explaining what a port is

I mentioned in my last post that I was over at the cancer center go get my port flushed. Had a commenter ask what is a port flush — which is actually a very good question because like everything else (running included — I mean think of how many non-runners can say "fartlek" without giggling — not many!) cancer has its own vocabulary.

 I guess a good place to start explaining what a port flush involves is to explain what a port is. 

Port is short for "mediport." This is me and this is my mediport — you can see a little what it looks like and where it is located on the upper part of my chest right below my collar bone.  Oh yeah, and definitely GO NAVY!  (The shirt was a gift and I love it.)  Anyway, a mediport is a vascular access device — a surgically implanted little object (mine is about the size of a dime) that resides usually in the chest on the right side to avoid driver side seat belt issues. Mine happens to be on the left because my chest masses were so large there wasn’t room on the left side.  (And yes, I do have seat belt problems sometimes from the shoulder belt rubbing against the port).  The raised slightly discolored area on my chest is the port reservoir. An attached lead runs up to the large vein in my neck. You can actually see the lead if you know where to look — it makes the vein sort of stick out more on that side of my neck.

By the way, I had this really awesome vascular surgeon implant my port.  He let me stay awake during the surgery and we talked about triathalons (he’s a triathlete, I would sink like a rock to the bottom of the ocean, so no tris for Jenny).  The whole thing felt just really weird.  It didn’t hurt very much.  Actually compared to the bone marrow biopsy my oncologist did the next day, the port surgery barely hurt at all.

This is what the port looks like accessed. (Like that rocking red sports bra?)  So now you know what a port is and what it looks like.

A port is useful for a cancer patient for three main reasons. First, it saves you from multiple needle sticks. The nurse “accesses” the port with a needle, but it is hard for them to miss, unlike with arm veins.  You should see the bruises I sport when I get CT scans.  Second, it saves your veins from the chemo itself. Chemo can actually sometimes burn your veins inside out. Finally, the port allows chemo to be given at a much faster rate. I guess you can think of it as just an easier, more efficient way of delivering poisons to tumors.

Anyway, a port can be pretty easily removed after chemotherapy is completed. I know a lot of Hodgkin’s patients get them pulled out right away given the high cure rate Hodgkin’s Disease generally boasts. Being a shot from out around half court rather than the typical slam dunk Hodgkin’s case, I still have mine and haven’t worked up the courage to ask my oncologist whether I can have it removed.

As a consequence of still having my port, every eight weeks, I have to traipse over to the cancer center and get the port flushed. A flush is about a two minute procedure where the nurse accesses the port and flushes it with some heparin to make sure it works properly and won’t form any blood clots (obviously that would be very bad). It’s really not a big deal, it just means another appointment, another trip to the doctor, another needle poke … You get the idea.

Anyway, if anyone has any questions about what I write about, I’ll try to answer them as long as they aren’t TOO personal.

Attitude.

I had to go over to the cancer center today to get my port flushed. Walked in and greeted the receptionist. Spied a new bulletin on how you can apparently now request a translator — even one, apparently, who speaks Swahili (but strangely enough not Italian or German). Cleveland Clinic is going all cosmopolitan apparently. Of course, I politely requested a Swahili translator for the sole purposes of getting the receptionist to laugh. I then walked around the corner to sign the port board and find a seat.

I’d like to say it was screaming yellow race shirt that attracted the stares, but every time I walk in to the cancer center and walk over to the waiting room for oncology, people stare at me. I don’t blame them, I look completely out of place. Fit, young 20-something year olds wearing marathon shirts don’t belong in an oncology waiting room. Everyone sitting there was at least thirty years my senior. I could have passed for someone picking up a grandparent or something except they make you wear this white paper wrist band that identifies you as one of the stricken, one of the victims. I like the nurses, like my oncologist, like the staff, but I hate how people look at me like I’m a victim. Every time I go into the waiting room I just want to slouch down in my seat and hide. (And actually I sometimes hide out in the corner by the fish tank so as not to be seen.)

I guess part of what bothers me most about the whole cancer things is … why me? I’m a runner. I eat a pretty healthy diet. And my life was just getting started. Why did this happen to me? Was this some sort of test? Did it happen for a reason? Or was it just a totally meaningless thing, just a random bad luck event?

There don’t seem to be any answers. None. No meaning, no reason, no logic. This always bothers me, but it really disturbed me today. I have seen cancer claim two bright young people in the last two weeks. I desperately want to understand why that happened. And try as hard I can, I can’t make any sense of it.

The first time I walked into this waiting room in February 2007, I took note of two things. One was the fish tank (no surprise there as I love fish) and the second was the Attitude poster. I was badly in need of the Attitude poster.

“The longer I live, the more I realize the impact of attitude on life. Attitude, to me, is more important than facts. It is more important than the past, than education, than money, than circumstances, than failures, than successes, than what other people think or say I do. It is more important than appearance, giftedness or skill. It will make or break a company…a church…a home. The remarkable thing is that we have a choice every day regarding the attitude we will embrace for the day. We cannot change our past. We cannot change the fact that people will act in a certain way. We cannot change the inevitable. The only thing we can do is play on the one string we have, and that is our attitude. I am convinced that life is 10% what happens to me and 90% of how I react to it.”

I like that poster. I like it because it reminds me that I do have control: I control how I react to what happens to me, even if I can’t control what happens to me.

It is really hard not to have control over cancer. With Hodgkin’s Disease, there isn’t much you can do to lower your chance for reoccurrence — we don’t even know what causes Hodgkin’s Disease in the first place. No one knows whether running or exercise does anything. What happens to me is decided by something far more powerful than I — be it God or the utter randomness that guides the universe — and that is something I have to accept.

And I understand the cynics … a good attitude isn’t going to change whether my cancer comes back or not. One of my friends who died last week was one of the best, upbeat people I knew. Fought the good fight, ran the race, kept the faith. All the while with grace and dignity and a good sense of humor. And he’s now gone anyway. None of that seemed to matter.

Or did it? I’ve slowly puzzled it out and what I think is really key about keeping a good attitude is not that it makes your prognosis better, it makes your life better. You can’t control how many days you have left here, but you can control how you live the days you have. You can choose to be miserable, or you can choose something else. The poster up there on the cancer center wall is right; no matter what happens, I don’t have to accept feeling down about it, or accept giving up hope. I control how I react. That’s why I run. Running is my hope. And hope is the best possession we have. As Victor Hugo put it, it is best to “be like the bird that, passing on her flight awhile on boughs too slight, feels them give way beneath her, and yet sings, knowing that she hath wings.”

I haven’t been running well the last few days because my shoulder has been hurting and I seriously considered just not running today. But when I left the cancer center, I decided I wasn’t going to feel sorry for myself. So I took control. And went for a run. And refused to feel sorry for myself. Instead, I took note of how spring is approaching — how the tips of the crocuses are starting to poke up through the ground, how there are buds swelling with new life on the trees, how you can now hear the call of the newly arrived red winged black birds, the rustle of a robin in the underbrush, the angle of the sun in the sky, the glint off the water. Spring is coming. It is inevitable.

I sure am glad someone decided to hang up that poster. I needed the reminder today about attitude and hope. Your attitude really does have the power to shape your life.

They’re BACK.

Cue the theme music to Jaws.

They’re baaaaaaaack!

I think there is a very good chance I missed my calling in life.  Rather than an attorney, I think I probably should have been a high school history teacher.  Or maybe a biologist.

I love animals.  I get a big thrill out of seeing, or even just hearing, a pileated woodpecker when out running in the woods.  I’m positively elated to see the elusive, shy, and very handsome blue belted kingfisher down by the pond, and it makes my day to see a yellow bellied sapsucker at my bird feeder.

But for all my love of nature, I have a confession.  Actually two confessions.  The first is I hate most insects (butterflies and praying mantis excepted) and the second is I am not particularly fond of Canada geese.  Its still way too cold for spiders and biting insects to bother my runs, but after several months of not seeing them, I noticed last week that the geese seem to have inevitably found their way back to Cleveland.

They’re baaaaaacccccckkkkkkkkk.

I’m not sure how to feel.  I guess it means spring is coming (though in all honesty I was happier to hear some red-winged black birds as spring’s harbingers than to see the geese).  Further, I will admit that as an amateur photographer, I like to capture them on film (or pixels, I guess, as I only shoot a DSLR).  However, I don’t like their mess and I don’t like their attitude.

Right now, the geese are fairly well behaved. But soon it will be breeding season.  I noticed that they already are starting to pair off (though you can’t tell which are the males and which are the females).   Very soon, probably just another month or two, they will begin to nest.  And then they will have babies.  And like good mama and papa geese they will instinctively want to protect their little cute balls of yellow fluff from predators.

They are fierce protectors, I will concede them that.  Other water fowl — mallards, wood ducks — don’t behave this way.  They simply shuffle the babies hurriedly off into the tall grasses to hide when you come anywhere close.  Not Canada geese.  These bad boys stand their ground and only retreat when forced.

And for some reason, I am considered a prime predator candidate by the geese.  I don’t know why.  On my morning runs, I’m by and through their territory in less than thirty seconds.  I guess they just don’t like me.  And so they barely tolerate me.  I always warrant a low threatening hiss as I run by, and I’m sure pretty soon they will be trying to chase me out of “their” territory.

In the spring of 2007, these guys were out in big numbers, and I guess I ticked one of them off pretty badly, because I came back from a run to find a goose actually sitting on top of the back of my car.  He was just sitting there, like he owned my car.  Of course, I couldn’t leave my car to some goose — had to reclaim my property.  Much arm flailing did nothing, and I had to resort to finding a big stick to wave at the recalcitrant goose to get him off my car.  He then stood there, neck feathers angrily fluffed all up in the parking lot hissing at me as I scrambled into the car.

I’m hoping for no geese warfare this year.  Hopefully we can just maintain that uneasy truce where I pick up my pace and run through at a faster clip in exchange for just a warning hiss.

Fingers crossed on that.

I like mud.

I admit it.  I like mud.  Which is good, I guess, because I live in Cleveland, Ohio, and we get a lot of rain here, especially in the springtime.  This means unless you’re a road runner, you have to deal with mud.  I don’t know where my love of mud comes from but my best guess is I like mud mainly because I played soccer growing up.  My first exposure to running was chasing after a black and white ball over a grassy field that more often than not sported a few substantial puddles.  I even remember where Canada geese took up residence on the field and were actually floating along on some of the bigger puddles.  It has now been over a decade ago that I played my last real, competitive soccer game, though, and one would assume I would have outgrown my love for mud since then.

Nope.

I no longer chase a black and white ball through the mud, but those years of running over muddy fields left me with a fondness for the earthy smell of mud, the slimy feel of mud, the cold splash of mud on the backs of my legs.  Now, rather than wearing cleats and chasing after a ball for an hour on a grassy field, I instead lace up my running shoes and run along dirt trails that have turned into rivers of mud and puddles.

I’ve run a lot of trails, and though mostly a lone wolf as a runner, I do occasionally get to run them with the pack.  It seems a lot of people don’t relish mud like I do.  They don’t go out of their way to splash through the puddle; rather, they go around it.  They high step daintily over the muddy ruts like an excited and keyed up thoroughbred going to the gate, or they even move off the trail to run through the grass to avoid getting mud on all too clean shoes.

Always seemed like a waste of a good muddy day, at least to me.

So you can imagine the obvious pleasure and eagerness I felt as I took off running down my favorite trail this weekend.  After week upon week of bitter cold, a warm pocket of air stalled over Cleveland, bringing with it sixty degree temperatures and bucketfuls of rain.  The rivers have swelled and the large chunks of ice at the mouth of the river have run up onto the shore.  I even saw a few piles of these dirty ice blocks that were as tall as I am.

Of course, all that rain and melting also produced a lot of brown, slimy, icky, slippery, and delightful mud.  My favorite trail was completely covered in mud.  Whole area smell like mud — that rich, earthy, distinctive shale mud scent.  There were some very large puddles there was no way you could avoid no matter how careful you were — no way not to avoid coming back wet and grimy and dirty.  And I loved it.  I was the only one I saw out in it; every other runner I saw had opted for the paved all purpose path.  Others eschew the mud, I embrace it.

I of course ended up finishing my run pretty much caked in mud.  I was lucky enough not to actually slip and fall into the mud (that has happened before more times than I would care to admit), but I had brown spots all over the back of my shirt and my legs as evidence that I had run through the mud.

I’ve written here many times that I love running because it makes me feel alive.  Well, mud running is just another aspect of that.  Living life to the fullest means doing things you enjoy, even if they are kind of silly, like an adult splashing through mud puddles just for the sake of splashing through mud puddles.  And so you can be almost certain that the next time it rains again on a weekend, I’ll be out running through the mud, enjoying another aspect of being alive and able to run.

Even bad runs have a place.

Never thought I would be saying this, but even “bad runs” have a place.

If you’ve been a runner for any period of time, I’m sure you know what a “bad run” is. It is a run that just doesn’t go right. Where you bonk. Get tired too fast. Can’t find your wind. Where your legs hurt. Or feel stiff and dead.

I’m quite schooled in “bad runs” right now because following a recent and very unpleasant case of bronchitis that left me sore from near constant coughing and weak from approximately a week of severely under-eating, running and I haven’t been on the best terms. Since the sickness began, every day’s run has left me breathing a bit too hard, with a nasty burning ache in the center of my chest that I cannot quite describe with words and the dreadful metallic taste of copper pennies in my mouth. It is hard to enjoy running when you can’t breathe quite right. And so each run was something of a struggle and not something I especially enjoyed.

I went through something eerily similar during chemotherapy in the summer of 2007 when I developed Bleomycin-induced pneumonitis in one lung. Running, once my solace, my special place to retreat from the world, became instead just another source of stress as I struggled to even just slowly jog without hyperventilating. Why I kept stubbornly going out to run every morning was a mystery to me. I pretty much knew every single morning for weeks that running was going to be a tremendous, frustrating effort — more of a punishment than something pleasant. And yet for some reason that still is unclear to me, I went out anyway. It was like some giant magnet hauled me out and I was entirely powerless against its irresistible pull. Every day would start out with ridiculously slow jogging, then I would find my breaths coming faster and more labored, and finally after fighting it for a few minutes, I would be forced to a walk. I struggled, grew frustrated, angry, depressed.

And then one day in late July, with the suddenness that was like the throwing a light switch, my lungs must have recovered enough, because I was suddenly able to run again. I remember how happy I was to just be able to jog for 20 minutes without stopping. Life is indeed a relative thing.

Today, the same light switch was thrown. After a mercifully short bout of abysmal runs (at least compared to the summer of 2007), I had one of those wonderful runs where you fall into a rhythm, where you find yourself running effortlessly, easily, just gliding over the ground. I headed down one of the steep hills of the Valley and ran along the river edge. The river was flowing in places around chunks of ice that I am sure are long gone now because we are currently experiencing a spate of warm weather. I watched the first pink color the sky to the east, and then noticed how it gradually became a deeper, darker, bloody red dawn. I gazed at the sun as it climbed above the horizon, and I finished my run feeling very good, rather than tired, breathless, and fatigued. It is funny because when I’m struggling I never notice the details. When the run is going well, its like my senses strongly intensify — the colors are brighter, the sounds sharper, the smells more distinct. I feel much more alive than I do at any other time. Having suffered through almost two weeks of struggle, the accomplishment of a good run seemed all the sweeter.

A lot of people run for fitness and health, and those are certainly respectable reasons to run, but that is not why I run. I think I proved that to myself in the summer of 2007 when I kept running even when it was doing absolutely no good and may have indeed been doing the opposite. No, there is something else to it for me. I love running, but I think there is even more to it than that. Running is part of who I am and my life isn’t whole without it.

This isn’t to say that every run is a wonderful, transcendental experience. I think I’ve just shown you that I certainly have suffered through my share of “bad runs.” But I guess because I have been running so long that the running thread has woven itself into my identity so absolutely that it has become an integral and fundamental part of me. Running is as much a part of my life as eating and a day without a run just does not feel complete. Just as eating nourishes my body, running seems to fulfill the purpose of nourishing my spirit and my soul. Even if the run is short, or does not go particularly, well, that is better than no run because a day without running does not feel like a day I lived life fully.

Living my life fully is something I’ve tried to make a conscious effort to do since being diagnosed with cancer. I am not always successful, of course, because a large part of life is just doing mundane things that are done on autopilot: getting dressed, riding the train to work, making the bed, cooking dinner. But every day, during my run — whether it’s a good run or a bad one or the more usual in-between one — I spend a few minutes reflecting on the fact that I am thankful to be running and to be alive. Running seems to be the perfect time to do that. For I have come to slowly realize that, at least to me, even if the run isn’t a particularly pleasant one, its better than no running at all. Having the possibility of no longer being able to run driven home hard in the summer of 2007 solidified my love of running to the point that I even can find meaning in and appreciate the bad runs. It has certainly taken me a very long while to find something to appreciate in bad runs, but they have there place; even if it just to serve as a contrast to make you appreciate the good ones so much more.