Another week, another dilemma. The most recent visit with the Dermatologist resulted in 8 areas being frozen off and one area on the left leg being biopsied. Just received the call from the Dermatologist I was expecting and ready for. The biopsy is again positive. Since the Interferon therapy I have had 4 basal cell carcinomas surgically removed. Basal Cell lesions seem to live very comfortably right along with their big bad brother Melanoma. This one is also basal cell carcinoma. It seems to be one of the "wonderful" side effects of Interferon. Now it is time again to decide whether to have the lesion surgically removed or watch it carefully for any further growth. The biopsy margins were not clear, but I have had 4 surgeries in 8 months and frankly can't even contemplate the thoughts of another.

Although I know that this will be a life long ordeal, the difference between knowing this and accepting this is worlds apart. I have spent the last couple of weeks trying to retrain my mind to think and not anticipate. This is a herculean task. Anxiety tends to walk the same path as the melanoma medical regime. From constant testing and Doctors appointments to the fatigue and worry, even an educated mind can get caught up in the "what ifs".

Dealing with the constant change in body image is a struggle even at my age. The increasingly numerous scars, the changes in body shape due to lymphedema and the inability to exercise all contribute to the multi-faceted complexities of this dreaded disease.

So, the saga will continue and I am grateful for the opportunity to contemplate the saga. I could have easily been on the other end of this dreaded disease named Melanoma with no options and no time. I have been blessed with the option of treatment and hope for a future, never taking for granted my life journey.

Whatever path this saga takes me down, I pray for the strength to cope with dignity and grace through the maze that defines medical technology and the life of a cancer survivor.

I have lost a whole month of my life that I can never retrieve no matter how I try. A month fraught with worry and levels of anxiety that cannot be described. Try as I might, no matter how I rationalize and intellectualize the need for constant follow up testing and that this is now and will be a fact of life for the remainder of my life, the same extreme worry precedes the testing and lasts until I see my Oncologist for the results. This last set of tests ended up provoking and even higher level of anxiety because of a 2 minute phone call from a secretary at my Oncologist's office. First and foremost, let me explain the events of the last 2 weeks.

My Oncologists, Dr. Armenio and Dr. Al Malki ordered a PET scan to be performed as it was 6 months since my last one. The standard of care for Malignant Melanoma calls for PET Scans twice a year. The insurance company denied this request. Because of this denial, the Physicians ordered 2 MRIs, one of the pelvis and one of the abdomen, both with and without contrast. Being a migraine sufferer, I had experienced several MRIs over the last 15 years but they were all of the head, not necessitating being placed full body into the MRI machine. I am not now nor have I ever been claustrophobic, but for the approximately 3 hours needed to perform both studies, I had to keep saying my Rosary just to calm myself enough to complete the studies. Words cannot describe the strength of will that it took to complete these tests. I have faced each test and procedure with as much bravery as I could, but I have to admit that these tests just about put me over the edge. Trying to understand why this was so difficult, I started to look back over the last 7 months to find an answer to my anxiety. It occurred to me after realizing just how much has been done that I was indeed at the end of my rope. Only after putting it all on paper did I realize just how much this poor aging body has been through. In 7 months I have had 4 surgeries, 4 MRIs with contrast, a PET scan, 3 ultra sounds because of a DVT (deep vein thrombosis), treatment for 12 weeks because of this clot, 2 CT scans with contrast, both ingested and IV push, visits with the medical Oncologist, surgical Oncologist, Dermatologist and my Internal Medicine every few weeks, blood tests almost every week and 2 months of horrendously toxic chemotherapy with Interferon. Just re-reading this diatribe gives me shivers and a new sense of wonder as to what one body can sustain without permanent damage. So, when I received a telephone call from the secretary at my Oncologist's office stating that the newest MRI results had been received and after reviewing them, the Doctor wanted to make sure that I had an appointment to come to the office to discuss the results.

Being an RN who has been in private practice for over 32 years, I knew what that meant. It meant there was something seen in the MRI that needed to be addressed. Little did I know at the time that both MRIs revealed positive findings. My follow up appointment with Dr. Armenio was not until a week from this above mentioned discussion with the secretary. It was the worst week thus far in this truly amazing medical journey. There were days that all I could do was go to work and throw myself into the duties of our very busy practice, then once at home, didn't even have the physical or mental energy to speak. I didn't share this with my family or my husband as I didn't want them to suffer with worry like I was. Of course, they knew by seeing me that there was something terribly wrong. I vowed to discuss this issue of waiting for over a week for any test results with Dr. Armenio.

The day of my visit came and the positive findings were discussed with the need for further testing. I expressed the absolutely unacceptable waiting time for the results of these tests and we came to a mutually agreed upon conclusion. If I couldn't be seen the day after a test was performed, one of the physicians would call me with the results. I am quite able to take any news in a phone call, what I can not nor will never do again is to agonize for over a week over results that could have been given to me so much sooner. Again, both of my Oncologists requested a PET Scan to further investigate whether the positive findings were directly related to the Melanoma. The first request was denied by the insurance company. The second request, in the form of an appeal of the first denial was again denied, necessitating a peer to peer review, which was also denied. This whole process took almost 2 weeks, so my anxiety and apprehension about these findings actually took on a life of it's own. The only option was to have a CT scan of the abdomen and CT scan of the pelvis both with and without contrast. This was booked for the day before I was to again see Dr. Armenio. I was in a state of torment unlike anything I had ever experienced. Even when I received the initial diagnosis, my acceptance of this devastating news was controlled and without angst. Of course, if I had any idea of what was to transpire in 7 short months, this probably would not have been the case. So, not only do patients worry and obsess about tests and their results, but add to that the struggle with insurance companies to approve the much needed studies, just makes this whole struggle a psychotic folly. And when you take into consideration that a PET scan in this area costs about $5,200.00 and the 2 MRIs and the 2 CT scans cost approximately $9, 500.00, it makes it just that much more unbelievable as to the lack of basic common sense to have denied the first PET Scan. Not only would I have been spared the physical torture and the multiple doses of toxic contrast, it would have saved half of the final cost.

The next day came and my visit with Dr. Armenio produced the best news I have ever heard. Yes, there were positive findings, but they were unrelated to the Melanoma and were not emergent. I took a deep breath for the first time in a month. After hugging Dr. Armenio, I departed to again return to work. During this drive as I was praying and thanking God, I realized that if I am to keep my sanity, I would have to find a way to face the frequent testing and waiting in a new and more constructive way. I shared with Dr. Armenio that the Melanoma wouldn't kill me, and he finished the sentence for me “the anxiety will kill me”. He stated that although he treats all kinds of cancer, it is only his Melanoma patients that experience this degree of fear and anxiety. Contemplating this statement, for me at least, I can understand exactly why that is. When I was diagnosed, my surgical Oncologist explained my specific pathology report and the importance of the mitotic rate. The mitotic rate is the frequency with with the cancer cells divide and multiply. A mitotic rate of 4 is bad news, my mitotic rate was 16. Compound that fact with the surgical Oncologist's need to send a second specimen of the lesion to Sloane Kettering Hospital in New York because he had never seen a mitotic rate that high without there being metastasis. All of these facts have turned a very level headed, even keeled kind of gal like me into a mushy lump of worry with each new test. I am always waiting for the next bad news. This must and will change.

It will now be my challenge to find a way to not only live with this disease but to embrace each new test as an opportunity to prove each and every time that,with the Grace of God, I continue to be healthy. The reality of the situation truly puts new light on the important events and needs of everyday life and how to prioritize. I look at everyday life with new eyes and a new awareness of what is important and what is truly not worth a second thought. And more and more subjects fall into the category of not worth a second thought.

It is with the good news of NED (no evidence of disease) that my husband and I decided to celebrate with a beautiful dinner at a gorgeous local restaurant. We shared our relief and our shared feelings of blessings for the opportunity to continue our fairytale romance. We will not give up without a fight, not ever.