Friday, November 27, 2009

Ciao, Cancer Chatter

I'm thinking this will be my last Cancer post till I move. The movers come one week from yesterday and I haven't packed a single thing. If I had a TV in my closet that would help; my closet, as you can imagine is one staggeringly intimidating behemoth.

Yes, I'm leaving Miami for good, but I'll have to be back once a month for check-ups and tune-ups. I've got Melnick, Schwartz, Chad, Rosenbaum, Mesko, my Yogis and my friends to come back to. In the meantime, I'll be on sabbatical based in Jax but doing Miami, Atlanta, Savannah and New York in December alone. And the last week in January I will crash with Brother and Savvy in their Chelsea pad while I skitter around uptown trying to find a suitable domicile for Wally and me.

Okay, following is part III of my transcript from my last checkup with Schwartz. Hope everyone had something to be thankful for yesterday. Moreover, I hope everyone gets some fabulous deals today on Black Friday.

Int., Schwartz's office for one-month on meds checkup:

Mom asks about dissecting the large node to determine if we are on the right treatment protocol. If at some point that might provide more information. Helloooo—TMFI already.

Here's the really super part:

"So long-term treatment protocol for me, if this is working . . . Am I on these drugs indefinitely?" "Yes." "For the rest of my life?" "Yes."

(And people wonder why I cannot envision myself having a normal future.)

"Unless something replaces these treatments."

"When it recurs, well . . . Will I ever technically be in remission again? Could I be?"

"Yeah, you could be in remission but that doesn't mean your 'cured.'"

"Even if I'm in remission I would take the pills still . . . What's the big mark? Isn't there like a five-year [Cancer-free] mark?" "In Breast Cancer, no. The numbers are very misleading." Translation: We're never safe. Five years doesn't mean shit.
I have to tell you guys that out of all my myriad Cancer friends, most of whom are well under 40, all but two have recurred.

(Exasperated.) "Every one of my young friends except for two—it's already come back. All under 35."

* * *
I ask him about Obama Care and what it will mean for oncologists.

"Our biggest issue hasn't been related to Obama. Our biggest issue is access. There's just a lot of people who can't see us. If you don't have insurance you can't be treated. the drugs are too expensive. [Each chemotherapy session in a hospital runs up to 10k I believe.] Medicare is fine. Medicare with Medicaid is fine. Just Medicaid, which is basically for young people—"

"I didn't know young people had Medicaid."

"Medicaid is basically for young people without money. They [Medicaid] don't pay for this," he gestures around the office and at me, "the doctors get paid, but the drugs don't get paid for. So you basically can't treat somebody who doesn't have insurance."

So they die. Hence, in my not very humble opinion, the soaring Cancer death rates. As the poor get poorer, the death tolls climb.

"Lemme ask you, cause a lot of my readers—oh, I have a book out, I forgot to bring you—the whole mammogram under 40 debate. Not even that, but are mammograms like, does insurance not cover mammograms for women under 40? Why do some people I know not want to get them because of insurance?"

"It's not really an insurance issue. It's more the guidelines, the 40 issue. Different groups have different guidelines. Some groups even say start at 50."

This transcript is a month before the media pounced on the screening at 50 mammo story.

"Did you see Norton on World News smacking down that [fucking asshole] head of the ACS who came out against early screening?"

"No, I read the story in the Times though."

I love having a doctor who reads the Times instead of watching Disney [ABC] News, even though I have my issues with the Times as well.

"I know [Dr.] Laura Esserman though. A breast surgeon in San Francisco whose paper has brought out all the [age issues] to re-examine the role of mammograms."

"Is she against early screening?"

Emphatically, "No. She's not against early detection. She's actually a really great doctor, but the data she collected didn't necessarily show the benefits of early detection—"

Mom: "Mmmmmh."

"And then it was misinterpreted. It basically shows that there are groups of women that detecting the tumor early, they're not cured because of that."

"Norton said in the Times story something like 24 percent of women who do go through early detection—it saves their lives or whatever. But this is what I don't get: What is the harm in having a mammogram?"

"The 'harm,' is this. You can end up having biopsies for a lot of benign diseases. That's one 'harm'—that's an inconvenience [not harmful]. So that's the minor harm is the inconvenience and the anxiety of repeated biopsies. The bigger concern, which is very difficult to prove, is there are probably some [women with] breast cancers who are better off never being diagnosed. That the on takes care of on its own."

A la prostate Cancer. When Prostate Ca shows up in old men, doctors often advise against treating it. I think something like 80 percent of men get Prostate Ca at some point in their lives, but only a sliver die from it.

"Really? That's what they're finding out now."

"It's not surprising. It's the same case with prostate. There are tumors that in effect will never affect—"

"But NOT high-grade, infiltrating Breast Ca like I [and my friends] have?"

"Exactly. But you can make an argument not to do mammograms on women over 75."

"But young people like me—"

"It's a different story. This doesn't apply to you, but it may apply to your readership."

Lol, I doubt many of you are over 75.

"My best friend is a radiology resident and he says what they're taught is 40. Is it 35 only for high-risk people?"

"Well . . ."

"You would say 35?"

"What I tell people [note how he said people, not patients] when they ask is for women to get a baseline mammogram in their 30s and then again [if everything is Kosher with the baseline] again at 40. Unless they have a family history."

"Which most people I know do. Mainly cause I hang with all Jews."

(If you girls have a family history, are in your 30s and haven't had a mammogram yet, well, you fucking piss me off if you want to know the truth. I've badgered several readers into getting mammograms. Nearly 10 of you now. Not one of them has found it 'harmful' in any way.)

Back to my case.

Mom: "So, basically it's kind of like treating a chronic disease."

"Exactly. And it's going to get more like that. [Thanks to all the cutting-edge treatments, including the PARP inhibitors. Google it if you are BRCA+ or think you may be.]

"What I tell my friends is that it's like the HIV cocktail you're on to prevent full-blown AIDS."

"It's going to get more like that. We're hoping it's not that far off."

"Well the Tykerb is new . . ." Jeez, what a cliched photo on that Web site.

"And there's a HER II vaccine. A lot is happening."

Indeed it is. Jesus I have so much to do and I'm still sitting in bed typing this. Ta. Fuck, I hate moving.

This is another one of Laura's awesome photos. Un-retouched (sorry L.) but I wanted to show you cause you can see all my scars. Yep, that's all of them. The only thing beneath the Yarmulkes are two perfect man-made mounts of mock mammaries.