As Ready As I'm Going to Be

January has been an eventful month for us. Rick is healing up nicely from his surgery and Zoe is progressing with her recovery too. We've posted Sasha's info and picture on three lost pet sites, posted flyers around the neighborhood and contacted the shelters. Meanwhile Gypsy keeps watching for Sasha to come back through the hole under the back fence.

My FMLA was finally officially approved, which is a huge relief (Thank you Lord!) Rick has helped me get some housework done. I've bought some soft seamless, wireless bras that I hope will be comfortable during my recovery and should come in handy during radiation later.

My lumpectomy surgery is the day after tomorrow. Our son, Paul, took the day off so he can pet-sit, which will be a big help and no small task, especially with one dog still recovering from her own surgery. Wednesday promises to be a very long day and a boring one for Rick. He'll take me to the Methodist  Hospital at 8:30 AM.

After being admitted, I'll start my day in the nuclear medicine department, where they'll inject a radioactive isotope to help the surgeon locate the sentinel lymph node. The sentinel lymph node is the first lymph node under the arm that the cancer would have spread to, if it has spread into the lymph nodes at all. That node will be removed during surgery so it can be biopsied. Additional lymph nodes may be removed if they are closely clustered with the sentinel node or if they look suspicious to the surgeon. Lymph node status is a major indicator of my prognosis and determines whether chemotherapy will be recommended. None of my lymph nodes are noticeably enlarged, so I'm cautiously optimistic about this.

After the isotope is injected, a radiologist will do the wire localization / bracketing so the surgeon will be able to locate the tumor with precision and remove it plus a margin of tissue around it. After all this high tech preparation is done, surgery should start around 2:00 PM and is estimated to take about 90 minutes. It won't be like some of the dramatic TV episodes you see where the surgeon comes out and announces to the relief of the anxious family, "We got all the cancer!" I will get the info from the pathology report Monday or Tuesday of the following week, although if there are any preliminary partial results by Friday, I could get that information before the weekend.

After spending time in the recovery room and then in observation, I expect to go home Wednesday evening. Kelly will be coming in late Thursday night from Dallas and staying the weekend. It will be so nice to have her here while I'm waiting to get the results of the pathology report. The pathology report will tell us the lymph node status, whether or not the margins of the tumor were clear, and the "staging" of the cancer more accurately than the biopsy report did. 

Statistically there is about a twenty percent chance that the margins will not be clear, which would mean going back in to have a second surgery. That surgery, if it happened, wouldn't be such a long involved process as the first one. My hairdresser, Erica, says that her mom had that experience and it really wasn't  too bad and she's doing fine four years later. I'm inclined to trust a woman who named her daughter Erika, even if she didn't know how to spell it.

My daughter, Erika, whose name is spelled correctly, will be coming in next Tuesday from Iowa and should be able to stay a whole week. That's long enough to really start missing her husband and children before she leaves, but I'm sure looking forward to having her here.

My heartfelt thanks to all of you who've been encouraging and praying for me, and to the friends who've shared their own breast cancer stories with me. I hope mine will be a help to someone else someday.

In this, as in everything, my life is in the hands of a loving God and I know He'll see me through, come what may.

Sunshine in My Forecast

Yesterday I got some of the happiest news I could imagine. Both of my daughters are coming to visit soon after my surgery. I wouldn't have asked them to. I don't expect my lumpectomy to be a big deal physically and don't think I'll  need much in the way of practical help that my husband and son wouldn't be willing and able to take care of. Both of my daughters have full, busy lives with families of their own. I never would have asked them to come or wanted them to feel like they should.

But, oh, how it lifts my spirits to know my girls are coming! Some of the happiest times in my life are the times I've spent one-on-one with each of them and times we've all three spent together. Neither of them has lived in San Antonio since they got married.

Kelly and Greg have lived in Dallas, Iowa, Kansas and now back in Dallas, where they are raising their three daughters, two of whom are teenagers, and where Kelly works full-time as a speech therapist.

Erika married the son of Kelly and Greg's former next door neighbors in Iowa, so Erika has lived all her married life in Des Moines where she and Darin are raising two active high-energy preschoolers, one of whom has special needs that require them to stay one step ahead of her just to keep her safe.

I am so thankful that both of my sons-in-law are encouraging and helping my daughters to come visit me. This is no small sacrifice on their parts. And I'm also thankful for their friends and in-laws who are also helping to make these visits possible.

Now if you'll indulge me in a little nostalgia, I hope you'll enjoy these pictures as much as I do.

April 1981

 October 1981

1987

1992

1995

2001

2012

How I love those daughters of mine!

All Creatures of Our God and King

I've been thinking that if God's eye is on the sparrow, His eye is also on little cats who are out trying to catch sparrows for lunch.  Thinking about that is comforting to me and encourages me to keep praying for our little lost cat. I keep calling her little, because she only weighs about five pounds and that's how I think of her.

She's little like Granny from the old Beverly Hillbillies show was little, though. She's old and bold, small and scrappy, a survivor. She thinks humans exist to meet her needs and I have no doubt that when she feels a need, she'll approach a human and loudly demand to have it met. Anyone who tried to take her in would probably be getting more than they bargained for.  I think of Sasha as our cat, but she's only been our cat for one of the more than ten years of her life. We're glad at least that the weather has been so nice since she went missing.

Since Sasha left, Gypsy, our mixed breed dog who we also brought home from the shelter, has taken up an interesting habit. She's been lying on the back patio a lot, eyes wide open, scanning the area where she may have last seen Sasha go through a hole under the fence. Gypsy is probably nine or ten years younger than Sasha. She must have a lot of some herding breed in her, because she has strong herding instincts. She doesn't accept the fact that you can't herd cats and she never stops trying.

Sasha tended to bully Luna, so I'm not sure Luna misses her very much.

Meanwhile, we're pleased with how well Zoe is doing after her surgery. If she were human we'd recognize her surgery as a much bigger deal than either Rick's recent hernia repair or my upcoming lumpectomy - more physically traumatic and harder to recover from. We're getting her out for walks daily, increasing the time gradually, and she's slowly starting to bear more weight on that hind leg. We're still giving her pain medication daily and keeping a close eye on her to try to prevent her from hurting herself by falling or jumping.

With Sasha gone, Penny is once again the senior pet in the household. She's the leader of the dog pack anyway and hanging onto that position by a thread. It's a tiring job, but someone has to do it.


These animals add so much to our lives.

All creatures of our God and King,
Lift up your voice and with us sing...

 Let all things their Creator Bless,
And worship Him in humbleness

- Francis of Assisi

Peace and Perspective

I'm feeling so much more peace now. I'm thankful to have family and friends praying for me.

Of course I'm sad and anxious that our little cat, Sasha, is missing and I hope she's not gone for good. I brought her home a year ago from a shelter. She has seemed so at home with us spending her evenings sitting in my husband's lap, waking us up early in the morning for breakfast, rubbing her little head against our hands, purring endlessly. We've treated her for ear infections and bought expensive special food for her because of her digestive problems. But she's probably over ten years old and who knows how many other families she's lived with or how much of her life has been spent fending for herself? Two days ago she went out the dog door, which she started doing months ago. I had intended for her to be an indoor cat, but she figured out the dog door and seemed to enjoy just puttering around the back yard and sitting in the sun. About a week ago I noticed her go through a hole under the fence, but she came back pretty quickly and  I realized she might have done that before. I know lots of pet cats are outdoor cats and do just fine. Being a cat mom is still relatively new to me. Some of  my friends have told me their cats take off for days at a time and always come home, but I still I find myself worrying about Sasha and praying that she'll be alright.

But mostly I'm feeling more peaceful than I was yesterday. I still don't know what's going to happen with my FMLA claim. We faxed paperwork to the doctor's office again and are hoping it's the right paperwork this time and that they fill it out to the insurance company's satisfaction. I probably won't even know if it's approved until after surgery, but I'm determined not to worry about it anymore.

Either way, I am going to have surgery on Wednesday, I have health insurance to pay for it, my cancer was caught early, I have over 200 hours accrued sick time, don't expect to need anywhere near that much and even if the FMLA doesn't come through, I'm sure I wouldn't lose my job for taking time off for cancer surgery. I just don't want to fret about it anymore.

After my surgery I'll come back to a comfortable home and a loving husband and son. I hope Sasha will be here, but there will be at least four other furry friends to welcome me home.

I am reminded once again of my many blessings.

I was reading about how people in underdeveloped nations have such higher death rates and suffer so much more from all types of cancer, because it's seldom caught when it's treatable and there aren't many treatment options available to them anyway. That helped give me some much needed perspective.

God's Got This

Today, I, a customer service representative, make that a senior level customer service officer who takes escalated calls from other reps, yelled at a customer service representative of the insurance company who handles FMLA for my employer. I lost it and I'm not proud of that. I was immediately sorry and wanted to apologize, but I didn't get a chance to. Apparently she was not trained to take rude, yelling customers in stride like I have to in my job. She started lecturing and threatening to disconnect my call if I yelled again, which I hadn't planned on doing, so I just hung up in shame and frustration. Then I did something I haven't done since I was diagnosed with breast cancer three weeks ago. I cried. For a long time.

Bear with me as I backtrack over what led up to this and I know I'm being redundant here. A blog is a great outlet for venting selfishly and I'm afraid you've stopped in on my pity party. My employer changed medical insurance carriers for 2013. I had opted for a more expensive (to me) but lower deductible plan knowing that my husband needed hernia surgery, but having no idea that I would be diagnosed with breast cancer on January 2. For the first week and a half of the new year, insurance company H had no record of us in their system, not when we called, not when our doctors offices called to try to verify coverage. Needless to say, this resulted in much frustration and wasted time on the telephone. That was finally resolved, Thank God, no really, I do thank God for that.

While that was going on, my supervisor encouraged me to call insurance company A, who handles Family and Medical Leave Act claims for our company. He knew as well as I did that regardless of how much sick time I had accrued, I would need to have my absence for surgery and recovery certified for FMLA in order for the absences to be "job protected." So I called insurance company A and told them I thought I'd need "Intermittent FMLA" since I knew I'd miss time for surgery, recovery, followup appointments, pre-op appointments, radiation treatments, etc. I got the paperwork from them, filled out my part of it and took it to my surgeon's office. When I talked to them a few days later, they told me that all they could certify was the day of surgery and continous time for recovery afterward, not intermittent absences. Fair enough.

I called insurance company A back and told them I had been wrong, I didn't need intermittent FMLA; I needed about two weeks for surgery and recovery. Brenda, the rep I talked to that day told me that what I needed was short term disability and that she would cancel my FMLA. (Today I found out that this is where the real problems began. She was wrong. All I needed was continuous FMLA. I don't even have coverage for short term disability nor do I need it.) Brenda transferred me to Frank, who kept me on the phone for about 20 minutes taking information that I had already given previously for the FMLA, but that didn't seem too unreasonable. Then I called my surgeon's office back to tell them to shred the paperwork I had given them and that I'd get the new paperwork to them when I had it.

Then I waited for the new forms to arrive by mail or email or for a new claim to show up on insurance company A's website. I sent several secure messages that seemed to go into a black hole. Finally I called back two days ago to find that nothing had been done on their end. Over the past 48 hours I've talked to at least a half dozen of their representatives, received and printed out three sets of forms, two of which were the wrong ones, and spent hours working on this. As of last night I thought maybe this was finally going to be resolved.

Then this morning, just as I began my work day, I got a cell phone call that went to voice mail. It was "Sean" an A insurance company rep calling to talk to me about my claim for...completely wrong dates. Anyone who has ever worked a call center job knows that every minute spent off the phone has to be documented and explained and I've had to document lots of minutes like that recently. This is Thursday and my surgeon's office only fills out this paperwork on one day a week: Friday. Tomorrow is the last Friday before my surgery. I got off my work phone, emailed my supervisor to tell him why, checked my cell phone voice mail and tried to call Sean back.

When I finally got through the automated system to a live rep, I told her that I was returning a call from someone named Sean. She was not Sean, but asked for my name, date of birth and claim number and then proceeded to tell me that they had a helpful website that could be used for most concerns people might call about. That's when I yelled. They have told me this on every one of the countless phone calls I've made  trying to resolve an increasingly more convoluted situation that the website offered no help for. So this time, when the representative started off by telling me that again, I lost it and yelled, "PLEASE, don't go there!" .

I get yelled at multiple times a day in my job, sometimes cursed at and called names, but I don't ever want to treat anyone else that way. That insurance company representative was not personally responsible for the mistakes others have made and she didn't deserve to have me take out my frustration on her. It still pains me to think about it, but I've asked God's forgiveness, not only for raising my voice, but for the attitude that led me to do it.

After that phone call and after I spent some time crying and praying, I was calm on my next phone call with yet another representative, but they never did get things sorted out. Two emails, one more secure message and another set of forms later, I finally called my HR department. They intervened and they think the problems are resolved. I'd like to think that the paperwork Rick faxed to the doctor's office for me yet again today will result in my FMLA being finally approved so that I can use two weeks of my own accrued sick time for surgery and recovery. I wish I could tell you that when I go to bed tonight I'll be confident that the issue is resolved. But I'm not counting on Brenda, Frank, Colleen, Jessica, Ken, Laura or Sean from the insurance company or my HR department or my doctor's office staff to make this happen.

As my niece, Grace, often says, "God's got this." At some point today I finally remembered that.

Now one of our cats has gone missing. I'm praying that God's got her too and will bring her home to us safe and sound. If you are a praying person, I'd appreciate it if you'd pray for Sasha too.

Weary Wednesday

More phone calls today, more secure messages, faxes and emails sent and receipts copied. More time after work documenting the few absences I've had so far. It's amazing how much time and effort it takes to actually be able to use accrued sick time and employer sponsored benefits like health insurance, short term disability, flexible spending accounts for medical expenses. Of course I'm working full time so this is all being done after work or on breaks.

I'm weary and feeling overwhelmed now at the end of the day. I can't imagine how exhausting and stressful this would be for anyone who was actually feeling the effects of their illness, which I am not. I know I've been dealing with stress by eating too much junk food.

Of course I've also been taking care of Zoe after her orthopedic surgery last week

and trying to prevent Rick from needing to lift anything over ten pounds in the aftermath of his surgery not quite two weeks ago.

I'm still glad they were both able to have their surgeries and be well on the road to recovery before mine.

My surgery is a week away and today a nurse from my surgeon's office called and spent a long time with me going over information about what will happen the day of surgery and afterward. She was very kind and helpful.

I'm still hoping that sometime before surgery I'll have time to get the house cleaned.

Sweating the Small Stuff

If there's anything that irritates me more than breast cancer it's dealing with insurance. Don't get me wrong, I'm truly thankful that I have it. It just takes a lot of work to take advantage of it sometimes.
 
It started with our medical insurance company having absolutely no record of us right when my surgeon, Rick's surgeon and the radiology practice where I was supposed to have an MRI were all calling to verify coverage. My employer had changed insurance companies as of Jan. 1. I was diagnosed on Jan. 2. Rick was scheduled for hernia repair on Jan.10. The new insurance carrier apparently had some kind of mix-up in loading my employer's records. So they deleted us all and it was days, I honestly don't know how many days, until they reloaded our records correctly. In the interim it appeared that we simply didn't have any insurance, except dental, which is not a lot of help when you're dealing with hernias and breast cancer.

That necessitated lots of time spent on the phone getting nothing but frustrated. Finally that issue was resolved the day before Rick's surgery, much to our relief.

Then it was time to certify for my time off of work for my surgery and recovery. Yes I have sick time, but to use more than a few days here or there, you have to get it certified as FMLA or Short Term Disability so that the absences are "job protected." I don't know if this is as critical for salaried employees, but I am hourly and work for a call center where any time off is closely scrutinized. Whether it's FMLA or short term disability, you have to deal with, once again, an insurance company.

So I started by calling to open an FMLA claim, then found out that this was not what I needed. I needed short term disability. So after getting my FMLA paperwork, filling out and signing my part of it and getting that to my surgeon's office, I had to call them back, ask them to shred it and told them I'd be getting the new paperwork to them.  This misunderstanding was probably my fault as much as it was anyone else's.

Then the real frustration began. Last week I called the insurance company that handles both FMLA and short term disability, told them I needed to cancel the FMLA claim and open a new claim for short term disability. A nice lady named Brenda said she had cancelled the FMLA, then she transferred my call to a friendly fellow named Frank (OK, I admit it, I love alliteration) who spent about fifteen minutes on the phone with me taking lots of information for my short term disability claim. I got off the phone feeling that I was at least now making some progress after my initial setback and loss of time.

There was only one problem. Neither Brenda nor Frank did what they told me they had done. I waited in vain for my new short term disability claim to appear on the website when I logged in. I waited for paperwork to arrive in the mail. Finally today I called back and was told that the FMLA claim could only be cancelled if I requested it in writing, a little detail Brenda failed to mention. And there was no short term disability claim pending. So once again I started over from scratch, I think. Surgery is just a week away.

Lord, please give me grace for the little things. 

More Blessed Than Brave

Port Aransas, TX

I'm feeling a little sheepish about all the sweet comments I've had from dear friends and family telling me how brave or strong I am in dealing with this breast cancer diagnosis. Yes, I am trusting in the Lord and I sense that He's giving me His peace. And, yes, I have been pretty calm about this so far, but that really isn't because I'm brave. I know this is not predictable, but come what may, I have it much easier than many women and I want to respect those women as I talk about my own experience.

My children are all grown up. I did not face a breast cancer diagnosis before having children, before experiencing breastfeeding a baby, or while raising my family. Many women are diagnosed younger in life and that would have been so much harder.

My cancer was caught at stage one, well maybe bordering on stage two based on the latest info from the MRI, but it's still very early. And it is not inflammatory, which is the very aggressive, truly scary type of breast cancer.

I have a loving, steadfast husband to walk through this experience with me, providing emotional and practical support. My son is in town and willing to help in any way that he can. My daughters, although they live out of town, are loving, supportive and faithful about keeping in touch with me and praying for me. I am aware that not every breast cancer patient has these kinds of loving family relationships.

I have wonderful friends who have been through breast cancer and are open with sharing information and their own stories with me. I have a loving extended family and a loving, supportive, praying church family.

I am well established in my job, have sick time accrued, coverage for short term disability or FMLA if I need it, plus good employer sponsored health insurance.

I'm not exactly looking forward to lumpectomy, radiation treatments or taking estrogen suppressing drugs with all that entails, but I am going into this experience with countless blessings and advantages. God forbid that I would take those blessings for granted and fail to thank Him, the Giver of every good gift. I pray that I will be faithful to trust Him who has shown Himself to be trustworthy in every other trial I've faced in life. 

And I pray that I can talk about my experience with breast cancer in a way that respects and honors women who've had it so much harder than I probably will.

Wires, Brackets, MRI and a Timely Email

Three days before my scheduled MRI, I was sitting in the recovery room of the ambulatory surgical center with my husband who had just had hernia repair. (Hard to believe that was just last Friday.) We were having a good time joking around with his nurse, a hearty woman a few years older than us with a great sense of humor. I pulled out my smart phone to check my email, burst out laughing and handed her my phone to share what I had just read.

"Boy, I'm sure glad she prepared me for that," I said. 

The email was from a friend who is a nurse who's had breast cancer:

 "I thought I would give you a heads-up on the MRI if no one has. You are lying face down on the table with your breasts hanging down through a hole in the table...I won't go into the jokes that my co-workers thought of... "

I had that MRI this past Monday, and had a hard time keeping a straight face when the male technician rather sheepishly directed me to the table.

Yesterday, which was Wednesday, I started the day by going with Rick to drop our dog Zoe off for her orthopedic surgery before my work day started. On my lunch break I got a call from my surgeon's office. The scheduling nurse told me that the MRI showed no additional cancer so I would be able to have lumpectomy, huge relief there. Then she went on to tell me that the MRI also showed that the tumor we did know about is larger than the mammograms and ultrasound had revealed. That was not a relief, but it does make me very thankful for the MRI, because that information will help my surgeon to be much better prepared. The nurse went on to talk about wires and brackets and "localization" and the need to schedule a radiologist for the surgery. She said that the surgeon has a particular radiologist he prefers to work with, so she'll check his schedule and call me back with possible surgery dates. I should hear from her again today.

About ten minutes later I got another call from a lady who gave the name of the medical testing lab she works for, rattled off the name of a test and asked if it sounded familiar to me. It didn't. She said my surgeon had ordered it if I consented and if my insurance covered it. She had already determined that it would be covered at 100%. She said the test was to predict the likelihood of my cancer recurring within the next ten years. Maybe some people don't want to think about that, but I saw no reason not to consent. I guess this test will be part of the pathology testing that will done on the tumor after the surgery.

I did a little research into the wire and bracket thing. This is from the Susan G. Komen website:

Breast cancers found by mammography or other imaging may be hard to feel in the breast. If the tumor is nonpalpable (cannot be felt), a procedure called wire-localization or needle-localization will be done before surgery. A radiologist uses a mammogram, ultrasound or MRI as a guide and inserts a very thin wire into the breast in the area of the cancer. The surgeon then uses this wire as a guide to find and remove the tumor during surgery.

 From the Yale University School of Medicine website:

If the cancer cannot be felt, a needle (or wire) localization with numbing medication will be done by one of our radiologists just prior to your operation to help guide the surgeon directly to your cancer. Occasionally several wires may need to be placed in your breast to “bracket” an entire area of concern for excision (removal). 

I think the nurse said at least two wires will be used for my procedure, but in the words of Scarlett O'Hara,

"I'll think about that tomorrow."

Today, I'm off from work and hope to hear from the veterinary surgeon that we can go pick Zoe up soon. That poor puppy is going to need a lot of TLC. One of my friends suggested that I need a good distraction during this time and I've got no lack of those. 

Hernias and Hip Dysplasia and Cancer, Oh My!

One of the greatest blessings God has given me since I was diagnosed with breast cancer ten days ago is the perspective of dear friends who've been through this experience.

Some of the most helpful advice I've received was,

"Take your time with asking questions and doing research. It's important. I know that after you get the diagnosis you feel you need to get on with the surgery yesterday, but really you have time." 

 "I think you are wise to get Rick's and the dog's surgeries out of the way. You have time to get your ducks in a row."

Although I don't think I'll ever have my ducks in a row, this was very reassuring advice. Before I got my diagnosis, we were already planning for Rick to have a long overdue hernia repair and had also scheduled surgery for one of our dogs.

I had enrolled in a lower deductible medical plan for 2013, mainly because Rick needed surgery, so we had scheduled his consultation with the surgeon early in the new year. Because he is self employed, he is covered under my employer's medical plan. When we got my diagnosis, his first inclination was to put his surgery on a back burner, but I thought we had already delayed it longer than we should have.

So Thursday of this past week, he went with me for the consultation with my surgeon and Friday I took him for his hernia surgery. It seems to have gone very well and he is resting at home. 

This Monday, I will have my MRI and then wait for results which will tell me whether I'm a candidate for lumpectomy or will need mastectomy. Wednesday, we plan to go ahead with Zoe's surgery.

I'll probably schedule mine the following week if it's lumpectomy, maybe the week after if it's going to be mastectomy with reconstruction. That way Rick will have had ten days or more to recover and we will be able to take good care of Zoe for at least her first week after surgery. Of course none of this is very predictable, but that's our tentative plan.

I already feel more peace knowing that Rick has had his much needed hernia repair. And although factoring a dog's medical needs into all this might sound crazy, people who've ever loved a pet might understand. Once I'm dealing with my own surgery and recovery, it would make me feel so much worse to be watching my sweet dog suffering and falling on the floor when her legs collapse under her. I think it will help my frame of mind to know that we've started the process that we hope is going to extend her life beyond her seven years and improve her quality of life. After all, a breast cancer patient needs her therapy dog(s)

 
And speaking of getting my ducks in a row, sometime before I go in for surgery, I hope to make time to clean the house!

WHAT WE KNOW SO FAR

So today Rick went with me to consult with the breast cancer surgeon. Perhaps I should backtrack a bit to say how I chose this surgeon. Initially when my gynecologist gave me the results of my biopsy, he gave me a list of surgeons he recommended, so my first step was to check my medical insurance provider roster and all those surgeons were on it. My next step was to talk to a friend who has had two experiences with breast cancer, one recent and one about eleven years ago. She had a different surgeon for each, but recommended both of them, Dr R and Dr K. Again they were both on the insurance roster, but only Dr R was on the list from my gynecologist. Then I called my primary care doctor, who specializes in internal medicine. He only recommended one surgeon, Dr. R, so I called to make an appointment with him. Then, I went to get my hair cut. I told my hairdresser about my diagnosis and to my surprise she asked who my surgeon would be and expressed approval when I told her. She is between my two daughters in age and told me that Dr R did her mother's breast cancer surgery about four years ago. I have researched this doctor's credentials, education, awards and recognitions and learned that he's quite renowned. All along I had also been praying that God would help me in the choice of a surgeon and I believe He did. 

Rick and I both liked the surgeon very much and felt that we had a good rapport with him. He showed us all the images from my mammograms and ultrasound and went over the pathology report from the biopsy with us. He explained everything very thoroughly in a way that answered most of our questions before we even asked them, but he also took time to answer the remaining questions we did have. 

Here's what we learned today:

My breast tissue is so dense that it's impossible to rule out the possibility of more cancer in either breast without MRI, which means I need an MRI before mastectomy can be ruled out. I'll have the MRI on Monday and the surgeon will call me when he gets the results. 

If no other tumors are found, then we'll schedule a lumpectomy. That would be done as an outpatient. The doctor would remove the tumor plus a margin of tissue around it. He would also remove one to three "sentinel" lymph nodes, more if those look suspicious for cancer. I would go home the same day. Statistically, there would be about a twenty percent chance that the margins around the tumor would not be cancer free and I'd hear from the doctor about two or three days later and would go back in to have more breast tissue removed. Lumpectomy is always followed by radiation and I'd probably start that two to four weeks after surgery.

If more cancer is found in either breast, then I'd be looking at mastectomy and reconstruction, which would not need to be followed by radiation. 

After surgery I'll be seeing an oncologist, who will have access to the pathology report on the tumor and the lymph nodes. The possibility of chemotherapy seems unlikely, but will hinge on whether cancer is found in the lymph nodes and to what extent. One thing I do know is that the tumor is ER (Estrogen Receptor) Positive, which means the drug Tamoxifen is in my future, since at the age of fifty-seven I'm still not quite postmenopausal. I'll probably be looking at five years on that or two to three years followed by two to three on another drug once I am postmenopausal.

All in all, I still think the prognosis is very good and I thank the Lord that my cancer was detected early, my tumor is small and slow growing, I have access to good medical care and I am blessed with a wonderful husband and supportive family and friends.

MY FAMILY HISTORY OF BREAST CANCER

I've thought long and hard about how to write this post without disrespecting the memory of an aunt I loved very much. She was my mom's only sister, at least her only sister who survived to adulthood. My Aunt Bonnie was in her late teens when my mom was born, so she was more like a mother figure to her. Mom was five when their father died and their mother went to work as a nanny, so my aunt and uncle took Mom into their home and raised her. They went on to have four sons who were like little brothers to my mom.

My brother and I to the left,  Aunt Bonnie with hands on knees looking in our direction,  1958.

My aunt doted on her baby sister and later she doted on me, especially in the first three years of my life when we lived in New York and Maine. After that I didn't see Aunt Bonnie often because the Air Force stationed my dad in Germany and in Texas but she wrote letters to me regularly from the time I could read. She was a great story teller, regaling me with funny stories about moose sightings in her yard and hair coloring mishaps. We were pen pals throughout my childhood.

Aunt Bonnie continued to write to me after I grew up and also wrote wonderful  letters to my children. She made beautiful unique quilts for each of my three children. She and my mom stayed in touch by letter and phone calls between Maine and Texas.

That's why her death was such a painful shock to my mom, her only sister. My aunt and uncle were in their seventies then and one of their sons and his wife had come to live in their big house with them to help take care of the home and property. It was a huge historic old house with one wing that was a like a complete separate residence.

The family home in about 2007

Aunt Bonnie was very sharp, not a trace of dementia. She had still been calling Mom fairly regularly, but one day her family called to tell my mom that her sister had just been diagnosed with advanced, metastasized breast cancer and that there was nothing that could be done. Even if there was, she refused to stay in the hospital or consent to any in-home or hospice care.

My cousin and his wife said that they had suspected for some time that Aunt Bonnie was living with a lot of pain, but she wouldn't answer questions about it or let anyone help her with anything that involved getting even partially undressed. Finally one day, she just passed out at home and her family called an ambulance, which took her to the hospital. That's the first anyone in her family knew about her breast cancer.

My mother never talked to her sister again. Mom quickly booked a flight to Maine, but while she was in the air, Aunt Bonnie died. Mom was heartbroken, deeply hurt to think back over recent phone conversations and the lengths her sister must have gone to to conceal her physical and emotional pain. She felt so shut out, so robbed of the opportunity to have any meaningful conversations with her sister in her last days on earth or to pray for her.

Aunt Bonnie was a wonderful woman in so many ways. I can't judge her motives for handling her illness the way she did. My mom did tell me that Aunt Bonnie always wanted to control her own fate and that made her reluctant to go to doctors or to let anyone help her with anything.

Since my aunt was my only relative who had breast cancer, I've thought a lot about her in the past few days. She lived in a house with three people who loved her. She talked on the phone regularly with her only sister. But none of them were able to help, serve, or comfort her in her last days or even to say good-bye.

The fact that one maternal aunt had breast cancer was probably not a significant risk factor for me, but I wish I knew what kind of breast cancer she had and how long she had it before she died. More than that, I wonder why she dealt with it the way she did. I plan to take advantage of the medical care that is available to me and I want my medical information and my story to be available to my daughters, nieces and granddaughters if any of them would ever benefit from it.

Like my aunt, I am blessed with a loving husband and family, but I can't imagine facing this experience without them. We'll go through this together and with God.

BREAST CANCER 101

After I chose the title for this post, I noticed that the Susan G. Komen Foundation website has a section called "Breast Cancer 101," but I don't think they'll mind. I know there's an abundance of information about breast cancer out there, including a lot of misinformation. As a newly diagnosed breast cancer patient, one of the things that is most helpful and encouraging to me is hearing about the experiences of women I know and trust who've been down their own variation of this road.

Since the possibility of breast cancer seems to be on every woman's radar, I thought I'd share some of my experience as it unfolds, in hopes that the information might be helpful to someone else someday. I decided I'd talk about diagnosis and risk factors first, since that's as far as I've gone down this road and what I've been asked about most. 

I know breast self examination is important and a lot of women find their own breast cancers that way. Honestly I haven't been very regular about self exams and never would have found my cancer that way, at least not until it was pretty far advanced. For one thing my tumor is fairly deep under the skin. My gynecologist had done a manual exam at my annual checkup a few weeks before my biopsy and didn't find it. My breast tissue is fibrocystic and extremely dense as I've been told by every doctor, nurse and radiology technician who's ever encountered it.

My diagnosis began with my annual screening mammogram. The radiology practice called me back in for additional views as well as an ultrasound, because there was "an area of concern." I'd had this part of the experience before. The radiologist reviewed the images while I waited and then I was asked into her office, where she showed them to me and pointed out the area of concern. She explained that the tissue in that small area appeared to be pulling down, sort of puckering, which was not a good sign, so they wanted to do a needle biopsy. That was going to be a first for me.

About a week later I had a core needle biopsy under local anesthetic. The radiologist injected the anesthetic, the only part of the procedure that hurt a little, and then made a small incision. He inserted the biopsy needle into the incision, and, guided by ultrasound, took three "core samples." The instrument made a sound like a staple gun with each sample he took, but I didn't feel anything. I came out of that with a dressing and some steri-strips over the incision, very little pain and a little bruising. Not bad at all. I went home knowing my gynecologist would get the report and would contact me with the results.

A few days later, his nurse called and said that he'd like me to come to the office that day or the next. I knew he wouldn't ask me to come in person just to tell me everything was fine, so I arranged to go in that afternoon. I was probably more nervous and emotional after that phone call than I have been since.  

My doctor sat down close to me in his office, looked me in the eyes and told me that the biopsy showed cancer, but that it was curable and had been caught very early. He explained that the next step would be to consult with a surgeon, who would go over the images and pathology report. He gave me a copy of the pathology report to keep and gave me a list of surgeons he recommended. He said I'd know more after talking with the surgeon, but that he thought the most likely scenario would be lumpectomy followed by radiation.

 My tumor is small, but it is not DCIS (Ductal Carcinoma In Situ), which would mean it hadn't invaded any tissue outside the duct. It is invasive, ductal carcinoma, grade 1, just under 2 centimeters. As I understand it, DCIS is the best diagnosis I could have received, but the one I got is pretty much second best and the prognosis is good. I'll be seeing the surgeon next week.

(Edit added 3 months later: I would come to learn that my tumor was actually 3.3 centimeters and stage 2, grade 2.)

As for risk factors, I did have a few, like onset of menstruation before age 12 and starting menopause after age 55, not a good combination. Simply being over age 55 increased my risk; I am 57.

Another risk factor is alcohol use, but probably not at the level that I consume alcohol, although I will definitely be cutting back. I've gone most of my life without drinking more than a glass of wine or a margarita once a month or so. About ten years ago I began having a glass of wine, occasionally two, most evenings. 

Having very dense breast tissue is also a risk factor, aside from the fact that it makes detection more difficult. Dense breasts have more glandular  tissue and less fatty tissue than is the norm. Breast cancer develops in the glandular tissue. 

Several people have asked me if there's a history of breast cancer in my family, because that's the biggest known risk factor. There isn't much of one. The only relative I know of who had breast cancer was my aunt, my mom's only sister. She died of it in her seventies, but her cancer may have been spreading for years while she lived undiagnosed, untreated and in awful pain. Sadly, that was her choice. 

It isn't mine. I hope and pray that neither of my daughters nor any of my nieces or granddaughters are ever diagnosed with breast cancer, but if they are and I'm the only female relative whose story they have, I want mine to be more encouraging to them than my aunt's is to me.

REFLECTIONS ON PINK RIBBONS

If I were superstitious, I'd say that I've brought this on myself by my critical thoughts and comments about all the "hype" about breast cancer awareness. I've criticized what seem like gratuitous promotions: sexual innuendos posted as Facebook statuses and campaigns based on images of busty young women in tight pink T-shirts. After all, the median age of breast cancer diagnosis is 61 and median age of death by breast cancer is 68. Who isn't aware of breast cancer? Why sexualize a disease? Because sex sells, I guess. I've suspected some of this has to do with the American obsession with female breasts. And I've been skeptical of corporations jumping on the breast cancer bandwagon, selling all things pink and promising to give a portion of profits for research. I've wondered if some of this is just good PR and a way to capitalize on a popular cause.

I've never minimized the seriousness of the disease or the need for fund-raising and research. I've had one friend who died tragically, painfully and fairly young from breast cancer. I've had other friends who've had miserable experiences with aggressive breast cancers, but who are now considered survivors. I have participated in the Race for the Cure a few times, twice with friends who've survived particularly rough battles with the disease.

But I think there are other diseases that the public should be just as aware of. I've known people who died young from other cancers and diseases that were every bit as heartbreaking. So I've often wondered, and too often wondered aloud, why breast cancer seems to get so much more attention and funding than other serious diseases. I've wished and hoped that those other diseases would get their fair share of research funding too, at least proportionate to the number of people affected. It would be hard, I guess, to use sex to promote awareness of colon cancer, for example.

Well, a couple days ago, I was diagnosed with a malignant breast tumor and I will be consulting with a surgeon next week. I'll know much more after that, but what I think I know now that it is small, non-aggressive, but invasive ductal carcinoma "grade 1," and has been caught early. That will probably only mean anything to people with breast cancer experience. My gynecologist thinks the most likely best treatment scenario will be lumpectomy followed by radiation.

So now I am going to benefit from all that money raised for breast cancer research and I am truly thankful for it. I am already finding the Susan G. Komen Foundation to be a great source of information. I am thankful for the medical technology that allowed for early detection and makes my prognosis so much more positive than it might have been a few decades ago. But I still hope people, especially children, suffering from other serious diseases can benefit  just as much from fund-raising and research. And right now, I feel anything but sexy.
 
More than public awareness campaigns, pink ribbons and Facebook posts daring people to re-post to prove they care about cancer patients, I am thankful for friends and family who pray for me. I'm thankful for friends who have walked this road before me and are available to talk to. I'm especially thankful for my supportive, loving husband and children.

Although I'll joke about bringing this on myself, I've tasted enough of God's grace to know He's not punishing me for anything, but that He will use this experience to bring about His own good purposes. I thank Him that my cancer was caught early, my tumor is small, and this didn't occur earlier in my life while I was raising my children. I know God's love and care for me are steadfast, no less and no more than they are for my friends whose experiences have been harder than I expect mine to be. And He'll be with me if this experience brings unpleasant surprises. None of it will surprise Him. I thank Him for His abiding presence through the good times and the hard ones and I will trust Him.