Mo About Cancer

Category: Perspectives

  • Melanoma? That’s it?

    Since May is Melanoma Awareness Month, I’ve invited others affected by melanoma to guest blog on the 7th, 14th and the 21st. I’ll wrap up the month by blogging again on the 28th. Today’s blog is written by Molly Menard.

     

    I am not a blogger. I had to google what blogging is all about. I am sure this is not your normal kind of blog, but here it is. I am sharing with you the dates I replay over and over again in my head. Many things that happened in between are painful and I don’t like to think about them. Hell, the stuff below is painful. But is there anything about Melanoma that’s not?

    January 2007.

    Mark, my husband, walked out of our bathroom one night in his boxers. I remember it just like it happened a minute ago. “I think my mole is changing” he said. I could not tell, but then again, I never paid it any attention, it was always there. We googled moles and came across pictures and at that time, the ABCD’s of Melanoma (sometime between 2007 and 2011 they added the E to the ABCD’s of melanoma). His mole did not look like anything we saw. So we did not worry.

    Mark Menard family42010

    A few months later I said to Mark, “I think you’re right; your mole is getting bigger. Maybe you should call and get it checked out.”   He put it off.   We were not too worried.

    June 2007.

    One day in late June, Mark was wrestling around with our youngest daughter Stacy who was 7 at the time. Mark grabbed his abdomen and dropped to the floor. Stacy’s foot had rubbed against her daddy’s mole, ripping it off. Mark decided to have it taken off. His appointment was right before the 4th of July.

    July 2007.

    A few days after the 4th, the phone rang, “Hello, this is Dr. Smith from the dermatology clinic at Balboa Naval Hospital. Is Senior Chief Menard available?”   I knew right then that something was wrong, because really, how often do doctors call you at home? She told me his biopsy results were in, he had melanoma. She had already made his appointment with Dr. Chan, the surgical oncologist. I remember thinking, “If he’s going to get cancer, at least it’s this one.”

    Before July was up, Mark had surgery – a wide incision and lymph node biopsy. Dr. Chan gave us the news that one lymph node from his groin came back positive, the melanoma had traveled. Another surgery was scheduled in a few weeks. They were going after more lymph nodes, this time in his leg. That is when we knew it just got serious.

    Mark Menard sandiego walk2010

    December 25th 2009.

    It had been two and half years since Mark was diagnosed with stage III Melanoma. In that time, Mark had a number of surgeries, scans, treatments and we lost count of the number of doctor appointments.

    After putting the kids Christmas presents under the tree, Mark and I crawled into bed shortly after 1:00am.

    I woke up almost an hour later. Mark was having a seizure. The next thing I knew, I was on the phone, repeating over and over 10182 Voge St, our address. 14 minutes later, the paramedics arrived. I hung up the phone with the 911 operator. Two paramedics and six firefighters were crammed into our bedroom and the hallway outside. I sat on the hallway floor shaking. Mark finally came too. He was confused. His first question to the paramedic, “Where’s my wife?” All that is going on with him and he was worried about me.

    5:00 a.m., I call our moms from the hospital, crying, begging for them to pray.

    6:20 a.m., Christmas morning, four hours after Mark had his seizure; I sat next to my husband, holding my husband’s hand, trying to be brave. The ER doctor sat on the other side of Mark’s hospital bed. Mark looked scared. I was scared. We knew what was going on. We knew what the doctor was going to say

    “The CT scan shows one tumor in the……..” I have no idea what he said after that. I was rejoicing! One tumor! Not multiples – just one!   Thank you God, just one! We can fight one! It was a small victory for us. Thank God! Just one!

    I called “the moms” with the news. Both moms had already booked their flights, they were on their way. Our neighbors loaded all of our Christmas presents into their car, along with our daughters and brought them to the hospital. By 9:00 am, we were celebrating Christmas on the floor of Mark’s hospital room. I was praying, begging God, “Please don’t let this be our last Christmas”. Shortly after the presents were opened, Mark’s best friend came to pick up the girls. We had no idea what was going to happen next and we did not want the girls to see it.

    December 27th, 2009.

    5:50 a.m., they came into the room to get Mark. They were taking him into surgery to remove the tumor from his brain.

    December 25, 2010.

    We are all smiles. The girls (ages 10 and 13) are sitting on the floor waiting for daddy to pass out their Christmas gifts piled under the tree. I am thanking God for giving us this Christmas. Mark was doing well. He had retired from the Navy in November after a 22 year career. We moved from San Diego and bought our very first home in Iowa. He was on a successful BRAF study. Things were looking up. I was thanking God.

    Mark with his kids June 2011

    July 14th, 2011.

    10:03 p.m., four years after being diagnosed with stage III melanoma, 8 surgeries and 5 failed treatments, my husband died. Mark died at the age of 41. Mark died because of a mole.

    It has been almost three years since we lost Mark. I think back to the phone call with Dr. Smith often. I had no idea. Mark had no idea. How could a stupid mole he had his entire life kill him?

    I tell people about doing self-skin exams, I tell them about the ABCDE’s of melanoma. I have set up free skin cancer screenings for anyone who wants to come. I warn parents and teens about the risk involved when using tanning beds. I have gone to local schools to talk to students and staff about melanoma. I have planted trees at our local school, so the kids can play on a shaded playground.

    I am still fighting melanoma.   I promised Mark I would not stop fighting.

    – Molly Menard

    Mark Menard

    The below photo is of Molly and her daugher Sarah, taken on Saturday, May 3rd at the Steve Yates Melanoma Awareness Golf Tournament in Waterloo, Iowa. Molly and Sarah held a free skin cancer screening at the event where nearly 50 people were checked for skin cancer by two dermatologists from the University of Iowa, Dr. Amanda Tschetter and Dr. Krishna Mutgi. Keeping that fighting promise to Mark, Molly coordinates a free skin cancer screening each fall in her home town of West Branch, Iowa. This year’s screening is scheduled for Saturday, October 4th.

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  • I’ve Got You Under My Skin

    Since May is Melanoma Awareness Month, I’ve invited others affected by melanoma to guest blog on the 7th, 14th and 21st. I’ll wrap up the Melanoma Awareness month by blogging again on the 28th. Today’s blog is written by Tom Armitage. Enjoy. 

     

    Do you know how men never want to go to the doctor? No matter what! “Oh, it will go away and besides it doesn’t hurt.” Well do I have a story for you! One day I noticed a small lump on my scalp under my rapidly receding hairline. But worse than that, my wife also noticed it. Before I knew it, my family doctor was looking at the lump. He said it’s a common cyst and should be removed before it causes trouble. Well, it wasn’t a cyst but instead it was termed a “vascular mass” and sent to the lab. It was not cancerous but the margins around the mass contained some melanoma cells. Was I surprised!

    After receiving a diagnosis of 4th stage melanoma, the first thing I did was to find out as much about the disease as possible. It didn’t take long to learn that it wasn’t a pretty picture. The second thing I did was to realize that cancer may change my life at some point but I wasn’t going to change my life because of cancer. So, I didn’t. I continued to do everything that I would normally do. After all, there is nothing on my bucket list. No need to skydive, sail the 7 seas, or run with the bulls in Pamplona.

    But, there I was, 64 years old and wondering what the hell was going to happen next. After all, I had no symptoms and the melanoma was discovered by accident. Then I met Mo. He kept telling me “this is not a freight train” as we explored my options and I became more anxious about doing something, anything to start a treatment. Another test? What was he waiting for? I began to realize that I was on a journey—–through a jungle and Mo was my guide. Although I knew Mo was an oncologist he was more like a mentor who was priming me to succeed. Mo made me feel that we were a team. We decided to try a new drug called Ipilimumab.

    Here I am, 67 years old, minus one pituitary gland, and cancer free. I’ve graduated to a PET scan every 6 months. So as far as I am concerned, I have no worries until the night before my next scan. I go through long periods of time not thinking of my diagnosis. Am I afraid it will come back? Not really, I know it will. I have a healthy respect for my situation but until it changes, I will follow the good advice of a friend that I walk with three mornings a week. Right Foot!…..Left Foot!……Breathe!…..Repeat!

    So, what’s with the positive attitude? In my early thirties, I was pretty sure I was going to die. No, seriously I thought I was going to die. It was traumatic. There was no medical evidence to support my contention and anyone who could dispel it was no longer living. When I was three, my father died at age 38, his father at 36, and both my namesake uncles at 28 and 34. Was I next? I grew up without a father and so did my father. My biggest worry was that my two young children would have this same experience. After I passed 38, I felt thankful and never looked back.

    Thirty years ago I realized that every day was a gift and after being diagnosed with melanoma, I am continuing to enjoy each day as it occurs. I am thankful for all my blessings and Doctor Mo.

    -Tom Armitage

    Tom Armitage

     

     

  • Is It a Choice?

    The research coordinator sat next to me and said “his insurance will only approve a phase 3 or phase 4 trial, and while this trial you are offering him is a phase 3 they have denied it anyway!” Frustrated she also added “we are in the process of appealing this, but it could take up to 30 days.” I stared into the cubicle I was sitting in. I never check which insurance company a patient has nor do I understand the “what is allowed or what is not.” I had met my patient a week ago and I counseled him with options that I felt would best serve his treatment and his goals. How do I explain that his recommended treatment is off -limits due to insurance, and we need to consider an alternative? Why should I? I honestly did not want to.

    I have practiced medicine in many different systems. In Jordan, recommendations for treatment are often coupled with a price tag. It is one of the big reasons why I do not practice there, and feel that a health care system does not need to discriminate in care based on a patient’s financial abilities. I have blogged about this hindrance previously and I do this again as I feel passionate about patient care and where it may be heading.

    In the modern health system of seeing patients in 20 min, we have to discuss an incredibly difficult and complex disease in the matter of minutes with our patients. The industry of medicine has truly become too demanding and very bulky. From a physician perspective there is a need to understand the exciting number of breakthroughs in cancer research at the same time present unbiased informed consent to patients explaining treatment options and offering a true reflection of what knowledge is out there. This is coupled with an explosion of technology, electronic medical records systems, the almost immediate availability of information, test results and expectations. The physician now faces the dilemma of appealing denied insurance claims to render his decision for the selected treatment “allowable”.

    Patient’s choices are limited by which insurance they belong to which clinical trials are available to them for cancer care. It’s the art of medicine to help the patient navigate such hard choices and ensure a good decision is made. I am a believer that everyone should have health insurance, however in our system it appears that some are better than others reminding me of the novel “Animal Farm.”

    My patient looked at me and said, “I want what you think is best for me in the treatments you have outlined for me.” This is a huge responsibility to walk a patient through a network of decisions influenced by the many changes taking place around us, yet we are being asked to do this in a very short period of time influenced by the politics of insurance companies. So I am left with a simple question today as I blog, is it a choice?

    Mo

     

     

  • Blog Holiday!

    Dear friends,

    I have enjoyed writing to you every week on my blog. We have had a few guest bloggers as well and the feedback from all of you has been great. This week I will not be blogging and will start doing that every 2 weeks with an occasional guest blogger jumping in on a break. Some of my patients would say “ Mo , you just needed a blog holiday” and I guess I am finally listening.

    Take Care

    Mo

  • “Stay out of trouble”

    “Nice to meet you Dr. Mayhem” he said mispronouncing my last name, but he had me smiling. “A pleasure to meet you too” I replied to my newly formed friend. In the background of the clinic, the laughter this word created reaches out to my depths and pulls out something I have longed to share. If you have seen me in clinic many times, my closing statement to each of my patient is “stay out of trouble.” It’s like my signature. I want to blog about what that actually means and why I say it.

    I will start by asking “the” difficult question. One you all know but maybe have never dared to ask. When a patient first gets diagnosed with cancer, be it melanoma or sarcoma or any other type, where do you think their mind goes? In my practice I have watched as my patients go to thoughts of death first. This is exceptionally vivid when I am the one who introduces this particular thought to them.  There is an awkward silence that usually follows. It is not awkward for me as I am the one being silent. This is broken on many occasions by a deep sadness, an overwhelming emotion that fills tears in everyone’s eyes who are watching. I create the space in time to accommodate and acknowledge this feeling. Silence has an end, it is not never-ending. My patients get into “trouble” trying to understand their cancer, their disease, their plan and how it is to be executed.  They are never left to do this alone. I will admit that initially they are lead to believe they are.

    Truth has a responsibility of being clear, sharp and honest. Telling a patient that they have a terminal cancer is no easy task. Yet I do that daily, begging the question from the observers of “how do you do this?”  To answer this statement of “stay out of trouble”, when asked to do the same, I end up saying “no I will not” because I am at the heart of it.  I have marveled at the psychology of the irrational fear of death that drives us towards a helplessness that cripples us to give up. I journey deep into these “hot waters” pulling my patients out of an irreversible outcome. No one does it better than the person on this journey and I end up learning so much from each of my friends as they face this certainty. So I walk beside them and find myself saying simply “stay out of trouble”.

    I usually say it as I leave the room; I point and stare deep into my friend’s eyes as I say it. I mean it; it is a real, reflex almost. I fought hard to get them out of the tribulation that they are being faced with. I want them to live fully and embrace what moments they have left. As important, I also point at those around them reminding them of the diamond that sits amongst them, that soon they may be forced to part with.

    Stay out of trouble my friends.

    Mo