Clink. Clink clink. Clink. Clink clink clink. A teenager sat to my left, opening and closing windows at the speed of light on the public computer. Her bangle bracelets jangled together every time she moved her arm. A couple of men of Middle Eastern descent walked arm in arm from the elevator area to Nuclear Medicine, on the far side of Internal Medicine, where I sat, waiting. They passed in front of me ten times in the two hours I waited for my appointment. I never could figure out where they were going or why they had to keep leaving and coming back. I wasn't nervous about it; I was puzzled. Over the two hours, four people wandered up to the coffee machine, some of them stood there and looked at the empty carafe for a few minutes before they left. Others actually attempted to make coffee, going so far as to remove the coffee basket, only to find that the filters and coffee were nowhere to be found. Being a pro, I knew they were locked in drawers under the cabinet.Two hours. My appointment with the Internal Medicine physician began to seem like an incredibly stupid idea. I'd already completed the 50 page (no, seriously) questionnaire within the first half hour. Why wouldn't I get up, leave the questionnaire and drive home? Why wouldn't I just continue to be exhausted? I was getting ready to check myself out when they called my name.
I'd handed over my completed questionnaire an hour earlier, but no one could locate it. I guess a search party was organized. They found it about ten minutes after I'd been sitting in the tiny exam room, still contemplating whether I could get up and leave. I knew the exam was going to be lengthy, because I had two scheduled, back to back. I had the Advanced Nurse Practitioner, then the Internal Medicine doctor. I was almost certain there would be blood work, which would mean I'd have to probably wait another 45 minutes in the lab area. Then there would be a four hour ride home.
Fatigue is hard to quantify. On the questionnaire they asked things like, "How much does your fatigue interfere with your ability to clean the house?" Please define the word "interfere" in this context. "Can you walk around the block?" Yes, but then I have to lie down for two hours. There was no place on the form to note the toll the walk would take. I can do virtually everything, but there is an energy cost and it's high. They attempt to quantify by assigning numbers to all of the answers and adding them up so that you fall into a range of fatigue levels.
Luckily, my new doctor didn't rely only on the answers to the questions. The nurse and I talked for about 45 minutes, then I spent another hour with Dr. Escalante. It was worth the wait. She listened to me, prompted me when she needed more information, then examined me. She ordered lab work.
Dr. Escalante reminded me that long-term fatigue is very common among breast cancer survivors and it's more likely for those of us who've had multi-modal treatment. That's a fancy way of saying that they've beaten me down with chemo, radiation and four surgeries. Of course I'm tired. There are some new research studies underway to try to determine why this is so, what internal mechanisms are factors in creating fatigue, but no one knows exactly why right now. Dr. Escalante acknowledged that I'm doing everything I can to improve my quality of life, so she suggested another alternative.
My new anti-fatigue drug is Ritalin. The other drug they use is something called ProVigil, which is FDA-approved for treatment of narcolepsy. I understand why that works, I think. I fall asleep sitting up, using the bathroom, anywhere I have a moment of inactivity. It's supposed to help with chemobrain, too. Some days I'm able to think clearly, but mostly not. I'm in a perpetual fog.
I got home around 11:00 Monday night. Wednesday night there was a terrible storm. We're still dealing with the aftereffects. It's been a long, long week. I can't feel any upsurge in energy since I started Ritalin. Next week, I'll tell you about Loathsome's take on the fatigue issue. You're going to love it.
