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.