Friday, September 18, 2009

Patience is Not My Virtue

I am an impatient person.

Did you hear that? I think I just heard my parents snort in amusement/understatement on the other side of the country.

It's somewhat ironic because I am also a terrible procrastinator. If there is something I need to do, say the dishes or a paper or some other potentially unpleasant task, I'll usually delay before getting around to it. Not so if it is something I want to do. In that case, woe to the person holding me back.

I bring this up because I am now at the end of Day 2 of the Great MRI Wait. As I wrote in the last post, I had hoped to get squeezed in at the end of the day yesterday (Wed.) and as it turned out they did have an appointment for me. Unfortunately, there was a small insurance snafu and the clinic couldn't get authorization for the MRI.

NOW, before someone starts spouting off about the nation's health care system, let me say that this snafu was the result of someone not doing his job and no matter who runs health care: private companies, the government, Lollipop Guild or Martians- there will always be a moron in a cube somewhere not doing his job.

Thankfully everything has been cleared up and I am all authorized to go lay in a big loud tube and hold very still (not my strong suit) while people take pictures of my innards- wheeeeeeeeeeee. good times.

However, the imaging clinic is now fully booked for the week. And so I wait.




I am scheduled for my MRI and ultrasound next Wednesday. In the meantime, while I fidget and tap my foot, my coordinator is checking for cancellations every couple hours and will reschedule me if some thing opens up. I really hope there is a cancellation because I'm not sure I can make it to Wednesday.

I guess while we're all sitting around twiddling our thumbs I can bore you with some more medical stuff.

In the last post I told you that I'll be doing chemo first followed by surgery but I was too tired to explain the treatment approach, let me see if I can explain it now. Bear with me, I need to work through some information first...

... and take notes, there may be a pop quiz.

I think almost everyone is familiar with the term "Stage", as in, "She has Stage II breast cancer." Stage is based on the size of your tumor and how far your cancer has progressed or spread in your body starting at Stage 0 (a very small tumor or precancerous mass) to Stage IV (spread to multiple organs). A term you may be less aware of is "Grade."

A quick explanation before I explain Grade: breast cancer can be in Situ which means it is contained within the duct or gland it began in or invasive which means that it has broken through the bounds of its original duct or gland and is spreading into the surrounding tissue. If left untreated, an in Situ cancer can become invasive.

Grade is a term which is used to further describe invasive cancers. It describes how your cancer cells look compared to normal cells when under a microscope. The more closely a cancer cell resembles a normal cell, the less aggressive it is:
  • Grade 1 - cancer cells appear almost normal, are generally "neatly" arranged and are not growing quickly; my medical oncologist described these as "lazy cancer"
  • Grade 2 - the cells appear somewhat abnormal but still maintain some semblance or organization
  • Grade 3 - the cells look abnormal, are disorganized (my medical oncologist described them as chaotic), and tend to spread and grow rapidly

If you remember from my last post, my cancer is Grade 3- lucky me.

As a result, is is probable that there are already cancer cells elsewhere in my body right now. Mind you, these are cells, not tumors (don't freak out) but a few stray cells here and there, kicking back and waiting to be evil. I suppose, if I am honest, there is the possibility that there are other tumors- otherwise we wouldn't be doing the chest MRI and lymph node ultrasound- but for now we'll be cheerfully positive and assume there aren't.

One last key piece of information- have I lost you yet? In my last post I referenced my Ki67 "score". Let me quickly explain this measurement. Ki67 is actually a marker that is present in cells that are actively growing and dividing but is not found in resting cells. A Ki67 percentage or score tells you, if you are looking at 100 cancer cells under a microscope, how many of them are actively trying to duplicate themselves at any given time. In my case, it's 85- anything above 26 is considered high. I'm trying to explain to my cancer that it has no need to be such an overachiever but thus far, it is ignoring me...

As I am sure you have gathered, the combination of an aggressively spreading cancer and a quickly replicating one is not ideal (don't try this at home kids!). Thus, in addition to treating the actual tumor in my breast we also need to address the potential presence of cancer cells in other areas.

The only treatment option that targets cancer cells everywhere in the body is chemotherapy. Radiation and surgery both only target specific areas. In order to make sure all the cancer cells are wiped out, I need to have chemotherapy.

I am choosing to have chemo first because this approach gives any stray cell less time to decide to become active. If the little buggers are floating around I want them eradicated before they decide to join the party.

In addition, postponing surgery until after chemo will actually be helpful in determining if my treatment is effective. By leaving the tumor (for now) my oncologist can actually track it and see if the chemo is working- if it is, the tumor should shrink, or at least not grow. If that doesn't happen, we know the course of treatment isn't effective and we can switch to different drugs. If the tumor is removed, you don't have a benchmark to measure against and you are basically assuming (hoping) the chemo drugs are working. Personally, I'm all for having hard evidence, hence pre-op chemo.

So that's the plan...

OK, I suppose I should go at least pretend to try to sleep even if all I'm really doing is staring at the ceiling while sending cancellation vibes to the MRI gods.

Good night!


ME215 said...

Sending cancellation vibes from Atlanta too.....


sonomahead said...

The mantra from NC "Come on! Of all you people with an appointment something has got to come up so that you have to cancel and Katie can have your time slot!!!" Better yet, just be polite and offer her the spot as you would offer your seat on the bus!!!
Also sending vibes of strength, distraction and patience to you Katie. I wouldn't be good at this either but I'm sending you everything I've got!!!!

Erin said...

I absolutely foresee an appointment in your IMMEDIATE future. Definitely not next Wednesday. Hang in there!

Jessica said...

Hoping something opens up soon. Good thing you're a knitter. We have something to keep us occupied when we can't be patient.

Leslianne said...

Sending cancellation vibes in addition to imploring those overachieving cancer cells to take a chill pill and calm down a second, would ya?


mames said...

there will be a cancellation and you will be in the tube by monday morning.... am willing it to be so.

you know what...i love the medical jargon. i mean, i work in medicine so it is not too jargon-y for me. and i have to say, in my time working in said medicine i have noted something...the fighters are the winners. the ones that do not lay down bring something to the table...something intangible but so damn important.

keep talking to your tumor, keep telling it to go, to shrink, to leave you. in my very un-scientific opinion, it really really helps. sending love and healing. amiee

weebug said...

i am so sorry about your diagnosis. if you need anything let me know...i've been through this journey and not that far away.

Tessa said...


Andrew and I just got back from traveling and I read your news on FB. :( Know we're thinking of you and praying for you. If there's any way we can help, please let us know.


Meagan said...

Wow, Katie - you are such a good teacher. Now I know all about Ki67.

...And surely, there will be a cancellation soon. This is ridiculous. Don't they realize you want to get this chemo started already?!?