Tuesday, April 27, 2010

In Today's Breaking News . . .

Got a call early this afternoon from the physician's assistant at my gynecological-oncologist's office. The lab results from my surgery were in. And guess what? My surgeon is not God. Turns out the mass he removed from me last Thursday was not, after all, a low malignant-potential tumor. It was bog-standard ovarian cancer. Stage 1A, Grade 1.

Which if you're going to get ovarian cancer is the stage and grade you want it to be. The PA said they took and analyzed "a gazillion" specimens and everything except the right ovary was negative.

So that means they got it, right?

Not so fast. Turns out the mass ruptured during surgery, so Dr. C himself puts it at Stage 1C instead.

Now I thinks to meself, I thinks, How on earth could that have happened . . . ? Did somebody poke a finger in the wrong place and Pop Goes the Weasel?

Yeah, right. That naive bit of dubiety rises from my imagining that my ovaries and other bits were just floating around loose in my abdomen and the tumorous one simply had to be picked up and cut off. No. Things in the body are adhered and attached to other things so they won't rattle around in your insides and get all tangled up. And considering that my right ovary/tumor had a very delicate-looking septation off one end of it (I know-- I saw the picture at my gynecologist's office in February), it's not surprising it should have torn a bit in the removal process.

In a couple of weeks I may well find out if my angle on this is correct, because I'm to come in for a follow-up visit with Dr. C and the PA. Still working out the logistics on getting a ride into town, but it'll be either on the 10th or the 17th.

The way I'm thinking about it is, the mass was a Stage 1C ovarian cancer, and we'll be discussing how to keep it in the past tense.

. . . Yeah, that very well could mean chemo.


Yeah, nobody does. But people take it and they get through it and come out fine the other end. And if they have to fumigate my belly, so to speak, to make sure all the cancer bugs are gone, that's what we have to do.

The Lord is good; His Spirit is with us, and I am reminded that the reason ovarian cancer is so scary is that most of the time it's not discovered until it's in a later and much less treatable stage. It's not that ovarian cancer cells are more virulent or potent than the kind that settle in elsewhere.

And even though this has turned out to be what I feared back in early February, it's not the same. Thanks to the providence of God working through my gynecologist, this mass was discovered early. And if the fight needs to continue a bit before total victory is won, so be it.


Otherwise, I'm doing pretty well this first full day home. Swelling and bruising going down, pain well under control even without constant Vicodin. Enough energy that I have to remind myself not to do Forbidden Things. Got up mid-afternoon and came down for some lunch; then early in the evening I got dressed (yay! I can get into my corduroy jeans!) and my friend Frieda* and I went out for a stroll around my garden to see what's in bloom.

After supper she sat down at the piano and played some music she'd brought, then started in on hymns. Unfortunately, the hymnals I had on the piano ledge didn't have some of the hymn/tune combinations we wanted, and I knew better than to run (!) up to the third floor to get the hymnbooks that do. So I set my Welsh hymnal before her and she played "Sanctus" and "Aberystwyth" for me while I stood there and sang them yn Cymraeg.

Oooh, danger! danger! Don't get someone who's even part-Welsh started singing Welsh hymns at 10:30 at night! Especially one who's only five days post-op! I wanted to sing more, more-- and knew I needed to stop before I messed myself up. Not from pain-- I'm trained to do intercostal breathing, so it didn't affect the surgery site. But from pure exhaustion, that I would have ignored from the hwyl of the words and the music.

No. There are times to sing till you drop. Tonight was not one of them.

Monday, April 26, 2010

Knowledge Is Power

My surgeon Dr. C was in at 7:30 this morning, the whole parade of interns, residents, and so on in train, and he confirms that I can go home today, hooray.

(True, all systems are not Go as yet, if you know what I mean, but they have ways of dealing with that . . . Yes.)

Dr. C sees no need to wait for the pathology report; everything points to my "low malignant-potential tumor" as having been Stage 1; that is, confined to the one ovary. That bit of me and rather more is now out, out, out, which means Problem Solved. The tumor was only 6 cm long, compared to the 9.7 it was scaled from the February 19th sonogram, so there's no way to get a comparison to see if it grew in the last two months. But it's nice to know it wasn't as honking big as my gynecologist originally thought.

No chemo, Dr. C confirmed. Great to hear; I wouldn't have looked forward to that, even if I did have insurance.

This is all very good, but I had more questions. Only 15% chance of recurrance, right. But if it does come back, how will I know?

There'd be lower digestive tract problems that don't respond to anything else. In fact, where LMP ovarian tumor fatalities come about is due to bowel obstructions and the attendant sepsis, not because its cells infiltrate and change an affected organ.

Where would it come back?

Someplace in the abdomen.

And the response?

Surgery, again, unless that meant taking out something I couldn't do without. In which case they'd try chemo, even though it's not that effective, since the LMPT cells are so close to normal cells it's hard to hone in on that target.

But, says Dr. C, why am I fretting over this!? We're only talking 15%!

No, I'm not fretting! In fact, it makes me fretful that he should think I'm fretting! My academic mind wants to know all the facts, sort through them, arrange them as needed, and go on from there! In one of my favorite novels, Dorothy L. Sayers' Gaudy Night, the hero Lord Peter Wimsey, is shown to be a paragon among men because he correctly interprets a female academic's question about a certain male wardrobe malfunction not as skittishness, but as a desire for precise information. My Dr. C is not necessarily a paragon of that calibre, but he knows his medicine. So if he wants to chaff me for being a worrywart, he can do it, as long as he answers the questions.

Though maybe I should admit to an smidge of Eeyoreishness . . . My prevailing feeling is that with me, a 15% chance of anything is like 0% should it be about something good. Like if I should play the lottery or if we're desperate for rain or I'm angling for a job. But if it's something undesirable . . . it may as well be even odds. I mean, I already "beat the odds" and got this weird kind of tumor, didn't I?

Never mind. Knowledge is power, and the more I'm master of it, the better. Anyway, who wants to be one of those patients who don't have all the available facts and goes around believing and talking as if her doctor is withholding information and may be doesn't know what he's talking about?

Saturday, April 24, 2010

Adventures in Medicine

Well, I've been in the hospital since Thursday morning and coherent enough to get online since Thursday night, but only this morning did I find a person here at UPMC Mercy who could show me how to get connected on their wireless network.

And that was by coincidence, since I'd intended to read the newspaper my friend Frieda* bought me yesterday this morning over breakfast, but I guess it fell on the floor over night and the cleaning lady cleared it away. I lamented the loss of my paper to the nurse (a guy) and he said, "I see you have your laptop with you. Why don't you go on one of the newspaper websites and read it there?" And he showed me how.

Believe it or not, breakfast this morning is a medical adventure in itself. I still haven't passed gas (a very important indicator!) so far, so technically I shouldn't have anything by mouth. And I'd been feeling queasy. Etc. But my surgeon's fellow in their practice, Dr. K, who was in early this morning, said they could try me on some liquids this morning, regardless. 4 ounces of apple juice down the hatch so far, and working on the grape. So far, so good.

But people (all two of you!) will want to know about the surgery on Thursday.

Here's the good news: My surgeon, Dr. C, says everything looks good; the mass they took out wasn't cancer and there was no sign of cancer anywhere in the abdominal cavity.

Here's the routine news: They've taken all my ladybits and scrapings of everything else in there (from the lower lungs on down) to the lab to make absolutely-certain-sure there's no cancer anywhere.

And now, the ambiguous news: The ovarian mass, while not cancerous, is nevertheless not a "normal" cyst. If I understand correctly, it's not even precancerous. What they're calling it is a "low malignant potential tumor," and I have no idea where the hyphens should go on that. Dr. K says they'll go over all that when I'm discharged.

The mass is not invasive and therefore not a cancer, but wasn't a benign thing to be having in me, even so. There's a 15% chance it could recur, and there's nothing that can be done to make that risk nil. There's no role for chemotherapy or radiation to obviate that 15%, because, well, it's not a cancer! But if I understand the doctor's message right, it's the short of thing that can pave the way for a cancer in the future.

I think. The inconvenience in all this is that Dr. C had leisure to talk to my friend on Thursday, but not to me-- I was in the Recovery Room. So I couldn't ask any questions!

She said Dr. C told her "Nobody wants to hear this sort of news. Everybody wants things black and white."

Well, maybe, but my first reaction was, "There I go again, being original! I never can seem to do things the ordinary way!"

And if I want things to be black and white, it's not just for my health's sake, but so I can explain it simply and easily to people and not bore them going off on tangents.

Oh, well. It is what it is. And if my breakfast of juice and jello will stay down nicely, that will be one less adventure to confront!