DCIS - I meet the medical oncologist

Thursday.

The waiting room smells like the winter clothes of a hundred smokers. There is no exhaust ventilation, just heat.   Above the check-in window is a sign with lots of circled words and underlining:

PLEASE NO STRONG ODORS AS

 A COURTESY TO THE PATIENTS.  NO

PERFUME, STRONG SOAP, OR LOTIONS

Apparently smoke odor is okay.  I would opt to wait in the hall, but I have to fill our more papers than I've ever seen before.

The woman in the next chair talks with me for awhile and suddenly says:  "You have the best doctor!"  Then my name is called.  I've gained weight, no big surprise.  My blood pressure isn't too high for a visit to another oncologist I've never met. 

Finally I meet him.  He is nice, and outlines the whole DCIS story quickly, without talking down to me.  I admit I'm interested in Tamoxifen, so before long we're on the subject of side effects.  Leg pain of course comes up.  I mention the nerves to my legs, and he says: "Tell me about the spine fusion."  He's a good listener; reassures me:  "In 17 years of doing this, I've never seen a case of endometrial cancer."  

My suspicions were correct:  No more diphenhydramine, period. Find something else for the allergies and sleep.  And no more soy bars, soy plants, soy anything. So phytoestrogens are dangerous.  His exact words:  If it says soy, run!

He motions me to sit up on the table, listens to my heart and lungs, looks at the still-pink breast. 

The word on Tamoxifen:  "If you're going to have trouble, it will be in the first month." He tells me to wait a couple more weeks until my sinuses settle down and I'm myself.  Then start taking the pills.  Come back in six weeks.  

It was pleasant.  But it was the second doctor visit in two days about DCIS.

I get some soy-free food and go home very tired.

CANCER - WAR AND PEACE . . . and my Rant

This morning's internet made me think about yesterday's rant.  No, I don't take it back!

However, I closed yesterday with a dig at the government, or all governments the WHO "cancer surge" report involves.

And today, an email that was sent yesterday tells me that CVS is taking tobacco products off its shelves this year.  Even JAMA was supposedly excited about that.  I felt corrected for assuming only governments will fight the cause.  This is an actual business taking action on a cause of cancer.  Then I clicked Medpage  later, and read that their reporter seems to think the CVS move is just publicity or something.  

Meantime, I read Sunrise Rounds where Dr. Salwitz discourages the "war" images of cancer care.  

And two minutes later, a report that one weapon against breast cancer, brachytherapy is not as proving as effective as direct beam radiation, which I had.

It's asking a lot for patients, including yours truly, to achieve the peaceful elements of immune power, even peaceful assertiveness, but also to endure our weapons against cells inside us that have gone rogue.  And in our spare time, asking ourselves to get tough, really tough on causes of cancer.   But if we don't . . .

***

Now, a quick shower, and I take my questions in hand and drive off to meet the medical oncologist - for war and peace.

LUMPECTOMY FOR BEGINNERS - Post - surgery followup and a Rant

This afternoon, the surgeon.  My incision looks as good to me as before radiation.  We'll see what the doctor says. I wanted to see the medical oncologist before today, but it didn't work out. Time seems to slip through my fingers since the lumpectomy.

***

Now for the Rant:  Last night I read the Yahoo news blog on the World Health Organization report that cancer will have a huge upsurge worldwide in the next two decades.

The blog said nothing about what the WHO bases this prediction on. 

 Diet, exercise, and early detection were mentioned as possible prevention for half of us.   Alcohol and tobacco were mentioned as causes.  But tobacco use has widely declined here.  Will we all start eating more fast junk, sit more than we already do with our horrendous commutes? 

Nothing about the environment!  Not a word about carcinogens around us and in our food and our sunscreens and, and, and.    

There was a photo of a cancer patient resting.  He didn't look as if too much red meat and too many martinis were his lifestyle.  Much of the world does not get a lot of fast food, alcohol, lengthy commutes, and lolling in front of tv.  Their air is not full of vehicle exhaust.  What gives them cancer?

My main Rant? Calling early detection "prevention" always makes  me furious!  We can detect a polyp and prevent some cancers. But detecting cancer means you've got it!    

Early detection of breast cancer in situ doesn't prevent cancer. It finds unhealthy cells.  We may need surgery and perhaps radiation to get what is detected. We hope that's all of it. If not, we hope our own immune systems will kill some rogue cells. We may take preventive medicine for years, enduring the side effects. And we wait.  

Some of us do believe that exercise and good eating habits help keep cancer away or keep it from showing up again.  Dr. Salwitz believes in exercise, and I believe him.  

Some of us, like me, believe the science published in books like The Immune Power Personality, and we work on our minds and behavior to help keep us healthy.

But some of us want to know what our governments are going to do about environmental causes.  Some take action with petitions and letters about pollution.  Obviously, that's not enough!  

CANCER TREATMENT - Who's the boss?

Today Jeff Haden popped up in my email from LinkedIn to announce an article called:  Your Boss is Happier Than You.  Maybe I read it because I've had a couple jobs where I was rarely happy.  

I saved this quote - hope he doesn't mind my using it here.  

Engagement and satisfaction are largely based on autonomy and independence. Just like a boss, I care more when I'm in charge and feel empowered to do what's right. 

That reminded me of how many articles I've read on medical sites that complained about patients not following their medication plan. And hospital committees formed to make patients follow their plan!

Since I needed a post for today, I went to KevinMD., and found a different kind of article:  When Something Natural Does Indeed Work, by A Country Doctor, MD.  It is a story about cooperation between a doctor and an older male patient.  Real cooperation.  The patient felt some of his medications were doing him harm.  They discussed it, and planned what to try.  His health soon suffered from giving one up. Instead of insisting, the doctor came up with an alternative, a medicine I've heard of, made from a plant.  Success!  

On the DCIS treatment, I've been lucky.  The surgeon suggested, did not order, that I meet a radiation oncologist and a medical oncologist. The radiation oncologist insisted I believe her about unlikely side effects.  But she did say radiation was my decision.  

When the see the medical oncologist this week, I'll have to talk about some medications I take that supposedly don't agree with the medicine I think he will recommend.  And I'll remember the problems others are having with one adjuvant medicine.  I want us to cooperate.  And I do want this to be my decision.  

I want to go back to real life, and be in charge, not in fear.  

  

SURVIVORS - The important three-letter word

 Doctors have told me to exercise, take my pills, and wear a mask when walking in the Hollywood hills.   

I don't remember even my favorite CA doctor prescribing fun.  But he probably did.  I know he has an absorbing interest in addition to medicine.

In Henry Dreher's book, The Immune Power Personality, Dr. George F. Solomon's name comes up again and again.  I Googled him for specifics.  In short, he was a pioneer in discovering the link between our minds and behavior and our immunity.  

The University of California's memorium for Dr. Solomon uses the phrase, "brain, behavior, and immunity."  In his autobiography, with his list of positive values, he included "having sports cars."  

When mine was stolen, I didn't replace it.  Hmmm.

In talking with Dreher, Dr. Solomon listed healthy traits he has observed.  Number seven is:  The capacity for pleasure and play.  

He is quoted later in the book as saying, "And some people don't know how to play.  I believe that people need a balance among love, work, and play in order to stay healthy." 

Do we dare ignore that?

DCIS - What's good so far

At this moment, I'm not in any kind of treatment.  It's not a pause that refreshes, mostly due to a really bad cold and sinus "ick."  My daughter, whom I live with right now, is optimistic, kind, and non-interfering.  She gave me pink flowers when I was diagnosed and offers to bring things I need from her errands.  She put up a sign that says, "Be a warrior, not a worrier." 

On my evening walks last year, I met a woman near my age.  In our chats, she once referred to herself as a cancer survivor.  She urged me to go with her to visit a gym where she has a regular workout several times a week.  When I was diagnosed, I took her up on her ongoing invitation to ring her bell for a chat.  She has been amazingly supportive. 

The most scary thing about leaving my longtime home in L.A. area was leaving my doctors, whom I loved and trusted.  When the biopsy results were not good, the mammo doctor referred me to a surgeon.  Her phrase "we work with him all the time," was not enough reassurance to calm me.  He turned out to be calm and delightful - no false optimism, no "white coat distance."  He feels like my medical safety net right now.  The surgery went beautifully.  Bottom line:   I like him.  We get along.  I trust him.

Radiation was not bad.  The very best part was the two radiation therapists I may have mentioned.  They were kind, knowledgeable, down to earth, and fun.  They treated me like a friend.

Wednesday, I see the surgeon again for followup.   

Then, the first medical oncologist visit. The surgeon thinks I will like this man.  I hope I will.  And I hope he will have solutions for some of my worries.  

Right now, I have to exercise.

So far, so good.  



  





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DEALING WITH DOCTORS . . . what I'm still learning to say

One healing trait from Dr. Spiegel's study (see yesterday's post)  was being assertive with doctors.  I think I'm pretty assertive with them, but it depends on the doctor and on how secure I feel.

I was more assertive with specialists in California because I felt that my primary doctor, whom I trusted completely, had my back.  Now being in Texas still feels new.   I don't feel I have a medical safety net yet, except for the surgeon. 

Sometimes, with a particular doctor, I'm not assertive because I feel it won't do any good.  Maybe I started out by being passive with that doctor.   Or right then I was just overwhelmed. 

Some women have always been discouraged from being assertive.  For instance, my ex-husband tried to make me leave an assertiveness workshop.   Maybe he thought assertive meant aggressive.

I need to remember to say:

Please let me finish.  (Said very politely before I get angrier)

No, it doesn't feel like that.

What else could this be?

I've had this before.

How else could we treat this?

I need to speak.

I was really upset when I learned that the directions were not complete!  How can we communicate so that doesn't happen again?  

Yes, these are in bold type.  They are urgent--urgent enough to practice before we get into the doctor's office. 

I wish you health.