Remission by any other name….

Did you notice I popped the R word into the last blog post? Perhaps it would have been more accurate for me to write “complete molecular response”. What is this, you ask (or maybe you don’t, but since I think it’s kind of interesting I’m going to tell you anyway)?

As I explain, please understand as I dumb this math down for myself. Math isn’t my strong point. Did I ever tell you my high-school math teacher, after tutoring me for months, suggested I drop the course before the exam to spare me an F on my graduating report card? Thank you, Mr. Fox.

The very smart hematologist who suspected I had CML took a bone-marrow biopsy, both to confirm her diagnosis, to stage the illness, and to get a baseline count of how many mutated cells I had. She determined, from this information, that I was in the chronic phase of the disorder, which is the first of three stages. Forget the F in math; thanks to this doctor, I received an A in CML. Now, every three to six months, I undergo genetic testing of my blood (commonly known as a PCR in CML circles) to determine how many cells with my special Philadelphia chromosome are coursing through my blood.

Within 12 months of treatment, I had attained a 4-log reduction (apologies to any mathematicians if I’ve written this incorrectly) in these cells, which means I had 1/10,000 of the leukemia cells I’d had upon diagnosis. Most CML patients who are diligent about taking their special Philadelphia-busting medications fall within this range or even lower within the first year of treatment. I am nothing if not diligent. I imagine you would be too if a doctor told you that carelessness could result in your leukemia progressing and potentially killing you.

So here’s the $128,000 question (inflation and all): If CML patients are in remission, a.k.a., at the stage of major molecular response, what would happen if we stopped taking the medication we were initially told we’d have to remain on for the rest of our lives? Sounds like an interesting research question, doesn’t it?

Normally I’m first in line to try something new. Hot new restaurant in town? I may not eat there, but I’ll know all about it. Hot new clothing store? I’ll tell you where it is. Hot new park in town? Let’s check it out, Jelly.

How about a hot new study for CML patients who want to rid themselves of the nasty side effects of their medications and are willing to stop taking the drugs altogether just to see what happens? No thanks. I’ll pass.

I’ve been a guinea pig for physicians in training over the last 17 years now. I can’t tell you (and not simply because I’m terrible at math) how many hands have palpated my ginormous spleen. That being said, I’m perfectly happy with my major molecular response, thanks; some other brave CML patients can step up to this plate and ditch their drugs in my stead. Once you docs are sure my leukemia won’t return or even progress to a more dangerous stage without my medication, maybe then I’ll consider going drug free. Good luck finding subjects!

Guinea pig

This is the old me.

 

Killing me softly, one poached egg at a time

Runny poached egg on toast

True confession: I love poached eggs. A poached egg on toast is the perfect breakfast. The other day I was reviewing the recommended diet for the immunocompromised person, and I discovered, to my horror, that any egg that is not hard cooked is a no-no. Have I been taking my life in my hands with each perfectly runny poached egg?

People with blood disorders, including CML, and those undergoing chemotherapy, often have a low level of neutrophils, those white blood cells critical for fighting infection. My neutrophils run high, yet they don’t function well, so I am sometimes infection prone. For this reason, I feel I should take reasonable dietary precautions.

I’ve written about this neutropenic diet before. Anything unpasteurized is out. Many fermented products, which are supposed to help our gut bacteria flourish, are verboten. Finally, a valid excuse not to drink kombucha. Raw cheeses, deli meats, salad bars, raw nuts, any uncooked vegetable or fruit may pose a danger. Too bad I ate an apple this morning instead of apple sauce. Meat must be shoe leather. And sayonara sushi. Even lox is on the list. (Hot smoked fish is safe, but cold-smoked fish is not.) Sure, I shouldn’t be eating that sodium bomb, and I rarely do, but consider this Jewish equation: brunch = lox + cream cheese. I’ll be a pariah if I skip the lox.

A few years back, the CBC published a blog by a resident physician undergoing treatment for Hodgkin’s lymphoma. (If you’re interested, here’s a link to his first post.) The self-named Dr. C. (for Cancer; his real name is Nikhil Joshi), shared his cancer journey across the country. Because he was in a chemotherapy-induced immunocompromised state through his treatment, his oncologist had forbidden him from eating out altogether. Eating out is dangerous when one’s immune functioning is weak.

Dr. C. was the model patient. Then one day he really craved a slice of pizza, so he went out for one. He knew better but he didn’t stop there, going out to eat a few more times. (He confessed his sins to all of Canada, but did he ever tell his oncologist?) He acknowledged he’d break the rules again were he in the same position. Even this doctor, knowing the risks he was taking, couldn’t be the good patient all the time. I imagine that experience made the now-cancer-free Dr. C. a better physician.

My infection risk pales in comparison to Dr. C.’s during his chemotherapy, yet it’s there, and I’ve been unknowingly pushing the limits on a daily basis. That slice of old cheddar–old cheddar is bad but medium cheddar is okay?–the miso in that salad dressing, the perfectly soft-poached eggs which I love. Every salad I make could be the death of me since it appears my vegetable washing isn’t up to snuff. Unlike Dr. C., I needn’t visit a restaurant to make myself sick; I can easily poison myself at home.

I might as well go out, don’t you think? There are great deals at hot restaurants during this week’s dining festival, and J. and I are going for lunch today. I am such a rebel. Maybe I’ll skip the burger on offer, though. Better that than shaming myself by insisting it be well done.

The Validator saves the day!

Boy at table in striped shirt writing with pencilCan you believe I started my blog three years today? As a writer, I decide which stories to highlight and how I’m going to tell them.These decisions are often completely arbitrary. Speaking of which, I ended Friday’s tale prematurely because I felt I’d dragged you down enough for one day. That and Joy doesn’t like it when Sadness steals the limelight.

Now that you’ve had the weekend to recover, I’ll finish what I started. After my chance encounter with Mr. Shuffle at the Cancer Centre, I headed back to the car. J. could tell immediately that my mood had shifted. I was glum and quiet, so she asked, “Whassup?”

I described my encounter, and how bad I felt for this man, who was unwell and appeared to be alone. (His family could have been waiting for him, for all I know; I just didn’t see anyone with him.) I’d made many potentially erroneous assumptions about his life. Then I added, “My cancer journey is so much easier than everyone else’s, I’m so lucky to have a good leukemia–a good leukemia? I said that?–and an easy chemo, blah blah blah.” You get the idea.

Enter the Validator, J.’s other superhero persona. (You’ve already been introduced to the Anti-Procrastinator, who completes tasks before anyone realizes they need to be done.) She said, and I paraphrase here, “Remember when you almost died? Remember when you were so weak that you couldn’t tie your shoes without tipping over? People stared at you because you looked so sick. Remember how many months it took for you to regain your strength and to complete a 5-star Sudoku again [excuse the humble brag]? You’re not working in the profession you love and you’re tired all the time and your cancer has been no piece of cake.”

You may recognize this old theme in my blog: the incessant need to convince myself that my cancer is lame, and that my suffering is small potatoes compared to everyone else’s. Heck, I’m 4-1/2 years in, and I’m not even dead yet. I’m a cancer failure.

All these things are true. I’m still alive, but cancer still courses through my veins. At one point, my leukemia made me as weak or maybe even weaker than Mr. Shuffle, not that cancer is a competition. You know this already; I’m just trying to convince myself that I don’t have to minimize my experience. I’m reminding myself yet again of the dangers of social comparison, which sometimes makes me feel better about my situation, but more often makes me feel worse.

So Mr. Shuffle, I’d love to nurse you through your illness, but I’m hoping you have your own community of support since I don’t have the energy. Believe it or not, I’ve got cancer too. I may look perky now, but my road has had its share of bumps. I hope you’re able to regain your strength and that you’re feeling better soon. Fight the good fight and know my heart is with you.

Then the Validator wisely reminded me that feeling crummy is often one stop on a cancer patient’s way to healing. Wise woman, that Validator. I hope she’s right, for Mr. Shuffle’s sake.

The Real End

My newfound fear of the pharmacy

Woman's hand receiving receipt and drugs from pharmacist

Did you see Freeheld? If not, skip it. The ratings weren’t great, and you’ll have to watch a woman die of cancer. It was a downer. The story is important though: It’s about a woman in the U.S. who wants her spouse to be eligible for her pension upon her death. No problem were her spouse male, but her spouse was female, hence the need for a movie. It’s based on a true story from the early 2000s.

We Canadians are so far ahead of the game. I’ve been on Judy’s benefit plan for years without issue, and I would have received her pension had she died before me. Human rights laws in Canada prevent discrimination on the basis of sexual orientation, and Americans were flocking to our fair land to get hitched for years until marriage became legal in 2015 south of the border.

Which leads us to J.’s retirement, and with it the loss of her benefits. Since I was covered under her plan, I could go to the pharmacy, flash my disarming smile, and leave with a bundle of expensive life-sustaining drugs without paying a cent. My drug plan, which cost me $63.50 monthly, and hers, a minimal deduction on her paycheque, together covered every penny. When we looked at whether we could afford to retire, we included in our calculations my drug expenses without J.’s benefits, which are significant.

In the meantime, J.’s retirement date jumped around a bit before she finalized it. When she told me she’d finalized December 2, I jumped for joy because the bulk of my drugs were eligible for refills that very day, allowing me another three months’ stash for free. Or so I thought.

On November 30, I approached my friendly pharmacist, Colin–we’re on a first-name basis after 15 years together–my list of renewable meds in hand. He informed me, to my dismay, that my calculations were off and I could not renew my prescriptions until December 12.

I was in a panic. I texted J., “I know your retirement party is today, but could you work until December 12 so I can refill all my prescriptions without cost?” Without even considering my request, J. selfishly declined. I was sad to learn I rated so low on her priority list, but I got over it.

I have been putting off seeing Colin, but this week, I will go to the pharmacy and seek those prescription refills. I will run out of my medications over the holiday if I don’t. I still have my drug coverage to soften the blow, but I will have to pay for whatever is not covered.  I will include this cost as a medical expense at tax time. It will not bankrupt us, and J. will not be forced back to work.

I remind myself that these drug expenses are a drop in the bucket relative to the medical expenses covered by the government, including, for example, all my doctors’ visits, hospital stays, and 100% of my prohibitively expensive daily chemotherapies.

I may turn to Kijiji to make up the difference. Anyone interested in buying my sugar stash? I have several untouched chocolate bars to spare. Sorry, no wine gums. I can’t even recall the last time I bought them.

 

Why does denial get such a bum rap?

Quote: Poeple don't want to hear the truth because they don't want their illusions destroyed, Friedrich Nietzche

I’ve been knee deep in denial lately, and I’m not apologizing for it. We all need denial to get through the day. I can’t speak for you, but I know that I’d be an emotional wreck without it.  I’d be thinking about death all of the time instead of just most of the time. Denial may be considered a primitive defence mechanism used by the psychologically unsophisticated, but I wear mine like a badge of honour. I hereby encourage you to hop on the denial bandwagon with me.

I was thinking about my favourite primitive defense last week at the pharmacy, when I was picking up my iron supplements. I have been taking iron for a few years now to compensate for my chemotherapy’s suppressing my red blood cell count. Without these supplements, I’d likely be chronically anemic. I buy one or two month’s pills at a time because they are costly.

I eternally hold out hope the doctor will tell me I can stop taking the iron. Yes, I deny I need the pills. Cost aside, why do I want to get off them? Let’s say they affect my score on the Bristol Poop Scale. I’ll spare you the details here, since those of you who’ve been on iron supplements will know exactly what I mean. Anyone who doesn’t know but is curious can look this information up easily on the internet.

Every time I see Dr. Blood, I ask her whether I can ditch these nasty pills. She has come to expect my question and her answer is, predictably, no. Last visit, she went so far as to double my dose, which was definitely a move in the wrong direction.

As much as I’ve convinced myself to despise these supplements, I’m wondering whether my increased energy might be attributable, at least in part, to them. If so, I’d have to embrace them fully, wouldn’t I? What if I reduced my iron dose, only to resume my sloth-like existence? Would I then have to admit the pills I hate are doing me some good?

My iron supplements are but one example of my penchant for denial. Denial has allowed me to preserve my basement office as a shrine to my working days, despite my currently seeing only the occasional client. Denial has conspired with me not to volunteer in case old (or even new) clients resurface. Maybe denial allows me to adapt to the changes and losses cancer brings at a snail’s pace. No wonder I rely on it so much.

Sometimes my denial is so firmly entrenched there’s no messing with it. Recently we consulted a financial planner to determine when J. might retire from her full-time job. He told us that, assuming we both live until 90–did he not hear me say I have leukemia?–we will have enough with our savings, J.’s smaller marriage-commissioner income, and my paltry disability pension. Did he say “live until we’re 90”? What a buffoon. So I asked him: “I can’t speak for J., but at this rate, I’m planning on living at least until 100. Can we still afford it?” He’s going to have to get back to us.

Anyone wanna Go Fund Me?

Three dogs standing on grass, in back Donor Melvin, in front clone Ken and clone Henry

Did you hear the one about the guy who is spending $50,000 to clone his dog? Would I lie to you? This fellow believes his dog is so outstanding that she is worth repeating, so that’s what he plans to do. If I had $50,000 to burn, I’d put the money toward travel or a place in the country or even leukemia research.

His plan has given me a really good idea, though. No, I don’t plan to clone Jelly. I’m not an idiot. Why would I want another counter-surfing, sidewalk-scrounging, off-leashing-in-the-house ill-behaved but loveable dog? I can think of much better ways to squander my precious funds. Rather, I was thinking, why not clone myself?

My insight stemmed from yesterday’s unexpected preoccupation with dying. My Cancer Centre appointment was cancelled, but I still had to drop by to pick up my chemotherapy refill. (Notice I didn’t have the drugs mailed this month? One-trial–or is that one-disaster?–learning.)

When I was newly diagnosed with leukemia, each visit to the Cancer Centre reminded me of how sick I was. These days, I can enter the building unscathed, except when I can’t. Yesterday was a scathed day, for whatever reason. Everyone looked so ill, and although some of these people need to get sick in order to heal–the irony of cancer treatment–I couldn’t seem to focus on that.

For whatever reason, when I entered that building yesterday, l felt like I was facing cancer for the very first time. These days don’t come often, surprisingly, since denial of the seriousness of my illness squelches most morbid thoughts before they surface.

To distract myself from my fear, I arrived at the perfect diversion. I figured, if this dog can come back as a dog created in her likeness, why can’t I? Maybe I wouldn’t be quite so scared of dying if I didn’t really have to die after all. I too could harvest some cells and create a mini me. If I get right on it, I could even raise her, molding her into my likeness. Who could be easier to parent than a little person just like me? I’m sure my mom would agree.

But I’m going to need some time to raise funds for this procedure. $50,000 will require over four years of my disability income, in fact. Do I have four years left? Who knows? So I’ve decided on another fundraising approach and created a GoFundMe account. Is this not perfect? Donate your hard-earned cash to go fund the re-creation of me and I will exist for perpetuity. If the donations exceed the $50,000 required, I’ll put the overflow toward the cloning of my clone.

Why have all those longevity researchers failed to come up with this most obvious solution? Cloning would be so much easier than adhering to a crazy calorie-restriction diet.

Let’s skip the whole nature-nurture curve ball for now. I’ve always wanted children, and I know this one would be perfect. Of course my clone will grow up to be just like me, perhaps even a better version, nurture be darned. I’ll see to that.

Big terrier and puppy seated, both wearing nerdy glasses

Would I lie to you?

I’ve had a surprising number of people ask me whether Ms. Supervisor, from last week’s Mystery of the Missing Medication, really had cancer. She was somehow able to find my missing chemotherapy after her underlings had not.

You should know by now that I am not a fiction writer. I do not have the capacity to come up with a complex plot, to develop character, and to bring everything to a neat resolution. I had a near breakdown in high school English when I was tasked with writing a short story. I would draw a similar blank presently if my stories came solely from my imagination. So no, I don’t make this stuff up. I am an observer, and I work with what life tosses my way.

Yes, dear readers, Ms. Supervisor did indeed have cancer. She understood from personal experience how urgently I needed her to resolve my problem. Perhaps her underling, Ms. Making Me Postal, was in the fortunate position of not having had cancer yet touch her life, and that is why she treated me like any other whiner with a missing package.

Do you think people need to experience something themselves in order to empathize with others in their shoes? Do you need to have cancer to understand what my life with cancer is like? No, I don’t believe that. If I did, professionals like me would be out of work.

Over the course of my career, I’ve seen people from all walks of life and with an infinite range of concerns. I can’t possibly have experienced all that my clients have. I counselled parents and I don’t even have children, except the furry kind. Sure, some clients have seen me once and never come back, but others have returned, some even telling me they’ve found our contact helpful. I’d like to believe I’ve shown them empathy despite my narrow life experience.

Occasionally my experience has mirrored that of my client. That client would not know this because I share little with clients, not to be secretive, but to keep the focus on the client’s needs rather than my own. Am I more deeply empathic if my client is discussing issues I’ve confronted in my own life? Maybe but not necessarily. I have to guard against my similar life experience’s distracting me from my client’s.

Empathy is not just for counsellors, my friend. I appreciate empathy in a clothing store because my body is different, and empathy at the supermarket because I move slowly some days. But can empathy be learned if it doesn’t come naturally to you? I think it can, at least to some degree.

I trust Ms. Making Me Postal was not hired for her empathy skills. If I could speak to her again, I would say: “I understand you have certain rules you need to follow, but could you consider how we might resolve my concern promptly? My life depends on it.”

Before I can teach Ms. MMP empathy, someone may need to teach her common sense. Is it a teachable skill? That I’m not so sure.

Common sense is a flower that doesn't grow in everyone's garden

The mystery of the missing medication

Package in cardboard box with "Urgent" in red on front

Anyone interested in the outcome of my recent postal debacle? The story could have ended so many ways. I could have died because my chemotherapy was lost in a mailroom maelstrom. My writing you today suggests that this did not happen.

Alternatively, I could have been recruited for a study of noncompliant CML patients who stop taking their medication because they don’t feel they need it anymore. I don’t qualify for that study. I’m taking my medication every day until I die, assuming it doesn’t get lost in the mail.

A third but unlikely outcome is the arrival of the package the next day. But that’s too simple. The situation must get worse before it gets better.

On Monday morning, I begged the Cancer Centre pharmacy for a week’s worth of chemotherapy until my missing meds were found. Then I called the post office for a daily update on my untrackable package. Because I am so difficult to please, again I was dissatisfied with the response. I learned that only the sender could instigate an investigation into the missing pills. Furthermore, Ms. Making Me Postal would not contact the pharmacy because she could not make outgoing calls; I would have to ask a pharmacist to call her.

Imagine my surprise that someone at a call centre cannot make outgoing calls! Aren’t most telephones capable of both making and receiving calls? I told Ms. MMP I would not waste the pharmacy’s time. The pharmacists at the Cancer Centre are run off their feet doling out chemotherapy to ailing cancer patients. They haven’t time to spend on hold with an incompetent postal worker. I ended the call frustrated and with no intention of involving the pharmacy in this mess.

If I am unsuccessful at solving a problem despite my best efforts, occasionally J. jumps in on my behalf. You may be unaware that J. can be quite persuasive. In fact, just yesterday a cashier who had never met her before accepted her credit card over her friend’s to pay for lunch because, in her words, “she looks scarier.” So J. called 1-800- Making-Us-Postal again, pretending to be me (yet another benefit of a lesbian relationship,  in addition to the obvious sock sharing).

When J.’s Ms. Making Her Postal repeated the same feedback I’d received, J. asked to speak to a supervisor. Why didn’t I think of that? I was incapable of effective problem solving by then. Remember this the next time you’re too angry to think straight: take a few deep breaths before you jump back in.

J. spoke to the supervisor who, upon learning the contents of the missing package, said she would ensure it was located and delivered promptly. She suggested we’d receive it faster if we retrieved it from the mail depot once it was found, but the irony of picking up something intended for delivery prompted J. to decline politely.

Ms. Supervisor was true to her word. The next day, the package magically appeared at our house, followed by not one but two calls to confirm its delivery. Wait, I thought those posties couldn’t make outgoing calls, they could only lose outgoing mail. Will wonders never cease!

Do you think this effective resolution had anything to do with Ms. Supervisor’s being a recent cancer survivor herself? Nah, neither do I.

 

Where oh where have my little pills gone?

Messy mail depot, packages all over the floor

No wonder they can’t find my package.

Sometimes the inspiration for a post comes while I’m in the comfort of my own home. This is one of those stories, but it is not inspiring nor comforting.

For 4 years now, Alberta Health Services has been providing my very expensive chemotherapy drugs for free. But just so I don’t stockpile them or traffick them, I am only allowed 30 days’ worth of drugs at a time. When I need more, I call the pharmacy, and receive a refill pronto.

I can either pick up the refill at the Cancer Centre pharmacy or have the drugs mailed to me. Since finding a parking spot at the hospital is less likely than finding that elusive pot of gold at the end of the rainbow, I usually opt for the mailing. Sorry, taxpayers, that’s on you.

I recently requested a new chemotherapy stash, knowing the trusty pharmacists would send me what I needed forthwith. Late on Friday afternoon, less than an hour before the pharmacy was to close for the weekend, I realized to my horror that I had not yet received my drugs, so I made a frantic call to the Cancer Centre pharmacy. “Yes, frantic caller, your chemo was mailed,” the kind pharmacist said, “and here is your package tracking number.”

And so I tracked my package online. This is how I learned that my drugs had been rerouted…twice. They were to be delivered that day, but dinner hour was quickly approaching so I was not hopeful. So I called. After I explained that I was not seeking my new frock from the Home Shopping Channel but my chemotherapy, the nice fellow told me he had no idea why my package had been delayed, he had no idea where it was, but he could escalate the urgency of the delivery if appropriate. And then he asked: “How urgent is it that you receive this package?”

I told the fellow that I’d place the urgency at 100 on a 1-10 scale. (No, that is not a typo.) I cannot speak for other cancer patients, but I take my chemotherapy to stay alive. I don’t pop these pills recreationally.

So the nice fellow received permission to escalate the urgency of the package, whereupon he placed me on hold. Fifteen minutes later he told me he had been unsuccessful at reaching someone but could have someone call me the following Monday. I nixed that, telling him that Monday morning, I would be at the Cancer Centre pharmacy seeking a replacement for the drugs his company had lost.

Ever the optimist, I continue to check my tracking number diligently. This morning’s message, for the third day in a row, was simple and to the point: “Item rerouted due to processing error; possible delay.” I’ve learned from this experience that tracking numbers aren’t much use when the company loses the package altogether. Just sayin’.

Might God be punishing me for being too lazy to pick up the drugs at the pharmacy? Or for all the money I’ve cost the province by needing these expensive drugs for four years now?

I’ll pay the ransom if you tell me what it is. You can take my first born child. Oh, I don’t have one of those. No, you can’t have Jelly instead. You’d just lose her.

 

Yet another pill post

Long line of pills from top to bottom of page

Pills R Us

My dear friend is now getting better at home, which is fantastic news for everyone but Jelly. Our poor single child is back to sharing her home with two boring humans. Thank goodness for the meet up with her park friends this morning.

On to less important matters. J. tried to dissuade me from writing yet another post about my pills. You’ve been there, done that, she said. Oh well, it’s my blog and I can repeat myself if I want.

My pill regimen has remained largely unchanged for the last 6 months now, except for a reduction in one pill to alternate days. I still have my granny pill case, which works well if I remember to take the pills in it.

Once every two weeks, I sort my pills into two morning and two later-day cases. First, I put my stash of pill bottles and cases on the counter. And then I count and sort and toss until my little cases are overflowing and I need a nap.

In my efforts to keep my pills organized, I’ve become obsessive. I need 7 pills in my morning case, and 4 or 5 spread across three later-day doses, depending on the day. But there’s one problem: pill designers are grossly lacking in creativity. I have 7 white pills daily, two of which are almost identical sizes, as well as two pale yellow, and one pale green. I can barely tell the pastels apart some days. My two capsules are more vibrant colours but they are a variation on a rusty theme and I confuse them too. Forget about sorting my cornucopia by colour.

Rather, I sort my pills in order of importance. Since my sorting is for naught if I die from cancer, I start with my chemo, three little round white pills in the morning and one after dinner. I consider these pills my highest priority. I want to live.

Then I move to my diuretics, one potassium-sparing and one potassium depleting. If I don’t keep my potassium in check, I could have a heart attack, assuming my pill arranging doesn’t kill me first. I need these two pills to pee. It’s pure coincidence that they are both yellow.

Then I throw in my thyroid pill. Thankfully I’m at the light green dose of late instead of light yellow or light grey. If I don’t take this pill, J. will start to wonder whether I’ve turned into Dr. Jekyll and check off the TSH box on my lab requisition when I’m not looking. She will also tell the doctor I’ve been “difficult” of late. She’s probably right.

Finally, I throw in a Lactaid pill because someone who is obviously not lactose intolerant determined that lactose would be a great filler for medication. Thanks for that, buddy. The negligible amount of lactose isn’t so negligible when it’s added to several pills.

That’s just the morning. I’ll spare you the later-day sorting or you’ll need a nap.

I fear you’re thinking that I should graduate to those daily dosing bubbles the pharmacies make up for old, forgetful folks. I’m still trying to overcome the trauma of my granny pill case, so let’s not go there. You don’t want to see my difficult side, do you?