Quick Update + Bone Marrow Transplant Info

A quick check-in, as I have completed 3 of 7 Vidaza infusions, the first 3 Venclexta doses, and all three 2-hour fluid infusions (yay!). I'm feeling okay overall, although I leave the infusion center feeling just generally icky, and am happy to head home, eat, take meds, and sleep. In the morning I'm mostly better, although my left knee continues to be getting more painful, despite the exercises I'm doing to strengthen it.

My counts are still on the upswing, and I have to think that that's good. From days 1-3:
WBC--2.8, 2.8, 2.9 (normal 3.9-11.2)
ANC--1.61, 1.86, 1.94 (normal 1.9-7.8)
HGB--8.8, 8.8, 8.8 (normal 11.3-15.1)
PLT--59K, 68K, 72K (normal 165-366K)

And my creatinine levels, which measure the impact of the Venclexta on my kidneys (which would be caused by tumor lysis syndrome), have been in the normal range. Hooray!


Now a bit about bone marrow transplants.

To be honest, I haven't thought an awful lot about the transplant, because the doctors at St. Luke's stressed that it wasn't "when I had a transplant" but "IF I had a transplant." Without remission, there is no transplant, and so I didn't really look much into the future. But now that my bone marrow is at least somewhat cooperating, the likelihood of a transplant is much more real.

My friend Bernie sent this five minute TED video on bone marrow transplants and I think it does an excellent job of explaining the basics behind transplant.

In order to actually move to transplant, I do need to achieve remission (including the genetic abnormalities), and to find a suitable donor who is healthy, willing and able to donate at a time when I can receive the donation. I am alternately impatient to get the transplant going as soon as possible, and terrified of the transplant, as there are so many risks associated with it--several of them fatal. 


Finally, I also wanted to share the actual flyers for the two local Bone Marrow Drives coming up. Please feel free to share them with people who you know that might be able to attend either of them.

UW-Milwaukee at Waukesha

Tuesday, February 4

11:30-1:00

4:30-6:00

Oak Creek City Hall

Thursday, February 13 

10:00-1:00

And if you're not local, or can't make it to either drive, you can always request a kit to be mailed to you at: join.bethematch.org/LorisLegion or by texting LorisLegion to 61474. If you do it, I'd love to see a selfie of you swabbing your cheek. :)

Vidaza + Venclexta: GO!

Today is day 1 of 7 Vidaza (round two) and the first of daily Venclexta. When I was under the care of St. Luke's doctors, this regimen would have started mid-January. But Froedtert waits for counts to recover before hitting you again, so today is my start.

And counts DID recover:
White blood cells: 2.8 (highest since 12/5, which was day 7 of the 7+3 chemo)
Absolute neutrophils: 1.61 (highest since 12/5)
Hemoglobin: 8.8 (woot!)
Platelets: 59K (down, but still well above the transfusion threshold of 10K)

15 minutes for pre-meds, 10 minute Vidaza infusion and
TWO HOURS of fluids to protect my kidneys from the Venclexta

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It's been over two months since this wild ride started. Nine weeks, actually. I missed my favorite parts of winter (Black Friday shopping, extended family Christmas, fat tire biking on the trails in the snow), but I have also been so fortunate to not be hospitalized for some big holidays (Thanksgiving, Christmas, New Year's and my 50th Birthday). I am especially feeling fortunate to have had the last "extra" 10 days to allow my counts to build up before being hit again. And January is almost over without any polar vortexes (vortices?). Here's hoping February is as kind.

I didn't get to fill everyone in on the voriconazole/hallucination report. Luckily, I didn't get any bad/scary hallucinations, but I didn't get any fun ones either. I do have light flashes in my peripheral vision for about two hours after I take the med (take it twice a day), but I think either those are fading or I'm getting used to them. Either way, I have felt completely safe driving, as any impact on my vision has been minimal. Again, I'm thankful for the little things.

Another thing I'm feeling grateful for is the extra energy to actually be productive while I'm stuck home. I have, for years, said that I just wanted like a week to be off of work but staying home to work on organizing the attics, my closets, the basement, and to toss all the crap that accumulates the longer you live in one place. This is not how I'd recommend getting that week to organize, but I've been trying to take advantage of it. And Greg will be making many trips to Goodwill!

I was pleasantly surprised that my appetite has come back. Starting in early November (before I was diagnosed, but when I was already showing symptoms), I had to really work to make myself eat anything. It was very strange, as I'm a person who plans almost everything around meals (whether cooking them or going out). From my highest to lowest point, I lost 28 pounds. But the hardest part was knowing that I had to keep eating to be strong to fight this. Instead, I was gagging down whatever high protein, high calorie foods I could. And nothing tasted good, which made me sad. I have since re-gained four pounds, probably due to the fact that I have to be super careful with eating fresh fruits and vegetables. I can't eat a lot of raw foods (too great of a risk for food poisoning) and so I'm defaulting to very carb-heavy meals. What I wouldn't give for a giant salad...

And I have so loved catching up with friends--whether they are giving time to drive me to appointments, walking with me, visiting, sending cards, texting or calling or messaging, I've loved all the re-connections.

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I was able to see the cytogenetics from my latest bone marrow biopsy and compare them to my first ones. I have never seen an abnormal karyotype before, so I'm not sure of the accuracy of my interpretation (if any of you have experience with this, I'd love to hear your thoughts, but I won't post my karyotypes on this blog. :)).  As Dr. Atallah had said, from the sample of 17 cells, 13 of them were normal (ie: 46,XX). However, 4 were still "messed up," although some of the original mutations were not present in those four cells. For example, in November, all 20 cells had "unidentifiable chromosomes present" while in January only four cells had unidentifiable chromosomes. In November, chromosome 17 (which houses the very-important p53) was missing. But in January it was not missing. I don't know if that was just luck of the four cells examined, or if it really does mean that the p53 mutation was successfully targeted by the round of Vidaza. Chromosome 18 is still messed up/missing parts, and that's where BCL2 is located, so adding Venclexta (which targets BCL2) is good. (At least that's how I'm justifying it to myself!)

And so while I was sad to start double chemo today (and I'm already feeling the tiredness and headache and general icky feeling, which will build), my brain knows that it is needed and it is the best thing I can do to keep moving forward toward a possible cure. So bring it on, Vidaza + Venclexta. I welcome your destructive powers!

More chemo in my future

Today was a day of a little bad, but mostly good.

Starting with the bad:

• I was not surprised to hear that the cytogenetics show that my bone marrow is still messed up genetically. What that means is that I need to do another round of the Vidaza, and also will need to add the Venclexta in.

Good stuff:

• My blood counts are awesome (for me).
• WBC: 1.5 (had been 0.4-0.8; normal is 3.9-11.2)
• Absolute neutrophils: 0.44 (had been too low to count; normal is 1.9-7.8)
• Hemoglobin: 8.4 (maintaining and gaining w/o transfusions; normal is 11.3-15.1; transfusion at 7.0)
• Platelets: 61K (maintaining w/o transfusions; normal is 165-366K; transfusion at 10K)
• Dr. Atallah called me "in recovery." This is good because my bone marrow is working toward doing what it should, and I'm also recovered enough to be hit with the next round of chemo.
• I will start Vidaza and Venclexta on Monday, giving me a "free" weekend. 
• Although my cytogenetics are still messed up, fewer chromosomes this time tested "messed up" (technical term).

Dr. Atallah said this was still "great" news, just not "excellent news." I said, "kind of like getting a B in grad school when you'd gotten all A's?" and he said, "no--it's an A instead of an A+." (Dr. Atallah is awesome!)

Greg and I asked about next steps and timing of additional bone marrow biopsies and the transplant. Dr. Atallah explained that it's a balance of timing. Ideally, I'd be in remission without any cytogenetic changes and a donor would be secured. However, the longer in remission w/o a transplant, the more likely that the leukemia will relapse and the longer I'm at risk for regular infections. So if a donor is found and there are still cytogenetic changes at my next biopsy (in 4-5 weeks), they might proceed with the transplant and continue chemo after.

I'm still waiting for the appointments to be scheduled, but I will receive chemo at Froedtert Monday 1/27/20 daily through Sunday 2/2/20. Most days will also have labs, and the first three days they'll give me extra IV fluids since I'll be starting the oral med, too. Some days may have transfusions (although I didn't need my first transfusion until day 7 the first go-arounds; not sure if starting lower will mean I'll need transfusions sooner...). I'll update the google drive as soon as my appointments are scheduled. Thank you all again for volunteering.

More good:

• I got the most perfect fuzzy blanket today from my friend Holly (who also drove me to my appointment). Look:

• This is a big of a brag, but I'm sharing anyway. Today I was supposed to present at a Preparedness Conference in Stevens Point. I ended up hospitalized, dropped the ball, and my supervisor had to do it all on her own (much guilt). But at this conference today, my colleagues accepted an award that I won--the Public Health Emergency Preparedness (PHEP) Coordinator of the Year award. It brought me to tears for several reasons. First, I was nominated by an amazing colleague. Second, I took my current job with no experience in Emergency Preparedness over four years ago. Though I struggled initially to understand this field which I'd learned nothing about in school, I grew to love the work--primarily because of the people who do it. I really wanted to be at the Conference! And finally, I'm not sure when (or if) I will get back to "doing preparedness," and that makes me really sad. So receiving this award was extremely bittersweet.

My plans are to enjoy this weekend while my neutrophils and hemoglobin are (relatively) high. (And I need to get out and fat bike when my platelets and energy are both up!) I will take what next week brings when it gets here--no need to worry now. :)

I probably should stop making predictions

Today was my second appointment with Dr. Atallah and the appointment where I'd get the results from my third bone marrow biopsy and would likely start the next round of chemo. As I'd written last week, unlike the doctors at St. Luke's, the Froedtert doctors like to do more frequent bone marrow biopsies to check on disease progression (or remission) before continuing with a chemo regimen. I *knew* going into the appointment that there was no way that I'd be in remission--especially since, due to insurance delays, it was only one of the two chemotherapies that I was supposed to have taken.

Dr. Atallah walked in and said, "your marrow looks great." I smiled and didn't think much of it. Then he said that the biopsy showed that my marrow was hypocellular with no visual evidence (per flow cytometric analysis) that there was any leukemia present. My jaw dropped and I told my kind, wonderful doctor, "SHUT UP!" My head was spinning and I couldn't believe what I'd heard. He said that there was no reason to start chemo today and since my blood counts were moving upward, he wanted to give them a chance to recover further. He told me to come in in a week, get labs done, and by then he'd also have the cytogenetics from the biopsy and we could figure out next steps. I think I said, "shut up" a second time.

I am by no means out of the woods yet. The cytogenetics are a big deal and given that my first two biopsies both showed the outrageous 14 genetic abnormalities, I'm not really expecting to get a clean report next week. If there are still cells with genetic abnormalities, and my counts have recovered well, then I will start another round of chemo next week. Depending on which genetic abnormalities persist will determine if I just get Vidaza (the hypermethylating agent that works indirectly on P53) or if I add Venclexta (which blocks the BCL2 protein). I'm pretty excited to NOT have to spend my birthday in the chemo ward!

But it is most definitely moving in the right direction and I am, for the first time, daring to consider my future a bit more.

I asked about the timeline to transplant, if I am determined to be in remission from a cytogenetic standpoint as well, since St. Luke's had said that I would likely have 4-5 cycles of chemo regardless of the biopsy results. He said that in addition to insuring that I am in remission (the biggest hurdle), they have to secure a bone marrow donor. My in depth results aren't back yet (insurance approved that procedure last week and I did the cheek swab last weekend), so he said in a perfect situation, the transplant would be two months from now. EEK! Again, everything would have to line up perfectly for that to happen, but we're talking about it, so that's something. Essentially, it seems that Dr. Atallah (rightly) feels that the longer I am walking around immunocompromised, the riskier it is. So build up those blood counts for now, and get to the transplant ASAP. I'm on board with that.

A few other things since my last post:

As I'd said, my blood counts are maintaining and sometimes climbing on their own. After I had the reaction to platelets on January 2, my platelets and hemoglobin went up.
Platelets: 27(with transfusion)>26>43>75>77>73
Hemoglobin: 7.2>7.3>7.5>7.9>7.7>7.9>7.7
All without transfusions. It's like my bone marrow heard that there was a severe shortage of blood in Milwaukee this month.

Unfortunately, my white blood cells seem stuck. In the same time period, they dropped from a "high" of 0.8 to 0.4, 0.5 or 0.6 (essentially all about the same level--and "normal" is 4.2-11.0). Here's hoping that another week off chemo helps with that, too.

I called Dr. Shah's office (my breast cancer oncologist) for a refill of my Femara prescription--the aromatase inhibitor that I take since my breast cancer was ER and PR positive. It's supposed to prevent recurrences. She said that I didn't need to take it now, and it had the potential to interact with some of the chemo/meds I'm on now or to cause more severe side effects. I'm not sure how I feel about that. On the one hand, I'm happy to be taking one less medicine--especially one that had significant side effects on its own. But on the other hand, it was my insurance policy (admitted not a great one...) against metastases. I have to trust that she knows what's best. :)

My insurance finally approved the switch in anti-fungals, so tomorrow is the first day I'll take the voriconazole--the one that can cause hallucinations. I'm kind of glad that I'll be easing into it without the added burden of chemo at the same time. And I'm still hoping I'm in the 70% of patients who do NOT have hallucinations. General problems with my vision are more likely, though.

I probably jinxed myself by saying multiple times that I had no pain, because my knees have gotten steadily worse--especially my left knee. I have no idea what it is or even if it's joint or muscle pain, but they are weak, and it's hard to squat or get up from bending down without pulling myself up by my arms. I've been trying to exercise through the pain, walking when it's safe (not icy) and riding my bike on the trainer. They hurt when I move and they ache when I'm still. But I am not going to let a little pain keep me from keeping up my strength as best as I can.

Finally, thank you so much to everyone who signed up to drive me to appointments, to be on call, and to walk with me. I will be contacting those who signed up to drive me to chemo this week to cancel the rides (hooray!). When I have my appointment with Dr. Atallah scheduled, I'll need a driver for that, and if he says I need chemo after that, I'll need drivers for the following week.

I also decided to add another tab to the spreadsheet. This week I spent a lot of time home alone as everyone was back at work and school and I only had appointments two days this week. And I learned that my mental health doesn't do too well when I spend too much time alone in one location. I know it's going to get colder and be dangerously icy for walking and not everyone likes to walk. So if any of you want to come visit--and are healthy and willing to wear a mask--I would welcome visits of about an hour. You can sign up on the tab to be on call :) or you can suggest a day and time to visit. Please remember that I still don't have neutrophils, so only come if you're healthy.

Karen came to walk with me and pushed me to walk 2.3 miles!

Right now I feel better and more positive than I have since this all began. I am taking the good days when I get them, knowing that there will undoubtedly be more cloudy days. Thank you all for your continued good wishes and thoughts and prayers. They move mountains!

Drivers needed

I have to start this post by thanking all of you who signed up for my BeTheMatch campaign and/or shared it on their social media or with friends and family. I posted the link at about 6:00 pm Thursday night and by Friday morning 46 people had registered through that link. Wow!

Knowing that I will almost certainly be starting another round of chemo next week, I've been trying to be as active as possible. I took two walks yesterday--almost adding up to 5K. I hope to keep walking outdoors as much as possible during treatment as well as biking indoors on the trainer.

And with Greg no longer being able to work mainly from home, the time has come to request help in the form of drivers. I have set up a Google Doc with the appointments I'll need drivers for, and room for people willing to be on-call (in case the driver who signs up wakes up sick or something), too. I added a place to let me know if you are around during the week and during the day for possible last minute walks, too! I don't want to link the Google Doc here, but I'll post it on my Facebook page (only viewable by friends) and if you're not on Facebook, feel free to email or text me and I'll give you the link as well.

Thanks in advance to anyone who can help. I hate that I'm not able to drive myself when Greg cannot, but I am too afraid of what the meds may do to my vision! As you'll see on the sign-up sheet, you don't have to stay with me for my appointments (although you can)--even just dropping me at the front of the Clinical Cancer Center would be most appreciated.

I have dates through my next cycle of chemo there now. I'll expand with additional days and times as I know of them.

Thank you all--so very much.

Help save a life

I've posted about my need for a bone marrow transplant as the only possible cure for my particular leukemia. I've shared links to donate bone marrow before, but I am sharing a special post today, as wonderful colleagues of mine and of Greg's have organized bone marrow drives in February. I'll share specifics under the image below, but know that if you cannot make it to either of the drives, or if you live out of town, you can also register online at the same link (Join.BeTheMatch.org/LorisLegion).

In person options:

UWM at Waukesha
Commons Lounge
1500 N. University Dr.
Waukesha, WI  53188
Tuesday, Feb. 4th
11:30 - 1:00pm and 4:30 - 6:00pm
Open to the public.  No parking tickets will be issued, visitors can park in any visitor, staff, or student spots.  Enter the Commons Building and the Commons Lounge is immediately to the left.

Oak Creek City Hall
Main Lobby
8040 S. 6th Street
Oak Creek WI 53154
Thursday Feb 13th
10am-1pm
Open to the public. Visitors can park in the lot south of the building or on the street.


Alternatively, accessing the website link Join.BeTheMatch.org/LorisLegion allows you to request a kit to be mailed to your home as part of this drive.

It is possible that one of you might be a match for me, but you could also be a match to save the life of someone else (and actually, it's most likely that you'll never be called upon). There's lots of information on the BeTheMatch site that explains the process of donation, and many employers give you time off that doesn't count against sick or vacation time if you're chosen to donate. I would appreciate sharing the image and/or information about these drives on your social media. I will post (separate from this blog post) on both Facebook (making it public) and Instagram. Please share--especially with your young adult children (aged 18-44) if you haven't already.

And thank you, dear colleagues, for all you have done to organize the drives. It means so much to Greg and I!

I have a new doctor--and a healthy heart!

Since my last post, I had a repeat (post-idarubacin) echocardiogram at St. Luke's and got the results:
My heart functions are in the normal range (LEF: 58%; GLF -19%). This means that I don't need to take any additional meds (like blood pressure or cholesterol) at this time, and won't need a repeat echo for a year.  Phew! One less thing to worry about. I'm so glad, however, that St. Luke's is proactive about monitoring for heart damage with cancer treatments.

Today I finally got to meet Dr. Atallah, who is the Froedtert oncologist taking over my care. He is just as genuine and down-to-earth as everyone described him. Greg and I both liked him. For the most part, my regimen will (likely) stay the same, but with a few modifications.

To review, when the St. Luke's team considered my 14 day bone marrow biopsy and neither my cellularity nor my blast percentage were under 5%, and they had my genetic sequencing results, they decided to switch chemo regimens to one that was more likely to work with my "complicated" leukemia. So I had the round of Vidaza (targeted at the chromosome 17 deletion), and was due to have a second round starting next week. At the same time, as soon as it became available, I was to add in the oral chemo Venclexta (targeted at BCL-2).

While I'd likely still be in the same place now, Dr. Atallah feels that one bone marrow biopsy is not sufficient to determine if I am on my way to remission. He says that there are two potential causes for my low blood counts--the leukemia or the treatment. The only way to be sure which it is is to look at the bone marrow, so he has scheduled a bone marrow biopsy for Tuesday (day 27 of the Vidaza). If (by some miracle) that biopsy shows that the bone marrow is empty (which is what we were wishing for back in December when I was waiting and waiting and waiting...), then we just wait and let my body recover the blood counts. But if the biopsy shows there's still cellularity and blasts, then we go on to the second round of Vidaza, adding Venetoclax on the same first day (likely on January 16).

Essentially, all I have to lose is another bone marrow biopsy, and I may potentially have a lot to gain. Again, given the complexity of my disease, I don't know the likelihood of this happening, but if anyone wants something to wish/vibe/pray for, it would be empty bone marrow at Tuesday's biopsy! :)

The other thing that Dr. Atallah did is change my anti-fungal. I've been taking fluconazole and it is the worst possibly shaped pill--it's actually a trapezoid--and it's dry and bitter and every morning I gag on it.

He is changing me to voriconazole, which he described as a "better anti-fungal." When I expressed my joy at being able to get rid of the trapezoid, he slowed me down and explained that I might not like the side effects of voriconazole. It can case liver disease, but it also has about a 30% chance of visual changes, including hallucinations. When I looked a little panicky, he said they weren't major hallucinations--just things like seeing spiders on the wall when they're not there or seeing flowers move in a painting. Eek!

After the reaction to platelets last Thursday, I've been super nervous about needing blood products. But both at Saturday's lab and today my counts remained above the cut-off:

Hemoglobin:   7.2 Thursday, 7.3 Saturday, 7.5 today!
Platelets:         7K Thursday, 27K Saturday, 26K today
WBC:              0.8 Thursday, 0.8 Saturday, 0.4 today (which panicked me, but Dr. Atallah said there's not much of a difference between 0.4 and 0.8--both are pretty close to zero.)

And now that I've met Dr. Atallah and have a (revised) plan, maybe my nerves will settle down some. I really should find a hobby (LOL!).

Always a difficult patient

Yesterday was another one of those too-long days at the hospital.

We left home at 10 am to get my PICC line swapped out for the kind that Froedtert uses. Because this was a swap and not a new placement, it was supposed to be a quick process. They run a wire through the old PICC line, pull it out, then guide the new PICC line into place over the wire. Half an hour tops. But apparently my body formed a stenosis around the PICC line and they were at first unable to slide the new PICC line through my vein. They have several layers of interventions and luckily mine worked with only the first level (ie: use a stiffer line to push through), but it seems to always be something with me! Add in the fact that my platelets were low (didn't know how low until after the procedure) and then I wouldn't stop bleeding from the placement and stitching, and the half hour procedure was an hour. But I do now have a shiny new PICC line! (No photos since I still have compression bandages around it.)

The one difference I can definitely say between Froedtert and St. Luke's is the waiting time. Today I arrived early for my labs and still waited 55 minutes past my appointment time to get in. I'm hoping that, with my future appointments mostly being in the morning, they won't be quite so far behind.

After labs, I have to see a nurse to interpret the lab results, determine if I need a transfusion, and generally check in with me on symptoms, etc. But I'm not officially transferred from Dr. Hamadani (transplant doctor) to Dr. Atallah (oncologist) yet, so I see nurses with Dr. Hamadani, who can't really answer my specific questions on chemo and side effects. However, I was able to move up my initial appointment with Dr. Atallah to next Tuesday (1/7). This is good because it will be before I'm due to start the next round of Vidaza.

My prescription for Venclexta finally cleared all the insurance hurdles and arrived yesterday, along with a delightful care package from the pharmacy. It includes such fun things as a giant water bottle to remind me how much water I need to drink daily while taking this med to protect my kidneys, some anti-nausea candies, Immodium, and lots of reading material. Of course, as soon as this arrived, I double-checked with Dr. Attalah's office and he doesn't want me to start taking it until after he's seen me! So weeks of pushing to even get the meds and now I can't start.

Unsurprisingly, my labs showed that my platelets had fallen below the 10K threshold (they were 7K) and so I needed a platelet transfusion. Unfortunately, the soonest opening to get the platelets was at 4:30--two hours later. This was not enough time to go home, but a big gap of time between appointments. I decided to sit and wait, hoping that a slot would open up sooner for the transfusion. It did--at a little after 4:00.

Every time I get blood products I'm asked the same question, "Have you ever had a reaction to receiving blood products?" And every time I answer, "Not yet!" and chuckle. Well, I can no longer say that. Last night, after a long, exhausting day of appointments, while receiving platelets, I said to Greg, "My back is kind of itchy and feels really hot. Can you look at it?" and he did, and saw nothing. A little while later, my chest also felt hot and itchy--still nothing. Finally I decided I was going to let the nurse know that I wasn't feeling quite right and by then hives had popped up all over. WOW! If you want to see nurses come running, have a reaction to an infusion! Five nurses, grabbing reaction kits, pushing Benadryl and hydrocortisone IV, calling supervisors...

In the end, the meds made the hives go down. Although I haven't seen him yet, Dr. Atallah took the nurse's call and agreed to hold off on getting more platelets last night (I got about half the bag in), and I was able to go home. Even though it was a relatively low dose of Benadryl, I only managed to eat dinner, nap, play a few games, and then sleep until 8:00 this morning. The biggest annoyance, I think, is that they'll have to pre-medicate me every time I need platelets going forward. And seeing how Benadryl affects me, my plan of gradually being able to drive myself to appointments may not work out. :(  Ugh! I am looking forward to meeting with Dr. Atallah to see how long he anticipates that I'll have such low counts and need to keep getting frequent transfusions. 

Yesterday also ended my wonderful almost-two-weeks of full family time. Ash went back to school. Travis leaves today. Cara will likely leave this weekend. And then Greg goes back the week of the 13th. It has been amazing to spend so much time with my favorite people in the world. We've cooked, we've played games--so many games. We've watched silly TV. We've laughed. I've stored up so much good to get me through the cold and ickiness that will likely be January and February. I feel lucky beyond measure.