Cancer Survivor

I’m getting tired of being a cancer survivor.

Oh, not the survivor part; that’s definitely preferable to the alternative. And in many ways I’ve been very lucky. I have excellent health insurance, awesome doctors who have managed to diagnose me early every time (and that’s not easy with ovarian cancer) and surgeons who were deft enough that all three times I’ve had clean margins on the pathology.

But three times?

This is not a matter of recurrence or metastases. I had breast cancer in 2008, spent most of the summer on chemotherapy and the winter on radiation therapy. No recurrence.

Then last summer I was diagnosed with ovarian cancer. Stage 1c, and I know I was very lucky that my doctor caught it. I had assumed that my difficulty in urination was due to diabetic neuropathy, but my doctor suggested one quick ultrasound test in her office. Two days later I had an appointment at the Women’s Cancer Center in Anchorage. (Keep in mind that problems with urination can be an early symptom of ovarian cancer, which is often symptomless until it is too late.) This tine the chemotherapy (precautionary) was much more severe, and I wound up spending about 18 hours a day sleeping for the third through fifth days after each infusion. Since both cancers were “women’s cancers” I was checked for the BRCA gene, but I have neither of the known dangerous variants.

Except a routine diagnostic mammogram (because of the previous breast cancer) showed up a very small suspicious spot in the other breast, which a biopsy showed was cancerous. I was just getting my hair back from the last time around! Surgery again (partial mastectomy because I wanted minimal impact on my type 1 diabetes) and I just “graduated” from radiation therapy on that one. I’ll be on Herceptin® infusion for most of another year, though my doctor didn’t want to give me any stronger chemotherapy right after the one for the ovarian cancer. I had a port installed (outpatient surgery and they didn’t even knock me out all the way) since I would be getting weekly infusions for a year, and my veins are getting hard to find.

A couple of things I want to say from the viewpoint of someone who’s dealt with cancer:

(1) Keep exercising as much as possible. With my balance so poor, it’s mostly stationary bicycling for me, but I kept up at least an hour or two a day throughout radiation therapy. I really think it helps.

(2) They tell you radiation therapy can produce sunburn-like effects on the skin. Effects, yes, but they’re more like zombie skin. Rotting rather than peeling, and downright painful (and itchy) near the end. So glad that mine’s over and I can put ointment on the skin!

(3) The Herceptin® is a breeze compared with either of the other chemotherapies.

Measuring Blood Sugar

Back in the middle of the 20^th century, long before I had diabetes or even thought much about it, I saw a magazine ad that talked about diabetes. It might have been an insulin ad. What I do remember was that it featured a Russian troika – a three-horse hitch – and likened controlling diabetes to driving a troika. Three things have to be balanced: insulin, food and exercise, and misjudging any of the three can throw you to the wolves.

That balancing act is hard enough today, with all the tools we have to help. It was a lot harder 42 years ago, when I was diagnosed. And I hate to think of what it must have been like at the time of the ad.

The key is being able to keep track of your blood sugar. Really high, and you need insulin – exercise may actually push you higher. A little high, and aerobic exercise may bring you down. Too low, and you need food, preferably fast-acting carbohydrates. But at the time of the ad, measuring blood sugar meant several hours of lab work, and you might hear back from the doctor the next day. In order to utilize food, insulin and exercise optimally, you have to have some idea of what your blood sugar is right now, and whether it is rising or falling.

There are some symptoms. Sweating, shaking, blurred vision, and tingling lips can all be symptoms of low blood sugar. They can also be due to other things. (I was put on hormones at menopause primarily because I could not tell the difference between a hot flash and low blood sugar.) But those symptoms tend to decrease with years of living with diabetes.

Symptoms of high blood sugar are even subtler. I may start feeling a little odd when my blood sugar is three or four times normal, but my feelings were certainly not enough to tell me when I was high. Anyway, in those days doctors normally prescribed a fixed amount of insulin and a fairly rigid diet, and pretty much ignored exercise.

My current glucose monitor

What was desperately needed was a way for diabetics to find out what their blood sugar was, preferably without slashing their fingers with a modified razor blade. (That’s how they used to get blood samples.) Eventually, and over the initial objections of some physicians and regulatory agencies who were afraid that patients would self-treat, glucose monitors were developed. From the point of view of most diabetics, the objections were just plain silly. We have to treat ourselves. We give ourselves shots of insulin (which cannot be taken by mouth because it would simply be digested.) We exercise. We eat. Doesn’t it make sense that the more we know about which of the three we need, the better?

The first monitors were reportedly large, clunky and slow. They improved rapidly, and by the time I got my first one, in the late ’80s, they were pocket sized (if you had large pockets.) My testing kit today fits easily into the belt pouch I use as a purse. I still have to poke my fingers many times a day, but I get results in five seconds. One important thing is not covered, though – I can’t tell whether I’m going up or down from an instantaneous reading.

There is also a problem of expense. Tight control means testing before each meal, at bedtime, before you drive, regularly during driving, and every 20 to 30 minutes when exercising. Test strips are not cheap, and there is a real problem getting insurance companies to cover enough strips.

I’m not the only person with diabetes to feel this way, and there’s been a good deal of research on continuous glucose monitors. The first one I tried was the glucowatch. This used a patch sensor on the arm or wrist, and gave the blood sugar on the “face’ of the watch. It could also be read by a computer. Drawbacks? Many. First, it would only operate for 12 hours, and took a while without readings to initialize. Second, the patch was very irritating to my skin. I invariably had a major welt that lasted a week or more when I removed the watch and patch. Third, any sweat made the readings unreliable – and sweating is a symptom of low blood sugar. The watch did confirm that I was having low blood sugars at night and that I responded by “bouncing” high – a fairly common reaction, and much better than staying low with possibly fatal results. But the combination of problems led me to stop using it.

Modern continuous glucose monitors are much better, though by no means perfect, and I’ll talk about them, and the problems with getting insurance companies to cover them, in the future.