Tag Archives: fear of recurrence

Four millimeters of anxiety

On Monday morning I drove to Boston for my monthly meeting with the trial team.  The roads were largely empty, as many people are yet on holiday.  When I arrived at the tolls, there were actually more vehicles in the northbound lanes, likely filled with skiers, boarders and snowmobilers.  This meant I had a commute minus the usual stop and go, which is undeniably a more pleasant trip.

After my labs, I met with Dr. Shaw to go over my latest scans.  Although some people are under the impression that I am now disease free (a notion that the media has perhaps inadvertently encouraged), medically my situation has never been characterized that way.  My response to the trial drug was indeed dramatic, but it was a partial response. This is due to the fact that there are still areas of abnormality in both lungs.  The radiologist’s report describes these regions in the following language:

“The patient is status post left lower lobectomy.  There are stable postoperative changes.  Again noted are persistent and unchanged focal areas of interlobular septal thickening with micro-nodularity/irregularity.  There is biapical scarring. There are multiple pulmonary nodules which measure up to 7 mm which are stable relative to the study of 2/24/08.”

Before I went on trial, my lungs were carrying a heavy cancer burden.  Much of what is seen on the scans now may represent inflammation or scarring, not an unreasonable scenario given the amount of disease that was present previously. What the radiologist is really looking for is stability or the lack thereof.  Whether the presenting nodules are benign or cancerous, stable is the next best thing to resolved.

This report noted one nodule that appears to have increased in size:

“In the left lung…there is a 4-mm nodule which first appeared on the study 3/13/09 where it measured 2 mm.  It has gradually increased in size over the multiple consecutive studies.”

Well.  What does this mean?  Undeniably, it could be suggestive of recurrence. However, there are other possibilities as well.  It is a tiny, 4 millimeter red flag. There is nothing to do at this point but watch and wait.  I don’t deny that it makes me anxious, but I have to remind myself that whatever this nodule represents, it is very small and apparently not very fast growing.

Following my appointment, I met up with my good friend Sally, who was visiting family in Brookline.  I joined Sally and her relatives for a preemptive celebration of the New Year. Our champagne toast to the good health of all gathered was particularly poignant, as one of Sally’s sister-in-laws is in treatment for Burkitt’s lymphoma.

After dinner Sally and I retired to the Marriott for a sleep-over, as I had an appointment scheduled for yesterday morning with the orthopedic department. My ankle is healing very well, and I even got a tentative thumbs up for a few runs on the ski slope.  As long as it is a gentle slope, there are no children or other people around, and I don’t fall…I’m good.  I might give it a shot.

I drove back to New Hampshire in a fierce wind and single digit temperatures.  It had snowed overnight, and I’d missed out on a serenade by a pack of coyotes in our backyard.  In addition, David found moose tracks in the woods.  It is always comforting to come home to this rather wild and wooly place where nature is simply going about its business.  My own worries seem inconsequential compared to the daily struggle for warmth and food that is part of being a wild animal.  We, each of us, are striving to get through another day; another night.  I have heard that one of the purposes of the cacophony of birdsong at first light is a roll call of sorts.  Each bird is singing to its neighbors:  “I am here, I am here”. And so we are.

The Pest in the House: a metaphor for cancer

We are battling an invasion of field mice.  A neighbor told me that all the rain has driven them indoors.

Several weeks ago I opened the drawer to my desk and at first couldn’t even fathom what I was looking at.  Where there had once been tidy stacks of stationary, it now looked as if a tornado had gone through. Papers were strewn about and in the back corner was a soft little nest with five dead baby mice.  I then recalled finding a pillow, the cover of which was mysteriously speckled with little rips. Further searching revealed that the fringe had been chewed off two different sections of our oriental carpet.  I hated to do it, (kind of a general no kill policy–and mice are really cute) but traps were laid out. We caught just under a dozen mice.  For a short while, it seemed we had restored a little of what we consider the natural order in our home (more of us than them).

Until yesterday.  I was helping my son clean out his closet and I came upon another soft nest–this one was empty.  This particular closet was also a storage space for winter coats, so I began to go through them.  Before long, I located the source of the plush threads:  a vintage wool coat of mine had an area about a foot in diameter gnawed out of the silk lining.  More distressing yet, an antique mouton coat had a whole chewed right through it.  This mouse had a taste for fine materials.

Although not pleased with the destruction brought about by the nest building mice, I do not take it personally.  They are simply doing what is their instinctive imperative and no offense was meant. However, I am not obligated to allow them entry into my home and unlimited access to and destruction of my possessions. What is good for them is bad for me.

I cannot help but see the parallel to cancer in this scenario.  It is hypothesized that we may all have circulating cancer cells at any given time.  These are generally kept in check by our immune systems, and have no noticeable effect on our well being.  However, an external event, such as exposure to one or more carcinogens, can upset this balance and the cancer cells may proliferate to the point where our health is compromised.  This is when we generally become aware of our “host” status to an uninvited lodger and we do our best to evict “it”–(the cancer).

We have had occasional sightings of mice ever since we moved in here, but until this rainy summer (the outside event) we have always had the upper hand.  Our modest efforts at keeping down their numbers are suddenly ineffective, and the mice have begun to inflict some costly damage.  We can no longer coexist without harm being down to our home.

I am pretty certain we will always have some mice, but if we can find a way to deplete their numbers, we can minimize the damage that they do and carry on living.  We may occasionally feel unsettled, as we hear them rustle in the walls, but the situation will not be untenable.

This is such an apt metaphor for my cancer.  Cure is almost certainly not possible, but as long as we are able to keep the cancer at a level where it is not severely compromising my health, I am able to go about my life.  However, just as I will occasionally be kept awake by the sounds of mice in the rafters, so too will I listen to the beat of my heart and think about the cancer that is yet traveling through my veins.  Should I find evidence of proliferation, it will be time to clean house.