Thursday, May 9, 2013

Dr. R Visit

Had my four-month follow-up with Dr. R today. Everything looks good (as I predicted).

As always, the visit is essentially a three-part check up. He does some blood work, does a physical exam, and asks me how I'm feeling.

Blood looks fine. Everything is solidly within normal range. As usual, there are a few things that will take a couple of days to analyze (like LDH and liver function), but problems with these are usually signaled by something amiss with the immediate blood tests, so I don't expect any panicked calls from him. The physical exam went OK, too. Nothing new popping up anywhere. At my last visit, I asked him to check on some bumps on my upper arm; he told me to keep an eye on them and let him know if they got bigger or if they increased. They may be slightly bigger, but only slightly, and they haven't increased. He wants me to continue to keep an eye on them. If they need to be checked, he'll send me somewhere else to do a Fine Needle Aspiration to get a small sample of the cells. [They won't let him do the FNA himself? This guy can do a Bone Marrow Biopsy and tear out a chunk of my hip, but he can't stick a tiny needle into me? What the hell?] He's actually not even sure they're swollen nodes. They might be lipomas (fat deposits, basically). No surprise that I have deposits of fat scattered about my body, if we're being honest.....

As for my own report to him about how I'm feeling, I told him I felt fine, which is true. We mostly chatted about the Red Sox, my oldest getting his driver's permit, and the like.  All in all, it was an uneventful visit.

I like Dr. R. He puts me at ease. My blood pressure was actually 10 points lower today than it was two days ago when I got my annual physical. I attribute the difference to Dr. R relaxing me, on the one hand, and my not anticipating a prostate exam today, as I did on Tuesday. [I told Dr. R that, and he offered to give me one anyway. "Too bad you weren't here last week. I had a medical student with me. We could have given him some practice." God knows what he would have said to me if my wife wasn't actually in the room with us.]

So we'll call this visit a success. The only problem (apart from the offer of a prostate exam) was the new computer system they had installed two weeks ago, part of their switch to electronic records. (Which, by the way, I am in favor of. My GP is on the same system, and knew I was going to see Dr. R today. I like having things so easy to share. I think it will cut down on mistakes and save money in the long run.) I had to answer 10 minutes of questions when I first checked in, to make sure all of the information was correct. [She seemed surprised that I knew the date of my diagnosis. I told her I celebrate it every year. That didn't surprise her, for some reason.] Then I had to answer questions from the nurse who took my vitals as she looked at the screen instead of me. ["Do you smoke?" "No." "Do you drink alcohol?" "I'm actually drunk right now...[no response, just typing]...Yes, occasionally..." She didn't even look away from the screen.]

Dr. R hates the new system. He meant to say "It's ironic that technology makes us less efficient," but it came out as "It's moronic," which we all agreed was OK, too.


Anonymous said...

Congratulations on your check-up and good blood results. I hope your LDH readings will be fine as well. At my hospital LDH and ALAT results are always back within a an hour and a half. I used to worry about the LDH readings, particularly when at the high end of the 250 range. My oncologist tells me he only worries when LDH suddenly doubles. What you write also makes sense: More readings would be off if there is anything to worry about. Thanks, Joanna.

Lymphomaniac said...

Joanna, one of the new things that has come from my onc's office being taken over by Yale is that I now get a printout with all of my blood work, whether I want it or not. I used to have to ask for it, and I usually didn't. I've said here before, any time I'm gotten deeply depressed about having cancer, it has been because I paid too much attention to numbers: blood counts, survival statistics, whatever. So now I just don't do it. It's too easy to obsess over numbers and what they mean. Or don't. I know some people find lots of comfort in numbers, but that's just not for me.
And thanks for the congratulations.

Anonymous said...

Hi that is indeed great news congrats!! my husband's doctor wants to treat him aggressively with R Chop and 2 year R maintenance, his reason is he's young (44 years old) and he wants to achieve a long remission, his condition is similar to yours, low tumor burden,low grade ,stage 3 asymptomatic with normal blood work, so off we go to a second opinion and probably 3rd either from sloan or MD anderson, by the way i just recently joined an awesome support group might be the same as the one you talked about, everyone has a signature, take care - Jeanne

Lymphomaniac said...

Jeanne, good that you're getting a second opinion. You can't get much better choices than Sloan or Anderson. Ask the support group if they have any suggestions for where you might go, or who you might talk to, for a second opinion. They're pretty good about sharing stuff like that. also has a list of patient-recommended oncologists that you might want to look at:

Good luck.

Anonymous said...

You are right about not obsessing over data too much. I remember agonizing over FLIPI versus FLIP 2 scores a lot in the beginning. I stopped doing that as they are after all, just statistics. On the other hand, solid numbers at the check-up visits still make me happy. We have so little to go by other than watching out for B-symptoms and monitoring the size of the nodes. This is the dilemma of W&W with which I am happy 90% of the time ( the other 10% I get excited about new research dvmnts, which could make the W&W paradigm obsolete or did already do so and we are missing out). Take care, Joanna