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.

Idoanwannadochemoidoanwannadochemoidoanwannadochemo!!!

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.

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?

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!

Fall Back and Regroup

I've had to postpone my surgery. I've caught the nasty local Kleenex-box-emptying cold and feel like boulders have been rolled over me all night. Surgeon's office says no, I shouldn't be operated on in that condition. Call back and reschedule when I feel better.

She says, "It's elective and not urgent surgery, so you can set your own time." This tells me my gyn-onc is very confident in his diagnosis and it's only a cyst. Still has to come out, though. Just not day before yesterday.

Still, I feel like a wimp. But a sensible wimp.

Good News

Quick bulletin, then I have to get back to cleaning the house:

I had my liver ultrasound on Friday morning. Before I headed for the hospital to get it, I called my surgeon's office. Nurse told me the CT scan had shown an "indeterminate lesion on the left hepatic lobe." Not a mass, she said, but it was showing more dense than water (water would be good, since that would be a benign cyst).

Well, I heard from the surgeon's office yesterday morning. The findings? The "indeterminate lesion" is a benign cyst. No malignancy. Perfectly harmless, perfectly normal. People get them all the time. Nothing needs to be done with it.

They had me run up to the local hospital Friday afternoon to pick up the CD with the CT scan pictures. Of course, I stuck it into my computer . . . Happily, I'd been researching on line about liver lesions, so I knew what to look for and didn't panic from confusing the ordinary liver structure for masses and malignancies. Yeah, I could see what they needed to know more about. It was dark, like water would show, but not dark enough.

And on the Web, I found out that ultrasound is often used to complement CT scans when dealing with indeterminate lesions, because one can show/confirm what the other can not.

And praise God! my ultrasound showed that as to my liver, all is well.

Still gotta get the ovarian tumor out day after tomorrow, and God willing, my surgeon is right and it'll prove to be only a cyst, too.

Ominous

Today I got called in to teach at an elementary school I'd never been to before. Despite what I'd heard about the difficulties of its open plan design and about the recalcitrance of some of the students, the day went rather well.

It wasn't until I was well on my way home that I thought at all about perhaps getting the results of Monday's CAT scan today. And I don't know why, but as I was putting my key in the door and wondering if there'd be a message on the answering machine, I thought to myself, "I don't have a good feeling about this."

And immediately reflected, "Yes, but my pessimism won't make things bad if they really are good, and I would like very much to be proven wrong."

Yes, the machine was flashing and beeping. It was the nurse at the surgeon's office, who had called this morning. The CT scan results were in, and I could/should call her to discuss them.

And, she said, there were a couple of things they needed me to do before the 25th.

One was to go to the local hospital where I had the scan and pick up the films. I'm to bring them with me when I come for my surgery. So (unless the envelope is sealed) I guess I could take a look at them myself after all.

As for the second thing, she said, "We also need you to get an ultrasound done, of your liver, prior to the surgery."

I sat there, still in my coat, on the arm of the sofa next to the phone table. My liver. Liver cancer. She's telling me the tumor on my ovary actually is malignant and it's already spread to my liver. Stage IV.

And again I have to face my own mortality. I've relaxed a bit from a month ago when my gynecologist gave me the word about the ovarian mass. I wasn't prepared for this, at this point. Maybe later, later, later, when I'd fought the good fight for awhile and was getting tired of it all. But now? Frankly, I was and am rather scared.

Feeling that way, I know it's time to rally the prayer troops. That's what kept me out of anger and despondency a month ago; that's what's going to do it now.

So although I'd planned to spend the evening patching my upstairs hall floor and working on my sermon for Sunday (I'm subbing for a very ill pastor over in Ohio), I used most of it letting people know my latest need. Facebook, email, phone (that call was to my mother), and yes, don't laugh! the community blog frequented by regular commenters on i can haz cheezburger.

And looking at online information about liver cancer. Oh, joy. Another of the types with only subtle symptoms, most of which I don't have. But now I'm wondering if the feeling of pressure I've had on the right side of my abdomen and just under my ribs is my liver being enlarged, and not referred pain from the ovarian tumor at all. Absurd, how I didn't feel it at all lately until after I got that phone message, and now I do with a vengeance.

I'd still like to write a page or two of sermon before I turn in. But I can't stay up too late-- they've scheduled that ultrasound for me at 8:45 tomorrow morning, at a hospital a few miles down the road towards Pittsburgh. Nothing by mouth after midnight. Right. I'm getting good at this.

I'll try to put in a call to my surgeon's office and talk to the nurse about the CT scan results before I leave for the ultrasound. Better I should know going in what it is they want from this new test and face it squarely, in the power of the Lord.

(Heaven knows I have none of my own.)

Tests

Yesterday I had my neutral pulpit preach and pulpit committee interview for the church over in the next county.

I told myself to treat it just like any other pulpit supply engagement; to preach the Word and minister to the people and give God the glory. But I couldn't help it-- I was afflicted with a slight buzz of nerves. Not enough to make me mess anything up, but enough to make me trip over my mouth just a little more than usual. And to have lousy breath support during the hymns, despite what's been beaten into me at Monday night community choir practice.

The pastor search committee took me to a local family restaurant afterwards for the interview. It surprised me that they didn't take advantage of the loooonnnnng wait we had to get our food to start with the questions. Instead, general conversation prevailed. They waited to get down to business until everyone was halfway through their food. Not that good an idea with me-- I'm a slow eater, and if I have to interrupt my eating to answer or ask questions, I'll be slower still.

Interview seemed to go well . . . good interchange of ideas, lots of information given about the church and its ministry. But I don't think they asked me that many questions. Five or six, tops. And then the chairwoman looked around and said, "I think we've heard all we need to hear. Blogwen," she asked, "Is there anything else you wanted to ask?" And there was just that something that told me the answer she expected was, "No, thank you, of course not."

I ignored it. Maybe I shouldn't have, but if my asking more questions about the church and reflecting how my experience and ideas would fit in with them was going to blow my standing with a nominating committee, I don't know that I'd want to accept their call. Because if that's all it would take to lose their favor, better it should happen now rather than later, when I'm wrestling with church crocodiles.

In any event, at that stage it seemed the atmosphere stiffened. Arms were folded over breasts. Eyes seemed to convey a profound lack of interest. I asked how soon they hoped to make a decision, to judge whether I should say anything about my upcoming surgery. Chairwoman told me "We're in no hurry. We've just signed our interim pastor up for another six months. Though of course we can break that, if we get the Right Pastor in." Very, very non-committal.

They hope to all get together this coming Sunday to sort through the candidates they've interviewed and come up with a short list. They'll let me know after that.

Then it was over, everyone got up, and the previous friendly atmosphere prevailed once more.

So who knows what that will all mean.

This morning, then, I went in for my CT scan, up at the local hospital. I'm not totally sure what it's supposed to show; I mean, if the gyn-onc thinks the tumor is benign and I'm getting everything out in a week and a half, why not just do it and save the money? But I went.

Didn't realize they make you drink nearly a liter of iodine-laced sterilized water after you get there, then sit for an hour or so while it runs through. I guess the idea is to deposit the chemical, because they do let you use the loo before the scan.

Then, unlike others I saw there in the Radiology Imaging waiting room, I did not have to strip off and put on a hospital gown for my scan. Just lay there on the table-bed in my street clothes, with an IV drip going into my right arm. Thought it was very fortuitious that I happened to put on a pair of slacks with a side zipper this morning; nothing to get in the way of the x-rays.

There was a slight mishap when the nurse-technician didn't get the IV needle in right the first time and made me bleed on the bedsheet. But she got it in on the second try and fetched a towel to keep me and my cashmere sweater out of my own blood. And the only thing that (momentarily) concerned me about the procedure was the requirement that I lie with my arms stretched straight "above" my head. I have rather dodgy shoulder joints, which have been known to pop out of joint when I get into positions like that. Well, it hurt a little, but nothing shifted.

Through the IV they run another chemical-- I forget which one-- that interacts with the iodine and the x-rays to give a good picture. "It'll make you feel really warm for a minute," said the nurse tech. Fine with me-- I was freezing after all that cold water. When that was in me, I was ready to go.

The CT machine is like a big donut that they slide you in and out of. The funny thing is that a computer voice orders you to "Breathe in!"-- and I did, in my best choir intercostal style-- and then it told me to "Breathe!" What? I did just breathe! When may I exhale?

I asked the technician. Oh. For this machine, "Breathe!" does mean "Exhale."

Ha. Try telling that to my choir director.

I underwent this process three times, then the test was over. I asked about the breathing. That's to keep your organs still, she said. I asked could I see the pictures. That's for my surgeon to show me, she said. His office should be calling me on Thursday or Friday to tell me the results.

OK. So that's two tests in two days and we'll see how well I did on both.

Maybe?

Tomorrow I have my first neutral pulpit preach in about a million years. Meaning, since 2003.

And lunch and an interview with a pastor search committee after.

The church is a small but active one, over in the next county. Quite within driving distance, by Pittsburgh area standards. I could see myself ministering to them and with them. God willing the fact that I live the other side of the hills won't set up an obstacle in their minds.

It's a 2/3 time tentmaking position, meaning I'd still be substitute teaching. And who knows when I'd get any house renovating done.

Never mind. It's an opportunity. Lord willing, all will go well and they like me. And that they're willing to work around my upcoming surgery and ensuing driving ban. I suppose that if they like me enough to make me their pastor, that won't be a problem.

My sermon's written and I think it will preach. Next step, decide what to wear and get some sleep. First service is at 8:30 AM.

Mild Hysteria

My surgery is two weeks from tomorrow. Today my MD cleared me as healthy enough to tolerate it. Too bad I'm not healthy enough to not need it!

And today I got the pathology report from what they sampled last Friday. No uterine cancer, thank you very much. And CA-125 levels in the normal range.

Which is good. But not always good for my attitude. Because it makes me wonder, do I really gotta go through this?

I mean, there's the "discomfort" of the post-op itself. Pain! Swelling! Mindless-making drugs!

Then there's the six weeks of enforced inactivity. Right when my house needs so much renovation! Right at the start of gardening season! Right when I should be taking advantage of the last weeks of the school year and getting in a lot of substitute teaching!

And what am I to make of what I read about hysterectomies online?

There's one site (which shall remain unlinked and unnamed) that seems dedicated to the proposition that 99.9% of all hysterectomies are needless and avoidable and only perpetrated by devious, greedy doctors out to make a quick buck at the expense of downtrodden women. What it tells you about the aftereffects will curl your hair. Nerve damage! GI tract disablement! Your ribcage falling down to your hipbones! Not to mention lifelong depression, loss of maternal feelings, and perpetual heartbreak, regret, and distress.

Then there's another site (which shall also remain linkless and nameless) where women who have had hysterectomies compare notes, and on it we have women complaining that their gynecologists wouldn't take their pain seriously and refused to take their bothersome female plumbing out.

Of course, this site makes its own contribution of stress, such as the contributors who say it was over six months to a year before they "got back to normal."

So with all this rattling around my brainpan, again, I can't help wondering, Do I really have to have this surgery? I mean, the gynecological oncologist is of the opinion that the ovarian tumor isn't even cancer! Can't we just ignore it and wait for it to go away?

. . . Oh yeah. Right. At my age, these things don't just go away. At my age, I really shouldn't have a goose egg in my abdomen like this. And malignant or "benign," the thing is growing. It's bad enough that it's already given me a pot belly I can't get rid of by any exercise of dietary discipline. But now it's interfering with my digestion. Benign or not, it can cause mechanical trouble. And they won't really know what sort of thing it is until it's removed.

So it's time to accept the PITA, and keep doing what I need to do to be as ready as possible when the time comes.

Promising

Outpatient surgery yesterday went well. And I'm blessed in that I have no trouble with anesthesia, before, during, or after.

And . . . how to say this without TMI . . . ? Let's just say that apparently it's been verified that the symptoms that got me to my gynecologist's in the first place-- the pain and the bleeding-- had nothing whatsoever to do with the mass on my ovary, and were, in themselves, annoying but harmless.

Meaning that it was a happy coincidence, or an act of Providence, rather, that caused this tumor to be discovered at this point.

The cancer surgeon is still pretty confident that it's benign. Hope he's right.

And it still has to come out. Along with everything else in there, what fun. That's in less than three weeks. All sorts of things I gotta do before then!

Exploratory Surgery

Tomorrow at the crack of dawn (6:30 AM) I'm due at the hospital in downtown Pittsburgh for exploratory surgery.

Well, ok, for a D&C. The other day at my first appointment with my gynecological oncologist, he examined me and said, "This doesn't feel like a cancer."

That doesn't mean we get out the bells and trumpets and kick up a celebration. No. But it is hopeful. Better odds than before.

However, says he, "That bleeding you're having. That ovary's not causing that. We need to do a D&C and see what's going on there."

So that's what's happening tomorrow. In and out the same day.

They'll biopsy whatever they find. Whatever it is, I still have to get the whole works out, which will happen March 25th. When that occurs, far as I can tell, best case scenario will be that the mass on my right ovary turns out to be a belated, post-menopausal fibroid and the bleeding was caused by, say, endometriosis.

Worst case would be that the tumor is, after all, a big nasty cancer and it's spread to my uterus. And who knows where else.

Best or worst case, it's all in the hands of God (with some help from the hands of my surgeon), and that's the best place for it. My job is to go get some sleep.

Where I Was Yesterday

I planned to write this post yesterday, but got busy doing other things. Which is good.

Friday, after I got the word about my extremely-possible ovarian cancer, I was strangely free of sensations of fear. No unseen hand viciously squeezing my gut, no leaden weight at the heart, no noose at the throat. I was full of nervous energy, yes, but I channelled that into thinking and planning and letting people know.

Friday night, I actually slept pretty well. But yesterday morning I didn't feel like lying in the way I usually do, and got up at 7:00. This is good-- I can't afford to be a slugabed. What wasn't good was that shortly after I got up, even when I was just greeting my animals and going about my morning routine, it hit.

No, not dire thoughts of fear and panic. No, no wild feelings of Oh My God, O My God! No, I was hit with a sensation of oppression in my upper arms, an annoying, distracting pain that all day tried to keep me from doing what needed to be done.

Weird, really. I know it's hormonal; adrenalin, probably. But it usually takes me in the gut. Why the arms?

I don't know. All I know is that I was tempted to do the flight-avoidance thing. To go back to bed or find some computer card games online to play (I've deleted them from both my computers). But that would be silly!! The thing I most resent about facing my mortality is that I may-- I say, may!-- not have the time to do all the things I've planned and want to. And am I now going to waste a perfectly good day on absurdities? I'll save that for when I'm feeling really grotty and have no choice.

More later, but it's time for me to head to church. Blessings to all!