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Autopsy results for Penny

I spoke with Dr. Brady today. He is the pathologist who did the autopsy on Penny. I asked him to identify the proximate cause of her death, that is, we knew she had cancer, and esophogeal erosion, asthma, diabetes, and she could easily have had a blood clot or other problem, and I wanted to know which it had been.

He seldom sees advanced cancer, and was actually horrified by the extent of the disease. It had, in a short few months, invaded her entire abdominal cavity, and was insinuated into every one of her internal organs. That includes, as well as some we had known about in the liver, apparently more recent intrusions into her heart and lungs, kidneys, esophagus, bowels, stomach, spleen, everything. It was working through her abdominal wall, which is where the biopsy was taken.

The CT scan showed us that the cancer was extensive, but it only revealed the places where the tumor material had 'lumped up'. It was pervasive in thin threads and sheets. Her body tried to fight it by creating fluid pockets to isolate it from the other tissues, and these became infected in places.

She had been coughing the day before and slept poorly Wednesday night ... Dr. Brady found evidence of a beginning pneumonia, but there wasn't evidence that had been the cause. He didn't find a clot or other problem.

The formal report will be provided sometime late this week or early next week, but it was the cancer that did it.


( 21 comments — Leave a comment )
Jan. 24th, 2006 02:44 am (UTC)
Hugs to you.
Jan. 24th, 2006 03:47 am (UTC)
It sounds like it was better for her to pass sooner rather than later, when it would have been much more painful to endure.

Sometimes, these things happen for the better.



Jan. 24th, 2006 04:00 am (UTC)
Oh my God.

I am so, so, so, so sorry.

My thoughts and prayers are with you.
Jan. 24th, 2006 04:11 am (UTC)
How strong she was to have survived that much disease for as long as she did! How did you feel when you heard all this?
Jan. 24th, 2006 08:31 pm (UTC)

She was tremendously strong, and we supported each other so much.

How did I feel? Frankly, I was surprised.

If you're familiar with the enneagram, I'm an 8 - the knight-errant, strength is my defense. I've deliberately been moving around to avoid relying on that, because I want my faith to be my defense, and it's been helping immensely.

So, to deal with her death, faith in the resurrection, in ongoing life, has been my refuge from the sense of loss and the loneliness. To deal with the emotional crashing and the shock when dealing with other people (which can set me off my center rather easily right now) I've been relying on the 'be strong' thing - sometimes that means being strong enough to express the grief.

The conversation with the doctor quickly got into the technicalities of how that particular cancer works - we had done considerable research, partly because we'd determined that Dr. Gosewehr wasn't going to be much use to us at all in anything that wasn't surgical intervention, and we needed to be able to speak the language with his associates who did know about non-surgical methods.

This is a particularly hard cancer because it only afflicts women, and it's innate to the kind of tissue that permits women to become pregnant.
Endometrial tissue is found in the lining of the uterus, and elsewhere in the abomen. It has many of the traits of a cancer naturally because it is the tissue that is used to build a placenta.

The causal mechanism for this cancer has been revealed in the past five or six years. It is found slightly more often in overweight women, because of our old enemy Syndrome X, the metabolic tendency that has become epidemic in America.

Basically, endometrial tissue has two separate progesterone receptors, called PrA and PrB in the literature. Each cell has these two chemical locks that progesterone opens. (This isn't necessarily a receptor site on the cell wall, I'm not clear on that. It might be genes that are activated at crucial times during protein synthesis in the normal functioning of the cell.)

PrA has an inhibitory effect. It prevents the endometrial cells from continuing growth. It is, essentially, the "Do not be cancer" switch which counters the estrogen-driven growth of this kind of tissue.

In people with metabolic syndrome, insulin resistance frequently results in diabetic symptoms, mostly in the form of elevated blood sugars. This is usually treated by giving the patient drugs which cause the pancreas to pump out huge amounts of insulin. This creates a state called 'hyperinsulinemia' by some doctors - the ones who think this is a dangerous way to treat something that should be managed differently.

It turns out that insulin, if it isn't taken up by other receptors, will bind PrA without activating, through a methylization process. This permanently disables the receptor, causing it to respond poorly if at all to progesterone.

Another side effect of the metabolic syndrome is that the elevated estrogen levels (fat cells are not just inactive; they create and release estrogen) can slow or stop the monthly cycle, resulting in a lower level of progesterone.

In Penny's case, she was also more susceptible because her mother had used DES - diethyl silbestrone - a birth control agent that was popular in the early 1950s, which was withdrawn when they discovered that there was an increased incidence of cancer in the users. Sadly, there were also significantly increased cancers in the daughters of women who used DES, and it turns out, in their daughters, and their daughters.

With perfect 20/20 hindsight, I look back at our life together and I can see the times and places where we could have changed this, removing some of the triggers that caused her cancer in 2002, but I believe she would still have gotten this cancer eventually.
Jan. 24th, 2006 09:17 pm (UTC)
Wow... thanks for the detailed analysis. I learned a lot from this.
Jan. 24th, 2006 04:17 am (UTC)
it is good to know what was happening finally. It is always a relief to have the mystery solved.

Jan. 24th, 2006 04:23 am (UTC)
Just caught up with the news... I'm so sorry. Wishing you the best of strength in all of this. :-/
Jan. 24th, 2006 04:37 am (UTC)
I'm so sorry, I only just found out the news. I wish you strength in the coming days.
Jan. 24th, 2006 08:40 pm (UTC)
Thank you.

I don't know you by this avatar. Could you remind me of others so I can place you?
Jan. 25th, 2006 01:21 am (UTC)
I was GC on Complex-- we're mutual friends of Chris "Robotech Master" Meadows.
Jan. 25th, 2006 02:34 am (UTC)
Ah! Thanks, I suspected someone from Complex but wasn't sure.
Jan. 24th, 2006 09:21 am (UTC)
Cancer... sucks. you know my view on it.

At least she's at peace, now... and you can finally be more peaceful, though you may not know with what to fill your time now. Your entire world, these past N years, has been focused around Penny and her needs. Now, though, you need to figure out what you want to do with your own self, and your own needs.

You could become an advocate for cancer research and treatment options, if you wanted to focus on that which trapped your wife and caused her to endure more pain than any of us want to think about. You can sit and digest it, and figure out how to look at this from a spiritual perspective for your lay ministry (which seemed to have fallen by the wayside as Penny's health deteriorated). You can go and see beautiful sights, without having to worry about how well she could navigate them -- knowing that her spirit is with you to appreciate them as well as you.

Cancer is the body's equivalent of used-car salesmen, who teach others to be used car salesmen. That's the way I look at it. I don't know if that idea makes any sense to you, but if you think about the fact that she died because an individual cell decided to take advantage of other cells around it, becoming a parasite in the midst of otherwise healthy tissue...

what we need are white blood cells that can detect the parasitic nature of other cells, and deal with them. Our bodies don't have much/any way of dealing with illnesses/diseases that are created from the inside.
Jan. 24th, 2006 09:22 am (UTC)
incidentally... that last anonymous and screened post was mine. I didn't realize I wasn't logged in.
Jan. 24th, 2006 07:59 pm (UTC)
Yeah... LJ has recently 'fixed' some security issues by disabling the remain-logged-in feature.

About the lay ministry ... Actually, I had three care receivers in a row, and then was unemployed. Normally we only do two, then have a year off. But I was also a care receiver myself, while unemployed, and there were sufficient men in the group who were available for the need, so they didn't ask me to take on a new care receiver, especially while helping Penny through the cancer treatment.

There is a focus training starting today on caring for those who are grieving. I'm considering going to the meeting.
Jan. 25th, 2006 02:31 am (UTC)
I'm not sure it would be wise for you to go to a training on how to care for those who are grieving. It's likely to be more clinical than you really need right now -- because you do need to grieve, and you need to show emotion, and you need to let that emotion out.

but, this probably reaches you much too late.
Jan. 25th, 2006 02:41 am (UTC)
Not really too late.

I have been hesitating for those reasons.

It's not quite that it's clinical, and I absolutely trust these people, but I think I might be a distraction from the intended focus because I (and many of them) am still in the early rawness of grieving.

But I want to shoot down that Kubler-Ross bullshit. Seven stages, nicely ordered, welcome to our sanitized and emotionally perfect world. Totally unsupported by actual science, the stages of grief were pretty much derived anecdotally from the experiences of patients whose deaths had been orderly and tidy and whose families were orderly and tidy and didn't cause any problems with their ugly emotional outbursts. Those were defined as 'Best' and the process those people went through was defined as what everyone should follow.

This was a quick and easy answer to professionals about how to handle the issue of fatal illness and grief, and has been used to impose a 'correct' mode of grieving by people who want to be comfortable themselves and who can't handle someone else's pain.

The 'stages', they are careful to say, are neither ordered nor do you go through them only once... well, even that is too simplistic.
Jan. 25th, 2006 03:23 am (UTC)
...and sometimes, when you think you've managed to at least putty over the chink left over from the loss of someone you valued, something hits you from a direction you never expected, and your walls come down again.

I'm /still/ not over my dog's death. It's been thirteen fucking years, and it still makes me cry when I think about it. I know other people who are the same way with close friends who passed... one of them saw a book on a shelf that made him think of a friend, and he broke down.

Though, you have to admit, the "I, Q" Star Trek book (about the end of the cosmos, from Q's point of view) was a fairly entertaining book based around the Kubler-Ross stages of mourning.
Jan. 25th, 2006 03:26 am (UTC)
Yeah... and frankly, some people really do NOT follow those stages at all, as you know.

I don't think I ever read "I, Q".

Though I did read "Q-in-Law" or whatever that one was.
Jan. 25th, 2006 05:22 am (UTC)
Here's how I perceive those stages:

1) Shock
2) Anger at what caused it
3) Attempt to stop what caused it
4) Turn anger inward when it doesn't work
5) Get over it

I don't think that that's a realistic view of how things are really done. It seems to rely on anger as the prime motivator for grief, and that's sometimes, but definitely not always, the case.

Sometimes the hurt inside is so raw because a piece of you, a piece that you felt you could rely on, a piece that you cherished... is suddenly not there. When that's the case, it's difficult to re-learn how to go about life without that piece of yourself.

Many people get jaded, and learn the lesson "never rely on anyone besides yourself for anything essential to your being." I must admit, I've gotten to that point sometimes, myself, and I wonder if I'm still there.
Jan. 25th, 2006 08:41 am (UTC)
You cannot get there and remain a living human.

Relying on others for things essential to your being... it starts with the placenta in your mother's womb and continues all your life.

It is not a bad thing to do.
( 21 comments — Leave a comment )