Monday, May 17, 2010

My Oncologist Never Sits Down - 5/12/10

She never sits down. Today, she pulled up the rolling, cushioned stool directly in front of me and sat with my rather large, light blue medical file in her lap.

I had been sitting and reading my book. I always have reading materials with me when I know that I'll have to wait for an extended time. The cancer treatment center that I attend is always busy. Waiting is not one of my better virtues. So that I won't feel like I'm wasting my time and getting angry in the process, I have a running magazine or good book to take my mind off of the wait. Today, I was reading "The Good House" by Tananarive Due, one of my favorite authors. I was nearing the climax of the plot, and I was totally focused on the book that I had in my lap. It had to be more exciting than what my oncologist had in her lap.

My first thought as she rolled the stool in front of me was that "she never sits down." She's like a little dynamo, constantly moving, talking, smiling, and touching. I imagine that she has an excellent bed-side manner, but she spends her time in this office, on her feet, reviewing her patients' vitals, scans, and other tests; asking them about any side effects from various treatments; asking them how they are feeling; administering prescriptions; and determining which of the multitude of treatment possibilities would work for each individual case. She is such a petite woman. I'm a good 3 or 4 inches taller than her, even though she always wears high-heeled shoes. How she manages to stay on her feet all day in those heels is a mystery to me. I wear my sneakers most of the time, even when I'm in the office. She probably doesn't weigh 100 pounds soaking wet, so I'm like a giant compared to her. She's sitting, and this is not a good sign.

She was upset because the new computer system was double booking patients, and there was no way for the scheduler to correct this easily. Therefore, she was even more overworked than usual, trying to see twice as many patients as she normally would on a daily basis. She was tired. It was a good idea for her to have a seat, and it was a nice change of pace for both of us.

I had a bone scan on Monday, and PET and CT scans on Tuesday. Today was Wednesday, and I was there for blood work and to get my results from the scans. There are times when you already know the answer before you ask the question. This was one of those times. I had been in so much pain lately that even without the scans, I knew something had changed.

She told me that I have new "spots." There is a tumor on the left side of my skull. There are two tumors in my left lung. I had thought that the chest pains were from my breathing problems induced by the anemia, and my oncologist had originally thought that I may even have some congestion. More than likely, the tumors in my lung were causing the problems. She continued. There is also a nine millimeter tumor in my liver. How can they measure something so small, I wondered. There is also more visible activity in my left hip, with extensive inflammation. My tumor markers have been constantly rising. Clearly, the Femara had stopped working. At what point is not really definable.

She asked, "How's the pain?" Constant. Every day and all day. Last month when I had my Zometa treatment and my quarterly Lupron injection, she had given me a prescription for OxyContin (time-release morphine in a pill form), that was not working. I was told by several pharmacies that they do not stock this medication on a regular basis. As hard as it was to have the prescription for this pain reliever filled, I was still taking Advil and on a more frequent basis. It was the only thing that gave me relief from the inflammation. For all the good the OxyContin did, I should sell it on the streets and get my money back. I've read that this pill is crushed and snorted to get high. Hah! I did not feel high with OxyContin, and the pain I should not have been feeling with OxyContin, was still present. Aleve, which is what my oncologist prefers to Advil, was a complete waste of time and effort. Nothing helped with the pain, but the Advil did allow me to continue to move, to sit, and to sleep for a few hours a night. The pain is really bad when I lay down. Sitting is equally as bad. Surprisingly, standing and walking eases the pressure on the nerves in my back, along my hips, and down my left leg. So, I stand and walk as much as possible during the day. If nothing else, it's time on my feet for training purposes.

"We have to switch out the Femara with something else. And I'll check to see what other treatment protocols we can try." She left the room for free samples of Aromasin. Because my cancer is estrogen-dependent, the treatment protocols vary according to whether a woman goes through menopause naturally or the menopause is medically induced. My menopause has been medically induced by Lupron, but that situation also rules out certain treatment options.

When I started my treatments for the bone cancer, I was told that we would try Tamoxifen and all three of the aromatase inhibitors (AIs) first. Afterwards, there were other treatment protocols to try before chemotherapy and radiation. We would stick with a treatment protocol as long as it worked, and then we would move on to the next treatment protocol. As long as the cancer stayed in the bone, chemotherapy would be the last resort, because it rarely produced successful results for bone cancer. Now that the cancer was spreading outside of the bone, chemotherapy was back on the table as an option.

Tamoxifen lasted for about a year before it stopped working. And now the Femara, the first of the AIs, has stopped after about a year. I will be taking Aromasin next. After Aromasin, there is Arimidex, the last of the AIs. Faslodex will follow. "We're dragging our feet on the chemotherapy," she reminded me. We both knew why. I had read so much about metastatic breast cancer that I knew that at the point that we tried chemotherapy meant that I would be running out of other, less toxic, treatment options. As long as there were pills, injections, radiation, and surgery at my disposal, I should use them. Because of the toxicity, you can only be on chemotherapy for so long before you're taken off of it. Enough time has not gone by to make me forget about the horrible side effects of chemotherapy. I was in no rush to start that process up again. Let's try one more pill. Aromasin, you're up!

Along with the free samples, she gave me a prescription for the Aromasin. Aromasin is $450 for a 30-day supply. With my health insurance, I pay only $75 a month. Femara and Tamoxifen were cheaper at $25 a month with the health insurance. It boggles my mind that a pill that is the size of a Tic Tac can cost so much. A month's supply of Aromasin is a race entry fee. Aromasin had better work!

Next month, I'll have my Zometa treatment. She'll check my tumor markers to see if the Aromasin has had any effect. The next scans will be in four months to also check for any tumor regression, progression, or stabilization. If there's regression, she's hoping that the pain will also subside a little. If not, we'll try radiation. We're at that point now. Palliative treatment is always the goal for metastatic cancers, to make the patient as comfortable as possible. I really wanted us to drag our feet on the radiation, too, but quality of life issues are at stake now. It's hard to concentrate on anything else when all you can think about is the pain. We had the discussion with the neurologist at the onset of my diagnosis about radiating the tumors in my spine. It's a risky procedure, but apparently, radiation can be directed to alleviate some of the pain. I'm all for that.

It's taken me almost a week to digest everything. Even after three years (two and a half of those years on a treatment protocol of some sort), I still can't believe my body is failing me. The results of my recent scans are frustrating and makes me angry all over again. I'm an engineer. Give me a problem, so that I can find a solution. I don't stress about the details, and I don't care how hard I have to work to solve the problem. As long as I have a plan of action, I'm ready, willing, and able. Metastatic cancer is like a maze. You never know when you'll hit a dead-end, before you have to retreat and follow another path. I like puzzles, so we'll figure it out. I also like my oncologist. She worked with me for the breast cancer, and now, she's working on the metastatic cancer. I'm not giving up, and I'm not going to allow her to give up either. I have enough faith for the both of us, and my faith is stronger than any cancer that has or ever will invade my body. There is a solution out there for this problem, and I am confident that we'll find it. I'll practice patience and wait on time.