A Lung Cancer Diagnosis

November 2018: I have posted about my different diagnoses throughout this blog. It's been a while since I've posted about being diagnosed with lung cancer.

It all started three years ago in August 2015.  I was in the first years of a serious relationship with my boyfriend, Jeremy.  We were passed that milestone moment when you realize your significant other is your forever person.  We were planning our future together and talking about getting married.

It was also the beginning of my career as a letter carrier.  By choice, I was on walking routes. I was walking approximately 35-40 miles a week.  I would walk anywhere from 6 to 12+ miles a day. Carrying mail was more than a job. It was my career and my passion.

I would run at least one 5k (3.1 miles) a week after work with my runner's club.  I was enjoying running for the first time in my life. There were times I'd run two or three 5k's in a week.  Running wasn't just the annual 5k for charity any more.

As active and healthy as I was, I had a persistent cough and some random breathing issues.  There were a few times between late 2014 and July 2015 that I felt a heaviness in my chest, something similar to bronchitis. Each time there seemed to be an acceptable explanation (post nasal drip, virus) to justify the breathing problems.   It didn't seem too serious at the time.

When breathing issues interfered with exercising and running, I decided to get things checked out. I went to  a doctor for my breathing problems.  I had a chest x-ray. The result...a mass in my right lung.  Further testing revealed a devastating diagnosis.

We heard the words, “inoperable”, “incurable”, “terminal”.  What seemed to be minor turned out to be inoperable, incurable, stage iv lung cancer.  It was late stage, stage 4, non small cell lung cancer. At the time of diagnosis, lung cancer had already spread throughout both lungs and to my spine.  

I asked:

• How long to I have to live?
• How did I get lung cancer?
• What do I do now?

Statistics said I had a 3 to 5% chance of living one year.  Lung cancer in young healthy adults, especially women, was on the rise.  My lung cancer is caused by the EGFR gene mutation. It’s not genetic or something I inherited from my parents. It’s genomic, something in my DNA has changed and mutated.

The mutation meant I would have targeted therapy treatment instead of iv chemo.

Days before we heard, “incurable” and “terminal”.  Now we heard something promising. I had a chance at living a normal life.  It’s almost like, “normal life” echoed as it came out of my nurse navigator’s mouth.

Over the years my treatments have been targeted therapies and radiation treatments to my lung and spine.  I take a chemo pill once a day that targets the mutation that is driving my cancer.

I was able to stay at work and continued living my active otherwise healthy life. Things were as normal as they could be with quarterly PET scans thrown in to monitor disease progression. Or in my case, we watched tumors and nodules shrink and disappear. the targeted therapy did it's job. I was No Evidence of Disease within 8 months.

Our moment of relief lasted 6 months. Then the nodules and tumors returned in my lungs. We monitored that growth for 10 months. In the mean time I had a bronchoscopy biopsy to test for a new mutation. I switched targeted therapies because I tested positive for the t790m mutation.

Life is back to normal, for now. Well, as normal as it can be with quarterly scans and blood labs thrown in to monitor for disease progression.

x

Two's Company. Three's a Crowd.

Just when my lung cancer and I were getting along and learning to coexist in the same body, there's something new in the mix.

I've been laying low and quiet lately because I was waiting on the confirmation of a possible new medical condition.

Last month I requested an early brain MRI, before my routine, annual, MRI date of October. I had some vision changes and other symptoms that sounded like possible lung cancer metastasis to the brain. I got the all clear. No cancer in my brain.

But what I did get was the news that they thought I could have a rare brain blood vessel disease called Moyamoya (moy-uh-moy-uh). In addition to the brain MRI, I needed an additional brain scan called an angiogram ct scan.

I got the results today. It's confirmed. I have Moyamoya.

Moyamoya disease is a rare, progressive cerebrovascular disorder caused by blocked arteries at the base of the brain in an area called the basal ganglia. The name “moyamoya” means “puff of smoke” in Japanese and describes the look of the tangle of tiny vessels formed to compensate for the blockage.

I am asymptomatic. I have no symptoms or signs of stroke or mini strokes. So, surgery is not my line of treatment at the moment. I will probably have to take a baby aspirin once a day because I am at risk of stroke.

My case will be presented at an upcoming neurovascular conference. It sounds like the neurology version of the lung cancer tumor board.

Not only am I a mutant because of my gene mutation driven lung cancer, I'm truly one in a million. Moyamoya is that rare. I will be doing some research regarding gene mutations and Moyamoya. If there a connection between my lung cancer and Moyamoya, I'll find it.

We don't know how long I've been living with this. It's even possible I was born with this disease. It hasn't caused any issues in the past. I'm hoping it doesn't cause any issues in the future.

A Clinical Study and a Collapsed Lung

Twenty-one days ago I participated in a clinical study. At one point I thought a clinical study and/or trial meant you are a guinea pig and even though you were seriously or terminally ill you got the placebo (sugar pill) or the trial drug that may or may not work. That's not the case. There are many different types and stages of clinical trials.

To learn more about clinical studies, CLICK HERE.

The study I took part in was to improve blood biopsies. There was no medication to take or multiple trips to the doctor to be examined or monitored. I simply had to agree to submit some vials of blood.

Twenty-one days ago I remembered what it was like to have to go through a surgical biopsy. For me, that was traumatic (my first surgery) and painful with a three week recovery. I submitted a few vials of blood to improve a non-invasive procedure to diagnose lung cancer. I was all for that.

If you thought I was on board twenty-one days ago, I am now the head engineer on that train that can't go fast enough. This week I was scheduled for an outpatient lung biopsy procedure. In and out, they send the tissue to pathology for diagnosis and we know what we are dealing with. It's a common procedure, but there are certain risks that are discussed before you start. One of those risks, ever so slight, is a collapsed lung. For the biopsy procedure they are putting a needle into your lung to capture tissue. In a sense, they are puncturing your lung. In most cases, after the procedure, the lung closes on its own and heals up at the puncture site. Not in my case. My lung collapsed.

Lisa at University of Colorado Hospital with DC, her #hopebot

I was admitted into the hospital and had to have a chest tube put in place to help "re-inflate" my lung. Although, not as traumatic as my first surgery, it was my first overnight hospital stay, EVER! 

I can't wait for the day when a lung cancer biopsy will be a simple office visit and a blood draw only.

Please note: these are descriptions of my medical experiences, how I understand them, in my laymen's terms. The procedures mentioned and defined may not be 100% medically accurate/correct or my doctors words. Thank you.

One Year Ago Today...August 21, 2015

One Year ago today I had my first surgical procedure. My PET scan showed multiple, multiple, tiny, star like nodules throughout both of my lungs. This was discussed at my cancer center's tumor board. A tumor board is a panel of oncologists, thoracic surgeons, radiology oncologists and others involved in diagnosing and treating cancer. My tumor board could not come to an agreement about my scan. It was inconclusive. The star like nodules could either be an infection, I had already tested negative for tuberculosis, or it could be cancer that had spread from the main lung tumor in my upper right lobe.

Until this point, the my biggest medical procedure was my bronchoscopy. I was scared. I've never been under anesthesia before. It was very early in the morning. My boyfriend, Jeremy, my mother and I were driving to the hospital. I had my usual satellite radio station playing, 50's on 5. We're pulling into the hospital. I'm thinking all the scary, anxious, thoughts any normal person that has never had surgery would have. And this song comes on while we are parking the car.

The first thing that comes to my mind is, of all the fabulous fifties songs, THIS will be my last song I ever hear if I don't make it out of surgery!!!???!!!!

Don't worry. I pulled through. 

Just as before, the staff were more than considerate when I voiced my fears of medical procedures while they were wheeling me into the surgery room. One man told me not to worry and to think of it as a day at the spa. I must have been the first to reply with, "I didn't pick out my nail polish color yet." I made myself laugh. He was not amused. 

My next memory is waking up in the recovery room. Of course, my first surgery experience wouldn't be typical. I got used to that recovery room. I was there the entire day. I was supposed to be moved to a hospital room. But there were no rooms at the inn that day.

It felt like it was almost immediately after coming out of the anesthesia that I was told that the stars were cancer. I remember speaking with my mom and Jeremy over the phone because I was still in a recovery area they were not allowed in.  They moved me off to a corner and as out of the way as possible. But at least at that point Jeremy and my mom were able to come back to see me.

After several, long, hours and being moved one more time, I was released to go home to my three week recovery period.

Just My Luck

Since my lung cancer diagnosis there has never been, why me? When talking about my lung cancer, the words, luck and lucky have come up over and over.

• How lucky am I to have a genetic mutation?
• How lucky am I to live in Colorado, so close to University of Colorado Cancer Center and possibly the best lung cancer doctors in the world?
• What luck to be diagnosed just weeks before the World Conference on Lung Cancer in Denver and I was able to register and attend a session.
• How lucky am I to have a beer dedicated to me and brewed in my honor?

That's right! My own beer! My friend, Todd Greiner, is behind this. He made a home brew. I taste tested it in April 2016 during a visit to Ohio. That is when the beer was, I don't know how to say it, 'gifted' to me. He said he wanted me to name it. He would brew the beer in my honor and portions of the proceeds would go to lung cancer awareness and research fundraising. After some brainstorming, we had a name. Lisa's Luck Amber Ale was created.

Todd entered Lisa's Luck in a brewing contest. He won! Fifth Street Brewpub in Dayton, OH is brewing 14 kegs of Lisa's Luck Amber Ale. It will be available on tap mid September.

Todd brewing the first batch of Lisa's Luck Amber Ale

at Fifth Street Brewpub on August 18, 2016

The beer will make it's debut at the Lisa's Luck Tapping Party and fundraising event on September 17, 2016.

Click HERE for details and to RSVP.

Stage IV Lung Cancer/One Year Ago Today...August 14, 2015

One year ago today Jeremy and I went to the appointment to get the results from my pet scan. We scheduled it for lunch time. We had plans to break off of work, go to the appointment, get the info and plan of action and return to work.

With the ct scan only, we knew there was a large tumor in my upper right lobe and I was a good candidate for surgery. We thought we were going to find out when my surgery would be scheduled and what the recovery time would be. We got some very different and shocking information...

INOPERABLE, INCURABLE,

STAGE IV LUNG CANCER WITH METASTASIS TO THE SPINE

We did not return to work. That wasn't what we had prepared ourselves for.

Lisa's 8/14/2015 Facebook post, hours after diagnosis

Not many stage iv lung cancer survivors get to celebrate a one year CANCERversary.

I got to have one hell of a celebration last night.

F*ck lung cancer with LessThan Zero
at the 1 Year CANCERversary Party

Lisa doesn't play bass, but looked the part
while sharing her lung cancer story.

Lisa and Jeremy

I'm sure that out of the ones that get to celebrate the one year mark, not many are NED, like me.

I did not beat lung cancer. I am not cured. I don't get to celebrate winning. I celebrate surviving. My fight is ongoing and has no end.

I would love to say I'm no different than I was a year ago. But so many things have changed.
I've lost:

• Energy
• Half of my hair
• My complexion
• Friendships
• A year of exercise and running
• Fears
• Life as I knew it

But I've Gained:

• A new appreciation of life that I think I could I have only achieved by facing the possibly of death head on
• Friendships
• Fears
• New traditions
• New motto: No missed opportunities...When you have a 4 hour layover in Utah. Don't sit in the airport. Jump in an Uber and track down the best burger in Salt Lake City.

One Year Ago Today...August 4, 2015

One year ago today I had the biggest medical procedure I had ever had, up to that point. August 4, 2015 was my bronchoscopy. This is a scope biopsy to get tissue from my largest lung tumor for testing.

I remember some things about that day. To say I was scared is an understatement. I had avoided all things medical my whole life. I do remember the nurse who was in charge of getting me prepped for the procedure. She made things a little easier after I told her why I was so scared.

It's funny how the mind works. Of all the things I should remember from that day, I remember the shoes I had on. They were my new Keds. I bought them that summer and only really worn them with my retro outfit I sewed for the Brian Setzer concert several weeks before. I called them my "cute shoes".

Brian Setzer concert, Hudson Gardens Event Center, June 14, 2015

While I was laying in the bed, scared, I would look down at my shoes and remember how much fun Jeremy and I had at the concert. And I thought about how I felt that day in my retro dress with my cute shoes.

I remember being in the biopsy room. The Drs. and I looked at my CT scan together. We discussed why I was having the procedure. I was given a sedative and someone either said I would smell or I would taste something bad. The next thing I know, I was back in the first room with the nurse and my mom.

I know someone from pathology looked at the biopsy that day, immediately after the procedure. Someone told my mom that it looked like cancer. They would send it off for testing and it would be several days before we would receive a confirmation.

I know my mom told me this news at some point that day. I don't know if it was the sedatives and my selective memory. I can't remember that exact conversation or the location of the conversation. Was I still in recovery? Were we in the car on the way home? Or was I at home?

I do know that I stayed off the Google searches. I didn't want to waste time searching for ailments and diseases I may or may not have. I waited to Google until the biopsy results came back and were official.

World Lung Cancer Day 2016

Today was a very special day for two reasons.

One Year Ago Today...July 24, 2015

One year ago today the Uncle Samta windsock was hung with care and the first toy donation was under the tree. I had last minute preparations to complete for our Christmas in July party that was scheduled for the next day.

One other thing I had to do that day was get a CT scan. This was the next step after something cloudy showed up on an xray two weeks before. I was to get the scan and have a follow up office appointment, a week or two later, with my primary care physician, Dr. Bird. I never expected a follow up phone call within hours of my scan appointment.

It was Dr. Bird. I can't remember the words he said. Whatever it was it sounded serious enough for me to grab the nearest pen and piece of paper and started writing words and notes from our conversation.

For other breathing issues I had a CT scan in 2008. So we had a baseline to compare to. When referring to my upper right lobe he used the words, mass and slow growing neoplasm. There were spots and nodules throughout both of my lungs. The nodules looked like an infection in the scan. I had been tested for TB. But it was days before we had the final results. There was a possibility I had tuberculosis. But I hadn't been out of the country or around anyone with TB. I discussed the party with Dr. Bird. I didn't want to spread an infection to my family and friends. And I didn't want to cancel the day before. He suggested I cancel the party. But if I decided to still have the party, I needed to keep my distance, wear a mask and not cough near anyone in case this was an infection. He referred me to a pulmonologist for the next test, a bronchoscopy, scope biopsy, to determine if the neoplasm was benign or malignant.

I had never heard the word, neoplasm. So I went to the internet to look up the definition. 

It was the the first time the word cancer had come up. I decided to stay away from the internet research until we knew exactly what we were dealing with. I didn't want to waste time and energy researching anything that didn't pertain to me and my condition.

I decided the show must go on. I didn't cancel the party. I didn't wear a mask. I had been around so many people at home and work. There was no way I had a contagious infection. Someone would have caught it by that point. We had fun, drinks and laughs that night. And we collected a bunch of toys for the Bob Telmosse Christmas Giveaway.

It was a good time and a much needed distraction that weekend.

One Year Ago Today...July 9, 2015

This is the first in a series of, "One Year Ago Today" posts.

One year ago today, on July 9, 2015, I met the man that ultimately saved my life.  One year ago today was my first appointment with my (then first and new) primary care physician, Dr. C. David Bird.

I explained to him I was having some shortness of breath and a persistent cough. I told him of my intermittent breathing problems and my brief, two appointment, history of going to two different urgent care type facilities and being told told, both times, (Dec 2014, June 2015) that my lungs sounded clear, when obviously to me they didn't feel clear.

At my Dr. Bird appointment I had an xray. That xray showed something in my upper lobe of my right lung. Dr. Bird said, although it may be the cause of my breathing problems, an xray wasn't enough to go on. He ordered a follow up CT Scan. The rest is history.

Why is it important to have a primary care physician? For me more frequent check ups, with one doctor, may have meant an earlier detection, possibly before a stage iv, inoperable, lung cancer diagnosis.

December 2014, I went to an urgent care type facility with what I thought was bronchitis. I was told my lungs sounded clear and my cough was from post nasal drip. Now, at the time I did have a terrible head cold. But at the appointment I made it a point to tell them that I coughed constantly, even without the head cold. I remember saying, "Jeremy says I cough all the time." No xray, no additional questions about my cough, no follow up suggested. I was given sinus meds to clear my head and sent on my way, like every other person with a head cold and post nasal drip that winter.

Fast forward to June 2015. Again, I thought I had bronchitis. I went to a different urgent care type facility. I told this Dr. that I felt like I had bronchitis and I coughed blood one time. I was told my lungs sounded clear and I had the tail end of a virus that was going around. No xray, no additional questions about my coughing blood, no follow up suggested. It really was one time, one cough, but I COUGHED BLOOD! I was given cough medicine and sent on my way, like every other person with that virus last summer.

It's so frustrating to think about stage iv lung cancer having the same symptoms of other, easy to fix, ailments.  It's also frustrating to think about the in and out exam offices and the lack of attention to individual patients. Or is it the lack of lung cancer education in the medical community altogether?

I owe my life to Dr. Bird.  Dr. Bird, a physician that listened to me and followed through until we knew exactly what we were dealing with.

One year ago today my life changed completely. It was just a few weeks later I would find out exactly how much it was going to change.

Peace Lungs and Football

I ran into an old gym friend and postal customer this week while I was at work. It had been over a year since we last spoke.  He asked how I was doing.  I said I was fine but followed with, "You won't believe what happened to me. I still can't believe it myself." I proceeded to give him my most condensed version of my lung cancer story. I've got it down to a few sentences for situations like this.

"In August 2015 I was diagnosed stage iv lung cancer. My cancer has a specific genetic mutation. My chemo is a pill. My last scan showed no evidence of disease. I love my job, so I'm still working and things are going well."

I'm very public with my story on Facebook, Twitter and this blog.  My co-workers know about my lung cancer. Delivering mail is one of the few things I have that isn't connected to lung cancer and being sick. I've been very selective in telling only a handful of customers about my diagnosis. But the very few that do know are now my biggest cheerleaders. I know it's no coincidence that the people I chose were either a cancer survivor themselves, had a personal connection to lung cancer or had a close family member diagnosed with cancer after I shared my story.

 

I've had the privilege to publicly share my lung cancer story two times this month. The first was at the Denver Lung Force Walk. It was such an honor to share my story along with three other Lung Force Heroes. Every story you hear starts with the initial lung cancer diagnosis shock and continues with courage, bravery, inspiration and hope.

I was a member of the Lung Force Walk Committee. This was my first time volunteering on the committee. It was exciting to help plan and be behind the scenes of such a successful event.  Thank you to everyone that participated and donated. We exceeded our fundraising goal by raising over $40,000!!!

 

On June 17, 2016 I shared my lung cancer story at the Patient Advocate Breakfast at the International Association for the Study of Lung Cancer.

Patient Advocate Speakers with IASLC staff

At the breakfast I heard the perspective of lung cancer from a 10 year old boy, Coy, who's mother, Kathy Weber, is a lung cancer survivor. If that doesn't hit you in the heart, I don't know what will. Kathy and Coy also spoke of their Pro Bowl experience. Kathy was the second highest fundraiser for last year's Team Draft Lung Cancer Survivors Super Bowl Challenge. Kathy and her family won a trip to the Pro Bowl. I've been interested in this contest since the first time I heard of it.

 

Football and the Cleveland Browns have been a big part of my life. Even more so this last year. I received my lung cancer diagnosis during the NFL 2015/16 preseason. Jeremy and I attended the first preseason game together. At that point we knew I had non small cell, adenocarcinoma.



Browns preseason game, August 13, 2015

The next afternoon was the appointment when we found out it was stage iv. The Cleveland Browns and the Pikes Peak Browns Backers were there for me each week during the first couple months of testing to getting my full diagnosis and adjusting to my radiation and targeted therapy treatments. At the time I was scared to make plans and go places. I called going to games my "Football Therapy". Watching the Browns is not so therapeutic for my blood pressure.  But it felt good to get up and out of the house each Sunday. Treatment could take my energy. But it was NOT going to take away my Browns.

 

Another speaker at the breakfast was Chris Draft, founder of the Chris Draft Family Foundation and Co-founder of Team Draft. Chris' wife, Keasha Rutledge Draft, lost her life to lung cancer in 2011. He is my lung cancer advocacy and fundraising hero. I didn't hesitate to tell him either.  He's an inspiration to me to continue to raise funds and to share my story as often and as loudly as possible while spreading lung cancer awareness.

 

 

 

~ Lisa's Lung Cancer Story ~

In August of 2015, at the age of 44, I went from having a very active, healthy, life with a persistent cough and a little shortness of breath, to finding out I have stage iv non small cell lung cancer. At the time of my diagnosis my lung cancer had already spread throughout both my lungs and to my spine.

Lisa climbing the Manitou Incline
~June 2015

How could this be?  I had no pain. I was a city letter carrier on walking routes. I would go to runner's club once a week, after a full day of work. Just weeks before my diagnosis I climbed the Manitou incline and ran down the Barr Trail, for the first time. The incline has more steps than the Empire State Building.

My incline experience was a major red flag. When people asked about it, I would say it was easy, but couldn't breathe or I couldn't catch my breath. I heard myself say that over and over. A friend asked me to do it again and go with her for her first time. I said yes at first. But backed out. I needed to find out what my breathing problems were before doing the incline again. I didn't want her first incline experience to be a helicopter rescue for me.

I had to find a primary care physician. I explained my intermittent breathing problems. I told him I had gone to 2 urgent care type facilities 2 times in the last 6 months thinking I had bronchitis and being told my lungs sounded clear. He ordered an xray that day.

I'll let you know that up until this point I had avoided anything and everything medical. I still have my tonsils. I have my wisdom teeth. I never had a baby because it involves medical procedures.  With that being said, within 9 weeks I had:

• Xray
• CT scan
• Scope biopsy
• PET scan
• Blood draws
• MRI
• Surgical biopsy
• Appointments between appointments
• Received my full diagnosis

It was almost like new information and results were coming in every two weeks.

• I have a tumor? Ok, I can deal with that.
• It's cancer? Ok, I can deal with that.
• It's stage iv? WTF!!!!????!!!!

My lung cancer has no cure. Surgery is not an option. My cancer can be managed. Early on I asked a doctor how long can it be managed for. He said they can't give a time frame because of so many different drugs, new treatments and clinical trials. 

I was curious  and researched some information on my own.  The statistics I found were old,  but said I had a 3 to5% chance of surviving for one year.  I beat those odds!

 I joke that I got into lung cancer on the ground floor. 6 lung cancer drugs were FDA approved in 2015. 5 of those were after my diagnosis. That gave me hope.

I started my treatments with an oncologist and radiologist in the UC Health Network at Memorial Hospital Cancer Center in Colorado Springs. After experiencing uncommon treatment side effects I switched my oncologist to Dr. Ross Camidge at UC Denver at the Anschutz Cancer Center.

I had 10 radiation treatments to shrink the largest tumor in my upper right lobe. My cough and shortness of breath disappeared. I started my targeted therapy. Because my cancer is caused by the EGFR gene mutation, my chemo is targeted treatment in a pill that I take once a day.

My first follow up PET scan showed the large lung tumor had disappeared. All the tiny starlike nodules throughout both my lungs were gone too. Since then I had a one time, high dose, radiation treatment to the spinal tumor to help reduce some new pain it was causing.

Lisa with other lung cancer survivors at
the World Conference on Lung Cancer ~September 2015

After the initial diagnosis set in I experienced every emotion you can imagine.  I'm happy to be alive and for the support from my family and friends.  I have fear of the unknown. How long will my current treatment work?  I got hope after meeting several stage iv lung cancer survivors at the World Conference on Lung Cancer, which just so happened to be in Denver in Septemer 2015, just weeks after my diagnosis.  I was angry about my late diagnosis, the public stigma about lung cancer and the lack of research funds.

That anger took me to the internet. I found blogs, videos and twitter accounts from lung cancer patient advocates and the organizations they are involved with. I found the American Lung Association and Lung Force.

Lisa in her Team PLH hoodie
~September 2015

I created Team Peace Lungs & HappinessTM along with two of my oldest and dearest friends. I started this blog to post my own lung cancer info, treatment updates and personal accomplishments, along with my Facebook and Twitter posts.  Team PLH participates in fundraising and advocacy events.  The team comes together to spread lung cancer awareness and raise funds for much needed research to improve my quality of life and eventually fund a cure for lung cancer. 

Adjusting to lower energy levels was more of a mental than physical challenge. There were some days with pain and discomfort. I still went to work. Life hsd to go on. But instead of just living life day to day, I now appreciating every moment of it. I jumped at the chance for any and all experiences. My new motto: No missed opportunities.

As of June 11, 2018, my lung cancer found a way to resist my targeted therapy treatment.  I started a new targeted therapy drug,  Osemertinib (Tagrisso) on May 1, 2018.  I should have results of my latest ct scan in a few days. 

With good doctors, the latest treatments and my positive attitude, I continue to live an active, otherwise healthy as possible life... with lung cancer.



Viva Las Vegas ~April 2016