Two Lines

Two lines to say that my CT scan from November 18th was clean, my CA-125 blood test number is low (which is good), and I got a very cheerful No Evidence of Disease pronouncement from my chemo doctor at my visit on November 22nd. 

He says I won't have to get another scan until six months out.  With my cancer having been caught so early and treated so aggressively, there's no point in exposing me to the radiation at quarterly intervals.  I'll have another blood test and visit in February, but that's all.

Unless the CA-125 levels are up.  But we won't invite trouble and expect that.

My head hair is about 3/16" long now, all white, or maybe it's platinum blond?  The eyebrows are returning, too, in a pale gray.  I hope that's won't be their final color.  Not sure about the eyelashes-- I'm so farsighted I can't see if they're coming back yet, even looking in the magnifying mirror!  I'll have to get somebody to look for me.

So now if I can get the rest of the copay bills discharged, I'll be on my way to putting this behind me.

God willing, of course.

Getting Lit Up

Today I embark on the next stage of my cancer cure journey.

Though maybe I don't want to use the words "next stage" in regard to cancer, since it implies things getting worse, not better.  Which, God willing, is not the case.

I'm presently sitting in the waiting room of the radiation oncology department of my local hospital, slurping iodine water to light me up for my baseline CT scan. 

Now that my chemotherapy's over, I get the exquisite pleasure (!) of going in for a CT scan every three months for two years to make sure the cancer zombies aren't coming back.  Then once every six months for three years after that.  The baseline scan today should-- no, blast it, will establish that I'm free of all abdominal and pelvic masses, tumors, lumps, bumps, and other execrences that could even vaguely be construed as cancer.

Coincidentally, yesterday my friend Ruth* (also a cancer survivor) sent me a link to an NPR feature about an oncologist who has just published a book called The Emperor of All Maladies: A Biography of Cancer.   In it he writes about the manifestations of cancer throughout human history, coupled with his own experience treating patients suffering from it today.  The excerpt seemed well-written and compelling.  I may read the book when the subject becomes less . . . personal.

But at the bottom of the book article were links to other NPR items, including a rather alarming one about increased risk of secondary cancers from both diagnostic and follow-up CT scans and other radiology techniques.  There is a particular danger, it said, for women in my age group who undergo repeated scans.  The author says that the amount of radiation varies from hospital to hospital, machine to machine, but in some the dosage is as high as what the survivors at Hiroshima and Nagasaki suffered . . . and we know what happened to them later in life.

Oh, joy.  Isn't this just designed to inspire confidence!  But as I understand it, I have to have these tests, because if despite everything the ovarian cancer manages to come back, it has to be found as soon as possible.  So a few minutes ago, when the nurse brought out the iodine water and the clipboard with the form to fill out, I mentioned the radiation risk.  And happily, she agreed that in my case, with the repeated scans scheduled, they should assuredly put me in the low-dose machine.  And happily again, that turns out to be the one they used on me last March.

So here we go.  God grant that I will now and hereafter be dancing with NED (No Evidence of Disease) and all this will be strictly routine.

I'm Not Sure

I had my first stint substitute teaching today since before my surgery last April, and I'm not sure I have the stamina for it.

If I were a better cat-herder-- I mean, a more proficient emergency teacher of 2nd graders-- I might think differently.  But by the end of the school day I was nearly weeping from exhaustion.  And now it's almost 7:00 PM and I'm sitting here still in my work clothes starving to death because I'm too shattered to get out of my desk chair.

Except for one child, who was so obstreperous early on that he started kicking the aide and had to have Security called on him, the kids weren't malicious or bad . . .  they just didn't know how to stay in their seats quietly doing their work.  They didn't understand that finishing a test early didn't give them the license to walk around the room bothering those who were still working.  They didn't realize that the end-of-the-day leaving chaos was not a good time for them to blindside me with fundraising forms, saying they had to take them to the office. And as my limited energy ran out, so did my creativity.  By 3:00 PM I was reduced to saying, "I know nothing about that.  Ask your teacher on Monday."

I'd just say No to substituting until the chemo treatments are over, except that a) I need the money; and b) I'm on a tiny bit of Unemployment Compensation, based on the subbing I did last fall and winter, and if I turn down work it's deducted from my benefit amount.  I don't know: the full possible benefit is equivalent only to two days of work and may not be worth demolishing my health over.  But again, anything coming in helps and it seems wrong to forfeit it.

My throat is sore, my sinuses are blocked, and I need to go eat. But I'm on to preach on Sunday with a sermon still to write so I won't exactly be resting this weekend.  We'll see what my blood counts look like when I go in for my chemo Monday morning.  The way my body feels now, I'm frankly glad I can't accept any teaching work that day, whether they can infuse me then or not.

Zombie Wars

I've often wondered why people have such an instinctual dread of cancer. It can't be simply because up till recent times it was pretty much always fatal. Tuberculosis, for instance, was just as much a death sentence and people didn't go around talking about it in whispers. My grandfather's first wife died in her 20s of consumption and from their letters I know they both knew she was doomed even before they got engaged. Everyone around her knew she had TB. Everyone was open about it; it was a fact of her life until she had no life left.

And I don't think cancer's basic horror is that it involves your own body turning traitor on you. Auto-immune diseases do that, too. So do infections. I remember a line from a Bill Cosby routine where he's recreating the scene when his mother took him to the doctor to see about getting his tonsils taken out. Doc says something like, "Kid, your tonsils are like sentries that're supposed to keep the bad stuff out. But in your case, they're fighting for the other side."

True, there is a mystery to cancer in that its cause is often so hard to trace. Otherwise perfectly healthy people (like me!) can pop up with it. It's not like you catch it from Aunt Martha at the family reunion-- in all due respect to an old lady I heard of, who kept the photo of a family member who'd died of melanoma securely wrapped in plastic, "Because it might be contagious."

But still, I don't think that's the font of the primal fear of cancer. I think it has to do with our dread and loathing of zombies.

Yes, zombies. Ever notice how our society's sick fascination with those monsters has grown along with our rising cancer statistics?

Anyway, I'm no expert on the Undead, but cancer cells and zombies have a lot in common. Both are mindless. Both have no "purpose" but to devour and assimilate the living. Both replicate themselves in fast and horrendous ways. Neither contribute to the good of the body (politic), but rather, feed on it and destroy it. And worst of all, both zombies and cancer cells are frighteningly difficult to kill.

Speaking seriously on cancer, I read someplace recently that that's what makes cancer, cancer. Ordinary helpful healthy body cells do their jobs then die off and are replaced. Cancer cells have mutated so they don't know it's time for them to die. They're so biologically brain dead, they don't even know they're damaging the body they infest from the word Go.

The idea of something mindless and destructive and horrendously hard to kill growing in you and taking over your system is inherently creepy. No wonder people have traditionally feared cancer and not wanted to mention its name. You don't want it to be true, and at the same time, you don't dare ignore it, unless you want your innards to be the physiological equivalent of those popular zombie-apocalypse films.

We are told on Very Good Authority (Wikipedia, right?) that the only way to destroy a zombie is by going after its brains before it goes after yours. Fighting cancer, we have a few more weapons, which is good, because this battle is real.

And I, tomorrow I'm engaging in front number two in my own zombie wars. We had the cutting-out campaign in late April; in the morning we begin the chemical warfare. I expect to be a bit battered before it's over this September: you have to expect to take a few hits when you're combatting the Undead. But fight I shall, and by God and St. George*, I expect to win.
________________________
*You'd think I'd invoke St. David, wouldn't you, if I'm going to invoke a saint at all. But St. David isn't known for his military prowess, and St. George is. Besides (should my fellow-Reformed object), I'm being more literary than religious. 'k?

Good to Go-- Mostly

Today's the six-week anniversary of my ovarian tumor and a lot of other things removal surgery. And yesterday, I had my appointment with my local gynecologist, Dr. P, to clear me for full activity.

And yes, I am cleared for whatever I want or need to take in hand. He said, "Everything inside is healed up by now." I mentioned how I had "been good" and given up on, say, opening stuck windows because I felt my abdominal muscles pull. "If you don't push past that," he said, "you'll never get any stronger." Good, that means I may and can and should go on with it. How much exertion is too much? Let's put it this way: As in ordinary exercise, I'm to ignore those who tell you to "go for the burn." Otherwise, let the garden digging begin!

And guess what? I wasn't crazy or deluded when I thought the ovary with the mass was the righthand one. Dr. P, going by the sonogram, thought so, too. Apparently, there's things you can tell from those images and things you can't.

I asked him if he was looking for some uterine problem when he clapped me in for that ultrasound. Yes, he was, and I picked up that he was more shocked than I was when the ovarian mass was revealed. I, after all, had been worrying about ovarian cancer before I even booked my examination by him in mid-February. I got my cancer anger and fear over with beforehand (thanks to the answered prayers of many). I mentioned this to Dr. P, and he said, "Yes. I see. And once you knew the mass was there, it was a matter of dealing with it."

I thanked him for his expeditious action and vigilance. As I've commented in this blog before, the symptoms that got me in to see him turned out to have nothing to do with the ovarian cancer. It would have been so easy for him to have treated them and sent me blithely on my way, with the mass silently growing in me until it was practically too late.

My friend Frieda* gave me a ride to this appointment, then had to return to work. She offered to excuse herself and come take me home, but I celebrated my liberation by walking the two miles home. It was a nice day to walk along the bluff above the Ohio River, admiring the houses and what was growing in people's front gardens.

And shortly after I arrived home, I got my car key and when out and drove it for the first time in six weeks. Only from one side of the street to the other, so I wouldn't get ticketed when the Borough swept the other side of the street last night.

But alas! not everything is good to go. The check engine light came on on the dash and wouldn't go off! This evening I asked my next door neighbor, who's been moving the PT Cruiser back and forth each week to avoid the Borough sweeper, if he'd noticed any lights that stayed on, and he said no. He thought the rotors on the front brakes were grinding, though. And when I moved the car back tonight, I noticed it, too.

I'd really hoped to go get some garden plants tomorrow. But I see online that driving with the check engine light on could prove dangerous. So I remain effectively carless until I get can get it into the shop and fixed. And that won't be till Saturday morning.

Otherwise, it's time to get back to normal and get things done.

Some Nice Straightforward Dithering

Yesterday I had my introductory appointment with my chemo doctor, Dr. L. My friend Frieda*, who'd been to the same practice when she was being treated for breast cancer, went with me and took notes.

There weren't really any major surprises about this part of the deal. I'll be getting my chemo through an IV, not through a port as I'd thought (thanks to the UPMC radio ads/public service announcements that've been running lately)-- my Stage 1 cancer doesn't warrant the big-gun doses that come with a port. Half hour of Carboplatin each time, then three hours of Taxol. I could have sworn the doctor said it was the other way around, but that's what Frieda's notes say and that's why I had her there taking them.

I'll have pills against nausea and Benadryl against some of the chemo side effects. Yep, this will all make me drowsy/spacy, and yep, not a good idea to try to drive myself home afterwards.

They'll check my blood cells and CA-125 levels each time. If the cells counts remain sufficient, the every-three-week schedule will continue; otherwise, I'll have to hold off a bit till they come back up.

I asked about supplements. A regular multi-vitamin might be okay, Dr. L said, but dosing up on one nutrient or another won't do me any good and may do actual harm. Better to do my best to maintain a healthy, balanced diet.

What about hydrocortisone creams? I'd read somewhere you can't apply steroids like that during chemo, but what am I supposed to do, mosquito season is here! No, he said, there's no problem with that, I can use them all I need to.

But speaking of skin care . . . I'd hoped my Sun Protection Factor 15 face cream would do, smeared on the top of my soon-to-be-bald (sob!) head. Nope, he said. SPF 50, at least. Wear it all the time outside, whether I have a hat on or not. "I'll get you some," said Frieda, who's recently started a job at a drugstore. "We have it on sale."

As to post-chemo-session side effects, they may not kick in till two days after. If five days afterward I'm still losing my lunch (or throwing up my immortal soul, as Mark Twain once memorably put it), that's the time to call the Cancer Center or the ER.

As I said, this was pretty much all fine-tuning and logistics. I didn't exactly thrill to the thought when Dr. L tole me what his mentor in med school, who is "an ovarian cancer guru" would have said about the fluid-filled capsule that ruptured in me. Dr. O, he said, would have classified my cancer as a Stage 2 because the sac was stuck to the abdominal lining, the peritoneum. "Hey! I don't need that!" I protested, doing the anti-vampire finger cross at him. "1C is bad enough!"

"No, I'm not saying you're Stage 2. Just emphasizing that you've absolutely made the right decision to go for chemo."

Oh, all right. Besides, no cancer was found in the solid areas of that capsule. Or in the scrapings of the peritoneum (taken from where it was stuck to, I should think???)-- they came up negative, as well. So there.

I mentioned that I'd learned online that my particular form of tumor is very rare as ovarian masses go, and that in 95% of those cases (or some number like that), it's benign. Just my luck to come out on the other side of the odds!

Yes, that's true, but at my stage and grade it will respond well to the chemo-- if there's any cells that escaped at all. Nice to hear, since I'd been on a cancer support chatroom where a couple of patients had said they'd been told that this mucinous kind is resistant to chemotherapy. Bugger that. If-- if!-- there's anything there, we gonna kill it dead.

We scheduled the first treatment for June 14th, after my birthday on the 12th and after school's out on the 9th. I'm doing mine on Mondays, so I'll (God willing!) be recovered enough to preach on any given Sunday this summer. The 7th was the date Dr. L suggested at first, but with my case, he said, another week wouldn't matter.

After I got dressed, it was off to the blood lab to give a sample so my base count could be determined (Frieda didn't have the nerve to stay in the room and watch-- shades of her own treatment), then to the scheduling desk, then to an interview with the financial aid counselor, concerning which I shall maintain a discrete silence.

Still all pretty darn straightforward. The dithering part begins with the brochures and pamphlets and certificates the scheduling nurse gave me about wigs and turbans and other headcoverings.

My hair should start falling out two to three weeks after the first treatment. I'm going to have to have some covering options, because this kid is not going "bold and bald." The world is not ready for the horror, nor am I. And laugh if you like, but I have gut-level religious objections against going around shaven and shorn, even chemically. But last night I'm looking at the wig catalog they gave me, and I'm thinking, these are inexpensive, that's good, a lot of them are cute on these young, high-cheekboned models, but I'm not madly in love with any of these styles for me, and none of the available hair colors really match mine, and do I really want to get something like this mail-order? And don't ask me why, but the fact that this company has given all their wigs girls' names really gets on my nerves. "Oh, golly, the best-looking wig is named 'Esmerelda' and a girl named Esmerelda was my worst enemy in grade school and now I gotta go round with her on the top of my head??!!!"

What I want to do is go to a local shop and have somebody advise me. Actually, the cancer center did give me a reimbursement certificate worth $200 that's good at a couple of area wigmakers. But there's still the question of real vs. synthetic and maybe real is way out of my price range and they say that it's harder to care for anyway, but what if synthetic is plastic and fake-looking and-- and-- and--!!!

OK, kid. Calme-toi, m'amie. Frieda has offered to bring me her wigs to show me what they're like, and I'll take her up on that. And I have the number of the nearest wig shop where I can redeem this certificate, and I can call tomorrow and make an appointment.

It. will. all. be. fine!

It may sound weird, but it's important for me to have this hair/head covering thing worked out before I start chemo. People are sympathetic enough already without me running around looking like "that poor cancer patient." And while I can forget and ignore the hysterectomy scar that's healing very nicely on my belly, every mirror will remind me that something in my body turned zombie traitor on me. I prefer to spend as little time as possible the next few months with my hopefully ex-cancer getting in my face.

Alarmed

Today I was looking at the copy of the pathology report I got at my surgeon's on Monday. I wanted to find out just what sort of ovarian cancer I'm dealing with so I could accurately put in the information on a cancer support website.

FINAL DIAGNOSIS

PART 1: ADNEXA, LEFT, SALPINGO-OOPHORECTOMY: MUCINOUS CYSTADENOCARCINOMA OF THE OVARY, WELL-DIFFERENTIATED . . .

Wait a minute. Left? left??

What the-- ? I could have sworn the problem was with the right ovary!

I read the report on the right one, and it said, "ADNEXA, RIGHT . . . ENDOMETRIOTIC CYST WITH CALCIFICATION IN THE OVARY." But that wasn't the 6 cm ovary with the Stage 1A tumor.

This shook me up! Ever since February 19th I was sure everyone had said the tumor was on the right!

I called my surgeon's office and talked to the nurse. "Yes," she reported, "the mass was always on the left. It's out now. Does it matter?"

Yeah, it matters. If I heard that wrong, what else have I missed?

It may be my intellectual pride talking, but this error of mine bugs me more than anything.

Do You Want to Go for a Ride?

I am two years and six weeks old. I am lying on a strange, high bed set outside a door in a long, gray corridor full of doors. Suddenly, a dark-haired young man in a white coat looms over me. His face is marked by disapproval, and a little alarm. His expression voicelessly rebukes me: "Why aren't you asleep?" (I know this grownup look.) He recovers himself, applies a smirk, and says to me, "Little girl, do you want to go for a ride?"

"Do I have any choice?" I think to myself.

I don't. I'm about to be taken to surgery to remove a benign cyst that has closed my left eye. I am not aware of this, or I had forgotten it, but I yield where I cannot rebel. More young men in white coats come, the high bed turns out to have wheels, and off I go.


Yesterday afternoon I had my first follow-up appointment with Dr. C, my gynecologic oncologist. Though nobody told me this ahead of time, I figured the agenda would cover checking up on how I'm doing post-op and discussing my further treatment.

I've been remarkably free of what is called "cancerhead"-- uncontrolled and fearful obsessing over one's cancer and its implications. But going into this appointment, I had three things I hoped would happen or that I would not have to face.

First, that I could ask my surgeon how my ovarian tumor came to rupture without coming across as judgemental or as casting aspersions on his competence.

Second, that he would not, in anywise, suggest or recommend radiation therapy. It's one thing if you're fighting breast cancer, but there's too much essential equipment in the abdomen that can get permanently fried. And according to accounts I've read online written by women who have gotten radiation for ovarian cancer, at some point in the process they administer the treatment by way of rods put up your . . . well, you know. O noes!! Du nawt want!!!

And third, that it would all be straightforward and conventional and I wouldn't have to make any hard choices. Did I want to go for a ride? I don't know, you're the prominent gynecologic oncologist, you tell me!


It worked out well that Ellen*, the friend who drove me to the doctor's office, is a Registered Nurse-- not in oncology, true, but knowledgeable and able to take notes while I asked questions. Did I want her in the exam room with me? You better believe I did.

So there we are, waiting, and in comes Dr. C wearing a bolo tie. Don't mess with Texas? He grins and says, "Boy, you just have to cause trouble!"

"Yeah, gotta be original!" I quipped back.

How original I am, he was about to tell me, right after my exam. Seems that when they got me open, they found that the tumorous ovary was lying on top of a sac of clear yellow serous fluid-- "It looked like pee, if you want to know." The ovary was adhered to it and it was adhered to the tissue below/anterior to it-- "Like endometriosis-- I had a terrible time getting it all off." It was this sac of liquid that ruptured; the problem ovary itself came away whole. And the quandary is, was that sac part of the tumor or something entirely separate stuck to it? The serum in it looked nothing like what was in the ovary (which Dr. C said "Was full of brown sludge.") And when the lab tested some of the serous fluid, it came up clear of cancer cells.

So that took care of concern No. 1. I'd figured adhesions came into it . . . Could that have been the septation Dr. P my gynecologist had shown me on the sonogram in February? "Oh, that ovary was full of septations. Like a bunch of grapes inside." But attached like a bubble head out the end of it? No, Dr. C didn't see anything like that. "Could what we saw have been this sac behind the ovary and on the sonogram it looked like it was in the same plane?" "Very possibly."

Which led us to the question of what to do about it all. "You've got a choice," my surgeon said, "And there's no right answer." **

Oh, no!!! You're just supposed to tell me what to dooooo!!!!! . . . Take me and my gurney and just wheel me down the hall!!

"Here's your choices. We can assume that the fluid under the ovary had nothing to do with it and the cancer was restricted to the ovary. The lab had to take several sections before they found the cancer in it. That would put you at Stage 1A. The tumor was Grade 1, very well differentiated, and that's the least aggressive kind. Chemotherapy would make no difference in your prognosis, the surgery took care of it all. We'd just monitor you every three months with a CT scan, an office exam, and a CA-125 test. And you'd watch to see how you felt and if you had any symptoms. Then we'd go to six months if there was no sign of recurrence, until you were five years out.

"Or . . . we can assume that the sac we found was part of the tumor, and since it ruptured, that puts you at 1C. A third of the time a test of fluids can come up showing no cancer cells but cancer is present. You can do chemotherapy to make sure there's no cancer in you, and again, we'd do the tests and watch and see."

He paused. "So what do you want to do?"

Oh, phooey. So this time I have a choice whether I want it or not.

Dr. C said that even at Stage 1C, the recurrence rate is really low, only 10% - 15%. "The probability is that you are cured."

He went on to say, "Now, chemo is poison. It's there to kill the cancer cells. It will kill healthy cells as well. But if you do chemo, things go back to normal. But with radiation, the damage is done and can't be undone. And there's a lot in your abdomen that can be damaged." In other words, radiation is not indicated for me-- yay!!!!

"It's up to you whether you want to do chemo or just watch and see."

I felt myself poised at the brink. I flirted with the idea that I could take my chances and not have to undergo the expense and rigors of chemotherapy after all. A reprieve?

But what if I was wrong?

I asked more questions and Ellen did, too. Dr. C said, "Have you ever heard of the term 'analysis of errors'?"

Ellen had; I had not. "No . . . is that like Worst-Case Scenario?"

"Not exactly. It's considering what could happen if you make the wrong decision. If you do chemo and there was no cancer there anyway, you've gone through all the stress of chemo for nothing. But you'll never know that."

"Like, 'See how great my elephant repellant works-- we never have elephants around here at all!'"

"Exactly. And if you don't do chemo and the cancer does come back . . . We couldn't talk about a cure anymore. The cure rate for recurrance is only 3 to 5%. "

Oh! I'd say that was a piece of information I needed . . .

"I'd be in remission only?"

"Yes, and remission for ovarian cancer would probably get you only two and a half more years. We can't just go in and take a tumor out. When ovarian cancer remanifests itself, it's all over the abdomen. Have you ever seen algae on a pond?"

"Yes."

"It looks like pond scum. It covers everything. We can do our best, but we can't get it all." And if I understood him right, at that stage you can't use the first line platinum-based chemo drugs, because the cancer will have developed a resistance. Or was he conflating this with what happens if one does chemo and it comes back anyway?

He explained that the metastasized cancer covers the organs and keeps them from reasbsorbing the four to five liters of fluid that wash through everyone's bellies every day. Which is why women with advanced ovarian cancer bloat up. "It's called ascites."

"Was that sac of fluid you found in me ascites?"

"No, no sign of ascites in you."

We asked more questions. He said they've developed good anti-nausea drugs that you get before chemo. "They make you drowsy, so most women just sleep through the therapy. Afterwards-- it depends on each person, you'll probably feel like you're getting over the flu for the next couple of days."

Ellen said, "I've had patients who've asked me, 'Is there alternative medicine for this?'"

"If there was, we'd give it," Dr. C answered her. "The alternative is, you can die."

More questions, more answers, more going over and clarifying what had been said before. Talked about statistics: Every year (in America?), about 20,000 women get ovarian cancer and in the same year 16,000 or so will succumb to it. And about odds and percentages. One can play them when dealing with large groups, but when it comes down to oneself, the odds are either 0 or 100%.

If it were to come back, my kind of ovarian cancer would recur somewhere in the abdomen. It isn't metastasized through the bloodstream, so it wouldn't go to the brain or bones or wherever.

Some comfort, when you consider all the damage it would do in one's midsection! Though maybe it's good to limit the twinges one could get cancerhead about.

For me, though, the fact that my cancer was caught at Stage 1 weighs heavily towards total cure, whichever way I would decide. Unlike for 80% of ovarian cancer patients, who aren't detected until they're Stage 3 or 4.

Finally, Dr. C looked me in the eye and said, "All right, do you want to do chemotherapy?"

I looked back at him and said slowly (and I thought, meaningfully), "I don't want to do chemo . . . "

"All right," he said briskly. "That's your decision."

"No, listen--"

"No 'buts'!"

"No, listen! Do I want to do chemotherapy? No, I do not. Do I think it might be wise to do chemo? Yes. Do I think the consequences of not doing it now and wishing later I had are too great? Yes, I do. So yeah, even though I don't want to, yeah, I'm going to do it."

Sheesh! Enough with the drama already! I didn't want to get ovarian cancer, either, but I've got it-- or at least, I need to make damn sure I've no longer got it-- so I have to deal with it, whether I want to or not.

Dr. C told me what it would be, and it was very familiar from my on-line reading. Six courses of Carboplatin/Taxol, one every three weeks. Happily, there's a UPMC chemo center a mile and a half from me, so I won't have to get a ride downtown. "The chemo's the same everywhere in the hospital system, no matter where you get it." He'd have his nurse look up the number and get in touch with the chemo doctors to set up an initial appointment.

I asked, oh yes, what about leukemia as a side effect? Ah. That's a danger for very young women, in their teens and early twenties, whose blood cells are still developing. (Or something of the sort.) "You're still young," he allowed, "but I think you're a little past that!"

Yeah, I'm not a little girl anymore. And this time, when the medical guy asked did I want to go for a ride, I did have a choice in the matter. Later this summer when my hair has fallen out and I'm feeling groggy and grotty and my mouth tastes like old aluminum, I may temporarily regret my decision. But given the fact that I've got my support system and my financial aid in place and my momentum's going, and given the consequences of being wrong, I think I've made the right one.

___________________________________
**Some dialogue word-for-word; other parts reconstructed or conflated.

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.

Home Again, Home Again, Jiggity-Jig

I'm home from my outpatient surgery. Got discharged around 2:30. I've got to see my doctor for follow-up in two weeks, after the lab work comes in, but in his judgment everything looks all right.

Praise God and hooray!

I'm told I'm supposed to rest and do no work the next two days. I established that "work" means going out in the garden and pulling weeds. I didn't ask if it also meant sitting in front of my computer working on church-related matters. Or blogging.

If it does, too bad. I've gotten that "work" done and now I can do my relaxing with a clear conscience.

Procedure

I'm due at the local med center at 9:30 tomorrow morning [later today], to check in for outpatient surgery for the health problem I noticed in June.

I feel fine. I'm not even worrying. That will resume when I'm waiting for the results of the biopsy thereafter.

Routine procedure dictates that I must ingest nothing by mouth after this past midnight. Not a lozenge, not a stick of gum, not a swig of toothpaste water (ick). The rule is so strict, I'm surprised they don't tell you you can't swallow your own spit.

I know what it's for. They don't want to run the slightest risk that you'll have a bad reaction with the anesthesia while you're under and throw up and choke. So I'm observing the strictures-- meaning that as soon as midnight struck, I was immediately sensible of a raging thirst, even though I'd had a couple glasses of water within the half hour!

Funny, what your mind will do to you.

I've finished the draft of my sermon for Sunday, so I can lie around Friday and Saturday, if need be. It's about two-thirds the length of my usual productions, and if anything, it needs cut down even more. The church I'm supplying this Sunday has Sunday School scheduled exactly an hour after the beginning of worship, and this is a Communion Sunday. With all three Lectionary readings. And a children's sermon, and a choir anthem. And they'll probably want at least ten minutes to get from the sanctuary to the classrooms. That leaves me fifty minutes if I'm lucky to get through everything.

Dickens of a way to do things, but it's the way it is.

Besides, the official Sunday School beginning time may be one of those merely monitory things, to keep people from showing up to class at half-past the hour.

On the other hand, the lady who called me from the Med Center said I was to be at the Outpatient Surgery door at 9:30 AM. Period, the end.

Test Results

I had my conference with my doctor this morning, and I was surprised to find I didn't have anything to be surprised about.

After all, three weeks ago when the nurse practitioner sent me for the sonogram, she did say I'd most likely be going for a biopsy thereafter. I mean, if nothing had shown up on the sonogram, where'd the initial symptom come from?

Only thing different is that the kind of biopsy I'm being sent for will entail my going under general anesthesia, not a local plus a head drug to send me into LaLa Land. I don't mind that for me-- I deal with anesthesia well enough. But it certainly adds to the cost.

The doctor was good-- or factual-- enough to say that the possibility of cancer is way down low on the list. That's a nice little sop to quiet the kishkas.

I'm to hear next week when the biopsy will be. And see how it goes from there.

After I left the doctor's office, I sat on the banks of the river, reporting in to my friends Frieda* and Hannah*, and watching the boats at their moorings. Something very peaceful about boats, I always think, whether they're going any place or not . . .

And Now, in the Medical News . . .

Almost four weeks ago, I discovered that my body was doing something it should not have been. Nothing shocking, or alarming . . . just . . . out of place.

So being a person of my time, I Googled this symptom, and found that it can betoken anything from stress or a mild infection, all the way up (or down) to cancer.

And that one should see one's physician about it as soon as possible. Which I did, in the next few days.

Findings from that examination were inconclusive. Actually, the test needed could not be run on me in the doctor's office. So I was sent for a sonogram at the regional medical center.

That came off on the 1st. The tech told me I'd have my results back in "one or two days." And that usually, if everything's fine and negative, they won't phone you at all.

I waited the 2nd. No word. The 3rd. No word.

Didn't consider myself out of the woods yet. "One or two days" can stretch to three and even four, if the lab is busy. And Friday the 4th was a holiday and Saturday and Sunday were, well, Saturday and Sunday. A friend of mine who's been through breast cancer and come successfully out the other side told me I should be sure and call the doctor's office regardless, to find out. Said she knew a woman who didn't know her test had come up positive until the hospital called her six months later to learn what treatment she'd undergone for the disease she wasn't aware she had.

Yes, I told F*, I was going to call on the Monday anyway. Count it as the third day.

And I did. Left a message at the voice prompt for "test results." Got a call back a couple hours later: "Oh, yes, your results are on the doctor's desk. He'll look at them and get back with you tomorrow."

No word on Tuesday. Was it because there was nothing to tell? After all, for the past two and a half weeks I haven't observed the symptom that drove me to the doctor's office three weeks ago. If I have any pain, it's my digestive system doing my worrying for me-- a task my brain never asked it to undertake-- and it varies with what and when I eat-- whether I'm occupied with work and other people or sitting around with an idle mind--which all sounds like stress to me.

But Wednesday morning, early yesterday, I got a call from the physician's nurse. She said, "The doctor wants to make an appointment with you to come to his office to discuss the options on your sonogram."

The appointment is set for 9:40 tomorrow morning.

But "options." What's this "options"? Will I have "options" indeed, or is that just doctor-speak for "Either have major surgery tomorrow or expect to drop dead in two weeks"?

I guess I'll find out. Meanwhile, I'm mentally practicing being intelligent and receptive of whatever he'll have to say. I don't want to sit there looking stupid-and-stunned or launching myself into the hinterlands of denial.

And I'm praying there will be nothing to go into denial about.