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Tuesday, February 9, 2016

Cancer Sucks

Despite the title of this blog entry, Gretchen and I had a good visit with Dr. Richardson on Monday.  Fortunately, my primary numbers are still good as I start my maintenance Cycle 44.  I did notice, as I have in previous visits, that my bilirubin number is high.  Normally, it should be <1.2, but mine was up to 1.8!  Some of my previous visits also showed high bilirubin numbers.

Since bilirubin is associated with the liver, I have been concerned that I might have some liver malfunction.  Considering the amount of alcohol I have imbibed over the years, I'm surprised it works at all!  Previously, when this number was high, Mary has told me that it is no problem because all my other liver functions are normal.  But when I brought this up to Paul on Monday, he casually said "Don't worry, you have Gilbert's Disease", as if I should have known this all along.  Oh really?  What's that?   All I need is another disease, right?  Anyway, he said it is no problem.

So I did a little research.  It turns out that it is a benign disorder of elevated bilirubin which has no serious consequences.  I found that those who have this Gilbert's Syndrome may suffer from mild jaundice.  So if I look a little yellow to you, now you know why (I'm not saying that I'm a chicken).  I also learned that this condition is associated with a much lower risk of Coronary Artery Disease.  Well that's comforting.  Maybe this is good news after all.  Not to worry, right?

As for the MMRF Boston 5K Run/Walk event, Pam's Team Epic for Bill has started out well.  I'm gratified that there have been some very generous donors.  I thank all of you who have contributed so far!  We have raised almost $2,500 to date, but we still have a long way to go to get to our fundraising goal of $10,000.  I think it would be awesome to raise that much money to fund MM research.  Those of us with MM depend on continued research to find the medicines that will either control or hopefully cure our disease.  I would appreciate it if you would contribute and reach out to others who might be interested in contributing to this cause and/or joining us in this event.  Thank you in advance!

I have started going back to the gym to train for this event.  Right now I am beginning interval training combining walking with running to see if I might be able to actually run rather than walk in this event.  I've been wearing a knee support to see if that helps.  I'm just starting, so I don't know where this might go, but I think it would be really great if I could actually run for 3K if my knees hold out.  If not, I will at least walk or crawl, but I'm determined to do it.

I'm really concerned about my favorite bloggist, Pat Killingsworth.  He has been a constant source of inspiration to me and many other MM patients over the past years.  He has suffered myriad setbacks along the way, but he manages to blog on a daily basis no matter how badly he feels.  We are planning to visit him in the beginning of April for his annual Pat's Beach Party in Amelia Beach, Florida.  I'm really looking forward to meeting him face-to-face for the first time. 

In the last few days, however, he has had some serious setbacks and has been in the emergency room for complications from his dual tandem stem cell transplants a few months ago.  All of us faithful followers are holding our breaths hoping that he makes it through this difficult stage.  Here is a link to his blog:  http://multiplemyelomablog.com/.  Here's to you, Pat!

Pat is one of the reasons that I titled this blog "Cancer Sucks".  There is more, but I will save that for a later blog.


Sunday, January 31, 2016

MMRF Boston 5K Walk/Run

Brian, Pam & Logan - 2015 Pittsburgh Marathon
Something very wonderful happened this weekend!   My son, Brian, and daughter-in-law, Pam, have recently spent the first Sunday in May running in the Pittsburgh Half Marathon.  Pam, along with her sisters and cousin, are all avid runners.  Last year, I went to Pittsburgh to cheer them on and to hook up with my family in the area.  This year, however, the Pittsburgh Marathon is on May 1, the same day that the Multiple Myeloma Research Foundation (MMRF) is sponsoring its annual 5K Run/Walk Team for Cures event in Boston.  Here is a link to the website:  MMRF Boston Team for Cures.  Last year, I attended the 5K event (as a spectator) and supported our friend Anne Riskin's team, Jeff's Juggernauts, in honor of her late husband who succumbed to MM.  I decided that I would stay in Boston this year to support the MMRF Team for Cures event again.

Yesterday, I found out that Brian, Pam, and her sisters have all decided to forego the Pittsburgh Marathon this year and run in the MMRF 5K instead!  More remarkably, Pam and Brian have created a team to raise funds on my behalf!  I was overwhelmed.  The team is called Team Epic for Bill.  Here is a link to MMRF team website:  Team Epic for Bill. They plan to enlist additional family and friends, including Pam's cousin, Guy, who will come up from Houston!

Doin' my job at the 2015 MMRF 5K
I have already joined the team and signed up to walk the 5K.  Last year, all I did was hold up one end of the finish line.  I know that is an important job, but I'll let someone else do that this year.  I just started going back to the gym after a long hiatus, and I have been using the treadmill.  I now have a goal to get myself in shape for this event.  If my right knee holds out (torn meniscus, arthritis, etc.), I might even consider running (or slowly jogging).  Dammit, I'll crawl if I have to, but one way or the other I'm going to do that 5K!

Dr. Richardson is the honorary chairman for the MMRF Boston 5K, and he also runs in it.  I emailed him about Pam and Brian's new team, and he is delighted.  As a coinkydink, I have an appointment with him tomorrow at the Farber for my monthly checkup.  I suspect this topic just might come up.

Team Epic for Bill has set a very ambitious goal to raise $10,000 for Multiple Myeloma research this year.  We will have to work hard to achieve that goal, so you can expect to hear a lot from me about this over the next 3 months.  Don't be shy...sign up now!

Wednesday, January 6, 2016

Still in Remission

Monday I went to the Farber for my monthly checkup, and everything is still good!  I am now on Cycle 43 of my Revlimid maintenance therapy that began in August, 2012.  I have now signed all the paperwork that extends this transplant clinical trial for another 3 years until 2018.  If I am lucky and stay in remission, I will still be a part of this trial until then.  What's really good news is that my Revlimid will still be cost-free to me as long as I am on this trial.  I can't believe how fortunate I have been so far with all of this.  What would have happened if I hadn't found Paul Richardson back in 2011 when I first got diagnosed with Smoldering Myeloma?  Where would I be today?  I don't even want to think about that!

The holidays were wonderful.  We spent Christmas at Brian and Pam's in New Jersey and got to watch Logan open his presents from Santa.  That was special.  The magic of these days will soon pass, but it's great to see it while we still can.  My bro, Terry and his wife Sherry came up for the week over New Years, so it was a really nice family holiday season.

I have signed up for us to go to Pat Killingsworth's beach party for MM patients at Amelia Island, Florida on April 1-3.  This will be the first time we have been able to go, and I am really looking forward to meeting Pat in person for the first time.  He has been through an awful lot lately, having tandem cell stem transplants, with all the associated complications, but he seems to be doing quite well now.  I hope to meet a lot of fellow MM survivors at the beach party.  Here is a link to his daily blog:  http://multiplemyelomablog.com/.  He continues to be a font of information to those of us in the MM community.  He's amazing!

After that, we plan to visit my college roommate friend, Steve, and his wife Sue in Coral Beach, Florida for a few days.  I hope this winter is a lot friendlier than the Snowmageddon of last year.  Maybe by the end of March we'll be glad to get out of Dodge.

May the Force be with you!




Sunday, December 13, 2015

Patient Education Symposium

I spent yesterday at the Farber's Multiple Myeloma Patient Education Symposium.  As usual, it was a fascinating, informative day, which incorporated the latest results from the recent ASH conference in Orlando.  The mood in the MM research and clinical community is ebullient these days.  It has been a banner year for MM advances.  There have been 7 FDA approvals for novel MM therapies this year alone, 3 in the last month!  The total arsenal of available novel drugs to treat this disease has just expanded by 45%.  No wonder everyone is really excited.  There was a palpable buzz of energy and excitement in the room, more so than in previous years.  it was really encouraging to feel the sense of optimism about where things are headed.

Of all the presentations of the day, Ken Anderson's was the pièce de résistance.  I would have made the trip to Boston just to hear him speak.  He has a way of presenting complex facts in a down-to-earth way that makes sense to ordinary people (not so with some of the other presenters).  He's also a great public speaker with a wonderful sense of humor that keeps the audience fully engaged.  He also shared an uplifting vision of where MM research is headed and some of the exciting new therapies on the horizon.  When he finished, he got a prolonged standing ovation, something that I've never seen at one of these meetings before.  Videos of this meeting will be available on YouTube in January.  I'll try to post a link to Ken's talk for any of you who might be interested.  It was amazing!

I'm not going to delve into some of the boring details of the meeting, but I'll try to give a top-level overview of my impressions.  I've had to spend a day sorting it out, because some of it was like trying to drink out of a fire hose.  Here are a few of my general observations:

There is a lot of focus now on the precursor conditions to MM:  MGUS and Smoldering Myeloma (SMM).  The thinking now is that by intervening earlier, not only may some of the bone and organ damage of MM be averted, but perhaps it can be better controlled or (gasp!) cured before full-fledged MM emerges.  Some high-risk SM patients are now being classified as MM and eligible for full therapy options.  There are also clinical trials underway to investigate use of experimental vaccines in SMM patients to help prevent progression to full MM.  This trend is likely to continue.

Long-term clinical trial results are starting to show that with the efficacy of the new novel therapies for newly-diagnosed MM patients, there may be no advantage to doing an early stem cell transplant.  French and American studies differ, but the American study shows that if Revlimid maintenance is continued indefinitely after induction therapy, deferring a stem cell transplant until after relapse may actually be better.  This could eventually result in a change in the current standard of treatment therapy, which now encourages an early transplant.  However, this would go against the Total Therapy approach (Arkansas), which advocates high-dose chemo and early tandem transplants in the expectation of a complete cure for normal risk patients.  Let's just see how this all plays out.

They are very excited about the approval for Ixazumib (MLN9708).  Me too!  It worked great for me.  In addition to being somewhat superior to Velcade, both in response and side effects, having a totally oral regimen is a major plus in terms of convenience for patients.  Aside from the potential insurance coverage difficulties that I posted about earlier, this could be a game changer for MM therapy.

Immunotherapy is the name of the game for the future.  Whether it is the expanded use of immunomodulator agents, (Revlimid, Pomalyst), monoclonal antibodies (Dararatumumab, Elotuzumab, SAR650984), checkpoint inhibitors (PD1-PDL1 blockades), or vaccines, that's where the game is going.  Vaccines are a particularly hot topic.  There are several ways in which vaccines can be employed, some of which involve extracting MM cells from the blood, fusing them with an antigen, and then injecting them back into the patient.  There are several clinical trials planned or underway, and I would expect to see a lot of developing news on that front in the next year or so.

While I was there, I ran into a couple of fellow patients that I had met before.  Paul and I had met a couple of years ago at the Farber, and he continues to follow my blog.  Fortunately, he is still doing well.  I also ran into Dee, with whom I have had previous discussions regarding the association of Lyme Disease with MM.  We both feel that there is a positive link that Lyme may be a precursor to MM.  I hope to communicate more with her and update some of those discussions in the near future

It was a good day.  Until next time.






Monday, November 30, 2015

Post Thanksgiving Musings

I hope all of you had a wonderful Thanksgiving.  This year, Thanksgiving was very special for us.  With the exception of Holly and Ryan who are still in Peru, everyone was here.  Brian, Pam, and Logan came up from New Jersey on Wednesday and stayed for the weekend.  Jeff, Christine, and her mother, Elmas, were here, and Jason came up from Hartford for the day.  We have a wonderful family and have much to be thankful for.   Everyone pitched in to prepare the traditional meal.  The food was to die for:  turkey, sausage stuffing, gravy, mashed potatoes, squash, spinach pie, cranberry sauce, green beans, rice pilaf, pies, cookies, and those are only the dishes I can remember.

Seacoast Science Center
The weather was fantastic.  Wednesday evening we were able to enjoy sitting around the fire pit on the patio.  On Friday we visited the Seacoast Science Center in Rye, N.H.  Logan found the marine exhibits to be very interesting.  Now 5 years old, he's growing up fast and is fun for grandpa to be with. 

Even though we had about a hundred pounds of leftovers in the fridge, we stopped on the way home on Friday at Markey's Lobster Pound to gorge ourselves on lobsters, steamers, oysters on the half shell, fried clams, and french fries.  I'm not sure why we did that, but it sure was delicious!  The Hell with the leftovers!

We are departing from our usual norm this Christmas.  Instead of our long-standing tradition of hosting Christmas at our house, we plan to go to Brian and Pam's home in South Orange.  We're not even getting a Christmas tree this year!  I'm having withdrawal symptoms already.  I don't think I've ever not had a Christmas tree in my entire life!  Jeff, Christine, and Jason may be able to join us in New Jersey (I hope).  I know the Santa Claus thing can be overdone, but I'm really looking forward to seeing Logan on Christmas morning.  The magic of these years won't last for long.

In my last post, I shared that the FDA had just approved daratumumab (Darzalex) as the first MM immunotherapy drug.  Well, they didn't stop there.  On November 20, ixazomib (trade name Ninlaro) was approved for patients with at least one prior therapy!  As you well know, that was my front line Phase I clinical trial therapy in 2011.  I knew it then as MLN-9708.  I'm really pleased that I was able to participate in that clinical trial, that it worked so well for me, and that it has now been approved as a viable therapy option for all Multiple Myeloma patients.  It's exciting to have this oral proteasome inhibitor as an alternative to Velcade, both because of the convenience of not having to visit the clinic for infusions and for its lower side effects.  It may even work better than Velcade.  However, there may be a fly in the ointment.  Most insurance plans cover infusion therapies for cancer, but some do not cover oral remedies under their prescription drug plans.  That's a real bummer.  Hopefully, this issue can be resolved so that Ninlaro may be made available to all those who need it.

But wait!  There's more!  Today, the FDA approved the second immunotherapy drug, elotuzumab (Empliciti), for MM patients with one to three prior therapies!  Wow!  This makes the third MM therapy drug approved by the FDA in the last three weeks and the fourth one this year.  This is such amazing news for us MM patients.  Our options for future treatments have expanded greatly.  It is a great cause for optimism and another reason to be thankful this holiday season.







Wednesday, November 18, 2015

Fall Update

I've been very remiss in updating this blog lately.  I'm not quite sure why, but it may have something to do with the fact that I seem to be in an extended remission so there is nothing new to report about my current status.  I also don't want to bore you all with technical bullshit about all the new therapies coming on line, like I did in the last post.

However, there is some great news on the myeloma therapy front that is worth reporting.  The FDA just approved daratumumab as the first immunotherapy drug for MM!  That's huge.  As of now, it's only approved for patients who have had three or more previous therapies, but that may be extended if the results continue to show the great results it has so far.  This is just another arrow in the ongoing defense against MM.  I'm feeling pretty good right now that when I finally have a relapse (I know it's only a matter of time), there will be a number of new options available, including this.

Anyway, my last visit with the Farber last week was great!  My numbers are still in the normal range and I'm still in remission.  Thank goodness!  While I was there in the waiting room, I saw Kathy Colson, who was the nurse who got me into the MLN9708 clinical trial because my initials serendipitously happened to be WO.  She was talking to another patient but when I was called in to get my vitals by "William O", she looked at me and smiled and cried out "WO"!  I don't think she'll ever forget that magical coincidence that got me into the MLN9708 clinical trial, nor will I.  I will be forever grateful.  Thank you, Kathy!

I just had a bone density test done.  The results showed that my spine is OK, but my pelvis density is low, showing some osteopenia.  That may explain why I have lost almost 3 inches in height in the last number of years.  I have to say though, my bones must not be too bad, since when I fell off the ladder a few years ago from a great height, I only just cracked some rib bones, which have now healed.  I mean really, how many people can fall about 15 feet off a ladder and still be here to say "Hey, I'm OK!"?

This weekend we are going up to the farm in Champlain, NY to close it up for the winter.  I'm sorry to see the season end, but I guess it's time to hunker down for winter.  I sure hope as hell it won't be as bad as the last one.

Happy Thanksgiving to you all!  Please enjoy the bounty of this season.










































Sunday, October 11, 2015

Immunization Therapies

I haven't updated my blog in a long time.  I apologize for that.  I don't have a good explanation.  I've just been a bit lazy lately.  On the myeloma front, every thing is still OK with me, so I don't have any news to report.  I am going into the  Farber on Tuesday for my monthly checkup.  I did have Mohs surgery on the squamous-cell carcinoma on my scalp.  Everything went well.  I had 21stiches in my forehead, but it seems to be healing well, and I don't think I will be too disfigured. That's good, not that I care too much about my looks these days.

In my last post, I gave short shrift to the various immunization therapies that are under investigation for MM.  I would like to expand on that in this post.  There are three immunotherapathy drugs that have great potential being tested now:  daratumumab, elotuzumab, and SAR650984.  Each of these does something that has never been done before:  teach the body's own immune system to recognize and attack the myeloma cells.  This post might be a little bit technical, so I won't be upset if you decide to skip some or all of it.

One of the problems with MM therapies is that MM is not a single disease.  It is genetically heterogeneous with multiple clones and subclones evolving over time and under the influence of treatment.  Each patient has a unique genetic risk profile.  This is why it has not been a curable disease to date.  The current advanced treatment therapies, including a proteasone inhibitor (Velcade, Kyprolis), immunomodulatory drug (Revlimid, Thalomid, Pomalyst) and steroid (dexamethasone) have been very successful in extending overall survival (OS) for most MM patients up to 7-10 years.  These treatments have worked well in suppressing the dominant clone.  But in most patients, the disease eventually recurs because of its heterogeneousity.   What could be done to suppress all the remaining recessive clones and subclones so that it will never come back?

Monoclonal antibodies are targeted against proteins on the surface of the MM cells, which are not usually subject to genetic variability, so they are likely to be unaffected by the genetic heterogeneity of the underlying tumor.  This is huge!

Now I want to concentrate on daratumumab (dara).  This drug targets a protein, CD38, which is heavily expressed on malignant MM cells.  In a phase 1-2 study, dara was given to a cohort of patients who had received a median of 4 prior therapies, 79% of whom were refractory to both proteasome inhibitors and immunomodulators.  These patients had a particularly poor prognosis:  the Progression Free Survival (PFS) was 5 months and the OS was 9 months.

In a typical clinical trial with a new drug, a Phase 1 trial will use a single agent with variable dosing to determine a safe dose level and see what effect it might have.  For a good drug candidate, a single agent dose overall response rate (OR) of 20-25% is considered very good, which would allow it to continue trials in combination with other drugs.

In the dara trial, the OR was 36%!  Furthermore, 65% of the patients did not have disease progression after 12 months.  These results are very encouraging!  Because of this, the FDA has recently designated daratumumab as a "breakthrough" drug , allowing its compassionate use for those who have exhausted other lines of therapy.  The FDA is expected to approve dara in the near future. 

I hope to update this blog more often, but we'll see.  I'm not going to promise to adhere to a particular schedule. 

Namaste.

Friday, September 4, 2015

Diagnosis

After my biopsy last week, I sported a pretty significant bandage as I went back to work for Habitat for Humanity that day.  That may not have been the best thing for me to do, as after sweating in the heat and crawling around under cabinets installing a kitchen counter top, the bandage basically fell off.  So afterwards I covered the wound with a small band aid.  The affected area is about the size of a dime and it wasn't healing well over the next few days.  The stitch actually pulled out by itself on Wednesday.  I had planned to go back today to get the suture out and get my biopsy result.  I called to see what to do, but the nurse said to just come in today and check it out.

I wasn't too surprised today when Dr. Pauline Reohr gave me the diagnosis of a squamous cell carcinoma.  I have had these before, so I know the drill.  Over 95% of these are treatable without mitastasizing as long as they are found in time.  Since it is on my face, they will do what is known as Mohs Surgery (named after the doctor who pioneered it).  This involves taking the minimum amount from the tumor and sending it to the lab in real time to see if any is left.  If so, more is taken and the process is repeated until it is all gone.

Since my wound is rather large (in my opinion), I asked Pauline whether this might be an issue.  She reassured me that it will be fine.  There is a lot of spare skin on the face and scalp, so the surgery will pull things together reducing the wrinkles, and everything will heal up normally.  As an optimist, I am thinking of this as a free face lift.  I'm looking forward to looking ten years younger again!  I'm scheduled to have this done on September 21.  Don't be surprised if you don't recognize me after this.

I have been following some of the recent blogs and news feeds about MM therapy developments.  It's really an exciting time for MM research.  The biggest buzz these days is about the new immunization drugs that are coming along.  The monoclonal antibodies, Daratumab and Elotuzumab, are both both showing great results in heavily pre-treated patients, and they will likely be approved as standard therapy options in the near future.   Immunotherapy looks to be the future of MM therapies, as well as with many other cancers.  I'm expecting to having multiple options when I finally have a relapse.

I'm really looking forward to having a wonderful Labor Day weekend here with family and friends.  The weather is supposed to be great and we are having a cook out.  I'm going to smoke my famous barbecued ribs.  This is what life is all about.  




Thursday, August 27, 2015

Dermatologist

View of Edgartown Harbor from Our Restaurant
Again, another long absence before updating this blog.  I have no real excuse, although I spent most of last week sailing with my friend, Lew.  We sailed to Edgartown on Martha's Vineyard on his 35-foot Cape Dory boat and then on to Cuttyhunk.  It was a wonderful, relaxing time, as usual. The sailing, company, and culinary experiences were delightful.  Now that I am no longer competing in Block Island Race Week, as I have for the past 20 plus years, it is just delightful to be on a sail boat with a good friend and experience the water, winds, and tides.  It's confronting nature at its best (and sometimes worst), which makes it a primeval experience.  The uncertainty always keeps you on your toes.  I also have to say that nothing quite compares with eating fresh-caught grilled swordfish while watching the sun set over the harbor.  These are life experiences that I will never forget.

Unfortunately, because  I was sailing, I missed the seminar sponsored by the MMRF last Saturday, where Paul Richardson was espousing on all the recent advances in MM therapies.  While I'm sorry that I missed it, I also think that I am pretty up to date with the current status of MM research and treatment options.  I'm sure I would have learned something new, but I don't think I've missed any of the important new developments either.  I do try to keep up with the latest news on this.

Last week I went to the Farber for my monthly checkup, and I'm pleased to say that everything is still on track.  This is now my 38th cycle on maintenance therapy with Rev.  This was supposed to be the last cycle of my clinical trial, but I know I'm supposed to be extended for another 3 years.  My nurse, Kristen, said that they are still working on getting the paperwork together for me to sign the consent form for me to continue on to the new clinical trial.  I'm glad I brought this issue to their attention a couple of months ago, but they still haven't gotten their act together on this.  I'm sure it will work out somehow.  Paul Richardson will not let paperwork get in the way of my treatment.  I expect a smooth transition.

Today I had an appointment with my dermatologist, Dr. Reohr.  I knew there was a problem, since I have had a scaly growth on my forehead for the last couple of months.  She zeroed right in on it, and said it is either a cyst or possibly a squamous cell cancer.  She took a biopsy and stitched it up.  I have to go back next week to find out the results and get the stitch out.  I also had about 15 actinic keratoses, mostly on my face, which are pre-cancerous growths.  She treated these with spraying liquid nitrogen on them.  That wasn't a lot of fun.  For the next week or so, I'll look like I've been in a prize fight.  She wanted me to set up an appointment to come back in a year, but with all of this happening, I told her I want to come back in 6 months, so that's what I'm going to do.

Today was my Habitat for Humanity day.  I've been doing a lot of carpentry work since I started this, and I'm having a great time.  Every day is different, and I learn something new each time.  Today, I was helping to install a kitchen counter top.  There was a lot of crawling around on the floor trying to screw things in from awkward angles, but I got it done.  I'm getting a little old for this.  I had to take a nap when I got home.  But it felt good to accomplish something and contribute in a small way to helping other people. 




Tuesday, August 11, 2015

Peru Trip

It's been a long drought since my last post, but part of the explanation is that we spent more than 2 weeks traveling to Peru to see our daughter, Holly, and her fiance, Ryan.  It was an amazing and spectacular trip.  Now that we are back, I am happy to announce that we managed to dodge all of the dangerous maladies that confronted us during our visit to the rain forest, including yellow fever, malaria, hepatitis, typhoid, dengue fever, rabies, and whatever else lingers in the jungle (except that Gretchen was bitten by a fire ant).  Other than that, we made it back unscathed. Hooray for us!

Machu Picchu
It was a magical experience.  We first met up with Holly and Ryan in Cusco, and from there we took a scenic train ride to Aguas Calientes, the nearest town to Machu Picchu.  We spent the night there and took a bus up to Machu Picchu the next morning.  The guide book said to get to the bus stop around 5:00 am to get the first buses up in time to see the sunrise and avoid the crowds.  What a joke!  When we got there around 5:15, there were at least 500 people in line in front of us.  So much for the guide book.

To say that Machu Picchu is beautiful is an understatement.  The views are breathtaking.  It was a bit challenging climbing over all the rocks at that altitude (8,000 ft.), but it was well worth the visit.  I've always wanted to see these spectacular Incan ruins, so now I can cross that off my bucket list.

Group Shot at Lake Sandoval
After spending a couple of days back in Cusco, we flew to Puerto Maldonado, which is part of the Amazon basin rain forest.  Our lodging there was more like a camp, with mosquito netting for the walls and no hot water.  But who needs hot water when it's 90 degrees?  The outdoor shower was actually quite refreshing.  It turned out to be a great relaxing place to stay.  We took a day trip by boat down the river Madre de Dios to Lake Sandoval, which required a 3 km hike through the jungle for us to get to the lake.  We then toured the lake by large canoe, paddled by our guide.  We saw a variety of wildlife, including monkeys, macaws, turtles, caimans (similar to alligators), various beautiful birds, bats, and even a sloth.  It was an exciting day.
Caiman

We then few back through Lima to Trujillo, in order to spend a few days at Holly and Ryan's apartment in Huanchaco, which is only minutes from the Trujillo airport.  Huanchaco is a small fishing village on the Pacific Ocean, which is a destination for surfers around the world.  Although this is the off season, there were still quite a few surfers doing their thing.  Their apartment is adorable, only 2 blocks from the ocean.  It is very comfortable and has a nice patio with an ocean view.  It was a delightful relaxing finish to what had been a whirlwind vacation until then.
Huanchaco Fishing Boats

The Huanchaco fishermen cling to their old traditions of paddling out over the surf in their odd-shaped, hand-made boats to set their nets.  Every morning, they sell their catch on the beach to local restaurants and vendors.  We had some fabulous fresh fish ceviche while we were there, which is a Peruvian specialty.  If you ever go to Peru, you have to try the ceviche.

We had an opportunity to visit Holly's Montessori pre-school and meet her students: about 27 children aged three to five.  They were adorable!  They love her, and she is obviously doing a great job with them.  We are really proud of her, both for the contribution she is making and how she has coped with this new environment.  She went down there in February speaking no Spanish and had to learn how to shop, find an apartment, and by the way, start teaching a class of children who don't speak any English.  She has learned a great deal of Spanish since, and now is able to communicate with the children as well as get us through the day as an interpreter. She's amazing!

Holly's Escuela
We found the Peruvian people to be a loud, boisterous, happy lot.  They love to make noise, and they seem to really enjoy themselves.  Things were even noisier than normal while we were there, since July 28 is their Independence Day.  They started celebrating days in advance with parades, fireworks, and numerous loud parties every place we visited.  One night, while having trouble sleeping through the mayhem in the jungle, some of us were tempted to get up, grab a drink, and go find the party!

It was a fantastic vacation.  It was wonderful to spend time with Holly and Ryan, as well as get in some good sight seeing.  I'll have to admit though, after two weeks away, it was kind of nice to get back home.