Wednesday, December 23, 2009

Physician's Report 12/23/09


Newly diagnosed metastatic breast carcinoma with bone and bone marrow metastases. The diagnosis of metastatic disease was on 10-16-09, when she was admitted to Memorial Hospital with progressive bone pain secondary to compression vertebral fracture. The tumor was estrogen receptor positive, HER-2/neu by FISH. Status post single fraction of 8 Gy of radiotherapy to the lumbar spine on 10/23/09. Treatment was initiated with paclitaxel weekly on 11/12/09, the patient had two right breast biopsies, one consistent with invasive ductal carcinoma and the other one with invasive lobular carcinoma with the largest tumor measuring 1.5 cm.

Lower back discomfort secondary to bone metastases.

Monday, December 14, 2009

Dr. Matei and Necrosis of the Jawbone

I learned early on that Dr. Matei was one tough cookie who could easily stand her ground with me.  Those of you who know me also know how important this is.  We have had several battle of the wills and here is one account of where I lost.

Dr. Carmen Matei had come very highly recommended by close friends of the family.  She was not immediately available so I had seen another doctor who helped orient me to Rocky Mountain Cancer and the fine art of cancer treatment.  It had been recommended that I take Zometa to strengthen my bones as the cancer had created an osteopenia situation.  He had carefully discussed with me the side effects which always has the ability to induce fear if you listen.  I was half listening when I distinctly heard him say Necrosis of the Jawbone which causes your teeth to fall out.  Upon hearing this I elected for the once every three month protocol.  I felt that this improved my chances of keeping my teeth.

Shortly after this I had my initial appointment with Dr. Matei who immediately put the kabosh on my ideas to avoid chemotherapy but that is a story for another day.  In December, I was in my private room with my Dad and Myra Tovey receiving my chemotherapy treatment when the nurse came in to set me up with Zometa.  (At Rocky Mountain Cancer they have a big room with lazy boy chairs for chemotherapy and they have private rooms.  If the private rooms are free and you have someone with you then you can receive your treatment there.  The big room was depressing for me as mainly older people occupy that room chatting with each other as they receive chemo.  They looked at me with such pity.  Upon discovering the private room option I never had chemo in the big room and this was such a relief).

Anyway, I informed the nurse that I was on the once every three month protocol for Zometa and she looked at me confused and stated that there were orders for the bone medicine.  I insisted that I was not having it and she said she would check.  Now if any of us had been looking at a stopwatch I swear that not two minutes would have passed before Dr. Matei came bursting into the room.  When I say bursting I mean bursting and so much so that my hands flew up in front of me in a defensive manner to ward off any impending blows. 

"You are having Zometa today and every month," she spit at me.  I rebelliously informed her that I was not as I had elected to do the once every three month protocol.  I think everyone in the room gasped at my bravado which in hindsight was pure foolhardiness but I didn't know Dr. Matei that well yet.  She then reminded me of my bony disease and her intention of having me walk and how she preferred that I walk in a straight up position instead of hunched over like a feeble old lady.  Now I couldn't argue much with that but I threw out the necrosis of the jawbone defense anyway.  She responded that this was rare and only occurred after two years of continual treatments.

She then snapped that she wanted me to live and I snapped back that I was clearly more concerned about my appearance then she was.  She was not daunted by my insolence and she explained that priority number one was that I would live, number two that I could walk and that number three was my appearance, besides, she added, "You can always get dental implants."  I wasn't getting anywhere so I said, "okay, okay I will do it."  Dr. Matei then curtly nodded at the nurse to hook me up.  The nurse was frozen in horror, as was everyone else in the room, and stumbled a bit as she tried to move into action.  Dr. Matei then turned on her heel and disappeared as quickly as she had appeared.

After the nurse left we all had a good laugh and my Dad said to me, "well I guess she told you."  I guess she did and I had a good laugh at my own expense.  Anyway the moral of the story is to be careful what you say to Carmen Matei.