The Difference With A Good Doctor

This morning I had a wonderful experience having injections in my spine around T8 and T9 where I have a couple of desiccated discs. (Apparently I did something to my back in the previous years - my money is on the time I knocked the wind out of myself in front of the upper ski lodge with a deck full of skiers.) Desiccated discs are common in older adults (70+). Once again I am proving I am less healthy than most people 20 years old than me.

Today my new pain management doctor did the procedure. He was nice and talked to me first. Then he asked me during the procedure if I could feel anything and he would add more pain meds. He asked me how I was doing. He told me if I felt pressure, he would add more pain meds. Afterwards he told me it would take a few days for I to feel any improvement. And he repeated his instructions to me about changing my other medication levels.

What a difference.

My old pain management doctor never asked how I was doing. He never offered to give me more pain meds while doing injections. He would shove in the pain meds and they would BURN! Then he would push in the steroids which would cause a lot of pressure in the area. And he never talked to me about anything else.

I am very impressed with my new pain management doctor. This really show the difference between a good doctor and a bad doctor.

• A good doctor asks how you are doing during procedures
• A good doctor talks to his patients to make sure they are doing okay.
• A good doctor is concerned if his patient is uncomfortable.

When you find a good doctor, keep them.

My Achy, Achy Back

My back has been very uncooperative recently. Actually its been a real pain, or in a lot of pain. I went to my pain management doctor a while back and he said that my back has been so bad because I haven't had any interventional treatments (a/k/a needles in my back) in a while and its time for another one. That is due for this Thursday.

But in the meantime, my back is giving me lots of grief (to put it nicely). Yesterday and Friday I was walking around hunched over in pain most of the time. My husband even cooked dinner because I was in so much pain.

Last night, I got in bed before 8 PM and took a breakthrough pain pill, an arthritis Tylenol, and a sleeping pill. I didn't wake up until 8 AM and my back feels better.... but not that great. I expect it to act up later today but I am happy with a few mostly pain free hours for now.

I do not expect a massive decrease in pain after Thursday's medical misadventure, but I do expect some improvement. And future needles in my back to help with this.

So What Will It Feel Like?

Have you ever wondered what your next medical adventure really will be like? I mean how will they really feel during and afterwards? Nurses and doctors tell you things like "there may be some discomfort", or the ever popular "little pinch". Maybe you might feel "tired afterwards" or "possibly nauseous", or "a little pain" at the site that can be handled by "OTC acetaminophen or ibuprofen". But you really need prescription morphine for the pain, cant get out of bed for three days because of fatigue, or spend days running for the bathroom.

They never can tell you more, like the real truth. Bounded by HIPAA concerns or the simple fact that they have never experienced it themselves. Face it most of our medical professionals have never experienced the procedures they perform on patients. Sure they have had blood tests, injections, and more, but have they had your chemo protocol, surgery, or invasive procedure? Probably not.

Hence there is no way for them to tell you how you will feel before, during, and after, other than scared sh**less, because they really do not know.

I hate this. I have learned to research all medical procedures before I have them. I also look to friends and others who might have experienced it to find out what its like from the patient's perspective. (I am so 'healthy' my father, in his late 80s, asks if I have had any new procedure recommended for him.) I do not obsess about it but I do want a good idea of what something will be like.

I have learned some important things like do I really want to go by myself because I won't want to drive home. Or I can come close to passing out after in the knee injections. Or... the list goes on. So I have learned to ask questions and do my research.

3000th blog post

My blog post is not about numbers or volume or anything like that but recently I realized I was nearing 3000 blog posts. Today is number 3000. My blog started June 2, 2007, 3089 days or 8 years, 5 months, 14 days ago.

I set out blogging as a way to vent my feelings and keep my friends and family updated through breast cancer diagnosis and treatment, which would be a year or so and then I would return to my 'new normal'.

It didn't work out that way. Not many of my local friends or family read my blog. I am still working on that 'new normal' (and if anyone ever finds it, please let me know where it is), and my health still sucks, even though there have been no new cancer misadventures.

I still benefit from my nearly daily blogging. It allows me a way vent my feelings on my sub-par health which is really what I need. I also like to think my so called 'words of wisdom' have helped others deal with breast cancer and other not so fun medical crap.

Along the way I have also met many wonderful people online who are dealing with their own medical crap and they have become friends, although we have not nor do I think we ever will meet in person. But we are friends. And as a result I have a bunch of greatly appreciated supporters when I go through my own bumps in the health roller coaster.

I think I will keep blogging, I see no reason to stop as long as it continues to help me.

Doctor chasing

This is always a pain. You need to talk to your doctor. You contact them, they call you back and leave an ambiguous message that doesn't allay your concerns and requires further conversation. You call back and they are gone for the day. You try again the next day and talk to their office. They call back and you miss the call because you can't take the call at that nano-second because your life does not revolve around the phone. And it continues.

Finally you resolve to tether yourself to your phone, and not talk to anyone else in case the doctor calls back. Eventually you find our you are not going to drop dead but need another test or follow up so you can continue the process all over again.

Well, that's not exactly what is going on but close. I'm still waiting to call the doctor back again and am in mid-chase. My goal is to make contact today because I want an answer before the weekend. But I have meetings and am traveling.

I just want an answer. Why? Because I can be whiny and hate waiting for medical information.

The imperfect mammogram

Sometimes I start to think, which can be a dangerous proposition and something that my husband believes I should not do too frequently. One thought that has wandered through my brain is that we make assumptions about mammograms and other medical tests and procedures. I also found an article that agrees with me.

To give a little history, I had a benign fibroadenoma at the age of 23, which was three years after my thyroid cancer, and have had mammograms since then. Fibroadenomas are benign and common in younger women but can put a woman at 1.5 or 2x the risk of breast cancer later on. (A little factoid I just learned and wish I had known decades ago.)

But after decades of mammograms, and breast cancer and a later fibroadenoma at the end of chemo, I can tell you I never felt they so wonderful or perfect. My first fibroadenoma was found by me and confirmed by a mammogram (my first). My breast cancer was found by a mammogram. My second fibroadenoma was found by an MRI and grew during chemo.

There has been a lot of disagreement, false information, arguments, stories about mammograms saving lives, and more in recent years. Komen says mammograms save lives (as her sister wanted - but that's another story). The AMA, ACS, and other groups have their own opinions.

But lets take a step back, as this writer describes, and think about the real mammogram numbers and results. Some cancers are missed on mammograms. Sometimes mammograms find benign conditions. These can lead to more testing or procedures or even over treatment.

First, no medical procedure, test, surgery or whatever is perfect. There is always a margin of error. Strep tests are good 99% of the time, flu shots don't prevent all cases of the flu, any surgery could have complications. Second, as patients we make assumptions that a medical whatever is going to save us. A doctor will come along and be able to save us from whatever. They do their best but research is always on going to learn more.

Screening for cancer can save lives but none of the tests I know of are perfect. A high number on a test can be a sign of cancer but it could be caused by something else. I am all for cancer screenings but we can't rely on them completely. We need to accept that medicine is not perfect but it is all we have.

Some portions normal

Yesterday I had one of those oh-so-fun medical adventures at the hospital to follow up on some symptoms. I was chatting with the technician during the test and at the end, I asked her if I was normal (for the test results) and she said 'some of it was normal'. What that means is that the doctor has to go read it and figure out what parts of it were normal, what was due to previous known issues and what is a concern.

For once, can't I just be normal and have normal test results? I think I would need to be healthy for that.

But anyway the doctor should have the results today and if I don't hear from her by next week I can call and get them. But I can also just swing by the medical records department and pick up a copy of the results next week. (I am a big fan of the medical records department since I have learned that I can go there at any time and get test results or appointment notes whenever I want.)

[I'll provide more information on the actual test and results sometime later when I know more. And its nothing that significant.}

Lymphedema sleeve and all

Yesterday I had a (not so fun) back procedure. As my arm has been acting up, I wore my lymphedema sleeve on my left arm. I am going to the lymphedema clinic in another week or so and will keep wearing my sleeve.

But I digress. I got there and got checked in and changed into a lovely hospital gown and robe - they make them ugly so people don't steal them. The nurse took my vitals after getting me settled in a big comfy chair. Even though I was wearing my sleeve she asked if she could use my left arm for blood pressure. Really? But she did put the IV into my right arm without questions

Then when I got positioned on the table with my back (and the bright red underwear I wore on purpose) exposed for the procedure, they needed to hook up heart electrodes on my chest as well as oxygen in my nose, and blood pressure, O2 sensor, and start the IV on my left arm. A student nurse asked if all three could be done on one arm and the other nurse said yes.

The procedure went well. It should help with my back issues. It was painful to have but it should really be beneficial once it heals up. Before it, I could barely stand for ten minutes before my back started to hurt. This morning, I slept late and it didn't hurt at all until I walked downstairs to feed the cat.

I have a love-hate relationship with my sleeves. I really dislike wearing them all the time. It will start to annoy me when either the little silicone disks cause a rash on my arm or I start to get a tan line on my wrist. (Both have happened in the past.) In addition, its a reminder about cancer - sort of like wearing your heart on your sleeve, you wear a sleeve for your cancer.

My back is winning currently

I look at the current weather forecast. Another 14-20"+ of snow is forecasted for us between now and tomorrow night. And another storm on Friday and the high temperature on Saturday will be 9 above.

In addition my back is being very bad and is currently winning in the pain battle. I am having problems standing for more than 30 minutes at a time. If I am walking, I can stretch it out a bit. I just need to sit down regularly. It can also complicate things like cooking dinner and doing laundry.

I have a radiofrequency ablation scheduled for my back on April 2. I called Friday and asked to be put on the cancellation list for something sooner because my back is so bad. This is worse than its been for a long time.

The problem is I need a procedure which requires sedation and they only do a set number each day they do procedures - which is twice a week. This is why there is such a long wait. And I already had a delay last fall when my insurance company didn't approve the same procedure on my right SI joint so I have essentially been waiting since August for this.

I am feeling stuck inside. I am going to try to go to the gym. My  husband is out shoveling snow and I am doing him a favor by taking the car out so he can clear out the snow and move the other car around.

While I am working out I also run into the problem of standing and working out. I have to sit down periodically so my back stops hurting. 

So I am whining as my back is winning.

But its not cancer so I just suck it up and keep on going.

Living with medical errors

I have a picture some place of when I went for knee surgery in 2001 of me home from the hospital with a big bandage on my right knee and the word "NO" scrawled in big letters on  my right knee. This was written by the surgeon after triple confirming with me.

Then I have the memory of me after gall bladder surgery in 2008 where I heard the nurses talking about the excessive bruising on my abdomen after a laproscopic procedure. Basically I heard the doctor must have been really rough on me because of the size and speed at which the bruise arrived - and ho w long it hurt afterwards.

In the past few years the state of Massachusetts has started requiring hospitals to report medical incidents - anything from a fall, surgery problem, wrong medicine, bedsores - annually. In the past three years - 2011-2013 - the rate has risen extensively from 366 incidents to 444 to 753 in 2013. And you say 'why the increase?' How about the electronic reporting system was adopted in 2012.

This all makes me say hmmmm..... Its nice the state wants the data reported and is requiring the electronic reporting system so that things can't be swept under the rug, so to speak. But what about me as a patient?

There is all sorts of advice given but I think it goes down to your comfort level. Lets face it, errors happen in life, 'to err is human'. But as patients we need to speak up and ask questions - what will happen, what should I expect, and communicate with family members so they can ask questions.

I would like to say that of the 753 events in 2013, 282 or 37.5% were from falls. The next largest group was 230 or 30.5% were from bedsores. The leading number after that was 44 serious injury or death from medication error.
 

I'm not that standardized

Here's a new proposal. Give surgeon's a black box to help prevent medical errors, like they have in air planes.

The proposal:

"Inside the operating room, video cameras track every movement. Outside, a small computer-like device analyzes the recordings, identifying when mistakes are made and providing instant feedback to surgeons as they operate.

This is the dream of the surgical "black box." Operations could become flawless. Post-operative complications could be significantly reduced. Surgeons could review the footage to improve their technique and prep for the next big case."

The goal is so a surgeon learns of a mistake when it can be corrected and not after the fact. They get a computer assist. And more significantly they could be adopted in the US without FDA approval as they are not a device or anything.

I'm not saying that I am against improving medical errors or anything. I have myself dealt with a few mishaps in the OR but I do not think the human body is standard enough for this. Each human is unique. That's it. We are all one of a kind.

If someone wants to operate on me, I have many issues - from lack of thyroid, previous surgeries which have left scars, and more. I know they can be programmed into a computer before hand but still.  An individual human being is needed who can interpret the information and unique qualities of the body they have opened up in front of them.

I think of it this way. You are going to a strange place and you program the address into your GPS and start on your merry way. But then the GPS sends you to a road which has a detour and it recalculates around it, so you keep going. It even tells you when you are speeding to give you additional information and recalculates your arrival time. Then it forgets to tell you that the off ramp is on the left and not the right. And then there is an accident ahead so you try to get off the highway and make another detour. And then your GPS sends you down a one way street in the wrong direction.

You needed a human there to guide you to read the signs and notice the detour ahead. Or to tell you about a new problem the patient is having.

A friend had a bad colonscopy and had to have a colectomy. The surgery took much longer than expected because the doctor who removed the polyp at the colonscopy did not note correctly where it was that it happened so the surgeon had to spend quite a bit of time looking for the exact spot. What would that little black box do then? React like the robot in "Lost in Space"? 'Danger, Will Robinson, danger!' That wouldn't exactly prevent much of anything.

There is research going on with these currently in Canada with plans to test them in Canada, Denmark and South America.

But I am really not ready for them to be used on me anytime soon. I would rather have a better trained surgeon than a computer assisted surgeon operating on me.

Why do they do that?

I have a policy with myself for when to call my back pain doctor. When I get to the point of needing 2-3 breakthrough pain pills to get through the day, its time to make the call for an appointment. I have been at that point for a while and got in to see him yesterday afternoon.

My points of discussion with him were two: My right SI joint is in serious need of having its nerves killed off and my varying total back pain needs to be discussed. We don't always change my pain meds at a single appointment, we often discuss them over a few appointments before making changes.

My right SI joint (which is the long seam joint down the side of your tailbone if you are wondering) has been giving me problems for months. We have had the treatment discussion before but previously we have focused on other pain areas.

Yesterday afternoon, he  had me lie on the exam table and he moved my legs around and pressed on my hip. That hurt. Then he had me lie on my side and he pressed right on the SI joint. That was like a live wire running through me. I had to catch my breath after.

I think he realized how much it hurt and said he would send the nurse in to schedule my treatment. It took a while for me to recover from the amount of pain. I know he had to make sure he knew where the pain was coming from before heated needles to kill the nerves - because you really don't want to kill the wrong nerves.... But, yowza!

October 25 is the date for the treatment... It will be three years from the last one, which was the second one on the same place. These treatments (radiofrequency) can be repeated over and over again and each time the nerves come back, it takes longer and longer and they are weaker and weaker so the pain levels are less and less.

On a side note, my pain management doctor says I can actually take up to 8 break through pain pills a day and he considers 2-3 a day a very low dose. But my rheumatologist tells me that from her point of view, 3 should be the maximum because of convulsions. Its the different perspective from the two doctors that gets damn confusing.

Better than a sharp stick in the eye

Or whatever that saying is. This morning I am off to another medical adventure. I love these medical adventures that involve needles first thing in the morning. Well its not first thing first thing. I get breakfast first after sleeping in a little bit.

The reason I am having this is because I have a bony growth on my neck between C4 and C5. As a result I have a pain in my neck and problems with my shoulders and top half of my arms. It lines up exactly with this picture below.

I don't have pain in my arms and shoulders but they don't seem to work always and are uncomfortable. So after discovering this new issue which is life long, not curable by surgery, but only treatable for the symptoms. So I am off to have this wonderful procedure this morning.

I can't wait. It sounds like so much fun.I even watched the video after convincing myself it was okay. But then I'll lie around and be justifiably lazy for the rest of the day.

Practice makes perfect

And why its a medical practice. I have had eight surgeries and a billion medical (mis)adventures but I have NEVER asked this question of the person doing the procedure: how many times have you done this procedure? I have never asked that. And this is scary.

A couple of weeks ago I had a filling, a rather large filling to be precise, which is/was borderline for turning into a root canal. I hate the dentist. I hate the drilling and the needles and the potential pain. I am a weinie and have been know to take an ativan pre-procedure to get me through it.

The dentist and I had a big conversation as we waited for the Novocain to kick in. She said if it turned out I needed a root canal she would send me to an endodontist because she didn't do root canals any more. She told me that she said an endodontist would have me in and out  in and hour because that is what they did all day long and they were very good and had the right tools and microscopes and all sorts of fun things I didn't want to hear about it.

Doctors who do the same procedure day in and day out have a much lower rate of errors and mistakes. You really want the doctor who does the same surgery again and again. Go read that article if you don't believe me. But I think its time I start asking questions....

Stupid stomach flu or how having ailments complicates everything.

I woke up at 430 this morning running to the bathroom in one of the inglorious sprints that have happened to all of us. Eventually I returned to bed and informed my husband I was going nowhere today. And the delicate cat wanted to sit on my stomach.

My husband was concerned but went out the door and I went back to sleep until 830 where I struggled mightily to be functional and eventually called work to inform them I would not be available today. My coworker who answered the phone recommended warm flat ginger ale. That sounded very good. I did try some ginger tea but it just wasn't the same. I normally try to live on the BRAT diet when not feeling well but the tea did not sit in my stomach and I tried a tiny nibble of a banana with the same result.

Between bathroom sprints I came up with two things I needed - warm flat ginger ale and something OTC that I could take to stop my sprints - that hadn't expired in 2008 or 2009 which is what we had in the bathroom. Between dashes, I was returning to bed in my pjs.

With that decision made, the next one was 'can I really go to Walgreen's in my PJs with a fleece over them'? I made the executive decision that I wasn't THAT sick and did manage clean clothes.

Its approximately 200 yards from my front door to Walgreen's. But I drove. I stumbled around the store looking for  the digestive ailments aisle where there are two options - Immodium and Kaopectate. I tried reading the labels but there were all sorts of conflicting things on them

One said not to take without consulting a physician if you are on arthritis medications and the other said not to take if you have liver disease. I don't have liver disease but my liver numbers are closely supervised because of my other health ailments.

I went off to ask the pharmacist where I was told I can't take Kaopectate because it conflicts with my arthritis medication. And Imodium is not that good an idea because of liver issues that I can take it but the least dose possible.

One item down, I went to look for ginger ale. I checked the cold beverage section and it was full of Pepsi Cola products and Coca Cola products and a bunch of weird 'waters'. They didn't have any ginger ale. How can that be? I checked the shelves in the food and beverage section and none there either. I left astonished. Ginger ale is a healthful beverage for upset digestion systems.

Out in the parking lot, I thought where to next? The grocery store would have it but that was a whole mile and I really didn't think I want to deal with a big store. There is a smaller convenience store right up the road that might have it. If not, I was willing to bet that the liquor store had it for mixers.

The convenience store did have it. I grabbed three bottles and went to pay. $5.40 and I had no cash. The little sign said '$7.00 minimum on cards'. Crap. I thought about buying another but the owner had sympathy.

Home at last where I downed my child's portion of Imodium and opened my ginger ale to warm up and go flat during my next nap. After more naps, I am beginning to feel more human. The warm flat ginger ale seems to be staying in place.

I am exhausted. Why isn't my life ever easy?

Medical adventures continue

My life is a series of medical adventures. Somehow there is a giant gap in my calendar for the month of December (but don't tell anyone because I might jinx myself here).  But I am sure that will change before then.

Yesterday I went to one of my newer doctors for a conversation, not an exam, to discuss treatment options. I was given a choice of two courses of treatment. One was for a milder program which could take a few months to get going but has fewer long term side effects. The other choice would kick in sooner but had the potential for more side effects. I opted for option one with some steroids to start feeling better sooner.

That was a BAD choice. One of the potential side effects of the steroids is they 'may' cause sleeping problems. Yes they do. We went out last night (and saw Weird Al Yankovic - if you haven't seen him, I recommend him as it was a great show). We didn't get into bed until after 11. I was exhausted and couldn't sleep. I finally did sleep but badly. Guess what? I won't be taking the steroids again and will call my doctor on Monday.

Then I also go back to my back pain doctor for more conversations on Monday. I was supposed to wait another few weeks to see him but he actually had a cancellation for Monday. So that will be two doctor conversations on Monday.

My life really is a series of medical adventures. My calendar is dominated by doctor appointments.

The medical roller coaster goes round and round

Yesterday I went to see a new doctor, Dr. P., to see if I have rheumatoid arthritis due to all my aches and pains that never seem to go away. I have a family history of RA from my mother and maternal grandfather. I was referred there by my pain management doctor, Dr. G.

When I got there Dr P said that Dr G had put in his notes that I had myofascial pain/fibromyalgia. I said he had never mentioned fibromyalgia to me at all. At first Dr P said she would clarify that with Dr G and that it would be treated through the pain management department as I already am. By the end of the appointment Dr P said that I probably do have fibromyalgia because I have all the signs after she pushed on all sorts of places that caused pain.

Dr P was also concerned that, because of my family history and symptoms, I could have other ailments. A family history of RA does not mean I will get RA but that I am probably more prone to getting other autoimmune ailments. Dr P also said that because of my history and symptoms this wasn't going to be a one time visit but that I would get all sorts of fun tests. So I left a urine sample, went for blood word, and hand, wrist and ankle x-rays. If everything comes back negative, she will follow up with me in six months. If anything comes back positive, I will see her in three weeks for more fun and games.

On the plus side, its not cancer. On the negative side, these things don't ever really go away. But I really am a healthy person - if I keep saying this, maybe it will come true.

Dealing with test results

We all have medical tests and adventures that provide little insights into our health. Gone are the days where we are at the doctor's mercy for our results. But now with changes in legislation, both current and future, patients will be able to directly access their results.

This is good and bad. Yes there is a bad side to it. Go read this article on it and the one below it. I am all for patients getting their test results promptly. But the problem is understanding and coping with them.
Its fine to get results promptly when they are what is expected. Normal blood counts, benign biopsies, and the like. But what about when they are vague or are not as expected? And how to decipher the doctor shorthand?

This is the balance that we need to decode. When I use the word 'we' I am referring to both the patients and the medical profession. The doctor can not be expected to be able to access and review all test results and get back to the patients promptly. They would end up being buried in paperwork.

However a system needs to be developed where speed of response is included and deciphering of results made available. Part of this is the patient's responsibility. Before a test, ask the doctor and the technician when and how the results will be made available. Make sure you understand what they are trying to find out and what the options are for good and bad results.

If its your standard annual blood tests, maybe you are comfortable with not asking many questions. Or you get sent for a blood test for a possible new condition - what does a negative result mean vs. a positive result? If you have the ailment what is next? If you don't have the ailment, well great they ruled that out so what is next?

As a cancer patient, you get all sorts of wonderful medical adventures with complicated results. We need to know what they mean but we are not waiting for our results. Our cancer diagnoses gives us a special pass for speedy results. But we still need to have our little plan of action for each one. \

Speed here is essential but channels of communication need to be there so that the information can be digested and processed.

Once again I am in avoidance mode

I am not the brave patient all the time. Well not even most of the time. I have an inner wimp that comes out when faced with large crawly things, big growling dogs, and medical adventures that do not promise to be fun.

I have had tennis elbow for over a year and a half. More than 20 years ago I was told I have ulnar tunnel issues in my elbow. I also have tingling in my hand which is getting worse regardless of how much I wear my brace- all of this is in my right arm. (Which is a good thing if it was in my left arm they would not be able to do much of anything because of lymphedema.) Its not getting better after lots of watchful waiting (I hate that term) and brace wearing and exercises. Monday morning I am going to have an EMG to decide if its tennis elbow, ulnar tunnel, or carpal tunnel and basically decide how to fix this.

Have you ever had an EMG? Its not a fun test. They stick lots of needles in you and then put little electric jolts to see how your  nerves react. You don't feel the electricity - maybe a little tingling. But you do feel all the needle pricks.

I had an EMG five years ago when I was diagnosed with bursitis in my hip I got tingling in my lower left leg and foot. I had an EMG to see if there was anything bad going on and there wasn't and we weren't sure how to proceed. Then I was diagnosed with breast cancer and that was put aside for now. I still have tingling in my lower leg and foot and bursitis.

I was told to allow 1-3 hours for my EMG. I can't wait. Three hours of needles in my arm? How fun! Not. I'll suck it up and whine a bit.

Then in August I have another fun test that I am not ready to discuss yet. I am focusing on Monday's fun in an effort to avoid thinking about the next one.

Obsessing

So how much do us cancer people think about cancer? This summarizes it. Except the years are wrong. This was my life in the years surrounding 1981 and surrounding 2007.

You do see that it starts to taper down but with every cancer related appointment or medical adventure you get yanked back up to the top level. This is my life. Today, we'll just say I have a couple of cancer related appointments. How's my stress level? I thought I was camouflaging it well but have been accused of crabbiness over the past few days so maybe I am a tad stressed.

We'll see what the day's adventures bring.  First I will go to the gym to work off the fattening food I ate yesterday. Then I will get some work done before spending some quality time at the hospital. Then I get to go to a meeting if I am still sane.

There was an article recently in the field of Psycho-Oncology that talked about how the way the patient feels in terms of fatigue, symptom burden and risk perception caused the worry regarding recurrence. But I disagree. Once you have cancer, no matter how you feel, you are going to worry about recurrence. And the field of psycho-oncology? I think all oncologists should have a background in psychology to help their patients cope and improve their bedside manner.

All cancer people obsess over recurrence whether overtly or internally.