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Health care

Cancer? Not so much…

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Yesterday my son took off work to schlep out to the Mayo with me and hold my  hand as I entered the Land of Sickness. We were to meet with a high-powered surgeon to whom I was referred by my long-time doc and old friend, Tim Daley. After a brief wait, we were ushered into the catacombs.

You would not believe the difference between the way you’re dealt with at St. Joe’s and at the Mayo. First off, we were met by a nurse practitioner who handed me a whole book on breast cancer and a notebook filled with business cards & phone numbers of people to call at the Mayo, with all sorts of information, with what to expect, and on and on. She asked a bunch of questions, filled in forms, and moved on. Then a PA came in, did an exam and asked more questions.

And finally Her Royal Majesty arrived. And what an incredible lady that one is!!!

She also examined me, and she’d already read the pathologist’s reports and studied the mammogram. She was annoyed that St. Joe’s hadn’t done another mammogram after the biopsy to confirm that they’d placed the marker tags correctly, and said now that has to be done. Then she said the following:

At this point she believes these are ductal carcinomas in situ (DCIS). They are not exactly cancers; they are pre-cancers. She assessed them as “Stage 0,” about as close to harmless as they can get without being nonexistent.

Not all DCIS lesions develop into cancer, and if they do, they develop very slowly. They could turn into cancer in a year, two years, ten years, twenty…or maybe never. However, the problem is that ALL breast cancers start as DCIS. Because there’s no way (yet) for doctors to know which DCISes will become invasive cancers, which ones will just sit there, and which may even fade away, the wisest course of action is to have them removed by way of surgery. But that’s all that is necessary. And there’s no hurry.

The current standards for lumpectomy no longer require such a wide margin of healthy tissue to be removed around a DCIS, and so the procedure is relatively minor compared to what one would have expected in the past. Once removed, the things have to be examined by a pathologist, but if they are what she believes them to be, there will be no need for any other treatment. No radiation. No hormone treatments. No chemotherapy.

She thinks these critters have been in there for years — she explained in detail why she thinks so, based on the known growth rate of papillary carcinomas — and were simply not seen on earlier mammograms when my lush besoom was denser and the machinery was less sensitive.

She explained that radiation therapy is an option, but that it would reduce the already extremely low probability of a recurrence by about one or two percentage points. I asked her whether, if she were in this position, she would opt for radiation.

“No,” she said, “I wouldn’t have radiation. But then…that’s just me.”

Looked at her and thought, Lady, you are one hell of a lot smarter than me and you are staggeringly expert on this subject. If you’re not havin’ it, neither am I.

So I scheduled a lumpectomy for August 7. She said one should be up and about in a day or two and back in the swimming pool after two weeks.

How amazing is that?

And, we might add, how effin’ outrageous…

The radiologist at St Joe’s said to me, in reporting on the biopsy results over the telephone, “I’m sorry to have to tell you this, but it’s cancer.” Period. Evidently that was a slight exaggeration…

This was after I had been told, by another radiologist there, that there was a 50% chance those little lumps were cancer. So they had me prepped to believe I already have cancer, and then they delivered exactly that news.

In fact, they’re not benign…but neither are they actually cancer. Not yet, anyway. Nor are they going to become cancer in the very near future.

My friend KJG, on hearing this, remarked on the difference between the medical treatment you get in hospitals in affluent vs. not-so-affluent neighborhoods. Ain’t it the truth, apparently: few places get more affluent than northeast Scottsdale. And another friend remarked, after admitting to a skeptical turn of mind, on how much St. Joe’s stood to gain by corralling me into six or eight weeks of daily unnecessary radiation treatment.

Un-freaking-believable.

So it looks like a confluence of lucky events rescued me from a great deal of painful, pointless, and dangerous trauma:

  • Old Doc Daley moved from his mid-town practice to the Mayo shortly after the clinic opened in Scottsdale, all those years ago.
  • I managed to keep myself on the Mayo’s rolls after hitting Medicare age by sticking with him.
  • St. Joe’s ER damn near killed me with the crassest kind of neglect when I had appendicitis some years ago, and so I wouldn’t have surgery done at that hospital, not on a bet.
  • And past experience has convinced me that you should ALWAYS GET A SECOND OPINION before letting anybody do any kind of procedure on you or put you on some drug.

Always. Get. A. Second. Opinion.

News of the Day…

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…Boob Department.

So, late, late late yesterday afternoon St. Joe’s called with the verdict on the biopsy: it’s cancer.

However, as cancers go, it’s far from the worst of all possible worlds. Their pathologist declared it a papillary carcinoma, which is a rare cancer that, in older women, is usually slow-growing. And in my case, both tumors are “encapsulated,” which means they’re closed off from spreading around with gay abandon.

If she’s correct, then as this kind of news goes, it’s actually fairly positive: According to the American Journal of Clinical Pathology “EPCs [encapsulated papillary carcinomas) are in situ carcinomas with an excellent prognosis and can be managed with local therapy with or without sentinel lymph node biopsy.”

That’s from a 2009 paper, so of course it’s a bit old. However, from what the radiologist said, the thinking must still be along these lines. She said they no longer yank out your lymph nodes — which, other than the disfiguration of your boob (which is hardly fatal), is the big issue with breast cancer, because it leaves you vulnerable to infection of even the tiniest little nick or paper cut.

Rummaging through the Hypochondriac’s Treasure Chest, we find a literature review in an open-access journal. Open access is less questionable in the hard sciences than it is in the humanities. As of 2014, this review of published research indicates “this form of cancer is usually low grade and rarely recurs. . . . Understanding the low-grade nature of this form of breast cancer allows treatment options to be less radical and safely omitted.” However, this same group of authors calls papillary breast cancer “diagnostically challenging” and remarks that if the tumor appears in conjunction with invasive cancer, that might not be great, especially if it occurs in a younger woman. However, I fortunately am old as the hills, and I’m told these things were quite small.

And finally, the Brits say, in a website dumbed down for the public, “Doctors usually treat papillary breast cancer with surgery. These cancers usually grow slowly, and don’t usually spread to the lymph glands or other parts of the body.”

So if I’m understanding what the woman said to me, it looks like the outlook is about as positive as it can get for a cancer diagnosis. I feel a great deal less frantic than I did while waiting for news…right now what I most want is just to get the surgery under way, get the damn things out of my boob, and move on.

My son is going to take the dogs for as long as I’m incapacitated. Suspecting this was coming up the pike, I’ve already hired a cleaning lady and lined up a pool guy. Cleaning lady has begun deconstructing my house — in addition to breaking the vacuum cleaner ($140!), she also quietly knocked the shower door off its track. Neighbor is coming over this evening to try to fix it. I just hate hiring cleaning help…honest to god, they do more damage than good! And then when they break things, they don’t tell you — they leave it for you to find out. Had a helluva time getting out of the shower stall this morning.

Let’s hope that’s not true of pool guys.

Tomorrow I’m meeting with a surgeon at the Mayo. I have no intention of letting St. Joseph’s cut me up, having damn near died there a few years ago. Besides, St. Joe’s Healthgrades ratings for patient safety are much lower that the Mayo’s and even lower than John C. Lincoln’s. JCL is located in the heart of a desperate slum, for hevvinsake, a few blocks from the headquarters of a dangerous meth gang. So…one wonders. At any rate, if I have to get radiation treatment and the Mayo doesn’t do that at its (relatively nearby) hospital on the 101, then I’ll have to get that done at JCL or St. Joe’s, since I can’t afford the gas to drive halfway to Payson five days a week for five to eight weeks.

So things appear to be as under control as they’re going to get. Unless, of course, the Mayo’s surgeon upsets the apple cart tomorrow…

Somethin’s gotta go…

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And I think it’s about to be this puppy…

Today or tomorrow, the biopsy report is supposed to come in. If it’s cancer, the first thing that’s gonna happen is Ruby is going straight back to the breeder. I certainly can’t care for her if I’ve got half my boob lopped off and am looking at weeks of irradiation and subsequent radiation sickness.

Even if it’s benign, I may have to return her. Mortal illness or no, we’re rapidly reaching the point here where I can’t take care of her.

She barfed all over the bed again last night. So at midnight I had to pull ALL the bedding off and remake the bed. This was after she’d had me up about once an hour from 10:00 forward.

Of course she went back in her crate at that point. Briefly. For the rest of the night, she was up about once every hour. I finally had to put her back on the bed to get her to settle down long enough to get 90 minutes’ or an hour’s worth of  uninterrupted rest.

I think her UTI is probably back, since I can’t find any new dog mounds in the yard, which means she’s not wanting to run out to squirt brown puddles on the ground. And what causes the barfing, I can’t imagine. This was SIX HOURS after she’d been fed. Normally, a dog’s food moves through its stomach quite fast. The entire digestive process takes six to eight hours. So she shouldn’t be woofing up virtually undigested food after six hours. Since the food does seem to be undigested, she actually may be regurgitating rather than vomiting, but if that’s the case, it’s mighty weird that the food would sit there without moving for all of six hours. In either case, it sounds like an expensive fix. Or a lifelong nightmare struggle.

{sigh} So. To add hassle on top of headache on top of worry, I’ll have to call the vet this morning and make an appointment so as to get in the door if I don’t have cancer (50-50 chance, we’re told), and then explain that if the biopsy results are positive, we’ll have to cancel because the puppy is going back where she came from. First thing, though — like right this minute — I’ve got to wash the sheets, blanket, and doggy throw.

In any event, the pup’s health issues are starting to drive  me crazy. I can’t deal with all this sh!t at once. Last night I didn’t read the stoont papers that came in — figure to read those while the students are in class today, since they’ll be in the computer commons putatively working on their 2500-word final papers (read “playing computer games, checking in at Twitter & FB, and surfing the Web”).

Even if the stress of the cancer scare goes away, come next Tuesday I’ll still have 62,500 words of drivel to read in a matter of maybe three days. Fortunately my associate will be back in town pretty quick, but since one invariably becomes sick after riding on airplanes and since she’ll be coming in from halfway around the world, it remains to be seen whether she’ll be in any shape to help out.

Made It through the First Trial-&-Trib

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Okay, so the dreaded biopsy, although it had its…uhm, moments…was not as dreadful as I dreaded.

At 9:45 ayem, I presented myself at St. Joseph’s Hospital and Medical Center, bearing a hybrid Attitude of annoyance, frustration, concern, and raw terror. And also bearing a laptop computer: my lovely students turned in nine more papers after I went to bed at 11:30 last night. Graded four of these while waiting to be conducted to the torture chamber.

Here’s something that’s kewl about getting treated at a teaching hospital: every procedure comes with a running explanation of what’s going on!

Yes. The senior doctors have underlings (we in academe would call those “graduate students”; doctors call them “residents” and “fellows”). These lovely creatures are allowed to do some parts of some procedures, but overall all parts of every procedure are turned into detailed lessons in medicine. Once again, I learned one helluva lot.

First off, I presented the distinguished professor of medicine and her apprentice with a challenge: one lump in your boob gets four samples excised. Two? Yesh: eight of ’em. And it takes some physical strength to pull this off. So our young thing, who was made to retrieve seven of the eight samples, got quite the workout today.

To my astonished relief, they did not place me face-down on a table and try to thread my boob through a hole in said table. Because of the location of my particular lesions, I got to relax on my back while they messed around with trying to figure out what (if anything) ails me.

First thing they do is pump your boob full of lidocaine. And hallelujah, sisters and brothers! It WORKS. The lengthy, repetitive procedure was almost pain-free. There was a little discomfort (well, we’d call that pain) when they had to enter the second lump that’s very close to the chest wall, but when I whined, they squirted in some more lidocaine.

Apparently, some people experience lidocaine injections as painful. Thank the heavens, I do not.

At every step along the way, the senior physician was encouraging and instructing the young(ish) fellow. This was a) helpful, because I could easily tell how she was doing and how far we were progressing and b) I learned an awful lot about the procedure itself.

They only made one “skin nick” (I would define that as a small incision) to access both “nodules.” The senior physician said she thought they actually were one object, but because others had seen them/it as two entities, she wanted to biopsy “both” of them. Whatever “they” are. I agreed that this was wise.

After the frolic was done, the elder physician volunteered (because, I’m sure, she realized I would have liked to ask her WHAT DO YOU THINK, DOC???) that she couldn’t speculate on whether the things were benign or malignant. However, she said, they are so small that if they are cancer, she thought they would not yet have metastisized into the lymph notes.

She said the element of most concern is my age: When you’re pushing 70, you don’t usually develop benign growths.

I said that about a year and a half after I had that last mammogram (with which they’re comparing the present results, three years later), I lost 30 pounds. My boobs had already started to shrink with age, but when I went on the diet, they reduced big time. And all my adult life, I’ve had “dense” and “lumpy” breasts.

“Ah!” said she. It’s possible, she opined, that the things are fibroadenomas and only became visible as the surrounding tissue became less dense and lost fat content.

So that upped the possibility that the damn things could be benign.

I think, from what I’ve heard from the other quacks, that the odds are not good. But if you go by what this woman says, even if it is cancer, I may not be checking out very soon.

LOL! She advised me to take ibuprofen for any residual aches and pains. I pointed out that I’m allergic to that, too. She was shocked.

I said by and large I just have to gut out whatever little pains come my way.

She said, “Well, then..plan to gut this one out.”

I said, “My preferred analgesic is whiskey.”

She laughed.

Flying into the Cloud Bank

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ooohhh-kayyy….. Tomorrow St. Joesph’s radiology department is supposed to puncture my boob to see if I have cancer. It’ll be the middle of next week, at best, before the result comes back; a miracle if it reaches the Mayo Clinic surgeon by the time I’m supposed to meet with him for a second opinion. I’m pretty well decided that if surgery is needed (as seems increasingly likely), I’ll have it done at the Mayo, simply because their safety level is much higher. However, if several weeks of daily radiation treatments are required, I will ask if that can be done at St. Joe’s, which at least is within driving distance. From my house, the Mayo is halfway to Payson; even if Medicare covers this entire flying circus, I still couldn’t afford the gasoline to drive out there every day for five to eight weeks.

Meanwhile, students are turning in papers today. My assistant is junketing in China, so the entire task of reading these golden words falls to me. I’ll have to read frantically, well into the night, to get through the stuff. Eight (of twenty-five) classmates have posted their papers so far. The things aren’t due until midnight, meaning the bulk of these things will have to be read when I’m in pain, scared, and definitively NOT of a disposition to spend my time on student drivel.

I’d resisted reading the radiologist’s report myself, preferring to just fork it over to Young Dr. Kildare and the beloved Old Guy at the Mayo. But yesterday I thought I’d better take a look at it.

Googled the terminology she used to describe the two lesions and discovered exactly why YDK disagreed with beloved OG@theMayo about the urgency of moving forward. Holeeeee shit! The radiologist’s alleged 50-50 chance of the things being benign (read “50% chance of malignancy”) appears to have been very optimistic. The probability that these things are cancer is higher than 50%. Possibly much higher.

Picked up paperwork to make my son a signer on my credit union accounts. This will make it possible for him to pay the bills if I’m incapacitated, whether for awhile or permanently, and it also will make it a great deal easier to access what will be his funds should I croak over. He’s already listed as a beneficiary for those and for the Fidelity IRA and brokerage accounts. Fortunately, I’ve dawdled endlessly on withdrawing the cash value from my semi-defunct whole life policy, so the insurance payout is still in force; he’ll get 40 grand from that, in the croaking-over event. So he’ll have enough to dispose of my remains and then some. Quite a bit some.

Unless he’s been reading this blog (which I doubt), he doesn’t know about the current flap. I’d prefer not to enlighten him until I know what the real story is. His dad, a notary public in addition to his corporate lawyerness, has refused to notarize the credit union documents. How the hell I’m going to persuade the kid to drive out to the credit union on Saturday to get his signature enrolled with that outfit without having to tell him what’s up escapes me.

At any rate, when (and if) that’s accomplished, all that will remain will be to figure out what to do with the dogs. I think my son will take them temporarily — for a week or two — if I  have to have part or all of my boob lopped off and endless radiation or chemotherapy administered. But after that: ????  I can’t imagine he’ll want to take on two corgis, now and forever, in addition to his marginally manageable adolescent retriever.

Why the fuck do these things ALWAYS happen when things are finally going smoothly and you just start to think you’ve got a grip on your life and you’re going to be preternaturally happy for awhile?

 

Another Day, Another $250 Hit… And more to come?

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Once again…not a single month has gone by since the first of the year without at least one unplanned financial hit! And I expect there’ll be more, what with this annoying medical thing. Lots more, no doubt.

Young fellow from Swimming Pool Service and Repair came by. He took the filter apart and discovered that Leslie’s had only replaced half of the DE filter’s eight white filter pad thingies. Their guy charged me $250 to replace all of them. Hm. Looks like I should’ve fired that outfit long before their recent effort to corral me into buying an expensive new pump!

You could tell which ones were fairly new and which were the old ones — the old, tired ones are kinda yellowed with age, mighty sickly-looking, while the newer ones look noticeably whiter. One of the old ones had several holes in it, which explains why the pool has been kinda hazy-looking: DE has been seeping out into the water.

Ducky. That’s going to be another $250, payable tomorrow when he shows up with eight new pads.

He said he’s about to take over his dad’s swimming pool service company — at the age of 57, Dad is recovering from a recent stroke. The kid said he’d provide weekly service for $90 a month. Sooo…if I have to have surgery that puts me out of commission in the heaving-around department, there’s going to be Sickness Expense the First. If I can’t lift things and my arms are effed-over by having the lymph nodes ripped out of them, I won’t be able to keep that pool clean on my own. At least not for quite some time.

Tomorrow morning I’m going out to the Mayo to see my old, OLD doctor, who practices out there. This morning I drove a CD with St. Joseph’s radiology images and the radiologist’s report out there, because I realized I couldn’t be here to wait for the pool guy and out there delivering the data at the same time this afternoon. Fortunately, the dog got up up at 3:30 again, so it was easy to get dressed, fed, and out the door by 7 a.m. A huge wreck closed the north- and eastbound lanes of the two freeways I would ordinarily drive to make this ridiculous jaunt, so I had to take surface streets all the way to the far side of East Scottsdale. However, traffic was light despite the dire warnings on the radio.

While plodding across the city, I reflected that Dr. Daley and I have known each other for almost 45 years! Holy mackerel! Who would think it? At any rate, he’s one of the Mayo’s grand old men now, and so if anyone can help me navigate through the hideous shoals of the medical establishment, he’s the one. Before I got off the phone from his underling, I had an appointment with him this week, like right now! He wanted to get his hands on said images/report early so that he could have a Mayo radiologist look at them. So, with any luck he should be able either to reassure me or scare the bedoodles out of me.

I’m taking the HealthGrades and Medicare.gov data to present to him, because of course the first decision I’ll have to make, should these things prove to be malignant, is whether to proceed with St. Joe’s or to go to the Mayo for surgery. The Mayo has the best safety record for patients — St. Joe’s is surprisingly wanting in that department. And I do want to ask him about St. Joe’s 16.5% mammogram follow-up rate, 2.5% above the level Medicare classifies as “unacceptable” and a pretty sure sign that they’re doing unnecessary procedures.

God! I’ve become such a skeptic in my old age! Take things with a grain of salt? Hell, I take everything with a pound of salt, thank you very much. I just don’t believe anything or anybody anymore, whether it’s a pool guy or a high-powered M.D.

Here are the issues that set off my bullshit alarm with the present cancer scare:

• The radiology tech looked at the second mammogram images and said, of the alleged nodules, “Those aren’t cancer.” Admittedly she’s just a tech — i.e., likely a junior-college graduate — and she no doubt was shooting off her mouth when she shouldn’t have been. But there’s also a bachelor’s degree program for these technicians, and if she has a lot of experience, she may very well have a clue to what she’s looking at. Thirty or forty minutes later, I’m being told there’s a 50% chance the things are malignant. It plants a little doubt, albeit not much.

• By way of trying to persuade me that I need more probing and possibly surgery and radiation, the radiologist asked if I’d ever taken hormone replacement therapy. When I said I had not, she said that was a bad sign — not doing HRT is a risk factor for breast cancer. Well, that is not altogether true. The American Cancer Society reports that HRT using estrogen and progestin raises your breast cancer risk, whereas plain estrogen therapy has a nil risk or even a slight protective effect.

• Then there’s that 16.5% follow-up rate. It’s the highest of any of the area hospitals I looked at. Boswell, out in Sun City, has a 7.7% rate, below the state average of 8.9%. Good Sam’s is 13.7% and John C. Lincoln’s is 13.5%, dangerously close to that 14% figure Medicare considers “unacceptable.” IMHO, Medicare is a cash cow (heh…okay, pun intended). To the skeptic’s eye these diagnostic tools look a great deal like milking stools. We have a relatively simple procedure that Medicare covers; we have a public convinced it should be used routinely; and we have a dread disease that so terrifies women it can be used to herd them toward increasingly profitable extra procedures…from mammogram to new mammogram to sonogram to biopsy to…??? Hm.

That’s not to say I absolutely positively think it’s bullshit. Obviously, it’s best to assume the worst of any suspicious lesion, and then to be pleasantly surprised to find it’s harmless.

You know, that’s why it’s good to be a cynic: you’re always pleasantly surprised!

😆