From Scotland to Houston

So much has been going on, I promise to try to fill you in as briefly as possible. I may not be able to pull off my typical so bare with me. Let's start with Scotland. I had a fabulous time at the Academy of Marketing Science World Marketing Congress seeing old friends and colleagues, meeting new ones, and presenting our paper on metabolic therapy for treating disease. For those not in marketing academia, there are researchers studying healthcare and food consumption, consumer well being, etc., and that's where our research seems to fit. Julie arrived on a Sunday, I arrived on a Monday (after a one day delay due to weather on the east coast of the US), and we presented on a Thursday. In the interim we enjoyed the other conference activities and found time to explore the area around the hotel a tiny bit, which was in the old town area of Edinburgh. For those who haven't visited before, it's pronounced "Edinboro," something I'd heard people say and often thought they were just saying it weird. But no, that's really how it's pronounced. 

I honestly never thought about visiting Scotland and it wasn't on my top 10 list for certain. However, what an amazing place! When the conference was about over, Kim showed up from Pittsburgh. I mean, I knew she was coming. She didn't just randomly appear in Edinburgh or anything. When I was all done in Edinburgh the two of us took off in the car she'd rented and were on our way across Scotland. She did a fantabulous job of driving on the left side of the road and my job was to keep yelling, "Stay left!" at random points when I thought she might forget or be tempted to habitually drive on the right. My biggest issue as the passenger was that I kept getting into the wrong side of the car. At one point I went to sit in the car and wait for Kim. When she came out she opened my door and said, "Are you driving?" I looked up and realized that there was a steering wheel right in front of me! 

Eating my required fat and staying in ketosis was so much easier than I thought it would be. One in a while I got a little too much protein from all the Scottish salmon, but once I discovered that I could just go to a store to buy double cream, all was well. I could buy thin or thick double cream and it worked well either way in my coffee. For the thin kind, I could pour it and basically just drink it straight if I need to. Most coffee shops also typically had double cream so just like at home, most of my calories were fat coffee. 

Traveling around Scotland was quite the adventure. We saw Loch Ness but, unfortunately, did not see Nessie. She was being a "wee bit" shy. (Side note. Jason told me that he thought the use of the word "wee" to be only a stereotype. It's real. We got to where we'd count how many times people would say it in one conversation and it's more than a wee bit.) When we arrived in Inverness and checked in for our lodging, the older couple seemed very odd. The husband was a wee bit grumpy and the wife told us several things more than once. The house rules were: 1) If you go out you are not allowed to come back sobah. 2) If you meet someone out, you can't bring them back. Go to their house. I think there was a third rule but I can't remember it. Shortly after checking in, we walked into town to look for food and we decided our two hosts must be drunk. We ran into one of my marketing colleagues and his wife, who I'd seen days before at the conference. They also were exploring Scotland's offerings post-conference. We stopped to chat with them and told them about our drunk landlords. They laughed and said they'd arrived the day before and had seen a ton of drinking as well. Later in our trip, in the Isle of Skye, a random Scot we were talking to told us that Inverness is known as a place of heavy drinking and known to be "a little rough." Not sure what "rough" would be in Scottish terms but we didn't see any knife fights while we were there. 

When we left Inverness, we (Kim) drove through the beautiful Scottish Highlands to Portree, where we explored and took a small bus tour around the Isle of Skye. The bus tour day was the first day that we had stereotypical Scotland weather of clouds and rain. And, of course, there were several stops where we had to get out of the bus and hike to see a waterfall or some sheep or a mountain that was often covered by clouds. Nonetheless, Kim was thrilled because that was more along the lines of the weather she was expecting. I will admit that it was the first day that I didn't get a sunburn throughout the trip. My present chemo pill makes my skin photosensitive (as I mentioned in my last post) and no matter how much a slather myself with all manner of sunscreen, I still get burned. For this trip I'd purchased special face and lip sunscreen, which mostly helped with the face situation, but basically anything else that was showing burned even though I tried to reapply sunblock often. When we left Portree, we took the car ferry to Mallaig, where we exited the ferry and were on to our next adventure: the city of Glasgow. 

When we first arrived in Glasgow we were less than impressed. It seemed dirtier than Edinburgh with more graffiti. We rested a bit and then found a nearby restaurant where I thought I may be able to find something to eat. It was about a block from our guest house. I explained to the waitress my diet and medical situation and she promptly told us that she was familiar with this diet, her roommate was treating her psoriasis with a low carb diet, that she had been learning about how to shop for groceries for it with her roommate, and that she and her manager had been discussing this just before we walked into the restaurant. We discussed my options, she went off to talk with the chef, and then the store manager came by to reassure me that they were working with the chef to make something work for me. I told her how grateful I was and she said, "We really were just talking about this diet just five minutes ago!" I mean, come on, readers. How likely is that?! When we were leaving, the waitress told us to check out the west side of Glasgow because that's where all the shopping and other stuff is. When we left the restaurant, we stopped by the corner Tesco (the predominant shopping hub in most European cities) to pick up double cream for the morning and went back to our room. 

The next day we took the subway to the west side of Glasgow and my mind was completely changed about Glasgow. I likened the west side to shopping on 5th Avenue in NYC. Lots of upscale shops, hustle and bustle, and restaurants. I spotted a Thai restaurant that I recognized because I had gone to one of its sister locations with conference attendees in Edinburgh and I knew they had options for my needs. Just like the one I'd eaten at in Edinburgh, the food and ambiance was great. 

On the last morning we packed up early, drove the hour to Edinburgh airport, and flew back to the US on the same flight. When we got to DC we ate lunch/dinner and then parted ways. 

I arrived in Houston a bit jet lagged but got over it quickly using the "Europe to US" adjustment methods I always use. As was already planned, a former student (now faculty member at another institution) came to visit me in Houston and I LOVED spending that time with her. We are already planning our next time together.

Since I hadn't seen Aidan in a while (he'd been at basketball camp when I left Lubbock 3 weeks prior), he flew into Houston and his Uncle Steve came for a night too. When Uncle Steve had to go, the two of us went shopping for school clothes until we were both exhausted, then spent his birthday together finishing up buying what we needed, getting pedicures, and waiting for his dad to arrive. Jason did get to Houston early evening. Totally by surprise, another former student texted me that she was in Houston so I got to see her for a while too! How lucky am I to have so many students who come back to see me when they can? Any faculty member will tell you that those relationships are what it's all about. They are kids to us when we teach them, but as adults they are family and we wouldn't trade those relationships for much of anything in the world.

All of that brings us to today. Scan day. Check up day. MDAnderson day. It started in a rush because both Jason and Aidan wanted to be ready to go to Lubbock mid-afternoon when the appointments were done. I had them drop me off at the building where I was having my MRI and I did that part alone. Afterward I had my obligatory blood draw. While I was in the waiting area Jason called and said they were there to pick me up so that I could go home with them and finish packing up so that we could get going after I saw Dr. No Naps. He was my last appointment of the day.

After going home and getting packed up, Jason and I went to the Brain & Spine clinic to get results. Dr. No Naps came in, said that he'd heard I didn't have any issues, muttered something about continuing to defy all odds, and then I stated that I didn't know because I feel fine, but I don't know what the scan showed. He pulled it up and showed us that there is some ambiguous change from 8 weeks ago. We left him a little bit befuddled, so I will summarize his words with the radiology report that I read afterward so that I can make it as clear as I can. The area around where the tumor has been removed showed no change. There was some increased "glowing" around the ventricles. Ventricles are areas in the brain that allows cerebral spinal fluid (CSF) to flow in and out of the brain and the spinal column. If my memory serves me from my neuroscience courses, CSF has a few different roles. CSF 1) delivers nutrients to brain tissues, 2) protects the brain because the brain "floats" in it and is less likely to bang up against the skull all the time, which would cause injury and 3) cleans out waste or tissues from basic brain use/metabolism. 

Ok, back to the scan results. Remember that GBM does not metastasize. Many cancers do and this means that random cancer cells may break off from the main tumor and enter the blood stream, traveling through the body and eventually finding a home to take root and grow a tumor someplace else in the body. GBM cells do not enter the bloodstream typically and many studies trying to test for markers in the blood have failed to do so. What it might be able to do, however, is break off from the tumor in the brain and get into the cerebral spinal fluid (CSF). Then, if it's floating around in the CSF, those GBM cells may be able to go to other areas within the brain or in the spinal cord. This is probably what accounts for stories of patients who are stable in one area of the brain and then something shows up later in a different hemisphere or on the spinal cord or something like that. It's rare but it can happen. Now, let me say that one of my problem spots has always been close to the ventricles. When I went to talk to a surgeon about the laser technology surgery a couple of years ago, I was not a good candidate because some of my problem spot was too close to the ventricle. When I had this last surgery in January, my surgeon stated that he had to cut into the area of the ventricle and that it could cause some extra recovery time and maybe some post surgery issues. Today's scan report also says that the area glowing around the ventricle could be due to treatment. The only treatments I've had a January's surgery, post surgery radiation, and chemo. So that's where the ambiguity comes in. The radiology report just said that the area should "be closely followed." No Naps' recommendation was to extract CSF and send it to a lab to be tested so we will know if GBM cells are in the CSF and if I am at risk for those potential complications.

So now I'm staying in Houston (Jason and Aidan went back to Lubbock) for a pending spinal tap later in the week. I have no idea how long the analysis will last but I was told that the extraction itself will be done in the clinic. I will fly home on Saturday so that I can attend a previously scheduled work conference in Santa Barbara. No Naps says I should be fine to fly on the weekend. Here's to hoping there will be no GBM cells in the spinal fluid and that whatever this glowing is will go away before the next scan. Until then, I will just be doing what I can to keep my stress low, as I've had more than a wee bit of that lately.