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Thursday, April 30, 2015

Cancer: Diagnosis Part II

Waiting is the worst. Then the results are the worst.  As warned, my MRI showed a lot of little marks.  Cysts here, cysts there, blebs all over the place. (I have no idea what a bleb is, but the pathology report says I have them.)  It noted the scoliosis in my lower spine which I have long known about and showed -- woot! -- minimal degenerative changes; it showed some old scarring in my right lung.  And then, because life wasn’t complicated enough, it showed two nodules in my lung, nodules where no nodules should be.

I completely freaked.  The nurse who should have reported the findings to me was away for the day, and the woman who I spoke to left me with the idea that these nodules (even after I cleared up my confusion that nodules weren't the same as nodes as in lymph nodes -- and what would they be doing in my lungs, anyway?  I was distressed and confused.), those nodules could be cancerous. 
               
“But it has nothing to do with the cancer in your breast.”

Oh, thanks, lady, thanks a lot.  Like it’s comforting knowing that my lung cancer isn't related to the cancer in my breast.  WHAT IS WRONG WITH YOU?!  From there it didn't matter that she told me the scarring was nothing and the nodules were probably inflammation.  Nothing mattered except that lung cancer is very, very bad indeed.

 I knew better than to go trolling on the internet, but that didn't stop me.  I can be as much of an idiot as the next person, and I was.  After about half an hour, I realized that reading about how awful lung cancer is was not helpful, and I set off for quilting workshop.   Normal, yes, normal is what I needed, and what could be more normal, more apple pie, than quilting.  I lasted an hour.

When I returned home, my husband and my wonderful friend had researched the Cleveland Clinic and Web MD -- you know, decent, informed web sites -- and reported that there was a lower than 4% chance that I had lung cancer.   They read that something like 90% of stuff (I’m using the scientific term here) in the lungs showed up when people were imaged for something else, like I was.  To put it even more clearly, a lot of you are walking around with little medical things in your body that you should be glad you don’t know about.

The mean lady (or, more accurately, the clueless lady) from the doctor’s office (and she is the only bad experience I've had so far) said the surgeon wanted me to schedule a CT scan of my chest for a better look at those nodules.  Just, you know, to be sure.  My appointment was 48 hours later.  (See?  Dire medical issue = fast medical attention.)

But, hey, that left a whole 24 hours in between.  No need to be bored.  I had a consultation with my radiologist.

My radiologist, what can I tell you?  He has a big intellect and puppy dog eyes.  Who wouldn't love that combo?  To top it off, he likes gin and tonic, a thing perhaps not discussed in all radiological consults, but, hey, that’s the way I roll.  He reassured me that the size of the lung nodules made them almost certainly insignificant and promised me the short, 3 1/2 week course of radiation.  I was to line up a preparatory simulation three weeks post-surgery, and he’d see me then.

The rules for the CT scan were firm:  nothing to eat drink, chew or swallow from midnight the night before.  No gum, no meds, no nothin’.   I asked if the scan was going to be with contrast, explaining my vein issue.  The scheduler didn't know but, bless her, suggested I drink two glasses of water before going to bed which I did.  The next morning, the needle slid in like silk.

The technician warned me that the dye, as it infused, made patients to feel like they’d wet their pants.  What kind of weird side effect is that?

Since the CT scan is a three dimensional picture, you can lay on your back.  Your arms are placed just so, and into the machine you slide.  A female voice orders, “Breathe in.  Hold your breath.  Relax.”    And do you know what this proved to me?  Forget science fiction:  the robot revolution has already taken place, and the robots won.  You think you’d resist?  You would not; you do exactly as the robot says. 

Half way through the scan, I felt warm liquid seep down my urethra, and I would have guaranteed you, I WET MY PANTS!  I mean, it felt like I was laying there with warm, wet pants.  Did I move?  Did I protest?  I did not!  The robot was ordering me to breathe and hold, and in case I was tempted to resist, the female robot took a break only to be replaced by what psychologist probably determined was more a authoritative male robot voice.

“Breathe in.  Hold your breath.  Relax.”  The stakes are high, and you are not going to blow it by disobeying your Robot Overlord.   

The scan was over.  I had not, in fact, wet my pants.  The nodes were reported as inflammation, probably left from a bronchial infection (ah, that time I had walking pneumonia).  The test would be repeated in six months for safety and to ensure my aggravation factor did not drop below the requisite level. 

I called the surgeon and scheduled my surgery.

Monday, April 27, 2015

Cancer: Diagnosis Part I

 I deliberated long and hard about posting this entry.   Not everyone shares my sardonic sense of humor.   (In fact, have you noticed, some people have no sense of humor at all.)  I do not want to upset or offend anyone.  I was hesitant, even with this disclaimer.  However, a friend of mine with a similar experience urged me to go through with it, so here we go.

I became apprehensive when they completed my follow-up mammogram  by walking me down the hall for one with ultrasound.  The ultrasound exam room had a lot more fancy equipment, but the exam table was the same.  I lay down on it and turned on my right side so the technician could view my left.  Her wand looked a rather like a grocery store scanner, and I asked her to turn the screen so I could see the image.   As she scanned my breast, even I could discern the distinct mass on the image.  I wanted to schedule surgery right then; if there was any kind of lump in me, I wanted it out.  The technician reasonably told me that they had to learn more before digging around. 

Two days later I was back at the hospital, a capable nurse explaining how, once my breast was numb, the guide wire would be inserted and the biopsy tool would follow, making a loud click-clack each time she took a sample.  Three truly loud clickety-clacks followed, with me craning my neck to watch the screen.  I know, I know, not everyone wants to see their medical tests being performed, but I like to KNOW!

When they called me with the results, I walked around in shock.  “I have a lump in my breast, and it’s cancerous.  I have a lump in my breast, and it’s cancerous.”  After 24 hours the news sunk in with a thud:  “Holy $*#%!   I have breast cancer!”

I had a Stage 1, non-aggressive, invasive ductal carcinoma.  In person-speak, this means the cancer began in a milk duct and then seeped out.  The lump was small and slow-growing (relatively speaking.  I learned that a on average, a breast tumor doubles every 100 days!).   This was good news as far as bad news goes. 

The speed with which medical things happen is in direct correlation with the severity of the illness.  It took me less 24 hours to get an appointment with the breast surgeon. (And just a brief note of appreciation here:  the nurse at my primary care office called me back within an hour with a recommendation that matched one from the hospital, and my physician called me that evening just to talk!)   

My breast surgeon is fantastic.  She is both skilled and nice.  I would much rather go out for cocktails with her than bare my breast, so to speak.   Her first step to removing all doubts about my diagnosis was to send me for a breast MRI.

The breast MRI is a unique and bizarre test.  I mean, I’ve had MRIs before.  I am not claustrophobic.  I crawl inside that tube with complete serenity.  I get so comfortable, in fact, that the MRI drum beat puts me to sleep.  But a breast MRI?  Oh, so different.

First of all, as I found out when I arrived at the hospital, this was an MRI “with contrast.”  I discovered that “with contrast” means they inject dye into a vein so that the MRI can be taken while the die infuses and defuses.  This might not matter for you, but my appointment was first thing in the morning, and had I known, I would have drunk two glasses of water when I got up.  When I’m dehydrated, my veins collapse like deflated balloons.  It took two technicians and four tries to get the line inserted.  And, yes, I watched every try.   It didn’t hurt much, but it was damn frustrating.

You walk into the MRI room with your IV lines dangling and arrange yourself on the platform which is slightly tilted head down.  You can’t lie on your back because then your breasts will pancake.  To get clear images, you have to lay face-down with a headrest rather like that on a massage table.  Unlike a massage table, however, there are two square openings in the platform at chest level.  “Square,” the nurse affirms, “must have been designed by a man.”  The square holes are HUGE:  designed by a man for sure.  You fit yourself into the holes, and the technician gently tugs your breast through and positions them for an optimum portrait. 

There you lie, your round pegs dangling through the square holes.  The platform slides into the MRI tube.  You feel like the star of some weird porn movie.  The machine clicks and ratchets and pounds. Your sternum hurts because it is taking all your weight between the square holes; your forehead hurts because your head is heavy.  Between rounds, you try to subtly adjust yourself, but the nurse cautions you to hold still.  This is a half hour when people pray or meditate or visualize or, you know, write blog posts in their heads. 


The test was to confirm that the cancer had not spread.   My surgeon warned me that a lot of little things show up when they do an MRI, things that are not important and they are not looking for.  She warned me not to freak out when such images were reported.   The results were due back in two days.
Waiting is the worst; at least, you hope it is the worst.