Surgery has been delayed until 2pm today. there was a scheduling snafu on the part of my surgeon’s office. So, after considering moving me to a private hospital room for the rest of the morning, I was given the option of going home and coming back at 1pm, which I gladly accepted. I appreciated the fact that Dr. Beatty came to explain the situation and to apologize in person, rather than making someone else deliver the bad news. Can you imagine how upset people must get?

John and I talked in the car on the way home about how well we have been coping with my cancer, as a couple. Despite the increased stress, we’ve been bickering less. I hope we are able to maintain this but I know it will be harder as time goes on. In my experience, being civil to one another is often hardest for families after the acute medical crisis has been resolved. They stop holding their breath, relax a little, and then the emotions can come crashing down. John and I decided to be mindful of this and to try hard to forgive each other and ourselves, when and if this happens.

Being angry and upset requires a lot of energy. I’m devoting so much right now to coping with my illness and functioning as a parent, wife, and professional. I don’t have enough left over to have a hissy fit. Anxiety does find its way in. But honestly, waiting for a delayed surgery this afternoon is not as stressful as waiting for Dr. Beatty’s phone call with my PEM results last night.

Dr. Beatty felt pretty apologetic. He even patted my shoulder, which I would guess is surgeon’s version of an outpouring of emotion. I tease because I love. I am in awe of anyone who has the emotional control, concentration, and technical skill required for surgery. Plus, I find a more professional, calm, straight-forward, and sincere apology to be more reassuring than what some of the health providers do. A few of them, physicians included, over-apologize and do so with distress in their voice. Not to mention the fact that they are apologizing for doing their job, which may result in my feeling some discomfort. The reasons I don’t like it are because their distress, makes me feel a little distress, and when accompanied by all of the apologies, communicates a lack of confidence. The first time I encountered this was with the radiation oncologist who diagnosed my cancer. Obviously, she knew what she was doing because she found my main invasive cancer tumor through a diagnostic mammogram, despite my breasts’ vampire-like resistance to getting their pictures taken using standard imaging techniques. She kept apologizing while she was doing the core biopsy, when she injected the lidocane and with each time she collected a tissue sample. It wasn’t as if I was wincing or anything or that it was really all that bad. I fought the temptation to tell her, “I think you are a very good physician and I appreciate your attention to my comfort. Please don’t apologize so much. It makes me think it should hurt and that you think you are doing something wrong. I understand that you are doing your job.” I don’t think it would have gone over well, though. She needs to hang out with a dentist or something. “There’s going to be a stick. Okay, now we’re done.”

But back to Dr. Beatty’s apology. Who knows? Maybe he’ll throw in an extra during surgery today. Maybe he can give me a lightening bolt shaped scar. I could use it professionally, as a rapport-builder with my patients who love Harry Potter. What a great way to build my business back up after I go back to work full-time!

 

This is going to be quick because I need to get ready for surgery in the morning. That means packing my bag and no food or liquid past 7 pm, which is in 10 minutes!

The reason for this packing frenzy? Dr. Beatty just called and let me know that there were no areas of cancer shown by the PEM scan. So the lumpectomy is as scheduled for tomorrow?

Now that still means that there will be another excruciating wait for a pathology report to confirm this news but for now I am happy and relieved.

I’m going to pack and take my “special shower,” with Hibiclens tonight and then another one tomorrow morning.

Nightie night, everyone and I will update tomorrow or the day after.

Thanks to all for your prayers, positive vibes, calls, texts, and emails.

Confession: I did not make up the expression, “getting panini’d” as a reference to getting a mammogram. I think it’s a popular joke in the mammography world, but it bears repeating.

I had my PEM scan this morning. It took 3 1/2 hours. During the first hour, I had to wait for an hour, sitting relatively still after a combo sugar/radioactive I.V. was placed. Then there were two hours of pictures taken, while I sat in a chair. How luxurious, you women who have participated in more standard mammography might think. No, I was sitting in a chair but there were still those lovely plastic boob-squishing plates on the machine. And each picture takes 7 minutes to take. (At least I didn’t have to hold my breath for each picture like in standard mammography.)

I am keeping my fingers crossed. Dr. Beatty will call me after 5pm tomorrow to tell me the results  and whether my second lumpectomy will go as planned for Weds. I am wishing for the best but if a mastectomy is recommended, I hope at the very least, that recommendation is based on what is actually seen using the PEM scan instead of based on a lack of information given by the other scanning technologies.

As you know, in preparation for tomorrow’s PEM scan, I’ve had to follow a SUPER low sugar diet today. Bleh! On the upside, I had almost no processed food.

Here’s what I had today:

Breakfast
2 eggs scrambled with Swiss cheese
black coffee

Lunch (I could have had one of the approved green vegetables but I was too lazy to cook)
Small handful of almonds
A few slices of cheese
Water

Dinner
Salmon filet poached in plain water (wine, lemon slices, onion, etc. were not allowed), with a few chopped almonds on top. I love salmon but I overcooked it a little plus I usually season it with spices, onions, etc.
Steamed green beans (actually the beans were really good)
Water

(Meanwhile, John ordered Indian food for himself and I smelled all of these delicious spice from his food.)

P.S. As a funny side note, I noticed that peanut butter was on the list of okay food but I don’t know how any body would combine it with any of the other foods unless you were to melt it over tofu or something. Maybe people just eat it by the spoonful out of the jar and imagine that it is on a sweet crunchy apple.

I woke up full of energy this morning, did some chores, and made breakfast for the family. I have managed so far to avoid violating my 24 hours virtually sugar free diet, required for the PEM scan tomorrow. The clinic calls it “sugar free” but I am allowed some veggies (green beans, cauliflower, asparagus, broccoli)  and I think there are sugars in all veggies. Let’s just call it a diet that is extremely low on the glycemic index. EXTREMELY LOW. I don’t think I’d make a good carnivore. I had two eggs with some cheese. (I would have thought that cheese would be on the verboten list since it is made from milk but have since read that lactose, the natural sugar in milk, is removed from the milk in the cheese making process.)

My energy soon went down the tubes after breakfast making and I took a nap. I’m still lounging under a blanket.

I got to get out in the yard and weed this morning. Yay! Here are some pictures of my Jungle of Delights!

Mindfulness is an ancient practice that has been adopted and adapted for use in psychological treatment, especially for self-regulation, in other words, not losing your shit. Two very famous people who are noted for their work in mindfulness are Jon Kabat-Zinn (up until 30 seconds ago I thought he was a psychologist and he actually has a Ph.D. in molecular biology; anyway, he is the writer of Full Catastrophe Living and other books) and Marsha Linehan of the University of Washington who developed Dialectical Behavior Therapy (DBT) originally for severely suicidal adults in the 80’s and over the years she has broadened her work to a wide variety of mental disorders and life circumstances that challenge emotion and behavioral regulation. (By the way, if you ever get a chance to hear Dr. Linehan speak in public, I highly recommend that you attend. I have heard her a number of times and she is amazingly brilliant and funny. You also may have seen the NY Times interview last year, when she disclosed her own history in early adulthood of suicidality, self-harm, and repeated psychiatric hospitalizations. She is quite a courageous person.)

I am on a mindfulness email list because I attended a FACES conference at U.W. a few months ago with my dear friend, Nancy Cohen. I received an announcement about the book, A Year of Living Mindfully: 52 Quotes and Weekly Mindfulness Practices. Each week begins with a quote selected by a mindfulness teacher, followed by a lesson, and a practice for the week. The book is divided into several themes. Being the Western-minded impatient cheater that I am, I skipped to Section VI, “Being in Difficult Life Situations: Stress & Suffering.” Here’s the quote (selected by Elisha Goldstein, Ph.D.) followed by the exercise. I invite you to join me this week if you feel so inclined:

Don’t turn away. Keep your gaze on the bandaged place. That’s were the light enters you.
-Rumi, 13th century poet/philosopher extraordinaire

Dr. Goldstein’s exercise (plagiarized directly from the book):

When you feel an uncomfortable feeling, try this experiment for a single minute:

“Breathing in, I feel this feeling; breathing out I let it be.”

You can shorten this to just saying “feel” on the in breath and “let be” on the out breath.

The instructions are simple, but the practice may not always be easy. Be kind and gentle to yourself through this process.

Okay kids, let’s be mindful. In the words of the Dalai Lama, “On your mark, get set, go! First person to the finish line wins!” (See, I already have the perfect mindfulness mindset.)

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There was another possible concern raised at the medical case conference, which was ruled out today by a good old fashioned mammogram. (I have decided to call the state of the art positronic emissions mammogram (PEM)  that I am having next Monday, a “fancygram”.

Bear with me, because this is going to require a little background explanation. When I had a biopsy last May, they inserted a tiny titanium clip into the biopsy site. This way, if the site is cancerous there is a marker there that helps the surgeon and radiologist find the site. And if it is benign, the fishy looking but benign clump of cells will be marked for future routine mammograms so you don’t have to keep getting biopsies on the same site.

On the morning of surgery, a radiologist placed a wire in my breast and used ultrasound to make sure she placed the wire according to the location of the clip. However, during surgery, the clip was no longer visible so the surgeon used the wire as a guide. He was not unduly concerned about it but enough to tell us. But then the pathologist didn’t locate the clip either in the excised tissue. Now apparently, these clips can get lost on occasion and it’s not something to get hugely worried about in and of itself. However, someone at the case conference pointed out the possibility, though unlikely, that the tissue that was excised was not the right tissue and it just happened that Dr. Beatty excited tissue with tumors in it. He/she recommended that I have another mammogram to make sure that the clip was out. And by the way, mammography has not had trouble “seeing” metal as opposed to the other imaging problems. Today, I got to see the metal markers that the surgeon placed as well as earlier pictures of the various wires and clips.

The clip is not in there. Hooray!

Well, the girls are going through another round of assessment before surgery. When we last met with Dr. Beatty last Monday, he seemed frustrated with the lack of complete information he’d gotten from my MRI, diagnostic mammogram, and ultrasound. On Tuesday morning, he left me a message sounding mildly excited about a suggestion he’d received at case conference earlier in the morning. Yes, my breasts have been presented at a case conference, which means that my cancer is no longer boring. The case conference was attended by a number of physicians who work with breast cancer, surgeons, radiologists, radiation oncologist, medical oncologists, etc.

I called him back and he told me that one of the recommendations was that I do a positron emissions mammogram (PEM). If this sounds a little like a PET scan, that is not an accident since PET stands for positron emissions tomography. I’m sure my physician would correct me but I’m going to say it’s basically a PET scan of my breasts. The main advantage of this technology is that the clinical trials (it is in stage III clinical trials, which is the last stage by which a drug or technique is tested and if the results are positive, becomes part of standard medical practice), have shown evidence that it is particularly suited to pre-menopausal women, with dense breast tissue, and hormone responsive tumors. Sound like anyone you know?

My understanding is that the other imaging techniques have taken “pictures” of the structure of the tissue and the form of the cells. PEM actually takes a picture of differences in the rate of glucose metabolism (rate by which sugar is broken down and converted to energy) across the breast tissue. Since cancer cells metabolize more quickly than noncancerous cells, they can be “spotted” in the picture because they are shown in a different color (or shade of black/white/gray). This is my understanding and it is somewhat tenuous. My grasp of nuclear medicine and cellular biology are kind of limited.

So they can control my sugar intake during the procedure, I need to follow a strict diet for the 24 hours prior to the procedure-meat, nuts, cheese, butter, peanut butter, and non starchy vegetables. There’s stuff I think would probably be okay like black coffee but it’s not on the forbidden or okay list so I’m not going to chance it. Before the procedure, they will inject me with a solution of glucose and radioactive stuff. Then I sit quietly for an hour. Then they take pictures  And as an extra bonus, I get to sit in a comfy chair for the entire procedure. Huzzah!

I know that one consequence of this is that they might find more stage 1 or stage 0 cancer that they didn’t know about before. My thought is that it is better to know about this so that we can do something about it. Fortunately, the specificity and sensitivity of the PEM is high. That means that the false positive and false negative rates are low while the true positive rate is high. Okay, that was not the clearest explanation about something in my area of expertise–measurement. But I’m in a hurry for another medical appointment so this will have to do for now.

So the big PEM day is next Monday. Wish me luck!

Lindbergh High School Reunion '82, '83, '84, '85

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George Lakoff

George Lakoff has retired as Distinguished Professor of Cognitive Science and Linguistics at the University of California at Berkeley. His newest book "The Neural Mind" is now available.

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