Those Tests Are Out to Get Me...

This is a continuation of the last blog entry, in which Dr. Stern's Stephanie told me that, although all the tests to detect cancer were negative, I need follow-up Pap smears for the next several years.

My initial thought was, "No, no way." That's still my thought. When I said to Stephanie, "I don't think I'll do that," I was waiting for counterargument. Is there something else you could recommend, could I be sedated, etc. She didn't answer with any other recourse.

The pelvic exams that were ordered by my doctor, Dr. Miller, were the reason I put off any exams for a year. Just as I had suspected, the 30-year separation from having any pelvic exams have not lessened the pain, and the ultrasound was unbearable and could not be performed. So, I just stopped mentioning it to my doctor. She didn't follow up on that issue until she wanted a full-blown physical, and at that point I talked with her about it. As it turned out, I had cancer, and that delay gave the disease further chance to spread.

Dr. Stern did warn me this morning that if I were to show any signs of bleeding, I should come back to his office immediately.

It was at that point that I figured out that he was telling me that I could make my own medical decisions -- fine -- but that there were certain warning signs to which I should pay attention. And he apparently figured out that I might be more willing to talk with Dr. Poddatoori about such things, or that she could figure out some sort of compromise, like sedation, etc.

In fact, Ruth and I made a pact: any signs of bleeding returning and I have to submit myself to Pap tests. I agreed begrudgingly. I can't figure out what's worse sometimes -- the cancer or the actual tests. I realize that's cavalier on my part, but please forgive me. I have never felt the ravages of cancer, even though I've had it twice. I've been rescued, both times, by surgery.

While my luck has continued along those lines, I don't feel that lucky. My purgatory involves a sharp instrument stuck up my vagina. Ouch.

Follow-Up to Cancer Surgery: The Good, the Bad, and the Ugly

I've been hoping and dreading this moment -- all at the same time -- where I walked into my oncologist's office, and he tells me the results of the post-surgery tests, tests which determine whether I still have cancer. Those tests are negative, thank goodness.

The CA-125 blood test, which is a unique test for cancer, was 18 prior to the surgery. It's now 7, a considerable drop, and in a very good place. The CT scan was negative. Dr. Stern told me that I shouldn't need either test again (at least at this point).

However, there are follow-up tests. Stephanie told me that because I had endometrial cancer, there is a risk that the cancer could occur. Therefore, I should have Pap smears every 3-6 months after surgery for the first two years, and then every six months for 3-5 years.

I was in shock. I had been told by Dr. Poddatoori, my gynecologist, that I would never have to have a Pap test ever again. The uterus is gone, the ovaries are gone, but there's still risk. Dr. Stern told me there's a 5% chance the cancer could recur. Then he paused and added, "Or greater."

I don't do Pap tests. In fact, when Dr. Poddatoori found out that I had had my last Pap test before she was born, her reaction made me trust her and like her so much more. She understands that I can't do a pelvic exam easily. Last time I had to be so sedated that the procedure was done in a hospital, and she performed it. (This was just prior to the surgery to remove the uterus, etc.) It's too painful.

I told Stephanie that I doubt if I would ever do that, and apparently she reported that to Dr. Stern, because when we got in to see him, he recommended that I go to see Dr. Poddatoori for follow-up instead of him. He suggested I see her after three months.

I'm still a bit freaked out. I don't feel like celebrating, like I thought I would. Still, I have a plan. And I think ice cream is definitely in my future. Because, damn it, life is too short.

Kidney Problems....?

I did get that phone call, yesterday, from Dr. Laura Miller, my general practitioner. Thankfully, my iPhone is working again. What a wonderful doctor.

She had called to say that she had seen the note from the people who did my CT Scan last week. I was to consult with her about resuming Metformin, my diabetes medication. When I told her I had already resumed the meds, she was fine with it, but told me to stop using it until after I had had a specific blood test.

The blood test will show whether there's increased creatinine in my bloodstream, and whether the kidneys are at risk. All because of the dye I consumed during the CT scan.

According to Medicine.Net, "Creatinine is a chemical waste molecule that is generated from muscle metabolism. Creatinine is produced from creatine, a molecule of major importance for energy production in muscles. Approximately 2% of the body's creatine is converted to creatinine every day. Creatinine is transported through the bloodstream to the kidneys. The kidneys filter out most of the creatinine and dispose of it in the urine."

So, what's the problem with a CT scan as it relates to kidneys? According to the University of Michigan Health System (www.med.umich.edu), "serious kidney damage... can be caused by the iodine-containing 'dyes' that doctors use to enhance the quality of such (CT) scans."

"People whose kidneys are already vulnerable, including many older people and those with diabetes or heart failure, are the most at risk from contrast agents..." The University of Michigan concluded from their study in 2008 that, "Mild to moderate kidney damage occurs in one in four high-risk people who have CT scans, and in as many as one in ten people with normal kidney function. In some cases, it causes acute kidney failure."

Dr. Miller looked at my last blood tests, and concluded that I have normally-working kidneys at this point, the point before the CT scan, that is. I swung by Lifelong this morning, picked up the lab paperwork she had prepared for me, and got to LabCorp by 9am. At midnight last night, as I was falling asleep, I remembered that I could make a LabCorp appointment, and so I did. The whole world shows up in that tiny little waiting room between 8am and 10am, because they're all fasting.

The photo shown is a CT scan of normal kidneys, top-down view.

So, the blood test is done. I am to resume Metformin this afternoon. Dr. Miller will call me if the lab results show there's a problem (probably in a couple of days). I tell you, if the cancer doesn't kill you, the tests will. Amazing.

My iPhone Has Fallen & It Can't Get Up

My iPhone hasn’t worked for the better part of two weeks now. That single event has changed my life.

It’s quiet now. It’s peaceful. I don’t automatically reach for the phone, looking to check to see if I got an email or a text message. Looking at Twitter to see what’s trending now. The iPhone is the epitome of instant gratification for a neurotic. And the lack of it is very freeing. I have to sit still, maybe read that book I’ve been saving. Actually sit down and talk to people.

Yeah. I hate it.

Seriously, though, what really bothers me is that the doctors' offices can't get hold of me, if need be. My instructions at the CT scan on Friday was, don't take metformin (diabetes medication) until 48 hours from now; then they gave me a piece of paper saying, don't take metformin 'til you contact your doctor. They told me they faxed this to the doctor's office. So it could very well be that Dr. Miller is trying to call me. (What I'm going to do is start taking the metformin on Monday. That is well past the 48 hours, and I'm not feeling any ill effects from the scan.)

I will keep trying to get my iPhone fixed. It's my third visit to the Apple Genius Bar tomorrow. However, I think that title is a misnomer...

Afterthoughts Re: CT Scan

My arms hurt today. I had to hold them over my head while I went in and out of the tube for the scan. Muscles I don't usually use, I guess.

And I didn't feel altogether great after the whole process. I mean, I drank a quart of chalky liquid, and then was injected with something that overheated in my body. They warned me I might experience some diarrhea. I didn't exactly have that, but my body felt uneasy as if it was swamped in something unpleasant, something it didn't understand.

Today, as you can imagine, I have a big bruise where he stuck me for the injection. That's the orifice where the blood freely flowed afterwards. It's not surprising that it's painful today, with a lump of purple flesh surrounding the pricked hole.

Someone asked me the other day how I was doing, how I was feeling, with a concerned look on their face. Frankly, I had, in that moment -- actually, most of the time now -- had forgotten about the cancer and the resultant surgery. I hope to continue on that fact, hoping the whole early 2012 scene becomes a distant vista in my mind's rear-view mirror.

A Different Kind of CT Scan

Today I had a CT scan taken of my abdomen to see if any cancer remained after the removal of the cancerous uterus.

It was done at the Hettrick Campus in the Alta Bates Women's Cancer Center over in Berkeley. First I had to find my way to the basement. But then there were two radiology departments, so I had to figure that one out. Then I checked in.

His first question to me was, "What flavor do you want for your Barium Sulfate?" The choices were banana, mocha and berry. I chose berry because I don't like coffee, and I had chosen banana for the colonoscopy liquid, which turned out to be a mistake. As it turned out, I think all answers are wrong. There was a slight hint of berry, but mostly it was fairly-hard-to-swallow gunk. And I had to drink the size of two medium-sized Cokes in half an hour. "Coke," as in what's Linda's favorite drink, was a wrong choice of words.

The Frederick Regional Health System website tells me that, "You may be asked to swallow baking-soda crystals (sometimes called fizzies), which will create gas in your stomach. Then, you will be given 20 ounces of liquid barium, which resembles a light-colored milkshake, to drink. The radiologist will note the passage of barium into your esophagus and stomach on the fluoroscopic monitor. Once the upper gastrointestinal tract is adequately coated with the barium, still radiographs are obtained.The examination is usually completed within 30 minutes."

And then I waited about an hour after chugging the liquid. After shucking my clothes in favor of two gowns, I lay down on the slab which would lead me into the scanner. Then he gave me an injection and warned me about the warmth. What he told me didn't begin to prepare me for what would happen about 15 minutes later.

Then there was the usual out-in-out-in stuff. When it came time to hold my breath, though, I was amused by the green face, amber face, the latter showing a balloon holding its breath. And then a timer telling me how many more seconds before I could breathe. All of those things helped, but it was no struggle this time to hold my breath.

Then he injected me, and I entered the tube again. This time, however, everything started getting really warm, fast. "Everything" included my groin area, which, for some reason, really startled me. Still, it wasn't terribly uncomfortable. But just when I knew we were almost at the end, I started getting nauseous. I felt like I was going to throw up at any moment, but I don't know why. I swallowed and swallowed, and was able to hold down the urge, until, finally, the guy said I was through.

He bandaged up my arm and I walked back to the storage locker to retrieve my clothes. As I pulled them out, I noticed blood amply dripping down my arm. The blood around the vein on my left arm had completely overwhelmed the bandage, so I went, in my two gowns and sock feet, to the reception area, and she told me to go back to the technician who promptly put gloves back on and asked, "Are you a bleeder?"

Well, no, not ordinarily. In fact, never. But he bandaged me up again, this time with one of those stretchy bandages, wound tightly, and problem was solved. However, there was blood all over my pants. We will see if the large spot will come out in the laundry.

It's not a pleasant experience, but at least for right now, it's over. I'll hear about the results in two weeks when I go back to the oncologist, Dr. Stern. I must admit, I am a bit anxious.

Put this gown on. And don't breathe...

I did finally hear from the Radiology department at the Cancer Center, about an hour later. My appointment for a CT scan is next Thursday. And, a little less than two weeks later, I'll be meeting with Dr. Stern to go over the results. The timing is very good.

The clerk told me this will be a barium scan, which means I'll have to drink the barium solution, then wait while it's being absorbed into my body. I won't be able to eat anything four hours beforehand. And the whole thing will take about 2 hours.

So, I made notes and will review them before I go to Berkeley.

I've never had a CT scan or anything like that which requires me to drink a solution. The last one, the PET CT scan, required an injection, and then we waited for an hour while I played "Angry Birds" on my iPhone. So this will be quite unusual.

Wikipedia says about the barium sulfate solution:

"Barium sulfate suspensions are provided by a radiologist in advance of a CT scan to allow for better computer tomography of the gastrointestinal tract. The patient is instructed to take nothing by mouth, which means to abstain from eating and drinking (fasting), with the exception of drinking the barium sulfate suspension.

"The amount of time for this fast may vary, depending on the instructions given by the imaging facility and the area of the body to be scanned, but generally lasts for several hours prior to the scan. The patient generally skips one meal, along with abstaining from all liquids, clear or otherwise, during this time. Consumption of the barium sulfate suspension begins 90 minutes to two hours prior to the CT scan, as instructed in the patient education provided. Consumption is paced, beginning two hours before the scan is to occur, with levels marked on the provided container indicating how much is to be consumed between each of the two hours prior to the test. A small portion of the suspension is reserved for the minutes just before the test, to ensure that as much of the gastrointestinal tract as possible is coated. After the scan is complete, the patient is encouraged to eat and drink normally, with special attention to plenty of fluids. The barium sulfate is excreted through defecation. Constipation is a possible side effect."

How pleasant. Time to put the gown back on!

Waiting for Godot

It's been three-and-a-half months since my surgery to eradicate cancer in the uterus. The plan was to have a few more tests in June, and see where I am.

I was told to go in early June to get my blood test, the same test that showed a negative result back in February. That was on June 1st, because, when it comes to this stuff, I don't fool around.

However, three weeks later, I'm still waiting to hear whether I have the go-ahead to do the CT scan. I called Dr. Stern's office today, and Shirley told me she had faxed over the insurance information to the scan place a floor below her. I called and they said they never got it, but gave me assurances that they would call me after they talked with Shirley.

That was 15 minutes ago, and I'm still waiting.

I have other appointments to make, phone calls to make, but those will have to wait because this appointment is and will be more important than having my home thermostat fixed, or figuring out when my next movie date will be.

In the meantime, my post-surgical status is excellent. There is only a little pain, and that happens only when I press on my stomach. Perhaps the only good thing that has come of that pain is that I stopped wearing a fanny pack. A stylish upgrade.

In the meantime, my phone goes with me everywhere. I have to get these tests in before I see Dr. Stern in early July, so that he can review them and tell me the results. If the tests come back negative from the blood test and the CT scan, I can breathe a sigh of relief with the knowledge that I am cancer-free.

It Itches

I am exactly 8 weeks and 2 days from my operation. In the first few days after I returned from the hospital (after spending 5 days therein), I couldn't sleep longer than 5 minutes at a time. I couldn't much focus on anything because of the vicodin and the pain. I couldn't drive anywhere. I was supposed to walk a little every hour (but we all know how that goes...). Today, I drive everywhere I want to go. I drink wine if I want to, because I'm not on painkillers, and haven't been for over a month now. But I have this 7.5-inch zipper from my navel down to where the sun don't shine. It isn't painful to touch any more, but it sure is red. And the vampire bite marks on either side of the surgical line are still there. It's a reminder of where I've come from. Not constant, but near enough. I have a slight bit of pain, right around the belt line. I pretty much don't pay any attention to it. It's not like even two weeks ago, when I knew the pain was there all the time. I have to be reminded now that I have any at all. I consider myself cured. What do I face now? I will walk unassisted into Lab Corp on June 1st and have my blood drawn for the first of two tests. I will then call the oncologist's office, and Shirley will apply for a PET CT scan one more time. I have to say I'm a little nervous about the latter, not because of the procedure, which is a piece o' cake, but because of what it might show. If it shows I'm free and clear of cancer, I'm home free. Well, pretty much, although the gynecologist will see me annually for five years. If not... well, I don't want to think about that. Oh, one further thing: the incision scar itches. It's the damnedest thing.

Searching for a Nutritious Diet

I have just finished my eighth week of recovery from the operation. If you don't know, I had surgery to remove cancer in my uterus on March 9, 2012. I am still recovering from that rather extensive surgery.

A medical student came to my house a few weeks ago to visit and interview me. This had nothing to do with the cancer or the surgery. In fact, I had seen her before several times at Lifelong Medical workshops on diabetes and stroke risk. She was required by her school, as part of her training, to do some in-home visits. After all, Dr. Miller explained to me as we were setting this up: you can learn a lot about a person by their home environment. Do they have a support system? What is their greatest worry or challenge?

My answer to that last question was: "I am recovering from cancer surgery -- my second cancer -- but that's not my worry. Diabetes kicks my butt daily." And so we talked about that. And that is the absolute truth.

I was talking to a friend the other day about what I would do differently 15, 20 years ago if I knew what I know now about how diabetes would affect me. Nothing, I replied. I don't think I could change a thing.

But that's not important, really. What's important is, what am I doing now? I'm taking my blood sugar levels every morning before breakfast, which tells m absolutely what path, what trend I'm on. I'm conscious every time I put something in my mouth, and now I write it down (in my new app in my phone). But I'm going one step further.

I'm ordering food from a local nutritionist. Yes, I've tried NutriSystem, and when the food was lousy and cardboard-like, I tried BistroMD. A little more upscale cardboard but still not tasty. And so I couldn't stick with it.

My nutritionist, Sandy Der, is making meals according to menus she puts together with my guidance. She will deliver the frozen goods to my door -- 20 of them -- and I'll eat them over the month. Then, next month we'll do the same thing. (Sandy has worked for year's with Oakland Women's Cancer Resource Center, teaching nutrition and helping people with cooking ideas.)

This month's menu items include:

Fish of the Day with sun dried tomato pesto. Side of wheat berry pilaf and broccoli.

Grilled lime and garlic marinated chicken. Side of cut corn and roasted sweet potatoes.

Beef stew with carrots. Side of egg noodles and sugar snap peas.

Hoisin glazed roast chicken breast with stir fried green beans and brown jasmine rice.

Turkey bolognese sauce. Side of whole wheat spaghetti and broccolini.

The whole idea is not to diet. The idea is to make better choices. I start May 12th. Wish me luck.