Thursday, May 14, 2009



No cancer.

No pneumonia.

No huge blooms of frightening fungal funk.


Seven biopsies, the man took. Seven.

And the lab found nothing wrong in a single one.

As a former smoker, believe me, I'm delighted to have this truly exceptional lung doc go poking around in there with such care, and tell me, --No cancer.

Or pneumonia or fungus or any other horrors. Especially when this former smoker is coughing up bits of blood, little as they may be.

Walter and I both noticed Dr. S seemed a bit PO'd at the lack of diagnostic guidance. He's not a doc who'd willingly let some damn germ put one over on him.

Here's a good place to explain something about how I think, analytically. Hey, Math Fans! You can probably appreciate why I'd willingly associate *thinking* with that very pretty, very useful math called Calculus.

When trying to diagnose a medical condition (or most anything else), we often start with a *snapshot,* then figure out what changed since that pic was taken. In the study of calculus - and of finance - a change from one point to the next is called an *increment.* The mathematical formula to describe a curve is calculus; the formula describes the changes in a line that could have been a straight line, but isn't.

Calc measures those increments, looking at smaller and smaller changes until they're so tiny they can't be seen with the naked eye, but can be expressed in a formula so comfortably that it correctly reproduces the curved line in question. (Okay, if you're not a Math Fan, but hated every second of the only calc class some vicious teacher or parent forced down your throat, maybe that formula could never feel comfortable to you. I'm the same way about electricity, so believe me, I'd never think any less of you.)

Say I'm looking at a sick plant. What's changed since last week when it seemed healthy? No rain, loads of rain, high heat, cold, plant food, no plant food, snails munching leaves... I look for an increment, a change, to guide me toward understanding the cause of the plant's illness, and therefore any cure. If cold never bothered it before, then chances are, this week's cold snap isn't to blame.

Identifying that incremental change can mean everything. Believing a change has occurred when it hasn't can steer you seriously astray.

So when a doctor questions me, I take care to say whether some event is new: whether or not it's *same old same old* is quite significant.

Dr S listens to me breathe. --Pain? Chest pain? --Always, but no change.

(He looks at me intently, inquiringly.) --I always have chest pain, all different kinds. It still hurts but there's no change in the pain from before. It hurts the same way it did when the blood started.

(Not localized knife-stabs, or a constant bad ache, but like breathing -20 degree/3% humidity air on a winter's day in Chicago. It hurts going in, but less when it's going out; it feels pretty much the same wherever the incoming air first hits lung tissue.)

--Fever/chills/night sweats? --Always, but no change. Nothing new except the same fever spikes I've been getting for a couple months now. My normal body temp is 97.4. Tuesday night it hit 99.1, which is very high for me.

--How much blood? --Just little bits, bright red, mixed with other lung stuff. Yesterday, a couple small dark pieces that looked like clots from a scabbed-over biopsy. --A tablespoon, a teaspoon? --No no no, tiny, like 1/4 teaspoon.

(--Breathe...he listens, moves the stethoscope in this dance where I need no directions but instantly know when he wants me to breathe again)

--Doc. Is the lab checking for fungal infections? --Yes. (If he were my cat April he'd roll his eyes in impatience. Well, they DON'T always do those tests, I really did have to ask.)

--So what is it?

--Inflammation. Bronchitis.

--Does this mean I have COPD?

(looking at me a bit sharpish, an odd look...) --No, those are two very different things.

(It's not that I want COPD. I want, and need, oxygen, but can't afford it. Medicare would pay for it if he'd 'fess up that I didn't really *cure* my longstanding COPD.)

He wants to do a follow-up CT scan in 3 months. Wants to put me on sulfa to ward off that nasty pneumocystis but I'm allergic to sulfa, so he writes a note to Dr C the ID doc about trying some other preventive stuff.

He HATES prescribing meds. *Hey. Patient! What are you DOING?!? Don't eat that, it's a PILL!!!!!!!!!* He especially loathes Prednisone. --How much Prednisone are you on these days?

I hate it when he asks me that.

Trying to save us both time, head him off at the pass, I say --80 mg-- then immediately launch into how tomorrow is the bone marrow biopsy, then we'll finally apply for the IgG boosters, yada yada yada... He likes that better than Prednisone any day of the week.

As much as I understand that No News is valuable news unto itself - as glad as I am not to have a Definite Horrible - I still feel some frustration at this sort of thing. Questions asked, unanswered.

Mystery. The unknown.

Despite all our advances, it can still come back to that. And often does.

Sometimes we aren't quite as big and smart as we think.

1 comment:

Pretty Lady said...

I looked up COPD, and it was described in terms of inflammation and bronchitis, among other things. Hello? It doesn't seem like there needs to be some other new dastardly cause. It's been there all along. I'm very glad that you don't have cancer, pneumonia or a huge fungal infection. I think your lungs are just stressed out from long term allergies and long term grief.

(In Chinese medicine, the skin and the lungs are considered to be one continuous organ, and the corresponding emotion when something goes awry with them is grief.)

I really loved calculus, at least in theory--mechanically figuring out derivatives and integrals got boring really fast, which was why I only got a B in college (the C in high school was due to sheer disaffectedness.) The thing I thought was the most fascinating is that you can describe the rate of change at a single point, not even between two points infinitesimally close together. Just at the ONE point.