Saol Gáire Grá: When Ignorance is Bliss

I've tried REAL hard to not spiral and worry about cancer recurrence. But even trying REAL hard doesn't mean it doesn't happen.

Goal: Continue to live your life in the now and not worry about cancer recurrence.

Reality: You have a new ache, oop, it must be cancer. You have a spot on your arm, you rub it real hard and it doesn't come off, oop, it must be melanoma. Meanwhile, with a little soap, it comes right off. I usually laugh at myself once I rule out that this thing is not a recurrence or secondary cancer, but then it happens again.

Most recently, this took place after my most recent labs taken at my oncology appointment. My oncologist says that my calcium level is a little elevated but it isn't anything to worry about right now. They said we'll check it again in 3 months. Me being me, I asked what a high calcium means. Almost nonchalant, they said "bone metastases". So I spin a little. Nothing to worry about? Easy for you to say. They then also mentioned hyperparathyroidism as a differential diagnosis and said that would be easy to treat with a referral to the same surgeon who did my breast cancer tumor removal since she specializes in thyroid as well. "Easy to treat" aka another surgery. Maybe I should define the word easy next time I see them.

Now add on my review of the rest of my labs and I see that I have a slightly elevated total protein and MCH (Mean Corpuscular Hemoglobin (MCH) is a blood test measuring the average amount of hemoglobin in each red blood cell). I just took a continuing education course that stated that people don't "google" things because they don't believe their clinical team, they "google" because they're scared. Well...

Per Google AI:

The #1 potential cause of this lab triad is:

"Primary Hyperparathyroidism: This is the most common cause of high blood calcium (hypercalcemia), accounting for ~90% of cases. It involves a benign tumor on one of the parathyroid glands, leading to high calcium, sometimes accompanied by altered protein and MCH levels." Primary treatment is surgery to remove the usually benign but occasionally, cancerous tumor. "Primary hyperparathyroidism occurs in approximately 2.88% to 7% of breast cancer patients, compared to roughly 0.1%–0.3% in the general population."

The #2 potential cause of this lab triad:

"Multiple Myeloma: A type of blood cancer that often presents with a combination of high calcium, increased total protein (often due to high albumin or immunoglobulins), and can cause changes in red blood cells." I won't even go into the treatment for this. This would be considered a secondary cancer, with a "Standardized Incidence Ratio (SIR) of 1.5 indicates that the number of observed cases in a specific group is 50% higher than what would be expected based on the rates in a reference or "normal" population."

Seems legit. But how do we score this? Well the Fear of Cancer Recurrence Inventory - Short Form, of course! Thanks, Canada!

I won't be revealing my score so no one tries to hold me on a Title 47. Here is the scoring in case this pertains to you (of note, it can be for those in cancer treatment, cancer survivorship, or caregivers/family of persons with cancer):

From the Canadian Family Physician article:

"Low to moderate severity (0 to 15 on the FCRI-SF).

Because FCR is a common experience for cancer survivors, normalizing this experience for patients in a supportive and empathetic way is recommended. This could include discussion around the frequency with which survivors report FCR and common triggers of FCR (eg, hearing of someone being diagnosed with cancer, aches and pains, reminders of cancer experience in general). Uncertainty is inherent to FCR; therefore, providing information to cancer survivors and their caregivers on signs and symptoms of cancer recurrence, frequency of surveillance tests, and what to expect in cancer-related follow-up care, etc., can be helpful.

If maladaptive coping strategies are present, introducing more adaptive coping approaches such as engaging in enjoyed activities, meditation, yoga, physical activity, journaling about FCR, and talking to supportive friends and family about their fears can help decrease the severity of FCR among patients.

High and clinically significant severity (16 to 21 and ≥ 22 on the FCRI-SF, respectively).

For cancer survivors experiencing high (score of 16 to 21 on the FCRI-SF) and clinically significant (score of ≥ 22 on the FCRI-SF) levels of FCR, referral to allied health care professionals working in psychosocial cancer care might be appropriate. Psychotherapists can provide cognitive-behavioural approaches to address clinical FCR. Such interventions are empirically supported in group, online, and individual formats. Additional online resources on FCR (available at CFPlus) can be shared with cancer survivors who present with high FCR."

Ok, back to real life. It continues to blow my mind how differently each person who encounters cancer reacts. I've observed that ignorance really can be bliss.