How hungry are you?

The hunger is the will to fight. Before dismissing a course of treatment, cancer patients must decide how hungry they are to beat the cancer.

Radiation

This course of treatment is not open to all patients. Only certain tumorous cancers can be effectively treated with radiation. Excluded cancers include blood cancers (leukemia), bone cancers (osteocarcinoma), certain lung cancers (mesothelioma), Stage 3 and higher lymphoma and many brain and other organ cancers (pancreatic, liver).

Radiation can also be used following surgery for more survival cancers like prostate, testicular, breast, esophageal, peptic and colon cancers.

Side Dishes

Nausea: Extreme enough to cause painful vomiting

Weight loss: Side effect of nausea and body's natural reaction to radioactive materials

Hair loss: Side effect of radioactive materials

Mutations: Some cancers mutate under radiation. Though the tumor is reduced, other cancers (melanoma) can result from extended exposure to radioactive materials.

If the tumor can be reduced, many times the radiation will cause the remaining tumor to enter remission. The remission, or dormancy of the cancer, can last for as little as a few months or as long as a lifetime.

Surgery

Again, this is not an option for many cancers which do not produce tumors. Some tumors are not positioned favorably for removal. Others are perfect (melanoma). For the ones where surgery is available, it, too, has a plateful to accompany it.

Side Dishes

Anesthesia: General anesthesia (GA) has inherent risks, including failure of organs or appendages to successfully regain function after surgery.

Pain: Though typically to reduce pain, most surgery requires opening of muscles or the skull. Post surgery pain is common.

Recovery: Rehabilitation of severed muscle walls and area surrounding removed tumor.

Amputation: Most common variety is mastectomy.

Failure rate: Not all cancer cells are successfully removed when the tumor is removed. Based on the size of the cells and nature of the tumor, 100% success of cancer removal during surgery is far from guaranteed.

Is your appetite spoiling?

Next, we shall talk about chemotherapy and the option of no treatment. Then, we will talk about the appetizers which accompany every single diagnosis of cancer.

Chin up,
Ann Marie

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Who is the bigger idiot...

...the village idiot or the one kidnapped by the village idiot? (Zee, Antz)

Yesterday, we delved into the mental side effects of narcotics associated with relieving cancer pain. By the sound of numerous effects, an air of irresponsibility appeared. I need to clear the air.

What are you doing, doctor?

Pain relief. You will note the previous fragment actually has a period after it.

The physical pain associated with cancer and cancer treatment is phenomenal. In order to cope with the pain, narcotics are a way of life, despite the side effects. In the doctor's (and often the patient's) mind, relieving the pain is worth the side effects.

Are you serious?

First, do no harm. -Hippocrates

Every doctor takes the oath. Human compassion demands to relieve suffering wherever it is found.

Pain is the body's natural receptor for bad behavior. -Ann Marie Dwyer, paraphrased from Taming the Terrible Twos: A Parents' Survival Guide

Bad behavior is not always defined as the patient's bad behavior. Sometimes, it is the body acting badly. Other times, it is the body acting badly because of the patient's having acted badly.

What choice is there?

Let me posit a scenario for you:

You go to the medical doctor with a headache. That small pain is what triggered your visit, since his job is to relieve pain.

He gives you a pain reliever to alleviate your suffering right now, but orders tests.

When the results come back, he tells you he knows there is a tumor growing in your head. Right now, you feel very little pain, but if only the pain is treated, you will lose all motor function within weeks. No walking. No writing. No talking. No eating. No caring for yourself or others.

He stands there and looks at you waiting for your question: What should I do? In his mind, he knows he needs to see other patients and has a golf game at 4:00 o'clock. He instinctively writes a prescription for narcotic pain control while he waits. His job is to relieve pain. You have options.

One from Column A and up to Two from Column B

Column A contains:

1. Nothing: Pain will increase, and death is imminent. (This is a full meal and comes with no condiments from Column B.)
2. Surgery: Absolutely no guarantee of cure; carries a chance of death in and of itself.
3. Dietary therapy: To reduce the intake of free radicals, increase the vitamin intake and boost the body's immune system to fight the tumor.

Column B

1. Radiation: Not a cure, but a stop gap to reduce tumor size and therefore pain and suffering.
2. Chemotherapy: Not a cure, but weighing the side effects against death...
3. Nothing. (This dessert ends in death and is not accompanied by anything else in Column B.)

All dishes served with a bowl of narcotics and vitamins to combat the side effects of the meal.

I'm not that hungry.

Before you say that out loud, consider the finality of death. What would you endure not to die?

Next, we will look into what you need to know before you decide how hungry you really are.

Trying each day,
Ann Marie

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Who are you, and what have you done with my husband?

Narcotics are nasty..."There is a reason they call it dope."

Watching the personality of your patient change is difficult, even when you know the reason.

It wore off.

When narcotics wear off, and pain reenters the picture, the voice coming out of the body is physical pain. Along with physical pain are myriad emotions associated with the pain.

• Frustration: The inability to control the situation of the disease and pain.
• Grief: The inability to do mundane daily activities, which, in retrospect, were not so horrid chores.
• Anger: The combination of grief and frustration.
• Self-Pity: The confusion caused when control over one's own body is lost.
• Shame: Loss of pride at admitting someone else must care for even the most basic of needs.
• Denial: The desire to be in another circumstance.
• Blame: The confusion leading the patient to believe the condition is the fault of the caregiver.

Pain is a way of life.

Sometimes the cure is worse than the disease. Poking and prodding and invasive maneuvers to get information can make your patient (and you) believe the treatment has an evil intent all its own which is equal to or greater than the disease's intent to kill.

To quote Disney's Genie from Aladdin: You would be amazed what you can live through.

Pain is a way of life for a cancer patient. Unfortunately, the narcotics in smaller doses only diminish the pain to a "bearable" level. Equally unfortunate: In higher doses, the narcotics remove the patient from reality.

Maybe that is not so bad?

Many people would run away if it were possible. They would manage their pain to the point of barely being conscious of their surroundings. This is an informed choice to be made by the patient with the consent of the doctor. Despite what the caregiver may desire, this is not a choice she can make.

What are the drawbacks?

For the patient, truly few...pneumonia is the largest threat, followed distantly by bedsores. Poor appetite can potentially cause other problems.

Cancer is not only a physical disease. The mental drawbacks are mighty. Let's look into a few:

1. Loss of long term memory
2. Failure to produce short term memory
3. Lethargy, lack of desire
4. Poor attitude
5. Poor impulse control
6. Inappropriate or flat affect
7. Mild dementia-like symptoms
8. Overstimulated REM sleep

Don't some of those have an upside?

To say they do not would be a lie.

1. This is more a problem for the family than the patient. As life comes to a close, family wants to rekindle memories of bygone happiness. Your patient may not remember enough to actively participate in such reminiscence.
2. This is a problem for the part time caregiver. Your patient will not remember activities of the day and self-report erroneously. This patient should not have access to medications or poisons. For all intents and purposes, this patient must be treated as a child for all important matters.
3. Lethargy can lead to surrendering the will to live. Caregivers need to be particularly cognizant of the depth of the lethargy. At all times, engage the patient in your own activities with him. Be aware of all activities with which you could interest your patient.
4. This understandable drawback is associated with the disease as much as the treatment. Do not wear your feelings on your sleeve. Take insults and apparent swipes with a grain of salt. Rarely are they intentional, but they are a needed release of anger.
5. Reduced inhibitions are a side effect of narcotics, but they are also a side effect of anger and frustration. Take particular care your patient does not put himself in harm's way in activities he may feel he can successfully attempt.
6. Engage your patient in conversation about something within his sight. Trigger any emotion which would allow for a change in his affect. Whether or not you are successful, report this to the doctor. This is an end-stage symptom.
7. Memory loss in short or long term will produce dementia symptoms. If your patient begins a conversation about a time period in which he has never lived, play along. Do report this to his physician.
8. REM sleep often extends for a short period into wakefulness. It is another manifestation of the poor impulse control during wakefulness. If your patient talks to you from REM sleep, talk back in a non-committal manner. Do not steer the dream in a certain direction. This is his mind coping.

The mental aspects of extended narcotic use are more difficult for the caregiver than the patient since the patient is not cognizant of the side effects as they occur. Seek help for yourself as routine to discuss your feelings about losing the personality of your patient.

Chin up,
Ann Marie

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A Moment of Silence

Rather than the post I intended for today, I feel compelled to update you on our situation, which will expound in personal detail the scenarios.

The Day of Truth

As I revealed, today was the day for a computed tomography (CT) scan. The results from today were compared to the results I posted on March 25, 2010. Do note, the first chemotherapy treatment was administered on January 19, 2010, thus marking three months since the first treatment.

As of today, the mesothelioma has failed to be curbed by the chemotherapy. Its resistance has resulted in further thickening of the pleura and advancement to nearly 90% encasement of his right lung.

The adenocarcinoma (tumor under his scapula-shoulder blade) has continued to grow. It now has broken the fifth rib, bringing a total of three destroyed ribs. It has advanced along the bone and has begun destroying the right side of both the T3 and T4 vertebrae. These are the thoracic (chest) vertebrae or the tenth and eleventh from the skull. They are opposite the sternum (breastbone).

No mention was made of affected lymph nodes, and no other major organs have been affected.

The Hard Place

With an unresponsive type of cancer which is neither operable nor a candidate for radiation, the choices are limited to two:

1. A different blend of chemotherapy drugs with pain management
2. A pain management only therapy

Yes, the second choice is not fighting the cancer with traditional medicine.

The Rock

Russell is on a chemotherapy regimen which is the industry premium for treating lung and bone cancers, among many others. The chemotherapy has depleted his body. He has lost more than 30 pounds in the last 60 days. Chemotherapy causes nausea, dehydration, mineral deficiencies and other similarly appetizing side effects.

His blood levels are dangerously unbalanced. The comprehensive metabolic panel (CMP) blood test reveals the chemicals have damaged the vessels going to and from his liver, pancreas and kidneys. This type of damage is irreversible and causes the organs to function improperly.

The Question

Is it better to live with the pain associated with the cancer and the chemotherapy or simply live as well as you can managing the pain of the cancer?

This is not a choice I may make for him. Russell must decide for himself how he will live.

Holding on,
Ann Marie

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Around the world in 80 minutes?

Where did you plan to take your dream vacation? Go virtually. Print a brochure, read a travel review, download a native recipe and make an afternoon of it. Eat authentic food and have a conversation about what you learned.

If you patient is snoring, no need to delay the trip.

• Read the brochure, and use your mind's eye to insert yourself into the scene.
• Call up a friend to whom you have not spoken recently. Discuss adventure.
• Play music from your destination.
• Get a movie about or set in yout destination.

Close your eyes, and let your spirit free to roam your surroundings. Yes, this is permission to daydream.

Where is the day care?

Cannot pull it off to the pitter-patter of little feet and curious hands? Bring them along.

• Do a native craft with them.
• Discuss the indigenous wildlife while they draw the animals. Do not correct the purple fur on the lynx. It is their virtual vacation as well.
• Sit in the recliner and rock to the sound of reading aloud the brochure. You have just been promoted to tour guide.
• Dress up for a native dinner party. See how imaginative the children can be in recreating native costumes from their own toy boxes and your closet.

Exercise that long dormant inner child.

To keep or to toss, that is the real question.

Organize a seldom used storage space. You can always find laughter in the closet and the cabinet.

• Stroll down memory lane by seeing which clothes you can donate. Laugh out loud when you see that double-breasted leisure suit, right before tossing it in the donate box.
• Rearrange the pictures in your photo albums and consider putting some of those into the frames in the Hall of Fame-ily.
• Look under the bathroom sink. Look at dates and wonder why in the world you ever kept it in the first place.
• Rifle through the stack of magazines strewn about your coffee table. Remove the address labels and toss them in a sack to take to your patient's chemotherapy waiting room. Are there not some books on the shelf with which you could part? They should go as well.
• What floor covering is in the bottom of your closet? Rediscover it. See if you can fill a garbage bag with items to either donate or pitch.

So what does this accomplish? You have...

...exercised your right to control your living environment.
...harmed no (human) animals in your quest.
...strummed the charitable strings in your own heart.
...rightfully identified there are those who are not as fortunate as yourself.
...lifted a burden off your heart.
...improved the living situation in your home.

And it did not cost you one penny. There is no better reward than one without a price tag.

From my inner child,

Keep playing,
Ann Marie

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Like Sand Through the Hourglass...

Day: a measure of time consisting of 24 hours, 1,440 minutes or 86,400 seconds.

Autopilot

The daily grind is simple when you are proficient in your rote activities. Chores take time, but rarely do they require an excess of conscious thought.

Do you find yourself cleaning when you are upset? There is a reason. By cleaning the crud off of belongings in your abode, you are exercising control. You may not be able to scrape the barnacles from the underbelly of your situation, but you can wax the hull above the water until it shines.

There is only one downfall to autopilot: Credit. No, not plastic or the time left nonsalaried in pursuit of K time.

With your brain in neutral, you run the risk of worrying. The only purpose of worrying is to burn Vitamin C. Do you have extra vitamins to burn? That is what I thought!

Lieutenant, engage.

If you absolutely cannot eradicate thoughts entirely, engage it in something constructive.

• Mentally plan some scheduled free time. (oxymoron explained below)
• Make a mental checklist of what you can accomplish tomorrow. (establish hope)
• Consider what you can do with your children or grandchildren. (celebration of life)
• Plan a favorite meal. (health consciousness)
• Think about all the jobs already checked off your list. (accomplishment)

Military Intelligence

Long the standing oxymoron to explain behavior which is expedited far in advance of the need for completion: Hurry up and wait.

Scheduling free time is just as poignant an oxymoron. Plan what you want to do during the quiet time. If you had an hour where no menial demands would intrude, what would you do?

In your own best mental health interest, do something you enjoy, even if it consists of nothing more than television watching you (napping with the dog and a snuggly blanket on the couch).

Consider meditating or exercising. Your brain will produce endorphins to raise your mood.

Are you up for a telephone free, no interruptions, locked door, candle lit, aromatherapy Epsom salts soak in a hot tub of water?

Do you know where the last book you bought, but never have had time to read, is?

These are great free time activities to banish the blues, worry and stress from your brain and heart without leaving your patient.

Company, dismissed.

If you can use your time to leave, go. Build up some Vitamin D by getting sunshine on your face. Even your backyard is away from the worry.

• Plant some flowers, vegetables or trees. (celebrate life)
• Take a ball or Frisbee to the dog. (fellowship)
• Sip tea on the swing. (relax)

Are you able to leave the premises?

• Go buy something for a project you have not finished. (foster accomplishment)
• Visit someone who needs adult interaction. (perspective)
• Visit a gym. (more endorphins)
• Bring your laptop to the coffee shop, and let someone serve you. (relax)

This free time is paramount to your sanity, which you may have noticed being AWOL on a more regular basis.

Lead by Example

Yesterday, I went to the hardware store for chicken wire to impede my dogs escape from the yard. When I came home, I shoveled, raked, wired and began leveling and repairing my back porch.

The endorphin rush led directly into a trip to the dump. How absolutely satisfying! Taking my recyclables (long neglected) to the solid waste facility allowed me to make a major dent in a project long on hold: My laundry room.

I brought my little man out to use his miniature shovel to help. Just some time with my son's excitement and satisfaction made me more buoyant.

And the best part of all of it? I slept like a rock. Rested this morning, I am content to work inside the house...but I am planning my next outdoor adventure: Exchanging my dandelions for zinnias; moving a crepe myrtle out of harm's (school bus') way and spreading more allysum to compliment the wild purple lantana in my yard.

New Orders

The next post will address the other better places you can go without leaving home and why it is vital to your success.

Forward, march!
Ann Marie

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Deafening Silence

With fans, compressors, dogs, a crotchety 16 year old cat, a telephone and children, one would think my house would never be quiet.

You are officially on ignore.

Some sounds I never hear:

The chirping of the fire alarms. No, the batteries are not dead. They are wired directly into the house. No, I do not know how to make them be quiet. Yes, they pass the monthly test. Yes, I can ignore it every 1.5 minutes (more than one beeping).

The neighbor's hounds (English bulldogs) barking at my hounds (Tennessee treeing coonhounds).

Snoring, despite species. Except for my parents (Sorry, Momma & Poppa.), snoring is a background noise to which I accomplish much, including slumber.

Trains and F-16s. We live one-quarter mile from a terrorist training target for a nearby Air Force base. No less than 15 fighters fly over the house each week. The only time a train wakes me is when it is late, and I do not hear it...freight train or subway.

The sound of little feet jumping on the bed.

Rip the knob off!

Some sounds enter my ear at a volume which would wake the dead:

A baby belch, cough, rolling over or kicking in a crib across the house with the doors all closed between us.

Apnea: Canine, feline or human. From a dead sleep (every time my eyes close), I am sitting up in the bed or staggering to the correct room to place my hand on someone's chest.

The sound of little feet hitting the floor in the middle of the night.

Silence is not golden.

Since my retirement, I have grown used to talking to Russell all day long. If he was at work, he used all our minutes to talk to me. Once he retired, we talked in person.

If you would have asked me ten years ago, I would have wished for a day like yesterday. The children were home from school (spring break) and one of my spotted dogs was in the house.

All through the house, not a creature was stirring. Cash was holding down the couch. The children were "camping" in the center of the floor on a brown blanket (island) surrounded by blue ones (water). Russell was sleeping so well, even Mr. Saw Mill was not snoring.

I took advantage:

• Eight loads of laundry
• Load of dishes
• Chili con queso
• Appliance cleaning
• Shoveled evidence of children
• Vacuuming
• Carpet shampooing
• Paying the last bill this month
• Trash collecting
• Video games
• Email catch up
• Lesson plans
• Career Day planning

So, for what do I possibly have to complain? No feedback. How lonely it is to float through a full day without speaking to another human, and in my case especially another adult human.

At least I could come in their rooms and see them to ensure they were still here.

To quote Momma, "Be careful what you ask for because you just might get it." I realize now how much the 47 telephone calls per day and hearing "Mommaaaaaaaaaaaa" twice as often was not half as annoying as I thought it was.

Now, I can tell you verbatim the last conversations Russell and I have had. Just as I would never dream of letting him walk out the door or get off of the telephone without hearing me say, "I love you," he will not close his eyes to rest without hearing it.

The Leprechaun was here.

The gold here is words will not be left unspoken, which happens to be a good practice regardless of health, distance or attitude.

Chin up,
Ann Marie

Photo Credit: Russell and Ann Marie's dog Cashisti (Cash) in South Carolina, 2009.

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Yes, it is contagious.

No, not the cancer, but the feeling bad.

Medical Records

My medical records look like the IRS code in hardback. People close to me know I act and operate healthy as a horse, but under the skin I am damaged goods with irritable bowel syndrome being the intense, stress-triggered reminder my body is not 100%. There are other irritants I have banished, most notably migraines. One (week's worth of) blog post we will discuss how to cope when caring for someone infinitely sicker than yourself.

Sympathy Pain

Even though it is psychosomatic, sympathy pain no less painful. Men get it when their wives are pregnant, especially morning sickness. Caregivers often feel the physical pain of the spouse fighting cancer. Just as the nurse asks you to rate the pain on a level of one (just noticeable) to ten (the worst pain you have ever felt), when you ask your spouse how he feels, be prepared to have your number go up with his answer.

Pets and Children

Just like the cat snuggles up to you when you do not feel well, and the dog insists on kissing your face and cleaning your "paws", your pets absorb some of the pain. Give some extra attention or perhaps a treat to console your pet.

In children, it does not usually manifest in physical pain but, instead, as emotional pain. Look for tantrums at even favorite activities and foods. Notice seclusion. It is a red flag your little one is hurting and is your call to duty as a parent to take action.

Depression

The single most common denominator for all cancer patients is depression, followed closely by major depression. From the moment of diagnosis, depression plays the part of the wet blanket...sometimes the wet, lead blanket.

Depression can cripple an otherwise healthy person. Imagine compounding it with catastrophic illness. Consider it exacerbated by a factor of ten.

Now, imagine depression of the caregiver. The point comes where there is no return from the cancer. Through the foggy fugue of depression, the caregiver is responsible for such cheerful activities as planning to distribute an estate, sitting at a bedside without acknowledgement of the patient and making funeral arrangements.

Guaranteeing the caregiver's mental stability is paramount to ensuring the patient's emotional state. It is only faked by the most Academy-awarded actors. The caregiver needs to maintain mental health to remain strong enough to care for the patient.

Insomnia

Insomnia is a symptom of mental health, medications and/or the lack of both. Do you know how easy it is to start a vehicle with a dead battery? Sure, some good Samaritan has a set of jumper cables, but you are the good Samaritan for your cancer patient. Without proper sleep, you will not and cannot give the quality of care your patient needs.

Your brain needs sleep to process information clearly. Have you noticed yet the effect of narcotic pain medications on your patient? You do not need insomnia putting you on par with him.

Talk to your doctor if you are not getting enough sleep. Based on your medical history, you may need vitamin supplements, sleeping medication, both or neither.

Germ Transportation

A cancer patient's immune system is compromised by the treatment, especially chemotherapy. Before you come in contact with your cancer patient: Scrub, change into fresh clothes, wear gloves/mask, spray an anti-bacterial agent on your shoes. What is a simple sinus infection to you will grow up to be pneumonia for your patient.

Who am I?

This is three fold: Your very own split personality.

First and foremost, you are a spouse who loves your patient more than any other persons trying everything in their power to heal your spouse.

Second and able to be deferred, you are a segue nurse. You can recognize symptoms which are unusual which a doctor or nurse may not know is unusual. You can take any level of professionalism your learning curve will sustain.

Third and most confusing, you are now your patient's spouse. As the medical team members come and go, you are not considered an equal in terms of intervention, interaction and information. Likewise, you are not considered your own entity, but rather a surrogate for what your spouse may not be able to understand or follow.

Where is the mirror?

Find a mirror and remind yourself. Whether you are looking into a compact or a puddle of water, look at yourself. Speak out loud.

"I am (state your name). I love (state spouse's name). This is the sickness I vowed not to defect, but to persevere. I am important to my spouse, who needs me. I am a whole person who is able to help."

If you do not think you can recite the speech, concentrate on the Spirit in your heart. The words will flow freely thereafter.

Chin up,
Ann Marie

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The Apex

Yesterday was the day after chemotherapy. By far, it is the best day of the cycle.

Full of it!

With liters of saline watering down the poison, Russell's blood volume was good. His heart rate was down from its normal 120+. His color was not the pallor of last week. The potassium and B12 gave him a boost of energy akin to the non-stoppable, ever-readiness of our children. I was ready to take full advantage of events others take for granted: We were going to tackle spot shopping.

Load up!

The children are home from school for spring break. I asked, "Who wants to go to the store?" To the credit of the school's speech pathologist, Nicholas raised his hand and said, "I do!"

Veronica asked, "Where are we going?" Ever the social director, she needed the itinerary.

"We are taking Daddy to the hospital for his medicine, and then we are going shopping. Do you want to go to the store?" Instantly, my mind's eye saw her with a pencil behind her ear, clipboard in hand, bird-dogging her help.

Getting everyone in the car, a mild adventure on a good day, was a chore with which Russell helped. (Victory!) He grabbed Nicholas' hand and out the door my men went.

Pick a channel.

Daddy likes light '80s. Veronica likes turn of the century NY clubbing music. Momma prefers classic '60s rock & rock. Since Veronica asked for a specific song before I turned on the player, clubbing music it was.

Halfway through the trip, Daddy started signing, "If I were King of the Forest" (1939 Wizard of Oz). Veronica was delighted and learned the words before we got to the hospital.

I am glad my car knows its own way to all the places we go. The ocapella chorus, of questionable quality, was as entertaining as the morning and evening chorus our hounds use to serenade us each day.

The smiles made my heart soar.

"I want hamburger chickens."

In the unending attempt to put weight on Russell, when have instituted a tradition: McDonald's after the hospital. Russell gets a high-fat sandwich. I get a fish patty. Nicholas gets French fries (his second voluntary vegetable). Veronica gets "hamburger chickens". She knows we go to get hamburgers, but she gets chicken nuggets. To her mind, they are "hamburger chickens".

Shoot me before Wal-Mart.

The sheer size of what I consider a microbial store, wears Russell. He does well to travel 300 feet at a clip before sitting down to catch his breath. We made a full lap of the store with Russell even traveling a few aisles to retrieve what interested him.

Interest alone is a victory. For more than three weeks, Russell has had no appetite. I have been unable to entice him to eat even his dyed-in-the-wool favorite foods. For the silver lining, the dogs are eating well as a result.

Back to the road!

With everyone having gotten a toy (Russell, too), we loaded up for the 35 mile trip home. A vibrant conversation ensued, with all occupants in participation. Nicholas even tried to keep up with the melody of the songs.

Please stow your tray tables as we prepare for descent.

We stopped by the mailbox. Russell rightfully fussed it was brimming. The mailbox has always been his job, but the quarter mile round trip to the mailbox is more than he can handle. Yes, our front yard is a bit over one-tenth of a mile.

I am not fond of snail mail. My paraplegic sister has been my postal ray of sunshine. We send each other cards and hand made postcards. She maintains, "It is so nice to go to the mailbox and get something from someone who does not want money." She is right.

The children were happy to bring in merchandise and help put everything away. The dogs were glad to see us with a full box of French fries. Russell was tired, but fulfilled from the trip. I was happy we had spent the time together.

Laughter is good medicine.
Ann Marie

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