Wednesday, June 9, 2021

May Reads

Much like the members of The Guernsey Literary and Potato Peel Pie Society, a happy astonishment of my life has been how one book leads to the revelations of another.  I prefer to think of the linkage of character's lives to mine as fate, destiny and explanations unfolding as they should, rather than coincidence or mere noticing.  Such was the world and thoughts of Isabel Dalhousie, protagonist of Alexander McCall Smith's Sunday Philosophy Club series.  On the heels of A Column of Fire, the history of the Scots was familiar and made revealingly relevant.  But it was the musings of Isabel herself that gave me pause, and smiles, in the way the best characters bring.  Her view of Jimmy Carter as a human too good to be terribly successful in the political scrum.  Her appreciative notice of the prickliness of mahonias.  Her ready acceptance of the fox in her garden as an integral part of her world.  The way she allowed her breath to be taken with the fullness in her heart when touched by her abiding love for her dear ones.  

Relatively light reading that, at least for me, held so much more.  In May, I read the entire series and made note of quotes I especially enjoyed ~

The Sunday Philosophy Club

              “She was tuned into a different station than most people and the tuning dial was broken.”

              “There were two classes of persons upon whom a duty of virtually absolute confidentiality rested:  doctors and lovers.”

              “There was a distinction between lying and telling half-truths, but it was a very narrow one.”

Frinds Lovers Chocolate

              “But don’t we often lie to people we love, or not tell them things, precisely because we love them?”

              “But that’s exactly the problem…  We’re all stuck with the same tires and trusted ideas.  IF we refused to entertain the possibility of something radically different, then we’d never make any progress – ever.”

              “She had been seized with a sudden existential horror.  The house had white carpets and white furniture and, most significantly, no books.”

              “There were countless injustices and difficulties in this world, but small points of light too, where the darkness was held back.”

The Right Attitude to Rain         

              “When you are with somebody you love the smallest, smallest things can be so important, so amusing because love transforms the world, everything.”

              “We never realize how transparent we are.”

              “The azalea was next to a mahonia bush, with its yellow flowers and those spikey leaves.”

The Careful Use of Compliments

              “Our possessing of our world is a temporary matter:  we stamp our ownership upon our surrounding, give familiar names to the land about us, erect statues of ourselves, but all of this is swept away, so quickly, so easily.  We think the world is ours forever, but we are little more than squatters on it.”

              “Do not act meanly, do not be unkind, because the time for setting things right may pass before your heart changes course.”

The Comfort of a Muddy Saturday

              “We like to think that we plan what happens to us, but it is chance, surely, that lies behind so many of the great events of our lives - - the meeting with the person whom we are destined to spend the rest of our days, the receiving of a piece of advice which influences our choice of career, the spotting of a particular house for sale, all of these may be put down to  chance, and yet they see how our lives work out and how happy - - or unhappy - - we are going to be.”

The Lost Art of Gratitude

              “Gratitude was a lost art, she felt.  People accepted things, took them as their right, and had forgotten how to give proper thanks.”

              “…virtues are best cultivated in discretion and silence, away from the gaze of others, known only to those who act virtuously and to those who benefit from what is done.”

The Charming Quirks of Others

              “Anger disfigured…  We are disfigured by anger and must avoid it.  We must, no matter how much we seethe.”

              “Gravity was there, and we felt it, but did anybody, other than theoretical physicists, actually understand it?  What if goodness were the same sort of force:  something that was there, could not be seen or tasted, but was still capable of drawing us into its orbit?  Perhaps we understood that, even if we acted against it, even if we denied it.  And that force could be called anything, God being one name people gave it.”

The Forgotten Affairs of Youth

              “She would never accept things as they were.  That was what made her do what she did…and what made her, and everybody else who thought about the world and its unkindness, do battle for understanding, for sympathy, for love, in small ways, perhaps, but ways that cumulatively made a difference.”

              “Cads, as they used to be called, do very well.  They thrive.  They live happily ever after.  It was enough to make one want to believe in the place below, where they’d get a good roasting for their efforts.  It would make the rest of use feel so much better, wouldn’t it?”

The Perils of Morning Coffee

              “Time, she felt, made quite enough claims on us, without our conniving in its relentless tyranny."

The Uncommon Appeal of Clouds

              “A single word, a phrase, a sentence or two could have such extraordinary power; could end a world, break a heart or, as in this case, consign another to moral purdah.”

              “The physical world—the world of stone and brick—is indifferent to our suffering, to our dramas, she thought. Even a battlefield can be peaceful, can be a place for flowers to grow, for children to play; the memories, the sadness, are within us, not part of the world about us.”

              “She liked a conversation that went in odd directions; she liked the idea of playfulness in speech. People could be so depressingly literal.”

              “…all the good things that we have in life are on temporary loan, at best, and can be taken away from us in an instant.”

The Novel Habits of Happiness

              “That was what counted, she told herself: those unexpected moments of appreciation, unanticipated glimpses of beauty or kindness - any of the things that attached us to this world, that made us forget, even for a moment, its pain and its transience.”

              “Biscuits are trivial, but lies are not.”

A Distant View of Everything

“Remember what you have and the other person doesn't. It was simple--almost too simple--advice and yet, like all such home advice, it expressed a profound truth.”

The Quiet Side of Passion

              “I know that we’re encouraged these days to make much of victimhood, but I believe in bouncing back.  And I don’t think we should allow people to make use miserable – that gives the victory to them.”

              “They held one another gently, as we should all hold those whom we love, as we should all hold the world.”

The Geometry of Holding Hands

              “Perhaps it was only a prolonged education, coupled with the security it brought, that encouraged nuanced thinking.  Isabel sometimes wondered whether liberalism was most enthusiastically practiced by those who could afford it:  you could be generous to others if the likelihood of your ever wanting for anything was remote; you could be kind to asylum seekers if they would never take up resources you would need yourself; you could be tolerant of crime if there was not much of it in your neighborhood.  And so on…”

              “He opened the book at random and found what he was looking for.  Three figures, in a typical Celtic circle, held hands with one another, arms in a complicated pattern of intermingling. “I love that,” he said.  “I think it says everything there is to be said about helping one another and loving one another and being part of…well, I suppose of being part of something bigger than oneself.”

              Isabel looked.  “The geometry of holding hands,” she said.”                                                           ______________________________________________                                                                           

I miss her.  ~ les

Wednesday, May 26, 2021

Running Thoughts ~ Te veo

While tying my running shoes, I heard the anxious, persistent and rather unpleasant chirping of the large forsythia's resident thrasher and knew what I would see ~ Te Veo.  

Te Veo has taken the place of Blanco Viernes.  Blanco was a white cat that lived with us for about a year, named in honor of Rosie's solid black Friday given their perfect negative image of each other.  Blanco was truly feral.  Initially, he would take off like a shot whenever you were within 30 feet, even if YOU did not see HIM!!  Gradually though, he allowed parallel play.  From a distance, he would tolerate our presence if we pretended he wasn't there.  He never took any food we left for him.  He was never petted.  And one day, he was gone.

Over the past few months, Te Veo has taken his place.  She's a unique kitty.  Long haired, in a strange mix of black, orange and brown with two white toes, a nose often smeared with mud (understandable given her penchant for smushing her face into chipmunk holes) and cute tufts jetting out of her ears.  She is rather business like most of the time; making her rounds in an efficient methodical sort of way.  However, when she chooses, she will meow and butt your legs with her head until you sit and pet her.  Some days she follows me through the woods like a puppy.  Other days she is not seen at all. 

Unlike Blanco Viernes, Te Veo is not easy to spot.  Her dappled coloring blends perfectly in the shade of trees and mulch of flower beds.  But her meowing, or the disturbed chirping of the protective thrasher, gives her away.  Unlike either feline, we humans hunger to be seen.  We long to be recognized for who we are - even if only in small part, by just a few.  And when others do, it is what most touches our soul.

Te Veo. - les

Friday, May 21, 2021

Something "new" in melanoma treatment???? Anti-LAG-3! Again...

With ASCO around the corner, perhaps (HOPEFULLY!!!) I spoke too soon about there being nothing new in the world of melanoma!  However, I have been reporting on anti-LAG-3 for YEARS!!!!  Here is my first report from 2014!!!!  It gives a pretty good breakdown of how our immune system functions and how anti-LAG-3 may give it, especially if combined with anti-PD-1 (nivolumab/Opdivo or pembrolizumab/Keytruda), a boost - How to make anti-PD1 work better with a new player...LAG-3????

And this - ASCO 2017: Anti-LAG-3 plus nivo, for melanoma already treated with anti-PD-1/PD-L1

Now ~  This report (from Evaluate Vantage) regarding the study looking at relatlimab andNivolumab combo, noted:  "Relativity-047, a trial in first-line melanoma, has yielded a 12-month progression-free survival rate only slightly below that in Yervoy/Opdivo’s corresponding Checkmate-067 study. But there is a vital advantage: severe treatment-related adverse events were 19% with the relatlimab combo – less than a third of that seen with the notoriously toxic Yervoy."

Gotta love those names, right???  Similarly, there is this from Fierce Biotech regarding the combo for melanoma:  

ASCO Bristol Myers, leading the LAG-3 pack, posts phase 3 melanoma data for Opdivo-boosting relatlimab - 

"Bristol Myers Squibb is no stranger to mixing checkpoint inhibitors—see the many indications approved and in development for the combination of Opdivo and Yervoy.

Now, the drugmaker is one step closer to offering a new checkpoint inhibitor cocktail for the treatment of advanced melanoma, with the first phase 3 data for a LAG-3 antibody in tandem with the PD-1 blocker Opdivo. 

The combination did twice as well as Opdivo at staving off cancer progression: patients who received the combo went a median of 10.1 months before their cancer got worse, compared to 4.6 months for the patients who received Opdivo alone.

The phase 3 results, to be presented virtually at the annual meeting of the American Society for Clinical Oncology, come from more than 700 patients with metastatic melanoma who had not tried any other therapies and whose cancer could not be treated with surgery. About half of the patients received the fixed-dose combination of Opdivo and the LAG-3 antibody relatlimab, while the other half got Opdivo.

At the one-year mark, nearly half (48%) of the patients who received the combo still had not seen their cancer worsen, compared to 36% of those who received Opdivo alone. The trial hasn’t been going long enough to report how long the combination is helping patients live, but the company will present those numbers when they’re ready, said Samit Hirawat, M.D., chief medical officer at BMS. 

Patients taking the combination experienced severe or life-threatening side effects at about twice the rate of patients who got Opdivo alone (18.9% versus 9.7%). Side effects led 14.6% of the combo group and 6.7% of the Opdivo group to quit the study and there were three treatment-related deaths in the combo group and two in the Opdivo group, which come out to less than 1% of patients in each group. 

...  That said, it’s important to note that BMS compared the Opdivo-relatlimab combination to Opdivo alone, and not to Opdivo and Yervoy. 

“It’s impossible to say one is better than the other because we did not do that study,” Hirawat said. 

So, where does BMS see the new combination in the spectrum of melanoma treatment? 

“Currently, patients with melanoma in the firstline setting are divided into thirds: one-third gets I-O plus I-O... One-third gets single-agent I-O and one-third is without an I-O-based regimen,” Hirawat said. “So, one could say 66% of patients are undertreated to an extent because they’re not getting the best treatment available.”  Though PD-1 drugs like Opdivo, Merck’s Keytruda and Roche’s Tecentriq have transformed the treatment of melanoma and other cancers, they don’t work for everyone—that’s why so many clinical trials are testing combinations to see which drugs might boost their efficacy. The hope is that adding relatlimab to Opdivo could give doctors another option to get the PD-1 blocker to work in more people. 

The LAG-3 protein is an immune checkpoint receptor found on the surface of T cells. In cancer, LAG-3 expression is linked to T-cell exhaustion, which helps tumors resist PD-1 blockade. Blocking LAG-3 as well as PD-1 could reinvigorate tired T cells, allow them to regain their cell-killing function and attack cancer. 

“We look forward to discussing these registrational data with health authorities to potentially bring this treatment to patients,” said Jonathan Cheng, M.D., senior vice president and head of oncology development at BMS, in a statement.  If all goes well with its studies in other cancer types, such as non-small cell lung cancer and liver cancer, BMS aims to launch additional phase 3 studies of relatlimab and Opdivo in those indications toward the end of this year and early next year, Hirawat said. "

From BMS there is this - Bristol Myers Squibb Announces LAG-3-Blocking Antibody Relatlimab and Nivolumab Fixed-Dose Combination Significantly Improves Progression-Free Survival vs. Opdivo (nivolumab) in Patients with Previously Untreated Metastatic or Unresectable Melanoma

"BMS today announced results from the Phase 2/3 RELATIVITY-047 trial, which showed that the fixed-dose combination of relatlimab, a LAG-3-blocking antibody, and nivolumab, administered as a single infusion, demonstrated a statistically significant and clinically meaningful progression-free survival (PFS) benefit compared to Opdivo (nivolumab) alone in patients with previously untreated metastatic or unresectable melanoma. This is the first regimen to demonstrate a statistical benefit over anti-PD-1 monotherapy in metastatic melanoma. Among patients treated with the combination, the median PFS (mPFS) was significantly longer at 10.12 months vs. 4.63 in those who received Opdivo. The PFS benefit of the fixed-dose combination was observed early, at the time of the first scan, and was consistent over time. In exploratory, descriptive analyses, the combination of relatlimab and nivolumab extended PFS regardless of pre-specified subgroups and stratification factors.

These findings (Abstract #9503), the first from a Phase 3 trial evaluating a LAG-3-blocking antibody, will be presented in an oral abstract session on Sunday, June 6, 2021, from 8:00 a.m. – 11:00 a.m. EDT during the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting and have been selected for the official ASCO press program.

“LAG-3 represents a new immunotherapy target and the results of the RELATIVITY-047 study demonstrated the significant benefit of inhibiting both LAG-3 and PD-1 with the novel combination of relatlimab and nivolumab,” said Dr. F. Stephen Hodi, M.D., director of the Melanoma Center and the Center for Immuno-Oncology at Dana-Farber Cancer Institute. “With the observed efficacy and safety profile, the combination with relatlimab may provide an important new treatment option for patients with metastatic melanoma.”

The safety profile of the fixed-dose combination of relatlimab and nivolumab was manageable and consistent with those previously reported for relatlimab and nivolumab. No new safety signals or new types of clinically important events were identified with the fixed-dose combination when compared to Opdivo monotherapy. Grade 3/4 drug-related adverse events were 18.9% in the combination arm compared to 9.7% in the Opdivo arm. Drug-related adverse events leading to discontinuation were 14.6% in the combination arm compared to 6.7% in the Opdivo arm.

Lymphocyte-activation gene 3 (LAG-3) and programmed death-1 (PD-1) are two distinct inhibitory immune checkpoints that are often co-expressed on tumor infiltrating lymphocytes (TILs) and contribute to tumor-mediated T-cell exhaustion. Combination therapy with relatlimab, a novel LAG-3-blocking antibody, and nivolumab, a PD-1 inhibitor, enables T-cell activation, leading to the initiation of an improved immune response and promoting tumor cell death.

Relatlimab (in combination with nivolumab) is the first LAG-3-blocking antibody to demonstrate a benefit for patients in a Phase 3 study. It is the third distinct checkpoint inhibitor (along with anti-PD-1 and anti-CTLA-4) for Bristol Myers Squibb.

“Bristol Myers Squibb is a pioneer in the development of immunotherapy combinations in melanoma. As the global incidence of melanoma has continued to increase, we have leveraged our deep insight into the interplay between tumors and the immune system to develop a novel immunotherapy combination,” said Jonathan Cheng, senior vice president and head of oncology development, Bristol Myers Squibb. “The RELATIVITY-047 data provide evidence that a LAG-3-blocking antibody coupled with nivolumab may bring the benefits of dual immunotherapy to more patients and address a remaining need in this space. While there have been significant treatment advances and long-term survival benefits provided by checkpoint inhibitors over the years, there remain patients with metastatic melanoma who could benefit from another innovative approach. We look forward to discussing these registrational data with health authorities to potentially bring this treatment to patients.”

Globally, the incidence of melanoma has been increasing for the last 30 years. The World Health Organization estimates that by 2035, melanoma incidence will reach 424,102, with 94,308 related deaths.

Bristol Myers Squibb thanks the patients and investigators involved in the RELATIVITY-047 clinical trial. The company has several ongoing trials evaluating combination use of relatlimab for the treatment of additional cancers.

About RELATIVITY-047 (CA224-047)

RELATIVITY-047 (CA224-047) is a global, randomized, double-blind Phase 2/3 study evaluating the fixed-dose combination of relatlimab and nivolumab in patients with previously untreated metastatic or unresectable melanoma versus Opdivo alone. The primary endpoint of the trial is progression-free survival (PFS) by Blinded Independent Central Review (BICR) and the secondary endpoints are overall survival (OS) and objective response rate (ORR). A total of 714 patients were randomized 1:1 to receive a fixed-dose combination of relatlimab 160 mg and nivolumab 480 mg or Opdivo 480 mg by intravenous infusion every four weeks until disease recurrence, unacceptable toxicity or withdrawal of consent. Follow-up for the secondary endpoints of OS and ORR is ongoing and the Company remains blinded.

About LAG-3

Lymphocyte-activation gene 3 (LAG-3) is a cell-surface molecule expressed on effector T cells and regulatory T cells (Tregs) and functions to control T-cell response, activation and growth. Preclinical studies indicate that inhibition of LAG-3 may restore effector function of exhausted T cells and potentially promote an anti-tumor response. Early research demonstrates that targeting LAG-3 in combination with other potentially complementary immune checkpoints may be a key strategy to more effectively potentiate anti-tumor immune activity.

Bristol Myers Squibb is evaluating relatlimab, its LAG-3-blocking antibody, in clinical trials in combination with other agents in a variety of tumor types."

My take:  It seems that the combination of relatlimab and nivolumab (Opdivo) has a response rate that is slightly less than that of the ipi/nivo (Ipilimumab/Yervoy and Nivolumab/Opdivo) combo which has proven to be around 50+ percent, but one that is possibly better than the 40% response rate when anti-PD-1 (nivo or pembro) is used alone. Perhaps the two most important things these (still preliminary - after all these years) reports tell us is that ~

1.  Side effects, that can be so devastating and difficult in the ipi/nivo combo may be much decreased in the relatlimab/nivo combo.

2.  For reasons we don't fully understand, melanoma responds differently to the same treatment in different folks.  For me, thus far, nivolumab alone was 100% effective.  Obviously that is not the case for most melanoma patients.  So having another effective immunotherapy combination, that may well be far less than 100% effective in all of us, may still be completely effective in some.

And, finally, as ever - the drug company did not see fit to configure the trial such that the new combo went up against the old one directly.  Why not BMS?  Why not????  Why not three arms?  One with nivo alone.  One with the ipi/nivo combo? And the third with relatimab/nivo?  WHY???

AND NOW - Colon cancer alert - Cause, you know?  Nothing like having a foot in the door of 2 deadly cancers to keep you on your toes! 

There is also this, regarding anti-LAG-3's use in colon cancer, this time combining Merck's version - favezelimab with Keytruda (pembrolizumab) ~  A report from Fierce Biotech states:  

"PD-1 inhibitors work well in about one-fifth of patients with colorectal cancer, but the other 80% are not so lucky. Their tumors are immunologically “cold,” meaning they don’t respond to immunotherapies like Merck’s Keytruda. 

Enter favezelimab, Merck’s LAG-3-targeting antibody, which helped Keytruda make a dent in metastatic colorectal cancer in very sick patients with microsatellite stable tumors. The phase 1 data will be presented virtually at the annual meeting of the American Society for Clinical Oncology next month. The combination is poised for a phase 3 study in the same type of colorectal cancer.

The combination, given to 80 patients whose cancer had worsened despite trying two other treatments, shrank tumors in five patients (6.3%), one of whom saw their tumors cleared completely. The treatment kept cancer progression at bay for a median of 2.1 months and helped patients live a median of 8.3 months—on par with the six- to nine-month range the investigators had cited in the study abstract.  

However, the combination did better in a group of 36 patients whose tumors expressed high levels of PD-L1, as measured by the Combined Positive Score, or CPS. It shrank tumors in 11.1% of patients and helped patients live a median of 12.7 months. After one year of treatment, 51% of these patients were still alive, compared with 40.8% in the overall combo group. 

That 11.1% may seem low, but it’s an improvement on the 0% Merck would expect had the patients taken Keytruda alone, said Eric Rubin, M.D., senior vice president of global clinical oncology at Merck Research Laboratories. Because immunotherapies don’t work in this patient group, they rely on chemotherapy and, later on, tyrosine kinase inhibitors. Cancers can develop resistance against the latter, underscoring the need for more treatment options. 

“The data are limited, but it does look like PD-L1 staining is predictive for efficacy in this combination. Like any biomarker, it’s not perfect, but I think it identifies a patient population that is more likely to benefit from this treatment,” Rubin said. It will come in handy down the line when Merck starts designing registrational studies for the combination, he added. 

Of the 20 patients who received favezelimab alone, none responded to treatment, which was “not terribly surprising” given what Merck has seen in its earlier research. 

Side effects struck patients in the monotherapy and combination groups at similar rates: 65.0% and 65.2%, respectively. Slightly more patients who received the combination suffered severe side effects (20%) compared with those who received favezelimab alone (15%).

The most common side effect for the combination was fatigue, affecting 16.9% of patients, while the most common side effects for the LAG-3 drug alone were fatigue and nausea, hitting 20% and 15% of patients, respectively. 

Merck and other companies are developing LAG-3 antibodies to make PD-1 blockers like Keytruda work in more people.  

“When you look at preclinical models in patients exposed to anti-PD-1s, the LAG-3 pathway is upregulated, suggesting that it might be a compensatory pathway for tumors to evade anti-PD-1 treatments,” Rubin said. 

Like PD-1, LAG-3 is an immune checkpoint receptor that acts as a “brake” to stop T cells from attacking tumors. In cancer, LAG-3 expression is linked to T-cell exhaustion, which helps tumors resist PD-1 blockade. Blocking LAG-3 as well as PD-1 could reinvigorate tired T cells, allow them to regain their cell-killing function and attack cancer. 

Fevezelimab isn’t the only checkpoint inhibitor that Merck is combining with Keytruda. In September, the company presented data at the annual meeting of the European Society for Medical Oncology showing that Keytruda, along with its TIGIT-blocking antibody vibostolimab, shrank tumors in 29% of patients with non-small cell lung cancer. That combo did even better—as expected—in a subset of patients whose tumors expressed high levels of PD-L1, shrinking tumors in nearly half (46%) of them."

Anti-LAG-3, in at least some of it's machinations!  The more you know. Be well. ~ c

Wednesday, May 19, 2021

Running Thoughts ~ Recent Musings - People and Chickens

A friend recently asked why I had been so quiet.  The easy and truthful answer is that I have been busy.  I have been working a great deal as a medical consultant for my local health department's vaccinations sites.  And I have been most grateful for it.  Grateful for the existence of the vaccine.  Grateful for my small role in making it available to others.  Grateful to be able to do it.  I wasn't really sure I could work again.  Losing a portion of ones bowel makes basic functions unpredictable, at best.  It has been nice to feel useful.  I have met many lovely new peeps and been happily surprised to renew relationships with coworkers and friends from years past.

I have spent many happy hours in my yard; The Demesne - as we laughingly call it.  A word I had to look up from my reading a bit ago. "Land attached to the manor for the land owner's use."  The name brings a smile. And more gratitude.  A survey done a few weeks ago allowed me to complete the clearing I started when B purchased the unbuildable lot next to us a year or so ago.  He has been my happy helper.  We studied shade loving rhododendrons and discovered mahonias.  Since then he has been the hole digger for some lovely rhodies: three PJM Elite with their dark pink flowers and four Cunningham Whites whose blossoms begin as pale pink buds before opening into large white flowers, as well as two Winter Sun and three Charity Mahonias whose sharp pointed leaves make hollies seem tame!

We have enjoyed watching a set of baby blue birds hatched from one of our boxes and a nest of wrens made under the porch in an old plant pot, utilizing a bit of cord that had been left within.  All bird babies have the same demanding chirp while fluttering their wings, as their harried parents rush to and fro to feed them what they could easily pick up for themselves, it seems.

I have done a great deal of reading.  And exercising and cooking and sewing.  I have enjoyed quilting while listening to Monty Don.  A most peaceful and encouraging fellow, as he shares the beauty of Long Meadow and gardening tips.  I have mourned some personal losses.  They are still far to frequent in melanoma world.  But mostly, I've been thinking...

A short while ago, I was summarily informed that I had but one reader of this blog.  It was a comment that stung, because that's what it was meant to do.  But, on really thinking about it, while as the administrator of this space I could tell you exactly how many times this site has been viewed since its existence, how many times each post has been seen - I don't care.  In the past, B occasionally asked, "What's your count up to these days?"  Never once in the past eleven years have I known the answer.  I have had to look it up.  Further, do those clicks mean someone actually read my words?  No idea.  I have written posts to help give comfort and information to folks with melanoma.  I know those have in fact been truly read, shared and appreciated.  I feel it is the least I can do with the skill set I have, the knowledge I have gained, and the lucky break I have been given.  As for the rest of the personal crazy I occasionally pour on these pages?  Perhaps there is one reader.  Perhaps there are none.  It seems that even those who claim to have read it - read INTO it what THEY choose to see - not what is really on the page.  

All of which has lead me to ponder ~ Why do people do what they do?  Why do so many feel that without a sufficient audience something is not worth doing?  Why is their goal only to attain a requisite number of 'likes'?  Why are those 'likes' admired more than the content?  Why is it that folks are so eager to tell you how much they loathe their neighbor - when they don't even know you very well?!!!!  Why are some folks generous with their praise and compliments - while others levy only criticism and accusations?  Why do strangers offer small and large kindnesses to people they have never met? Why are some open about their mistakes, foibles and disease while others hide them behind a cheery fa├žade - sometimes even from themselves?  Why do people give sage advice, which largely figures on all that you are doing wrong, but when similar events happen in their lives, they fail to follow their own admonitions?  Much less acknowledge the error of the "advice" they once "shared" so knowingly?  Why are real apologies so few?  I have no answers.  I do think how we see the world, and others in it, is a reflection of our past experiences combined with our current joys or disappointments.  I think solitude is beneficial for some and not for others.  As I always told my children, accusations and ugly statements tell you much more about the person who makes them, than the person against whom they are directed.  I do not understand the motivations of most.  I can only try to be honest about who I am and what it is I do.

So...  Whether I have but one reader or none, I will carry on.  In my way.  In my time.  Sadly, there is not much new on the melanoma front.  Still, I will continue to post things that might be helpful when they come along.  Beyond those, an audience is not something I ever created anything for.  Perhaps writing keeps me sane.  Perhaps it keeps my dear ones sane!  Yes, dear B, Danita, and Tammy B!  I have seen those looks!  They are totally justified!  "There she goes.  Off on one of those tangents again!!!"  Perhaps this space is my small way of recording my existence. My way of sharing - a kindly light of hope.  

Whatever this is, I will write of the way I spend my days.  How I make it through dark times.  My small joys.  The strange thoughts that strike me.  To that end, I am embarking on a new installment ~ Running Thoughts.  (Musings that often begin while exercising.)

Today during a run, and while working in my garden after, I enjoyed the faint homey clucking of a neighbor's hens.  Despite some decidedly unfortunate experiences with roosters in my childhood, I like listening to the gentle murmurings of distant chickens.  And that got me thinking.  For those of you opposed to your neighbor's chickens, kept penned up and out of view, with no roosters to announce  the dawn or any other moment they care to embellish...  What exact harm do they inflict on you?  Why do you care if your neighbor has a chicken?  Or who they choose to love?  Hmmm?  What possible adverse effect do their personal choices have on you?

Yep.  Running Thoughts.  The fact that they are random, tangential, reflections for which I lack any real answers or conclusions may be the only things they have in common.  Apart from the fact that they begin in my head and land on this page.   

Breathe deep.  Seek peace ~ les

Friday, May 14, 2021

Across ELEVEN Aprils!

 Last year I celebrated my Tenth April with all the beauty of my own yard.  That post tells the story of how my crossing Aprils began ~ "Ten years ago today [April 30th], I had the right upper lobe of my lung removed three days after having radiation to a brain met all due to melanoma..." ~ as do these:

Across Nine Aprils

Across Eight Aprils, with links to the ones that came before

And if it's April, and I am able, my B always takes me on our favorite walk in the Smokies.  An 8 mile hike up Lead Cove Trail, across a bit of Bote Mountain, and down Finley Cane Gap.  It is an especially lovely fairy land of the most delicate wild flowers in early spring.  This year, the Serviceberry Trees and Dog Woods were particularly beautiful.  

Eleven Aprils post Stage IV melanoma.  But far more importantly, 32 Aprils with this guy!!!

Thanks for making all my Aprils beautiful. ~ love, les

Tuesday, May 11, 2021

April Reads

 A good month in many ways! I enjoyed  ~

  • The Doctors Blackwell - Janice Nimura.  Hmmmm....  Well written.  Didn't realize that Elizabeth Blackwell (the first woman doctor) had a sister who became the THIRD woman doctor.  Also, I liked the sister much better!!  She seemed to care about being a physician in order to heal and care for people.  Elizabeth seemed to be on some strange personal/save women from themselves mission that she somehow equated being a doctor - which admittedly was no small thing, certainly at that time!!! - with achieving.  Her personality was rather selfish and without any significant depth of feeling toward any humans as best as I could tell.  There was no hint at her having removed her own breast to save herself from breast cancer.  A part of the storyline laid out in great detail in the biography I read of her as a child.  (At least it was there in my head - and I don't see how I could have dreamed that one up!!!)  She did however lose an eye (and almost her vision) due to a gonorrheal infection acquired post delivery of an afflicted new born.  Unfortunately, her zealot tendencies and unpleasant personality reminded me of Florence Nightingale - with whom she shared quite the love fest initially.  But, as one might predict between two so similar creatures, devolved into pettiness and jealousy.  Still, we women in nursing and medicine owe them both a great deal for paving the way.  Humanity owes them as well, given that they, without benefit of established germ theory, were the first to recognize the benefit of adequate nutrition, fresh air, and cleanliness in preventing disease and fostering good health.
  • The Talented Mr. Varg - Alexander McCall Smith.  Loved it!!!  So looking forward to The Man with the Silver Saab to be out this July.  Smith is able to tell imaginative though common tales through relatively ordinary characters utilizing a particular turn of phrase, providing deeper meaning, without being pedantic or boring.  
  • A Column of Fire - Ken Follet.  The final of the Kingsbridge series, vividly depicting the horrors inflicted one against the other between Catholics and Protestants; the intrigue between Church and State as well as France, Spain, England, Mary Queen of Scots and Queen Elizabeth; the slave trade; and right up to Guy Fawkes and the Gunpowder Plot.  It was oddly comforting to see that the world survived such horrors; that this too, shall pass. I really enjoyed reading of events in places I've wandered - Ile de la Cite, Rye, Seville, Paris and London.  
Yes.  Of late I've enjoyed various serial works.  Though honestly, it is something I've always done.  If interested in an author, I tend to read ALL their works - whether written as a series of not.  May words you enjoy cross your path.

More to come Across 'X' Aprils! - les

Sunday, April 4, 2021

Recent Reads!!!

After so much time of relative nothingness, over the past several months all manner of things have been happening here!  Some difficult.  Some confusing and hurtful.  Some lovely.  New jobs for me and B.  All together = very busy!!  That's life, isn't it???  I'm here for it.  And I'll try to get some words down about some of it soon.

One crazy difficult bit is pertinent to my reading list - an injury produced a condition I designated as The Little Ease that made most of December and January incredibly miserable!!!  Somehow or other I managed to do something to my right hip.  It started with really significant back pain and transformed into a broke bootie!!!  There was no way to BE!  I could only stand, sit, or lay for a few minutes at a time.  Not a very productive nor restful existence!  The activities I could participate in were extremely limited and the amount of time I could maintain them were quite disrupted!  As ever, B was my hero and figured out my actual diagnosis - greater trochanteric bursitis.  He created a regimen to help me deal with the pain and muscle spasms through massage, heating pads, and topical creams.  He also researched and directed stretching exercises that got me through it.  I was worried because it had not completely resolved when I started working on the vaccine team in January.  Standing all day was pretty tricky, but I got through it and am fine now and back to my regular activities and exercise.  However, in those difficult days, my dear B not only took care of all household stuff and such, supervised and directed my care and PT/rehab, he read to me to keep me entertained and distracted from the pain!  

And now - my reading list....

JANUARY - (all read aloud by B!!!)

  • All Over But the Shouting - Rick Bragg.  B really enjoyed it!  He noted that some bits were rather repetitive. (Something I hadn't really noted on prior readings, but he was right!)  I always think of time with my Granny, driving her down Quintard Avenue or time with her in Jacksonville, when I read it.  
  • A smattering of short stories by Somerset Maugham.  B didn't care for these at all!  To him they were exceedingly racist, sexist and employed an author's easy out far too frequently.  The usually male protagonist whose bad behavior and choices have put him in a pickle often resolves his personal problems - not to mention that of the storyteller - by suicide. B made some valid points!  Though I still feel that the categorizations of women and those with dark skin were made by the characters Maugham held up as examples of the horrors of man, rather than the writer's personal commentary.
  • Winnie the Pooh - A. A. Milne.  We both laughed a lot through this one.  Not least because I could quote most of it from memory given the number of times I read it to the kids.
  • The Tao of Pooh - Benjamin Hoff.  B did not care for this as much as I thought he might.  He felt it was too simplistic.  If we all lived as 'uncarved blocks' would anything be accomplished?  Would bills be paid?  Would the human race find a way to overcome a pandemic?  I think not.  Though taking time to enjoy bird song, the beauty of clouds and holding hands while walking with your best friend remain essential as well.
  • The Evening and The Morning - Ken Follett.  A prequel to The Pillars of the Earth, in the Kingsbridge Series.  Perhaps it was not as good as the other two volumes, but Follett keeps things rolling and your attention - no matter what.  Just what I needed as I finished my recuperation!
  • Normal People - Sally Rooney.  I wanted to like this more than I did.  I liked the relationship between the two main characters - to a point.  There was just TOO much drama and TOO many crazy relationships interjected!  I did like the ending. 
  • The Girl in the Spider's Web, The Girl who takes and Eye for an Eye, The Girl who Lived Twice - David Lagercrantz.  Books 4, 5, and 6 in the Millennium series originated by Stieg Larsson.  Pretty true to Stieg Larsson's characters.  And while I read them all in rapid succession, they were not quite as good as Larsson's books.  Lagercrantz attempted the chapters of interspersed tangentially attached topics, but the depth and connection Larsson could impart was lacking.  I did especially like the data/computer espionage/hacking portions.  I fancy myself acting as one of the White Hats if I knew anything about such things!!!!
  • The Department of Sensitive Crimes:  A Detective Varg Novel - Alexander McCall Smith.  This is the first of three books in the Detective Varg series written by the same author who wrote The No. 1 Ladies' Detective Agency.  I didn't immediately love it and the characters the way I did Mma Precious Ramotswe.  But they definitely grew on me and the ending was absolute perfection!  Looking forward to the next book!
That's it for now.  Happy reading! - c