Family Physician's Role in the Cancer Journey

I have the relatively unusual distinction of having ten medical professionals involved in the care of my two primary cancers: metastatic melanoma and papillary thyroid cancer.  Among this collection are Oncologists and Surgeons of various specialty, a Dermatologist, an Endocrinologist, a Gastroenterologist, and even a Naturopathic Doctor. 

Add the complication of long-distance travel to see said professionals, and my calendar notebook is a kaleidoscope of sticky notes and forget-me-nots.  Names, phone and fax numbers, dates, and directions to offices in the maze that is Sunnybrook Health Sciences Centre crowd my notes and cause me the odd moment of confusion.  

There is one individual who tracks all of this even better than I do, and that is my Family Physician, a.k.a. Primary Care Provider, or the Saviour.  She has known me for years, she has cared for my children at every bump and (bone) break, and she gives me straightforward advice about cancer.  She is organized and has detailed notes about my health and history, and she magically delivers questions in a painless way, even when I am trying to dodge her about something. 

She gets all the shit jobs really; she was the one who had to tell me - TWICE - that I have stage 3 cancer, she kicked my butt into gear when I was panicking about surgery, she closely monitors my thyroid hormone levels, AND she is in charge of my day to day complaints (of which there are many, if you can imagine!?  - I should issue a formal apology to the other patients in her practice who have had to wait after one of my "quick" appointments).

She has spent countless extra hours researching treatment options for me, she translates medical speak into common language, and she asks the questions that need to be asked, of myself or of other doctors in my circle.  She patiently explains my CT scan or bloodwork results, and she always offers to print them out for me.  She goes above and beyond by expeditiously filling out employer and insurance forms, and she even communicates with me after hours if we have an urgent concern.  

She also maintains an air of reality about my situation; for example, when I was first diagnosed I exclaimed that I wanted to have every cancer test known to mankind, and she gently explained to me all the tests I would not need as they are not related to my particular type of diagnosis.  She also said some of the tests could wait as I would become simply "Doctored Out."  And she was right.  I have been pacing myself on the peripheral tests unrelated to melanoma, and I am definitely Doctored OUT.  (I say that with all due respect of course)

I am fortunate to have the thorough General Practitioner that I do, as I am aware that it isn't like that for every patient.  It could be considered that we have a shortage of GPs in Ontario Canada, so many patients do not have the luxury of a choice in family physician, let alone the quality of care they may (or may not) receive.  

My advice to a patient in a dubious or uncomfortable relationship with their family doctor is to be prepared, stay strong, and ask LOTS of questions.  

It can be intimidating to be in the clinical office, but being honest about your fear or anxiety will help build a straightforward rapport with your doctor.

• Make detailed notes of any questions you may have, and prioritize those questions just in case you aren't able to get them all answered if there is a rush.
• When calling to book your appointment, be polite but firm with the assistant answering the phone.  They are trained to be gatekeepers, carefully guarding the precious resource that is their employer, but if you treat them with respect and explain that you may need extra time with your doctor in order to not go over the allotted time slot, they will usually soften. 
• If they cut you off on the phone?  Call back.  
• If that still doesn't work?  Lay the "Cancer Card" - softly ask them how they might wish to be treated had they been diagnosed with a life-threatening disease.  They cannot withhold the care of your physician.  Yes we have to be considerate of others' time and availability, but we also have to fight for ourselves.  To me, self-advocacy is as important as waking up every morning, so every now and then I place a well-timed hissy fit.  
• Arrive for your appointments slightly early, and be prepared in case you have to stay later if the appointment is delayed.  Not always easy to coordinate rides and other appointments etc., but it is imperative to keep a cool tool at these times.  What else is more important than your health care - Nothing!
• Ask for a second opinion on the big stuff - or on any stuff.  You're not going to hurt anyone's feelings, you are simply looking after your own best interest.  All's fair in Canadian health care. 
• Be organized, keep notes, have a friend or family member with you at appointments whenever possible.
• Follow your Dr.'s instructions, unless your gut tells you otherwise - and if it does tell you otherwise, ask more questions. Let your doctor know that you don't feel good.  They are humans after all... just like us.  

The Family Physician is an integral part of the cancer care journey, or any extended health care situation.  They coordinate, monitor, translate, advocate, and guide our best interests.  Whether or not we want to be in the situation we are in, we are best to make friends with our primary caregiver, as they are there for the long haul.   

Hard to see in this very well-put graphic, but that blue horizontal arrow at the bottom?  That is the Family Physician, in the cancer journey. All the way through it.

 (click for larger image, it will take you to the website of the Ottawa Hospital, with an excellent article all about navigating the cancer journey)

Note:  

These points are just some suggestions based on my own experience with cancer care and the medical system, in Ontario, Canada.  Some or all of them may or may not be helpful if you are a patient of another affliction(s) and/or you live in another part of the country or world.  I wish you the best in whatever medical journey you may be on.  

And for the record, I am not a medical professional... I'm just doing time in the system. 

And to the lovely Dr. E MD, this post is dedicated to you.  Thank you for all of the crazy and wonderful things you do for my family and me.  You serve as an example of what I wish every cancer patient could have in their family doctor, their family member.  xoxo

Guest Blog - Her Magazine - School Lunches, To Pack or Not to Pack?

I am pleased to say that Her Magazine has asked me to write for them again, and not necessarily about "just" cancer. They have published a piece I wrote last year, some of you may remember it.  It was popular and I got a tonne of response from it, so I thought their readers may enjoy it as much as my family and friends did.  It is even my kiddos favourite.  :-)  

School Lunches - To Pack or Not to Pack? 

(update 30-March-2018: sadly, Her Magazine has been retired from the internet, so the links to my articles there no longer work. To read my original blog about this please feel free to click on the link above or the image below - thanks!)

 

Natalie Richardson shares the stress of packing school lunches for her teenage daughters and how cancer changed her attitude:

My 2nd ByLine on Huffington Post Canada

I received a nice little surprise today: an email from Her Magazine letting me know that they submitted the article I wrote in April (for Her Magazine) to Huffington Post, and it was re-published. 

My second byline on Huffington Post! This time on Huff Post Living (Canada) now titled It's Time We All Take Skin Cancer More Seriously, posted by Her Magazine Canada, with myself listed as the author, at the end of the article. It even links to my Huff Post profile, and to blog!

Please click here ...and I appreciate your clicks and shares...  xoxo 

I am grateful to all involved: Huffington Post for publishing, Her Magazine for the collaboration, and Save Your Skin Foundation for asking me to be part of the #NotJustSkinCancer campaign in the first place.   

A bonus for this, May is Melanoma Awareness Month. 

PS - My Portfolio  :-)

Column - Meaford Express - Simcoe.com May 2016

Please click below to view my column in the Meaford Express this month; I appreciate CF putting it in print as well as online.  Much gratitude for helping to share this message.  

May is Melanoma Awareness Month

There are 12 months in every year, and hundreds of diseases or reasons to raise awareness, but for the sake of this column I will choose the one that is closest to my heart: May is Melanoma Skin Cancer Awareness Month... 

Keep Melancholy and Be Calm On

I find myself to be a bit of an emotional heap today, and I keep ranting to anyone who asks me how I am, so I have decided to stay home for the rest of the day and just pout in private rather than embarrass myself further.  Oh wait.. no... first I'll blog about it  - on the world wide web! - you didn't ask, but I'm going to tell you anyway!

I'm mad at cancer today.  I think I have been most of the week, but it is really pissing me off today.  

Two years ago to the day, in a dumbfounded haze of fear and panic, I prepared to be away from work (for a few months?!) for surgery for stage 3b melanoma.   I had only been at my new employ for eight months, was just settling in as nicely as anyone could expect in the environment I was in, managing a busy cash office and payroll system, constantly jumping hurdles to keep shit together PLUS being a mother and home owner and all that regular good stuff.    

My boss and I chose a team to cover my work in my absence, and I had full confidence in the leader(s) we picked.  I still do, though we rarely see each other (I have needed it to be that way) and we have managed to pass months into years - two years - and the store is still standing and everyone is still alive.  Including me, which is great.  Well, in my opinion.  

Today it is my replacement friend's last day as Acting Front End Manager, and I am a mess.  I wish her well in her future endeavours, and I certainly harbour no hard feelings! I have changed jobs many times along the steps of my career so I understand why she is going.  Hanging on waiting to see what my schedule is going to be is hard enough for ME to do, I certainly don't expect my friends and co-workers to pause life and wait as well!  But it still sucks.. I should be there today.  I should be in there counting cash and slugging carts and working my ass off.  But I'm not.  

This SUCKS.

Thanks for listening.  

On a personally-melancholy day like today I typically kill myself listening to sad jazz music that makes me reminisce, or I pore over photos, wondering at all the antics my friends and kids and I have caught on film, and I remember what a great life I have.  How far I've come.. And what I feel I have left to do.  

But today I distract myself with some images I have been collecting along my journey of stealing - ahem borrowing - graphics for my blog.  I have noticed a trend: I have always liked the "Keep Calm and Carry On" adage, and I have giggled lots of times when I have come across a new adaptation of that saying, and have saved it to my files.  

Enough pouting, this is what I need to do:

Oh yes.... and this too:  

PS - If anybody out there comes across the code for an image I have posted that is theirs please comment below or email me some hate mail and I will happily add your link to my site - apologies in advance, I stole them yes, but in malice? No.   

Oh and one more.... GGGGRRRRRRRRRRRRRRRRRRRRR

Me, Guest Blogger! Yahoo Canada - Style: Why no tan is a good tan

I am excited to share that I was asked to write an article for Yahoo! Canada in the Style section, about melanoma awareness and the Become A #SkinChecker campaign which kicked off in Toronto on May 2.  Thank you Yahoo! for helping us to share the message that it's #NotJustSkinCancer  

This guest blog piece required me to write in an open letter format, so it was an interesting challenge to write in that style for Yahoo! Style's Open Letter Series.  I am honoured to have been asked, and I stepped up to the topic in a bit different way - beauty, skin, tanning, vanity, style... a fashion-thinking approach.  I would be sharing the page with articles about the likes of the Kardashians after all!  

As for a photo to accompany the article?  Why my MOST tanned-skin picture of course!  The first one that came to mind was this one - my Southern-Belle tan was the perfect shade to show off this exquisite ivory silk dress which shimmered and was so soft and fluffy. 

I have recalled this particular image many times over the last two years, it has become a bit of a symbol in my archives.  For many reasons (since my divorce of course) but mainly as evidence of my perpetually bronzed complexion.  

Update November 2022 ~ Sadly, this article is no longer live on the Yahoo! Canada site. I have pasted it here for reading purposes: 

Dear Sun Worshipper,

I noticed your tan.  I fondly remember the warm relief of turning my face to the sun and feeling the heat through to my bones.  My happy place was lying, sitting, walking, anything! - under the bright rays of the sun.

  

I have been a sun-baby my whole life, my Ukrainian-Canadian skin rarely burned, and was always glowing bronze.  Even before it was called a “contour,” my contour was naturally golden, blemish-free and required a dusting of bronzer only on days I would wear black, or want to stun the party scene post-vacation. 

Come the month of May I would be flaunting my tank tops and starting the summer-day ritual of sneaking out on my lunch breaks to a private sunny corner to expose as much skin as possible to the renewing spring sun.  Little did I know this habit would lead me to spend sunny days far differently later in life. 

 

May is now for me the start of a season of limited outdoor time and repeated pangs of regret.  May is Melanoma Awareness Month, and I am painfully aware of that… as I have melanoma. 

 

Two years ago I had a mole turn ugly, far uglier that any piece of skin should have a right to be.  When I had it removed, the testing showed an aggressive form of skin cancer.  More tests quickly led to a diagnosis of stage 3b nodular melanoma; it had spread to my lymph nodes.  I quickly learned this was not JUST skin cancer.  It was inside my body, never to leave.

  

To help rid my body of this disease, I have had four surgeries, one of which landed me on bedrest for two months and has caused permanent damage to my leg, which remains swollen and heavy from lymphedema.  After that I had immunotherapy treatments over the course of 68 weeks which have so far staved off the spread of melanoma to my organs, but in return have disrupted my gastrointestinal system to uncomfortable proportions.  

My children, friends, and family have suffered alongside as I have struggled to survive melanoma.  We have all learned too much about this deadly disease, this disease that will afflict over 6 800 Canadians this year, almost 1 200 from which will perish.  Even writing those words makes my blood run cold.  I can no longer heat it up in the sun, and I wish I never had. 

 

I continue to recover from the blow that melanoma has given me, but I also continue to have CT scans every three months and frequent appointments with my oncology team.  I cannot make a medical move in the care of my own health without first discussing it with at least three doctors.  I appreciate my physicians immensely, but if I could choose?  I would prefer my old lunch breaks back; my carefree days of privacy and a glowing complexion, my confidence and ambition for a long life ahead. 

 

All of those are gone, but what I am left with is a new perspective on beauty and a better glow, a glow from within.  An ambition to change perspective on what appears to our society as healthy skin.  It is not the old days, when tanned skin was perceived to be healthy, connected with athleticism and a blooming lifestyle.

  

Tan skin is damaged skin.  Melanoma is a disease in which malignant (cancer) cells form in the skin cells called melanocytes (cells that color the skin).  Melanoma is caused by overexposure to ultraviolet (UV) radiation from either sunlight or tanning lamps; UV radiation damages genes that regulate cell growth and division.  It is considered the least common yet the most serious of the three main types of skin cancer, which also include basal cell and squamous cell cancers. (source)

In my case, melanoma has metastasized to my lymphatic system, therefore my risk of malignant cells making their way to my vital organs is high. I live in constant fear, waiting for the other shoe to drop.  I live with stage 3 cancer.  No tan was ever worth that. 

I am thankful that I have the opportunity now to bring awareness to this critical issue.  I started with my teenaged twin daughters: they avoid sun over-exposure at all costs and they encourage their friends to share their sunscreen.  I see their generation being more careful with their skin, and I love that tanning salon attendance now allows only 18+ customers.  

I would like to speak with the 18+ tanners as well, I could show you my scars and describe to you the tears through which I have learned this lesson.  I would show you photos such as the one above: myself as a young bride with a remarkable brown shade of skin.  And then I would show you my new favourite brand of mineral sunscreen with a tinted base.  I feel beautiful – AND healthy – when I put it on.   

I would tell you to look after your largest organ, to keep it out of the sun and to inspect it regularly for irregularities or unwelcome changes in mole appearance.  And I would invite you to learn from and participate in such campaigns as the Dalmatian-loving “Become A Skin Checker” movement.  

Detect. Protect. Keep Skin Cancer in Check. Spot Skin Cancer to Stop Skin Cancer.  

All easy things to keep in mind.  Besides the informative message to stay out of the sun between the hours of 10 a.m. and 4 p.m., wear sun-protective clothing, UV-blocking sunglasses, a hat, and SPF30+ sunscreen, Become A #SkinChecker offers detailed information on how to find a dermatologist to help maintain your skin health.  

#SkinChecker is connecting people world-wide with a healthy approach to skin and in turn, a greater awareness and observation of skin maintenance.  An earlier-detected skin cancer diagnosis means less pain, fear, and risk of shortened life span.  Don’t put your beautifully tanned head in the sand as I did, it’s not worth it.  

I guarantee you are beautiful with your natural skin, please embrace it, look after it, and enjoy your healthy body without skin cancer melanoma.  

Your Truly,

Ex-Sun-Worshipper