Paul's Heart

Life As A Dad, And A Survivor

Archive for the category “Education”

Preparation For Chemo – Part 3


Of the three parts of this series, I have saved the most important for last.  Why?  Because there is no factor more important, than the mindset of the patient, especially as they head toward a fork in a road, where both roads are a potentially fatal choice.  One will kill you for sure, the other has the potential to kill you.

My team of medical providers seemingly complete, I went to my pre-chemo appointment to make my final arrangements  to begin.  All of my testing was done.  What happened next, I was not prepared for, and evidently neither was my doctor.

I checked in with the receptionist, and sat down waiting to be called back to the exam room.  As always, there was a stop by the lab to draw my blood, and into the second exam room on the left I went, with a legal pad under my left arm, a pen clipped to the pad (we did not have smart phones to record conversations, had to take any notes the old fashioned way).

I had chosen Dr. M to treat my Hodgkin’s Lymphoma for one reason only.  Though I referred to him as older than dirt, he did cure my grandmother of her breast cancer just five years earlier.  I could overlook him being long in the tooth, and the fact that the bedpan had more of a personality than he did.  This was going to be the guy to get me through this ordeal.

Dr. M. closed the door and sat down on his stool in front of me.

Dr. M:  So, we have gotten all the preliminary testing done.  How did you make out with the sperm harvesting?

Me:  They said there was not enough to be worth storing.

Dr. M:  You should have insisted anyway.  One could have been enough for you to have a family.

Me:  But, I…

Dr. M:  Ok.  Your heart scan and lung tests came back good.  They will be able to tolerate the chemotherapy plan.  It’s my understanding you would be okay with starting Friday (2 days later)?

Me:  Yes.  Because I would not have to miss much work for my treatments.  I would just leave an hour early from work, and have the weekend to rest before going back to work on Monday.

Dr. M immediately began to stand and walk towards the door, appearing to have finished our appointment.

Dr. M:  Very well, that is okay.  Will see you Friday afternoon.

Me:  Excuse me doc?

Dr. M turned around having already mentally concluded the appointment.

Me:  I have some questions about going through the chemo.

Dr. M slowly and hesitantly turned around, looked at my left hand, which had now exposed the first page on the legal tablet to be full of writing.

Dr. M:  What is that?

Me:  Like I said, I have some questions.

Dr. M had not even seen the second page of questions.

Dr. M:  Are you serious?  I don’t have the time to spend with you answering all that.  You will have to talk to the nurse.

And Dr. M walked out.

As I mentioned earlier, my team involved with reaching my cure, was almost complete.  Dr. M did not realize, or did not care, there was another member of the team.

Dr. M did not acknowledge me as a team member.  Without me, there would be no treatment.  Yes, I know that would mean that I would die.  But I had serious questions about being given drugs that were so toxic, that were going to not just kill the cancer cells, but many of the good healthy cells in my body as well.  Going through chemotherapy is not just a physical battle, but a mental one like none other you face in your life.

I was not considered part of my team by Dr. M.  And that is where he was mistaken.  In this case, and others like mine, there is actually an “i” in team.  And yes, I know the punchline, it is in the “A hole”.  And the minute you start to advocate for yourself, the reaction is to actually respond to you as if you are being an asshole.  But there is no doubt about it.  I was a member of the team, the most important member, not just because I was the patient, but because without putting the fires out in my mind of all the concerns that I had, I was going to die.  Just because a doctor did not want to answer my questions.  And yes, I acknowledge there were a lot of questions, and they all pertained to what I was about to go through.

For my own sake, I, and I repeat, I was a team member, I needed to advocate for myself.  If you remember anything from this post, or anything on “Paul’s Heart,” it is the importance of advocating for yourself.  In most cases, it will make a difference, especially if you do not have the confidence in others to get your through your difficult time.  You must do what you need to do, to get through.

I was about to break down completely as a nurse walked in.  She introduced herself as Brenda.  She did not give her last name.  She was old enough to be my mother, a fact that I will talk about later in another post.  She introduced herself as the nurse that would be administering my chemotherapy.  I did all I could to fight back tears of fear.  Because at this point, I was prepared to die, preferring quality of what would be left of my life, rather than dealing with the uncertainties that could come because of chemotherapy.

Brenda:  Good morning Mr. Edelman.  My name is Brenda.  I am your chemotherapy nurse.  I understand you have some questions that you would like answered before we begin.

This did not begin the way I thought.  Dr. M said he had no time to talk to me about my questions.  So he sent someone in to do it for him?  No.  I wanted the doctor, not a nurse.  I wanted the knowledge, not the routine.  As if she knew where my mind was at, the doctor had the personality of a bed pan, she spoke:

Brenda:  Dr. M is a good doctor.  He is also quite busy.  And he does care.  He just cannot show it.  He cannot open himself to personally caring directly with a patient.  Dr. M deals with a lot of patients.  Many survive.  Some do not.  He has been at this a long time, and he has lost a lot of people he has cared about, and it is his demeanor that protects him from any further hurt.

Me:  That’s all well and good.  But I need to know what is going to happen to me.  He saved my grandmother’s life.  I trusted him.  I thought he would care.  I no longer feel that way.

Brenda took the time to answer ALL of my questions, two pages worth.  Questions that dealt with the drugs in the chemotherapy cocktail, side effects, what to do in the case of…, and more.  And after nearly an hour, she offered me one more suggestion.  She heard something in the questions that I had asked, and the comments that I made.  She recommended one more member for my team.  Someone to talk to.  Someone who had experience with patients who struggled not only with their diagnosis, their treatments, but their survival.

I had one more appointment to make before that Friday.

The Observation


Something strange has been happening with me this year.  I do not know why just this year.  I am not doing anything differently than I have for fifty-three years.  It is not something I publicly talk about, unlike other topics about myself.  And if it only happened one time, I would probably just think it was a coincidence.  But since February, it has now happened four times.

Around President’s weekend, I had been visiting with a friend with my daughters.  We were inside a small shop when a complete stranger came up to me.

Stranger:  Excuse me.  But are you Native American?

Yep.  Not even a “hello”, just jumped right into it.  Now a little known secret up until now, yes I am, or at least partially.  But the question caught me off guard.  I do not really discuss my heritage with anyone, just my daughters, who happen to be Asian.  So I have the discussion with them to teach them the importance of knowing your culture.  I believe the conversation came up once when I was in elementary school, and of course the kids in school relentlessly mocked me, which became why I never discussed it publicly again.

Stranger:  I didn’t mean to offend you.  I was just curious.  I study indigenous cultures.  And I just noticed your strong features.  Do you know if you are of Native American background?

Me:  Yes I am.  (I intentionally gave a short answer, being totally weirded out).

Stranger:  By any chance, are you of Cherokee background?

Now I was totally baffled.  My great grandmother was Cherokee.  I have known this my whole life.  I have just never publicly acknowledged it, or made any kind of issue out of it.  As far as anyone was concerned, I identified as a Caucasian.  Sure, my skin color is slightly darker.  But if I am being honest, I really never saw any particular characteristics that would point out a Native American background.

Well, at least until I started growing my hair back out again.  For a long time, I kept it very short.  The last time I kept my hair long, no one ever mentioned or inquired about my background.  But I suppose I can see some Native American in my photos.

So, more of a curiosity, how did my great grandfather meet, get involved with, and marry a Cherokee Indian woman?  I am not well versed on racism, other than the blatant examples we see on the news every day, but I do know in the late 1800’s and early 1900’s, racism still existed.

First, you need to understand the history of the Cherokee woman.  Cherokee women were considered equal to Cherokee men in all aspects of life.  Something that American women of today still do not have that right.  Financially, spiritually, sexually, Cherokee women were respected as equals to men.  Crimes against Cherokee women by Cherokee men were rare, especially rape.  Family ancestry actually was guided by the women.  Because of land owned by the Cherokee, it was profitable for white men to marry Cherokee women, as it was the Cherokee women who owned and were in charge of the land in most cases.  I have only recently begun to study more of the interesting history.

I am enjoying the research I have now given myself to do.  And out of the four people who approached me, I have an uneasy feeling that three out of the four had other issues other than genuine curiosity about me, with the fourth actually stating she had an educational background.  It is a fact that bigotry and racism are escalating again, and I would like to hope, that I was not experiencing it because of my background.  As I mentioned to a classmate of mine, still friends after all these years, “you finding out that I have a Native American background does not affect or change how you know me, does it?”  The obvious answer was, “of course not.”

Preparation For Chemo – Part 2


So the first pre-chemo testing I underwent was for my future life after cancer.  The next set of testing was to determine my body’s ability to tolerate two particular drugs in the chemo cocktail.  Newbies will likely recognize the drugs, Bleomyacin, and the other, Adriamyacin.  I would be given seven total drugs, four at one appointment, the other three the following week.  Both of these two particular drugs would be administered in the second week of the cycle.  Blood tests would be done weekly for the duration of my treatment schedule, eight months, or “cycles” in the cancer world.  Any delay makes it longer than the months, so that is why “cycle” is used.

As far as the drugs and what they do, what they cause and such, that will be in an upcoming post very shortly.  But in preparation for the chemo, what you have read here, is basically all the knowledge that I had at the time.  All that was explained to me, was that the two drugs mentioned above were known to potentially cause issues to the body.  Adriamyacin could have an impact on the heart, and Bleomyacin could affect the lungs.

Now here is where progress has changed from 1989.  In 1989, the tests that would be administered to me, would be for the purpose of seeing if my heart and my lungs would be strong enough to take the pounding from the drugs.

A MUGA scan would reveal the blood flow in my heart.  A pulmonary function test would determine how strong my lungs were.  Again, it was this simple.  With both tests completed, and results negative, chemotherapy would begin as soon as scheduled.  As expected, I had no issues with either test.  My heart was strong and so were my lungs.  Chemotherapy would begin in days.  I was handed several pamphlets with information on the drugs I was going to be given and my appointment was made.

And that is what I knew then.

This is what I know now.  One of the few times I will spoil my story (you already know my long term health issues from my treatments), this is what these tests now provide.  Yes, they still confirm that your body is strong enough to take these drugs, but they also serve as a “base-line.”  In other words, the numbers on these tests, will be compared following future cycles, and if anything comes up like complications.

You see, the Adriamyacin, though critical in the standard treatment regimen, has the potential for damaging the heart so badly, you could end up with CHF, congenital heart failure.  The drug damages the heart so badly, that if left undiscovered, a heart transplant is necessary.  And you cannot get a heart transplant for up to five years post-chemo.  Unfortunately for me, and for those not considered “newbies,” we were not followed up this way.  Whatever happened at the end of our treatments happened.

But I reported on an earlier post a long time ago, technology available, that can discover this damage after the first or second treatment, before it gets too bad.  This would allow either a modification of the dose, or use of a different drug.  A simple ultrasound after each cycle can keep track of this progress.  To be fair, this issue affects only roughly 5% of the patients, so until recently, it was not considered that big of a concern.  That is, unless you are one of the ones facing CHF.

Both tests are easy to go through.  They are non-invasive, and over in minutes.  But the information that they provide prior to, and now during, and after, is critical.

In part 3 of this series, an epic showdown with my oncologist that almost stopped my treatments.  One of the few times I have been able to prove… there is an “I” in “team.”

 

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