Sunday, July 22, 2007

Radiation Treatment Begins

The atmosphere was different today - more pleasant, kinder. The secretary showed me how to pass a card under a sensor to announce to the radiation technicians that I'd arrived. While I waited for them to call me, Alison, the radiation nurse I'd met a few weeks ago, passed by, chatted for a bit with me and Gabi, then went to see how long it would be before I was called.

The same two technicians greeted me with broad smiles and explained exactly what they were going to do and how long it would take. Again I lay on the table, arms raised, and again I experienced the illusion of heavy machinery moving towards me when in fact, I moved toward it, suspended once again above the floor. I was zapped from one direction and then zapped from the other. Strangely, the angle of the circular platter that was presumably the zapping agent, seemed to point at my right breast, rather than the left. Once I'd been lowered and could move again, I asked why it appeared that the wrong breast was in the line of fire. The technician said that the instrument was precisely aligned in order to minimize contact with my lung. That took me aback a little - I knew that they try to avoid the heart, but I didn't realize that my lung was going to be, even minimally, affected.

The whole exercise took about 10 minutes and was much less onerous that the two previous sessions. As my appointments are in the afternoon, we were able to park in the employees car park for free and within half an hour of arriving, left the hospital.

I have my first appointment with a psychologist, scheduled for July 31. Yay!

Saturday, July 21, 2007

July 19, 07. Whatta Day!

Eating Right

Mirit the dietician confirmed Liora’s claim to nutritionist bilbul (confusion). The rule of thumb for a healthy diet seems to be to eat as many non-processed foods as possible (or as few processed foods that is feasible), and to reduce quantities of dairy and sugar-laden products. Tuna should hail from the ocean where there is less mercury begriming the waters. As glucose in fruit is natural and takes longer to be absorbed, I should continue to eat about three fruits a day. To all my questions, such as the hormonal and antibiotic content of cattle feed, she gave the equivalent of a verbal shrug; research into what we consume is so dynamic it’s beyond a mere dietician to know more than a mere cancer patient. I cannot in any way fault her attitude - she could only dispense information that has been proven today in the knowledge that it might be disproven tomorrow.

I won’t be making many changes to my diet - for years I’ve followed what could be deemed an essentially healthy regime with occasional forays into the high-fat cheese and cake departments. Before cancer, I frequently mentally patted myself on the back for my adherence to good eating habits, regarding it an adequate talisman against such horrendous diseases as, well, cancer. In fact, a few weeks before my diagnoses, there was a report on how eschewing beef can reduce the risk of cancer. I haven’t eaten beef for years - I originally stopped eating it because of Mad Cow’s disease, but once the crisis was over, I was never even tempted to start eating it again. I’ve also considered giving up chicken considering what is probably put into their feed to say nothing of the unsavory way chickens are bred. I was amazed, therefore, when Mirit said I should be eating red meat, beef, three times a week, in order to maintain B12, folic acid and iron levels. I’ll have a blood test to determine if I have any deficiencies and then make a decision.

For years I have eaten several almonds daily based on something I read over 30 years ago. Edward Cayce
, aka the Sleeping Prophet, was an illiterate man with no medical training whatsover, who claimed that while in a deep sleep, his psyche travelled around the body of what he referred to as an entity and located whatever was awry in that body. He would then prescribe some herbal remedy, from which, according to the book, the entity recovered. Cayce claimed that three almonds a day would protect against cancer.

Incidentally, Cayce also claimed that our planet would not end with a big bang of a nuclear explosion but would whimper to an end through ever-increasing occurrences of drought, famine, pestilence, floods, volcanic eruptions and earthquakes, all due to increased pollution. And that was in the 1940s.

Hmm! He was wrong about the almonds!

I showed Mirit a list of suggested natural remedies from the internet. This particular article, although well written and seemingly authentic had no attribution, nor was there any official endorsement from a research or medical facility. Articles such as these cause me no small amount of turmoil because they induce guilty feelings. If imbibing, smearing or swallowing one or many of these items would ensure my continued survival, then I am clearly not acting in my best interests by ignoring the advice. On the other hand, these very same items, taken in incorrect, or even recommended, proportions or in conjunction with other preparations, could in fact be injurious to health. Medicine Man Tea and Blue Green Algae will have to wait until I’ve exhausted other, recognized, options.

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What Do You Have To Do To Get A Psychologist Around Here?

The day took on a Pythonesque twist. The week before, I’d asked Liora the social worker to arrange for me to consult a dietician and a psychologist. Mirit had phoned a few days later but as no psychologist had yet contacted me, I called Liora to remind her. She gave me a phone number she said I could call to make an appointment. As soon as I’d taken my leave of Mirit, I called the number but I got an answering machine inviting me to leave a message for one of three doctors.

As I was already in the hospital, I thought it would be a good idea to go along to the department and try to make an appointment directly with a secretary or nurse. No-one in Reception knew where the Psychology department was so Nachum and I went over to Information.

The clerk behind the window didn’t know where the Psychology department was either, and, noting my meaningful glance at the sign above her head proclaiming Information in Hebrew, English and Arabic, protested that she didn’t know everything that happened in the hospital. She went to ask the ‘girls’ but they didn’t know where the Psychology department was either and, clearly feeling that she had made a supreme effort, indicated that my query had been dealt with to the maximum of her ability and would I now just go away.

The deputy manager of the Reception department came out of her office to see what the altercation was about and invited us into her office. She tried to help by calling a few numbers, the upshot of which had us running back to Oncology to look for Room 31 where we would find Shlomit, a social worker who apparently was responsible for psychology appointments. Room 31 turned out to be a room containing a doctor and a patient who appeared justifiably disgruntled at being interrupted so we followed the signposts to Social Workers and found Shlomit’s office (Room 30) just as Hannah emerged from it. We told her that we were trying to locate the Psychology department and that Anat in Reception had sent us to Shlomit. She went off to find out some more details and a few minutes later, a dismayed Liora appeared in front of us, puzzled as why I would want to consult Shlomit about something she and I had discussed at length only a week earlier.

It seems there are only three psychologists attached to the Oncology department on a part time basis and they are usually not available to answer a phone. At Liora’s suggestion, I phoned again and left a message, which I probably should have done in the first place. But if no-one had contacted me after Liora passed on my request a week ago, how will leaving a message now make a difference?

One can go nuts trying to get an appointment with a psychologist around here.
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Radiotherapy Planning

At 3.00, I returned to Rambam for radiotherapy planning. When I entered the room, a technician pointed a digital camera at me and took a picture of me. It is something I am wont to do in social situations but I felt that under these circumstances, a friendly explanation would have been in order.

I was told to remove my top and bra - behind the curtain naturally - and then lie down on the table, arms raised and resting in the grooves of the bright red blocks. When I queried what was about to unfold I was told that they were going to ‘apply the simulation’, referring to the simulation I had undergone on June 20. I was under the impression that this would take only a few minutes and, thinking they were done, started to get down from the table. This was clearly a mistake as the two technicians told me to lie back, keep still and breathe deeply - this was going to take 20 minutes.

The room grew dark. I was lying under a sort of giant, 2-pronged propeller with a massive circular platter above me and a square one to my right. The circular platter appeared to move towards me and hovered at about half a meter above me. It whirred a few times as the technicians shouted out numbers at each other. Inexplicably, the table I was lying on occasionally shuddered. Lying as I was, stretched out with arms above my head staring at the ceiling, I could make out very little in my peripheral vision. At some point, the circular platter revolved to the left and the square platter appeared in my line of vision on the right. Suddenly, one of the technicians applied something to my breast and I raised my head, only to quickly lower it when she shouted at me. She repeated her action and the second technician laid something that felt like a cord on my body. I had a sensation of being captive to a bunch of lunatic aliens. I was aware only of bobbing heads somewhere in the periphery of my vision as, mystifyingly, the technicians, appeared to be going about their tasks on or about my body while seated on very low chairs.

About 15 minutes into this activity, one of the technicians told me that Dr. Bernstein (the radio therapist) was going to mark a place on the scar on my breast and in a voice reminiscent of a drum roll, announced that Dr. Bernstein had entered the room. Totally misunderstanding, I lowered my arms and began to sit up. Again I was told - brusquely - to lie down and Dr. Bernstein, who was barely visible in my peripheral vision, made a mark on my scar, also seemingly from a sitting position.

By this time, even my right arm, which, unlike my left one, had not undergone an operation in the recent past, was feeling the strain of being in a constantly raised position. The circular and square platters continued to whir into action interchangeably and I was reaching the point where I’d had enough.

The whirring stopped, the lights went on and I discovered that the table on which I lay was raised a few meters from the floor, which explains why I’d only been able to make out the tops of heads from my prone position. Well, here was a lesson is perception - I had been sure that the circular platter had moved towards me when in fact, the table, had moved towards the platter. How lucky I had been that in my enthusiasm in greeting Dr. Bernstein I hadn’t leaped from the table to what would have been the floor, very far below.

This unpleasant session ended when, after lowering the table (!), I berated the technician for not informing me what they were doing while they were doing it. She asked if I meant that they should have pointed out that... and then she sarcastically reeled off a litany of activities they had performed on or about my body. I waited patiently for her to finish and said, ‘Yes, the answer is yes.’

Generally speaking, the higher up the scale the practitioner, the more the patient is treated with courtesy and given some explanation of what, why and how something is being done to them. Perhaps it is merely a matter of training in which case, radiation technicians need to be better taught to understand that the bodies lying on their tables belong to human beings with curiosity and fears, all of which could be allayed if they were to relate in a friendly manner.


Friday, July 13, 2007

My New Oncologist

OK, I’ve been around, I know the drill. It’s usually done when I first enter the room - but there have been times when I was already prone, ready and waiting. Sometimes I manage to sit for a while, talk for a bit, but the end, I get up and remove my top and bra. I move over to the bed, lie down and raise my arms above my head. My breasts, both of them, are then prodded, poked, pounded and pummeled and - not to be too P-centrically alliterative - jabbed, joggled and jiggled. The whole routine is then repeated with me in a sitting position. Then the prodder who did the jiggling smiles and says, OK, everything’s OK and I get dressed again.

I’m not sure what they expect to find. It was only a short while ago that the cancerous lump was removed from one such breast. Do they expect it to come back for a return visit?
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It's Thursday, July 12, and before keeping my appointment with Dr. Sarid, I met Liora the social worker. Since discovering the lump in what seems like eons ago, my life has been dominated by operations and waiting, usually tensely, for the results of various tests. Now all the labs are in, and the final piece in the jigsaw of my cancer is in place; there is no more action, just the reality of a dividing line between my life before cancer and my life after cancer. There are times when this realization plays havoc with my sense of well-being.

I want, I told Liora, a psychologist. I want to be able to pour out my emotional meanderings and find my way back to equilibrium. (Note: Even with access to a dictionary, there was no way I would be able to express that sentence in Hebrew. What I actually said was far more mundane, a linguistic compromise, if you will, but the message was the same.) Liora asked me if I had lost my appetite (no, if only!) and if I had sleeping problems, either oversleeping or under-sleeping (again no, so long as she didn’t count
losing consciousness for about 20 minutes every evening in front of the TV as oversleeping). She concluded that I was not depressed, but that I was sad. That was a relief, because for a moment I was afraid that I would be denied a psychologist if I were judged insufficiently miserable.

I also asked her for access to a dietician or nutritionist because I am very, no extremely confused about what to eat and what not to eat. Tofu, for example - who hasn’t felt noble at eating tofu? They are now telling us that the phytoestrogens in tofu, instead of being beneficial, could well be a contributory factor to breast cancer. Furthermore, last week on Channel 10, there was a report on green, leafy vegetables, such as petrosilia (parsley) and cusbara (coriandar) - those we’re exhorted to eat for good health and to keep cancer at bay - and how they are saturated in carcinogenic substances. As if that weren’t enough, Liora told me that she attended a lecture where the role of organically grown produce in promoting health was impugned. Apparently, the very substance which destroys worms and other produce gnawing mites could be injurious to our health. The nutritionists themselves are very confused, said Liora. However, one concept that appears to be more or less universally acknowledged is that cancer cells love sugar: (http://www.webmd.com/breast-cancer/news/20070710/meat-sweets-boost-breast-cancer-risk). I don’t envisage cutting down on my sugar intake as a major hardship.

I got off to a rather shaky start with Dr. Sarid when he asked for my test results and I had nothing to give him. Nachum and I had gone to his secretary’s booth to confirm the time of the appointment but she wasn’t there and after waiting for about five minutes, we left because I was afraid we were late. I was dismayed and began to protest that I had no idea why he didn’t have my test results, that I wasn’t responsible for or even cognisant of administrative practices in the hospital. He calmed me down, told me that he was happy to tend to me because I was the mother of a colleague and that I should remember to bring all the documents next time. He also told me that if I continue to respond to him in that way, he'd be afraid to say anything to me, so I shut up. There was an element of warmth in him which had been lacking in Dr. F that I found compelling. I left his room feeling satisfied with my team of health care specialists.


I begin radiation treatment on July 22 at 3.55. There will be 33 treatments in all, every day, five days a week. I can expect to feel fatigued and weak as the treatments progress. On the way out of the hospital, I popped in to Steimatzky's and bought three books.

Friday, morning shower: After
my breasts have been poked, pummeled and joggled, and have received a clean bill of health, I have no qualms applying moisturizing lotion to my body. I reckon if the doctors are satisfied, the possibility that I might chance on something untoward is pretty low. During intervals between breast jiggling, I tend to be reluctant to use the lotion because that is what triggered this whole drama - and there are some places I do not want to revisit.

Thursday, July 5, 2007

New Oncologist, Life Returning to Normal (well, almost)

Gabi took my file to Dr. Sarid, who has agreed to be my oncologist. I have my first meeting with him on Thursday, July 12, and in the meantime, I'm waiting to be invited for my first radiation treatment, which should happen around the end of July, beginning of August.

Now that my immediate future is less of an enigma, the first thing I need to do it cut my hair, something I avoided doing for no rational reason other than a vague idea that there wasn't much point if it was all going to fall out anyway.

With everything falling neatly into place, it's a little disconcerting to find that my latent hypochondria has gone into overdrive. One would think that once the disease you've most dreaded actually strikes, there would be some relaxation in hypochondriac angst.

Unfortunately, that doesn't seem to be the case. I've been anxiously examining my eyes to make sure the whites are not yellow, indicating the presence of liver cancer. The other day, I had an irritating cough and I dreamed I had lung cancer. The next day, my throat hurt and I lost my voice, so now I'm worrying I have throat cancer. Yesterday morning, I had a sudden pain in a small area of my head and felt a little dizzy - no prizes for guessing what kind of cancer I'm thinking of.

I think it's time to go back to exercising. When I left the hospital, I'd lost 3 kg., the only bright spot in the whole experience, and although I've gained back about 2 kg., the fat seems to have redistributed and my clothes are feeling tight on me. Another reason for returning to exercise class is that it would be good preparation for the radiation, which can leave patients feeling tired and weak. It's time for me to start rebuilding my strength.

Tuesday, July 3, 2007

July 3, 07. The Oncotype Results

NO CHEMO.

Yay! My oncotest result was 8: "Patients with a Recurrence Score of 8 in the clinical validation study had an Average Rate of Distant Recurrence at 10 years of 6%" is what it said in the page Gabi faxed me from Oncology this morning. That means that something in the sliver of malignant material sent to Oncotype suggests that 10 years from now, I will have a 6% chance of recurrence - undergoing chemo would reduce that to 4%, which is considered insignificant.
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Being in doctor limboland had made me anxious that my results from Oncotype would arrive and nobody would inform me, so I'd called Teva early in the morning to find out when I could expect the answer. The answer arrived this morning
and it was faxed to Dr. F, I was told by the Anglo lady who answered. She refused to tell me what the results were and told me to contact Dr. F directly.

I spoke to Gabi who was getting ready to leave the paggia (premature baby unit) and she told me she'd go over to Oncology to pick up the fax. It would take her about 10 minutes. Next I called Hannah, who was in the clinic. As the clinic is housed in a separate building from the hospital itself, it would take her too about 10 minutes to reach Oncology and pick up the fax.

I paced up and down waiting for Gabi and Hannah to converge on the Oncology ward and call me with the results. 10 minutes came and went, 15 minutes, I paced, I sat, I got up and paced, my heart pounding, my palms sweaty. Finally, the phone rang and Gabi told me the good news. The relief sent a bolt of energy coursing through my body.

Dr. F invited Gabi into her room and explained to her the significance of the result and told her she'd be happy to explain it to me. Is she really impervious to the trauma she'd caused me just over a week ago? Is she being arrogant or simply defensive in failing to acknowledge her oversight? I cannot begin to fathom her behavior.

I need an oncologist I can depend on. Hopefully, that will be taken care of in the next few days.