Protected: Scarier than Cancer
After a couple of recent inquiries about my physical health, I realized that I have not provided an update for some time. So I will take out a bit of time from my concentration on my emotional and cognitive health (a post about my challenges with attention, organization, and memory is forthcoming) and focus on my medical status.
Medications
I started taking Lupron injections last summer. I now get one every three months and will continue to do so for a total of two years. Lupron “shut down” my ovaries by disrupting the signal between my pituitary gland and my ovaries. So my ovaries think my days of monthly cycles are over and done with. I am currently infertile and functionally in menopause. However, Lupron induced menopause is reversible. Once I stop taking Lupron, I may start my cycles again and go back to being peri-menopausal.
In October, I started taking tamoxifen, another hormone blocker. I will take that for a long time. At the time of my diagnosis, the usual treatment protocol was to take it for 5 years. Subsequent research suggests that 10 years might be better. I’m not going to worry about it because we’ll have more information by the time that decision needs to be made.
Other than those stupid hot flashes, occasional foot cramps, and having to work out harder to maintain a healthy weight, I have been very lucky and tolerated these medications very well. Knock on wood.
Scans
I have an annual diagnostic mammogram and an annual MRI, staggered by six months. I had a “clear” mammogram last January. I will have my next MRI in September, six months after my TRAM surgery. (Recent surgery makes it harder to read the images for MRI.) Both diagnostic mammography and MRI missed three of my four invasive tumors as well as a 6cm area of DCIS. A disadvantage of being “young” (under 50) in the breast cancer world is that our breast tissue tends to be denser because there is higher water content. The water shows up as white on imaging as does cancer. So it’s hard to know. I have also read measurement research on the sensitivity and specificity of breast imaging techniques. Imaging should get considerably more sensitive as I age. However, the specificity of mammography in particular is not great. As you know, there is a high rate of false positives. But that was not my problem. My problem was of false negatives.
Surgeries and recuperation:
As many of you know, I had seven surgeries between 6/27/12 and 3/11/13. I know I mention this a lot. I also know that it is not a race as in she who gets the most surgeries wins! Let’s just say that one of the reasons I keep mentioning it is because I am still trying to believe it. And I kept my sanity that whole time. And I know that many of you out there have been through similar and even rougher treatment protocols. Let’s pause a second to reflect on our resilience. It’s really rather incredible.
Back to me, sorry, I told you that I was going to write a post about my ever-changing cognitive functioning. I had an appointment with Dr. Welk, my plastic surgeon last Friday. Even though I was feeling good and nothing appeared to be amiss with my healing, I was kind of nervous about the appointment as I had not seen him since April. I am happy to report that nothing appears to be amiss.
I am still slightly swollen from my TRAM surgery, which was 4 1/2 months ago. A significant portion of my sensation has returned to my abdominal area. There are no areas that are totally “dead” to heat, pressure, etc. I intermittently feel those little electrical shock sensations associated with nerve regeneration, especially right after my acupuncture appointments. And then after several hours of on and off shocks, I notice that I have more feeling. I just now read a plastic surgery abstract from a very small study of women post TRAM surgery. A good number of them had at least some sensation return. (Yes, it would be better to read the entire article but the journal was charging $30 for the privilege.) I had not expected any sensation to return and so had not mentioned this issue to Dr. Wang. I will talk to her about it next week when I see her. Perhaps there could be some welcome improvement in the “being able to feel stuff” department.
An unexpected positive is the fact that my abdominal strength is much better than I expected it to be. I had a pedicle TRAM procedure which means that one of my rectus abdominus muscles was sacrificed to create a blood source for the transplanted tissue. Microsurgical procedures can be used to prevent this but I was not enamored with the higher rate of complications and failed surgeries. There is a little bit of controversy regarding the pluses and minuses of these procedures but I am happy with the choice I made.
I am seeing Dr. Welk again in October after my follow-up MRI. I may have another set of plastic surgeries, which Dr. Welk said could be done in one office visit. (Dr. Welk’s time estimates are like dog years so this means two office visits.) The purpose of the procedures would be to improve symmetry between lefty and righty. But at this point, I don’t have to do a thing and Dr. Welk was very clear that this was a perfectly reasonable option. He provided a range of possibilities including doing breast enhancements on each side, which would involve getting a set of implants. For me, this is a big “no, thank you”. He was fine with that.
Healthcare visit schedule:
Currently, I see my breast surgeon every six months, my medical oncologist every three months, my naturopathic oncologist every 4 months, my Chinese medicine physician every two weeks for acupuncture, and my psychologist every two weeks. And I continue to get a full body massage every three weeks, something I have done for nearly 13 years now for stress and chronic pain management. (I had chronic neck pain for twelve years during my 20’s and early 30’s. It went away after two months of massage.) I typically have 1-3 healthcare visits a week, about half of which are across town or in another city. I am very lucky to have such wonderful care. The logistics, however, contribute to a frequently interrupted life and work flow especially on top of parenting duties.
So that’s the state of the union as of today. I will keep you posted and thanks to all for your continued support and concern.
I grew up in a loving household, in a good neighborhood, and went to good public schools. Despite this, as an adolescent girl, I became quickly and keenly aware that part of being female was being prey to boys and men.
I went to middle school in the late 70’s. Like many teens, I had an ugly duckling/swan transformation. As a 7th grader, I was considered to be rather homely. Boys fake-flirted with me to humiliate me. They treated me like I was stupid. By 8th grade, I had undergone a bunch of pubertal changes, lost weight, grew several inches, and got fashionable. But it didn’t matter whether I was pretty or not. That school was an incredibly humiliating place for a girl. Walking the hallways was like running a gauntlet because boys hands would be groping everywhere and I mean everywhere in what seemed to be full view of teachers. Not one of the adults did a damn thing about it.
The summer after 8th grade, we went to a Seafair (Seattle’s summer-long festival) parade. One of the Seafair clowns, a GROWN ASS MAN, picked me out of the crowd (did I mention I had just finished the 8th grade?) and gave me a sloppy kiss full on the lips. I tried to make a joke to regain my footing and recover from the confusion and humiliation. He made some mildly sexual comment. That was my first kiss, by the way.
When I was a high school freshman, I often walked the mile between my bus stop and home by myself. There were other kids in the neighborhood so I don’t know exactly why I walked alone so frequently, but I did. On more than one occasion, a car would pass, come to a halt in front of me, and open the door to the passenger side of the car. They were strange men waiting for me to get into their cars with them like this would be something I would want to do. I would freeze and I remember being afraid to walk past that open door. After a bit the door would close and the car would drive off.
When I was in the 10th grade my history teacher, who was at the time THE SAME AGE AS MY FATHER, engaged in some super creepy behavior with me. Whenever we had independent work time, he would sit on top of the desk in front of me and stare at me. Occasionally, he would try to start up a conversation. I hate to be crass but feel compelled to point out that when he was seated this way, his crotch was right at my eye level. I argued with him about one of my grades once and he looked a little desperate, as if he were somehow losing me. He put his hand on my shoulder and told me that he loved me. I told two teachers and a guidance counselor about this. I was told that I had misunderstood what was fatherly concern. My peers teased me and told me that I thought everyone was in love with me. I felt ashamed and didn’t tell my mother about this or any of the other middle school and high school incidents. I would learn later in my life that my mother would have likely kicked some ass and taken names on my behalf. That’s because my mom did kick ass and take names on my behalf but that’s an incident that I’d rather keep private at this time in my life.
These events were creepy and felt clearly wrong to me. But there were many other experiences with peers that were far more confusing. Some of my male peers could be disgusting one moment and sweet another moment. I dated very little in high school but I did have one little “fling” at music camp when I was 15 years old. The boy was smart, funny, and at times, sweet. At one point he characterized the appearance of my legs as “good for spreading.” I can’t remember the context of this comment except that there were other kids around when he said it. I made out with him anyway, in the kind of barely PG-rated way that a 15 year-old girl “good Catholic girl” would do.
This is the world of females, when being sexually desired is mixed with degradation. And I would clarify that it is the world of straight females but even non-heterosexual girls and women are subjected to expectation from many boys and men that they exist for male pleasure and domination. What a way to tarnish healthy sexual development. What a way to make it feel wrong and dirty.
Why do I tell you about my life experience? Is it because it is so unusual? No, I describe my experiences because I think they are close to the typical female experience. Actually, my experiences may arguably be better than the typical female experience. Tellingly, I took myself off of the dating market until college by having crushes on boys so shy they’d never ask me out or boys who I would later learn, were gay. And I went to a high school where being a smart, outspoken girl meant a death knell to dating. I kept my head in the books. I decided when I was 12 years old that I wanted to get a Ph.D. I was lucky enough to have academic skills and support that I could leverage, to build this future for myself.
Last week, I learned that Larry Flynt and his “gentleman’s club” put on an event called “Flight of the Ta-Tas”, a topless skydiving event to benefit Living Beyond Breast Cancer (LBBC), an organization devoted to women and men who have had breast cancer and later developed metastatic cancer. As it turns out, LBBC’s logo was used to promote the event without their permission. They did not sponsor the event. To read more about this, Knot Telling wrote an excellent series of posts about it as well as communicating directly with LBBC about it.
But let’s back up a second to Larry Flynt, the publisher of Hustler Magazine. The first time I learned about this magazine was when I saw this 1978 cover.
But look at Larry Flynt’s quote on the side, “We will no longer hang women up like pieces of meat.”
Oh wow, Larry Flynt was speaking up for women. He was trying to help! You buying this because I’m sure not. When one looks at the context of this statement, the context of all of the degrading photos of women in Hustler not to mention the juxtaposition of this quote with an image of a woman in a meat grinder, the real message is as clear as day.
Sexism has long been protected by ignoring context. That is why I’ve told you about aspects of my life. And no, not all males are exploitative of women. And not all women allow themselves to be exploited. I am talking about culture, the group. And as a group, girls and women are subjected to sexism and it hurts.
Yes, I can see a specific instance where going topless skydiving might be a positive experience. But done within the context of the sexism that pervades our culture as well as the culture that trivializes and sexualizes breast cancer because it involves “boobs”, “The Flight of the Ta-Ta’s” does more harm to women and girls than it does to help by raising money for a worthwhile cause. A lot of people may think that I’m making too much out of this, wasting my time and energy. I mean LBBC would get a big check if they chose to accept it, right? Let me ask you this. Would the same rationale apply to a black face/minstrel show to raise money for the NAACP?
Larry Flynt, I’m not taking the candy you offer me to get into your car. Keep your money. We aren’t going to sell ourselves, other women, or our daughters.
As a child/adolescent psychologist, I work with a lot of moms. They often express feelings of guilt for their children’s challenges. I often respond by saying, “You have the rest of your life to feel guilty as a mother. Save some for later.” This statement usually gets a laugh and often the guilt although not gone, is small enough for us to move forward in our conversation. It is often, however, not so easy. People get stuck. Even psychologically solid, reasonable parents can get stuck on guilt. Several years ago, I worked with a wonderful mom of a very young child who was showing signs of significant developmental challenges in multiple areas. She had professional experience working with children and was acutely aware that her son may have handicaps that would greatly change the future possibilities in his life.
Although there was no evidence that she had done anything to contribute to her son’s difficulties and further, it was yet unclear as to whether his difficulties would be short-lived or chronic, she felt guilty. She felt guilty and stuck. During one session I asked, “What do you think you are getting out of this guilt?” She looked at me understandably with a confused expression. I went on, “It may sound backward but sometimes people hang onto guilt because it gives them a sense of control in situations in which they feel totally out of control. We cannot have guilt without a sense of power, even if the power we feel is to harm.”
She was dubious but I had planted a seed. She came back a week or two later and basically told me that she had thought what I had said made no sense but upon careful reflection, it actually made sense. It was a turning point in her grief process.
Guilt is blame turned inward. It can also be turned outward. In Atom Egoyan’s 1997 film, The Sweet Hereafter, a town grieves for the loss of a busload of school children in an accident. Ian Holm plays an attorney who travels to the small town to file a class action law suit against the bus company. He has his own grief back story, which is his adult daughter’s drug addiction. Holm’s character tirelessly pursues blame. Someone must be responsible for the tragedy. That someone must pay. Things don’t just happen. They happen for a reason. He was going to find the reason at all costs. I won’t spoil the ending for you but let’s just say that letting go of blame and accepting the loss of control is a major theme of this film.
As for myself, I have had issues with letting go of anger. There is a release that comes with losing my temper and in the moment, it feels good. But because I am at heart a peacemaker and an empathetic person, I feel regret at having hurt other people, especially my husband. My anger is usually rooted in anxiety, anxiety that a problem can’t be controlled or solved. Anxiety that my house will never be an environment that I can control and make a sanctuary. Fears that my cancer will return. Fears for my family, especially my teenaged daughter. I have fears of not being a good enough psychologist when my patients are having particularly treatment-resistant struggles.
Most people would consider me to be a very disciplined person. One exception to this has been my life long struggle to eat healthfully and to exercise regularly. I love food. I am an excellent home cook and I love good restaurants. I love to eat a large amount of food. The act of eating is an amazing, highly enjoyable, sensory experience. It is also a wonderful social experience. And I know when I am overdoing it and often in my life, I just keep eating. And at these times, it seems too hard to put the time into preparing healthy meals. Quick and easy is convenient but not nutritious. The rest of my health suffers and I just don’t feel as good during the non meal parts of the day. It also feels good sometimes, not to exercise. “Ah, I can just sit here and rest.” This is particularly true when I let my work and family life burden me. I work too many hours at work and at home, doing things and worrying about people. I am tired and I feel that I deserve to rest even though I know that I deserve the kind of treatment that promotes good health. But like many caretakers, I put my self-care low on the priority list even though I have counseled countless moms to avoid this. But putting my health at lower priority made my daily to-do list shorter. It made it seem like I was juggling fewer balls in the air. It was a false illusion.
In my 20’s, I gained and lost the same 20 pounds over and over. By my 30’s and 40’s, I have gained and lost the same 40 pounds twice. Right now, I have given up the convenience and the joy of eating to the point of indulgence for healthier foods. Yes, it is work to plan my meals, to make entrees ahead and freeze them in reasonably-sized portions. I take the time to make sure that I always have healthy vegetables on hand. I love vegetables and you know what, eating a large volume of vegetables is actually good for me. And I’ve gotten so that I look forward to my daily 3 mile walks. The key for me was realizing that I was self-employed and could therefore set my own hours! I am better at exercising in the morning and had been trying to add it to the end of long clinic days, which didn’t work at all. So, I just started seeing my first patients at 9:30 am instead of 8:30 am. What a rut I was in to not think of that solution years ago!
Letting go of these things has required patience, which does not come naturally. But I have grown and changed over the years. I have learned to manage my anxiety pretty well and with my mindfulness practice, I am learning to practice acceptance and further, that acceptance is not the same as doing nothing. It is not accepting that can spin me in circles, feeling like I am doing something but getting no where. Endless anxiety and anger can be a trap where you expend so much energy that it feels like you are doing something productive and your are not. And as a person who has been clinically depressed twice in my life, I can tell you that the helplessness and hopelessness of that passive state is one of the loneliest places in the world. I can’t tell you how thankful I am that I have not been near that place for over 10 years.
It can be hard to let go of anger, of grief, of impatience, or anxiety, of sadness, of guilt, at the point when I need to move on. Emotions are vital to our lives, even the “bad” ones. They motivate, protect, and educate us. But they do not always work in a healthy way with our thoughts and behaviors. I know that I will be working and reworking this balance for the rest of my life. I try not to think about how things “should” be in respect to things over which I have little control. I got breast cancer when other people with similar lifestyle and risk factors did not. I got it when people with more risk factors did not. Disease is part of the natural world and it doesn’t make sense to me to be mad at the universe. That just doesn’t work for me and the cost is too high.
We all have to make our own paths in life. In my life, I feel pretty unstuck right now but know that the cost of each day is a different set of gains and losses. Yes, I have lost the illusion of control but I have gained so much. I write this to reflect. I write this to remember the peace I have in my life at this moment.
I let go to gain freedom. I let go to go on.
I’ve written a couple of posts lately about how much things cost ranging from Botox to Lupron to high school year books. My last post was short, a bit flip, and on the humorous side. Shortly after I wrote it, I read this amazing post on Not Down or Out. I complimented Cheryl on her post and much to my surprise, she said it had been partially prompted by my “what things cost”-themed posts!
I’m not saying that I’m never deep because I know that’s not true. But I threw off those posts about costs and didn’t really think about them that deeply. So I started thinking about costs a bit more, relating them to my own cancer experience as well as of those about which I’ve read.
Breast cancer treatment costs a lot. We lose things we would have preferred to keep such as money, time, a sense of safety, taking our health for granted, relationships, a brain that works properly, and last but not least, body parts. We gain things we’d rather not have like nausea, fatigue, weight, neuropathy, hot flashes, aches and pains, and grief. Everybody’s experience is a bit different and for each individual, the experience can change over time.
Putting aside the fact in our lives as tainted test tubes, we don’t know for sure whether each ache or pain or other side effect is really due to cancer treatment. (Okay, I know some of them are pretty obvious, but generally speaking, we don’t always know.) But we do know our current day to day experience and what we like and don’t like about it. And a good number of things that we know about are costs of having cancer and having been treated for cancer.
What we don’t know are the costs of the roads we have not taken. Those of us who had surgery for DCIS will never know if left untreated, whether it would have become invasive or not. And those of use with early stage invasive cancer, don’t know what our outcomes would be if we’d foregone all or a portion of treatment. Finally, those of us with metastatic disease will never know if we chose the right balance between strategies to extend life verses those that preserve quality of life.
Instead, we must make decisions based on our understanding of research on assessment and treatment of our particular diseases, our other risk and protective factors, our personalities, what is important to each of us, and what is not important to each of us. And we must try to make well-reasoned decisions, accounting for all of these factors, while under incredible life stress. Not to mention the fact that we all have people who love us and depend on us. There are costs to family members and friends. As my friend Nancy says, “This disease has tentacles.”
And how many assessment and treatment decisions have each of us made in our experience with cancer? Tons, right? This means there are many paths not traveled. To really understand the costs of our decisions, we would need to be able to live many lives, each based on a different set of decisions.
We’ll never really know because each of us have just one life to live. I often write about my own decisions, “I made the best decisions I could based on the information I had at the time.” It may sound kind of nerdy but it frees me from a good deal of “what if” kind of thinking. I try not to dwell on the costs of the roads I didn’t take. I will never know what they are and to do so would have me walking in circles instead of pursuing the path I chose.
Protected: Best of Blog: Men of America–You Have Been Punked!
There was about a month-and-a-half between my right side mastectomy and the placement of the tissue expander. Consequently, I lived with an “unleavened breast” for a good while. I needed some humor to help me deal with the state of my body. So I wrote, not one, not two, but three blogs with joke names for my breasts. Looking back at this, it seems a bit absurd. But it did help get me through a rough time. Honestly,
I originally posted Righty Needs a New Name on 8/28/13.
For some reason, I am finding a need to refer to the right side of my chest as something other than “surgical site.” It’s going to be several weeks before I start the temporary inflation process with the tissue expander so a name would be handy. And yes, I could stick with “righty” but that implies some kind of symmetry with “lefty”. A few ideas of various levels of quality:
The Tissue Formerly Known as Righty
Breast-to-Be (I kind of like this one. Maybe a friend will throw me a shower before surgery. Yay, presents!)
Vegetarian Sweater Meat
Ugly Duckling (Some day it will turn into a bee-you-ti-ful swan.)
Breasterpillar (Some day it will turn into a bee-you-ti-ful breasterfly.)
Puppy Pupa (continuing with the metamorphosis theme)
Empty Jug
Sad Sack (waah!)
Berefticle (waah!)
Scarla
Storage Chest
Bosom in Waiting
Breast, in Space Saver Mode
Unleavened Breast
Late Bloomer
Bosom’s Buddy
Fixer Upper
Do-Over
The Start of Something Big
Under the Shoulder Boulder Holder
The next day, I had still not gotten this out of my system and I posted, The Name Game (Continued).
Okay, so my cousin, Beth got me thinking about coming up with names for both righty and lefty. They are a set of a kind. So here goes, my stream of consciousness. As I did yesterday, I will add more as inspiration arises:
Boob and Boo Boo
Scooby and Scrappy
Lefty and Lucy (inspired by John’s suggestion “Righty Tighty and Lefty Loose-y”, which is backwards, unfortunately)
Benjamin and Button
Mammy and Mummy
Party and Pooped
Ta-da! and To-do
Zan and Jayna (The Wonder Twins, suggestion thanks to Lisa)
Waggy and Baggy
Jiggly and Scraggly
Lennie and Squiggy
Herman and Pee Wee
Judy and Punched
Hit and Miss
Denver and Phoenix (Okay, a little obscure but think about it and then groan.)
Teton and Won Ton
Ham Bow and Big Ow
Yin and Yang
Mickey and Mini (spelling intentional and I hear you all groaning.)
Bonnie and Clyde
Cupid and Psyche
Ernie and Bert (Okay, this one makes no sense but made me smile so I’m keeping it.)
Lilo and Stitched
Oscar and Felix
Simba and Scar
Wow and Ow
On 8/31/13, my parents got into the act so of course, I posted it in, Name Game-Part III, A Family Affair.
So my mom has been dying to come up with a name to contribute to the name game. Earlier today she told me that she didn’t think she could think of something because because she “loved me too much” and didn’t want to make light of my cancer.
Oh how the love has faded because, drum roll please…, she has contributed:
Liv and Let Live
My dad, not to be left out and offering a mechanical interpretation:
Built and Re-Built
Both of those ideas made me laugh aloud after a very hard day. So I guess they love me a lot after all.
When faced with cancer or any other serious illness, it is only natural to think about the uncertainty of our futures. Lately, I find myself thinking about this more frequently. A year after diagnosis, I find myself finding more and more room for non-cancer related life, “the new normal” as it is often called.
I find myself thinking that I have no way of knowing whether I have cancer in my body or not. Frankly, this is the truth for everyone with “no evidence of disease.” I don’t know if it will come back. I also know that just like everyone else, I may have a different serious disease or injury in my future. And my family and friends will face illnesses and other hardships. We often think about disease and death as the enemy, but they are part of the natural world, and we will all face them.
By nature, I crave certainty and dislike ambiguity. In my job, I help kids and families reduce the chaos in their lives. I am the family administrator at home. I may have even been described as a “control freak”, maybe just maybe, once or twice in my life.
The last two years have been the most challenging in my life. I been been mired situations that I’d hoped I’d never have to face, full of ambiguities and dire possibilities.
What I have been noticing the most in the last month or so is the fact that I am not freaking out. Even in the scariest, grayest parts of these years, I’ve found a constant. There has always been love. Love from family, love from friends, love from healthcare providers committed to help. And the love I have for others is stronger than ever.
Life can be murky, ambiguous, and downright scary. But love is clear and love is always beautiful.
XOXOXO







