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Friday, April 14th, 2006

Consult with the Surgeon

This morning I met with the surgeon recommended by my oncologist, a Dr. Paul Goldfarb. He went through my medical and family history, and really started laying into me about my smoking. He said that I’ve dodged the bullet so far, and with my weight and smoking, plus the high cholesterol indicated by my niacin regimen, he basically told me I was going to keel over at 60, even without cancer coming back into my life. Now that I’ve had a few friends do so, plus the math – 60 is only twenty years away, and it means I’m already two thirds of the way through my life – this is starting to hit home. He recommended gradual reductions – half a pack a day for a month, then five cigarettes a day, then quitting – and I’m going to give it a try. He recommended against nicotine gum and patches on the grounds that they’re just as addictive and would only prolong the problem, and told me to use a cigarette case, filled daily, so I can’t easily cheat. He seemed impressed that I was able to take 1000 mg a day of niacin, and recommended Lipitor™; I told him I was using the flushless form, inositol hexanicotinate, and he asked where I found it. I really had to hunt for it myself – all the drug stores that I had checked out either didn’t have it, or had it in small quantities of 100 mg pills for exorbitant prices. You want to know where to find true flushless niacin, not time-release, in 500 mg pills for a reasonable price? Try the Walmart. I’ve found botttles of 60-count 500 mg capsules for less than five bucks under the Spring Valley label from Nature’s Bounty – which is cheaper than buying direct.

He also said my former surgeon, Dr. Michael McCue, had been very aggressive in my earlier treatment, much to my advantage, and I think that that had been part of the reasoning behind the “dodging the bullet” statement. My sentinel node biopsy had pulled one node out of each armpit after radioscintigraphy had indicated two sentinel nodes. The one from my left had a micrometastasis of only 0.1 mm diameter and the one from my left turned up a single cell. Initially, Dr. McCue had thought to go after only the nodes in my left armpit – removing lymph nodes from the armpit leaves you with a life-long high risk for edema, which could result in my arm swelling twice its size for up to a year, and it meant I shouldn’t have any restrictions on either arm, including short duration stuff like a tourniquet for blood-drawing or getting my blood pressure taken, and even wearing a watch was out. But during surgical boards, the consensus was to go after both sides. Good thing, too. After my bilateral axillary node dissection, I had seven nodes removed from my left, which all tested clear, and eight from my right, one of which had another micrometastasis.

So we decided to wait on getting a biopsy from the lump in my right chest until after my PET scan on Monday. He wanted the benefit of the undisturbed scan, which makes sense, and we’ll do the biopsy in the afternoon. If the lump is benign, I’ll be getting a relatively minor lumpectomy. If it’s melanoma, I’m up for getting a good chunk of my right pectoral muscle removed, and if it’s breast cancer, I’ll lose the nipple and any breast-like material above the muscle. Of course, if the PET scan reveals other metastases, the chest area might be the least of my worries. Stay tuned for Monday’s report.

Posted by Greg as Melanoma, Posts About Me at 13:53 PST

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Oh No, Not Again

To quote a bowl of petunias.

A couple of days ago, I was at work, slouched in my chair, scratching my chest, when I felt something that wasn’t supposed to be there. There was a lump in the fatty tissue over my right pectoral muscle – an area I cannot help but describe as my breast.

Normally, I wouldn’t be so concerned that this might be a metastasis of my old melanoma, because it’s not an area that I was lead to expect a metastasis would appear. I was under the impression that it would be more likely to happen in a blood-rich organ, such as the brain, lungs, liver, or so forth, and I just had a PET scan last October that said I was free of any sign of hypermetabolism. But that was six months ago, and I have a family history of breast cancer – maternal grandmother and an aunt – and a local tv personality here in San Diego just recently had a well-publicized case of male breast cancer. So I took the uncharacteristic step of actually going to see my doctor about it in less than a week.

My oncologist, Dr. Jurgen Kogler, a staid German gentleman, confirmed that there really was something there. He wants to check it out thoroughly. His words were guarded – he didn’t give any indication as to whether he thought it was more likely to be a melanoma metastasis, a completely different case of breast cancer, or merely some sort of benign growth. But his body language said differently. Normally calm and reserved, he practically paced around the examination room, and I could tell he was concerned. I got blood drawn right away, I have a consult with a surgeon tomorrow morning, and I’m scheduled for another PET scan for Monday morning.

Hopefully, this will turn out to be nothing important. My research indicates that melanoma metastasizing to the breast is very rare – I found one study of eight patients, all women, with a median time from original diagnosis to discovery of 62 months. It’s been 66 for me. And one case of it occurring in a man. So it behooves me to go through the various tests and wait for something definitive rather than worrying, but I did learned one thing – if it is melanoma, I have awfully dismal odds of living another five years.

I’ll be reporting further as I learn more.

Posted by Greg as Melanoma, Posts About Me at 00:27 PST

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