Friday, August 27, 2010

Moving along

It's been a busy week, for someone on medical leave.  On Monday I saw Dr. Drake for my post-surgical follow up.  In his words, "Girl, you heal fast!"  I always seem to from surgery, with one notable exception that was not my body's fault.  He cleared me to start systemic treatment, and told me I was okay to go back to work the next week.  What a wonderful man; very concerned about me, told me that he'd even consulted with the surgeon who performed my nephrectomy in 2005.  At the end of the appointment he gave me a big hug.

Wednesday was Rebecca's first day of second grade.  She was very nervous the night before, to the point of making herself sick, with worries about whether her teacher would be nice or mean, and if she would be able to do second grade work.  Fortunately, she woke up with a much sunnier attitude and was all smiles as she got on the school bus.  I missed seeing her get off the bus in the afternoon (see below) so she called my cell to tell me about her day.  It sounds like her teacher is pretty strict, pretty serious.  I hope that the atmosphere loosens up once the school year is well underway.  Several people have mentioned that this is a good teacher, so maybe she's one of those who isn't as friendly as some teachers, but really gets the kids to learn... the most important thing.  Getting off the bus at home is new for Rebecca; last year she went to the after care program at the same place Carly attends preschool.  We decided that while Jim is still unemployed, Rebecca will just come home directly, saving us that tuition.  Hopefully we can keep Carly enrolled because I think she can really benefit from the program; it will depend on our bills and on how long Jim continues to receive unemployment.  Carly moved to a new classroom this week; she is now officially in Pre-K 2.  It's a smaller class, 12 instead of 25 or so.  Carly started there Wednesday as well, and that morning was very tearful about it.  As we talked about her anxiety, I learned that she was upset because her new class is in the basement at her school.  She was afraid that if they were to have "a real fire drill" (aka an actual fire) that she would not get out of the building in time.  I mentioned this to her teacher, who told me that this was one of the subjects she was planning to discuss and to reassure the students about.  Sure enough, that afternoon Carly was all smiles when she came home, announcing that she LOVES her new class.  Here are both girls on their first day:



On Wednesday afternoon I saw my oncologist Dr. Rini about starting systemic therapy.  Quick lesson for newer readers:  renal cell carcinoma (kidney cancer) doesn't respond to traditional chemotherapies, that is, drugs that work to kill the cancer cells in the body.  For many years, the only treatment was High Dose Interleukin-2, which is extremely toxic and has a low response rate.  In the past several years, a number of drugs have been approved to treat kidney cancer via anti-angiogenesis.  These drugs stop the growth of new blood vessels, thus cutting off the 'food supply' to tumors.  I remember when my dad was being treated for lung cancer in the late 1990s, he read something about the then experimental idea of anti-angiogenesis and was fascinated.  Who knew that more than a decade later, this process would become very important to my life?  Dr. Rini and I had pretty much decided at my last visit that I would try the first and most popular drug, Sutent.  It's a pill that I am to take once a day for 28 days.  I then have 14 days off the medication, then start it again for 28 days.  After two cycles they will re-scan me to see if the drug is helping me.  The scan reports were unclear about exactly what we're looking at; they mentioned possible new mets in my liver, though they were comparing the MRI to a previous CT scan, which means that they were looking at apples and oranges, basically.  The mesentery mass still exists of course, and a left adnexal mass by the uterus was noted as still being there.  I had been under the impression that they were removing that mass in my surgery but I guess not.  There was one sentence on the MRI that scared me, however.  I don't have the exact wording right now; I didn't get a hard copy of the report at the appointment, and so I need to have my results put into my electronic medical record.  At any rate, something indeterminate was noticed at my L-2 vertebra.  It could be nothing, or it could be the start of bone metastases.  I asked Dr. Rini about it and he said that there is really no information about it at this point, so while it's not an area that will be looked at in terms of assessing whether Sutent is halting progression of the cancer, it is something that will be watched in future scans.  

I feel so out-of-control about my situation right now.  How did I end up here?  Statistically I wasn't supposed to have any recurrence once the kidney was removed.  But here I am now.  It baffles me and it scares me more than I want it to, though I will continue to throw everything I can at it.

Thursday was open house at Rebecca's school.  Yes, on the evening of the second day of the year.  What is that all about?  The teacher was polite but had little to say.  She did ask Rebecca if she had told us of her 'big' award that day, which Rebecca had... if a student is behaving particularly well, they get an "Emmy Award" to place on their desk for that morning or afternoon.  Rebecca earned the Emmy that day, which didn't surprise me at all.  As we walked out of the classroom, Jim asked me what people were signing up for on the wall.  Turns out it was the conference schedule; had Jim not noticed it, I would have completely missed it.  The teacher hadn't mentioned it to us.  Luckily since we were there right at the start of open house, we got a desirable slot for us.

Then today Jim and I got a chance to do some real clearing out at home.  He's been working on clearing out the garage, and earlier this week we were able to get two boxes of stuff into the trash.  We found an item of my dad's that my sister had been looking for, so she was able to get that, along with some other items; two more boxes' worth... yeah!  Then Jim's brother's family was having a garage sale this weekend, and my sister in law (SIL) had asked me if I wanted to bring anything to sell along with their stuff.  We have a stroller that nobody in our circle of family or friends needs, that my SIL knew I wanted to get rid of.  I could think of a few other candidates to try to sell too.  So, this morning after the girls went to school Jim and I loaded up the van... along with the stroller were a sump pump (bought new for my dad's house but dissed by the inspector hired by our buyer, so Jim ended up re-installing the old one!), a deep fryer, some various electric decorative items that were never used, and a light therapy box.  I then went into the kids' stuff and got out a riding toy that Carly is too big for, a set of squishy 'tiles' that have cutout alphabet blocks, and some unopened buckets of sand toys.  In the garage Jim found a toddler seat that straps onto a chair, and a plastic easel that he'd pulled out of the trash at some point.  We put the stuff out at the sale and sold over half of it in four hours' time.  In fact, as I walked up the driveway with the first load of stuff, a lady stopped me and bought the package of squishy tiles right there!  We had to leave the sale before it closed for the day, but I think my SIL sold the stroller for us after we left.  There is almost a clear wide path now from the garage door to the back of the garage now... so we're on our way to getting a car back in there... my car, thank-you-very-much. 

The girls have been pestering us for a hamster for the past several weeks.  We had told them that they need to really clean out their bedroom before we would consider it.  Today I discussed it with them and we decided that if they could pick some toys that they could part with, we'd see if those toys would sell at the second day of the garage sale.  Any money we make from the toys will go toward hamster expenses.  It will be interesting to see what they decide thy don't need any longer!

I hope we can keep up this momentum once I get back to work next week.  I like having clear, open spaces in the house and we've had too few of those for too long.  And right now the house is not company-ready at ALL.  I really want to have people over more, to spend as much time as we can with the people we care about.  Maybe as we declutter the house, my body will declutter the cancer.  That would be the ultimate.

Tuesday, August 17, 2010

Sneaky mama

Tonight Carly was very angry with me for not letting her do something she wanted to do at bedtime.  I laid down in bed with her as she fell asleep.  She told me that she doesn't like me.  I understand, I said, but I still like you.

Then, to get more of a response, she said, rather quietly, "I hate you."

"Well, I can't stop you from hating me, but I still love you anyhow.  Even if I were mad at you, I would still love you."

Hm, that didn't work on mama... let's try another tactic:

"I'm not going to sleep here anymore."


"No, sweetie?  Where are you going to go?"

"The woods."

"Oh, okay.  Will you just sleep outside or will you have a tent?"

"A tent"

"Good idea, Carly.  You wouldn't want to get bit by the bugs."  Our windows are open tonight and we can hear all the night sounds.

"Also the thunder, mama."

"Oh true, you'd need a tent to stay out of the rain."

"Or maybe I will live by S (friend from preschool)."

"Ok, will you live in her house or just by her house?"

"In her house.  And I will eat their food if it is okay with her mom.  I wonder if I will like what they have to eat.  Maybe they will not have some things that I like, like lasagna.  They definitely won't have Cinnamon Toast Crunch."

"Yeah, it's hard to know.  I wonder if they have enough beds for you.  Maybe you will need to sleep on the floor in your sleeping bag."

"I will take my sleeping bag."

"Well, I will miss you... I hope you come back and visit sometimes, Carly."

"You can come visit ME, mama."

"True, maybe I can, if it's okay with S's mom.  But I will still miss you a lot."

"You're trying to make me fall in love with you, mama!"

Friday, August 13, 2010

Sutent Nation welcomes Liz

Back in 2006, when I was still statistically supposed to stay cancer free forever because my kidney tumor was "caught in time" I attended a kidney cancer patient support meeting at a local cancer support center.  The speaker was a young doctor from Cleveland Clinic named Brian Rini.  (cue foreshadowing) He spoke about the newest advances in drug treatment for metastatic kidney cancer.  At that point one drug, Sutent, had been approved and a couple of others were close behind in the FDA approval process.  He explained how the drugs were meant to work - they are anti-angiogenesis agents, which means that they stop the creation of new blood vessels to tumors.  No new blood vessels = no nutrition for tumors to grow.  The patient survival statistics he gave didn't sound all that great to me; I didn't know at the time that so early on in the drug's life, they just didn't have long term results yet, and didn't stop to think that many of the participants in the clinical trials were probably people who were very sick, looking for anything to try.  I remember coming home that evening and telling Jim that I sure hoped I would never need drug treatment because Dr. Rini's talk had scared the bejeezus out of me; there was no 'curative' chemotherapy available and so the choices sounded frankly pretty crappy.


Fast forward 4 years... in that time I had a lung nodule scare, which caused my uro-surgeon to send me to an oncologist... the first appointment available being with one Dr. Brian Rini.  The nodule turned out to be nothing and I enjoyed another 2 years of NVED status.  That joy was blown away by finding single metastases in July 2008 (surgically removed), Nov 2008 (surgically removed). July 2009 scans brought the motherlode - multiple lesions in the liver and a lesion on the ovary.  Goodbye surgery, hello High Dose Interleukin-2.  The IL-2 appeared to do wonders for the liver mets but the ovarian mass continued to grow, decided to balance things out by appearing on the other ovary, and just for fun, adding a mass that attached itself to my colon.   Last week's surgery caused me to go through menopause in 3 hours, but while my surgeon was able to remove the ovaries and their masses, he chose to leave the abdominal one behind.  His thinking was that I was going to need drug therapy, so opening me up to remove that mass would have caused me a much longer recuperation period before I could begin drug therapy.  (Oh and there's that pesky little business about how I would have had a temporary colostomy to deal with.) 

Dr. Rini and I met today, to truly discuss drug therapy for the first time.  He was in agreement with Dr. Drake's surgical decision.  At this point it's clear that as much as we chase the cancer around my body and pluck it out, there are still cells in there, waiting for their chance to be "alpha dog".  A couple of years ago I would have been willing to continue the chase, but even thick-headed me sees that it's never going to be the 'last one' removed surgically.  So, the question became, what drug would he recommend?  When we first talked about drug therapy last year, he recommended either Sutent or a clinical trial of two other drugs.  Prior to today's visit, Jim and I discussed what options I might be offered this time, and Jim said what I was thinking... no clinical trials right now.  Dr. Rini didn't mention trials this time anyhow.  He felt that my best options right now would be Sutent, which is considered the gold standard for renal cell carcinoma, or a similar but newer drug called Votrient.  Votrient is believed to maybe have fewer side effects than Sutent, but because it's so new, there's not much data on whether it's also more effective than Sutent.  Dr. Rini started off by saying he had no real leaning toward one or the other, but it became clear as we talked that if he had to pick for me, he'd pick Sutent, which is what I did choose.  He did also mention that since the liver mets are stable (except for the one that shrank, yay!) and the abdominal mass left seems stable, I could wait 3 months and re-scan before starting treatment.  He and I both shook our heads "no" at that idea.  Drugs are inevitable, and waiting 3 months might be okay, or might be a fertile breeding time for my cancer cells.  After all, I had clean scans in April of 2009, and all hell broke loose as a result of July's scans.

I need to do some more healing from my surgery, as stopping my body from creating blood vessels might not be a good idea while it's trying to mend.  Next week I will be going for scan-o-rama day on Tuesday... CT of head and chest, MRI of abdomen and pelvis.  When we talked in May, Dr. Rini told me that he'd probably have me do MRI of abdomen and pelvis from now on, and a chest xray.  I was surprised by that, and folks I know in the kidney cancer community were insistent that I should be having CT of the chest instead.  I asked him about it today and as I suspected, he's mostly concerned about the amount of contrast I'm having to take (not good for kidneys!) but agreed that we'd get a CT this time for a baseline.   I'll then see Dr. Rini on 8/25 and we'll decide when I start taking the Sutent.

It's an orally administered drug, so no having to go to the cancer center and be hooked up to an IV periodically.  The dosing schedule is 28 days on, and then 14 days off.  After two of those cycles I will have scans for comparison.  If side effects make me too miserable, we'll look at changing the dosage.  I asked Dr. Rini if it was reasonable to be able to keep working throughout treatment.  He said absolutely, that was the goal, and that having the drug help get rid of the cancer isn't worth it if you are too sick.  I was glad of that.  Another thing I thought was cool was that as soon as we decided on Sutent, he paged a financial counselor to look into what my health insurance copay will be for the drug.  I like that he was concerned about that aspect of the treatment; these drugs are EXPENSIVE.  I'll find out next week just how expensive for us. 


The side effects are just lovely; from the Sutent site they are listed as follows:

Common side effects

Patients who take SUTENT have these side effects more often than other side effects:
  • The medicine in SUTENT is yellow, and it may make your skin look yellow. Your skin and hair may get lighter in color
  • Tiredness
  • Weakness
  • Fever
  • Gastrointestinal symptoms, including diarrhea, nausea, vomiting, mouth sores, upset stomach, abdominal pain, and constipation. Talk with your healthcare provider about ways to handle these problems
  • Rash or other skin changes, including drier, thicker, or cracking skin
  • Blisters or a rash on the palms of your hands and soles of your feet
  • Taste changes
  • Loss of appetite
  • Pain or swelling in your arms or legs
  • Cough
  • Shortness of breath
  • Bleeding, such as nosebleeds or bleeding from cuts
I know many fellow kidney cancer patients who have had various combinations of the above; there's lots of information they have already and will share about combating these effects.  

Sounds like a treat, doesn't it?  I'll admit, I'm a bit scared that we've arrived at this point.  But I also feel hopeful that we'll see good results with the treatment.  And 5 other drugs have been approved since Sutent, so there are other avenues to try if it doesn't work for me.

Monday, August 09, 2010

Royalty

After having surgery, many people rest, relax, take it easy.  Not many are lucky enough to be able to spend some of their downtime making themselves into royalty!

The girls stayed home today; and while playing found a tiara making kit that Carly had received for her birthday but never opened.  There were three tiaras included; perfect for our family since Jim is not into the bejeweled thing.  So we girls sat at the kitchen table busily gluing bling onto our cardboard forms, then took them outside to photograph.


















Bailey, King of Dogs, was not too impressed, but enjoyed the attention while also enjoying the sunshine.

Sunday, August 08, 2010

48 hours ago

48 hours ago I was deeply asleep, while my surgeon probed my pelvis.  He found that both of my ovaries needed to be removed; we knew the right one was going but the left was questionable.  He could tell by the sight of it that both had been invaded by renal cell carcinoma... so while that was not good news, it was far better than if they'd found ovarian cancer.  Two primary cancers is something I don't need in my life!  I have a hard time fitting one primary into my busy schedule.  So, 48 hours ago I was a woman with eggs, old as they were, still inside me; now I am in menopause.  But the removal of the cancer is far better - I wasn't really using the eggs anyhow.  The hormones produced by the ovaries I will miss, but that can't be helped.  Hopefully my transition into post-menopause land won't be harder on my family, friends and coworkers than in will be on me.

48 hours ago I had hope that all viewable cancer inside me would be removed in my surgery.  However that wasn't meant to be.  The one mass away from the pelvis seems have to communed with my colon, so the surgeon chose not to remove it.  Removing it would have meant converting to an open procedure which would have a longer recovery time, thereby delaying the start of drug therapy.  My sweet sweet husband, after talking with the surgeon, immediately called my oncologist to make an appointment to talk about systemic (drug) therapy.  We'll see him on Friday, the 13th... hopefully not an omen of a date!

48 hours ago I assumed I'd be spending the night at the Hotel Cleveland Clinic; something I hate doing but knew was a necessity.  It was hard on the girls when I told them I'd have to spend the night in the hospital, so we'd be apart two nights.  But I told them that they could come with Daddy to pick me up, a small consolation but one that helped a bit.  When I was in the PACU (post anesthesia care unit or what we used to know as recovery room) I started to find out that maybe this wasn't the plan.  I asked the nurse when I would see my family, since I expected them to come into PACU to see me.  She told me that once they moved me to the outpatient area, I would get to see them.  Outpatient area... huh?  Sure enough... after I'd been in PACU about an hour and a half, and my pain was under control, I was sent down to the same area I'd been in for pre-op... in fact only 3 rooms over from where I'd been just about 7 hours earlier.  I was told by the nurse that once I was able to get up and use the bathroom, that if I wanted to go home, I could.  I did have the option to stay overnight if I wanted to or felt that I needed to.  I had actually convinced myself that an overnight stay would be okay, so that I would have the use of the moving bed and bed rail to get in and out of the bed that first night.  But on the other hand, I would likely have the leg compression cuffs on, and an IV attached, which would mean I would still need assistance to use the bathroom.  And the hospital is noisy and hot, and you never know who your roommate will be.  So I chose to go home.

48 hours ago my girls thought they wouldn't see me until Saturday.  Jim had called the day camp after surgery to let everyone know I was okay.  On Carly's side the teacher relayed the message to her, which helped her feel better because "I was worried about you all day, Mama".  My poor baby... On the 'big kids' side of the building, the teacher let Rebecca talk to Jim.  He explained that Mom "might" come home on Friday or on Saturday, but that he would be the one picking her and her sister up that afternoon.   Jim and I left the hospital around 3pm, after I had done the requisite peeing, gotten dressed, and received a dose of percocet for the road.  We stopped for a small bite at McDonalds, dropped of my prescription, and went to pick up the girls.  I of course stayed in the car.  Rebecca about flew out the door of the school and into the car, where she lapsed into a stunned, happy silence.  Carly was equally happy to see me.  After that, we stopped at my sister's house (less than 2 miles away) to pick up the girls' overnight things, then to the pharmacy for my drugs, and were still home by 5 pm.  So in less than 12 hours we were back home.  Amazing.

48 hours later, I am sore, but the medication is very helpful.  When awake, I feel good, very much like myself.  I am napping more, and having the longest, weirdest dreams... fortunately not a bizarre as the ones I had during my IL-2 treatments.  Friday night I slept in a recliner in the living room, with Rebecca in the room with me in case I needed help.  Last night I slept in my own bed, and was able to sleep on my sides; what bliss.  After the nephrectomy it was a good 3 weeks before I could do that, and I never properly appreciated how good it feels to sleep in bed until then.  I have been good about taking it easy, though last night before I went upstairs I felt compelled to empty the dishwasher.  Hm, maybe this surgery will turn me more domestic?  Wouldn't that be nice!  After I see Dr. Rini on the 13th, I'll have my follow up with Dr. Drake on the 23rd, which is Jim's and my anniversary.  Hopefully at that point I'll be feeling well enough to go back to work.  I will not push myself back too soon, but on the other hand, if I can do it, I'm not going to laze around the house for extra weeks of leave.  We just can't afford that, since my short term disability pay is only 70%of my pay.  But it will all work out, because it always does.  I plan to remain here to pester my loved ones for quite some time still.

Thursday, August 05, 2010

I know, I should be in bed...

... seeing as how I have to be at Cleveland Clinic at the eye-rubbing hour of 6AM!  I guess I'm the first procedure of the day.  I'm actually glad of that, so that Jim can spend time with me then go home to the girls.  They're at my sister's house tonight; he'll pick them up from day camp tomorrow.  They took the news of my surgery better than I'd anticipated, mostly because I don't have to travel to another city this time.  I told them they could come with Daddy to pick me up on Saturday, assuming that I'll be only staying the one night, and they liked that.

Today I felt anxious about the surgery; I can't put my finger on my specific thoughts but I just didn't feel confident that things will go well.  Late this afternoon I decided that maybe I should take a xanax to help me sleep (since it worked so well last week!)  But now I'm feeling more optimistic about it, and thinking that maybe my positive thoughts will influence what happens tomorrow.  This idea shouldn't be a new one for me; in fact, it's a good outlook to have in general.  However, I think I've been afraid to think positively in case something negative happens, so that I won't feel so crushed.  That happened to me 2 years ago, when I had my first met removed.  I'd been sure it was just an oversized lymph node; when they told me that it was in fact RCC I was stunned.  But now that I'm firmly on Stage 4 Street I can handle this kind of news a little bit better... maybe not much better, but a little bit.

I took the day off from work and it's been a lazy one, other than catching up on laundry.  I took Rebecca to Dick's Sporting Goods for her first pair of soccer cleats and shin guards.  She is signed up for our local rec soccer league this fall, and I had enrolled her in a four-day skills camp to get her up to speed.  Carly will be playing soccer this fall as well, but a group comes to her preschool every week and has a soccer class, so I'm not too concerned about her.  Rebecca was pretty excited about the new shoes, and is looking forward to the season. 

Afterward, we went to the library, so that I could stock up on reading materials for next week.  She wanted to look for books too, now that she has become a real reader.  She just finished her first chapter book, Beezus and Ramona.  Her interest was sparked in the upcoming movie, but she really enjoyed the book and is now started on another Beverly Cleary book.  I am so excited for her - there are so many good books out there!  I told her that I had read Beezus and Ramona too, as well as a lot of other books we looked at today.  We wanted to look something up in the library catalog so I coached her as she learned how to search on their computer system.

Carly chose not to come on our errands with us, so we had some nice one-on-one time. 

Carly had something to say...

Last night at Target, she kept asking me, Mom, what about the roast beef and the pea soup?  I had no idea what she was talking about, and she kept asking me, not using different words, but talking louder, like volume would help.  Finally she said, "Anyone can roast beef, but nobody can pea soup."

Pause...

Then I started to laugh... Oh my.. where did she hear this one?  She proudly announced, "On iCarly!"

Thank you Nickelodeon, well played.

After I finished laughing, I did explain how to set the joke up better, by asking, "what's the difference between roast beef and pea soup?"  So tonight she tried that out on my sister and her family.

It's a proud mama I am today... (shaking head and laughing)

Monday, August 02, 2010

Cleared and ready for takeoff, or should that be take-out

Last week I had my pre-operative appointments at the Clinic... came through just fine, though I didn't think there would be much of a problem.  My blood pressure was a touch on the high side, just the upper number, which the internist I saw commented on but wasn't concerned about.  I met with Dr. Drake's nurse practitioner, a super-nice woman named Barb.  She went over what I need to do before surgery, which is the dreaded bowel prep (aka clean out your intestinal tract quickly with the use of chemicals).  Now I know why I scheduled PTO for the day before surgery... I had somehow had the crazy idea of doing something fun on Thursday!  Silly, silly mama.  We talked about what he'll be removing, and I got some clarification from our conversation.

The right ovary - gone.  It's in the middle of this mess so it's out.  The mesentery mass - gone, unless it's too close to a major blood vessel, as Dr. Drake had explained.  Left adnexal mass - gone.  I've been thinking a lot about the left ovary, which has the mass close to it but not on it.  The idea of leaving the ovary in has been bothering me, given that while small, the chance that we are looking at ovarian cancer is there.  So I asked Barb if he shouldn't just take it out.  She explained that they will look at a sample of the mass right away while I'm in surgery so they will know if it's ovarian cancer or not... and so if not, and he can spare the left ovary, he will.  That was reassuring news; both in terms of my ovary and in not having to wait so long for answers.

If Dr. Drake is able to do the whole procedure with laparoscope, then I'll stay over one night in the hospital and go home Saturday.  That is my big hope, so I'm sending positive vibes to my mass, telling it to get the hell away from my intestines!  As many of you know, staying in the hospital is torture to me.  I know it's no picnic for anyone, but I am just so uncomfortable there, and can't stand not being at home where I can relax. Wah wah wah... I feel truly grateful that in comparison to many other people, I have it quite easy... however, it's my blog so I'll whine if I feel like it.

Now I will tell a shameful tale about myself.  On Thursday I felt pretty sleepy, going in to the hospital for my tests.  Friday I was also really sleepy in the morning.  A friend drove me to work Friday because she had meetings in my building and Jim and the girls were picking me up to meet some folks for dinner.  I tried to stay awake and perky during the commute, but my friend was on to me... in a nice way.  Both days coffee and activity at work got me going after a bit. Then on Saturday I just wanted to sleep and sleep again.  Jim asked me if I'd taken my morning meds, one of which is a stimulant for ADD.  I told Jim that I had, but maybe not having any coffee was really knocking me out.  In the early afternoon I finally roused myself enough to do some chores.  In the kitchen I stopped to refill my morning pill minder.  Each day along with the ADD med, I take an anti-depressant and blood pressure med.  A couple of my meds look different lately because one recently went generic, and the other is a generic from a different company than it used to be from.  So, I'm still getting used to how my pills look.  As I refilled the daily boxes, I came to a horrible realization... for the past few days, instead of my hypertension pill, I was instead taking a Xanax.  NO WONDER I WAS ASLEEP!!! And now it made sense that my blood pressure reading on Thursday was a little high.  I am now back on the right pills and the Xanax is tucked away in keeping with its 'as needed' status.  Another bout of spaciness... chemo brain, overwhlemed brain, aged brain, combination?  Who knows.