Vacation Week! Woo-hoo! Except Not.

I was supposed to be off this whole week, but I screwed up my schedule and accidentally put myself in clinic on Monday. That sucked but it was only one day. Until I got violently ill the evening before. Man, it just came on out of nowhere! I had to call in sick Monday morning. This is a very rare event for me. Even after all the sick leave I’ve had to take for appointments and such, I still have nearly 22 weeks (five months!) of sick leave. Too bad we can’t get paid out for that.  

So technically I am off but not able to spend this week as I had planned.

Anyway, as I was laying there into the wee hours of Monday morning vomiting about every hour on the hour, hoping the last time would be the last time, it dawned on me that I couldn’t allow myself to get dehydrated because it would throw my labs all off, and god forbid I spend my days off in the hospital as has happened before.

So at 4:00 AM, I tried to find an urgent care with a video visit option (no way I was leaving the house). The easiest one I found was through CVS’s MinuteClinic. I’ve gone there before when our hospitals required certain tests be completed RIGHT NOW in order for them to renew our “permission” to work there (don’t get me started). You can use your insurance, or you can just pay outright; my visit was $59.00. I opted to do that because it was worth the $60 for me not to have to get up and go find my wallet and my insurance card. I scheduled an appointment for 11:00 that morning.  

I slept off and on until that time, and I’m not proud to say I didn’t even sit up for this video visit. I just felt so awful. The doc was late coming on, but I expected that. He informed me he was a board certified physician in NM; at this point, I didn’t really care. If he was the maintenance guy with good forgery skills, count me in.

I told him what was going on and that I mainly just needed a prescription for Zofran, an anti-nausea medication to prevent dehydration due to the kidney disease, blah blah blah. I actually had some Zofran but it was really old. I didn’t want to put my faith in it. And Zofran is, at least for me, very effective; it’s also completely safe to use with kidney disease (I did my googling). I was hoping he would give me 100 or so (wishful thinking) because they are good to have on hand, but I got 16, and that was fine. He asked if I thought I needed to go to the ER for hydration. Nope. Nope. Nope. Let’s get these pills on board and avoid all that nonsense. But he did say not to hesitate to go if I felt I needed to.

My very sweet and concerned mother picked up my prescription, saltine crackers, and Gatorade (the meal plan of the sick), and once I got the Zofran in my system, things were much better. Like I said, that stuff is really effective.

The worst was behind me (no pun intended) by late afternoon Monday, but man, even now two days later, I am completely wiped out. I had three appointments today, one of which was changed to a video visit by the doctor (yay).  

I had a mammogram first thing in the morning. My mother had breast cancer at the age of 47 but luckily it was caught early, and she is still kicking butt decades later with no recurrence. The technician told me an interesting thing: if you’ve had a COVID vaccine within four to six weeks of the mammogram, it can give a false-positive result because the vaccine can cause some swelling of the lymph nodes. She also said Moderna is more likely to produce a false-positive result. I had had a vaccine within four to six weeks, and yep, it was Moderna. She just wanted to reassure me not to get too freaked out if the results were wonky. Good to know, but… why didn’t they ask me this when I scheduled the test?  I could have scheduled it at a later date to avoid having to potentially go back and repeat this uncomfortable process. Hey, at least this way they can bill the insurance twice. Not that I’m cynical or anything.

Back in 2019, on the recommendation of my gynecologist, I went for genetic testing for the BRCA1 and BRCA2 genes due to my mother’s history of breast cancer, primarily since she had it at a young age. These are the genes most commonly affected in hereditary breast and ovarian cancer. The whole experience was good, although… unsettling? I’m not sure of the right word. I’m used to it now, for better or for worse, but that was the first time I was in a room full of people who likely had cancer. Yeah, it was unsettling.

I went to the UNM Comprehensive Cancer Center, which is NOT located at the main UNM Hospital. (Thank goodness! That place is chaos defined.) Everyone there was incredibly nice; again, just like at the oncology office I visit weekly, it’s obvious that they have been specifically trained in working with people who are potentially dealing with the news that they have a life-threatening illness. No one yelling “NEXT!!”  No long lines—they give you the buzzer/light things that you get at a restaurant. The chairs in the waiting room were plush and super comfortable, nice artwork on the walls; they tried to make it as homey as possible. There was even a man playing soothing acoustic guitar. I got a lovely tote bag upon check-in with lots of information in it that mostly didn’t pertain to me.

The genetic counselor at UNMH was also excellent. She explained everything very clearly, and she just also had a calm tone of voice and manner of delivering information. She started sketching out my family tree, and I saw immediately that this would be a problem. When you have a very fractured family as ours is (mostly for good reason), it’s hard to know who had what diseases. Most of my family members don’t talk to more than two other family members at most (I talk to one), so the information is very limited. But with the limited knowledge I had, there were no relatives known to have died of cancer.

She asked if I only wanted to test for the BRCA genes or if I wanted the complete panel. She said for some people it’s too overwhelming to test for everything. Totally understandable but my thinking was, “Bring it on, baby. Let’s see what I’m in for.” I ordered the whole panel.  As best as I recall, the test itself was just a saliva test, so I picked that up, completed it, and sent it off. I then returned a few weeks later to meet with the genetic counselor again to get the results. Overall, there were no overly significant concerns. There were two abnormal genetic markers, both with the caveat of “A Variant of Uncertain Significance,” meaning there’s just not enough information available about them yet. I googled them tonight since this was a couple of years ago, but they remain categorized as the same.

The first was a type of colon cancer found in about 2% of young people and more commonly in males. In those with the syndrome, they develop polyps before the age of 20 but they are at higher risk throughout their lives for many different types of cancer. (And they are often born with extra fingers and toes! Wow, I wonder what the connection is there?) Keep in mind, I have a variant of this gene, not the gene itself. But I did have a positive Cologuard test, so it’s a good thing I’ll be having a colonoscopy even if I’m the opposite of an under-20-year-old male.

The second, and potentially more concerning, abnormality is a variant of the BRCA2 gene. But again, it’s a variant, and there is sparse information available. She advised that I keep current on my mammograms, which of course I do, and consider asking my PCP if I should have them more often and consider a breast MRI. In reading up on that though, I don’t know. It says the MRIs can result in a fair number of false positives and are slightly more invasive than a regular MRI, in that a contrast dye is given through an IV. (The IV thing doesn’t concern me [please], but the false positives can lead to unnecessary tests, treatments, and biopsies.) So if anything, I think I’ll start with more frequent mammograms.

I didn’t pursue this at the time because this was right around the time I started having the kidney symptoms and was going to for appointments, tests, ultrasounds, biopsies, etc. One thing at a time! And then I kind of just forgot about it until the mammogram today. So I’ll follow up. This is a good motivator:

“The influence of BRCA1/2 VUSs [Variants of Uncertain Significance] on the cancer risk and their association with the response to treatment is uncertain… Patients with VUS should be followed up regularly with use of individualized screening and prevention strategies.”

My video visit with the endocrinologist was at 10:00. She was very pleased with the drop in my A1C since starting the Trulicity. She doesn’t want to change anything with that at present. She did say I should try to incorporate more protein into my diet. “For example, if you eat oatmeal for breakfast, try instead to switch to an egg and cheese.”

Uh, what? What is this “breakfast” of which she speaks? I’m on the road at 6:00 every morning, if not earlier. If there’s breakfast at all, it’s a protein bar. I’m surely not going to whip up eggs and cheese. But I nodded along dutifully.

The lab results showed that I have hyperthyroidism (overactive thyroid, or in my case, too much thyroid medication), so I will cut my Sunday pill in half. No big, but it might make me more tired than I already am. Maybe I won’t even notice!  Many years ago, I had significant hyperthyroidism, and it made much of my hair fall out. Right as I realized that, I had met Rose in LA for a Dodger game (and pan dulce), and I had to go buy a hat because otherwise I would have fried my noggin. It’s amazing to me how such a tiny change in that medication can affect so many things. (Did I ever mention that back in the day I wanted to be an endocrinologist?)

June will be 10 years since I’ve had my thyroid removed. She’s not particularly concerned about that anymore. I do still have a ‘suspicious lymph node’ on the right side of my neck. It’s in a place that can’t be biopsied nor removed. But luckily it has changed little over the past decade. So we’ll continue with annual neck/thyroid ultrasounds (next one in October) and bone density scans every two years.  I won’t see her for another three to four months, when we’ll repeat labs.

My next appointment wasn’t until 2:00 so initially I had some grand plans for doing a couple things around the house. Instead, of course I opted for a nap. Then I headed over to the oncology clinic. When I called to pre-register for my mammogram, they went over my insurance info and said, “We have Blue Cross/Blue Shield Federal as your primary and Oncology Copay Assistance Payment as a secondary.” I asked her if she could give me any further information on that, and she was able to give me the address, which was the same address as the oncology clinic. I asked about it when I got there but the scheduling person didn’t know much. She said it was a program that helps with payments for chemo (that part I knew) so patients don’t incur out-of-pocket costs. “So does it cover whatever the insurance doesn’t cover?” “Uh-huh,” she said. But I don’t have a ton of faith in that, by which I mean if they cover the out-of-pocket costs for all their patients getting chemo, they’re gonna go broke! Oncology is not a particularly money-making specialty. They lose money on the meds all the time. Just ask Nurse Rose!

The lab was busy today—probably one of the busiest days I can recall. I knew it was going to be a while before I was called but I had no plans. Despite my concerns about my being sick throwing off my labs, things looked relatively stable. My creatinine was 1.6, my eGFR was 37, and my hemoglobin was 10.7, so no shot needed again. While I was sitting there, I checked my FepBlue “dashboard” through the app—yep, it said that as of yesterday, I had met all my out of pocket costs, even though technically I haven’t. I’ll never understand all this. I lack the skills for much of this “adult” stuff.  

One of the nurses left about a week ago to become a traveling nurse. She was really nice; I’ll miss her. The group of four nurses they had there really seemed to work well together. The new nurse has started, and she seems really nice too. OH—get this. She has an accent, and today one of the patients asked her where she was from. “Poland,” she replied. Another patient, an older woman (it might be relevant), said, “Oh, have I got a long list of jokes for YOU!” I don’t know if the nurse heard her. If she did, she made no comment about it. But good god, how rude. Good thing to say, too, to someone who will soon be jabbing a needle in your arm, idiot. One of the other nurses said, “[Nurse] has a house in Poland that she has opened up to Ukrainian refugees.” I think that shut the old bitty up for a while.

Off the topic, I was in the customer service line at a store the other day, wearing my mask, as I do. The gentleman in front of me was not wearing a mask. Hey, no big, I’m not throwing shade, just setting the scene. He starts talking to me and completely oversharing for the reason he’s standing in line. He has the upgraded membership at the store, but he’s fallen on hard times, and needs to downgrade but he has cash back on the original membership, and he’s hoping he can use that toward the downgraded membership but if he can’t maybe they can put it on a gas credit card for him. Just on and on. I mean, take a breath. And I’m just standing there nodding, cursing the fact that I grabbed the toothbrushes that weren’t on sale and had to exchange them for those that were.

So after his loooooooong explanation of why he’s there, he says to me (again, I’m clearly wearing a mask):
“I’m sure glad they lifted that mask mandate.” [Really dude?]

“I’m not.”

“Oh, you wanted them to extend it longer?”

“Uhhh … yeah.”

He wasn’t rude about it, but buddy, learn to read the room. It was just an odd encounter.

And as usual, I’m ending on a “pup” note. This little guy celebrated his 18th birthday this past Saturday. He really is an amazing pup. He’s outlived three of our other dogs as well as countless fosters and hospice dogs who came through our doors. I’m sure when we brought a new dog home, he just thought, “Come on in. I’ll be here after you go, sucker.” Nope, he can’t see well, he can’t hear for shit, he might have a slight touch of doggie dementia, and he has cancer (shhh, we haven’t told him this), but he is a pain-free, incredibly happy dog who still pirouettes on his hind leg for dinner, runs around the house like a maniac, and makes us laugh with his crazy antics. When we had our ‘original’ crew of three dogs, I would always say that Arrow was the court jester; he’s a silly guy. He is just full of life, kibble, and personality. Of course, we don’t know how long we’ll have with him (and at his age, we could and certainly have said that without his having cancer), but he has shown no decline in his function or love of life since we got his second cancer diagnosis six weeks ago. We’ll just enjoy him for as long as we have him.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s