Monday, June 16, 2008

The Treatment (part 1)

Having spent the first 28 years of my life north of the 49th parallel, I, like many Canadians, came to believe that health care in the US was made up of pharmaceutical lobbyists, greedy insurance companies, and long lines of uninsured people being kicked out of emergency rooms because they couldn't least that's the way they portrayed it in the CBC after-school special I saw :)

Seriously though, it was a big factor for us when deciding to move to the US in the late 90s. We grew up with decent "free" health-care, so moving to a place with privatized medicine and big, bad insurance companies was something that gave us pause for thought. Our first serious experience with it came when our 1 year-old son began losing weight, vomiting 4-5 times a day and regressing in his motor skills. The doctors performed a series of tests for hearing, balance, vision etc. If the word 'cancer' doesn't make your knees drop out from under you, then the words 'brain tumor' when used in reference to your 1 year-old son surely will. All those tests turned up negative and after a few more months, we finally had a diagnosis of Celiac Disease. CD is a genetic auto-immune disease which affects as many as 1 in 122 people, most of whom go undiagnosed and spend a life of unexplained stomach/digestive problems. Because the symptoms of CD often mimic other diseases, mean time to diagnosis is 11 years. After a GI tract biopsy (the gold standard for CD diagnosis) we had our diagnosis in 4 months. The course of treatment was quite simple. Stay away from wheat, barley, rye and oats for life. Considering all the shitty hands we could have been dealt, this was an ace-high flush. 5 years later, our son is a healthy, thriving boy, and except for our references to "good-belly" (food that is gluten-free) and "boo-boo-belly" (food that contains gluten), you'd never know he has CD. I cannot say enough about the quality and timeliness of the health-care we received. From his pediatrician who initially diagnosed him to his pediatric GI specialist who treats him, we have had access to the best health-care and caring professionals the world has to offer.

We wanted to tackle Linda's breast cancer head-on, as quickly as possible, as anyone would. We were scheduled for chemo to start less than 3-weeks after her initial diagnosis. Because there was a spread to the lymph nodes, chemotherapy wasn't an option, it was a necessity. Chemo is known as a systemic therapy because it treats the whole body. Surgery and radiation are known as local therapies because they treat the affected site (her breast and lymph nodes). The only real choice we had here was the order of treatment. Surgery first, chemo second and radiation third or chemo first, then surgery followed by radiation. With the doctors help, we chose the latter because of a couple reasons.
  • There was a risk that the cancer cells had made their way past the lymph nodes and into the rest of the body. Her diagnostic scans (cat scan & bones scan) had shown the cells hadn't metastasized anywhere else but free floating cells were always a possibility. Early chemo would kill those bastards if they were out there.
  • Having chemo before surgery (known as neo-adjuvant therapy) also allows the doctors to watch the tumor and see how it responds to the drug cocktail.
With that decision made, next up was the "Power Port". Being an avid gamer, I was pretty sure this was an accessory for my XBox. Turns out it is an under-the-skin catheter that runs from the upper right chest (in Linda's case) under the collar bone and into (or near) the heart. This allows the chemo to be administered at a much quicker rate and to be diffused into the bloodstream quicker due to the proximity to the heart. A standard IV injection tends to "burn up" the veins. Nice thought eh? So just before New Years, Linda had the port "installed" at the hospital during an outpatient visit. Strangely enough they don't 'knock you out' with a proper general anesthetic, they just give you goofy gas (same stuff you get when getting your wisdom teeth out). In true Linda fashion, she managed to wake up during the surgery. Long enough to feel a burning in her chest and hear someone say "...she's awake...", then knocked back out. She has a strange knack of being in the "1%" of the "this only happens in 1% of the cases". This knack is so fine tuned that during our immigration health checkup, she actually got a mild case of German Measles from a rubella vaccine. No shit. She has her own CDC record of the event and was home-quarantined for 3 days. Some crazy odds like 1 in a million. I like to call her "patient zero".

I'm pretty sure there was some discussion about doing tequila shots in her port that New Year's Eve. We were glad to be done with 2007 and looked forward to 2008, especially Jan 2, her first cycle of chemo.

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