My sister and thymoma

This is an x-ray image of a chest. Both sides ...Image via Wikipedia

No one ever wants to hear bad news, especially when the bad news involves cancer. Twelve days ago, we received simply dreadful news.

My dad called me that Saturday morning, and said “Are you sitting down?” If you’ve ever heard those four words, you can be almost guaranteed to receive Very Bad News, or find out that you’re pregnant. My dad, being of the male persuasion, was not going to be pregnant unless God decided to do something Truly Bizarre, so that was out. He had just had a cat scan the previous day on his carotid arteries to see if there was any blockage. So, naturally, I assumed he was calling to tell me he was going to have surgery. Since I’m a doctor, this does not constitute Very Bad News in my book, although I will readily admit that unblocked neck arteries are far better than blocked ones, and carotid surgery isn’t on my Top 10 List Of Fun Things To Do. However, it’s not a life-threatening kind of thing. I continued pouring the morning coffee into my mug.

He said, “Your sister, Kate, has cancer.” Those five words were indeed Very Bad News. I sat down. I set my coffee cup on the table because I wasn’t sure how bad the shaking in my hands was going to get, and coffee burns on top of Very Bad News would have made my day even worse.

My sister is 3 years younger than me. Unlike me, she will readily admit she’s 40. I still am in denial and state that I’m 29. Permanently. So it’s not like we were expecting something like this in the prime of life.

Kate is an amazing woman, beloved wife of a pastor (‘pastor’s wife’ being an unpaid full time job in and of itself, but that’s a story for another time), fantastic mother of 3 terrific kids, and owned by this completely cute giant fuzzball of a sheltie. I say ‘owned by’, because Kate is so nice, she doesn’t know how to say ‘no’ to giving the dog treats like, say, whole hamburger patties and the remains of last night’s casserole. She says he makes these really sad puppy dog eyes at her, and it makes her heart break. The dog is now on special prescription low-calorie dog food because he’s as wide as he is long, but I suspect a hamburger sneaks its way into the special diet food just the same.

It’s been a long 12 days, not unlike riding a giant roller coaster, except not fun. The initial diagnosis was lung cancer or mesothelioma. There are several tumors in her chest cavity, including one wrapped around the major blood vessels as they enter and leave her heart. I despaired, because the prognosis for that, with as big as the tumors in her chest are, was Very Bad. ‘Horrendously Bad’ would have been the understatement of the century.

Then we got news that it might be lymphoma. More tests were done, including a needle biopsy and then a surgical biopsy. By this time, my poor sister had turned into a giant pin cushion. Good thing she had an air mattress in the hospital. The surgeon even told us a week ago after doing the surgical biopsy that he was pretty sure it was lymphoma, but, like everything else, we had to wait for the final pathology results. I told my pastor that you’re in a really weird place in life when you pray FOR lymphoma, the alternatives being that much worse. We did a little happy dance at the surgeon’s news, because lymphoma has something like a 70% cure rate, not just ‘treat it until you can’t see it on tests, and then treat it again in a year or two when it comes back’.

A couple days after that, we got bad news again on this down-up-down evil-coaster ride. The oncologist and pathologist thought some of the cells on the pathology slides looked like a kind of rare cancer called thymoma, rather than lymphoma as we were hoping. They decided to transfer her to Northwestern University Hospital on Monday so that she could get more advanced care because it’s such an unusual cancer. After yet more tests, and some initial treatment with prednisone to shrink the tumors, they finally confirmed today that it is indeed thymoma (a type of cancer that starts in the thymus gland), and actually started chemotherapy tonight. The ideal treatment is to do surgery to remove all the tumors, but the ones she has are so big right now it would be too risky to do it. Of course, being a doctor, I immediately went to the National Cancer Institute’s website to learn more about it. I also found the Foundation for Thymic Cancer Research, which I forwarded on, that being about the only thing that is within my power to do aside from praying, which I’ve been doing since we got the Very Bad News. Waving a magic wand is outside my sphere of knowledge. I work with eyeballs, and God has the corner on miracles. My sister is a woman of amazingly strong faith, but she’s going through a rough time emotionally as well as physically. If you’re the praying type, please put her on your prayer list. There’s a verse in the Bible, James 1:2-4, that says “Count it all joy, my brothers, when you meet trials of various kinds, for you know that the testing of your faith produces steadfastness. And let steadfastness have its full effect, that you may be perfect and complete, lacking in nothing.” I told God, “I understand the testing, but perhaps a little less joy and perfection would maybe be OK?” God replied, “Yeah, right, I don’t think so.” I’m not sure, but He might even have rolled His eyes at that one. Nuts.

In the Ultimate Irony Category, I got a phone call tonight. It was from the American Cancer Society. They were calling for a donation.

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Pay Problem Resolved and 10 Pounds Lost!

First, I have to say “Kudos!!” to both Senator Herb Kohl and Representative Paul Ryan, both of whom took the time to contact me. Senator Kohl’s office actually called me. I appreciated the care and concern very much. I don’t know if it was just the idea that we had the attention of a Senator and Congressman or not, but the pay problem suddenly got solved, and we got paid on October 30th. So, I didn’t have to go sign up for food stamps and the free school lunch program as I feared, and we made it through my medical leave in November without a financial hitch, thank God.

My lap-band surgery on October 27th went well. I went home the next day after surgery, and at my first follow-up appointment 9 days later, I had lost 8 pounds! At my one month follow up I had lost 2 more pounds, which is really good considering I hadn’t had a fill in the band yet. Losing 10 pounds in 1 month is exciting!! A ‘fill’, for those of you not familiar with the lap-band, is where they inject saline into a little port under the skin. The saline goes through a tiny tube and into an inflatable ring that lines the inside of the band, making it expand. This shrinks the stomach opening and slows down food from emptying the small area of stomach just above the band. That allows me to feel full much longer, and eat much less. I had one band fill on November 30th and it’s helping some. I’ll probably need another fill or two before it gets to the point where it keeps food in the stomach long enough for me not to get too hungry. I have another appointment at the end of December for another fill. As I get smaller, the band might need to be tightened a bit more. That’s the beauty of the lap-band–it’s adjustable to meet changing needs, and it’s the least invasive of the bariatric surgeries. Those are the main reasons why I chose this particular surgery. It also involves a cool device, something that always appeals to the Geek side of me! 😀

If you ever have questions about the lap-band, weight loss surgery, or other weight loss issues, feel free to ask!! You can also check out the Obesity Help website and forums. I’ve received a lot of terrific support there.
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How to Have an Upper GI Test

Author: U.S. National Institute of Diabetes an...Image via Wikipedia

After approximately 8 months of dietitian appointments, psychologist chats, doctor visits, a detour to a cardiologist for cardiac clearance (happily, nothing wrong), and reams of paperwork for insurance, I’ve managed to (insert amazement emote here) finally get a date for lap-band surgery. Dr. Chua’s going to do the surgery on October 27th for those of you who wish to pray and/or think positive thoughts on this day. For those of you who read this because you can’t stand me, it’s scheduled for some time in 3011, so save your evil black thoughts for that year.

Last week I had to drive up to the hospital to have the pre-op testing. I thought it was going to be just one test. It turns out I had to have a whole bunch of tests, including an EKG (despite the fact that I had just seen the cardiologist), blood tests, pre-op interview, chest x-ray, blood pressure, pulse oximetry, urinalysis and pregnancy test, investigation of my fingernail clippings, collection of any toejam (none for me, I’d showered that morning), and counting the number of wrinkles on my kneecaps. This was done in a giant hospital gown that could be used as a sheet for five queen sized beds, it was so large. Now, I know that this hospital is a bariatric center, and we big people are a normal patient base for them. However, a Volkswagon Beetle could have fit under that gown and there still would have been enough material left over for the 18 people stuffed inside the car. After pulling up on my gown because the neckline had fallen off my shoulder umpteen times, I decided to rename it a toga. I walked proudly through the hospital hallways to the various stations, one shoulder exposed for all the world to view.

One of the tests required before weight loss surgery is the famous ‘Upper GI’. This is a nice way of saying “Here, we’re going to make you drink a cup of liquid white chalk and irradiate you until you glow in the dark”. That test description doesn’t fit on insurance forms very well, however. As we all know, we must never make insurance companies do any work, or they’ll charge us another 666 dollars. Per letter. Now you know why test names are so short and cryptic.

Anyway, after hearing any number of people complain about this test, I decided that I, a woman proudly wearing a Beetle-sized blue-diamond print white toga, would not complain. I would suck it up and deal with it. When I introduced myself to the radiology techs, I was “Jae, the Toga Woman”. I then politely asked if I could pick my flavor of barium. This immediately amused the technicians, who then cheerfully informed me they only had one flavor. They assured me the liquid chalk would ‘taste faintly like bananas’. Now, I’ve made fake-banana flavor in organic chemistry, although we gave it the fancy term ‘isoamyl acetate‘ in class because we had to show off our chemical knowledge. I was pretty sure I didn’t want fake-banana flavor on an empty stomach, but I had vowed not to complain as they handed me the cup of liquid ‘faintly banana-flavored’ chalk. Instead, in a completely geeky manner, I noted out loud that the cup was quite heavy and asked them what the atomic weight of barium was (137.33 g·mol−1 for the truly curious). Neither of them knew, but I could tell by the pleasant surprise on their faces that they were expecting complaints, and this was something different for them. I didn’t feel so bad when the radiologist couldn’t remember the atomic weight, either. Normally, it would make me a tad nervous that a doctor didn’t remember this trivia, especially a radiologist, but I figured as long as he knew how to do his job, we didn’t have to care about something that was only required for medical boards and had no relevance to Real People Medical Care.

After the tech handed me the heavy cup, she then told me I had to first swallow a medicine cup full of white crystals, followed by 2 teaspoons of water. Mind you, I had not had anything to drink since my last sip of decaf coffee at 11:59 pm the night before, because you can’t have anything after midnight the night before you have the “drink liquid white chalk and get irradiated til you glow in the dark” test. I could not begin to imagine how I was going to swallow dry crystals when my mouth was already dry as the Sahara. These crystals were described as something that would ‘make an air bubble in the stomach’ and would taste like ‘really fizzy 7-Up’. Good thing I like 7-Up. After the tech mixed the 2 teaspoons of water into the crystals for me to immediately toss back like a shot of something that would likely have been far more tasty like, say, rum, I discovered it was not like ‘really fizzy 7-Up’ at all. It was more akin to drinking an entire case full of Pop-rocks poured into said 7-Up. It was a good thing I didn’t try to to knock the crystals back dry. My mouth probably would have done a marvelous Mt. Vesuvius eruption.

I then discovered ‘make an air bubble’ was a euphemism for ‘this will cause massive gas’. The staff had neglected to specify the size of the air bubble, which was quickly approaching Hindenburg proportions. Next, I followed the instruction to gulp the barium down as fast as possible. This did not help the air bubble (read, massive gas) situation one bit. Then they laid the table back and urged me not to burp. This is equivalent to gulping a 2-liter bottle of pop in 20 seconds and then being told that belching is not allowed. I did my best guppy impersonation, swallowing every quarter second to keep that air bubble from exploding. I was afraid that if I burped at that point, the force of the gas would rocket me out of the x-ray machine. I told the staff when I did finally get to burp, I was going to be able to outdo my 12 year old son. That’s quite an achievement, by the way, because we all know that 12 year old boys can burp at a volume approaching heavy metal rock concert level.

An upper GI test is not your ordinary ‘lie still’ test, either. They asked me to do a couple log rolls to move the barium around, lie in a variety of poses, one of which I called the ‘Cleopatra pose’ to the further amusement of the staff, do a variety of gyrations I hadn’t done since 6th grade gymnastics, and rest on my stomach. If you’ve ever had ‘an air bubble’ in your stomach, and you’re not allowed to burp, the last thing you want to do is lie ON your stomach. I went back to guppy-gulping to keep the air in, knowing that I was going to pay for it when it came out the other end.

After quite the photo shoot, I got to see my stomach, my reflux, and my esophageal muscles not quite doing their job correctly. The pictures would have been even more cool if they hadn’t been mine. Hopefully after the surgery and weight loss, that will improve. I won’t be able to entertain the staff in my Cleopatra pose once the reflux is healed, but I’ll take that one for the team. Yes, I did let out a giant burp or three (or ten) when we got done. No, I didn’t get blown through any walls.

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