Tuesday, September 1, 2009

D Day

For those of you who know my husband, Mark, you know that he is not afraid of disaster. In fact, he is trained as a police officer, owns his own cab company, and runs the Command Center that coordinates emergency assistance in Ramsey
County. Stress, pressure, chaos- to me, maybe- but not to him.

This morning, Mark, my mom and I went to meet the oncologist I was referred to. This man would give me my diagnosis, my prognosis, my answers, my plan. The mistrust I felt for doctors and healthcare in general- like a stinking, leaking garbage bag filled with pain, worry, and fear- would fall right into this man's lap. Unfairly. We agreed to keep our distance and to listen to his spiel, while keeping a firm grip on the escape hatch. And so I waited, facing my own mortality, looking into my mother's teary eyes, and witnessing Mark's first panic attack.

A nurse came in to speak with us. She explained what would happen on this visit. She told me that everyone in this clinic would be affected by my cancer, because seeing someone my age was rare. Mark quickly diverted the conversation to his own breathing difficulties, heart palpatations and feelings of overwhelming anxiety. He said he couldn't sleep last night- especially after seeing the look on my mother's face after she had spent a few hours googling "Stage 4 Breast Cancer." He said, "I have been trained to read faces and gestures and, let's just say, it wasn't good." The nurse cautioned us about getting medical information from the internet and acknowledged that Mark too may need help in dealing with my diagnosis and that he should talk to his doctor.

If you know Mark, you also know about his filter. While some people claim he doesn't have one at all, it's more like he chooses to keep the setting at "Wide Open" most of the time. This leads to some moments that may be perceived from inappropriate and socially unacceptable to simply honest (sometimes, brutally honest), to lighthearted or just plain funny.

Dr. Laudi, my Oncologist.
Dr. Laudi entered the exam room, placed my file on the desk and reached for my hand. "Sarah," he said, his voice warm and soothing, "If you hear nothing else today- hear this: WE CAN TREAT THIS." He let these words sink in, then continued "Can we cure this? I don't know. But we can treat this." He took Mark's hand, then my mom's hand- not shaking, but holding.
Calm. Peaceful. Hopeful. He not only saw the baggage we had lugged to this visit, but he accepted it as a gift to be recycled into something new.

My diagnosis: Infiltrating Ductal Carcinoma
-with T9 and T12 vertebrae pressing slightly into my spine
Lymph node status: 1 node involved
Tumor size: 2.3 X 2.6 X 2.5 cm (the largest mass)
Nottingham grade: II of III
Nottingham score: 6 of 9
Mets: +
Hormone receptor status: Estrogen +
Progesterone +
Herceptin -

Dr. Laudi put the discs of my scans into his computer and started to interpret them. I had mets to every bone visible on the scan- spine, ribs, pelvic bones. These mets ate away at the bone, displacing it and making it fragile. He told us not to be concerned with the number of mets- one or one hundred- the treatment would target them all.

Mark blurted out, "Can't we just order her a new spine from China?"

Dr. Laudi derailed- momentarily speechless. "Well... probably not in the way you are thinking, but I have a plan."

Though I thought losing my breasts was a given, since the cancer had already spread beyond them, they would stay- the traitors. (Left one- I'm talking to you).

Tests:-Bone Scan
-Brain Scan
Lab:-CA27-29 Tumor Marker [<35] = 66
Pain Control:-MS Contin BID
Hormone Therapy (to remove my cancer's food supply):
-Tamoxifen (binds to cancer cells, turning them off)
-Lupron (stops ovary function)
-Laxatives (to counteract the narcotics)
-Calcium and Vitamin D (to help build bone)
-Zometa IV (to strengthen bone and reduce fractures)
Referrals:-Radiation (to my spine)
-Orthopedics (weight restrictions, fracture risks)
-Genetics: BRCA 1 & 2 (to see if there is a genetic component and risks to my mom, sisters, children)

No treatment is without risks or side effects. I learned that narcotics will relieve pain, but make me tired and constipated. Tamoxifen can cause weight gain and blood clots. Removing the estrogen from my body would put me into menopause with hot flashes. I already had questionable fractures, so I would have to take an indefinite leave from my job at Children's Hospital where I worked in the storeroom and as a nursing assistant. The Zometa can cause kidney problems and a rare jaw bone necrosis.

"You're scaring me here." Mark said. He went on to describe his vision of my potential transformation- flushed and sweating, bloated, necrotic- I will spare you.

Obviously, Dr. Laudi had never met anyone quite like Mark before. Have any of us, really? "He's stressed out." I said and the doctor nodded, continuing with the plan.

Riding down the elevator and stepping out into the sunny day, we all admitted that we had a good feeling about this doctor. My mom liked that he was present, hopeful, and appeared current on breast cancer care.
Mark said, "Yeah, I liked him, too. But did you notice the times he glanced down and to the right?" 

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