Mayo Visit #1

First things first. We've had problems sorting out the "Comments" feature of the blog.  If you authored a comment and it didn't take, we apologize. I think it is now set up so that anyone can post a comment. There is a word verification step and the comment goes to my email for approval before it is posted. Perhaps that is overly cautious, but let's try it this way to start so we don't get bombarded with spam and/or inappropriate anonymous commenters. Not that we are all that popular on the www, but insidious spammers have a way of finding any opportunity.

JoAnne had an 8 AM appointment this past Monday at Mayo Clinic. We had planned the leisurely 85 mile drive through the rolling farmland of southeastern Minnesota for Sunday evening with a stay in the local hotel. Snow rolled in Sunday morning and began accumulating at an alarming rate so we loaded up and headed out after lunch. By then the winds were blowing and blizzard conditions had set in. We caravanned it with the other demented souls who dared the elements. Interestingly, once we got into the flatlands, the wind was so intense, there were extended stretches of freeway blown completely clear. It turned out fine, but the added tension wasn't what was needed on a trip like this.

There is an inside joke that circulates among doctors who are not Mayo bred that the 3 most overrated things in life are home cooking, first loves and Mayo Clinic. I spent many years calling on their heart surgeons during my medical devices career, and it was an extraordinary experience. It's sheer size coupled with the history and architecture makes one feel very small.  And yet, in dealing with the doctors, nurses and employees, each patient is made to feel as though they are the only patient.  Mayo believes they are the best at what they do, and everyone right down to the parking ramp attendants and volunteers buys into that attitude.  It is a model of efficiency, productivity and care unlike anything I have ever witnessed.  In an odd way, it almost makes one feel good about needing health care.

At first glance, one thing you notice is..........there are a lot of old people hobbling around. And they are not all Arab sheiks and celebrities. There is about a 1 in 2 chance that the couple you get on the elevator with is an Iowa farm couple in town for a back, knee or heart tune up before the planting season begins.  Iowa's health insurance system is in fact, struggling a bit as so many come to Mayo which is out of network and more expensive.  Wind your way through the parking ramps and like Disney World, the license plates on the cars are from everywhere.

In the pre 9/11 days, Mayo was a destination for Middle Eastern royalty.  Driving by the airport, you would see a 747 with a royal flag painted on it parked in a remote area of the tarmac with guards and a few limos parked underneath it.  The delegation took over entire floors of some of the local hotels and stayed for extended periods.  Their shopping extravaganzas were legendary.  All of that has gone away with stricter travel rules and regulations.  Nonetheless, Mayo has continued to grow tremendously in size and scope.

On Monday morning, we met with JoAnne's doctor, Tim Call, MD. He spent considerable time reviewing JoAnne's medical history related to her cancer; thank goodness for CD's and DVD's. He scheduled her for a series of extensive blood tests immediately following, and a bone marrow biopsy the next morning. We are also scheduled to meet with him again on March 1st to discuss the results of the testing in greater detail.

The bone marrow biopsy on Tuesday morning was an interesting experience along with being a bit uncomfortable. It was the third one JoAnne has had over the years. The efficiency of the team was remarkable. Scheduled for 8 AM, they called for her precisely on time.  We walked into the room where 2 techs and the RN who does the procedure were standing in wait of her arrival. They talked her right through the procedure including jokes and personal small talk. They do 20 of these a day and the RN has personally done 5000. That is stabbing a lot of butt cheeks. They numbed her with some local anesthetic and then penetrated the bone by drilling in with a large gauge needle. After sucking out some marrow, they slapped on a big band aid and she was ready to go. Less than 30 minutes.

One thing we had forgotten was that the last biopsy done probably included some additional narcotics to deal with the pain. A little propofol, otherwise known as milk of amnesia or Michael Jackson's sedative of choice, would have been helpful. Our girl toughed it out anyway and its behind her now.

Although there is still much to be discussed, Dr. Call did suggest that we begin to consider the serious option of a bone marrow/stem cell transplant. This is a difficult and complex decision and it is challenging to explain. If JoAnne were to stay on her current course of treatment with available chemo agents and palliative care, she might buy a couple to a few years. She would be highly susceptible to infection and bleeding issues that could easily turn fatal. A successful bone marrow transplant could give her a 50/50 chance of several to many years of remission, but she cannot wait until she is much sicker to do that. The downside of a transplant is about a 25% chance that it won't take and another 25% that she would not survive the transplant.

A stem cell transplant is no small undertaking and we are only in the early stages of exploration. Right now we will be satisfied just knowing that we have it as an option. We will have a better understanding of the details following our next appointment. As always, your thoughts and prayers carry us through.

Cancer sucks.