Saturday, September 28, 2013


2013 September 

Too Much in a Short Time

There have been multiple events that have had the effect of overwhelming me both very recently, and over the last several months. I want to share, because I think part of the centering process for me, is in sharing.

There is the ongoing circumstance of my Dad and his cancer diagnosis and prognosis. After spending about five months in Pittsburgh after Daddy's surgery, unrelated to the cancer, and the cancer diagnosis, we spent eight weeks traveling before returning to the area on September 19.

One reason for the return to Pittsburgh was my Dad's 88th birthday. Another, was a series of doctor's appointments and procedures that I wanted to accomplish before heading south for the winter. And, additionally, it was time to have the difficult conversations with Daddy regarding his wishes regarding end of life issues. 

All of this has been emotionally draining. Add to that, the fact that I have been diligently trying to reduce my dependence of Prozac to treat my depressive symptoms for the last year, and I seem to have hit an emotional wall. In fact, I hit that wall and began to slide down it. The fact that I was also ingesting a hormone as part of the treatment of hyper estrogen production, contributed to my emotional fragility, too. And that hormone was making me extremely emotional and skewed my already impaired perceptions.

The breaking point seemed to come about three weeks ago. My thought processes became very dark. I recognized the shift enough to reach out via text message to my former therapist, requesting an appointment when we arrived in Pittsburgh. I am grateful that her cell number hadn't changed, and that I kept that number. I am also grateful that I knew that if I made an appointment to see her, it would help me hang on until we got back in the Pittsburgh area.

All of that is related to the emotional aspects of my life. Then there are the physical aspects.

We arrived in the Pittsburgh area in September 19. The morning of the 20th, I had an appointment for a uterine biopsy. Still feeling very depressed, and anxious, I was overreactive when the OB-Gyn was, as usual, running behind schedule. Our interaction was less than pleasant, especially when I was emphatic about NEVER taking progesterone ever again. I left his office angry and unsatisfied with regard to the state of my estrogen/uterine health, and awaiting biopsy results. 

The following Monday, I had three doctor's appointments. First was my PCP, for an annual check up, for which I had already had blood work done. Because she is a caring and thorough doctor, she is also notorious for running behind schedule, and because I love her, I forgive her. It is also why, if possible, I try to schedule to be her first appointment of the day. I arrived at 7:50, for my 8AM appointment. At 8:20, I was getting extremely nervous and agitated, as my next appointment was at 8:45, one floor above. I set the timer on my phone to go off with enough time to get up the stairwell and to the next appointment on time. When my Dr. entered the room, I held up the phone, showing her the timer and announced that she had six minutes. To her credit, she took one look at me and asked, "Are you thinking of harming yourself?"  I immediately broke down, sobbing. Her ability to cut to the chase when necessary is another reason I love her. We discussed, (quickly), my Prozac dosage, my upcoming therapy appointment, the results of my blood work, and my Dad's situation. When my alarm went off, she told me to take the emergency door, so as not to be late for my urology appointment, and to come back later to pay my co-pay and pick up prescriptions. 

By the time I made it into the Urologist's office, only one minute late, I was feeling like maybe the world wasn't collapsing in on me, and that maybe, if I increased my Prozac, even temporarily, I might find my way out into daylight again.

My urologist is another doctor whom I love. I am completely comfortable with him. When he entered the room, he asked if I had any questions. I told him my only question was the date of my last bladder tumor and if it was long enough ago, could I move to yearly cystos. He said that he had wondered that very thing himself, and checked my records. Turned out my last "new" tumor had been in August 2009, so barring any developments, I could move to yearly checks of my bladder. As he was doing the procedure, I was chatting with the nurse, so I was unprepared when Dr. Traub said, " We may have jinxed ourselves. There is a new growth at the top of your bladder wall that we need to remove."  While I do love Dr. Traub, I was looking forward to seeing him once a year. Now, suddenly, I knew I was back to the every three month schedule, and it felt like the low point in my day. The good news was that because he is aware of our lifestyle, he went above and beyond to schedule the removal (fulgeration) later the same week. 

When I finished with the urologist, I had thirty minutes before my next and final appointment of the day at the Orthopedic surgeon's. I went and paid my PCP and picked up paperwork. If I had eaten, I would've gone and had some follow up blood work done, but since I hadn't and Dr. Ebbert clearly stated this was "non-fasting", I put it off for another day.

At the Orthopedist's office, I got taken back to an exam room right at 10. Things were looking up again, since my appointment was for 10. Little did I know… Dr. Smith arrived in the exam room around 10:15, which wasn't too bad. He was much more engaging than on my previous visit. He showed me my MRI and explained all that was happening in my cervical spine, little of which was good. We discussed my initial positive response to Medrol and the return of my symptoms after seven weeks. We discussed my symptoms and the probability of their progression. He tested my arm strength, which shortly thereafter induced more symptoms. He told me that I was "on the surgery track." This was NOT something I had expected to hear. He also said that surgery wasn't necessary immediately, but would be in the near future. I asked about cortisone injections. He explained that he generally doesn't like to inject necks, but that, in any case, mine was not a single area problem, but rather, a three tier problem. That means that my cervical spine isn't just screwed up in one area, but in three! (Just typing that makes me want to cry.) 

I told him that I had gotten the cervical traction kit and he suggested I also get a soft cervical collar to wear at night, in hopes of making sleeping easier. We discussed the possibility of anti-inflammatory drugs. But all of these are short term, stop gap measures, until I decide to have him cut my neck. 

He explained the procedure, too. A small incision would be made in my left anterior neck. My trachea and esophagus would be moved to the right, while my carotid artery and large neck muscle would be moved to the left, allowing a clear plane for the surgeon. He would then chip away the bone which is causing pressure on the nerve that passes through it, in several areas. Then cadaver bone would be placed, essentially as a spacer. And this comes with all the "normal" surgical risks, in addition to the additional risks involved with spinal surgery. As to the cadaver bone, it is used because to use bone from one's own hip is extremely painful, and, I am assured, cadaver bone works just as well. 

To say I was overwhelmed would be a gross understatement!

I did ask if I could wait until spring for the surgery. Dr. Smith said I could, if my symptoms allowed, and revisited the progression I might experience. I explained that we have a rental commitment in Florida for the winter. His response, is still puzzling to me. He said, " Well, if you wait until February for the surgery, I'll need to re-evaluate you in January."  In what universe is February, spring? Anyway, what he meant was that if I put the surgery off for longer that 90 days, the insurance company will require him to re-evaluate me prior to the scheduling process. To be honest, I still haven't quite wrapped my brain around all the logistics involved when I schedule the surgery. But, more about that later. 

That was all on Monday. Monday night, I did increase my Prozac dosage as suggested by Dr. Ebbert. Tuesday, I had an appointment with my former therapist, Lisa. Wednesday, I bought a soft cervical collar, which produced my first good night's sleep in several weeks. I also tried to fill a prescription for anti-inflammatories, but ran into an insurance snag. Still trying to get that sorted. On Thursday, I had my fulgeration of my "new" tumor, and Dr. Traub graciously has allowed me to either have my next cyst in March, or, if I come back sooner for the neck surgery, he'll see me sooner.

I am feeling brighter, thanks to increased Prozac. So, the emotional strains are getting under control. The physical strains? Well, that remains to be seen.

Today is Saturday. Monday my brother, Vinny and I will take our Dad for his oncology recheck. Perhaps the emotional strains will be tested further. 

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