Reset Osmostat and The Envy of the Clinic

 That time I was in the hospital, the time after my first chemo, the time I refer to as "That Time I Was So Sick", 2 out of the 9 diagnoses I had, were Hyponatremia and S.I.A.D.S. 

Hyponatremia is the medical word meaning that I had an electrolyte disturbance which made my blood sodium level too low. Normal blood sodium level is between 135 and 145 mEg/L. Mine was down to 115. That is very bad (and dangerous). It caused me to have severe headaches and confusion. If sodium goes low enough it can cause permanent brain damage, coma, and even death. If mine had dropped any lower, I was going to be taken to ICU.

Dr. V called in a Nephrologist (Kidney Doctor) who diagnosed and treated me for S.I.A.D.S. which is Syndrome of Inappropriate Antiduretic Hormone. I don't understand it, despite doctors explaining it and also reading about it. What I know is it makes the body fluids too dilute, thus making the sodium too low.

These conditions were caused by both my Lymphoma and the chemo they used to treat it.

After I finished chemo and all my blood levels were slowly coming back up to the normal range, my sodium stubbornly remained at 128. Because I was asymptomatic, Dr. V didn't think there was any clinical significance to it. But because my husband had seen how gravely ill I had been from low sodium, he remained concerned. So, Dr. V referred us back to the kidney doctor who treated me in the hospital.

Kidney Doc want me to do a 24-hour urine test. I was given an orange jug and a "urine hat" in a red biohazard bag. I was told to pee into the hat, which conveniently had a spout, and pour it into the jug, which was to be stored in the refrigerator, for 24 hours.

After I started the test, I quickly realized I was going to pee more than that jug would hold. I called the clinic and asked if I could use a jar for the excess--I was thinking about one of my canning jars. The nurse said yes, "as long as its clean".  Really. Did she think I was going to finish the jar of peanut butter and start peeing into it without washing it? As it turned out, I used a clean plastic milk jug.

The next day, when I delivered my 2 jugs of pee to the clinic, I thought I would be able to drop it off and go. But no, I had to have a seat in the waiting room, with my 2 jugs of pee proudly displayed. About 15 minutes later, I was called to the back and still lugging my 2 jugs of pee, which are quite heavy by the way, seated in the lab to have blood drawn.

There was already another woman there having blood drawn, but her nurse was not having any luck. I commented about my jugs of pee and the woman exclaimed, "2 jugs! I only had about this much", indicating a couple of inches with her fingers.

My nurse got into one of my big fat juicy veins right away and the blood flowed. Both the patient in the next chair and her nurse looked longingly at my body fluids--my 2 jugs of pee and my easily collected 2 vials of blood. As I walked away, the nurse was still gouging around in the poor lady's arm, trying to get into a vein.

When I returned to Kidney Doc, he laughed at the amount I peed--5 liters. All the testing they did came back normal. He said I no longer have S.I.A.D.S. and that my kidneys work just fine. He said I have Reset Osmostat. Which basically means my new sodium level is 128 and that is now normal for me.

I told him about my experience in the lab and he said, "I bet you were the envy of the clinic". 

 

 

Pictures at this post are compliments of Google Images

 

Side-Effects List

 

 

 

Beau's Lines

 

 

I'm pretty sure I was more worried about side-effects of chemo than I was about the actual chemicals being pumped into my body. As it turned out I had good reason to worry. I had some doozies of side-effects.

 

Here is my Side-Effects List. These did not all occur at once, of course.  I had a combo platter of symptoms depending on where I was in the chemo cycle.

 

Alopecia (that means my hair fell out)

Anemia (and many blood transfusions)

Anorexia (but not Nervosa) a.k.a. lack of appetite

Anxiety (!!!)

Constipation*

Diarrhea*            *they took turns

Dizziness

Dry eyes

Dry, dry, dry, parched, peeling, skin

Edema (once I had elephant-sized feet and legs)

Electrolyte Imbalance

Fatigue

Fever. Fever.

Headache

Infections

Low blood counts

Nail changes (Beau's Lines)

Nervousness

Neutropenia

Peripheral Neuropathy and foot drop

Rapid Heart Beat

Shortness of Breath

Vertigo

Visual Disturbances (Ocular Migraines)

Weakness

Weight Loss

 

Most of these have gone away since I am no longer taking chemo. I do still have trouble with fatigue and I still have some balance and mobility issues. I also continue to have electrolyte problems--I have been referred to a Nephrologist for a consultation. Appointment is next week.

 

I think the most fascinating thing was what happened to my fingernails. Nothing felt bad or wrong but I developed pale bands that went from side-to-side across my nails. Dr. V said they are called Beau's Lines. They are growth arrest lines caused by a decrease of blood flow to the nail matrix. I got one for each chemo. By the time I finished, you could count the lines, like the rings of a tree, to see how many times I had chemo. Weird.  The lines started growing out once I finished chemo.

 

There are also After-Effects of hospitalizations, severe illness, and treatment for a life-threatening disease. I will talk about those in another post.

 

 

Beau's Lines half grown out

Staying Positive

I believe a positive attitude helps health. I believe that people who can remain hopeful, determined, and positive have better outcomes when faced with illness. I believe optimism heals. I believe that God wants us to feel happy and confident.

I know that maintaining a positive attitude can be hard work and almost impossible to maintain when faced with major losses. . .of loved ones, relationships, security, health, serenity. There have been many times when I have felt hopeless and scared and sad and mad and worried and in pain and weak and sick with fever.

As I have journeyed through Lymphoma, I have had to search my soul and I have often had to reach very deep within to find something to be thankful for. Other times, my blessings are abundant, obvious, and easily felt.

To help myself stay encouraged while facing a life-threatening illness and coping with side-effects of toxic treatments, I have tried to keep my words and language positive.

It is very popular to use such language as battle with cancer, cancer warrior, the beast, the nasty beast, war against cancer, victim of cancer, monster, struggle, hate, cancer sucks, fight. 

I don't use any of those words. They are all negative; some are violent.  I don't use hateful words in any other aspect of my life and I believe in peace.  In fact, I'm glad my cancer has its own name, Lymphoma, so I don't even have to use the word cancer if I don't want to. I call it my Lymphoma Journey. I will not hate my Lymphoma as it has become part of me and I will not hate myself.

I try not to fear my Lymphoma. If it takes my life then that will be the way I go.

M R S A

I wish we could send  Bad Doctor   a bill to be reimbursed for the thousands of dollars he cost us, not to mention the sickness and pain, because of his bad work! Two hospitalizations and two additional surgeries as corrections for the 2 surgeries he did.

Bad Doctor gave me the gift of Methicillin-Resistant Staphylococcus aureus (MRSA). When I was told I had cancer, I was very brave but when I was told I had MRSA I broke down and cried like a baby. The doctor and nurse both cried with me.

Amongst the things I never wanted to know how to do, I was taught to give myself  IV's to treat the MRSA. I had a very sweet and super cool home health nurse who accessed my port and showed me how to clean and attach the bottles of medication and how to flush it afterwards. She came to draw blood for testing and also came to change the needle into the port. Afterwards, she came in and de-accessed the port.

A very large box was delivered to our home. It contained 24 bottles of the correct dosage of medication for a 90 minute infusion. It also included boxes of surgical gloves, masks, alcohol wipes, prefilled syringes with both saline solution and heparin for flushing my port, and additional supplies for changing the port and drawing lab work.

The bottle pictured above has been used. That post in the center is covered with a deflated balloon. When the bottle was new the balloon was filled with the medication (think: water balloon). As soon as I attached it to my port line and unclamped it, it would start flowing by pressure. I infused myself twice a day for 2 weeks.

I am thankful I was able to do this at home. The active infection is cleared up but it is doubtful I will ever be free of MRSA.

Bad Doctor. 

 

Bad Doctor

In the beginning of my Lymphoma Journey, I had a Bad Doctor. The most excellent Dr. V referred us to a surgeon to have a port-a-cath placement with ultrasound guidance and an underarm lymph node dissection for biopsy. Both procedures were done at the same time in an outpatient surgical center. I went straight from the surgical center's recovery room to the hospital for my first chemo.

It did not occur to me at the time to wonder why I wasn't having those procedures done at the hospital, since I was going there anyway.

 

 

The day after the surgery, my underarm surgical wound was draining at lot of lymph fluid. It was soaking the very thick bandages the nurses were applying and soaking my bedclothes and bedding. A nurse said the wound was not completely closed and reported it to Dr. V, who called Bad Doctor to come see about it.

 

About 8:30 PM, Bad Doctor came into my room, late, acting furtive and sneaky. He looked very unkempt and smelled bad. I'm pretty sure he had been drinking. He did not wash his hands even after I pointed out the hand sanitizer and gloves.

 

First thing, he starting scolding me for "telling everyone in the hospital" that he hadn't sutured my surgical wound. I promptly told him I didn't say anything to anyone, that I was sick in bed and couldn't even see it!

 

He had brought a stapler, a suture removal tray, and steri-strips with him. He said he could staple the wound but that the fluid would get backed up and I would get a swelling the size of a baseball under my arm! He was putting pressure on me to tell him what I wanted him to do.

 

My husband was down the hall, in the lounge, making family phone calls. I picked up my phone and told Bad Doctor I wanted my husband. Bad Doctor starting yelling at me!! He said he didn't have time to wait for my husband to get there as he only had 5 minutes and his wife was waiting in the car. Again, I snapped back at him, "He's in the hospital"! I have never had a doctor be so rude to me.

 

I buzzed the nurse and asked her to locate my husband. I think they both ran to my room. And surprise, Bad Doctor suddenly became Mr. Nice Guy when my husband walked in. My husband, the nurse, and I unanimously decided to send Bad Doctor away.  He left the room muttering something about God's will. Indeed. 

 

Was Bad Doctor really going to remove stitches and staple my surgical wound, in his allocated 5 minutes, there in my room, without sterilization or anesthesia of any kind, without even washing his hands??  Probably so.

 

I learned later that Bad Doctor does not have any affiliation or surgical privileges at the hospital! So that is why I had the surgery elsewhere.

 

 

And this was not the end of dealing with the after-effects of Bad Doctor's shoddy and nasty work.

 



 



Sick Food

During my hospitalization, the one I refer to as "that time I was so sick", I lost 22 pounds (in 11 days).

When I got home, I had no appetite whatsoever. Dr. V even wrote, "anorexia" (but not nervosa) in my chart. I was also very weak and needed to eat. My husband did a great job of feeding me, but it was a challenge for him. Almost nothing sounded good and thoughts of food smells was disgusting. Also, my spleen was very swollen from the lymphoma and pressing on my stomach, making me feel full even after eating a few bites. 

Here are the things I ate, almost exclusively, for about 6 weeks.

Egg Sandwich with Butter

Oatmeal with Raisins, Cinnamon & Butter with Toasted Raisin Bread and more Butter

Baked Bean Sandwich on Buttered Toast

Carrot Juice, Nuts and Trail Mix

And Thank God for Boost
 

Hair Progress

This is my head with my few remaining hairs after 8 rounds of R-CHOP. The photo was made 6 weeks after my last chemo and the hair is just starting to come in.  Surprise! The new hair is pushing out the old hairs, so I lost the little bit of hair you see here.

Here is my head today, just one month after the former picture. My husband says it looks like a coconut with ears.

Hospitalization and the 9 Diagnoses

Here I am, sound asleep, receiving a blood transfusion and antibiotics.

My first chemo didn't go well. This was as bad as it would get.

Because I was so symptomatic, I was admitted to the hospital and the first R-CHOP was done there. I was discharged home on the 5th day. Four days later, I went to Dr. V's office for labs. My blood counts were very low--red, white, platelets--everything. Nothing was even close to the normal range.  And I had fever, so back to the hospital we went. Did I mention I felt miserable?

While we waited for a hospital room, I received, at Dr. V's office,  IV fluids, antibiotics, and a Neulasta shot to stimulate my bone marrow into making more white blood cells. I progressively felt worse and worse and left Dr. V's office in a wheelchair.

I remember getting to my hospital room and changing into one of their lovely gowns. I remember meeting my nurse. I remember pain setting in. I have tiny fragments of memory of several days. I remember being surprised one morning to learn that I had been in the hospital for over a week!

This is why I was hospitalized:

Neutropenic Fever
MSSA Port Infection s/p removal
SIADH
Stage III transformed Marginal Zone Lymphoma
Left pleural effusion s/p Thoracentsis
Pancytopenia
Anemia s/p PRBC transfusion
Hypophosphetemia and Hypokalemia
Deconditioning

Needless to say, we had to look up most of those words.

Things I know from my husband and his notes:

Day 1: Fever, shaking chills, temp up to 103.9; finally got hydrocodone for pain; Ativan; Clonodine after a tough round of fever with high BP and heart rate; by 1AM, vitals back to normal, temp to 100.

Day 2: (Pictured above) Hemoglobin down, transfusions ordered; Oxycodone and Morphine added for pain; 4PM CT scan and ultrasound done, more fluids, antibiotics, Albuterol for Wheeze (new today).

Day 3: Fluid in left lung, will see lung Doctor; lymph nodes shrunk somewhat; white count still way down. platelets about the same, hemoglobin up; Pulmonologist  says left lung less than 1/2 aerated; when platelets and blood count go up enough, will use needle to remove fluid from around lung and test to see if it is from the lymphoma; platelets are at 30, he wants a count of 60 to do procedure.

Day 4: Platelets 50; red cell improved; white not yet--still at 0.0; port must come out, Staph Aureus;
sodium down, limit fluids; 1 PM port removed.

Day 5: Platelets 75, still low; white count not up; sodium level 118, low, salt tablets ordered; Cipro and Unasyn ordered. Nephrologist ordered 3% sodium infusion, 100 ml. to raise sodium without adding water; kidney function good, but R is seriously retaining water and this dilates her sodium level and causes confusion, etc; water intoxication; sodium at 115; if it drops after infusion to 113 then it's off to ICU; 11PM Good News! R's sodium back to 118.

Day 6: Sodium up to 124; Platelets 123; white counts and Neutrophils up; all good news; may get PT today; may get lung procedure today or tomorrow.

Day 7: Thoracentesis done using a needle to draw off 1200 ml. fluid; fluid was bloody but no sign of infection; 1200 ml about 1/2 of fluid present but stopped due to pain and coughing from pleurisy which should subside in a few hours; 1PM chest x-ray showed normal but 02 saturation went down to 86%; got 2 lpm  02; level went quickly back up.

Day 8: Blood good; electrolytes good; sodium 124; phosphorus still low; no infection from lung fluid, will know more tomorrow; will add hydrocodone and d/c morphine; wound care nurse teaching.

Day 9 through 11, I can remember!  I started getting physical therapy; the fluid from my lung was negative for lymphoma; blood counts good. I was discharged on Day 11 with 11 prescriptions, a walker, orders for home health physical therapy, and a 1 week delay in Chemo #2.

View from my Hospital Room

R-CHOP

I had no idea there are hundreds of drugs used for chemotherapy. I didn't know there are so many recipes and blends, nor that chemotherapy combinations are targeted to specific malignancies. Even people with Lymphoma, which I have learned is categorized into many subtypes, don't get the same drugs.

The only things I knew were the snappy nickname, "Chemo", that it makes you go bald and that it makes you vomit.

My cocktail was R-CHOP and consisted of:

R--Rituximab, which is technically not a chemo agent but a chimeric monoclonal antibody. MmmK

C--Cyclophosphamide, which my nurses called cy-toxin. Nice. It is a mustard gas derivative. Nice.

H--Doxorubicin Hydrochloride, which is red and my nurses called it "red zinger".  It is an anti-tumor antibody.





O--Vincristine (Oncovin), which is a plant derivative of the lovely periwinkle.

P--Prednisone. Also not a chemo drug but is used as an anti-inflammatory, treatment for nausea, and to stimulate appetite. It gave me energy and I joked about being on performance enhancing drugs.

I took R-CHOP through my port 8 times. I did lose my hair but I never threw up.

The side effects of chemotherapy are seemingly endless. I couldn't listen to Dr. V, the nurses, or even my husband when they tried to talk to me about possible side effects I might experience. It scared me. Fear and the fact that I believe strongly in manifestation made me cover my ears and beg them to stop.

The fact that I did not experience the classic side effect of chemo, horrible nausea and vomiting reinforced my idea that "not knowing" worked best for me. I knew that I would know what side effects I would have as they occurred.

Over time, as I settled into acceptance of my diagnosis and treatment, I sought out more knowledge. But my sickness, diagnosis, procedures, testing, and treatment happened so FAST! I was too stunned to process everything.

Port-a-Cath Placement

That first day I saw Dr. V, he ordered the placement of a port-a-cath (a central venous catheter), a small device, about the size of a quarter, which looks like some kind of transmitter. It is surgically placed under the skin of the chest, then an attached catheter (tube) is threaded underneath the skin and inserted into the jugular vein in the neck. This allows infusions without the need to have an IV started in the vein each and every time. I have had chemo and other medications, blood transfusions, and blood draws for lab tests, all done through my port.

This is the device causing the bump, which is not "accessed", on my chest in the photo above. To use it, a special needle called a Huber needle is inserted into the port's septum, the silicone center of the port. When a needle is in place, the port is "accessed".  My port has been accessed for up to a week, then it has to be changed.

This is a Huber needle. The needle is inserted into the port using the little grip that looks like a clip. The padded part rests flat on the chest and the little clip is folded down like a butterfly. The whole device is taped into place. The port is now accessed and ready to use. The blue cap is removed, then syringes and other specially made catheters can be screwed into place. The clamp is used for stopping the flow while the port is still accessed but not in use or while catheters are being changed.

Here I am with my port accessed, receiving an infusion. It really is convenient because both my arms and hand are free. I can used my computer, Kindle, eat, and all the things I do, while passing the hours I sit in this recliner. 

Hair

Natalie

 

Before I go into my fun with chemo, can we talk hair?

Everything I have heard and read takes the stance that chemo induced hair loss is basically a vanity issue. Though the articles are less blunt and say things like "women consider their hair their crowning glory". Then go on to talk about how much time and money women spend on hair dressers, hair products, etc. How devastating it is because women "identify" with their hair.

Yes, the looks aspect of hair loss is traumatic. (I look like my Dad!)  And, yes I have spent plenty of time and money on my hair. But that was not my greatest concern. I am a very private person. My dread of losing my hair was of being transformed into someone who must reveal to the world, through my baldness, that I have cancer. 

I didn't especially want my grocery store cashier or librarian, much less perfect strangers, to know that about me. I don't want people giving me that look.

I didn't do the head shaving party or take before, during, and after photos. Too sick to party. Too upset to want my picture taken.

I ordered a cheap wig named Natalie from the American Cancer Society catalog. It cost $48. They have some cute hats too (as well as plenty of ugly ones). Another place I ordered a few cute hats was Head Covers.

Stay tuned for much, much more about hair loss and regrowth.

I am going to an Oncologist (c-a-n-c-e-r d-o-c-t-o-r)

Asheville Hematology & Oncology

 

The first day we met Dr. V, he got right down to business. I truly don't remember too much about what we talked about that day. My husband probably remembers more than I do and he probably took notes; he has been very meticulous about that. And I felt like hell--still running fever, still short of breath, getting weaker by the day.

One of the things I do remember is the Bone Marrow Biopsy. Oh yeah. The very first day we met! I didn't think he had even gotten to first base and here is was going all the way for the home run. Yep, we marched to another room where I got onto a table on my side with one leg pulled up. My husband was there, Dr. V's assistant, and someone from the lab who was dressed in full protective gear, face mask and all. I couldn't tell  what was going on in the room once I was in the position.

What I remember is feeling a lot of pressure. Then a lot of pain. A lot of pain. And I started crying. They let my husband come and hold my hand.

On my way to get the bone marrow biopsy, I went by the lab where 11 vials of blood were drawn.

Afterwards, I walked to the other side of the building to meet another doctor, an oncology surgeon, who would be placing a port-a-cath into my chest and excising a lymph node from my armpit for biopsy. I had an ultrasound of said armpit in order to mark which node would be excised.  That doctor seemed very nice that day, but my husband and I both would develop very bad feelings about him over time.

I also got orders, that day, to go to the heart tower at the hospital for an echo cardiogram, and also to get a PET scan.

What a day! I barely remember crawling to the car to drive home and nothing of that evening.

I don't know if Dr. V used the blue handled or green handled awl (or both) to drive into my hip bone. My husband said he was straining, shaking, sweating, and working hard to get into the bone.

CT Guided Core Needle Biopsy

My Back the Next Day After Dressing was Removed

That Tuesday, in Dr. N's office, she told us she was going to order a biopsy of an abdominal lymph node. Friday, my husband and I went to the hospital for our introduction to Interventional Radiology, of which we would become quite familiar. I liked the doctor I had that day and I loved the nurse. Her name was Angie. She was good with needles, which always helps, and she started an IV with no problems. While I was being prepped, the doctor came in and explained the procedure--he would be going through my back with a long needle to take a sample of an abdominal lymph node. Yikes!

Angie told me I would receive sedation consisting of Versed and Fentanyl. She said I would most likely be awake but just not care. She rolled me into the procedure room where she and a tech positioned me on the very narrow table, face down, feet towards the tube, arms stretched out over my head,  and strapped me down. Angie admonished me not to move and if my nose started itching (??) let her know and she would scratch it for me. They backed me in and out of the scanner a few times to align me for the doctor.

When the doctor came in, he proceeded to stick the needle in. I could hear it crunch and said so. He was surprised because he thought I was asleep. He told the nurse to sedate me and I was immediately asleep. When I awoke, I was on my back, on a gurney, with Angie wiping sweat from my face.

She rolled me back to the recovery room where 2 bottles of that delicious contrast liquid were waiting for me. After I drank it I was rolled away for an abdominal CT scan.

Both procedures turned out to be rather pointless and our insurance company originally balked at paying. The biopsy confirmed lymphoma but no other needed information was gleaned, such as the type and stage of the lymphoma. My first CT scan had already shown the abdominal lymph nodes.

It was only after I asked, demanded really, that I was referred to Dr. V, my Hematologist/Oncologist. My husband and I both have really appreciated our relationship with him. Much, much more about Dr. V and his wonderful nurses and staff will follow. 

The Beginning

Last August 10th, several family members got together for a few days visit to our twin grandsons. We all stayed in the same hotel and we all left sick with upper respiratory symptoms. We didn't speak of it at the time but we all thought there was something funky about the ventilation in the rooms. 

Monday, my husband and I woke with scratchy throats. Tuesday, I developed a scorching sore throat. Wednesday, at work, it became more and more difficult to breathe and I stopped on the way home for Mucinex.  Everyone else's sickness got better, but not mine.

I kept getting sicker and sicker. I started running fevers that lasted for weeks. I was struggling to breathe. I started having drenching night sweats. I felt so bad, but never, ever, not one single time did it ever occur to me that I had cancer.

I went to the family doctor 3 times, took antibiotics twice and steroids once. Nothing. Finally Dr. N gave me a breathing test which I flunked. She then gave me a breathing treatment and re-tested me. Still flunked it. She ordered an x-ray, which was abnormal, and followed by a CT scan--my 1st of many to come.

My husband and I met in Dr. N's office and she informed us that I most likely had Lymphoma. I had no idea what that meant, so she had to spell it out: c-a-n-c-e-r.

Twin A and Twin B

 

Before and After

When I first became sick with Non-Hodgkin Lymphoma, it was suggested that I keep a diary of my experiences as I traveled on this journey.  There are plenty of reasons I did not.  First one being that I was so sick and felt I would never want to remember it. Secondly, I was in shock and couldn't fathom how gravely ill I really was. Writing it down may make it a reality I couldn't deny. Furthermore, there are periods of time I am unable to remember. My husband has filled me in little by little as I have continued to regain my health.

My Remission was confirmed in February and it is May now. I finally want to talk about what I have been through. I want my voice heard and it is my hope that someone who is where I once was will find my little corner of the Internet and be comforted and cheered. Things really and truly will be better. I promise. 

This photo was taken 6 weeks before my diagnosis and 8 weeks before my first chemo. I had no symptoms and no clue! I had never been sick and had just been given a clean bill of health a couple of months before this. My mammogram, pap smear, and all my blood work were perfectly normal. I took no medications of any kind and had never had any surgeries. I have always loved to cook and I believe in eating healthful foods. I went to the gym and was physically fit. I was healthy! Never had colds or flu. Never missed work due to illness. No complaints of aches or pains. No headaches. I can't have cancer; that is preposterous.

I miss my hair! I miss my color and the healthy glow of my complexion. I miss my scar-free chest.

~ ~ ~

Nine months later, it looks like 20 years have gone by. I lost a lot of weight very quickly and it sure shows in my face. Since I no longer have that nice layer of fat under my skin, it just hangs there. Because I have had a lot of trouble with chemo induced anemia, I have been as pale as snow. At least I am getting some color back. Here, I am wearing lipstick and eyebrows but no other makeup. And they say I look good. It makes me feel so sad thinking of how I must have looked when I was really sick.

Quick, put on a wig and scarf!