Today’s adventure was a meeting with the plastic surgeon who is also, incidentally, the chairman of the provincial Cancer Care Melanoma Cancer Site Team. After the obligatory two and a half hour wait he looked at my healing heel and saw that it was good. I am now down to Polysporin and a bandaid in terms of further care. This is good news. I can now walk more or less normally and will soon be able to shower normally as well. After the good news came the Lecture. He was obviously somewhat unhappy about my decision not to have the remaining lymph nodes removed from my knee. Just when I thought I had it all figured out someone comes along and starts poking at my assumptions.
His argument is that the nodes in a particular area form a “basin” in which they all share the incoming gunk among themselves. If one node is infected with something (e.g. melanoma) then they probably all are, or at least some of the others probably are. Removing them all may mean a greater likelihood of my leg swelling up for the rest of my life, but will almost certainly improve the chances of being melanoma-free. Put this way it sounds as though there is not much downside and quite a lot of upside to having the surgery.
Before the Lecture I was fairly convinced that I was going to leave my body alone to sort itself out – or not. I got there by reasoning as follows: if there was a clear advantage to having the surgery, no surgeon would let me get away with refusing it without something approaching an argument; conversely, if there were clear disadvantages to having the surgery I would not be let off lightly if I wanted to do it just for the hell of it. Until today I had heard no strongly expressed opinions either way. My thanks to P for supplying a reference to a study that offers some statistics. According to this I have something like a 20% better chance of being alive in five years if I have the rest of the lymph nodes removed than if I don’t. That tilts the balance a bit.
I have made another appointment with the general surgeon who would be the one to perform the excision. This meeting won’t happen for another month which gives me enough time to do a more thorough job of considering the issues. P thinks I should go for it and I’m inclined to think she’s right.
Melancholynoma 
Gilda Radner said, “Now I’ve learned the hard way that some poems don’t rhyme, and some stories don’t have a clear beginning, middle or end. Life is not about knowing (but) having to change, taking the moment and making the best of it (or the best decision) without knowing what’s going to happen next.”
It seems to me on this journey at each cross road you make the best decision you can, with the information available. As we’ve discussed before navigating this process is as much an art as a science.
By: Sylvia on July 16, 2008
at 12:36 pm
You know what my feelings are on the pros and cons of increasing your chances to be around to be part of your daughter’s graduation, marriage and the potential thrill of being a grandparent. I know that in normal circumstances, these may not be all possible, due to her choices in life, but you making the decision to take part in the treatment offered to you by the experts in the field of treatment, will make it more possible. Nothing in life is a guarantee as we know but not doing anything is like a poor game of Russian roulette!
We have chatted in the past about the best and worst case scenarios of melanomas, but ultimately the choice is yours. When you chose to have a family, you have made a commitment to do everything possible to guide your child into being independent and content. To wear a compression stocking for the rest of your life seems a small price to pay for increasing your odds by at least 20%. Who knows whether that is a higher number but by doing nothing seems to be selfish. Life is all about unknowns. Think about becoming a gambler and suck up the end results whether they are good or a bit inconvenient. At least you will feel that you did everything possible to be around as long as possible..
Your friend indeed,
Kim
By: Kim on July 16, 2008
at 8:29 pm
Please do not look at the statistics when considering your choices. At least, not with a weighty decision such as this. In my decision making process I listened to my family members, read the treatment side affects, asked my doctors, all of them, including a Doctor of Pharmacology. She was able to hone in on the details of the drugs and how it could affect me. The interferon shots were uncomfortable and inconvenient, and I felt awful, BUT, the alternative was letting the guessing game start without me having even trying to fight. It was a comfort to me to know that every bit of drug was a chance of killing the minutest particle of cancer. I made a decision for me, though, and you have to make a decision for you. Just don’t forget to ask questions, take notes (always take another person to doctors appointments, and ask them to write things down…you’d be surprised how your brain skips when you are in the cancer fog!!). Be an advocate for yourself. Remember, life is short. Act accordingly. Take a deep breath, ask lots of questions and don’t rest until you are truely at peace with your decision.
Best regards,
Ellen
By: Ellen on July 17, 2008
at 3:49 pm