Breast Cancer Journal

I'm Not Home Yet

2008-12-04T10:41:00.002-06:00

I threw away my prosthesis Monday night and moved my wigs off of my dresser. I don't know why it's taken so long, nor do I know why there are still things I can't look at and can't get rid of.

I have several tote bags in my bedroom that I've used in the 3 years I've shuttled back and forth between here and M.D. Anderson. They're filled with insurance forms, bills, magazines, puzzle books...the stuff that accumulates while you wait. Waiting is an art in which I've become well versed.

I can't make myself go through it. I try now and then, but that chemo nausea returns like a ghost to remind me of how bad it's been.

I also carry a small notebook with me that includes, among other things, several pages detailing the physical reactions I had to chemotherapy. I agreed to participate in a study that required I keep track. I can't tear those pages out.

I remind myself that I've been through a lot. I got rid of the prosthesis, I moved my wigs. It's a journey of reconciliation. I'm not home yet.

25 Breast Cancer Myths

2008-11-26T12:33:00.003-06:00

Get the facts; there are lots of myths and misunderstandings floating around out there in the American consciousness. Check out the article at Health.com.

Canola Oil May Prevent Your Daughter's Risk Of Breast Cancer

2008-11-25T11:30:00.003-06:00

WebMD has an article today about the potential for canola oil to diminish your daughter's risk of breast cancer. The findings are based on a study done with mice, so there's more research to be conducted before we can known with certainty.

Nonetheless, it couldn't hurt to make the change from corn oil to canola. It's good for you.

See the article here http://www.webmd.com/breast-cancer/news/20081117/canola-oil-may-affect-breast-cancer-risk?ecd=wnl_brc_112508

Bride of Frankenstein, Part 2

2008-11-11T09:02:00.002-06:00

My boss told me yesterday that one of his friends gave him a calendar with photos of women who've survived breast cancer. He called them "cheese cake" photos.

I love my new breast, but I don't think anyone would want to actually look at the poor scarred thing.

My Cancer Was A Gift

2008-10-24T14:05:00.000-05:00

My Cancer Was A Gift

Indeed it was.

Hidden Comments

2008-10-23T13:59:00.002-05:00

To protect the privacy of people who are kind enough to leave a comment, I have hidden them. Nonetheless, I'd love to hear from you and if you leave an email address, I'll respond as soon as possible.

Breast Cancer Information Resources

2008-10-21T14:43:00.001-05:00

A (not complete) list of Internet resources on breast cancer. Inclusion in this list does not necessarily imply a recommendation.

Detailed Breast Cancer Risk
GE Health Care
Breastcancer.org
Cancer.com
Discovery Health
Revolution Health
National Coalition for Cancer Survivorship
Planet Cancer
ICON Magazine
National Cancer Iinstitute
Susan G. Komen Foundation
National Breast Cancer Foundation
Medline Plus: A Service of the U.S. National Library of Medicine and the National Institutes
of Health
Breastcancer.net
WebMD
MedicineNet.com
Mayo Clinic
M.D. Anderson
National Cancer Institute
American Cancer Society
Healthline
Oncolink: Abramson Cancer Center of the University Pennsylvania
Doctors' Guide to Breast Cancer Information and Resources
Centers for Disease Control and Prevention

I am sorely tempted to (compulsively) alphabetize these, but I've been interrupted by my computer challenged co-worker and now it's time to leave. More tomorrow, perhaps a brief intro to these.

Comcast Pink Ribbon

2008-10-20T14:03:00.001-05:00

Watch a wide array of informative, entertaining and inspiration programs from Lifetime Television, Parents TV, Discovery Health, Showtime and Exercise TV with medical direction sand original content provided by Breastcancer.org.

To help raise awareness and provide important information about breast cancer, Comcast partnered with Breastcancer.org and several cable networks to launch The Pink Ribbon Campaign, an original video-on-demand and online initiative bringing together educational and inspirational content for all women and their loved ones.

The Pink Ribbon Campaign presents dozens of programs about prevention, detection, treatment and living with breast cancer as well as discussion forums, health and fitness advice and relevant news clips.

Throughout the entire month of October, Comcast customers with On Demand service will have free access to programs that will encourage and inspire women who are fighting or have survived breast cancer, including episodes of HBO's Sex and the City, Showtime's The L Word, celebrity bios from Bio Channel and Lifetime original movies, such as Living Proof, starring Harry Connick, Jr.

In addition, there are dozens of programs in categories including:

Pink Originals
Original, exclusive programming created specifically for the Pink Ribbon campaign by Lifetime and Parents TV. Topics including how to talk to children about cancer, and what to expect from diagnosis, treatment and recovery are also covered.

Meet the Doctors
New and original content produced by Comcast, in partnership with the University of Pennsylvania Abramson Cancer Center, provides an overview of risk factors, importance of knowing family history and tips on how to detect and defeat cancer.

Prevention-Healing
Programs from Discovery Health and Exercise TV provide in-depth information about prevention, including how to perform a breast self-exam.

TV and Movies
Special segments from TLC, Style Network and Lifetime provide advice for patients and survivors from demonstrations on how to wear a scarf to tips on boosting confidence and self-esteem.

Pink Ribbon Online
Fancast.com will feature most of the programs available On Demand, including episodes of The L Word, Whose Wedding Is It Anyway, One Tree Hill and profiles of celebrities who have battled breast cancer from Bio Channel. Additional content including videos in The Fan, links to relevant news articles and discussion forums is available at http://comcast.net/pinkribbon.

Can Breast Cancer Be Prevented?

2008-10-17T10:08:00.001-05:00

From the American Cancer Society

There is no sure way to prevent breast cancer. But there are things all women can do that might reduce their risk and help increase the odds that if cancer does occur, it is found at an early, more treatable stage.

Lowering your risk: You can lower your risk of breast cancer by changing those risk factors that can be changed. If you limit alcohol use, exercise regularly, and keep a healthy weight, you are decreasing your risk of getting breast cancer. Women who choose to breast-feed for at least several months may also reduce their breast cancer risk.

Not using post-menopausal hormone therapy (PHT) if you don't need it can also help you avoid raising your risk.

Finding breast cancer early: It is also important for women to follow the American Cancer Society's guidelines for finding breast cancer early. (See the section, "How is breast cancer found?")

For women who are or may be at increased risk

If you have a higher risk for breast cancer there may be some things you can do to reduce your chances of getting breast cancer. Before deciding which, if any, of these may be right for you, talk with your doctor.

Genetic testing: There are tests that can tell if a woman has certain changed (mutated) genes linked to breast cancer. With this information, women can then take steps to reduce their risk. Recently the U.S. Preventive Services Task Force made recommendations for genetic testing. They suggest that only women with a strong family history be evaluated for genetic testing for BRCA mutations. This group is only about 2% of adult women in the United States.

If you are thinking about genetic testing, you should talk to a genetic counselor, nurse, or doctor qualified to explain the results of these tests. It is very important that you know what genetic testing can and can't tell you, and to carefully weigh the benefits and risks of testing before these tests are done. Testing is expensive and may not be covered by some health insurance plans. For more information, see our document, Genetic Testing: What You Need to Know.

Breast cancer chemoprevention: Chemoprevention is the use of drugs to reduce the risk of cancer. Many drugs have been studied for use in lowering breast cancer risk. The drug tamoxifen has already been used for many years as a treatment for some types of breast cancer. Studies have shown that women at high risk for breast cancer are less likely to get the disease if they take tamoxifen. Another drug, raloxifene, has been approved to help reduce breast cancer risk in women past menopause who are at high risk for breast cancer. Other drugs are also being studied.

Preventive surgery for women with very high breast cancer risk: For the few women who have a very high risk for breast cancer, preventive surgery such as bilateral (double) mastectomy may be an option.

Preventive (prophylactic) double (bilateral) mastectomy: For some who are at very high risk for breast cancer, this surgery (a double mastectomy) may be an option. In this operation both breasts are removed before there is any known breast cancer. While this operation removes nearly all of the breast tissue, a small amount remains. So although this operation greatly reduces the risk of breast cancer, the disease can still start in the breast tissue that remains after surgery. To date, this has been a rare problem.

The reasons for thinking about this type of surgery need to be very strong. There is no way to know ahead of time whether this surgery will benefit a particular woman. A second opinion is strongly recommended before making a decision to have this type of surgery.

Preventive ovary removal (prophylactic oophorectomy): Women with a certain gene change (BRCA mutation) who have their ovaries removed may reduce their risk of breast cancer by half or more. This is because taking out the ovaries removes the main sources of estrogen in the body.

Although this document is not about ovarian cancer, it is important that women with this gene change also know that they also have a high risk of getting ovarian cancer. Most doctors recommend that these women have their ovaries removed after they are done having children.

Stages of Breast Cancer

2008-10-16T10:14:00.001-05:00

From breastcancer.org

Stages of Breast Cancer. Cancer stage is based on the size of the tumor, whether the cancer is invasive or non-invasive, whether lymph nodes are involved, and whether the cancer has spread beyond the breast.

The purpose of the staging system is to help organize the different factors and some of the personality features of the cancer into categories, in order to:

best understand your prognosis (the most likely outcome of the disease)
guide treatment decisions (together with other parts of your pathology report), since clinical studies of breast cancer treatments that you and your doctor will consider are partly organized by the staging system
provide a common way to describe the extent of breast cancer for doctors and nurses all over the world, so that results of your treatment can be compared and understood

Stage 0

Stage 0 is used to describe non-invasive breast cancers, such as DCIS and LCIS. In stage 0, there is no evidence of cancer cells or non-cancerous abnormal cells breaking out of the part of the breast in which they started, or of getting through to or invading neighboring normal tissue.

Stage I

Stage I describes invasive breast cancer (cancer cells are breaking through to or invading neighboring normal tissue) in which:

the tumor measures up to 2 centimeters, AND
no lymph nodes are involved

Stage II

Stage II is divided into subcategories known as IIA and IIB.

Stage IIA describes invasive breast cancer in which:

no tumor can be found in the breast, but cancer cells are found in the axillary lymph nodes (the lymph nodes under the arm), OR
the tumor measures 2 centimeters or less and has spread to the axillary lymph nodes, OR
the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the axillary lymph nodes

Stage IIB describes invasive breast cancer in which:

the tumor is larger than 2 but no larger than 5 centimeters and has spread to the axillary lymph nodes, OR
the tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes

Larger Version

Stage III

Stage III is divided into subcategories known as IIIA, IIIB, and IIIC.

Stage IIIA describes invasive breast cancer in which either:

no tumor is found in the breast. Cancer is found in axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone, OR
the tumor is 5 centimeters or smaller and has spread to axillary lymph nodes that are clumped together or sticking to other structures, OR
the tumor is larger than 5 centimeters and has spread to axillary lymph nodes that are clumped together or sticking to other structures

Stage IIIB describes invasive breast cancer in which:

the tumor may be any size and has spread to the chest wall and/or skin of the breast AND
may have spread to axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone
Inflammatory breast cancer is considered at least stage IIIB.

Stage IIIC describes invasive breast cancer in which:

there may be no sign of cancer in the breast or, if there is a tumor, it may be any size and may have spread to the chest wall and/or the skin of the breast, AND
the cancer has spread to lymph nodes above or below the collarbone, AND
the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone

Stage IV

Stage IV describes invasive breast cancer in which:

the cancer has spread to other organs of the body -- usually the lungs, liver, bone, or brain

"Metastatic at presentation" means that the breast cancer has spread beyond the breast and nearby lymph nodes, even though this is the first diagnosis of breast cancer. The reason for this is that the primary breast cancer was not found when it was only inside the breast. Metastatic cancer is considered stage IV.

Additional staging information

You may also hear terms such as "early" or "earlier" stage, "later," or "advanced" stage breast cancer. Although these terms are not medically precise (they may be used differently by different doctors), here is a general idea of how they apply to the official staging system:

Early stage

Stage 0
Stage I
Stage II
Some stage III

Later or advanced stage

Other stage III
Stage IV

Doctors use a staging system to determine how far a cancer has spread. The most common system is the TNM staging system. You may hear the cancer described by three characteristics:

size (T stands for tumor)
lymph node involvement (N stands for node)
whether it has metastasized (M stands for metastasis)

The T (size) category describes the original (primary) tumor:

TX means the tumor can't be measured or found.
T0 means there isn't any evidence of the primary tumor.
Tis means the cancer is "in situ" (the tumor has not started growing into the breast tissue).
The numbers T1-T4 describe the size and/or how much the cancer has grown into the breast tissue. The higher the T number, the larger the tumor and/or the more it may have grown into the breast tissue.

The N (node involvement) category describes whether or not the cancer has reached nearby lymph nodes:

NX means the nearby lymph nodes can't be measured or found.
N0 means nearby lymph nodes do not contain cancer.
The numbers N1-N3 describe the size, location, and/or the number of lymph nodes involved. The higher the N number, the more the lymph nodes are involved.

The M (metastasis) category tells whether there are distant metastases (whether the cancer has spread to other parts of body):

MX means metastasis can't be measured or found.
M0 means there are no distant metastases.
M1 means that distant metastases were found.

Once the pathologist knows your T, N, and M characteristics, they are combined in a process called stage grouping, and an overall stage is assigned.

For example, a T1, N0, M0 breast cancer would mean that the primary breast tumor:

is less than 2 centimeters across (T1)
does not have lymph node involvement (N0)
has not spread to distant parts of the body (M0)

This cancer would be grouped as a stage I cancer.

Chemo Brain

2008-10-15T10:01:00.000-05:00

From breastcancer.org

“Chemo brain” or “chemo fog” are terms used for thinking and memory difficulty that some associate with chemotherapy treatment. While some research suggests a link between chemotherapy and problems with thinking and memory, findings are not yet consistent and more studies need to be done. What we do know is that for many breast cancer patients, “chemo brain” is a very real issue. You may not remember where you put your keys or why you went to the store, or you may simply not be able to think of the right word. Join us to find out how other aspects of treatment can affect your cognitive abilities, learn ways to improve your mental skills, get the latest research on chemo brain, and more.
Join us tomorrow night between 7:00 p.m. and 8:30 p.m (EDT)* for this month's Ask-the-Expert Online Conference: Managing Chemo Brain. Christina Meyers, Ph.D., A.B.P.P. and George Sledge, M.D. will answer your questions about how long memory issues can last, what you can do to keep your brain active including tips to sharpen your memory, and more.
Christina Meyers, Ph.D., A.B.P.P. is a board certified neuropsychologist. She created the Neuropsychology Service in the newly formed Department of Neuro-Oncology at M.D. Anderson Cancer Center in 1984.
George Sledge, M.D. is the Ballvé-Lantero Professor of Oncology at Indiana University at Indianapolis, where he co-directs Indiana University Simon Cancer Center's Breast Cancer Program.
If you'd like to ask a question for our MANAGING CHEMO BRAIN conference, but will not be able to join the conference tomorrow night, you can submit your question now.
We'll answer as many questions as we can during the conference. A conference transcript will be posted at Breastcancer.org by October 22, 2008.
To join the conference, visit Breastcancer.org any time between 7:00 p.m. and 8:30 p.m. EDT* tomorrow night and click on the "Join Conference" button. It’s easy to participate; no special software is required. The live conference will appear in text on your screen.
Visit the Ask-the-Expert Online Conference page for more details.

Screening

2008-10-10T10:59:00.003-05:00

From the National Cancer Institute
Screening

Screening for breast cancer before there are symptoms can be important. Screening can help doctors find and treat cancer early. Treatment is more likely to work well when cancer is found early.

Your doctor may suggest the following screening tests for breast cancer:

Screening mammogram

Clinical breast exam

Breast self-exam

You should ask your doctor about when to start and how often to check for breast cancer.

Screening Mammogram

To find breast cancer early, NCI recommends that:

Women in their 40s and older should have mammograms every 1 to 2 years. A mammogram is a picture of the breast made with x-rays.

Women who are younger than 40 and have risk factors for breast cancer should ask their health care provider whether to have mammograms and how often to have them.

Mammograms can often show a breast lump before it can be felt. They also can show a cluster of tiny specks of calcium. These specks are called microcalcifications. Lumps or specks can be from cancer, precancerous cells, or other conditions. Further tests are needed to find out if abnormal cells are present.

If an abnormal area shows up on your mammogram, you may need to have more x-rays. You also may need a biopsy. A biopsy is the only way to tell for sure if cancer is present. (The "Diagnosis" section has more information on biopsy.)

Mammograms are the best tool doctors have to find breast cancer early. However, mammograms are not perfect:

A mammogram may miss some cancers. (The result is called a "false negative.")

A mammogram may show things that turn out not to be cancer. (The result is called a "false positive.")

Some fast-growing tumors may grow large or spread to other parts of the body before a mammogram detects them.

Mammograms (as well as dental x-rays, and other routine x-rays) use very small doses of radiation. The risk of any harm is very slight, but repeated x-rays could cause problems. The benefits nearly always outweigh the risk. You should talk with your health care provider about the need for each x-ray. You should also ask for shields to protect parts of your body that are not in the picture.

Clinical Breast Exam

During a clinical breast exam, your health care provider checks your breasts. You may be asked to raise your arms over your head, let them hang by your sides, or press your hands against your hips.

Your health care provider looks for differences in size or shape between your breasts. The skin of your breasts is checked for a rash, dimpling, or other abnormal signs. Your nipples may be squeezed to check for fluid.

Using the pads of the fingers to feel for lumps, your health care provider checks your entire breast, underarm, and collarbone area. A lump is generally the size of a pea before anyone can feel it. The exam is done on one side, then the other. Your health care provider checks the lymph nodes near the breast to see if they are enlarged.

A thorough clinical breast exam may take about 10 minutes.

Breast Self-Exam

You may perform monthly breast self-exams to check for any changes in your breasts. It is important to remember that changes can occur because of aging, your menstrual cycle, pregnancy, menopause, or taking birth control pills or other hormones. It is normal for breasts to feel a little lumpy and uneven. Also, it is common for your breasts to be swollen and tender right before or during your menstrual period.

You should contact your health care provider if you notice any unusual changes in your breasts.

Breast self-exams cannot replace regular screening mammograms and clinical breast exams. Studies have not shown that breast self-exams alone reduce the number of deaths from breast cancer.

You may want to ask the doctor the following questions about screening:

Which tests do you recommend for me? Why?
Do the tests hurt? Are there any risks?
How much do mammograms cost? Will my health insurance pay for them?
How soon after the mammogram will I learn the results?
If the results show a problem, how will you learn if I have cancer?

Risk Factors

2008-10-08T14:00:00.001-05:00

From the National Cancer Institute.

Risk Factors

No one knows the exact causes of breast cancer. Doctors often cannot explain why one woman develops breast cancer and another does not. They do know that bumping, bruising, or touching the breast does not cause cancer. And breast cancer is not contagious. You cannot "catch" it from another person.

Research has shown that women with certain risk factors are more likely than others to develop breast cancer. A risk factor is something that may increase the chance of developing a disease.

Studies have found the following risk factors for breast cancer:

Age: The chance of getting breast cancer goes up as a woman gets older. Most cases of breast cancer occur in women over 60. This disease is not common before menopause.

Personal history of breast cancer: A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast.

Family history: A woman's risk of breast cancer is higher if her mother, sister, or daughter had breast cancer. The risk is higher if her family member got breast cancer before age 40. Having other relatives with breast cancer (in either her mother's or father's family) may also increase a woman's risk.

Certain breast changes: Some women have cells in the breast that look abnormal under a microscope. Having certain types of abnormal cells (atypical hyperplasia and lobular carcinoma in situ [LCIS]) increases the risk of breast cancer.

Gene changes: Changes in certain genes increase the risk of breast cancer. These genes include BRCA1, BRCA2, and others. Tests can sometimes show the presence of specific gene changes in families with many women who have had breast cancer. Health care providers may suggest ways to try to reduce the risk of breast cancer, or to improve the detection of this disease in women who have these changes in their genes. NCI offers publications on gene testing.

Reproductive and menstrual history:

The older a woman is when she has her first child, the greater her chance of breast cancer.
Women who had their first menstrual period before age 12 are at an increased risk of breast cancer.

Women who went through menopause after age 55 are at an increased risk of breast cancer.

Women who never had children are at an increased risk of breast cancer.

Women who take menopausal hormone therapy with estrogen plus progestin after menopause also appear to have an increased risk of breast cancer.

Large, well-designed studies have shown no link between abortion or miscarriage and breast cancer.

Race: Breast cancer is diagnosed more often in white women than Latina, Asian, or African American women.

Radiation therapy to the chest: Women who had radiation therapy to the chest (including breasts) before age 30 are at an increased risk of breast cancer. This includes women treated with radiation for Hodgkin's lymphoma. Studies show that the younger a woman was when she received radiation treatment, the higher her risk of breast cancer later in life.

Breast density: Breast tissue may be dense or fatty. Older women whose mammograms (breast x-rays) show more dense tissue are at increased risk of breast cancer.

Taking DES (diethylstilbestrol): DES was given to some pregnant women in the United States between about 1940 and 1971. (It is no longer given to pregnant women.) Women who took DES during pregnancy may have a slightly increased risk of breast cancer. The possible effects on their daughters are under study.

Being overweight or obese after menopause: The chance of getting breast cancer after menopause is higher in women who are overweight or obese.

Lack of physical activity: Women who are physically inactive throughout life may have an increased risk of breast cancer. Being active may help reduce risk by preventing weight gain and obesity.

Drinking alcohol: Studies suggest that the more alcohol a woman drinks, the greater her risk of breast cancer.

Other possible risk factors are under study. Researchers are studying the effect of diet, physical activity, and genetics on breast cancer risk. They are also studying whether certain substances in the environment can increase the risk of breast cancer.

Many risk factors can be avoided. Others, such as family history, cannot be avoided. Women can help protect themselves by staying away from known risk factors whenever possible.

But it is also important to keep in mind that most women who have known risk factors do not get breast cancer. Also, most women with breast cancer do not have a family history of the disease. In fact, except for growing older, most women with breast cancer have no clear risk factors.

If you think you may be at risk, you should discuss this concern with your doctor. Your doctor may be able to suggest ways to reduce your risk and can plan a schedule for checkups.

Understanding Cancer

2008-10-07T10:13:00.001-05:00

From the National Cancer Institute:

Understanding Cancer

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.

Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.

Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.

Tumors can be benign or malignant:

Benign tumors are not cancer:

Benign tumors are rarely life-threatening.
Generally, benign tumors can be removed. They usually do not grow back.
Cells from benign tumors do not invade the tissues around them.
Cells from benign tumors do not spread to other parts of the body.

Malignant tumors are cancer:

Malignant tumors are generally more serious than benign tumors. They may be life-threatening.
Malignant tumors often can be removed. But sometimes they grow back.
Cells from malignant tumors can invade and damage nearby tissues and organs.
Cells from malignant tumors can spread (metastasize) to other parts of the body. Cancer cells spread by breaking away from the original (primary) tumor and entering the bloodstream or lymphatic system. The cells invade other organs and form new tumors that damage these organs. The spread of cancer is called metastasis.

When breast cancer cells spread, the cancer cells are often found in lymph nodes near the breast. Also, breast cancer can spread to almost any other part of the body. The most common are the bones, liver, lungs, and brain. The new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer. For that reason, it is treated as breast cancer, not bone cancer. Doctors call the new tumor "distant" or metastatic disease.

The Structure of Breasts

2008-10-06T10:08:00.001-05:00

(from The National Cancer Institute)

The Breasts

The breasts sit on the chest muscles that cover the ribs. Each breast is made of 15 to 20 lobes. Lobes contain many smaller lobules. Lobules contain groups of tiny glands that can produce milk. Milk flows from the lobules through thin tubes called ducts to the nipple. The nipple is in the center of a dark area of skin called the areola. Fat fills the spaces between the lobules and ducts.

The breasts also contain lymph vessels. These vessels lead to small, round organs called lymph nodes. Groups of lymph nodes are near the breast in the axilla (underarm), above the collarbone, in the chest behind the breastbone, and in many other parts of the body. The lymph nodes trap bacteria, cancer cells, or other harmful substances.

These pictures show the parts of the breast and the lymph nodes and lymph vessels near the breast.

Breast Cancer Awareness Month Begins

2008-10-01T12:50:00.000-05:00

From Breastcancer.org

Your Pathology Report

Page last modified on: June 26, 2008

At a Glance

Manage Your Anxiety
Getting tests done and waiting for their results can create a lot of anxiety. Here are some suggestions to help you manage your anxiety:
Get to know the people on your medical team and make every effort to meet them in person. You'll find out who is the best communicator, who can answer which questions, who is available to help you when you need it most.
Find a doctor who communicates with you who invites your questions and takes your concerns seriously, who gives you as much or as little information as you feel comfortable with.
Make plans with your doctor about how to receive test results in a prompt way. Try to schedule important tests early in the beginning of the week, so you don't have to wait over a long weekend, when lab work may slow down or doctors aren't communicating with each other.

In this section you'll find the web version of the breastcancer.org booklet: Your Guide to the Breast Cancer Pathology Report.

Wait for the Whole Picture

Waiting is so hard! But just one test can lead to several different reports. Some tests take longer than others. Not all tests are done by the same lab. Most information comes within one to two weeks after surgery, and you will usually have all the results within a few weeks. Your doctor can let you know when the results come in. If you don't hear from your doctor, give her or him a call.

Get All the Information You Need

Be sure that you have all the test information you need before you make a final decision about your treatment. Also, don't focus too much on any one piece of information by itself. Try to look at the whole picture as you think about your options.

Different labs and hospitals may use different words to describe the same thing. If there are words in your pathology report that are not explained in this booklet, don't be afraid to ask your doctor what they mean.

Breast anatomy showing close up of ductal cells

Larger Version

Breast Cancer Stage

The pathology report will help your doctor decide the stage of your breast cancer. It could be:

stage 0
stage I (1)
stage II (2)
stage IIIA (3A)
stage IIIB (3B)
stage IV (4)

Staging is based on the size of the tumor, whether lymph nodes are involved, and whether the cancer has spread beyond the breast. Your doctors use all parts of the pathology report as well as the breast cancer stage to shape your treatment plan.

How to Start

First, check the top of the report for your name, the date you had your operation, and the type of operation you had. Make sure they are right for you.

Parts of Your Report

Specimen: This section describes where the tissue samples came from. Tissue samples could be taken from the breast, from the lymph nodes under your arm (axilla), or both.
Clinical history: This is a short description of you and how the breast abnormality was found. It also describes the kind of surgery that was done.
Clinical diagnosis: This is the diagnosis the doctors were expecting before your breast tissue sample was tested.
Gross description: This section describes the tissue sample or samples. It talks about the size, weight, and color of each sample.
Microscopic description: This section describes the way the cancer cells look under the microscope.
Special tests or markers: This section reports the results of tests for proteins, genes, and how fast the cells are growing.
Summary or final diagnosis: This section is the short description of all the important findings in each tissue sample.

How Would You Like To Be Remembered?

2008-09-19T10:05:00.001-05:00

Before he died of cancer, one of my heroes (Leroy Sievers) asked his readers to tell him how they'd like to be remembered. I watched a bit of his memorial service yesterday and thought some more about it.

I'd like people to remember all the times when I could have judged, but didn't. I'd like them to remember my warmth. I'd like them to remember the times I made them laugh or shared with them one of those random facts no one else would know.

I wish there were someone who could share, when the time comes, how hard my life has been and how I rose above it, time and time again. That's really the greatest accomplishment of my life. I have thrived in an environment that could have destroyed me. My cousins survived, but I triumphed over bad genes and dismal nurturing.

I hope they remember how brave I've been. Not because I've lived through breast cancer. Not because I lived through my dad's suicide. I've been courageous by refusing let go of compassion, no matter what. It's a work in progress, letting go of anger and resentment, but I continue to put one foot in front of the other.

When all is said and done, there aren't many choices to make in life. You're born into certain circumstances and, as terrible as things eventually may get, all you can do is keep going. As I've said before, no one gets to call in sick to life. We wake up every day and try to get through it, no matter what. That's all we can do.

Getting up and going on doesn't require courage. Maintaining humor, gentleness, compassion and integrity--for those qualities I've had to reach deep inside. I have had to bring my attention back day after day. They've tested my mettle.

I wish people would remember that about me. How would you like to be remembered?

Ike Threatens People I Love

2008-09-12T12:18:00.000-05:00

The migraine raged on all afternoon, all night and was there to greet me first thing this morning. I didn't cook dinner last night. I stuck it out at work until it was time to go home. When I got there, I actually went to bed and put a cloth over my eyes. Even in the midst of chemo, I rarely hung around in bed.

Hubby made dinner: turkey burgers. He did a great job, but I may never be able to stand the smell of turkey burgers again. I wonder if, because of chemo, I developed an overly acute sense of smell. There are so many things I can't stand to smell anymore. Raw beef. Turkey. Chicken (unless it's heavily disguised by spices). I'm still good with fish. I hate the smell of coffee cake and barbecue (these are definitely related to chemo). Enough of that.

I lived 19 years on the Gulf Coast of Texas. I'm accustomed to hurricanes, the anxiety of whether the path is true and it will eventually find its way to your home. I've lived through the endless rain, the high winds, tornadoes, the endless endless rain in an area not too far above sea level.

Today, I'm worried about all of the people who took (and continue to take) such great care of me at M.D. Anderson. I hope they're safe and that their homes are spared. I know Dr. Ross will be at the hospital, sleeping on a cot, taking care of the people who are so sick they can't go home. It's probably one of the safest places to be in Houston.

I remember every last one of them, from the people who park my car to the nurses who helped me get out of bed or stop bleeding, the medical techs who x-rayed me or ct scanned me to the doctors who saved my life. I can't know how they'll fare.

I'm holding my breath a little bit and saying prayers for all beings living on the Coast. But especially all of those people to whom I'll always be grateful.

Learning to Love the Scars

2008-09-11T10:31:00.005-05:00

I've started doing yoga again. It's the slow, meditative type that allows me to "yawn my body open." I hope it helps with the osteoarthritis in my hips, but even if it doesn't, it's the first step to regaining my physical fitness regimen. Slowly but surely, I start again.

This week, Carson Kressley's show, "How to Look Good Naked" featured a woman who had been unable to feel attractive because of extensive medically-created scars on her body. I thought about watching it, even watched the first five minutes of it, but ultimately I decided to move on. Makeup, a new haircut, a new wardrobe--none of that is going to fix my own scar issues. Everyone tells me that no one would ever know, by looking at me, that I had breast cancer. People even tell me that I'm pretty.

My only thought is, "That's because you haven't seen me naked." I'm working hard to accept my scars, if not love them. Some days are better than others. I accept that they're there. I know that having them is preferable to being dead. I even know with absolute certainty that my husband still finds me attractive.

Someday maybe I will. All the time, not just intermittently.

Losing Weight

2008-09-04T12:54:00.001-05:00

Lisa, the only M.D. Anderson employee I dislike, pointed out that I've lost weight since my last visit. She attributed that to the Ritalin, but since I haven't taken it in a month, I don't think that's the cause.

The question is, after having been alerted to diminishing weight, why do I think that's a reason to restrict food intake?

Feeling a little nutritionally crazy, teetering on the razor's edge of my long-time eating disorder potential.

On the up side, I'm not weighing myself yet. And yes, I do still own scales.

Not Myself

2008-09-03T11:56:00.000-05:00

The second night of insomnia. I'm not sure if it's fatigue or maybe the after-effects of surgery or maybe the coming to terms with new diagnoses, but my intuition fails me. Back in Crazy Land, I have conversations but I can't determine the mindset of participants. I hate not being able to read people. I'm frustrated and baffled by my insularity. I need to see inside their heads.

I'm fairly certain that no one else here is attuned to the subtleties of human interaction. Otherwise, they might have noticed the distance in my eyes. They might have heard my voice coming from far away, as if I were standing in an empty room. On the one hand, it's a very good thing: I'm never vulnerable. On the other hand, it's a very lonely experience.

Clearly, I'm not myself. Whomever that may be at this point.

Test Results

2008-09-02T08:44:00.000-05:00

The mammogram was fine, except tissue density makes it hard for them to say with certainty that all is well.

I've developed osteoporosis in my hips and spine, thanks to the chemo. That aching pain in my hips is arthritis.

"You've been through a lot," Dr. Ross told me. If he says it, it must be so.

I feel like I'm tired, anxious and depressed. I got to see Dr. Ross, though.

Up At 2:00

2008-08-26T11:47:00.001-05:00

Another night of sleeplessness. I've been waking up at 4:00 every morning for about the last three weeks. Too much stress at work, at home and the nagging anxiety about Thursday's tests jolt me awake every night.

I saw Dr. Nuesch, my radiation oncologist this morning, believing we were finally through with each other. After his examination, he said he thought we should keep an eye on the hardness that refuses to go away. It's on the side of my breast and a ridge under my left breast. Generally speaking, I try not to notice. I'll be seeing him again, but I get a break for a year.

While I was waiting, I noticed a photograph of me in my (extensive) patient files. No wonder people cried when they saw me. I looked really sick. I was really sick. Seeing it made me a little sad. I'm not sure why.

Tomorrow, off to Houston.

Annual Check Up

2008-08-25T09:29:00.001-05:00

I'm hiding in my office today, feeling profoundly unproductive. My annual breast cancer check is coming up on Thursday. It's always nerve-wracking, even though I have every reason to believe all is well.

Not much will get done today or tomorrow. Wednesday, I'm off to Houston. Thursday is the marathon day at M.D. Anderson, beginning with blood work at 7:00 a.m. I'll see Dr. Ross at the end of that day. It's something to look forward to.

I won't be able to drive back until Friday, but then I get a non-medical day off on Monday. I just want to get the week over with.

Thank you, Leroy

2008-08-21T09:21:00.000-05:00

Before I had breast cancer, I never had heroes. The very concept eluded me. Now I have several--Dr. Ross, Dr. Christafanilli, Dr. Kronowitz, Lance Armstrong and Leroy Sievers. Leroy Sievers died on August 15. He was 53 years old.

Leroy waged a mighty battle against the cancer that eventually took his life. Like Lance Armstrong, he was fearless in his commitment to staying alive. He endured through countless procedures and treatments. One of the last treatments involved injecting glue into his spine. He developed a post-operative infection and almost died from it.

Leroy had many friends on the Internet. He wrote about his illness every day in his blog, "My Cancer," and gave voice to so many of us who've shared the same journey.

I always think that, if cancer reoccurs as it did with Leroy, I won't be willing to go through chemo again. If that means I die, then so be it. Leroy was a stronger, braver person than I. He grabbed onto life and held on, no matter how scary the ride got.

I hope Leroy can hear all of us left behind, saying thank you for the tremendous gift of his spirit.

Thank you, Leroy. I'm going to miss you so much.

Keeping Secrets From Myself

2008-07-04T21:17:00.001-05:00

I finally figured it out. It's anxiety. In the past three weeks, I've

burned my right arm twice on the oven
burned two fingers of my left hand, testing the heat of a grill
sprained one of my ankles
cut both of my feet
hit my lower back against a sharp-edged table

I'm a disaster. All of these were accidents, but they form a pattern, obviously. Whenever I'm anxious, I'm so distracted that I go through periods of accidentally hurting myself. For as long as I'm fearful, I'm a danger to myself.

I haven't been aware of thinking about my surgery, but clearly my mind has been focused on the pain ahead. I'm so good at keeping secrets from myself. It's how I got through my childhood. I compartmentalize to keep anxiety at bay. The Inner Fascist asserts herself and, as always, finds an abundance of qualities that need correction.

Why, why, why. I shut down the Inner Fascist and wonder why she's back. I wonder why I'm falling, cutting, stumbling, injuring myself repeatedly. They defend me from what seems like unbearable anxiousness.

I'm a slow learner. Shhhh. Don't tell anyone, especially not me.

Surgery, Round Four

2008-06-04T11:54:00.002-05:00

I've been complaining for weeks about not hearing from Dr. Kronowitz to set a surgery date. Yesterday, Brenda left a message on the machine requesting that I call her to discuss Dr. K's schedule. I was immediately plunged into depression.

I don't have to do this. I could allow the necrotic tissue to remain. Dr. Kronowitz suggested doing some scar revision on the tummy tuck. He said the scars might come back, though, and it will definitely be painful. I tried to think clearly about it last night, to determine whether I'd be sorry if I didn't do either one.

The brain was already hunkered down, trying to steel the body for the coming onslaught. I'm familiar with the mental strength that must be marshaled to get through the pain, though it most certainly will be pain of a variety I've already experienced.

At this moment, I don't think I can stand another abdominal surgery. Certainly a few more steroid injections might help with the pain I still experience over both of my hips. I plan to ask Brenda about whether surgery ultimately will be more efficacious in resolving this chronic pain. My guess is that it won't.

I can't speculate on how much of a toll surgery will take on my energy level, which is being managed relatively well with Ritalin. I need to carry on with my life and that requires that I'm not burdened with insurmountable fatigue.

I've worked so hard the past several months to regain strength, stamina and mobility. I wonder how much will remain after the surgery. Of course, I will start rebuilding again as soon as I'm able. Right now, I need to come to terms with the loss.

I can elect to move on and leave things as they are. I regularly remind myself of that fact. Just as regularly, my thought process shuts down. I know I will have the necrotic tissue removed. I like to think that in the dissociative silence settling over me that my brain is sending messages to this body beaten down by three years of medical assault. It's reminding the body that I can get through this.

Ritalin

2008-05-16T11:07:00.000-05:00

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.

Tattoo

2008-05-14T14:33:00.001-05:00

It was a standard-issue M.D. Anderson day: Arrive early and wait...and wait...and wait. I thought I had an appointment with Dr. K.'s nurse to have myself tattooed. Brenda and I had a difference of opinion, though. I wondered why she never appeared on my schedule. We had a couple of phone conversations about it, but she neglected to pencil me in. After about 30 minutes of waiting as she scurried around getting the necessary approvals, we got down to the ink.

It took a couple of hours to finish, including the prep time spent finding the right colors, drawing the template, etc. There were a couple of areas where I had some pain, but I'm virtually completely numb. In case you don't know, scabs will form that must not be disturbed or the color will come off with them. I can't wear a bra for 5 days and I have to apply Aquaphor twice a day. I hated to see the jar of Aquaphor. They gave me that during chemo to stave off the sores on my hands, but it did absolutely no good. My brain automatically rejects everything that was related to chemo.

So here I am at work, bra-less. Being a member of the groovy generation, I used to go without a bra rather frequently, before propriety and gravity asserted themselves. I don't think, even in my youth, that I ever showed up at a job lacking adequate foundation garments. Today I wore a large NBA tee shirt from the year the Phoenix Suns were in the Finals, but the Aquaphor almost immediately created a dark round spot the exact size of the tattoo (or aureole). I'm not sure how I'm going to get through the rest of the week. I simply don't have that many XL tee shirts, even of the NBA variety (of which I have quite a few).

The other issue is one of bounce. The girls are pretty perky and, no matter how slowly and carefully I walk, they tend to move around a bit. The thought that Loathsome or Mr. Moneybags glimpsing the girls actually moving makes me a little queasy.

There's ever so much more to share; the day actually went downhill from there. However, in my absence, Crazy Employee has managed to make part of one of the databases malfunction. I can't figure out how she did it. She's gifted, I suppose.

Due to database repair and exhaustion, Part Deux tomorrow.

Steroids

2008-04-16T12:11:00.000-05:00

Dr. Kronowitz agreed that I've healed enough to move on to the next step, the tattoo. We discussed the upcoming (final, I hope) surgery to remove a lot of necrotic tissue caused by the high radiation doses I received. He may also try to cut away some of the chelation at the donor site so that maybe I'll have less ongoing pain. We had originally discussed doing it in July, but now Dr. K. thinks his schedule may be too busy.

I guess that could be a good thing. I would have more time to continue to recover physically and psychologically. I'm less concerned about my physical condition than my mental strength to endure more pain. It's far easier to rehab physically than to rebuild psychological reserves. At least with physical strength and flexibility, there are identifiable milestones and definitive means towards reaching them. Though I may be in a lot of pain from tearing internal scar tissue while I do my exercises, I know the pain will end shortly after I stop working out. After surgery, there is no predictable end in sight. Pain will end when it feels like it.

Brenda is supposed to call me soon to set up the appointment for my tattoo and I suppose we'll discuss a surgery date then, too.

We rounded up the visit with some more steroid injections in the scars running across my tummy and my "umbo" (his PA's word for my navel). Jennifer also did some injections in my sides above my hip bones. I didn't realize we were going to be doing that until Dr. Kronowitz told Jennifer to get the supplies. It's probably good that it was a surprise. At least I didn't have a couple of weeks of anticipating the excruciating pain.

I'm back at work today, feeling mostly brain dead. One of my colleagues in Virginia called to ask about a legal issue and I could barely summon an intelligible response. I must look pretty beaten up, too, because everyone is giving hugs today.

There's some strictly lay-out work that I plan to do today so my diminished intellectual ability won't be a problem. Maybe tomorrow I'll be more capable of working and writing. I had a phone call from an old friend as I was scurrying around, trying to leave town on Monday. I'll try to get around to that tomorrow.

Celebrate!

2008-03-28T12:06:00.001-05:00

Today is the second anniversary of my final chemotherapy treatment!

Hero

2008-02-25T14:03:00.001-06:00

I just spent an hour on the phone with my health insurance provider, straightening out my complex maze of doctor bills. For many years, I've tried to do at least one good deed every day. I recently upped that ante to 3. My second good deed of the day was to be patient and cordial with the insurance guy who helped me get it all cleared up. He was obviously surprised when I thanked him and wished him a good day, even though we came up with another $900 in bills I have to pay. I'm certain he talks with a lot of angry people every day and I hope our conversation makes his day a little better. My previous good deed today was traffic-related. One more to go.

I happened to see Elizabeth Edwards on television over the weekend and was once again impressed with her positive energy and commitment to getting on with life, even though she battles Stage 4 breast cancer. "She's my hero," I thought. Lance Armstrong is also my hero. Before I was diagnosed with breast cancer, I had absolutely no heroes. Now I do. I have three.

I discovered that I am my own hero.

Nipple Reconstruction

2008-02-06T10:59:00.001-06:00

I was told not to wear jewelry, but I didn't think that meant rings because I don't need any nipples on my fingers. Brenda, the nurse, made me take off my rings and jeans, then attached a pad to my back to ground me. I wasn't sure I heard her correctly, so I asked her again why I needed the pad. I still have no idea why I had to be grounded, but removing all metal from my body prevented me from being burned in those places.

Jennifer, his PA, came in and asked me if they'd given me any nipples to try. I know. Go ahead and laugh. She handed me a plastic nipple and told me to put it where I wanted the new one located. Well heck, I didn't know. I stood in front of the mirror and tried to find the right place. I turned around and asked everyone (Brenda, Jennifer and one of Dr. Kronowitz's fellows) what they thought. They reached a consensus opinion and helped me to move it to a better site. When Dr. Kronowitz came in, he didn't think much of the placement and moved it to where he thought it should be. Couldn't we have just waited for him?

The room had a chair much like a dentist's chair, but much more comfy. After they reclined the chair, Brenda put a cool, damp cloth over my eyes and turned on some "new age" music. It was all very calming. Then Dr. K. went to work. He double checked to make sure I couldn't feel anything.

He was in high spirits and we all had a fabulous time. He made me laugh almost the entire hour and a half that it took to create the new nipple. There were a couple of places that hurt, but Dr. Kronowitz gave me some local anesthesia immediately. The fact that it hurt is great news. That means the nerves are forming new connections. Someday I may actually have sensation in the new girl.

It's a little like breast origami; Dr. Kroniwitz cut some of the existing skin and twisted and turned it until it looked like a nipple. They asked me, after he left to report to my mom, if I wanted to see it. Of course I did. They asked if I was sure. I have to say it wasn't pretty.

Jennifer put a piece of foam over the new nipple. It's 2 inches in diameter and about 1.5 inches tall, with a hole cut in the middle like a donut. That will prevent the new nipple from being compressed and potentially dying.

I'll wear my dressings for the next two weeks, then in 3 months, I'll go back for the tattoo. Maybe no more nerves will have reconnected by then. Three months after that, I'll have my final surgery. The end is in sight.

Size 2 Is Not Fabulous

2008-02-05T13:40:00.001-06:00

I broke down and bought some new (on sale) pants for work this weekend. It's official. I'm now down to a size 2. I see women on t.v. diet commercials, enthused about reaching that size. I'm not thrilled.

Even I can see how tiny I am now. All of my doctors have commented, as did my physical therapist. I only note that my jeans are baggy and all of my old clothes (sizes 6 and 8) hang off of me.

My mom thinks I'm not eating enough. She's started bringing food over and checking my menu items. I'm eating enough. As a matter of fact, I just consumed 3 Shrimp en Brochette, fries and a very large piece of cheesecake.

As you can see, I'm working on it.

Sandbox Revisited

2008-01-25T13:32:00.000-06:00

"Finish every day and be done with it. You have done what you could. Some blunders and absurdities no doubt crept in; forget them as soon as you can. Tomorrow is a new day; begin it well and serenely and with too high a spirit to be cumbered with your old nonsense. This day is all that is good and fair. It is too dear, with its hopes and invitations, to waste a moment on the yesterdays." ~ Ralph Waldo Emerson

Thirty minutes of intense pedaling on the stationery bike relieved me of all my fury last night. My legs are still tired this morning, but my mind is calm. I emailed a note to Dr. Cristofanilli's scheduler to see if I could manage to work in a trip to the lab next Tuesday (nipple day revisited). I conceded that I might not be able to see Lisa (his nurse practitioner) that day, but we can always discuss the report via telephone. (Usually one sees the doctor/PA/ nurse the same day as the tests.) Though it's highly unlikely that anything unusual will turn up, not checking makes me crazy and scared.

Dr. Sandbox gave me a little lecture about the limits of technology and how, even if there were some early signs of cancer, a blood test might not be subtle and sophisticated enough to spot it this early. True enough. No question about it. It's not "predictive," he pointed out. There is another reason to take a look at what's going on, though. It's important to have a clear idea of whether the level of Tamoxifen is adequate. I'm not as clueless as he seems to believe. Furthermore, if the National Cancer Institute recommends it, shouldn't we do it if only to ease my troubled mind?

Sandbox reminds me of why I used to hate doctors, specifically male doctors. It's the arrogance, the utter lack of interest in the patient's questions and concerns. Yes, you've been to medical school, but so has my ex sister-in-law. Believe me, I'm not that impressed. I, on the other hand, have lived in this body 54 years now. I'd like to live in it another 20 years or so, long enough to take up smoking again. (I've promised myself that, if I make it to 70 or 72 depending on my mood at the moment, I can throw all caution to the wind. Thank you, Frank Sinatra, for the inspiration). Sandbox and all of his ilk should listen more and talk less.

I was momentarily called away from my relentless Sandbox bashing to do a little freelance computer assistance for my friend the Superhighway. What blind faith they have in me. Fortunately, she had a question I could answer and I even remembered the exact process without fumbling around the way I do most of the time. I always find my way eventually, but I hate making my faithful friends wait while I noodle around endlessly.

I've belabored Sandbox enough, anyway.

It's a cold, gray, rainy start to the weekend. I had to go downstairs a little while ago to fetch my yogurt from the refrigerator. The atrium is always chilly, so I ran upstairs. The wooden stairs creaked mightily as I did my best to sprint. As a matter of fact, it sounded to me like the entire building shook. I'm reminded of the proverbial herd of buffalo. Can I blame this on the boots? Wait. Maybe Sandbox is somehow responsible.

No Blood Work

2008-01-24T16:51:00.001-06:00

Warning: Ggirl is furious. Bad language will be used. If this offends you, move on to another post.

I just got back from seeing Dr. Sandbox. He is now being called by that name because he is one of the most narcissistic people I have ever met. And that's saying a lot. My dad pretty much had the market cornered on that quality.

He entered the examining room and I said, "Hi, Dr. Sandbox. How are you?" I'm a southern girl. I have southern manners. We always ask.

"I'm here," he says.

Oh really. Well I'm fucking fine, too, asshole. I'm thrilled to be here. At least you're getting paid.

He makes me take my clothes off and pokes around on my breasts. It's not like I don't have millions of guys doing that. Seriously. I do not need my oncologist to feel. It is a massive waste of my time and it makes me cold sitting on that stupid table.

"Are we doing blood work today?" I ask.

He launches into a lecture about how blood work doesn't really tell you anything. Again, oh really? Then why does the National Cancer Institute recommend one every six months. Am I at six months? Hell yes.

So we did not do blood work. That scares me. If we're not doing blood work, then I'm wasting my time. Seriously. There is absolutely no reason for me to be there if all he's going to do is poke around on my breasts. Even I do that. An extra pair of hands is NOT NECESSARY.

Then I broach the question, once again of BRCA1 and BRCA2. I noted that the last time I saw him, he thought I should do one. He said that after I mentioned it, though. So.

"If you think I should have the test, then I'll have one. Don't do it because you're humoring me, though. I don't have any vested interest in having one, but if you think that's what I should do, then I'll do it."

Again another lecture that has little bearing on the issue at hand. Finally he said he thought we should pursue it. Okay. So we're doing genetic testing but we are not doing blood work. This makes complete sense to me.

BRCA1 and BRCA2 are indicators of whether it's likely breast cancer will develop in the other breast and whether it seems likely ovarian cancer is a risk. Fine. We'll test, but I am NOT having anything cut off. I am not having ovaries removed. I am sick to death of surgery.

On the other hand, I don't want to wake up two years from now and find out I need to do more chemo. (Again, another important reason for BLOOD WORK.) I will not do chemo. I don't care what that means. I WILL NOT DO MORE CHEMO.

So here's tomorrow's agenda. I will call M.D. Anderson and see if I can schedule and appointment with my oncologist's nurse practitioner and see if she will do blood work. Then I will cease the procrastination and find a local oncologist I don't hate.

Dr. Sandbox. What an asshole.

Blood Work Day

2008-01-24T14:41:00.001-06:00

It's time for more blood work (I've really started to love the sound of that), so I'm seeing my oncologist today. I can't stand that guy, but what with the rescheduling of the rescheduled scheduled nipple reconstruction, I haven't gotten around to finding a new one. Okay. It was also because I always, always avoid thinking about breast cancer, if at all possible. So I've procrastinated.

Before I was diagnosed, I never procrastinated. It's not a thing that comes naturally to me and it used to make me anxious. In the past two years, I have become a pro. I am a world class procrastinator. Make a hotel reservation in Houston? I wait until the week before the appointment, even if the Houston Live Stock Show and Rodeo are imminent. Talk with M.D. Anderson about changing physician notification? I've been "meaning" to do it for about six months now. That, my friends, is an accomplishment. I find I've topped myself. Not locating a palatable oncologist wins me the gold (thanks, Mitt) in the Olympic Procrastination event.

I've been coping with my anxiety by being giddy all day. I've been a source of great amusement to all of the denizens of Crazy Land. They wish I could have Oncology Day every day. Hilarity abounds. We had a birthday celebration today and I was absolutely manic. Not to take credit or anything, but I laughed at everyone's jokes, encouraged their camaraderie and spread love as if it were high grade margarine. It was a remarkably festive event. Oh for the days of Little Miss Sunshine, when I was willing to put in that kind of effort every day.

Yesterday, Crazy Employee and I rescued a couple of puppies from our next door neighbor. Lillian has allowed her two dogs to repopulate the entire neighborhood and she's been doing a mighty fine job of reproducing herself. Luckily, other people rescue her human offspring. The puppies and I had an immediate Love Connection the likes of which even Chuck Woolery would be impressed.

I'd love to share with you why I'm so exhausted. I've started keeping track of my physical fitness work every day. Yesterday, after reviewing all the work I've done in the past three days, it was clear to me why I drag myself out of bed every morning feeling like I've been run over.

I've had a dream two nights in a row. I've just started the new year in high school, have been assigned a homeroom and a locker. I've also been assigned the topic for my senior honors English class thesis. It's O'Henry...I think. I get sick after the first day of school and I'm absent a long time. When I go back, I'm anxious about finding my homeroom again. The worst part is that I can't remember if it's actually O'Henry who's supposed to be the subject of this enormous project. I frantically try to write a paper in an hour that was supposed to take all semester. While I'm writing it, though, I'm thinking, "Why O'Henry? I hate O'Henry. Surely that can't be right." I wake up drenched in sweat.

I may be the only person I've ever known who's found herself terrified by thought of William Sydney Porter.

BRCA Breast Cancer Gene Risk Varies

2008-01-23T14:26:00.000-06:00

From WebMD:

Odds of Breast Cancer Vary for Relatives of Breast Cancer Patients With BRCA1 and BRCA2 Gene Mutations

By Miranda Hitti

WebMD Medical News

Reviewed by Louise Chang, MD

Jan. 8, 2008 -- Scientists have some new clues about breast cancer risk among the sisters, daughters, and mothers ofsome breast cancer patients.

Those clues center on the BRCA1 and BRCA2 gene mutations, which make breast cancer and ovarian cancer more likely.

In a new study, nearly 1,400 women diagnosed with breast cancer before age 55 got BRCA1 and BRCA2 genetic tests. They were also asked if their mother, daughters, or sisters had ever been diagnosed with breast cancer.

The vast majority of the breast cancer patients had no BRCA1 or BRCA2 gene mutations.

But 5% of the patients who had had breast cancer in one breast and 15% of those who had had breast cancer in both breasts had BRCA1 or BRCA2 gene mutations. Their close female relatives were more likely to have had breast cancer than the relatives of patients without BRCA1 or BRCA2 gene mutations.

Age also mattered. Younger breast cancer patients were more likely to have a mother, daughter, or sister with a history of breast cancer.

Besides BRCA1 and BRCA2, other genes likely "play a major role" in the study's breast cancer risk variation, and environmental and lifestyle factors may also have been involved, write the researchers.

They included Colin Begg, PhD, of New York's Memorial Sloan-Kettering Cancer Center. Their study appears in the Jan. 9/16 issue of The Journal of the American Medical Association.

Infinite Varieties of Pain

2008-01-17T13:39:00.001-06:00

When the Physician's Assistant, Jennifer, came into the examining room, I immediately sensed that something was amiss. She asked several times, "Why didn't I know you were here?" Well, that's hardly a question to ask me. I didn't know. She asked me if I was having any problems or wanted to pursue any revisions to the reconstruction. There is one place under my arm that's still hideous, so I mentioned that, even though I couldn't see that the conversation had much relevance to the reason we were there. Jennifer told me that all revisions must be completed before the nipple construction. Somewhere along the way, I noted that the nipple was my whole raison d'etre for being there. Uh oh.

Gwen, the lady who made my appointment stuck her head in to verify that I'd originally been scheduled for last Thursday. "That's absolutely right. That's what I thought." I was puzzled that they thought there was any way I'd be confused about when to show up.

Dr. Kroniwitz finally arrived to tell me that he doesn't do procedures on Tuesday. Gwen (who is generally excellent at her job) scheduled me for the wrong day. Dr. Kronowitz was embarrassed and clearly felt terrible about the expense and inconvenience. He personally went to reschedule my appointment for January 29. He offered to see me next week, but I couldn't do it. I needed a break before the trip, a break from the stress.

"Well, we have to do something, Dr. Kronowitz," I told him. Otherwise my supplemental insurance wouldn't reimburse me for any of the travel and hotel expenses.

"Okay. Let's do some injections," he suggested.

I was cheered up and agreed immediately; he was awed by my enthusiasm. I waited, flat on my back on the exam table for about 15 minutes; it was beginning to hurt by then. Eventually, they arrived to perform the steroid injections on various chelated scars. We did my reconstructed breast. No problem, except for a huge scar underneath the breast. It's not numb and, though the steroids are mixed with lidocaine, the anesthetic didn't have time to prevent pain as he stabbed me several times with the needle. Jennifer commented that the needle was larger than she expected. Then the real fun began.

He began a series of injections in the scars across my lower abdomen. I am not numb there, either. He also injected the two scars on my pelvis where the drains were inserted. Nope, not numb.

I think one of the biggest revelations of my breast cancer journey is the discovery that there are a lot of different kinds of pain. I had no idea pain could take so many forms. (I'm certain that I still haven't experienced all of them.) There's surgery pain and chemo pain (which in itself involves several previously unknown types of physical suffering), there's pain from needles inserted into my breast, pain from having massive amounts of skin and tissue moved from one place to the other. I've also experienced unspeakable psychological pain from simply trying to withstand the process and, after my tram flap, from being dependent on other people to move me from one place to another. Steroid injections into the abdomen and pelvis definitely provided me with yet another novel form of pain.

The steroids are systemic and the revved up feeling reminded me of the way I used to feel the day after chemo. A chilling memory.

There is yet another surgery coming, but I deferred it for six months. I have officially hit the wall. I don't have the mental strength to undergo another surgery any time soon. It took several days to steel myself for the nipple reconstruction. As I sat in the living room on Sunday (the day before I left town), I knew that I've reached the end of my psychological rope. The warrior spirit has been completely depleted.

For the next week and a half, I'll be trying to mentally prepare myself for another round of stress, another visit to a previously unknown type of pain. I can do this. Yes I can.

Scientists Discover How BRCA1 Gene Causes Cancer

2008-01-10T14:08:00.001-06:00

From Breastcancer.org

What breastcancer.org says about this article

The study reviewed here seems to have figured out how abnormal BRCA1 genes (BReast CAncer gene 1) lead to breast cancer. When BRCA1 genes are healthy, they fix DNA breaks (protein strands that make up chromosomes and genes). When BRCA1 genes are abnormal, they can't fix DNA breaks, specifically breaks in a gene called PTEN. PTEN genes stop cancer tumors from growing. If a PTEN gene has a DNA break that isn't repaired, cancer cells have nothing to stop them and grow rapidly.
DNA breaks happen all the time as cells in the human body grow and multiply. In most cases, the cells realize a mistake has happened and fix the problem. But if a "fixer" gene such as BRCA1 is abnormal, there is no way for the cells to fix the mistake. As researchers have learned more about the role of specific genes and proteins, they have developed a group of medicines called targeted therapies that tell genes and proteins to do specific things to stop cancer growth. Herceptin, Tykerb, and Avastin are all targeted therapies.
The results of this study may help researchers develop new targeted therapies to repair breaks in the PTEN gene. This could help women diagnosed with what's called triple-negative breast cancer (estrogen-, progesterone-, and HER2-negative). Right now, this type of breast cancer has limited treatment options because current hormonal and targeted therapies don't work.
According to statistics from the National Cancer Institute (NCI), about 15% of all breast cancers are triple negative. Young African American women are more likely than women of other ethnicities/races to be diagnosed with triple-negative breast cancer.
Stay tuned to breastcancer.org for the very latest news on research that may lead to new breast cancer treatments.

Last Updated: 2007-12-11 11:17:09 -0400 (Reuters Health)

By Julie Steenhuysen

CHICAGO (Reuters) - Mutations in the BRCA1 breast cancer gene appear to be linked with the loss of a protein important for putting the brakes on cell growth, a finding that could lead to new therapies, researchers said on Sunday.

The breakthrough could lead to more effective therapies for women with an aggressive and especially deadly cancer known as triple-negative that does not respond to current advanced drugs, the researchers said.

"It doesn't have a good target for therapy at this point," said Dr. Ramon Parsons of Columbia University Medical Center in New York, who worked on the study.

Scientists have known for more than a decade that women with certain alterations in the BRCA1 gene were at high risk for breast cancer. What they have not understood is exactly how a mutation in this gene leads to cancer.

Researchers at Columbia, working with at team at Sweden's Lund University, now believe mutations in the BRCA1 gene can leave cells incapable of repairing routine DNA damage. When such damage occurs in a protein called PTEN, which regulates the growth of cells, cell growth is unchecked and tumors form.

Women with faulty copies of BRCA1 or BRCA2 have a 50 to 85 percent chance of getting breast cancer. Mutations in these genes account for 5 to 10 percent of breast cancer cases.

Most breast tumors are called estrogen-receptor positive, because they are fuelled by the hormone estrogen. About 20 percent are HER2-positive, because a protein called HER2 is involved. A third type is driven by the hormone progesterone.

These types of cancer have good treatments.

Then there are basal-like or triple-negative tumors, so named because they lack estrogen, progesterone or HER2 receptors needed for most breast cancer drugs to work.

UNCHECKED GROWTH

"The basic idea is that BRCA1 is a repair enzyme that is involved in coordinating the repair of double strand DNA breaks," said Parsons said in a telephone interview.

"When it is mutated, it is no longer present in a cell. If a cut occurs in PTEN, there is no way for this cell to fix it," said Parsons, whose study was published in Nature Genetics.

"It is like cutting the brake cable on a car," he said. "If PTEN is broken, you turn on a pathway that tells the cell to grow. It tells the cell to start dividing. It tells the cell, 'don't die.'"

Parsons said loss of the protein PTEN is how breast cancer gets started in women who have inherited the BRCA1 gene mutation.

His team made the connection between BRCA1 and PTEN by searching for chromosome breaks within the PTEN gene.

They scanned 34 biopsies taken from women with BRCA1 tumors. The PTEN gene had been split in two, but inadequately repaired in about one-third of the cancers. In some cases, entire sections of the gene were missing.

They said these chromosomal mistakes trace back to the tumor's lack of BRCA1, which is charged with cell repair. He estimates that about 50 percent of BRCA1 breast cancers harbor mutated PTEN.

"These tumors have very high frequency loss of the PTEN protein," Parsons said. In breast cancers from women with normal BRCA1, they rarely found large mutations in PTEN.

"A lot of drug companies are working on this. There is reasonably good hope that this approach will improve therapy for patients," Parsons said.

Basal-like breast tumors are also found in 10 to 20 percent of women whose cancer was not caused by BRCA1 or another gene. The researchers found PTEN is lost in most of these breast tumors as well.

New Nipple ETA

2008-01-10T13:02:00.001-06:00

Nipple reconstruction was postponed and I'd actually cheered up, thinking that we might not be able to reschedule it for a month or so. The nurse called me a minute ago to advise me of my new date, next Tuesday. She also advised me regarding what I can expect pre- and post-procedure. It does not sound good. More not bathing, more huge dressings. Great.

Prior to the cancellation of this week's scheduled nipple work, the Inner Fascist had a return engagement to help me cope with my anxiety. It appears that, when distraction finally fails me, self recrimination steps in to take up the slack. I noticed the Fascist voice very quickly this time and told her to stop. Loudly. Once was not enough, but at least I heard the inner taunting relatively soon after it started. Having made the connection between anxiety and the IF while I was in the midst of making myself feel bad was a big step forward. I'll have more time to practice by late Saturday afternoon, I'm sure. By then, distraction will have lost its power to disguise my anxiety.

Screaming Physical Therapy

2008-01-04T11:19:00.000-06:00

I'm just back from physical therapy, feeling like screaming. It happens every time. Massaging scars and pushing my muscular/flexibility limits is very painful.

The up side? My PT says I can cut back to once a week because I consistently work every day at home. She says I'm making progress and I try be content with the small gains I've made so far.

The other wonderful news is that she thinks I have good posture, something I've been trying to mindful of as I go through my day. I got accustomed to slumping a bit after the reconstruction surgery. Time to stand up straight, which helps with energy and stretches out those internal scars where the tubes ran vertically inside my body from both sides of my groin to new breast.

The very best news (and I know this sounds a little silly) is that PT says I have perfect crunch form. The former fitness addict (and perfectionist) in me rejoices at that news. Muscle memory. It's an amazing thing.

It's been a good Friday so far. Well, except for that need to scream.

Next week, I'll report on the saga of the latest injured employee who's driving me crazy.

New Nipple Arrives January 10

2008-01-03T10:26:00.000-06:00

The pie making season is officially over and what a blessing that is. The first (Thanksgiving) pie was fabulous, but the Christmas pie disappointed. I haven't been interested in baking in many years, so I'm a little puzzled by my enthusiasm for it this year. The oven can now take a well-deserved rest until Easter.

Nipple reconstruction is scheduled for January 10. It's an out patient procedure, using a local anesthetic. I know they will tattoo the aureole to match the other girl. When I first read about that technique, after I had tattoos for radiation, I was anxious about having it done. I didn't know then that the new girl would be completely numb.

As for the nipple itself, that tissue sometimes comes from the inner thigh area, sometimes from the labia. Either way, it doesn't sound like much fun to me. On the other hand, there's nothing they could do to me that would hurt worse than the things they've already done to me. I try not to think about it. Ignorance is bliss.

My physical therapist is impressed with the progress I've made in muscle strength and flexibility. I've been doing the exercises she gave me as homework and I changed my yoga routine to include more stretching in the tummy area. The goal is to tear the scar tissue under my skin. Yes, as a matter of fact, that does hurt. It all hurts.

My mom convinced me to stop riding my bike because of my constant fatigue. That's a typical problem for someone who's had chemo, radiation and multiple surgeries. Fatigue plagues many people for years after their treatment. I go to bed exhausted and I wake up exhausted. As a matter of fact, I started falling asleep on the sofa at 3:00 p.m. yesterday and kept drifting off all evening. Once I fell asleep in the middle of one of Hubby's sentences. I tried to pretend that I hadn't, but I failed to respond appropriately to his comment, so I'd be surprised if he didn't notice.

My physical therapist encouraged me to get back into my bike routine and to integrate some other types of cardio exercise into my daily workouts. I have many dance aerobic dvd's and the thought of being able to do them again makes me happy. I may try one of them today and see how it goes. I'm certain I won't be able to make it all the way through the workout the first time, but maybe soon.

Meanwhile, my weight is still an issue. I've been on an eating rampage during the holidays, but I still haven't gained any weight. That's good and bad, you know. It's bad because all of my clothes hang on me. It's good because I'm always balancing precariously on the edge of an eating disorder and thinner always means better to me. Even when it isn't better. My (psychological) therapist suggested that I think of gaining weight as a means to building strength. I'm good with that and heaven knows I've been the festal sausage for over a month now. When I weigh myself (infrequently), the numbers never change.

I hope the coming year is a lot less painful than the past two. I hope I regain some of my lost stamina. I hope I find sources of greater joy. I hope the next pie I make is better than the last.

So Long to a Fellow Survivor

2007-12-21T10:25:00.000-06:00

Tyler was my age. Ten years ago, he was diagnosed with a rare form of throat cancer with a high mortality rate. (He never smoked.) Tyler went to my friends at M.D. Anderson, where he received radiation treatment, followed by surgery to remove the tumor. He went about the business of surviving.

Three years ago, after an argument, his wife killed herself. He had spent the night at a hotel and came home the next morning to find her sleeping. He noticed that her head was lying at an odd angle on the pillow, but thought nothing of it. Tyler went out to run some errands and came back to find his wife had shot herself. When the autopsy was completed, he was told that she apparently took an overdose of medication and, waking to find that her suicide attempt was unsuccessful, she pulled a gun out of the bedside table and shot herself.

Tyler struggled to regain his equilibrium the past three years. I'm not sure that he ever really did, though. As a suicide survivor, I know that road is long and treacherous. I can't imagine how it's possible to recover when your wife shoots herself, in your bed, after an argument. He went on and tried to find a new life.

Every year since his surgery, Tyler had to go back to M.D. Anderson to have scar tissue from the surgery removed from his throat. He had his last surgery about three months ago. He left a message on our machine a couple of weeks ago, wanting to hear how I've been doing. It was something Tyler did regularly.

His message sounded almost like he was on a respirator. I could hear his labored breathing in between phrases. There's only so much you can do with scars. Ultimately, removal of scar tissue only creates more scar tissue. For Tyler, the scars finally made it impossible for him to breathe and he died in his sleep.

Here's to you, Tyler, to your long struggle to survive. Here's to your will to endure your wife's death. We walked the same paths, but now you've left me far behind. Would you have guessed that I'd be crying for you? I am, just as I'm celebrating your courage and tenacity.

So long, Tyler. We'll all see each other soon.

Hark, the Festal Kielbasa Cometh!

2007-12-19T11:18:00.000-06:00

"Humor is the instinct for taking pain playfully." ~ Max Eastman

Today, I'm stuffed into what used to be known as "foundation garments." I remember, as a kid, trying to figure out what the hell those were because, in the olden days, you never saw bras or girdles on television commercials. It was too risque even to offer a definition. It seems so quaint now.

I saw my physical therapist yesterday, which is a tantamount to paying someone to abuse me. All of my scar tissue always hurts (and I have a lot of it, everywhere), but after she finishes massaging and pinching, I'm ready to start confessing to things I've never done. I'll say anything, but please don't torture me anymore.

This morning, I woke up feeling more than a little ragged. I'm exhausted and it seems entirely possible that an army of little demons stabbed me with forks all night long. I am not at my best.

PT told me that, if I wore my special compression bra and girdle (the one I wore 24/7 for three months), I'd have a lot less pain. Damn. I was in no shape to be stubborn about it today, so I'm packed into my underwear like a kielbasa. "Less pain" is the operative phrase here; I have a lot left over, despite my discomfort.

I wore one of my festive shirts today, the one with a reindeer who's holding a martini while he has one hoof perched on a beach ball. It's a little loose, but you can still tell there's something weird going on under there. We're having Owner's birthday party today, so I wanted to amp up the merry for the occasion. Not feeling particularly convivial, I knew special effort would be required to get through the Crazy Land lunch. I'm not sure the shirt's going to help much, but I've done all I can. I'm a kielbasa with a reindeer and jingle bell bracelet, earrings and necklace. Hark, the festal sausage cometh!

PT gave me some new exercises to do, specifically aimed at regaining strength and range of motion in my rotator cup and pectoral muscle. The exercises feel just dandy, too. I've added them to my daily 25 (25!) minutes of stationary bike and 20 minutes of yoga. After I finish with those activities, I have self-massage to do. That takes another 30-40 minutes. In a way, my life is still all about breast cancer. Not that I'm whining. All of this is far more bearable than the chemo and recovery from multiple surgeries. Nonetheless, how annoying. How very un-holiday.

When I got home yesterday from physical therapy, after getting stuck in college basketball game traffic, Hubby was hanging around waiting for me to make dinner. I'd gotten some tamales, so all he had to do was cut a couple of holes in the packaging and stick the damn things in the microwave. The brown rice was microwaveable, as was the refried beans. I'd already mixed the salad. Would any of this be hard to do? If your wife was being tortured, wouldn't you want to microwave the damn dinner for her? Yes, you would.

Not my Hubby. My level of pain made it hard to focus on what exactly needed to be done and in what order. While I wandered around the kitchen, getting things together, Hubby was in another room checking his email. Santa will be delivering a lump of coal for Hubby if he doesn't shape up. During dinner, I mentioned several times how exhausting the pain is after physical therapy. Hubby made a sympathetic face, but I assure you that, if it were he who was suffering, there would be no tamale dinner. There would be plenty of whining, though.

That will be about enough from me, too. Here's hoping for a fun, if not jolly, Crazy Land lunch. Owner's been in a funk the past several days, so he may be entertainingly annoying. Mr. Moneybags is weighing in with some serious crotchety, too. The cake has already arrived. Oh God. I just heard the dulcet tones of Loathsome. Looks like we're headed for some choppy waters. The Kielbasa* will keep you posted on the Crazy Land festivities.

*Finally. I think I've found my very own nickname: Kielbasa. Or Sausage. Hey, Mimi, it's the answer to the question you posed so long ago! I've officially earned my own Crazy Land nom de guerre.

Stage 3, Step 3

2007-12-14T10:33:00.001-06:00

When the Japanese mend broken objects, they aggrandize the damage by filling the cracks with gold. They believe that when something's suffered damage and has a history it becomes more beautiful. ~Barbara Bloom (I'm not sure this quote goes with this post, but I like it anyway.)

It dawned on me last night that I was diagnosed with Stage 3 breast cancer. Oh shit...how did I not know that? I reviewed what I know about breast cancer staging, just in case I'd jumped to a hasty conclusion. No. Stage 3. Then I called my mom this morning and told her I'd just realized I have Stage 3 cancer.

"Well, they told you that at the time," she said. "I don't think you could handle it then. There were too many things happening too fast to deal with it all."

Well, hell. I wish someone had mentioned it more than once. Seems a little silly to be terrified now. It actually seems kind of funny. Or maybe that's just the hysteria talking. Epiphanies. What a riot!

Today, I have step 3 of the new plan. I thought of it last night in between panic attacks.

What do I know about suffering?

I know that, no matter how good things are, we are never satisfied. We're filled with a restless hunger. Have the perfect job? If only we liked our kitchen more. Have the kitchen redecorated? If only the sun would come out. Sun shining? If only we were having a better hair day.... It's endless, this longing.

We want to push change away, halt time in its tracks, because with change comes loss. We don't like loss; it never feels good.

We yearn so much for feeling good (in all its possible manifestations) that we are unable to accept each changing moment as it comes. That is the solution to my suffering. I have to relearn it every so often. I thought I'd gotten it down during chemo, but no.

I am mourning the loss of my breast. The breast is gone and the new one is scarred and hardened in places. I was diagnosed with Stage 3 breast cancer and now I'm afraid. Things are as they are.

I can let go and experience these truths without judgment, holding close to me in loving embrace the sorrow, anger and fear. I can stop rejecting the breast and love it. I can stop rejecting the body and love it. It is my oldest friend, it will be with me until I die. I can feel some empathy for this skin that carries me around in it.

I can remember that, as much as I don't like this moment, it's perfect, nonetheless.

One More Thing...

2007-12-13T13:34:00.000-06:00

I'm not angry with my beloved Dr. Ross. I still have him penciled in my datebook to elope with whenever he has time enough to think about it. Well, time and...you know...interest.

Jingle jingle.

Steps One and Two

2007-12-13T13:22:00.001-06:00

" Man performs and engenders so much more than he can or should have to bear. That's how he finds that he can bear anything." ~William Faulkner

After physical therapy, my day is almost gone, even though I've been at Crazy Land since 6:15 today. (Purely accidental, I assure you.)

Step one of the new plan has already been implemented. I've been listening to Christmas music and wearing my jingle bell bracelet. Okay, I confess. I always wear my jingle bell bracelet from Thanksgiving until Christmas. I make it tinkle whenever I walk around the office. I do what I can to annoy the natives in Crazy Land. Of course, they'd never mention it to me if they found it irritating, but it's bound to get under somebody's skin.

Step two of the new plan is to sit with the sorrow, to maintain some inner silence while I feel the loss. It's hard to write or talk when I'm listening to the sadness, so I've gone missing this week from everyone.

When Dr. Ross told me that I had to have a mastectomy, his physician's assistant told me that a year from treatment, no one would know anything ever happened. I held onto that prediction as if it were a lifeline. I don't think I ever really dealt with the loss of my breast. I didn't have to; I believed her.

It dawned on me last night that Dr. Ross actually talked to me about the problems I would face with reconstruction. He said he would discuss them in conference with his colleagues and try to find the best way to deal with them. I assumed all would be well.

The type of breast cancer I have is not the kind most women have; only 10 percent of diagnosed breast cancers are like mine. There were cancer cells throughout my entire breast, extending very close to the chest wall. After the breast was gone and chemo endured, there was an enormous amount of radiation to the area. My doctors feared the proximity to the chest wall and the neck. We were unable to save any skin, which would have made reconstruction easier.

I'd rather be alive than dead. I'd rather have this breast than none. Nonetheless, I'm angry and frustrated. And sad. So, so sad. I'm present with the heartache; I'm silent as I mourn.

The new plan will continue to unfold and, inevitably, I will be better. As Julian of Norwich said, "...all shall be well, and all shall be well, and all manner of thing shall be well."

Tinkle tinkle.

Searching for a New Plan

2007-12-11T13:17:00.000-06:00

There will be no more surgeries (aside from nipple reconstruction on the new breast). That means the hard, necrotic tissue will remain where it is, perhaps for years.

Dr. Kronowitz did inject steroids into the chelated areas on the new breast, navel and donor site. That may help with the way the scars look.

I started physical therapy today in hopes of improving strength and range of motion in my left arm.

There's not much else for me to say right now. I'm coming up with a new plan to come to terms with this new, permanent reality.

Working on Healing

2007-11-29T10:07:00.000-06:00

I decided not to move up the time on my stationary bike this week. The twenty minutes of riding and twenty minutes of yoga are still exhausting. Last night I fell asleep several times while sitting on the sofa, watching television. I'm really interested in my Yao Ming book, but I'm so tired I haven't been able to read it.

The next visit to Houston is coming up next week. Yay for the end of the girdle. I'm going to have to ask him about the tissue necrosis under my left arm. I'm afraid to do that, because I'm not going to be happy with the answer, no matter what. If it's going to stay that way, I'll be crushed. On the other hand, the prospect of another surgery is daunting. I'm trying to not think about it much. I'll cross that bridge when I come to it, as always. Breast cancer is like that.

I may ask Dr. Kronowitz to help me get some physical therapy for my left shoulder, back, arm and chest. I've been working hard, trying to rehab with yoga. It's definitely working, but it's slow going. I was thinking that formal physical therapy might help me move along a little faster toward regaining strength and range of motion.

Yoga. I can feel scar tissue being stretched everywhere when I practice. I've also been continuing to work on my lymphatic system.

I'm certain that someday I'll be able to just live, as opposed to working on healing all the time.

Getting Back in Shape...Again

2007-11-21T10:38:00.001-06:00

This week, twenty minutes on the stationary bike, twenty minutes of yoga. I'm exhausted. I spend part of every evening, sleeping while sitting on the sofa. It reminds me a little of how morphine affected me. One minute, I'm waiting to see Steve Earle on Law and Order, the next thing I know, I've missed 10 minutes of the program.

I'm trying to get back in better condition before my December 6 appointment with Dr. Kronowitz. I want to feel better. I want my doctor to be impressed with my progress. Why? Beats me. He's not even Dr. Ross.

When I do yoga, I can feel all of the scar tissue in my body. There's a lot of it. I can also feel how all of the muscles in my right shoulder, arm, back and chest are shortened and weak. It hurts to stretch them out, but it's nowhere near as painful as the surgeries and radiation that caused it.

Only 15 more days of wearing the girdle 24 hours a day, 7 days a week.

Progress

2007-11-15T09:59:00.000-06:00

I'm now up to 15 minutes on the stationary bike and 20 minutes of yoga every night. I continue to have trouble gaining back the weight I lost after surgery. After counting calories for a couple of days, I figured out that I'm simply not eating enough. Breakfast and lunch combined only added up to about 450 calories. I'm trying to eat more.

My next trip to see Dr. Kronowitz is on December 6. After that, the girdle is gone! Two and a half months of wearing a girdle 24 hours a day, seven days a week has been relentlessly uncomfortable. I guess I'll find out then whether there's any hope for my new girl to look normal. I'm not sure I want to know the answer.

Thank you

2007-11-09T09:02:00.001-06:00

This is from my wonderful friend, RubyShooz. Please pass it on to the people who make a difference in your life.

“Gratitude unlocks the fullness of life. It turns what we have into enough, and more. It turns denial into acceptance, chaos to order, confusion to clarity. It can turn a meal into a feast, a house into a home, a stranger into a friend. Gratitude makes sense of our past, brings peace for today and creates a vision for tomorrow.”
-Melody Beattie

An Apology, Of Sorts

2007-11-07T12:39:00.001-06:00

I just received a comment about my most recent post from a very kind man. He is a member of a support group for survivors of a very rare and (at this time) incurable cancer. He could have been stern with me or angry with me. There are a whole range of unpleasant reactions he and others would have a right to express. I thought I should clarify my position on support groups.

I am asocial. That's the bottom line for me. I was a member of a Survivor's of Suicide support group after my father died. I found it amazingly comforting to sit in a room with 12 other people who knew exactly what it felt like to live through that terrible, terrible event. Every week, we'd all stand up and say our names, the names of our departed loved ones, the date they died, and how they chose to leave us. That was as far as I ever got. I listened to everyone talk and I cried for the two hours it lasted every week. The very last week I went, the facilitator actually asked me to talk about my feelings. I talked, but I never went back.

I also participated in fairly long-term group therapy a couple of times in my life. I think my unwillingness to share my heart or my thoughts with groups of people stem from those experiences. They were not positive.

I understand how important it is for people to reach out to others, to have a stable base of supporters who are living through the same difficulties and traumas that you are. Please know that I don't mean to disparage that need or anyone who finds hope and solace through support groups.

This much I know: We all get through it how ever we can. Whatever crises life sends your way, the important thing is to just get through it. No judgments.

Being Upbeat Doesn't Keep You Alive

2007-11-07T09:00:00.000-06:00

I'm not a joiner. I don't do support groups. Throughout my breast cancer treatment, my primary care provider and my psychiatrist constantly urged me to get into a support group. "It improves your chances of survival," they told me. I read books that said the same thing. It came to seem almost like a judgment, that if I was unwilling to do the required sitting and sharing, I was inviting death to make a house call. My doctors disapproved of my decision and they disapproved of me. It made me angry and it caused me to question my own intuitive understanding of what I needed to do to get through treatment.

I didn't care what anyone said. The thought of sitting around with a group of women, some of whom definitely would not survive the fight, and talking about having breast cancer made me just want to go ahead and die. I decided that, if that's what was required of me, I'd have to take my chances. No support groups.

If you asked the people who saw me every day, they would tell you that I always maintained a positive attitude throughout my treatment. They're right, but they're also wrong. Mostly I was focused on how much everything hurt. I was primarily aware of how big the pain was. It was as if I'd become a 600 pound lump of agony. I was open to distraction, though. As a matter of fact, I sought out distraction wherever I could find it and whenever I had the energy to use it. When people told jokes, I laughed. When they looked at me and started crying, I comforted them. Then I made a joke, so they could be distracted from my pain. I don't think they knew the diversion was less for them than for me.

I was not upbeat all of the time, not even most of the time. I'm not even sure what "maintaining a positive attitude" really means in that context. I was relatively confident that I wasn't getting ready to die any time soon. I was certain that I was going to be required to endure whatever the treatment regimen dictated. Is that the same as being upbeat? I'm not so sure.

Today, I read an article from WebMD that made me feel better about being asocial and stoic. It turns out that the commandments "Thou shalt be positive or die" and "Thou shalt participate in support groups or die" are wrong. Here's the proof:

Attitude Doesn't Affect Cancer Survival

Study Shows Positive Thinking by Patient Has No Impact on Surviving Cancer

By Salynn Boyles
WebMD Medical News

Reviewed by Louise Chang, MD

Oct. 22, 2007 -- Having a positive attitude may help cancer patients deal with their disease, but it doesn't directly affect survival, according to one of the largest and most rigorously designed investigations ever to examine the issue.

The study included more than 1,000 people treated for head and neck cancer; the emotional state of patients was found to have no influence on survival.

The findings add to the growing evidence showing no scientific basis for the popular notion that an upbeat attitude is critical for "beating" cancer, says University of Pennsylvania School of Medicine behavioral scientist James C. Coyne, PhD, who led the study team.

"I wish it were true that cancer survival was influenced by the patient's emotional state," he tells WebMD. "But given that it is not, I think we should stop blaming the patient."

'The Tyranny of Positive Thinking'

Jimmie Holland, MD, agrees. The Memorial Sloan-Kettering Cancer Center psychiatrist is a longtime critic of the "mind over cancer" proponents who tell patients they must stay positive to survive their disease.

In her book The Human Side of Cancer, Living with Hope, Coping with Uncertainty, Holland coined the term "the tyranny of positive thinking" to describe the belief.

"The idea that we can control illness and death with our minds appeals to our deepest yearnings, but it just isn't so," she tells WebMD. "It is so sad that cancer patients are made to believe that if they aren't doing well it is somehow their own fault because they aren't positive enough."

Holland does acknowledge the benefits of staying positive during cancer treatment, and she is an advocate of techniques like relaxation, meditation, support groups, and prayer to help patients cope with their disease.

But she says there is no credible evidence that positive thinking alone directly influences tumor growth.

"People really want to believe this, so even very good studies like this one probably won't change public thinking," she says. "But the scientific community is getting the message."

Attitude and Cancer Survival

The newly published study included 1,093 patients with head and neck cancer who completed quality-of-life questionnaires during their treatment.

Coyne says the study group was limited to patients with a single cancer who had similar treatments to better assess the impact of state of mind on survival.

A total of 646 patients died during the study follow-up. Even after accounting for other variables that could affect survival, a patient's emotional state was found to have no bearing on whether or not he or she lived or died.

The study appears in the Dec. 1 issue of the American Cancer Society (ACS) journal Cancer.

In a separate review of other studies published earlier this year, Coyne, University of Pennsylvania colleague Steven Palmer, PhD, and ACS researcher Michael Stefanek, PhD, found insufficient evidence that participation in psychotherapy or cancer support groups plays a role in survival.

In that report, the researchers concluded that the hope that emotional state is a driving factor in cancer outcomes "appears to have been misplaced."

"If cancer patients want psychotherapy or to be in a support group, they should be given the opportunity to do so," they wrote in the journal Psychological Bulletin. "There can be lots of emotional and social benefits. But [patients] should not seek such experiences solely on the expectation that they are extending their lives."

Making Chemo brain Treatment Decisions with a Chemo brain

2007-11-06T10:32:00.000-06:00

I woke at 3:30 this morning and never went back to sleep. Little Andy (my big baby Husky) needed to take an emergency bathroom break, so I got up to let him out of his crate and into the back yard. That was the end of sleep for me.

I read yesterday that M.D. Anderson now has some services to address chemo brain. It all sounds tiring and complex. There will be neurological tests. Heaven only knows what that would entail. Since chemotherapy, I'm noticeably more stupid. My therapist, my husband and my mom can't see it, but I know how much more slowly I think. I notice how frequently I can't think of the right word, can't follow logical progressions in my database development, have difficulty concentrating.

My psychiatrist recently suggested (and I just that same day read) that chemo brain may be trauma-induced. The diagnosis, the chemo, the radiation, the uncertainty of a long-term future are, without a doubt, traumatically stressful. After it's over, we're left to process all of it emotionally and try to cobble together a new life.

I'm mulling over my options. I don't know if I'm willing, at this point, to endure what will be required of me to figure out how (or if) we can fix it. Maybe I simply need to wait a while, continue to work through the past two years and hope things improve.

I'll be in Houston on December 6 and, if I were going to pursue treatment of some kind, it would be great if I could work that in on the same trip. On the other hand, I don't know how likely it would be that I could combine the two. They're busy, you know.

On five hours of sleep, it's hard to come up with the right answer. I think I'm going to allow my intuitive brain to work on this without my intellect getting involved. The right brain is always right. I'm willing to wait while it decides for me.

Just Because It's Over, Don't Forget

2007-10-31T12:32:00.001-05:00

This is officially the end of Breast Cancer Awareness Month. Just because it's over, don't forget. Specifically, don't forget to take care of yourself. Don't forget self exams. Don't forget mammograms. Don't forget to arm yourself with reliable information.

Today, an article from a British website, one of the few I've found that discusses alternative treatments. Not everyone wishes to undergo chemotherapy and radiation. Visit their website, CancerActive, for more information on breast and other types of cancer.

This article has been compiled by Chris Woollams from worldwide research and expert sources*

Who gets breast cancer?

But doesn’t breast cancer run in families?

Putting together a treatment plan

The possible contributory factors to breast cancer

Other useful tips and therapies

Overall

Confused by it all??

The CANCERactive Difference: Intelligent Information. Independent Voice. On this web site you will find more information about more treatment options (Complementary and Alternative, not just Orthodox), and on more 'possible contributory factors' to the development and maintenance of your cancer, than on any other UK cancer web site. Some experts believe that approaching your cancer in this 'total' way can increase an individual's chances of survival by as much as 60 per cent.
The very latest research evidence from all over the world in our news section Cancer Watch supports all this.
We can do this because we are not hide-bound by vested interests, and so we can always put people first. We are not influenced by companies who seek to make financial gains from patients, we have no trustees working for, or sponsored directly or indirectly by such companies, our directors take no remuneration at all. This is our true independence, from which you benefit directly.
But this comes at a price – we rely on you, and people like you to support our work. 47,703 people visited our site in March 2007, viewing 11 pages on average. Every month we add 20 new pages to this site. If you feel an independent voice is essential in cancer, please, please help by making a donation. Every little helps.

Who gets breast cancer?

Despite the high profile cases of Pop stars in their twenties and thirties contracting the disease, the plain fact is that usually 80 per cent of all cancers come in the over 60 age group. Sadly, with ageing comes increased deficiency in cellular replication systems, more chances of genetic mistakes, reduced hormone levels and a build up of toxins.

Breast cancer, however, has seen a gradual lowering of the age of diagnosis with approximately 40 per cent of diagnoses in women below the age of 65, and 60 per cent above that age. So there is more to this cancer than mere ageing.

The breasts are made up of ducts connecting the nipples to glandular tissue containing the lobes. Some of the breast tissue extends into the armpit where lymph nodes are found. All this is surrounded by fat and here in lies some clues to cause. Fat is a wonderful solvent and will dissolve and hold all those chemicals, toxins and hormones (your own and ingested ones) that you really should be excreting. Being overweight will not help as that will increase the percentage of fat, nor will a lack of exercise as this helps stimulate lymph flow and excretion, whilst helping provide more cancer hating oxygen to the tissues. Certain deficiencies in minerals have been found in women with breast cancer, as have vitamin deficiencies.

Although still small numbers, increasingly men are being diagnosed with breast cancer.

But doesn’t breast cancer run in families?

Another concern you often hear is that Breast Cancer ‘runs in families’. Whilst it is true that some people have a genetic ‘weakness’ – genes that weaken the immune system’s ability to spot a cancer cell, or genes that prevent the cell’s ability to repair its own DNA (you may have heard of BRCA1 and BRCA2) - these types of genes are present in less than 7 per cent of women. More genes linked to a higher incidence of breast cancer are still being discovered – for example PALB-2 - but these also seem more to do with the repair and immune systems than the breast tissue itself. Even if you have these genes estimates suggest that the risk of getting breast cancer is less than 70 per cent, although – more clues here – this figure has risen from about 40 per cent 50 years ago, quite probably along with increased levels of toxins around us, poorer diets and less healthy lifestyles.

By and large prevention (See Breasts, Breasts, Breasts ) is still largely in your own hands with breast cancer and if you have had breast cancer and been given the all clear there is so very much you can do to prevent a recurrence.

Putting together a treatment plan

Fret not – there is so much you can do – mostly to help yourself. When my daughter developed her brain tumour and was given just 6 months to live we found out so many things that could help – but it took at least 6 months hard work and a pair of science degrees. The aim of this site is to short circuit all this for you and to empower you – to pass on all our knowledge, our research findings, the expert studies and the possible causes so that others can benefit immediately. This is also why, when the doctors asked me, I gladly wrote ‘Everything you need to know to help you beat cancer’. The book has been a best seller in the UK for three years – and you cannot even buy it in a shop – only direct from the charity!!
Now, let’s first try to understand what is going on, and what factors might be maintaing this cancer, helping it progress in your body.

The possible contributory factors to breast cancer

Various epidemiology studies have shown that smoking increases risk, as does increasing levels of regular alcohol consumption.

Dietary factors are clearly important. Various global studies show that women with breast cancer have lowered levels of vitamin C, vitamin D, vitamin B-12 and long-chain omega-3. Professor Hollick of Harvard has stated that 25 per cent fewer women would die of breast cancer if they took adequate daily levels of vitamin D. Research shows that tocotrienol vitamin E, fish oils and garlic appear to be protective. Studies have shown that women with a history of breast cancer have lowered levels of the mammalian lignans enterodiol and enterolactone, which are made from plant lignans in the intestine. These have been shown to be made from plant lignans (e.g. in Flax seed) by the beneficial bacteria in your intestine; both reduce your oestrogen levels.

Women who exercise regularly (the best is a little every day) have less breast cancer – and those with it have 50 per cent less mortality if they take daily exercise.

However by far the biggest risk factor is a heightened level of the hormone oestrogen. ‘Oestroge-driven’ cancer may well account for over 80 per cent of all breast cancers. Cancer Research UK has stated that Breast Cancer rates are rising at 2 per cent per year, while oestrogen levels are rising in women by 7 per cent.

There are a number of possible reasons for this. For example:

Women are having less children and breast-feeding them for shorter periods. Both factors (more children and breast feeding for 9 months or more) decrease risk. This may well be due to decreases in the lifetime levels of natural progesterone, a known oestrogen balancer

Women are starting their periods earlier and ending them later. Modern woman has almost twice the number of periods of her 16th century predecessors.
Women in the Western World consume large amounts of Dairy. Several research studies from the Swedish experts at the Karolinska Institute suggest that the critical factor is the cow’s hormone Insulin Like Growth Factor (IGF-1), which seems to stimulate hormones such as oestrogen and other localised cell factors to make your cells grow rapidly. The more dairy you consume, the greater your breast cancer risk according to Karolinska. Another study, this time by researchers in Denmark, amongst 117,000 girls showed that those who put on a big growth spurt between ages 8 and 14 eventually had a higher risk. Again a finger was pointed at dairy.
Women now have more stressful occupations; many of these lead to sleep irregularities and deprivation (e.g. Nurses and Air Hostesses). Research shows that this results in lowered levels of the hormone melatonin, which seems to counter excess oestrogen under normal conditions.
The finding that women who had taken more than 25 doses of antibiotics in their lives (Journal of the American Med Assn 2004, Feb 18; 291) started people questioning antibiotics. However the truth is far more likely to be the destruction of Beneficial Bacteria in the intestine which results in decreases in vitamin K, vitamin B-12 and other B vitamins, reduced effectiveness of the immune system plus likely infestations of yeasts (Symptoms like cystitis and thrush may indicate this). Over 100 clinical trials now suggest we ignore the contribution of beneficial bacteria at our peril. You simply must have adequate daily levels of a variety of strains of beneficial bacteria (Probiotics). See below.

We ignore the contribution of beneficial bacteria at our peril

The US State of Evidence report 2006 summarizes the findings of more than 350 experimental, epidemiology and ecological studies and recommends new directions for the future in disease management. In particular it looks at the growing and vast amount of research on the effects of chemicals and EMF’s on the risks of developing the disease:

There is increasing evidence that various Electromagnetic Forces can also reduce these levels of melatonin whilst stimulating levels of IGF-1 and other hormones. This is not a modern myth. Scientists are growing increasingly worried by the electronic smog that surrounds us all – from masts, to mobile phones, to WiFi – even electric blankets!
The use of synthetic oestrogens: CRUK has provided data on the increased risks of breast cancer when women take the contraceptive pill – especially if they take it after the age of 30. HRT is also a risk factor. Indeed new research from the USA has shown that breast cancer levels have declined by 7 per cent in 2005 as a direct result of women giving up HRT.
Xeno-oestrogens: Increasingly, chemicals that mimic the action of oestrogen in the body are believed to be a significant and modern link to risk. Pesticides like DDT and Lindane, toiletry and personal care chemicals like DEHP and toluene, BPA from white lined cans and even kiddies toys, and Phthalates from plastic bottles and packaging are all thought capable of mimicking the action of oestrogen in the body by experts. Worse Dr Ana Soto of Tufts believes them to be cumulative.

All in all, there may be many factors that contributed to your breast cancer. On this web site we also cover possible links to the thyroid hormone, Thyroxine, plus an article from Eileen O’Connor who is so convinced EMF’s from a local mast gave her breast cancer that she is now a leading campaigner against such EMF’s.

Now, the important point is that we are not listing the possible contributory factors so that you dwell on things that have happened in the past. We want you to understand what factors might still be present in your life and might be contributing to the maintenance of your cancer. Then you can formulate an action plan. You might try to cut EMF’s out of your life, or you can act to lower the oestrogen (natural and synthetic) in your life – oestrogen that might be fuelling your cancer right now. (We have a book ‘Oestrogen – the killer in our midst’ that tells you the simple steps you can take to cut your natural and synthetic oestrogen levels today). After all that is exactly what your oncologist will try to do with Aromatase Inhibitor drugs like Arimidex. Then there are minerals you can take, like selenium, or complex compounds like chlorella that can help you eliminate heavy metals, or increase levels of Vitamin B-12. And articles on why breast cancer patients should take vitamin D and other natural supplements. You can find out comprehensive information on these topics and more elsewhere on this site.

Diagnosis

About 40,000 - 44,000 cases of Breast cancer will be diagnosed in the UK in the next 12 months. However, if you are pre-menopausal and your diagnosis comes from a mammogram you should read our article on screening mammograms immediately, and understand the high levels of false positive readings occurring. Do not under any circumstances have any treatments until cancer has definitely been confirmed through a means other than screening. (You could use Thermal Imaging, even Iridology as a back up). A biopsy is the most reliable method.

You should check your own breasts regularly. You are looking for lumps, or thickenings especially behind the nipple, sudden inversion of a nipple, dimpling on the skin surface, a rash, or a swelling under the armpit.

Most lumps are not cancer and are benign. Most often they are cysts, which are sacs of liquid randomly appearing in the breast tissue, or they can be benign ‘fibroadenomas’. Either way they are easily treated and no cause for concern.

If a cancer is suspected, the normal procedure is to have a biopsy. This may take tissue from under your armpit as well as from your breast. Only after tissue has been taken can anyone correctly tell you the spread (the Stage) and aggressivity (the Grade) of the cancer. After analyzing the biopsy tissue, the experts should be able to tell you clearly

A Whether the tumour is oestrogen and/or progesterone sensitive
B Whether you are HER-2 positive

Other

There have been articles in the Lancet about biopsies possibly spreading the disease, but it is a small risk.

There have been research studies covered in icon on abortion and whether it increases risk of breast cancer. Absolutely no evidence of increased risk has been reported by expert studies.

US research on Swedish women with silicone breast implants (Yes, seriously!) showed that while they had no higher risk of breast cancer, cases of lung cancer were higher than expected (Journal of the Nat. Cancer Inst. 2006; 98; 557).

DCIS and LCIS

About 50 per cent of the anomalies shown up by mammograms are Ductal (DCIS) irregularities. There seems total disagreement around the world on this. The team at Christie Manchester sent us a press release stating that they were going to test various drugs on women with DCIS to try to halt this very aggressive form of cancer. Meanwhile US experts were claiming that DCIS is neither cancer nor pre-cancer but calciferous particles blocking the ducts. The lead Professor at the 2004 US Breast Cancer Symposium told everybody that only 20 per cent of cases go on to be full breast cancer. If these are calcium deposits, it might explain some of the issues with dairy and the benefits of fish oils and vitamin D.

Treatment

Surgery: If you are pre-menopausal, you must try to have your operation in the second part of your cycle not the first, for then progesterone, not oestrogen dominates. Two studies from Guys have shown significant long-term survival benefits.

You may have a lumpectomy, or a full breast mastectomy. (You may be advised to have chemotherapy prior to surgery to reduce the size of the tumour and increase your chances of a lumpectomy rather than full-blown breast removal). If you have lymph node removal you should find out about lymphatic drainage, which may help you in the longer term.

Reconstructive surgery may then be proposed and effected at the same time, although US research suggests waiting.

Radiotherapy is most commonly used after surgery to kill off any localised and remaining cancer cells. It may also be used on the lymph glands under the armpit if they were infected. We have a good article on how to maximise the effectiveness of your radiotherapy. (Look under ‘Treatments’ – radiotherapy.) You should continue to take all anti-oxidants and supplements during this time. We also have reports from MD Anderson and UCLA that they increase the effectiveness of Radiotherapy.

Although dosage is much more targeted, you should be clear that radiotherapy to the chest region could cause problems with the lung and heart tissue. In the past these were quite common and could be pronounced with up to 20 per cent of lung tissue damaged. Modern techniques have reduced this.

Chemotherapy: The actual programme of chemotherapy depends totally upon the individual (age, health etc) and the state of the cancer. Several drugs may be suggested at the very outset, before a very specific plan is drawn up. You can find a full review of the most common drugs on this site (Click here) and a clear analysis of what diet you should be on to maximise its effectiveness.

Be clear. The purpose of the drugs is to try to kill any remaining cancer cells and especially to try to PREVENT a recurrence in the other breast or spread to secondary organs like the liver (Vitamin K has been shown in Japanese and US research to reduce the dangers to the liver).

The two standard therapies that are most commonly talked about are:

1 Tamoxifen (for five years) followed by three years of an Aromatase Inhibitor (e.g. Arimidex).

CRUK has opined that by the end of the 8 years your cancer will have gone away. (We think it may, but only if you have altered the factors that gave it to you in the first place). Tamoxifen aims to sit on, and therefore block, cellular receptor sites that in breast cancers are attacked by oestradiol. ‘Blocked sites means no attack’ is the theory.

Since over 20,000 women in the UK are currently taking Tamoxifen, we thought it wise to say a few words here about this drug:

Tamoxifen: When told the possible side effects less than 1 in 5 US women want to take the drug

When told the side effects less than 20% of women want to take Tamoxifen

(Cancer 2005: 103; 1996-2005). For example: Recent research by CRUK on cancer of the womb, which has risen by 30 per cent in a decade and is now twice as common as cervical cancer, implicates a number of factors like being overweight, not having had children and Tamoxifen usage. Dr Bushnell of Dukes, USA reviewed 9 studies on Tamoxifen and concluded that it more than doubles a woman’s risk of ischemic stroke.

Research results carried in icon (Vol 3 Issue 4) from the University of North Carolina showed that it had a minor effect (6-8 per cent) in breast cancer prevention in women with no cancer but at higher risk; however the conclusion was that side-effect risks outweighed the benefits..

US research has shown clearly that the use of natural vitamin E in its total 8 forms reduces the need for Tamoxifen doseage by 25 per cent – as it increases its effectiveness.

It is however the first line drug, the Gold Standard, in oestrogen-driven Breast cancer and blocks sites on cells that oestradiol would normally bind to, and then cause havoc inside the cell. Recent US research shows that its effects continue for 5 years after the last dose. Normally prescribed for 5 years, followed by an Aromatase Inhibitor for three years, many of the makers of these latter drugs are questioning why the patient is not moved more quickly from Tamoxifen to their drug. But then they would, wouldn’t they? There has already been a study (American Soc. Clin. Onc) which suggests better long-term survival results if women come off Tamoxifen and go onto the Aromatase Inhibitor Exemestane earlier.

2. Herceptin. Let’s be clear – about 20 per cent of women are HER-2 positive and this drug will work well for about half of them. Yes, and it does cost 20,000 pounds per year. A recent trial (Lancet 2006) confirms that Herceptin offers benefit with early stage breast cancer patients too.

Ask whether the combination of drugs proposed for your chemotherapy have been through clinical trials

The side effects of any chemotherapy are very individual, not insignificant and depend upon your condition and the drug. You should also ask whether the combination you are on has actually been through clinical trials. Sometimes only the individual drugs have been.

Treatment for anaemia: Managing and counteracting anaemia can reduce death from anaemia by 50 per cent. Research published by the Cochrane Collaboration showed that epoetins (alfa and beta epoetin) show significant survival benefits. Particularly striking were the results for patients with solid tumours (Breast, lung, colon) where risk of death decreased by 51 per cent). In a second study (European Soc. For Medical Oncology- 31st Oct 2005) epotin beta was shown to reduce risk of tumour progression in patients with anaemia.

Treatment for fatigue: icon has run several pieces on fatigue. A qualified naturopath will be able to suggest dietary changes to boost energy levels. Qualified homeopaths may be able to suggest ways to counter fatigue. Energy therapists (e.g. acupuncture, cranial osteopaths, Reiki Masters) may well be able to help. Italian research showed a lack of acetyl-carnitine which supplementation could correct. UCLA scientist report that a series of genetic markers become blocked either due to the cancer or due to the chemotherapy treatment. The California team note promising results with Etanercept. Apparently 30 per cent of women who have had chemo for breast cancer have long-term fatigue, even after the cancer has ‘gone’. This may well be true for other cancers.

Other useful tips and therapies.

Professor Howell, of Christie Manchester and one of our Patrons, at our Cancer Prevention Conference told the audience all about the new drugs designed to prevent the return of your breast cancer. Well, good diet, exercise, mental therapies and much more are available for you to start as soon as you wish – all with the very same aim: Preventing this cancer returning. And they can be extremely successful.

Professor Ben Pfeifer has clinical trials on his Diet Therapy. Originally developed from Prostate cancer it has proved so successful they are extending it to Breast cancer treatment. You may be interested in the Gerson Therapy, or the clinical trials of Dr Gonzalez in New York – both are diet based. You can read about Jane Plant who beat her breast cancer by developing her own diet therapy and avoiding dairy completely.

Living Proofs - where women who beat breast cancer tell their stories

You can also go to our Living Proofs – where women who beat their breast cancer tell their own personal and very individual stories – you might find some useful tips and insights. You might also want to know about Phytoestrogens and their relationship to oestrogen. Try reading Pillar II of our 4 Pillars of cancer (you might find it worth reading them all).

The most aggressive oestrogen is oestradiol, which can increase sodium levels and reduce potassium and oxygen levels inside the cell, causing havoc. Oestrone is its less aggressive sister (about 40 times less potent) and plant oestrogens – called phytoestrogens – are even weaker still. Many people argue that the lowered rates of breast cancers in Asia are due to large levels of circulating plant oestrogens – well which one would you rather have sitting on your breast cancer receptor site? The best sources of plant oestrogens come from ‘greens’ and pulses (like chickpeas, kidney beans and soy) and red clover. The British Journal of Cancer (2006) reports on the benefits of one such phytoestrogen, genistein. Apparently it can increase the repair proteins in a cell – even those in short supply due to the presence of BRCA 1 and BRCA 2. Some people prefer to go this route than take Tamoxifen.

Other foods can make a difference. For example, polyphenols: Like those in Green tea and olive oil, and Indole 3 carbinol (broccoli, ‘greens’) have been shown in research to turn nasty oestradiol into its safer sister oestrone. The same study above on Genistein, showed that Indole 3 Carbinol can also increase repair protein levels in cells. Sulforaphane, also in broccoli and brussel sprouts, can inhibit the development of breast cancer cells. US Dr Keith Singletary and his team claim it works as well as the chemotherapy drugs, by causing the release of certain cancer killing enzymes. Our book, ‘The Tree of Life – the Anti-cancer Diet’, will tell you much more, and even give you a shopping list and recipes.

Recently there has been an enormous flury of research on the role of beneficial bacteria in our bodies. You really shouild read our article on the subject, and the links to cancer. Over 4000 research studies and 100 clinical trials have shown that Beneficial Bacteria in the gut:

stimulate and strengthen the immune system
help produce certain cancer fighting vitamins like B-12, folic acid and vitamin K
help produce short chain fatty acids which reduce harmful fat production (like chlorestrol)
can actually chelate to (bind to) heavy metals and help excrete them
can actually neutralise and eliminate harmful chemicals like oestrogen and nitrosamines

There are over 800 strains of bacteria in the gut – about 400 have been identified and a dozen or so seem, according to the research so far, to have the greatest impact on our health. 60 or more years ago we would consume daily supplies of a number of strains – but we no longer live on farms nor drink raw milk and, , instead, we chlorinate our water, fill our chickens with antibiotics, irradiate our food and pasteurise everyuthing. Worse we take drugs, antibiotics and anaesthetics which deplete our stores further.

There is another school of thought that explains that these Beneficial Bacteria at night feed off the yeasts, microbes and non-beneficial bacteria we accidentally consumed during the day. Yeast infection is now endemic. It is estimated that 70 per cent of the population has excess yeasts – signs in men include bloating after meals, yellow toe nails and athletes foot;
in women it’s thrush, cystitis, bad breath and/or bloating and problems trying to lose weight! Try reading Can Candida cause cancer? on this web site.

Consider this quote: “Cancer patients undergoing chemotherapy did not ultimately succumb to cancer, but to an infestation of Candida albicans”. That comes from the 1993 Spring edition of the prestigious US medical journal Contemporary Oncology. Topping up with probiotics (strains of beneficial bacteria shown in clinical trials to deliver a benefit) and following a prebiotic based diet – lots of whole foods and whole grains – with no sugar, dairy or alcohol and certain yeast killers will help defeat the Candida albicans. It’s all in the article. The recent finding that women who take more than 25 lots of antibiotics in their lifetimes have twice the risk of breast cancer, is just one more factor pointing the finger at yeast infection and a lack of enough beneficial bacteria in the body.

Several US studies (Seattle, Integrative Cancer Therapies, Philadelphia Uni.) have all shown the importance of exercise and complementary therapies. Moderate daily exercise can reduce mortality

US studies show that exercise and complementary therapies are important

rates by 50 per cent according to this research. If you want to know more about complementary therapies start with our ‘kiddies guide’ prepared for us by the London Breast Cancer Haven.

According to the American Medical Association, women who take more than 7 aspirin tablets a week reduce their breast cancer risk by 29 per cent. Many ‘solid’ cancers involve prior inflammation. Aloe Vera would also provide salicylin plus other anti-inflammatories. Since the work by Sir John Vane on localized inflammatory hormones called eicosanoids, we now know garlic, ginger and long-chain omega 3 (fish oils) can reduce inflammation too.

If you are not sure where to start try reading our summary ‘Cancer – your first 15 steps’. We even have a helpful book by the same name. Both allow you to start planning your ‘integrated’ or ‘holistic’ therapy programme.

Overall

40,000 women get breast cancer every year in the UK and it’s rising. Eurocare 3 shows that England has a 73 per cent 5-year survival rate but the figure is lower in other areas of Britain. These figures are all below the European Average, and below France and Germany at around 81 per cent. Sweden has the highest 5-year survival rates at 83.3 per cent.

Research by the US magazine Integrative Cancer Therapies has shown the benefit of building an integrated programme of complementary therapies around your orthodox regime. Some experts state that it increases survival by as much as 60 per cent.

On this site you can find out about alternative options (and all the research) like Ultrasound (HIFU) instead of surgery, Photo Dynamic Therapy, the truth about vitamin B-17 and the Oasis of Hope, and even John of God.

Or go to our Home page to find a list of the ten hottest topics we have covered recently – we promise one or two will definitely be relevant to you.

On this web site you will find more information about more treatment options (Complementary and Alternative, not just Orthodox), and on more 'possible contributory factors' to the development and maintenance of your cancer, than on any other UK cancer web site. Some experts believe that approaching your cancer in this 'total' way can increase an individual's chances of survival by as much as 60 per cent.

This is all supported by the very latest research evidence from all over the world in our news section Cancer Watch.
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IMPORTANT INFORMATION

* Cancer (and its related illnesses) are very serious and very individual diseases. Readers must always consult directly with experts and specialists in the appropriate medical field before taking, or refraining from taking, any specific action.
This web site is intended to provide research-based information on cancer and its possible causes and therapies, so that you can make more informed decisions in consultation with those experts. Although our information comes from expert sources, and is most usually provided by Professors, scientists and Doctors, our easy-to-understand, jargon-free approach necessitates that journalists, not doctors, write the copy. For this reason, whilst the authors, management and staff of CANCERactive, icon, and Health Issues have made every effort to ensure its accuracy, we assume no responsibility for any error, any omission or any consequences of an error or omission. Readers must consult directly with their personal specialists and advisors, and we cannot be held responsible for any action, or inaction, taken by readers as a result of information contained on this web site, or in any of our publications. Any action taken or refrained from by a reader is taken entirely at the reader’s own instigation and, thus, own risk.

Plant Foods May Cut Breast Cancer Risk

2007-10-30T13:35:00.000-05:00

More information from breastcancer.org

Plant foods may cut breast cancer risk

What breastcancer.org says about this article

A healthy diet is an excellent way to take care of yourself, whether you're being treated for breast cancer or trying to lower your risk. A diet rich in fruits and vegetables is recommended by cancer experts as well as registered dietitians. Besides fruits and vegetables, a diet rich in plant foods includes whole grain breads and cereals, nuts, seeds, rice, pasta, and beans. Nutrition experts say that variety is key, because different fruits and vegetables have different nutrients and compounds. Lignans are a compound found in plant foods.
The large study reviewed here (almost 60,000 women were in the study) found that women who ate foods high in lignans had a 17 percent lower risk of breast cancer compared to women who didn't eat foods with a lot of lignans.
It's not clear how lignans work to reduce risk. We do know that lignans may have a weak estrogen effect. When a weak estrogen-like substance takes the place of your body's natural strong estrogen in a breast cell's estrogen receptor, then the weak substance can act as a relative anti-estrogen. By acting in this way, lignans might help work against breast cancer that depends on estrogen for its growth.
Visit the breastcancer.org Nutrition Section for more information on how to create a healthy diet and the role of diet in breast cancer treatment and prevention.

Last Updated: 2007-03-21 14:40:18 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Postmenopausal women who eat healthy amounts of plant foods rich in estrogen-like compounds called lignans may reduce their risk of developing breast cancer, according to a new study.

"Following the general dietary guidelines for a healthy and prudent diet, that is, consuming large amounts and varieties of fruits, vegetables and whole-grain cereal products daily (all foods rich in lignans) may also help prevent breast cancer in postmenopausal women," Dr. Francoise Clavel-Chapelon told Reuters Health.

Clavel-Chapelon, from the National Institute of Health and Medical Research, Villejuif, France, and associates evaluated the relationship between the amount of four types of plant ligands in the diet and breast cancer risk in 58,049 postmenopausal French women.

Over an average follow-up period of 7.7 years, 1469 women were diagnosed with breast cancer, according to the study, published in the Journal of the National Cancer Institute.

Analysis of the data showed that women with the highest total amount of lignans in the diet had a 17-percent lower risk of developing breast cancer compared with women having the lowest dietary lignan levels.

"The reduction in risk was confined to breast cancers positive for hormone receptors, the major type, of which incidence is increasing," Clavel-Chapelon noted.

A diet containing lots of plant foods is hypothesized to offer a breast cancer prevention strategy, the researcher added. This hypothesis was recently confirmed by a study that found a reduced risk of invasive breast cancer among postmenopausal women with high lignan levels in their diet, Clavel-Chapelon said.

SOURCE: Journal of the National Cancer Institute, March 21, 2007.

Patients and Caregivers Making Treatment Decisions

2007-10-24T10:00:00.001-05:00

Please go to National Coalition for Cancer Survivorship for much more information on breast and other types of cancer.

Making Difficult Treatment Decisions

Treatment decisions by you, the caregiver, may be necessary in the event the person with cancer is not able to make them for him- or herself. The patient and caregivers should discuss this situation, and take steps to assure that the person with cancer receives treatment on his or her own terms. One way that is both legal and effective is for the patient to complete an advance directive to express his or her wishes. This approach makes one's wishes clear — and this can be of great importance to caregivers. There are two components to an advance directive, and a person should have both in place when facing any serious illness.

The living will is a message from the person whose will it is to health care providers in regard to the kind of care that is and is not wanted if the patient can no longer make his or her decisions personally. The topics usually covered in a living will include directives about artificial feeding, use of a respirator if a person cannot breathe on his or her own, and whether or not the patient wishes to have cardiopulmonary resuscitation (CPR) if his or her heart stops. No one must respond to every question in a standardized living will format; if a question is not answered, then the health care provider will make those decisions. Also one can add more information detailing what is and is not wanted, directly on the forms. Many living will standard forms are vague, and so it is up to the person involved to add the details that make it appropriate for his or her care, as is wanted.

A more "user-friendly" version of a living will can be found in a document called Five Wishes, created by Aging with Dignity and legal in most states. This document is clearly written and allows a person to make wishes known in understandable language. To obtain a copy, go to www.agingwithdignity.org and follow the instructions there.

The durable power of attorney for health care designates another person to act as the named individual’s representative in making medical decisions for a person if that person cannot make them. It is simpler than a living will, in that it usually just states that if the named person is unable to make his or her own health care decisions, another person, named in the document, is authorized to do so. This document does not have a list of the kinds of care an individual does and does not want. The person chosen to represent the named individual you choose to have your health care power of attorney should be someone who is trusted and who will honor the wishes of the person giving the power of attorney.

For more detailed information on making wishes known, see Thinking Through Your Wishes on this site.

Other sources of help and information include:

• Family and Medical Leave Act (FMLA) — Passed in 1993, FMLA requires businesses and organizations with 50 or more employees to grant leave without pay for a variety of reasons including caregiving of family members, including parents. If you have been employed at least 12 months by the employer or at least 1,250 hours during the previous 12 months, you are entitled to a total of 12 workweeks of unpaid leave during any one year to care for a family member (parent, spouse, child only), as well as for other reasons, such as the birth of a child, your own health problems or adoption. FMLA may also be applicable to your loved one, once regular sick leave has been exhausted during the course of cancer treatment. Note that the 12 weeks of leave does not have to be taken all at once, but can be used as needed. For more information, see your employer's human resources office and the Department of Labor's website. Also see the extensive and helpful information on the website of the National Partnership for Women and Families.

• For detailed information about cancer survivors' rights as employees, see Your Employment Rights on this site.

• National Family Caregiver Support Program — Enacted in 2001 as part of the Older Americans Act, this program calls for states, working with area agencies on aging, to have basic services such as information services, counseling, and respite care available for family caregivers caring for the elderly and older caregivers caring for young children. Special assistance is provided for people with greatest economic and social needs, and those caring for individuals with mental disabilities. In some instances, these services may be available to caregivers of people with cancer, if other criteria are met. To find out if you may qualify, contact your local Administration on Aging office; look for numbers in the "government" section of the phone book, or ask the hospital social worker for help in contacting these offices.

• The Older Americans Act - helps frail and disabled people 60 or older to remain independent. Covers home care aides, escorts, meal delivery, shopping, etc. Contact your local area agency on aging for information and referrals — look under county or city government headings. Or, call the hotline run by the U. S. Administration on Aging at 1-800-677-1116. This helpful referral service is also available online at www.eldercare.gov.

• Medicaid: Medicaid, a joint state-federal program for low-income people, is, like Medicare, coordinated by the Centers for Medicare and Medicaid (CMS). Medicaid coverage varies from state to state, but usually includes some amount of coverage for nursing, aides, equipment and supplies. Get information from your community's welfare office, state department of health, and on the Internet at www.cms.hss.gov/Medicaid.

Male Breast Cancer

2007-10-23T12:26:00.001-05:00

More important information from Breast Cancer.org

"I knew I had a problem for a couple of years—something wasn't quite right—a disfiguration. I had a pre-employment physical and the doctor said, 'You ought to go see your personal physician.' What happened is that the breast cancer had metastasized to my hip, so I had to have a hip replacement. They found out that the cause of that was breast cancer. That's why I say, 'Don't put off what seems to be minor." If you have any suspicion that something is abnormal, don't hesitate—go do something about it. — Larry, living with metastatic male breast cancer

Male Breast Cancer

Breast cancer in men is a rare disease. Less than 1% of all breast cancers occur in men. In 2005, when 211,400 women were diagnosed with breast cancer in the United States, 1,690 men were diagnosed with the disease.

You may be thinking: Men don't have breasts, so how can they get breast cancer? The truth is that boys and girls, men and women all have breast tissue. The various hormones in girls' and women's bodies stimulate the breast tissue to grow into full breasts. Boys' and men's bodies normally don't make much of the breast-stimulating hormones. As a result, their breast tissue usually stays flat and small. Still, you may have seen boys and men with medium-sized or big breasts. Usually these breasts are just mounds of fat. But sometimes men can develop real breast gland tissue because they take certain medicines or have abnormal hormone levels.

Because breast cancer in men is rare, few cases are available to study. Most studies of men with breast cancer are very small. But when a number of these small studies are grouped together, we can learn more from them.

The Risk Factors for Male Breast Cancer

It's important to understand the risk factors for male breast cancer—particularly because men are not routinely screened for the disease and don't think about the possibility that they'll get it. As a result, breast cancer tends to be more advanced in men than in women when it is first detected.

A number of factors can increase a man's risk of getting breast cancer:

Growing older: This is the biggest factor. Just as is the case for women, risk increases as age increases. The median age of men diagnosed with breast cancer is about 67. This means that half the men who are diagnosed are over 67, and half are under.
High estrogen levels: Breast cell growth—both normal and abnormal—is stimulated by the presence of estrogen. Men can have high estrogen levels as a result of:
- Taking hormonal medicines.
- Being overweight, which increases the production of estrogen.
- Having been exposed to estrogens in the environment (such as estrogen and other hormones fed to fatten up beef cattle, or the breakdown products of the pesticide DDT, which can mimic the effects of estrogen in the body).
- Being heavy users of alcohol, which can limit the liver's ability to regulate blood estrogen levels.
- Having liver disease, which usually leads to lower levels of androgens (male hormones) and higher levels of estrogen (female hormones). This increases the risk of developing gynecomastia (breast tissue growth that is non-cancerous) as well as breast cancer.
Klinefelter syndrome: Men with Klinefelter syndrome have lower levels of androgens (male hormones) and higher levels of estrogen (female hormones). Therefore, they have a higher risk of developing gynecomastia (breast tissue growth that is non-cancerous) and breast cancer. Klinefelter syndrome is a condition present at birth that affects about 1 in 1,000 men. Normally men have a single X and single Y chromosome. Men with Klinefelter syndrome have more than one X chromosome (sometimes as many as four). Symptoms of Klinefelter syndrome include having longer legs, a higher voice, and a thinner beard than average men; having smaller than normal testicles; and being infertile (unable to produce sperm).
A strong family history of breast cancer or genetic alterations: Family history can increase the risk of breast cancer in men—particularly if other men in the family have had breast cancer. The risk is also higher if there is a proven breast cancer gene abnormality in the family. Men who inherit abnormal BRCA1 or BRCA2 genes (BR stands for BReast, and CA stands for CAncer) have an increased risk for male breast cancer. This risk is approximately 6% over a man's lifetime. That's about 80 times greater than the lifetime risk of men without BRCA1 or BRCA2 abnormalities. Still, the majority of male breast cancers happen in men who have no family history of breast cancer and no inherited gene abnormality.
Radiation exposure: Having radiation therapy to the chest before age 30, and particularly during adolescence, may increase the risk of developing breast cancer. This has been seen in young people receiving radiation to treat Hodgkin's disease. (This does NOT include radiation therapy to treat breast cancer.)
Symptoms of Male Breast Cancer

One study found that male breast cancer is on the rise, with a 25% increase over the 25 years from 1973 to 1988. But it's still rare. It's unclear whether the reported rise means the disease is slowly becoming more common, or whether men better understand the symptoms and report their symptoms, leading to diagnoses that might have been missed in the past.

If you notice any persistent changes to your breasts, you should contact your doctor. Here are some signs to watch for:
a lump felt in the breast
nipple pain
an inverted nipple
nipple discharge (clear or bloody)
sores on the nipple and areola (the small ring of color around the center of the nipple)
enlarged lymph nodes under the arm

It's important to note that enlargement of both breasts (not just on one side) is usually NOT cancer. The medical term for this is gynecomastia. Sometimes the breasts can become quite large. Non-cancer-related enlargement of the breasts can be caused by medications, heavy alcohol use, weight gain, or marijuana use.

A small study about male breast cancer found that the average time between first symptom and diagnosis was 19 months, or over a year and a half. That's a very long time! This is probably because people don't expect breast cancer to happen to men, so there is little to no early detection.

Earlier diagnosis could make a life-saving difference. With more research and more public awareness, men will learn that—just like women—they need to go to their doctor right away if they detect any persistent changes to their breasts.

Mass Cancer Study

2007-10-22T09:53:00.000-05:00

News about an American Cancer Society study from breastcancer.org
U.S. cancer group launches mass cancer study

WASHINGTON (Reuters) - The American Cancer Society said it was looking for half a million volunteers willing to let researchers watch them for the next 20 years to see if they get cancer.

The aim is to match similar big studies in Europe and Asia that are looking on a large scale for the environmental and lifestyle factors that cause cancer, the second-leading cause of death in the United States after heart disease.

"This type of study involves hundreds of thousands of people, with diverse backgrounds, followed for many years, with collection of biological specimens and assessments of dietary, lifestyle and environmental exposures," Eugenia Calle, managing director of analytic epidemiology at the American Cancer Society, said in a statement.

"It also requires active follow-up to discover if and when study participants develop cancer."

The group will recruit men and women between the ages of 30 and 65 who have never been diagnosed with cancer. They will give blood to be tested and answer questionnaires at various times over the next 20 years.

Similar big studies have confirmed the link between cigarette smoking and lung cancer, shown that obesity increases the risk of several cancers, and linked aspirin use to a lower death rate from colon cancer.

They have also found evidence that defied conventional wisdom, such as the Women's Health Initiative study that found hormone replacement therapy actually raises the risk of breast cancer, stroke and heart attack.

Financing Breast Cancer Treatment

2007-10-18T10:36:00.001-05:00

I know a couple of women whose families have lost everything because of the enormous cost of treatment. Many of us don't have access to health insurance and, once you're diagnosed, premiums skyrocket. The following information comes from the Susan G. Komen Foundation.

Financing Issues-Medical Assistance

NeedyMeds.com
Drug assistance program information.
http://www.needymeds.com/

Partnership for Prescription Assistance
Drug assistance program information.
https://www.pparx.org/

Pharmaceutical Research and Manufacturers of America
Directory of pharmaceutical manufacturers' assistance programs.
http://www.phrma.org/

Y-Me National Breast Cancer Organization
Financial assistance for wigs, prostheses and mastectomy bras.
http://www.y-me.org/

CancerCare Linking A.R.M.S.(TM)
Financial assistance for some medications and medical supplies.
http://www.cancercare.org/

CancerCare
Financial assistance for diagnostic work-up, as well as information on drug assistance programs. See also Transportation Assistance.
http://www.cancercare.org/

Financing Issues-Transportation Assistance

American Cancer Society – Road to Recovery
Transportation assistance program.
http://www.cancer.org/

Mercy Medical Airlift
Air travel assistance for cancer patients.
http://www.mercymedical.org/

National Patient Air Travel HELPLINE
Air travel assistance for cancer patients.
http://www.patienttravel.org/

Lifeline Pilots
Air travel assistance for cancer patients.
http://www.airlifelinemidwest.org/index2.htm

Air Charity Network
Air travel assistance for cancer patients.
http://aircharitynetwork.org

Corporate Angel Network
Air travel assistance for cancer patients
http://www.corpangelnetwork.org/

CancerCare
Financial assistance for transportation to and from treatment and childcare when a parent is having tests or treatment. See also Financial Issues.
http://www.cancercare.org/

Warrior Spirit: My Own Inner Survivor

2007-10-17T12:16:00.001-05:00

My body is scarred and misshapen now. I have a scar running all the way across my lower abdomen past both of my hipbones (from tram flap surgery and radical liposuction). There are a couple of circular scars below that one from where tubes were inserted up through my body into my reconstructed breast. I have scars running all the way around the new breast. I now have scars on the right breast from a breast lift and re-placement of the nipple (to attain symmetry with the constructed breast). There is a hard lump under my left armpit with a ridge running under my new breast (remaining tissue necrosis from extensive radiation). Though it's all an improvement over the way I looked after my mastectomy, it's definitely not a pretty site.

I've regarded them as deformities so hideous that I've never let Hubby see them. Last week, when he asked me when I thought I might be interested in resuming intimacy, I told him that I'm afraid he'll be repulsed. He reassured me, but I still had my doubts. Obviously, those doubts are centered in my own revulsion.

I'm working on a new perspective. Every day, I look at myself in the mirror. I'm reminded that these are battle scars that should be respected and honored. They're evidence of a rite of passage like those celebrated by warriors in aboriginal cultures. I've walked through darkness and fought with demons. I emerged bloody and wounded. The scars are a roadmap of valor.

I look into my eyes, searching for some glimmer of beauty and wisdom. Then it's revealed. I'm beautiful because I have warrior spirit.

On Becoming A Breast Cancer Survivor

2007-10-16T13:22:00.001-05:00

Harvard Women's Health Watch | October 2006

On becoming a breast cancer survivor

Getting through treatment is only the beginning.

The impact of breast cancer is as individual as the women who survive it. It can be an arduous though temporary challenge or an experience so transformative that it divides existence into two parts — before and after.

Perry Colmore has experienced the disease both ways. When she was 45, she was diagnosed with lobular carcinoma in situ, a noninvasive disease that signals an elevated risk for invasive breast cancer. Given the choice of preventive double mastectomy or simply removing the small tumor, she opted for a lumpectomy. “I breezed right along, assuming I’d be among the 80% who don’t have a recurrence,” she says.

And so she was — for seven years. Then a lump in her other breast turned out to be an invasive cancer that had already reached 12 lymph nodes. She underwent a mastectomy followed by radiation and chemotherapy.

Colmore has been cancer-free for more than a decade, but her health has suffered. Radiation treatments damaged one of her lungs, causing wheezing and breathlessness. She’s weathered bouts of pleurisy and pneumonia. And intensive antibiotic therapy for her lung diseases triggered severe diarrhea, resulting in a 40-pound weight loss.

Colmore’s experience isn’t typical, but it does suggest the range of later effects that can follow in the wake of breast cancer. The good news is that most breast cancer survivors are living long past the five-year survival benchmark of yesteryear. But many also find themselves facing the long-term consequences of the treatments that saved their lives.

Growing recognition of survivor needs

As the ranks of cancer survivors have swelled to more than 10 million, their health has attracted increasing attention from scientists and physicians. The Institute of Medicine (IOM) has formed an expert committee to consider the quality of life and care of cancer survivors. The panel’s report, From Cancer Patient to Cancer Survivor: Lost in Transition, published in 2005, acknowledged that cancer care too often ends when patients complete their initial treatments. There may be little communication between the patients’ oncology teams and their primary care doctors. The IOM advises physicians to craft a “survivorship plan” to guide health care in the years following treatment.

Several large cancer hospitals around the country, such as Dana-Farber Cancer Institute in Boston, Fred Hutchinson Cancer Research Center in Seattle, and Memorial Sloan-Kettering Cancer Center in New York, have already instituted special programs or clinics for survivor care. At these centers, clinicians specialize in keeping cancer patients healthy and strong, reducing the risk of subsequent disease and, for breast cancer survivors, recognizing and treating the effects of breast cancer therapy.

Schedule of follow-up exams for breast cancer survivors
Exam	When
Physical exam	Every 3–6 months during the first 3 years after treatment Every 6–12 months during the 4th and 5th year after treatment Annually after 5 years
Breast self-exam	Monthly
Mammogram	Annually
Pelvic exam	Annually
Source: Guidelines developed by the American Society of Clinical Oncology

Treatment’s toll on the body

Cancer survivors are at risk for two kinds of side effects from treatment: Long-term effects, which begin during therapy and persist after it is completed, and late effects, which arise months or even years after treatment has ended.

The most common long-term effects include the following:

Fatigue. About 30% of breast cancer survivors are fatigued for five years or more after successful treatment. Any number of physical factors, including anemia and inflammation resulting from radiation or chemotherapy and loss of muscle mass, can account for fatigue during and after treatment. The psychological toll of treatment can also be exhausting. Though there’s little research on the subject, many women continue to shoulder responsibilities for jobs and managing households during and following their cancer treatment. Who wouldn’t be exhausted?

Weight gain. For reasons that science hasn’t fully explained, women undergoing breast cancer chemotherapy gain an average of five to eight pounds. Moreover, the excess poundage is all fat, rather than a combination of fat and lean tissue.

Nerve damage. Surgery can damage nerves in the treated breast and chest, resulting in numbness or pain. Chemotherapy may affect peripheral nerves, particularly those in the hands or feet.

Late effects can include these:

Lymphedema. Up to 25% of breast cancer survivors experience some degree of arm swelling following the removal of underarm lymph nodes, which is essential for evaluating the extent of the disease. Lymph node excision can damage the lymphatic drainage system, causing fluid to build up in the arm on the affected side. Lymphedema can appear weeks or months after surgery and is exacerbated if the arm is injured or infected.

Menopause discomforts. After breast cancer treatment, many women take tamoxifen, a selective estrogen blocker, for five years to prevent a recurrence. On the positive side, tamoxifen increases bone density and improves cholesterol. But it also produces menopausal symptoms, primarily hot flashes and vaginal dryness.

Osteoporosis. Women who undergo menopause following chemotherapy have a higher rate of bone loss than women who have a natural menopause. Aromatase inhibitors, such as anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin), which are frequently a part of breast cancer therapy, block the production of estrogen in fat and other tissues. Treatment with these drugs is associated with a higher risk of fractures than tamoxifen therapy and may also be responsible for joint and muscle pain.

Subsequent cancer. Breast cancer survivors have an increased risk of developing cancer in the other breast. Also, some treatments increase the probability of developing certain other forms of cancer, although the risk is very low. For example, tamoxifen is associated with an increase in endometrial cancer risk, and high-dose cyclophosphamide therapy heightens the risk of acute myeloid leukemia.

Lung damage. Lung tissue can be damaged if radiation to the chest cavity reaches the lung. In about 1% of survivors, it leads to radiation pneumonitis, an inflammatory condition that usually occurs two to three months after treatment and can result in susceptibility to respiratory infection.

Congestive heart failure. Cardiac damage is increasingly rare as chemotherapy doses decline, but women who received high doses of doxorubicin (Adriamycin) may sustain damage to the heart muscle. Such damage can result in fluid buildup in the body and lungs, making it more difficult to breathe and exercise.

Breast cancer’s effects on the psyche

The end of treatment is one of the most stressful events in the cancer experience. Often friends and family expect a woman to be fully engaged in life the day she finishes treatment. But while a breast cancer patient may rejoice that radiation and chemotherapy have ended, she typically feels anything but normal. Not only is her body irrevocably changed, she’s also likely to be on uncertain emotional terrain.

“What others usually don’t realize is that the recovery from treatment may take as long as the treatment itself,” says Hester Hill Schnipper, Director of Oncology Social Work at Beth Israel Deaconess Medical Center in Boston. Schnipper and other health professionals who work with cancer survivors have observed that the emotional effects of cancer therapy are far less recognized than the physical effects, yet they are just as profound.

Typically, a woman marshals all her psychological defenses to get through treatment. When therapy is over, she can finally let her guard down but then may be flooded with intense and conflicting emotions. The occurrence and intensity of reactions vary from woman to woman, but most experience the following:

Fear and anxiety. For women who have just completed chemotherapy or radiation — or five years of tamoxifen therapy — the end of active cancer treatment can be disconcerting. After months of regular medical care and attention, they often find themselves abruptly severed from the oncology team that’s sustained them during treatment. Equally common, and more distressing, is the specter of recurrence, which can color every aspect of life.

Grief. Breast cancer brings loss — be it as minor as the claim to perfect health or as monumental as the ability to have children. Grieving is a natural response to loss, and it may take months or years to complete.

Erosion of self-image. The physical effects of treatment — loss of a breast, hair loss, weight gain, radiation burns, and surgical scars — are reminders of one’s vulnerability. Breast cancer survivors may feel that they’re less attractive and that their vitality is diminished. The adjustments can be especially hard for young women who are thrown into menopause by chemotherapy.

Changes in intimate relationships. It goes without saying that a woman’s sex life is affected by breast cancer. Illness is a notorious thief of libido. In addition, a survivor’s partner may feel breast cancer’s toll on body and body image as deeply as the survivor herself.

Effects on the family. Breast cancer is a family affair. Family members are likely to want to get the household back to normal after treatment ends, and they may not be patient with the partner or mother who needs more time to recover.

Resources for survivors

After Breast Cancer: A Common-Sense Guide to Life After Treatment, Hester Hill Schnipper, Bantam Books, 2006

LIVESTRONG SurvivorCare
866-235-7205 (toll free)
www.livestrong.org

Cancer Survivors Network
American Cancer Society
800-227-2345 (toll free)
www.acscsn.org

The Wellness Community
888-793-9355 (toll free)
www.thewellnesscommunity.org

Breast Cancer: Strategies for Living, a Harvard Medical School Special Health Report, Harvard Health Publications, 2006

Living Through Breast Cancer (from Harvard Medical School) by Dr. Carolyn Kaelin, McGraw-Hill, 2005

The Breast Cancer Survivor's Fitness Plan (from Harvard Medical School) by Dr. Carolyn Kaelin, McGraw-Hill, 2006

Being a survivor

Breast cancer is a rough storm, but many women weather it well, buoyed by gratitude for life, hope for the future, and the support of loved ones. Some, like Perry Colmore, use it as the fulcrum for a major life change. When breast cancer returned, Colmore was a newspaper editor. As she experienced the intensity of the disease, she decided that it was a story worth telling. She told it through the experiences of 40 breast cancer survivors in the photo-essay book, Living with Breast Cancer: 39 Women and One Man Speak Candidly about Surviving Breast Cancer (Andover Townsman, 1997).

Perry and her husband also took stock of their life together. Their children were grown, so they traded their suburban home for an apartment in the city and a house on the beach. She quit her job to devote more time to working with breast cancer patients. She now volunteers at a hospital as a companion for women undergoing treatment and leads a cancer support program at her church. “I can’t say that I’m happy I got cancer, but I’m happy with my life,” she says.

Getting the help you need

If you’re a breast cancer survivor, these steps may help:

Work closely with your primary care doctor. According to Jennifer Potter, M.D., director of the Women’s Health Program at Boston’s Beth Israel Hospital, it’s important to make sure your clinician has your complete cancer history — including surgical reports, radiology records, and drug information. At your first post-treatment visit, you may want to discuss your treatment experience and openly air your fears. If your doctor seems ill at ease with your new status, find one who has experience with cancer survivors.

Join a support group. Breast cancer survivorship may not be a sorority you ever intended to join, but its ranks are legion. It can be therapeutic to talk with someone who’s walked in your shoes. If you’re looking for a specific type of survivor group, for example, single women or mothers of teenagers, there’s a good chance you can find it — if not in your community, then possibly online.

Stabilize your relationships. If cancer has put a strain on your relationships or unearthed problems that took root earlier, consider getting help. A mental health professional can help you develop healthier ways of interacting.

Treat yourself. When you were sick, it was probably comforting to have others take care of you. You may not be a patient any more, but there’s no reason for the nurturing to end. Make a list of things that might give you pleasure — from a vase of fresh flowers to a visit to a day spa — and schedule them into your life.

Invest in the future. This can be something as small as planting an amaryllis bulb to bloom in a few months or as large as launching a new career. Planning for the future is one of the best ways to overcome the fear that it won’t be there.

U.S. Breast Cancer Death Rate Drops

2007-10-15T08:57:00.001-05:00

Good news and bad news from the American Cancer Society, brought to you by WebMD. http://www.webmd.com/breast-cancer/news/20070925/us-breast-cancer-death-rate-drops?ecd=wnl_brc_100907

But a Race Gap Persists in America's Breast Cancer Death Rate

By Miranda Hitti
WebMD Medical News

Reviewed by Louise Chang, MD

Sept. 25, 2007 -- The American Cancer Society (ACS) today reported that U.S. breast cancer deaths continue to drop, but that decline still hasn't reached all ethnic groups.

That news appears in the ACS' biannual report on breast cancer in the U.S.

According to the report, breast cancer deaths declined by 2.2% annually from 1990 to 2004, partly due to earlier detection and advances in treatment.

But there are racial gaps in those figures, the report also shows.

Breast Cancer Race Gap

The ACS reports that breast cancer deaths dropped 2.4% per year from 1990 to 2004 in white and Hispanic women, compared with 1.6% annually in African-American women.

Women's breast cancer death rates didn't change during that time among Asian-American/Pacific Islanders, American Indians, and Alaska natives.

The precise reasons for those racial patterns aren't clear. Genetics may play a role, but other factors including income and access to medical care are also important.

"A woman today has a lower chance of dying from breast cancer than she's had in decades," says Harmon Eyre, MD, chief medical officer for the ACS, in a news release.

"Unfortunately, not all women are benefiting at the same level," says Eyre, noting that by 2004, breast cancer death rates were 36% higher in African-American women than in white women.

The ACS estimates that about 40,460 U.S. women will die of breast cancer in 2007 -- and that about 2.4 million women living in the U.S. have a history of breast cancer.

But breast cancer isn't U.S. women's leading cancer killer -- lung cancer is -- and heart disease kills more U.S. women than all cancers combined.

Latest Breast Cancer Statistics

In the new report, the ACS predicts that an estimated 178,480 new cases of invasive breast cancer will be diagnosed this year among U.S. women.

Invasive cancer has spread from its starting point into surrounding breast tissue. Most breast cancers are invasive.

The ACS also estimates that 62,030 new cases of in situ breast cancer (cancer that hasn't spread beyond its starting point to other breast tissue) will be diagnosed in 2007.

Breast cancer is far more common among women than men. The ACS predicts that in 2007, about 2,030 cases of breast cancer will be diagnosed in men, accounting for about 1% of all breast cancers.

The ACS estimates that 450 men will die of breast cancer in the U.S. this year.

Breast Cancer Rarer?

Breast cancer is U.S. women's most common cancer (except for skin cancers), but it may be becoming rarer than in the past.

Don't race past that word "may." Undetected breast cancers due to missed mammograms may be contributing to the trend.

The ACS reports a 3.5% drop per year in breast cancer cases from 2001 to 2004.

That decline follows a sharp rise in breast cancer cases from 1980 to 1987 that slowed until 2001 and then headed down.

Why the turnaround? The ACS notes two possible reasons.

Reason No. 1: Many women halted hormone replacement therapy (HRT) starting in 2002, after the Women's Health Initiative linked HRT to breast cancer risk. Researchers continue to debate that risk.

Reason No. 2: Mammography rates are down. Some women may have breast cancer and not know it. That would make breast cancer rates look lower than they really are.

Mammography isn't a perfect test, but it's the best way to screen women for breast cancer.

Breast Cancer Perspective

A woman living in the U.S. has a 12.3% (1 in 8) lifetime risk of developing breast cancer, states the ACS report.

But remember, that's a general number about a woman's odds of developing breast cancer at some point in her life -- not this year, or even this decade.

Breast cancer becomes more common with age, but it can also strike before menopause, so the ACS encourages women to learn what's normal for their breasts and to get lumps checked by a doctor.

Most lumps aren't breast cancer. But don't assume that a lump is no big deal. Check with your doctor to find out -- and remember, if it is breast cancer, the sooner it's detected, the better your chances may be of survival.

U.S. Breast Cancer Death Rate Drops

2007-10-15T08:57:00.000-05:00

Good news and bad news from the American Cancer Society, brought to you by WebMD. http://www.webmd.com/breast-cancer/news/20070925/us-breast-cancer-death-rate-drops?ecd=wnl_brc_100907

But a Race Gap Persists in America's Breast Cancer Death Rate

By Miranda Hitti
WebMD Medical News

Reviewed by Louise Chang, MD

Sept. 25, 2007 -- The American Cancer Society (ACS) today reported that U.S. breast cancer deaths continue to drop, but that decline still hasn't reached all ethnic groups.

That news appears in the ACS' biannual report on breast cancer in the U.S.

According to the report, breast cancer deaths declined by 2.2% annually from 1990 to 2004, partly due to earlier detection and advances in treatment.

But there are racial gaps in those figures, the report also shows.

Breast Cancer Race Gap

The ACS reports that breast cancer deaths dropped 2.4% per year from 1990 to 2004 in white and Hispanic women, compared with 1.6% annually in African-American women.

Women's breast cancer death rates didn't change during that time among Asian-American/Pacific Islanders, American Indians, and Alaska natives.

The precise reasons for those racial patterns aren't clear. Genetics may play a role, but other factors including income and access to medical care are also important.

"A woman today has a lower chance of dying from breast cancer than she's had in decades," says Harmon Eyre, MD, chief medical officer for the ACS, in a news release.

"Unfortunately, not all women are benefiting at the same level," says Eyre, noting that by 2004, breast cancer death rates were 36% higher in African-American women than in white women.

The ACS estimates that about 40,460 U.S. women will die of breast cancer in 2007 -- and that about 2.4 million women living in the U.S. have a history of breast cancer.

But breast cancer isn't U.S. women's leading cancer killer -- lung cancer is -- and heart disease kills more U.S. women than all cancers combined.

Latest Breast Cancer Statistics

In the new report, the ACS predicts that an estimated 178,480 new cases of invasive breast cancer will be diagnosed this year among U.S. women.

Invasive cancer has spread from its starting point into surrounding breast tissue. Most breast cancers are invasive.

The ACS also estimates that 62,030 new cases of in situ breast cancer (cancer that hasn't spread beyond its starting point to other breast tissue) will be diagnosed in 2007.

Breast cancer is far more common among women than men. The ACS predicts that in 2007, about 2,030 cases of breast cancer will be diagnosed in men, accounting for about 1% of all breast cancers.

The ACS estimates that 450 men will die of breast cancer in the U.S. this year.

Breast Cancer Rarer?

Breast cancer is U.S. women's most common cancer (except for skin cancers), but it may be becoming rarer than in the past.

Don't race past that word "may." Undetected breast cancers due to missed mammograms may be contributing to the trend.

The ACS reports a 3.5% drop per year in breast cancer cases from 2001 to 2004.

That decline follows a sharp rise in breast cancer cases from 1980 to 1987 that slowed until 2001 and then headed down.

Why the turnaround? The ACS notes two possible reasons.

Reason No. 1: Many women halted hormone replacement therapy (HRT) starting in 2002, after the Women's Health Initiative linked HRT to breast cancer risk. Researchers continue to debate that risk.

Reason No. 2: Mammography rates are down. Some women may have breast cancer and not know it. That would make breast cancer rates look lower than they really are.

Mammography isn't a perfect test, but it's the best way to screen women for breast cancer.

Breast Cancer Perspective

A woman living in the U.S. has a 12.3% (1 in 8) lifetime risk of developing breast cancer, states the ACS report.

But remember, that's a general number about a woman's odds of developing breast cancer at some point in her life -- not this year, or even this decade.

Breast cancer becomes more common with age, but it can also strike before menopause, so the ACS encourages women to learn what's normal for their breasts and to get lumps checked by a doctor.

Breast Cancer's Impact on Relationships

2007-10-12T10:14:00.001-05:00

Please check out WebMD for this article and others related to breast cancer. http://www.webmd.com/breast-cancer/features/breast-cancers-relationship-toll?page=1

Breast Cancer's Relationship Toll

Any major illness can strain close relationships. But for women with breast cancer, it can be an especially difficult emotional challenge.

By Colette Bouchez
WebMD Feature

Reviewed by Louise Chang, MD

For many women, the diagnosis of breast cancer represents not only a major physical battle, but also the ultimate emotional challenge -- one that affects every relationship in our life.

Indeed, from friendships to romance, from being a parent to being a daughter, the way you relate to everyone -- and the way they relate to you -- can be affected.

"I do think cancer has more impact on emotions and emotional relationships than other catastrophic diseases, because with cancer, death is often the first thing people flash on. There's an immediate shock and emotional impact that few other illnesses have," says Katherine Puckett, LCSW, national director of Mind-Body Medicine at the Cancer Treatment Centers of America in Chicago.

Moreover, Puckett says that the uncertainty of the disease itself enhances that impact. "It's the not knowing aspect of breast cancer that increases the emotionality in regard to all your relationships. It heightens anxiety, but it heightens and changes everything in your life," says Puckett.

But the changes, she says, don't have to be negative.

Indeed, for some women, breast cancer can be the catalyst that turns casual friendships into deep and meaningful bonds, that brings couples closer, that helps the family unit become stronger and more cohesive.

For others, however, it can be a lonely and isolating time -- a period of life when people we counted on most seem to all but disappear.

So what is it that determines how breast cancer will affect you and the people in your life? Experts say it’s often linked to a willingness to let others share your burden, something that doesn't come easy for many women.

"Women are the caregivers. We are used to taking care of everyone else, so it can be a huge emotional struggle to give up some of that control and let people in. Even with illness, women still want to handle everything on their own," says Gloria Nelson, LSCW, senior oncology social worker at the Montefiore/Einstein Cancer Center in New York City.

Moreover, experts say, many women view asking for help as a sign of weakness, so they won't allow even those who want to help to do so.

"They think that needing help means they have no willpower or strength. But in reality, being able to share your feelings and ask for help when you need it is a sign of strength that can strengthen the relationships in your life when you need them the most," says Mauricio Murillo, MD, an onco-psychiatrist and director of Supportive Services at the NYU Cancer Center in New York City.

So where -- and how -- do you begin to do that? The best way to start, say experts, is with honest, open communication with family and friends.

Breast Cancer and Your Family Relationships

Among the most important relationships in our lives are those we forge with our partners and especially our children. And whether they’re toddlers, grade school-aged, teens, or even young adults, experts say if you want to keep the family unit strong during this challenging time, it's essential that you confide in them from the very earliest stages of your disease.

"It doesn't work to keep this important a secret from your children. Kids are remarkable in that they pick up on everything going on in their parents’ life, and they almost always know when something is wrong," says Puckett.

Moreover, Murillo cautions that when kids do sense a problem but don't know what it is, they often blame themselves.

"They begin to feel guilty, as if they are causing the situation, and they pull away. So it's very important to talk to them honestly and openly right from the start," says Murillo.

While Nelson says very few parents use the word "cancer" in their explanation -- most, she says, refer to tumors or lesions, or sometimes just say “Mommy is sick” – what trumps the list of suggestions is assuring your children that you are doing everything possible to get well.

"You can't promise your kids that you're going to be alive and that everything is OK, but you can say you are working with the best doctors you could find and that everyone is going to do their very best to help you get better," says Puckett.

And what if your child asks, "Mommy, are you going to die?" Puckett says the answer is always "I hope not."

"Tell them you are doing everything you can to stay with them, and you'll let them know if anything changes. Building a sense of trust is key to building a strong, supportive family unit during this time," she says.

(How did your relationships change during or after cancer? Share your own coping tips on WebMD's Breast Cancer: Friend to Friend message board.)

Breast Cancer And Your Intimate Relationships

While crisis automatically bonds some partners in a unified front, sadly, that's not always the case. Indeed, experts say that when partners try to shield each other from the pain and worry of breast cancer, often they grow further apart -- and don't even understand why.

"This is an area that most patients have the most difficulty with -- not only the patients, but their partners -- and it occurs mainly because they are not sharing with each other, so neither knows how the other is thinking or feeling," says Murillo.

When you don't know what your partner is thinking, he says, you often assume the worst -- that they don't care, or that they don't want you. And the natural reaction is to withdraw.

"But often the real issue is that he doesn't bring things up for fear he'll make her feel worse. And she's not bringing things up because she doesn't want him to worry. So the communication stops at a time when they both really need to share these feelings," says Murillo.

But it's not just the emotional communications that can go awry. Very often the separation starts in the bedroom as breast cancer affects a couple's intimate life.

"Women connect their breasts with their sexuality and their femininity in a way that is not typical of any other cancer," says Nelson. As a result, she says, any type of breast cancer treatment has the potential to impact intimacy.

Indeed, Puckett tells WebMD, it can often leave a woman feeling that her sex life will never be the same, that her partner will be turned off, or that she herself won't ever feel like making love again. This in turn causes her to pull away from her partner at a time when sharing a physical connection can be life-affirming.

To help solve -- or prevent -- any of these problems, experts say keep the lines of communication open and be as real as possible about what you are feeling in all areas of your life.

"Any catastrophic illness, but cancer especially, forces people to look at and deal with many things they didn't pay attention to before. So take advantage of that and view it as an opportunity to make your relationship stronger," says Puckett.

She also advises talking to your doctor about any intimate problems on your mind. "Women sometimes wait for their doctor to bring it up, but doctors often don't say anything until the woman brings it up. So many miss out on the wealth of helpful medical and lifestyle information that can help with some of these problems. So don't be embarrassed or ashamed to ask about it," says Puckett.

Breast Cancer: Getting The Support You Need

While sometimes a little creative communication will be all you and your partner need to get back on track, Puckett says this isn’t always the case. Sometimes, she says, a partner is simply emotionally unable to provide you with the support you need, and no amount of communication is going to change that.

But instead of being hurt and disappointed, experts say to accept those limitations and appreciate that person for what they can give you, and then allow others into your life to fill the gaps.

"You have to be open to people. You can't expect to get everything you need from one person, even a spouse," says Nelson.

But while knowing you need help is one thing, asking for it can be quite another. What can make it easier, says Nelson, is to recognize the opportunity as a gift you give to others.

"As hard as it is for you to face your cancer, it's also hard for the people who love and care about you -- and allowing them to help you helps them to cope. So in a way, accepting their help is a little gift you give to them," says Nelson.

At the same time, Puckett says that it's also important to be as specific as possible about what you need.

"Many times people want to help but just don't know what to do," says Puckett. By being as specific as possible, she says, you'll make it easier for friends and family to give you the support you really need. Take some time to make a list of things you know you’ll need help with while you’re going through treatments, so when friends or family offer, you’re ready. For example, if you know you’ll be fatigued and sick after a chemotherapy session, ask a friend to bring over dinner or even take your kids out for a bite to eat while you rest.

Finally, experts say, don't be disappointed if not everyone in your life steps up to help, even when you ask. It doesn't mean they don't care.

"Everyone reacts to, and copes with, crisis in a different way. And very often, you don't find who can't handle things until the crisis occurs," says Puckett.

If this is the case, don't despair. Experts say the key is to recognize the role each person can play in your life. And if you need more help, don't be afraid to turn to a professional or a support group for the rest.

Says Puckett, "From counselors and social workers at your treatment center, to online communities, to chat rooms, to local support groups, to various cancer organizations, don't overlook the incredible communities of people who will open their hearts -- if you let them."

Looking for Breast Cancer Clinical Trials?

2007-10-10T14:39:00.001-05:00

Go to "Clinical Trials by Cancer Site" at
http://bethesdatrials.cancer.gov/breast_cancer/index.asp

Breast Cancer and Alcohol

2007-10-09T11:29:00.000-05:00

The following article is from The Society for Women's Health Research. Stop by the site for more information on a broad array of women's health issues, not just cancer.
http://www.womenshealthresearch.org

Wine, women and... spirits, beer and breast cancer risk

Barcelona, Spain: One of the largest individual studies of the effects of alcohol on the risk of breast cancer has concluded that it makes no difference whether a woman drinks wine, beer or spirits (liquor). It is the alcohol itself (ethyl alcohol) and the quantity consumed that is likely to trigger the onset of cancer. The increased breast cancer risk from drinking three or more alcoholic drinks a day is similar to the increased breast cancer risk from smoking a packet of cigarettes or more a day

Speaking at a news briefing today (Thursday) at the European Cancer Conference (ECCO 14) in Barcelona, Dr Arthur Klatsky said: "Population studies have consistently linked drinking alcohol to an increased risk of female breast cancer, but there has been little data, most of it conflicting, about an independent role played by the choice of beverage type."

Dr Klatsky, adjunct investigator in the Division of Research, Kaiser Permanente Medical Care Program, Oakland, USA, and his colleagues studied the drinking habits of 70,033 multi-ethnic women who had supplied information during health examinations between 1978-1985. By 2004, 2,829 of these women had been diagnosed with breast cancer. In one analysis, the researchers compared the choice of drink amongst women who tended to favour one type of drink over another with women who had no clear preference. They also looked for any association between the frequency of drinking one type of alcoholic drink over another. Finally, they examined the role of total alcohol intake, comparing it with women who drank less than one alcoholic drink a day.

They found that there was no difference in the risk of developing breast cancer between wine, beer or spirits. Even when wine was divided into red and white, there was no difference. However, when they looked at the relationship between breast cancer risk and total alcohol intake, the researchers found that women who drank between one and two alcoholic drinks per day increased their risk of breast cancer by 10% compared with light drinkers who drank less than one drink a day; and the risk of breast cancer increased by 30% in women who drank more than three drinks a day.

When they looked at specific groups, stratified according to age or ethnicity, the results were similar.

Dr Klatsky said: "Statistical analyses limited to strata of wine preferrers, beer preferrers, spririts preferrers or non-preferrers each showed that heavier drinking, compared to light drinking, was related to breast cancer risk in each group. This strongly confirms the relation of ethyl alcohol per se to increased risk."

He continued: "A 30% increased risk is not trivial. To put it into context, it is not much different from the increased risk associated with women taking oestrogenic hormones. Incidentally, in this same study we have found that smoking a pack of cigarettes or more per day is related to a similar (30%) increased risk of breast cancer."

Although breast cancer incidence varies between populations and only a small proportion of women are heavy drinkers, Dr Klatsky said that a 30% increase in the relative risk of breast cancer from heavy drinking might translate into approximately an extra 5% of all women developing breast cancer as a result of their habit.

Other studies, including research from the same authors, have shown that red wine can protect against heart attacks, but Dr Klatsky said that different mechanisms were probably at work.

"We think that the heart protection benefit from red wine is real, but is probably derived mostly from alcohol-induced higher HDL ("good") cholesterol, reduced blood clotting and reduced diabetes. None of these mechanisms are known to have anything to do with breast cancer. The coronary benefit from drinking red wine may also be related to favourable drinking patterns common among wine drinkers or to the favourable traits of wine drinkers, as evidenced by US and Danish studies."

Dr Klatsky said that all medical advice needed to be personalised to the individual. "The only general statement that could be made as a result of our findings is that it provides more evidence for why heavy drinkers should quit or cut down."

He concluded: "This has been fascinating research. Our group has been involved in studies of alcohol drinking and health for more than three decades, including in the area of heart disease. We are fortunate to have data available about a large, multi-ethnic population with a variety of drinking habits."

Having Watched the River Flow

2007-10-08T14:33:00.001-05:00

"You must love the crust of the earth on which you dwell more than the sweet crust of any bread or cake. You must be able to extract nutriment out of a sand-heap. You must have so good an appetite as this, else you will live in vain." ~ Henry David Thoreau

"The deeper that sorrow carves into your being the more joy you can contain. Is not the cup that holds your wine the very cup that was burned in the potter's oven?" ~ Kahlil Gibran

The three days away were absolutely blissful. The sound of the Guadalupe River, high and fast-moving these days, soothed my soul. Time away from Crazy Land and from the hurtful hands of medical professionals was a joyous reminder of how things could be.

Then, on Saturday, a major water main break left us without water until Sunday at 5:00 p.m. It's funny how attached you become to bathing regularly. Fortunately, my mom is generous with her shower.

Aside from that, we're rapidly approaching the ten year anniversary of my dad's suicide. He decided to check out nine days before my birthday. I've always wondered how he could have done that to me. Oh wait, silly me.

My father was a deeply disturbed man who spread misery of all kinds wherever he went. Physical, emotional, spiritual: It was all fair game for him. He saved a large measure of it for me. Nonetheless, he was my one and only father. I loved him, even though I didn't like him, and his suicide was devastating.

These days, memories come unbidden as I watch television or do the dishes or any of a thousand mundane acts. Sometimes, it's as simple as the word "Daddy" echoing in my head. The ironic thing about that is that I stopped referring to him by that name when I was very, very young. The horrors of my very own childhood concentration camp washed that name out of my vocabulary. I guess it's those tiny-child memories that take hold deep within our subconscious, springing up to surprise us when our guards are down. Shortly after his suicide, I remember sitting in the bathtub, with my head absolutely empty of thoughts, which were blasted away by the holocaust of his gun shot. "My daddy's gone." It felt unbearable. The silence that preceded and followed that thought stretched on like nuclear winter for what seemed an eternity.

Ten years later, I've come to terms with it, as much as one ever can. The reality of his self-murder, the anguish of not being able to penetrate his self-destructiveness and delusion have been tempered by time. I'm angry with him still. I pity him still. I still wish he had been capable of love. I still live with the wounds he inflicted on me, before his death and after. I'll continue to talk about his death as the month grinds on, because that's what I do, that's all that I can do.

Life seems to be an intricate maze in search of reconciliation between the child I was, the adult I thought I might become, the person I am and the one I'm becoming. I'm trying to recreate the inner narrative by which I define myself. The stories we tell ourselves about ourselves are critical to human beings; they are, in essence, that which denotes our individuality. I'm a composite of events, cataloged and assigned personal symbolic meaning, separate and apart from others' remembrance of the personality they once knew or their perception of me now.

We are all many things to many different people in this journey. Our brains hold our histories, keeping track of songs long-since forgotten, tiny moments that are unavailable to us in conscious memory. I struggle to meld together the things I remember all too clearly and the puzzle of what comes now, allowing those deep, hidden roots of memory to nourish me in silence and darkness.

It's not an altogether dark exploration, though. The Guadalupe River is high. There's a squirrel napping on a limb outside my window. The mystery of the cosmos takes my breath away.

Breast Cancer Awareness Month: Caregivers Research Study

2007-10-08T11:40:00.001-05:00

The National Cancer Institute (NCI), a federal agency that is part of the National Institutes of Health (NIH) and the George Washington School of Public Health, would like to talk to women who are providing care for a family member or friend with cancer. We’d like to learn about your caregiving experience and how you have coped.

If you are:

*Female
*African American
*Between the ages of 31 and 80
*Currently providing care for someone over the age of 20 with cancer, OR you provided care for someone over the age of 20 with cancer at end-of-life within the last year

Please call us toll-free at:

1-888-249-0029
(Monday to Friday, 9am-5pm EDT)

We will ask you some questions about yourself and your caregiving experience. Participating in this study involves a total of 15-20 minutes by phone. If they qualify, eligible participants may be asked to provide additional information about their caregiving experiences in a follow-up telephone interview that will last approximately 45-60 minutes.

National Breast Cancer Foundation

2007-10-03T08:57:00.000-05:00

Connect with a community of peers and find encouragement and support.
http://www.nationalbreastcancer.org/

Watching the River Flow

2007-10-03T08:43:00.001-05:00

Annual physical. Check.
Dentist. Check.

Until next week, I'm finished with people in white coats. What a relief. Next week, another dentist appointment and an appointment to discuss genetic testing, which I'm going to cancel. With any luck, that will wrap up all of my medical commitments until December. I'm breathing easier already.

I don't know if this is an industry-wide change, but my primary care physician has a brand new way to do pap smears. Guess what? It involves more pain.

For ten years, I refused to have a pap smear. I had had one of the best ob-gyns in town, a man. From the first time I ever had one, they always evoked memories of my sexual abuse as a child. In my late thirties, I found a woman general practitioner whom I trusted. Since that time, they've all been bearable, until last year. My regular doctor was out, so I had a nurse practitioner do my annual physical. I thought the painful pap smear was because she was a stranger. Maybe the new, improved pap smear methodology was implemented last year. Welcome back to childhood.

I had a accident with my puppy (who weighs 50 pounds) on Sunday, when he rammed his hard, pointy little head into the bottom of my chin. There was a lot of blood (mine) and I was afraid I'd loosened a tooth from the force of his head against my jaw. My dentist says I'm fine.

It's been a tough couple of weeks, so I'm taking a break from work (and maybe the computer) for the rest of the week. Tomorrow, my mom and I are going to have lunch at a little restaurant about 30 miles from here. It's in an old grist mill, with decks perched among the trees, along the banks of the river. You can hear the river rushing beneath the tree canopies. It's one of my favorite things to do and something my mom and I did every year until I was diagnosed. We've been deprived of the fun for the past two years. I was determined to find a way to do it this year, so my colleagues in Crazy Land believe I'm on my way out of town to see more doctors.

I don't even remember when I last had a day completely devoted to relaxing and doing something I enjoy. It's finally here.

I may be away from the computer until next week; I'll have to see how it goes. Until then, I invite everyone to take a day for themselves and remember what's important in life.

Information from M.D. Anderson

2007-10-01T13:00:00.001-05:00

Here's a link to the people who've taken such great care of me for the past two years. They have some excellent information about breast cancer and, if you go to the main site, you can find links that lead you to articles about other types of cancer.

http://www.mdanderson.org/diseases/breastcancer/

Research indicates that breast cancer is a chronic disease. There is no cure, but survival rates continue to rise for most forms of breast cancer. Don't forget your monthly self exams and never, ever miss annual mammograms after the age of 40.

Men can get breast cancer, too, so encourage your male friends and family members to be alert to changes in their breasts.

Breast Cancer Awareness Month: Working During Treatment

2007-09-28T09:43:00.001-05:00

It's a couple of days away, but I received a transcript from breastcancer.org this morning and I wanted to share the link before I forget. I worked as much as I could during my breast cancer treatment (and, of course, I'm working during reconstruction), but it wasn't easy.

On September 19, guest speakers Barbara Hoffman, J.D. and Irene Card and moderator Ruth Oratz, M.D., F.A.C.P. answered questions about the legal, financial, physical and emotional aspects of working during breast cancer treatment. You can find the transcript here:

http://www.breastcancer.org/community/ask_expert/index.jsp

All's Right With The World, My Soul-Specific Absurdity

2007-09-26T10:23:00.001-05:00

"The leaves fall early this autumn, in wind. The paired butterflies are already yellow with August Over the grass in the West garden; They hurt me. I grow older." ~ Ezra Pound

It's shaping up to be a fabulous day. I saw my new medical oncologist yesterday and I'm not sure I like him. He spent a lot of time talking about the history of breast cancer treatment, dictated notes to be sent to my g.p., and made a book recommendation to my mom. He noted that I'm hypertensive, even though the exact opposite is true. My blood pressure usually hovers somewhere around 106/70. I'm almost certain he used that word. I managed to catch little snippets of information while he was doing the dictation, but he was talking so fast I couldn't understand much.

Here's a thought: Ask me. I think virtually everyone's blood pressure gets a little elevated when they visit a doctor. Maybe the doctor doesn't have time to ask me (although he could have worked it in if he hadn't been giving that long book report to my mom), but his nurse should have. I actually did tell the nurse, but I guess she didn't feel it worthy of writing down. I was also running a temperature. If my temperature is 98.6, I'm really sick. I constantly try to point this out to my phalanx of medical professionals and, across the board, they all ignore me.

On the osteoporosis front, I'm 1/2 inch shorter than I used to be. The rapid diminishment in height is a direct result of chemotherapy. Prior to breast cancer, I already had osteopenia (the early and less serious form of osteoporesis), but I had no idea how much my bone density had fallen victim to breast cancer treatment. Great. Now I only have one real breast, tissue necrosis, scars everywhere and I'm now bitty. Things are definitely looking up.

Dr. Sandbach (new M.O.) ordered a chest x-ray, which I'll have to pay for. Hubby has sucked virtually all of the money out of the Breast Cancer Slush Fund, so that won't be as easy as it has been in the past. This puts me in a simply marvelous mood. I have to admit that it's been a bad day right from the get-go (as we like to say here in Texas) and it's only 9:25 a.m.

Autumn is here. I got a few glimpses this morning of my steadfast squirrel friend; the leaves are already thinning enough to make it easier to find him. Autumn is never good. I've just passed the 3 year anniversary of my best friend's death and, in October, the ten year anniversary of my dad's suicide is coming up. Two years ago, right around this time, I was trying to prepare myself psychologically to get through my mastectomy.

Then there are all those awful memories from childhood that carpet the season. Flashbacks happen any time of year, but fall invokes a pall that is too rich, too complex in pain to be able to tease out the specific memories. It's always been this way and maybe the lack of distinct recall is a good thing, anyway.

I'm physiologically highly attuned to changes of season. The advent of autumn is the beginning of dying for so many things. My little squirrel soon will come to be very visible; all of the leaves on his playground of trees will have died.

The skies are overcast today. I've gotten to work on my seasonal affective disorder right away. Why waste time when you can get started now?

It's all pretty amusing, if I look at it in the correct context. I'm sitting here in Crazy Land, eating dry cereal and feeling like hell, contemplating the cycle of life. I'm stressed out over the continuing medical events and still in pain (especially my colon). For a little over 3 weeks, I've worn a girdle 24 hours a day, 7 days a week (because of the liposuction in the donor site), which is extremely uncomfortable, though significantly less so than how it feels without the girdle. Of course this is how I'm spending my morning. Otherwise, it wouldn't fit into the overall paradigm of my life. My entire life would lack consistency. As it is, in all of its soul-specific absurdity, this morning is further proof that God's in His heaven and all is right with the world.

The Solitudes of Childhood

2007-09-25T12:44:00.001-05:00

"How is it possible not to feel that there is communication between our solitude as a dreamer and the solitudes of childhood? And it is no accident that, in a tranquil reverie, we often follow the slope which returns us to our childhood solitudes." ~ Gaston Bachelard

I have a dear friend (Hello, C!) who recently suggested to me that two years of breast cancer treatment and reconstruction surgery triggered a recurrence of many Post Traumatic Disorder symptoms. She's a very wise person.

I saw my psychiatrist yesterday, armed with a list of my issues: crying (and crying and crying), nightmares so horrifying that I'm afraid to go to sleep, nearly invisible self esteem, a staggering inability to concentrate, colon pain (the return of IBS). I'm just hitting the high points here; there's no need to enumerate them all. I'm certain you get my point.

Having returned on Friday from a seminar about Post Traumatic Stress Disorder, my psychiatrist understood immediately that all of the new breast cancer related physical and emotional trauma reawakened the areas of my brain that store all of my childhood trauma. The brain recognizes the similarity. My friend, C., was right. My PTSD was relatively well-managed for almost ten years (things got out of hand when my dad killed himself), but the symptoms are back with a vengeance.

My ongoing brain fog is at least partly due to that area of my brain that controls cognitive functioning, logical thinking, etc. going on strike, so to speak. I've been attributing it to chemo brain (which I've read can last for up to ten years), but it may have nothing whatsoever to do with chemotherapy.

The nightmares were certainly no mystery. I dream of people chasing me so they can conduct medical experiments on me. I dream of being physically assaulted. (A humorous aside: my most recent assault dream featured some people beating me up with a large wooden penis. I'm guessing that's because my oncology doctors are all men. It wasn't so funny in my dream, though.) Some of the nightmares have clearly hearkened back to specific incidents of childhood abuse, a fact that hadn't occurred to me.

I have new, short-term medication to help me deal with those nightmares. I've been terrified to go to sleep, but last night there were no nightmares.

I've also started taking a very low level of a medication I just weaned myself off of with a great deal of difficulty. It addresses serotonin issues. I'd already guessed that might be part of my problems, but I've been trying hard not to add new medication to my already beleaguered body. If nothing, else, this will address the colon pain. Eliminating any single source of pain can only be helpful at this point. I'll deal with weaning myself from it again when I can. I hope that's in the near future.

Diminished cognitive functioning explains why I've had so much trouble formulating the structure of the database I've been working on forever now. Of course, knowing why doesn't help me be more capable of working faster and thinking clearly. At least I know I haven't gone permanently stupid, though.

Today, I have an appointment with my new medical oncologist/hematologist. No trip to M.D. Anderson this time, which means I won't be quite as tired and stressed as I usually am when regularly scheduled blood tests are required. Had they not taken Dr. Crisofanilli away from me, I would have gone, anyway. The upsurge in patients means they move those of us not actively doing chemo to nurse practitioners. Doesn't it seem like the better solution would be to hire more medical oncologists? Of course, no one asked me.

The saddest part of that situation is that it must mean an upsurge in cancer diagnoses. That means more people, their friends and loved ones will come to understand a new, higher level of suffering than they may have previously known. They will learn to live with a higher level of fear.

As for me, I'm optimistic about my new doctor and about my blood tests. It would be great if I could work in a nap while I wait. I'm trying to work longer hours this week, but today doesn't bode well.

It Goes On

2007-09-18T09:19:00.000-05:00

"In three words I can sum up everything I've learned about life: it goes on." ~ Mark Twain

It dawned on me a couple of nights ago that things may never be the same. The swelling in the new girl had finally gone down a bit and I was able to feel a ridge running underneath it. It's like having an underwire bra under the skin. That may theoretically seem like a good thing, but it's not.

Everyone I know who's had reconstruction surgery has always told me that, in the end, no one will know that the "breast" I end up with isn't a breast at all. No one, they told me, will even know I had breast cancer unless I choose to tell them. I sort of had my heart set on it. Of course, I also had my heart set on everything being finished a year ago, but this is a lot harder to accept. I've gone through so much to make that outcome possible when it may not be, after all.

The problem is definitely radiation and possibly, to some extent, my body's tendency to create massive amounts of scar tissue. I heal quickly, but thick ridges of scars form almost immediately. Radiation caused a lot of tissue necrosis. There was a lot of radiation because of the wide-spread nature of the cancer (which wasn't a tumor) and the fact that it came so close to the chest wall and my neck. Once tissue is irradiated, it gets very hard.

When I was at M.D. Anderson a couple of weeks ago, I talked with a young woman while we waited to give blood. She had exactly the same conditions as I had and the doctors weren't enthusiastic about even trying to do reconstruction surgery on her. It was the memory of my conversation with her that clarified my own dire straits.

Dr. Kronowitz did an excellent job of cutting some of that necrotic tissue and scar tissue out, but there's still some there. Maybe there always will be. I thought about calling him last week when I had this epiphany, but then I decided that I might not be able to stand the answer. Not yet.

I was devastated last week. Today, I'm emotionally numb. I can only feel that bad for a limited period of time. Plus, I'm still exhausted and in pain from the surgery a couple of weeks ago. This is no time to obsess about visual wholeness.

Next week, a new round of medical appointments begins. I have an appointment with my psychiatrist (whom I'm probably going to try to fire because she's more than I can afford) and a blood check/medical oncologist visit. The next week is my annual physical and a trip to my dentist.

I'm not a human being anymore. I'm just a series of medical events.

Could We Get Along Without It?

2007-09-11T18:48:00.000-05:00

"I have traversed many kinds of health, and keep traversing them...And as far as sickness: are we not almost tempted to ask whether we could get along without it? Only great pain is the ultimate liberator of the spirit." ~ Nietzsche

I'm Here, But Not Exactly Here

2007-09-08T15:20:00.000-05:00

"Our life is always deeper than we know, is always more divine than it seems, and hence we are able to survive degradations and despairs which otherwise must engulf us". ~ William James

"Strength does not come from physical capacity. It comes from an indomitable will." ~ Mahatma Gandhi

I'm not online much these days because I'm battling post-surgical pain and loss of stamina. Did I mention depression and despair? They have a choke hold on my will to sit in front of a computer and do anything, from catching up on friends to reading email and comments.

First the news. I had an MRI on my abdomen last week and all was well. The skin abnormality didn't worry Dr. Ross. The surgery (with five, count them, five incisions and liposuction) was successful. Surprise. Plastic surgery is painful. Breast lift, painful. Liposuction, painful, Correction of donor site, painful. More surgery on my relocated navel, painful. I do not recommend plastic surgery. My last, physically devastating surgery gave me unrealistic hope that this round would be relatively easy. It was, in fact, not in the same league as reconstruction. Knives cutting through flesh is nonetheless not without physical consequences. Note to self: Surgery is painful. Now commit that to memory.

Earlier today, I read a review of a book written by a Harvard professor that purports to provide something of a blueprint for increasing personal happiness. Self reflection was right up there at the top of the list. In my opinion, introspection is highly overrated, especially as a strategy to increase happiness.

Here's where introspection leads me: I give up. I don't know anymore whether I can find my inner phoenix and coax it into yet another rebirth. I give up. I don't know what to do anymore to fix anything in my life. I'm overwhelmed and, as my therapist pointed out yesterday, it's most likely related to my pain level. Nonetheless, for right now, I give up. The reason is almost irrelevant.

What if the best that will ever happen in life has already happened? It's a standard mid-life crisis question, one we all face sooner or later, I think. However, when I review the history of my life, the best of my life has been only slightly less than grim. If that was as good as it will ever be, then what?

The answer to the question is obvious: Nazi death camps, Darfur, Katrina, human tragedy on a breathtaking scale. People survive, people triumph over much worse than I've endured. I will endure, too. This month, this week, today, I find nothing particularly inspiring in that understanding. I can endure. I will endure. Endurance isn't triumph, though.

I'm not sure I have the will or the energy anymore to push myself forward into the glorious future. Glorious futures require the vision to create them. They require relentless will, boundless energy and an immeasurable amount of luck or grace. I've experienced grace and luck. I've summoned will and energy. Were those things not true, I would not be here. I'm not sure where they've gone, though.

I have more surgery coming, in approximately three months. It's classified as elective, but that's a lie. I can't stop now. It's like the lie of remission. Remission means nothing to me. I have more blood tests coming, regularly, for the next five years. The next round will be at the end of September.

People at work say to me, with a smile, "You're in remission now, right?" What they do not know is that oncologists don't really like that word. "Not medically evident" is the correct phrase. I'm angry when comfort people comfort themselves or offer it to me in the form of the magical word, "remission." The question isn't if, but when.

I don't deserve this life. I require from myself the spiritual strength to not only accept the cross, but to welcome it. In better days, I've known how well equipped I am to carry my own burdens. Others may not be so blessed and it's always incumbent upon me to be mindful of that fact. These days, though, the burden is too heavy for me, too.

My old friend, the fascist who live within taunts me: Self pity and hanging onto being a victim are unacceptable. That's where I'm living and my inability to break away from this state of mind makes me embarrassed and ashamed.

This is my self reflection for today. I can check that off my list of things to do. Next step on the road to happiness requires that I enumerate the things for which I'm grateful. There are many, but this month, this week, today, gratitude is not enough.

Grace

2007-08-21T11:50:00.000-05:00

"The weak can never forgive. Forgiveness is the attribute of the strong." ~ Mahatma Gandhi

I just hugged someone who betrayed me several years ago. I thanked her for stopping by. I'm not sure whether that means I've moved farther down the road to forgiveness or that I'm not brave enough to continue on with my cold indifference. I could say having cancer makes a difference in one's ability to see past human frailty, but I'm not sure that's true.

Every day, I pray for and work towards forgiveness and the abandonment of rage and hatred. In this particular case, hugging was a manifestation of grace in my life. There's still a small part of me keeping track of the things she did. Maybe someday I'll stop remembering. I'm not quite that strong yet.

Surgery countdown: 7 days

Surgery: Clearly in Sight

2007-08-20T19:34:00.001-05:00

M.D. Anderson is clearly in sight now. I'll be leaving Wednesday to ensure I get to an early morning sonogram. Later on, The Beloved Dr. Ross. I'm hoping on this trip, he'll ask me to move in with him so he can take care of me forever. Let's not forget that I have hair and muscle tone now. Anything could happen. (Obviously, I'm hard-pressed to contain my anxiety. Dr. Ross is the perfect antidote.) Friday, I drive back to Austin.

On Monday, I drive back to M.D. Anderson for pre-op consults and an appointment with Dr. Kronowitz early Tuesday morning. Wednesday: Surgery.

I got all new "roll out" materials to their appointed destinations and provided on-site managers with extra copies of required forms. I rock.

For all the lovers of Crazy Land tales, an encounter with Foot Lady for your pleasure. I went downstairs to her office to provide her with the extra forms to take to her supervisors. Guess what we talked about next? Yes! Yes! Her feet! She did not plop her foot on the desk for illustrative purposes, but she did flop it on a nearby chair. Some things simply will not change. Foot Lady's ongoing foot problems is one of them.

The workers' comp company is driving me to distraction. I received a new claim today for an insect bite. I recently allegedly gained the ability to submit claims online. Twice I have tried it, twice it has not worked. I called tech support today, told the guy the problem, and he says, "Well, you got me stumped. I'll have to have someone call you." Great. I've got all the time in the world.

I submitted yet another paper claim, after having wasted a fair amount of time and an enormous amount of patience trying to get the lightening-fast online reporting system to work. I got the letter to the employee printed, but that's as far as I got.

Crazy Land denizens kindly held a Team Ggirl meeting, complete with warm, homemade cookies (of many kinds) and a lovely parting gift. Let us all celebrate my upcoming surgery! My friend the Information Superhighway did lots of shopping and arrived with a whole grab bag of cookies, magazines, crossword puzzles, toiletries...all gifts that were useful and touching. I like to recount the foibles of my co-workers, but my feelings for virtually all of them are quite cordial. Clueless though they may sometimes be, frustrating in the extreme and wildly annoying though they may be, I'm very deeply touched that they care. Not to be cynical, but warm cookies is a Team Ggirl event that's a win-win for everyone and is not necessarily a reflection of how much I've endeared myself to my coworkers.

That completely halted the workers' comp paperwork fiesta, which just means I have to focus on it immediately tomorrow, along with getting my biopsy slides sent to M.D. Anderson. There will be plenty of faxing going on. I got a call on Friday from my dermatologist's office, letting me know they sent the biopsy results, instead of the slides. No one told me that's what they were sending. Nor did they tell me whom to call to arrange it for myself.

I have a late afternoon appointment with the dermatologist tomorrow. I'm sure we'll be covering all of this. That means my last day of Crazy Land will be a short one. That would be great, but my tasks require more time than I may have at my disposal.

I guess that's another antidote to anxiety. Owner asked me today how I got all of the new insurance stuff taken care of. "I worked my ass off." I will be working said ass off again tomorrow. Lots of the workout will be personal, so I don't suppose complaint is in order here.

The upshot is that I may be away for a while from my online friends and my own weblog. Rest assured that all is well and all shall be well and all manner of things shall be well. (Bowing to Julian of Norwich.) I'll see you when it's all over, if not before.

P.S. Sorry for the wholly unimaginative title line. What can I say?

Think. Who, me?

2007-08-17T20:08:00.000-05:00

Craziness abounds, even over and above my daily sojourn in Crazy Land. Crazy Land continues to spin, though, and I'm definitely caught in its many manifestations of nuttiness-inspired stress. My anxiety about getting everything accomplished before my Wednesday departure is significantly diminished. Nonetheless I'm always aware of the endless shiver of anxiety burrowed under the level of my daily consciousness.

In the middle of conversations, I suddenly notice the lunacy in my voice. The more I try to tame it, the loonier I sound. Very disconcerting. I wish I could preface every interaction with an explanation that I'm soon having my fourth surgery in two years and that I'm therefore virtually unable to think clearly. As a matter of fact, I'm virtually unable to function.

Now and again, it strikes me that, since everyone around me seems to expect me to continue on as usual, I should most certainly be able to do that. Maybe I should be able to, but my mind periodically goes blank. The brain keeps track of pain and it will not be distracted from another imminent physical insult.

"How can you possibly expect me to do anything more than arrive at work and stay there for 8 hours," I think. Actually accomplishing things is simply completely out of the question.

Sometimes there's no choice. I've had the infamous "roll out" to orchestrate, a major coup considering the daunting amount of information not available. It's been a struggle to simply find out how many sites each manager services and how many employees are at each site. Is it any wonder my mind goes blank from time to time? It's a little like a cultural adaptation in this case. Everyone else is in some information-deprived haze. I'm just doing my part to fit in. Now there's a good excuse.

When it rains workers comp claims, it pours. Unfortunately, lately it's been pouring guys who've chosen to not report their work-related injuries for a week or so. The amount of paperwork alone that has to be generated and disseminated wears me out, even when reporting is prompt. When our employees wait to illuminate anyone about their hurties, my work becomes even more time-critical and positively stuffed with paper to be printed, faxed, copied, printed again and mailed to several people.

Last but certainly not least, I've been having serious issues with my dermatologist's office. When I visited, at their insistence, to discuss my diagnosis and treatment, the nurse practitioner was completely useless. No need for treatment, or maybe there is, who knows? Nonetheless, they called to make a six-week follow up visit. I also have an appointment with the doctor herself on Tuesday. To top it all off, I've been unable to have biopsy results successfully sent to Dr. Ross.

See? This is another moment when the mind goes absolutely blank. I have no idea what to do now. The nurse tells me to call the Pathology Lab and arrange it myself. They might have shared that with me when I called last week specifically to have them do that. I can't. The new hill of endless paperwork seems too big to climb at the moment.The noise you hear is my head as I beat it against the wall.

Inflammatory Breast Cancer

2007-08-15T11:38:00.000-05:00

http://toddlerplanet.wordpress.com/2007/07/23/inflammatory-breast-cancer/

Important information about inflammatory breast cancer from a woman who knows. She's amazing. Check her out.

Things You Can Be Sure Of

2007-08-13T15:02:00.001-05:00

"Everything Must Change" recorded by virtually everyone, my favorite of whom is Nina Simone.

Everything must change
Nothing stays the same
Everyone must change
No one stays the same

The young become the old
And mysteries do unfold
Cause that's the way of time
Nothing and no one goes unchanged

There are not many things in life
You can be sure of
Except rain comes from the clouds
Sun lights up the sky
And hummingbirds do fly

Winter turns to spring
A wounded heart will heal
But never much too soon
Yes everything must change

The young become the old
And mysteries do unfold
Cause that's the way of time
Nothing and no one goes unchanged

There are not many things in life
You can be sure of
Except rain comes from the clouds
Sun lights up the sky
And butterflies do fly

Rain comes from the clouds
Sun lights up the sky
And music
And music
Makes me cry

"Everything Must Change," Bernard Ighner

Time is limited these days. I'm trying to clean up a workers comp mess left by Loathsome, "roll out" a new workers comp insurance program and forestall the complete rewriting of the employee manual. Patience is also limited. So is emotional stability.

I cry at least four times a day every day. Today has actually been a really good day. It's 2:00 p.m. and I've only cried once. Crying is impromptu, it's always a surprise. Just thinking about crying can make me cry. I'm loads of fun to be with.

Every once in a while, the thought breaks through, "I'm having surgery on the 29th." That's when things really start to get out of hand. Every surgery is cause for new terror, if only because every surgery still hurts. I never cry when I see it coming. I do, however, freeze for a moment or two and wish there were some way to escape this life I've been assigned. The thought of another surgery is dumbfounding.

I'm out of sorts these days. Everything seems bleak. The future seems not worth living. I wonder why I tried so hard to stay alive. What exactly did I have in mind? Did I believe things will someday improve in my life in any meaningful way? If that's what I thought, I can't imagine why I believed it.

I'm angry at the universe. I keep thinking back, wondering what it was exactly that I did to deserve my impossibly difficult life. It's not just the breast cancer. It's the years and years of physical, emotional and sexual abuse. It's the rape. It's the suicide. It's the job I hate that just won't stop. No matter what, I have to be here. All of those things seem beyond the boundaries of good taste when heaped upon one small person who's made a lifetime career of not passing along the violence and pain.

I'm a good person, a gentle person, a person with enormous compassion. As if that counts for anything. I'm sure there's some purpose to all of this accumulated suffering, but lately I'll be damned if I can see what it might be. Oh. I know. I've been sent the plague of my existence to create the possibility for gentleness and compassion. It's a mighty big price tag and one that I don't feel much inclined these days to continue to pay.

Last night, I watched a program on the travel channel called "Jeff Irwin Inside Alaska," or something like that. The vast, primeval spaces reminded me of why I don't matter. As I watched bears tearing apart salmon they'd just caught in the river, I kept thinking, "Something dies so that something else may live." That seemed comforting somehow.

Over the weekend, I though a lot about the gift of seeing the end in advance. My life seems broken beyond repair, my body wounded forever, my mind diminished. The changes are irrevocable. It's the coming attractions, folks.

Unless we've somehow managed to find a quick end, death invites us to leave in tiny increments. We lose a little of ourselves, a little of our joy (assuming we ever had any) moment by moment. Alaskan brown bears die because they have cavities in their teeth. They suffer, dying bit by bit. We do, too. Right now it's not so much the leaving that bothers me as the slow, painful journey to get there.

Day after day. I get up and come to work. My body hurts. I "roll out" workers comp insurance. I cry about the pathos of the universe. I fill out forms reporting an injury. I rage against the injustice of the universe. I proofread invoices and wonder when my damn copies are going to be ready to be picked up at the local FedEx Kinko's.

When I look at it that way, it makes me laugh. I'm feeling dramatic today. It's nothing a good surgery won't cure, though.

What's the Diagnosis, Anyway?

2007-08-02T15:00:00.001-05:00

There are two possibilities for what's wrong with me. Either I have morphea (a rare type of scleroderma) or I have morpheaform basal cell cancer. Obviously, I'm hoping for the latter. Unfortunately, from all of the credible sources I've found on the Web, neither of them match my symptoms. We've got a biopsy, though.

Morphea is an extremely rare type of scleroderma, occurring in approximately 25 in one million people per year. It's characterized by red or purple splotches that gradually turn whitish. I assure you that if I'd had red or purple splotches running down either side of my spine, I would definitely have noticed. Unlike generalized scleroderma, it will not kill me. That's a plus. No one knows what causes it. It's not hereditary.

I don't even want to talk about morpheaform basal cell cancer. Will that kill me? Oh yeah. You can see why I'd prefer the first diagnosis.

I've been searching for information, obsessing, being absolutely crazy about it. Everyone assures me they would be, too, given my breast cancer diagnosis. Originally, my dermatologist had scheduled an appointment for me on August 21 to discuss the diagnosis and treatment options. This is after they rather frantically tracked me down to tell me the doctor wished to see me. It's not like I didn't make myself very available. There are two numbers where I can be reached and both have voice mail options.

I'm supposed to see Dr. Ross on the 23rd of August, so I contacted him and I'm having biopsy slides sent for his review. I started to think that was a really stupid idea and that I should just cancel the message I left asking for instructions on how to do that. My mother, my therapist, my co-workers all insisted that I shouldn't have to wait that long to find out what's going on. Furthermore, if biopsy results aren't examined by a pathologist at M.D. Anderson in advance, Dr. Ross will have no ability to make a reliable diagnosis. You know how I trust this man, so even if it's totally crazy and stupid, it will at least ease my mind to have his opinion.

Meanwhile, physical therapy continues. There are numerous places on my body, both inside and outside that have scar tissue build-up that we're trying to break down. I was surprised to find out that I even have scar tissue running from my groin to my new girl from the drainage tubes I had to have after reconstruction. Obviously, my upcoming surgery will only create more scar tissue.

Breaking up scar tissue is painful. Now there's a surprise. Has anything in the past two years not been painful? Hell no. It's all relative, though, and it's far less painful than the needles-in-the-breast episode and the whole reconstruction (so far) ordeal.

I have exercises to do every night to get my lymphatic system up and running. Then I have to use a hand-held massager to work away at that scar tissue. That's in addition to the twice weekly manual manipulation with the physical therapist.

It feels like virtually every working moment is dedicated to some sort of body maintenance or bodily healing or trying to get my records sent here and there or trying to get an earlier appointment. I could go on and on.

But I won't. I spend so much time now in my weblogs cataloging the latest events that I never get around to how I'm feeling inside these days. I guess there's not much point in examining it. I'm emotionally ragged and exhausted. I'm so stressed out that I'm barely functional. Maybe tomorrow I can think about that a little more and feel it a little more.

Right now, I'm going home to eat something and work out to manage my stress level. Manage. There's a laugh. There's no managing to be done; I'm just trying to get through this. I don't think that counts as actually coming to terms with anything.

With any luck, I'll have enough time tomorrow in between resolving more medical issues to chronicle the latest emotional debacle.

Things Can Always Get Worse, Part 57

2007-08-01T08:36:00.000-05:00

Note: I attempted to post this yesterday, but it disappeared into cyberspace.

I got back from physical therapy a few minutes ago to find a message from my dermatologist's office. You know, I'd already decided that everything was fine and I'd just have stitches from the biopsy taken out text week and be on my way. Wrong again. Something is wrong. The message said they'd been trying to get in touch with me and want to set up an appointment to discuss my "diagnosis and treatment."

You know they're not going to tell me anything over the phone. They never tell you anything over the phone. I don't think it's skin cancer because I've never heard of skin cancer manifesting that way before.

Nonetheless. Things can always get worse. Can I put that on my headstone? I'd prefer to be cremated, but maybe they could just put a headstone in some random, unfilled corner of a cemetery. It wouldn't have to be big, obviously.

If not "Things can always get worse," then I'm considering just "Fuck you."

Keep you posted on the fun new developments.

Skin Biopsy Results

2007-07-31T12:51:00.000-05:00

If not "Things can always get worse," then I'm considering just "Fuck you."

Keep you posted on the fun new developments.

Skin Biopsy and Self Injury

2007-07-23T14:35:00.000-05:00

I had an appointment with my radiation oncologist on Thursday morning. He diagnosed the pain and swelling as localized lymphedema. I'd considered that possibility before, but my several sources of information only mentioned swelling down the arm, not under the arm. I don't understand why sometimes it's localized and sometimes it isn't. He said that physical therapy might be very helpful and referred me to a clinic here in town. They're supposed to contact me sometime this week. I'm enormously relieved that it's nothing more serious, although lymphedema, untreated, can produce disastrous results. It's also really unattractive.

Thursday evening I fell four times. Four times. That's excessive, even for me. I'm not sure why I fell the first two times, although I think all of them may have been a result of having my eyes dilated earlier in the day. I had an opthamologist check the progress of my macular degeneration. (It didn't get any worse--Yay!) It's possible that, even though it seemed my vision was back to normal, there may have been some depth perception distortion.

Anyway, the first couple of times I fell I was just walking around in my house. I didn't sustain any injuries. The third time, I misjudged the two steps down from my bedroom into the living room, slipped and sprained my ankle. Within about an hour, I was going through the den to let Andy the Demon Dog outside, fell and bruised my knee. Both the huskies' crates are in the den, but his is close to the path to the back door. I usually keep the crate door cracked so he can go in if he wishes. I've had disastrous encounters before with the wide-open crate door and I'm actually a quick study when it comes to ways to prevent collisions. I've had a lifetime of practice.

I guess Hubby left the crate door wide open and I didn't turn the lights on in the den. Too much time and trouble to turn on lights, you know. I slammed into the door with my knee and just collapsed on the floor. Luckily, the knee wasn't sprained, too.

Earlier in the evening, I accidentally whacked my head against a cabinet door. I have a bruise on my nose and forehead. They're not bad; they just look like maybe I'm not the most fastidious person in the world. My husband thinks I'm trying to get him arrested for assault. (Note I did not say "domestic assault." I think it minimizes the crime.) The most amazing news? I did not go to work. I always go to work with sprained ankles. Yes, I have them rather frequently. I think it runs in the family; my mom's ankles collapse for no apparent reason.

Today, I had my annual skin cancer check with my dermatologist. She found an area on my lower back that looked a little weird. It wasn't a mole or anything like that; it was a gray area that spread across my hips. We did a biopsy; results expected within 3 to 5 days. I'll have to have stitches taken out in a couple of weeks.

The great news here is that if it turns out to be something scary, my beloved Dr. Ross is an accomplished skin cancer surgeon. As a matter of fact, he consults throughout the country on difficult cases. Lucky me. Have I mentioned lately how much I love him?

Last Wednesday was Hubby's birthday. I was confused. I thought it was Thursday. Good move. I don't know--I was confused about the date all last week. Who am I kidding? I never know what day it is. I mean I'm not even sure if it's Tuesday or Thursday. It's either the monotony of daily life or the lingering effects of chemotherapy. I like the latter explanation later.

I'd already bought a gift for Hubby, so I was clear on that count. However, I didn't wish him a happy birthday until he pointed out to me that I should have. I noted that he forgot our wedding anniversary last year. We're even now.

Aside from giving you a blow by blow account of the numbers of loads of laundry I did this weekend, that about wraps it up. How timely. It's only about ten minutes before I get to go home. I'm working on being much more entertaining in the days to come, so don't give up on me now.

Distractions

2007-07-18T14:55:00.001-05:00

"Her mind lives tidily, apart From cold and noise and pain, And bolts the door against her heart, Out wailing in the rain." ~ Dorothy Parker

I just ate an apple without washing it. Do you suppose it will kill me? Big ironic smile here. My dark sense of humor has grown much darker the past couple of years.

I finally broke down and called the radiation oncology office yesterday. They were busy, of course, and the recording suggested I leave my name, number and what hell I was calling about. I did that. Have I heard anything? Hell no. With the help and encouragement of my online friends, I overcame my fear of seeming like a crazy hypochondriac and called. Thanks so much for getting right back with me about the pain and swelling, cancer guys. I guess they figure those two things don't necessarily mean anything that will result in imminent death, so no rush.

I can't recall whether the oncology office recording said they'd get back to me within 24 business hours. That's the usual standard these days. It's been 24 business hours now. Maybe I'll have to call back, just to check. I don't want to miss the opportunity to give people an enormous amount of trouble about breaking the 24 hour rule.I'm generally such an empathetic personality that I'm willing to cut people an enormous amount of slack. However, woe be to those who overestimate my level of good will. Ask the folks at Holiday Inn. They can attest to that fact.

As far as I can tell, I'm not overcome with anxiety anymore. God only knows what's going on beneath the level of ordinary consciousness, though. Nothing like having a brain that walls itself off automatically to protect against unwanted emotion. Generally speaking, though, it requires that I put some active effort into it.

There are all kinds of thoughts and fears that I examine, then put aside into little individual compartments in my head. "I'll just get back to this later," I think. It's highly conducive to the ability to function, no matter what. Thank you, crappy childhood. Of course, it's not the most mentally healthy way to deal with things, I've been told.

From time to time, when I talk about moving problems over to their own little room in my head, my therapist asks me how I do that. I have no idea. I do know that there have been times when keeping things in those compartments requires visualizing many locks and an occasional barricade. I've been able to count on the locks and barricades when it's absolutely necessary.

All of that is a clearly pragmatic decision to put things aside until later. As I mentioned before, sometimes my brain kindly moves fear and anxiety directly to secret places without any effort whatsoever on my part. Sooner or later, though, the gates somehow open and I'm flooded with the memories, thoughts or emotions that have been hidden from me. The surprise is invariably unpleasant.

I think everyone does that to some extent. There are all kinds of nasty things floating around in what Freud would have called the unconscious. I'm not a big fan of Freud's view of the world, but when he's right, he's right. Carl Jung (among others) agreed. He's much more palatable to me.

For instance, I suspect that each of us harbors ill-will towards others, even though we may never perceive it. We might vehemently deny it, as a matter of fact. When I clearly see into what Zen Buddhists call "Hatred Mind," I always find some previously buried hatred, resentment or anger. It requires "opening the hand of thought" to find Hatred Mind and what lies within it. I try to be benevolent towards everyone, but I'm not seduced by that desire.

Freud would say there are shameful desires, primeval fear, unassailable rage that we're incapable of confronting because they pose unspeakable danger to our psychic wholeness. It's sort of like the mind-splintering direct encounter with the divine, alluded to in every spiritual tradition of which I'm aware. The infinite, though blindingly loving, is too much for us to bear. Wholeness can lead to madness just as surely.

Notice how I veered off into theoretical exploration? That's my brain offering up distraction and solace. Every once in a while, I can see it as it happens. It no longer matters to me, at this moment, whether the sacred 24 hour rule has been violated. I'm still stuck on the idea of hatred mind and the mystical meeting of humanity with infinite love.

The Outskirts of Consciousness

2007-07-17T11:00:00.000-05:00

"I've been trying to get as far away from myself as I can," "Things Have Changed," Bob Dylan

I tried calling in sick to Life. "Hello, Life? I'm not myself today, so I won't be coming in. I'm sure I'll be back tomorrow." Life does not accept those kinds of calls. I'm reduced to living on the outskirts of consciousness, tamping everything down and floating around the edges where nothing serious lives.

I'd love to take a vacation from myself. I get that old claustrophobic feeling I had after my last surgery. If only I could rip some part of myself open and step out of this body for a while. Or if I could just scream long enough, maybe all of the anxiety would drain away.

I've written several posts and abandoned them or saved them for some day when I can concentrate. I haven't been visiting my friends online. It feels like half of my brain is dead. Maybe more than half. I spend my Crazy Land days trying to work on the database, but it all seems so complex and unfathomable. I haven't accomplished much.

I've been crying at the smallest of things. Even writing that sentence makes me teary. I become enraged at unpredictable moments. When I'm not enraged, everything irritates me. So, let's see...crying, then being enraged, then being irritated, then back to crying with a little irritation mixed in. I've got my own private Crazy Land going on in my head. No one pays me for showing up every day, though.

My mother seems to call me every 15 minutes. I love my mom, but get off the damn phone already. I had a psychobitch meltdown with Hubby yesterday. I'm sure he'd like to get away from me almost as much as I would. Crazy Land is easy. I'm in my office where I pose no danger to anyone else. If I don't see them, I don't yell at them. I don't crumple up into a little ball and cry at the copier. I don't expect them to understand where I'm living these days.

Most of the time, though, I'm able to keep it together. I chat with people, I read, I listen to music. I do not talk about fear. I try not to engage fear on any level. My inner debate continues: Am I being crazy about the mass under my arm (and the pain and swelling) or does it make complete sense that it terrifies me? The question arises regularly and just as regularly, I push it away.

It's one of those times, I suppose, when no one can help me out of this. Why don't I go to see my radiation oncologist, people ask me. I don't know. I don't want to. That would require that I allow fear a free hand in my consciousness. Maybe I just don't really want to know what's going on. Maybe it's stupid to even think I need to see him. If I see him, won't he just tell me he doesn't know what's causing the problems, that I should give my oncologist a call? Or maybe he'd tell me to get over it. Hell, I can tell myself to get over it without having to shell out the $15 copay. Maybe if I just wait a little while longer and keep the panic corralled, my logical brain can get control over things and I won't have to go at all.

Anguished. That's the word. If I had to sum up everything going on inside me, that would be it. Feeling it is almost more than I can bear. As I type these words, there's a voice inside reminding me that my problems are small compared to most people's. There's a whole lot of suffering going on in the world.

I either need to get some greater perspective on my problems or open my heart and mind to the anguish. I should observe the fear and rage and sadness. I should note how they feel to this physical body. Mindfulness meditation. Maybe I can get around to that later on. Not now, though. Right now, I'm going to summon the energy to push it all away again.

Ignorance and Insensitivity

2007-07-11T14:08:00.000-05:00

"Consider that thou dost not even understand whether men are doing wrong or not, for many things are done with a certain reference to circumstance. And, in short, a man must learn a great deal to enable him to pass a correct judgment on another man's acts. ~ Marcus Aurelius

Warning: If profanity offends you, stop now.

Want to know what offends me? Continuing conversations with my co-workers about Elizabeth Edwards. Not only does it offend me, it enrages me. The owner of my company just called me to advise me again that he doesn't believe Elizabeth Edwards should be out campaigning for her husband.

I muzzled my rage and told him, in a reasonable tone of voice, that I've given her circumstances a great deal of thought. I don't judge other people trying to endure cancer, especially when it's clear that ultimately they will not survive. Even if it seems like they will survive, no one and I mean no one, has the right to make those judgments. Especially when you have not experienced the disease yourself. I don't mean just reading about it or watching documentaries about it or even knowing someone who has it. When you have walked the walk, then and only then, do you have the smallest scintilla of right to criticize others who are just trying to get through the fucking day. How ever they can.

"Well, I just think it's a matter of priorities. They have children, you know." he said.

No. Really? They have children? What would you have her do, sit around her house all day, waiting to die while her children crumble? You don't know. Maybe you would do it differently, but here again, you don't have fucking cancer. So shut up.

What would I do if I knew with certainty that death by cancer was going to severely limit my time with my children? I have no idea. I know I used to have a lot of ideas about how to get through the struggle, even shortly after my diagnosis. You don't know until you get there. I don't know what I would do. How can so many people in my office be so deluded as to think they know? Well, aside from being judgmental assholes, of course.

If you don't like John Edwards, I don't give a fuck. Campaign against him. Vote against him. I don't have a horse in this race. Don't call me up to argue with me about his "arrogant campaign tactics." Allow me to repeat myself: I don't give a happy goddamn about John Edwards. He doesn't have a snowball's chance in hell of winning the nomination, in my opinion. People do not contribute to political campaigns out of pity, in my opinion. (This is politics--anyone can have an opinion as to the mechanics and outcomes of political campaigns.) Who the hell are those people? Find some for me, provide me with some reputable sources of information on that score and I might be willing to change my mind. That really isn't the point. Judging someone who's dying of breast cancer, who's going to endure an enormous amount of pain (including the certainty that your children, young and adult, will have to live their lives without their mother--that's the point.

Furthermore, could you just stop talking to me about this? I'm emotionally ravaged by two years of doing whatever I had to do to get through it, sometimes sixty seconds at a time, because that's all I could manage. I have this weird thing going on under my arm. Everyone here knows that and, even though I don't wander around with a worried look on my face, cut me some fucking slack, could you? I expend an enormous amount of energy every day trying to keep my own internal debate at bay. "Oh of course it's fine. Silly me," alternating with, "Fuck! This is how it happened the first time. Why is there pain and swelling? Why is there that hard mass?" I do not have the extra energy to stuff all of that back down just because my co-workers think it's their right and duty to express their ignorant opinions. To me. If you'd like to talk about it, if you think you must, talk to someone else.

I've asked that people not talk to me about it. I've asked politely and patiently. I've told them it makes me anxious. I've walked away when they ignore me. I sincerely hope that no one here (or anywhere) has to find out what it feels like to actually experience this disease. In these circumstances, I say that with a certain amount of bitterness. When and if my esteemed co-workers wake up to their own cancer diagnosis, they can come to their own conclusions about the behavior of everyone else with the diagnosis.

Until then, fuck off.