Monday, December 30, 2013

Week 19: The Grinch looks west

This week, we went to New York to celebrate Lemon's first Christmas.  Not being raised in a Christmas-observing household, I am quite a Grinch myself, but fortunately for Lemon, Papa Bear, Grandma Carol, Grandpa Dudley, and Great Grandma Virginia really get into the holiday spirit.

Santa (ie Grandma Carol and Grandpa Dudley) got Lemon all kinds of nice toys.  He seemed very interested in all of them, particularly one that has flashing lights and plays music.  We figured out right away that his little brain can only handle one song per session though--if you press the button on the toy again to start a second song, he sort of short-circuits and cries.

We also had a nice time visiting with the ever-fashionable Uncle Jared (and Aunt Lauren), as well as Nona and Opa who joined us for the occasion, providing us with our first opportunity for a four-grandparent photo.

On Boxing Day, we hopped on the train back to Boston to be home in time for another big adventure--a drive up to New Hampshire to close on our new house in Wisconsin.  You may ask why we had to drive to New Hampshire to close on our house, and the answer is that we have absolutely no idea.  Our mortgage company told us to do it, and the path of least resistance was to do what they said.  So, we drove to a random office park in southern NH, went to a company whose business seems to be renting furnished conference rooms by the hour, went into a conference room, signed a ton of papers, and became home owners for the first time.  After a delicious celebratory lunch with our dear friend Eric P. at the Purple Finch Cafe, we headed home to face the reality of moving.

We scrambled around frantically for the next couple of days, getting together with a few friends for the last time, taking care of Lemon, and getting our house organized for the packing crew.  The packers came today and in a matter of 4.5 hours reduced our home of 4.5 years to 80 cardboard boxes.  The only noteworthy aspect of today's activities was the packer's thoroughness--we told them to pack everything in Lemon's room, not thinking it necessary to indicate that they should not pack the trash bag containing dirty diapers.  Well, let's just say the packers took us at our word, and those diapers will be on the truck to Wisconsin tomorrow.  The movers must have thought we were crazy first-time parents, to be saving these precious relics of our baby's first months...

We watched the soaking wet Patriots/Bills game on TV as we were making our final preparations, and I explained to Lemon that no matter how long we live in Wisconsin, as a native of the wonderful state of Massachusetts, he will always be a Patriots fan.  Luckily he will have his Uncle Jared to set a good example for him in this regard--and his first set of Patriots clothing in just the right size to wear during this year's playoffs.

I can't quite believe that next week's post will be written in Wisconsin, but that is the reality; we have just 4 full days left in Massachusetts.  If I thought any of the weeks leading up to this one was an adventure, I have a feeling I haven't seen anything yet.  We've done travel with a baby several times now.  Someone said on a travel blog that I read that the first time she traveled with her baby, it felt like moving.  I now know exactly how she felt--so my question is, if traveling with a baby feels like moving, what does moving with a baby feel like?  I guess at this time next week, I'll know!

Monday, December 23, 2013

Week 18: Stem cells to the rescue!

This week, Papa Bear and I met with Dr. Jay Rajagopal (a colleague of mine) to get a personal update on all the great science that is going on in CF research.  Dr. Rajagopal is a pulmonologist and a stem cell scientist, and he told us about the advances made in his lab and others on the use of stem cells to study CF. I've written up a layman's version of our conversation here, illustrated with some key pictures and videos from this week to provide a little break from all the science.  We were so excited to hear about all the great things that are coming in CF research, and feel so lucky that Lemon was born now, when such great research tools are coming on line.

A basic problem in CF research is that some of the most severe pathology of the disease occurs in the lung, and the lung tends to be located inside a patient, where it is difficult to study.  So, although it is possible to get a small number of lung cells to study by doing a biopsy on a patient, these small numbers of cells just aren't enough for major research efforts.  Research using cell grown in a petri dish is a critical component of the process to discover new drugs, and the process requires absolutely huge numbers of cells, far more than could ever possibly be obtained from patients.  What to do?  Up until now, scientists have had to use imperfect methods like artificially turning on the cystic fibrosis gene in some type of cell that is easy to grow in a dish, but isn't a lung cell.  This is certainly better than nothing at all, but is far from a perfect system for studying lung disease.  Especially in a disease as complicated as CF, the more closely the cells in the petri dish resemble the actual cells that are causing trouble in the patient, the better the medicines that are discovered using them are likely to be.

Enter stem cell technology.  The most simple definition of a stem cell is a type of cell that can either divide and make two identical new cells, or divide and keep one cell as the stem cell and produce another cell (a so-called daughter cell) of a different type.  The first kind of stem cell that can help with CF research is called the basal cell, which is actually a type of stem cell that lives in the lung.  The basal cell can divide to make more cells just like it, or it can produce the two key types of cells that line the lung.  At least, it can certainly do those two things when living in its natural environment (ie, the lung) but until recently it has not been possible to grow basal cells very well in a petri dish--a lot of cells are very particular about where they will grow, and without the right environment they will stop growing and die.  Luckily, research in Dr. Rajagopal's lab has identified some tricks that allow basal cells to grow happily in petri dishes and produce lots and lots of daughter cells.  In other words, it may soon be possible to take a small biopsy from a patient's lung, and grow that patient's very own basal cells in a dish.  If provided with the right cues, the basal cells will start making the other two key lung cell types, too.  This provides one way to make very large amounts of lung tissue that is both genetically identical to the patient, and pretty similar in structure to the lining of the lung--that is, an ideal system to use to study CF in the lab.

The second type of stem cell that could potentially revolutionize CF research is called an "induced pluripotent stem cell" or iPS cell for short.  These cells are very similar to embryonic stem cells, but are actually artificial stem cells that can be made in the lab from a skin biopsy from a patient.  Like embryonic stem cells, iPS cells have the ability to form any cell type in the body--at least theoretically.  The main trick with iPS cells is that since they have the potential to form all possible cell types, it is often difficult to get them to focus on forming the cell types that are of particular interest for a particular research problem--in this case, lung cells.  Again, Dr. Rajagopal's lab has been leading the way to find the technology to convince the iPS cells to make lung cells, and has made incredible progress--he guesses that in the next year or two, his lab should be able make lung cells from iPS cells routinely and in large numbers.  Because iPS cells can easily be made from any patient, this technology provides a second way to make lots and lots of a patient's own lung cells to study.

Right now it's a little tough to say which technology (the basal cells or the iPS cells) will ultimately be the best way for finding CF drugs, but either approach is likely to be so much better than the current technology (technology, which, it should be noted, has already produced some amazing discoveries like Kalydeco).  We're all eager to see what a drug-discovery company like Vertex will be able to do once they actually have the right types of cells, derived from actual patients, to work with.  Papa Bear and I were so grateful to Dr. Rajagopal for taking the time to talk to us, and for giving us so much hope as parents that the amazing progress in his lab will help find cures for Lemon and all the other patients out there with CF.  In the mean time, Dr. Rajagopal asked me to help him by educating people in the CF community about the importance of stem cells, and making sure that everyone I know is out there advocating for stem cell research.  So, consider this blog post my first small effort in response to his challenge, and stay tuned... 

Monday, December 16, 2013

Week 17: Countdown

Our move to Wisconsin is getting closer and closer.  This week, we started saying goodbye to people that we won't see again for a long time.  This is the hardest part of the move for me, and luckily Lemon came through with some cute new developments to take my mind off of our impending separation from our friends and family.

The biggest new thing Lemon is doing is really, repeatedly, reaching for things with his hands, batting them, and occasionally trying to bring them to his mouth.  It's pretty fun to watch, even though I know that it heralds an era where nothing in our house will be safe from those little grasping fingers.  

As a sneak preview of our future, we had some dear friends over for a farewell brunch who have two young sons.  This gave Papa Bear a chance to teach a paper airplane making lesson, and win the admiration of his young student.  I know Papa Bear can't wait until Lemon is old enough to make paper airplanes, too!

Our friends both seemed to enjoy the trip down memory lane provided by our little guy.  I can't really believe that he might be walking the next time they see him.

We had a wonderful fondue dinner with some of our friends that we've known since we were in college.  It's hard to believe that we soon will be living so far from these people who have been so important to us for the past 18 years, and that they won't be a regular part of Lemon's life as he grows up.  Boston has been really good to us.  

This coming week is my last full week on the job, so I submitted my letter of resignation, which had a scary sense of finality to it, and had my good-bye lunch (delicious Otto's pizza).  The lunch went off as planned in spite of the bomb scare on campus that had all kinds of different police agencies all over campus.  As usual, Lemon was the star of the show, and my presence was purely in a supporting role.

The cats seem to have noticed that something is afoot, and one of them is trying to indicate that he would rather not use a regular cat carrier on the big day.  Little does he know what's actually in store...

Monday, December 9, 2013

Week 16: Superman

We now have about two weeks of vaguely normal life left in Boston before we move, so our days are growing full of doing things for the last time.  For Lemon, this included his very last visit to the CF clinic at Children's.  This visit was mostly just another weigh-in, and Lemon tipped the scales at around 13lb.  He's still only in the 25th percentile but he's staying right on his growth curve so his doctors are really pleased with his progress.  His bloodwork revealed that he is a bit low on vitamin D, in spite of the daily dose of aquADEKs (the really nasty orange vitamins), so we have to supplement that with a 1mL dose of regular infant vitamin D drops.  Fortunately, those taste much better and don't stain anything, so it's not really a big deal.

We will definitely miss Children's.  They got us off to a great start, and we can only hope that the staff at the clinic in Wisconsin are as warm, caring, and competent as the people we worked with here.  It seems like the staff here will genuinely miss Lemon, and one of his doctors snapped a couple of quick pictures to remember him by.  We made sure that we had a perscription for enough enzymes to cover us until we get to Wisconsin (Lemon is up to 3 pills per feeding), got a few last bits of advice on chest PT, and bid a fond farewell to Children's. 

In addition to the "lasts" this week, we also had an absolutely wonderful "first."  By coincidence, two of my wonderful first cousins also had baby boys this summer, one in June and one just two days after Lemon himself was born.  The three of us had formed a mom's group that met monthly using Google Hangouts while we were pregnant, and continued after the babies were born.  This weekend, all three of us first cousins and the three little second cousins got together in person for the first time.  We got them dressed up in matching outfits and had a fun photo-shoot at my uncle's house. 

My grandmother was there, so we got to capture her surrounded by her three newest great-grandchildren for the first time. 
We also managed a shot of the four generations of my family (Great Grandma Frieda, Opa, me, and Lemon).

My grandmother noted that it didn't seem right that after a few short hours together in Boston, the three of us first cousins and our boys were all dispersing to our separate homes--in Rio de Janeiro, Washington, D.C., and soon to be Madison, WI.  I think we all wish that it were somehow possible to live closer together, but our lives have pulled us in different directions.  At least with the marvels of modern technology, it is easier to stay in touch, and we already began making plans for our next reunion. 

In other firsts and lasts, I attended my last meeting with a book group that I've belonged to for something like six or seven years.  In addition to it being my last meeting with this book group, it was the first time that I hadn't read the book--there's just too much going on right now!  That, and I have my last assignment for my very last class at the Harvard Extension School due a week from tonight.  I'd really better get started on that...

Monday, December 2, 2013

Week 15: Thanksgiving

This week marked another milestone in Lemon's life--his first Thanksgiving.  Our family Thanksgiving is a big, raucous affair with 35 or so in attendance, many of whom were meeting Lemon for the first time.  To make sure Lemon was ready for prime time, I gave him a little coaching before we got started.

Judging by the reactions of Aunt Lauren and Grand-Aunt Nancy, the coaching paid off!

One of the highlights of this Thanksgiving was introducing Lemon to his second cousin, Alex, who is just two months older than he is.   Unfortunately, with two babies in the room, it seems like no one had enough free hands to take a picture.  Luckily for us, Alex is in town for another week before heading home to Brazil, so we should get another chance at getting the two of them in a picture together.

Another highlight of Thanksgiving weekend for the past few years has been the observance of FAT (Friday After Thanksgiving) where Papa Bear and I host a big vegetarian feast at our house.  I very much wanted to do it this year, since it is our last year in Massachusetts, but doing it with Lemon in the house made it infinitely more complicated than it has been in years past.  I made myself a little cheat-sheet telling me which tasks to do for what course on what day. 
Somehow, we managed to complete all the prep on time.

With a little help from Lemon, who did not want to be left out of the meal preparation activities...

...or the meal consuming activities...

...and especially not dessert-consuming activities.  Next year he may even get to taste the pumpkin flan!


A major highlight of FAT this year was Lemon's first ukelele lesson from Grand-Uncle Joel.  Lemon continues to be totally fascinated by music, and by his musician uncle in particular.
When Jared and I were growing up, we were always convinced that Uncle Joel was a famous rock star, since no matter where we went in his home state of Maine, we always ran into people who recognized him and came running up to greet him.  I think Lemon has come away with the same conclusion, and is eager for his hands to get big enough for his first real uke lesson.

Both Papa Bear and I feel as though the passing of Thanksgiving marks the end of our time as real residents of the Boston area.  Now, all our energy is really focused on getting everything in place for our new lives in Wisconsin.  It is a bittersweet feeling.  We have so much to look forward to there, but so many wonderful friends and family members that we are leaving behind on the east coast.  It's hard to acknowledge that we don't really know where we will be for Thanksgiving next year, or who will come to FAT, or if we will even have FAT at all.  But, as someone once told me, with those that are dear to you, it's never "goodbye," it's just "see you later," even if you don't really know yet when later will be.

Monday, November 25, 2013

Week 14: Single Mom

This week, Papa Bear went to a conference, leaving me and Lemon home by ourselves for 5 days and 4 nights.  Going in to Papa Bear's absence, I was calm and confident.  After all, I figured, despite the fact that we aim to be a pretty egalitarian household, I do at least 75% of the child care stuff.  So, I didn't think that being solo would really feel that different.  I mean, tired is tired, right?  WRONG.  That 25% that Papa Bear handles is clearly the buffer that is saving me from total disintegration.  Thankfully, with help from Nona and visits from a few friends, we made it through.

I didn't cook anything more complex than a can of tomato soup, let the house fall into a state of severe disarray, and only barely prevented the cats from dying of either starvation or dehydration (good thing evolution equipped them with the ability to make noise!).  I believe I washed my hair exactly once, and only managed that since Nona was there.  I have absolutely no idea how anyone manages to be a single parent full time.  It is an astonishing act of strength and will that should  command our utmost respect.

Due to the extenuating circumstances, this week's post will be relatively short, and heavy on photos.  For example, Lemon in the bath tub.  Is there anything cuter?  I didn't think so.

Lemon has just completed Phase II of babyhood, as defined by Burton White.  One of the things White identifies as an indicator of the end of Phase II is "hand regard," when babies stare at their hands and slowly come to understand that the hands belong to them.  Lemon has his own take on this: foot regard.  He has no real interest in his hands yet, but those little feet are just the right distance from the eyes to be easy to focus on, and they sure move around a lot.

While it may be too recent a phenomenon to be covered in White's book, the end of Phase II also seems to be accompanied by what I will refer to as "screen awareness."  We are in trouble.

Lemon has also become a lot more vocal in the last few days, adding a variety of high-pitched squeaks and squeals to his vocabulary.  One of the best ways to elicit these, we discovered, is to sing to him.  Here is a little video clip of Lemon with my dear childhood friend Jen, demonstrating his growing enthusiasm for music!

Monday, November 18, 2013

Week 13: What's it worth?

After an incredibly busy week last week with our trip to our future home in Wisconsin, this week has been mercifully a much more normal one.  Thanks to Nona and Opa, Papa Bear and I were even able to get out on a date.  We had an absolutely delicious meal at Upstairs on the Square, which you should visit soon if you are in the Boston area, as they are closing at the end of this year.  We had gone there way back when we were first dating, so it was fun to take a little stroll down memory lane and see how far we've come in the last five years.

Since nothing of significant note happened in Lemon's life this week, I thought I would devote this week's posting to a topic that has been on my mind a bit over the last few weeks: a medication called palivizumab (which goes by the brand name Synegis).

Synegis is a treatment that can reduce the severity of lung disease caused by respiratory syncycital virus (RSV) in "at risk" babies (babies born prematurely, babies with certain heart conditions, and maybe babies with CF).  Most children in the US have an RSV infection by the time they're two.  RSV infections are usually mild but can occasionally be severe enough to require hospitalization, especially in premature babies or babies with some other condition that compromises their lung health.  Unfortunately, there is currently no vaccine that can protect babies against RSV.  Vaccines act by stimulating the body to produce antibodies against the particular pathogen that causes a disease.  Synegis, which is a man-made injectable antibody against RSV, is effectively a short-cut; instead of getting the body to make its own antibodies, the doctor simply injects the baby with ready-made antibodies.  The idea is that these ready-made antibodies help the baby fight off an RSV infection if it happens.

One of the first things I wondered about when our doctors first recommended that Lemon receive Synegis was how much it really helped.  At the time, Synegis had mostly been studied in premature babies, with relatively little data available for CF babies. There just aren't that many CF babies (only about 1000 per year in the US), so it is hard to get enough of them to do a meaningful clinical study.  A recent review that collected all the published data so far on Synegis in CF babies found that might be beneficial--untreated CF babies had about a 1% chance of being hospitalized for RSV, and treated babies had about an 0.1% chance.  So, as a parent, how do you think about that result?  Do you think that your baby was very unlikely to be hospitalized for something in the first place, and with the treatment he is even less likely?  Or, do you think, "Wow, this treatment reduces the chance of my baby being hospitalized by 10-fold!  Sign me up!"

Next, you might think about the costs of the treatment.  There's the inconvenience of an additional visit to the pediatrician once a month for five months to get the shots.  There are the (very minor) risks associated with receiving the shot, which is overall an extremely safe therapy.  In contrast to what my fellow residents of the blogosphere seem to believe, the shots don't contain any rat DNA, and the recombinant DNA technology used to produce the antibody is very safe.  Then, there is the financial cost.  It's hard to find out exactly, of course, but there is no doubt whatsoever that Synegis is an extremely expensive medicine--about $1500 per shot, or around $7500 for the full treatment course.  It's so expensive, in fact, that the drug company that makes it sends you a nice little gift box once they receive the order for the drug from the pediatrician's office.

We're very fortunate that our insurance company covered Synegis without much fuss, so we didn't have to think about the financial cost at all, nor did our doctors.  But, isn't this exactly what we're told is wrong with healthcare in America?  That both the patient and the provider have no idea how much things cost, so lots of money is spent on treatments or procedures of minimal utility?  By deciding that I wanted Lemon to receive Synegis, even though the actual benefit might be quite small, am I becoming part of the problem?  If I had to pay for Synegis out of pocket, would I do it?

Interestingly enough, I might have the opportunity to answer that question.  The CF center in Wisconsin doesn't seem to think that Synegis is worth it, and the doctor we met there said our new insurance would be very unlikely to cover it, especially since Lemon will have received 3 of the 5 shots by the time we get there.  So, do I cover the remaining two shots out of pocket?  If I do, and he doesn't get RSV, would I feel like it was a waste of $3000?  If I don't, and he does get hospitalized with RSV, would I feel like it was my fault because I wasn't willing to shell out the money? 

Last week, a loyal blog reader pointed out this article from the New Yorker that was published about 8 years ago.  It discusses how different CF centers were getting very different outcomes, despite a supposedly unified set of guidelines for patient treatment.  At one of the centers that was getting the best outcomes, there was a doctor who was absolutely fanatical about maintaining lung function in his patients.  In his view, each day a CF patient had a 0.5% chance of catching a dangerous lung infection (that is, a 99.5% chance of staying healthy).  By being absolutely obsessive about treatment, the patients could reduce that risk to 0.05% per day (a 99.95% chance of staying healthy).  That difference doesn't sound like much, but over a year it is the difference between an 83% chance of getting a lung infection and a 16% chance--which is huge.  There is some evidence that viral infections like RSV can make CF patients more susceptible to the bacterial infections that lead to permanent lung damage.  So, does that mean that Synegis treatment is part of staying in that 99.95% category? If it is, then it's totally worth the cost to me.  I just wish I knew!

Monday, November 11, 2013

Week 12: Home is where the heart is

In addition to everything else that's been going on in our lives, before Lemon was born, we decided to relocate from Boston to Madison, WI.  We'd both been offered really good jobs there and felt like it was time to try something new after nearly two decades in Boston.  This week, we went out to Madison to look for a place to live and sort out a few other details of our new lives before the big move in January.

This was our first time flying with Lemon, so we were a little nervous about how everything would go, and how we would manage the giant pile of luggage that an infant seems to require.  Luckily for us, we were "randomly" selected for TSA-pre at Logan, meaning we were allowed to leave our jackets and shoes on, and leave our laptops and liquids inside our carry-on bags.  The flights themselves went very smoothly, much to our surprise and the suprise of our fellow passengers, who looked at us with fear in their eyes as we were boarding, but after the flight complimented us on what a good baby Lemon is.

Our housing search ended up being relatively straightforward.  We looked at a bunch of houses on Thursday, went back for a second look at our favorite on Friday afternoon, put in an offer on Friday evening, and had the offer accepted on Saturday.  Somehow we forgot to take a single picture of our new house, so I'll have to save that for January.

Nona commented that Papa Bear and I seemed extraordinarily calm throughout the whole home-buying process. We had done a lot of research before we left, which certainly helped.  At least for me, though, buying a house was just another material purchase.  Yes, it's a lot of money, but in the context of having a baby with a serious diagnosis, it honestly just doesn't seem like that big a deal.  It's a very nice house in a nice neighborhood, so I'm sure we'll like it, but if we change our minds at any time, we can sell it and move on.  If only we could cure CF that easily.

Another highlight of the trip was meeting Lemon's new CF specialist.  He was recommended to us by Lemon's current team at Children's, and seems like a good fit for our family.  It was interesting that in just our 30 minute meeting with him (just a meeting, not a clinical visit), many differences came out in terms of the standards of care applied at Children's as compared to Madison.  Most strikingly, they seem to be much more relaxed about infection control measures in Madison--unlike Children's, they do have a waiting room, and the CF care team doesn't put on fresh gowns before going into the exam room with a CF patient.  According to our doctor, Children's in Boston started doing that after they had some "bad outcomes."  Which makes me wonder--is it right for Madison just to wait and see if they have any "bad outcomes" before they switch to the more rigorous procedures?  They also use higher enzyme dosages, and tend not to use Synegis (an antibody shot that protects against respiratory syncytial virus) that was pushed pretty hard by our team at Children's. 

It's so hard as a patient to know what the right course is for any of the CF treatments.  I even did a quick literature search on the enzyme dosages, just because I was curious, and it seems like the reason there are differences between centers is that the research just isn't that clear about what's best, so each center tries to find its own way.  Boston seems to like to dose at the low end of the published range, whereas Madison goes about 3 times higher.  Madison does seem to have better outcomes in terms of BMI, so maybe they are on the right track, but it's so hard to tell.  As a patient it would be comforting to believe that the doctors have all the answers, but especially for a rare and complicated disease like CF, that simply isn't true.  Everyone is trying to do their best with relatively limited information, and to adjust the care to each individual patient. 

With the house and the CF doctor taken care of, we had some time left over to get into the true spirit of Madison.  We bonded with Nona and Opa over the Badgers-BYU football game, which had the entire town full of enthusiastic alumni, all wearing red (we found out that UW Madison has 400,000 living alumni!).

Papa Bear also took advantage of the opportunity to make friends with our new mascot.
It's hard to believe that this move is less than 2 months away--19 years in Boston draw to a close.

Monday, November 4, 2013

Week 11: Clapping for clearance

Wednesday of this week found us back at the CF clinic once again.  Each visit has the regular check-up with Lemon's doctor, and then a little something extra.  This week, we met with a physical therapist who taught us how to do the airway clearance therapy (ACT) that will be a daily part of our lives from now on.  The idea of the therapy is to loosen the sticky mucus in the lungs of CF patients so that it can more easily be coughed up and cleared.  At this visit, we learned the "old-fashioned" way of doing this: clapping on Lemon's chest with cupped hands.  We'll do his therapy this way until he's bigger, probably around 6 or 7, when he can start using a special vest to create the necessary vibrations mechanically.

To do the therapy, we have to clap on the sides of Lemon's chest

                                                            the front of the chest

and the back of the chest, each for 3 minutes.

We put what we learned into practice first thing Thursday morning.  Although babies don't have the very thick secretions that clog the lungs of older CF patients, it's important to start the ACT early so that they (and their parents!) get used to it as part of their daily routine.  Lemon certainly seemed surprised when I picked him up and started thumping on his chest, but he quickly settled down.  On Saturday morning, he actually fell asleep during the session.

Even though the therapy itself only takes 15 minutes at the moment (it will become longer and more involved as Lemon gets older), it has solidified in my mind the feeling that I've had since Lemon was born that my mornings are not my own anymore.  For someone who has been training in the morning for the better part of 15 years, this represents a major adjustment.  I'm slowly coming to terms with the fact that I will become one of those insane people who trains on a treadmill at night, at least during the week.  It will be sad to give up my morning runs and rides, but there isn't even a question as to what is more important. 

In addition to all the CF stuff, we had some fun times this week--Lemon's first world series and his first Halloween (thanks to Lemon's friends Andrew, Sarah, Linn and Dave for the great shirts!).

Papa Bear and I even managed to get a little work done on Sunday morning!