
The diagnosis - danso
http://boingboing.net/2011/12/09/the-diagnosis.html
======
outworlder
I shudder to think what could have happened, had she delayed the exam. From
what I understand, she was not in a risk group and didn't yet require periodic
exams. Not many people will jump through the hoops unless they have been told
by a doctor that it is something they _need_ to do.

And that's not even counting the heavy procrastinators, such as myself, that
will postpone exams even when the doctor asks for them. Which reminds me...

In any case, I find the bureoucracy a pain. For most exams, you have to
schedule an appointment in advance. Depending on what prompted you to seek
medical help in the first place, you might even be feeling better already. Too
many times I have been told that there was nothing wrong - no kidding, I was
feeling better already.

Don't even get me started on how hard it is to find good doctors...

I believe we are reaching a point where we have the technology to cure most
maladies, but which doesn't do us any good because it is not applied
consistently enough, even disregarding economic factors.

I guess that's why the Star Trek's sick bay appeals to so many people. It is
not hard to envy a future where one just has to walk-in with an obscure
disease, get state-of-the-art scans, done by one of the very best doctors, who
will not stop until he finds what's wrong. And not go broke afterwards.

Yeah, give me that over a transporter any day.

~~~
addrenavan
Were she to delay the exam, her life would have gone on pretty normal for a
while, Eventually the lump, the cancer, would have grown, all the while trying
to sneak into the rest of the body. Perhaps she would have eventually made it
into a GP, and not a place that specialized diagnosing breast cancer. Lumps
are normal, she's young, it's probably not anything to worry about, come back
if it grows.

It's cancer, of course it grows, she goes back in a couple of months,
eventually it's large enough to warrant removal regardless of what it is,
they'll do the biopsy after they remove it.

Biopsy comes back, now she know it's cancer, but hopefully it's not too far
along. They get her a PET scan, hopefully it's not in the blood.

The PET scan comes back, it confirms multiple tumors in the body. Metastatic,
they call it. Atleast that explains the back-pain. Her options are limited
now, there are treatments that can slow the growth, but not much hope in the
way of getting rid of the cancer.

Chemo is much less useful at this stage, Chemo is a much more distant worry
now, loosing your hair a much more distant worry, which makes it feel, a bit
less real. The treatment is still very minor. She still feels pretty healthy
all things considering, and this is just what the doctors are telling her.
It's not real, but again, the cancer doesn't much care.

~~~
olliesaunders
I don’t think they ignore lumps on the basis that you are young because
cancers in younger people grow significantly faster.

~~~
Arelius
You wrongly assume that all doctors think the same way.

------
huxley
My 35 year old sister found out earlier this year that she has Stage IV breast
cancer (spread to one of the lymph nodes and into both of her lungs).

I can't express how fortunate we've been that she has responded extremely well
to tamoxifen therapy, which seems to have halted growth (and even resulted in
some shrinkage) for almost 11 months now. Hers is apparently not a common
result. In spite of the frightening diagnosis, she has stayed very active all
these months and has suffered almost no ill effects from the treatment (a few
pills each day).

As some people have pointed out, the long term prospects aren't good for
advanced stages of breast cancer, but last January, the surgical specialist
who examined my sister didn't give her more than a year to live. Thankfully we
met a spectacular oncologist who has been as much terrific support network as
he has been a doctor.

It's worth reading Stephen Jay Gould's great essay on his fight with cancer:
"The Median is not the Message"

<http://cancerguide.org/median_not_msg.html>

He was diagnosed with peritoneal mesothelioma (a cancer of the abdominal
lining) and told that the median survival rate for it was 8 months. He
researched his cancer and decided he would do whatever was necessary to get on
the good side of the median. He was treated with chemo, radiation and surgery,
and ended up surviving 20 years (eventually dying from an unrelated metastatic
cancer).

I really wish Xeni the best of luck and hope things go well.

~~~
Arelius
It's great to hear your story. My sister, at 22, has just started with a
similar treatment.

------
sounds
If you haven't read the article, you should. This is one woman's journey --
being diagnosed with breast cancer. It's amazingly well written.

~~~
skore
I was amazed by the laser-guided precision of its emotional payload. The
transition from relative playfulness to delivering the realization of the
mercilessly impending dread in small portions, always quick to cover it up -
only to open it up again shortly after in yet another, more devastating
fashion is absolutely ravaging.

Reading it, I was taken by what I imagine to be a homeopathic dose of the
feelings that Xeni may have gone through in that situation. The sentences
sometimes don't make immediate sense - you have to reread them carefully. And
then they hit you. Hit you in a place where you are not sure how to deal with
them.

------
jonnathanson
Jardin has always been a fantastic writer. While this news is certainly
terrible, the silver lining is the beauty and honesty with which she delivers
it.

~~~
bh42222
That's..... really not much of a silver lining in this situation.

I would have gone with caught early, modern medicine, etc, but A for effort.

~~~
araneae
It was not caught early. It had already metastasized (gone into a lymph node.)
It was good she went in when she did, but not going to the doctor for 10 years
was pretty stupid.

~~~
tptacek
Involvement of a nearby lymph node can still be classified as Stage II.

~~~
araneae
Stage II is not early, it's actually right in the middle. There are 5 stages:
0, I, II, III and IV.
<http://www.breastcancer.org/symptoms/diagnosis/staging.jsp>

~~~
tptacek
You'd know better than I do, I'm just saying, how ever early it isn't, it's
also not "late".

------
sukuriant
For what it's worth, this makes me want to go get a routine physical again.
I've been avoiding it because "I'm a man!" ... but really, men get cancer in
our more personal places, too... and often we ignore it/think little of it.

Best to catch these things early.

~~~
DanBC
Is it best to catch prostate cancer early?

The treatment is harsh, and the cancer is slow growing. I understand that many
men die with, but not of, prostate cancer. But then maybe I'm totally wrong?

~~~
wonnage
Testicular cancer is probably the more pressing matter.

------
keithflower
"Over the phone, the clinics all sounded like places you'd take a pork chop to
be examined, not a human breast, not a person, and not me."

Our technology is improving. Rigorous, evidence-based practice is the standard
of care.

And yet we often fail to help.

Oft-used aphorisms in medical training include, "The secret of care of the
medical patient is _caring_ about the patient" and "Recommend to your patients
what you'd recommend to your own family". Yet that approach often vanishes
somewhere during training or soon after. Some may start viewing people as
"consumers" rather than "patients".

Compassion is curative, and by that I don't mean a bunch of hand-waving mumbo-
jumbo. I mean that people will seek preventive care, trust diagnosis and
treatment, stay in treatment, and work with docs when they feel they'll be
heard, when their pain and fears (often unspoken) and questions will be
addressed, and when their choices will be respected.

For lack of a better phrase, there remains a science _and_ an art to medicine.
Both need to advance lock-step.

Best wishes to Xeni. Her writing has always been brave as it is here, and
selflessly sharing what she's going through will help others.

------
ryandvm
Wow. So well written.

------
donw
Fantastic delivery, doubly so given the gravity of the subject. I sincerely
doubt that I could write this well, given the circumstnces.

Here's to hoping that whatever the outcome, she has a speedy recovery and a
long life.

------
ricardobeat
Ouch. From the biopsy onwards it just makes me shudder.

------
AznHisoka
Did her lifestyle choices contribute to her getting breast cancer(being
overweight, not active, etc)? it would really help to know if it was simply
bad luck or if her life decisions were risk factors.

~~~
wonnage
It's hard to say in an individual case. Even with smokers, how can you
_really_ say with any certainty, that it was the smoking and not an
independently malignant cell that was the seed for lung cancer?

We have group statistics that say healthy diet, getting your vitamin D, etc.
are associated with lower incidences of cancer. But on a human level, cancer
is not like getting an e. coli infection, where we can point to contaminated
food or something as a direct cause.

So personally, I encourage my loved ones to eat well and live healthy and all
that jazz. But if heaven forbid they come down with a major illness like
cancer, I'd leave their life decisions out of it; as much as we can say with
statistics, I don't want them to feel like that last unlucky coin flip was in
any way their fault.

TL;DR: I don't know, and people are probably going to downvote you for being
insensitive.

