The presence of cancer cannot be verified except by biopsy, a microscopic look at cancerous cells taken from the suspicious tumor. Any opinions prior to that analysis are merely suppositions. To collect a sample tissue from a tumor on my liver, the procedure applied was an “UltraSound guided needle biopsy,” a minimally invasive surgical procedure, conducted in early November, 2006.
The surgeon introduced himself, and, not waiting for my response, leapt into legally required disclosures for which I had already signed an agreement printed in three point type. First item he mentioned was that the procedure he was about to perform could result in my death. He then recited a lengthy list of successively less dire possibilities until he ran out of doom and gloom.
With a considerably subdued patient and having finished his legal duty to the hospital and his practice, he brought my insides into focus on the monitor. How many of us get a chance to see our insides while they are functioning? I wasn’t going to miss this show especially since the surgeon had pointed out that I might not survive, so I declined a sedative.
Surgeon, pathologist, nurse anesthetist, and UltraSound technician, each armed with specialized equipment, squeezed around me in a closet-sized room. We watched the careful progress of the needle through my skin, into my liver and positioned to suck up a tissue sample from the tumor. The surgeon passed the first extraction over to the pathologist for approval. Thumbs down; a second pass at my liver produced a sample that satisfied him.
Next: segue to treatment.
Copyright 2008
www.lindalater.blogspot.com
Posted August 30, 2008
Saturday, August 30, 2008
Monday, August 25, 2008
Diagnostic Whirlwind
This blog was born to keep family and friends informed of new developments in diagnosis and treatment of this cancer. Now, almost two years later we return to look at that time to better understand the flurry of events and emotions between the first whisperings of illness and November 19, 2006, the date we started the postings.
Our family doctor reviewed my complaints in early October: diarrhea, fatigue and leg pain. The series of tests he ordered would help us, he said, eliminate possibilities and zero in on a single likelihood. The ultra sound was to investigate complaints of persistent leg pain over a long period. It came up clean, no anomalies. Next, a chest CT to check the condition of my lungs. The results of this suggested a CT of the abdomen/pelvic area. Next was an extensive array of blood analyses. After a thorough review, the doctor called me into his office three weeks later on October 26, 2006 at 4:30pm. I went alone. The first words out of his mouth: “The results of these tests indicate cancer.”
That is what I appreciate so much about this doctor. He is unfailingly direct, leaving no room for misunderstanding or misinterpretation. He showed me the CT scan which revealed a 1” diameter tumor on my pancreas and numerous shadows showing more tumors piercing the smooth grain of my liver like potholes in macadam. My reaction split at once: I set aside the impact of his words in order to clearly hear the information. I gazed at the shadows on my liver, willing them to disappear, yearning for a rewind and revision of the scene, wanting to defer acceptance just a little longer.
Next: Refining the diagnosis.
Copyright 2008
www.lindalater.blogspot.com
Posted August 25, 2008
Our family doctor reviewed my complaints in early October: diarrhea, fatigue and leg pain. The series of tests he ordered would help us, he said, eliminate possibilities and zero in on a single likelihood. The ultra sound was to investigate complaints of persistent leg pain over a long period. It came up clean, no anomalies. Next, a chest CT to check the condition of my lungs. The results of this suggested a CT of the abdomen/pelvic area. Next was an extensive array of blood analyses. After a thorough review, the doctor called me into his office three weeks later on October 26, 2006 at 4:30pm. I went alone. The first words out of his mouth: “The results of these tests indicate cancer.”
That is what I appreciate so much about this doctor. He is unfailingly direct, leaving no room for misunderstanding or misinterpretation. He showed me the CT scan which revealed a 1” diameter tumor on my pancreas and numerous shadows showing more tumors piercing the smooth grain of my liver like potholes in macadam. My reaction split at once: I set aside the impact of his words in order to clearly hear the information. I gazed at the shadows on my liver, willing them to disappear, yearning for a rewind and revision of the scene, wanting to defer acceptance just a little longer.
Next: Refining the diagnosis.
Copyright 2008
www.lindalater.blogspot.com
Posted August 25, 2008
Thursday, August 21, 2008
On the Brink
August 2006: Two weeks in New York City: a dream vacation made possible by a house swap. We walked the riverfront each morning, feasted on ethnic delicacies, and stoked ourselves on the unique flavors and aromas of New York. We shopped the farmers’ market, applauded park concerts and reveled in the end-of-summer giddiness before returning to the “real world.” It was a magic time.
September 8, 2006 we drove from The City to visit friends and attend two reunions. This day marked the first appearance of a common symptom of this illness: diarrhea.
During the next three weeks, I developed skills I never guessed I would have to learn. Each stop tested my ability to identify with all due speed the location of a public rest room. Courtesy gave way to urgency in ladies’ room lines. Hasty excuses presaged a flight to a loo. There was no time for witty euphemisms or demure excuses. My body felt dissociated, acting independently without forethought, and failing to give me sufficient advance notice to gracefully tend to excruciatingly private urgencies.
During the remainder of the trip, other symptoms appeared. Daily walks took longer to cover the same distance. My ankles and feet became chubby with edema. Any sparkle I might have brought to the events dimmed, replaced by anxiety.
Back home at last, I delayed calling for a doctor’s appointment. A tinge of dread replaced the uneasiness I had been feeling in July. Then the pictures from the two reunions began to arrive and I saw myself not as in a mirror but as others saw me. I was stunned: “That is a sick woman!” my mind shrieked. I picked up the telephone immediately and arranged to see my doctor the very next day.
Next time: Diagnostic tests.
Copyright 2008
www.lindalater.blogspot.com
Posted August 21, 2008
September 8, 2006 we drove from The City to visit friends and attend two reunions. This day marked the first appearance of a common symptom of this illness: diarrhea.
During the next three weeks, I developed skills I never guessed I would have to learn. Each stop tested my ability to identify with all due speed the location of a public rest room. Courtesy gave way to urgency in ladies’ room lines. Hasty excuses presaged a flight to a loo. There was no time for witty euphemisms or demure excuses. My body felt dissociated, acting independently without forethought, and failing to give me sufficient advance notice to gracefully tend to excruciatingly private urgencies.
During the remainder of the trip, other symptoms appeared. Daily walks took longer to cover the same distance. My ankles and feet became chubby with edema. Any sparkle I might have brought to the events dimmed, replaced by anxiety.
Back home at last, I delayed calling for a doctor’s appointment. A tinge of dread replaced the uneasiness I had been feeling in July. Then the pictures from the two reunions began to arrive and I saw myself not as in a mirror but as others saw me. I was stunned: “That is a sick woman!” my mind shrieked. I picked up the telephone immediately and arranged to see my doctor the very next day.
Next time: Diagnostic tests.
Copyright 2008
www.lindalater.blogspot.com
Posted August 21, 2008
Sunday, August 17, 2008
Analyze This *
Bloodwork results from the last trip to Charleston are mixed. CEA measures my body’s response to general cancer cell activity. That is down 23% from the last measure in April. (Down is good.) Calcitonin measures the activity level of cancer cells specific to the thyroid. Now it is up 8% versus April’s measure. (Up is not good; we want it to go down.)
The last seven months summarized:
2-4-08 vs 12-27-07 CEA ↓15% Calcitonin ↑11%
3-28-08 vs 2-4-08 CEA ↑ 13% Calcitonin ↓ 32%
4-25-08 vs 1-31-08 CEA ↓ 12% Calcitonin ↓ 50%
7-21-08 vs 4-25-08 CEA ↓ 23% Calcitonin ↑ 8%
Analysis: CEA is trending downward. Results fall within a range of 11 percentage points for each of the last three periods framed by four measurements over a span of seven months. Three (75%) were down.
Calcitonin, conversely, is moving laterally: two up, two down in a range of 42 points. The two measures showing the greatest change (32 and 50%) are both down, a total of 82 percentage points during a six month period. By comparison, an 8% rise in the most recent three month measure is only 10% of the previous 6 month decline. This view puts the current increase relative to the historic changes in perspective. The momentum of the trend is still favorable despite a small “adjustment” as the Wall Street analysts are fond of saying in a different context.
Applying financial analysis tools to interpret results of a blood test may be a stretch. My training in financial analysis assists (warps, some might say) me to look at an imminently threatening situation more objectively. The interpretation: the illness continues in retreat.
Let’s cheer retreat and focus on continued positive trends! Thank you for your invaluable support and good cheer.
*Copyright 1999 Warner Bros.
Copyright 2008
www.lindalater.blogspot.com
Posted August 17, 2008
The last seven months summarized:
2-4-08 vs 12-27-07 CEA ↓15% Calcitonin ↑11%
3-28-08 vs 2-4-08 CEA ↑ 13% Calcitonin ↓ 32%
4-25-08 vs 1-31-08 CEA ↓ 12% Calcitonin ↓ 50%
7-21-08 vs 4-25-08 CEA ↓ 23% Calcitonin ↑ 8%
Analysis: CEA is trending downward. Results fall within a range of 11 percentage points for each of the last three periods framed by four measurements over a span of seven months. Three (75%) were down.
Calcitonin, conversely, is moving laterally: two up, two down in a range of 42 points. The two measures showing the greatest change (32 and 50%) are both down, a total of 82 percentage points during a six month period. By comparison, an 8% rise in the most recent three month measure is only 10% of the previous 6 month decline. This view puts the current increase relative to the historic changes in perspective. The momentum of the trend is still favorable despite a small “adjustment” as the Wall Street analysts are fond of saying in a different context.
Applying financial analysis tools to interpret results of a blood test may be a stretch. My training in financial analysis assists (warps, some might say) me to look at an imminently threatening situation more objectively. The interpretation: the illness continues in retreat.
Let’s cheer retreat and focus on continued positive trends! Thank you for your invaluable support and good cheer.
*Copyright 1999 Warner Bros.
Copyright 2008
www.lindalater.blogspot.com
Posted August 17, 2008
Thursday, August 14, 2008
This is Retirement ! (?)
Late Summer, 2006. My thoughts hovered over a lifetime “to do” list reviewing what I wanted to check off before I checked out. We had sold our business importing feathering and folding sailboat propellers from Europe a few months earlier. (Check one off the list!) By July we had returned from an extended cruise on Chesapeake Bay in our own sailboat. (Check another off the list!)
We were preparing for a six-week auto tour of our favorite haunts in New England visiting family and friends and attending two reunions: one gathered my parachuting buddies from 40 years earlier and another celebrated the 50th (!) anniversary of high school graduation. It was an exciting, happy time, not one to brood about the fragility of life and its ultimate destination.
And yet, I felt rather than heard a distant bass vibration sifting through to my bones leaving a trace of uneasiness. I brushed the sensation aside.
Being an intensely visual person, I often translate feelings into mental images, sometimes abstract, other times realistic. They reside with me for a time, then dissolve to reappear later or never again. As the summer wore on, an image was evolving, strong and implacable. Negative thoughts whirled, melding at the center of a vortex into an immovable form, a stainless steel column at the core of my being. Worn thoughts clustered, coalescing into an unassailable object as if compressing all the dust, out of place objects and dirty windows in a fury of house cleaning. (Freud would have a field day with this!)
Carrying this image around in my head was exhausting, a burden added to my flagging energies. Pre-diagnosis recollections continue in future blogs.
Keep well, dear ones. Guard your health fiercely!
Copyright 2008
www.lindalater.blogspot.com
Posted: August 14, 2008
We were preparing for a six-week auto tour of our favorite haunts in New England visiting family and friends and attending two reunions: one gathered my parachuting buddies from 40 years earlier and another celebrated the 50th (!) anniversary of high school graduation. It was an exciting, happy time, not one to brood about the fragility of life and its ultimate destination.
And yet, I felt rather than heard a distant bass vibration sifting through to my bones leaving a trace of uneasiness. I brushed the sensation aside.
Being an intensely visual person, I often translate feelings into mental images, sometimes abstract, other times realistic. They reside with me for a time, then dissolve to reappear later or never again. As the summer wore on, an image was evolving, strong and implacable. Negative thoughts whirled, melding at the center of a vortex into an immovable form, a stainless steel column at the core of my being. Worn thoughts clustered, coalescing into an unassailable object as if compressing all the dust, out of place objects and dirty windows in a fury of house cleaning. (Freud would have a field day with this!)
Carrying this image around in my head was exhausting, a burden added to my flagging energies. Pre-diagnosis recollections continue in future blogs.
Keep well, dear ones. Guard your health fiercely!
Copyright 2008
www.lindalater.blogspot.com
Posted: August 14, 2008
Sunday, August 10, 2008
Early Days
Sometimes delaying reflection brings events into sharper focus and promotes a clearer understanding of their meaning in the context of our lives. As the approach of the second anniversary of survival nears, events at the onset of this illness have been on my mind. I can identify stirrings of awareness of something seriously wrong as early as three months prior to Diagnosis Day (October 26, 2006).
For example, in July 2006 I found myself telling Michael, out of the blue in a lull in dinner preparations that I hoped he would remarry after my death, surprising myself as well as him. Where did that come from? We discussed it briefly, mostly along the lines of “what are you thinking of?” and “what brought this up now?”
In the months that followed other similar non-sequiturs burst without bidding from my lips. There had been no recent deaths of family or close friends that might cause me to reflect on my mortality. No physical cues appeared to alert me that illness lurked in the near future. At that time I felt the same as ever.
I tried to puzzle out the meaning of these thoughts. They didn’t alarm me but their appearance gave me a vague sense of uneasiness. I was curious about why they popped up. Looking back, some might say they revealed unconscious premonitions. Perhaps it was simply a natural cluster of thoughts about “putting my affairs in order” appropriate to that time of my life. At no time did I share these thoughts with Michael. More about pre-diagnosis days in a future blog.
We are grateful to have had these two years to find an effective chemotherapy treatment that has extended my life and to all of you who have so actively given your time and prayers on our behalf.
Copyright 2008
www.lindalater.blogspot.com
Posted: August 10, 2008
For example, in July 2006 I found myself telling Michael, out of the blue in a lull in dinner preparations that I hoped he would remarry after my death, surprising myself as well as him. Where did that come from? We discussed it briefly, mostly along the lines of “what are you thinking of?” and “what brought this up now?”
In the months that followed other similar non-sequiturs burst without bidding from my lips. There had been no recent deaths of family or close friends that might cause me to reflect on my mortality. No physical cues appeared to alert me that illness lurked in the near future. At that time I felt the same as ever.
I tried to puzzle out the meaning of these thoughts. They didn’t alarm me but their appearance gave me a vague sense of uneasiness. I was curious about why they popped up. Looking back, some might say they revealed unconscious premonitions. Perhaps it was simply a natural cluster of thoughts about “putting my affairs in order” appropriate to that time of my life. At no time did I share these thoughts with Michael. More about pre-diagnosis days in a future blog.
We are grateful to have had these two years to find an effective chemotherapy treatment that has extended my life and to all of you who have so actively given your time and prayers on our behalf.
Copyright 2008
www.lindalater.blogspot.com
Posted: August 10, 2008
Friday, August 8, 2008
Credibility Gap
You look great! they say. Or on the telephone: You sound wonderful! So strong and healthy! I don’t argue because hearing that gives me a lift, an especially beneficial remedy. The surprise in their voices reveals their expectation of seeing an emaciated, tottering, critically ill patient, the stereotype of a person with cancer. Or, it may be due to a comparison with a remembered version of me earlier in this illness. Then I wonder: How did I sound or look before?
The fact is that I am feeling somewhat better, though not as much better as I would like to feel, nor as well as others perceive. Right now I feel fundamentally stronger than I did a year ago, while simultaneously experiencing a wave of momentarily (meaning days or weeks) more intense side effects or symptoms, especially nausea.
We briefly glimpsed what feeling better means a few months ago when I was experiencing exuberant strength and gleeful good spirits. I immediately started planning a Fall full of enticing travel plans which we have had to cancel one by one as strength and spirit have eroded. A small step back even as the imaging and bloodwork numbers improve.
So a credibility gap has developed between appearance and reality. One reason is the carryover effect of my previous persona. I have spent a goodly portion of my life in public “on stage” as a presenter and a marketing person, promoting the best aspects of a product or service as well as myself. Furthermore, I am an unabashed Pollyanna, always looking for the positive in any situation even in the shadow of a daunting reality.
Here’s to bringing reality closer to perception! Thank you for being here and living this time with us.
Copyright 2008
www.lindalater.blogspot.com
Posted: August 8, 2008
The fact is that I am feeling somewhat better, though not as much better as I would like to feel, nor as well as others perceive. Right now I feel fundamentally stronger than I did a year ago, while simultaneously experiencing a wave of momentarily (meaning days or weeks) more intense side effects or symptoms, especially nausea.
We briefly glimpsed what feeling better means a few months ago when I was experiencing exuberant strength and gleeful good spirits. I immediately started planning a Fall full of enticing travel plans which we have had to cancel one by one as strength and spirit have eroded. A small step back even as the imaging and bloodwork numbers improve.
So a credibility gap has developed between appearance and reality. One reason is the carryover effect of my previous persona. I have spent a goodly portion of my life in public “on stage” as a presenter and a marketing person, promoting the best aspects of a product or service as well as myself. Furthermore, I am an unabashed Pollyanna, always looking for the positive in any situation even in the shadow of a daunting reality.
Here’s to bringing reality closer to perception! Thank you for being here and living this time with us.
Copyright 2008
www.lindalater.blogspot.com
Posted: August 8, 2008
Tuesday, August 5, 2008
Linda by the Numbers
Last Fall, we developed a rating scale to rank the relative impact of the side effects of the Zactima chemotherapy trial (see blog October 28, 2007). A subjective evaluation of each category would provide a base for future comparisons. I ranked each side effect/symptom on a scale of 1-10 (10 is most severe, 1 is hardly noticeable). Now, 10 months later, I have again ranked each side effect/symptom according to how I feel now. Here are the results, showing changes up or down.
NAUSEA=5 (↑ 1)
FATIGUE=5 (↑ 2)
DIARRHEA=8 (↑ 1)
RASH=2 (↓ 3)
ANXIETY=4 (↑ 1)
DEPRESSION=4 (↑ 2)
EDEMA=2 (↓ 1)
SKIN SENSITIVITY=6 (extreme dryness has replaced bruising) (↑ 1)
SIGNATURE=2 (↔)
Disclaimer: These are subjective evaluations based purely on my “sense” of my status compared with a theoretical personal “norm.” I certainly wouldn’t expect “norm” to describe everyone equally. Precise category definitions exist in my head. The abbreviated definitions above are self-evident. The descriptive strength of this profile is that the subject remains the same; the weakness is that the state of mind of the subject may vary from one evaluation to the next leading to non-comparable results.
This is only the roughest of profiles meant to give me a semblance of progress or lack thereof in the course of an illness that defies definition and confounds prognosis. In my experience, the illness appears to be “custom designed” for each individual, making it difficult to compare notes with others diagnosed similarly or even with professionals having broad experience.
Until next time … yours, as ever.
Copyright 2008
www.lindalater.blogspot.com
Posted: August 5, 2008
NAUSEA=5 (↑ 1)
FATIGUE=5 (↑ 2)
DIARRHEA=8 (↑ 1)
RASH=2 (↓ 3)
ANXIETY=4 (↑ 1)
DEPRESSION=4 (↑ 2)
EDEMA=2 (↓ 1)
SKIN SENSITIVITY=6 (extreme dryness has replaced bruising) (↑ 1)
SIGNATURE=2 (↔)
Disclaimer: These are subjective evaluations based purely on my “sense” of my status compared with a theoretical personal “norm.” I certainly wouldn’t expect “norm” to describe everyone equally. Precise category definitions exist in my head. The abbreviated definitions above are self-evident. The descriptive strength of this profile is that the subject remains the same; the weakness is that the state of mind of the subject may vary from one evaluation to the next leading to non-comparable results.
This is only the roughest of profiles meant to give me a semblance of progress or lack thereof in the course of an illness that defies definition and confounds prognosis. In my experience, the illness appears to be “custom designed” for each individual, making it difficult to compare notes with others diagnosed similarly or even with professionals having broad experience.
Until next time … yours, as ever.
Copyright 2008
www.lindalater.blogspot.com
Posted: August 5, 2008
Saturday, August 2, 2008
Crossing the Threshold: Goal Setting
This series of musings focuses on my experience of learning that I have an incurable illness and the significant ways in which that knowledge irreversibly changed my world view and actions. The change was instantaneous (Diagnosis Day October 26, 2006), while my awareness of the implications has been slow to evolve. An occasional epiphany helps to clarify my current view and further an altered understanding of myself.
All my life I have been an inveterate goal-setter, working in reverse linear, that is, to identify a goal and work backward, mapping a route to fulfillment. Ultimately, I find myself at the starting point: what can I do to take the first step now. In my post-diagnosis world, I am far slower to set goals. I ask myself: Can I really count on having the energy to carry me through to completion? Are others counting on me to meet my commitment? So I have cut back on the number of goals I have at any given moment and concentrate only on the quality of those I commit to. That way, I unburden myself of half-hearted efforts and savor the true delight of a worthwhile accomplishment.
Some goals may seem trivial, disguising their true value. For example, my “Therapy Afghan,” which I crocheted during a stressful period of my life bringing me great comfort and calm. With deliberation and care, I selected the mohair yarn, warm, strong and exceedingly light, in my favorite colors. For months I experimented until evolving a pattern that appealed to me. It took several starts and a few unravelings before, two years later, I finished. A bonus was the loving companionship of our cat Felix who blissed out on the luxurious mohair whenever I took up my yarn and hook.
Other musings will follow as they present themselves to me. Thank you for being with us; your support is our strength and comfort.
Copyright 2008
www.lindalater.blogspot.com
Posted: August 2, 2008
All my life I have been an inveterate goal-setter, working in reverse linear, that is, to identify a goal and work backward, mapping a route to fulfillment. Ultimately, I find myself at the starting point: what can I do to take the first step now. In my post-diagnosis world, I am far slower to set goals. I ask myself: Can I really count on having the energy to carry me through to completion? Are others counting on me to meet my commitment? So I have cut back on the number of goals I have at any given moment and concentrate only on the quality of those I commit to. That way, I unburden myself of half-hearted efforts and savor the true delight of a worthwhile accomplishment.
Some goals may seem trivial, disguising their true value. For example, my “Therapy Afghan,” which I crocheted during a stressful period of my life bringing me great comfort and calm. With deliberation and care, I selected the mohair yarn, warm, strong and exceedingly light, in my favorite colors. For months I experimented until evolving a pattern that appealed to me. It took several starts and a few unravelings before, two years later, I finished. A bonus was the loving companionship of our cat Felix who blissed out on the luxurious mohair whenever I took up my yarn and hook.
Other musings will follow as they present themselves to me. Thank you for being with us; your support is our strength and comfort.
Copyright 2008
www.lindalater.blogspot.com
Posted: August 2, 2008
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