Thursday, May 30, 2013

New Doctors - Intimidating Facility

It was the day after the official diagnosis of invasive ductal carcinoma, and I was already being whisked into the chief of oncology’s office at the University of Arkansas for Medical Sciences – by choice.  Thanks to Don’s medical connections, I have the privilege of consulting with some of the country’s best medical professionals.  Rest assured that I haven’t and won’t take this opportunity for granted.

At 10:30 a.m. on May 9, my life was no longer my own.  I officially turned it over to a minimum of five doctors and an army of nurses at my new home away from home – UAMS. The day started in the Winthrop P. Rockefeller Cancer Institute’s Breast Center.  The paperwork was comprehensive, as expected.  The orders say to arrive at least 30 minutes early, and it’s always about the paperwork. 
Finally, Don and I were escorted to a cubicle to await the arrival of the oncology chief, Dr. Westbrook.  His silver hair with a tinge of red dominated his jolly face.  “Well, young lady, I’m here to confirm that you have Grade 3-Stage 3 breast cancer,” he said. “You will need a mastectomy, rather than a lumpectomy, because of the mere size of the tumor.”  Ok, I thought, that’s out there pretty quickly.  I’m only one day into digesting the confirmation that I even have breast cancer and it’s already time to cut off the little ta-ta.  Whee!  My cancer-surviving friends said that things would really start moving fast, and they weren’t kidding.

While Dr. W. was still discussing the seriousness of my disease, a tall, female doctor with short, dark hair and a slight slump in her shoulders came into the room with hand extended and introduced herself as Dr. Suzanne Klimberg.  Wow! It was THE Suzanne Klimberg, elected recently as the President of the American Society of Breast Surgeons. I have been blessed with the best. 

She immediately started checking for lymph swelling in my neck, shoulders and under my arms.  She manually felt the mass and said it was  “good-sized” (hmmmm, don’t know if I would have used the adjective “good,” but ok) one that would definitely require surgery.  But first, she said, we would do chemotherapy to reduce the size of the mass. This process will help save more tissue and skin for reconstructive surgery. 

breast cancer, invasive ductal carcinoma, UAMS, Little Rock, Arkansas, Marla Crider
She momentarily excused herself and returned with a medical book that she quickly and proudly introduced as her publication in which she and Dr. Yuen, my yet-to-meet plastic surgeon, wrote together.  She showed me numerous “before and after” photos of previous breast reconstruction surgeries.  I’m convinced.  She even told me I could pick any sized ta-tas I wanted. J  More about that later.

Dr. Klimberg wanted to do a lymph node ultrasound to see where we stood with that possible issue.  I asked when I needed to return for that test.  She said, “You’re here; let’s do it now.”  Really?  Really!  So off I go to a dark little procedure room, disrobe and plop the girls on the gurney for another ultrasound – this time, with my right arm over my head.  She talked me through what she was seeing.  And, then came the “hmmmm.” 

She said she wanted to do a needle biopsy…right then and there.  My how fast things move at UAMS. 

Dr. Klimberg prepped me and personally administered the local anesthetics.  Not too bad.  Once again, I heard the clicking sound indicating when she was cutting the tissue for microscope review. When she completed the process, she stood for more than 10 minutes holding pressure on the wound to make sure I wouldn’t bleed.  We conversed the entire time.  She’s such a soothing and knowledgeable surgeon.  Love this woman!! 

My mind was finally accepting the inevitable and ready to make a plan for a cure.  I’m going to be cancer’s worst enemy! Oh, by the way, the lymph node biopsy from under the right arm came back negative.  Finally!  Some good news.

Over the next 2 ½ weeks, my visits to UAMS went something like this:

May 10 – Breast MRIGuess what I have invasive ductal carcinoma in the right breast and it’s large. Nice to have an expensive confirmation. (Sorry, sometimes the sarcasm just rolls across my tongue!)

May 17 – Dr. Issam Makhoul – OncologistThis blessing of a doctor spent nearly three hours with Don and me talking us through the entire process of chemo, what to expect when, etc. One of the most important (and interesting) things Dr. Makhoul told me was that the second day after each treatment, I would come back to UAMS for a Neulasta injection to stimulate extra white blood cells to help fight infections.  He said that in many cases it’s the chemo related infections that cause people to die, not the cancer itself.  None of what Dr. Makhoul said scared me.  In fact, it got me in my fighting mode. Bring on the chemo.  Let’s get this insidious disease out of me.

May 20 – Dr. Hardee – Radiation OncologistWhen the doctor entered the room, I could have sworn he was 12 years-old.  Young or not, the dude knew his stuff. He answered every question I had with authority and knowledge and explained that I might not have to have radiation after the chemo.  Only the surgery would tell the tale along with the lymph node harvesting. Dr. Hardee is also on the Westbrook, Klimberg, Makhoul breast cancer team – MY team.

May 22 – Port Placement and MUGA ScanUAMS can be a difficult campus to navigate.  Patients must allow time to move around the WPR Cancer Institute, the Outpatient Clinic, and the Nuclear Medicine area.  After a brief workout walking from one end of WPR Cancer Center and the place for the port placement, I was ready for a shower.  After more paperwork, my name was called by Dr. McDreamy – no, really – this young resident was scrumptious, and my inner cougar made an unexpected appearance..  I told Don the procedure might not be so bad, after all.  He just rolled his eyes. Dr. McDreamy accompanied me to the procedure room, where a male RN that could have been a Vin Diesel double, big biceps and all, assisted me on the gurney.  Again, the tag-team told me every move they were making.  I didn’t really care; I was too busy looking at my medical team.  They hooked me up to the ultrasound to find the correct vein under the left collarbone (the placement is almost always on the opposite side of the cancer).  Then I hear them chattering about how they can’t see it - the vein.  NOTE:  If you have small, rolling veins, like me, just get ready.  They pull tricks out of their scrubs to assist in this, sometimes, impossible task of finding veins. And I did say TRICKS.  Nurse Diesel tilted the gurney, head down, to increase the blood flow to the neck.  It worked.  Dr. McDreamy administered the first of the locals.  Not unbearable.  He fished the line down through the vein.  Then came the port hook-up.  More local anesthesia to deaden a broader area where Dr. McDreamy and Nurse Diesel would make the incision and create a flap to hold the port.  Ummmm….this time I took my eye off the prize (Dr. M) and the local really got my attention. Once finished with that, he tugged and pulled skin to cover the round port, then stitched me up internally and used glue for the exterior.  I’m not going to lie. When that little ¾” port area “woke up,” I wanted to slap one young, beautiful resident.  It took about two days for the achy feeling to subside then my inner cougar was raring to go, again. 

MUGA Scan (same day as port placement)  This is a heart scan with contrast dye to confirm the heart can withstand the burden that can come with chemo treatment.  First, I’m pleased to tell all those who have called me a heartless bee-atch over the years, I do have a heart.  I even have a scan of it for proof.  And, it’s ticking along just fine.

May 24 – PET ScanSince I am an insulin dependent diabetic (thank you, Crider genes), this test is a little different.  Because the technicians basically inject the patient with pure, radioactive sugar, I wasn’t allowed to take my daily injection or any of the oral meds.  Needless to say, I couldn’t eat or drink anything for six hours leading to the appointment -  it was scheduled at 1 p.m. -  and my evening meal the night before was a piece of fish with broccoli – yum!!  When another cutie medical professional escorted me into the steel-doored cubicle, he immediately began looking for a vein. 

To make the job easier on the poor lab techs that cross my path these days, I automatically say:  butterfly needle and vein finder.  I learned quickly that lab techs hate to use the vein finders because they think it signifies technique inefficiency. Heck, just don’t stick me two or three times trying to find one of my little blue veins, that’s all that matters to me.  The tech was almost relieved when I suggested the vein finder.  Finally, he discovered a good vein and quickly collected a blood sample into a vial, then injected me with the radioactive sugar.  He handed me a large Styrofoam cup with a concoction in it (uh, Styrofoam isn’t “green” is it?  Shame on UAMS!).  He said it was for the PET scan contrast.  It was orange flavored.  Frankly, I was so hungry and thirsty, that I could have consumed pure lemon juice and thought it was champagne! The tech gathered all the remnants of his vein-finding debacle and hit the steel door button on the side of the wall and said he would see me in two hours.  Then, the steel door slammed shut and made the sound like you hear on cheap, public service announcements about not drinking and driving. 

Exactly two hours later, the tech opened the steel door and came for me and into the round tube I went.  The scan took about 30 minutes.  In all honesty the hardest part was going to be waiting for the results.  You see, this is the granddaddy of all the scans.  It tells where any and all cancer is located in your body.  The plan was for Dr. Makhoul to divulge the results to me immediately before the first chemo treatment on May 28.  I’m in for a long, long weekend. Hurry up chemo treatment.  Let’s get this show on the road!

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  1. Marla, a very informative recall of your trials written with the wit and honesty I expected from you! Thankfully you are in excellent hands and judging from your OBVIOUSLY hand picked staff (Vin Diesel - Dr. MCDREAMY for Gods sake - geesh) I expect a speedy and complete recovery! Keep me posted and will talk later.

  2. Thank you for showing that nothing is too big to overcome. You are a true inspiration for so many!

  3. Praying for your speedy recovery Mar. Love you. Gor, BTW I really hate you are having to go through this but UAMS IS the best and knowing you I have every confidence that You got this!

    1. Gor... I received your sweet phone message last night. Thank you for the support and encouragement. It means more to me than you know.


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