Every Breath a Gift: Medical Addendum #2

by
Larry Pearce
12/15/24

See original post Every Breath a Gift: A Memoir

See also Medical Addendum #1

As you may have guessed by now, discovering that I have cancer and being treated for it has been and is the most challenging medical aspect of my rich life to date. But, the uncertainty of my recovery is not limited to my shots. I recently learned of yet another challenge in accepting my treatment. Hopefully this test will be just mental and not physical. You see, in February I met the third oncologist in 18 months on my list of doctors provided by the Conemaugh Memorial Medical Center (CMMC). The hospital, now owned by Duke-Lifepointe, the site of my Cancer surgery on March 28, 2023, has undergone many changes over the past few years including, unfortunately, the release of my first oncologist, Dr. Sheetal Higby (see her resume in the Medical Addendum #1 link above.) and now the second, Dr. Mariya Apostolova. There are many good things I could say about her, but let me start by saying that she seemed more like a neighbor than a doctor. I had just learned to pronounce her name and now she’s gone.

I had heard that she was driving out to CMMC’s Somerset location from Pittsburgh so I asked her where she lives at our first appointment. I was born and raised there, so naturally I wanted to know more. When she said “North Hills” and more specifically “Pine Township,” I asked her if she knew where Pearce Mill Road in North Park is. She replied something like, “That’s where I live.” I don’t know about her, but I forgot all about my cancer and we shared additional information, like “My dad was born in the old mill house there,” I said, and “The park is where I learned to swim and ice skate and where I proposed to my wife.” Needless to say, our first meeting was very meaningful.

Dr. Apostolova was back at the Conemaugh Memorial Medical Center, Johnstown and Somerset, PA, after completing an internship there over a decade ago. She had completed a fellowship in Hematology/Oncology at Allegheny General Hospital/Western Pennsylvania Hospital in Pittsburgh, PA, after receiving her medical degree from St. George’s University School of Medicine located in Grenada, in the Caribbean. Dr. Apostolova most recently worked in Butler, Pennsylvania, where I was born, and is affiliated with multiple hospitals in the area, including Allegheny Valley, St. Elizabeth’s in Youngstown, Ohio, and St. Luke’s University Hospital-Bethlehem, PA, Campus.  She has been in practice for over 15 years. She has been perhaps best known internationally during that time for her 15 peer-reviewed academic articles.

My first medical addendum to my memoir is dated March 1, 2024. The CT scan at that time showed very few traces of the Neuroendocrine Tumors (NET) that had been removed the year before, but additional monthly shots were in order as well as a PET scan on August 22. That would compare to at PET taken on November 9 of the year before.The reading on the most recent CT scan, October 9, 2024, is as follows:

FINDINGS: No pathologic-sized hypermetabolic cervical lymph nodes are seen. No pathologically enlarged or hypermetabolic lymph nodes are seen within the chest. No definite hypermetabolic pulmonary nodules are identified. Chronic and degenerative osseous changes. There is limited evaluation of the pelvis due to right hip prosthesis. At the inferior tip of the intramedullary rod portion of the right hip arthrodesis of there is a focus of increased tracer uptake with a maximum SUV of 3.2. Hypermetabolic foci are again identified within the pancreas most densely in the head as well as the mid body and tail. This is similar to the previous examination. The patient had a lesion previously seen within the pancreas on a prior MRI and can be reevaluated by that modality. There is heterogeneous intense activity throughout the liver. Cannot evaluate the liver lesions previously described on MRI and these can also be reevaluated by that modality. The previously seen mass within the mesentery which may represent nodal metastasis has decreased in size.

These findings were sent to Pancreatic oncologist and surgeon Dr. Amer Zureikat at the University of Pittsburgh Medical Center (UPMC), as a follow-up to a meeting we had shortly after my 2023 surgery. No news is good news, and we never heard from him until he wanted to see me this year. An earlier scan revealed a shriveled tail on my Pancreas, not unusual for a 76-year old. In my research I have found that some believe there is a link between such a condition and Eczema symptoms and even Essential Tremors. Wouldn’t it be a blessing of surgery relieved my awful itching and shaking! However, Dr. Z, as I think of him because I’m not much of a speller, believes there is no proven connection. The good doctor was featured this month in the UPMC Hillman Cancer Center newsletter. He says that, as a child, he and his father, a cardiologist, traveled the world looking for a treatment for his younger sister, a victim of cerebral palsy. “That left a lasting legacy on me,” he reports. He became a surgeon, specializing in diseases of the pancreas, stomach, liver, and duodenum. The day after his son was born he performed his first Whipple surgical procedure and he reveals that, “It was like a light-bulb moment. I knew I had to be a pancreatic surgeon. I will always do my best to do the right thing and extend someone’s life of give them a better quality of life.” My favorite part of the article is where he describes meeting with the patient and family after recovery: “That five to ten minutes when you get a handshake or a hug is a phenominal feeling. I cannot describe it.” Should surgery be necessary for me in the future, and Dr. Zureikat performs it, and I come out better, guess what he gets!

Even as I was writing this account, I received an e-mail from Dr. Zureikat’s office asking to see me on October 9th at 8:30 AM. That’s rather early to get to Pittsburgh, you say, especially at the height of what we former radio jocks call “Drive Time.” Oh, don’t worry, his secretary Diann implied with a chuckle. I’m informed that the doctor would like me to have a CAT scan at UPMC before. That procedure required me to drive at 5:45. I can imagine her smiling as she cautioned me, “Watch for deer. They’re in rut, you know.” Oh well, who can sleep, knowing that a life-or-death verdict might be delivered?

We left the Laurel Highlands at 3:15 that morning, barely passing a car. The other good news of our trip to Pittsburgh at that hour was that there were plenty of parking spaces. in the garage adjacent to the hospital, although we didn’t know how to get out of the place. We finally found a glass walkway across the street and into UPMC. There was no one in the waiting room for the radiology department. Susan and I had breakfast down the hall, and by the time me came back, the receptionist was waiting for us. She said, “I don’t know why the schedulers have people arrive so early!” But waiting apparently is the name of the game. We were also early for the good doctor/surgeon. By this date, after all the monthly injection expenses in Somerset, I had surpassed my required insurance Out of Pocket payments. My scan was free to me, but the Pancreatic Center managed to get a co-pay out of me. Who was I to question. I eventually got my money back.

I’ll be as concise as possible here regarding my meeting with Dr. Zureikat. He looked me in the eyes and said: “You have Stage 4 Cancer, but that’s not the same as a death sentence from a single malignancy. A Stage is counted by the number of places affected.” While most of my disease was removed with surgery on the small intestine last year, he believes I still have part in my belly, on my liver and pancreas. Surgery would also require the removal of my spleen. Dr. Z smiled at my wife and me and reassured us that because this cancer is so slow-growing and the hormone shots appear to be working, surgery might not be the best approach at this time: “You’re an otherwise healthy, active 76-year old. While surgery may help, it could also harm. You may return home and resume your life until Conemaugh contacts me otherwise.” In what we thought was unusual, He explained that UPMC’s cancer team meets regularly to discuss cases and make recommendations. His office would report any discussion on my situation. He never did. I guess “No news is good news – for now.” With plenty of smiles to go around, Susan and I thanked him and skipped our way back to the parking garage. Oh, we did pay for parking.

Oh, and one more bit of good news, even as I post this Medical Addendum: All of the major news outlets today are excitedly announcing the positive results of a new vaccine to keep Pancreatic Cancer in check. Lots more work will be done before it gets government approval, but at this “Stage,” any weapon is good news against this deadly disease. I would certainly volunteer for further research if the opportunity becomes available.

An amazing thing to me is that I avoided my quarterly Eczema shots because of what I call “itching subsidence.” Let me explain.  With the hot, dry weather we had this summer, I was in the pool almost every day. We use a minimum of chlorine, a chemical that can cause irritation, so I didn’t shower every day. I applied lots of Tacrolimus ointment and CeraVe anti-itch cream and I had been good-to-go. Now that autumn is upon us, the pool is covered, and another ailment which I’ll describe below, I requested and received an eczema shot in desperation.

The first major ailment I suffered since cancer surgery in March of 2023 was a fall from my beloved ATV on July 14 of this past summer. Susan was down in North Carolina helping our son move. I hesitate to use the work “fall,” because that’s one of the first questions asked in a Primary Care Physician’s (PCP) annual wellness visit: “Have you had any falls recently.” If you say “Yes” it seems you’re put in the “elderly” and “feeble” categories. So, I prefer to use the word “slide,” thinking like the Little League player that I was. I actually slid off my ATV while mowing my field just as a rain storm began. The machine seat was getting wet, and I hit a hidden log in the deep grass and all  began to roll over. I had two options: hold on to the handles and possibly be crushed by the tilting monster, or push back and fall out of the way. Well, I instinctively did the second and landed flat on my back. At first, I felt no pain and was able to get the ATV and mower back into the barn, out of the rain. But, as I made my way up to the house, the agony Began to set in. I called my PCP for an X-ray but was told to either make an appointment, which would probably be days later; go to the ER, which would probably mean a bit of a wait and major expense; or go to Med Express in Somerset or Johnstown, a longer drive and possibly more money. I joked that I shouldn’t have to have an appointment because I had already  diagnosed the problem: “I was in pain.” There was no laughter at either end, and I didn’t get the X-ray.

Well, to cut to the chase, I didn’t do anything but rest and the pain subsided after several weeks. The injury only hurt when I twisted (and shouted). That is to say that I didn’t sleep with my wife during that time, which would have required twisting to get in and out of bed. Rather, I found the living room recliner the best option, where I could sit and “handle” myself down and up.

Just as my back was healing, near the end of September, we had covered the pool and I was almost done stacking firewood on the back porch. Dragging a piece of the free fuel down from the rather steep back yard, I found myself “slipping” along a small stream coming from one of our cisterns. Letting go of the dead branch and unsuccessfully trying to regain control, I went down into the water on my left shoulder. Nearly covered with mud and water, at first I lay there wondering what had happened. In trying to get up, I realized that I had no use of my left arm. After a few minutes, soak-and-wet, I managed to wiggle my way onto my feet. I carefully got out of the water, down the slope, through the yard, andante the porch. Sticking my head into the back door, I shouted to my wife, “I need some help.”

While taking a rest on my favorite back porch rocker, and with the help of Susan, I carefully and painfully removed my filthy shirt and pants. This time I was amenable to a visit to Conemaugh Hospital’s Emergency Room. Somehow I got into the shower and washed what I could. Of course, Susan drove. Now, understand that there are horror stories of this big city ER as far as wait times and expenses. (See the story of my overnight experience there just days after my cancer surgery.)  However, this was a Saturday afternoon, and we counted only an hour from check-in to the end of X-rays. There were few patients there at that time. I figured everyone must be watching football. Drs. Wales and P(?), the nurses, and X-rayers were wonderful. I had taken a leftover post-surgical Oxycodone for the pain, so I was half asleep. As we waited for the results of the shoot, we heard a helicopter on the roof above us, and learned of a bad ATV accident on a nearby mountain. The woman who was transported had several broken bones. My news was much better: NO broken bones, unlike my older brother who had a similar fall near his condo in Virginia and suffered a broken collar bone. Although my pain quickly subside, I still have limited upward motion with my left arm. He wore a sling for many months and was advised not to move his arm.

Just when Susan, with all her medical woes, and I with mine, thought we couldn’t be tested to any greater extent, our region in Northern Appalachia went without significant rainfall for nearly two months. The experts called it “Severe Drought.” While most people in America’s northeast had water, the danger of forest fires threatened fields, forests, and homes as far as New York City and Boston. We have enjoyed the luxury of free and crystal clear water in abundance from our three springs for 50 years. As if the threat of fires and the natural deterioration of the cisterns weren’t enough, our water supply came to a complete stop on Veterans Day of this year. That was also the 27th anniversary of the death of Susan’s mother, Hilda. We’ve had minor stoppages several times before: there were freeze-ups in the winter, once when the deer path in the woods had exposed the waterline to the cold temperatures. An extension cord and a heat tape took care of the problem. But this time as hike up the hillside revealed a complete absence of water. Our church had come to the rescue before with 5-gallon Igloo portable water coolers. Dear Pastor Mike even delivered them to us. The same was true this time, only we didn’t rely on the “Holy” water from the church. Friends Joe and Jim from just up the road supplied the public water refills. Not unlike during my accident this summer, Susan was away at our daughter’s to help her recover from foot surgery, when the rain started up again and our spring water returned. That was 2 1/2 weeks we had been without water. I have come to believe that most of us take for granted the liquid sustainer the Good Lord provides.

Our swimming pool had been officially closed since Labor Day, but our kitties were able to find small pockets of water atop the cover. We hauled some water in buckets for flushing. Salvaged gallon jugs were filled at the church, Laurel View Village, and friends’ houses for cooking, the coffee maker, and minor cleaning, including the hands and faces. That Priority Club membership at the Village allowed us to swim and shower in the pool area when we visited friends there.

We paid a visit to the Conemaugh Municipal Authority which manages the public water for folks, businesses, and institutions in and around Conemaugh Township. Their reservoir sits on the side of Laurel Mountain, just to the west of our house. We paid them at $1,500 tap in fee and a $50 inspection fee. But now we had to contract an excavator, installer, and plumbing specialist. Our neighbor, Berkey Excavating, just up the road was recommended. Dave maintains and digs for over a dozen cemeteries in the area and I’ve called on him many times. He came to the house and gave us a plan. The only problem was that he couldn’t begin work until the temperatures outside were a steady 40-degrees plus. By the time the Municipal Authority had obtained the permit from the State to bore under the road to get to the main line, some 900-feet from the house, we were into winter with most temperatures well below Dave’s limits. As for the inside work, we decided to contract Hinkle Plumbing and Heating in nearby Johnstown. They are operated by a relative of Susan and installed our water pressure system several years ago. Unfortunately, the pump they installed sprang a leak, but they accepted the warranty and replaced it. Also unfortunately, shortly after our cistern water returned, our filter began a small leak. The genius that I am decided to catch the leak in a bucket and use the scarce water for washing the clothes. All worked out, and when the temperatures dipped below freezing, the drip actually came in handy. Ironically, the drip stopped as suddenly as it began and we had to resort to a small drip from the spigot. The second irony came when we learned that Dave Berkey was working with Hinkle in installing plumbing at our very own Laurel View Village. It’s a small world. Now, if we can get public water, especially need when and if we sell the house.

Another blessing from tragedy was the gift from our daughter of a two-stage water filtration system to go along with the installation of public water. The first removes the chlorine, which while protecting us from bacteria, can also be hard on the body and affect smell and taste. It’s said that chlorine can cause the deterioration of water heaters and other utilities in the house. Knock on wood, we’re still using the same water heater after fifty years with natural spring water. Believe me, we get plenty of chlorine otherwise with our pool in the summer and regular visits to friends, neighbors, and the pool at Laurel View. The second filter removes minuit impurities that the public water system might miss. Thank you, daughter Annie. By the way, she uses ultraviolet light to purify her collection of rain water for the house and apartment. Read the story of her sustainable life.

So, who is to be my oncologist in February? His name is Dr. Imran Ali Idrees, a middle-aged physician who began his studies at Iberoamerican University (IBERO), one of Mexico’s first private institutions of higher education and their oldest Jesuit school. Dr. Idrees has practiced at hospitals throughout Pennsylvania for more than 24 years. One of the major teaching/nursing hospitals in Pakistan is also named Imran Idrees, but he didn’t seem to know much about it. My first impression of the handsome doc was his neatly trimmed beard. The previous women physicians I had didn’t have such an amenity – laughter. I don’t know what he thought of my gray beard, nor did I ask him. Our meeting was otherwise brief. He didn’t seem concerned with my blood test numbers as they were all average except for the high white blood count (WBC). It seems that is due to my cancer, which apparently is under control. I’ll see him (or his replacement) in late spring after another CT scan. My wife was also in on the appointment as she is taking drugs for blood clots and he is also a hematologist. He said that she is doing fine.

I’ll leave you with a bit of bad news, depending on how accurate the report is and how the information is accepted. Every so often my primary care physician asks for a certain type of blood test to be administered along with my monthly pre-cancer shot blood test. Last month, my wife and I managed to sneak in a meal at Dairy Queen before, which included my favorite, two servings of sweet tea and a hot fudge sundae. The next day I received a call from the PCP’s office, and the nurse simply said, “You have diabetes,” and asked, “Do you want pills or an appointment with a registered dietician?” Once I picked myself up off the floor in disbelief, I asked for the dietician.” When I explained the context of my latest test, sugar from DQ, she explained that the test report included findings of “older cells over the past four months.” I’m not sure I understand, even to this moment, and the dietician my wife and I counseled with said the same thing. I ironically, the standard blood glucose readings for that time period were all normal – except for the ones taken after DQ.

I continue to lose a few pounds from month to month, even during our harsh winter when I seldom step outside. The jury’s still out on this fourth negative health condition after Eczema, Essential Tremors, and Cancer. I wish I could “put the puzzle pieces together.” I hope the fifth negative health condition isn’t death, but if it is, I’m ready to meet my maker. By the way, Susan and I recently moved our local church membership away from what we’ve long held after my Scots-Irish Presbyterian and English Methodist heritage. I’ve written quit a bit about the positive influence those traditions have had on our marriage and lives in general. But now, you might say we’ve moved back closer to Susan’s German Lutheran Reformed tradition by joining the United Church of Christ, a denomination in our county that goes back to when her ancestors on both sides of the  family first came to the Laurel Highlands. In addition to attending worship, we’ve joined the choir and take part in weekly Bible studies along with congregational events. The observance of the Liturgical Year, the accompaniment of traditional hymns with the majestic pipe organ, and being immersed in service music provided by master musician Dave we like to say is “Somerset’s best-kept secret.” We especially like Pastor Matt’s welcome: “No matter who you are, or where you are on life’s journey, you’re welcome here!” We are greeted each week by folks of all ages and walks of life, but especially those our age, with whom we can share our common experiences. The stresses of medical conditions and taxes, for example, seem much less. We’re anxious to share this with others.

Perhaps an additional medical addendum will be in order. I’m told that my type of cancer is rare and slow growing. By catching it early and continuing my monthly shots I hope to stay ahead of it. I have been fortunate to have the UPMC for Life insurance plan, and while I expect to have to pay deductibles, my out-of-pocket should be met within six months of next year, and injections, testing, and physician appointments should be free after that.

Return to Medical Memoir #1, part of Every Breath a Gift: A Memoir – Table of Contents

Last edit 2/20/25