It's a numbers game.
I am happy to say that I can start this installment off with good news. I know, good news, an anomaly.
Well are three ways by which my doctors can discern how well I am doing. First, by a PET scan which are extremely expensive at about $10K a pop. The second is by the highly subjective method, my doctors ask me how I am feeling and I tell them. The third and most objective is by measuring a cancer marker in my blood called CA 27-29.
Let’s learn about cancer markers. I will need some help from the American Cancer Society. (www.cancer.org)
What Are Tumor Markers?
Tumor markers are substances that can be found in the body (usually in the blood or urine) when cancer is present. They can be products of the cancer cells themselves or of the body in response to cancer or other conditions. Most tumor markers are proteins.
There are many different tumor markers. Some are seen only in a single type of cancer, while others can be detected in several types of cancer.
To test for the presence of a tumor marker, the doctor sends a sample of the patient's blood or urine to a lab. The marker is usually detected by combining the blood or urine with manmade antibodies designed to react with that specific protein.
For these reasons, only a handful of tumor markers are commonly used by most doctors. When a doctor does look at the level of a certain tumor marker, he or she will consider it along with the results of the patient’s history and physical exam and other lab tests or imaging tests.
Determining the Effectiveness of Cancer Treatment
Most doctors find that the most important use for tumor markers is to monitor patients being treated for cancer, especially advanced cancer. If a tumor marker is available for a specific type of cancer, it is much easier to measure it to see if the treatment is working rather than to repeat chest x-rays, computed tomography (CT) scans, bone scans, or other complicated tests (PET.) It is also less expensive.
If the marker level in the blood goes down, it is almost always a sign that the treatment is having an effect. On the other hand, if the marker level goes up, then the treatment probably should be changed. (One exception is if the cancer is very sensitive to a particular chemotherapy treatment. In this case, the chemotherapy can cause many cancer cells to rapidly die and release large amounts of the marker, which will cause the level of the marker in the blood to temporarily rise.)
Specific Tumor Markers
CA 27.29: CA 27.29 is a marker used to follow patients with breast cancer during or after treatment. This test measures the same marker as the CA 15-3 test, but in a different way. Although it is a newer test than CA 15-3, it does not appear to be any better in detecting either early or advanced disease. It may be less likely to be positive in people without cancer. The normal level is usually less than 38 to 40 U/mL, depending on the testing lab. This marker can also be elevated in other cancers and in some non-cancerous conditions and may not be elevated in some women with breast cancer.
Now that you have had your tutorial about the fascinating subject of tumor markers I will give you the good news. On July 17th my count was 210. By August 8th the count was up to 278. During this time I was in unremitting pain. I was up at all hours of the night either with pain, nausea, or trouble moving. I could only sleep off and on and was miserable. I believe that there was this part of me that a lot of this time period I was just overwhelmed with what was happening. My diagnosis, how strange my cancer was behaving, how aggressive it was and how long I had suffered with the symptoms.
For many of you that are not around me on a day-to-day basis you missed what had been going on since January 2007. Every week or two I would have another area of my body that would just flare up in pain. First it was my ribcage on the left. I could barely drive or breathe. I went immediately to the Physical Therapist and got three treatments in 3 days. It seems to resolve. The other said would flare up. I figures that since I had been guarding the left it made since the right was bugging me. Then it was my hips. First, one side and then it would resolve about 3 days later. Then my sternum or shoulder or collar bone. These are all examples of the metastatic bone cancer spreading throughout my body from January to July. What was I saying to myself? “I am 40 years old; I am a working mother of 2 and my body is falling apart.” Ask Matt how many times I complained about our mattress and how we needed a new one because I couldn’t sleep without pain. Again, I am just getting old and falling apart.
On July 26th I had my first treatment. By July 30th my pain was being managed very well but my GI symptoms were just unbearable. We were warned about this. All this distress and agony meant that the treatment was working. I must say it is super hard to get yourself wrapped around this miserable existence when your arms are wrapped around the toilet.
On August 3rd I was in to see the oncologist again because my nausea/diarrhea was out of control. At this time they drew another CA 27-29 and as you previously read it was up to 278 from 210. This is one of the aspects of cancer treatment that is counterintuitive. Just like when you are first pregnant. Sometimes if your morning sickness is really bad and you are puking every day you go into see the obstetrician and the nurse full of smiles asks you if you have been experiencing any morning sickness. “Yes,” you reply, “Every day and it is so bad and I can’t be away from the bathroom and I feel sick all the time.” Then the obstetrical nurse responds, “Good, that means the baby is sticking.” Grin, smiles, and a little wink.
So it is with cancer. The shittier you feel the better the better the treatment is working. From August 3rd to August 14th I really had a marked turn around. Since the 14th I have felt even better. So with this news I am happy to let you all know that the blood draw from August 14th was down to 157. That is more than 100 points. My oncologist is optimistic, Matt is cautiously optimistic and I am over the moon. The gross, disgusting days of feeling like crap may return. But I say to you with a grin, smile and a wink at least we know it is working.
Tuesday, August 28, 2007
Friday, August 10, 2007
Thirty days hath September
Thirty Days Hath September.
April, June and November. So this means, technically, that today we have known about my cancer for exactly 31 days. It was July 9th when I was scheduled for my mammogram and ultrasound. That test was scheduled at 8:30 a.m.
It was patently obvious from the way the technicians responded to me that the mammogram didn’t look good. I understand completely that they are bound by rules of conduct and could not ever reveal to me, during the exam, that things looked bad but anyone who has ever been through a diagnostic exam gets it. They aren't fooling anyone by their silence and focus on their work. Once the ridiculous banter about the weather, the Mariners, the wait, the waiting room, stand here, okay hold your breath, okay relax, okay uncomfortable for just a minute, hold, hold, and relax comes to a screeching halt, it’s bad. If the banter stops AND the Supervisor is brought in for some “special extra views” it’s really bad. Then the final strike (think Family Feud and Richard Dawson) if the banter stops, the Supervisor is brought in and the doctor is going to come and talk to you in the waiting room, you’re screwed.
The ultrasound was completely uneventful. I don’t know how Holly, the ultrasound tech, has such amazing composure but she did. She actually spoke with me, acknowledged my presence, continued with the inane banter and was smiling and happy the whole time. I could tell that she was taking a lot of pictures but she “just wanted to get it right for the doctor.” If ultrasound doesn’t work out for her she should definitely go for the World Poker Tour.
That is what happened to me 31 days ago. When the doctor came in and met with my to confirm the ‘screwed’ diagnosis really not a lot is revealed then either. The very pleasant physician just mentions that they found some ‘areas of serious concern’ on the mammogram and would it be possible for me to stay until 12:30 p.m. for a MRI of the breast. As if by a miracle they had an opening and I will be fit in. Can we talk about strikes 4, 5 and 6? Oh wait that is supposed to be for another batter or contestant or family on the Feud.
Continuing on July 9th I get some food, pizza and a Fresca (I do have priorities) and call Matt from this beautiful outdoor courtyard at Evergreen Hospital. He is at work probably just out of roll-call. I tell him what is going on and the additional tests that have been ordered and my personal curbside diagnosis for what this “really means.” If there is one thing I know in this world it is physicians and I know them well. I have the amazing ability to see the English translation to everything they say, not unlike the opera. Every nuance, their body language, every carefully chosen word, how they are dressed, how they sit, where we talk is all translated into ‘layperson’ for me. After meeting with Dr. Shook, the Director of the Breast Center at Evergreen, I knew pretty much what was going on. “What do you think is going on?” Matt asks me. “I am not sure of the exact details but I am certain of this: It is bad and it is cancer.”
Still July 9th (I now think of FDR’s unmistakable voice after Pearl Harbor “a date which will live in infamy”) but having completed the Breast MRI. What a treat this test is. NOT. Let’s just leave it at this. Very loud, very surreal and they utilize this wacky, inverted Roman chest plate and you lie on your stomach and drop your boobs through the holes. If you really don’t have enough to ‘drop’ through then you get propped up with all sorts of towels and washcloths and whatnot. Just weird as far as tests go. Again, the reaction from the staff told me everything I needed to know. This was bad.
After the MRI I spoke again with Dr. Shook. She was going to add me on at the end of her day because “the MRI had confirmed that there were some bad looking masses in the left breast and left axilla” and she wanted to do a needle biopsy and lymph node aspiration that day still July 9th. She added me on at 5:30 p.m. and I was to call in and make sure that there wasn’t someone that comes in through the ER that would bump me. Either way, she was intent on getting that biopsy that day and I do believe she would have stayed until 11:59 p.m. to “git-r-done.” She is nothing like Larry the Cable Guy but on July 9th my whole life changed and one major change was that we are all about gittin-r-done. That’s what we do now is git-r-done.
Matt calls, he is on his way to the hospital. It was so great that he left work because I was getting ready to come unglued. I say meet me at the house not the hospital. We do. It is strange but I barely remember being at home at all on July 9th. We had to though. We had to get the girls and arrange for a sitter and all that stuff but I don’t even remember being at home. I remember nothing. Not what we talked about, not who we called or what we ate or did it is just completely blank.
Matt and I return to Evergreen at 5:30 p.m. for the biopsy. Dr. Shook is there and Holly the fabulous. They were just excellent and so caring. Dr. Shook did a great job preparing me as well and letting me know what was going on every step of the way. It is odd but that kind of a biopsy is nothing to scoff at. Holy cow! It is a very physical procedure and still today, 31 days later, I have a giant bruise from the biopsy. It is now in the green/yellow phase of bruising but think about that…………a month out and there is still bruising. I just listened to my iPod and zoned out, pretending that this was NOT my life.
When it was done Holly gave me a single long-stemmed red rose. I think this is a really sweet gesture but odd. When do you receive a single long-stemmed red rose? When someone loves you, when you go to Prom, when someone is sorry, when in Mexico, when caught off-guard in Belltown (too intoxicated) and the gal reels you in, Valentine’s Day when you are not really sure if you are dating, the airport and poor planning, I like you but not all the way to a dozen and apparently when you have breast cancer.
So thirty-one days since July 9th and the rose has long since died, the bruising is still proof positive that this is happening to me and we are still here, intact and soldiering on. It is amazing what can happen to a person in a month, 31 days, 744 hours, 44,640 minutes now this is just getting a little too ‘RENT’ but it is amazing.
April, June and November. So this means, technically, that today we have known about my cancer for exactly 31 days. It was July 9th when I was scheduled for my mammogram and ultrasound. That test was scheduled at 8:30 a.m.
It was patently obvious from the way the technicians responded to me that the mammogram didn’t look good. I understand completely that they are bound by rules of conduct and could not ever reveal to me, during the exam, that things looked bad but anyone who has ever been through a diagnostic exam gets it. They aren't fooling anyone by their silence and focus on their work. Once the ridiculous banter about the weather, the Mariners, the wait, the waiting room, stand here, okay hold your breath, okay relax, okay uncomfortable for just a minute, hold, hold, and relax comes to a screeching halt, it’s bad. If the banter stops AND the Supervisor is brought in for some “special extra views” it’s really bad. Then the final strike (think Family Feud and Richard Dawson) if the banter stops, the Supervisor is brought in and the doctor is going to come and talk to you in the waiting room, you’re screwed.
The ultrasound was completely uneventful. I don’t know how Holly, the ultrasound tech, has such amazing composure but she did. She actually spoke with me, acknowledged my presence, continued with the inane banter and was smiling and happy the whole time. I could tell that she was taking a lot of pictures but she “just wanted to get it right for the doctor.” If ultrasound doesn’t work out for her she should definitely go for the World Poker Tour.
That is what happened to me 31 days ago. When the doctor came in and met with my to confirm the ‘screwed’ diagnosis really not a lot is revealed then either. The very pleasant physician just mentions that they found some ‘areas of serious concern’ on the mammogram and would it be possible for me to stay until 12:30 p.m. for a MRI of the breast. As if by a miracle they had an opening and I will be fit in. Can we talk about strikes 4, 5 and 6? Oh wait that is supposed to be for another batter or contestant or family on the Feud.
Continuing on July 9th I get some food, pizza and a Fresca (I do have priorities) and call Matt from this beautiful outdoor courtyard at Evergreen Hospital. He is at work probably just out of roll-call. I tell him what is going on and the additional tests that have been ordered and my personal curbside diagnosis for what this “really means.” If there is one thing I know in this world it is physicians and I know them well. I have the amazing ability to see the English translation to everything they say, not unlike the opera. Every nuance, their body language, every carefully chosen word, how they are dressed, how they sit, where we talk is all translated into ‘layperson’ for me. After meeting with Dr. Shook, the Director of the Breast Center at Evergreen, I knew pretty much what was going on. “What do you think is going on?” Matt asks me. “I am not sure of the exact details but I am certain of this: It is bad and it is cancer.”
Still July 9th (I now think of FDR’s unmistakable voice after Pearl Harbor “a date which will live in infamy”) but having completed the Breast MRI. What a treat this test is. NOT. Let’s just leave it at this. Very loud, very surreal and they utilize this wacky, inverted Roman chest plate and you lie on your stomach and drop your boobs through the holes. If you really don’t have enough to ‘drop’ through then you get propped up with all sorts of towels and washcloths and whatnot. Just weird as far as tests go. Again, the reaction from the staff told me everything I needed to know. This was bad.
After the MRI I spoke again with Dr. Shook. She was going to add me on at the end of her day because “the MRI had confirmed that there were some bad looking masses in the left breast and left axilla” and she wanted to do a needle biopsy and lymph node aspiration that day still July 9th. She added me on at 5:30 p.m. and I was to call in and make sure that there wasn’t someone that comes in through the ER that would bump me. Either way, she was intent on getting that biopsy that day and I do believe she would have stayed until 11:59 p.m. to “git-r-done.” She is nothing like Larry the Cable Guy but on July 9th my whole life changed and one major change was that we are all about gittin-r-done. That’s what we do now is git-r-done.
Matt calls, he is on his way to the hospital. It was so great that he left work because I was getting ready to come unglued. I say meet me at the house not the hospital. We do. It is strange but I barely remember being at home at all on July 9th. We had to though. We had to get the girls and arrange for a sitter and all that stuff but I don’t even remember being at home. I remember nothing. Not what we talked about, not who we called or what we ate or did it is just completely blank.
Matt and I return to Evergreen at 5:30 p.m. for the biopsy. Dr. Shook is there and Holly the fabulous. They were just excellent and so caring. Dr. Shook did a great job preparing me as well and letting me know what was going on every step of the way. It is odd but that kind of a biopsy is nothing to scoff at. Holy cow! It is a very physical procedure and still today, 31 days later, I have a giant bruise from the biopsy. It is now in the green/yellow phase of bruising but think about that…………a month out and there is still bruising. I just listened to my iPod and zoned out, pretending that this was NOT my life.
When it was done Holly gave me a single long-stemmed red rose. I think this is a really sweet gesture but odd. When do you receive a single long-stemmed red rose? When someone loves you, when you go to Prom, when someone is sorry, when in Mexico, when caught off-guard in Belltown (too intoxicated) and the gal reels you in, Valentine’s Day when you are not really sure if you are dating, the airport and poor planning, I like you but not all the way to a dozen and apparently when you have breast cancer.
So thirty-one days since July 9th and the rose has long since died, the bruising is still proof positive that this is happening to me and we are still here, intact and soldiering on. It is amazing what can happen to a person in a month, 31 days, 744 hours, 44,640 minutes now this is just getting a little too ‘RENT’ but it is amazing.
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