And sometimes it gets very messy. So messy it compresses your spirit, collapses your perspective, convinces your intellect that it’s as dark as it seems and there’s no sliver of daylight for a wedge of humor or irony. Basically leaving you whining and bereft of resources. And just about the time you reach that muddy bottom of the stinking anoxic soup that your life has become, you realize someone else is even worse off. And at that point, a spark burns deep inside, because you know the world—or at least said unfortunate individual stuck deeper in the dark goo than you are—NEEDS humor and irony. You rally. Do your job as a human being. And at the same moment discover that you’re not nearly as bad off as you seemed moments ago.
What triggered this Sunday evening harangue? The mother of one of Molly’s high school friends was diagnosed with tongue cancer, much like mine although it hadn’t made it full blown to adjacent glandular tissues—call it Stage 3. She is being treated at Greater Baltimore Medical Center, by the same head and neck cancer specialists who diagnosed and treated me. To save her, they had to surgically remove her entire tongue. They rebuilt it with a chunk of thigh muscle. This woman will have no taste for the rest of her life, and she’ll have to learn to talk by teaching a slab of leg meat to speak English.
And I thought I was having trouble getting my voice back. Jeez.
Anyway. I had an appointment with my oncology dentist (when I say that, doesn’t it sound like I have a whole staff at my command? “Wendy, please ask Charles to come to the Great Hall when he’s finished starching my wardrobe. The Sterling needs polishing…”). Which I figured was a good thing—as my mouth has gotten stronger, my tongue strength and gape improving, I’ve noticed a dull ache in my left rear jaw when I press my molars with my increasingly functional tongue. And last Monday night, as Tim and I finished our three hour class at the university, I noticed my mouth was filled with blood.
I was in for my first cleaning since my diagnosis a year ago, but I mentioned the pain to Dr. C. He took a quick look inside and said “Ooh. Let’s get an X-ray of that.” These are not good words to hear from ANY dentist, much less an oncology dentist.
It turns out I have a naked stretch of jawbone exposed in my mouth. Which is now coated with a nasty microbial film making a good living off the bone surface and microvascularization. The explanation for this contretemps, according to Dr. C, is that mouth tissue surrounding the six (!) teeth they pulled in preparation for my radiation treatment last year didn’t have time to heal before it was devastated by the radiation. When the soft tissue fried under the particle beams, it sloughed off. Leaving a length of my jaw exposed to the bacterial elements.
You know, I KNEW pulling those teeth wasn’t a good idea. But would anybody listen to me? Of course not. It is, apparently, a delicate balance. If your teeth are weak, the radiation kills ‘em and they rot in place. And in my case, if you yank the weak teeth, your mandible bone rots in place.
Sigh. Cancer. If it doesn’t get you coming, it gets you going. For all that, I’m actually doing rather well. My voice and gape are indeed improving apace. We spent the weekend in Atlanta feeding Colin at a high-end restaurant that cooks straight out of monumental encyclopedia Modernist Cuisine (they even put a spiced foam on Colin’s gorgeously crisped and perfectly cooked sea bass, served the rectangular chicken “nuggets” with spiced sauces in laboratory pipettes and a little blob of “encapsulated” blue cheese, and offered bleu cheese sorbet with the dessert assortment. The latter was not bad at all). I ate two whole slabs of chicken, half a crab hushpuppy, and a quarter-cup or so of incredibly rich cauliflower-cheese soup. I was still full this afternoon when we flew home after watching lacrosse Friday, Saturday, and Sunday.
So, in reality, I’m good. And grateful to you all for stopping by. Thanks so much!!!
PS--don't miss my new weekly weblog on Global Sustainability over at http://www.aehsfoundation.org/ . If you have a few moments to kill, I think it's worth a read. But then I would, wouldn't I?
In 1950, cancer in invertebrates was poorly understood. A review article [1] reported “spontaneous growths” in annelids (worms), arthropods (insects, spiders, and the like), molluscs (clams, snails), sipunculids (small rare blobby things), and ascidians (sea squirts, oddly closely related to true vertebrates and thus to people. “Oddly” because ascidians themselves are rather blobby, although not particularly small or rare), but pointed out that evidence of true neoplastic character was nearly completely lacking.
Since 1950, it has become clear that cancers are ancient genetic artifacts and that many invertebrates are subject to malignancies (for example, bivalves, [2]). Indeed, people are hopeful (as ever) that near-magic anticancer drugs will be extracted from the marine environment for applications in human treatment.
I’m skeptical myself. It seems to me that if we’re going to find magic cancer bullets, we’re more likely to find them in our own closely-evolved-in-concert-with-our-cancers physiologies than in the remote genomes of squishy or click-clackety invertebrates. But that’s probably why I’m not a cancer researcher.
I bring this entire arcane discussion up because I spent last week in Fort Lauderdale at a technical conference on managing contaminated sediments. Molly had a long weekend off, and she came down to vacation. On one of our jaunts to the Everglades, we managed to fulfill one of the top items remaining on my life list of things to do: find a uropygid in the wild. Uropygi are vaguely scorpion-like things that manufacture acetic acid which they spray defensively from a tube in their abdomen. They are popularly known as “vinegaroons”.
This little lady is only about ¾ of an inch long (in my browser, if you double click on the photo, it enlarges). When she grows up, apparently she will be the size of the palm of your hand.
Anyway. I ran out of time last Monday before I left for Florida, so I shipped a case of liquid medical food via FedX without strapping it with additional packing tape (which the office was out of, and I didn’t have time to stop at a FedX store to get the damned thing dealt with). It arrived at the hotel minus one can and wrapped thoroughly in packing tape. That’s pretty much what I figured would happen.
However. I pretty much managed to make it through the week without using my feeding tube at all. I stopped at grocery stores and bought as much Carnation liquid breakfast (and, when that was unavailable, Special K Dark Chocolate Protein Shake) as they had. Pounded down 4 to 8 bottles a day. Ate raw oysters, tuna sashimi, a few forkfuls of creamed spinach and wasabi mashed potatoes, and a bite of Molly’s incredible roast duck. Went offshore fishing on the last day of the conference, hiked for two weekend days with Molly, and only lost a couple pounds.
I must confess I fed myself two cans of food on the last night in Lauderdale. Thought I might dehydrate after all that walking in the Florida sun and wind. Still, I left 21 cans in the hotel room. We got back late last night. Haven’t used my tube today, either. My mouth is incredibly sore (I think the thrush is back. The morning after the night I ate a few spoonfuls of clam chowder, the back of my throat was still hiding blobs of chowder. THAT’S not hygienic, although I really can’t figure out how to completely clear things out). I seem to be out of Fluconazole, for some reason—thought I had half a dozen doses left. But, since with the anti-yeast biocides it’s always a toxicology race between your liver and your yeast, maybe it’s all for the best.
My weight was 187 this morning, and 192 before I took my evening meds (still via tube for those) last night. That’s not bad. I was up to 196 last weekend, so lost a little bit. Still, if I can get most of my calories by mouth, the last deep physiological impairment of the cancer will be overcome. Then it’s just working on my voice and getting some frickin’ exercise.
I’m on it. As best I can be. I slept most of today. Two days of hiking the Everglades was more than my shrunken musculature can handle. But I’m on it. Full report next week. Thanks for being here—you are still making my comeback possible. PS—my “singing” voice, such as it is, seems to be returning ahead of my speaking voice. I have half a dozen songs written that need production. If I can follow the Levon Helm model and get back to close-to-in-tune croaking (and I’m not sure why I should worry about being in tune NOW as opposed to the past), I’ll get ‘em recorded and up on the web for you. Thanks again. Love to all!!!
Note Florida pix and some travelogue up over at http://docviper.livejournal.com/ . Take a visit if you have a few moments. Some pretty pix. We packed a lot into two days!!!
Notes
[1] Scharrar, B. and M.S. Lochhead 1950. Tumors in invertebrates: a review. Cancer Research 10:403.
[2] Muttray, A.F., Schulte, P.M., Baldwin, S.A., Invertebrate p53-like mRNA isoforms are differentially expressed in mussel haemic neoplasia, Marine Environmental Research (2008), doi: 10.1016/ j.marenvres.2008.06.004
A Canticle for Leibowitz, by Walter M. Miller, Jr. is one of the greatest science fiction novels…in fact, one of the greatest novels in general…of all time. Miller wrote it after spending part of his World War Two enlistment at Monte Casino in Italy, watching friends and enemy die day after day in the shadow of an ancient monastery. Then he watched the monastery itself be destroyed when the allies got frustrated at their inability to move the German 10th Army out of the path to Rome.
Bombing the monastery proved to be both a strategic (the Germans weren’t using it as a fortress, at least initially) and tactical (once it was flattened, the place became a serious defensive position of rubble piles and deep cellars) error. But that’s beyond our purview here. Canticle closes with a stunning long-latent effect of radiation overdose after the thermonuclear destruction of North America. The punchline comes from the development of a slow-maturing tumor over many years. It turns out, the recovery from therapeutic radiation can take almost as long.
Timelines for cancer recovery—more specifically, recovery from radiation therapy—vary enormously from person-to-person and problem-to-problem. I’m now nearly 8 months out from the end of my treatment. I’ve recovered on many axes. Of the things that were hanging around the longest, that pain under the left base of my tongue is getting less and less. I think it’s probably just a patch of hard scar tissue pasted over the place where the tumor spent its frantic but thankfully truncated life. I have a surprising amount of salivary function back. Considering that my right parotid gland had been taken over by a large mass of tumor cells, I’m very lucky to have any moisture in my oral cavity at all. Indeed, many patients with Stage 4 mouth and throat tumors regain only a small percentage of salivary function after 36 months [1]. Presumably for those folks that is a permanent condition.
I do have that accumulation of mucous in my throat throughout the day and especially in the evening. And, most critically, I still have trouble swallowing. That is likely to be permanent in my case, I’m afraid. I’m gonna have to learn how to eat through the discomfort, dammit.
I saw my new Radiation Oncologist this week. A very young guy who replaced the big-personality woman who started me down the path. Somebody asked me last year when I reported how young Dr. H (Oncology Surgeon) was, whether I was ok with that (his youth). You know, technology and treatment change so rapidly that I’m inclined to think the younger the better. I’m reminded of a teleconference a couple weeks ago with our corporate “Young Scientist’s Group”. We’re transitioning its leadership from the young man who did it for the past couple of years to a younger woman. Her knowledge of communications technology kicked both my butt and the butt of the former Group leader. I’m guessing Dr. H has to struggle to keep on top of developments in his field, and the kids coming out of their residencies are further along the technical learning curves.
Anyway. Young Dr. N (who replaced retiring Dr. Z) peered around my mouth and throat. He said “Man, there’s a lot of swelling in there.” And he said “I don’t mean to be rude. But do you notice that foul rotten-meat smell from your throat?” I told him only sometimes. He says that’s from the radiation- and chemotherapy-killed tissues yet to be resorbed. He says given the size of my tumors, it could take years. And that for some patients it takes three years for the swelling to go down.
Icky. I guess I’m in for the long haul. Hopefully not as long as the Second Coming in Canticle for Leibowitz. And I suppose I need to do my part—start getting more exercise and learn to eat by mouth. For all that, a casual web search suggests that for many mouth and throat cancer patients, immune system function takes at least 12 months to come back and the throat mucous problem can take five years to forever.
Turns out I’m lucky. Not just to be alive, although that’s certainly a matter for gratitude given how advanced my cancer was. But to be as healthy as I am at this point, less than a year after treatment. And to think, I remember when a year was a long time… .
Notes
[1] http://www.ro-journal.com/content/6/1/125
Parotid gland-recovery after radiotherapy in the head and neck region - 36 months follow-up of a prospective clinical study
Jeremias Hey, Juergen Setz, Reinhard Gerlach, Martin Janich, Guido Hildebrandt, Dirk Vordermark, Christian R Gernhardt and Thomas Kuhn. Radiation Oncology 2011, 6:125 doi:10.1186/1748-717X-6-125
When my kids were younger, I used to tell them that my generation would be the last to die of cancer. I presumed we were close enough to cracking cell-specific mechanisms for cancers to be preventable, or at least easily treatable, diseases.
I missed it by a generation, maybe two. Still, the cutting edge of cancer research is in places where phenomenal treatment technologies are just a few meters further down the path. We are situated squarely between the brutal past and the subtle future of cancer therapy.
Consider. The 2011 Nobel Prize in Medicine went to researchers unlocking molecular gates to the immune system. In particular, Jules Hoffman and Bruce Beutler discovered the molecules that allow the innate immune system (the initial response to infection, and the one most closely associated with inflammation) to recognize microbes and trigger response. In fruit flies, these are called Toll Receptors, the equivalent in mammals are Toll-Like Receptors. TLRs (and, I suppose, TRs, although I didn’t research them as rigorously) bind specific lipopolysaccharides (LPS) that characterize various pathogenic microbes. The combination of TLR and LPS induces innate immune response, including inflammation. Structural mutations of TLRs are associated with either increased risk of infectious pathology (because the immune system doesn’t work as well) or inflammation diseases (because the mechanisms don’t turn off).
These were late 90s discoveries. Within the past few years, TLRs have been exploited in cancer research. Tumors suppress the inflammatory response. Researchers have found molecules that block the suppression by keeping TLRs functional, resulting in intense antitumor activity of the immune system. Indeed, a number of the susceptible mice in the studies completely rejected their tumors and were resistant to additional tumor formation.
This kind of thing is among the many lines of subcellular research likely to yield a host of new and efficient cancer treatments in the next couple of decades. Contrast that with where we are in the real world.
Earlier this month (January, that is) Medical News Today reported a study that concluded that “a subgroup of advanced head and neck cancer patients treated with radiation therapy plus the chemotherapy drug cisplatin had more positive outcomes than patients treated with radiation alone, and continued to show positive results ten years post-treatment.” That’s the treatment I got. It is state-of-the-art for the time, including a linear accelerator to generate the particle beams and three-dimensional modeling to site the beam impacts. Much of the technology thrown at radiation therapy is intended to truncate side effects in non-malignant nearby tissues. The same is true of the mix of substances given with the cisplatin in the chemotherapy brew.
Man. Assuming the side-effect-minimization methods worked in my case, I sure as hell am glad they were there. Because after my treatment ended, as you know from my rather insistent whining, the side effects nearly killed me, and for a couple of nights at least left me kind of wishing they would.
And this week? A great week here in cancer-recovery-land. I worked 5 long (ish—it’s still hard to function on less than 10 hours of sleep, and mornings are particularly difficult) days, got a lot done, had a lot of energy. Speech and swallowing are both improving, the latter rather more slowly. But I’m down to just a small cap of thick mucous depositing itself on my dysfunctional epiglottis a few times a day, where until now I had a whole face full of thick, ropey mucous. I’m hoping—and sort of assuming—that when I can swallow that mucous cap away, my swallowing will be back, at least for some foods. The pain under my tongue isn’t gone, but it’s less. And I saw Dr. H, and he can’t see anything that could be causing the pain. He says if it persists we’ll do another PET scan (the one that images radiolabeled sugar uptake in metabolically active cells, i.e. tumors). But he’s skeptical. A malignancy that can cause pain should show some sort of lesion that a practiced eye (and I certainly trust Dr. H’s eye, along with therapists Bethany and Jessica and Dr. T) can see, and the back of my tongue is “as smooth as a baby’s butt” as one of the medical staff put it in a weak moment. This week I go to see the radiation oncologist who replaced mine when she retired. That’ll give me one more check.
If things keep up like this, I may be back to full energy, and able to start posting bug and bunny photos for you this spring, along with additional weblogs. We’ll see. In any case, I’m traveling rather more regularly, so anxious to lose the feeding tube. When they take it out, I’m gonna frame it in a shadow box and hang it on the wall. Along with the rock and roll album covers. Rock on, all!!!
Had to travel to Atlanta for an overnighter. FedX’d 5 cans of food and a couple of bottles of Instant Breakfast to the hotel. That got me through two days of meetings. At Hartsfield coming back, I got a full body scan at security. They got 9 hits on my torso. So they pulled me out to pat me down. I told the guy I had a feeding tube and a blood port and started to show him the tube. He said “No, no, don’t take it out. Is it gonna hurt you when I pat you down? Don’t let me hurt you.” I assured him I would survive the pat-down. But the poor guy was so shook up by then that he did a crappy job patting me down. I could have had a set of vice grips and a ball peen hammer in my pockets and he wouldn’t have found them.
I got back Wednesday evening. Thursday I went to the hospital for rehab. Therapists Bethany and Jessica worked with me on improving my speech (although I got through two days of meetings relatively coherently) and strength. Then we went to check out how my throat infrastructure is doing in relation to the swallowing process.
Jessica numbed my nostrils with lidocaine, and slipped a scope in through my sinuses. Meanwhile, Bethany died a bunch of foods and drinks green so they’d contrast in color images. Then we went to work watching me swallow.
Let me orient you to the above photo. If you are standing on the screen surface looking in, that cave heading back straight away from you is my airway. The structure deep in the back there is the top part of my vocal cords. At your feet, in this view, falling away down from your toes, is my esophagus. The swollen blobby pink thing running across the bottom of the photo is what’s left of my epiglottis. The radiation turned it into a dysfunctional, clumsy mass.
As you can see in this photo. The greenish goop is some dyed applesauce. In a normally-functioning throat, the epiglottis would rise into place to block the airway so the food would be swallowed down the esophagus. Here, the airway is open, and a big blob of applesauce is dripping its way ominously toward my bronchi.
Which you can also see in this photo. This time it’s a thin liquid I’ve ingested—green-dyed water, I think. Most of it is bubbling down behind my tongue into my esophagus. But the airway is still open back there. My epiglottis is not inverting to do its job.
But, the human body is pretty smart. This photo shows what my throat is doing to substitute for the dysfunctional epiglottis. That ring in the back there is part of my vocal cord structure and upper airway contracting to shrink the entrance and so help to keep goop from entering my trachea, and instead have it pour down my esophagus right in front of you there behind my tongue. This substitute system, combined with my still partially paralyzed tongue, remains unable to deal with solids, or anything more challenging than thickish liquids (which I can pretty much pour right down my open esophagus, since I don’t have to swallow to move my epiglottis out of the way). But, with constant work on tongue rehab and swallowing exercises, I should get to where I can meet my daily calorie ration without pouring stuff through the tube directly into my gut.
From stuff I’ve read, it can take up to 3 years for this full substitution effect to operate effectively. I don’t have that kind of time. Now that I’m back at work, traveling is a necessity. And in May, I’m going to Germany. I want to be off the tube by then. I don’t want to be wandering around central Berlin looking for a Wal-Mart where I can buy liquid medical food. I may not be able to handle currywurst (long skinny curried sausages served on the street in hotdog buns). But I’ll be damned if I won’t be able to survive on soup, syrup, and ice cream. Germany, here we come!
Charles Mingus studied classical music and composition for years, and then went out and became one of the best and most original jazz bassists ever. He wrote groundbreaking music as well, played piano, led bands playing live around the world for decades. Then he was stricken with amylotropic lateral sclerosis, a paralytic disease of nervous system. First thing he could feel go were his fingers. Not long after, too young at 57, Mingus died of ALS.
I bring this up because numerous friends have pointed out the cruel sense of humor of the gods who would give me, devoted as I am to food, drink, music and public speaking, cancer of the tongue and throat. I will acknowledge that my gods, such as they are and when I take notice of them, seem to have perverse and ironic senses of humor. However, as a dilettante and marginally-to-un-talented cook, singer, and wine steward, I’d say I’m too small-time to be the target of any god’s cruel irony. Now Mingus. THERE was some irony.
As there was, for example, in Levon Helm getting throat cancer in the 90s. Having survived The Band, while carving out a niche as a singer-songwriter, Helm was diagnosed and passed on a laryngectomy in favor of a grueling (and with that I can truly sympathize) course of radiation and chemotherapy. By the 2000s, Helm was back singing and now he says his voice is 80% back. Maybe there’s hope for me yet.
Helm not ironic enough for you? How about Def Leppard drummer Rick Allen, losing his left arm in a car accident? Doctors reattached it, but the subsequent infection forced them to remove it permanently. Allen made it through the depression of waking up as a drummer without an arm, did some engineering and electronics, and was back in business.
Then there’s Pat Martino, genius jazz guitarist of Philadelphia. Had severe mental problems starting in the late 60s, with episodes so intense he underwent electroshock therapy to keep him in circulation. In the 1980s, his brain tumor was finally diagnosed and removed. The operation left Martino with amnesia in general and specifically without memory of how to play guitar. Took him seven years of re-learning to get back his facility.
Finally, Django Reinhardt. Practically invented modern jazz guitar in Paris clubs. Growing up in a French clan of Roma (Gypsies), one night the caravan he and his family lived in caught fire. Reinhardt and his neighbors rescued his wife and young son, and he ended up with two fingers on his left (chord) hand burned into permanent misshapen paralysis. While he was in the hospital, his brother brought him a new guitar. He taught himself to play fast (incredibly fast) jazz with just his two working fingers, using the damaged ones for chords.
Once again, my friends, the lesson for us is clear. The universe does not maliciously step into your life and smack you around for fun and games. The universe simply is. And bad shit happens all the time. And sometimes, ironically funny shit happens. You have to enjoy those wry moments, even the most tragic.
And me? I’m not bad. Have been trying to eat. My cousin suggested an entry or so ago that I make myself a big pot of pasta fagiole and let that slide down my throat. Which I am going to do tomorrow, in honor of my birthday. Meanwhile, the rest of the family ordered Italian takeout for dinner last night, so I threw in for a bowl of pasta fagiole. It was delicious and spicy. Two spoonfuls in, I got a bean stuck on the remnants of my epiglottis and wavered between choking to death and making myself crazy for like an hour before I could get rid of it. Tomorrow I’m thinking I’ll blend a portion of the fagiole into a smooth paste before I tackle it.
Lots of travel coming up. Look for slapstick humor here, as I’m still not free of the liquid medical food and have to FedX it to hotels nationwide. Also, a heads-up Happy Birthday to Dr. Dan. Bet you never thought we’d make it to this point of life, did you Bubba? I can sure as hell tell you that just about a year ago next couple of months, I was very sure I wouldn’t make it here.
Take that, universe. There’s your smeggin’ irony!
At the Greater Baltimore Medical Center you don’t get a cancer doctor. You get a designated SWAT squad. Among MDs, I have a surgeon, a radiologist (since retired), an oncologist, and a dentist. At the next level, I have a PhD dietician and a Master’s level physical therapist.
I went to see Dr. T, oncologist (and haematologist, but I haven’t needed that specialty), this week. On my way in to the examining room, I passed Dr. D in his office. Dr. D was on duty in the emergency room that Sunday morning I showed up dehydrated and anemic. He remembered me. That’s a skilled physician!
Dr. T is generally happy with my condition. My weight is stable on a diet of one enormous Carnation Instant Breakfast shake and three cans of liquid medical food a day. My teeth are good—dental hygiene is a huge concern in throat and tongue cancer because salivary glands are destroyed and damaged by radiation. Visible infections in my oral cavity are all gone.
But that pain at the lower left side of my tongue—approximately where the tumor was—came back as soon as I closed out the Fluconazole—that’s the vaginal yeast infection stuff—prescription. Dr. T looked close, and went back to check the post-treatment imaging. There was absolutely no potential tumorous activity at that spot then, and there is no tumor material there now. No thrush, either. But, since the Fluconazole fixed the pain and now the pain’s back, she put me back on Fluconazole. We’ll have to see how it goes this time.
Speaking of salivary glands…we were speaking of those somewhere up there, weren’t we? Oh, there it is. Ok, speaking of salivary glands. Mine seem to have sorted themselves out within the past week or so. The thick ropey mucous forms in the throat from one kind of gland, a type that survives the radiation. The reason you mostly don’t have a problem with it is that it mixes with the thin mucous from the glands higher in the throat (and mouth) and the net texture is normal saliva. The past few days, some of my thin salivary glands seem to have started functioning. This is much more comfortable. And easier to work with. As in “at work”. A bunch of us share a very small space in our Eastport marina location, and there’s only one bathroom. It’s not really possible to politely clear a mucousy throat under such conditions.
I took my first stab at a jog today. It’s warm enough outside so I didn’t feel like I was going hypothermic immediately. I managed about 300 meters jogging, and a few more walking. My body felt like…well, like it had spent the past year in bed. Which it pretty much has! But the exercise felt good. Hopefully I’ll be back to 5K a day soon. I’ll have to watch my weight, though. I’ve been stable at 194 (down from a peak of 276, I’ll have you know). I may need to increase my calorie intake. And, since I need to start getting substantive calories by mouth (beyond my thick shake), the timing is perfect. Scrambled eggs, here we come!
Thanks for stopping by, everyone. I hope everybody’s noticed that day length is increasing palpably (can day length be “palpable”?). Spring is just weeks away. The beach house is rented for July. I can not WAIT to park my not-so-rotund-as-before butt in the sand and watch the manta rays leap out of the surf! Special thanks this week to Ginger, Gail, and Sam S. for the nice notes. Happy New Year, everybody. With a little bit of luck (and/or Xanax) it’ll be a good one!
