You recognize them by their grey hair and burgundy blazers. George Bush (the first) would have praised them as glimmers among his 1,000 points of light. They are the legions of hospital volunteers, who donate their time and good cheer to foster our better health.
These good Samaritans play a visible role in cancer treatment. During chemo, I noticed the same woman volunteering every time I was there. She brought pillows and blankets to the patients hooked to IVs, chatted with family members, and assisted the nurses in small ways.
The radiation technicians and doctors rely on volunteers, too. Bill, a courtly gentleman in his late seventies, is at the hospital four mornings a week to assist with the radiation process. Because radiation is a daily occurrence, it's hard not to know Bill. He sits in the "gowned" waiting room, which is where patients, dressed in hospital robes, wait their turn to lie under the beams. Bill learns all the patients' names and gleans little tidbits about their lives -- whether or not they have children, where they work, what they're reading, etc. By doing this, everyone sitting nearby also learns a little something about the others being treated. Thus, Bill breaks the ice and creates a social network among the patients.
Bill also helps the technicians by escorting patients to and from the treatment rooms, or to the examination rooms on the days when they see the radiation oncologist. I don't know what Bill did before he retired and became a hospital volunteer. He's a natural at creating a welcoming environment and helping people to relax.
Those who prefer to keep to themselves in a hospital setting may wince at the idea of Bill facilitating conversation among strangers in a waiting room. But Bill's efforts are a good thing, because the whole process of cancer treatment wears people down. Exposure to his kindness, which he dispenses regularly and without pay, is uplifting, really.
I had a less than kind moment myself the other day, and since confession is good for the soul, let me get this out. I was in the bank parking lot about to get back into my car when a woman passed by me and said, "I like your hair." Since I'm now sporting a credible likeness to Sinead O'Connor, I was taken aback for a beat and paused before responding, "It's the chemo. This my post-cancer look." Hearing this, the woman visibly drew in a breath and was clearly stunned. I finished off the moment by saying, "Thanks, it's starting to grow back," before getting into the car.
Later, I thought about my reaction. I could have just said, "Thanks," and skipped the explanatory language. Perhaps my gut instinct was that her words were insincere, although in retrospect I doubt that was the case. I think now that she was applauding my boldness. So I'm chalking this experience up to my being a little slow on the learning curve and not being fully comfortable in my own skin yet. The next time someone makes a comment, however, I'll be better able to respond.
I have the example of Bill and the other hospital volunteers who dispense so much caring each day. They've taken the bumper sticker notion of committing random acts of kindness and incorporated it into their daily routines. Here's to the folks in the burgundy blazers.
6/22/08
6/15/08
Photons And Electrons
Radiation is a curious process. It differs from chemo in that the gestalt of radiation is more akin to a science experiment than to a medical procedure. We're all familiar with chemo. Very strong drugs are infused intravenously and circulate throughout the body on a search and destroy mission.
Radiation, however, resides at the intersection of physics and biology. Some people have radioactive seeds surgically implanted in their bodies. My treatment is more traditional. Rays are being beamed at the site where my growth was removed. The radiation penetrates into the body's tissues and attacks all the dividing cells in the neighborhood. Later, the normal cells will reinvigorate themselves and resume their regular activities, while the dead cancer cells will lie scattered about as so much detritus.
Treatments are dispensed in small increments. My individual radiation plan calls for 35 treatments, each lasting just a few minutes. During my first 28 treatments, the technicians are sending photons, which have to ability to go deeply into the breast tissue. For the final seven sessions, they will switch to electrons and target the top layers of skin around the surgery scar. Treatments are given five days a week, which means that radiation takes about six weeks to complete.
Thus far, I've been radiated three times. Compared to chemo, this is a snap. You undress from the waist up, put on a hospital gown and wait for a technician to find you. Once you arrive at the treatment room, you remove the gown and lie down on the table. Two technicians adjust your exact positioning based on what the oncologist prescribed. They remind you to keep very still, and then they leave the room. The machine that delivers the radiation hovers about 24 inches overhead and to the right and briefly emits a high-pitched whine. Next, the machine re-positions itself about 75 degrees counter-clockwise from where it started. Again, the high-pitched sound signals treatment is underway, lasting another 30 seconds or so. Once the whining ceases, the doors to the room swing open, the technicians re-emerge, and the session is over. Time for me to move along, so the next patient can have a turn.
Finally, the last phase of my breast cancer project has arrived. Sometime in July I will be done with all of it, and move into a closely monitored maitenance mode. My hair is now about 1/8" long all around. I had a coming out of sorts last night, when my husband and I went to a nice restaurant for dinner with my head uncovered. Although some people did a noticeable double take, I just smiled, enjoyed my meal, and reveled in my return.
Radiation, however, resides at the intersection of physics and biology. Some people have radioactive seeds surgically implanted in their bodies. My treatment is more traditional. Rays are being beamed at the site where my growth was removed. The radiation penetrates into the body's tissues and attacks all the dividing cells in the neighborhood. Later, the normal cells will reinvigorate themselves and resume their regular activities, while the dead cancer cells will lie scattered about as so much detritus.
Treatments are dispensed in small increments. My individual radiation plan calls for 35 treatments, each lasting just a few minutes. During my first 28 treatments, the technicians are sending photons, which have to ability to go deeply into the breast tissue. For the final seven sessions, they will switch to electrons and target the top layers of skin around the surgery scar. Treatments are given five days a week, which means that radiation takes about six weeks to complete.
Thus far, I've been radiated three times. Compared to chemo, this is a snap. You undress from the waist up, put on a hospital gown and wait for a technician to find you. Once you arrive at the treatment room, you remove the gown and lie down on the table. Two technicians adjust your exact positioning based on what the oncologist prescribed. They remind you to keep very still, and then they leave the room. The machine that delivers the radiation hovers about 24 inches overhead and to the right and briefly emits a high-pitched whine. Next, the machine re-positions itself about 75 degrees counter-clockwise from where it started. Again, the high-pitched sound signals treatment is underway, lasting another 30 seconds or so. Once the whining ceases, the doors to the room swing open, the technicians re-emerge, and the session is over. Time for me to move along, so the next patient can have a turn.
Finally, the last phase of my breast cancer project has arrived. Sometime in July I will be done with all of it, and move into a closely monitored maitenance mode. My hair is now about 1/8" long all around. I had a coming out of sorts last night, when my husband and I went to a nice restaurant for dinner with my head uncovered. Although some people did a noticeable double take, I just smiled, enjoyed my meal, and reveled in my return.
6/8/08
Mind And Body
It's Not About the Bike: My Journey Back to Life is Lance Armstrong's account of his struggle against advanced testicular cancer and his subsequent successes in the Tour de France. In the book, Armstrong takes the reader through his early years as a cyclist, through his devastating cancer experience, and finally through his rise, phoenix-like, to the pinnacle of his sport.
Armstrong's theme, which he hints at in the book title, is that he succeeded in the grueling Tour de France partly by drawing on the lessons he learned in his fight against cancer. Armstrong's disease was quite advanced when it was discovered, having reached his brain and other vital organs, and his survival is indeed miraculous. He contends that his illness changed him both psychologically and physically, which worked to his advantage as an athlete. He notes that cancer helped him grow into a more mature, less cocky cyclist. Physically, Armstrong said that his post-cancer physique was leaner, which allowed him to attack the hill-climbing components of the sport more efficiently since he was carrying less bulk.
Although Armstrong goes through a period of aimlessness following his treatment, which he refers to as "survivorship,'' he mostly maintains a positive attitude throughout his cancer ordeal. What is interesting, however, is how he characterized the mental components of illness and recovery. He writes: "I believed...in the doctors and the medicine and the surgeries.... I believed in the hard currency of... intelligence and...research." But Armstrong also noted that he "believed in belief, for its own own shining sake."
He decided that belief in something was preferable to belief in nothing and eventually arrived at the following conclusion: "I didn't fully see, until the cancer, how we fight every day against the creeping negatives of the world, how we struggle daily against the slow lapping of cynicism. Dis-spiritedness and disappointment, these were the real perils of life, not some sudden illness or cataclysmic millennium doomsday."
Dr. Bernie Siegel has also written about illness and positive thinking in several books, including his bestseller, Love, Medicine and Miracles. Dr. Siegel was not really on my radar, but another woman with breast cancer told me that she found his book helpful. So I listened to an Internet radio broadcast in which he focused on breast cancer. For those who are interested, here is the link: http://www.blogtalkradio.com/breastcancerwellness/2008/02/19/Love-medicine-and-miracles-for-breast-cancer-survivors
In short, Dr. Siegel advises patients to empower themselves in many ways: to be proactive in their treatments and to take charge of their lives. He teaches people to use positive messages, imagery, and humor to aid in healing. Dr. Siegel also believes that many of us carry emotional baggage from our childhoods with us, which can lead to illnesses.
Armstrong's theme, which he hints at in the book title, is that he succeeded in the grueling Tour de France partly by drawing on the lessons he learned in his fight against cancer. Armstrong's disease was quite advanced when it was discovered, having reached his brain and other vital organs, and his survival is indeed miraculous. He contends that his illness changed him both psychologically and physically, which worked to his advantage as an athlete. He notes that cancer helped him grow into a more mature, less cocky cyclist. Physically, Armstrong said that his post-cancer physique was leaner, which allowed him to attack the hill-climbing components of the sport more efficiently since he was carrying less bulk.
Although Armstrong goes through a period of aimlessness following his treatment, which he refers to as "survivorship,'' he mostly maintains a positive attitude throughout his cancer ordeal. What is interesting, however, is how he characterized the mental components of illness and recovery. He writes: "I believed...in the doctors and the medicine and the surgeries.... I believed in the hard currency of... intelligence and...research." But Armstrong also noted that he "believed in belief, for its own own shining sake."
He decided that belief in something was preferable to belief in nothing and eventually arrived at the following conclusion: "I didn't fully see, until the cancer, how we fight every day against the creeping negatives of the world, how we struggle daily against the slow lapping of cynicism. Dis-spiritedness and disappointment, these were the real perils of life, not some sudden illness or cataclysmic millennium doomsday."
Dr. Bernie Siegel has also written about illness and positive thinking in several books, including his bestseller, Love, Medicine and Miracles. Dr. Siegel was not really on my radar, but another woman with breast cancer told me that she found his book helpful. So I listened to an Internet radio broadcast in which he focused on breast cancer. For those who are interested, here is the link: http://www.blogtalkradio.com/breastcancerwellness/2008/02/19/Love-medicine-and-miracles-for-breast-cancer-survivors
In short, Dr. Siegel advises patients to empower themselves in many ways: to be proactive in their treatments and to take charge of their lives. He teaches people to use positive messages, imagery, and humor to aid in healing. Dr. Siegel also believes that many of us carry emotional baggage from our childhoods with us, which can lead to illnesses.
While I agree that a mind-body connection exists (anyone who has blushed with embarrassment knows this to be true), Dr. Siegel and I part ways at the idea that one's unresolved emotional issues can morph into cancer cells. Many theories exist to explain the growth of cancer cells, including exposure to toxins, hormonal imbalances, genetic pre-dispositions, and poor diet. Scientists don't fully understand all the underlying causes, but I'm skeptical of the theory that holding a grudge against one's parents is a cancer catalyst. A similar theory, which some authors have floated, is that women bring on breast cancer by being passive and "bottling-up" their emotions in their chests. This idea is ridiculous, and only casts blame on those who are unlucky enough to develop a lump in their breast.
The truth is that well-balanced, fully expressive, upbeat people get sick, too. One of Lance Armstrong's physicians, Dr. Einhorn, spoke to this point in the following observation: "I've seen wonderful, positive people not make it in the end. And some of the most miserable, ornery people survive to resume their ornery lives."
The trick of illness is not to be emotionally defeated by it, but to learn how to use its lessons to a later advantage. Lance Armstrong took the idea of the mind-body connection to the extreme and conquered the Tour de France. He also started a major cancer fundraising organization. But small efforts are good, too. This weekend, I went to Bikram Yoga, a 90-minute yoga class held in a room heated to 105 degrees. Yes, you read that right. It was definitely hot, but I persevered and felt pretty good at the end. I also start radiation in a few days. At the beginning of this detour, I might have had some trepidation about being radiated, but not now. I've vanquished chemo and survived a session of Bikram yoga. How bad can radiation be?
5/29/08
Pack Mentality
Exactly two months after my last chemo treatment, my hair started to grow back. Rather than being stark white, my scalp is mostly covered in a very Nixonian five o'clock shadow -- a foreshadow, if you will, of hair to come.
While I'm finally able to look at my bare head in the mirror without gasping, I still haven't let anyone else see me like this. I keep my head covered at all times, even around the house, and even while I'm sleeping. My head has an alien quality to it, which is just too much to share, even with those who are closest to me. My look undeniably screams cancer patient, which is what I am. But why hammer the point home.
On an airplane recently, I sat next to a young man, who had absolutely no hair on his scalp or on his arms. I wondered if his condition were permanent and what had caused it -- childhood illness, congenital condition, heredity, or pharmaceutical side effect. The average person has about 100,000 hairs on his or her head. This fellow had zero.
Sitting next to this man triggered my thinking about appearance and image and why they carry so much importance in our culture. It's not just hairlessness. Consider the fat kids who are teased by their peers, or the morbidly obese adults whom we privately judge. Think of Michael Jackson and his skin condition or the people who are either extremely short or extremely tall. None of these physical traits goes unnoticed. While these characteristics are involuntary, many people intentionally alter their appearances in dramatic ways -- multiple piercings, extensive tattoos, outlandish hair and dress.
After mulling on this for a bit, I came around to this conclusion: Appearance is such a fundamental core concern that it's probably linked to an anthropological need to be part of the pack. We're just like the canines. The kids who demand the expensive tennis shoes, and the gang members who wear specific colors are acting on the same basic pack mentality. Even those who opt for multiple tattoos and piercings are still signalling their membership in a sub-group (sub-pack?) of non-conformists. When you get down to it, aren't skin-deep differences, when paired with fear or ignorance, the recipe for racism, which is really just pack behavior gone bad.
So my horror at being a hairless female likely stems from a deeply held human characteristic that both urges us to project health and vigor and to keep our appearance within accepted norms. No one wants to be the sick dog with the bad fur. It also explains the wig issue. During this cancer experience, many people have gently suggested to me that a wig was the perfect solution. I understand their thinking to some degree because a wig would shield me from public scrutiny, essentially allowing me to appear normal and avoid inquires from the pack. Honestly, if I were in a situation in which I wanted to hide completely the fact that I had cancer -- say, I had a customer-service job or lots of interaction with young children -- I would have considered wearing a wig. But a wig is a band-aid at best. It may blanket the evidence of illness, but underneath the wig, you still have no hair. In the mirror, you're still the sick dog with the bad fur.
Unfortunately, chemo is often the only effective treatment for cancer, and hair loss is collateral damage. So you cope as best you can because you really have no choice. And you laugh at yourself for being happy because you have a five o'clock shadow on your head. It signals how far you've come. It signals an approaching return to health and vigor.
While I'm finally able to look at my bare head in the mirror without gasping, I still haven't let anyone else see me like this. I keep my head covered at all times, even around the house, and even while I'm sleeping. My head has an alien quality to it, which is just too much to share, even with those who are closest to me. My look undeniably screams cancer patient, which is what I am. But why hammer the point home.
On an airplane recently, I sat next to a young man, who had absolutely no hair on his scalp or on his arms. I wondered if his condition were permanent and what had caused it -- childhood illness, congenital condition, heredity, or pharmaceutical side effect. The average person has about 100,000 hairs on his or her head. This fellow had zero.
Sitting next to this man triggered my thinking about appearance and image and why they carry so much importance in our culture. It's not just hairlessness. Consider the fat kids who are teased by their peers, or the morbidly obese adults whom we privately judge. Think of Michael Jackson and his skin condition or the people who are either extremely short or extremely tall. None of these physical traits goes unnoticed. While these characteristics are involuntary, many people intentionally alter their appearances in dramatic ways -- multiple piercings, extensive tattoos, outlandish hair and dress.
After mulling on this for a bit, I came around to this conclusion: Appearance is such a fundamental core concern that it's probably linked to an anthropological need to be part of the pack. We're just like the canines. The kids who demand the expensive tennis shoes, and the gang members who wear specific colors are acting on the same basic pack mentality. Even those who opt for multiple tattoos and piercings are still signalling their membership in a sub-group (sub-pack?) of non-conformists. When you get down to it, aren't skin-deep differences, when paired with fear or ignorance, the recipe for racism, which is really just pack behavior gone bad.
So my horror at being a hairless female likely stems from a deeply held human characteristic that both urges us to project health and vigor and to keep our appearance within accepted norms. No one wants to be the sick dog with the bad fur. It also explains the wig issue. During this cancer experience, many people have gently suggested to me that a wig was the perfect solution. I understand their thinking to some degree because a wig would shield me from public scrutiny, essentially allowing me to appear normal and avoid inquires from the pack. Honestly, if I were in a situation in which I wanted to hide completely the fact that I had cancer -- say, I had a customer-service job or lots of interaction with young children -- I would have considered wearing a wig. But a wig is a band-aid at best. It may blanket the evidence of illness, but underneath the wig, you still have no hair. In the mirror, you're still the sick dog with the bad fur.
Unfortunately, chemo is often the only effective treatment for cancer, and hair loss is collateral damage. So you cope as best you can because you really have no choice. And you laugh at yourself for being happy because you have a five o'clock shadow on your head. It signals how far you've come. It signals an approaching return to health and vigor.
5/15/08
The Radiation Question
Maybe it's me, but meeting with doctors to get one's questions answered can be tricky. The information is complex, and sometimes physicians just don't understand what you really want to know. Should they dumb it down for you, or do you have enough background to make sense of the textbook answer.
The problem is two-fold. One, when we talk to our doctors, we're usually not displaying our best selves. The format of doctors' appointments, and the anxiety that accompanies them, prevent us from being on top of our game. As a result, doctors may not get a true sense of who we are, at least not initially. Two, doctors have a history of being a little superior. While the profession has worked to reduce the egotism and improve patient communication, evidence of doctors' loftiness is still apparent.
Consider the wardrobe problem. While having serious conversations with physicians, I'm often wearing an ugly hospital gown that is exposing my bare back. Not my best look. The doctor, however, is usually dressed professionally and sporting a bright white lab coat with his or her name embroidered on it. As patients, our forefathers must have been really ill to let this imbalance get established. Would you go to any other meeting only half-dressed and wearing a hideous shade of green or an unflattering hue of blue? I didn't think so.
Second, the doctor's name on the lab coat is always followed by the capital letters M.D. Since it's a pre-requisite for physicianship, I just assume that they graduated from medical school. Why do they need to wear their credentials on their coats? Others with advanced degrees don't wave them around so openly. I fully accept that doctors are better at science than I am. That's why they make the big bucks.
Given the considerable differences between us, maybe patients and doctors should spend a little time getting to know each other at the outset in order to establish a style of communication. I recently found myself talking to the radiation oncologist again, as I tried to get a treatment question answered. After a minute or so of conversation, my background as an investigator emerged and took over the questioning, because I just couldn't get the answer I wanted -- mostly because the doctor and I needed to get on the same page.
My question was this: Why does a patient still require radiation if she has already undergone surgery and chemotherapy and achieved clean margins? Here's how the conversation went:
Setting: Little exam room. Doctor has just completed a brief physical exam. I'm sitting on an examination table wearing faded blue, oversized hospital garb that keeps coming untied. Doctor is sitting straight and tall on a stool wearing a pressed dress shirt, tie, and a very clean white coat.
Doctor: Everything looks good. Do you have any questions about radiation?
Me: I do have a lingering question. I've had surgery, chemotherapy and a re-excision. Tell me why I need radiation, too?
Doctor: In the old days, every woman with breast cancer was given a radical mastectomy. This was very disfiguring, so doctors moved away from this practice. Now we try to remove just the diseased tissue and then treat the breast with radiation. Because you didn't have a mastectomy, you need radiation. It's the standard of care.
Me: I understand that it's the standard of care. But why?
(Doctor's cell phone rings. He fishes for the phone in his pocket. Doctor looks at caller ID, answers the phone, and says "I'll be right there." He turns his attention back to me.)
Doctor: We find that radiation reduces recurrences that occur at the site of the original cancer. Women who have had surgery and radiation do much better in the long-term than those who only had surgery.
Me: But if women have had chemo, why do they still need to be radiated. Why isn't chemo enough to kill any remaining cancer cells in the breast?
Doctor: Chemo is more effective at reducing metastasis in other parts of the body. Radiation kills the dividing cells in the breast.
Me: But why? Doesn't chemo work the same way as radiation-- by killing dividing cells.
Doctor: That's correct. Chemo and radiation work on the same principle. They both destroy dividing cells, but they attack them differently.
(Doctor's cell phone rings again. He answers it, saying with slight impatience, "I'll be right there." He again turns his attention back to me.)
Me: You need to go. I'm keeping you too long.
Doctor: No, they can wait. Do you understand what I'm saying?
Me: I understand the words that you're saying, and I know that radiation is the standard of care. But I'm still not clear on why chemo doesn't do the job. Why do we have to bring in the radioactive substances if I've already had four rounds of chemo?
Doctor (looking like he is out on a limb): Because surgery has changed the vascular structure of the breast, so chemo may not reach the cancer cells there.
Me (cartoon-type light bulb over my head illuminating): Oh!!! It's a highway construction problem. Maybe the chemo drugs can't get to the cancer cells in the breast because surgery has realigned some of the veins. Essentially, the roads may be bad.
Doctor: Yes. Also, there are lots of cancer cells at the actual disease site, so surgery may not remove them all and chemo may not kill them all off. Radiation provides extra protection and helps to prevent recurrence.
Me (appreciatively): Thank you. Now I get it.
Doctor (looking relieved): You're asking the types of questions that medical researchers ask. Scientists want to know why one treatment works better than another treatment or a combination of treatments. I'm going to download some information for you from the Internet.
Me: That would be great. Thank you.
To his credit, this doctor did not leave the room until I was satisfied with his answer. He could have used his ringing cell phone as an excuse to exit, but he didn't. And for that, I was grateful.
The problem is two-fold. One, when we talk to our doctors, we're usually not displaying our best selves. The format of doctors' appointments, and the anxiety that accompanies them, prevent us from being on top of our game. As a result, doctors may not get a true sense of who we are, at least not initially. Two, doctors have a history of being a little superior. While the profession has worked to reduce the egotism and improve patient communication, evidence of doctors' loftiness is still apparent.
Consider the wardrobe problem. While having serious conversations with physicians, I'm often wearing an ugly hospital gown that is exposing my bare back. Not my best look. The doctor, however, is usually dressed professionally and sporting a bright white lab coat with his or her name embroidered on it. As patients, our forefathers must have been really ill to let this imbalance get established. Would you go to any other meeting only half-dressed and wearing a hideous shade of green or an unflattering hue of blue? I didn't think so.
Second, the doctor's name on the lab coat is always followed by the capital letters M.D. Since it's a pre-requisite for physicianship, I just assume that they graduated from medical school. Why do they need to wear their credentials on their coats? Others with advanced degrees don't wave them around so openly. I fully accept that doctors are better at science than I am. That's why they make the big bucks.
Given the considerable differences between us, maybe patients and doctors should spend a little time getting to know each other at the outset in order to establish a style of communication. I recently found myself talking to the radiation oncologist again, as I tried to get a treatment question answered. After a minute or so of conversation, my background as an investigator emerged and took over the questioning, because I just couldn't get the answer I wanted -- mostly because the doctor and I needed to get on the same page.
My question was this: Why does a patient still require radiation if she has already undergone surgery and chemotherapy and achieved clean margins? Here's how the conversation went:
Setting: Little exam room. Doctor has just completed a brief physical exam. I'm sitting on an examination table wearing faded blue, oversized hospital garb that keeps coming untied. Doctor is sitting straight and tall on a stool wearing a pressed dress shirt, tie, and a very clean white coat.
Doctor: Everything looks good. Do you have any questions about radiation?
Me: I do have a lingering question. I've had surgery, chemotherapy and a re-excision. Tell me why I need radiation, too?
Doctor: In the old days, every woman with breast cancer was given a radical mastectomy. This was very disfiguring, so doctors moved away from this practice. Now we try to remove just the diseased tissue and then treat the breast with radiation. Because you didn't have a mastectomy, you need radiation. It's the standard of care.
Me: I understand that it's the standard of care. But why?
(Doctor's cell phone rings. He fishes for the phone in his pocket. Doctor looks at caller ID, answers the phone, and says "I'll be right there." He turns his attention back to me.)
Doctor: We find that radiation reduces recurrences that occur at the site of the original cancer. Women who have had surgery and radiation do much better in the long-term than those who only had surgery.
Me: But if women have had chemo, why do they still need to be radiated. Why isn't chemo enough to kill any remaining cancer cells in the breast?
Doctor: Chemo is more effective at reducing metastasis in other parts of the body. Radiation kills the dividing cells in the breast.
Me: But why? Doesn't chemo work the same way as radiation-- by killing dividing cells.
Doctor: That's correct. Chemo and radiation work on the same principle. They both destroy dividing cells, but they attack them differently.
(Doctor's cell phone rings again. He answers it, saying with slight impatience, "I'll be right there." He again turns his attention back to me.)
Me: You need to go. I'm keeping you too long.
Doctor: No, they can wait. Do you understand what I'm saying?
Me: I understand the words that you're saying, and I know that radiation is the standard of care. But I'm still not clear on why chemo doesn't do the job. Why do we have to bring in the radioactive substances if I've already had four rounds of chemo?
Doctor (looking like he is out on a limb): Because surgery has changed the vascular structure of the breast, so chemo may not reach the cancer cells there.
Me (cartoon-type light bulb over my head illuminating): Oh!!! It's a highway construction problem. Maybe the chemo drugs can't get to the cancer cells in the breast because surgery has realigned some of the veins. Essentially, the roads may be bad.
Doctor: Yes. Also, there are lots of cancer cells at the actual disease site, so surgery may not remove them all and chemo may not kill them all off. Radiation provides extra protection and helps to prevent recurrence.
Me (appreciatively): Thank you. Now I get it.
Doctor (looking relieved): You're asking the types of questions that medical researchers ask. Scientists want to know why one treatment works better than another treatment or a combination of treatments. I'm going to download some information for you from the Internet.
Me: That would be great. Thank you.
To his credit, this doctor did not leave the room until I was satisfied with his answer. He could have used his ringing cell phone as an excuse to exit, but he didn't. And for that, I was grateful.
5/9/08
Family Tree
Although I have yet to face my oncologist with this decision, I told his nurse practitioner that I'm declining the invitation to become a human test subject. I've decided against joining the national clinical trial researching the impact of osteoporosis medicines on reducing breast cancer metastasis to the skeletal system.
No single fact tipped my hand. Rather, the cumulative bad news concerning these drugs, known as bisphosphonates, weighed too heavily against their possible benefits, at least for me. First, their potential to destroy the jaw bone irreparably, while a statistically rare side effect, was still a frightening one. Moreover, anecdotal evidence about the jaw problem just keeps surfacing, making me question how rare this side effect actually is. Meanwhile, this class of drugs has been linked to other health problems. Just last week, one such drug, Fosamax, was blamed for incidents of irregular heart beats. Additionally, in January, the FDA issued a warning advising that Fosamax and other bisphosphonates marketed as Boniva, Reclast, Zometa and other labels may be responsible for a sudden onset of musculoskeletal pain. That's three medical complications l'd like to avoid, but who's counting.
My overall bone health is still a question mark. With last week's surgery, we delayed the diagnostic bone density test. If my bones are crumbling, I may have to take bisphosphonates anyway, but at least my doctor and I can select the specific drug and dosage, rather than being constrained by the protocols of a clinical trial.
Genetics, of course, plays a big role here, and I don't know of any family history of osteoporosis. But you're never completely certain that a grandparent or great-grandparent didn't suffer from a particular health problem. Case in point: Since learning I had breast cancer, I've been telling doctors that I have no family history of the disease. That was before the postman brought a card last week from my Aunt Sallie. In her mid-eighties, Sallie is my father's eldest sister. She lives in Colorado with their third sibling, my Aunt Mary Jeanne. Both of my father's parents were deceased before I was born. Growing up, I rarely saw these aunts, and I know very little about my father's branch of our family tree.
So I read with great interest Sallie's information that my paternal great-grandmother died of breast cancer. Unfortunately, this nugget was the sum total of what Sallie revealed about her. Since she was a great-grandmother, and thus a few generations removed from me, I don't know how medically significant this fact is. But my curiosity is still peaked. What was her maiden name? How old was she when she died? What was her ethnic background? Where was she born?
Each of us is the amalgamation of so much genetic code. Beyond the color of our eyes or the texture of our hair, our forefathers give us a propensity for so much else -- from heart disease, to blood disorders, to alcoholism, to longevity. Learning their life histories can be fascinating from a self-awareness point of view. Now I see that it's also medically useful. The next thing I write should be another letter to Aunt Sallie.
No single fact tipped my hand. Rather, the cumulative bad news concerning these drugs, known as bisphosphonates, weighed too heavily against their possible benefits, at least for me. First, their potential to destroy the jaw bone irreparably, while a statistically rare side effect, was still a frightening one. Moreover, anecdotal evidence about the jaw problem just keeps surfacing, making me question how rare this side effect actually is. Meanwhile, this class of drugs has been linked to other health problems. Just last week, one such drug, Fosamax, was blamed for incidents of irregular heart beats. Additionally, in January, the FDA issued a warning advising that Fosamax and other bisphosphonates marketed as Boniva, Reclast, Zometa and other labels may be responsible for a sudden onset of musculoskeletal pain. That's three medical complications l'd like to avoid, but who's counting.
My overall bone health is still a question mark. With last week's surgery, we delayed the diagnostic bone density test. If my bones are crumbling, I may have to take bisphosphonates anyway, but at least my doctor and I can select the specific drug and dosage, rather than being constrained by the protocols of a clinical trial.
Genetics, of course, plays a big role here, and I don't know of any family history of osteoporosis. But you're never completely certain that a grandparent or great-grandparent didn't suffer from a particular health problem. Case in point: Since learning I had breast cancer, I've been telling doctors that I have no family history of the disease. That was before the postman brought a card last week from my Aunt Sallie. In her mid-eighties, Sallie is my father's eldest sister. She lives in Colorado with their third sibling, my Aunt Mary Jeanne. Both of my father's parents were deceased before I was born. Growing up, I rarely saw these aunts, and I know very little about my father's branch of our family tree.
So I read with great interest Sallie's information that my paternal great-grandmother died of breast cancer. Unfortunately, this nugget was the sum total of what Sallie revealed about her. Since she was a great-grandmother, and thus a few generations removed from me, I don't know how medically significant this fact is. But my curiosity is still peaked. What was her maiden name? How old was she when she died? What was her ethnic background? Where was she born?
Each of us is the amalgamation of so much genetic code. Beyond the color of our eyes or the texture of our hair, our forefathers give us a propensity for so much else -- from heart disease, to blood disorders, to alcoholism, to longevity. Learning their life histories can be fascinating from a self-awareness point of view. Now I see that it's also medically useful. The next thing I write should be another letter to Aunt Sallie.
5/2/08
Progress Note
From the Chart
Patient: Watkins, C.
Date of Procedure: April 29, 2008
Nature of Procedure: Re-excise small amount of additional tissue from left breast. Section marked for removal is located on the outer, inferior side, around 4 o'clock (if breast were a clock face). Objective is to achieve a clean margin around the pre-cancerous DCIS. (Doubt that patient will notice much change. Surgical plan calls for removing only a couple of minutes from breast clock, say 4:17 to 4:20.)
Pre-Surgical Events: Ms. Watkins was extremely polite and well-mannered despite the fact that we kept her waiting on the ultrasound table for a full hour due to a malfunctioning ultrasound machine. Query: How were surgical guide wires placed before ultrasound? Does anyone remember?
Surgical Notes: Mission accomplished! Procedure completed in a jiffy. Patient sent home one hour following surgery. A couple of nurses remembered Ms. Watkins from her prior surgery last November. Good time had by all.
Post-Surgical Follow-up (24 hours later): Nurse placed follow-up call to patient's home. Ms. Watkins reported feeling flattened and was watching hour after hour of Top Chef while reclining on her sofa. Possible that she is reacting to lingering effects of anesthesia, which may have addled her brain. Propose watchful waiting to see if penchant for reality TV cooking show wears off as anesthesia dissipates. Husband advised to call immediately if patient dons white chef coat and/or toque.
Post-Surgical Follow-up (72 hours later): No pathology report yet. Hope "mission accomplished" reference above was not premature. Patient reports returning to normal activities, including blog writing. However, Ms. Watkins is experiencing a continuing craving for episodes of Top Chef. Suspect that patient has underlying fantasy of winning Top Chef competition herself. In any case, checking with anesthesiologist to see if other patients are reporting similar side effects related to cable and/or reality TV. Perhaps basis for new research study. What are the recuperative effects of viewing American Idol or Dancing With the Stars while in post-surgical daze?
Final Note: Preliminary pathology report is in. No evidence of any cancer. Nurses told patient Ms. Watkins that she can relax. Final pathology report yet to be issued, but preliminarily, things looks very good. Re-excision appears to have been the right course. Hurrah! We seem to have gotten it right.
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