Butterflies

I now have butterfly suture strips (3M Steri Strips) covering the stitches on my cheek.  The surgeon put three strips on yesterday, after removing the bandage that had been in place for a week.  I looked at my cheek in my compact mirror after the assistant had taken off the bandage; the area looked a bit swollen and red.  The Steri Strips don't cover the whole area--they're very thin--so you can see redness and some rawness where the lower part of the bandage was.  That's where some blood seeped and stayed on the bandage.

 The edge of the Steri Strip near the corner of my mouth never really adhered--I push it down, but it pops up again.  He said the strips should stay on for a week, until next Friday; the assistant said they would be on about 4 days.  So I asked him what I should do if the strips fall off before next Friday.  He said that was OK, I shouldn't try to put new strips on.  Once the Steri Strips come off, I can put makeup on the area.  And of course sunscreen.

He didn't recommend using silicone or vitamin E oil or anything else I've read about on the Internet to reduce scarring.  He said I should wait 6 weeks, then take a close look at the area and if there was anything about it I didn't like, I should see him and we would discuss what to do.

I'll take my morning walks, but will otherwise try to stay indoors until I remove the Steri Strips (or they fall off).  Both because I can't really put sunscreen around the area--I don't want to have to wash around the strips too much, because they're not supposed to get wet.  But also the sun and heat could loosen the strips.  I'll be happy when I can finally wash my entire face without worrying about getting bandages wet.

Yesterday my son came home from a doctor's appointment and asked me what kind of cancer I had--that he didn't know.  I said I had told him--melanoma--and he looked distraught.  I think he discussed it with his doctor, and probably had been told melanoma was the "bad" skin cancer.  Even though I had already told him that.  He hugged me hard and said he loved me.  And then he said "even though it's over, I'm still really upset about this".  I gently told him it wasn't over, since I have to now watch for other places on my skin that might turn into melanoma.  But then I let it go; I didn't want to dwell on that.

But I do look at a splotch near my wrist on my left arm, and a splotch on my left leg, and wonder.  And I wonder whether I can prevent splotches from becoming melanoma.  Or is the die already cast?

This is getting old...

Wearing the same bandage for a week, on my face, is getting old, literally and figuratively.  I feel self-conscious venturing out, since the bandage is so large and has dried blood at the edges.  And I haven't been wearing foundation because it's difficult to keep the rest of my face clean without getting the bandage wet.

I ventured out to Starbucks this morning for the first time, then to CVS.  The CVS guy asked me what happened--only the 2nd person to ask in 2 weeks--I just say I had some surgery that required stitches.  The only other person who asked was one of the women cleaning our hotel room at the beach.  But that week the bandage fell off a few days early, so I was in the process of replacing it with a nonstick pad and tape when she saw me.  That didn't work--the tape seemed to have no stick to it at all.  So I ended up using a regular Band Aid, which (barely) covered the wound area.

I ended up taking my normal 30+ minute walk this morning; I walked a bit more slowly than I usually do, but I don't exactly power walk anyway, so I didn't think I would get flushed in the face (which is what the doctors want you to avoid the first week after surgery/sutures).  It felt good to move my legs more.  Next (after a break and snack of black grapes and almonds) I'll vocalize for 1/2 hour, then take another break and do yoga to a DVD.  This afternoon I will try to play the flute and see how that feels.

I have a bunch of questions for the doctor when I see him tomorrow morning, but he doesn't hang around--he's in and out so fast that I don't even remember what he looks like.  I looked at the photo of the doctors in the surgery practice on their website, and wasn't sure which one he was.  He's one of the two guys with the beard.  I think.  Anyway, I hope someone can answer my questions--mainly about wound care and scar prevention going forward.  One web site suggests that one should wear the silicone strips for 3 months.  That's a long time to have something on my face.  But maybe it's better than having an exposed scar.  I'm assuming they'll say I can resume normal activity as tolerated, but I'll ask.  I do so many things that involve physical exertion--walking, bicycling, weight lifting, yoga, fitness classes, flute playing, singing...I'm not sure what's considered "normal".  But I know I'm tired sitting around on my butt for nearly 2 weeks--in fact I do get tired easily--not sure whether it's from the inactivity or the aftermath of surgery or both.  Funny how doing nothing seems to be more tiring than being physically active.

It's swell...ing

I slept partially upright, propped up on pillows for 2 nights, as recommended by the surgery center, to prevent bleeding.  I was relieved to be able to sleep normally last night, but had a fitful night.  I woke up around 4am and my face felt very tight.  I touched it, and could tell it had swelled.  So I sat up the rest of the night (until 5am, when I get up), and put ice on it after I got up.  I'm not sure ice helps with swelling if you don't apply it during the first 24 hours, but the outer bandage on my face was so thick I don't think ice would have helped that first day.  Even if the ice doesn't help the swelling, my cheek and lip feel better with ice (inside two twist-tie bags for insulation).  Sitting up helps the most, to keep the blood flowing away from my face.  I'll probably prop myself up again tonight, to try and keep the swelling down.  My face didn't swell much at all after the first surgery--must be all the stitches that are causing the irritation.

I taught my yoga class today--I already had a sub for last week's classes, and didn't want to have subs 2 weeks in a row since I'm already the sub for these classes.  I felt shaky and nervous, but had mentioned to the class that I was having surgery so they weren't totally surprised.  I didn't say much--just that I'd had stitches a few days ago.  I felt fine guiding the class--I was afraid I would get spacey and mislabel directions or body parts.  But it went fine--I could tell I was already less flexible after not doing much for over a week.  I was worn out by the time I got home, and have rested (watched new PBS Mystery series Silk, which was rerun from last night).  Well, I slept through part of it, but saw the last hour.  I thought if I stayed up, I would try to do too much.  I keep wanting to play my flute, but know that's a really bad idea, with a swollen lip and cheeks.  I'll go a good 2 weeks without playing it.  Maybe not a lot in the grand scheme of things, but I'm more aware that the time I have to learn the flute could slip away from me if I continue to have physical health issues.  I may try to play it later this week and focus on the fingering without working the embouchure.  Is that possible?  It's not like the piano, where the sound comes from the fingers only.  Maybe I'll try tomorrow afternoon...

Two surgeries later...

I try not to think about how much my surgeries interfered with our vacation--we still got to the beach, but for fewer days.  And a lost half-day in between.  I had, in essence, two surgeries--the first to take out the melanoma, the second to stitch up the wound.  Everything would have worked out if the stitching had been done at the same time as the cancer surgery, but since there was a chance that I had more cancer, the surgeon wanted to wait to do the stitching.  The family plan was that we would go to the beach as scheduled (the day after the first surgery); then my husband and I would drive back on Tuesday for the scheduled stitching.  We left a day later--I wasn't feeling well enough to travel the day after the surgery--and I was pretty sure I wasn't going to feel like going back to the beach after the surgery on Tuesday.  But I didn't say anything about that--my husband would have to go back to the beach since my son was there without a car, and I was hoping they would stay the few final days without me.

I knew there was a chance that the test results wouldn't be back in time for the Tuesday stitching--the surgeon had said there likely would be only a few hours to spare--and I thought about checking my voicemail as we were driving back (about a 4 hour drive).  But I didn't check the voicemail until we got home (I hadn't given them my cell phone number, which I should have done).  The test results weren't back, so they wanted to postpone the surgery until Friday.  It was about 11:30am; my husband said he wanted to go to the beach that day, so we got right back in the car and drove the 4 hours back to Virginia Beach.  And I still didn't know whether I had more cancer.  It didn't even feel like I'd been in the car for 8 hours--I had to sit around anyway, so why not in a car?  I just wish I had checked our home voicemail while we were driving; they called around 9:40am, which means we could have cut out half the trip.

We decided to leave Va Beach Thursday evening after dinner, so my son and husband could get in one more day at the beach.  The surgery center had called to confirm the Friday surgery, but I still called Thursday morning to confirm that the surgeon had the test results.  They left a message for him to call me back, and he did; the results showed that all the cancer had been removed.  I was overwhelmed and teary-eyed with the news; I had been anxious about the thought of more cutting, more areas that would have stitches; and maybe even a more invasive cancer.  So we were quite relieved.

But the stitching surgery is actually a more difficult recovery.  I have another week of needing to stay quiet and not exert myself, but the stitching hurt more than the cutting did, and my left cheek and upper left lip have swelled up, which didn't happen with the first surgery.  I'd only expected to need a week to recover, and I am scheduled to teach 2 yoga and 1 pilates classes this week.  I find it difficult to talk--it hurts when I open my mouth--so tomorrow's yoga class could be difficult.  And I don't know when I'll feel up to trying to play the flute.  Not until toward the end of this week at the earliest, so I'll have to cancel Friday's lesson.

At least the stitches dissolve on their own.  I have two layers of stitches--4 or 5 stitches inside, and then a continuous stitch, like a baseball stitch, on the outside.   And they feel itchy and they hurt and it feels like my cheek is swelling as I write.  Lying down doesn't help as much as it usually does, because I can't prop my feel up like I usually do--that would cause more swelling.  Ah, well, this is all temporary; each day will get a bit better.

It Ain't Over

One of the questions on my list was "what about the splotches near the site where I've been diagnosed with melanoma"?  (OK, the question just said "what about the splotches," but I felt I needed to elaborate).  I explained to the surgeon that my dermatologist had done a biopsy somewhere in that splotcy area over a year ago, and the results came back negative, but now the splotches were starting to look a bit scary.  He explained that the margin he would use in cutting out the cancer would include some of the splotcy area, and that the lab would be able to determine whether that area also had cancer.

So my surgery isn't done--he gave me a temporary stitch until Tuesday, when I have to go back in.  He said he should have the lab results back--probably with only a few hours to spare--but wanted to move quickly either way.  If the splotchy are also is cancerous, he will do more cutting; if it's not, he will stitch up the original wound.

But I didn't realize he was asking me to come back this Tuesday--3 days from now.  I had in my mind the "5-7 days" for the return visit, and assumed he was allowing a little more time.  It wasn't until the third time the date was mentioned that I indicated I thought he was talking about a week from Tuesday.

This matters because we were supposed to go to the beach this morning.  I didn't mention to the doctor that I was planning to be in a car for several hours less than a day after my surgery--I knew what he would say.  But having to go back in for surgery on Tuesday clearly threw a wrench into everything.

So we've been discussing as a family what to do about the beach.  For one thing, I don't feel well, although am getting slightly better.  For another, the would extends to one corner of my lip and covers a fairly large area of my cheek beyond that, and I can barely open my mouth.  The assistant had said not to eat anything like a burger for last night's meal.  I had trouble eating tuna fish and spaghetti.  Basically had to eat with my hands to shove the food into a small area.  And brushing and flossing my teeth was tough on the left side, where the would is.  If I open my mouth too much or too wide, I think it increases the bleeding.

The reality seems to have set in more for my husband and son, seeing me with a bandage over half my face.  My husband was confused about the whole Tuesday issue ("I thought it was supposed to be 5-7 days"); I had explained it, but explained it again.  I may have more cancer.  They may have to cut more.  I didn't mention the other thoughts that are in the back of my head--what if the splotchy stuff is melanoma, but not in situ?  And how much will he have to cut, since the splotches are spread out?  I'm trying not to think about that.  But it's there.

My son's having difficulty dealing with the uncertainty of the trip, but is trying to be adaptable.  And before he left this morning he said he loved me and hugged me--very long and very tightly.

 

Are We There Yet?

This week is inching by.  I wake up and try to remember what day it is, and whether it's a yoga teaching day, and if so which one, so I can orient myself to the class time and location.  But this week it seems like it should be later--today should have been tomorrow, or Friday.  Friday, when I have my surgery to remove the melanoma on my face.  Friday, when the cancer that seems to grip my cheek will be scraped away.  I keep thinking ahead to all the things I want to take care of before the surgery, since I'm not supposed to bend over, lift anything, or do anything strenuous for a couple of days.  Here's what the surgery center website says:

If your wound site is located above the shoulders, you should be cautious not to stoop or bend over for the next 48 hours. For example, we urge you to lift your foot up to you rather than bending over in order to change or tie your shoes. No lifting, straining, or exercise should be done over the next two days. Any of these activities or anything that rapidly raises your blood pressure will put pressure on the healing blood vessels causing them to bleed. Also, keep your head elevated while sleeping.

I know it's only 2 days, but staying upright and doing very littie will be a challenge, since we're planning to travel the day after my surgery.  Who goes to the beach the day after they have melanoma removed?  Oh, well, I didn't want to disrupt the family plans.  But I also didn't want to wait any longer to have the surgery.  Waiting until Friday is already too long.

Why am I eating eggs?

I had eggs down on my shopping list, because I decided I should eat them more than once a week (when we go to Sunday brunch).  But now I can't remember why I'm supposed to eat them more often.  Oh- I found it--the yolk has carotenoid, the same substance that's found in deep yellow/orange fruits and orange and dark vegetables.  And that may help prevent development and growth of melanoma.  Which is why I bought a mango (deep yellow); tried to buy apricots but realized I have no idea what they look like, or whether stores even sell them fresh; had broccoli last night and will have carrots tonight.  Not to mention rosemary (somewhere someone said something about herbs and preventing melanoma).  And purple grapes and red wine (for the resveratrol, which may inhibit formation of melanoma).

I had a stomach ache this morning--not sure if it was something I ate yesterday, or anxiety over my impending surgery, or both or neither.  I was worried about teaching yoga feeling that way--unlike an office job, where you can still function when you don't feel well, yoga requires one to be "on"--guiding the practice, demonstrating poses, answering questions.  I took a Pepto Bismol and was fine for the class--felt very comfortable, in fact.

Maybe it's my body adjusting to more fruit, or different fruits.  Melons!

It's all right, Ma

My son asked me today how I was feeling about the surgery and everything.  I thanked him for asking; it gave me an invitation to speak slightly openly about my fears and concerns.  I said I was more curious than concerned about the surgery--how much beyond the cancerous splotch will they cut out; what kind of would closure will they opt for--open, stitches or skin graft.  But I said I was focused more on the future--since the research says once someone gets melanoma they're likely to have it elsewhere.  I said I was researching what I could do to prevent future occurrences, to the extent that prevention is possible at this point.  Hence the focus on diet--eating the melons and grape in the fruit medly that comes with our Mexican food, for example, instead of the pineapples and strawberries (I can't eat everything).  And I mentioned that I'm wearing a stronger sunscreen on my face.  But I also said I look at all the spots on my skin and wonder which ones might become cancerous.  I don't really know how much he took in, and I stopped before I started to sound to obsessive and worried.  But I was glad he asked.

A whiter shade of pale?

I use Neutrogena spf 55 for my sunscreen, at my dermatologist's recommendation.  But I've been using CeraVe a.m on my face (also at her recommendation).  CeraVe contains ceramides, which are supposed to be good for the skin, and is available at drug stores for around $15--quite a bargain compared to the expensive department store products.  But CeraVe a.m. doesn't say it's broad spectrum, so I thought I needed to switch to something that would block both UVA and UVB rays.  (According to Wikipedia, UVA rays can increase the rate of melanoma--and many sunscreens do not block UVA rays.)

CeraVe has a new facial sunscreen product that's SPF 50 (CeraVe a.m. is SPF 30) and the tube says it's a broad spectrum sunscreen.  I'm looking at the two products side by side--the difference is that CeraVe sunscreen face lotion has more zinc oxide (4.7% vs 3.5% for a.m.) and also has titanium dioxide; CeraVe a.m. does not have titanium dioxide.

According to WebMD, the following ingredients protect against the melanoma-causing UVA rays:  ecamsule, avobenzone, zinc oxide and titanium dioxide.  (Neutrogena has avobenzone.)  So the CeraVe sunscreen face lotion has better  UVA protection than CeraVe a.m.  I tried the sunscreen face lotion this morning--I looked like I was making up to be in a Noh drama--I got that "ghostly white" look that one website said used to be a problem, but no longer was with newer versions of products containing zinc oxide.  Oops, they were wrong.  The CeraVe instructions on the back of the tube say the product "...spreads easily and dries with a clear finish..."  Clear white, that is.

I'm not giving up on the CeraVe sunscreen--I really like CeraVe products.  And if the sunscreen face lotion helps protect against (more) melanoma, then I'll just have to look a bit ghostly.

They drink ouzo, don't they?

The Mediterranean diet--that's what one web site says can help prevent cancer.  But what does that mean beyond "eat more fruits, vegetables and nuts"?  Are they including pizza?  After all, Italy is on the Mediterranean, isn't it?  I don't see much reference to the types of carbs people eat--I didn't think Mediterranean countries were big on whole grains.

Red wine, apples, broccoli, tomatoes, avocados, citrus fruits when consumed in large quantities (?).  Did I mention red wine?  That's what one web site says can help prevent melanoma.

Most skin cancer-related websites don't even mention diet--they just focus on protecting the skin from the sun.  But I'd like to do more--it hopefully can't hurt and may help.

Here's the dietary run-down after scanning several websites and articles that do mention diet and melanoma:

Antioxidants can help protect the skin from harmful sun effects--foods include fish, beans, carrots, pumpkin, broccoli, green tea.  I'm leaving out foods I'm not going to eat, like chard.

Apegin (a flavenoid, whatever that is) may help prevent melanoma from forming, according to an article on Livestrong.com; foods with apegin include onions, broccoli, celery, tomatoes, apples, cherries, grapes.  Tea and wine also contain apegin.  (Article wasn't specific--green tea and red wine?)

Resveratrol is a flavonoid, also found in red wine, which may inhibit the formation of melanoma (according to the same Livestrong.com article, written by Sara Ipatenco (June 12, 2011).  "Adding a glass of red wine to your daily diet is one way to increase your consumption of this beneficial antioxidant."  I'm already on the case--switched from one glass of white to one glass of red each day.

Tumeric, an ingredient in curry, has certain anti-cancer propertie.  Same Livestrong article--she in turn is citing the University of Maryland Medical Center (UMMC).

Carotenoids are found in deep green and yellow/orange foods--carrots, sweet potatoes, cantaloupe, as well as dark green vegetables.  May help prevent development and growth of melannoma.

The one rigorous study I found (googling "diets that prevent melanoma") says the most consistent result was that "greater intake of carotenoids are associated with decreased risk for melanoma, while greater alcohol intake may increase the risk for the disease."  So there you go--supporting my assertion that the more research you do, the more confused you'll get.  (The study is "Diet and Melanoma in a Case-Control Study" Amy E. Millen et. al. (Cancer Epidemiology Biomarkers and Prevention June 2004 13; 10420.

I only read the abstract of the above study, but I see no indication that the authors controlled for the type of alcohol consumed.  So I'm holding out hope that the red wine drinkers may have had different (better) outcomes than the beer drinkers (for example).

And the UMMC website (last updated May 7, 2013, so much more current than the 2004 study) cites resveratol as a substance that may help protect the skin from sun-related damage.  In addition to apigenin, curcumin (tumeric), and resveratrol, the UMMC website also cites Quercetin--a flavonoid (there's that word again!) found in apples and onions--as a skin-protecting substance.

Guess I'll start eating those cantaloupe chunks they give me with my quesedilla.

Wrists and knees and table balance

I specialize in teaching yoga to seniors, and strive to help improve their strength, flexibility and balance.  But I also have to modify poses and moves based on who's in the class.  One of the sequences I really like to do is table-child-table balance (where you balance on one knee and hand, while the opposite leg and arm are extended.  The pose improves balance and strength, but since you're close to the floor, it's a safer way to practice balance than standing.

But especially in two of my classes, people either have knee or wrist issues that make table and table balance difficult.  In another class, one lady has rheumatoid arthritis, and her wrists are swollen and painful.  I've offered modifications to people--for wrist issues, they can rest on their fists, for knees they can do poses and moves in a chair or near a wall.  For the arms, people can also balance on their forearms, but that is more challenging for the low back, especially if they aren't able to keep a firm low belly.

I'm thinking I should eliminate table and table balance from my senior repertiore--but then I need to add other poses and moves to compensate.  I may still try to do low plank and puppy/down dog, which start with table but don't stay there.  We'll see.  I'll need to add more seated work, and more standing (including at the wall).  Chairs aren't an option in two classes--the chairs they have are too big and cumbersome.  And I tried the folding chairs in another class, but they seemed to get in the way more than anything.  And I don't think people will want to sit in chairs--I think they pride themselves on being able to do "real yoga"--once they start sitting in chairs, it's "chair yoga".  For old people who can't do "real yoga".  Or maybe I'm just imagining that.  They all are able to get up from the floor to standing and back down again--a big plus.  I just need to be creative.  With senior yoga, the range of poses may be more limited than with a regular class, but there are more options for creative warm-ups, stretches and balances.

I wish I had a network of senior yoga instructors to consult with and learm from; mabye through Yoga Alliance we can develop that.

wrong order

I did it again--I ordered something at a restaurant that I order frequently, and got the name wrong.  The first time was a few weeks ago, when I ordered a mimosa at a local Mexican restaurant.  I meant to order a chispas (very refreshing!) but the wrong word came out.  And I didn't realize it until I got the drink.  My husband and son said they wondered, since I never order mimosas there, but they didn't say anything when I ordered.  Then last night, at our favorite steak place (our favorite restaurant, really--Ray's the Steaks), I ordered the usual--or so I thought.  I always get filet mignon with blue cheese sauce--it's so good, it's hard to think about ordering anything else.  But I asked for blue cheese dressing; the waiter repeated the order (now I know why--I'm probably the first person who asked for blue cheese dressing with their steak); my husband and son said nothing.  Until my son and I got our steaks.  He ordered blue cheese sauce with his steak, and I noticed his sauce looked darker than mine.  That's when they told me I had ordered blue cheese dressing.  They had wondered, but said nothing.  I asked them to say something the next time I mess up an order.

Is this normal memory loss/confusion?  The other day, I couldn't remember the name of my type of cancer, even though the word melanoma goes through my head hundreds of times each day now.  When I tried to retrieve the name while talking to my husband, I couldn't.

I keep looking at this discoloration on my leg, wondering if it will turn into (or is) cancer.  And the splotch on my face near the splotch that's melanoma.  Will the surgeon cut that out while he's at it--it's so close to the spot he'll be removing, and it's starting to look more ominous to me.

Hostas, crape myrtle, magnolia, glossy abelia, spirea--names of plants in our yard that I have trouble remembering.   I look at the plants and say the names over and over to help remember. Add melanoma to the list.

No water

Ugh.  The county workers have been outside our house for hours, making a muddy mess.  Apparently our next door neighbors complained about their water pressure, so the county is digging up the street to replace the pipe that goes to their house.  Not sure whether our house is the only one affected, but I wish they had let me know.  They first couldn't tell me whether they would need to turn off the water, then they did without telling me.  So I went out to ask them when they thought they could turn our water back on and they said several hours.  Hopefully by the middle of the night.  One toilet was working, now none are.

Guess I can use my witch hazel wipes to clean my face tonight; I won't be able to sleep if you face isn't clean.  And with this melanoma spot, which feels like it's clawing at my face,  I want to feel as clean as possible.

I just wish they had notified us in advance; we could have prepared better.  Looks like they got started and had no idea what they were in for or how long it would take.  At least the rain has held off.  But then again maybe it would wash the mud away.

Building confidence

It's taking a long time for me to feel confident and comfortable teaching yoga.  I started very slowly after I completed my training in the summer of 2011--the first opportunity I got was to apprentice with an experienced teacher who was leading adaptive yoga and pilates classes for a physical therapist's patients.  I was gaining experience, but had few opportunities to lead the classes on my own, and was pretty tentative when I did.  Just before I completed my training, my former employer asked me to come back to work part-time, so I didn't pursue other teaching opportunities.  I wanted to focus on teaching yoga to seniors, and those classes meet during the daytime.  I did chair yoga for about a year on a volunteer basis at a local senior apartment complex, but was using a video.  It gave me a start, but then became very limiting.  Just as my stint with my former employer was winding down, in Jan. 2013, I learned of an opportunity to teach at a senior center.  The timing was perfect--I started the week after my work ended.  The prior teacher had been teaching at the center for 5 years, and was very good (I observed a few of her classes), so I felt pretty intimidated taking over from her.  Hopefully, I've improved since then.  And they've added a second class, so now I'm teaching there twice a week.  People have been very polite, so if they're disappointed they don't show it.  I'm sure they miss the other instructor, but they enjoy doing yoga and have continued to sign up for the class.

And a few substitute teaching stints look like they're going to turn into more permanent arrangements.  I'm subbing for 2 senior yoga classes this summer, and as a result am teaching Monday through Thursday.  The Monday instructor isn't returning, and it's in the works for me to take over that class.  In addition, the yoga/pilates instructor decided to stop teaching at the physical therapy practice in January, so I've been the lead instructor there since then.  And another senior center where I subbed a few months ago has asked me to take over for that yoga instructor, who is quitting.  I'm also teaching once a month at Washington National Harbor--they have a great program through the summer where people can do yoga twice a week at no charge.

I'm still anxious about teaching, but less so as the weeks go by. I prepare a plan for each class--I started doing that initially to minimize the chances for panic; now I prepare them in part so I make sure I'm doing a different mix of stretches and poses each week.

I've received very positive feedback from students the two times I taught at the National Harbor, and today after one of my senior yoga classes, a woman in the front row blurted out "I love your class" and another said I should be on TV.

I have a lot of anxiety and self doubt, so this kind of feedback means more to me than it might to others.

Faster and faster

I'm trying to play the J.J. Quantz Presto (of Arioso and Presto) up to speed, which is quarter note=108.  That's extremely fast, and perhaps faster than I'm able to play.  The sixteenth note runs, that is.  After some weeks of taking it at a tempo that felt comfortable, I'm now pressing ahead with the speed, which is very difficult for me.  I can't play with the metronome going--I get too flustered when I can't keep up--but listen to it before I start to try to set the pace as close to that as I can get.  I lose focus and get distracted easily, and now the words melanoma and cancer run through my head a lot.  And I look at all the spots on my skin--I have so many.  I used to worry about them turning into age spots; now I wonder if they're going to develop into melanoma.  I read that the most common place for melanoma is women is on the leg (for men it's on the back).  I see a large splotch on my left leg, along the shinbone, and it seems to turn ominous before my eyes.  And my hands--I have red splotches; will they start to turn malignant?  Do I just watch spots and splotches turn into cancer, or is there a way to arrest their possible development?  Is whatever is currently on my skin already programmed to whatever it will become, or can I influence the future now that I know that melanoma in situ is a precursor for invasive melanoma?  Is the Trojan Horse already in place?

Wracking my brain

I'm staring at the plants and can't remember their name.  And my husband had just mentioned them a few hours earlier.  Hostas, that's it.  I have trouble retrieving names of other trees and shrubs around our yard--the magnolia; the crape myrtle.  Is this natural aging, or something worse?  I've started looking in the yard and repeating the names so I can remember them.  Yet I was watching a movie the other night, heard a voice I recognized, and realized it was Hugh Beaumont, who played Beaver's father.  Why do some obscure pieces of information come readily, while I struggle for others?  Especially labels for things.  I have to work at remember people's names, but that's a longer-standing issue.  I'm much better at remembering voices than faces.  But naming objects seems like it may be getting more difficult.  Guess I should monitor and observe.

The (little?) C

Melanoma in situ.  One very scary word; one very good phrase.  I had just read that some cancer doctors are recommending declassifying some "in situ" breast cancers so they are no longer considered to be cancer.  So when the physician's assistant said "melanoma in situ"  I knew the "in situ" was a good thing.  "In situ" means "in position" in Latin; in the context of skin cancer, it means the malignant cells are only on the outer surface of the skin (epidermis).  There is no invasion of the deeper layers, according to info on Cancerconnect.com, so essentially no potential for spread.  But it's still melanoma--"a very different and more dangerous kind of skin cancer" than basal cell or squamous cell carcinomas. Melanoma is much less common than the other types of skin cancer, but far more deadly, accounting for 75 percent of deaths from skin cancer (according to Wikipedia).  And a diagnosis of melanoma in situ is believed to be a precursor for invasive melanoma.  And I knew it was the bad skin cancer because my husband's nephew's mother-in-law has melanoma.  I mistakenly thought it was the "good" skin cancer, but no, it's the "bad" one that spreads.

The Call

I was practicing the flute in the basement when I heard the phone ring; the caller ID gave the name of our dermatologist.  My son had an appointment with her scheduled for later that afternoon (Wed.), so I assumed they were calling with a last-minute change.  But then it turned out the call was for me.  I was expecting results back from the biopsy, but this was a few days earlier than expected.  And they were calling me--I knew that was likely not a good sign; if there had been nothing, they would have waited for me to call them.  The physician's assistant was very professional--it can't be easy to call someone knowing you have to tell them over the phone that they have cancer.  She paused, asked for my birth date to confirm my identity, then said something like "I have some information I need to give you".  I heard the words melanoma in situ--the bad and the good.  She emphasized the good news of "in situ" (which as I note above I had read about recently so was able to absorb the info a bit better).  She gave me the name of the doctor and surgery center I should call--no immediate need, but surgery should be done soon.  I called the surgery center as soon as I got off the phone; the first available surgery time with the recommended doctor is 2 weeks from today.  The day before our weeklong trip to Va Beach.  The scheduler said I should stay local for a week after the surgery; I mentioned the beach trip and she said as long as I could get back home within 3 hours in case of an emergency it was OK.  It's longer than 3 hours, but I didn't want to postpone the surgery, so I said getting back in 3 hours was no problem (yes it is, there's no way it's a 3-hour trip; more like 5).

I went back to practicing my flute--I hate interrupting my practice because the flute gets cold and my embouchure seems to lose something and it's harder to play.  I felt queasy and could feel my heart beating faster.  But the queasiness could stem from the fact that I was sitting on the basement carpet while I was on the phone, and was inhaling the fumes from cat and dog pee and all the chemicals I've applied to the carpet trying to get rid of the cat and dog pee.  Or maybe it was the words "melanoma in situ".