I've always felt blessed at the good fortune of my senior years. A wonderful wife of thirty-three years. Financial security. Good health. Matinée-idol good looks. (O.K., maybe not that, heh.) I've been particularly smug over my good health. SInce I got my arthritic knees replaced, I've been pain-free and more active than I've been in years. I feel absolutely great. And I blithely assumed that I would be that way always.
That was hubris.
You see, gang, I just had it confirmed . . . I've got liver cancer.
The thing of it is . . . I still feel absolutely great. It was through a stroke of luck---and my regular physician of thirty years---that I discovered that I had a problem. For decades, I've gotten a check-up every three months and my annual physical every December. The numbers have always been in the green. I do have essential hypertension, but that's been under control for decades. Every three months, I've gotten lab work done, and every three months, I've gotten a clean bill of health. Including my liver functions, which always showed normal.
And that's how the numbers came out at my last physical this past December. In fact, my doctor joked, saying maybe on my visits, he should just bring a six-pack, and we sit around and swap war stories for thirty minutes. Then, at the end of the session, he mentioned that there is a new test, a blood test that checks one's DNA for cancer markers. He asked if I was interested in taking it. "Sure," I said. "Why not?" With TRICARE, it wasn't going to cost me anything, and I didn't expect it to find anything significant.
Again, hubris. The test came back at the end of the month, indicating that I had a 60% chance of having some form of liver cancer. My doctor ordered an MRI for me. The MRI results indicated a suspicious lesion on my liver. After giving me the news, my doctor picked up the phone and called the head oncologist at the city's leading clinic for oncology, and said, "I have a friend in trouble . . . "
The next day, I'm having a consultation with this oncologist. He ordered a PET scan for me, and the results confirmed the MRI's indications: I have a large malignant tumour across the breadth of my liver. Things have moved fast after that. In the past week, I've spoken with my oncologist again, and with a surgeon who specialises in both liver surgery and oncology surgery, and with a oncology radiolgist, and I consult with the leading radiologist in the area in a couple of days.
Now, before you folks get all weepy-eyed, there's significant good news with this diagnosis.
One, I am completely asymptomatic. I still feel great. My numbers are still within normal range. If all of this hadn't happened, I'd never know I had a problem. Two, the tumour, while large, shows very little activity. It's mild---that's why my liver functions are still completely normal. (In fact, there's a 5% chance still that it isn't malignant, at all. But I told my doctors to go with the odds and not waste time with a biopsy; they agreed.) Three, and most important, the cancer hasn't spread; it's localised to that tumour alone.
The only unfortunate aspect is the size and placement of the tumour. The liver is remarkable in that it can regenerate after a resection. The problem with my tumour is that it spreads across the very centre mass of my liver. Surgical resection is not practical---it would take 80% of my liver. Doable, but very radical. Only one slight step above a liver transplant.
Therefore, radiation is the most recommended approach to treatment. There's a technique in which radioactive beads can be inserted directly into the tumour which will shrink and ultimately, destroy the tumour. This is the preferred approach. After I see the radiologist next week, I'll be scheduled for a "mapping" operation, which will determine the precise locations where the Y-90 beads should be inserted. The one concern is if the tumour has spread across too many different segments of my liver. If so, then the radioactive beads are out, and they'll use computer-directed bursts of radiation to kill the tumour. I'm hoping the beads are useable; statistically, 70% of patients who undergo the bead technique see total destruction of the liver tumour.
But, even if we have to go with the computer-directed radiation approach, my odds are still excellent. Because the tumour is showing so little activity, because it hasn't spread, and because my overall health is strong and vital enough to endure a harsher approach.
The time line is, sometime next week, I'll undergo the mapping procudure, then have the actual radiation treatment within the next three weeks.
Aye, it sounds like I've had a bad break. But I don't view it that way. At my advanced age, something was bound to hit me, sooner or later. I'm lucky: I have a physician who is thorough to the Nth degree. If he hadn't mentioned, "by the way", that DNA test for cancer markers, a year from now we would've been having a much grimmer conversation. Because we caught it now, the doctors are able to deal with a cancer that is only mildly active and hasn't spread. If one has to have liver cancer, I've got it under just about the best conditions possible.
Cheryl and I waited until yesterday to inform our family of the news. I wanted to wait until I had a definite diagnosis and a plan for attack. To-day, I am giving you folks the news, for you are as much a family to me as my blood relations are. The thing to keep in mind is that I'm confident in my chances. Not in some cheerleading-type "Rah rah!" sense. But in the knowledge that the odds are strong on my side. It's a calculated confidence.
So, what's new with you guys?
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Commander Benson said:
One thing the surgeon who performed my gastric cancer operation impressed upon us (apart from his bold declaration that his goal was to get me cured) was the need to move from being a patient to being a person. To get past the point where every little ache or pain is a harbinger of worse physical changes in your body ... and, moreover, to stop thinking that of every little ache or pain. You'll get there.
I find that as age-related issues merss up this physiological system of mine, or that system ... and so on, I have a difficult time telling my doctors that I never was the sort who'd complain about every little ache or pain, and that family and friends had to argue with me that I really should consult a physician by now, again and again. Rather, I took pride in sweating it out. I'm afraid that they'll diagnose me as one of those perrenial hypochondriacs.
It can be frustrating. Hang in there!
Speaking of "age-related issues", sir: see above, heh.
I'm not thirty-five years old, anymore, either. A man of my years is going to be subject to sundries aches, pains, and moments of ill feeling just from age.
It's like the old gag:
When you're young and you wake up sore, you can usually pinpoint a specific reason: ,"Oh, I shouldn't have made that diving catch paying sportsball yesterday."
When you're old and you wake up sore,it's often "No reason. Just sore."
I hope you had a chance to see what I originally posted here, CK. I had taken to heart your advice and then waxed on for a paragraph or two about how I had come to take my good health for granted. Unfortunately, while I was catching up on the new posts below on my phone, I wanted to make an my post here---and @&!%@^!!, I hit "delete" by mistake. It's that deleted post to which Mr. Mankowski and Mr. Willis and the Baron have responded.
The one thing I wrote that I do remember with clarity so that I can repeat it here: Thank you, my friend. You are a wise fellow.
Yes, I did see what you wrote previously. You're very welcome.
When I got married at the age of 41, I almost never went to a doctor. My wife changed that for me. A year or so after we married I had some very mild symptoms. Even though tests were inconclusive I went ahead with a procedure. My appendix was close to bursting. If this had happened before I was married it easily could have killed me 35 years ago.
A ceramics classmate of Gayle’s was up in years and never went to the doctor. It turned out that she had undiagnosed diabetes, which destroyed her eyes.
Advise to everybody: go to a doctor before you wish you had!
Advise to everybody: go to a doctor before you wish you had!
Amen, sir.
I've often puzzled over why people, especially men, are reluctant to make regular visits to a doctor. There's the usual "ostrich head in the sand" argument---that folks avoid the doctor because they're afraid the doctor will find something wrong with them. But, obviously, that makes no sense; logically, if there is something wrong, you want your doctor to find it as early as possible, so it can be treated as easily as possible. There are other reasons, though.
First, it's a pain in the ass to find a medical or dental professional with whom you'll be comfortable. I don't have to scavange for medical professionals often---my vetting technique has been so successful, the ones I've picked have been with me for years, if not decades. But the vetting is a true act of labour. When I have to do it, I start out with two non-negotiable criteria, and in my on-line searches, if a certain medical professional's own website shows that he violates either one of the two requirements, then I immediately dismiss him, without going any further. That usually narrows the field by half or more. After that, it's in-depth parsing of the professionals' web-sites, looking for tiniest details, either positive or negative. I admit, this part is largely instinct and guesswork. It's also time consuming. A few years back, I required a podiatrist for the first time, and it took me days to narrow it down to the one I chose. (And she's marvelous!)
Most folks just don't want to go to this much trouble. The most they usually do is ask a friend or relative who he goes to. That's rather hit-or-miss.
But even in the case of doctors' referrals (and with this cancer thing, I've had a lot of referrals lately), it's still awkward. It's always a bit uncomfortable presenting yourself to them for the first time. Most staffs of medical facilities really do try to put the patient at ease, but it usually takes the form of treating the patient like a twelve-year-old child. They explain every little action, like you're standing there with big, round orphan eyes, and they call you out of the waiting room by your first name, like little Johnny being called into the school counselor's office. (The distinction becomes even more obvious when the physician enters, saying something like, "Hello, Jim, I'm Doctor Cosgrove.", immediately putting the patient on the junior level.) Grown adults of individual achievement either put up with this juvenile treatment, or they can take steps to correct it---it usually doesn't take much to correct that attitude, but it's uncomfortable to some extent to do so.
On-line resources such as patient portals and MyChart actually have functions to minimise that sort of thing, such as a line in which the patient enters how he wishes to be addressed. But it's been my observation that the doctors and nurses don't read much of the personal information there. I'm often asked the same questions that I answered in the e-check in or on MyChart. Occasionally, I'll chime in, "Didn't I answer those already? They should be in MyChart.", to which I'll get a sheepish, non-descript reply.
Whether one takes a stand on being treated as a responsible, reasonably intelligent adult, or he goes along to get along, it's vaguely uncomfortable.
Of course, none of that is any excuse for not going to the doctor.
A personal account: ten years ago, I needed a new dentist. I went through my usual vetting process. It took me a day and half. The one I selected did not have either of my two "unforgivables" on her web-site; I saw no recurring hints of red flags in the patients' comments on Google and Yelp; and one plus was that she was a former Navy dentist. I actually visited her offices and explained to the receptionist why I was there. I explained why I was leaving my current dentist and what I was looking for from this one. I was satisfied with the answers and made an appointment.
Here's where that kind of research paid off. The morning I arrived for my appointment, the dentist herself---not a tech or some flunky---came out to greet me. She gave me a tour of the professional spaces before turning me over to the tech for an exam and a cleaning. It turned out that I had a quite a few problem areas. Now, here is another way this dentist departed from the usual. Every other dentist I'd ever experienced stands in front of you, while you're still in the chair, and goes down the list of things that need to be attended. The patient is at a psychological disadvantage; it's like he's at his desk in elementary school, and the teacher is standing over him, lecturing him. It makes it more difficult to ask the necessary questions and take part in one's own treatment.
This dentist, however, when it was time to go over her findings, took me out of the chair and into a consultation room, where we sat on equal levels, and showed me on her computer, image by image, the problem areas she detected. She was thorough, but it also allowed me the opportunity to ask specific questions, which she answered. Then, she handed me what she planned out as the best schedule of dental events spread out over the next year. Bless this woman, it looked like every schedule of events I'd ever reviewed in an operations order for a military exercise. Then she asked me if I'd prefer to rearrange the order of events.
This is how such things should be done in a medical office. That was ten years ago, and not too long ago, I told her that she can't retire until I'm dead.
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