Sloan-Kettering Appointment: Thurs May 20th

Just got an appointment with Dr. Nash at Sloan-Kettering for Thursday, May 20th (see post below). Dr. Nash only sees patients on Thursdays due to his surgery schedule, and May 13th is already booked (they will call me if there's a cancellation). I don't need a colonoscopy (yay)- but I do need to get my glass pathology slides from RWJ... I wonder how difficult that will be.

PC Love

(Picture: after my surgery, when I came back to school, two of my senior boys handed me this little balloon along with a scribbley handwritten note....and yes, they really did cross out "It's a Girl" and write "Welcome Back" in black marker. What hams.)

I have been feeling very guilty about the amount of school I have missed because I love my kids and only want what's best for them. I am usually the kind of person who doesn't want to show even a hint of weakness or vulnerability in the work place, but today - again - I forced myself to stay home and nurse a soar throat instead of doing what I usually would do (which would be to go to work anyway). I finally decided that if I was going to get through the remainder of the year, I would need support at work in order to avoid the overwhelming temptation to push myself beyond my physical limits.

So, today I decided to let a few of my close colleagues at Paramus Catholic know about my situation. Below is the email I sent to them and some of the amazing words of encouragement I received in response; I am so lucky to have such caring people in my life.

"Dear Friends and Colleagues, First of all, thank you for all of the incredible support, prayers, love, kindness and help in keeping my classes going. I wanted to share with you that I was recently diagnosed with a rare carcinoid cancer, which is the cause for my recent absences. I have every reason to believe that with God's help I'll beat it, but my body right now is not letting me do what I want (which is to be at school working). I guarantee I'll be back in full force very, very soon! I am so lucky to have found my second home at PC - each one of you has made such a positive impact in my life; I am truly blessed."

* Beautifully said. I'll keep you in our intentions today as I teach! Love you. - B.G.

* You are truly an inspiration to me in the way you love the students and this profession. I am confident that you will return but in the meantime I will pray for your continued strength and determination to beat this. Take good care of yourself - we will miss you and look forward to your return. God bless you! - M.P.L

* I am so sorry to hear what you are going through. I will keep you in my thoughts and prayers. If there is anything I can do to help, please let me know. - A.P.

* By the grace of God, I know you can beat this. If I can be of help in any way, please let me know. Know that you will be in my prayers. Hugs. - L.R.

*I had no idea! If you need anything, please let me know and I will def say a prayer for you but I have faith that your faith is already carrying you through this and it is done. I will see you soon, again please don't hesitate if you need anything, to talk etc. I do have friends that work at Sloan Kettering if you need a second opinion or anything :) - M.L.

*Your directness, your openness, your balance of optimism and pragmatism do you credit. You are a good role model, in many ways. I'll see you later - F.M.

* Thank you so much for keeping me updated. I knew you have been out, but did not know why! Please know that Our Lord and His Mother will be hearing from me on your behalf!!!!! If you need anything else, PLEASE let me know. I am available and happy to be of service. God bless. - S.B.

*I am SO SORRY to hear of your illness. You happen to be one of my favorite teachers here - always so professional and accommodating. You will be in my prayers, and I believe you will beat it! - N.K.

* My thoughts and prayers are with you...come back to us soon!! - C.S.

* You'll be in my intentions every day...if you ever need anything let me know - T.S.

* First of all, I've subbed a few of your classes and they have been great kids. Second, I am very sorry to hear about your diagnosis. Anything you need at all please let me know. I will keep you in my prayers and pray for a speedy and safe recovery. You are not just a respected colleague, but someone who brightens my day whenever I get to see / chat with you. I hope to see your smiling face again soon. - J.S.

*I had no idea !!!! I just wanted to tell you that I am here... - B.R.

* It was inspiring to hear from you. My thoughts and prayers are with you for a successful outcome and your return to PC. We are truly blessed to have you in our PC family and English Dept. You have enhanced our PC community in many ways with your unique skills, special gifts, outstanding talent, amazing background, bright mind, cooperative nature and outstanding heart. I hope we see each other more next year on a professional and personal level. Your students love you and miss you. May the Lord's strength and peace be with you. - L.D.

* I had no idea. Please be assured that you will absolutely be in my prayers, and from the bottom of my heart if there is anything I can do please, please do not hesitate to ask - from grocery shopping, washing laundry, to taking you to doctor's appointments - I'll be there. Just keep me posted. - C.L.

* So very sorry to hear about your current setback. Try to keep in mind that God can make something good out of every kind of hardship. I guess He is asking something different from you right now. I will place you in my prayers, and, if you would like, I would have your name placed on the Felician Sisters' prayer list. -K.D.

* I hope you are feeling better. Please let me know if there is something else I can do to help. - C.D.

Dr. Garrett M. Nash, MD, MPH at Sloan-Kettering

I just received a call from Nicole at Memorial Sloan-Kettering Cancer Center. Basically, the conversation went like this:

Nicole: I wanted to let you know that I received all of your reports, and I forwarded them to a colorectal surgeon Dr. Garrett Nash for review. He may require a colonoscopy before he sees you.

Me: Does he specialize in carcinoid cancers?

Nicole: Yes. I specifically worked with a nurse on that team and she recommended either Dr. Nash or Dr. Temple, but Dr. Temple is not in next week and I thought that you wouldn't want to wait that long.

Me: Is Dr. Nash in your New York office?

Nicole: Yes, they all are. (See below for explanation of "they")

Me: I am scheduled for a colonoscopy, but my doctor doesn't want me to have it until the day before surgery.

Nicole: Yes, I know. I see you have it scheduled for the 7th, and I told the nurse that but sometimes our doctors will not see you without one, so we are trying to get it approved.

Me: I see (long dramatic pause)

Nicole: I only work part time, but if you don't hear from someone in this office by Monday, feel free to call me on Tuesday.

**Pleasantries Exchanged - Phone Call Ended- Googling Commenced**

There are two names that have come up at Sloan-Kettering as carcinoid experts, neither of whom are Garrett Nash. However, Sloan-Kettering uses a team approach, and both doctors who have come up in association with carcinoid cancer treatment (Philip Paty and David Kelsen) are on the Team of Colorectal Experts along with Garrett Nash.

Dr. Nash's education includes both Harvard and Columbia schools of medicine - so I think it's safe to say that he's good (see below); let's just hope he'll see me without anymore tests.

Education
MD, Columbia University College of Physicians and Surgeons; MPH, Harvard School of Public Health

Residencies
University of Massachusetts Medical Center; NewYork-Presbyterian Hospital/Weill Cornell Medical Center

Fellowships
NewYork-Presbyterian Hospital/Columbia and Cornell; Memorial Sloan-Kettering Cancer Center

Surgery Notes and Pathology

I had my post-surgery appointment with Dr. Wagreich today, who was pleased with my progress but indicated that it would still be a couple of months before internally I was entirely healed. When I asked her about my appendix having to be cut away from my abdomen, she said that she had already spoken to Malone about it - and Malone would have to go in and biopsy that entire area since Wagreich, unaware of the potential for cancer, left some "scar tissue" that was connected to my appendix attached to my abdomen wall.

Wagreich also gave me copies of her and Dr. Davidov's surgery notes (he is the general surgeon who performed my appendectomy), as well as my pathology reports. I also went to University Radiology to pick up my barium drinks and CT / MRI reports.

I don't want to brag, but I've passed a couple of pretty tough tests in my day, most notably the California State Bar Exam and English Praxis Test. The feeling is always the same when you see that envelope, and today's little white envelopes were no different. The butterflies still fluttered even though this time I already knew, for the most part, my results. Unlike the CA Bar and Praxis, however, I didn't pass my pathology tests on my first try. (Warning to the medical world of rare cancers: I'm bringing my A-game to all future exams.)

Interestingly, since most of my medical tests and reports were so focused on my ovarian cyst and fibroids, little to no mention of my appendix appears. It is a little scary that no one seemed alarmed until pathology came back. Perhaps the most unsettling report concerns the CT scan because Dr. Malone said that she couldn't even see the appendix on the CT films, yet the CT report indicates the appendix looks normal.

The relevant report findings appear below:

3/18/10 CT Scan Report: "the terminal ileum and appendix appear unremarkable"

4/21/10 Surgery Notes from Dr. Davidov: "appendiceal tip slightly swollen and edematous in a clinical picture that might be consistent with a history of possible appendicitis that had improved, and now has recurred."

4/22/10 Pathology Report: "the tip of appendix is enlarged measuring 1.2x0.8x0.8 cm. sectioning of the tip reveals an area with soft yellow mass measuring 3x0.5x0.5 cm and extends to 1cm from the appendix base. Final pathological diagnosis of appendix, appendectomy: appendiceal carcinoid (3 cm in greatest dimension). Tumor infiltrates through the muscularis propria of the appendix into periappendiceal adipose tissue. Perineural invasion is noted."