Stupid doctors. Stupid cancer.

[auntmousie]

As I've mentioned somewhere else, my wife is battling metastatic breast cancer.

About a month ago as I write this, we had an in-person oncology visit (despite COVID restrictions I'm allowed to accompany her as a caregiver, because chemo-brain is a thing, and she's mobility impaired and can't really manage her oxygen tank while steering her power chair). The doctor looked at an alarming distal rash on the breast where the cancer was the first time, and said, yup, that's tumor tissue. "Good" news is, that means they can do a better biopsy than what they got from the fluid that's filling her chest and limiting her ability to breathe. So, they did.

About three weeks ago, that biopsy came back: Ovarian cancer. Yes, you read that right. And the following two weeks were pure hell. Because they immediately scheduled a diagnostic laparoscopy to do a repeat biopsy using tissue from the ovary itself. (Themselves? Unknown whether both are involved. None of the PET scans to date have suggested ovarian tumors.)

My immediate question was, honestly, who gives a sip? It's still cancer. It's still metastatic - clearly, if it's ovarian tumor on the exterior of the breast. And it's still causing a pleural effusion. What difference does it make where it came from? Have you not seen how bad her breathing is? Do you really want to risk general anasthesia here?

The answer seems to be that chemotherapy is a bit more sophisticated than I gave it credit for, and the drugs you use for an ovarian cancer are different than the drugs you give for breast cancer. And if they can switch to a drug that's a better match for the cancer she actually has, maybe buy her more time, but at the very least let her breathe better. And I was like, yeah, okay, I guess that makes sense. (It's important to get me on board, because I'm the cheerleader here; if I don't do that, she doesn't do . . . anything.)

First preop appointment, the doctor says "the way you're breathing right now, there's no way I would clear you for surgery." Oh. Great. So, we head straight to the ER for a thoracentesis. And a few days after that a second thoracentesis on the other side - so now both lung cavities have been drained, and her breathing is as good as it gets... but she's too worn out for the final pre-surgery visit (a week ago yesterday).

At first they say if she can't come in we can't proceed with the biopsy. I tell her that, she decides to push herself and go in, but just as she's about to stand up they call back and say, no, it's fine, we can do a video visit as long as someone swings by to pick up the pre-surgery supplies. (Welcome to managed care - you do your own antiseptic wipe-down and other surgery prep, at home. Which means waking up at five in the bloody morning for a surgery scheduled at 9:15.)

Monday night, and we're trying to go to bed early but she's anxious and panic is affecting her breathing so she can't lay down. We get the prep work done, grab three or four hours of sleep. Tuesday morning I caffeinate myself enough to get her to surgery, drop-off at 7:30 and then go on home, can't stay here and wait (because COVID), but that's okay I didn't even take the day off - gotta go home and log in and watch the phone for news.

9:15. Surgery time... and I get a call from the surgeon. She's not breathing well enough, surgery cancelled. Can't honestly say I'm surprised - but here's the icing on the cake: "We're just going to proceed on the info we have, the first biopsy is enough, we don't really need this one."

SO WHAT WAS ALL THIS ABOUT?!

*sigh*

[Seannery]

SO WHAT WAS ALL THIS ABOUT?!

If I might guess.. poor diction, understanding. They meant, my guess, they'd prefer the more data.. And not knowing something so simple as a procedure requiring someone's in-the-flesh presence.. only to exchange objects. It really shows in these extreme cases, but all the same frustration happens everywhere. it's.. it sucks.

[Rorschach]

So...going by the biopsy results the presumably already have, she's going to be treated for ovarian rather than breast cancer and is no longer going to get a second biopsy?
May I ask - has she had chemo before? I suppose she must have by this point.

[auntmousie]

Had chemo and radiation with the first (breast) cancer back in '08. That cancer went into (apparent?) remission. Had chemo again in 2019, when the metastatic (now apparently ovarian) cancer came up. Did three cycles of weekly infusions, then punked out ahead of a fourth because she was feeling too weak. Of note, she was stronger when she felt too weak to continue chemo, than she is now. She wasn't even on oxygen at that point and didn't start it until more than a year after chemo infusions ended.

After infusions, she was on some newfangled drug there are ads for - Ibrance I think - but it didn't do enough to slow the progress of the blood indicators, so they switched to some other drug I don't remember ever seeing ads for, and then to an oral chemo agent that I also don't remember the name of. They stopped that when the biospy changed the type of cancer we're aiming at, so this week we'll get a new protocol.

[auntmousie]

The new protocol is alternating infusions, between the breast cancer stuff ("taxo") and the ovarian cancer stuff (for which I don't have even the hint of a name).

Obviously no one is ready to offer an answer for what we do when she's too weak to continue that.