Sunday, April 26, 2015


This post is being written by Cara's husband Jeff.

Sadly, Cara passed away at 4:15 am on Friday, April 24 in a room on the Palliative Medicine floor of the Cleveland Clinic. Her mother and I were with her when she passed. I know how many people loved Cara and were following her struggle through this blog, so I want to attempt to provide some closure.

At Cara's previous doctor's appointment, when we received the news that there had been further progression of her cancer and she would be stopping Zykadia and entering an immunotherapy clinical trial, I remember she said to her mother something like, "You know this is probably going to kill me some day, right?" This startled me. Although I knew she was right, I had never heard Cara say this before. Nor had I ever said anything like it to her.

She did not say it meaning that she expected to die soon. Not by any stretch of the imagination. But maybe a part of her sensed something.

After that appointment, Cara went back on supplemental oxygen for the first time in over a year. Considering how close to death she came around Thanksgiving of 2013, it's really remarkable that she was able to do so well for so long. It's a real credit to the doctors and scientists working in the fight against this horrible disease. Cara was prescribed 2 liters/minute of oxygen. We were set up with a condenser to use at home and tall oxygen tanks that could be wheeled around for use outside of the home. Cara began a draft of a post here that she never finished writing, although she did post her Photoshopped image and caption to her Facebook. The unfinished draft went as follows:

As long as I have to wheel around 5-liter oxygen tanks, I ought to be able to put them on a "corn popper". 

I feel like that's what I have when I'm pushing it around, the only things that are missing are the brightly colored plastic wheels, balls, and the sound.
On Sunday, April 12, Cara and I went to an organizational meeting for the Breathe Deep Cleveland charity walk/run that she had taken the initiative in founding. It was a great meeting; we all shared a lot of ideas and made plans for a wonderful event. Cara talked about how she and one of the other women could go around to businesses to solicit donations for the event, and Cara said it might help get donations if she had her oxygen with her. She might as well take advantage of it while she could, was the thought, since we were very hopeful that the upcoming clinical trial would once more take away the need for supplemental oxygen.

Cara wanted to have the small, portable tanks that could be worn over the shoulder so it would be easier for her to do things outside the house. She needed to be evaluated by Home Health Care before getting this, because the small portable tanks use a pulsed rather than continuous flow and it has to be verified that the patient's oxygen levels can still be maintained adequately, so I called to set up an appointment. She did not want to take time off from work (I know, isn't it crazy that she was still working 30 hours/week??), and Fridays were the only days she wasn't working, so I ended up having to schedule the appointment for the Friday of the next week - that is, Friday, April 24 - at 9:30 am.

In the days after that Breathe Deep organizational meeting, Cara began to have a little more difficulty breathing. She dialed up the oxygen flow she was receiving, especially when she was going up the stairs to our residence on the second floor of a house. On Thursday the 16th, I picked her up from work as usual. When we got home, she really, really struggled going up the stairs.

Friday was her day off, and she stayed home all day. By Saturday, it was exhausting for her to just walk between rooms of our house. We decided that we really needed to go to the hospital. When it was time to go, she said that she couldn't do it; it was too hard. I told her that that was all the more reason we did need to go. Finally, we went. It was a horrible struggle for her just to go down the stairs.

We went to the ER at about 6:30 pm and ended up spending the whole evening there. Cara was given a CT scan and had blood work done. After she messaged her oncologist, he called me and told me he had looked at the CT scan at home and didn't see a dramatic difference from the one of a week and a half prior. He also noticed that her white blood cell counts were very elevated. He said it would be unusual for cancer to change so much in such a short time to explain why she was suddenly having so much trouble breathing, so he suspected she might have an infection such as pneumonia.

Cara was taken to the ICU, and began receiving antibiotics in the hopes that it was an infection. The next day, Sunday, her mother came up from Columbus to join us.

The days that followed are something of a blur. Remarkably in retrospect, for the first couple of days after going into the ICU, Cara began to feel better. She was having less trouble breathing, and the oxygen flow she was receiving was dropped from 12 to 10, to 8, to 6. The antibiotics, it seemed, were working. Who knows the actual reason for this apparent improvement - maybe there really was an infection, but it was only on top of the also significant cancer growth - or maybe receiving adequate oxygen after having not done so for several days was the sole cause. But by midweek, Cara started to feel worse again. Doctors said it no longer looked like an infection. Things now began to look grim, because that clinical trial that had sounded so promising would certainly not enroll someone so sick as Cara (and plus, as her doctor explained, immunotherapy takes a lot longer to cause significant improvement than ALK inhibitors do, so it wouldn't have been a good option anyway), and there wasn't really anything else left that would turn things around, because every treatment normally given for her cancer had already failed.

We all became aware that Cara was dying, for real this time. We didn't know when, but we knew that her days on this Earth were numbered. She wanted to be able to see her home and our cats again before she went. There was talk of getting her home. First, she was moved out of the ICU (she hated it there) and to the Palliative Medicine floor. We thought that, because the worsening of her condition had accelerated after she stopped Zykadia, it might help her some to go back to taking the oral chemo. Maybe this would cause a temporary improvement in her breathing and let her get to a stable enough condition where she could safely go home and then live her last days or weeks in a comfortable environment. (Maybe, I hoped against hope, it would cause enough improvement that we could then try something else and extend her life even more. I knew this was unlikely, but I still didn't want to give up.)

It's all so surreal looking back on it. On Thursday, I went to see Cara in the morning, then went to a meeting at work (I work in a research lab at the Clinic, just a few minutes' walk from Cara's room). There I told one of my coworkers about what was going on, and she was very shocked and saddened. She is a Korean woman who was pretty new to Cleveland, and once, a few months ago, Cara and I had taken her to the West Side Market and then lunch at a Korean restaurant. She said that Cara had seemed to strong when she met her. After the meeting, I spent much of the rest of the day at Cara's room, but also did a little more work in the afternoon. That afternoon, Cara restarted Zykadia. She noticed that she only had a few days of pills left, so late in the afternoon I called in a refill of the prescription. At about 7 pm, her mother and I left her to pick up a few things from our house and to pick up pizza for dinner (she wanted to have Papa John's). At that point in time, she seemed to be doing okay enough that we felt comfortable leaving her alone for an hour.

Cara did get to enjoy her pizza. I sat in a chair next to her bed and watched the second half of the Cavs game as they took a 3-0 series lead over Boston. But later that evening, things took a dramatic turn for the worse. A nasal cannula was no longer keeping Cara's oxygen levels high enough, even at 12 liters/minute, and she had to be given a face mask, which she did not like. Her breathing and heart rate threatened to spiral out of control, so she was given more potent narcotics in her IV. This calmed her down, but as nurses periodically checked her oxygen levels, I noticed the levels were becoming inexorably lower even with the face mask. She had already decided that she did not want to be intubated, knowing that this would leave her unable to speak and that, with the way things were going, the intubation would be permanent.

My parents were planning to come up from Columbus on Saturday. At about 1 am, I called and told them she was getting worse and they had better come up that morning instead. She was in a calm enough state that I still guessed she'd make it through the night, although I was by no means certain.

It was not to be. At 4:15 she was gone.

At the same time that the nurse informed us of the obvious (for Cara's heavy, labored breaths had suddenly become very slow and irregular and then ceased completely), my phone's text message notification chime sounded twice. Startled, I looked at the phone. "What was that?" her mother asked. I had received two text messages from my mother. Both messages were blank. Was Cara's spirit trying to communicate with us at the moment she left the world? My mother later showed me that she had indeed sent the messages at 4:15, to tell me that she and my father were leaving Columbus. I don't know what sort of glitch caused the messages to appear blank on my phone (and this wasn't the first time it had happened with a message from my mother), but in any case, it was quite an uncanny coincidence that she sent the messages at that very moment. In a way, it was poetic.

That morning after we had returned home, my mother said she thought she heard a knock at the front door. This was odd, but I went down to check. A man from the Cleveland Clinic said he was here for Ms. Cara McManus.

I suddenly remembered the appointment to evaluate her for personal oxygen tanks. All I could do was to say, "She passed away this morning." He was shocked and offered his deepest condolences.

I miss Cara tremendously, and I am still processing the shock of what happened. Less than three weeks ago, we were optimistically looking forward to a new clinical trial that might extend her life for months or even years. Six days ago, we were in the ICU but thought she had an infection that was improving and that she could get to the trial after it went away. Three and a half days ago, we knew things were very grim, but still had no clue how soon it would be over. I remember Cara, as she talked about how she wanted to live out her last days in her home in the company of her cats and family members, saying repeatedly that no one had told her anything indicating she had to get her affairs in order at that very moment. Because of this, she felt irritated at how the doctors seemed to be pressuring her into making decisions and answering questions.

This is undoubtedly a depressing post to read. It has not been fun to write, but it was important for me to do it. Let me try to close on a positive note. Cara was such an amazing person who touched so many people's lives, and the outpouring of love and support we've received since she passed have made me all the more aware of how incredible she truly was. Although I had no idea how quickly the end would come, I can also say that, in December 2013, I would have been stunned to learn that she would live as long as she did. I'm so grateful for all the extra time we got to make so many happy memories together. Without the enormous advances in treatment methods that have occurred in recent years, this never would have been possible. We need to increase our efforts to support this research, so that more cases of lung cancer can be detected early and so that some day even those people who do get the grim diagnosis of stage IV lung cancer can reasonably expect to go back to normal healthy life.

Cara was such an inspiration in the way she persevered and lived her life and I will take that inspiration with me for the rest of my life and I know that many others will too. I will close by sharing her obituary, which includes the details of her funeral arrangements. Rest in peace, my sweetheart.

CARA JOY McMANUS (nee Williams), age 36, avid cyclist who courageously battled lung cancer, died April 24, 2015 at the Cleveland Clinic surrounded by her loving family; beloved wife of Jeffrey; loving daughter of Joyce Williams and Trent Wyckoff; devoted granddaughter of Margie and the late Fred Lon Williams, Jr.; cherished niece of Jean Williams, Janet Hassfeld, Jeri Kinney and the late Joan Williams and William Bryant; treasured daughter-in-law of John and Pamela (nee Harrison) McManus; dearest sister-in-law of Jennifer and Christopher McManus; fond niece to many aunts and uncles on Jeffrey’s side of the family; dear cousin and friend of many. Cara is also survived by her feline companions Mitters and Eponine.
Cara was born and raised in Columbus, Ohio. From childhood, she was a creative and artistic person with a keen sense of curiosity about the world around her. At Dublin Scioto High School, Cara was a proud member of the marching band in which she played the clarinet, an instrument she continued to enjoy playing into adulthood. In 2006, Cara and Jeff’s lives changed forever when the two, having originally become friends after meeting via an online game, fell in love and began a long distance relationship. After meeting Jeff, Cara began to ride a bicycle, and this sparked a life-long passion in her. Cara moved to Cleveland to be closer to Jeff in 2008; the two became engaged in 2010 and married in June 2011. In Cleveland, she became very active in the cycling community. Just weeks before being diagnosed with stage IV lung cancer in August of 2013, Cara completed a two-day, 150-mile MS charity bike tour. Throughout her battle with cancer, Cara’s strength, determination and courage shone through all the more brightly. She continued to show her numerous talents in hobbies such as cooking and drawing, continued to work diligently as a test proctor at Case Western Reserve University, and continued to light up the lives of all those around her with her wit and spirit. She also was instrumental in founding the Breathe Deep Cleveland lung cancer charity walk/run, an event she continued to work on into the last weeks of her life. Cara will be remembered most as a determined, passionate, courageous and effervescent woman who brought great joy to everyone who was lucky enough to know her.
In lieu of flowers contributions may be made in Cara’s memory to Breathe Deep Cleveland,
Celebration of Life Service Wednesday, April 29, 2015 at 10 AM at THE DeJOHN-FLYNN-MYLOTT FUNERAL HOME OF SOUTH EUCLID, 4600 MAYFIELD RD. (just east of Green Rd.). Graveside Service will take place at Union Cemetery in Columbus, OH at 2:45 PM on WEDNESDAY. Family will receive friends to pay tribute to and celebrate the life of Cara at the FUNERAL HOME TUESDAY 3-5 and 6-8 PM.

Wednesday, April 8, 2015

Told Ya.

Yeah, so the scans weren't so great. Not like "Oh my god, your lungs are going to explode" but more like my lungs looked "different" and of course, my liver continues to be an asshole.

So yeah, whatever. I actually felt better after hearing the bad news because I knew I felt crappy. It wasn't a surprise, really. Plus...The next words out of the mouth of my oncolgist were:

"I have a plan..."

And yeah, I might've pictured him as Willy Wonka after he said this, only because he was really pretty psyched about this plan - and not like a "OMG THIS WILL TOTALLY WORK FOR YOU" but if you've ever seen a scientist get excited about the way stuff works, the sort of pure whimsy and excitement that you hear in their voice or see in their faces... Yeah, like that.

The (sort of) bummer is that I'm back on oxygen. I say sort of, because I actually feel a LOT better on it. When I got home and slowly crept up the meager amount of stairs to my house/apartment I threw myself on the couch (walking past the condenser) and gasped "Turn it on, please" which somehow magically my mother understood - flipped the switch and handed me the tubes. Within a minute, I could breathe without gasping. An hour or so? I stopped coughing. It's supposed to be for when I'm moving around but they didn't bring me any portable canisters - but I want to go to Target tomorrow so I might have to be that jerk that takes a motorized cart and drags a canister the size of an adult leg behind me. Who knows.

It's not really a negative, though. Yeah, the plastic tube across my face certainly is a kind of beacon that hey, there's something wrong with me. People will probably make assumptions, whatever. Why isn't it a negative? Let's think about this. It makes me feel better. And let's be honest, if wearing neon orange boyshorts in public makes you feel better, do it (unless it breaks some sort of law where you live). No, that's a bad comparison to make. Oxygen = good. Whether I get it straight from the air around me or from a condenser or tank, it's a good thing. I will deal. I'm not even the slightest bit bothered by it, honestly.

So the fact that the medication wasn't doing a whole lot but making me throw up, guess what? I don't have to take it anymore!

I'm in the paperwork phase of another clinical trial (remember that plan?) for some promising Immunotherapy stuff. I'm serious when I say my doc was excited about it. I kind of hoped he would have made some crazy gesture with his arms and would have said "Just look what SCIENCE can DOOOOOO!"

Muhahahahaha!! (Ignore the gun in Boris' hand)

So yeah, we wait. That's okay. In the meantime I will breathe and the world will keep on turning!

Monday, April 6, 2015

I can't even.

I don't want to crap all over my last post, which was pretty sunshine-y but real talk?

I don't feel good. I have scans tomorrow and I don't feel good about it at all. The one thing that keeps me from sinking into a pit of bottomless despair is that I know there are other things we can do.

I've felt kinda crappy for a couple of weeks, ever since I got back from Miami Beach, really. I've never wanted to have a cold so badly in my life. I'm coughing every so often. When I cough I lose my breath. I'm short of breath going up stairs. I don't know what would happen if I rode a bike. I don't have a fever, I just feel lousy.

I'm anxious. I'm scared every night that I take my chemotherapy drug that I'm going to wake up the next morning vomiting. I'm terrified that I'll have to either go to work sick, or call in. I hate being a burden on anyone, much less an employer. I know, I know.

It's not my fault.

You can tell me that until you're blue in the face and it doesn't matter, though. In addition to my anti-nausea pre-meds, I've been taking Xanax nightly to deal with this creeping fear/anxiety. I don't like letting people down. I hate it when people think I'm doing a second rate job (being social, being a friend, writing e-mails/texts, whatever) on something on purpose.

I know 99% of people understand this. I'm not vaguely calling anyone out, I'm just saying what I'm saying to say it. So it can be said. I said it, get it?

Stay with me...

Positives? Okay, sure. Bone pain has been less, overall. I have discomfort in my shoulder the most lately, but a warm heating pad helps. So, there's that - but do you know what makes me SO ANGRY? Earlier, I couldn't really walk any distance because my legs hurt. Now I could probably walk to the drugstore and whatnot but I'm so tired/short of breath that it's a chore. I would kindly like my body to stop screwing with me. 

I think if it were a sentient being, Cancer would unabashedly admit that it enjoys making people miserable. It would laugh and laugh as I cried and cried. Cancer would find my coughing HILARIOUS.  

See what I did there?

Seriously, I hate you Cancer. I wish you'd die (and not take me with you).

So I would say yeah, I've got "scanxiety". I have scanxiety on steroids. I have mega-scanxiety. I want to know, but I don't want to know. If it's working and I've just got a cold or whatever, let's fix that. If Zykadia is a big fat failure, let's move on and not dwell too much on what went wrong (at least I don't want to dwell). 

I hope that everyone is kind to me tomorrow, and if there's bad or less than good news to give - let's focus more on what's next and let's get stuff done - that's what I want to do. I can get better. I've done it before, it's just about trying another key or another piece of the puzzle. 

Today though, seriously...It's hard to be happy. I can't.

Wednesday, April 1, 2015

Good Morning, Sunshine...

There's something about sunshine that makes me a little giddy. The warm blanket hug of sunshine on my face and hair, the way a fuzzy kitty's head smells after she's been basking in the window for a little while... It's good stuff.

Yeah, it's not very warm yet. If I told you that today's high was going to be around 50, many of you would probably shiver out of empathy - 50 isn't that bad when it comes to Cleveland, not after weeks and weeks of sub-zero temperatures anyway.

My Brother-in-Law is coming to visit us tomorrow, and we're going to see a Cavaliers game with him. It should be pretty good! I'm not interested in basketball in the slightest unless it's the Cavs, and I'm seeing it in person. Snobby, huh? Nah, I just think watching a bunch of athletes running to and fro on a TV screen is boring.

Last year, I made a March Madness bracket and busted it on the first day. Don't care.

Spring is definitely coming - I'm anxious to rip the plastic off of all our windows and mop all the floors/walls/everything so that our house smells like sunshine and Murphy's Oil Soap. I don't think we're at that point though, I'm afraid. Not quite. I really miss the outdoors, though. I miss the smell of sunscreen, I miss eating ice cream outside with bare shoulders. I miss a lot of weird things, but you know exactly what I'm talking about because I bet you've experienced and enjoyed a lot of these same things.

You know that feel, bro. You know.

I can't believe we're less than two months away from the Breathe Deep CLE event, it's surreal. I have such high hopes for this thing. We have 15 people signed up and a good chunk of money raised already but we need more. I want this thing to be EPIC. I know it has the potential to be - if you think about how many people are impacted by lung cancer in some way - or hey, even cancer in general... Come give us a shout out. Walk a few miles (you can borrow my shoes, if you want!) and eat a bagel. Hug someone, ask questions, learn things. It'll be fun. My hopes are so, so high.

Remember what happens on this episode of Saved by the Bell? Well don't worry, I'm not going to go on a speed bender and break down in Mark Paul Gosselar's arms (unless he's available?). I'm just a little scared. I'm afraid of failure. I'm reminded of a time when I had a birthday party and only two people came. One of those people stole some of my presents. Why was I friends with her, again? Never mind.

It has to succeed, it just has to. I'm not saying this because my name is all over it - I just want people to come out, take a walk, and learn things. Understand what a huge impact lung cancer has on us all.

There was a time in my life when I liked sweets and candies and overall horribly bad, processed foods on the regular. No, seriously. A "fancy" dinner for me used to be frozen peas, Shake & Bake pork chops, and instant mashed potatoes.

My favorite lunch was Bagel Bites. Ew, right? I did crave them with one of my treatments, but it was a one time thing. They're cardboard saucers with "cheese" and some horrible sauce. If you aren't familiar, be glad.

My point anyway, was that I also used to hoard Cadbury Creme Eggs. I hadn't had one in ages, so I decided to get one. Hello terrible chocolate with gritty sugar filling! I'm kind of sad I hate them now, but in a way, I'm really not. I don't need that stuff.

My love for marshmallow eggs will never die, though. I'll probably buy one this weekend. Maybe. I think we're going to have a "traditional" Easter dinner this Sunday, with deviled eggs and ham and that sort of thing. In other words, leftovers forever!

Monday, March 30, 2015

Truth is the best medicine?

Yes, this is actually a photo of my pills I lined up on my messenger bag right before I took them. No, they don't actually say "This will make you vomit" but maybe they should, right?

I met someone online - another ALK+ NSCLC person who is on Zykadia right now. We shared side effects and ended up being pretty damn similar. In one message the guy asked me, "Do the stomach cramps ever stop?" I wasn't having them at the time, but I know how he feels.

I'm still unsure of whether I have a cold or just trouble breathing. I e-mailed my nurse. I have scans in a week anyway. I still don't like food very much and for me? That's just wrong.

Thursday, March 26, 2015

Past Tense

Nil sa saol seo ach ceo,
Is ni bheimid beo,
ach seal beag gearr.

Lyrics (Gaelic) from Aisling's Song, The Secret of Kells

I caught myself speaking about bicycling in the past tense today, and it really bothered me. I was talking to a friend about ways to grab quick carbs and calories and I linked her to some energy cubes and told her;

"I used to use these on all of my rides."

Then I thought, what is this "used to" BS, huh? I can still ride. I will still ride. I do that sort of thing all the time. I'm like the Browns, I feel like I'm in a "rebuilding season" right now. First of all, I've been sleeping - lots. The only thing I can figure is that there's some sort of epic battle going on inside of me. (At least, that's what I hope)

No more saying "when I used to ride".

I also tend to split my life into BC and AD eras, but not how you'd think.

BC = Before cancer
AD = After diagnosis

That's sort of how things are described by me, when I'm speaking about things in the past tense. I don't think that's unhealthy or anything, it is what it is. On the day I was diagnosed it was like a meteor struck the earth and my surroundings, absolutely everything changed and will never, ever be the same again.

We're now officially "gearing up" for this 5k walk/run in Cleveland in June!! Please sign up, make and/or join teams and you'll be in for quite a treat! You can also donate to me directly, if you don't feel like participating.

And now, for my tangent of the day: Have you ever heard of Fordite or Detroit Agate? I want a piece of Fordite jewelry. I'm going to buy this one in a week if it's still there. From the pendant's page:

"Also known as Detroit or Motor Agate. Originally, Detroit auto manufacturers would tow cars on a rail and pallet system through the paint booths. Over time, the paint over spray would accumulate on the rails and skids, requiring the crews to remove the accumulated paint from time to time to avoid mechanical failure of the system. Some of the workers got the bright idea of taking some of this material home to cut and polish for jewelry. And so was born Fordite!

Cars are no longer painted this way, and haven't been since the 80's. Fordite is a generic term that refers to any chunk of accumulated over-spray paint. All Fordite is, by definition, a recycled use product.

The Fordite material used in this pendant was sourced from Detroit and is from the Ford assembly plant in Wayne, MI."

I have seriously put in in and taken it out of my cart 50 times today. I don't need it, so I'm not buying it. Yet. 

Monday, March 23, 2015

Breathe Deep, Cleveland!

I've been talking off and on about hoping to have some sort of event in Cleveland to raise funds for lung cancer research. After nearly a year of planning, I'm happy to say that our dream has been realized, and that Cleveland will have a 5k Fun Walk/Run to raise awareness and funds for lung cancer research!!

The website is a GO! 

When: June 27th, 2015
Where: Edgewater Park

Event Page
Event Facebook Page
Event Twitter
My Donation Page

I know a lot of people are doing a lot of different fundraising things, but I ask you to send a dollar or two my way. My goal is steep - and if I meet it I'm going to go even higher. Lauren Hill has inspired me to raise as much as I can for lung cancer research. If you don't know of her story, click here. She has raised over one million dollars toward cancer research. If we're being honest, I want to do the same. If you know someone with deep pockets, send them to my donation page!

Honestly, though...I'd be happier if a lot of people donated a little - instead of one or two people donating a lot, but I'll take it all.


I had a weird dream last night. I blame pain medication.

I was abducted. I don't know if it was by humans or aliens, but they appeared to be human. They took me to a place that seemed to be some hippy-dippy "New Age" healing center. They gave me radiation therapy with gemstones that were unavailable to anyone else. I was told I could choose one person to give the knowledge to, and enough gemstones to start the process of developing more stones.

I chose my oncologist. When I returned home (I got the feeling I never left Earth but who knows - this was a dream after all) I was scanned and was cancer free. Cool, huh?

Anyway, I did a bad, bad thing yesterday. I didn't take my chemotherapy meds. Intentionally.

Why? I really didn't want to throw up this morning. The nausea medicine I was given to take in place of Zofran at night before Zykadia actually does work, about 75% of the time. The other 25% I'm very sick for 10-45 minutes. I take medicine to help me stop throwing up, and then I fall asleep. I'm not entirely sure, but I think I slept most of the day yesterday.

Yes, I'll take them tonight and again the next night and so on. But honestly, it's starting to affect my job a little bit. If it's working, I will pick this treatment over my schedule - barfing or no barfing.

I'm a little afraid to be weighed again. I feel like I at least get one good meal in a day - with some snacking here and there... But sometimes I don't. Lots of times, it's completely my fault. I have frozen fruit in my freezer. I could make smoothies. My goal is to work on that.