Sunday Funnies

Who doesn't like the Sunday funnies. They're in color and start your Sunday off in a good way. With a few giggles.

I had a great laugh yesterday morning. It was early and I had just crawled out of bed. It would be some time before the swelling under my eyes would subside. After brushing my teeth I pulled off my sleeping hat and the image that greeted me in the mirror was a smiling, good-natured grandpa who was very happy to have some company and beared a striking resemblance to me. The remaining hair on his balding head stuck up in a hilarious halo around his head. The wisps he uses for his comb-over were not paying attention to gravity either. And thats when the funny thought hit me. I'm my own Grandpa.

I hope you enjoy the visual as much as I did. Take a listen to the humorous song too. I apologize in advance if it remains in your head for the rest of the day.

I'm My Own Grandpa

Amy

This post is dedicated to my best friend Amy. The kind of friend you meet young, in our case the summer before 6th grade, and live next door to until you leave for college. She knows me as well as any one on earth. After years of not being in touch we can pick up the phone and talk as easily as if we had spoken the day before. Amy is petite and blushes. Her smile and sweet disposition made her popular with all social classes in school. She was smart and the cutest cheerleader on the squad.
The boys absolutely loved her. When we were sophomores in high school she had the most popular seniors falling all over themselves to be her boyfriend. And I was lucky enough to have her as my best friend.


Amy was diagnosed with breast cancer early fall of 07, a month or so before I was diagnosed. I remember the shock when I heard about her diagnosis and upcoming mastectomy and chemotherapy. In disbelief, I could not stop thinking about Amy and felt fear for her and what laid ahead. I couldn't imagine the world without her. Memories flooded into my mind of growing up together. She was the more outgoing of the two of us. She always included me in her plans and I depended on her graciousness when I was too selfconscious to invite myself along. We spent countless long summer days suntanning at the lake. Waitressing together at the Schoolhouse resturant on Flathead lake. Summer nights cruising mainstreet singing along to the Grease soundtrack. Sneaking out of slumber parties to roam the neighborhood until the wee hours of the morning. Doing backbends on the hill between our houses. Learning how to drive and putting dents in both ends of the station wagon perfecting our parallel parking skills. Looping a string between our house's decks so that we could write notes about what we were wearing to school the next day for the other to pull across and read.

Amy is married and has three beautiful, athletic girls. She was about a month ahead of me throughout our simultaneous treatment for cancer. When she was recovering from surgery and apprehensive about beginning chemo she unknowingly made me feel better about my diagnosis by forging ahead with bravery and a positive attitude. The carved courage angel she sent to me gave me courage when I badly needed it. A best friend knows what you need. I will treasure it forever.

Who could ever have guessed that we would be sharing such a journey, a sisterhood that neither of us would have chosen and that binds us now in ways that only those who have shared in it can really understand. Amy's last chemo treatment was March 5th. Congratulations Amy. I love you and miss you and am so proud of you.

Hope and Trust

It feels much safer for me to stay on the ledge rather than take hold of the rope and allow myself to be pulled up toward trust and hope that cancer won't return.

It was a terrifying fall. I was running along a beautiful mountain trail feeling healthy and free. Not paying attention, not being aware that at any time I could lose my footing. When the fall happened, everything was a blur. I kept dropping and dropping through shock and harrowing fear, finally landing on a small ledge. Many times I have allowed myself to peek over the edge and see how much further I could fall.

I have also glanced up to see blue sky and rescuers offering a way up and out of my solitude. But leaving my ledge, which I have managed to make relatively comfortable, takes bravery. If I allow myself to be pulled up, to join the people waiting for me at the top, then I risk another fall. My mind reasons that it would hurt much less to fall to the bottom of the gorge from my ledge than to fall from the ridge above.

It takes alot to wrap your mind around the fact that you have cancer. I think it will also take alot to wrap my mind around not having cancer.

I Can't Wait

I am obsessed with hair. I can't wait to start growing it. I figure in about 3 weeks I'll see evidence of some new growth. How we take hair for granted. It will feel so freeing not to have a crazy itchy wig or snug hat on my head. My hat slips off sometimes when I am sleeping and it feels so good to wake up and feel my scalp breathe.

Its probably difficult to understand. I miss blow drying and styling my hair. It took time, sure, but it also made me feel "fixed up" and ready to start the day. My morning routine is much different now. Get out of the bath or shower. The little hair I have is dry by the time I reach the mirror. Throw on a hat and a little makeup and I am ready to go. No quiet prep time to think about whats in store for the day.

I've been lucky to keep about 50% of my eyelashes and eyebrows. I dreaded losing them as much as my hair. Of the 5 hairs per square inch that I have on my head now, the long ones remaining are all brown. The gray ones have all fallen out.

By fall I will have a cute short pixie do. I wonder if my hair will grow in curly. That would be fine by me.

Chemo Brain

Its hard to take finals when you have chemo brain. Its difficult to start a new job when you have chemo brain. Here's Mayo Clinic's description of one's own personal preview of dementia.

For God's sake I have twenty years of experience, of learning, of conquering each task put before me. But with a fresh onslaught of chemo brain you can't trust that you will remember anything. Then if you're like me, you learn quickly how embarrasing it is and you break into a cold sweat thinking about when it will strike next. You can't blame your slowness on chemo brain to your new coworkers. You have to swallow your pride and ask them for help again.

I have learned humility through this experience. Had no other choice. I wanted to succeed because I really like doing something new. I don't know how long I will be satisfied doing this job and who knows where it will lead. Probably back into the IT world, using acquired knowledge about pharmacy workflow and software to leverage a position in a hospital. I will surely gravitate back to more responsibility at work. But for now, for the rest of this year at least, I'll enjoy learning from some really cool pharmacists.

Fog Lifted

Work is going better. I don't have the brain fuzzies like last week when I was trying to appear competent at my new job. I've got 10 glorious days of feeling relatively normal before chemo #6. I have been lazy of late. During recoveries from prior treatments I've pushed myself to get out and jog by now. This time, instead, I've taken walks or naps.

I'm really loving Yoga. Had to get through the first few sessions where stretching did not feel good. Now, I'm getting stronger all over. My flexibility and balance is better. Fewer headaches too. Its also helping stretch out scar issue under my left arm that developed from surgery to remove lymph nodes. The most important benefit, deep breathing and relaxation, surely helps my system recover from chemo.

I have thoughts about what I want to do after coming out of treatment. I want to see some new places and experience other cultures. I want to really live life to the fullest. It doesn't make sense to wait for "someday" when the timing is just perfect. The urge is strong. More on that when plans are in the making.

Just Say Om

My announcement came at dinner time. "Guess what guys, we have plans for tonight!" John and Tanner responded with looks of mild interest. "You are going to learn Yoga!" They laughed and went back to their conversation. I interrupted again a few moments later to let them know they would have a half hour after dinner to get changed into suitable yoga gear and mentally prepare for their quest in search of Om.

After inserting the Yoga World DVD and convincing John of the high probability of beer spillage if he didn't forfeit his beer bottle, the guys stifled their giggles and settled into cross legged poses on the floor.

It appeared as if John was a born natural when he easily slipped into the Lotus pose. All & all it went remarkably well and I haven't laughed so hard in ages. No one was hurt when Downward Dog balance problems occured and there were frequent groans and complaints, which were not sympathized with. Only laughed at. John really got into rhythm when he realized that we didn't need to crane our necks up to see the tv screen in order to know when to change poses. The considerably loud sound of Tanner's knees cracking became our cue.

The guys endured the entire 45 minute DVD. You can see them here in the final pose, the Corpse pose, at which point they farted and fell asleep.

Stop By Sometime

I've really been slacking on blog entries. I started working four
l o n g hours a day at my new job this week. I leave Target frazzled and drained each day. Monday was tough. After being on my feet for a couple of hours focusing on learning the pharmacy software I literally HAD to excuse myself and sit down. My vision had grown blurry and my legs were shaking and I felt panicky. ICK, I hate that feeling, it felt like low blood sugar. After sitting down, eating and drinking for 15 mins I was back on my feet but I had a hard time recalling what I'd just learned. Oh well. My boss knows I'd just had a treatment a few days prior and she is a pharmacist afterall, so she knows about its side effects.

I've been successful at reminding myself to just take it slow and be extremely careful. I check each prescription three times before handing it off to the pharmacist for a final check. I would never forgive myself if I made a medication error and someone was hurt by my error.

So, stop by Target if you are in the neighborhood and wave hello. I probably can't stop and talk but I'd love to see you. My shift is 11 - 3 for the next two weeks.

Speaking of two weeks. TWO WEEKS FROM TODAY IS MY LAST CHEMO! ya ba da ba dooooooooo

Subconscious Manipulation

I came across my surgical pathology report about a week ago while organizing my desk. I read it with interest as I had not looked at it since before the first of the year. Since then I've become familiar with some of the terminology used in pathology reports.

One of the measurements (mitoses), used in grading cancer, is the number of cancerous cells that are dividing when viewed under a high power microscope. We have known from the beginning that my cancer was rated as high for mitosis count. But this time I was taken aback by how high the number is. This lead me on an obsessive online search through medical articles and books for another example where the mitosis count was as high. I wanted reassurance that the mitosis rate was not all that unusual and that we aren't dealing with an uncontrollable force. Unfortunately what I found was documentation that made me much more concerned rather than less. Still, there was fragile underlying comfort in knowing that I am not a scientist and that I might be misinterpreting what I read.

I allowed myself to go down the effortless road of pessimism and selfishness. Looking back now, I think I was also looking for drama so that I could manipulate my loved ones into giving me attention.

After chemo last thursday Dr. Schmidt took me in to an examining room, gave me an exam and told me that a cancer marker had been steadily increasing over the past four blood tests to the point where it was a bit of a concern. She also stated that she did not find any evidence of disease in my lymph nodes and chest during the exam. She went on to say that 1/3rd of the time the increased cancer marker is a false positive caused by chemo treatment. When I told her that I was not surprised, that I have been consciously reminding myself not to rest easy and to assume that the cancer will reoccur in order to avoid being blind-sided with bad news, she grew concerned. She suggested I schedule another guided imagery session. She also decided to schedule a CT and bone scan for a couple weeks from now to look closer for evidence of disease in other parts of my body.

My brother, sister and nephew Jareth were in the chemo room when I came out and in my excitement in seeing Jareth and the wonderful company of my siblings put all thoughts of the discussion in the exam room out of my mind. My mom arrived the next morning and I happily climbed into a cocoon where nothing is expected of me and my every need is attended to, for the next two days. I slept as much as I needed while mom, once again, unselfishly worked to make our home the haven that it is. John, my ever-understanding and devoted husband kept up his arduous mission of supporting us while caring for me and the kids.

Steroid withdrawl had its normal affect on me Sunday. Pessimism and anxiety came in waves throughout the day. Several times I wanted to break down and heave my fears and anxieties onto John. At other times though, I recognized that my thoughts were extreme and wanted to protect him from them. He is so perceptive though. He encouraged me to let it all out and after not much convincing I did.

I told him that I feared my prognosis was bad and more suffering was only a matter of time. I let him know about my obsessive search for reassurance. I talked about the cancer marker news.

John bravely took on the heavy and difficult job of understanding, reassuring me that my thoughts were not, as I had labeled them, “crazy” and acknowledging the facts that we’ve known all along. But most importantly pointing out that letting myself buckle under thoughts that I inflated would take away time that I could be experiencing joy and contentment. We all have a limited amount of time to enjoy life. I am no different in that respect than any of you.

He is one of those wise people who keep a sense of humor and is pleasant and giving through the toughest of situations. When he is stressed from the frustrations of life he seeks out humor rather than pitying himself. I have learned so much from him and could not have a better partner to get through this with. Thank you sweetheart for bringing me back once again. I am optimistic today and feel no fear.

Onward

One more treatment. We've almost reached the summit. Thank you for accompanying me on an ascent that no one chooses to take. I wish I were courageous enough to look at the view of the top. Does it look pretty? Is the sun shining up there? Will there be a refuge where we feel safe and can breathe easy?

I am in need of a guide. Someone who can help me find sanctuary when this journey ends. I will get the help I need. For today though I will sleep.

Back Home

I'm beginning to feel at home in the chemo room. Especially when I have my brother and sister with me.
My brother made us some I AM STRONG rubber bracelets. I love them, and him for doing this. He also gave me a XM radio receiver. Yaaa Hoooo. No more cassette tapes in the car for Laurie.
We got to sit by my favorite chemo pal today. She thinks our (mine and my siblings) eyes look alike and could tell we were siblings when we walked in the door. That was a first. I adore her and she is a bright star in what otherwise can be a gloomy room. She is my inspiration.

Chemo #5

Another new development. My sister got the day off at work tomorrow so she is coming to chemo with my brother and I. Heck, I am almost excited for tomorrow. It will be great hanging out with my siblings all day. We are starting the day with breakfast at Pauls Pancake Parlor, then chemo appt at 10 and should be out of the clinic by 2-2:30.

My sister also surprised me with a hour long massage for saturday morning. What a sweetheart. She has done so much for me. A couple weeks ago when I was out taking my pharm tech cert test at the university, she came to our house and cleaned it from top to bottom. Is there nothing better than walking into your house greeted by freshly cleaned and vaccumed floors, bathrooms cleaned, dishes clean and laundry folded? I am so fortunate to have her as my little sis. She is always there to listen to my crazy thoughts without ever judging. She is the toughest person I know. I think she understands me in a way no one else does. I can tell her anything because I know how strong she is. She is heartbroken by all that has happened and I love her for her unwavering support.

I have high hopes that this chemo treatment and recovery will be uneventful. I'll try to post tomorrow night while I'm still high from the steroids.

Why I'm Doubtful I'll Die Of Something Else

The following excerpt is from this article in Atlantic Magazine.

http://www.theatlantic.com/issues/96jun/cancer/cancer.htm

Only the most profoundly interested will have the time or interest to finish the article. It's long. This article does not make me any more frightened than I was before I read it. But it does a good job of explaining why people perceive breast cancer to be highly cureable now. And it is, for slow growing or moderately growing cancer. I have a "poorly differentiated" and fast growing cancer. Coupled with, or perhaps caused by, a genetic flaw called BRCA2 which causes an incapability to suppress the growth of cancerous cells. Cancer agressiveness is graded on a scale of 1 to 9. My tumor was graded 8. I have debated with myself about writing about recurrence here because of the effect it would have on my family. Its not my intent to scare people. I started this blog so that I could let go of repetitive thoughts. It also helps me make sense of them by periodically rereading my own blog entries. I considered starting another blog where I could write about stuff that I felt I shouldn't write about here. However I made the decision not to because this blog is about being real with myself and the people I love. I think that we as a society fear death because we don't allow ourselves to talk about it. Its not death that I fear, its uncontrolled suffering and the sadness that death leaves in its wake. I don't believe that I'll die any time soon. But I do believe that cancer will recur.

Breast cancer is as diverse as the breast itself, appearing in many different guises. Some cancers seem to erupt out of ordinary breast tissue with an awesome virulence, spreading rapidly throughout the body. When viewed under a microscope, the cells in these cancers almost always bear no resemblance to ordinary duct or lobule cells--they have lost all the specialized characteristics that differentiate cells in the breast from cells in other parts of the body. "Poorly differentiated" malignancies, as pathologists refer to them, are usually bad news, no matter what we bring to bear therapeutically.

Fortunately, these poorly differentiated, clinically virulent cancers are relatively uncommon. Much more often--perhaps in half of all breast-cancer cases--pathologists see malignancies that still bear some of the characteristics of normal breast tissue. These "moderately differentiated" tumors have a wide range of outcomes, though the prognosis for the patient is generally more favorable. A substantial number of women with moderately differentiated tumors will survive for years after treatment--even decades. In most cases these tumors evolve more slowly than their poorly differentiated cousins, probably taking years to become detectable. "Well-differentiated" tumors, a less common form, are more indolent still. Indeed, pathologists sometimes have trouble ascertaining whether they are truly malignant; women have a good chance of surviving them. The less resemblance cancer cells bear to the tissue that spawned them, the worse the prognosis for the patient.

As I have said, almost all cancer researchers think that the disease is triggered by an accidental change in the DNA of at least one cell. That cell divides, producing two cells, then four, then eight, and so on, with the volume of the tumor doubling in each successive generation. By the time the tumor has doubled twenty-three times, the original cancer cell has multiplied to more than eight million. At that point the tumor is about an eighth of an inch in diameter, just big enough to be detected (sometimes) by a mammogram.

Such a tumor is not very dangerous by itself; the danger lies in the metastases. The question is how soon the tumor metastasizes.

For almost thirty years John S. Spratt, a cancer surgeon now at the University of Louisville Department of Surgery, has been measuring the growth rates of breast tumors. In one of his most recent studies, performed in collaboration with researchers from Heidelberg, Germany, Spratt examined the progressive mammograms of 448 women who had tumors that turned out to have been visible in mammograms made before the tumors were diagnosed. (The women's doctors were not necessarily at fault for missing the tumors; in many cases mammographic imagery is ambiguous.) Comparing first, second, and even third mammograms provided evidence of how fast the tumors grew in the intervals. The median doubling time was 260 days, but the range was considerable: the fastest tumor doubled in ten days, the slowest in 7,051 days--that is, almost twenty years. These figures have striking implications.

Consider a woman who is unlucky enough to develop a single cancerous cell on her forty-third birthday. If the woman is especially unlucky, the cell has a fast doubling time of, say, thirty days. Twenty-three cell generations later the tumor might be visible on a mammogram; in another six or seven doublings it will be just big enough to feel. By then the woman will be forty-five. She will probably die before her fiftieth birthday. If, though, the woman develops a cancer with a slow doubling time of, say, 360 days, twenty-three doublings will take about twenty-three years, at which point the tumor might be seen with mammography. The tumor will be palpable in another six or seven years, meaning that without mammography it probably would not be detected until the woman was in her mid-seventies. By that age some people have already died of other causes.

I have simplified these calculations considerably. Spratt and his German colleagues found that breast cancers do not grow at a constant rate but instead slow down as time passes. Yet the principle holds that tumors that begin with fast doubling rates grow faster than tumors that begin with slow doubling rates at comparable stages of formation.

Close scrutiny of tumor doubling times could explain why the earlier diagnoses provided by mammography seem to provide so little prolonging of individual lives, despite the statistical appearance of benefit caused by earlier diagnosis. Although mammography is able to spot tumors as small as an eighth of an inch, which contain eight million cells, the average size at diagnosis with mammography is about 600 million cells. Such a tumor is only a bit more than a quarter of an inch across, but it has already doubled almost twenty-seven times and may have been in the body for decades. The average size of tumors detected by palpation is about 45 billion cells and about an inch and a quarter in diameter; these tumors have doubled an additional eight or nine times. To argue that earlier diagnosis provides an important benefit, one must believe that the tumor is considerably likelier to spread in those eight or nine later doublings than it was in the preceding twenty-seven.

There is no evidence that this is the case; indeed, the small amount of available data suggests that this view is wrong. With mammography we can see breast tumors earlier than we could before. But it is illogical to assume that our newfound ability to observe breast tumors between the twenty-seventh and thirty-fifth doublings means that they are especially likely to spread during this time or afterward and not before. If tumors are more likely to metastasize after rather than before mammography can detect them, the burden is on mammography advocates to demonstrate it. Meanwhile, I believe that the reasonable course is to assume that breast cancer can spread at any time in its development, and that metastasis has probably already occurred by the time we are able to detect the primary tumor. If this view is correct--and I should stress that studies to prove it have not yet been conducted--then it would explain why research has had such difficulty proving that mammography can save women's lives.

Similarly, examination of tumor doubling times could explain why chemotherapy boosts five- and ten-year survival rates but has little impact on the annual percentage of women who die of breast cancer--that is, why it helps women with the disease to live longer but leaves them just as likely to die of metastatic breast cancer in the end. My best guess is that adjuvant chemotherapy wipes out 95 to 99.9 percent of the residual cancer cells in a patient's body. (It doesn't get them all because the remaining tumor cells are innately resistant to chemotherapy.) Expressed as a percentage, the figures are impressive, but the actual impact is surprisingly slight. Suppose that a woman's tumor has metastasized and that the new tumor has grown to a million cells--a lot of cells, but not enough to be seen by the naked eye, or palpated, or spotted by any current imaging method (CAT scan, ultrasound, magnetic resonance imaging, and so on). If chemotherapy kills 99 percent of the cancer cells in a woman's body, this prophylactic treatment will reduce the metastasis from a million cells to 10,000. The remaining cells, which are resistant to chemotherapy, will keep on proliferating, more than likely at the same rate. In six and two thirds cell generations the tumor will have grown back to a million cells and the woman will be right back where she was before treatment began.

Cruelly, chemotherapy helps least those who need it most. If a woman's cancer has the short doubling time of thirty days, the six and two thirds doublings the tumor needs to recover from chemotherapy translate into about 200 days. Because chemotherapy is often administered monthly for six months, the gain is roughly equivalent to the length of treatment. Producing so much suffering, chemotherapy would in this case be a dubious exercise. If the woman's cancer has a doubling time of 360 days, however, she would gain 2,400 days, which is six and a half years. That sounds like a good payoff, but does she need it?If cancer were diagnosed in that woman at sixty-four (the median age of diagnosis), her slow-growing metastases would probably not become life-threatening for twenty to twenty-five years, when she would be in her late eighties. Because most people do not live that long, there would be little point in subjecting her to a round of chemotherapeutic treatment that would give her another seven years when she probably would die of something else in the meantime. If chemotherapy has little impact on a woman's chance of surviving either aggressive or indolent tumors, is it any wonder that it makes few inroads on mortality?

At the same time, chemotherapy should not be dismissed. The calculations above, for doubling times of thirty and 360 days, represent extremes; I used them to illustrate my point. A more representative example would apply Spratt's median doubling time of 260 days to my hypothetical forty-three-year-old woman. If, as before, the first cancer cell develops on her birthday, the resultant tumor could take eighteen to twenty years to show up on a mammogram. (Such calculations are necessarily inexact, because individual tumors do not always grow at the same rate.) The woman would then be in her early sixties--near the median age of diagnosis. With no treatment other than lumpectomy, she would be likely to die before the age of seventy-five. But if chemotherapy gave the woman the time it would take the tumor to double another six or seven times, the onset of life-threatening metastatic disease would be postponed until the woman was at least eighty; antihormonal therapy might buy an equivalent number of years. In real terms the achievement would probably be smaller, because people in their eighties are likely to die of heart disease or some other condition. Nonetheless, the woman would have gained five to ten years of life. This is a precious gift, one that she and her doctor can justly celebrate.

But consider the breast-cancer patients doctors most dread seeing--women in their thirties or forties. Such cases are relatively uncommon; breast cancer owes its status as the leading killer of women in this age group mostly to the even lower likelihood that they will be killed by anything else. Nonetheless, the individual tragedy of a disease that strikes down young, vibrant people makes it disproportionately urgent to treat them. Sadly, younger women in whom cancer is diagnosed are more likely than older women to have fast-growing tumors, because slow-growing tumors are usually still too small to detect. Given the probable doubling rates, these women will be lucky if we can give them an extra five years. Five years is, of course, much better than nothing--but much less than the thirty or forty years these women will lose. Anyone who treats younger breast-cancer patients knows that we will not have made major progress in the treatment of this disease until we can give women like these, with fast-growing cancers, thirty doubling times rather than six or seven.



CANCER OLD AND NEW


In effect, mammography today provides our definition of breast cancer. Any tumor spotted on a mammogram is treated, almost reflexively, with surgery, radiation, and often chemotherapy and antihormonal drugs. Thinking about doubling times suggests the inadequacy of this approach. When doctors diagnosed breast cancer by palpation in annual exams, they found principally fast-growing tumors--ones whose average doubling time, according to the work of Spratt and other researchers, was about ninety days. Despite decades of work, medicine still is unable to treat this kind of cancer effectively. Today the spectrum of breast cancer is different. Perhaps because of the hormonal changes created by the changes in women's lives, physicians are increasingly likely to observe the "new" cancer described above, which is slower-growing and much less dangerous. These cancers, because they progress so much more slowly, have a radically different impact on women's lives. For that reason we should be more discriminating in how we treat them.

"New" may be a misnomer for this slow-growing breast cancer. Although its incidence has risen, I suspect that it has been with us for at least fifty years; we just weren't able to see it. In fact, I would not be surprised if someday we are all found to harbor somewhere in our bodies several small, slow-growing tumors that will never cause us any problems. (They are beaten to the punch by cardiovascular disease or faster-growing cancers.)

Among the most important varieties of the new breast cancer is the in situ tumor--the small, localized, almost nongrowing tumor that at the time of diagnosis has seemingly neither become invasive nor developed the capacity to metastasize. Prior to mammography, as noted earlier, in situ tumors accounted for only one to two percent of all breast-cancer diagnoses, whereas today in communities where people see doctors often and have lots of tests, in situ tumors account for at least 10 percent of all breast-cancer diagnoses. After lumpectomy and radiation, only one out of ten in situ malignancies recurs in the next five to eight years.

Most of my colleagues celebrate this as a triumph, because it appears that we are catching cancers earlier than ever and curing more of them. They may be right. But consider this--if one out of ten in situ cancers recurs after treatment, nine out of ten do not. If my view is correct, even without treatment many or most in situ cancers would never have grown big enough to be detected by palpation, let alone to pose a threat to life. They might even have become invasive and metastasized, but the metastases would also be too small to be detectable and would never be lethal--rendering the recurrence rate and thus the question of treatment ultimately unimportant to survival. As a result, mammography is only leading physicians to diagnose an ever-larger number of harmless tumors. Patients who otherwise would never have known they have cancer may needlessly suffer through the unique pain, anxiety, disfigurement, and expense associated with modern medicine and cancer. For all we know, the chief effect of mammography has been to disguise our inability to cure the old cancer, by burying it in cases of new cancer.



WHEN THE DIAGNOSIS
IS POSITIVE


Because of the prevalence of in situ and other slow-growing breast cancers, women who receive a positive mammogram should not despair. Two thirds to four fifths of positive mammograms lead to biopsies that do not reveal cancer. Even if the biopsy indicates cancer, the patient should keep in mind that not all tumors are truly dangerous, and she should strive to learn what kind of tumor she has.

Although scientists are divided in their opinion of its accuracy, I believe that one of the most promising gauges of risk is the "S-phase fraction," which is a rough measure of a tumor's doubling time, derived from a technique known as flow cytometry. Technicians calculate this measure by chopping up a small amount of tumor tissue in a kind of specialized blender, staining the cell nuclei with a dye, and squirting the result one cell at a time through a very fine nozzle. The cells shoot through a thin laser beam, each nucleus casting a shadow as it crosses the light. Computers record the shadows with enough detail to discern the approximate percentage of cells in the sample that are dividing. From these data physicians can infer whether the cancer is aggressive (a doubling time kf sixty days or less), moderate (sixty-one to 150 days), indolent (151 to 300 days), or very indolent (more than 300 days). Because tumor growth rates may change over time, and metastases do not necessarily march in lockstep with the tumors that spawned them, the actual situation faced by patients is more complex than indicated by this summary. Nevertheless, Ibelieve that the broad principle holds:armed with information about a tumor's growth rate and the patient's age at diagnosis, doctors could often be more informative than they are now about what lies ahead for their patients.

If doctors could accurately gauge tumor growth rates, using any agreed-upon test, my strong hunch is that about a third of the tumors now detected would be found not to need treatment beyond removal of the tumor itself. Perhaps another quarter of women in whom breast cancer is diagnosed could gain considerable time--enough to take them safely into old age--with antihormonal therapy alone. The remainder could be helped by the combination of surgery, radiation, and chemotherapy, though not nearly as much as the providers of these treatments or their patients would hope. For this last group of women, I am very sorry to say, modern medicine has less to offer than newspaper headlines suggest. The outcome was dictated well before diagnosis--by the date the first cancer cells developed and by the rate at which they grew.

If, as I suspect, a woman's fate is set very early in the development of a tumor, it seems implausible that advances in detection will have an impact on the disease. One can always hope that science will develop a wonder drug that eradicates tumors completely, even when they can't be seen or felt. But for the present I think we should focus research on improving our ability to distinguish between women with breast cancer who can benefit from aggressive treatment and the larger number who will gain little from it no matter what we do.

Dreaming

By the end of the year I should have enough hair for a style. I am so damn excited to have hair again. I can't tell you. I'm over wearing hats and my wig is itchy. Drives me insane. Try to imagine this style on me rather than the cyborg its sitting on here.

Egg Sauce Dead

You read that right. I'm exhausted from working five hours today. Meeting lots of new people, trying to pay attention during orientation and freezing my ass of all day did it. My brain doesn't handle stimulation very well these days and my eyesight is getting worse, but I don't think that's chemo-related. Its going to be a relatively low stress job. I'll be paid about one third of what I was making this time last year however alot has changed since then.

I quit my 20 year career in IT, got married, went to Hawaii on a honeymoon, sold John's house, we bought a house, rented my old house, John started having heart arrhythmias, I went back to college, I got cancer and had a double mastectomy and oophorectomy followed by four rounds of chemo, passed my pharmcy tech certification test and then started a new job. No wonder I'm tired. John is very tired these days also.

Three days from now I'll be in the chemo room again. My big bro is coming for this one. What a guy! It will be really nice to have him there. He'll be a great diversion from the rather scary process. He is so good with people. Puts everyone at ease with his good natured personality and tells incredibly lame jokes. They make you groan and then you can't help but laugh because he thinks they are funny. I wish I was more like him. Here he is sneaking cheesecake seconds while no one's looking. His oldest son and darling wife are in the picture also.

Waking Up

I am proud of my body. Its stunning to me to witness how it recuperates. Its sunny today in Missoula and in the new office that I have set up in our loft I can look out four different windows. I see snow covered mountains shimmering in the sun. Blue sky beyond.

I have a new job to start tomorrow. New adventures, new people and a renewal of my spirit which had grown somewhat depressed over the past couple of weeks.

I will take a nice long run in the sun this morning. Then a hot bath. What could be better? Its all down hill from here. In three weeks and four days I will have my last chemo treatment. I will be set free from many reminders of my new life with cancer.

I am also quite proud of my ability to accept cancer. I have honestly never questioned why it happened to me. I accepted it and moved quickly to get it removed from my body wherever it might lie. I don't like to use the word fight. I have not fought cancer. I am not a fighter in any way, shape or form. I have tried to visualize chemotherapy killing remaining cancer cells but my mind refuses. Its too violent. I liked the idea of surgery cutting out the cancer cells and then letting them go outside, like a spider. After all, those cancer cells are ME.

I've finished my big cup of tea and now its time to get moving. Hope your day is wonderful. If your child asks you to play today stop everything and play. They will stop asking one day.

I See A Pattern

For two days after a chemo treatment I am physically ailing enough that I don't have spare energy for worry or doubt. When physical effects begin to subside but I am not yet strong enough to resume interesting activities, my mind gravitates to dark places. Its during that week long period, when the toll chemo takes on my body is particularly evident, that I am convinced I cannot do another. Recovery from chemo is unlike other illnesses I've experienced. Its not like a cold or flu. Its as much mental as it is physical. Its dizzyness and despair. Nausea and depression. Mouth sores and grief. Fatigue and distress. Sore muscles and exasperation. But it doesn't last forever. After that week, only fatigue, sore fingers and dull taste buds persist. I am caught off-guard by feelings of joy. I can begin to run short distances. The final couple days before treatment I can run as far as four miles, albeit slowly.

My next chemo treatment is a week from today. I can now forsee when turmoil will set in and I hope this knowledge keeps me from repeating the pattern.

I don't have the guts to not finish my chemo treatments.

Limits

Labor started on a Friday afternoon. It was the first day of the Masters tournament, April 1994. I left work early with labor pains occurring every ten minutes or so. I was apprehensive but also relieved that Tanner would be born soon. I was two and a half weeks overdue and ready. By late Friday night the pains were coming every five to seven minutes and we went to the hospital. After a quick examination by a nurse we were sent home. I was only two cm dilated.

Friday night was a long night. I spent a lot of time in the shower alternating the water temperature between warm and hot. I had found that the goose-bumps that accompanied the switch to the hotter temperature was a natural pain reliever. I tried to sleep but was woken up every few minutes with contractions.

Saturday was more of the same. With the Masters Tournament on the TV, I spent the day on my hands and knees resting my head on a stack of pillows, breathing through each contraction. My water had still not broken and we were told not to come back to the hospital until it did. Saturday night was spent in the shower again. I was growing exhausted having not slept for close to forty hours.

Sunday brought the agony of back labor. We phoned a chiropractor who made a house call. He showed Gordy how to apply pressure to the base of my spine which helped with the pain. By Sunday evening with no end of labor in sight we went to the hospital again. I was still only two cm dilated. My OB doctor said that it was still false labor and to go back home. My doctor didn’t think highly of ultrasounds and had not done one during my pregnancy. The hospital did not do an ultrasound during labor so we did not know that Tanner was turned posterior. This was the reason for the non-productive contractions. During each contraction Tanner’s head pressed against my lower spine rather than downward on my cervix. I remember nothing about Sunday night except for desperation for someone to help me.

At five am Monday morning, with my water still not broken and contractions continuing to come every five minutes we went back to the hospital. I had only dilated to three cm. Finally my doctor broke my water with a metal hook and started an IV with pitocin, which would strengthen my contractions. Monday was hell. I was utterly exhausted from not sleeping for more than a few minutes at a time in three days. The back labor continued because Tanner was still posterior. I begged for epidural anesthetic but my doctor would not allow it until I was at least five cm dilated. That day was the only time in my life that I have wanted to die. When I finally got an epidural I dilated to ten cm within an hour.

It was time to push. Adrenaline served me well and I was able to push quite well. Tanner’s head emerged and the doctor turned him. It was at that point that my strength gave out and I gave up. Tanner’s heart rate was dangerously low. The doctor inserted forceps and a silicon suction cap to aid in pulling Tanner out. I remember hearing “if you do not push the baby will die”. Those words were powerful and I pushed. Tanner was born silent and blue. He was revived and I was emotionally vacant.

The misery and desperation of the final minutes prior to Tanner’s birth is difficult to describe but I recall the intensity of the need for someone else to endure for me. There were times when my cancer diagnosis was fresh and nighttime would bring on terror of what laid ahead. As with the desperation of labor, I needed someone else to endure for me. I resigned myself to the fear and wailed into John’s shoulder until I was again, like after Tanner’s birth, emotionally vacant. I think there is a limit to how much fear we can endure before abandoning our cognizance.

My Pal

My silent partner around the house, sweet little Ringo, in his brand-spanking new cat tree that my Dad built for him last week. My Dad can build anything.

Temptation

Now and then I allow myself to have a glass of red wine, sometimes two. I feel guilty afterward because my doctor says more than one glass a day causes a 20% increase in cancer risk. She says I shouldn't drink at all. Its hard on your liver and my liver is already being slammed by chemo. I also believe that wine consumption is part of the reason I got cancer. Why do I do it? A glass of wine means more to me than the taste and the relaxation that accompanies it. While I have the glass in my hand I feel like I don't have cancer. POOF its gone.

After diagnosis I started a strict diet recommended by my doctor. Sugar is poison. So is white flour. Meat and dairy that is not organic contains growth hormones which might raise your cancer risk. Red meat is especially bad.

Tonight I ate meatloaf (made with organic beef) and a small chocolate heart. It feels empowering to eat they way I used to eat, even if it's only occasionally.

I long for the end of chemo and the return of my strength.


I dream of returning to Tulum Mexico to feel the warm sun on my skin and to lay reading by the ocean for hours hearing nothing other than the sound of the surf.