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Two Patients in the Waiting Room



When a woman is diagnosed with breast cancer, doctors immediately investigate whether the cancer is hormone-sensitive. They hope so, because hormone-dependent cancer can be fought by quickly shutting off the hormones. This won’t directly treat the cancer; it only lowers hormone levels, which can slow tumor growth.

Doctors recommend (and in my case, beg and insult) female patients to remove their ovaries, to stop the hormones.

The second-best remedy is shutting down the ovaries with drugs. Never mind that the body produces estrogen in other places besides the ovary. Never mind that many women who have their ovaries removed still die from cancer. Never mind that estrogen-deprivation creates new problems. Never mind that when cancer patients reach menopause naturally, their cancer stubbornly continues to grow. LET’S SHUT THOSE OVARIES DOWN.

I’m being sarcastic. I am traumatically stressed about how my ovaries were viewed as evil, when my cancer was diagnosed. I did, briefly, allow my ovaries to be chemically shut down with Lupron, before I had even chosen a doctor.
In my experience, doctors gloss over exactly what happens when Lupron is injected in one’s butt cheek. I imagined an OFF switch on my ovaries. I found out later how Lupron behaves. It heads straight for the brain.
“Lupron … is classified as a leutinizing hormone releasing hormone (LHRH) agonist. HRH agonists work by telling the pituitary gland located in the brain to stop producing leutinizing hormone, which (in men) stimulates the testicles to release testosterone and (in women) stimulates the ovaries to release estrogen.  Lupron … does not have a direct effect on the cancer, only on the testicles or ovaries. The resulting lack of testosterone (in men) and estrogen (in women) interferes with stimulating cell growth in testosterone or estrogen dependent cancer cells.” (http://chemocare.com/chemotherapy/drug-info/Lupron-Depot.aspx)
“Telling the pituitary gland” is still a bit of a sugar coat. The drug scrambles the signals the pituitary gland sends to sex organs. The gland controls many bodily functions. That’s why patients on Lupron experience hot flashes. Ineffective body temperature control is collateral damage. And when Lupron treatment is withdrawn, the ovaries try to self-correct, releasing lots more eggs than usual, of importance to aspiring conceivers. Hence, Lupron is also used as a fertility drug.
I don’t hate Lupron and I understand its necessity in cancer treatment. But I regret the suffering it causes and I yearn for the day when treating cancer will not require such heavy hands on a patient.
This morning at a doctor’s office, I heard a receptionist tell a patient that his Medicare wouldn’t cover his Lupron injection. She explained that he had to pay 20% of the bill, and his share was more than $100. I could tell he didn’t have a hundred dollars, because there was silence after the receptionist said that pre-payment was required. She clicked her tongue to counter the dreadful silence that filled the room. She reminded him that he had paid before the previous visit. He then produced another insurance card, but it was for prescriptions, not doctor visits. I can understand the logic.

I didn’t have money to help the man pay his bill, which most certainly was for treatment for prostate cancer. I doubt he would have been comforted by any of my words, especially if I told him that I think prostate cancer is more overtreated than breast cancer.
I left silently, helplessly, before the matter was resolved. I couldn’t stop thinking about the man. I knew nothing about him, not even his face, because his back was to me.
And yet, I KNEW him, in a way that only people undergoing cancer treatment know each other.

The gratitude we feel to be alive can fade to black when dollars we don’t have are standing between us and the horrible drugs that we pray will keep us alive.
I don’t have a grand ending to this story. But it’s not a sad ending, either. I was reminded that there are people who need help, even when I’m doing OK. Even though I couldn’t help the man who crossed my path today, in doing so, he helped me.


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Filed under Breast cancer, Cancer