PSA, from me to you. You’re welcome.

From time to time, I like to provide a public service announcement for the greater good. In other words, I learn the hard way — the expensive way — and share my lesson in hopes that some diligent reader out there in the blog-o-sphere heeds my words and avoids the painful/stressful/costly conundrums in which I tend to find myself.

Today’s PSA does not concern courteous driving (although perhaps it should, based on the overwhelming number of idiot drivers I’m surrounded by every time I venture out of my house). Today’s PSA will not address healthy living or how to fortify your liver for maximum alcohol consumption. Today’s PSA won’t even mention Pinktober, pinkwashing, or how misguided The Susan G Komen for the Cure organization has become. Today’s PSA doesn’t have anything to do with our little piggie (pity that, as she is infinitely entertaining).

Today’s PSA is all about how your health insurance company can — and likely will — try to screw you with the whole in-network/out-of-network debacle. i-534ec9e4fe422e37f2c7b9b58810e809-operation%20game

I recently had a surgery that, lo and behold, had absolutely nothing to do with breast cancer or breast reconstruction or breast reconstruction revision. How refreshing! I did my due diligence in researching a specialist who was the right guy for the job. I asked before I even made the appointment if he accepted my insurance. I provided all the nitty-gritty details insurance details before I saw the doc (ID number, group number, 800 number for claims). The benefits coordinator at the surgeon’s office reviewed everything on her checklist and assured me that we were good to go.

I saw the doc, he confirmed that the surgery was medically necessary and with just cause, and we scheduled a date. I paid my co-pay for the office visit and filled out all the paperwork, including multiple recitations of the insurance company details. I paid for my portion of the surgery well in advance. I followed all the rules (so I thought), and like a veteran soldier readying for battle, I eschewed any aspirin or blood-thinning products that can promote bleeding during surgery; I drank plenty of water the day before surgery to aid the anesthesiologist in finding a good, plump vein; I ate a healthy meal that would hopefully see me through being NPO the night before surgery; I washed the area to be sliced & diced with Hibiclens in my paranoid ritual of warding away any bacteria that might host a party in my surgerized body; I procured prescriptions in advance for the 2 antibiotics that are forever a part of my arsenal since that pesky post-mastectomy infection; I showed up before the crack of dawn on surgery day with an empty stomach and a powerful ache for my usual cup of coffee. I know the drill; been there, done that, multiple times. I got this.

Surgery was uneventful, recovery was long for my impatient self, but there were no complications.

Until I got a bill from the surgery center for more than $20,000.

20,000 clams for a surgery that was on the up-and-up and had been cleared for take-off well in advance.

Say what?

After suffering a minor heart attack, I called the surgery center and was told to take it up with my insurance company. I called my insurance company and was told to talk to the doctor’s office. I called the doctor’s office and was told to retrace my steps and start over with the surgery center. Egads.

After spinning my wheels and listening to untold atrocious Muzak songs while on hold for what seemed like forever, I remembered that my insurance company provides a patient advocate service. I’d used this service with my previous insurance company and was forever grateful for my advocate, a former RN, who checked in on me post-mastectomy and throughout the course of the year-long infection battle. She intervened when the insurance company said it didn’t want to pay for the $5,000 Oncotype test, which dissects my particular cancer to determine the best way to treat it and determine how likely it is to recur. She helped me navigate the pages upon pages of medical bills that weighed down my mailbox in the early stage of my cancer “journey.” She was very helpful.

The new insurance company could take a lesson from her. Their patient “advocate” department sucks. I can barely stand to use the word advocate in relation to them (hence the quotation marks).

The first “advocate” I dealt with on this issue did some research and determined that the surgery center my in-network doctor used is out-of-network. So my surgeon is in-network but the surgery center is not.

Huh??

Oh, and by the way, it’s my responsibility to check to be sure the surgery center is in-network.

Again I say Huh??

After all the checking and double-checking and verifying and pre-qualifying and certifying, I’m supposed to ask about the surgery center? How in the world would I even know to ask about this? What fresh hell is this?

Oh, yes indeedy, the “advocate” told me, I should have checked on that. And I should have known to check on that by reading the Standard Plan Description, a bazillion-page online document that details the ins and outs of my coverage.

While I’m grateful for the coverage I do have, I’m pretty sure my insurance company hates people like me who ring up millions of dollars in expenses for a disease they did nothing to cause and for which they actively tried to prevent. I imagine my file has a big red X on it to denote all the trouble I’ve caused and money the company has had to spend on my behalf. I’m guessing that when I call the insurance company with a question, the phone has a special ring, sorta like the Bat-phone, to alert the poor sap who answers it that I’m a raucous troublemaker who is bleeding their employer dry.

I get it. I’m not the ideal customer. But expecting me to verify that the surgery center is in-network is absurd. I don’t care what the bazillion-page online document says. If the doc is in-network and no one raises a red flag about the surgery center, then I assume I’m all clear.

A $20K bill and an instant heart attack are rather the antithesis of all clear.

And that, dear readers, is why I’m here today — to lead by example, to inform by the hard lessons learned. The word to the wise, learned expo-facto, is this: even if your doc is in-network, the surgery center may not be. Even if the doctor’s office staff have dotted every i and crossed every t, it may not be enough. Your insurance company my turn on you like a hungry dog on an alley chicken-bone and try to chew you up and spit you out. Consider yourself forewarned.

 

 


Live to 100? No thanks!

I get a handy-dandy email in my inbox every day from Oprah’s magazine. I like her magazine and always find something useful, whether a book review or an article about a do-gooder in some random far-flung part of the world. Because Oprah is queen of the world and can cover whatever stories or topics she chooses, you never see ridiculous headlines or teasers on the cover of her magazine, like what we see on so many magazines. Sometimes I’m downright embarrassed by them while waiting in line at the grocery store: do we need to know that Hilary is cheating on Bill with a lesbian lover? Do you really want to guess which celeb’s backside is completely covered in cellulite but only partially covered by a yellow bikini? I’m never embarrassed by the cover of O Magazine.

So today’s email had Dr Oz’s tips on 10 things you can do to live to 100 — or beyond.

Egads.

I’m all for healthy living, but I most definitely do not want to live to be 100 — or beyond. I’m exhausted just thinking about that. Perhaps living to 100 — or beyond — but never growing old, feeble, and/or dependent on others wouldn’t be too bad, but given my not one, but two bouts with cancer, coupled with my degenerating joints, I’m guessing that won’t be in the cards for me. If I live to be 100 — or beyond — but my knees won’t bend and I’m stuck in a wheelchair, or even worse in bed, relying on others to care for me, I’m going to be hopping mad. Not that I have a death wish, but I am realistic. The average age of women diagnosed with breast cancer is 61; I was 20 years ahead of  the curve. While strides have been made in treatment, and while my personal recurrence rate was predicted to be low, I don’t know that I can rationally expect to live another 57 years — or beyond.

Maybe I’m taking Dr Oz too literally. Does he really think that by following his 10 tips, we can live to be 100? I dunno, but here are his suggestions.

1. Eat red foods. The examples he give are beets, which relax blood vessels, and red cabbage, which protects against cancer. I love, love, love beets, so perhaps my blood vessels are relaxed. However, I clearly did not eat enough red cabbage, as it most definitely did not protect me from cancer.

2. Drink a cup of black tea. It’s supposed to boost survival rates of those who suffer a heart attack by 28 percent. Ok, I admit that stats like these confuse me. Does this mean that black-tea drinkers who have a heart attack are 28 percent more likely to not die from the heart attack, or 28 percent les likely to have a heart attack in the first place? I’m confused, but I do drink a lot of iced tea, so hopefully I’m covered either way.

3. Dial one phone number from memory every day. Not using speed dial or your cell phone’s memory exercises the brain’s “chunking” ability. By grouping info into chunks, you can keep your brain active and alert. I think working a crossword puzzle does the same thing, but don’t quote me on that.

4. Use the first stall in a public restroom. Ok, I do this whenever I am stuck and must use a public restroom, although I avoid public restrooms at all cost. Being the good germophobe that I am, I already knew this trick. See, most people seek privacy in a public restroom, so they tend to use the farthest stalls. More use equals more bacteria, which freaks me out. Now I’m wishing I hadn’t shared this tip, though, as I predict a rush on my preferred first stall.  Some days I wonder how I’m able to leave the house at all.

5. Take the stairs, two at a time. We all know that taking the stairs instead of the elevator is preferable for good health, but Dr Oz says take that a step further — literally — and take two stairs at a time. Easy for him to say, with his long legs. I’ll try it, even though my legs aren’t long, but I’ll probably have to use the handrail, which I’m pretty sure is covered in germs. Never mind.

6. Stretch after you shower. Stretching is good. Tight muscles and tendons are bad (says the girl who hates to stretch). Once your muscles are good and heated from the shower, it’s easier to stretch them, and stretching promotes good posture and helps decrease muscle soreness from taking the stairs two in one go.

7. Hold your breath. Dr Oz touts this as a mini workout for your lungs, and something that can be done anytime, anywhere. He recommends holding your breath for 10 seconds, then blowing it out through pursed lips, which activates all the little nooks & crannies in our lungs. I tend to hold my breath while using a public restroom, so as long as I blow it out through pursed lips, I guess I’m good.

8. Do the reverse warrior. Dr Oz does a lot of yoga, and if he says the reverse warrior is the most important pose, I believe him. Click here to see how to do it. This pose strengthens the legs, increases flexibility in the spine, and stretches the hips, inner thighs, and groin. Get to it, y’all.

9. Chew your food 20 times. Grandma said it first, but Dr Oz tells us why: not only does it slow us down and helps us avoid eating like a pack of wild animals, it can decrease our risk of diabetes. Horking down food too fast leads to overeating, which can lead to obesity, which can lead to diabetes. Dr Oz says if you don’t want to count out how many times you chew, get into the habit of putting your fork down in between bites.

10. Cut your cravings in half. Instead of trying to deny your cravings, Dr Oz recommends giving in to them, but only by half. So instead of gobbling down a bag of potato chips, eat half the bag. Instead of devouring the carton of ice cream, just eat half of it. Actually, the example he gave was a cookie. One cookie. Which he wants you to break in half. So I’m guessing he would counsel me to go ahead and pour myself a glass of champagne, but to only drink half of it. Yet another reason to not live to be 100 — or beyond. I want the whole glass!


Trapping the jumping beans

“Sometimes I have to let go and mother myself, kiss the hurts away. Tell myself that sometimes bad things just happen. But writing about it helps a lot, it scrapes it out of the dark corner, holds it up to the light and somehow heals the wound. It borders on miraculous.”

I have no idea who wrote these words. If any of y’all know, will you tell me? This quote spoke to me, though, at some point, because I wrote it down, and today as I cleared off my desk I found it. Scrawled on a scrap of paper and placed in my “I’ll get to this later” pile, the quote has lingered, waiting for me to get to it. How very patient.

I’m pretty sure I didn’t write it (although I wish I had). Perhaps it spoke to me because of the idea of having to mother myself. Being a motherless daughter, I don’t often think about mothering myself, and yet I do. Making myself go to bed when instead I want to stay up all night reading my current favorite book. Being diligent about pulling that load of shirts out of the dryer and hanging them up instead of letting them sit indefinitely in a wrinkled heap. Wiping up the spills on the stove top now, not later, before they’ve hardened into an indeterminate glob of laminated goo.

In the early days of navigating life without my sweet mama, I actively avoided any mothering that might come my way. That hole in my heart was too new, too raw to allow anyone else to even attempt to approximate any of the things my mom did. Seven years later, I still eschew any overt mothering. Somewhere along the way, though, I must have started mothering myself a bit. I certainly don’t hold out any hope that the hurts can really be kissed away, although I do tell myself often that bad things just happen. Telling myself that doesn’t help my innate desire to question, to wonder about the reason, or to pick things apart in a futile effort to figure them out. Sometimes it just is.

Writing about the things, whether the bad things or the confounding things, does help. Perhaps that’s the line that most spoke to me in the above quote. Perhaps that’s the reason I jotted the quote on a scrap of paper and put it in the pile on my desk. I’m a big believer in writing as healing, which I why I sit in front of my computer, keyboard clacking away as the words fill the screen. For me, just getting the words out of my head and the thoughts onto the screen is therapeutic.

Writing about the good stuff and the funny stuff is important, but writing about the bad stuff is even more so. Like the mothering I inevitably do for myself, writing about the bad stuff helps make it better. Somehow it purges the toxic stuff from my soul and helps filter the insomnia-inducing worries that blanket me after the lights go out and the house is quiet. No matter how much distance I try to put between myself and the cancer “experience,” those worries return. Sometimes it’s the fleeting thoughts before a routine oncology visit, and sometimes it’s a more concrete feeling. Sometimes it’s a visceral assault, like the smell of the hospital that fills my senses when I’m just visiting. Sometimes it’s a random trigger that takes me back to the heat of the battle. Regardless of the form or the impetus, the worries remain. Hence the need to write. Hence the need to read the stories of others who have walked this path. Ray Bradbury explained it perfectly:

“If you stuff yourself full of poems, essays, plays, stories, novels, films, comic strips, magazines, and music, you automatically explode every morning like Old Faithful. I have never had a dry spell in my life, mainly because I feed myself well, to the point of bursting. I wake early and hear my morning voices leaping around in my head like jumping beans. I get out of bed to trap them before they escape.”

Knowing that I can drown out the insomnia-inducing worries with the “morning voices” is sublime. It borders on miraculous.

 


I’m thankful for…

…all the usual suspects — loving family, great and true friends, a happy home, abundant sunshine, a fridge full of good things to drink.

But today I’m extra thankful for an endocrinologist who emails her newest, worried patient after the close of business the day before Thanksgiving to say, “I know you’re awaiting your biopsy results, and I know you don’t want to have to wait out the holiday weekend.”

That, my friends, is quality health care.

And the result from the needle IN MY NECK is good. Very good. The biopsy is negative.

I’m thankful.

Happy Thanksgiving, y’all.


There’s a zombie on my lawn

Much has been written, in this space and in that of countless other blogs, about the far-reaching fear of metastases. Once cancer comes to town, no matter how small the tumor or early-stage the disease, the fear of recurrence prevails. Forever. Or until it actually happens. Kinda like in the traditional wedding vows: until death do you part.

When cancer returns, you go directly to Stage IV. Don’t pass go, don’t collect $200. No matter how “good” your cancer was initially, regardless of you doing your due diligence and “catching it early,” once it returns, you. are. screwed.

I think about this. A lot. Way more than I’d like to think about it. Maybe it’s just my personality. I don’t think I’m a gloom & doom kind of girl, but my mind goes to recurrence all the time. Perhaps it’s a natural by-product of having watched my sweet mama die a nasty death from an even nastier disease. Cancer, no matter what kind, no matter what stage, is nasty, and once it infiltrates your life, it’s always lurking in the shadows, ready to pounce upon your body or mind, or both.

Cheery thoughts as we head into the Thanksgiving holiday, I know.

My recurrence fears roared to life this week. I should have been relishing the upcoming Thanksgiving holiday, my favorite holiday because it encompasses all the food & fun and none of the stress of gifts. Instead I was enduring a crash-course in thyroid issues, and in the process of seeking a second and then a third opinion for my hypothyroid, I found myself back in the ultrasound department at my favorite local hospital. My new endocrine doc ordered an ultrasound so we could have a little look-see into what is causing my thyroid to limp along like an aging marathoner at mile 25. Good thing she did: there’s some sort of party going on in my thyroid, with lots of guests: the loudest, pushiest of these guests is a 1 cm nodule on the left side of my thyroid. The size itself is not terribly worrying but its mere presence is, and especially the presence of  the “debris” it brought to the party. Debris is definitely not a good thing when it comes to nodules. At best, it raises a red flag. At worst, it can be indicative of cancer.

The thyroid gland is one of those myriad body parts for which you may not even know exactly what it does until it stops doing what it’s supposed to do. If you fall into that camp but are now curious, read this. I never thought too much about it myself, being preoccupied with my more ill-behaving body parts. What I know now is that my thyroid is lazy and shiftless. Well, maybe not shiftless; I threw that in there out of frustration. But lazy, yes. It’s an underachiever in the tradition of the slackers who populated Austin, TX, in the mid-90s, scooping ice cream at Amy’s or building delicious sub sandwiches at Thundercloud instead of  working a traditional desk job. Like the scoopers and sandwich artists, my thyroid is covered in tattoos, likes to sleep until 2 pm, and is slowly working on breaking through into the upper echelon of the indie music scene. What I want from my thyroid is not a 6-inch-long braided goatee and a knitted-in-a-Guatamalan village skull-cap but a three-piece suit and shiny shoes with a briefcase stuffed with pie charts, spreadsheets, and proposals.

We always want what we don’t have.

Because my slacker thyroid is sporting a nodule where a nodule should not be, and because I’ve got a dual-cancer-surviving history under my belt, my endocrinologist ordered a thyroid biopsy. It’s unlikely that breast cancer would metastasize to the thyroid, but …. She was kind enough to tell me that it’s not a pleasant procedure, but nothing I and a xanax can’t handle. Thank the pharmaceutical gods for xanax.

So basically a thyroid biopsy is just as you might envision: a fine-gauged needle stuck in your neck to suck out the cells and some of the debris that fill the nodule.

Yes, you read that right — a needle in the neck.

After changing into a gown and filling out the consent forms (yes, I understand what they’re about to do to me. Yes I agree to have a needle stuck in my neck. Yes, I know how an ultrasound works. Yes, I get that some of the ultrasound gel may stick to my hair. Yes, I absolve the radiologist from any responsibility for honest mistakes. Yes, I will donate my unused cells and debris to research. Yes, yes, and yes, just get it over with), it was showtime.

The room was freezing, as rooms in which horrific procedures occur tend to be. Esther, the sweet Nigerian nurse, gave me a warmed blanket, asked if I’ve had a thyroid biopsy before, and remarked on how calm I was (again, many thanks to the creators of xanax). She distracted me from the many sharp objects being placed on the metal bedside tray by chattering about her one-year-old’s upcoming birthday party with an “elegant princess” theme. She raved about the radiologist who would be sticking that needle into my neck and said he’s a sweetie, just a sweet, sweet, sweetie pie. Good information to have about the person who will be sticking a needle IN MY NECK.

In walks Dr Sweet-Sweet-Sweetie Pie to explain to procedure and to apologize for the unnatural position in which he needed me to prop my head so that he’d have full access to my neck when it came time to stick that needle in there. No prob, Dr Sweetie. Really, it’s all good.

He explained that he’d be giving me a shot of lidocaine, again IN MY NECK, to numb the area for when he would stick the real needle IN MY NECK. He said the lidocaine shot would feel like a bee sting (IN MY NECK). I can’t vouch for the validity of that, as I’ve never been stung by a bee (true story), but I hope like hell that when and if I ever am stung by a bee, it’s not IN MY NECK.

After he explained the part about the needles, he said he’d squirt the gunk he extracts onto 3 slides for a cytologist to look at under a microscope. The cytologist was in the next room, waiting for the gunky slides, so it’s all quite efficient. If on the off-chance — and it is an off-chance — the cytologist doesn’t think there’s enough gunk on the slides, Dr Sweetie Pie will plunge another needle IN MY NECK and extract more gunk. But, Dr Sweetie reiterated, that’s on the off-chance, and the vast majority of times it only takes one plunge of the needle to get enough gunk.

He took a peek with the ultrasound wand to what lies beneath and quickly located the offending nodule. “There it is, for all the world to see” was what he said about that nodule. Once the lidocaine had gone to work, he told me to hold my breath and he stuck the needle IN MY NECK. And left it there. And wiggled it around in circles to extract the cells and debris. Gross.

While I couldn’t feel outright pain, there certainly was pressure, and there was enough feeling to know that the needle was not only still IN MY NECK but also moving around. “Creepy” does not even begin to cover it. I tried going to my happy place, which I’ll be honest, is a HUGE room full of bottles of Veuve Cliquot accessible by me and only me. I tried to summon the sound of the cork popping. I tried to imagine the gentle upward swim of those tiny bubbles in my favorite glass. I tried to console myself with promises of a bottomless glass just as soon as I got home.

Instead, all I could think was that there’s a needle IN MY NECK.

This took me back to the recent days in which my kids were obsessed with Plants vs Zombies, and the theme song that rang out incessantly from the computer: There’s a zombie on your lawn. Instead, in place of zombies and lawns it was needles and my neck. Gross.

The needle-in-the-neck part seemed to go on forever, but in reality lasted just a few minutes. Out comes the needle, and Dr Sweetie Pie fills the slides with my neck gunk then whisks them next door for the cytologist to view. I lay there and thought about zombies and needles and bubbly. After a brief respite, Esther the nurse and the radiology tech whose name I didn’t catch came back into the room and started bustling around. Neither made eye contact with me, which is a dead give-away to bad news. If ever you find yourself in an exam room or a procedure room or an operating room and the medical personnel don’t make eye contact, brace yourself because bad news is a-coming.

Sure enough, in comes Dr Sweetie to say that the cytologist didn’t think there was enough gunk and he needed to go back in and get some more.

Really??

Really??

Dadgummit, just once I’d love to be the normal one. The one who’s not the exception to the rule. The one who is just like everyone else. The one who skirts complications with nary a backward glance. Apparently that’s not to be; there’s something about complications and me that just go together.

In he went with another needle IN MY NECK to get more gunk. More digging in a circular pattern to extract maximum gunkiness. I didn’t have the nerve to ask if um, there’s ever a need for a third pass. I did ask what happens to the patients who pass out from this procedure. Dr Sweetie laughed and said it’s actually a bit easier, and they’re already lying down so there’s no real risk. Again, I give thanks for xanax.

The second look from the cytologist was satisfactory, so Esther wiped the ultrasound goo off me, applied pressure to the puncture wound IN MY NECK, and applied an industrial band-aid. I was free to go.

I changed out of the gown and into my clothes without even looking to see if my hair was sticking up or to determine how red my neck was from that harrowing experience. I high-tailed it outta there and into the waiting area, where my trusty sherpa Amy and the Hubs waited. Neither seemed too squeamish by my description of the needles — plural — IN MY NECK. Like me, they’ve been through a lot and are a bit hardened to even the most atrocious medical procedure.

We paid for parking, navigated the hospital-to-parking-garage elevator system, and soon were on the road for home with time to spare before school carpool. I spent the rest of the day with an icebag on my neck and a cold beverage in my hand. The worst part is over, but now the waiting begins to see what the gunk reveals. Like a fortune told from tea leaves in the bottom of a china cup, my neck gunk has a story to tell. Fingers crossed that it’s a good story, a happy story, a for-once-just-once-in-my-life-for-the-love-of-all-things-holy an uncomplicated story.

While I wait, I’m sporting a pretty bad-ass-looking mark on my neck that could very well have come from a vampire. Maybe a creepy but kinda hot vampire who would do himself a favor by ditching that milquetoast and hanging out with a chica who can easily withstand a good jab to the neck. 

 

 

 

 


Medical musings

If not for the priceless blog fodder, I’d be pretty steamed after my visit to my dermatologist yesterday. I’m ever so grateful for my sense of humor, especially after last week’s doctor’s appointment on a day that went from bad to worse to are you freakin’ kidding me??

My dermatologist is lucky I have this little blog as my outlet for all the things I’m compelled to rant about, to rail against, to bitch & moan about in general.

A little background: she’s a fantastic doctor. She embodies many of the traits I’ve come to appreciate and insist upon while spending time in an exam room. She’s punctual, no-nonsense, very thorough, and more than ready with the prescription pad. Her office is staffed by all women, with nary a male doc in sight, which thrills me to my feminist bones.

She is, however, not going to win a prize for compassionate bedside manner. She is not the most compassionate doctor I’ve ever met, and this was on full display yesterday.

Perhaps it’s my bad for scheduling a first-thing-Monday-morning appointment. Maybe she had not had her RDA of caffeine. It’s possible that her personality pills had yet to kick in at that early hour. Whatever the reason, she didn’t waste any time with pleasantries. I’m cool with that, and as much as I enjoy having a comfy relationship with my health-care practitioners (especially those who see me naked), I’m good with the all-business appointment that gets me out of there and on with my life.

I sat on the paper-covered exam table in my thin paper gown precariously close to shivering — yes, people, a temperature of 52 degrees in South Texas does count as c-o-l-d, and I’m aware of the fact that 52 degrees could be considered a heat wave in some parts of the country at this time of year. I was awaiting my doctor to come in and do my annual mole check. Because I had melanoma several years ago, I take my mole checks very seriously, and as much as I hate stripping down to have every inch of my flesh examined, it’s a necessary evil and one I never skip out on.

My melanoma showed up on the inside of my right foot, on perhaps the one and only body part without any excess flesh. A number of specialists were consulted on how best to excise the infested tissue in such a delicate area. Opening the area and excising the melanoma weren’t the problem, but closing the incision was. Little did I know that that experience would be the first of many “think of the most complicated scenario” scenarios in which I would find myself. Post-mastectomy mycobacterium, anyone? In case you’re wondering, the solution to the flesh-less foot melanoma was Mohs surgery in which the surgeon used a zig-zag shaped incision to allow him to close that incision with limited flesh upon which to draw together. I have a now-faded zig-zag scar that predates Harry Potter’s lightning bolt on his forehead. I had a lightning bolt scar before lightning bolt scars were cool.

Anyhoo, back to my terse and not-so-warm-and-fuzzy dermatologist. The first thing she said when she walked into the exam room was, “What are you doing about your rosacea?”

Um, I didn’t know I had rosacea. My face gets red when I exercise and when it’s cold outside — and again, 52 degrees does count as cold — but I certainly have never had the bright red spots that I associate with rosacea. Great, now I’m feeling self-conscious.

I asked her what she thinks I should do about my rosacea (and I want extra credit for not asking it in a smart-assy way; I mean, she is the doctor, after all). She shrugged and said there aren’t any creams on the market that really help, although there are a couple in FDA testing that should be available in a few years. Meanwhile, she thinks I should go for several laser treatments, which start at $600. Out of pocket, I’m sure. She suggested that I figure out what my triggers are and avoid them. Since she didn’t go into any detail on the common triggers, I looked them up myself and found that they include stress (not gonna get away from that one anytime soon), spicy food (I do like my jalapenos and Frank’s Hot Sauce; I put that beep on everything!), hot beverages (I’m a two-cup-a-day coffee girl), sun exposure (did I mention I live in South Texas?), exertion in hot weather (again, South Texas), oral antibiotics (so I’m guessing that 267 days of two different oral abx would factor in here), and drumroll please…the last trigger for rosacea is…alcoholic beverages.

Ok, I’m out. I’ll just have to figure out a way to live with my extra-rosy cheeks because every item on the list is a factor, but the last one is a deal-breaker.

Moving along, she examined me and made notes of the normal-looking moles scattered here & there on my body. Because of being inducted into the pink ribbon club, I’ve spent plenty of time mostly naked in doctors’ offices. I’ve had my flesh poked & prodded and examined quite intently enough times that I don’t even think twice about it; in fact, I got so used to the weekly follow-up exams after the mastectomy, the multiple surgeries to rid my chest wall of the mycobacterium, and then the Big Dig reconstruction that it seemed weird to not take off my clothes at the doctor’s office.

However, none of my previous time spent in my birthday suit with a doctor prepared me for her question: Why did you have a mastectomy?

Ummmmm, because I had breast cancer?

Why else do women undergo such a physically and emotionally taxing surgery? What kind of question is that???

I wondered for a sec if I’d heard her right, then answered “Ummmmm, because I had breast cancer.”

She then wanted to know why I had a bilateral mastectomy; was the cancer in both breasts? I replied no, at least not that was detected by the multiple mammograms, bone scan, or PET scan, but that was the right decision for me. Once I heard I had breast cancer, I took a slash-and-burn approach. Good thing, too, because my post-mastectomy pathology showed a large and scary smattering of micro-mets that were likely just waiting to organize into a full-blown tumor, with a bonus of Paget Disease to boot.

She complimented my reconstruction and said it looks good, that they see a lot of it, and mine is better than most. I replied that I was very fortunate to have such skilled surgeons, yadda yadda. It never seems like the right time to mention that while my surgeons did an incredible job with my reconstruction (especially considering how wrecked my right chest wall was after the infection), it’s still reconstruction, and I was perfectly happy with my breast before I had to have them chopped off and rebuilt using another body part. It never seems appropriate to talk about how the reconstruction restored some mass to my previously scooped-out chest, but it’s not the same and will never be the same as it was before. I never feel as if the conversation will meander toward the topic of how no matter how skillful the reconstruction, there’s no way to escape the constant and visual reminder that I had cancer. I’ve yet to find a way to say that the myth of getting new boobs after breast cancer is just that, a myth. Yes, they’re new, but they’re not really boobs. I can’t ever figure out how to say that while I’m very grateful to have had access to the best docs in one of the best medical facilities in the world, and yet my reconstruction still leaves me feeling less viable. It’s certainly not considered polite chit-chat to recount how grueling the DIEP surgery is, how precarious the transplanted blood vessels are, how unbearably uncomfortable it was to be in the ICU with heaters blowing to warm those blood vessels, or how the stress of flap-failure can bring on some serious PTSD.

All that from a sincere compliment about my reconstruction. Sheesh, what a head case I’ve become.

Just as I was talking myself down from the myriad ledges my brain landed on and working hard to get back to the present moment, which was a simple mole check, my dermatologist asked another question: Where did they get the flap from for my DIEP? From my belly, I replied, and braced myself for the inevitable comment about how nice it must be to get a “free” tummy tuck. Before she could utter that platitude, I launched into a distrationary tale about how I had to gain weight to create enough belly fat to make a good flap; ha ha ha, I said, it was so funny that I had plenty of fat in my hips & thighs but not in my belly. As I lay on my belly and she examined my back, she asked why they didn’t take it from my back (because apparently there was plenty available, and she was staring right at it). Well, because I didn’t want to lose my tennis serve, I said, resisting the urge to ask for a mirror so I could see just how fat my back is.

The coup de grace, though, came when she said how lots of people probably envied me having to gain weight for the surgery, and then delivered the final crushing blow to my already-battered ego by saying, I guess you’re still working on losing that weight, huh?

Yep. Still working on it.

And I’ll keep working on it. Right after I find a new dermatologist.

I wonder if this guy is still in practice.


Welcome to Cancerland

polyvore.com

Like the 7 levels of the Candy Cane forest outlined by Buddy the Elf in the movie Elf,  there are levels in Cancerland. The levels in Cancerland aren’t nearly as fun as those in the Candy Cane forest; I’ve yet to come across anything approximating the swirly, twirly gum drops at any point along this cancer “journey.” I don’t know what the official levels in Cancerland are, or if they even exist outside of the esoteric nature of those saddled with the disease, but I suspect they are akin to the 5 stages of grief. So for now, let’s say that the 5 stages of Cancerland include utter shock upon being diagnosed; extreme pissed-off-edness at losing body parts and quality of life, coupled with the potential for losing my life itself; crippling helplessness and a total lack of control in regards to recurrence; unpredictable fear and panic at any given time; and soul-crushing depression at the “new normal” that follows a cancer “journey.”

Today I ran smack-dab into level 2, the extreme pissed-off-edness. Sometimes this level manifests in its pure form, which is flat-out anger at the wrongs done to my body & mind by cancer. But sometimes, like today, it’s a more specific form of pissed-off-edness: extreme irritability. We’re talking the worst PMS rage multiplied by a prime number, divided by the number of times the urge strikes to choke someone, subtracted from the complete absence of rationality, added to the utmost amount of self-control required to avoid screaming and spewing at anyone who’s unfortunate enough to cross my path.

When this specific phase of pissed-off-edness hits, woe be unto the person who absent-mindedly leaves their shopping cart parked in the middle of the aisle while they price-compare cans of soup. I pity the fool who on the road ahead of me who finds him/herself in the wrong lane and stops in the middle of the road instead of continuing along with the flow of traffic until able to execute a U-turn or otherwise get the hell out of my way. Too bad, so sad for the person who lingers at middle-school drop-off in the morning to wish their child a good day or to remind that child to do their best in all pursuits today. Move it or lose it, people.

Today the specific phase of pissed-off-edness reared its head and tried my patience and self-control in many ways. Allow me to set the scene: as I walked into yet another doctor’s office for yet another interminable wait to hear yet more depressing news about the new normal that follows life in Cancerland, I tripped over the uneven sidewalk. I fell on my newly-repaired knee and tore my favorite workout pants. My purse clattered to the pavement and my iPhone skittered out of my hand. My other hand, which broke my fall, became embedded with dirty gravel.

An elderly Asian man stopped to retrieve my phone and tried to help me up. I rudely shook him off, not caring that I appeared ungrateful. I muttered a terse thanks with eyes averted, head bowed. Collecting the shreds of my dignity, I hobbled into the building, trying to be grateful that my knee wasn’t bleeding (it was easy to ascertain this through my torn pants) but knowing my attempt at gratitude was futile. The elevator doors closed just as I reached them, solidifying my opinion that precious little was redeemable in this day, even though it was not yet 9 a.m., and hinting at the scent of extreme pissed-off-edness that was swirling around me, but not in a twirly gum drop kind of way.

An hour later–a full hour–I was still stuck waiting in the waiting room (has ever a more apt term existed??), captive in an uncomfortable chair and unable to escape the annoying prattle of the TV, tuned to an awful loop of medical advice, exercise tips, and pharmaceutical ads. I can now easily recite the side effects for AndroGel from memory. I’m most definitely not going to try the recipe for homemade spelt crackers the perky woman shared on the cooking segment. I exercised great restraint in not throwing something at the TV during the segment on BMI and weight-control. As the announcer droned on & on about the importance of physical exercise for overall health & well-being, I wanted to hurl expletives and yell that I’d love to be pursuing some physical exercise if I weren’t trapped in this blasted waiting room, WAITING for the doctor.

Just when I think it can’t get any worse, a woman shuffled in and sits right next to me, despite an entire row of empty seats. She alternated between conducting a loud conversation on her cell phone about her hurt feelings regarding being left out of a relative’s birthday party, and coughing violently and wetly in my direction. When I got up to move away from her and her disgusting germs, she muttered, “How rude.” Oh, that’s rich, and rife with pissed-off-edness.

An hour and a half later, I was still waiting. She was still yapping about the birthday party, and she was still coughing indiscriminately. While she yapped and coughed and the TV droned on & on, I thought about all the things I was not getting done while I sat and waited. Cue even more pissed-off-edness. This is par for the course, a normal day, another thrilling ride through Cancerland. I know this, I’ve been there before, and yet it still results in this particular brand of blood-boiling pissed-off-edness.

When the nurse finally summoned me, she apologized for keeping me waiting, and I struggled with the proper response: to say “no problem” implies that’s it’s ok, when it’s not, but to let her know that it’s not ok seems rude,especially since it’s not her fault.

As she took my blood pressure she asked for my copies of my test results/lab work. Like a whiny pupil caught without last night’s homework, I muttered that I didn’t know I was supposed to bring that. No one told me to bring that, and anyway, I wouldn’t know where to start, how to untangle that knot. Then I realized she meant my last round of blood work, which I had done a few days ago at my oncologist’s office. She offered to call his office to get the results while I wondered if I’ll have to sign a release for that. She assured me that they all “try to work together,” even though I’m guessing he’s never heard of this doc, and vice versa. What about the pages of privacy paperwork I’ve had to sign? Are those just lip service that crumbles in the interest of “working together?” These are the things I think about as I wait, and wait, and wait for the doctor.

The nurse left me to go make that phone call, and I waited some more.

I was sorely tempted to steal the In Style magazine with Gwyneth Paltrow on the cover, even though I don’t even want to read it. Just looking at her glowing good health on the cover made me mad, a feeling that only intensified as I thought about her macrobiotic vegan lifestyle. I’m jealous, I admit. Although I don’t aspire to a macrobiotic vegan lifestyle it angered me nonetheless that she practices it. I bet she never waits like this in a doctor’s office. My belief in the karma wheel stopped me from stealing the magazine out of spite–toward the long wait, toward Gwyneth’s good health, and toward her macrobiotic vegan lifestyle.

My long to-do list mocked me as I waste more time waiting, always waiting. I grew restless and bored, not to mention irritable, and found no solace in my kindle. I chided myself for not paying more attention in the 3 yoga classes I’ve attended in my lifetime, because some calming breaths and restorative chi would be great right about now. Perhaps such mindful, peaceful practices could help me ward off the pissed-off-edness monster huffing at my gate.

By the time the doctor walked through the door, 2 hours had passed and I’m exhausted from the waiting and the pissed-off-edness. I scolded myself for letting this get the better of me and reprimanded myself to be polite to the doctor, even though I want to show her my bitchy side and peel back the curtain to expose the extreme pissed-off-edness in all its raging glory.

Instead, I recited my sordid medical history since April 2010 when a lump in my right breast set off the chain of events that landed me here, in yet another doctor’s office, exhausted, bored, disgruntled, and contemplating kleptomania. I’m experienced enough and jaded enough (and pissed-off enough) to believe she will offer no solutions beyond perhaps adding another prescription drug to my burgeoning stable or perhaps patting my hand, frowning sympathetically and encouraging me to buck up while reminding me that I’ve been through an awful lot recently. I’d already decided that if she were to tell me to get used to it, that this is all part of post-cancer life, my response will be swift and premeditated: I will overturn the biohazard waste bin, kick the exam table, and maybe even hurl her stool through the window. These are my fantasies as I navigate my way through the levels of Cancerland.

Lucky for her, she did not pat my hand or rush to her prescription pad. She took copious notes on my symptoms, perhaps highlighting and flagging the extreme pissed-off-edness that lingered just under the surface of this normal conversation. She ordered yet more blood work and told me to schedule yet another appointment in a week to see what the blood work reveals. My guess is that my iron level will be low, my thyroid will be underperforming, and my level of extreme pissed-off-edness will be off the charts.