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Archive for the tag “echocardiogram”

Lymph Nodes, PET Scans, and Lies

breast_stageIIb_large2I wanted to write this post last week, but was feeling too Percocet-y. And now I find that I am reluctant to put words to it. I don’t have any especially staggering news to report. As expected, the cancer has spread to my lymph nodes. Four of them, according to Buffy the Cancer Slayer. Which is a weird thing because if it was three lymph nodes, I’m safely still in Stage 2, albeit I get a slight bump from 2A to 2B.

With four bad nodes though, I may be upgraded to Stage 3. No one with any authority has re-staged my cancer, but I’ve spent quite a bit of time consulting my books and the almighty Internet. Honestly, the stage isn’t going to make a difference in my treatment (I don’t think) because we’re starting with the big guns (chemotherapy) in the first place. Will it be more likely that I have a mastectomy than a lumpectomy? I don’t know, honestly. I guess some of that will depend on what, if anything, shows up in my left boob, which hopefully will have an MRI-guided biopsy this week. And if we’re tracking the fucks I give, I have none to spare for my rack. The ladies served me well and I’m totally okay with being rid of them if it keeps me alive longer.

I’m rambling, I know. Here’s what’s gone down since my last post:

Two days post Mediport surgery.

Two days post Mediport surgery.

Thursday I had surgery to install the “power port” in my chest. I was given the choice between “twilight” anesthesia or “knock me the fuck out” anesthesia and I selected door number two. Boy was I glad I did, because a forty minute procedure ended up taking two hours. Apparently I have a very robust collarbone and so Dr. Boobcutter had to dig around quite a bit to find a good path to my vein. Anyway, I guess all went well. I went home that afternoon with an ice pack and a Percocet prescription and a sleepy head. For the next twelve hours I felt dopey and headachey and kinda barfy. And I’d only been home an hour before Buffy called to give me the word on my stupid lymph nodes.

Dr Cappuccino, my oncologist called just a little bit after that. He said that he and Buffy and Dr. Boobcutter had been conferring and they’d decided that I should push back chemo a few days so that we could get that MRI-guided biopsy on my left boob and a PET scan. He said that some other people were pushing for a bone scan as well, but he was on the fence on that and thought the PET would be enough to see what’s what. “Hang in there,” he said. “We’ll get you through this.”

That afternoon at school my daughter was crying on the playground so her friend Jasmine took her to the “recess lady” who, when my daughter sobbed “My mom has cancer!” took her to the school counselor. There she got some stickers and drew this picture.

It says "Cancer is 1,000 pieces of poops."

It says “Cancer is 1,000 pieces of poops.”

Is it weird that I didn’t get a call from the school? Is my kid high-maintenance? When she cried again that night “I wish you never had cancer!” I decided that I’m out of my depth on this one. I left a message with the oncology social worker to see if there is a support group or a therapist I should be sending her to.

Friday I spent most of the day in bed except for a trip back to the hospital for my baseline echocardiogram. The drugs in my chemo cocktail that target the HER2 antibodies are known to play a bit fast and loose with the left ventricle, so we needed to check mine out so we can track any damage (which is temporary in the majority of people). So of course, I’m sitting there thinking…every fucking thing they’ve checked (minus my DNA, which does NOT have the breast cancer gene!) has been bad news. So I’m like “does my heart look normal, ha ha?” And the tech of course isn’t able to make a diagnosis–only the doctor can do that. So that freaks me out and  I become the Liz Lemon of the echocardiogram. “Hey look, Gunny, I DO have a heart!” “Is that my aorta or the sarlacc pit?” Ba dum tish.

sarlacc-pit

Then all weekend I looked up stats about how that one extra node effects my prognosis. And I get shit like this.

IMG_1716

Five year survivalWhat do I believe? Who do I trust? Am I being alarmist? Probably. But there’s enough concern to look at the rest of my body for more cancer.

So last night my son was over for dinner, milkshakes and Game of Thrones. And when the show was over and he was getting ready to leave we were chatting and I tell him chemo now is going to start on May 5 [insert joke about tequila in the IV for Cinco de Mayo] and he laughs and I follow with “Of course, that’s because they found more cancer and I have to get a PET scan har har.” And Allison, who is clinging to her brother’s leg like a tick–and who I apparently failed to notice–says “They found more cancer?”

“No,” I said. “No, I was just kidding.”

What stage of cancer involves lying to your kids?

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Cancer gets real

It’s my second visit to the oncologist, Dr. Cappuccino. My husband and daughter are with me, and I’ve got my Binder of Doom tucked under my arm. It’s filled with all my shit: insurance approvals, notes, bills, etc.

BinderI say hello to the lady in reception. I call her Harley because she has a Harley Quinn lanyard around her neck. It’s our thing. Most of the people in this office have no idea who Harley Quinn is. Among the patients here, my middle-aged ass is a spring chicken. When you think cancer you think bald kids and lovely young women and handsome athletes. This is not the truth of cancer. The truth is that it’s primarily an old-person’s disease. As a population’s life expectancy increases, so do the rates of cancer. Oncology offices are chock full of the elderly. It’s like an early-bird buffet with chemo instead of roast beef.

I’m in good spirits because with this visit we are armed with more information about my particular flavor of breast cancer. It’s estrogen-positive, HER2 positive, and I don’t carry the breast cancer gene. Now we can get serious about a plan. And I need a plan of action to stay sane. The waiting and the unknown are making me nuts.

Dr. Cap lays out the plan for chemotherapy, which we will do prior to surgery. This is called neoadjuvent therapy and it’s rather new. I will still have surgery, but if all goes well with chemo, Turdy will be small to non-existent.

Take THAT, shithead.

Take THAT, shithead.

So here’s the plan: On or around April 27 I will begin 6 rounds of chemotherapy spread over 18 weeks. So every three weeks I’ll have an infusion of drugs and then 10 days later I’ll have a blood test to check my white counts. Here—as I understand it—is the cocktail I will have:
Carboplatin
Docetaxel
Herceptin
Perjeta
That’s if everything stays status quo. Because there were also a couple new possible complications discovered in the MRI.

If the lymph node in my right boob is cancer the treatment will be mostly the same (I think). If the area that lit up in the MRI in my left boob is cancer we’ve got a different set of problems. It could even be a different kind of cancer—hormone negative for instance. This is too much to think about right now. I decide the left boob is nothing and hope the biopsy will prove me right.

mediportDr. Cap then says we need to get my surgeon (Dr. Boobcutter) to install a mediport in my chest. And he’s ordering an echocardiogram to get a baseline because the antibody drugs (Herceptin and Perjeta) can cause—usually temporary—heart damage.

He asks if Nurse Buffy has scheduled the MRI-guided biopsy for my left boob and the ultrasound/possible biopsy for the lymph node in my right boob. I’m rubbing my forehead with my knuckles and my shoulders are up around my ears. Not yet, I say. Now I am looking at four new appointments, a possible second cancer and different plan of attack. Dr. Cap is talking about a clinical trial in which they administer the hormone therapy at the same time as the chemo instead of after. (Did I mention I’m going to have hormone therapy for five years?) The trial will require an additional biopsy of the original tumor and if the left boob is fucked up then I’m ineligible.

I break at this point. It’s too much and too real. I start to cry and Cap searches his cabinets for tissue. There is none. At some point a nurse I’ve never seen before has come in and her face is impassive while I cry. She doesn’t offer to go find tissues. It occurs to me she may be a bot. I feel terrible crying in front of my daughter. The first time she saw me cry was on 9-11 and the shock and horror on her four-year old face made me never ever want to see it again.

“Will I be a bad person if I don’t want to do the trial?”
“No, it’s voluntary,” Cap says.
“But will I be killing future people if I don’t?”
“No, not at all.”
Nurse Bot just stares.
“I’m sorry. I don’t want to do it. I don’t want any more meetings or changes in the plan. I just want this shit out of my body.”

Cap understands and he types up the orders for the echocardiogram and the mediport (which still fucking grosses me out). My husband asks him to please put it in as a referral because our insurance, Tricare, makes us pay a higher portion if they don’t pre-approve everything. So that blood test he told me to scoot next door to have done last time? Tricare didn’t pre-approve it, so we paid more. To be fair, Tricare hasn’t failed to approve anything my doctors have asked for, but waiting for them to green-light every fucking fart and belch is frustrating.

Finally, Cap is done and Nurse Bot wants to feel me up. She wants a little hands-on with Turdy and it’s not clear to me why. I ask my family to leave and she gets her feel. Her hand’s on my boob and she says, “Christa Charter, what a great name for a writer…”

Two minutes later Nurse Bot is giving us a tour of the treatment room (big recliners, IV poles, large sunny windows, dishes of candy) and she introduces me to the chemo nurses as “Charlaine.” Seriously. She says “She’s thinking about the clinical trial.”

I despise her now. And the unsmiling, unfriendly nurses. “No I’m not. I’m not doing the trial.” I hate them. I hate everything. I hate that my body has done this to me. I do not want this.

Gunny takes me home and fetches Jack in the Box for dinner. I shouldn’t be eating this crap, but I’m just…in a bad place. My head hurts and I feel nauseous. Stress has to manifest somehow and today it is giving me a migraine. Every time I think Okay, I accept this, I’m dealing with it, I learn that no I am still floating on this river of denial. Maybe writing about it hasn’t helped me deal at all and has instead made me believe on some level that this is fiction. This is just another Lexy Cooper adventure.

I was not brave and positive and funny that day. I was sad and angry and cried in front of people. On my horizon is waiting for Tricare to decide it’s okay to fucking treat this cancer and being poked and prodded and possibly learning more really shitty news. But I will shove that to the back of my aching head and I will watch Mad Men and build my new LEGO set and get my hair did for the last time before it comes out.

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