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.

To Write of Random Things

I guess most new bloggers start off with an inaugural post introducing their blog, telling why they decided to create it, why they titled it as they did, and what kinds of things they'll be blogging about. I didn't do that, so I suppose this post is overdue by about two months.

I've thought about starting a blog for over a decade now and both of my daughters, who have their own blogs, have encouraged me to for almost that long. They both love to read and write as much as I do and they are good at it. My oldest daughter, Kelly, was once challenged to write every day and she challenged me to do the same for a month. We were going to share what we wrote with each other via email on a daily basis, but life was busy for both of us and we kept that up for about a week.

I was finally compelled to start blogging in the aftermath of the most recent presidential election. I had been thinking for so long about some issues that I was hearing a lot of rhetoric about, and finally the dam just burst. These thoughts were not necessarily profound, but it can be difficult in casual conversation or in Facebook comments to explain why you've changed your mind about something or how you've arrived at a position contrary to what others in your life may believe.

I prefer to put things in writing, in part because it helps me process ideas and sort things through. I tend to decide I want to explore an issue and examine my assumptions about it, which will lead me to read and research and end up coming up with an opinion that may leave my family and friends scratching their heads. Sometimes things just happen, in your own life or in the world, that cause you to think differently or more deeply about something than you ever had before.

Writing has always been therapeutic for me. Most of what I'll be writing about here is not political or controversial or all that important. I like to write about how one thing leads to another as I trace how changes came about in my life or in my thinking. I like to write about life and about things I like or why I don't like other things. In other words, I'll be writing about random things, but two of my relatives already have blogs with the word, "random" in their titles. 

My mom read to us a lot growing up, and she liked to quote, yes, at random, from children's literature.

" 'The time has come,' the walrus said," Mom would quote, out of the blue,

" 'to talk of many things...' "

Those words will pop into my head, quite at random, like so many other things that make me think of Mom on any given day. And obviously, those words from Lewis Carroll inspired the title of this blog. 

I'm hesitant to write about the really big things, heartbreaking, profound, important things. I'm reluctant to tread clumsily on sacred ground. Someday I'll write more about my mother and the experience of losing her by degrees to ALS.

I don't have aspirations of attracting a lot of followers or earning money through advertising on my blog. I'm blogging because I like to write and because my daughters have encouraged me to and because maybe someday my grandchildren will be interested in reading some of what I've written here.

My sister-in-law is a published novelist, my brother-in-law writes a blog for the Houston Chronicle, and my oldest daughter has sold articles for publication in magazines. I am not talented or hard-working enough to write like that. Even if I was, I'd be too thin skinned to handle pesky editors telling me to change this or cut that.

It'll be so much easier to just write my own little blog. I hope you'll like it, but if you don't, you don't have to tell me.

For Love of a Dog

Zoe honestly came in from the backyard one day with this Plumbago flower stuck just so.

Rick and I have made a decision about surgery for Zoe. It's interesting how decisions about medical care for pets can be so complex. People can be quick to judge others' allocation of money to care for their pets, speculating about how much good could be done for needy human beings with those funds. I sometimes wonder why the same people don't make those judgements about others' decisions about spending on things like electronics, furniture, vacations, cars or hobbies.

We are solidly in the middle class and have had some financial setbacks as Rick's business slowed considerably during the recession. And giving to help human beings in need is just part of our lifestyle as Christians. But when we get a pet, we see that as a commitment to take care of that animal, exercising reasonable stewardship according to our means. Our Weimaraner, Dusty, lived to be fifteen and our Labrador, Shadow, made it to thirteen, both outliving the average life expectancy for their breeds.

Zoe is a French Brittany (Epagneul Breton,) a breed with an average life span of  12-13 years. She has hip dysplasia that has progressed very quickly and at the age of seven years, she lives with a lot of pain. Her back legs frequently collapse and she falls down hard. She can't keep her footing on smooth floors at all. But she gets some traction outside and still loves to go for her walk. I guess the endorphins kick in because she walks fast, if somewhat awkwardly, out ahead of our other two dogs when we take them all out together.

It's pretty clear to us, though, that if we don't do something for her, we won't be able to maintain her quality of life for very much longer. And we just love her. She's sweet, affectionate, loyal and loveable. The neighborhood kids call her "The Lickster," because she can't keep her tongue to herself.

We've always assumed that total hip replacement was the only surgical option and that was just not within the bounds of what we consider reasonable stewardship of our resources. If we had unlimited financial resources we'd do it in a heartbeat.

We recently learned of another option, considered more of a "salvage" surgery, that should greatly reduce her pain, increase her mobility and improve her quality of life, even if it won't make her hips as "good as new." It's called "Femoral Head and Neck Ostectomy," and will involve removing the ragged tops of her femurs and smoothing them out. Scar tissue is supposed to fill in and form something almost like a joint. We've now talked with three veterinarians who agree that Zoe's hips are very, very bad and that she should be a good candidate for this surgery.

She'll have to have one hip done at a time, so we've scheduled her first surgery for mid-January. It's going to be hard on her and hard on our budget, but we think it's our best option and that we can all manage it.

That Dog is Our Dog

Parts of  Gypsy's story would resonate with anyone who has adopted a dog with an abusive past. After Rick came home on New Years Eve, 2011, the day I brought Gypsy home, she tried hard to avoid him, but didn't want to let me out of her sight. She followed me everywhere unless he was close by. If he entered a room she was in, she got up and walked quickly out of it, tail between her legs. I knew that if anyone could win her over, my husband could, and by the next day she was starting to relax around him.

It took her longer to warm up to our son, Paul, who is single and spends a lot of time at our house, but eventually she decided he might be safe too. They were both patient with her and learned to wait for her to come to them. For a long time she cowered when either of them raised their voice just to be heard from another room or in excitement over a sports play on TV. She did the same if one of them moved toward her abruptly. Sometimes if they lifted a hand  in her direction she cringed and yelped in anticipation of pain that didn't come.

She became completely comfortable with both of them in time, with Rick first, of course. Now she loves to play "rough and tumble" with  him  and knows he can always be counted on for a treat.

She was afraid of any situation that presented no way of escape. She liked to rest in the crate I had put her in the day I brought her home, as long as the door stayed open, that is. The first time I latched the crate door and left the room, she panicked, crying, jumping and pawing frantically against the wires.

If I wasn't around, she was comforted by anything with my scent. She would pull my bathrobe off the bed and lie down on it, or snuggle up with one of my shoes.

Our home was the only place she felt safe and it was a struggle to even get her out the front door. She pulled hard on her leash to turn around and go back in. We would start out the door for a walk with all three dogs, but couldn't get Gypsy to venture past the middle of the front yard, so I'd bring her back in while Rick walked Penny and Zoe. We kept working at it, coaxing her a little farther each day, until we could finally go all the way around the block.
 
Still she was afraid of everyone she saw. One day Rick was ahead of us with Penny and Zoe when a neighbor came out of his house, talking in a loud, but friendly voice. Gypsy stopped in her tracks as I tried to coax her forward. She pulled back hard, jerked her head, slipped her collar and ran in the opposite direction, leaving me holding the leash and empty collar. Rick gave chase and caught her as she headed around the block back in the direction of our house. I took her home while he finished the walk with the other two dogs.

Now she eagerly anticipates her walk and will allow the neighbors to pet her, although not as enthusiastically as Penny and Zoe do. The neighborhood children have been more than happy to help us socialize her.

She is still wary of anyone new coming into our house and she's so afraid of going anywhere new that I often have to carry her out of the car and inside the vet's office or pet supply store, which must look ridiculous. Once inside, she plants her feet and I have to coax her forward step by step. She's making progress though.

Through all this, we've never seen her fear take the form of aggression.

There's so much we'll never know about her old life, but let me show you a little of her new one:

She gets along quite well with her new big sisters, Penny and Zoe.

She loves to chase Luna, who likes Gypsy better when she's sleeping. I found them both at the shelter on the same day and since they're the youngest animals in the household, I hope they'll grow old together.

She likes to lick Sasha's bowl clean, but knows better than to mess with her. Nobody chases Sasha.

Although she likes to cuddle with my tennis shoes, she prefers sandals for chewing.

She likes to steal bubble wrap and run out the dog door with it so she can have it to herself as long as possible before she gets caught.

 She loves store bought chew toys but is also perfectly happy to find her own in the backyard and haul them in the dog door.









       If sweet friendly children want to pet her and walk her, she's okay with that now.

 She sleeps quite soundly like this...

        or like this.













When she wakes up in the morning, she comes and paws gently at my side of the bed. If I don't respond she pushes her face close to mine. If that doesn't work, she'll plant her front paws and upper body on the bed until I say good morning to her and stroke her head. Only then is she ready to start her day, even if that means going back to sleep for awhile.

I think "that dog" is happy to be our dog now.