Friday, June 15, 2007

One more appointment out of the way

I saw my medical oncologist yesterday. As far as the melanoma angle goes he thinks that I'm doing well. Since my CRP has been elevated for at least 10 months and my scans during that time period have improved, he doesn't think it's likely to relate to the melanoma. If it turns out that I do have an autoimmune disease, he thinks that it will depend on how bad it gets as to whether I would want to take autoimmune suppressants and indicated that only I can answer that. He said all things equal it's better to avoid systemic treatments that would suppress an immune response but sometimes they are necessary. I know that as long as my pain is managed, I'm not going to want to risk it. If anyone stumbles across my blog and wants to know what the heck I'm talking about, here's a pretty good description of CRP: "When the immune system senses injury or a foreign invader (e.g., harmful bacteria), immune system cells secrete inflammatory chemicals. These are chemical signals that launch an inflammatory cascade as the body begins the healing process. CRP is produced in response to elevations in these inflammatory chemicals. CRP is also produced in response to blood coagulation." Okay then, so as I read more the list of specific conditions that can cause an elevated CRP include cancer, heart attack, unstable angina, rheumatic fever, rheumatoid arthritis, systemic lupus, tuberculosis, pneumonia, postoperative infection, heat stroke, trauma, high blood pressure. There are medications that can cause mild elevations, same with exercise, etc. but none of those factors cause it to be as elevated as mine is. For that matter, mine is higher than would be expected with heart disease which is why the autoimmune diseases or cancer seemed more likely to the rheumatologist at this point. That's why it was a relief for the oncologist to think cancer is unlikely. He said he'd schedule another full body scan after I see him in six months and that I should feel free to call if I need to come in before then. He also said I should try to stop taking premarin. He said at my age I may not even have hot flashes or other symptoms and that I should try to wean off the premarin so I'll discuss that with my gynecologist when I have my September check up with him. Perhaps the biggest surprise was how he changed my pain meds. He's concerned about all the tylenol I'm taking and wants to protect my liver and kidneys. He said that he would get in touch with my pain doc but in the meantime he wrote out a new script for a stronger med that didn't have any tylenol in it. He said if I occasionally need to add tylenol that's fine but I shouldn't take as much tylenol as I've been taking. The pain med my pain doc had me on had tylenol in it and I also added tylenol when my level of pain medication wasn't sufficient. I don't feel like I have a good enough rapport with my pain doc to request something stronger. I was surprised that the medical oncologist would take care of it without me asking him to. The pain doc is fine and lately my appointments with him have gone fine but he offended me at our first appointment and I've never really gotten past that. I think that's more about me than him. I'd rather make do than risk him pissing me off but it's nice that the medical oncologist is taking care of it.

1 comment:

Anonymous said...

oxycodone is better than percocet.