Today is my Five Year Anniversary Post-Ovarian Cancer Treatment!

This is a momentous day for me and for anyone who has suffered from cancer.  Today marks the fifth anniversary since I finished treatment for advanced ovarian cancer – epithelial, stage IIIC. I was diagnosed in March of 2008 and received eight months of treatment involving two major laparotomies and nine cycles of both intravenous and intraperitoneal chemotherapy. I have been followed every six months since finishing treatment.  For three years, this meant a CT scan, plus a CA 125 blood test, an internal exam and careful questioning about symptoms.  At my three year anniversary, without signs of a recurrence of my cancer, I elected not to receive any more CT scans. From the time of diagnosis through my three year follow-up I had received a total of ten and had growing anxiety about hurting my apparent, and hard-won, good health by subjecting my body to pretty high doses of radiation with each CT scan.  I discussed this with my oncologist who acquiesced to my decision as long as I watched and reported any symptoms and continued to be followed with blood tests.  If symptoms occurred, or the CA 125 began to steadily rise, we would then do a CT scan to provide additional information.

I had my intravenous port taken out just last May, four and a half years after finishing treatment.  Given my diagnosis, the chances of a recurrence were over 75 percent, I was urged to keep the port as an “insurance policy.”  So, I did, faithfully getting it flushed every 1-2 months all those years. I paid out-of-pocket for these flushes as well as the CT scans since I had an individual insurance policy with a high deductible.  My total out-of-pocket costs in a year amounted to $20,000 before finally getting on Medicare last December.  What a relief!

I will travel to Johns Hopkins Hospital in Baltimore today to see the third gynecologic oncologist I have had since I began treatment, the other two have since left Hopkins for other venues.  This doctor was part of the team that treated me in 2008, so he saw me in clinic at least once and dealt with an infection in my abdominal medi-port site.  I don’t know if he will consider me “cancer free” at this five year mark without a CT scan, but I fervently hope so.  I am hoping he will say I am discharged from the Kelly Gynecologic Oncology Service to the annual care of a local gynecologist.  We will see.

This is a day for reflection.  The first thoughts and feelings I have are extreme gratitude for my apparent good health.  I have been able to truly push the anxieties of having had cancer into the deeper recesses of my psyche where it has only surfaced around my six month follow-up visits.  Much more difficult has been dealing with the profound feelings of loss after my husband’s death from pancreatic cancer just six months after finishing my own treatment.  He became ill the week before my last chemotherapy and had emergency surgery for a completely blocked gastrointestinal system the night before that last treatment.  It took three weeks to get a definitive diagnosis, and the completely devastating news that he had advanced pancreatic cancer.  That news was delivered to us in a room on the same floor, just steps down the hallway from where I saw my GYN- oncologist – my destination today.  So my hope and feelings of gratitude are tinged with sadness for my husband who died in otherwise excellent health at age 59.  Life, for sure, isn’t fair!

My gratitude goes first to the doctors and nurses and other members of my care team at Johns Hopkins who gave me top notch expert care.  This article published in the New York Times last March explains why that expertise is so critical to a good outcome.  The study featured in the piece involved more than 13,000 ovarian patients and found that two-thirds did not receive standard care recommended by the National Comprehensive Cancer Network.  Dr. Bristow, the lead author on the study, used to head the Kelly Gynecologic Oncology Center at Johns Hopkins, and he was my gynecologic oncologist all during the active treatment phase of my care.  I not only had excellent, expert “search and destroy” surgery, I also had aggressive chemotherapy involving both intravenous and intraperitoneal delivery of chemotherapy drugs which research has definitively shown significantly improves survival.

Two paragraphs from the article offer, I think, surprising and strong reasons for ovarian cancer sufferers to feel hopeful:

“Ovarian cancer has unusual traits that make it more treatable than some other cancers. It is less likely to spread through the bloodstream and lymph system to distant organs like the lungs and brain. The tumors do spread, but usually within the abdomen and pelvis, where they tend to coat other organs but not eat into them and destroy them, said Dr. Matthew A. Powell, a gynecologic oncologist and associate professor at Washington University School of Medicine in St. Louis.

 And most ovarian cancers are extremely sensitive to chemotherapy, experts said.”

My gratitude goes secondly to my family and friends without whose steadfast support I could not have sustained the difficult journey of being diagnosed with a late-stage cancer, undergoing debilitating surgeries and chemotherapy, followed quickly and unbelievably by the illness and death of my closest best supporter, my husband.  Without these people in my life, I believe my medical team would not have been able to succeed as well as it seems they have.

Today we will see if I am done with this nightmare and can finally truly and completely move on.

 

Help Has Arrived!

Faced with a whole mountain infested with Ailanthus sprouts, the legacy of 10,000 mature trees killed over a three year period between 2005-2008, (see September 12, 2013 post) I called out for help.  And I got it today.  Ryan Klopf, PhD, Mountain Region Steward for the Natural Heritage Program , a Division of the Virginia Department of Conservation and Recreation which holds the conservation easement on Naked Mountain, and Wes Paulos, Mountain Region Steward Operations staff came armed with backpack sprayers.

Ryan Klopf, PhD and Wes Paulos, stewards with the Virginia Natural Heritage Program treating Ailanthus sprouts on Naked Mountain

Together we surveyed about a fifteen acre area to treat with diluted Round-up (Glyphosate).  I scouted for what we hoped would be the margins of the infestation, and Ryan and Wes treated the small sprouts with the herbicide. Unfortunately, I never found the margin; Ailanthus sprouts showed up no matter how far down the North or the South slope I traveled.  Very discouraging.  But, we have a plan to treat the whole mountain, section by section next season, or as much of it as we can.  Ryan will equip me with a backpack sprayer that works; I have an old one that doesn’t.  I was impressed today that their approach is much more efficient than my painstaking hand-pulling method.  Ryan and Wes covered three times the area I have covered after 16 hours of work!  I have my pesticide certification, so this is something I am familiar with and I know how to apply the chemical as safely as possible to protect native plant species, pollinators and human species.

While I was scouting I saw a gorgeous Late Purple Aster with knock-your-socks off color.  I assume the species is Symphyotrichum patens, but could it be S. phlogifolium which Flora of Virginia notes occurs mainly in rich upland forests and dry calcareous woodlands?  That would describe Naked Mountain.

Late Purple Aster (? S. patens or S. phlogifolium) Blooming on Naked Mountain. Click on photo to enlarge.

I also encountered a small but very distinguished critter.  He, or she, was the size of my pinky finger, about ¾ inch thick, maybe ten inches long and curled up on the root ball of a downed tree taking a sun bath.

Baby Timber Rattlesnake curled up in the sun on Naked Mountain. Click on photo to enlarge.

Last evening as I was returning home from a fascinating short course on Pollinator Conservation Planning provided jointly by the Xerces Society and the Natural Resources Conservation Services agency of the US Department of Agriculture, I spotted an interesting plant blooming next to my lower gate.  Here it is blown up.  Can you see the pollinators at work? Click on the photo to enlarge it.  Do you know what this rather common, but gorgeous species is?

Finally, I need to tell you that I am now in receipt of my fabulous 65th birthday present from a very dear friend.  Here it is:

Lara Call Gastinger, the extremely talented botanical artist who produced it and recently visited Naked Mountain (See September 12, 2013 post) was also the featured speaker at the annual meeting of the Virginia Native Plant Society.  What a treasure this gift is!

Oh, by the way, I was elected Chair of the Conservation Committee at the VNPS annual meeting.  Looking forward to the challenge to serve an absolutely fabulous organization!

 

Special Visitor Comes to Naked Mountain

I had a very special visitor come to Naked Mountain last week:  Lara Gastinger, the principal artist for the Flora of Virginia.

Flora of Virginia artist, Lara Gastinger, on my deck on Naked Mountain.

Lara has received a commission from a friend of mine, a 65th birthday gift, to paint a watercolor portrait of a plant of my choosing.  Since I have so many wonderful plants to choose from on Naked Mountain, I asked Gary Fleming to help me decide.  Gary, senior vegetation ecologist with the Natural Heritage Program within Virginia’s Department of Conservation and Recreation, has visited Naked Mountain several times and knows its flora well.  Gary suggested I choose Phemeranthes teretifolius (Fameflower) because it only grows in the Piedmont on mafic barrens.  Naked Mountain has many of those and several support this unusual plant.  The plant is unusual because each flower only blooms for one sunny afternoon and then progresses rapidly to fruit.  Lara wanted to visit the plant in person to help her complete her portrait.  I can’t wait to see it.  Lara is a truly fabulous botanical artist which a peruse of the Flora will immediately evidence.  You can read more about Lara and see her exquisite work on her website here.

During our visit, Lara and I took a short hike up to the summit of Naked Mountain.  She was interested in seeing the flora that were blooming in the thin, mostly Quercus prinus (Chestnut Oak) woodland that grows in the sparse soils between the lichen-covered rocks.  Below is a sampling of what we saw.

Gerardia laevigata (Entire-leaved False Foxglove). Photo by Lara Gastinger. Click on photo to enlarge.

Campanula rotundifolia (Harebell). Photo by author. Click on photo to enlarge.

One of the tasks I have been engaged in for two weeks is pulling literally thousands of Ailanthus (Ailanthus altissima) seedlings.  I first realized the problem when I checked the area around a tree on the ridgeline that had blown down in the July, 2012 derecho. I found 50-100 Ailanthus seedlings sprouting.  I then began checking all the blow down sights near the summit of Naked Mountain and began pulling dozens up to hundreds of seedlings in each site. Clearly, the damage from the derecho and this summer’s record rainfall has created excellent conditions for the Ailanthus seed bank to explode.  This is very discouraging since my husband and I killed probably 10,000 mature Ailanthus trees over a three year period from 2004-2007.  A check last summer (See the August 12, 2012 post) revealed almost no Ailanthus trees or saplings growing on Naked Mountain and the few that were found were treated with Garlon 3a via a hack and squirt technique around the base of each stem.  To now find that thousands of seeds are sprouting is overwhelming as I must try and monitor infested sites over nearly three hundred acres, much of it on very difficult, steep and rocky terrain.  But I am trying very hard to do this.  

 

One benefit of this lonely task is that it forces me to go out into tough terrain and so I see some interesting and completely new parts of the mountain.  I discovered, for instance, a second drift of Eurybia macrophylla (Large-leaved Aster).  This one is smaller than the one right at the summit that is about 20 feet by 20 feet in size.  Here is a photo of a selection of probably 100 plants in full bloom tucked in and around an old log.

Aster Macrophyllus (Large-leaved Aster). Photo by author.

I also discovered a rock cliff, covered with beautiful plants – grasses, ferns, flowers. on the top of the Northwest slope near the summit.  Several Fringe trees grew on top of the cliff. Here are a couple of photos from that discovery today:

Rock cliff on Northwest slope of Naked Mountain. Photo by author.

 

Rock cliff and Aster divaricatus (White Wood Aster). Photo by author.