BMA TEST TODAY

 

Many journeys hinge on single events.  Previous battles culminate in one moment of decision. 

It all boils down to this.  The BMA test.  Today at 2pm.

Kristina must be in full remission to go forward.  Test today, results on Tuesday.

There’s nothing to say she isn’t in full remission.  She’s being treated at a top notch facility, by a top notch team.  To date, despite some road bumps, everything has gone according to plan.  Everything should go well.

Should be in full remission.

The test results will change those first two words.

So here’s the ask today.  Think of Kristina.  Pray for Kristina.  Send positive energy her way.  Let’s reach into the cosmos and, in her words, get “as much collective juju vibes we can muster”.  This is it.

Must. Be. In. Full. Remission.

THE CALM BEFORE THE STORM

 

Kristina’s Neutrophils are at 0.13 (or 130).  This is the 4^th day of steady increase. Her Ox level is 95, which is about as close to normal as she can get.  So all metrics are pointing north.

Kristina is feeling much better at the moment.  The chemo really knocks you down, but then the body slowly recovers.  She’d like to express her sincere ‘thank you’ to all the well wishes she’s gotten but while there’s a momentary lull between the Chemo and the Transplant, she knows that however bad the Chemo was, the Transplant will be worse.

While this round of Chemo had some complications, all and all it was (when viewed through blurred eyes) normal.  And she’s out of that phase and feeling pretty good.

She’s planning on making the rounds in the next few days and live the next couple of weeks as normally as possible.  She’ll be wearing a mask and hope that others do as well – K95’s preferred.  The risk isn’t zero, but are fairly low.  Did I mention she feels pretty good at the moment?

The next big thing is Wednesday when Shannon will take Kristina for the BMA (Bone Marrow Aspiration) test.   This will determine if she has achieved full remission and confirm that the Chemo did what it was supposed to.  This is the gateway to Transplant.

Then the tests begin and likely more transfusions.  For many of the tests, she can drive herself but if there are blood draws or platelet transfusions, she’ll be needing someone with her and in several cases someone to drive her to and from the appointment.  We’ll use the Calendar to manage that activity.

Believe it or not, the acute need right now is the signup for care giving in August and September.  After transplant, she needs to have 24 / 7 care and she’ll need to prove that she has 24 / 7 care covered on JUNE 6th to qualify for the Transplant.  If that box isn’t checked, then she can’t go forward with the transplant.  In other words, action is required by June 6th.  (or NOW.  Just do it).  Weekdays are covered by professional caregivers (great to mitigate that if you can work from home at her place) but the key needs are the weekends.  If you do sign up, click ‘all day’.   So if you have days  to spare especially a weekend, use the calendar to sign up.

Right now Kristina is dead set on getting out of the hospital and enjoying herself.

HOMEWARD BOUND

 

HOMEWARD BOUND

This morning Kristina woke up feeling different.  Better.  Stronger.  She’s had a couple of good meals.  A few nights of reasonably good sleep.  No fever in the last 48 hours.  Her Neutrophils count was still climbing, now at .07 (or 70, depending on how you express it).  Low but rebounding.

Then Dr Cassidy came in and assessed her.  Kristina asked the question. 

 “When can I go home?”

Dr Cassidy said “well, I can’t think of a reason to keep you.  I think we can send you home this weekend”.

Joy.  I can just hear her now “OmGawd, OmGawd, OMGAWD!!!”

She can’t wait to sit on her own couch.

And yet some logistics remain.  Supplies.   She still has her Hickman in, and it’ll be there for next year, so now there’s some logistical considerations to get supplies (cleaning, etc) for the daily care.  That and some other considerations (like packing, taking down all the decorations, etc) need to happen. 

Unexpected good news and the BMA test, the biggie, still scheduled for next Wednesday, the 24^th.

A blip on the radar

 

In typical nautical fashion, Kristina described her latest Neutrophils as a 'blip on the radar'.  That fuzzy image that shows something is there.  Maybe.  That distant target that on one sweep of the radar beam shows, then on the next sweep disappears.  It's there.  It's not there.   Is something out there?  Then another sweep and a shadowy target appears again.  Over time the situation becomes clear, but that first initial brush is full of questions.

And so it is with the Neutrophils Count.  Kristina cautions it's not a linear process.  Just like the radar, it's possible that the next test will show zero.  Or too low to count.  Or it might go up a little, but then come down.  It's all part of the process.  

But it appears as if the immune system is at least thinking of coming back.  Perhaps not a start, but sign that the start is about to begin.  That first blip on the radar.

A WEE BIT BETTER...

 A “Wee bit” better 

I thought ‘wee bit’ was Irish, but appears be Scottish in origin, based on mid 15^th century Old English.  But I digress which is good news, as there’s no huge news from Kristina.  She says she’s a ‘wee bit’ better. 

She did have some fevers last night, and is now on 2% oxygen, with her vitals near normal.  Again, grading on a curve, generally positive news.  Platelet count jumped from 5 to 40 with yesterday’s transfusion, and they’re going to see how long she can maintain that.  Normal is between 150 and 400, so 40 is low.  But better than 5. 

On the other front the Neutrophils have moved from zero to ‘too few to count’.  Unfortunately this doesn't mean much.  It's like going from zero to nil.  Or going from nothing to zilch.  Effectively her count is still, well, too few to count.

The 24^th is still the target date for the BMA test for her blast cell count.  As she approaches that date, there are many ‘small’ questions that need to be resolved – will she still need oxygen?  Will she still be on Vancomycin? Is the C. Diff resolved? How’s her Neutrophil count?  So many things that influence the hospital discharge date and the BMA test date.  Everybody is different responding to Chemo and as doctors rotate in and out some have different opinions – but uncertainty is part of the game.  It’s frustratingly normal for these types of cases.  Variability with each patient and their own bodies reaction, then variability with how different doctors view results.   

Part of the patients' task (and their advocates) is how to assimilate the various pieces of information and make sense of it – while accepting that some things aren’t knowable now.   

The BMA test results are a huge milestone.  Medically, emotionally, it’s big.   

The doctors are concerned about the diarrhea.  The C. Diff was very much an unwanted thing and the medical folks are paying attention to it.  There are only so many fronts you want to battle on and that’s an ongoing issue for now (for the sake of the readers, we’ll not cover the details.  Or use the word explosive.  Ooops).  

Other than some internet issues connecting today (with everything else, really?) nothing too much to report.  She's a wee bit better.   With occasional explosions. 

IMPROVEMENT

For the first night since admission, last night was a near normal night of sleep – she had some help with some mild meds, and grading on a curve, a reasonably good night.

Over the phone, she was sucking on ‘ice chunks’, which makes her mouth feel pretty good.  She was hesitant to say it, it is too early, but perhaps the worst aftereffects of Chemo may be over (we’re all knocking on wood).

Some of her recent Neutrophils  tests say ‘too few to count’ instead of zero.   Good news?  She’ll check on it today with her doctors.   She’s is getting transfusions of platelets and she’s still on 3% supplemental oxygen.  Her ox level was 98, which is good.  There’s still some fluid in the lungs.  Blood pressure is near normal at 119/67.

Her blood type may have changed again – she’s getting AB+ now.  Pre Leukemia, she had B+, but then changed to A+.  In 2014, she got hundreds of transfusions, mostly of O+, but last night she got AB+.  On one record her blood type is listed as NTD (No Type Defined).

Probably still no visitors at the moment – the protection protocol is cumbersome and she’s trying to marshal her energy.   She’s not out of the woods yet and the transplant will be no picnic.  But for now, she’s on the upswing. 

While no visitors, she’s having fun with texts – don’t be surprised if she responds simply with an emoji, but know they are read and appreciated.

 

IF IT'S NOT ONE THING IT'S ANOTHER (BUT SHE'S FEELING A BIT BETTER)

 

****Quick update to below:  I should have put this in the blog, but for now, no visitors (unless OK'd by Kristina) for the next few days. Even though she is feeling a little better, the contagious nature of C. Diff warrants caution.

If it’s not one thing, it’s another.  For those going through Chemo and a hospital stay, there’s the big story – Leukemia and the transplant – but there are also dozens of ‘little stories’ that inconveniently hitch along for the ride.  One indignity after another.

For Kristina, the latest one was the diagnosis of C. Diff.  Which stands for ‘clostridium difficile’.  A punch to the gut.  Literally.  This was not totally unexpected in a hospital setting.  There are a variety of ‘bad’ things floating around a hospital – MRSA, CMV, RSV, even Shingles among others.  So this wasn’t totally unexpected.

C.Diff causes diarrhea and is highly contagious.   It also causes an elevated protection protocol – (gown, gloves, mask etc.)  She’s on a 10 day course of oral Vancomycin and the impact on the arc of her discharge and transplant are currently unknown.  So many unknowns and each one has its own worry.  Which Kristina’s been doing since about midnight.

Her Neutaphils are still zero, but in a surprise statement her doctor said ‘oh we can still discharge you even if they haven’t come back’.  Kristina’s still processing that, but it’s another example of ‘new thinking’ vs older thinking but there’ll be more discussion on that front over the next few days.  Her BMA aspiration, the test to assess the level of blast cells, is still set for the 24^th, but the new C. Diff diagnosis may alter that.

Despite all this, Kristina was feeling a little better.  Her temperature this morning was 36.9, which translates to 98.4.  About right and about time after having 5 days of fever.  Blood pressure 114/61, still low, and her oxygen was 93.  Still low but better than before.

She’s on 3% Oxygen now, the delivery of which has caused another indignity.  The rubber nasal cannula that she wears has rubbed her nose raw and she’s been battling bloody noses all night.  Kinda gross, but very real and uncomfortable.  Did we mention the diarrhea?   It’s uncomfortable battling a life threatening disease.

All these things – the 2 rashes, the streptococcus infection that jumped from the mouth to the blood, the low blood pressure, low oxygen levels, the sand papery / gun metal mouth feel, hair loss, skin peeling from the lips – and now C. Diff.  One indignity after another.

No wonder she posted “After this week I really need to be taken out…on a date or by a sniper, either one is fine with me at this point”. 😊

Despite all this, she’s saying she’s OK.  It’s just hard at the moment.  She’s battling boldly and her voice sounds pretty strong. 

Yesterday she raised her blinds up for the first time in several days and today’s chore will be dealing with the last of her hair.  It’s really starting to fall out at this point.  That first cut early in the week was the toughest.  This is just clean up.

More news later on how the C.Diff diagnosis impacts her trajectory of discharge, tests, and transplant.

Saturday Mid Day Post

 

Saturday, just after noon.

Kristina texted and also chatted with Shannon.  In Kristina's words, feeling "Maybe a wee wee itty bit better".  With a ? at the end.  At least not worse.  

She kept down some coconut yogurt and some mint tea, so that too is good news.

No energy to carry a conversation, so no visits today or tomorrow (Kristina may certainly override this, but that's the word I'm getting).

They took her off supplemental oxygen, but now back on at 1%.  She still is having fevers but at lower grade.  "Bags of stuff" still hanging, presumably in reference to fluids, meds, and nutrients being given to her via IV.

Her final sense was 'Grrrr.  Feeling pretty crummy all the way around'.

FRIDAY MORNING STATUS

***Update 11:40am*** Shannon just texted and the request was for no visitors today.  She's simply not up to it.

***Update 10am*** Her supplemental oxygen flow has been decreased from 2% to 1%.  A positive development.

This blog was set up to communicate Kristina’s status and with her wide scope of friends, Kristina accurately predicted difficult times when she’d be unable to effectively communicate.   We’re in one of these time periods now. 

 Last Tuesday she had a fever during the day of just over 100 degrees and then it spiked to 102.5.  Since Tuesday the high temps have hit 103 and 104.  She’s on Vancomycin, a heavy hitter antibiotic.  She’s on oxygen as her blood oxygen dipped to 83 (on-line resources say ‘seek immediate medical attention below 88, ‘normal’ is around 97 *** per the 10am update, this may have changed to a more favorable number as her supplemental oxygen has been reduced).   

 

Kristina’s neutrophil count (those ‘good’ white cells that fight bacterial infection) was still zero as of yesterday.  We’re still within a general bandwidth of ‘normal’ (there’s nothing normal about this process) for Kristina as her neutrophil counts lag after the G-Clam treatment, but we’re entering a time when her body needs to produce them.  She needs her immune system to recover.  As a housekeeping note, that level needs to be at 500 for discharge and most of us have levels around 1,000. 

 

Yesterday they did confirm she’s fighting a staph infection but weren’t sure what’s causing it.  A cat scan was taken and there’s fluid in the lungs for reasons as yet unknown.  Her blood pressure last night was 116/67.  Low, but it’s been lower. 

 

Shannon brought some bone broth over last night and hopefully Kristina could keep it down.  The nurse said she’s been battling waves of nausea.   Shannon also said that Kristina is pretty weak. 

Kristina is sporadically responding to texts as energy allows.   From a personal standpoint I’ve been trying to economize my texts with her as I know she feels compulsive to respond to each one despite her energy level. 

 

So this is where we are at the moment.  If you are on the calendar for a visit, text in advance to ensure it’s still ok.  She is pretty weak and about 10 minutes of concentration were about all she could muster yesterday, then would drift off to sleep in mid-sentence.  

It’s just a very tough, tough time right now. 

INFECTION AND ANOTHER ROUGH DAY

 Last night Kristina's temperature spiked to 104, so she's feeling pretty miserable.  She's canceled visits today.

Shannon talked with her this morning and it sounds like this infection may ebb and flow for a few days -- so use the calendar but check in with either Kristina or Shannon before visiting.  

Shannon is bringing her some food (she hasn't eaten in 2 days now).  She knows she should eat, but nothing sounds good.  

At last report her Neutrophils are still at zero.  While consistent with her previous bouts, this is becoming a thing.  While the count needs to get to 500 before discharge, her body needs the immune system. 

More as things are known.   

ROUGH TUESDAY NIGHT

 

Kristina had a rough night last night.  Yesterday morning the rashes (we think there are two separate rashes) spread.  Visible around her neck and face and she said even her eyelids were being impacted.  That, along with the mouth sores made things more uncomfortable and unpleasant. 

Last night her temperature started to rise then spiked to 103.  Infection.  With her immune system all but non-existent, this is bad.  Last night they started her on Vancomycin, a heavy hitter antibiotic.  Called out when other approaches aren’t working. 

This morning she texted she’s feeling horrible and she’s ‘rain checking’ all visitors for the day.  Then she said something typical of Kristina.  “We knew these days would come”.

So not good news, but she’s been through this before.  It doesn’t make it any easier.

So go long on the positive energy today and if she doesn’t respond, you know why.

HAIR LOSS AND MORE TRANSFUSIONS

 

 From a physical standpoint, hair loss is one of the more minor side effects of Chemo.  From an emotional standpoint, it’s one of the more major.  Chemo ravages the body.  In an effort to ‘kill the cancer’ Chemo devastates the body and hair loss is a glaring visual reminder of the indignities of both the disease and the treatment for it.  It sucks.  Big time.

The hair started to fall out on Thursday.  It’s a process and Ba and Brian came over to cut it to shoulder length as an interim style (note the sloop tavern burgee on the wall).  As the hair fell away they both had a moment neither wanted.

All of this is bittersweet as once again Kristina loses her hair.  As she says, ‘this isn’t my first rodeo’ but at the same time it doesn’t really make it any easier.  It’s just another in a string of poignant moments.

The new look.  Still Bold.

Adding insult to injury, more transfusions have been needed (O+, her third blood type in her life).  Her blood pressure is still low, but as long as it’s mapping above 60, it’s OK.  She’s ‘mapping’ between 62 and 72.  There’s an ongoing rash which is still be diagnosed. 

Her white blood cell count, which had climbed, retreated last night and neutrophil count is still zero.  Last time her neutrophil counts struggled to come back, so for now, not a huge concern, but something to monitor.  It does need to get to 500 before discharge.  Her risk of infection remains high.

Kristina did want to include this shot of her G-Clam regimen for other transplant patients seeking first hand information.  The names of the 'cocktail', times, and check marks that it's been administered.

Hearing from you or seeing you would brighten her day!  Use the calendar to the right to schedule time.  And if you are reading this on a mobile device, scroll to the bottom and switch to the ‘web version’.  Then the button for calendar will appear above Kristina’s picture.

 

 

 

 

ROOM WITH A VIEW

 

Coffee, binoculars, crew races and a parade.  And the view is right from Kristina's hospital room!  (all these pics were taken by Kristina, from her room).

 

Kristina said there were comments ‘where are the pictures’ and ‘we want pictures’.  So this is the first of two posts with pictures.

Kristina’s room is on the 8^th floor of the Montlake tower, looking over the Montlake cut.   The room is pretty comfy according to Kristina and has a more than adequate view.

For those of you out of town or on the east coast, a quick history of the Montlake cut.  Heck, I was born at Harborview, right here in Seattle, and I learned some new things about this small stretch of water.

Saturday started out with crew races

In the 1800’s, Lake Washington was quite a bit higher than it is now and the run off was at the south end of the lake through the now defunct ‘Black River’.  While it Lake Washington came close to a small arm of water then named as part of Lake Union, the lakes never met.  The land between them was called by the first nation peoples ‘carry a canoe’, as they had to portage their canoes and carry them over the land to get from one lake to the other. 

Then there was another portage, or ‘carry a canoe’ section between lake Union and Puget Sound.  So two lakes at different levels and Puget Sound at a lower level still.  3 levels.  With ‘carry a canoe’ being a common name for the areas where you had to carry your canoe.

When the area was settled, “Carry a canoe” didn’t translate well to “Carry a yacht”, so there was talk of digging a canal.  Various schemes were thought of, one with two sets of locks as there was the difference in height between Puget sound and Lake Union, then another difference between Lake Union and Lake Washington.  The army corps of engineers under the leadership of Major C.W. Kutz opted for one set of Locks in Ballard which would result in the lowering of Lake Washington by nearly 10 feet, destroying wetlands and substantially rearranging the landscape for landowners.  Lawsuits ensued and the Army Corps of engineers endured setbacks in their plan.  It looked as if the legal challenges would prevent the cut from being made.  At which point Kutz sent his assistant, a Captain Arthur Phillips, to plant dynamite at the head of the cut to drain the lake and dispense with the legal niceties.  On October 26^th, 1910, the large explosion began ‘the big drain’ and subsequent digging ensued.  It was completed in 1916.  

As my grandfather always said, when the lawyers can't get it done, bring out the dynamite (he didn't really say that). The current UW history essay on the subject essentially says "yeah, they shouldn't have done that.  But we're glad they did".  Ok, they didn't really say it in those terms, but I think it's a fair summary.

While the cut did have commercial value in its early years, it’s primarily used by recreational boats to transit between the lakes, through the ship canal and to the locks which lower boats to the level of Puget Sound.  Just like ol ‘dynamite’ Kutz envisioned.

It’s also the local venue for the UW crew’s 2000 meter races, and Kristina had a dandy view of the last 150 meters to the finish line.  For any ex rower out there who has rowed in a race there, that last 500 meters is an exhaustingly awesome experience.  Crews sprint the finish and the goal is to cross the finish line having gave every ounce of effort you could summon.

Kristina had a view of this year’s ‘Windemere Cup’ an annual race featuring the US drubbing various crews from around the world, having won the thing 27 times.  This year they beat the team from Australia.

Following the races is the annual boat parade through the Montlake Cut, signifying the annual so called ‘opening day of boating season’.  Pro tip:  The best cruising around the northwest is in the winter.  Kristina has organized cruises for Sloop Tavern Yacht Club and the winter cruises are the best.

The above pic appears as if sailors are doing what sailors do -- head in different directions.  Maybe they've been drinking.  Or not.  Sailors sometimes mimic birds being able to appear to move at random yet never hit each other.  Almost never.  At least actually hitting is mostly uncommon.  Mostly.  

They are actually competing in the annual 'Wilson Seamanship Trophy'.  This prestigious award goes to the club that can field at least 5 or more boats and demonstrate sufficient control and nautical appearance to win the prize.  Without hitting each other.  Royal Victoria Yacht Club won this years award,

Kristina took the above pic, and oh my,  What a sailboat.

Initial Transplant Plan

 

A transplant plan is unfolding.  With uncertainties and some questions.

But first some housekeeping issues.  A third iteration of the Calendar is on the blog to the right.  It’s easy and intuitive to arrange a visit.  Pro tip:  could be a great way to watch the opening day parade from the comfort of Kristina’s hospital room on what could be another drippy Seattle day.  Picture it as a private suite with views of the crew race finish line.   (I should sell tickets).   

But please do visit and use the calendar to make arrangements.  It’s quick and easy.

The past few days have been up and down – she’s fighting a rash, on Thursday her red blood cells and platelets dropped, and she needed another transfusion.  Fun fact:  She’s had so many transfusions that her blood type has changed. 

She had two surprise biopsies on Thursday as well.  Not fun.

In addition, her hair is beginning to fall out.  Predictable, she knew it was coming, but dammit.  When it starts to happen, it sucks.  At every turn there’s another reminder.  Strong and bold melts to occasional self-pity.  Yes, there were tears. 

Kristina’s discharge date from this round at the hospital will likely be between May 20^th and 24^th.  As mentioned earlier, her bone marrow test is on the 24^th at which point they’ll measure the blast cell level.  Which now needs to be zero, not the 5% we’ve talked about for reasons we’ll get into in a bit.

The conditions for her hospital discharge this time are many, but the key is her ability to fight infections.  And the key to that is her neutrophil count.  What’s a Neutrophil you ask?  They are a type of white blood cell that kills bacteria.  Neutrophil cells confront bacteria, ask ‘friend or foe’, then kill the bad guys (er, bacteria).   Picture them as guardians coursing through your body.  Pretty sure it doesn’t work exactly like that, but you get the point.

The Absolute Neutrophil Count (ANC) …the medical community is a virtual acronym generator… is an estimate of the body’s ability to fight infections, particularly bacterial infections.  The ANC measures the number of neutrophils in the blood. 

So, what are the counts of these crime fighting cells in the human body?  It varies.  (googles, brings up handy chart, see below)

Risk of infection	ANC value
Highest	Lower than 500
Moderate	500-1,000
Lower	More than 1,000

 

If the ANC value is under 500, the risk of infection is high.  Kristina’s count yesterday was zero.  The result of Chemo.  These counts need to rise before Kristina can be discharged.

So while a general date of discharge is on or about May 20^th, her ‘counts’ need to improve and it’ll be the counts that drive the discharge date.

Now to the transplant plan.           

Two possible donors, both in Europe, have been identified.  Both are 12/12 matches which is about as good as it gets.  The only rub with European based donors is it’s about a week of extra logistics.

Her first meeting with the transplant team is scheduled for June 6^th.  But that’s just the opening salvo in the process.  In the two weeks after June 6^th, she’ll be subjected to a battery of tests to ensure she’s in sufficient shape for the transplant.  Is her heart ok?  Que the echocardiogram test.  Are there any infections in her mouth (there’s a dental exam specifically for prospective transplant patients).  Are her lungs ok.  Etc, etc.   There’s a comprehensive panel of tests in store for Kristina.   But wait.  There’s more.

‘Across the pond’, somewhere in Europe, the donor will be going through their own battery of tests, coincident with Kristina. 

If all is still going well, Kristina will be admitted back into the hospital on June 27^th.  There’s more treatment, low doses of radiation, that she’ll have to endure before the transplant. 

On or about July 4^th, a cancer care alliance volunteer will fly to Europe.  At about the same time, stem cells are extracted from the donor.  As the plane lands, the stem cells are driven, encased in cold packaging, to the airport.  Somewhere in the terminal, the exchange is made and the volunteer flies back to Seattle, stem cells in hand.  Or more likely in the overhead baggage compartment.

Now for the transplant itself.  Kristina’s previous transplants have been ‘conventional’ allogeneic stem cell transplants.  Full transplant.  What her doctors are proposing this time is a ‘Non-Myeloablative transplant’.  A mini transplant. 

Kristina’s perception of the ‘mini’ transplant isn’t great.  She’s seen it used for patients who are not good candidates for the conventional approach.  The ‘old’, or folks who are terminal but want to make it to their granddaughters wedding date.  Historically it’s been used more as a temporary band aid to buy a few more months.

Kristina is also under consideration for one of two medical trials – C-Glam and Flu-mel.  The first is a similar ‘cocktail’ to what she went through 2 weeks ago, the second is a different chemical cocktail.  In either case, she’ll undergo TBI – total body irradiation,  Nothing is set yet, but Kristina is, candidly, fearful of the irradiation.  There may be significant – and long lasting side effects.

Kristina doesn’t want a bandaid.  She wants to go full throttle, recover and rock and roll for many more years. 

There may be a disconnect between Kristina’s perception of the historical use of the ‘mini transplant’ and how it is now used.  The doctors are saying they have seen good outcomes from this approach.  In addition, her blast cell count now needs to be zero for this ‘mini transplant’.

Questions remain on this approach.  More dialogue is needed.  In the meantime, use the calendar to the right.  She’d love to see you.