Tuesday, September 23, 2008

The Verdict

It seems I built a little bit of suspense for today. My apologies for this post coming a little bit later than I'd intended, but I took notes while I was with Dr. Amatruda, and gapped a few things after I went back to work -- so now I'm trying to regather my thoughts and double-check my interpretation of what I believe I heard.

As an aside, I believe I have invited Dr. Korteum, Dr. Economou, and Dr. Amatruda to visit this blog.
Perhaps they can offer comments or corrections for any of my wild-eyed assertions.

So now I'll attempt to answer the question that many have had, and which I had as well. Unfortunately, now it's my turn to pretend to be the doctor and present it from the beginning.

Good or Bad or In-Between? In-between.

I've been very pleased to be receiving test results to this point that point towards the better outcomes (oh, there I go already with doctor-speak). But further tests will yield more definite prognoses. And so I'm scheduled for another couple tests, first pursuing the 'whatever' that Dr. Korteum mentioned regarding my liver.

I am scheduled for an MRI regarding the 'whatever' that made them curious. They also did another blood draw today to accompany these results. I will revisit with Dr. Amatruda after these tests have been performed.

In The Meantime...

This is my current best paraphrasing of the conversation I had with Dr. Amatruda this afternoon.

As to further evaluation, I mentioned that already. As to surgery, there is nothing to cut off at this point (but I'm still going to try to milk the "what a pain in the neck" and "ain't no skin off my back" quips).

The Breslow's depth seems to be much more significant than my earlier "location, location, location" comment. While I believe we are currently still in the process of staging, I think the current understanding is that I'm about at "Stage II, T4b: High Risk Melanoma, 4.00 mm or greater primary w/ Ulceration" -- which, if Wikipedia can be trusted (and you know I don't fully trust them), means 40-85% survival.

Let's just say that what I retain from my discussion with Dr. Amatruda is that the basic numbers are this: 50% survival after 5-10 years. (It all seems to become a numbers game once you've started playing: that there are no definite answers, merely percentages and time frames.)


Dr. Amatruda presented his assessment and recommended to me interferon to treat it. There were actually a couple of further options to consider. But the basics I took from it, as I took notes during our discussion, is that the interferon would start with one month of receiving daily (5 days a week) injections. And then the remaining 11 months in the cycle ... well, that's where the options came in.

The options I somewhat gapped, but were regarding being a guinea pig, err, test participant, in one of two unproven medical studies underway. One was with the Mayo Clinic and the other is local, if I remember correctly. There were various specifics for each, but I failed to note them. Essentially, the blood work from today will help determine which I may be better suited for, and I kinda left it at that.

I believe I noted that the interferon treatment improves the outlook by 5-10% over the duration. I'm sure I'll be getting to know the details better over the upcoming days. As will the doctors as the tests roll in.

But For Now...

I'm feeling fine. I had an appetite return recently. I need to tone down to a near standstill with the beer I love because the interferon will require it. But I have found that Busch N/A may be a reasonable substitute for the taste of real beer. Such issues are not a big deal to me, though.

So that's about what I know. Melanoma apparently tends to return, and when it does it may not be on the skin. And when it does return, it tends to be fatal. So the outcome is generally mentioned, at least from what I have been privy to, hedged in percentages quantifying 'tends' over some specified duration.


I'm okay at the moment. It's likely I won't be that way forever. In the meantime I need to do what I can to improve my odds. But this here natural born pessimist has been saying, "some people have to make up that 18%" when I was preparing myself for the worst. My odds have only gotten better. I hope to keep it that way.

Sunday, September 21, 2008

September Football Sunday

The weather here is absolutely gaw-juss.

Slide show.

Happy Birthday Mom!

Thursday, September 18, 2008

Back to Work

Back to the grind. I went in to work as usual ... and worked.

But at least I was pleasantly reminded that today was the chili cook-off. I sampled 14 different and delicious chili recipes from folks in the office -- and voted on one that lost. But good chili is always in the taste buds of the beerholder, and alas we had no beer. The winning entry was quite good, by the way; I just prefer to add onions, cheese, sour cream, and jalepenos to mine, so I look for a "thinner" variety.

Towards the later part of the workday, my clothes were beginning to wear a bit on the bare naked wounds (as in, no bandages nor magic goo). I had left the house in haste today without bandages or the magic goo. I remedied that quickly after I got home.

So the day was much closer to "the normal" already: I gave Heather her bath (which took me a while to get all that hair back the way I try to keep it), but Angie didn't let me carry her to bed. Other than that, it's been pretty close to business as usual (with a notable exception about being wary of turning my head to the left when backing up a vehicle).

Until Tuesday I remain in a happy little holding pattern. "All is well."

Wednesday, September 17, 2008

Bandages Off

I took a break for a late lunch and picking away at the bandages. I got the neck one off first. While cleaning it up I thought it looked like I grew a gill.

The other one took a little while for me to get a good angle on. Angie had offered to take them off, but I chose to do it myself -- as well as their cleaning. I don't think she cares to touch them directly.

But I did make her put the magic goo on them, though.

Hm. Looking at the photo, it appears I have a little more cleanup to do on the big guy.

Update: Dr. Economou called just now (about 4:45) and asked if I wanted to hear the results of the pathology tests. Knowing now that 'over the phone' = 'happy results' I said "sure!" He told me that the node looked good and the surrounding skin that was excised did too.

So now all the information goes to Dr. Amatruda and on Tuesday he'll let me know where we go from here. My only remaining concern is that Dr. Kortuem had mentioned maybe something with the liver(?), and the pre-op for yesterday's work had indicated some "elevated" levels of 'liver stuff'. But at this point I'm hoping that the news will continue to come up positive.

I want to thank everybody for keeping me in their thoughts and prayers.

The Morning After

Today I'm working from home. My thoughts last night that I'd sent my co-workers (slightly edited):
Thoughts on work tomorrow:
  • Things went fine: Todays Adventure.
  • Afterwards I've been feeling okay, I just have the sore shoulder and back.
  • I would probably come in if I knew how I'd be tomorrow, but I'm still playing it by ear.
  • I haven't taken any pain meds yet, but if I need 'em one of them is vicodin.
  • So I'm kinda leaning towards WFH, in that I can work on the [work specifics], as well as the usual audio trimming.
  • Plus I can maybe call the IT folks and finally figure out the VPN.
  • Then if I do need any pain meds, I don't have to worry about the drive home.
  • Or if I need to lie down for a bit, it'd be easier to do here. (Heh.)
But basically I feel fine and would like to get some work done tomorrow, rather than lying around the house being bored.
I'm pleased to have finally gotten the VPN working (perhaps because I finally used Contivity instead of the other methods I'd confused myself into thinking were the ones to use). Some of the things I'm doing over the network are a bit pokey, but it gives me a moment or two to write this.

I'm still avoiding the pain meds; it's more 'discomfort' than 'pain'. It feels like I had skin that used to be two inches apart subcutaneously sewn together. But then again, I believe that's what happened.

So far, so good.

Tuesday, September 16, 2008

Today's Adventure

I'm returning from the hospital to report that things went okay.

The first thing they did was the search for the sentinel node. For this I got several injections of some slightly radioactive substance (not as radioactive as for the PET/CT scan) near the site of the original melanoma. After a short wait I was positioned on a machine that looked a bit like the PET/CT setup.

It took a while for them to get me adjusted to an angle that allowed them to see the sentinel node more clearly. I was on my back, on my side, at various angles in between; arm up, arm down. But they finally found a decent picture to take.

I forget which one they said it was -- I thought I'd heard suprascapular, but I think later perhaps lateral, which after looking it up sounds like it might have been a subscapular axillary node in the lateral group. But what do I know. They drew a spot on me between my neck and my shoulder.

After they finally got the good picture, the got me prepped for the surgery. I was having a bit of fun with all the questions they were asking:
Do you smoke?
Do you drink?
More than I should.
Street drugs?
Uh, no thanks.
I got in a little earlier than my 3:30 time slot, I believe. And apparently all went well and it took about an hour. Angie said that Dr. Economou told her that all went well, that the node had a little crud in it but looked pretty good. The results of the excision should be coming in a couple days.

Right now the meds are wearing off a bit, so I'm starting to figure out where things are going to hurt. From the excision, the skin in that area seems tight, but doesn't really hurt. I believe they had to do some digging for the node, so that part is probably going to be the one that will hurt most. At least that's what it seems like right now.

Sunday, September 14, 2008

A Good Time

Last night Angie got me out of the house!

We went over to a party at Noel's and had lots of good eats and drinks and laughs and fun. It was an 'eat lots of fatty foods' and drink beer and make a fire kind of thing.

We had deep fried venison, deep fried homemade onion rings, deep fried perogies, deep fried homemade corndogs, deep fried egg rolls; grilled jalepeno burgers, grilled sweet corn, grilled hot dogs, taco dip, deep fried homemade doughnuts. All kinds of yummy.

Dan and Sandy came to town to join in, and Al and Melissa were there too. Plus many of Noel's neighbors that join him far more often than I. It was a bit rainy most of the day, but it wasn't raining in the evening. Still, Noel got a bonfire going in the back, and we had many laughs (such as me cracking wise about being most afraid of hearing, "It rubs the lotion on it's skin" in reference to my upcoming excision).

Kathy* and I had some of our typical mock-fighting. Later in the day she happened to be wearing a flannel that looked quite a bit like mine. At one point she whipped it off because of something I said (like, "Where's my twin sister?" or something), and went to do something. I quietly replaced hers with mine. When she returned and put it back on she had a most quizzical look regarding the meds in the left pocket.

With all my other news being kind of a downer lately, I thought I'd share the good time I had last night to bring back some good cheer.

[*]Angie put 'Kathy' on the birthday card for her that we finally brought over (Cathy's birthday is in March).

Wednesday, September 10, 2008

Consultation With Dr. Economou

Today I met with Dr. Economou regarding my wide excision/sentinel node biopsy. I think he first explained some of the previous stuff that he'd gotten from Dr. Korteum, some of which was reassuring. The most salient tidbit was this: the depth of 5.2 mm is normally quite bad, but as with real estate, location is everything.

Since it was on my back, the skin is thicker there than, say, on the hand. This helped make the difference between being a class 5 something (through the skin) and a class 4 something (not through the skin). He was also happy to hear that the PET/CT scan was already done and was negative (which to me means positive/happy results).

He proceeded to describe the surgical procedure I will be undertaking next week on Tuesday. It starts out with by making a series of injections with some radioactive stuff in the area surrounding the initial spot that was removed. Then I go wait for a couple hours. When the waiting is done, there's another round of injections of some kind of dye, but I'll probably be under general anesthesia as the main bit begins.

The incision and such was something I was curious about, and he described it well enough for me to find a picture of how I imagine it. It would be about at a 45 degree angle on my back, starting on the lower left and angling toward the neck. But it's only taking the skin, not getting into the underlying tissue (I think because it was the class 4). So he's going to remove that football of skin and send it off to the lab and stitch me up.

Then he'll start poking around with a Geiger counter to find the sentinel node -- which I understand to be the lymph node most likely to which the melanoma drained to. Then they'll remove the sentinel node and send that off for biopsy. I may have the order wrong, but I trust he knows how to do it.

Upcoming Stuff

I'm starting to feel like Mom and Dad with the relative number of doctor's appointments I've been making lately.

Today at 2:30 is the surgical consult with Dr. Economu. Then what will be taking place on Tuesday the 16th is a sentinel lymph node biopsy.

I'm getting started with the oncology stuff with an initial consultation with Dr. Amatruda on Tuesday the 23rd. By then all of the test results should have been gathered and examined by him and then I'll know more about what future adventures I will be having.

Tuesday, September 9, 2008

Test Results

Dr. Kortuem called not long ago and told me the specifics which I vaguely recall at the moment, but the upshot is that the result of the PET/CT scan was the preferred outcome.

So now it's on to the next round of tests, which I believe include a lymph node biopsy and a wide local excision. I guess it will be Dr. Sam Economou who does this work.

Update: I've got an appointment at 2:30 tomorrow with Dr. Economou.

Monday, September 8, 2008


Today's update isn't much of one. I had the PET/CT scan, and that's about it.

I tried calling my dermatologist, Kimberly Kortuem, M.D., and the oncologist she recommeneded me to, Thomas Amatruda, MD. But by the time my 'fancy pictures' were likely ready, it was late afternoon.

So, the waiting game continues. In the meantime, I've been amusing myself with the temporary title "Radioactive Man". Since I've still got leftovers in my system, I have to do crazy things like avoid children and double-flush for 24 hours.

I believe it is this that I've got in my system:
The only other obstacle to a wider dissemination of PET-CT is the difficulty and cost of producing and transporting the radiopharmaceuticals used for PET imaging, which are usually extremely short-lived (for instance, the half life of radioactive fluor18 used to trace glucose metabolism (using fluorodeoxyglucose -- FDG) is two hours only. Its production requires a very expensive synchrotron as well as a production line for the radiopharmaceuticals.
The tech told me the half-life was 110 minutes, and they called it a radioactive sugar solution.

I really enjoyed my Culver's Bacon ButterBurger Deluxe after not having much of an appetite this past weekend. And I can still have some beers (until they tell me otherwise) while I watch the Monday Night Football season opener of the Vikings at the Packers.

The girls are watching the game at a friend's while I hang out downstairs and putz around with the computer -- the only thing extraordinary in that is that the girls usually come down and join me during the evening. Tonight has been "too quiet".

That's about all I've got for now.

Sunday, September 7, 2008

Unpleasant News

Back in May, I believe, I was feeling very lightheaded and dizzy at work, so I drove to the emergency room. I seemed to get a clean bill of health, but one of the folks examining me recommended that I get a mole on my back looked at. The dermatologist was booked for quite a while, but I finally got in and had it removed.

On Thursday I got the result of the biopsy: malignant melanoma. I believe that my Breslow's depth was 5.2 mm. On Monday I have a PET scan to determine more.

I'll try to keep everybody posted.

Update: For the curious, here is what the paperwork might look like.