Dangerous and/or Unpleasant Procedures

It’s the week of a thousand appointments. Well, okay, only five. On Monday Andrine gave me the last massage for a while. Next week she goes to the coast to write for a week and she’s thoroughly booked for the week after that. I can only be very grateful for her help these past several weeks. I’m convinced that it is the weekly massage that has helped me recover as quickly as I have. That, and the homeopathic and naturopathic support I have received.

I went to see Dr. L at OHSU yesterday. Howard attended as well. He was the kind of doctor I tend to like, very no-nonsense, ready to discuss the research in great detail. I brought him an article, charts, and questions about the oncotype dx test, hoping that he would order it and I would be in the low risk group and not have to do chemo. He very patiently explained why he thought we should go ahead with chemo anyway. That was because the tumor was a grade 3, there were two tumors, and there was significant angio-lymphatic invasion of the breast tissue, which means that the cancer had spread throughout the breast. This is a very aggressive cancer.

He also pointed out that the receptor status of the second tumor had not yet been determined. So the second tumor could be completely different from the first. It could be ER- and Her2+ (the larger one is ER+ and Her2-) which will definitely complicated the treatment plan, should that turn out to be true. I had no idea. So he ordered that test.

On the down side, he seemed to be very disparaging of naturopaths. He said that they gave herbs that were phyto-estrogens and could exacerbate the cancer. I asked him to look over the list of supplements I had provided and he couldn’t find an instance of that. However, I don’t know what’s in the Chinese herbs exactly. But his unfamiliarity and disrespect of naturopathy set off my alarm bells.

He spent quite a long time with me and I do believe that he made the case for doing chemo. He’d like me to start next week, if not sooner. His nurse came in and talked about what to expect, and gave me a list of possible side effects. There’s a .8% chance of getting congestive heart failure and a .5% chance of eventually getting a very aggressive form of leukemia, all in the interests of boosting my survival rate by 2.2% over ten years. It wasn’t terribly reassuring, especially since my mother's true cause of death was congestive heart failure from the effects of chemotherapy. However, that was her third round.

I took a look at the infusion room. It looked fairly dreary, but OHSU is moving its oncology department to the waterfront in the next month, so that part will improve. The other problem that I have is that OHSU is terrible about making patients wait. I find that disrespectful and it drives me crazy.

I still have to see Dr. V. at Northwest Cancer Specialists tomorrow. I won’t make any decisions until I see him. It turns out that he was Ginny’s doctor (Ginny is my co-worker who just went through chemo) and she loved him. She also says that he’s used to working with naturopaths. It might be a better fit. Unfortunately Howard will not be able to attend that appointment. He was very helpful in bringing up questions. Jasper will come with me, and while I appreciate his help, he doesn’t have the sort of familiarity with my medical profile that Howard has. Howard also has a degree in biology, which helps.

So, the case has been made. It looks like AC and taxol, a four month ordeal of eight infusions, one every two weeks. The alternative is taxoltere and cytoxin, but Dr. L felt that it would be slightly less effective than AC + T. The question is where. I know I’d do fine at OHSU, but I’m hoping that NW Cancer Specialists, which is closer to home, will turn out to be the right place.

The one thing that is clear is that hormone therapy will definitely boost my survival chances, so I’ll follow chemo with tamoxifen. It’s all so vile to contemplate. I have never been able to deal with pharmaceuticals well and now I’m caught up in this nightmare of treatments that are toxic and fraught with side effects and complications.

Somehow, during this time, my job is going to disappear as well and I will have to look for another one that will have good health benefits. I felt so confident that I could create one or find one but now I’m completely overwhelmed. It doesn’t help that when I go to work, I’m working at what feels like half speed because my mind is whirling with all these unpleasant possibilities.

I suppose I should count my blessings that this is all happening while I have health insurance. For many years my health plan was "don't get hurt, don't get sick." Now, without ever having felt a day of actual illness (just the effects of treatment) I'm embroiled in a confusing maze of toxic treatments with the threat of death hanging over me. It just seems surreal.

Then last night I had an MRI on the remaining breast. It was another unpleasant procedure. I had to stay still for 45 minutes. Usually, I can just repeat Buddhist chants under those sorts of circumstances and drop into an alpha state, but there was no possiblity of that. I felt a rising panic. I'm not given to anxiety, but I was trying to keep myself from freaking out entirely. Finally I hit on the idea of singing every silly song I could think of. My brains felt sort of addled, so it was difficult to recall lyrics, even though under normal circumstances I have no trouble remembering them. I was face down with my head on a pillow that seemed to be covered with a material resembling burlap. It was very scratchy and uncomfortable. The nurses were very nice and one of them explained that the machine raises one's heartrate so it's fairly usual to interpret that as a feeling of panic. That might have been nice to know going into the process. It was profoundly disturbing and I was very glad to get out of there. I marveled that I had actually requested the procedure. It's like begging to have a root canal.