In case anyone's listening

I haven't posted in so long, I doubt anyone is bothering to monitor this site. But just in case, I want to say that I'm feeling healthy and fine, my treatments are over, and I am now on five years of drug therapy and monitoring. But more importantly, I have to say that I have never in my life been as proud of my country and my fellow countrypeople as I am today. And considering my advanced age and all that has happened in the past half century, that is saying a lot. Frankly, if Barack Obama does nothing for the next four years but work to alleviate the plight of the African American people in this nation, it will be alright by me. This one's for you, Grandma!

Prevention news - from Dr. Andrew Weil

Resveratrol May Prevent Breast Cancer

It’s still much too soon to say for sure, but new research suggests that resveratrol, the antioxidant found in red wine, the skin of grapes, blueberries, raspberries and cranberries, may have a role to play in breast cancer prevention. Laboratory studies indicate that resveratrol can slow the formation of abnormal cells that leads to most types of breast cancer. Breast cancer often begins when estrogen interacts with DNA molecules to set a process of cell transformation in motion, which eventually leads to the disease. Researchers at the University of Nebraska Medical Center measured the effect of different doses of resveratrol and found that even amounts as low as you would get in a glass of wine did the trick. In addition to its effect on abnormal cell formation, resveratrol increased production of an enzyme that inactivates dangerous estrogen metabolites, possibly further decreasing breast cancer risk. So far, all of this has happened only in the test-tube. No one knows if resveratrol will have similar effect in humans. The study was published in the July 2008 issue of Cancer Prevention Research.

Note from Marcia: If this were the case, I'd have thought I'd be immune.... I quit drinking about 6 years ago - maybe that was my mistake! ;)

Radiation - 1 of 30

To those of you who actually check this site for updates - my apologies. Just haven't felt like blogging. Had my last chemo infusion on June 26. Have been gradually getting my strength back with a couple of setbacks. Felt ill for a few days last week. Have some anemia. Also have steroid myopathy - an atrophy of my leg muscles from the steroids I was taking for chemo. My thigh muscles are very weak and it makes it difficult for me to stand, climb, even bend or straighten my legs. Doc says this should ease up in time.

Had my first radiation treatment today. Treatments will be daily (M-F) for 6 weeks. Takes about 10 minutes total. I lie on a metal table and receive two radiation doses, one from each side. I'm likely to experience some skin reaction (like a sunburn) starting in a couple of weeks and am using products to help alleviate or prevent the burning.

Also started taking Tamoxifen today. This is a drug which prohibits my body's production of estrogen, which feeds my particular type of cancer. I will take this daily for at least three years, at which time I will likely be switched to a drug called Femara, which I'll take for another two years at least.

The good news - and there is a lot of it - is that I'm feeling stronger all the time. I'm getting my sense of taste back. I have a little bit of hair on my head. I haven't noticed any negative reactions to the Tamoxifen. Not sure yet about the radiation, since that was just an hour ago.

Anyway, the poem posted below which I found today was particularly meaningful to me because I know I have lots of support from many realms. I want to say "thank you" to the many friends who are supporting me right now. It means so much to me to know you're there.

The Warrior

For surely you did not choose this battle.
Rather it chose you.
And standing on the edge of what
you cannot escape is most tormenting.
But take one final breath before the plunge.
And charge forward -
knowing that you go not alone,
but in might company of all who stand ready to fight at your side.
And knowing that where your spirit is weakened,
there you will find untold strength.
Where your heart is fearful,
there you will find immeasurable courageousness.
And where your soul is mired in darkness,
there you will find the most penetrating light,
the most powerful beacon showing you the way.

Mark Peters, Copyright 2005

I'm still here!

Sorry I haven't posted anything in so long. I'll try to be brief with this update. Had my third infusion Thursday, June 5th, and it went without a hitch. Due to my earlier reaction to the Taxotere, it was dripped in more slowly this time. I was there over 3 hours, which is kind of a drag, but it is what it is. For whatever reason, I developed another fever this time. Following infusion #2, I had a brief fever about 3-4 days later, but it only lasted about 10 hours. This time, my fever started some time Monday afternoon and didn't let up until this morning. It never got to 101, so I did not take antibiotics, just monitored it. Between the fever and the chemo sickness, it was a long few days, but both let up today and let me tell you, I don't know when I've been so happy to be alive. I had a smile on my face while loading the dishwasher and washing machine - that's how happy I was. One infusion left - June 26th.

Couple of things I've learned: That old saw, "When you have your health, you have everything" - those may be the wisest words ever spoken. And sadly, they don't become truly meaningful until you lose your health and understand why they're such important words. Please do whatever you can now to protect and improve your health. Hopefully, you won't experience "the moment that changes your life," but if you do, best to be in optimum health so that you can meet the challenge in the best condition possible. And in the meantime, enjoy every moment to the fullest.

Other thing I've learned: Twin Peaks was a weird show. I'm watching it thanks to NetFlix and I had no idea what it was about or what its style was. Leave it to David Lynch. No wonder people were intrigued by it. Anyway, I'm still in Season 1 so no spoilers please. :D

Curious? Watch Curious.

PBS's NewsHour last evening (5/20/08) had a bit about bisphenol-A that went so far as to suggest a link to the increasing breast and prostate cancer rates in the US. Bottom line, despite the famous line from The Graduate, the word today is not "plastics." It's glass, or any other known-to-be-safe, recyclable product. Why wait to find out more? Switch now. All the plastic we use - and we use tons of it - will sit in the landfills for centuries. It's not good for us or the planet. OK. Enough of that for now.

PBS also aired episode #101 of Curious last night which included two segments: one on capturing solar energy, and one on an important breakthrough in chemotherapy treatment for cancer patients. I highly recommend watching the program if you can. It will air again in San Diego on 5/22 between 3-4 a.m., and on 5/27 between 2-3 a.m. That second segment concerns a woman with breast cancer, her husband (a researcher at Cal Tech), and a man from Long Beach, CA, who has pancreatic cancer that has metastisized. Having lost my own father to pancreatic cancer, the program was especially poignant for me; but I felt light as a feather after watching it. I hope you will see it.

Meanwhile, I'm slowly regaining strength following my chemo, and have now managed 3 of 5 injections of Neupogin. Will be glad to have the 5th done with on Saturday. Can't say I'm wild about it, but trying to keep a positive outlook all the same. Hair is gone and I'm learning scarf-tying tricks. Actually, I've only learned one, but perhaps it will suffice. I still shampoo my head. Old habits.... :D Saves a lot of time in the morning when you don't have any hair. Putting on makeup seems odd when you're bald, and jewelry, but at least I look a little more like a girl. I think. Hope you have a nice Memorial Day weekend - stay safe.

Round 2 this afternoon, plus link to video

I have my second infusion this afternoon, and what a difference from the first time. No jitters or anxiety at all. This time, I'll be receiving instruction in subcutaneous injections so that I may administer Neupogin, an immune system booster, 5 times over the 10 days following my treatment today. At least I know what to expect now, and will likely skip the day of feeling sorry for myself that I indulged in last time. I am armed with your love and good wishes, and a really terrific Netflix lineup. :D The current season of The Riches, which I had Tivo-d, pulled me through last time. This time, I've got Buffy (season 2), Twin Peaks (season 1), and both seasons of England's The Enemy at the Door; all being seen for the first time. Also got a couple of Eddy Izzard shows, for good measure.

Recently, NPR aired an excellent documentary entitled The Truth About Cancer, which was followed up by a fascinating panel discussion hosted by Linda Ellerbee and composed of four doctors who are all cancer survivors. While the documentary is heart-wrenching, it is also a very worthwhile thing to see. It offers a most honest and thorough picture of cancer and its treatment. I tried to watch it on my "poor me" day following the first chemo treatment, and found I couldn't stand it. But I gave it another chance when I was feeling stronger, and was so glad I did. It is an important film that needed to be made, and I hope you will see it, if you can.

Best wishes to all, and lots of love - I know I have yours and it means the world to me. Thank you!

Quick update

Well, as you know, I felt pretty lousy the first week after treatment, and then I gradually started feeling better. Then I entered the so-called "nadir" stage, or period of lowest white blood cell count and lowest immunity. This stage happens 7-12 days following treatment and chemo patients have to be extra careful not to get sick during this time. This past Monday was the 11th day and I did start to feel poorly that day. A fever developed and I ended up going to the hospital and was admitted. I received antibiotics and then after a day - when my white blood cell count (WBC) remained too low to suit my doctor - I was given a white blood cell production booster. That did the trick and I was released the following day. Mom was down at the hospital every day, supplying me with magazines and crossword puzzles. I had a comfortable room and good nurses. The food was terrible, and they don't give you enough (nod to Woody Allen). Actually, it was garbage, and I ate every bite. It's no wonder all those people in there are sick. Tip: Bring your own food, or have it catered. Anyway, I was very happy to get home to my own bed and to see Buster again. From here on out, I'll be using the WBC booster for 10 days following treatment. It doesn't eliminate the possibility of infection, but reduces it considerably; I'll still have to be careful. Next treatment: this Thursday. I'll be halfway done! I picked up a free wig and brimmed hat (chemo makes your skin sun sensitive) courtesy of the American Cancer Society. I think that's all the news for now. Happy Mother's Day to everyone!

Round 1 after effects

Well, I guess I might as well post about what the chemo feels like. I don't recall feeling anything but a bit out of it on Thursday, after I got the treatment - probably from the steroids, not sure. Friday I was feeling weak but not terrible. Saturday I felt pretty bad, I guess. Weak and just not well. While I would get hungry, food didn't sound good. My mouth had an almost oily coating which didn't help. I seemed to experience a lot of hot flashes as well. By Sunday afternoon, I seemed to be feeling a bit better, but that evening the aches and pains started. Hard to describe - they just come and go, all over my body. I'm taking digestive enzymes when I eat to help with digestion, and I seem to be digesting alright - not great. The steroids, which I take for three days whenever I get the treatment, kept me awake; the doctor prescribed a sedative which helped. I have some trouble relaxing and feeling comfortable because of the aches and pains. Hoping all of this will ease up as days go by. My mouth seems to be not as bad as yesterday. I have to be careful of the sun, so I'm using sunscreen when I go out. I did work today for a few hours, which helped distraction-wise. Not sure I did a very good job, but I was there, anyway. Long as I could sit still, it was okay. Moving around was a bit of a challenge, due to the weakness. I left early and stopped to have my hair cut off on the way home. It's hot here, and I just don't feel like messing with it anymore! It'll be gone in a couple weeks anyway. The big news is that I exercised this afternoon - sort of. It will help, hopefully, with digestion and general well being. Buster seems okay with all of this, which is nice. I was afraid I'd smell different or he'd sense something, but he seems just fine. His appetite is great, as usual. :D I'll post again in a couple of days. Take care.

Round 1 is over

My first appointment went very smoothly. The nurses were exceptional. I was plenty comfortable the whole time. No reactions to any of the drugs, which is all I could hope for. It was a long afternoon - about 4 hours - especially, following a sleepless night, thanks to the steroids which I must take for three days each time I do chemo. The doc gave me a sedative to take tonight to help me sleep. Met some very nice people, and listened to a wonderful healing audio CD provided by a dear friend. I feel a bit tired, but don't know what to attribute that to. No nausea. In fact, I'm eating a lovely bowl of lentil soup. Thanks again for all your good wishes! I know I had a lot of people pulling for me today, and I so appreciate it. I'm so very lucky, and I know it!

Starting chemo today

My first treatment is scheduled for three hours; the chemicals are administered more slowly the first time in case there is a reaction. And I'm having my teeth cleaned right before, since dental work is recommended against while having chemotherapy. I will be made very comfortable during the treatment - lounge chair, blankets, TV. Side effects are well managed these days, and I don't expect to have any serious problems with the treatment. Fatigue throughout is likely. And hair loss. Hopefully, that will be the worst of it. I'll let you know how it goes. Meanwhile, here's some very interesting news about resveratrol from Dr. Weil:

Resveratrol Against Cancer
Resveratrol, the antioxidant found in grape skins and red wine, has been studied in recent years for its potential effect on longevity, but new research suggests that it may also have an anti-cancer effect. When tested in conjunction with radiation, resveratrol prompted human pancreatic cancer cells to malfunction and die. In a laboratory study, researchers at the University of Rochester Medical Center in New York found that resveratrol seemed to work against the cancer cells by interfering with the activity of their mitochondria, the energy producing mechanism needed for cellular function. When combined with radiation, resveratrol stimulated production of destructive substances within the cancer cells that could make them easier to kill. Exactly what this means for human cancer treatment isn’t known. It’s too soon to say whether taking resveratrol supplements or drinking more wine (a questionable idea during cancer treatment) would do any good, the researchers said. (N.B.: Drinking and smoking have been directly linked to breast cancer. - Marcia) Next on the agenda: find out whether resveratrol acts on tumors in the body the same way it does on cells the test tube. The study was published in the March, 2008 issue of Advances in Experimental Medicine and Biology.

Never mind

Contrary to my last post, I will not be entering the trial. Long story short: the size of one of my surgical margins did not meet the standards set for the trial. I have decided to undergo chemotherapy, and will start next Thursday. It will be administered four times, three weeks apart. I expect to sail through it, and will certainly keep you apprised of my progress. I've been exercising and eating well, and am probably healthier than I've been in years, so I'm going into it in optimal condition. Thanks for your support throughout this tough decision process. I am greatly relieved to finally be moving forward again. My love to all.

I will enter the trial

I made the decision to enter the trial. I just spent 20 minutes on the phone trying to let anyone at Kaiser know that, without success. But that's another story.

As you may have surmised, this wasn't an easy decision for me. There is not enough information currently available to point definitively toward Yes or No for chemotherapy, in my case. For what it's worth, I am just not convinced that it is necessary in my case - but I wouldn't turn it down if I am chosen for that treatment.

Besides that, the notion of giving up control of the decision (by entering the trial) hasn't been easy for me to accept, which will come as no surprise to those of you who are intimately familiar with the women in my family....

In case you have time on your hands and are interested, here is a link to an interesting article about the breast cancer chemotherapy decision.

Green Tea - more reason to drink it

Dr. Andrew Weil says: "An antioxidant found in green tea seems to fight breast cancer in mice and might be beneficial in humans as well. A study at the University of Mississippi found that the EGCG (epigallocatechin-3-gallate) in green tea slows the growth of breast tumors in mice. Researchers added EGCG to the drinking water of female mice and gave plain water to a mouse control group. Then they injected all the animals with breast cancer cells. After five weeks they found that the breast tumors developing in the mice that drank water laced with EGCG, were much smaller than those of the mice who drank plain water. The study leader suggested that the EGCG helped by suppressing formation of new blood vessels needed to nourish the tumors as well as hindering the proliferation and migration of the cancer cells. The findings were to be presented at the 121st Annual Meeting of the American Physiological Society. While there’s still no proof that EGCG will work this way in human breast cancer patients, its potential to prevent oxidative cell damage and premature aging have been established in previous studies."

I'm not wild about the flavor of green tree, but have found a widely available product I like well enough to drink daily: Good Earth's decaffeinated Green Tea Blend which is flavored with lemongrass.

Treatment could start soon

I learned today that if I enter the trial, a decision would be made and treatment of one kind or the other (either chemotherapy or radiation) could start as early as next week. I will spend the rest of today coming to terms with the trial idea - meditating on the two possible scenarios to make sure I'm comfortable with them and willing to give up control of the decision.

Trouble deciding about chemotherapy

I pored over my books and on-line stuff this weekend until I couldn’t see straight. I was comparing the various treatment options and combinations thereof. I found statistics for dying, local recurrence, distant recurrence (metastisis), recurrence in the other breast, absolute and other kinds of stats – I couldn’t get any of it to line up neatly on a chart and point the way to a best decision.

I did, however, note some telling phrases from two highly regarded doctors/researchers – Susan Love and John Link. Basically, I’d be a fool not to do radiation and Tamoxifen. I at least have to try. I had been leaning away from these treatments due to their side effects, but it seems this would be foolish. And the chemo - in my case - is just a crapshoot. It is more likely than not that it won’t help me a lot, but it is somewhat likely that it might help me some.

Bottom line: I have decided to volunteer for the trial and be randomized to receive chemotherapy or not. The trial is to determine which women in the Oncotype DX score range of 11-24 are helped by chemotherapy. At least I'll be doing something positive for medical science and the women who come after me. I decided this morning, and I am living with this decision until sometime tomorrow; then I’ll notify my doctor. I posed some questions to him this morning via e-mail about timing – how soon would I learn whether I am to have chemo or not, and how soon could chemo or radiation start? I hope I'll hear back from him shortly.

Stay tuned.

Oncotype DX Score

The results are finally in. My score is 15 - toward the upper end of "low," the range for which is 1-17 (full range is 1-100). My oncologist tells me that my prognosis is good, generally speaking, and said he himself wouldn't know what to decide about chemotherapy were he in my position. He input my score into an online database called Adjuvant! Online, along with specifics about my status (age, overall health, tumor info), and the resulting report indicated that chemotherapy would likely reduce my risk of recurrence within 10 years from 9.8% to 7.5% - a reduction of 2.3%. I must weight the benefit of that reduction with the risks associated with chemotherapy.

So, it is now up to me to decide and I must make the decision within the next day or so. I'll post as soon as I've decided something.

Thanks so much for your prayers and good wishes the past couple of weeks! I truly appreciate it. Keep 'em coming, if you don't mind, as I can use all the help I can get as I sort through my treatment options. Take care.

More waiting

My doctor tells me that he still has not received the results of the Oncotype DX test, so it will likely be some time next week before I hear. Meanwhile, researching of treatment options continues....

Your next assignment

My doctor sent my sample to the Oncotype DX folks for testing yesterday. Results should be in late next week or so. The sample undergoes testing on 21 genes. Based on the findings, I will receive a score. The lower the score, the less likely that I would benefit from chemotherapy (i.e., the less likely I will have a recurrence). If my score is low, I will likely decide to forego chemotherapy, and will begin radiation treatments.

So, here's your assignment: I need you to focus on my receiving a very low score on this test - a 10 or less. "Marcia's test will come back with a score between zero and ten." I will certainly post here as soon as I know the results. Thanks very much for your good wishes and positive thoughts! I know it makes a big difference for me, and I am so very grateful to all of you. Thank you!

Meanwhile, our local PBS station aired a program about "talking about cancer" today (March 26th). If you are interested, you may listen to the program via this link:
http://www.kpbs.org/radio/these_days

Make first decision - check!

After some re- and soul-searching, I've decided against participating in the trial. I'm just not comfortable with being randomized in the middle group. This has been a difficult decision for me. I spent years working with researchers and have a keen appreciation for their work and the courage of trial participants. I wanted to be able to say yes.

I will have the Oncotype DX test and let my score guide my decision about chemotherapy.

I'm relieved to have the most time-sensitive decision made, and plan to now have an enjoyable and relaxing weekend. I hope you do the same! Happy Easter.

Decisions to make

I met with my oncologist this morning. I've been going over the ins and outs of various treatment options in preparation for this meeting, so I had a good idea what to expect. He invited me to participate in a clinical trial, but if I do, I have to decide to do so this weekend. It's for the Oncotype DX Breast Cancer Assay. I was already very interested in the test because it evidently helps determine who will benefit most from chemotherapy. I had no idea the test would be available to me, but it is available whether I decide to participate in the trial or not. The test uses your own tissue to come up with a score which indicates the likelihood of cancer recurrence. It's a highly regarded test.

The trial involves three groups: those who score 11 or less receive hormonal treatment alone (tamoxifen, for instance); those who score between 11 and 25 are randomly assigned to receive either hormone therapy or chemo- plus hormone therapy; and those scoring 25 or more receive hormone and chemotherapy.

He was able to give me some statistical information about my cancer (from Adjuvant!.com) to help me to decide what to do. I will also be researching the Oncotype DX test further and reading whatever I can get my hands on. Wish me luck as I sort all this out.

Soy and Breast Cancer Risk

From Dr. Weil: Japanese scientists have presented new information on the effect of soy foods on breast cancer risk, at least among Japanese women: eating soy-based foods on a regular basis is protective. But excessive amounts of genistein, a compound found in soybeans, might have the opposite effect. The investigators from Japan’s National Cancer Center in Tokyo followed approximately 25,000 women between the ages of 40 and 69 for an average of ten and a half years and compared blood samples from 144 women who developed breast cancer and 288 who did not. The tests showed that women who ate whole soy foods - about 3.5 ounces of tofu daily or 1.75 ounces of natto (Japanese fermented beans) - had protective levels of genistein. This group reduced their breast cancer risk to one-third of what it was among women whose genistein levels were lowest. However, the researchers warned that excessive consumption of genistein and other isoflavone compounds from soy isolates or from supplements rather than whole soy foods may actually increase breast cancer risk.

Note from Marcia: If you take synthetic thyroid hormone supplements for hypothyroidism, check with your doctor about incorporating soy into your diet. Soy can interfere with absorption of the synthetic hormones. Generally, it is considered best to limit consumption to one serving or less of soy per day.

Do yourself a favor and follow this link...

This interview aired back in January on C-SPAN's Q&A program. It contains some very important information concerning cancer prevention from someone who should know - the volunteer president of the American Cancer Society. His story - and his mother's - are very interesting, as is his perspective on health care. It's a little long (the interview was one hour), but very much worth the read. I advise that you read the transcript rather than viewing the video because the sound quality combined with his accent may make the viewing difficult.

http://www.q-and-a.org/Program/?ProgramID=1163

"No surgery for you!"

I just came from a very happy meeting with my surgeon. He explained to me that the margins - all of them - are quite clear. One of them - the so called "deep" margin, which was on the side of the tumor closest to the chest wall, or furthest from the skin - was a very thin margin: only 1 mm. It was the most he could excise without cutting into my chest muscle which would have been a different thing altogether (essentially, a mastectomy). So he took all of the tissue he could, and that tissue was clear. He explained that there would be no point in going back and biopsying the chest muscle, since all of the margin which was removed was clear. I am satisfied on this point. And thrilled at the work he has done for me, and told him so. The tumor did measure 1.9 cm, which is 1 mm shy of the 2 cm threshold for stage 2. The cancer is positive for estrogen and progesterone receptors and negative for HER2 receptors, which are all good things. He also explained that while the cancer has not entered my lymph nodes, it is on its way there. For this reason, as well as that of the size of the tumor, my oncologist (who should be assigned shortly) will be advising me on whether or not to pursue chemotherapy in addition to radiation therapy. In any event, I will have five to six weeks of radiation as well as five years of hormone therapy. The oncologist will enter all of the specifics of my particular situation into a computer program, which will return information concerning the relative benefits of chemotherapy. If the data shows that the chemotherapy would be beneficial in my case, that's what I will do. My understanding is that the oncologist will then refer me for the chemo and/or radiation treatments. So, I'm back in waiting mode, but feeling very, very lucky indeed! The arm pain is also gradually improving (I said it was an inflamed nerve but it's actually an inflamed vein). Thanks to all of you for your kindness, caring, support, and good wishes these past few weeks. It has meant the world to me and I feel so blessed to have so many wonderful people in my life! Thank you. I will continue to update as I learn more.

The results are in!

But the doctor is out. Yes, my sugeon is off for a couple of days, so I won't get to talk to him about this until next week. But I have learned that the final pathology report (released late yesteday) shows that there were no cancer cells found in the biopsied lymph nodes! That is exceedingly good news. Also, the tumor measured 1.9 cm, which makes it a stage 1 cancer, which is better than stage 2 (which a tumor of 2 cm would have been considered). As I learn more about what this means for me, I will post here. Apparently, the margin of tissue surrounding the tumor is still a question mark. It may be that the surgeon will recommend additional surgery to remove more tissue from the area where the tumor was. I am all for this idea. The person I spoke to didn't want to guess at what my surgeon would recommend in this regard, but did say that the margin wasn't completely clear. At any rate, I hope to speak to the surgeon about all this Monday, but if not I do have an appointment with him on Tuesday so will learn and post more then. Meanwhile, I am bothered by inflammation of a nerve which was cut during the surgery which is causing pain in my right under/upper arm area, but this is normal and to be expected. Hoping that will ease up soon. Thanks for your continued support and good wishes! Be well.

tick tock, tick tock

Still waiting for the report....

I've been told, though, that no news is good news in this case. If there were anything worrisome going on, I would have know about it right away.

Lymph node confusion

I just realized how unclear I've been in my last couple of posts. To clarify: lymph nodes were removed on the day of surgery, but only the so-called "sentinel" node/s. This is the first node (sometimes there is more than one) in which cancer cells would turn up if they were spreading beyond the duct/tumor. The quick, initial biopsy which was performed the day of surgery revealed no cancer in the sentinel node/s; Kaiser's accuracy rate on this test is 80%. The sentinel node is then sent for further study, along with the tumor and margin which were removed. So the final pathology report which I am still waiting on will reveal whether or not there is lymph involvement, as well as the exact tumor size, and whether the margin which was removed from around the tumor was clear. All of this will inform the doctors concerning the stage of the cancer and how to proceed with treatment. As for me, I'm feeling hopelessly healthy, to quote my anesthesiologist. :D

Mission accomplished! (for now)

My surgery went exceedingly well. I did not have lymph nodes removed; however, the final pathology report on the lymph nodes takes 3-4 days. So, PLEASE continue to send positive thoughts. I am so grateful to all of you - I know your prayers and good wishes made all the difference for me today. I will post more soon.

Your mission...

Well, tomorrow's the big day. I'm very calm and not anxious or worried. I'm not working today, and will spend the day getting my mind and self ready for tomorrow. I'm having a stress-relieving massage this afternoon, and looking forward to that. The first thing the surgeon will do is a preliminary biopsy of the "sentinel lymph node." This test is performed before the lumpectomy to see whether the cancer cells have spread to the lymph system - the sentinel node (identified by a special test) is the first place the cells would go if it has spread. If there is lymph node involvement, the surgery will include removal of the tumor and a margin around it, as well as removal of lymph nodes. Recovery in that case will take a little longer, and the lymph nodes will then be biopsied further - that will take several days. But the important thing is - we don't want the lymph nodes to be involved. If you pray or think about me tomorrow, please concentrate on this positive idea: Marcia's lymph nodes are clear and healthy. Thank you! I plan to go to Mom's after the surgery for at least one night. My sister and her husband will look in on Buster while I'm away from home. Wish me luck! I'll update the blog as soon as I can. Take care of yourselves.

Interesting article about surgery choices

http://www.msnbc.msn.com/id/23005766/from/ET/

It's a date!

OK, things are looking up. I finally have a surgery date - February 12th. Just far enough away to give me some time to plan and prepare, but soon enough to suit me. I wasn't at all comfortable with the idea of putting this surgery off, so I'm glad they found me a date early in my requested window of time. I need to have an EKG done prior to the surgery, which will be simple since I can go to the Kaiser facility next door to the campus where I work to have this done, on a walk-in basis. If I'm up to it, I will go home after surgery (it's outpatient, so I expect to go home the same day); if not, to Mom's until I'm able to be on my own. Primary issues will be pain management and possibly dealing with a post-surgery drain thing which I may or may not need help with (and may not even have - it will depend on how things go on the day of surgery). Then, if things go as planned, I will begin radiation treatments a week or so after surgery. I think I described those briefly in an earlier post, so won't bore you with that again. My spirits remain high and my outlook positive. I had a very helpful session yesterday with my counselor Alisa whom I haven't seen in a couple of years, but we picked up as if no time had passed at all. She thinks I'm doing great, and her only concern is that I allow myself time to grieve as much as I need to. I tend to want to start crying in meetings, or while behind the wheel of my car, or at other inappropriate times. I need to ensure that I allow those squelched feelings to surface and deal with them at more opportune times, so I will henceforth be scheduling time to cry. Imagine! What a world we have created, where we have to schedule grief into our busy calendars. Please don't think that I'm depressed or sad - that is not the case. 98% of the time, I am quite positive and happy. But there are times when the reality of the situation becomes overwhelming to me or scary, as I'm sure you can understand. Anyway, the worst thing is that I will have to miss a quilting class I had scheduled on the evening of February 12th, unless maybe Mom could wheel me in there on a gurney....

Quick update - surgery date

I've learned that the estrogen level at the time of surgery can have an effect on survival rates in premenopausal women, especially when their tumors have tested positive for estrogen and progesterone receptors, which mine has. In light of this, I will be asking for my surgery to be rescheduled to some time later in the month of February. More later....

Long time, no post

I apologize to those of you actually following this blog - it's been a busy week with work and school picking up pace. Here's the scoop: I decided on Monday to move forward with a lumpectomy. I learned yesterday that the surgery is scheduled for Thursday, February 7th. I'm a little disappointed to wait so long, but at the same time I have a lot I want to do to prepare (mentally, physically, and emotionally) for the surgery. My spirits are high - I'm truly feeling very positive about things. I feel extraordinarily lucky and I remind myself of this several times a day. In particular, I am lucky to have the love and support of so many precious friends and family members. I feel your support and I am very, very appreciative of it. Some of the things I am doing to prepare are improving my overall health (through exercise and nutrition - and I've cut out herbal supplements that might have blood thinning properties), reducing stress levels (through biofeedback, breathing exercises, and yoga), and learning as much as I can about the surgery and recovery process and ways to speed healing. If all goes as planned, I will likely begin radiation treatments about 2 weeks after surgery. Radiation has come a long way, but is a bit arduous: 5 days a week for 5-6 weeks. I understand that you are in and out in about a half an hour, and there is a radiology unit nearby in Escondido, so I'll be able to go over during my workday. There may or may not be some fatigue and some skin damage ("tanning") from the treatment. The radiation is directed in such a way that it does not damage any underlying tissues or organs, so I don't need to worry about that aspect. Nonetheless, if I have radiation I will plan to do whatever I can to mitigate its possible effects, expected or otherwise. I will try to do a better job of posting, so you'll know how I'm faring. But know that I am confident in my care providers, confident in myself and my ability to cope with what lies ahead, and confident in your love of support. The most important things I've learned these past few weeks is that I am surrounded by angels, and that I am a lucky, lucky woman!

What a difference a day makes

Something happened yesterday. I don't know for sure what it was, but it has made a big difference for me. I snapped out of a depression I didn't know I was in. I think it was a combination of things. The nurse in the plastic surgeon's office Tuesday night was actually an angel. That's where it started. Then I met two other angels yesterday - one was Kaiser's breast cancer program coordinator and the other was Ann, one of Kaiser's survivor/volunteers. If you're looking for angels, there are apparently a lot of them working for Kaiser Permanente in San Diego.

Anyway, I'm feeling much better about things - less overwhelmed and more confident in my ability to make the decisions I have to make. Breast cancer and its treatment are very complicated. It's great to have so many treatment options, but it's almost too many. At least it seems that way when you've just been told you have cancer.

At any rate, I learned that plastic surgery is no cake walk and the decision to go that route is based on a number of medical and personal issues. Lumpectomy with radiation presents its own issues. And the fact is, until surgery - whatever kind - we won't know the true size of the tumor and how much tissue must be removed, nor will we know whether lymph nodes are involved. And if they are, additional surgery to remove lymph nodes would be required. I wish there were a way to know that ahead of time, but Kaiser will only perform the lymph node biopsy at the time of the lumpectomy/mastecomy operation. Results of the biopsy take up to a week.

In light of this information, I have decided to go to a quilt show tomorrow - the largest show in California - with a couple of close friends. I am leaning toward lumpectomy with radiation, but expect to have a final decision made this weekend. I want to get the surgery/biopsy over with so that I can move on to whatever comes next.

Forgive me if I don't respond right away

I've gotten so many kind and thoughtful e-mails, with encouraging stories, and good advice and resources to look into, and offers to help. I was trying to keep up with them, but I've lost that battle. So this is my message to all of you who have not had a response from me - Thank you! I am reading your messages and I am so grateful to all of you for taking the time and caring enough to send these messages. Please don't stop. But please do forgive me for not responding. I hope you understand, and know that I am taking all of your kindness and helpfulness to heart. It means the world to me and I don't know what I'd do without you.

About BSEs and mammograms

I don't think I've mentioned this yet, but I have had regular mammograms for several years now. My last one was July 2007. It's very likely the tumor was there in July, but the mammogram did not pick it up. The reason for that is that I have very dense breast tissue, which mammograms are not good at imaging. My point here is that - had I been doing regular BSEs, which I had not, I may have discovered this thing much earlier than I did. It has been there for a while. 1.9 cm is about 3/4". (That's the size it appears to be on ultrasound - actual size may be smaller or larger.)

When I went in for the clinical exam (hands on exam by a nurse) on 12/31, I was allowed to feel a model of a breast that had models of tumors in it. The "tumors" were hard and deep. I had never felt one of these before, and I highly recommend that you ask to feel this model next time you have an exam - it's very educational. My own breasts - thanks to the dense fibers - have always felt lumpy and bumpy to me, which made self exam a rather frustrating and discouraging process - which bumps are old/new? which are good/bad? which are me/not me?

Bottom line - please don't put off your BSEs, and please learn to do them properly (see video linked below), and please ask to feel a model and get input on how best to examine your own breasts. If you have any concerns despite a clear mammogram (expecially if you have dense tissue), ask for an ultrasound.

So many women I've talked to recently have admitted they don't examine regularly. All of this is up to you. No one else is going to do this for you.

Okay, I'll stop preaching. For now. Have a happy day! :o)

Good ultrasound news

My ultrasound revealed nothing on the left side - a great relief. I will have a consult with plastic surgery (just in case) tomorrow night. Will have to decide soon about the type of surgery/treatment to have.

This darn cold - since I started on a new antibiotic yesterday, I was hoping for a dramatic improvement today, but that hasn't really happened. I cut out dairy yesterday (almond milk is good, I think - can't really taste anything right now) and drank a hot tomato tea all day (V8, garlic, lemon juice, cayenne, and hot sauce-all you can handle). I think those two things have done as much to provide relief as anything. Symptoms are better today which is a relief, since I haven't been able to breathe for several days. And breathing is kind of important, unless you're a fish. So I may not have a sinus infection, just a bad cold, but since it's my third cold since December 9th, and since I'm prone to developing sinus infections, and since I've already started the antibiotics, I'm going to finish them.

Links to sites explaining breast cancer

In case these are helpful to you and yours:

Especially for kids:
http://www.kidshealth.org/kid/grownup/conditions/breast_cancer.html

An excellent, extremely thorough explanation:
http://www.nationalbreastcancer.org/about-breast-cancer/beyond-the-shock

Another good site:
http://www.cancer.org/docroot/CRI/CRI_2x.asp?sitearea=LRN&dt=5

Monday update

I am scheduled for an ultrasound tomorrow morning, to find out if there's anything on the left side. I've also started the wheels turning on meeting with a plastic surgeon - so far we're exchanging phone calls, but I expect to have an appointment scheduled tomorrow. That is just in case I opt for mastectomy with reconstruction. That option didn't appeal to me at all yesterday, but today it's in the hopper. I also had a nice chat with my GP, who told me she has the utmost faith in the surgical team. She's very candid and objective - she's not a cheerleader for Kaiser. She has been with them for decades and has been both a doctor and an administrator - she's top notch. She has been my doctor since 1989, and was my father's doctor and is still my mother's doctor. She told me that the current diagnosis and treatment recommendation is pretty straightforward, and while she didn't discourage me from pursuing a second opinion, she said that she herself wouldn't bother; things are pretty black and white and the same options would be made available no matter where I went based on my diagnosis. She thought it might just cause added stress, which frankly I don't need. I took her comments to heart, but have not ruled out getting a second opinion. She did suggest that if things become complicated later, it might be advisable. Thing is, we won't know the size or stage of the tumor or extent of invasion until the day of surgery. It's possible that a lumpectomy could be performed, and days later we'd learn that lymph nodes are involved, so that will mean another surgery. So there are some ways it could get complicated. (She also prescribed an antibiotic for what we think is yet another sinus infection; hope it works.)

At this point I know that my cancer is ductal, and it is invasive, which means it has grown out of the duct and into the surrounding tissue. We know that it has tested positive for estrogen and progesterone receptors which is favorable. We don't know yet whether it is positive for HER2 receptors, but will learn that after surgery. We don't know the "stage" - the size, rate of growth, whether cancer cells have infiltrated my lymph nodes, but will learn at least some preliminary information about that on the day of surgery; final test results on the lymph nodes will come a few days later. A couple people have asked about chemotherapy - that might be prescribed once tumor size and lymph node status are known.

I have received such warm and supportive messages from you, and I can't thank you enough. It means the world to me to know that I have the support and good wishes of so many whom I hold dear. Please know that I am very optimistic - ever the Pollyanna, I guess. I know it's going to be fine. Just might take a while.

I know that my news and the shock of reading this blog has been hard on many of you, and I am very sorry for that. I'll post again tomorrow. Take care.

BSE Video

Here is a link to an excellent video on how to properly perform a breast self exam:

http://www.imaginis.com/breasthealth/bse_video.asp

Meeting with surgeon

About two weeks ago I discovered a lump in my right breast (had my last mammogram in July). I was examined by a nurse and scheduled for a special, more thorough kind of mammogram a week later. Turns out I have dense breast tissue which makes it hard to see anything on a mammogram. Something looked suspicious, so they immediately did an ultrasound exam. That exam revealed a worrisome spot, so they immediately did a needle biopsy - removed some tissue to examine. That all happened on Friday, January 4th. On the 9th, I was told that the sample tested positive for cancer, and an appointment was set for me to meet with a surgeon.

This morning, I met with a surgical oncologist at Kaiser to discuss my breast cancer treatment. I have a ductal cancer (grows in a mass without fingerlike projections, which is another type of breast cancer), approx. 1.9 cm. tumor (actual size won't be known until surgery); don't know about lymph node involvement yet (will also be revealed when surgery is done). They will have to do surgery in order to determine whether the cancer has spread to any lymph nodes and to determine its actual size; they would then remove the tumor and some of the surrounding area plus any involved lymph nodes. Because the nurse who examined me a week ago thought she felt something on the left side as well, the surgeon agreed that I should have ultrasound on the other breast before deciding about my treatment. That ultrasound will happen within the next few days.

My current options (if nothing changes) are lumpectomy (lump removal) + radiation therapy, or mastectomy (removal of entire breast). Outcomes as far as survival rate/recurrence are about the same for both options. Some women opt for mastectomy since it frees them from worry about developing breast cancer again, in that breast. But that doesn't mean the cancer won't turn up elsewhere, which is a possibility. Kaiser is very much on top of this - their breast cancer program is excellent and I have a great deal of faith in the care they provide. That said, I may decide to get a second opinion concerning treatment from the UCSD Moore Cancer Center (La Jolla), which is one of only 39 listed by NCI/NIH as top research/care centers in the US.

So, right now, I'm waiting and thinking. After the ultrasound on the other side, I'll know more. If there is a problem on the left side, that may influence the decision I make about treatment. I can think about this for a little while, but should not put off surgery any longer than necessary. If I opt for removal, I would likely also have reconstruction, which brings its own set of timelines and issues. Some kind of surgery will be done within the next couple of weeks.

I have set up this blog because I wanted a way to be able to communicate with my family, friends, and co-workers. It is important to me that people understand what's happening and take heed. I have no family history of breast cancer and did not believe I would ever hear the words, "You have breast cancer." Please be dilligent with your own self exams - learn to do it right - and do it regularly (I'll post some links). Also, keep your immune system strong - it's your first line of defense against any kind of cancer. This means eating well and exercising regularly, and monitoring your stress levels.

I hope that you don't mind this method I've chosen of communication. I have to weigh my strong desire to inform those I care about with my equally strong desire NOT to talk on the phone about this ad nauseum. I need my energy right now to get well and to think - I'm fighting my third cold in the past month, so clearly my own immune system isn't what it should be. I hope you understand.

Please feel free to e-mail me. I can deal with e-mails more easily than with phone calls. Mom has also offered to field calls on my behalf. She sat in with me this morning with the surgeon, and has been studying the situation and is close to becoming an expert in the field herself.

My love to everyone. Thanks for your good wishes, your support, and your understanding. I will update this site frequently, so stay tuned.

Marcia

Buster wants to blog

Buster's been after me to do this. I keep telling him I won't have time to keep it up, but he thinks I will, so - okay. We'll see what happens.