Coffee heat rising

Health care

Here we go again…

by

Or so I expect.

Today is the day. In an hour or so, I have to drive (eternally!) to the east side of Scottsdale (again!) for another chat with WonderSurgeon. She’ll have the results of the scary MRI exams of both boobs.

Every time I’m subjected to some new procedure by these doctors, the results are always negative and sometimes hair-raising.

WonderSurgeon told me that she wanted an MRI made of my  non-guilty boob, since we propose to kill off both breasts by way of a) making me not have to spend the rest of my life lopsided and b) virtually eliminating any chance of any new growths. She said she wanted to see if anything was in there, so, said she, she could work her way around them.

Well, when I got there it turned out she’d ordered MRI’s of both boobs.

Frankly, that sounds a lot like a fishing expedition to me: let’s find something new to biopsy, to operate on, and to create another three to five opportunities for more surgery. And, to my distress, I found some confirmation of that: a 2013 study shows that “DCIS patients who undergo preoperative breast MRI are far more likely to undergo additional biopsies.” The group of researchers, publishing in the Annals of Surgical Oncology, suggest that the benefit of routine MRI before breast surgery is dubious and may lead to yet more unnecessary procedures…of which, IMHO, I’ve had a-plenty.

So I’m bracing myself, and trying to think clearly about what I’m going to say when confronted with what I’m certain will be more bad news. Sure as I’m sitting here, she’s going to tell me they found some new mass in the other breast and they want to biopsy it. Or that they found something in the guilty breast and want to biopsy that. When I say no, just cut it off, she will say, “But we have to know if there’s invasive cancer because if there is we’ll have to take out lymph nodes.”

Then I’ll have to decide whether to take my chances on whether it is or is not cancer, on whether it’s a DCIS that may or may not morph into cancer, and whether I want to proceed with more torture or just walk away.

A breast biopsy is painful: much more so than a lumpectomy. I really do NOT want to go through another of those, and I’m inclined to say if that’s what she wants, I’m done. On the other hand, I don’t want to just throw away my life.

But on the other other hand, there’s not that many years of life left to me at this point, and breast cancer grows pretty slowly. By the time it takes me away, I will have lived out my allotted years — assuming a heart attack, stroke, or car wreck doesn’t carry me away first.

Dayum, but I hate this!

Black Friday Craziness Casts Gray Pall on Thanksgiving

by

As if the Christmas decorations before Halloween weren’t enough, now we get Thanksgiving dinner cut short by by retailers stirring up riots of buying frenzy along about 6:00 p.m. on the newly dubbed “Gray Thursday.” Jeez. There really is not shame out there.

Like…REALLY? Your buyers, dear Mr. Avaricious One-Percenter Retailer, really and truly can’t wait till the morning after TG to stock up on more STUFF? One article describes people selling their places in line to the highest bidder — and sitting on $90 bids because they know they can get more. What on earth can be worth debasing yourself like that? A 40-inch TV? Sure, $119 is the next best thing to giving it away for free. But you couldn’t get me to behave like that if you did give the thing to me for free.

But then, what the hey…I have no use for a TV set anyway. 😉

My friend Carol and I spent Black Friday at the Mayo Hospital, where I was invited to have my boobs subjected to an MRI preparatory to lopping them off. The last time they tried to get me in an MRI tube — the time I dislocated my shoulder tripping over Cassie — I panicked and ran away. So to lure me back, they had me drug myself with Valium.

Since I don’t take any kind of drug at all (other than a little Maker’s Mark 🙂 ), the stuff had quite a kick. Of course, driving up there was out of the question, so Carol chauffeured me. I’d been told the MRI would take about a half hour.

Well. Yeah. Depends on how you look at it.

About a half-dozen 3- to 4-minute scans (18 to 24 minutes) plus one 15 minute scan do indeed add up to about half an hour. BUT…that doesn’t count all the dicking around beforehand and between times. We left my house at about 9:15 a.m. and got back right at 12:30. THREE HOURS AND FIFTEEN MINUTES.

The morning was shot for both of us. And since I’m bat-brained from the Valium, for me the whole damn day is shot. I’m going to bed whenever I finish cranking out this post.

The MRI itself was not bad. Because they have you lie face-down for a boob MRI, you can’t SEE the inside of the horrid tube, and so it’s nowhere near as claustrophobic and terrifying is it is when they roll you in there face-up. And the noise was just not that traumatic. More strange than anything. As it developed, there was no need to be drugged with Valium — in fact, it made things worse by drying out my mouth so badly it felt like the back of my throat was turning to petrified wood. Would’ve been a lot more comfortable without it.

Speaking of comfort, despite the loveliness of the afternoon and the prettiness of the front courtyard, wherein Cassie and I are writing this, I am retiring to the comfort of the sack.

Good luck in your shopping, if you’re up to that!

Image: Shoppers surging into Target. Public Domain.

Boob Update: Back, Forth, and Back Again

by

Okay, so WonderSurgeon is at last convinced, and so am I, that the best thing to do is to have the boob OFF, and better yet, to get them both off so as to bring a stop to concerns about the other breast and so I don’t have to spend the rest of my life lopsided.

It’s taken a while to get to this point.

Last week (was it only last week?) I went in to see the radiation oncologist. By then WonderSurgeon and I had decided to keep the boob and do radiation and aromatase inhibitors. This new doctor, though, said she would do it but that the chance of recurrence was high and that the side effects I’ve heard about are real. Among them, she said, I will have scarring of the lower lobe of the right lung, which may lead to pneumonitis, which can be life-threatening. Aromatase inhibitors are not yet approved by the FDA for preventive treatment of DCIS, and so they would prescribe tamoxifen, which I have no intention of taking. She remarked in passing that if it were her, she’d have the mastectomy.

So by the time I saw WonderSurgeon, I’d changed my mind in favor of chopping off the boob. Even though I was very certain that I wanted a mastectomy, she wasn’t so sure. She felt there’s a possibility there’s no more abnormal cells in the breast, in which case it would be unnecessary surgery to remove the boob. Between the two of us, the uncertainty factor was enough to give us pause. We decided that she would order an MRI of the guilty boob, slated for next week: if any more mass appears on that, then we would amputate; if not, then we would try radiation and hormone treatment. Neither of us was thrilled with this scheme, but neither of us knew for sure which way to jump.

Well, yesterday she called me up with a new report:

Still worried, she had taken my endlessly troublesome case BACK to her colleagues for another conference. First she asked the pathologist to revisit the samples she had excised and to analyze the results more carefully. Then she asked them for their opinion. And, she said, she was careful to keep her mouth shut and just listen to them.

The consensus, she said, was overwhelmingly in favor of removing the offending boob.

Well, I was relieved.

You know how when you’re worrying about something or thinking about some major project, you’ll wake up in the middle of the night with your brain spinning on it — with no hiatus between awaking and starting to think on the issue? Well, that happened a two or three nights ago. I woke up about 4 in the morning with a perfectly formed thought in mind: Trying to save this breast is the wrong thing to do!

It seemed as perfectly obvious as the dogs sleeping on the bed next to me. I do not want my chest irradiated. I do not want my lung scarred. I do not want pneumonitis, for godsake. I do not want to run the risk of fractured ribs, new soft-tissue cancers, leukemia, and some blood disorder whose name I can’t even pronounce. I do not want my life disrupted for another four to six weeks with daily trips to the hospital for radiation treatments. I do not want to take aromatase inhibitors that will thin my hair and give me joint and muscle pains on top of the nearly crippling back pain, thank you very much. And I most certainly do not want to take tamoxifen!

Furthermore, I do not want to wait five or ten years until a new DCIS, probably harmless, is found in the other breast and then I have to go through this entire nightmare circus again! I do not want to go around lopsided, having to stuff plastic or fabric prostheses in an empty bra cup in an attempt to look normal enough not to frighten small children. And I do not care whether I have blobs of flesh hanging off my chest, because I’m not a young girl anymore and I’m not in the market for a man.

At four a.m., I could not think of how to tell WonderSurgeon about this revelation without making her think I’m crazy. So I decided to wait until the MRI revealed more mystery tissue in there, which I felt pretty sure would be the case. If it didn’t, then I’d cross that bridge when I got to it.

So, weirdly, her call to deliver what she thought would be received as bad news was really very good news.

I told her that I had quietly come to the same conclusion. She sounded relieved that I didn’t burst into tears or some such stupid thing. Then I asked if she would take both boobs off, so as I could be the same on both sides and so we could be certain that no recurrence would appear in the contralateral (medico-talk for “the other”) breast. She agreed to do so. And she even folded on the “no goddamn reconstruction” topic.

We’re keeping the MRI on the schedule, but instead examining the contralateral boob so as to see whether there’s any DCIS in there. She said there was only about a 3% chance that would be so. I reminded her that every time we’ve had positive odds, I’ve managed to defy them. Pessimists drive the poor woman nuts. 😀

Do you realize what this means?

No. more. effing. mammograms. EVER AGAIN!

And….this is the best part…

I will never, ever have to shop for a goddamn brassiere again!!!!!!!!!

WAHOOOO!

Boob: To Be (attached) or Not to Be (attached)

by

Okay, so the Mayo docs have relented on the clinic’s policy to the extent that they’re offering me a choice: if I want to take a chance that the 2014 no-ink-on-tumor guidelines for excision margins are safe, they will give me radiation and hormone treatment. Or, if I prefer not to run the 20 percent risk of recurrence and 10 percent risk of invasive cancer, then they will lob off the offending boob.

Which, they wonder, do I prefer?

A man of my acquaintance thinks I don’t understand anything I read on the Internet, especially if the reading level exceeds that of, say, Cosmo or People magazine. I imagine the editor of Mathematical Biosciences and Engineering would disagree, but that’s neither here nor there. Assuming he’s right that I’ve been overthinking this thing, I’ve done a little cost-benefit analysis, based on my subjective feelings about the matter and informed only by facts available in the most dumbed-down sources available to us pretty little air-headed girls.

Interestingly,  here’s the result, quite the opposite of the direction in which I’ve been tilting.

Boob yea or naySo in this thing, a negative number represents exactly that: a negative. A positive number represents a desirable outcome. A zero indicates either that the circumstance is not applicable or that I don’t care about it one way or the other.

I’ve tried to think of all the aspects entailed in keeping the boob and in having it amputated, and of all the implications entailed in each aspect. Probably I’ve missed some…but I’ll bet I haven’t missed much that matters, at least to me — and this is supposed to reflect my subjective preference.

In terms of whether to keep the boob or not, both options are very negative. We have now heard not one but two heavy-hitting oncologists, both women and at least one of them nationally respected, state that if they personally were faced with this choice, they would try to avoid radiation. I have never reacted well to hormone therapies of any kind, birth control included, and you may be sure that whatever side effects aromatase inhibitors evince, I will be enjoying those. One of them is joint pain. With chronic back pain and sciatica that sometimes flares to the point where I can barely walk down the hall to the bathroom, I don’t feel I need more joint pain. So the fact that each of these therapies has negative side effects, some of them life-threatening, is a bad thing. And even with radiation therapy, the Mayo crew estimates risk of recurrence at 20% and risk of invasive cancer at 10%.

Obviously, the mutilation, the violent surgery, and the ensuing pain of a mastectomy amount to a bad thing, too.

So we’re trying to figure out which is the least bad of two bad options.

And lookit here! Keeping the breast accrues more than twice as many negative points than getting rid of it!

Then we have the fact that these doctors — and one doctor in the wild — are pressuring me to get reconstructive surgery. From what I’ve been able to tell, reconstruction has some failings, most of which result in further surgery or at least disfigurement that you have to learn to live with. Because I am not my boobs, I do not believe that (as one quack informed me) I will quickly become suicidal if I don’t have a fake boob pasted on my chest.

But, just in case I’m staring at this question through a glass darkly, I decided to ask the Excel Ouija board about reconstruction, too. The options presented in my first effort, “Do It” or “Skip It,” seemed a little vague, as it was difficult to know how to score “skip it.” So I tried again with something roughly like a cost/benefit comparison: what are the benefits vs the drawbacks of a) going ahead with reconstruction and b) declining reconstruction?

Here, the result accords more closely with my inclination: the point value of the benefits for no reconstruction outweigh the drawbacks by about three to one. The drawbacks of reconstruction outweigh the benefits by more than three to one. (Would be nice if I’d typed that correctly, but I’m not jumping through the hoops to build and upload a new jpeg for ONE character!)

So. I think this quantifies my point of view on the issue: given two bad choices, the least bad option is mastectomy.

Time for Some Self-Di$¢ipline

by

Welp, I’m officially out of money, at least til the end of the year. The amount transferred from savings to supplement Social Security and teaching income enough to keep me afloat through 2014 is gone…and we have almost two months to go.

{sigh}

This is all incident to the endless health-care flap, which arose last June and has not quit and probably literally will have no end. When I realized I was going to be undergoing surgery — even before I  understood that meant “surgery after surgery after surgery after…” — I also realized that with half my chest ripped up I would not be brushing down pool walls, mopping floors, scouring sinks, scrubbing toilets, oiling furniture, deconstructing and cleaning the gas stove, dusting light fixtures & blinds, and polishing mirrors & windows. So I hired a pool guy and a cleaning lady. That added $240 to the monthly tab.

Then there was having the plumber come and fix up the shower in the front bathroom, where the tub has an easy-to-clean 1970s plastic tub & shower surround. The house’s master-bedroom shower was beautifully renovated by the idiot previous owner, whose parting shot (literally!) was, “Oh, and this travertine has to be stripped and resealed every six months.” Huh-uhhhh…. Between that and the fact that the damn clear glass showers have to be polished dry and the damn travertine has to be wiped dry from ceiling to floor every time you shower, I never use that thing — I’d been using the tub in the front bathroom and taking actual baths, except in the summer when I could shampoo outdoors in the hose after swimming. Since I’m not allowed to get the incision underwater for three weeks after each surgery, that means I couldn’t bathe…all summer long and into the fall. I still can’t get the boob seriously wet. So…I’m glad I had the plumber install a functional showerhead in the outmoded but radically convenient front tub, but still…it did cost something.

So it has gone since last June: one unplanned expense after another.

The car also racked up several hundred bucks worth of bills. It now needs its brake drums replaced: $500.

So, financially I’m back where I was when the university laid me and my underlings off. Except that the stock market hasn’t tanked. Yet.

I probably should buy a new car now, before the Republicans do a repeat performance of their excellent financial leadership under Bush. Presumably within another eight to twelve years my shirt will be tattered again, and so it might be good to have a decent vehicle in the garage. One that the dogs & I can live in… 😉

And speaking of tattered, the diet is getting that way, too. The accursed surgery, which you would think would debilitate one and cause weight loss, had exactly the opposite effect: it’s made me gain weight!

Shee-ut!

I think that happened because I was forbidden to swim, and swimming formed a major part of the exercise program. Now it’s too cold to get in the pool — not that I’m allowed to do so anyway, but within a week or two in theory I will be. Assuming we decide not to lob off the guilty boob, in which case it will be yet another month or two before I can take a real bath or indulge in any vigorous exercise.

After dieting and walking four miles a day this week, the result has been another pound gained!

I’m now about five pounds above the desired weight. Figured that two pounds off a week would restore the coveted sylph-like figure in a month or less.  But that just doesn’t seem to be happening. And I don’t know why. None of the strategies I used to drop those 30 pounds a year or two ago are working anymore!

So, what to do?

Well, first I’m going to have to re-institute the stringent budget. This means cranking out those accursed Excel spreadsheets and tracking every. single. expenditure as it occurs. And staying out of Costco. And staying out of AJ’s and Whole Foods.

Haven’t bought any clothes since the current fiasco started, since I have no idea what will fit on top and no way of knowing until I could see the final result of whatever they end up doing to me.  Now even if we decide to keep what remains of the boob intact, I still won’t be able to buy any much-needed shirts — the old ones are wearing out. And if the boob comes off, I’ll just have to figure out how to cope with the old cleavage-displaying shirts and crocheted tops.

The dogs will have to not get sick or hurt. If they do, they’ll just have to suffer through it.

No more eating out. No more concerts. No more anything that costs any sort of extra money.

No Christmas present for my son. Nor will I be able to entertain over the holidays. Which probably doesn’t matter, because I’ve got to stop eating, anyway.

Assuming no more extraordinary expenses arise, I’ll need about $2,000 to make it to the end of the year — not counting the $500 for the car. Enough to repair the car does reside in a short-term emergency savings fund, so it won’t have to be drawn down, taxably, from retirement savings. But two grand to cover living expenses? Not good.

Between now and mid-December, I should extract about $1500 from the community college district, with both classes in full swing.

That’s going to leave me $500 short. In two months, if I pinch every penny in a vise, lay off the pool guy, lay off the yard guy, and cut back the cleaning lady, I might manage to make that up.

Merry Christmas!

This, That, and the Other…

by

This…

Finally feeling up for re-engaging the exercise routine. The endless spate of surgeries has meant I wasn’t able to use the pool all summer long, and a significant part of the fat-reduction plan has to do with daily, vigorous swimming. The result, of course, is that despite my best efforts to starve myself, the fat is slowly crawling back.

Actually, in moments of particular distress and depression, I’m afraid “starve” was not the operative word: have recourse to comfort foods was more like it. My concept of “comfort food” entails large portions of pasta followed by large portions of ice cream. Or maybe even just a whole meal of ice cream with some fine sauce dumped over it.

{sigh}

Anyway, for awhile there I was as much as six pounds over the desired weight. Now we’re back down to three. So it shouldn’t take much longer to get back down to what I crave to regard as the New Normal.

That…

Speaking of the which, last night Ruby and Cassie BOTH trotted two miles with me, without dragging, sitting down in the middle of the road, begging to be picked up, or otherwise impeding traffic.

The weather is finally cooling down enough that Cassie, whose hair is about three times thicker than Ruby’s, can go more than half a mile without threatening to expire of heat exhaustion. Last night’s low, ô mirabilis! was 46.7 degrees. It was in the 50s when we sallied forth after dark. And I’ll tellya, those were two mighty happy dogs!

Happy human, too.

In the morning, I took them for a mile-long walk, then returned them to the house and went out for a second mile undoglested. So for moi, that amounted to four full miles over the course of the day!

And that’s my target: since I can’t swim or do a lot of yoga, I’m trying for four miles a day. If that doesn’t get the fat off, nothin’ will!

The ’Tother…

Yesterday the Mayo called to set up an appointment with a new radiologist. I’d already seen one, but WonderSurgeon wanted me to see whoever was in the “conference” in which she planned to discuss my “unusual” case. Other than scheduling an appointment with me at the standard three-weeks-later surgical check-up, she has had nothing to say. So I have no idea whether the consensus (if any) was to lob off her Work of Art or that it’s worth trying to save the newly and amazingly rebuilt boob. It may be that she just can’t bring herself to tell me they think it should go. Or it may be that she wants me to hear what this new radiologist thinks are the prospects for therapy. We shall see.

The more I think about it, though, the more I feel it’s six of one, half-a-dozen of the other…and that really, mastectomy may be the smartest course of action.

If that’s what the docs recommend, I’m going to ask if they’ll give me a two-for-one…  Since the entity that seems to have invaded half the right boob has been mammogram-invisible for years, it’s reasonable to suspect a similar one infests the left boob. If they can make a convincing argument for that, we should be able to persuade Medicare to cover it.

But even if we can’t, if they could keep the out-of-pocket cost under ten grand, I would just pay to have the left one lobbed off, too. That would obviate a whole slew of problems, mean I’d never have to see another mammogram machine for the rest of my life(!!!!), and make me even on both sides. The cash is there to buy a car; since I’ve already decided that a new car is off the table, I could use the automobile savings to cover the cost of lopping off the second boob.

So, there we are.

Meanwhile, one of my three fave clients resurfaced this morning with another book, bless his heart! Dearly love the man. He’s a very good writer, a very interesting human being, and he pays without wincing. 😀