Monday, April 09, 2007

What's up, doc?

I went for my quarterly visit to see my new oncologist, Dr. G., last thursday. As you may recall I have decided to leave the doctors at my old practice and become a patient of Dr. G's after an initial meeting with him last year for a second opinion. Whereas the docs at my old practice were very gung-ho, wanting me to get frequent inspections and regular imaging in order to keep on top of my cancer, Dr. G. has a much more mellow approach. As long as I remain asymptomatic, I should not worry. No need for more PET scans; they just cost money and provide something to obsess over. Simply come in for a gross physical exam and some blood work every three months, and thats it.

This is an attitude that is much more in line with my own. So I am now a patient of Dr. G's. There are some immediate improvements. Although his office is much farther away, it is nicer. Bigger, airier, better chairs. Coffee and donuts in the morning. They are also much faster. Where before I would wait for hours in Dr. T's cramped waiting room, here I was seen almost immediately for my porta-cath maintenance, and saw Dr. G himself less than a half-hour after our sceduled appointment time -- pretty good for a doctors office these days.

So whats the bottom line? Mostly good news. Based on my blood work and physical, I am still perfectly healthy. In fact, Dr. G. doesn't even like to use the word 'cancer' to describe my condition, he prefers to simply call it a 'malignancy.'

The bad news is this: unlike Dr. T, who told me that this was not a life-threatening problem, Dr. G believes there will be an impact on my life-span. Since the lymph system is so central to the body, there is a large possiblity that it could impact (Dr G said the word 'sperad' was inappropriate and incorrect) other organs, including my lungs, heart, or brain. Based on the experiences of other patients with my type of cancer, my median life expectancy at this point is five to 15 years.

Well, oh shit. My first thought is: the lump on my back was at least four years old. So does that mean my median life expectancy is now one to 11 years? Answer: no. It seems that this particular clock starts ticking from the time of diagnosis. Of course in my case, that makes no sense. My cancer malignancy could have been diagnosed four years ago, starting my clock then, and nothing would have changed, objectively. This just shows the futility of trying to apply gross statistics to individuals, as Dr. G was at great pains to point out. In fact, since I have been malignant but asymptomatic for four years now, it means that I really do have indolent (read, 'slacker') malignancies. Plenty of his patients present tumors that look the same under a microscope ( low-grade folicular lymphomas) but who require aggresive treatment in short order. So there's still a lot of hope that I'm pretty far to the right side of the life-expectancy bell curve.


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