Green Bananas, Two Years Negative and Keep Going On With Life

Two years ago I had a kidney stone. That brought me to the ER. Late that night, an ER doc that I have known for many years came in with a very somber expression. He opened my CT scan on the screen and showed me my 10 cm left adrenal mass. That was followed by another CT scan, labs, then surgical resection, radiation and the chemotherapy mitotane. Adrenocortical carcinoma (ACC) was the pathological diagnosis. ACC is a rare cancer with only about 300-500 cases per year in the United States.  ACC can recur despite the best efforts to get rid of it. The protocol then is to do CT scans every 3 months so that if it comes back, we could respond and treat it.

In May 2020 I had some enlarged lymph nodes in my chest. Just when I was regaining confidence that this was going to be behind me, the reality of it all came home. We spent some tense days and weeks of wondering if it was back. My August scans showed the lymph nodes as being smaller. On November 1, 2020 I had my two year scans. Those scans now show the same trend (lymph nodes getting smaller) and thus provide clear reassurance that those are not likely cancer.

Good news.

It does have implications, however. It means it is ok to buy new shoes. I sometimes reassure my patients by joking that they can buy “green bananas.” The idea is that they will be around long enough to have them ripen and enjoy them. New shoes also implies that you will be around long enough to wear them enough to justify the expense. 

What it really means is figuring out how to go on with life.

I joke with my patients about this but it is not a joke. It is an important part of their treatment. They have to change their thinking. They have to start thinking about how to go on living. They have to do this even if they have ongoing symptoms.

We all have to do this even if the world is not behaving how we want it to.

We all have had to deal with this in 2020. In late March we locked ourselves in our homes to get through the storm of COVID 19. We treated it just like we do a blizzard. We made sure we had supplies. We found books to read or shows to watch. We set up a card table and started doing puzzles together. We could stop life because it was a crisis. We were excused from a lot of what normally makes up our lives.

I can remember in late April when I saw the COVID projections extending into 2021. A pit formed in my stomach. This whole thing was losing its novelty. We were going to be stuck dealing with this for far longer than any of us would like. We had to come up with different strategies. For my part, I wrote our governor. I pleaded with her to consider pulling together experts to consider sustainable models for social distancing and control of COVID 19. It was time to move beyond shutting down everything and holding our breath. It was time to think about how we could live with new patterns for 1-2 years.

All of us have had to come to some sense of understanding of how to live in an era with COVID 19. It is not what we want. We want to be together. We want to hug our friends and have big get togethers with our family and friends. We want to go and linger at our favorite restaurants and sit in coffee shops for hours on end. 

On top of this, 2019 and 2020 have brought really hard things for many of our family and friends. I find my prayer list growing and growing and growing. Life is hard. There are things that cannot be fixed.

For me, my CT scan result means accepting my current symptoms and learning how to live in the body that I have. I have been left with adrenal insufficiency. With this comes a variety of unexpected issues and limitations. It means that I am not normal. I have another blog that I have written about this and will share it soon. That will go into more details. 

In brief however, in June I started to feel crummy again. I worried it was a cancer recurrence draining my energy. I was waiting for the other shoe to drop. I would somehow just muddle along with fatigue, muscle aches, and dizziness until I had to go through the next wave of treatments for cancer.

It isn’t cancer. 

That means that it is not something that will get a lot worse. It also means that there is not necessarily a clear path through it to get better. It means that it is something that I am going to have to figure out how to live within. Some days I come home, and I just want to collapse. I think by and large I do a good job of hiding it. My wife can immediately see it. I don’t want to distress her by it. She is just too perceptive. 

I am now on more hydrocortisone. I have learned to push fluids and to have a high sodium (salt) diet. I have learned also to understand my limitations. I am also experimenting with exercise. All of that seems to be helping. I am doing better than I was in June.

What does this all mean?

1. I don’t have any evidence of residual or recurrent cancer.
2. I do have symptoms that are not magically going to go away. 
3. I am going to have to learn how to manage my symptoms, live within them, and live for all the good things that I can do.

What does it mean for you?

1. I am sorry for all the pain that 2020 has brought. COVID 19 and its limitations and implications have brought pain for everyone. On top of this it has been a year of enormous grief, pain, and loss for more friends than I can ever remember. 
2. We do not have a magical cure. I cannot make COVID 19 go away quickly. I cannot also take away the pain from my friends, no matter how much I want to and no matter how earnestly I pray for them. 
3. We go on. We live. We do what we have to do. We try to make the best choices and decisions we can but mostly we just have to go on with life.

This morning my body ached all over. I got up because it was at least as good to be up as it would be to be aching in bed. I took my hydrocortisone and plopped in a chair with my computer and my coffee. I waited for my body to warm up and get ready for the day. I would love to have a magical cure. Maybe I even secretly hoped that the scans would show cancer or something that would be a way to explain my symptoms in a way that could be fixed. I didn’t really want that, however. I am very pleased with my results. It just means that I need to get up, keep moving, and keep living.

This is what all of you have had to do. In spite of COVID-19, in spite of elections and election results (whatever they may be), and in spite of horrendous losses that can make both of those look trivial, you just get up and decide to live. Go ahead. Buy some green bananas. Treat yourself to a new pair of shoes.