Friday, May 30, 2014

Oncology Visit

Today was my appointment with the oncologist at the University of Colorado, in Aurora. When I was told that I would be meeting with Dr. William Robinson, his name meant nothing to me but Linda recalled working with a doctor by that name at the cancer center in Williamsport. Linda worked there, doing PRN (as needed) nursing before we went on the road. Turns out that this Dr. Robinson didn’t work in Williamsport but his son, also an oncologist, currently works in Chambersburg, PA, where Linda B is from. How weird is that ! We chatted about a whole bunch of things after that. He was born in Breckenridge (where we are currently staying) and he told us how his dad was part of the mining crew that created all the huge piles of gravel and stone that you see along the river as you drive towards Breckenridge. He asked if we’ve tried panning for gold in those stone piles and that there are also a lot of red stones that you’d find there. I can’t remember the name of the stone but it was a fun chat regardless.
He was a super nice guy and we were so impressed with the whole experience and all of the staff. First off, no fussing about where to park or having to hoof it to get to the correct building. You pull up in front and they have free valet parking. You get out in front of your building and give them the keys to your car and go to your appointment. We were about 20 minutes early by the time we got to the Oncology dept. but we probably didn’t wait more than five minutes and we were taken in. After a couple minutes in the exam room, Dr. Robinson stopped in and introduced himself, asked if we needed anything and said that he would return in 5-8 minutes. I don’t think we waited more than 5 minutes for any of the services we needed to get. We were really impressed with the level of service and the courteous staff !
We learned some interesting information about melanoma today. According to Dr. Robinson, you get melanoma when you are a youngster and your skin is growing and stretching, etc. and you are exposed to high doses of sun and get burnt. With multiple exposures like this, the scene is really set for a later onset of melanoma. The fact that I had basal cell is a strong indicator that I could get melanoma at a later time (I was never told this with my basal cell). I had been told that if my basal cell came back (which is not common since basal cell does not spread in the body like melanoma does), it would likely be near the original site. Constant exposure to sun can lead to squamous cell carcinoma, which again is not a spreading cancer, but another form of skin cancer. He asked me a lot of questions about occupation, childhood and ethnic background, which is a big pre-disposer to whether someone gets melanoma. He said brown haired, northern European descent people are at higher risk. He also talked about northern European people (I’m PA Dutch – German as far as I know) having webbed toes and I thought he was joking but then he said to the resident who was working with him, “see how her little toe is more connected to the one next to it”….Before you start getting visions of a mermaid or something fishy, I don’t have webbed feet. LOL Can’t swim….don’t especially care for the water so no marine mammal connection there. Bottom line is if you have young kids, grandkids, etc., make sure you get a good SPF lotion on them before they are outside for any length of time. All kids have recess or outside time at school, so put it on them before they get dressed in the morning. It’s no wonder that melanoma numbers are skyrocketing, when you think about my age group and our lack of sunscreen growing up. Let’s give the next generation a better chance with this deadly disease. Too many young people are getting melanoma and it’s something they will have to be checked for the rest of their lives. Once you get it, it’s not going to go away. You have to be vigilant and keep an eye out for new spots or problems.
Dr. Robinson checked me all over my body for another primary site and none were found. I had a chest x-ray done and blood work drawn (6 tubes). Some are for a bunch of tests he wants to run and some is for a research project I volunteered to participate in. Dr. Robinson is trying to identify markers for melanoma since no blood tests exist that can detect it. He will use participants blood and tissue (from when I have surgery) to see if he can find correlations that will help detect melanoma early. He checked (with his hands) my liver, kidneys and lymph nodes in my neck and armpits and did not detect any lumps or growths. He said that if melanoma spreads, it typically goes to the liver, kidneys, brain, or lymph nodes.
The next phase is surgery next Friday. I will have a pre-op meeting, with the surgeon (not Dr. Robinson) next Thursday and surgery will be at 1:30 on Friday. They will inject a radioactive tracer and follow it to see where it goes and thensurgical site dye will be put in, near where the biopsy was done. The dye will be followed through the lymph system to see if the dye shows up in any nodes. If it does, they will remove any node that is colored by the dye. He said years ago they used to remove all the lymph nodes but they’ve learned that it’s stupid to do that and they don’t do it anymore. They only take out the ones affected. If the melanoma is found in the lymph nodes, then there will be more scans and such because that means the melanoma has spread. The spot at the bottom of this picture is where the punch biopsy was done and where melanoma was found. That is 6 mm across in size. The mitosis rate, from the pathology report was 3-4 mm, which he didn’t like. This number means how much the cells are duplicating. They like to see this number at zero. The basal cell surgery, that I had done in 2007, is the long scar above the melanoma site. The basal cell spot was the size of a pencil eraser and was in the middle of this scar line. In order to get all of the tentacles of the basal cell, they had to cut a lot of tissue out, hence the long scar line. While I tend to like things that match, I don’t want matching scars. A small incision would suit me just fine next Friday.
Tomorrow we leave Tiger Run Resort and we’ll move down the mountain to the Aurora area. We spoke today with the state park, near the hospital, about our reservation and the upcoming surgical date. We could only get a site for Sunday – Friday but the woman in the campground office said that they might be able to put us in an overflow site. We don’t care if we have to move between sites, during our stay, but we really would rather not have to leave the campground for the weekend, then come back in again. She said that people, in the Denver area, book sites 6 months out and book Friday – Sunday, for the whole summer, so that‘s why nothing is available. She was very helpful and I think we might be able to get the extra nights that we need for our stay. The doctor, doing my surgery, leaves on vacation for a week after my surgery so not sure when we’ll get the pathology results or when we’ll have a follow-up visit. When Linda was stressing to Dr. Robinson that we needed to get this taken care of quickly, because of our work and RV lifestyle, he promptly told her that this was about “Better, not quicker”. Highly skilled surgeons, who deal with melanoma do the surgery (they have 4 of them) and he isn’t one of the surgeons. They have to proceed in a manner to make sure everything is looked at and considered because as he said, “We’re talking about her life….this isn’t something that can be rushed.” We’re not used to being slowed down and told to wait. We’ve had busy work schedules, for quite a few years but his advice put things into perspective. Do it better, not quicker…


Donna B. McNicol said...

Better, not quicker. I like that...thanks for keeping us all in the loop!

BC said...

I know someone with webbed toes. It's more common than you'd think. I'm sending all my strength and love to you both. <3

Bobbie and Jim said...

I know it will be hard for you both...but do what you are told already!!! This is the time to slow down