Why don't the authors of the electronic signage content ever think about what they are providing and what it really means to the average driver?
On my way to Dana Farber in Brookline today, I must have seen four electronic signs that displayed: "Construction Rte 28 S Expect delays Seek Alt Rte". Sure, in Massachusetts where the state flower is a white and orange construction barrel, you often see signage similar to that or, "Can't get there from here" or, "Give up and die". Route 28 S meant nothing to me as I was on 93 S and was expecting to take Storrow Dr. through to Brookline. Having worked in Boston and vicinity for most of my career, I learned today that 28 S was Storrow Dr. Of course this little gem of wisdom didn't become apparent until I was stuck in queue on the Leverett Connector with no chance of escape. Suddenly what I had expected to be a breeze turned out to be stagnant air. This was due to construction on the Longfellow Bridge, so traffic did clear up after passing that. Still, I was less than pleased.
Not sure if I was fumbling through traffic reports or what, but my GPS seemed to be sending me to my brother's house in Cambridge. Of course there's no safe spot to pull over and check, so I crossed the bridge and arrived at Pleasant St where I was able to pull into a driveway and recalibrate. Back in action, I purposely turned right onto Memorial and not left since I knew it was leading me back to Longfellow. Luckily I was able to back-track and get to Longwood and eventually to Dana Farber with a half hour to spare. As luck would have it, the 'all full' sign for the parking garage was just being moved aside clearing my way to P3. [This luck continued since all parking was free today.]
I made it up to the ninth floor and as a repeat visitor/patient, they found me and directed me to the waiting area. Extremely busy today, but most seemed to be moving in and out - except me. My appointment time came and I waited an additional hour before being seen.
Dr. Overmeyer joined me in an examination room and was profusely apologetic for the wait. [She mentioned a go live that was transpiring today, so I know how stressful IT roll-outs can be. I was just thankful to be in her audience.]
Doctor O indicated that she read my file had spoken with Dr. Mehta and was up to speed. She had hoped that she had the post op notes and the slides (pathology), but they were not in her file (electronic or paper). But she said, based on the information she had, she was ready to provide consult and answer any questions I had.
At the highest level she said she was in agreement with Dr. Mehta that I would benefit from chemo. She reviewed the OncoDX assay and explained the results that support a two drug therapy. She also understood that there were two drugs that required a choice - Adriamycin (AC) or Taxotere (TC).
Adriamycin (AC) [A.K.A. - Doxorubicin] is the conventional chemo. However, among the host of side effects there is a 1% chance of my having congestive heart failure. In a patient's lifetime there is a certain amount of this drug that can ever be taken. My therapy would call for my having half this amount. She cautioned that I would need to have an echo cardiogram to determine if I were even a candidate for this. Not knowing my medical history (or that of my family) she couldn't provide more information, but stressed having this done. She did add that AC affects the (heart) muscle not the vessels, so the Triple A is not a concern. In addition, she said that there's a 2% chance of my developing Leukemia.
Taxotere (TC) [ A.K.A. - Docetaxel] is the preferred treatment since the major side effects are fatigue and fluid retention. She indicated that there are drugs (and thought I heard her say therapy) to counteract the fluid retention. She did say that there is a chance of some degree of neuropathy, but thought that it wouldn't be that much of a hindrance. She said there are some homeopathic remedies such as a B6 regimen and a vinegar soak (for fingers) that can lessen the impact. [I'll need to research these.]
I said, "So basically it's flip a coin." She said yes, but the echo cardiogram results may make the decision for me.
Dr. O asked what was going on with my arm (rash). After explaining the background, she said that I need to watch that. If it's there's no dramatic improvement over the next few days (after my taking the prednisone) [which was filled today], I would need to see my primary care doctor for an antibiotic. She suspects that it's an infection. She's concerned for spreading and having fluid 'back up' into the chest wall and causing cellulitis. She cautioned me not to start chemo until this is under control.
In summary she said the order of precedence would be: the arm, echo cardiogram and finally genetic panel, but the panel can wait.
Looking through her notes she said that a genetic panel (over and above the BRACA1 and 2 panel) should be done. (As she had stated before) this would identify if I (or my genetics) predisposes me for breast cancer. The long term therapy of Tamoxifen will prevent (or halt) the growth of ER (estrogen receptor) fed cancer, but rogue cancer cells and 'friend' cells can escape the affects of Tamoxifen and this panel will identify those 'other' cancers so it can be determined if those cancers are preventable.
She did give me her number (again) and said that she would schedule something with a genetic counselor after the panel results are known.
So I have more information, questions and action items.
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