good news, tempered

Today I finally got an appointment scheduled with the University of Michigan, which was made that much sweeter by our rather useless visit to the oncologist yesterday, which went something like this:

Hi, Dr. French. I have some questions -

1. If mammograms are not great imaging tools for dense, fibrous breast tissue, am I being reasonable or unreasonable to think them a little untrustworthy in terms of monitoring myself for recurrence as follow-up care for a lumpectomy?

2. If MRIs are the other monitoring tool I'd use after having a lumpectomy and they also miss things, why should that make me feel any better about monitoring after surgery? Read: Given the apparently poor tools for post-op monitoring, is it safer to have a mastectomy?

3. What does the data say about rates of recurrence for cancers with micropapillary features? Should I be concerned about regional recurrence (in the armpits or other breast), or local recurrence?

4. I understand that whether I have a lumpectomy or a mastectomy, my life expectancy does not change. What I am worried about is what happens between now and me getting old and dying. I don't want to go through this again. Am I more likely to go through this again if I have a lumpectomy?

To which the kind doctor said my concerns were valid, these were smart questions, that regardless of the type of cancer (read: micropapillary/aggressive or non-invasive) the treatment methods don't really vary, and that she would have to do research to find the data I hoped she could give me. Friendly, not great at listening, unable to answer my questions. My confidence in the cancer center staff is really shooting through the roof right now. Maybe I'm being too harsh. It is entirely possible that I've worked my hopes up too high for the doctors at U of M and maybe they can't tell me anything more than what Dr. French has said. At least after I hear it from them, I will feel more confident that what little information we have is all we have, rather than deluding myself into thinking someone out there can tell me more. July 23rd I will find out.

After getting home from visiting Jason at work to send the last of my medical records, lab reports, and images to U of M, I came home and got a call that is working hard on whittling away at my hopeful mood.

The insurance company does not cover pre-treatment cancer fertility services. She said it three times as I tried to ask questions, assuming there must be some way to reroute her into reneging on her statement. Coverage for all fertility services denied for pre-treatment cancer patients - retrieval, storage, and in vitro are not covered. not covered not covered not covered $15,000 $15,000 $15,000 It was on the tip of my tongue, but I still somehow neglected to ask if I would be eligible if I weren't a cancer patient. From the way she kept saying, "no coverage for pre-treatment cancer patients, in vitro services are not covered " it felt like that would be the case. I guess the real question that stuck to my tongue is this: From the way she phrased the insurance company's denial, it would seem that I would be eligible for fertility services after treatment, but what would be the point then? Because here's the real trouble - it is the treatment that threatens my fertility. And here is the insurance company saying they will not cover fertility services until treatment is complete which is five years and potentially post-fertility loss from now.

*Update: I misunderstood what the insurance agent was telling me. They do not cover fertility services at all, for anyone, cancerous or not.