Glass Half Full

In early March I joined a phase-2 trial (study) of Celgene's new IMiD drug CC-4047, with once-weekly dexamethasone. The first three one-month cycles brought very good results, each with approximately a 25% reduction in markers, but the fourth and fifth cycles have been less spectacular. My two primary markers are IgG and M-spike:

• IgG actually went up 15% in the fourth cycle, then down half of that difference in the fifth to a value of 1360 mg/dL. IgG does bounce around, though, as it responds to internal bacterial and viral infections, so the meaning is not clear.
• M-spike went down from 1.2 to 1.1 g/dL in the fourth cycle, then stayed at 1.1 in the fifth. It is the best measure of monoclonal protein, which in turn is the best measure of total tumor burden other than a bone marrow biopsy (ouch), but it may only be repeatable to 5% or 10%. Zero is the ideal value. Lambda free light chains are down 22% over the two months, which must be a good thing. They can be another measure of tumor burden for some people, though we haven't been focusing on them in my case.

So the bad news is that there is no change, at least none for sure. The good news is that there is no indication at all that the tumor burden is climbing again, as it had at every test for the previous five years. More important, IgG is in a "normal" range and M-Spike is at a value last seen three years ago. I hope for more improvement, but if none comes I'm still far better off than before I started on the drug trial. Life is great!

We will continue with 2 mg of CC-4047 daily and 20 mg DEX once weekly for the sixth cycle. Here are some related links:

	My Myeloma		A discussion of my myeloma, not very technical.
	My Treatment History		Not technical.
	My Test Charts		Graphic displays of several key test results over time.
	My Test Result Table		Best with a wide browser window. Very "technical."

Side effects of the two drugs, CC-4047 and dexamethasone (DEX), are described in a previous post.

Other things that came up:

• Much of the appointment this time was handled by KD, a certified nurse practitioner, who asked most of the questions and actually performed the hands-on part of the checkup. Evidently this will be the new normal, with KD or Dr L checking me out on alternate months. This time Dr L did come in for a while, to answer my little list of questions, and I don't know if that is part of the new normal.
• I asked if there was any resource to get advice about mitigating the effects of dexamethasone, and Dr L wasn't aware of any. Just exercise and a high-protein diet. Guess it's up to me to find or create the resource.
• HHV-8 was discussed at length in some blog comments (see earlier post). Dr L said that there was a time when some doctors were quite excited about a perceived link between myeloma and HHV-8, but since that time no one has been able to reproduce their results.
• Lipids - we checked mine for the first time in many years: Total cholesterol 168, HDL 42, LDL 109, triglycerides 83. I'd like the HDL to be a tad higher and LDL a bit lower, but I'll take it.

Here are a few specific test results:

Test		May 29		Jun 26		Jul 24		Remarks
IgG mg/dL		1260		1450		1330		Some variation is normal
M-spike g/dL		1.2		1.1		1.1		Best tumor measure
L FLC mg/dL		4.25		4.03		3.30		Down is good
Calcium mg/dL		9.7		10.1		9.7		Below 1.2 is best
Creat mg/dL		1.1		1.0		1.0		Liver function, low is better

	Post-run breakfast: Gluten-free oatmeal with organic flame raisins and dried cranberries, blueberries, organic apricot, organic walnuts, mango, papaya, dark chocolate, organic pomegranate juice, organic nonfat milk.
Dex lunch, low carbs and high protein: Organic pork chop, organic broccoli with shredded parmesan cheese, organic cherries.
	Dinner: Organic chicken with onions and brown rice, organic nectarine, organic mixed vegetables with shredded parmesan cheese.

Cool Calendar Program

We recently discovered a nice calendar program called Mozilla Sunbird. If you are interested, here is a post about it.

Diabetic for a Day

Or two. DEX makes us temporarily diabetic by messing with the glucose transport system, which decreases the body's normal ability to move glucose out of the blood and into muscles and other organs.

I have a blood glucose monitor and did a simple study of my own blood glucose, taking a reading every half hour or so all day long, on four different sore-fingered days. Here is the bottom line result, where Day 1 is the next day after taking the DEX the previous evening. The "glucose" value is an average for the whole day, expressed in mg/dL:

Day	Dose mg	Glucose	Comment
1	40	144	Highest was 193
2	40	101
5	40	88	DEX effect must be gone
1	20	116

More information about this little personal "study" is detailed in earlier blog posts HERE and HERE. Graphics included. The graph here shows Days 1, 2, & 5 on 40 mg DEX.

I am NO expert in diabetes, but when Dr. L at Mayo saw the graphics and numbers for Day 1, she reduced my DEX dosage from 40 mg to 20 mg. The glucose spike of 193 mg/dL seemed to be a particularly important factor. Fasting glucose for a non-diabetic should be in the range of 80 to 120, and diabetics are urged to keep their glucose, fasting or not, below 180.

Many diabetics will need insulin shots along with a careful diet, but those of us who are not normally diabetic already have the insulin, except that its effect is inhibited by the DEX. Therefore we need to manage our temporary DEX-induced "diabetes" at least partly through diet. When I asked Dr. L about this, she commented that several of her patients are eating a low-carb diet on DEX day.

Here is a set of dietary principles that I have recently been following, with the help of Sunshine and Sweet Pea (they're the cooks!), on DEX day 1 and, to some extent, on Day 2:

• Most important: Keep the amount of food modest, because all food raises blood sugar. I do this with Weight Watchers "journaling," but calorie counting would work too;
• Reduce carbohydrates in favor of protein, and good fats such as nut oils, olive oil, and fish oils;
• Prefer carbohydrates with a low glycemic index, to reduce the glucose spike;
• Eat some of the protein and fat first at each meal, because this slows the entire digestive process and thereby moderates the glucose spike;
• Good food: Chicken, fish, vegetables, nuts, eggs, certain fruits and berries, legumes, whole-grain foods; and
• Bad food: Sugar (except fructose), soda, potato, candy, white bread or any relative, (the list goes on).

One caution: People whose kidneys are already at risk should be careful about increasing protein, and every myelomiac should take plenty of fluid to help the kidneys. As always CONSULT YOUR DOCTOR! But don't settle for "oh, don't worry about it." This is real, and somewhat outside the experience of many oncologists. Know what you are talking about, be your own advocate, and press a little. If you're interested, a blood glucose monitor costs between $30 and $100 with supplies.

You might notice that the foods that we eat on the DEX diet are foods that are really good for us anyway, and delicious. Those that are bad are ones that we never eat, ever. We just tilt the balance of protein, fat, and carbohydrates. So except for the protein issue for those with kidney disease, there is no downside to eating like a diabetic for a day or two. The food can be wonderful!

I wholeheartedly invite your comments, pro or con, and I especially hope that you will straighten me out if I have made any errors, or share with us if you have something to add.

Examples of DEX day meals that I have recently eaten. Oh, the suffering that we put ourselves through :-)

Today's DEX lunch: Organic chicken breast, Jim's broccoli, dill cheese, organic strawberries. Weight Watchers points = 6.


Today's DEX salad: Organic romaine, cucumber, avocado, organic cashews, organic strawberries, pecans, organic red wine vinegar. Weight Watchers points = 6.


Yesterday's DEX dinner: Wild-caught Alaskan sockeye salmon, organic lime, Jim's organic beet greens, spinach, and onions, with a few organic raisins, plus orange and mango. Weight Watchers points = 8.

Equivocal Results

In early March I joined a phase-2 trial (study) of Celgene's new IMiD drug CC-4047, with once-weekly dexamethasone. The first three cycles brought very good results, each with approximately a 25% reduction in markers, but this fourth cycle was less spectacular. My two primary markers are IgG and M-spike:

• IgG is actually up 15%, definitely the wrong direction and suggesting an increase in monoclonal protein. However, IgG has a normal variation because it responds to bacterial and viral threats to the body, so the increase may be entirely normal and could mask an actual decrease in monoclonal protein.
• M-spike is down 8%, and although that test is the best measure of monoclonal protein, it may only be accurate to 5% or 10%. Lambda free light chains are also down slightly, however, which does lend more credence to an actual decrease in M-spike.

I get to interpret these results as I please, and I say that there is a modest decrease in monoclonal protein and therefore, most likely, a decrease in tumor burden. So there.

Side effects of the two drugs, CC-4047 and dexamethasone (DEX), are described in a previous post.

We will continue with 2 mg of CC-4047 daily and 20 mg DEX once weekly for the fifth cycle. Here are some related links:

	My Myeloma		A discussion of my myeloma.
	My Treatment History		Not technical.
	My Test Charts		Charts of key results over time.
	My Test Result Table		Needs a wide browser window. Technical.

Other things that Sunshine and I discussed with Dr. L today:

• I have noticed a slightly irregular heartbeat, an occasional extra beat actually, on two mornings while laying in bed on my left side, both times a day or two after taking the DEX. The irregularity goes away if I move off my left side. Neither Dr. L nor I are very concerned about it.
• I am NO fan of DEX, but for a day or two after taking it I do notice some unexpected benefits:
  • My chronic headache disappears and I don't need to take my usual naproxen;
  • My BPH also disappears; and
  • So does my nighttime stuffy nose, for which I otherwise take a nightly nasal spray.
• The meaning of LDH: It is a non-specific marker of "cell turnover" (cell death) which was once of some value in prognosis for a newly-diagnosed patient because it correlated inversely with survival. However, other problems such as heart disease can also give rise to high LDH, resulting in an incorrect cancer prognosis. Newer markers are much more specific to myeloma, and Dr. L wondered if LDH should even be included in the standard battery of tests any more.
• I asked why the myeloma drives IgA and IgM (in my case) so low, and Dr L responded that the reason for that is not yet well understood.
• Though I'm a long way from "remission" at this point, we discussed the three treatment options that seem to be available after remission is achieved: (1) Continue treatment; (2) Continue treatment at a reduced dosage or frequency; or (3) Stop treatment and wait watchfully. Dr. L confirmed that the studies which have been done thus far do not clearly indicate a survival advantage for any of the three.

Here are a few specific test results:

Test		5/29		6/26		Remarks
IgG mg/dL		1260		1450		May be a normal immune response
M-spike g/dL		1.2		1.1		I hope this is real!
L FLC mg/dL		4.25		4.03		Down is good
Calcium mg/dL		9.7		10.1		Hopefully just a normal swing

In addition, the absolute neutrophil count (ANC) dropped from 2.41 last time to 1.65 this time. This could indicate that the CC-4047 is suppressing the neutrophils, and if that happens we will have to change the test regimen. However, there is a note in the results saying that the ANC was derived in a different way this time and may not be comparable to previous results.

I'm more concerned about a remark in the CBC results saying that "toxic neutrophils" are present. I'm not quite sure, but I think it means that my body actually is dealing with a minor infection (I do have a sore nose), or maybe a muscle-repair job from the marathon that I just ran.

Perhaps I'll call Dr. L.

Friday, June 27: Dr. L says it's nothing to be worried about, probably just a normal response to a minor infection or other threat, so I won't worry.


Fruity breakfast: Gluten-free oatmeal, organic flame raisins and dried cranberries, organic strawberries, organic nectarine, blueberries, organic cashews, mango, organic pomegranate juice, organic nonfat milk.

Agent Orange

Vietnam veterans and other veterans who have myeloma and who may have been exposed to the herbicide/defoliant Agent Orange are eligible for benefits from the Veterans Administration and other agencies. There is no conclusive evidence that Agent Orange causes myeloma, but there is some evidence and it is acceptable to the Veterans Administration. If you are a veteran who was exposed to Agent Orange, then you may know the cause of your cancer.

But what about those of us who were not in the military and certainly were not knowingly exposed to Agent Orange. It is quite possible that we WERE exposed, not to Agent Orange but to other commonly-used commercial weed killers containing the same ingredients as Agent Orange. One of those, widely available in the USA and fairly typical, was Ortho Weed-B-Gon, which once contained two primary ingredients: 2,4-Dichlorophenoxyacetic acid (2,4-D); and 2,4,5-Trichlorophenoxyacetic acid (2,4,5-T).

The second ingredient, 2,4,5-T, was also marketed separately under the brand name Silvex. It contained a dioxin called TCDD, produced as an inevitable by-product of manufacture. TCDD is toxic to humans in the smallest qualtities, and was banned for use on agricultural crops in 1970, but remained in use for lawn weed control until 1985. TCDD can cause cancer 20 years or more after exposure.

The first ingredient, 2,4-D, is still widely in use in the USA, most European countries, and most of the rest of the world. Most government agencies have concluded that it is safe. However, a different dioxin called DCDD is present in 2,4-D, and some believe that DCDD may be as harmful to humans as TCDD. It is banned for use on lawns in a few countries including Denmark, Sweden, and Norway.

Agent Orange was a mixture of approximately equal parts of 2,4,D and 2,4,5-T. Commercial lawn preparations of the 1950's, 60's and 70's typically included more 2,4,D than 2,4,5-T, but only a little 2,4,5-T could contain enough dioxin to be harmful.

Personally, I have used Weed-B-Gon nearly every year since the late 1950's. I have sprayed thousands of gallons of that stuff, some of it on dandilions and much of it to control poison ivy. Most recently, of course, Weed-B-Gon has not contained 2,4,5-T with its TCDD dioxin, but it always contains 2,4-D with DCDD. Was my myeloma caused by exposure to 2,4,5-T twenty, thirty, or even fifty years ago? Was it caused by 2,4-D more recently? We'll probably never know. But you may be sure I'll be wearing a very high-quality mask the next time I attack that poison ivy. No more bare-faced Don.



Breakfast with lots of antioxidants: Gluten-free oatmeal with organic flame raisins and dried cranberries, mango, organic strawberries, banana, blueberries, cashews, organic pomegranate juice, organic nonfat milk.

Good News from ASCO

The International Myeloma Foundation (IMF) has posted a news article announcing findings presented at the American Society of Clinical Oncology (ASCO) last week indicating that "novel" treatment options such as Revlimid and Velcade have significantly improved patients' survival. In particular:

• Two-year survival has increased to 93% for newly-diagnosed patients. The survival rate for people without myeloma is only three percent higher,
• Velcade has produced a high complete-response (CR) rate, and
• Further improvements are made by using Revlimid and Velcade in sequence or in combination.

The IMF believes that we are coming closer to making myeloma a chronic disease instead of a fatal one.

Stick around, it's getting better and better!

CC-4047 Rocks Again

Three months ago I enrolled in a phase-2 trial (study) of Celgene's new IMiD drug CC-4047, with once-weekly dexamethasone. This third cycle brought another good result. My two primary markers, IgG and M-spike, are both down more than 50% after three months. This is an excellent response, especially since I stopped responding last year to thalidomide, a relative of CC-4047. I know that other patients have done well too. CC-4047 is not a cure for myeloma, but it may become a very important tool in managing it and an actual lifesaver for some who have exhausted other options. I hope it becomes more widely available SOON.

CC-4047 side effects for me:

• Bradycardia - my resting heart rate has dropped from about 48 to about 41.
• Slight reduction in red cell count and hemoglobin, taking both just below the reference range.
• Tinnitus from the aspirin that I take with the CC-4047.

No neuropathy, thromboses, leukopenia, neutropenia, or other difficult side effects yet, though these are all possible.

Dexamethasone side effects:

• "Peppy" and not-so-peppy days, fitful sleep one day a week.
• Increase in belly fat - I'm pretty sure this is happening.
• Loss of muscle mass, especially quads - my running speed is declining.
• High blood sugar levels on "dex day," as measured with glucose monitor.
• Thinning of my skin; it seems quite fragile now.
• Dex voice (tight).

Considering the good response and the dex side effects, Dr. L reduced the dex dosage from 40 mg to 20 mg once weekly for the third cycle just completed. We will continue with 20 mg for the fourth cycle.

I'm lucky, or blessed, in so many ways. Though I can't run as fast as I once could, that's unimportant in the big picture. Most important, myeloma has not yet hurt me. Aside from painless lesions inside three bones, I have no symptoms from the disease itself, and symptoms from the treatment are quite livable thus far. I wish that all myeloma survivors were so lucky, or blessed. Thank you for your prayers, and I offer you mine.

Related links:

• My Myeloma A discussion of my myeloma, not very technical.
• My Treatment History Not technical.
• My Test Charts Graphic displays of several key test results over time.
• My Test Result Table Best with a wide browser window. Very "technical."

Other things that Sunshine and I discussed with Dr. L:

• The loss of muscle mass and the thin skin, both caused by dex, may be reversible if I can ever stop using dex.
• There is not enough information yet on CC-4047, or on its relative Revlimid, to know if either drug is likely to cause other cancers or to change the myeloma to a more aggressive type. So far so good.
• The absolute amount of drop in IgG and M-Spike seems to be somewhat less for each successive cycle, and that trend is likely to continue. It's the direction that is important. I notice that the drop in IgG as a percentage of the previous measurement has been about the same from cycle to cycle, about 25%.
• I expressed the view that since the current treatment is working and there are lots of other treatments available, I might expect not to die from myeloma for five or ten years even without any advances in treatment. Dr. L thought that was not an unrealistic expectation. Cool.
• We talked about running a little too. :-)

A late-arriving result: Dr. L had my blood checked for stored ferritin, with a result of 32 ug/L compared with a reference range of 24 to 336 ug/L. It's on the low side; I need to research this and maybe discuss with my naturopath, Dr. H.



Tonight's celebration salad: Organic romaine, cucumber, organic walnuts, avocado, organic strawberries, blue cheese, organic red wine vinegar, organic pomegranate juice.

Dex and Blood Sugar, Part 3

In early April I did a little experiment, measuring my blood glucose approximately every half hour on three different days: (1) Dex day (after taking dex the night before), (2) the next day, and (3) the fifth day (hopefully no dex). Results are here.

I didn't like that much dex for several reasons, and when I showed the shart to Dr. L she reduced my dex dosage from 40 mg to 20 mg. This week I did the measurements again for "dex day," and found the glucose levels significantly lower, as expected.

Here are averages for each of three different days:

Dex		Glucose mg/dL
40 mg		144.3
20 mg		115.8
None		88.2

Bottom line: 20 mg of dex puts the average glucose approximately midway between 40 mg of dex and no dex. Huh - no surprise.

Here is a TABLE showing actual measurements and times.

Below is a chart. Click to enlarge.

CC-4047 Study at Ten Weeks

Yesterday morning I had the blood draw for ten weeks in the trial of the new drug CC-4047. Here is a table showing several CBC values on four different dates including yesterday:

	SMG	Mayo	Mayo	SMG
CBC	Mar 28	Apr 03	May 01	May 15	Minimum
WBC (leukocytes) K/uL	5.3	7.7	6.0	4.9	2.0
NE# (neutrophils) K/uL	2.6	4.98	3.26	1.7	1.0
PLT (platelets) K/uL	232	303	243	251	50
RBC (erythrocytes) K/uL	4.54	4.42	3.95	4.32
HGB (hemoglobin) K/uL	15.0	15.1	13.5	14.4

SMG = Stillwater Medical Group in Stillwater, MN
Mayo = Mayo Clinic in Rochester, MN

Dr. L at Mayo is especially interested in the top three counts. If the CC-4047 trial drug causes any of those three to fall below its displayed minimum, the protocol will be changed for me, or, eventually, I could even be dropped from the study. Leukocytes are down a bit and neutrophils are down more, actually below the reference range, but both are still within the normal range of fluctuation observed over the past five years. Good.

I am also interested in the other two. RBC and HGB are always near the low edge of the range for me, and in fact RBC is still below the reference range. But it is up slightly, so my non-medical opinion is that it is stable too. Good.

I left out one set of numbers, taken April 18 at Stillwater Medical Group (SMG). Those showed a lower value for WBC than I have ever had in the last five years, and higher values for RBC and HGB than I have had. My local Dr. L at SMG seems to agree that those are NOT my numbers; there was a mixup somewhere. He is also concerned about the OTHER person, who may have gotten MY results, which probably would have shown a sudden movement in the direction of anemia but no problem with the white counts.

Bottom line: Never make an important treatment decision based solely on ONE set of labs, especially if those labs are inconsistent with other recent ones.



Lunch of leftovers: Hearty chicken soup with free-range chicken, organic carrots, organic peas and more; organic brown rice pasta with organic corn, organic tomato and more; free-range bison with onions and organic carrots.

CC-4047 Rocks!

In early March I joined a phase-2 trial (Mayo Clinic study) of Celgene's new IMiD drug CC-4047, with once-weekly dexamethasone. My two primary markers, IgG and M-spike, are both down almost 50% after just two one-month cycles. This is an excellent response, especially considering that I stopped responding to thalidomide, a similar IMiD. Another patient that I know had an even better response on the same study, with markers dropping by half in just the first cycle. I have heard that other patients have done well too.

CC-4047 is not a cure for myeloma, but it may become a very important tool in managing it and, I'm sure, a lifesaver for some who have exhausted other options. I hope that Celgene will do whatever it takes to get it approved soon - people's lives are on the line.

CC-4047 side effects for me:

• Bradycardia - my resting heart rate has dropped from about 48 to about 41.
• Slight reduction in red cell count and hemoglobin, taking RBC just below the reference range.
• Tinnitus from the aspirin that I take with the CC-4047.

No neuropathy, thromboses, leukopenia, neutropenia, or other difficult side effects yet, though these are all possible. Albumin seems low, but other liver markers are normal.

Dexamethasone side effects:

• "Peppy" and not-so-peppy days, fitful sleep one or two days a week.
• Increase in belly fat - I'm pretty sure this is happening.
• Loss of muscle mass, especially quads - my running speed is declining.
• High blood sugar levels on "dex day," as measured with glucose monitor.
• Dex voice (tight).

Considering the good response and the dex side effects, Dr. L has changed the dex dosage from 40 mg to 20 mg once weekly. And the study continues, now well into the first week of the third cycle.

I'm lucky, or blessed, in so many ways. Most important, myeloma has not yet hurt me. Aside from painless lesions inside three bones, I have no symptoms from the disease itself, and symptoms from the treatment are quite modest thus far. I wish that all myeloma survivors were so lucky, or blessed. Thank you for your prayers, and I offer you mine.

Related links:

• My Myeloma A discussion of my myeloma, not very technical.
• My Treatment History Not technical.
• My Test Charts Graphic displays of several key test results over time.
• My Test Result Table Best with a wide browser window. Very "technical."

Free-range no-hormone no-antibiotic chicken, organic chard with dried cranberries, macadamia nuts, organic apple, organic pomegranate juice.

Lucky Don

If you skip over the fact of the cancer, I'm a very fortunate guy. The CC-4047 trial is so far very successful for me. After the first one-month cycle, IgG dropped from 2960 to 2230, and after the second cycle it is now 1610. Similarly, M-spike dropped from 2.7 to 1.9, and now to 1.4. This brings my markers back two to three years in just two months.

Best of all, side effects have been quite modest so far, the worst coming from the dexamethasone, not the CC-4047. The regimen will continue for another cycle, probably many cycles, but at half the dose of dex.

I am VERY happy!. Time for celebration. Much more to say about the results and my conversation with Dr. L, but no time to post it tonight. Big weekend coming, so it may be next week before I can bring it all together.

Drug Study at Six Weeks

This morning was the end of six weeks in the trial of the new drug CC-4047. Here is a table showing several CBC values on four different dates including today:

	SMG	SMG	Mayo	SMG
CBC	Mar 21	Mar 28	Apr 03	Apr 18	Minimum
WBC (leukocytes) K/uL	5.8	5.3	7.7	3.6	2.0
NE# (neutrophils) K/uL	2.9	2.6	5.0	1.8	1.0
PLT (platelets) K/uL	245	232	303	148	50
RBC (erythrocytes) K/uL	4.28	4.54	4.42	5.52
HGB (hemoglobin) K/uL	14.3	15.0	15.1	18.5
Albumin g/dL			3.4	3.5

The top three counts are ones that Mayo is particularly interested in watching, because the CC-4047 trial drug may eventually drive those numbers down. If any of those three counts falls below its minimum, the protocol will be changed for me, or, eventually, I could even be dropped from the study. Sorry to say, every one of those counts has dropped dramatically in just two weeks, though they are all still well above their minimum values.

I am also interested in the other three. HGB (hemoglobin) is slightly out of the top of its range. I don't know what to make of that. In fact, both HGB and RBC (red cell count) are higher than I have ever seen them in five years of tabulating results. They're nothing to worry about, but they don't seem like my blood. I'm actually wondering about a lab error.

Albumin, on the other hand, is almost exactly what it was two weeks ago at Mayo, and it is at the lowest I have seen in the five years. More to discuss with Dr. Lacy in a couple of weeks, when we will do the tests again. Albumin is one of the liver-function indicators, and is right on the boundary where the International Staging System would place a newly-diagnosed patient in Stage II rather than Stage I.

Bottom line: Albumin makes sense, though I don't like it much. The others seem wacko for me. I do believe that the albumin blood was drawn into a different tube than the CBC blood, so there is the possibility of a lab mixup in one and not the other. I sort of hope so.



Recent salad: Organic romaine lettuce with cucumber, organic dried sour cherries, blue cheese, salted pistachios, clementine, organic red wine vinegar.