Did The Mash, I Did the Monster Mash…
I had to hit the ground running this morning. Tomorrow is my niece's birthday and, as usual, I hadn't made her card ahead of time. That would be, I dunno, just not panicked enough for my style! So, I needed to make her card at 7 am and then fly out the door to drive to San Francisco for my appointments at the Breast Care Center. Here's the card that I made:
Those are pink rhinestones at the top of the arch. The showgirl is from a postcard from the very early 1900s. I put sheet music behind her (the words say "You Dear"). She's involved in musical theater, which is why I went with this theme. I hope she likes it!
Luckily, I made it to San Francisco in time for the mammogram, but it turns out they were running behind in the imaging department. After changing into a gown, I sat for a while in the interior waiting room, reading an XHTML book. Finally, they called me back. One technician was showing another how to use their (somewhat new) digital mammogram machine -- the Lorad Selenia -- and so I would be part of the demo. I like new equipment, so I entertained myself examining that. They set me up for about six or seven different images. The last two--magnifications of the site where they removed the tumor--hurt like heck. Release the breast! Release the breast! Ow.
I read more of my book while waiting for them to run the images past the radiologist. Then they told me I could get dressed and go. I walked out to the parking garage feeling confused. I put my hand on the handle to my car door, wondering, "They just let me go? They didn't want to call me back?" Then I immediately wondered what my problem was. Was I expecting bad news? Maybe I am negative! Huh, I never thought that about myself before, at least not about medical stuff.
I had several hours to kill before my oncology appointment, so I had lunch at Japan Center and then sat in my car for a while writing on my laptop. Finally, I headed back to UCSF.
While a nurse was taking my vital signs, my oncologist walked by and asked if I was okay seeing a fellow (as in specialist resident, not a guy) in place of my nurse practitioner. I nodded. As she strode off, she called over her shoulder, "I told her you were funny!" The Velcro on the blood pressure cuff began crackling as it inflated. "No pressure!" I called after her.
The fellow gathered information about the how my Tamoxifen treatment worked...or didn't work, as the case may be. I forgot to bring my list of side effects, so I kept remember things as the exam went along. The anxiety, short-temperedness, and depression were easy to remember. But the rest would come up while she was pushing on my abdomen or listening to my chest. "Extreme forgetfulness!" "Forgetting how to drive streets I drive every day!" "Increased urinary frequency!" It was like some strange game show where you shout out side effects until someone rings the bell. I don't think she knew what to make of my symptoms. She just said, "Hmmm, that's odd."
The oncologist then came in. She asked to feel my hair. Because it was just bleached, it's very pale and fluffy, finally getting thick like real hair. I love to have people touch it. I told her about the red wig I just bought (the fellow understood what I meant by "Alias, pilot episode!"). My doctor was disappointed I didn't wear it in, so I'll have to wear something fun next time.
We talked about how the hormone treatment worked. She suggested that something we could try is suppressing my ovaries without Tamoxifen. They use monthly injections of drugs like Zoladex or Lupron to do that. She has a patient who tolerated suppression very well. My doctor did say that in that case, when they added an aromatase inhibitor (what they give to post-menopausal women instead of Tamoxifen now) she became anxious. But when she went off the AI and continued ovarian suppression, she was fine. I was glad she was honest in telling me how it worked out with that one patient, even though we don't know for sure how it would play out for me.
Even so, I am nervous about trying ovarian suppression after my Tamoxifen experience. She understood, but said that as my doctor she would bring this up again later (I assume when I see her in May). Tamoxifen isn't exactly the same as suppression, she pointed out, because Tamoxifen doesn't stop the body from producing estrogen; it just blocks the receptors from absorbing it. They don't really know how the effects of that differ from stopping the estrogen first. I said I'd think about it.
I was telling her about my blog and in the process, I mentioned the entry, What Your Cancer Center Doesn't Tell You About Chemotherapy. Of course, she wanted to know what they don't tell! I told her about how patients can get the idea during chemo education that all their side effects will be treated, when really the medical team wants to keep patients alive and can't treat them all. She said they have a lot of patients who think they are dying during chemo when the staff knows that those symptoms will pass. Having just had someone confide in me that she thought she was dying, I knew what my doctor meant. I confessed that for me, though, I just kept worrying that I was doing chemo wrong! She laughed and made a remark about what an over-achiever I am.
(Okay, anyone else there like me have their brain stop at words like "over-achiever"? I mean, what does that MEAN? How can you achieve too much? Is there a limit on achievement? Friends say my confusion is proof that's what I am, but ... I still don't get it!)
The doctor also told me that my mammogram came back with an abnormal result and she gave me the report. There is an area of microcalcification posterior to the area where they removed the tumor. I said to her, "It could be nothing," although I was also thinking, "Aha! I knew there was something on the mammogram! I knew it!" Now, I've been through this microcalcification thing before with my other breast. When I saw the surgeon the very first time (after I was diagnosed by my PCP) she sent me to get a core needle biopsy in the opposite breast because of microcalcifications on the mammogram. In that case, she also ended up doing a surgical biopsy in that spot at the time of the lumpectomy and the results were benign.
Of course, I always knew my right breast was clear. With my left breast, which has already had cancer, I'm less assured. My oncologist agreed that it might be nothing at all as she checked the "urgent" box on the follow-up sheet. "I want you to see the surgeon within two weeks." Hmmmm.
When I brought my pink slip to the scheduler, she said that the surgeon is really booked up and she would need to call me with the appointment time. I eagerly said I would be happy to see her assistant. After all, how big of a deal can it be if they have you see the assistant? By the time I arrived home, I had a voicemail message confirming an appointment on the 28th with the surgeon herself. Darn it.
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