Follow up - February 22

Sorry everyone, I know I’ve been remiss in updating you following my appointment on Wednesday. For those who sent me gentle reminders, thanks. Your e-mails have obviously gotten me back in gear!

My hard cast was removed and the stitches taken out. The incision is healing well, but it is long, about 10 inches according to Ed. It starts on the side of my foot about two inches from the bottom of my little toe and continues around my “ankle” and up my leg. According to the operative report, there was a defect on my talus (the bone that forms the ankle joint along with the fibula and tibia), so I believe Dr. Healey removed part of it. He also had to remove all of the tissue surrounding the biopsy site in one mass, so that partially accounts for the long incision. We didn’t get a copy of the report until the end of the appointment, so we couldn’t ask any questions about it. We’ll have a list for the next time, though.

Dr. Healey decided to move me into a walking cast rather than another plaster cast. I’m supposed to work up to walking on it over the next four weeks (my follow up is March 27), beginning with my current method of using two crutches and putting no weight on it, to putting a little weight on it, to using one crutch, to using a cane, to finally walking unassisted. I am taking it slow and will begin putting weight on it on Monday. Ed’s new name for me (the former being “Gimpy”) is Big Foot.

Dr. Healey then informed us that the pathology report indicated the tumor was high grade, not low to intermediate as previously determined. This means there is a much higher chance that the cancer will recur locally in the soft tissue of my lower leg or metastasize to another site. (LMS tumors generally have a 7.5% chance of local recurrence.) I have an appointment with Dr. Keohan for March 3 to discuss my treatment options. Dr. Healey recommended chemo, perhaps with radiation to the operative site, for several reasons, including my general good health and ability to tolerate chemo, and the possibility of preventing recurrence or metastases. The downside is that there is no proven chemotherapy for LMS, so prevention is not guaranteed. We’ll have to hear what Dr. Keohan recommends, but I was hoping to somehow avoid chemotherapy or at least have a choice, which now I don’t think I have. Despite the side effects and long-term damage of chemo and radiation, if I didn’t do the treatment I would regret it if I had a future recurrence. If I do the treatments and still have a recurrence, at least I’ll know I tried to prevent it.

On a positive note, there was no indication of cancer in the remaining tissue, so Dr. Healey definitely removed the bone and surrounding tissue with clear margins (the tumor had broken through the bone and was in the surrounding soft tissue). I am currently in surgical remission.

My philosophy at this point is this: Life is a crapshoot. Every decision I make may or may not be the “right” one, but I take a chance. Not all of my decisions have turned out well, while I have reaped the benefits of others for decades (and some of those were made without a lot of thoughtful consideration). You just don’t know what the long-term consequences of your choices will be, but sometimes you have to go with your gut in the face of the unknown. This is one of those times for me. With the support of my family and friends, I will get through this and hopefully reap the benefits for the rest of my loooooong life.

I am reminded of my favorite poem, which I’d like to share with you. It was written by Robert Frost in 1915 and is titled “The Road Not Taken”:

Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth.

Then took the other, as just as fair,
And having perhaps the better claim,
Because it was grassy and wanted wear;
Though as for that the passing there
Had worn them really about the same.

And both that morning equally lay
In leaves no step had trodden black.
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.

I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I --
I took the one less traveled by,
And that has made all the difference.