Ground Hog Day - Update

 Well it appears that Punxsutawney Phil has seen his shadow and scampered into his den, thus signaling 6 more weeks of Winter.  Apparently his counterpart, Staten Island Chuck has signaled Spring right around the corner.  Clearly one is dealing with alternative facts.   Time will tell.

I had my appointment with Dr. Jonathan Ross of New England Neurological in Lawrence this morning.  I was referred to him by my Oncologist, Dr. Mehta as a result of my 'gradual' worsening of the neuropathy in my feet (balls of feet and toes on each foot).  After finding the office and filling out the obligatory patient paperwork, I was called into Dr. Ross's office for patient interview to gather history and a subsequent examination.

After telling my 'story', Dr. Ross asked me to remove my pants and socks.  He had me stand on each foot with my eyes closed; on my tip toes; and on my heels. He seemed pleased that I could pass the 'field sobriety test' and had me sit on the examination table.  He looked into my eyes and had me verify some of his hand movements.  [Not sure why he was checking eyes, but I did tell him I had cataract surgery last May.]

He checked my reflexes then moved a cold-to-the-touch, implement at various points on my legs and feet.  I was surprised how I couldn't feel any coolness on my lower feet.  To some extent, I had a lesser sense of the temperature all the way up my calves before I could feel how cold the implement really was.  That was an eye opener for me.

Dr. Ross then asked me to close my eyes and tell me when I could feel a pin.  I had no sensation until he got to my ankles.  As he went up the calf, I could feel the discomfort.  Another eye opener.

After all the testing, Dr Ross stated that he agreed the neuropathy was a side effect of the chemo and most likely won't get worse or improve.  He said, "Unfortunately there is no cure and your being tall is not helping you.  The regeneration cells/nutrients have far to travel in your body, so your lower extremities are exhibiting the various degrees of neuropathy. You may, over time have some improvement, but all you can do is wait and see if it worsens before having neurological tests performed."

Well I can't say I expected any more or less.  It is what it is.  I'd gladly take this amount of neuropathy over a second round of cancer.  As long as I'm still able to enjoy life and be mobile without nerve pain, I'm happy to monitor its progression.

I did mention to Dr. Ross that Charcot Marie Tooth disease (CMT) runs in my family.  He thought that this wasn't that, but recommended a test if it progresses.  He did ask if I knew which gene my siblings had.  Apparently there are many genes capable of causing CMT so I'll ask.

So it appears that there is nothing he can do for me or my condition.  He did mention again to contact the office if things change (worsen).  If this does happen he wants to give me some tests.

Updates on other health issues

• Triple A - After some research, I decided to go with the current traditional endo-vascular repar (EVAR) approach.  I have an appointment at UMass Medical in Worcester in a few weeks.
• My sore foot - After two months of being unable to take my daily walks due to an unexplained pain in my left foot, I'm happy to report that I was able to take a 1 mile walk yesterday.  The foot is not 100% yet, but I'm hoping to build the muscle back so I can resume my regimen of 2-5 miles per day.  Baby steps!
• Reconstruction - I have an appointment in a few weeks for my aureola tattoo.  This should be interesting.

More to come!

Buckle-up kiddies, rough road ahead!

Mid-January and Mother Nature has been kind - so far.  We've been needing rain and we're getting it.  Yes, some snow from time to time, but luckily in manageable amounts that don't last too long.  I'm hopefully optimistic, but am well aware of what February can mean to the North East.

I had my follow-up appointment with Dr. Pare today to discuss the CAT scan I had at the end of 2016.  [Technically it's called a CT scan, but the vernacular always leans to CAT].  I was really hoping that he would be telling me that the aneurysm has gown a little, but we'll continue to monitor - NOT.  Unfortunately, the opposite transpired.

Dr. Pare greeted me and asked me to have a seat (not a good sign).  After exchanging pleasantries, he asked if we had discussed the stint.  [Geesh, cut right to the chase.]  I said, "We did, briefly."  He then excused himself to retrieve a stint.  On the way out he said, "You are a good candidate for the stint."

Upon his return he had something resembling Chinese finger cuffs.  He then told me that my aneurysm was now 5.5 cm [Sh*t] and we now have to look at options.  He began a rough drawing trying to depict my aorta and bulging sack.  He mentioned that the CAT scan was clear and he could see that it had progressed to the point where I was encouraged to do something. He gave me the sample stint and told me that it is inserted through my femoral artery and it opens to what we are now looking at.  He positioned the stint over his drawing to demonstrate where it would be placed and then showed another piece that is attached.  [Looked like a pair of pants.]

He said the procedure is day surgery.  Generally, the patient is admitted the night before and given a blood thinner.  The apparatus is inserted at the groin (both sides).  Most are discharged that day.  The recovery is quick and entails changing the dressing with yearly follow ups.  He did say there was a risk of endo-leaks, but it did not require surgery to remedy.  Like any procedure there are other risks, but each is monitored.  I asked what the time-frame was.  Dr. Pare said that 'the company' would take measurements from my CAT scan image and produce a customized stint.  He mentioned that my bulge was far enough above the 'split'.  This makes for a better 'seating' of the stint.

I had mentioned two other types that I have heard of and he was very supportive of my looking into those options.  He said that the more information I had - the better.  So he's going to contact the company and initiate their measurement process and he will contact me next week to discuss a timeline.  He thought that it might be 6-8 weeks for the procedure.

Now I've reach a point where I have to do something.  I will re-connect with St. Elizabeth's in Brighton to see how their 'pilot' program is progressing.  They have a 'new' procedure that decreases/eliminates endo-leaks where they inject a polymer into the sack.

So, more research and phone calls are on the agenda.

More to come.

2016 Year End - Update

What a year 2016 was.  So many musicians and public figures have passed and with a new President being sworn in in less than a month who knows what will happen next.  On the health front, 2016 was maintenance mode for me.  I guess it defined the new normal and I'm now learning how to deal with the after effects of chemo.  Unfortunately, my Triple A has demanded attention so I'll be facing the new challenges that are presented.

I had a CAT scan performed today at Holy Family.  There has been a threat of bad weather, so I'm glad it was scheduled early.  Happily there were not too many 'patients' waiting and I was taken before I had a chance to read the first page of my newspaper.

Being escorted to the imaging room, I was asked my name and date of birth while the medical technician reviewed my chart.  "So we are looking at the abdominal aneurysm today", she said? Answering to the affirmative, I was asked, "Have you had this done before?" and "Have you had any adverse reactions to the dye?"  "Yes, I'm a repeat customer and No, I've had no problems in the past," I said.

As I positioned myself on the very narrow scanning bed, I was asked which arm I preferred.  Given my node removal on my left, I said, "You only have one choice, my right."  She began to tie off my circulation and started thumping at my veins.  [Last week's blood draw resulted in some bruising, so I'm sure the vein was not in the best shape.]  She announced that there would be a pinch.  Ouch!

She asked, "Does that hurt?"  I said it felt like it was in the meat.  She quickly removed the needle and began looking for another area to poke.  I had mentioned the blood draw last week and she indicated she could see where the hole was.

It seemed to take quite a bit of time and lots of 'thumping', but she decided to 'go in' at my wrist.  She needed to remove my patient ID bracelet.  She 'got in' and asked, "Does that hurt?".  I said, "It's just very uncomfortable."  I was told that I would feel warmth as the IV fluid entered my body.  I did.

She brought my arms above my head and had them resting on the pillow.  She said, "I'm going to take some images without the dye.  You'll hear a voice telling you to breath in and hold your breath, then exhale."  She left the room and after a few passes, she returned.  "OK, I'm going to give you the dye.  You'll feel hot", she said before leaving once again.  I could definitely feel the heat spread through my body.  It was an oddly disturbing feeling.  But it didn't last too long and the machine shuttled me in and out until I heard her say, "We're done."

Returning to the room she removed the needle and tightly wrapped my wrist with a flexible bandage.  She wished me a happy new year and instructed me to drink plenty of water to flush out the dye.

Now the waiting game.  More to come.

Happy New Year!

pre-Winter Solstice Update

12/21  marks the last day of Fall and tomorrow (12/22) , the first full day of Winter: The Winter Solstice.  I'm looking forward to gaining a few more moments of daylight as the days progress.  Unfortunately, the Winter brings my least favorite weather: snow; cold; ice; and host of other meteorological 'joys' that demand immediate attention. As has been the case, time will fly by and we'll be changing the clocks ahead.  Until then: wait and see.

I had my follow-up visit with Dr. Pare for my abdominal aortic aneurysm (Triple A).  Six months ago I was given good news that my malady had no changes in size.  Unfortunately, I did not receive the same prognosis after today's ultra sound.

Dr. Pare said, "Last time your aneurysm was about 4.8 to 4.9 cm. Since then it is now measuring 5 to 5.1 cm.  I don't want to alarm you, but we are now at the point were we need more information.  I will order a CAT scan at Holy Family to have a better view.  Based on that, we can make a determination on the next step.  I believe that a relatively non-invasive stent can be placed at the site.  Let's see what the CAT scan shows. We'll make an appointment today for sometime in January."  He asked if I had heart troubles, pains, shortness of breath, to which I responded no.  I did say that there is a history of heart disease in my family. After wishing me happy holidays, I was told to button up and see his assistant on the way out.

I walked by the assistant's office when I heard my name being called. I went in and she (didn't get her name - she had an accent) told me that I would need blood work and insurance authorization before scheduling.  In addition, I would need a follow-up with Dr. Pare after the scan.  She will call me over the next few days once the insurance company gives approval.  However, she said that I could go anytime for blood work.  While I was in Methuen, I decided to head to Holy Family to get the blood done.

All of my blood work had been done at the Dana Farber Cancer Care unit, so I went there first, but I was directed to the main hospital.  Upon entering the lobby, I was greeted by a woman who looked at my work order and directed me to the lower level.  I found room G-21 and immediately recalled that I was there during the reconstruction of the Dana Farber lab.  I entered, spoke with the reception and was told to wait to be called.  They weren't busy, but I waited almost a half hour.  It was lunch time.

A woman walked by and asked if I was there for blood work. [Well dah!!!] Answering yes, she then invited me into her lair.  She went right to work and drew blood with a minimal amount of discomfort.  Merry Christmas, she said as I left.

So now it's a waiting game.  Depending on the results and prognosis following the CAT scan, if I do need a procedure, I will contact St. Elizabeth's in Brighton.  I originally went there, but was told to 'take care of the cancer first'.  I got the baseline images for the Triple A, at Dr Pare's only out of convenience.  If there was no change (as was the case up until today), I would continue to have it monitored locally.  Now let's see what the CAT scan shows.

Not the Christmas gift I was hoping for.  More to come.

Mammogram anyone?

Arrived at Holy Family's Breast Cancer Care unit for my (I guess it will be) annual mammogram.  It was quite busy in the waiting room, but I needed to complete some paperwork so the wait seemed lessened by the time it took me to complete the task.  While answering the questions or placing N/A for answers ( - When was your last period?), I sensed some hubbub about a machine and/or computers not working.  Lovely.

After almost a 45 minute wait, I was called in.  I followed the technician to an imaging room and was asked to remove my shirt(s).  After the obligatory questions to determine if I am the correct patient and that the proper procedure will be performed there was some question as to which side was going to be imaged.  I was under the impression that both sides would be done. However, the order stated that just the left breast would be done.  There seemed to be some confusion as to which left - mine or hers.

[Recollection of the Three Stooges - "Walla Walla" episode came to mind. The Stooges needed to open a wall on the left. Of course depending on how you were facing both sides could be considered the 'left'. They ended up opening both sides.]

She left the room to get clarification.  While waiting bare-chested, I began to get chilled since the AC was keeping the electronics cool.  Not too long after, she returned and said it was my left (non-cancerous) breast. It makes sense now considering the right one was removed and there was now no breast tissue that could be considered cancerous.  While waiting there chilled, she was having trouble with the machine.  Feeling sorry for me, she asked that I place my shirt over my shoulders.  After some fussing with the machine and related PC she determined that it was not operational.  I was escorted to another room and was instructed to stand in front of the imaging machine.  After some very uncomfortable squeezing and pinching, I was done.

She asked that I wait in yet another room, while the doctor/technician reviewed the images to ensure that they were 'good enough'.  Thank heavens they were.  I was given the green light to get dressed and be on my way. Glad that's done.

More to come.

[Post Script: I received a letter a few days after this mammogram indicating that no cancer was found/detected.]

Icing on the cake?

I had my 6 month follow-up with Dr. Chatson today.  All staff members had mentioned that they couldn't believe it's been that long since my last visit.

After my vitals check, Dr. Chatson's assistant, Jude was making some chit-chat as she recorded my results.  She had mentioned that Kelley, the Physician's Assistant had recently departed the practice.  A new P.A. is now on board, but I did not meet her - yet. Jude left me and indicated that Dr. Chatson would be right in.

And it was true, he came right in.  After exchanging pleasantries he asked me to remove my shirt(s). As I was disrobing, he said, "I was looking at your chart notes and we were going to see if the new nipple needed to be reduced or if any other 'sculpting' was needed." Upon seeing my bare chest he exclaimed, "This looks very good.  I'm happy with the shaping (sculpting) and the nipple had receded (somewhat).  So there's no need for a reduction."  I was happy to hear this, since I was not looking forward to any more cutting and healing. He then asked me to re-dress. While I was dressing he explained the next step - tattooing. 

He said, "Tattooing is a half hour procedure performed under local anesthetic where I will attempt to get the aureola and nipple color as close to the other."  He asked that I schedule something after January.  He wished me a Merry Christmas and a Happy New Year and said he'd see me early next year.

On my way out the receptionist was already looking for a time for my tattooing and finally settled on February 22nd. So this next step will be very cosmetic, much like icing on the cake. 

More to come.

And the beat goes on....

La dee dah dee dee; la dee dah dee dah

Had our first 'shovel-able' snow yesterday.  Was supposed to be a dusting then turn to rain.  Wrong!  How about 3+ inches of heavy wet snow?  It is what it is - or was, for that matter.

Today I had my 6 month check-up with Dr. Mehta at Dana Farber, Methuen.  After check-in and vitals check, I was greeted by a smiling Dr. Mehta.  Right away he got to business asking me how I was doing and how my side effects were progressing.

I told him that the neuropathy of my feet appeared to be getting 'worse' on my left foot. So much so that I was not walking correctly and may have injured my heel (somehow).  Since this had just happened a few days ago, I've been refraining from my daily walks.  As a result, my muscle spasms have increased.  The odd neuropathy in my finger thumb continues to exhibit a cycle on its own [that I'm trying to figure out - with no luck.]

Dr. Mehta said, "The neuropathy is a result of the chemo and not a side effect of Tamoxifen (which was not my understanding)."  He continued, "Tamoxifen does not 'go after' new cells like the chemo.  It goes after a specific type of receptor cell.  In your case, the estrogen receptor."  He asked if I had seen a neurologist.  To which I answered, no.  He then indicated that he would refer me to Dr. Ross.

Dr. Mehta asked that I remove my shirt(s) so he could examine me.  Upon completion of my partial disrobe, he said, "Wow, he did a great job on the reconstruction.  It looks completely normal."  That was nice to hear especially since I have an appointment with Dr. Chatson tomorrow morning.  I'm hoping he has the same reaction.

As Dr. Mehta was examining me and feeling for 'lumps', I had mentioned that I had seen Dr. Moore last week and requested that I have a mammogram (also scheduled for tomorrow).  I told him Dr. Moore performed a similar exam and said he found nothing unusual.  Dr. Mehta then said, "I'm going to say the same thing."  He then asked about any other side effects specifically hot flashes.  I admitted that I have had few episodes but they were few and far between.  He said that if they become too numerous, I could take ginseng. [Interesting.]

He said that he would see me in six months and he would also refer me to Dr. Ross.  I re-dressed and proceeded to check out.  While I was checking out the healthcare associate was on the phone with Dr. Ross's office registering me as a new patient.  Shortly after she asked if February 2nd was OK.  I said, yes.

So the beat goes on.   More to come.