Persistent Postoperative Changes? What the 5FU Does That Mean?

From: The Astonishing FartMan
Sent: Tuesday, May 24, 2011 9:07 PM
To: ZoomberGirl
Subject: Re: I Started a Blog

Hey ZoomberGirl,

You are such a good sport for so graciously and for so long tolerating the all the nonsense I had posted in the comments section of your blog. I guess I needed an outlet, but me and my alter ego doing our own blog probably makes more sense (or more nonsense), doncha think?

I will hoist a large glass when they disconnect you permanently from that port-o-pump.

I’m doing okay (thanks for asking) and hope you are, too. Got myself CT Scanned Friday, and this morning my onc (who is not my uncle) sent me a vague email describing the results. Man, I thought we lawyers were the ones who were supposed to be purposefully vague, but when it comes to conjuring up a dark cloud of disconcerting obscurity, my onc’s email surpassed anything I could ever achieve. In case you don’t believe me, here’s the reply, verbatim, he emailed me when I asked him what was in my CT scan report:

From: Dr. B___________
Sent: Tuesday, May 24, 2011 8:08 AM
To: The Astonishing FartMan
Cc: M__________

The CT looks pretty good. There are some (what looks like) persistent postoperative changes around the liver and some tiny, stable, indeterminate lung nodules. Nothing else to do to evaluate these. We should check another CEA and CT in 3 months. Please call [my assistant] M____ to schedule these.

M____: can you please order a CBC, CMP, CEA, and CT C/A/P for Mr. W____ to be done at the end of August, with an appt with me the Monday after these tests?

Dr. B_________

Pretty good???? Persistent postoperative changes???? Indeterminate lung nodules???? What the 5FU am I supposed to make of that?!?!?!

So I spent several hours this morning frantically googling “persistent post-operative changes” and “stable, indeterminate lung nodules.” Finally, I gave up and emailed my onc (who is not my uncle) a list of stupid layman questions, the first of which was: “Based on what’s in the CT scan, does it look like there is 'probably' or 'certainly' cancer still in me? Or does it look like there is 'probably not' or 'certainly not' cancer still in me?”

Three email exchanges later, the good Dr. B______ finally got around to writing, in a rather offhand manner, there is “no evidence of cancer by CT” scan. Geez, doc, couldn’t you please have just told me that three heart attacks ago!?!?!

If you are curious, my first reply to my onc's email is reproduced below my signature. As you might surmise from the slightly snarky tone of that reply, I’m sometimes a difficult patient, but at least I keep it interesting, which is good, I guess, because, as you well know, cancer can be awfully boring . . . unless you happen to have it yourself.

BTW: You had mentioned on your blog something about getting your port-o-cath removed once you are done with chemo. My onc (who is not my uncle) told me today that he wants me and my alter ego to leave ours in for at least a year, in case we have a recurrence. The thing is, now that I’m off chemo, I’d like to feel normal for at least a little while, but can’t feel normal with that dern port bulging under my collarbone. I might have them take it out anyway, ‘cause I don’t want no more chemo!

To avoid closing on a sour note, let me tell you that I’m really enjoying your blog. I think you are cutting deeper and deeper every day, and I know how that can hurt . . . but it’s worth it.

And to close on a humorous, obnoxious, and inapposite note, here’s a picture of a binfull of Teddy Bears, which my alter ego shot with his phone cam when he and his wife and daughter and I were at a super kitschy souvenir shop in Las Vegas last summer. (Please note the silly, clever, obnoxious, and perfect title I’ve given it.)

From the smiles on all their faces, it sure looks like they’re having a good time. (I am soooooo bad!)

You Go ZoomberGirl!

Yours truly,
The Astonishing FartMan

P.S. Here's my email replying to my onc's vague report about my CT Scan. Doncha like the snarky tone?

From: The Astonishing FartMan
Sent: Tuesday, May 24, 2011 12:17 PM
To: Dr. B______
Cc: M_____
Subject: Re: What Is the Plan for W_____ Going Forward?

Dear Dr. B______,

Could you ask M___ to please post the CT Scan report in my online records so I can read it for myself?

As a lawyer (fond of equivocating parentheticals), I appreciate the vagueness of the words “(what looks like) persistent post-operative changes” and “some tiny, stable, inderterminate lung nodules.”

But as an ordinary human being, I’m stymied.

And I would rather not wait until the end of August to understand all this better.

While I can accept uncertainties so far as they really are uncertain, and can understand that no further evaluation is possible right now, can’t someone explain better what is meant by “persistent post-operative changes around the liver” and “indeterminate lung nodules?” (I hope you know that I want to know the boundaries of the uncertainties as well as all the facts.)

Some questions, ranked in order of stupidity, with my stupidest question first:

1. Based on what’s in the scan, does it look like there is “probably” or" “certainly” cancer still in me? Or does it look like there is “probably not” or “certainly not” cancer still in me? (I know this is a stupid question, but if I could get you on the witness stand under oath, I would not let you go until you answered “probably,” “certainly,” “probably not,” or “certainly not.”)

2. What kind of “persistent post-operative changes?” My smarty-pants wife is wondering aloud whether you might be leaving open even the possibility that a tiny fairyland giraffe has grown up and established its permanent residence around my liver? When we say “persistent post-operative changes,” are we talking about cancer, or something else? I can telll you that, four months after the liver surgery and two weeks after my last-scheduled chemo, the area around the liver still hurts most of the time, and I still tire very, very easily. Are those symptoms, perhaps, probably, or certainly, the result of “persistent postoperative changes,” such that I will have to learn to live with persistent pain and the fatigue? Should I be doing something (diet, exercise?) to ameliorate the “persistent postoperative changes,” whatever the heck they are?

3. What about the lung nodules? Were they discernable in previous scans or are they something new in this scan? If the nodules were apparent in previous scans (as seems to be the case from what is reported in those older scan reports), why had you not mentioned them before, or is there something different now that makes you mention them now?

4. Is it reasonable for me to get my port removed now? If not, why not?

5. Should we explore taking me off the blood-pressure meds (Amlodipine 5 mg) now that I’m not on the Avastin?

Thanks, Dr. B____, for taking such good care of me these many months. I think you are a very fine doctor, and otherwise a very good man. Sorry for being such a PitA, and sorry for the stupid questions, but those are the only kind I know how to ask.

Yours truly,
The Astonishing FartMan

So, do you think my onc (who is not my uncle) is gonna wanna ditch me?

Later,
T.A. FartMan