So, yesterday (Friday) Mike went to Emory where they placed a catheter into his vena cava. I think that’s a big blood vessel. Probably so, because the dressing is a little on the bloody side. He will get it changed Monday. There are 3 thingies hanging down from the upper chest wall that they can use to give him 3 different infusions at the same time, or draw blood out. Gross! But he still has a good attitude. Mike says he has never been much for wearing jewelry, but the dangling thingies have a certain aesthetic to them. We will take a picture once the dressing is changed, but I don’t know if Mike will let me post it. We (that is, Mike, Judy, Michelle, and I) all met with Dr. K. this week. Mike signed a bunch of consents, and we asked a lot of questions. Mike had been advised by a friend to get a second opinion about the transplant. In a way, he already has a second opinion from Dr. B., who is treating the lymphoma, and she said to go ahead with it. Mike told Dr. K. that he wants the second opinion from him. Dr. K. was thorough and honest about the alternatives, and the potential risk and benefit of both doing the transplant and not doing the transplant. We are doing the transplant.
A word or two about second opinions. While generally speaking they are a good idea when contemplating a major treatment intervention, they are far from a gold standard. Two illustrative stories are worth telling. Mike had a patient who had severe back pain, and was advised to have surgery. She wound up getting 3 opinions, all recommending surgery, but all 3 recommending a different procedure. It was confusing and stressful for her, and it was up to her to decide. Eventually, she opted for the most extensive procedure, and Mike thinks it worked out well. He was able to get her off of her pain medication afterwards, which was a big accomplishment. The other story involves his late wife, Penny, who back in 1991 had a recurrence of breast cancer in a hip bone. Her doctor told her that she was in a gray area where the studies had not yet answered the question of what to do next in her circumstance, as far as chemo was concerned. He solicited opinions from the two top cancer treatment centers in the country, and got 2 different recommendations (opinions). He discussed them with Mike and Penny at length. Penny opted for the more aggressive approach, and unfortunately, the chemo knocked out her bone marrow and immune system, and she died of pneumonia after a long battle in intensive care. So, the second opinion is nothing more than an opinion, and not necessarily the right treatment option. I do think patients need all the information they can get before making such an important decision, so I am not saying they shouldn’t get a second (or third) opinion. Many patients are distrustful of their doctors, and shop around until they find a doctor who tells them what they want to hear. This is a fear-based approach, and as Mike always says, you should never make an important decision based on fear alone. Mike’s brother was like that. He went to doctors constantly, never followed their advice unless it suited him, and his poor self-care eventually cost him his life. It wasn’t entirely fear-based decision making in his case. He also relied heavily on denial, which as Mike wrote in a recent article he had published in the Atlanta Jewish Times, is more than a river in Egypt. The article was in the November 27, 2019 issue. It deals with the denial in the Jewish community about its own problems with substance abuse and mental illness. If you are interested, you can find the article at https://atlantajewishtimes.timesofisrael.com/sharing-stories-and-creating-community/ Denial is in fact an ego defense mechanism which serves to protect people from acknowledging painful or terrifying realities in their lives. Unfortunately, being in denial too often leads to people failing to take necessary action to prevent a personal or even community-wide calamity.
There is another thing I should tell you about Penny’s treatment. It involves one of Mike’s pet peeves. He doesn’t respect doctors who tell their patients that their previous doctor gave them the wrong treatment. The exception to this would be if that piece of information directly affects their subsequent care. Otherwise, it is just gratuitous to tell a patient that they had the wrong operation or the wrong medication. It is easy to offer a retrospective opinion after a bad outcome and, in Mike’s opinion, reflects badly on the opining physician. So, Penny had been in the ICU for about 3 weeks when her oncologist, Dr. G. told them that he had a long-planned vacation that he wanted to take. Mike told him to go. By that time there were many specialists involved in Penny’s care including a kidney doctor, an infectious disease doctor, and a lung specialist. Dr. G. had a covering oncologist, Dr. P., who would also be involved in taking care of Penny in his absence. One evening Dr. P. told Mike that Penny should never have had the treatment that she had received. Of course Dr. P. was unaware of the process that had led to the decision to opt for that particular treatment plan. Mike was offended by his statement. Some time later he contacted Dr. G. and told him what Dr. P. had said. He thought Dr. G. ought to know that he had been back-stabbed.
Tomorrow Mike goes back to Emory to have lab work and see if he has mobilized enough stem cells. If not, they will give him an infusion of another medicine to mobilize the stem cells from his bone marrow. Then on Monday back to Emory to start the cell collection and separation process. I will tell you more about that after I see how it is done. Mike plans on bringing a couple of good books. His friend, Bruce, gave him a book about the making of the atomic bomb. Mike is interested in the history of science, so the book should be interesting and terrifying at the same time.
Mike had breakfast with his friend Rev. Larry this morning. Mike asked him to visit him and pray with him when he is in the hospital. He seldom asks anyone to do anything for him. But, he did ask his friend Danny to take him to a 12-step meeting a couple of weeks ago when he was unable to drive (after the colonoscopy.) This is humbling him in a good way, I think. And Judy has just flushed his 3 dangling thingies with heparin so they won’t clot up. She is not squeamish, fortunately. Once about 6 or 7 years ago Mike had emergency surgery for an infected sebaceous cyst in his back. The doctor drained the cyst, and then sewed it up and left a drain in. A couple of weeks later he went up to Minnesota to visit his mother, and the whole damn thing broke open while he was there. He was grossed out beyond belief. He called his doctor who ordered antibiotics and wet-to-dry dressings. Judy went on line, viewed a You-tube video on wet-to-dry dressings, and changed his dressings like a champion. He healed up beautifully.
So, and most importantly, football is large this time of year. Marietta High School won their semifinal game last night, and will play for the state championship next week. Good for them. The University of Georgia plays LSU this afternoon for the SEC championship. Go Blue Devils and go Dogs! It is fun when the home teams do well, and a good distraction from real life. Oh wait, football is real life. Sorry. Well, that’s all the news from Happy Meadows this week except that you should know that the outdoor decorations have added cheer to the neighborhood, and the holidays are racing towards us madly. You will hear from me again very soon. Until then, be safe, be well, and be nice.