Not That I Was Worried

From: Neuro Squared

To: Me

Subject: Re: Any results yet re: paraneoplastic labs from Mayo?

Great news - they were negative!

Enjoy the weekend!?

Today's email.

Me: Just checking on paraneoplastic results. Are test results back yet?

Her: Not yet - they were mailed 5/6 at 5 pm from Mayo. Check back with me Monday or Tuesday.

Tick tock.

Sure, I Can Wait

Dr. NeuroSquared's reply to my email this morning:

The paraneoplastic panel is still pending. It will take a few weeks at least. We send it to Mayo. Call or email me in a few weeks if you have heard nothing. The MRA of the neck was normal. No evidence of subclavian abnormality. I will mail you the report.

MRA was done yesterday (Sunday morning - IV and hospital at 7 am - and how was YOUR weekend?) to look for vascular abnormalities in the brain, which would have been an explanation for the cognitive problems. Cerebral-vascular problems would restrict blood flow, thereby impairing vision and function. I was actually hoping something would show up on that, since vascular problems can be fixed with medicine or surgery.

The paraneoplastic panel is the "you are toast" test ... (and UNFIXABLE) ... so NO rush on those~! Take your time, Mayo! It is not like I am waiting to know!

And husband, I suggest that you do not look at the AmEx bill for the next few weeks and just consider the on-line shopping a medical expense. I am positive that new shoes are a valid tax deduction. Alternative medicine? Medical devices? Supportive therapy?

Any accountant friends gonna back me up here?

Is There A Fundraising Walk For That?

My world is heavy these days and appears to be getting no lighter in the near future. This past week I was evaluated by a rheumutalogist *(that is probably spelled wrong but my spellcheck will not provide me with another spelling, so be it...), an ophthalmologist, an endocrinologist, one neurosurgeon, had a phone consult with a neurologist who specializes in seizures, had an emergency brain MRI, more labs that NIH probably handles in a busy month and capped off the week on Friday with the neurocognitive neurologist appointment. Herein out for the sake of typing efficiency, the double-neuro will be Dr. NeuroSquared. By the way, what is with my Friday afternoons these days? A far cry from pretending to stress about exams while enjoying dime beers at the Balcony. (I refuse to call it Top of the Stairs. End of Discussion.)

I have only about ten ounces of blood left in my body after the vampire nurses have had their way, and for someone who never adopted a street drug habit, am sporting some mighty impressive track marks. Anemia nonwithstanding, I managed to purchase an Easter basket for Ethan. And by Easter basket, I mean, of course, an Easter wicker hamper ... this thing is stuffed with enough toys and candy to keep a brood the size of the Jolie-Pitts busy for most of spring. Overcompensate with material things to make up for Sick Mommy Guilt Syndrome? Me? Never!

First, let me say, I have wonderful wonderful friends. Thank you so much for all the phone calls and emails and flowers (love the flowers!). Again, I am so sorry I am not getting back to anyone these days ... what with the bloodletting, the appointments, and all the sleeping in the between appointments and bloodletting ... well, there you go ... that has been the past couple weeks. I have not been getting back to anyone - not just you - I promise. Even though I have been a terrible correspondent in recent weeks, I so very much appreciate all of your kind words and thoughts and prayers. Please keep 'em coming.

I have a theory that there are three kinds of sick. There is Annoying Sick, this is the kind of illness otherwise healthy people get, the kind where you complain to friends on Facebook about how you have to take Sudafed and watch Oprah all day. There is Lifetime Movie Channel Sick, this is some sort of life-altering, even life-threatening, diagnosis that warrants enough drama to be interesting and heart-wrenching enough for a two-hour movie (maybe watched while one is Annoying Sick). LMCS requires the patient "fighting" and being "courageous" and having family and friends rally around them through treatment. There is usually some sort of walk for this type of thing. And then there is Scary Sick. Scary Sick is where you are actually jealous of LMCS people, which is, in a word, sick. I am sad to report I may be Scary Sick.

The good news is that the tumor appears stable! The bad news is ... read on ...

The dreaded appointment was to review the results of my neurocognitive assessment. I was referred to Dr. NeuroSquared, after the neurosurgeon at Hopkins noted my self-reported memory and cognition problems. The neurosurgeons' recommendation was to see this "specialized" neurologist to get a baseline cognitive function exam and see if she could shed light on why I was having reported cognitive difficulty (he did not think my brain tumor was causing those issues but could not tell me what else could be). The cognitive exams included neurological assessment and detailed cognitive function testing, which included, among other things, evaluation of memory, executive function, and fine motor skills.

I walked out of the testing feeling ill, knowing my results would be awful. I could not recall ANYTHING. I was shown a figure and then asked to draw it from memory and could not. I was given a list of fifteen words and asked to repeat them back and could not. I had to put pegs in a grooved pegboard with each hand and had the fine motor skills of a one-hundred-year old (testing showed me at the 2.3% percentile for this). I did not know the time or the date or who the President before Obama was (that one might be selective memory blockage - sorry Republicans.)

While I had been lamenting to Jeff for months and months that I cannot remember anything and was getting worse, he claimed that he did not notice. I knew, though, but chalked it up to the tumor in my brain. Most logical people would. Even if they were telling me I was having no impairment effects from the tumor, it seemed obvious to me that there were memory issues, and I underplayed how bad they were, thinking the thing in my brain explained them away, that since I had not walked out of the house wearing just underwear (*yet), I was probably still OK.

It seems insane to me, in retrospect, that Jeff did not notice I was such having substantial memory impairment. He sees me every day - but he claims not to have noticed. I think in his defense, I have always been more than a little attention impaired - LOOK SOMETHING SHINY! - Wait, what was I saying??

Yes, attention: I have on more than one occasion neglected to put my car in park and it rolled into something (on the way to a graduation celebration, that "something" was a lake), I have left the house with two different shoes - one brown, one black, different heel heights - and headed to work (to the amusement of my then-secretary), I am terrible with names and if I say, "Hey YOU! It is so good to see YOU ... so good! ... YOU, there .... have you met my husband ... Jeff, this is that PERSON I was telling you about ... ?", it should be clear to you that in my mind you are Whats-Her-Face-That-Lady-With-The-Weird-Cat-That-Walks-On-A-Lease. Or whatever.

That has always been me. Spacey, yes. Dumb, no. Though, admittedly, sometimes it is hard to differentiate between the two, so I get how maybe he would not notice.

But, attention and cognitive skills involving memory and recall; the two are different animals. Despite the car-rolling footwear-ignorant name-forgetting, in the past, I have always had a virtually photographic visual memory. If I read it once or twice, it will be stored somewhere (and I read everything). School was always easy for me. Scratch that, school was always easy for me, except for law school, which is only easy for genetic freaks (Hello! to one-half of my Facebook friends and former Law Review Editors - I meant "genetic freak" in the nicest possible way!) or people disinterested enough not to care (Hello! to other half of those Facebook friends!). Point being, I always tested well, for what that was worth, and this fact was due largely to a better-than-average ability to recall.

My husband can attest that in the past, I had been blessed (?) with the ability to remember conversations verbatim and all corresponding details. This skill has proved useful in court, once or twice, but more often than not, serves no purpose in any sort of real-world context. Most marriage counselors would agree that no good will come of interrogating your husband about arguments you had a decade ago -- even if you KNOW you are right AND he still has not apologized (*just saying' J).

Poor Jeff has endured far too many conversations like this over the years:

You sir, are INCORRECT. What you actually said - seven years ago today - was that you thought Mary Sue Misckey was extremely ATTRACTIVE and you might date her if we were not dating, but we WERE dating, so you would not, but then you said if we had an open policy about dating, maybe you consider it. And then you ordered the Oysters Rockefeller and dropped your napkin on the floor by accident and then you asked Joe, our server, for another napkin, and then I said "Whatever!" and stomped off to the bathroom and the bathroom had sage-colored walls - no, no, more of a celery, really - and I looked in my Louis Vuitton (knock-off) bag and discovered I had left my Orchid Passion Madness lipgloss at home and so I returned to the table and we ordered entrees - filet for you, sea bass for me, I substituted the potato gratin for the roasted tomato - and your filet was undercooked, but tender. HOW DO YOU NOT REMEMBER THAT?!

I think if you marry a lawyer - especially a female one with tendencies toward the neurotic (all part of my charm) - you are on notice that such conversations will happen. That is my way of making a blanket apology for all such past conversations, without really apologizing. Hmm. So I M attempting humor because if I dwell too long on the real subject of this, I do not know how I will keep putting one foot in front of the other. Have you ever had an experience so bad that you do not dare let yourself start crying because you are afraid you will not be able to stop once you start? That is where I am right now. Jokes, no tears. Because the breakdown - once it comes - will be epic - and I just not ready for that. Not right now.

So, back to two Fridays ago ... I had the testing done and was told by the tech that the report would be ready for me on Monday. I was also told if this highly-specialized neurologist wanted to see me, she would call and bring me in (she only sees four patients a month). If not, then the report would be sent to my neurosurgeon and he could review the results with me.

Dr. NeuroSquared called the day after testing and I was on high alert. Red Flag Number One: She wants to see me. This meant I passed the threshold Objectively Screwed Up Enough To Be Medically Interesting cut. Red Flag Number Two: She refused to send me the report ahead of time, telling me "we had to review it in her office." Famous last words.

The testing proved mild cognitive impairment/dysfunction. What does this mean?

This is from NIH's publications website: Mild cognitive impairment. (from International Psychogeriatric Association Expert Conference on mild cognitive impairment). Mild cognitive impairment is a syndrome defined as cognitive decline greater than expected for an individual's age and education level but that does not interfere notably with activities of daily life. Prevalence in population-based epidemiological studies ranges from 3% to 19% in adults older than 65 years. Some people with mild cognitive impairment seem to remain stable or return to normal over time, but more than half progress to dementia within 5 years.

As explained to me, despite the name, "mild" cognitive impairment for my age, level of education, and former occupation (I am not practicing right now and have handed off all my cases on an emergency basis), is not considered a "mild" finding. Given those factors - as explained to me - my memory and executive function are *way* below what should be expected. My test results might be acceptable in the context of a 90-year old with a GED, but as applied to me - age and education-wise - they are considered pathological.

Upon further review of the research, I discovered that the medical literature indicates clinically-defined mild cognitive impairment "should not interfere with daily activities of independent, unassisted living", such things as the ability to "purchase things at the grocery store" or "balance a checkbook." Because I went to law school to ensure I would still be able to pick out a cantaloupe on my own and, even, select the right bill out of my wallet to pay for it. In my early thirties. WITH NOBODY ELSE'S HELP.

So what does Dr. NeuroSquared think is the cause of this dementia lite at the age of 33? What about all the other stuff? All the abnormal labs, breast issues, visual problems, thyroid, debilitating fatigue? She has reviewed all of the test results, scans, labs, and consults with other specialists and has a working differential diagnosis:

Parneoplastic neurological syndrome

An exceedingly rare, irreversible and rapidly fatal progressive neurodegenerative disease. There is no treatment or cure for the disease.

Sweet. Mother. Of. God.

An Introduction to Paraneoplastic Neurological Disorders

http://www.paraneoplastic.org/

What are paraneoplastic neurological disorders? Paraneoplastic neurological disorders (PND's) are autoimmune diseases that occur in response to the presence of cancer somewhere in the body. The cancer cells in paraneoplastic patients express proteins which are normally only made in the brain. These proteins cause the body's immune system to produce antibodies in an attempt to suppress the cancer. Unfortunately, these same antibodies can trigger an autoimmune attack on the brain and the body's neurological systems. Doctors are not yet sure why the immune system reacts the way it does in some patients with cancer, but not in others.

What types of cancers are most commonly associated with paraneoplastic disorders? Breast, ovarian and lung tumors are the most common cancers to be associated with PND's. However, cases of paraneoplastic neurological disorders have also been found in patients with other forms of cancer, including lymphomas, testicular cancer, childhood brain tumors and cancer of the larynx. In about two-thirds of patients, the neurological symptoms of PNDs begin before cancer is found.

Is cancer always found in paraneoplastic patients? No. It is entirely possible to have the neurological symptoms and antibodies associated with a PND and not have any identifiable cancer. Some doctors theorize that this is because the proteins associated with PNDs act as a natural anti-tumor weapon, thus preventing the cancer from growing large enough to be found.

Are there different types of paraneoplastic neurological disorders? Yes. There are a number of different antibodies and autoimmune reactions that are classified as PND's. The most common PND's include Paraneoplastic Cerebellar Degeneration (PCD), Opsoclonus-Myoclonus Syndrome (OMS), Eaton-Lambert Syndrome, and Paraneoplastic Limbic Encephalitis (PLE). There are others as well. Symptoms and treatment options can vary depending on the type of PND and the underlying auto bodies involved.

What are the most common initial symptoms? Difficulty with walking, balance, or speech; hand tremors; memory and mood disturbances; lack of coordination; weakness. These symptoms may begin suddenly or may be gradual.

How are PNDs diagnosed? For the most common paraneoplastic syndromes, diagnosis is usually made by a blood test which looks for common antibodies associated with the syndromes. In more difficult cases, however, PET scans, spinal taps, and other diagnostic methods may be used.

What is the life expectancy for someone who has been diagnosed with a paraneoplastic disorder? It is impossible to give an average life expectancy for paraneoplastic patients. Many variables can affect how long a patient with PND will survive including their age, the type of underlying cancer, the type of PND, the success of cancer treatments, and other pre-existing health conditions. Several small scale research studies have indicated an average life expectancy of between two and three years. Although the International Paraneoplastic Association does not keep formal records, we have noted a wide variety in the life spans of the hundreds of paraneoplastic patients who have contacted us. Some patients deteriorate very quickly and pass away within months of the beginning of neurological symptoms. Others live for 3, 4, or 5 years. We have been in touch with paraneoplastic patients who survived for 10 years or more, and have at least one report of a paraneoplastic patient who lived for 35 years after neurological symptoms began.

Do paraneoplastic patients ever fully recover? Very rarely. Of the hundreds of patients who have been in touch with the IPA, we know of only two patients who fully recovered after successful cancer treatment. However, many patients find they stabilize with proper treatment and may even show some small but gradual improvement over a period of months. Early treatment before severe neurological damage occurs is key.

Do all paraneoplastic patients end up in nursing homes? No. While many patients will need some form of assisted care, many manage to remain at home with the assistance of loved ones.

So here is what I know: 1) The doctor suspects I have it, she is testing for it, but she needs to put all the pieces together before she can diagnose it. Blood, LP, many more tests in coming weeks. 2) I am almost 100% certain that if I DO have it, it is not due to testicular cancer.

Paraneoplastic assay labs tomorrow, done at Hopkins (7 am - nothing like a blood draw before sunrise). The blood will be sent to Mayo for analysis, then an EMG where they will try to stimulate a seizure (I have been instructed to stay up all night - apparently, tired brains seize better).

Later this week, another brain scan to look at blood vessels and a lumbar puncture. These doctors have *really* have wanted to puncture that lumbar of mine for awhile now, and I think there is no getting around this one. The LP will look for "inflammation and floating cancer cells in spinal fluid." I also need to pursue the breast biopsy, the thyroid biopsy, lymph node biopsy, thymus studies - maybe dermatology too - to try to determine if there is some occult cause (meaning, hidden, not witch doctor) of underlying cancer triggering the neuroimmune response.

I plan to do all of that at Hopkins because 1) It is close to where I live and 2) To do all tests together makes it easier to triage what needs to be done first, and for all the doctors to share results as they come in. As you would imagine, a lot of specialists are involved. (A tip for anyone reading because they are having their own medical problems: A one-stop major medical center makes it easier logistically).

I am really hoping she is wrong, a differential diagnosis is not definitive, obviously. But I cannot deny the fact that doctors do not think lightly about telling a patient that a horrifying and fatal disease is "of concern" to them. I am still with it enough to recognize, beyond the mere humanity aspect of such a thing, is the fact that they risk getting sued if they are wrong. (And I really hope she is wrong.)

I debated not posting this because I do not know if this is what I have and it seems too early to panic. I need to get the blood back and the LP test results before I will know ... but the blood turnaround time for these highly sensitive tests at Mayo is 21 BUSINESS DAYS. I realized I cannot keep my mouth shut about something of this proportion for that long. And when people ask how I am doing, the answer is somewhat more complex than "fine!"

PS To those very close to me, please please please stop telling me "not to worry." I know you are only trying to reassure me, but when the doctor with a 79-page CV who *only* does this type of crazy rare complex disorder tells you this is what she *is looking for* and orders 50,000 more scary, invasive tests and super-expensive tests to try to confirm it, worry is permitted. My Worry Is Hereby Noted, on the record. Big Worry. Lots of Worry. No matter what you say. Unless you somehow want to pony up a sample of your own spinal fluid for me to offer up to the lab, then I will worry less. Until then, my Big Worry will be ongoing until I get some test results to the contrary. Then I will go back to worrying about normal stuff, which I do well. For example, if things were "normal", I would be worrying about how the root part of my hair is now almost as long as the blonde part and how my eyebrows have not been waxed in so long that they look like they are eating my forehead.

PS (Last time - cross my heart, hope to ... no WAIT, not that) Reflecting back on the appointment, I asked the doctor about my driving. Can I drive again? Here was her response: "You can drive. It is in your best interest to stay as active and maintain your normal life, as much as you possibility can ... while you are still able to do so ..." The impact of that statement did not really hit me at the time, but now .... typing it ... ? Drs. do not say that to patients they think will be OK? More worry.

Alright, according to my research, there are only about ten doctors or medical centers that "do" cases of PNS - Hopkins being one - and Dr. NeuroSquared is the expert there. I am hoping she is wrong and was having an off day when I was in. I'll do all the tests and go from there. Right now I am just trying to keep breathing AND trying to avoid looking at these crazy eyebrows and black roots in the mirror.

Rock, Paper, Scissors

First breast surgeon (Hopkins): You need surgery! Might be cancer! Line-up surgery in next two weeks.

Second breast surgeon (GBMC): No surgery! No cancer! Come back in three months.

Who to go with? Third opinion?

Six month MRI is in two weeks. I will follow up with Surgeon #1 after that and hope they tell me to go home (after declaring that "they" are real and, also, spectacular).

Happy Boob Day!

Packing the brain away for a few more months. I have told it to stay in its room and play nicely with the other organs. I do not want to hear a peep from upstairs until Fall. Got that? I have not updated recent brain developments, need to get on that! Am now moving down the torso to other body parts currently in need of a good spanking and a time-out.

To recap: At the end of November, I saw a breast surgeon for evaluation of a lump and chronic breast pain. Surgery - specifically, a ductal excision - was recommended at that time. All appropriate tests had been run and it could not be determined whether the lump was benign or not without surgery and pathology on the abnormal tissue.

One presurgical consult test conducted was the ductogram - which I cannot talk about, to this day, without feeling slightly dizzy. If you have to have one, it hurts less than labor but more than ... almost anything else. The nurse actually winced slightly as she read me the informed consent about where catheters go and then patted my back afterward and told me, "This is the worst thing we do here!"

A bit of unsolicited personal advice from the trenches: It is not wise to consume cream of crab soup the day of a painful medical procedure. True - cream of crab soup is satisfying and delicious and soothing, especially with cornbread! - but there is an appropriate time and place for such a meal. Because when you throw up on the resident who is holding your hand during said painful medical procedure, she will NOT be pleased that you opted for this particular Maryland delicacy.

The surgeon's estimation about odds of breast cancer, based on this lump, symptoms, and family history were "low" - about 15 - 20% - but "of concern." The surgery recommended is not a small procedure, more like a mini-mascetomy than a traditional biopsy, in that more tissue would need to be removed because the abnormal tissue is deep within the ducts. Given the invasive nature of the surgery, I asked if I could punt for awhile and explained the brain thing (Her candid take: "Well, good you know that this is not an aggressive brain tumor, because you'd be dead by now!" A comment I found - oddly - refreshing. The last PA I saw cried when I told him, which was not an approach I found helpful).

When asked about surgical alternatives, she said she could also recommend a conservative approach and line me up for another MRI scan in a few months to reevaluate (any of this sound familiar?). Even if it is breast cancer, breast cancer is "slow-growing" and this conservative approach would "not be inappropriate" given the size of the lump.

I told Jeff back in November that I did not want to go through breast surgery if I also needed major brain surgery within a month or two. That would be like a corporation spending time and resources pressing charges against the petty cash guy in accounting who has "borrowed" an extra hundred dollars, while ignoring the fact that the CEO is embezzling millions and forging documents to the SEC.

So I shelved this for a few months and now it is Boob Day, round TWO! No cream of crab soup for me. But maybe, martini/(s) later with a side of buttery nipple/(s) (pun intended).

The Patient Patient

Eight doctors appointments, three separate trips to three different hospitals, an ambulance ride and one MRI in seven days.

Oh, and one Xanax. Cannot forget that Xanax. I was stressing about my MRI and my mom offered me the last of hers to take at the hospital "as long as I promised not to waste it." Which I did not. That is love right there. Thanks Ma!

So my driving privileges are not yet reinstated and I still have no answers. Other than my (extensive) list of doctor visits, I have not really left the house in eight days. EIGHT days. Wait, that is not true, my dad drove me to Filene's Basement this weekend so I could buy some slippers. Which was FABULOUS. Also because I was a good girl and did not cry for the IV, Jeff took me out for french toast after my MRI ... but I don't really recall all that much from the experience because I was still Zanny'ed up (Thanks, AR, for my new favorite nickname).

So the neurosurgeon from Hopkins called my cell this morning before 7 a.m. and I missed the call. I MISSED THE CALL because I was asleep still and my phone was downstairs. And what super-over-achieving doctor calls before 7 a.m.? Ethan does not even get up until 7 a.m. I treasure my sleep (apparently more than my brain scan results).

I called back soon thereafter but he had already left for the O.R. At about 4 p.m., I called back again and spoke to the neurosurgeon's assistant. She told me he was STILL in the O.R. (what the hell is going on in there - a head transplant?), so unfortunately, he would likely have to get back to me tomorrow.

When I sounded panicked and told her I had been in the hospital and could not see well, she honestly, did not sound that impressed by my plight. She did concede that she could email him and leave him a note to follow-up with me tonight, if at all possible. I then realized that assistants in this field are not all that impressed when patients complain about being a big mess and worrying about something life-threatening because ALL of their patients are a big mess and worrying about something life-threatening. Take a number.

So I spent all day waiting by the phone to hear the results for naught. Except when I was eating cookies. Or calling my husband to report that nobody has called me yet. Or calling back three minutes later to report still no call. Or now, one hour later. Or pacing back and forth in front of the bathroom because I did not want to take a pee break in case the phone rang. Or eating more cookies. Or doing a little light stalking on Facebook. Other than that, I sat by the phone and waited patiently.

I felt like the neurosurgical equivalent of the classic He's Just Not That Into You woman. I was one step away from calling all my friends and whining, "Why? Why didn't he call!? He SAID he would call! Should I call him? NO! ... No? Are you sure? ... Maybe he lost my number? ... Maybe I should email him? .... No? ... I mean, I guess he IS busy at work ... Right? RIGHT!?" and then putting on slutty patent leather boots (you know the kind) and going out to get trashed on cosmos and multiple buttery nipple shots. (Shout out K and L). After which I would call him anyway, slurring, "I thought I meant something to you! Or do you say that to ALL the girls with intraventricular tumors and potential hydrocephalus?" And his wife would hang up on me and then block my phone number.

But before it got to that point, I asked nicely and requested that maybe if the surgeon got a break, he could call me tonight. Ya know, if he got bored of his 12-hour surgery and wanted to wash that cerebellum off his hands and get a snack or something. It's OK - I don't mind if he talks with his mouth full - I was, in fact, raised in a barn! Or if he was busy, he could even just send me an email with either ( - : or ) - ; in the subject line. All I need.

The assistant DID tell me that the MRI had been read by the radiologist and she had the report on her desk. Of course, she could not tell me what it says. I have to talk to the surgeon about that. Hmm. I briefly debated calling Hopkins MRI to fax me the report but I have been down that road before and I, personally, recommend never ever reading your own radiology report before you talk to a doctor. Sometimes it is better than it sounds and Wikipedia will do you no favors on this front. You will spend an obsessive night (or nights) convinced you have four hours to live. Or maybe that is just me.

Alright this entire post makes me sound INSANE (- r, than usual), but what can I say? I am a little frayed around the edges right now. And if the shoe ... or slutty boot ... fits ....

Now if you will kindly excuse me, I hear some cookies calling my name.

Getting My Ducts In A Row

So, I took almost two weeks off. A health siesta.

I did not make a single phone call to even one doctor and sat around eating mayonnaise from the jar with a spoon and drinking absinthe spiked with aspartame-laden Kool-Aid while I chain-smoked cigars. I am very glad I did.

What was supposed to be an hour-long "second look ultrasound" appointment last Friday turned into one of those four-hour-long ordeals where multiple doctors march in and out while I lay prone on a table shivering in a paper napkin and flipping through a stained 1987 copy of Time magazine. Never had one of those? Trust me, they are crazy fun.

Jeff hung around in the holding tank of the aggressively PINK waiting room because no men were allowed back past the double doors into the inner sanctum that is The Breast Center. When I finally emerged, he asked what it was like back there, with the hint of awe and wonder that most men feel when confronted with an image of A BREAST (or, even, the word). A continuously-looping DVD demonstrating how to do a proper self-exam played for hours while he waited and I think he was at sensory overload.

I told him it was just like Key West in April, but with fewer tan lines and more sagging and grey hair. He then asked what a mammogram felt like. I told him when we got home he could remove his pants and I would do my best to replicate the feeling using equivalently-tender gender-specific organs and my two heaviest books from law school. The questions stopped there.

The general agreement among the whispering breast guys (and they were all guys, this struck me as a bit ironic given the no-male sign on the double doors) is that there is "something" in a duct. Confetti? An underwear gnome? A lost sock from the dryer? Your guess is as good as mine.

I am scheduled bright and early tomorrow morning for a repulsive-sounding procedure that involves threading a catheter into a place catheters ought not to go (one hint: it rhymes with "whipple"). Yeah.

I did my own research on-line about how this procedure may feel. "Mild discomfort" is what I uncovered; which, I have learned by now is medical site jargon for, Jesus God and Mary!! HOLD ON TO YOUR F$#%*$G HAT!!

Will keep you posted. If nothing else, I expect this will be good blog material.

The Girls - Update

LIFE HAS BEEN CRAZY. Here I go with the caps again. In real life, I tend to speak in ALL CAPS punctuated by wild gestures which have been known to send objects within a three-foot radius flying (watching myself on video can be painful). One of my best friends banned me from red wine at her wedding reception for this reason. She wisely realized that the equation of wild hands + Merlot + white silk gown = potential unpleasant outcome.

As for this latest medical blip, I think it will probably be fine. The odds of me having breast cancer at my age are pretty low. But since my body seems to enjoy flashing the Big Middle Finger to medical statistics - with this one in two million brain thing! - it is certainly not something to ignore.

I saw the nurse practitioner at Hopkins Breast Center on Monday. She was not sure. So the Breast Cancer Tumor Board (bet that is one wild bunch!) reviewed the films. I just heard back that they would like me to come in for a "second look ultrasound" next week and then plan a course of action. Right now, the jury is out on whether to biopsy or not.

The mass is very, very small (@ 5 mm) so if it is something bad ... breast cancer at an early stage is usually treatable, so that is positive. The surgeons do not seem overly worried. I have experienced a "worried" doctor before and hope never to again. Last year when I got THE brain scan reports my then-neurologist cancelled her medical school lecture and all her other patients so she could get me into her office, the day before Thanksgiving. She also gave me her home and cell numbers during the appointment - it was at that moment that I realized, "Oh my, this cannot be good ..." Before I ever knew the rest of the grim facts, I found that singular act alarming.

At this point, I am viewing this latest medical blip as more of a hassle than something to stress intensely about. Not to minimize breast cancer; it is a terrible disease. I lost an aunt to breast cancer just a few years ago. I recognize it is serious - I mean, it is cancer. But I think once you find out that something is wrong with your brain, problems with other areas of the body - even serious ones - seem manageable. It may sound odd, but I am almost relieved that there may be a medical problem that I can actually DO SOMETHING about. Biopsy? Hell ya! Cut that lump outta there! It is a much better place for a Type A individual to be mentally than the watch-and-wait tumor approach.

Speaking of As ... I told Jeff that if I do need replacements, he should be prepared for me to go full-out with the double Ds (for some reason, he did not seem displeased by this prospect). I have always wondered what it would be like to be part of the traffic-stopping cleavage club. Might as well have big loud ta-tas to go with the rest of my ALL CAPS persona.

Back To The Drawing Board...

I saw a new GP yesterday, which might prove to be a mistake. My old GP was fine, I suppose. My only complaint about him is that he is young; he graduated med school the same year that I graduated law school. And while I am perfectly competent to handle a divorce or adoption or breach of contract dispute; I can even show up in court in a dark, serious suit and say most of the right things in mostly the right order, if you showed up in my office with capital murder charges, I'd refer you out. Same concept applies in medicine, in my mind. The young GP has handled my sprained ankles and mild anemia just fine, but given that my recent medical history has been - shall we say, a bit checkered? - I decided to find someone, going forward, who has kicked a few more medical tires.

The reason for my appointment is that I needed to get my permission slip signed. I dragged a friend of mine (one of the other preschool moms) to a fundraising meeting with me and somehow ended up signing up for a half-marathon to raise money for cancer. As a precaution, all participants have to have their docs sign off on a form that says, in pertinent part, "If [Patient X's] heart explodes during the training or the race, I will not sue you."

First of all, my new doctor's name - without divulging new doctor's privacy, I'll just say he has a designer last name. Let's call him Dr. Dolce & Gabbana. My husband saw his business card sitting on the coffee table (where all important filing goes in our house) and burst out laughing, "The name of your new doctor is DOLCE & GABBANA!?"

This is amusing to him because I am a card-carrying snob. I like my shoes from Italy, my water from Fiji, and my men from Sweden. (Alright, the water part is a stretch, I really don't have a preference about water. Though I did recently buy a case of water from said tropical island simply because of the lovely photos on the label and gosh darn if it does not make me happy to look at while hydrating.) The part about Italy and Sweden, however, is true.

I show up for my appointment and the first sign that this is not going to go well is the scrimmage with the nurse. She calls me back and hands me the sample cup (know in Florida as "dat der cup you take a TANKLE in!"). I politely decline and tell her, "No thank you." And then she says, firmly, "Just try." This goes back and forth for a few more seconds before she gives up and writes something mysterious in my chart, likely something along the lines of "Patient refuses to pee. Use extra sharp needles as punishment for non-compliance."

Then there is the blood. (Let me digress for a moment: Why are only the MIDDLE of those medical tables covered with the paper? Why do the sides not also deserve their own covering? It seems to me that it is only logical that most of the patient ick would spill over onto the sides of the table, and not stay neatly ensconced in the middle? Just a thought.) So I settle myself squarely on the middle of the paper, trying my best not to lop over on to the sides, where all the germs lie in wait, beside themselves with excitement at the chance to infect me with my 200th cold of the winter, when I see out of the corner of my eye - to my horror - that Nurse Tinkle is removing scary rubber tubing and vials out of the cabinet! Using my superlative powers of deduction, I say, "You draw BLOOD in the room, RIGHT NOW, before I even see Doctor Dolce & Gabbana? What if he does not want any blood samples?"

"Oh, he'll want blood. Arm please."

I protested that I have been known to pass out and really really needed to lie down and really, couldn't I just see the doctor first before we made this rash decision? She was unmoved by my plight. When I reported that, "It hurt!" she informed me, not overly warmly, "Well, there is a needle in your arm."

As I am recovering from this battery, Doctor Dolce & Gabbana enters the room. His shoes did not match his bag, in case you were wondering. I hand him my three-inch stack of medical records and then tell him I am just here so I can get my form signed so I can enter a half-marathon. He looks me up and down: "Are you a runner?"

"Nope, it is for fundraising - not really much of a runner."

Flipping through my chart: "A half-marathon is a long way ..." And then more than a tad derisively, "Oh, I see, an attorney. One of those overachievers .... " I bite my tongue and do not point out that all the doctors I know are WAY more overachiever-ish than the lawyers. But, I keep quiet, because after the extra-sharp needles, I do not want to know what else he has up his sleeve for the difficult patients.

We go through the basics. Let me tell you, if you want to get your new doctor's attention and fast, tell him or her that you have a brain mass. But that it is really nothing. And no, you have not had a biopsy to "label it" because it is really nothing. Oh, and you haven't gotten around to seeking a second opinion yet because your husband travels a lot for work and you have not wanted to go alone and it IS REALLY NOTHING!

I left the appointment in tears. Not only did he NOT sign my form (apparently, I also have an "odd" heart murmur which needs a scan and my heart may, in fact, be in danger of exploding during distance running. Since I can only deal with one major organ falling apart at one time, heart takes a back seat for the time being. I bet Jeff is PISSED right now that he did not sign up for the extended warranty wife plan when we got married - at this rate, there is a good chance our new dishwasher will outlast me), BUT Dr. Dolce insisted that I see a second neurosurgeon immediately, if not sooner. In fact, Dr. Dolce was about to call from his office to set up the appointment for me to ensure that I did it RIGHT NOW.

He explained that because the mass is in my ventricle, even if it is benign and non-cancerous, even if it is not growing, even if it is congenital and has always been there, there was a good chance that at some point, it would impede my flow of cerebral spinal fluid and cause blindness and brain hemorrhage. So, it would need to come out before that happened.

He also told me that I was very pale and correctly assumed that I did not spend much time outside (Duh? It is February!?), so I was probably lacking in Vitamin D. I was warned that if I did not take a supplement now, "my bones would rot ... someday." Now I am not a medical professional, but since my brain is in danger of bleeding, my heart may be failing and I am in desperate need of either a Caribbean vacation or a serious slather with some self-tanner, rotting bones in the far-off future seems like kind of a minor thing to nitpick about.

After my appointment with Dr. Dolce, I did what any reasonable person would do and went to Trader Joe's to pick up some lobster bisque and multiple artichoke products - pesto (no nuts, of course), tapenade, dip, and marinated hearts. My love of the artichoke knows no bounds.

In case anyone is still reading, my appointment with Hotshot Neurosurgeon # 2 is this Friday. Will keep you posted.

Well-Groomed

I am trying to compile an executive summary of tests/etc for my appointment tomorrow. All this medical nonsense started last summer, when out of the blue I was having problems with motor skills, like walking up the steps and picking up things and I just started to feel icky, all the time. I also had some speech issues. Once in court, I was called to the bench because I slurred my speech and the judge inquired whether I had been drinking. That, of course, was a ridiculous question. It was 9 am - I mean, I am a professional, it is absurd to think I would drink before a morning court appearance. Every good attorney knows the rule that cocktails are for NOON or later ... So, I started going to the doctor (to address the odd symptoms, not the drinking problem).

I started with my internist; conclusion: I was "stressed, working full-time, and a mom." Hmm ... is that diagnosis in the Mayo book? Then I saw a rheumatologist (Fibromyalgia? Lupus?). Then I saw a neurologist (infection? Lyme Disease? Myasthenia Gravis? MS?). I have complied quite the volume of medical records in the past year or so ... which I am now trying to put together and highlight, in pertinent part, for the "new guy."

If you have never had the pleasure of reading through your medical records, I highly recommend it as a fun activity for a rainy day. I never knew I was under such scrutiny when I went to the doctor. Some highlights:

"Patient is a pleasant 31-year old woman" [Well - that is nice!] "Patient is mother to a 3-old son, who has food allergies and asthma." [Ok - true.] The notes continue, "Patient works 60-70 hours per week, occasionally more if preparing for trial. Patient admits to a poor diet, infrequent exercise, excessive caffeine consumption, and occasionally heavy social drinking." Wow. He left out the part about how, "Patient enjoys littering in public places, as a hobby. Patient does not recycle, donate to charity or serve food to homeless people on holidays. Patient also admits to clubbing baby seals for recreation on weekends."

Here is another good, if perplexing, clinical note:

"Patient is extremely well-groomed." WTH? I cannot recall any special "doctor" preparations - did I have a fresh mani/pedi, a good hair day, a bikini wax in the shape of a unicorn?

And my favorite:

"Patient is well-nourished." Ok - well - that is a bit harsh. I suppose it is time to renew that gym membership.

Now - if you'll excuse me - I am off to lose 10 lbs, get my highlights touched up and kick my coffee/wine habit before my appt tomorrow.....