Ooh Child, Things Are Gonna Get Easier

Ooh Child, Things Are Gonna Get Easier

This is the phrase I need to hang on to over the next few days, possibly weeks.

Let's recap,  My CA 27-29 cancer markers have been going up since April. Sadly, that trend continues today. Now we add the CA 15-3 into the mix. Something is not right. Here is a snapshot of these numbers over the past few months:

Lab Range 19-Jun 5-Jun 22-May 8-May 10-Apr CA 15-3 0 - 32.4 42.5 #N/A 29.7 25.5 20.7 CA 27-29 0 - 38.6 90.3 69.3 61.8 62.8 46.2 What does this all mean? Well, nothing good, I assure you. Generally, the higher the CA 27-29 level, the more advanced the breast cancer or larger the tumor burden. [4] If the tumor produces CA 27-29, then tumor marker levels tend to increase as the tumor grows. The highest levels may be seen in metastatic breast cancer, particularly with metastases to the liver or the bones. However, CA 27-29 can be low or absent in all of these settings since not all breast cancers produce CA 27-29, or it may be too early in the disease process to detect CA 27-29 levels. Normal levels, therefore, do not ensure absence of localized or metastatic disease. CA 27-29 levels, in conjunction with the history, physical examination, and diagnostic imaging findings, are typically used to monitor treatment response of metastatic breast cancer. A decrease in CA 27-29 levels can indicate tumor response or regression of disease. Stable or increasing CA 27-29 levels, despite adequate treatment, can indicate tumor nonresponsiveness or tumor recurrence.
Higher CA 15-3 levels have been correlated with more advanced stages of breast cancer [1] or with larger tumor burden. If the tumor produces CA 15-3, marker levels will increase as the tumor grows. The highest levels may be seen in metastatic breast cancer, particularly when metastases to the liver or bones exist. However, CA 15-3 can be low or absent in all of these settings, since not all breast cancers produce CA 15-3 or early stage breast cancers may not produce detectable CA 15-3 levels. Thus, normal levels do not ensure the absence of localized or metastatic breast cancer. Elevation of CA 15-3 levels can also be seen in healthy individuals, in benign conditions, and in other malignant conditions. However, CA 15-3 levels tend to remain relatively stable over time in benign conditions; thus, elevated levels need to be interpreted within the context of the patient’s history and physical examination, diagnostic imaging, and laboratory workup.
There is a chance that these levels can be elevated for benign reasons, but the odds are not in my favor. I suspect the liver is involved, as we know I have a tumor on my liver. And I can feel my liver more these days: when I cough, when I laugh, sometimes when I bend over. Does it hurt? Not yet; it's more like a cramp or feeling tight.  What's strange is you would expect my Bilirubin levels to be high. They aren't. They remain in normal range. So now what? After the June 19 results came in, I received a call from the doctor's office. Up 20 points in two weeks. I cried for a few minutes when I heard the news. I'm scared ... seriously scared. They want a PET done STAT! Texas Oncology was able to get approval from my insurance company very quickly (no small feat when it comes to PETs, I assure you; it typically takes days, sometimes weeks), but ARA did not have any slot available until late next week. Now what?  We look for another provider (like TX Oncology) We schedule the PET for Wednesday morning. Come to find out, switching providers requires a new approval. Seriously?! Needless to say, they called to cancel because we don't have approval yet. It rocked my world. I see you rolling your eyes. Oh the drama! For a terminal cancer patient facing rising tumor markers without a clue as to why, delaying testing and/or treatment is very, very scary. Remember I have a tumor that, if it gets too big, can kill me before the cancer does because of its location. So .... bite me if you don't get it! And then the skies part, rainbows appear, birds are singing! I get a call from Blue Cross Blue Shield. I've been assigned my own personal nurse, Esther. "I've been assigned to provide you with resources and provide any help you may need. What can I help you with Ms. Bishop?". God has shown me, many times during this journey, that he/she is here for me. Bringing me Esther at this moment is one of those times. I explained the situation with the PET, the approval, and the importance of getting it done before my oncologist goes on vacation starting Wednesday, July 1. We talk a long time, about my diagnosis, my mental state, etc. Esther was planning on calling it a day, as she only had a couple of minutes left before quitting time …. but she decided to contact one more patient - ME! I told her God works in mysterious ways. She agreed. Esther is now on the case to get approval quickly. God isn't finished yet …. I receive a call Friday morning from ARA. They have me scheduled for Monday at 8 AM, arrival time 6:30. I contact TX Oncology to advise. Apparently, TX Oncology JUST received approval for the PET to be done at TX Oncology on Tuesday in South Austin. Now what? I have two PETs scheduled, one at ARA in central Austin, one at TX Oncology in South Austin. My preference? Duh … ARA on Monday. I call Esther. She puts me on hold and pulls in a specialist. BOTH PET approvals are still good …. for one month. I can go to either one. Whoop!! We talk a few more minutes. Esther will call me again on Wednesday to see how the PET went, the results and where we go from here. Told you God wasn't finished yet.  There's more ... I contact TX Oncology to advise I can go to either, so we pick ARA. TX Oncology will cancel the Tuesday scan. While on the phone, I ask if I can meet with Dr. Kocs on Tuesday to discuss scan results until waiting to meet with the PA on Thursday. Guess what? It just so happens he had one telemedicine slot left …. for Tuesday morning. Thank you, God!! So, here is the plan for next week:  PET on Monday, meet with Dr. Kocs to discuss results and any change in treatment Tuesday mrorning, then in the office for treatment on Thursday afternoon. I love when things fall into place, even if it took some divine intervention. Now, what to do about the results. In my opinion there is bad news and really bad news, with the bad news being my treatment quit working; the really bad news means I have a brand new cancer. I am hoping for the bad news. Here's the deal … and I'm keeping it real …. as scary as this seems, I am still at peace. It doesn't mean I won't cry for a bit when I hear the results. I am sure I will (after we get off the phone with Dr. Kocs; I'm getting pretty good about keeping it together until after we hang up). My overall philosophy is I can't change it, so there is no point on allowing myself to live in a dark place. Will I visit it initially? Of course - I'm human, after all (note: some may challenge that 😏). But I will not allow myself to stay in that space. Why? I can't change what is. I have a choice:  wallow in self pity and despair or put on my big girl panties and kick ass. I prefer to kick ass!  So …. I am ready for whatever comes my way. This cancer will probably kill me some day, but that day isn't here yet. I will do everything I can to stick around as long as I can. BRING. IT. ON!!