The Neuro Visit That Almost Wasn't

With all of the other medical issues going on I decided to take advantage of the fact that my Medically Needy Share of Cost had been met and try to get an appointment with my new neuro, Dr. Silliman, at Shands Jacksonville Neurology Department. He had been the lead investigator in my TRANSFORMS clinical trial and was very familiar with me.

I didn't have a neuro outside the study (long story; last neuro had a stroke) and I had sort of been leaning on the trial to do all the neuro-esque stuff to me and catch anything that needed catching. In the trial I was poked and prodded and tested to the brink of insanity every three months.

It had now been 5 months since the study completed on Jan. 20, 2011.

So I called a couple weeks ago and got the person in charge of scheduling. She says "can you come at 3:20pm on June 23rd? It's the ONLY appointment he's got left for this month." And my answer is "of COURSE I'll be there! Put me down for it."

So I plan my trip accordingly. It's a 1.5 - 2 hr. drive to get there depending on how you go (I take the long scenic SLOW route as opposed to I-95 which scares me to death.) and I made sure to work in a planned stop to JoAnne's Fabric store so I could feed my new addiction - sewing clothes for my granddaughter. I also planned to stop for something to eat at Crispers which was on the way and has really tasty soups and sandwiches. (I had the Citrus Chicken Wrap <-- totally awesome!).

I spent the morning coloring my hair so I didn't have to wear my "Please don't feed the Skunk Woman" shirt, and I was out of the house right on time at 1:15.
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Geeze, I started this post quite a while ago (June 25th and it's now July 14th) and probably don't remember what all happened now to finish it. I need to stop starting stuff and not finishing it! I bet I'm ADD (but there I go on another tangent.... oo! a butterfly!.... what was I saying?)
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Anyhoo, to get to the point (was there one other than the main one about what I ate for lunch?) I get there and was signing in and they are looking at me all curious like from behind the counter. I notice the waiting room is empty. It's 3:15 in the afternoon. I ask which sheet is the one to sign in on for Dr. Silliman since there is a whole line of clipboards on the counter.

The ladies exchange glances that tell me they are bracing for the Angry Patient Response that they both know is coming. She asks for my name and tells me to come sit at the chair in front of her desk like letting me sit in the comfy chair will make what she's about to tell me all better.

I sit down and she starts clackity clacking on the keyboard doing stuff with that number pad over on the right that I never ever use. I hate when they do that because I can't figure out what they're up to. Then she stops suddenly and said, "You were bumped."

I say "Huh? Nobody told ME!"

She said "They didn't call you?"

"NO!"

"Is your contact phone blah blah blah?"

"YES! And I didn't get a call"

"Hmmmm" (long awkward pause).

Me: "Look, I just drove for 2 hours to get here and I'm not leaving until someone sees me. I was told this was his last slot for the month and my share of cost is met and it's the end of the month practically so I guess you need to find another neuro who can squeeze me in."

(she makes that "eeesh" face, upside down smile thing with open mouth that suggests that might not be too easy)

"See, he had his schedule cleared for this afternoon because graduation is today." (I keep forgetting it's  a teaching hospital).

"Yeah, well that's fine but it would have been nice to KNOW 2 hours ago before I wasted my day and thirty bucks in gas."

I sat down again (having stood up when I became irate) and said "I'll wait here until you get something figured out because I'm not leaving until I see a neuro."

She left and came back about 15 min later telling me Dr. Nameaslongasyourarm would see me and whisked me away down a maze of hallways that ended up looking awfully familiar. The spot I ended up in was one of the exam rooms over on the Research side where I always went during the trial. I was "home" and immediately felt comfortable.

I saw a guy in a white lab coat who seemed a little unsure of stuff I was telling him. I was guessing it was due to the fact that I'd been on Gilenya for nearly 4 years while it's only been approved since last September. I was thinking maybe the doctors who weren't involved in the study aren't as well versed in the stuff. Either that or they put a lab coat on the janitor and told him to wing it. Turns out the truth was somewhere in the middle. He was a resident. When he brought up my MRIs on the computer and had my initial one from the study side by side with the latest one from Jan 2011, I started asking questions he couldn't answer. Then he starts whapping me with that rubber mallet and when he hit my left knee I kicked him.

I didn't meant to kick him, but shouldn't a neuro who is examining an MS patient have sense enough to stand to the side when testing their reflexes?? He abruptly left the room. Wow. What a wuss. I only kicked him in the shin. It wasn't like I nailed him in the privates or something.

He returns with another guy in a lab coat who seems a whole heck of a lot more at ease with himself and confident. He shakes my hand and introduces himself as Dr. Somebodyelsewhosenameiforget. He takes the mallet from the first guy and gives me a whack. Immediately I could tell he knew what he was doing. He stood off to the side as my leg flew up as if to launch the winning field goal.

He turns to the janitor and says "You're right! Her reflexes ARE brisk!"

Then he taps me all over, watches me walk, and looks in my eyes. This is when he said "I see some optic pallor more prominent in the right eye than left."

Whoa! Back the truck up! I have never had an MS related issue with my eyes so the way he said it, like it should be no surprise, surprised me.

Of course I had to come home and google it. I'm not buying what he's selling though because none of the real eye exams by the neuro ophthalmologist ever revealed any issues whatsoever, so this guy with a pen light and no dilation drops isn't about to intimidate me. I don't care what he thinks he sees.

Speaking of what he saw, he also looked at my side by side MRI scans and got them to sync so that he could scroll through matching image slices like seeing my brain melt away from the top down and compare things. He stopped at one point to teach the janitor/resident about Black Holes. Apparently I have one. News to me.

A Black Hole is where MS has done so much damage that not only is all the myelin all gone but so are the axons it was meant to protect. Total nerve annihilation. He did say that it was so small I probably didn't even have any noticeable symptoms from it.

They did a blood draw after my prompting and a little researching on their smart phones once I mentioned that in the trial they did blood work every 3 months especially since there can be elevated liver enzymes. No mention of any eye exam, PFT or any other test that was so common place during the study.

I left there feeling a little less confident about my eyesight and my brain, but decided they may not know what they're talking about. I'll wait until I get to see the neuro I'd intended to see. I was told to make a 3 month follow up with him.

The day after my appointment I got a phone call. It was a courtesy call to let me know I was getting bumped... from my appointment the day before. Duh.

A Xanax, a Sonogram and a Great Big Needle

That's how I spent my morning on June 17th. I didn't even get to enjoy my coffee before I was undressed, draped in paper and being swabbed down with iodine. The doctor's nurse held the transponder (that thing that looks like a computer mouse that they move around to get the images when doing a sonogram) and the doctor wielded the needle.

It all started with a lump I found in my breast about a month ago. Felt to me to be the size of an egg but later found out what I was feeling was the surrounding tissue that was inflamed. The actual lump was only about an inch across.

Anyhow, doc sent me for a mammogram and ultrasound and the radiologist recommended aspiration and possible biopsy.

I went with aspiration so there I was laying on the table, draped in paper, dripping betadyne solution.

First there was a burst of cold when he numbed my skin with a topical spray, then a slight pinch as he gave me a local anesthetic, and then a pretty good size pinch of the aspiration needle despite all the prep to numb me up.

I watched on the screen as the cyst collapsed. Doctor, nurse and I all cheered. It was fascinating. Would have been more fascinating to watch on Discovery Channel while snug in bed eating ice cream or something. Not really crazy about being in the lead role.

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That was a week ago today.

Yesterday I went back for the results. I was told there is no cancer (YAY!!!) but that there were too few epithelial cells present to make a diagnosis.

So we discussed various things. Because of all that angry tissue that had surrounded my cyst my doc wants me to have a consult with a surgeon to discuss whether or not a biopsy is in order. He did say that he suspects his answer will be to let things settle down for a few weeks and see if it all goes back to normal. Chances are it was just an inflammatory response to the presence of the cyst.

That appointment will be on the 6th of July.

The other things we discussed dealt with the fact that he took me off Estradiol which I had been given to help with my Osteopenia and increase my absorption of calcium. The fact that it also brought an end to night sweats, hot flashes, insomnia and other "old lady" afflictions I had been suffering due to menopause was just icing on the cake.

He took me off about 3 weeks ago so now I'm back to sweating, flashing and not sleeping but other than that I'm fine.

He talked to me about Evista and perhaps getting me started on that instead. It's a targeted estrogen that will tell my bones "yes there is estrogen present" so they can do their calcium absorbing magic while telling my boobs "nope, no estrogen here" so maybe I will quit trying to grow my own implants.

An added benefit of Evista, according to him, is that it reduces the chance of developing certain types of breast cancer by a major percentage. I don't remember the figure. At least 40% but maybe he said 70%? I am just not sure.

He said he would LIKE for me to get a BRCA1/BRCA2 test to find out if I am carrying the gene that would make me a higher risk for developing breast cancer but I am on Medicaid with a share of cost and I'm pretty sure they're going to balk at the idea of that even if my mother's sister DID die of breast cancer at the age of 54.

At any rate, I am so very thankful to have this doc on my side. He is so rational and thorough and has a very calming effect on my psyche. I can go into his office on the verge of a panic attack and come out feeling like I'm floating on Xanax. I just know he's going to be my body guard and do his best to protect me from whatever strange things my boobs can throw at me.

Next up: My first neuro checkup since the TRANSFORMS clinical trial ended back in January 2011.

Here we go again... One Lump or Two: Revisited

About 18 months ago I was blogging about how I had found a lump in my breast and had to have a mammogram and it turned out to be a cyst.

Well here I go again. I found a HUGE lump in my breast a couple weeks ago and went to see my GYN. He said it was GOOD that it hurt as breast cancer is usually not painful. But he agreed that it was huge, about 2" across, and set me to go have the mammo and ensuing ultrasound.

The radiologist came to speak with me and showed me the blown up image of my cyst on the screen. It was not a simple cyst according to him and he suggested aspiration followed by cystology. If the cystology comes back fine, we're done. If there are any suspicious cells in it, then I have to have a biopsy. Ugh.

I was told I have Fibrocystic Breast Changes, a condition where the breasts are lumpy, sometimes tender and often grow cysts which come and go. Great.

I told my GYN that my attempt to grow my own implants wasn't going like I'd anticipated.

He took me off Estradiol and mentioned some drug called Evista which he may put me on later for my Osteopenia. Yeah, like I can afford that.

So Friday morning I will be eating my happy pill, (a/k/a Xanax) and then going into the doctor's office so he can do a needle aspiration on my boob as he looks at it with an ultrasound.

I've got news for him. If we don't hurry up, that cyst is about to disappear and he may be jabbing around in there for nothing.

It's hell getting old. I never had any of this junk going on when I was younger... or maybe I did but I was too oblivious to care or too stupid to realize the consequences. If age has taught me nothing else it's that life is a crap shoot and every day I get older is one day closer to going bust.

Bust. Heh. That was not an intentional play on words, but back to the topic at hand.... if any of you prayin' types out there want to add me to your list of things you bug God about, by all means please do. I'm bending his ear non stop so you may just get a busy signal, but if it goes to voice mail, leave Him a message. He'll get back to you.