go into my right front pocket, and my cell phone goes into my left front pocket. Ever the old fashioned guy, I have a handkerchief in my right rear pocket. Another confession. Until TSA got so snippy about pocket knives, I used to always have one in my right front pocket. I was always cutting off branches on field trips around campus to show students botanical concepts.

It never occurred to me to put the bulb in the pocket of my shorts. I did for the grocery shopping and the tube was neatly hidden by the shirt. Of course now I’m discombobulated because my phone has joined my house keys and car fob which causes me all kinds of confusion. Half the time I can’t find my phone now. If I still have the drain for Halloween, I think I’ll sit outside the house and pass out candy with the bloody bulb visible.

The feels like temperature is only 106°F today. We are yet to have our afternoon thunderstorm but there’s still time. I did manage 1.4 miles this morning but it was at 7 am and still somewhat cool, comparatively.

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On my walk this morning I passed a house that has their front yard looking like a jungle. Both the swale and the front yard are overgrown with both native and non-native plants and when you walk on the sidewalk it’s like you have a jungle canopy over your head. It’s a great look and I like all the plantings. One plant jumped out at me in that it was right at eye level.

Can you believe the color of this? I grew up with maypops or passionflowers (Passiflora incarnata). I always told my students it looks like a flower from outer space. Most of the genera Passiflora are said to be neotropical. Perfumed passionflower is native to Central America and northern South America. The fruit is technically a berry but I know the fruit of P. incarnata (maypop) is mostly hollow with fleshy seeds. I think most are all vines in their growth form.

It’s called a maypop because when you step on the egg-sized fruit, you get a loud pop as it splits open. My first exposure to this phenomenon was visiting my brother at his father’s house in Brandon and riding horses in his pasture. The pasture was full of maypops and the horses would step on them. Then when I walked the pasture, I would take great pleasure in jumping on the fruit to get the popping sound.

Later, I found out the fleshy covering (aril) over the seeds was edible and I became addicted. Unlike rattlesnake, the fleshy seeds didn’t taste like chicken. It had a creamy, tart taste that is very distinctive to the fruit. I always liked taking students around campus where we had P. incarnata growing and letting them taste the pulpy seeds. Food always interests young college students.

Most species are a source of food for butterflies and you can often see caterpillars feeding at will on the leaves.

Several years ago, my friend Chris gave me a young native species Passiflora suberosa. It’s also known as the corky stem passionflower which pretty much tells you what the stem looks like when cut open. It has a very tiny flower and is pretty much green or cream colored . It still grows along the northern edge of the pool in among my Cabada palms. Florida has 12 species of Passiflora and one hybrid species. As far as I know, the fruit of all species are edible.

Stay tuned!