Saturday, January 31, 2009

Much to Celebrate!!!



This FRIDAY THE 13TH (of course!)
5:30 to 10:30pm

Chris, Teresa & Seamus' home

Clean margins, clean lymph nodes, no more surgery, a few weeks of "rest" before chemo, and hey, I'll be 46 freakin' years old--so much to celebrate! So if you are reading this (and you, um, actually know me) you're invited to come celebrate. Email me that you are coming and if you need the address I'll send it to you. No presents!! That would just be silly (I'm, you know, 46). There may be a few of you Chris calls to help by bringing an appetizer or something, because we're just throwing this together and he's a fabulous cook, but busy being a nurse these days too. Casual, fun, stop-by when you can sort of thing. Just wear pink!

Oh, and the pOpC design was my idea but executed beautifully by Mike Easley of Vital Excess Design. So if you are offended blame me (and hey, I have CANCER!!! Back off). If you love it and can't stop staring at it, the credit goes to Mike (and um, you might want to consider therapy).

Friday, January 30, 2009

Clean Margins and Dirty Martinis

Two posts in one day! It's like I'm sitting around recovering from surgery with nothing to do...
But I do have some really excellent news to share. The Carneys stopped by and Francis made me his world famous dry martini! So yep, I've had my first post-surgery drink!! Woo-hoo!!! Oh, and the doctor called and said the "margins were clean"--which means they got the whole tumor and I'm through with surgery. Cheers again!! Drinks for all my friends!

And here's how the rest of my day went:
Yeah, Seamus is exhausted because he hates delivery people and they kept showing up with flowers. He spent the day chasing them off. He's wiped out from this.

Flowers are from mom & Ted (top left), The board of Alternatives to Domestic Violence (top right) and the board, staff and volunteers of the Riverside Humane Society. I thought they were just happy I took a leave of absence from their boards for a few months, but they genuinely seemed to be wishing me a speedy recovery!

I also was able to shower and semi style my hair today. No one is happier about this than I am...well, except Chris. I'm pretty sure he's happy about that.

So Friday was a pretty good day, all in all. And a special thanks to another support team:

My assistant Michelle, on the left, and paralegal Laureen (on the right, but you probably figured that out), kept my office going all week. At least I think they did. But they were wearing the pink ribbon pins and "Together We Can" solidarity bracelets all week, so what could possibly have gone wrong?? It's all fine, I'm sure it's fine. It's fine. I was only gone 3 1/2 days. I'm sure I still have a law practice. Of course I do. It's fine. I'm good.
Martini anyone?

How Medicine Made me a Hot Babe--the nuclear medicine portion of our program

Wow, sorry about that long post yesterday. Apparently I needed to vent all that. And now you probably need some of my Vicodin just from trying to read it. I'll see if I can be more precise. Or funnier. Or just less gory.

When we last met, I was just about to go into surgery...well, surgery day. We were up at 5:30 and while there is no point to make-up and dressing nicely, I did shower and do my hair (since I wouldn't be able to do either for another 48 hours) and I donned the pink sweat-sort-of-suit. We dutifully reported in to the surgery center at 7 a.m. So did about 173 other people. Wow. And apparently it was half-off surgery for children day because they were lined up out the door. And crying. Children cry when confronted with surgery. I cry when confronted with 7a.m. and no Starbucks. It was not a pretty, nor quiet, scene.

After they one by one took pretty much everbody else back to surgery and Chris and I were still stashed in the corner (shaking, crying and promising we'd never, ever have children), I had to remind the front desk lady that I was expected down in nuclear medicine at 7:30 (it was 7:35). She said "for what?" Ummmm...aren't you guys supposed to know that? I kid you not, I got the "I'm new at this" response. Eventually a nurse came and got me and then another nurse took us down to nuclear medicine. Which is every bit as scary as it sounds. So scary they stash it away at the bottom of the 'North tower' and you have to take a secret elevator to get there. You'll know you are there by the arctic temperatures that accost you upon entry.

Two other things happened when we entered. A lab coat wearing man, we'll call him Larry (because that was his name) entered and the receptionist said "we have a such-and-such brain serious major procedure today" (I'm paraphrasing) and he said "Really? I haven't done one of those in 20 years." Comforting huh? Please god, do not let me find out my brain is in my right breast.

Also in the waiting room was a somewhat swarthy looking man in his early 40s, unshaved and wearing a leather jacket and boots, and next to him was a woman who looked like "mom"--just not his mom. Mom like Mrs. Cunningham, or June Cleaver, or any of those moms who did not have swarthy looking sons. They took swarthy back into the treatment rooms and five minutes later a tech comes out and says to mom "Mrs. Jones? Your son-in-law would like you to be with him for the procedure." Mom smiled sweetly (and knowingly) and got up and went back. Really? Who does that? His mother in law??? And where was his wife? I'm really hoping this had nothing to do with his prostate.

Then it was my turn and oh yeah, Chris came back with me. We were greeted by "not in 20 years" Larry. Larry was quite chipper (he likes inflicting pain, it's just obvious) and he says to me, "So you understand why you're here and what we're doing?" I, who haven't had Starbucks, said "um, yeah, kinda...I just know it's painless." And he laughed at me. Full on laughed in my face. I stopped dead in my tracks. He said "Oh, come on. It's four injections. It's going to hurt. There's going to be pain." BWAHHAHAHAH!! Thanks, Larry. This was the part where they were injecting radioactive material into my breast to find the sentinel node. I don't know how I got the rest of the way down the hall into the treatment room. Once there I was happy to find that Larry the Ass was not the doctor. Larry is not even a doctor. The doctor was a young woman (of course she was young), Dr. Tabib, and far, far kinder.

I will describe what was about to happen by medical terms, courtesy of John Link, M.D. and his book "Breast Cancer Survival Manual" (which I read cover to cover yesterday):

"Doctors use the radioactive tracer as follows: They inject it in and around the cancerous area (or under the nipple) at the time of the initial cancer surgery. ...In the operating room using a portable Geiger counter known as a gamma probe, the surgical team identifies the first draining node and removes it following the removal of the primary cancer. The pathologist then analyzes the node using a technique called frozen sectioning. He freezes the node by using liquid nitrogen and then cuts the tissue into thin slices and views them under the microscope. If he sees no cancer, no further surgery is performed."

So, I had four injections around the cancerous area. And I guess, again, where mine is located is somewhat fortunate for these parts. 3 out of 4 of the injections weren't really much. But the one closest to the nipple...yeah, um... ow. Not off the charts, and certainly tolerable, but Ow. Enough to make me bite my lip. Did I mention that Larry is an ass?

Then we had two hours to kill while the radioactive material is finding its way through my breast (no, I couldn't feel anything) before I was to return for "pictures." We chose not to hang out in the arctic zone. Instead we delivered my health care directive and HIPAA release to patient services (I'm still being a lawyer) and then sat in a sunny window reading. I was reading David Sedaris's "When You Are Engulfed in Flames" and Chris was reading "Then we Came to the End." Perhaps we should have thought about our selections ahead of time.

We returned to nucler medicine and waited for "pictures." At least they gave us blankets this time. When they came to take me back this time there were other patients around--they do bone and brain scans and all sorts of "man you are really sick" stuff, and again, I'm squeamish. There was an old guy on a gurney in the hallway asleep (please god, he was just sleeping) who was just skin and bones, with his mouth open and his body contorted. Yeah, that eliminates any possible feeling bad for myself I could have mustered. (And why do they always leave someone on a gurney in the hallway??)

The "pictures" turned out to be not as simple as you would think. I was picturing a quick little x-ray and I"m gone. Not so fast. Again, I had to lay down and then this panel comes down on top of me (they ask again "are you at all claustrophobic?" so that gives you an idea how close the panel gets). And they take two "pictures" that take five minutes each. The tech points out on the screen what they are doing. So I turned my head to see the screen. As I'm waiting out the five minutes I noticed that there were actually 3 screens. The one he pointed to, a much bigger one in the middle and then one in my periphery vision that I can barely see. But the big one in the middle, while difficult to see, is scary looking. It's got a lot of red, some yellow, some pink, and a big ol' scary looking jagged-edge black spot in the middle. Wow. I've seen lots of scary pictures of my cancer but that one was the worst. Probably because of the red everywhere, and it was obviously extremely close up since they were looking for a little tiny lymph node, but that one was freaking me out a little. I kept trying to figure out where this famous lymph node was on the screen amidst all that pulsating blood. Finally I decided I just couldn't look at that screen anymore and I went back to the perfectly harmless looking black and white screen he had told me to look at. It had a nice little countdown clock on it too and that helped.

Eventually, the pictures were done and he said "good job. We found the node. I'm just going to mark it on you." Which they do. He drew on my underarm to pinpoint the node for the surgeon. Then they said I could sit up , so I did. And there in front of me was the scary, frightening, big computer screen....with a beautiful red, yellow and pink sunset and the black silhouette of a palm tree sticking up in the middle of it. The words "Polynesian Spa Music" were written across the top. But in my defense, I couldn't see that from my position under the panel!! (Louise, if you are reading this--you have to be reminded of the glass dancing booths at this point). It's possible I was nervous. But Chris got a big kick out of my story when I came back out. I blame Larry.

Seriously, squint sideways at this.... you can see cancer can't you??

Alright, back up to surgery we went. With my pictures in hand and a notebook full of medical info on me (which the nurse gave to Chris originally and made him swear under penalty of death he would return to her when we got back to the surgery center). Oh, and I had to go in a wheelchair...because of the whole "I see cancer in the sunset" thing, I'm sure.

Surgery is a giant blur to me. I remember this much: the anesthesia nurse was Steve and he was very kind and good at what he does (and was the first voice I heard when I woke up, which also let me know I was still in the surgery center and not in the hospital, which meant good news on the lymph node thing, at least in my mind). The other anesthesia nurse (apparently there to supervise Steve) was an attractive woman with a really cute, colorful surgical hat--until I noticed it was images of coffee and said "latte" "coffee" and other such words all over it, which is just cruel to me in my then state. She was concerned I might rip it off her head when the anesthesia kicked in and I lost the last two inhibitions I had left. Apparently, I did not. But I don't know because I never saw her or her hat again.

Oh, and the infamous blue dye shot straight to the nipple? Yeah, I had it, but I don't remember it. Dr. Karam assures me that I felt it because I "tried to help"--which is to say I tried to knock it away. And I was out of it. It's just crazy that they do that to some women without anesthesia. Other things to note--the blue is not indigo blue. I thought it would be like ink. It's not. It's more of a dark turquoise color. Sort of pretty. Just not, you know, for a breast. It's already faded away however. I think. There may be something there under the bandages, but I can't tell at this point.

So that was surgery day. You know the rest of surgery/ recovery day (or can scroll way, way, way down or click on the Archives for the "A Very Big Breast Day" posting to read it). Now we just wait to hear if Dr. Karam got clean margins around the tumor (i.e. no cancer cells at the edges, which means he got it all and no further surgery is necessary).

I go back to see Dr. Karam next week and at the same time will meet with a medical oncologist about the chemotherapy and treatment options. I've now heard and read enough to know that my best chance of not having a recurrence of cancer is indeed the chemo and radiation. My kind of cancer and my "test" scores indicate a high chance of recurrence (I have no idea the actual percentage--my own guess from the reading is 20-25%; I assume they'll tell me this in the next meeting). So even if Dr. Karam got all of this tumor, there is still the chance that there are some dastardly cancer cells still on the loose and ready to wreak havoc. They must be stopped.

Today I'm going to enjoy a leisurely day off. There will be sleeping, reading, and probably a phone call or twenty. Or maybe I'll start planning our Christmas/ Jimmy Buffet's birthday trip to Maui now. Since, you know, I've got tropical sunsets on my mind.... Aloha.

Thursday, January 29, 2009

Dogs, Frogs, Mice, Rats and Fish...or, All the Medical Stuff

(That's actually a Pacman frog...I humor myself. Keep'll get it!!)

Now that I'm back home and resting comfortably in a recliner by the fire with my highly inspirational beagle Seamus nearby, I can perhaps report in more precisely on the medical stuff. I have been told on several occasions throughout this now month-long breast cancer journey that I am a "good" patient. Or that I did "great." Or some such thing. That makes me laugh, and I'm sure it makes every member of my family laugh or at least go "Huh?" Of everyone in my family I am by far the most squeamish. My dad's a doctor, my brother is a regional vice president of a medical equipment manufacturer, my sister is an OR nurse, and the rest have no trouble with gore. Me? I can't even watch medical shows on TV or the fakest of the fake horror flicks, because I simply cannot see blood. And the thought of stitches about makes me pass out.

Despite this, it seems, I've been long trained to be a "good" patient. My father once took out stitches in my hand on the dining room table, to the delight of the other neighborhood children. And then there is the infamous childhood story when my family was on a cross-country motorhome trip and I fell off a ladder and broke my arm in South Dakota. We made it to Las Vegas, Nevada before my parents decided it was in fact broken. Here is the point where my father would like for me to mention that he did put my arm in a sling and even after we arrived back in California (what no hospitals in Nevada back then??) and the arm was examined, it still was only placed in a sling. No cast was necessary. I'm a good patient after all. Oh, and my mother would like me to point out that she knew it was broken in South Dakota. I just don't know why that's better?! I'd just like to point out that there are three states between South Dakota and Nevada. Big states. And we were driving. So yeah. I'm a good patient; I don't complain much. I also don't cry a lot. I have yet to cry over this whole cancer thing--except the night of the actual diagnosis, but that was because as I was telling Chris the diagnosis his sister called to tell him the family dog had to be put down that evening (RIP Chloe!). Now that made me cry. (And no, Chris did not say "Oh yeah? well Teresa has cancer!" We waited a respectable five or six days). And the surprising thing is, I'm getting less squeamish as time goes on with this. I'm finding the medical aspects sort of fascinating. So for those of you who might actually be more squeamish than me, you may want to skip over this. And I'll break this up into the various stages/ procedures so you can just skip to the good parts, however you determine "good."


On December 23, 2008 my primary care doctor calls and says "highly suspicious of malignancy." And he wants the lump out. Not just a biopsy. Excise the lump. That feels a lot like "You have cancer," but it isn't. Because I still had hope (and a friend who was told "you have ovarian cancer" and she didn't). My actual diagnosis day is January 12th. I messed up the poll--January 13th was my MRI day to see if it had spread any further, but actually Dr. Karam had called me on January 12th to tell me it was in fact cancer. And he confirms for me that's the day considered my "diagnosis day." So January 12, 2009 is the day that will live in infamy. My D-Day.

How does that feel? Well, I kept thinking about that folklore (science-lore?) that says if you throw a frog in a pot of boiling water it will jump out immediately, but if you set it in the water and slowly turn up the heat it will stay there even up to boiling (please don't try this at home or anywhere else!!). The "highly suspicous" conversation was like being thrown into the boiling water--all I wanted to do was jump out. Instead, I talked to a few people, I went about my regular life (I didn't tell anyone so as not to ruin anybody's holidays and to keep my mind off things) and then had a doctor's appointment with a calm doctor who said "you don't know it's malignant until you have the biopsy." So I got out of the pot in a manner of speaking. Let me also mention here that if you ever feel a lump or have a suspcious mammogram and they are telling you "85% of these turn out to be nothing"--they are probably right. I've heard that experience from lots of women and lots of men who were trying to calm me (or themselves) about the situation. Trust me though, I never heard that from any medical personnel dealing with me during this time. I could tell to a person, from absolutely everyone's reaction (from the PA who first saw me, to mammogram technician, the ultrasound technician, my primary care physician, the Riverside surgeon, and everyone one at UCLA--I think the parking attendant knew!) that they thought "cancer." I got "95% chance this IS cancer." Not the "85% are nothing" response. So if you get that one, you are not a frog and there is no boiling water around.

Then there was the debacle of getting health care in Riverside over the holidays. Let me be clear here--the problem here may not be the quality of care, it's quite simply that we don't have enough doctors "out here." And that's just crazy. (Come on, UCR Medical Center!! Can't arrive soon enough.) The earliest we could get a biopsy scheduled in Riverside was January 16th. Nearly a month after my first doctor's appointment. That would have been a month of "highly suspcious" and "but you never know." Carry on.

My nemesis became the ditzy Brenda from the surgeon's office who was supposed to be scheduling my biopsy but couldn't stop drinking eggnog long enough to read the "Stat" written on my file and kept forgetting to call me or the imaging place that was supposed to handle the biopsy. Oopsy.

That's when it felt like I was back in the pot and the heat was being turned up. But in a good, albeit weird, way. When I was stuck in the Riverside health hell, my feeling was "oh hell no. Not cancer. I can not have cancer." Then Stacey helped me find my way over to UCLA and Dr. Karam and my attitude moved to, "okay fine, it's probably cancer, but no way am I having a masectomy." And that becomes, "okay, well I can handle that. I can be Christina Applegate and her 'I'll have cute boobies in my 90's' attitude. But no chemo. I can't handle chemo." And eventually, as Dr. Good Karma slowly, politely, humorously (yes humorously), but quite clearly turned up the heat, it became "Okay, let's just get on with this. I can handle whatever it is. The dog lived. And so will I." I've come to think of the diagnosis process, lengthy though it is, as helpful to the mental adjustment. For me, anyway. So, keep that in mind as I explain, in what turned out to be this really, really lengthy blog posting, what one goes through to get the diagnosis of "Breast Cancer. Right breast, 10 o'clock."

THE MANY TESTS (December 19, 2008 to January 5, 2009)

Let's see...first it was a mammogram (Dec. 19th), of course (remember, I found the lump myself). That occured on a Friday. Then the following Monday (the 22nd) I went in for an ultrasound of the right breast. Yes, I watched the screen and yes, I was pretty sure it was cancer. Then I watched the face of the tech and yeah, you kinda know. They can't say anything of course, but they can become a lot more solicitous. Then came the call from the doctor (the 23rd), then came a Christmas Eve spent trying to get a meeting with a surgeon scheduled in a town where clearly healthcare is closed for the holidays. Right, the folks at WalMart have to work but health care workes? Eh, call after the 1st of the year. I also had to drive over to the Breast Imaging Center to pick up my own "films" to take them to wherever my doctor might be able to get an appointment for me, whenever that might occur...because the films are old fashioned films and not on computer disk so that can't simply be transferred by the click of a mouse.

Then we went to Christmas Eve dinner with Chris's family. Of course we did. That's usually a place that makes me quite nervous. But talk about perspective! I was fine. And I had wine. And not that Chris's mom knew (although she is a breast cancer survivor herself) but she gave me a really beautiful, really comfortable mocha-colored wrap that is extremely soft and has been wrapped around me for much of the last month, and a little Coach purse that turns out to be the perfect size for the items I can have with me at the hospital (and perfect for Chris to be able to stash in the backpack he's been carrying around for both of us).

Finally, on December 30th Chris and I went to meet with a surgeon in Corona. In a place that looked like Mother Teresa would have come to visit the dying there but no one else would or had since her passing. We almost bolted, but for the fear that we'd have to wait until 2011 for another appointment with another surgeon in Riverside. The surgeon was great. Very calming. And a woman (ruining forever Chris's two-women fantasy when she did my breast exam; it's just not what he had in mind at all. At all.). But alas, she turned me over to the heartless twit that was her scheduler and not remotely helpful. By January 5th (6 days and countless calls--mostly by me-- later; not exactly "stat") they had my biopsy scheduled for January 16th. The biopsy is what tells you whether you have cancer or not. You know, a month after you find the lump!My frustration turned to rage and I then turned to Stacey (who likes my rages and humors me and then helps me), who turned me to UCLA. But I do keep wondering--I'm self-employed, articulate, assertive and have several contacts in the medical field (yes, I used some of them); I could take the time and could afford to do a lot of the footwork myself and had friends who could and did help. What on earth do women who don't have all of the above do???

THE BIOPSY (January 6 to 9)

Lunch with Stacey was January 6th. She had her UCLA doctor email me within an hour. Email! Within an hour! An actual doctor! No Brenda-bimbette involved! Stacey's doctor (who had never so much as met me) not only referred me to the great and good Dr. Karam, but called and had them hold an appointment for two days later. I spent January 7th driving to no less than 5 different medical offices in Riverside (and one in Corona because the twit Brenda sent me to the wrong location first) picking up all of my various records to hand carry them to Dr. Karam. January 8th Chris and I drive to UCLA. Dr. Karam reviews my films (the July 23, 2008 mammogram showing nothing, and the December mammogram and ultrasound showing holy hell) and says "walks like a duck, quacks like a duck" and then immediately goes downstairs to radiology to try to get my biopsy scheduled ASAP. It's scheduled for the next morning. ASAP/ Stat obviously mean different things in different counties.

As mentioned, the biopsy is how they can tell for certain whether it's cancer. That morning (January 9) we arrived at 9:30 and they did another ultrasound. My radiologist was a resident by the name of Dr. Koo and she too was about oh, 19 years old? Dr. Karam stopped by and told me he was scheduling the MRI as well. If it turned out not to be cancer, we could cancel the MRI (and this makes so so much sense, but is not, I have learned, how things are done in Riverside). I did then finally say "you seem to only be talking about this being cancer; I assume you know already that it's cancer." And he said, "I"m 95% certain it's cancer." The radiologist could be heard letting her breath out. Clearly she also could tell it was cancer but couldn't say anything. When Dr. Karam left, Dr. Koo launched into the "survival rates are really high when you catch it this early" routine. And thanks, but "survival"?? Honestly, it hadn't occured to me that there was any other option!! I still refuse any other option. Oh and Dr. Koo said "Your doctor seems really young." This still cracks me up! Hi pot? Meet Kettle.

The biopsy is an interesting procedure. Again though, I was well trained. You have to lay still for about 30 to 40 minutes while they insert a needle and a little thingy that was best described (for we older folks) as a "Pac Man" that goes in and extracts little chunks out of the tumor (3 to 5; naturally, they needed five from mine). My tumor, as we all know, was at 10 o'clock, and way on the side. Thus for the radiologist fellow Dr. Overstreet (another woman!) to get to it, I had to lay on my side but with my top half twisted back and my arm moved even further back. This is remarkably similar to the position one assumes for certain chiropractic adjustments....which I've been getting since I was oh, five or six years old. Now, the needle that goes into the breast to numb it for the biopsy...not a lot can train you for that. It stings. But then it goes away. So all in all, not too bad.

Post-biopsy they actually did another mammogram. And if you think a normal mammogram is painful, try it after Pac-Man has attacked your breast! Let's just say there was bleeding. And while Dr. Koo bandaged me up again we had the Harvard (where she went) v. Princeton (where Chris went) discussion. UC Santa Barbara (where I went) wins!!! (hey, I'm the one with cancer). Then I was sent home with ice paks and steri-strips and all was well. I even stopped by the office, until they kicked me out. The bruise on my poor boobie lasted almost two weeks. But that was just the beginning of the blue period.

CANCER FOR REAL/ The MRI (January 12 and 13, 2009).

After "the call" where "it is what I thought it was" there really is a lot that goes on. Turns out there are all sorts of breast cancers and all sorts of factors that weigh into the treatment plan. My particular cancer is not, unfortunately, "in situ." Meaning it isn't just situated in the duct. And it's got highly invasive tendencies. On the Bloom Richardson scale of 1 to 9 with 9 being the most invasive...mine's a 9. (Not a time you want to be a 9!!). In fact, my pathology report (from the biopsy) says this about all the various factors:

Invasive ductal carcinoma, poorly differentiated
Modified Bloom and Richardson score 9 of 9 (I'm a chronic over-achiever!! that's not on the report; that's strictly gratuitous on my part)
Tubule formation: 3
Nuclear pleomorphism: 3
Mitosis: 3
In-situ component: not identified
Lymphvascular invasion: not identified
Microcalcifications: not indentified
Breast biomarkers/FISH: pendingMost of that was good, well...except the whole cancer part. The bad ones were the 9 and later when the pending FISH came back. They look for cancers that are "hormone receptive"--if they are the patient can be treated with anti-hormone medication (granted, this medication goes on for five years, but it's not chemo). My particular cancer was 0% receptive. 0%. Don't waste your hormone medication on me! (I'm probably not supposed to be, but I'm kinda glad I won't be taking medication for 5 years; chemo or not).

Next up was the MRI. This basically gives a good look at how large the tumor is and whether there are cancerous cells detected anywhere else--like in the lymph nodes. My MRI was January 13th and afterwards Chris and I went to dinner and met with our LA Writers Group. The MRI was, for me, not a big deal. Yeah, it's difficult to lay still for that long and it's a tight space and really loud, but for all the test does, it's just not that bad. Unless you are claustrophobic and then, well, yeah. It's gonna suck. I planned the blog during mine. My biggest issue was that the tech told me "no deep breaths. If you need to take a deep breath do it now. No deep breaths when you are in." Which pretty much guaranteed that all I could think about was taking a deep breath!! Don't think about purple. Stop it! No Purple. Do not picture the color purple. NO!! Purple is death!! Stop it!! (now let me know when you stop thinking about the color PURPLE. See, there you go again! Purple.).

By about 5pm that evening, Dr. Karam called to tell me the MRI was beautiful. No signs the cancer was anywhere other than where we already knew it was. But it was closer to 2cm than the 1.5 that had been earlier estimated.

THE TREATMENT PLAN (January 15, 2009)

This was basically a meeting with Dr. Karam to discuss his recommendations and "sign me up" for the lumpectomy. I think this is reasonably well detailed in an earlier post so we'll just say, the heat is turning up but I'm still not jumping. Oh, and purple. Stop thinking about purple.

I had to return to Riverside healthcare to get a medical clearance for surgery from my primary care doctor on January 20th. I had to wait 4o minutes to get in and they asked me for the $20 co-pay. Neither of these things have occured at UCLA. I passed. All clear for surgery.

LAB RAT-NESS (The research study; January 27, 2009)

As I mentioned, I was asked to participate in a research study. Here's the description of the study, straight from the materials they gave me:

"Between December 1997 and October 2008, a total of 98 subjects were enrolled in a study at UCLA examining patients with malignant and benign breast cancers, and healthy women. An additional 30 subjects will be enrolled at UCLA over the next year. This additional research has been funded by the US Army Medical Research and Material Command."

[The army!! who knew! And I think I'm number 13 of the additional 30 they are trying for.]

"It is hoped that this investigation will result in a new technique to image benign and suspicious areas in the breast. This clinical research project is designed to learn if MR imaging/spectroscopy (MRI/MRS) is a reliable anatomical and biochemical tool for identifying breast cancers... The outcome of this study will help the researchers in developing a better diagnostic tool for breast cancer..."

I'm going to scan in and post the whole description, for those of you who are interested, because it's really kind of fascinating. Basically, for those who get the "85% of these turn out to be benign" talk when a lump or spot on a mammogram is discovered, this MRI Spectroscopy may one day be the option instead of a biopsy. Much, much less invasive. No Pac Man. No bruising. Just time alone in a tube. For an hour. Okay, yeah, it got uncomfortable and I was pretty fidgety for the last 10 minutes. But the actual test "in the future" won't be that long.

Scott and Sherrie (my physicists! the researchers) did tell us they were having a hard time getting volunteers for the research and they weren't anywhere near the numbers the wanted for the "malignant tumor" test sample. And they did seem awfully thankful. Apparently, some women are upset with a cancer diagnosis (note to self: you are not normal!!) and can't handle another doctor's appointment or the timing is just too difficult to work out (you have to be a lab rat before your surgery of course). I can understand that. It just didn't occur to me to say no. In fact, it helped to think I was helping science and future patients the night before my surgery. Kind of getting out of my own drama. And then of course many people can't handle the MRI tube. And this time, I did notice how really small the space was. I tried to turn my head from one side to the next and hit the roof. Oops. But I"m glad I did it and I'm going to follow their research (or, I'm going to make my dad and my sister follow it, since I may not understand it!). I was after all, lucky lab rat #13.

That brings us up to surgery day and my trip to the surgery center, the nuclear medicine department, two hours of roaming the medical center while blue dye roamed my breast, back to the surgery center for pre-op check-in, back to nuclear medicine, back to the surgery center, into the operating room (or so I'm told), and finally the recovery room--which you've heard about. It was all about Roger. I think however this post is long enough. Nuclear medicine can wait. Probably until 3a.m this morning, since I can only sleep on my back and after a few hours my back begins to spasm. But I am not complaining! I'm a good patient. A really good patient. Oh, and have you stopped thinking about purple yet?

Wednesday, January 28, 2009

A Very Big Breast Day

THUMBS UP!!! Surgery went as well as it possibly could have. That's Dr. Good Karma (and Hands!) giving the thumbs-up post-surgery (also holding the Jaboulet 2005 Parallele 45 Cote du Rhone we gave him as a thank you for all his good care). He located the sentinel node, removed it successfully and voila! The report came back that it was cancer free. Woo-hoo!!! So the lumpectomy proceeded and by 1:30 I was waking up (I remember absolutely nothing of the surgery--which is how I hoped it would happen).

Took a little while to get recovered enough to leave the recovery room and the guy next to me seemed to be taking priority (well, to be fair to the nurses, the dude was demanding priority!). Chris and I spent a couple of hours listening (no matter how hard we tried not to) to a rather loud and extensive diatribe from next-curtain-over patitent Roger about how unfair it was that they wouldn't let him leave until he peed and he couldn't pee (I'll spare you the details but clearly his surgery was "down there"); that was followed by the many things that "normally" make him pee and his demands for the same (to wit: walking, the elevator in their home, coffee, and running water). So while I quietly lay there counting the moments until Starbucks was possible, the nurses offered this guy everything from cranberry juice to apple juice (eventually he asked them to mix the two!!) to coffee while he strolled up and down the room in his high fashion gown discussing his urinary progress!!! But then my incision started to ooze and well, that got the nurses attention. Apparently I bleed a lot. That's mostly what my delay was--took awhile to get the incisions (yep, two--one for the lymph node and one for the cancer that is no more) to stop bleeding. And ironically, I really needed to use the little girls room (and yes, it was blue. Tidy-Bowl blue!)

Eventually we were released. I'm sure Chris was as relieved as I was since I at least got a nap and he, poor baby, was up at 5:30 a.m. with me and roaming hospital waiting rooms for the day (except for a nice break when Emily picked him up for lunch--thanks Emily!). My plans for Starbucks however were foiled by the stairs between me and the Starbucks in the hospital. I wasn't up for that. I tried to settle for a Dr. Pepper and chicken noodle soup at the cafeteria, but quickly found myself in the bathroom almost, but not quite, well...getting nauseous. So the Dr. Pepper was slowly sipped and the saltine crackers were savored. Not really up to the standards we had set last night, but I really needed to get rid of the "no caffeine in 24 hours" headache.

Finally, back at the hotel at last, I took off my cute pink hoodie and....well, let's just say the incision was oozing again (saturated is the word they use. TMI?). We may not be seeing that pink hoodie again. Chris to the rescue though. He got the ice pack in place, put me to bed (I zonked out. Best nap in a long time), called Dr. Karam and about an hour later Dr. Karam showed up in our hotel room! He fixed me up, changed out everything, gave me a full report on the surgery (all good!) and rode off into the sunset (with his wine--the picture was taken in the hotel room. Yep, he does house calls too!!).

All is good now. I haven't even had to take the Vicodin. Tylenol seems to be working fine. Chris gave up Lost for Sex and the City reruns, we've had a room service dinner and I'm back to my delusion of a long weekend away at a great hotel. Oh, and cancer has left the boobie!!

Thanks for all the well wishes and thoughts and prayers, and calls and emails and Facebook comments, and blog comments... it was nice to see when I got back to the room. Tomorrow I'll tell you more about the medical parts. I have plenty o' stories! Did you know there are a lot of sick people in a medical center??

Tuesday, January 27, 2009

Our Very Breast Adventure--The Last Supper

I survived my research MRI Spectroscopy and all they gave me was this lovely hospital gown! Well, that's not entirely true. Scott (on the left, in case you are wildly confused) also gave some good restaurant recommendations and there's a check in the mail for $75. No, really. They promised. And here's how it went-- we arrived exactly on time (Chris really knows his way around this part of LA, I've got to hand it to him) and found our way back to the corner where MRI Research is stashed. The photo is of the physicists conducting the research (and yeah, I know, I think that brings the average age of the medical professionals I've seen down to like, 16.). That's Scott Lipnick on the left and Sherrie Lin on the right. And the lab rat in the middle. They were great and I don't think I did so bad myself (although, I was starting to fidget there at the end).

I spent close to an hour in the little MRI tube. And it got littler and littler as time went on. But there was the humorous intermission when the good and wise and ever-so-steady-handed Dr. Karam made a surprise appearance and talked to me mid-Spectropscopy over the intercom system. Apparently the rest of the time he talked to Chris about France and wine. Hey!! I'm stuck in a tube here, people!! Eventually they remembered me and let me out. Then I was able to observe lovely images of the girls and the obnoxious (but not so terribly huge looking) spots on the right twin. I was also able to learn more about the research they are conducting--all good stuff that in the future should eliminate a lot of unnecessary biopsies for women. I will report in more on that later, because it is indeed fascinating stuff. But the most important fact of all was that I was research subject number....13. Of course I was!! And then Scott valiantly tried to stumble through some distorted reason for why I might not be #13, but said the word "malignant" about 142 times...which really reduces any effect being number 12 or 14 rather than 13 might possibly have had! Again though, there were good restaurant recommendations.

We just didn't take them. We went back to the hotel and had my last supper....well, last meal for 18 hours or so. We went to West at the top of our hotel overlooking Sunset Blvd. Very, very good. So, last meal.... frisee salad (mmmmmm poached egg on wilted frissee with lardon and croutons that were more like brioche), 12 oz bone-in filet with gorgonzola butter and truffle fries. And there was wine. Because it was half-off Tuesday! Wine bottles were half off! It's like they knew we were coming. Did I mention I'm enjoying my surgery long-weekend? We'll see how tomorrow goes but all looks good for now.

Oh, and I know you are all as concerned as I am about this...turns out I remembered I do in fact own a sort-of sweat suit outfit thing (it pains me to even type that!) and it's PINK!!! So don't worry--I will be in a pink Jones New York "sweats" outfit for my surgery appearance. Well, until I'm in a paper dress with comfy, thick socks (thanks for the tip Stacey!). Fingers crossed, I'll be posting again in 24 hours! Tomorrow--cancer does NOT win!!

Our Very Breast Adventure--part 1

We have arrived at the Angeleno hotel and I must say, it's adding to my delusion that I am on a nice long vacation weekend with Chris! Great hotel. And they put us on the Getty side, not the freeway side, which is (or at least will be) super helpful. The feathertop bed looks fabulous as well. See, total vacation! (surgery extra).

Michelle (my assistant) emailed me a photo of flowers that arrived at the office for me...just right after I left. Sweet clients! And yes, great assistant. Here's how I'm enjoying the flowers:

That's right--I'm enjoying them "virtually" and sharing them with you (my two faithful readers).

As we checked in the desk clerk asked if we wanted dinner reservations at the restaurant up top (Italian steak house...I could probably have a fettuccine in a rich cream sauce!). It was tempting for a "last meal." But clearly I cannot think that far ahead. I didn't pack anything remotely dinner-date like to wear. Dang. Room service it is. Just as soon as the lab rat experience is over. Oh, and the researchers called as we were driving in. Apparently I'm to look for a "young man and a young woman" Scott and...hmmm...Susan was it? They are the folks conducting the research. They are physicists. Wow. Add that to the list of professionals I've seen in January. I'll see if I can talk them into pictures too. I wonder if they'll be wearing pink?

24 hour countdown

In just about 24 hours I will be at UCLA Medical Center in the nuclear medicine department getting a radioactive seed shot into me. And I'm not even on Star Trek (although I will be playing the bald chick in a real life movie soon enough). Yep, surgery day is almost here and that's the first part of the great search for the "sentinel node" (hey, now I'm in a Tom Clancy novel...with breasts). But first things first, tonight I'm a lab rat participating in the research MRI with Spectroscopy.

Chris and I are headed into LA this afternoon. Thanks for all the suggestions for where to stay. Apparently there are two choices in Westwood. The "we're completely booked" hotel and "you can't even afford to ask about our rates" hotel. But I have CANCER!!! Alright, it's early to whip out the "Cancer Wins" card, so I held it. We found a room at the Angeleno Hotel which is owned by the Joie de Vivre boutique hotel chain. And that just cracks me up. It's that round building right near the 405 that used to be a Holiday Inn? Three things caused us to overlook that "right by the freeway" part: room service and feather-top mattresses, and well, they had a room available. So rather than driving in the LA traffic we'll be sitting right above it (please, crazy fates, way above it if you could; thank you) Tuesday and Wednesday night. Surgery is Wednesday.

If all goes as expected, I'll be home Thursday afternoon. If all goes really well, there will be blogging again immediately post-lab rat and post-surgery (Wednesday night? Hmmm. Can she do it??). For now though, life as a normal person goes on for a few more hours and I must head into work! My clients need me. (This is what I tell myself. Humor me).

Sunday, January 25, 2009

Brad Garrett Doesn't Care that I have Cancer

Saturday Chris and I decided we'd just go do something other than work or doctor's appointments or talking to people about cancer or thinking about cancer. That required getting out of town. We went into LA (a surprising choice, all things considered, but our car drives there automatically now) to the Los Angeles Art Show at the Convention Center. No, I know what you're thinking, and there was no velvet, no Elvis, and no mass-produced oil paintings of ships, children, flowers and sunsets. Yeah, I know, we were disappointed too!! This was a show that featured 125 galleries from around the world (and none with regular spots at the swap-meet). Anyway, it worked. We got to walk around for almost four hours just being normal people (really really normal actually, as the "art world" is as odd and eccentric as the Hollywood world). No one knew and no one cared about my breast cancer. Including me!! And just to hit that point home, in just about the last row we walked down there was Brad Garett perusing the art with a surprisingly normal looking woman. He didn't even so much as glance at my cancer breast! Brad Garrett doesn't care that I have cancer. God bless him! (and yeah, he really is super tall. Even I thought so. But, to find that photo for your viewing pleasure I Googled him. His bio says 6' 8 1/2". Now once you hit 6'8", really, what's the point of adding that 1/2"? Is he also 49 1/3 years old now?).

After that we went to Pizzaioli (yes, scene of the extremely delicious crime that was the fettuccine in Gorgonzola cream sauce). They knew just how to make me feel perfectly comfortable. It involved wine, calamari, wine, the aforementioned fettucine, wine, wine and as it turned out...a roomfull of bald people to start my adjustment! (Okay that's me with Mimi DeGrezia--daughter of the owners, Tom & Kris, but note all the folks in the background. Coincidence?? I think not.)

Support Group #2: The DeGrezia Family:
Thanks guys!

4a.m. Follow-Up (How to and not to respond)

Yeah, more insomnia. This is fun. I am steadfastly ignoring that I was up at three in the morning when I had fettuccine alfredo (and wine), and now I'm up at 4a.m. after having fettuccine in a Gorgonzola cream sauce (and wine). This is pure coincidence.

But it is also giving me a chance to read your comments here and on Facebook and in emails. Perhaps I was a bit strident in my directions on the "care and feeding" of "cancer person." Perhaps. But it's working! Here is what may be my favorite response to date:

"...[I] was led to your blog which made me cry and laugh and cry. But I am glad I found it because I would have said something foolish to the effect of 'my grandma beat it and you'll beat the odds too.' But that's not what you said you need, you need numbers tipped to your side and she is just taking away from your chances. The bitch!

So here goes (remember, I am Holly's child and with that comes her sense of humor)

'I am so sorry, especially because the ten people I have met with breast cancer have all died.'

I hope that helps to put the numbers back on your side again! And if you need anything at all, just ask. Especially chef services, I'll whore Brein out to you and Chris any time!

That's from Roryann Clements. And it's my favorite for two reasons: 1) it's damn funny, and 2) she and her husband Brein are the owners of my favorite Riverside restaurant Omakase, so I'm all over that chef services offer!! (He is unlikely to prepare fettuccine in any kind of cream sauce, so I'm okay there).

And then there is my least favorite response to date. Both of my parents (who have agreed on precisely two things ever in life--one resulted in me and the other resulted in my brother) suggested that I should tell my ex-husband about the breast cancer. So I did. And three days or so later, here's the email I got in return. Get the tissues ready:

Sorry to hear about your health issues. I had no idea. I really do hope that the doctors at UCLA and the science we have today will be helpful in treating you successfully. I wish you all of the best.

Okay, now wad up the tissue and throw it at the computer screen!! I promise you that is the entire response. I spent ten years of my life with this man! Clearly he has been beseiged with emails from ex-wives recently diagnosed with life threatening illnesses and he was forced to develop a form response so he could just hit "send" as necessary. But I'm not bitter. I understand. He was raised to think emotions are like dirty underwear--you don't display them. I know deep down though he's worried. He's worried I won't be able to pay my medical bills and this will damage his credit report since I still have his last name.

Oh good, I feel better now. And it's 5:15a.m. and I can hear that in the other room Chris is now wide awake and watching TV. Poor baby. This is going to be a long 8 months.

Saturday, January 24, 2009

Proper Care and Feeding of A Cancer Patient

(The above is one of Cancer Vixen's cartoons. Did I mention I just adore her?)

I mentioned I went to the Mayor's State of the City Address on Thursday. My first public foray post-diagnosis. From this small, but extremely scientific survey, I can tell you there are five basic responses a person has to encountering someone who has been diagnosed with breast cancer, to wit:

1) Person assumes serious, even pained, facial expression, grabs "cancer person" by hand and winces in a barely audible voice, "I've heard about your situation/diagnosis/ illness" (you can pick euphemism; I'll just tell you--no one can utter the word "cancer"). "I'm soooooooooooooooooo sorry. Are you okay?" Then cocks his or her head to the side and continues peering at "cancer person" as if she is dying on the spot.

2) Person assumes stoic face, says "Hi. How are you?" to cancer person while glancing furtively at cancerous breast but refraining from in anyway outwardly acknowledging that they've "heard."

3) Person rushes over to cancer person, hugs, smiles, or just generally effuses and says "Oh my god, I read your blog. It's so great that you are keeping your sense of humor." Or "I heard. You look great and you seem to be handling this well" and frequently there's the "If there is anything at all I can do, please let me know."

4) Person rushes up to "cancer person" and immediately begins a barrage of things "cancer person" must know, people that must be contacted, information that must be gathered, doctors names, other "cancer people" that must be talked to, and 614 stories of people who have survived; this frequently includes graphic descriptions of things that cancer person may have to endure but is in no mood to contemplate at the moment.

5) Person sees "cancer person," and perhaps even makes eye contact, looks horrified, glances away and then runs away or quickly begins a conversation with the stranger next to him or her, while still glancing repeatedly in the direction of "cancer breast." (I will allow for my paranoia causing this feeling--but some people are just remarkably obvious in their inability to "deal.")

Guess which response is my favorite? That would be #3. I think that if you know someone who has been diagnosed with cancer, and particularly breast cancer, there's a few things you should keep in mind. Early on, the person feels fine. I can't tell, physically, that I have a disease right now. Other than the yellow-green fading bruise from the biopsy, physically I feel fine. So why wouldn't I continue on with my normal life? The other thing is, I'm still the same person. Post-diagnosis I don't think a person is going to suddenly be a different person. I deal with things with humor, mostly dark humor. I will continue that as long as I can because I don't like the other options. So when you encounter a "cancer person" if you know this person at all-- treat her the same way you normally would! If she is an extremely private person, then probably you wait for her to bring it up or you discreetly say something. In my case, I showed up in a room full of a thousand people in a tight black t-shirt with a pink stiletto and the words "Pink Heals" on my chest. It's gonna be okay to say something to me. For those who may in the future be in categories 1, 2, 4 or 5 above, a few comments:

1) This response most frequently actually comes from men. I understand--men want to fix things and solve problems and this is not one that most men can fix (Dr. Good Karma can however!). But the response is awkward at best. Again, I still feel fine. And it makes me feel like I have to comfort YOU and assure YOU that everything will be alright. And hey, this is about ME!! ;-)

2) You're kidding when you look at my breast, right? Are you expecting to see something bursting Alien-like from my chest? We caught it early; there will be no bursting forth. And for me, I'd prefer "so I heard you've had some bad news lately' or something that at least opens the door for me to say "yes" or change the subject or do something other than think "wow, this Person is really uncomfortable right now; I wonder what I did?" Eventually I began to say "So I assume you heard?" Every once and awhile though I was wrong--the person hadn't heard! So I am paranoid! But, I can't tell you apart (those who've heard and therefore are uncomfortable and those who haven't heard but apparently are uncomfortable with me in general!) so speak up (just not wincing and crying when you do so).

4) Um, wow. I can't carry that kind of information in my head. And while I know you mean well, every woman's situation is different and I'm really, really squeamish so lots of the details need to be left out. I'll deal with it when I have to. It's better if you write something down or just say "I know of a good doctor/ someone who's recently been through this/ a great website" etc... followed by "would you like me to SEND you the information?" Much, much better. Because then "cancer person" (who has very little control over the disease she is recently battling) can at least maintain control over information and decisions. And the information is available when it's needed. I can't tell you how many post-it notes and scraps of paper I have stuck in my purse currently. I can barely keep track of the number of doctor's appointments, restrictions, instructions, tests, results, etc. that I currently have, let alone things I may encounter in a few months time. (And as for the survivor stories...right. The ones who don't survive don't seem to be telling their stories!)

And you response #5 people: Well, you clearly don't know me well. So let me just say, you can't catch cancer.

In general, I'd say this: I have cancer. Cancer doesn't have me. I'm still me. If people can keep that in mind, we'll all do just fine.

Thursday, January 22, 2009

A Blue Day

So today's theme was not pink. It was blue.
Perhaps the universe was reminding me that all is not pink. Or rosy. Oh, wait, the universe always reminds me of that. First, I went to the Mayor's State of the City address (kudos to me; kudos to you; kudos for all my friends; and you only get that joke if you were there)--first public appearance since I broadcast my diagnosis across our tiny little town. More on that in a later post probably. But it was fun and I was in a jovial mood when I got back to my office. Except there was a message for me from Sasha at UCLA. Hmmm... this is not a name I'm familiar with. And by way of a little background, among the many, many, many things I have marveled at in the great institution that is UCLA Medical Center is that no matter how often I show up or how many "procedures" I have, no one-- but no one-- has so much as uttered the word co-pay to me. Or even "pay." Or "how do you intend to...." Never. [Okay, wait, the parking lot attendant always holds us up for $11, but that's not a co-pay.] I called Sasha. And Sasha as sweetly as can be informs me that Blue Cross informs her that my coverage lapsed on January 1. Right. So now I need cardiac care. Know any good clinics?

As calmly as possible, I said "that can't be right. I know I've paid the premiums and I've had the same insurance forever." She told me that I should call Blue Cross and straighten it out. Honestly, it took me three tries to dial the number correctly. And while I waited the 6 days, 19 hours, 43 minutes and 8 seconds they had me on hold, I perfectly envisioned my life as a bald, bankrupt, bag lady. And the bag was not Coach. Turned out it was Blue Cross's mistake (and they even said that!). They'd input my policy date wrong, but my coverage goes from January 1 to December and I was fine. Covered. They'd correct it and UCLA could call back in 15 minutes. Phew.

I recovered and went about my day being a lawyer rather than a "cancer person." Then, at about 6:30 a friend who has "been there/done that" circa 2007 called. She gave me all sorts of great information and of course we compared types of cancer, treatments, procedures, and the general poor state of health care in the Riverside area (it's a theme). Then we got to discussing my upcoming surgery. There's a part where they shoot blue dye into one of the twins (the ailing one of course) and well, let's just call it dead center. With a needle. They do this to find the road map to the sentinel node. Well my friend had this too. And so did my guru the Cancer Vixen. Both of them describe the pain as "off the charts." On a scale of 1 to 10 it's an 11. And my friend has three children. The children are not adopted. You do the pain math.

I'm a wimp. Who isn't with that kind of info. I hung up the phone and emailed the great and wonderful Dr. Good Karma. It's now about 7:45pm. I asked if this would be the case for me. Give it to me straight. Then I closed up the law shop and went home. To panic. I should have just reached for my Blackberry. He responded in less than a half hour. And because it makes me laugh for several reasons (mostly at myself) here's the response:

"The blue dye is the one I use in the operating when u r asleep so u
won't feelit plus my skilled hands will keep the any pain away ;-).
u may get some staining of the breast that is temporary and
ure urine turns blue and green for a day (
the college kids I treated always get a kick out of that.
The shot u get in the morning is for that tiny bit of radioactive
material that also goes to the sentinel lymph node and that
is not painful. I use both techniques so I can make sure to find
the sentinel node. "

Sounds like fun huh? Hey, after what I thought it was going to be...that's a good time right there. And yeah, my doctor's a Black(crack)berry addict and uses those abbreviations and a smiley face.

I am blue no more. Until next week anyway, when I will be quite!

Wednesday, January 21, 2009

Showing the Girls Some Love

[This is perhaps more of a "ladies only" post; but should any guy be reading it, you might find some useful information to pass on to the ladies you love. Whether you volunteer to assist in the exam is entirely up to you...just make sure you actually know the lady you are talking to. And that she's not your mom. 'Cause that's just weird.]

So I did say I'd try to pass on some useful information. And it seems I've been discussing mammograms and breast self exams quite a bit of late (coincidence, I'm sure). I have to say, I'm a little surprised at how many people are surprised I caught "it" myself and horrified to know it was only 5 months after I had a normal mammogram. Hey, ladies---that's why they tell you to do a self exam!! I've since learned that in "younger" women (yeah, I'm only young for cancer; dang) it is common that the cancer would be a faster growing one, so a younger woman who catches "it" early is most likely to catch it herself. I hate to think what shape I'd be in now if I had just waited another 7 months until my next mammogram.

And then here's something that was surprising to me, and would have been helpful if I had known this before. When you do your self exam, you're not just looking for lumps. You are looking for something different in your breast. Anything different. So yeah, that means you need to know what the girls normally feel like. No, not whether they feel perky, or droopy, or in need of some company. Are they normally dense, lumpy, squishy, whatever? That's what you need to know. Then you need to check for changes of any kind. I felt what I can only describe as a sort of thickening at the "10 o'clock" spot on the right about a month or even 6 weeks before I felt something that finally made me say "no, I think that's a lump." So that means, 3 months after my "A-okay" mammogram I could feel a change--and I could only feel it with my arm raised over my head when I was laying down. It didn't feel like a lot, but it was something different. I just didn't know then that "something different" should have been enough to scoot my boobies into my doctor's office. That's all you are looking for--something different. "It" doesn't necessarily feel like a "lump." Of course, now post-biopsy mine feels like a golf ball attached inside my breast at the 10 o'clock position, but that could be partially in my mind (and partially in my breast!).

Here's some helpful info direct from the American Cancer Society:

How to Do the Self Exam

I actually searched for a video (so you wouldn't have to), but really it's a bit much. Apparently pretty much anyone with a pair can do a video on self exam. And I think there's some fetish stuff out there. (I shudder to think what sorts of spam I'll be getting the next few days.) So, Cancer Society posting it is!

Update: Thanks to Laureen I found another great website (and OMG a great t-shirt!) and it has an even better posting for how to feel your boobies.

click here: Learn to Feel Yourself Up!

Tuesday, January 20, 2009

I'm a Lab Rat!!

I feel so proud. Or, er, well, happy. No, um, I guess just willing. This goes with the "silver linings" I suppose. UCLA has asked me to participate in a research study on "MRI and Spectroscopy." Which sounds like something I would totally flunk (there's a reason I went to law school and not medical school). But the pressure is off. They asked me to participate because they already know I will flunk. They are studying the use of MRI and Spectroscopy as a way of diagnosing breast cancer without the need for a biopsy. I have had both. Trust me, you prefer the MRI (unless you are seriously, seriously claustrophobic; I'm not. I'm seriously, seriously tired and would have slept through my MRI were it not for the fact that Chris planted the idea for this blog in my head right before I went in for the MRI--thus, instead I was planning the blog and time just flew by; the guy knows me!). So because I'm now a lab rat, I'm going back to UCLA Tuesday evening (the 27th) for another MRI and Spectroscopy (I won't feel a thing, despite what it sounds like) which is purely for their study--since they already know my biopsy results they can compare what they would have found if I had only had the MRI with Spectroscopy. I kind of think it's cool I get to help. In whatever way I can. My breasts are going to be so popular! (It's like high school all over again! ...Kidding! Totally kidding! Mom, dad...I'm kidding!!!) Plus, it means we will stay overnight in Westwood which makes it so much easier to get to the Medical Center by 7:30a.m. which is what time I have to check in to the Nuclear Medicine department so they can shoot blue dye into my right breast in preparation for "THE surgery." (Now there's a good time!). So what the heck, we're going to make a little vacation of it and stay the night before and the night after the surgery in Westwood. Sounds better than driving in heavy traffic while trying to change the ice pack on my breast every 20 minutes. Currently thinking Hilgard House, as per Stacey's recommendation. Any other suggestions? Really, really close to UCLA. That's all I ask.

Here's a link to a little bit about the MRI and Spectroscopy studies for those who are interested:

MRI and Spectroscopy

(I searched for something that was close to "plain English.")

UCLA is going to pay me a whopping $75 for this! Which covers, like, the first 5 minutes of parking, so that's totally cool!

Today (Tuesday) was a busy day on this little blog. Thanks for all the support (or schadenfreude!!). But it seems we have learned the age cut-off for "blog comprehension" and it's 35. For those of you over the age of 35 who would like to leave a comment: first, thank you for caring. Or cursing. Either way. Second, if you click on the "0 comments" (or whatever the number is with "comments" following it) right below this post, you will be able to enter a comment. Then you will see a "post comment as" button with a little drop down menu. Don't be afraid...use it. If you select "Name/URL" and then just fill in the space with the name you want to use for your post (for example "John Smith" or "Inept Techie" or "Not my Boobies"; however you want to identify yourself) that is all you need to do. You don't need an "account" or anything else. Just enter your name, type your comment and click on "Post." And you're good. Or at least I think that's what Chris said....

Monday, January 19, 2009

Pink Shirts and Silver Linings

More things I've learned about breast cancer: it brings out a lot of pink shirts and silver linings.

Shirts first. My step-sister from a former life, Laura, says she's sending a shirt from "Save the Ta-Tas" foundation. I'm looking forward to proudly wearing that one! Then, Sunday my step-dad Ted (from a current life; yeah, my family's complicated) gave me the shirt in the photo. It's from
He happened to see the truck/organizers in Arizona on the very day I called to tell him and my mother about my diagnosis. Great shirt, huh? It says "Pink Heals" and it's got a pink stilletto right there. Get it? Pink Heels...Pink Heals?! Shoes are clearly important to this whole breast cancer survival thing.

And then there's the silver linings. I've discovered some on my own, and some friends are determined to point out the silver linings to me. So, Breast Cancer silver lining number one: who knew I had friends that were optimists?! And then there is the fact that I don't think I've ever heard "I love you" so many times from so many people (well, sober people anyway). I've heard from lots of friends and family, including some I hadn't heard from in a long time (hey, we all get busy and wrapped up in our lives). Some people have suggested that there might be weight loss with chemo (I try not to think what they clearly think of my current weight), there is a certain focus to my life suddenly (I have time for two things: work and dealing with "this" and hey, I can't spend any money on anything else that simplifies things greatly). And then finally there is the "CANCER WINS" silver lining. No, really, it's a silver lining. Basically "I have cancer" while true, is also a fantastic way to get out of anything and everything!! Oh, and get my way on anything and everything! Cancer Vixen calls it the Cancer Card. You can just whip it out and run it through like a credit card. It's accepted everywhere! Who can say no to "I have cancer, can you do me a favor?" No one!! (okay, except Seamus--he is completely unmoved by this). I'll try not to let the power go to my head. I'm pretty sure I'm going to have to conserve it for when I really need help. Besides, Chris is on to me.

update: Thanks to "The Bachelor" Chris has found a website with "I (Heart) Boobies" shirts. What's the over/under on how quickly he has a pink shirt himself?

Sunday, January 18, 2009

Cancer Vixen!

No, I don't mean me. And yes, I have been spending time on the internet today (what would you be doing??). I mentioned I've been reading Cancer Vixen--a graphic novel by Marisa Acocella Marchetto. Apparently, it may be turned into a movie starring Cate Blanchett. Cool. I feel so hip.

And, to give you an idea why I love this book:

(but I can't do 5" heels. That makes me 6'4" and no one wants to see that)

More about MammoSite

The good karma Doctor (Doctor Karam) emailed me (yes, emailed. My doctor emailed me. Personally. Wow. I haven't tried, but I'm thinking he returns phone calls too! I'm still marveling at this). Anyway, he sent along some information on the pros and cons of MammoSite. I just don't think it's for me, and neither does he. Give me the best long term chances possible, please. So that question is answered. (Until I get Shawna's comments....which should be appearing below any moment!).

Here's the article:

Saturday, January 17, 2009

D Day

I've had a little time to do some reading and of course I'm still obsessing with reading about BREAST CANCER. And I've received a few emails and calls from women who've "been there done that." So I realized, I'm a little unclear on what my "D Day" is. That is, on what day was I actually diagnosed. Help me out here... the choices are as follows:

1) December 18, 2008. First doctor's appointment where I say "I feel a lump" and the physician's assistant says "I don't like this at all."

2) December 23, 2008 when my ultrasound and mammogram reports are in and the doctor calls and says "highly suspicious of malignancy."

3) January 8, 2009 Dr. Karam looks at my July 23, 2008 mammogram and my December 19, 2008 mammogram and says "walks like a duck, quacks like a duck" and schedules my biopsy for the next morning.

4) January 9, 2009 when same doctor says, right before the biopsy, "95% chance this is cancer", or,

5) January 13, 2009 when the biopsy results are officially back and Dr. Karam calls to say "It's what we thought it was." (Note how rarely the word "cancer" is actually used; and yes, it's a duck. Actually, it's duct cancer--maybe he has more of an accent than I thought!!!).

I feel like the D day is January 13, 2009 (hey, I had a 5% chance before then!!). Which works out great for the February 13th birthday bash. But from what I'm reading (books and emails) may actually be the December 23, 2008 date (which is a bad day in my family for so, so many reasons).

What do you think? Leave a comment below or vote to the right! (This lets me know I'm not talking to myself. Okay, I'm not talking to just myself.)

Oh, and I did eventually get to sleep last night. But tonight...Tylenol PM is my BFF.

At 3:45 a.m. Cancer isn't funny

I woke up at 3:10a.m. and haven't been able to fall back asleep. I'm thinking it's the fettuccine Alfredo I had for dinner (on top of the quarter pounder with cheese I had for lunch; what bad eating habits??). Or perhaps, cancer isn't funny and I may have a little anxiety. Mixed with indigestion. I moved into another room to give Chris a chance at sleeping.

So here's what I'm thinking about as I tossed and turned... surgery is the 28th and I'm pretty comfortable with what will happen and with my doctor. But my sister calls today (she's an OR nurse at UCI) full of UCI does this and that information and asking if my doctor has talked to me about something called "mammosite"--apparently this is something they can insert at the time of surgery that is then used to direct the radiation later on. The radiation then takes less time and has less side effect (which, I suppose is burned breast, right?). She also asks how many hundreds of surgeries Dr. Karam has done because "even a resident has done a couple of hundred surgeries." And all I can think is, I can't get my head ahead to radiation, I don't really want something "stuck in me" for the next 5 or 6 months before we even get to radiation, and a couple of hundred surgeries is good enough for me.

By coincidence, Dr. Karam called shortly after so I asked him (besides, Shawna can be like a pit bull about these things so it wasn't going to go away). He had a perfectly good reason why the mammosite wasn't a good idea for me---but don't ask me what it was. Something about the highly invasive nature of my particular cancer that makes it best we stick with the traditional treatment and not the new technology. And something that made me think "give it all the radiation we can." Did I mention "highly invasive"? There's too much information right now and if I don't need to store it in my head, I throw it out. (That loud clunking noise is the "mammosite" falling on the ground). But somehow I need to explain this to my sister. And there's no way I asked "how many hundreds of surgeries have you done?" I'm comfortable with the surgeon. Chris is comfortable. My dad is comfortable. Why do I want to make myself uncomfortable? Besides, "my" cancer is "highly invasive" seems to be the reason for everything and that's what's driving the treatment. These are not words that say "slow down, take some time, explore options."

Then I got an email from a breast cancer survivor who is a friend of a friend. Lots of helpful information and I started to read the web page journaling her treatment. May have been more gory detail than I was ready for. And again, there was the suggestion that I need a second opinion and all too much evidence that doctors screw up (her case was initially not handled well). But I have a PPO (she, sadly, had an HMO) and UCLA was my second opinion. And I don't want to find out if there is an alternative to surgery. I want the highly invasive little bastard out!!! Besides, it's not even a general anesthesia, no reconstructive surgery needed, and I'm home the same day. Sure, I have a scar and an ice pack on my right boob, but I'm home and the cancer isn't!

Things that are not keeping me up: I do not ever feel like "Why me?"; Mostly, I feel like "oh, of course this happened to me!!" (These are probably two sides of the same coin). And I do feel like this isn't something Chris should have to put up with (he's 33!). I have not spent any time trying to figure out what caused it. It doesn't run in my family (but I do feel a little bad that now my niece will have to answer that question with "yes"; maybe it will allow her to get mammograms covered by insurance sooner rather than later), and "my" cancer isn't hormone based (my score was 0% in that regard. 0%. I don't think it gets any more definitive than that). That's apparently not good news because it means the anti-hormone medications won't work on me. But I'm okay with not taking medications for years on end and because it isn't hormone based, drinking wine isn't an issue. That's as far as my analysis of how I got cancer goes (and some of it isn't even my analysis--the 0% part). I don't really see the point in figuring out the how or the why.

What I do need to figure out....I can only take Tylenol during this countdown to surgery. Can I take Tylenol PM??

Thursday, January 15, 2009

The Treatment...The Team

It took 7 hours but we are back from UCLA and my brain has been jam-packed with information (some of it I'm just rejecting out of...well, mind). Surgery (the "lumpectomy" just really isn't dramatic enough is it?) is scheduled for January 28th at 11 a.m. Of course, I need to get there at o'dark thirty and I can't have coffee, wine, gum, candy, heroin or scrambled eggs after midnight so by 11a.m. I'll pretty much be begging for anesthesia (and/or death; but I realize some of you might not find that amusing right now). The good doctor promises an IV of Starbucks when it's all over. He's quite funny but that better not be a joke. And speaking of the good hands man, that's him. Dr. Amer Karam. What he's holding is a spectacular drawing of what's going on inside my "right breast 10 o' clock"; yeah, it made me nervous about his manual dexterity too, but he just overslept when they taught "cancer cartoons" in med school. Still, if you ever hear the words "highly suspicious of malignancy" give the man a call. And yeah, I know, he looks young. He assures me he's done seven breast surgeries before (okay, he said "hundreds" but I heard "seven"; I'm like that). I'm trying to remember that I was 23 when I graduated from law school and I expected everyone to take me seriously. I'm taking him seriously. It's the cancer I refuse to take seriously.

Oh, and IT WAS MY GOOD FRIEND STACEY ALDSTADT WHO REFERRED ME TO UCLA and personally made sure I got to a doctor long before the medical community of Riverside could even find my chart or return a phone call. Thank you Stacey. Thank you, Thank you, Thank you. No, really. Thank you.

And that brings me to other supporting players. Here's my January team:

Dad on the left, Dr. Karam, and Chris. That was our little team today figuring out my whole "treatment plan." I focused on margaritas, martinis and wine (when each was applicable); Dad asked medical questions (how is this relevant??? Geez. Dads.); and Chris took scrupulous notes while trying not to giggle every time Dr. Karam said "breast" (which the dude says a lot. A lot.)

In the end, the plan was the lumpectomy and search for the "sentinel node" on the 28th (more on that sentinel later; it's kinda fascinating). If all goes well (meaning there's no cancer in the lymph nodes) I'm home that evening (well, after a 5 to 6 hour drive home in rush hours traffic). I insist on being back at work the following Monday. I have appointments scheduled!! Then after a week or so, I go back to Dr. Karam. If he got "everything" in the first surgery, well, Dr. Karam ends our relationship and it's goodbye to him (unless one of you starts dating him; and there seems to be volunteers among you). But alas, that is not the end of my cancer journey. Then I have to go see an oncologist and convince him or her I don't really need chemo, or I just need chemo light. Dr. Good Karma, who thus far has not been wrong about a single thing (apparently he didn't miss all of his med school classes; just the drawing one) seems to be preparing me for the inevitability of chemo. So that will likely start sometime in March and go on for 4 months. Reminder: Birthday Bash in February still an option! I'm thinking Friday the 13th! Totally appropriate. After that will be radiation. Which should be delightful in Riverside in you know, July or August! Stay out of the sun? Are you kidding me??

So basically, not much changed today. Except we have actual dates and a sort of schedule. Oh, and they had me do 1) a chest x-ray; 2) blood tests (4 vials); 3) a urinanalyis and 4) an EKG in preparation for surgery. They managed to accomplish all of that in about an hour. Astounding. And I didn't have to drive all over the place and carry my records myself. I could do the whole testing journey in super-cute 4" strappy silver sandals walking only as far as the elevator. Oh, and there was one "it could be worse" moment when Dr. Good Karma told me one of the tests was a pregnancy test. I may have threatened his life if he came back to me with "you're pregnant." (Security was called prematurely in my opinion!!) This whole cancer thing may be over in 8 months. Pregnancy? The child never goes away, right? I'm 45. My dad came to my appointment today. (Thanks, Dad. ;-)

Wednesday, January 14, 2009

Things I've learned

You know how when you buy a white car you suddenly notice how many people have white cars? Breast cancer is the same way. Geez, does everybody have breast cancer or know someone who does? Yes. The answer is yes.

And apparently there's a lot a person needs to know to deal with this all (sadly, get the #@%& out of town for treatment was one of the things I learned--note the lag time between "feel a lump" and "Yep, that's cancer"; 25 days.)

So here's my thoughts with this blog... 1) it's my therapy. Yes, it's incredibly self-absorbed but hey it's better than bombarding people with emails about my "right breast 10 o'clock." And it's a better way to update those who might actually care (occasionally, no one is going to care daily!) and aren't squeamish; 2) if anyone else has been through the experience and is willing to share advice, stories, encouragement this is as good a place as any, I imagine (the waiting room at UCLA Medical Center seems a little tense!) so please pass this along to anyone who might be willing to share/ add comments and keep me informed; 3) good lord there is a lot of misinformation out there on mammograms, self-exams and breast cancer in general. If folks only knew the difference between catching it early and not (it's the difference between lumpectomy and masectomy and "chemo-lite" and well, not so light; and that's just for starters!), I assume that those of you who have said to me "I guess I should schedule that mammogram I've been putting off" (you know who you are) might actually do it. So I'll share what I learn and what women should know about this. I caught mine by self-exam (although, truly, Chris deserves and wants some of the credit for the ahem, "exam"). Show the girls some love, ladies.

I'm super early in this whole process. And so far I've only bought two books (and read half of each; Love "Cancer Vixen" by Marisa Acocella Marchetto...who I think is Italian...) and talked to 2 surgeons, 4 radiologoists, a hospital administrator, several cancer survivors, and a whole host of "I had friend who..." folks. I'll sift through and share the good stuff. You do the same.