Tuesday, August 24, 2010

Know your enemy

Or so Sun Tzu suggested as an effective strategy for winning a war. So on I marched, to the literature, to the doctors, to the organic section at Trader Joe's. What I've found is that there is a stranger in the hall pointing a gun at me with his finger on the trigger. I can memorize the lines on his expresionless face, I can see the details of his cold steel, I can run toward him or away, but he's always going to be there. For now, I've decided to throw organic vegetables at him.
I talked to Christopher Fletcher from Dana today. He's the premier pathologist who sets the standards for diagnosing angiosarcoma. We talked about all things angio, both before and after looking at my biopsy/lumpectomy slides. In 2008, he published a paper that challenged the long standing dogma in the field which suggested that tumors under 5cm had a better prognosis, and that grade was a prognostic factor. Not so he said. He started to become suspicious of that report by Rosen when he was reviewing case after case of low grade angiosarcoma of the breast. They metastazed too. They killed too. When he looked at the mets of those cases, they still looked like low grade angio, in terms of their morphology..they were still well differentiated, didn't have necrosis, didn't have blood lakes, had no multi-layering of endothelial cells, but what they did have was the ability to penetrate into the surrounding tissue and invade like guerilla warfare.
Crap! And here I thought I had some small advantage, that I leaned ever so slightly in favor of that 30% of people who live for 5 years (even though the majority of them have evidence of disease by that point). Not so I learned today. As you might have guessed, there was a pity party on the car ride home, and another one after those little babies fell asleep. I want so badly to help them with their homework, to give them every chance at happiness. I want to walk at least 20 steps behind them in the mall. I want to pretend like I don't exist when they're teenagers...the key word here is pretend.
I knew it was going to be a rough day, even before my friendly visit with the world scholar. I had to decide which time slot I wanted for Charly's parent teacher conference in November and all I could think about was that it'll be time for my next scan by then.
O.K. then, enough of that. I'm fine now...sometimes it reallllly isn't easy. Thank God it usually is.

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