The Silly Little Things Get Me Down More Than The Big Ones

When I moved to California in 1997, I passed the exam to be licensed to practice medicine and surgery, but I failed my driver's test. I had a bad case of arrogance. I thought that since I'd been driving all my adult life I didn't need to study. The exam turned out to have questions involving things like how many days you have to report to the Department of Motor Vehicles when you've sold a vehicle, how many feet from the car you have to place flashers if you've broken down on the side of the road, and what the fine is for littering on a state highway. I missed all 9 questions on the test that involved knowing an exact number of something that has nothing to do with actually driving. I survived the big horrifying ordeal of an oral and practical exam by the California Osteopathic Medical Board (6 men in suits grilling me under bright lights), but the silly little driving test brought me down.

I read the excruciatingly boring little book that the state issues with the laws and rules of the road, underlining all the topics with numerical values, and I passed the re-test a few days later.

Fast forward to last Wednesday, the day on which I had my 6-month follow-up PET scan. My bone tumors are all quieting down and only my 3rd rib, where it meets the sternum, glows in the dark, which they think is an acute injury at the area the tumor destroyed. They propose that my 3rd rib might just be injured and not metabolically active with cancer, since the other 8 or 9 bony cancerous lesions are all so quiet. I seem to have developed 2 areas of pseudoarthrosis - my sternoclavicular joint (which you read about a few weeks ago) and my right 3rd sternocostal joint. A pseudoarthrosis is the condition that ensues after something fractures or separates and heals in 2 separate pieces instead of uniting. It leaves me with "false joints" in my chest wall. This makes all upper body movements, like exercise, Continuum, yoga, dancing, hugging, carrying laundry and groceries, and sleeping challenging because my whole chest wall is so "wonky." This is one explanation for why I hurt so much.

On the CT part of the PET scan, you can see all the places where the bone metastases have left holes or bumps in the bones (sternum, ribs, clavicle, scapula, ilium, ischium, pubes). The bony architecture is altered, and in some cases quite deformed, but these areas aren't doing anything metabolically. This implies that what used to be tumor is gone. Although they say that there are probably active cancer cells in circulation, they are just not at a detectable level. They seem to be mystified at my progress, and want to attribute it to the anti-estrogen treatment. They can't quite fully embrace that all the other things I do for my health  (diet, supplements, acupuncture, exercise, meditation, love, laughter, chocolate, and much more) might have something to do with my mysterious progress.

They agree that since I'm 10 months post my last (and final) infusion of Zometa that my increased pain level is probably due to my osteoclasts starting to function again. Yay!!! I need some bony remodeling big time. I took the drug because it made sense to help stop tumor spread by inhibiting the osteoclasts, the cells that cause breakdown of bone. But in order to remodel a bone, you need to break some of it down. Now I'm able to do that again, but I'm feeling it, and it is going to feel worse before it gets better.

My tumor markers are also down and my liver and renal function are holding steady. My left kidney, however looks completely obliterated by polycystic kidney disease, which is (relatively) ok since my right one is not too bad. It would be a very sick joke indeed, if I survive Stage 4 cancer, and end up on dialysis in kidney failure. Let's just hope I don't have to face figuring out how to adapt and laugh in the face of that possibility.

In the midst of this, Steve and I decided to go to Cape Cod on Wednesday immediately after my PET scan. He is so curious about experiencing all the nooks and crannies of the east coast and seeing the places where I spent a lot of time before I knew him. He was ready for some time off and I thought it would be a great distraction to be on a road trip while waiting for the result. We set off for Massachusetts for the 6 hour drive to the cape. I showed him many of my old haunts along the way - places where I have visited friends in and around Boston, and all the places I've been on Cape Cod. He saw the pond where I first canoed, the bay in which I first embarrassed myself on a windsurf board, and the jewelry store where I had my left ear pierced in 4 places. We thought it would be great to be there pre-season while it was still quiet. It was, but (as Pee Wee Herman says, "Everybody has a big butt...") it was too early in the season to be there and fully enjoy it. It was cold and windy, and hardly any restaurants were open. After 2 days of wandering through the dunes and on the beach, we came home a day early.

It was so good to be home, because as we drove home, I realized I was coming down with a cold. Over the next 3 days it turned into a coughing. sneezing, sinus infection, sore throat, bronchitis, conjunctivitis nightmare. I had a fever for 3 days and felt like I couldn't celebrate my fabulous PET scan result because I felt like I had been run over by a truck and couldn't imagine surviving. Like the driving test, the silly little thing got me down.

It's such an interesting paradox, when being present in the moment feels so awful. I know that if I intellectually look to the future, I will get over this benign upper respiratory infection, but for the time being, I am stuck in the melodrama of feeling awful. I'm embarrassed to admit this because I know that it is a waste of precious life force to be so melodramatic about a virus, when I'm in the process of conquering cancer! Admitting this to you all helps me have a good laugh at myself and appreciate the opportunity to practice dying. I hope I don't flail this much when it's time for the real thing.