Humor After the Tumor

I want to start today's blog by thanking my dear friends Cathy and Ed for driving all the way up from Fairfax, VA to visit a few hours with us yesterday. Cathy brought some very sweet strawberries and a plate of homemade brownies. Both tasted absolutely delicious to me. Mark also knew that it was National Nacho Day, according to the Hungry Girl website, so he had made one of her recipes. These were very odd nachos, using soy chicken, barbecue sauce, and baked tortilla chips, but they were superb tasting. We all sat around the table enjoying them.

Cathy is also a breast cancer survivor. Although I had heard some of her story before, it was really good to hear it again and get more details. We are sisters in this now for all time. She was fortunate not to need chemo, but she did undergo radiation therapy. She also had a very nasty bout of infection following her lumpectomy. Every woman's journey is different.

Ed is a professional Santa, and he REALLY looks like Santa all the time. I have never seen him in his official suit, but I cannot imagine he looks anymore realistic all dressed up in his red suit than he does on a regular basis. He's just a natural. My only regret for the day was that I forgot to have a picture of us all taken together. I really wanted to do that, but I just forgot.

Thanks, Ed and Cathy, for coming up and visiting us. It was delightful. You both are fabulous!

Despite the great two hour visit, I felt very fatigued all day and fought diarrhea for the second day in a row. Even so, I did have some fun as well. During the course of the day, when I was awake, I actually read an entire book. My friend Ellen in Buffalo had mailed me a nice package of a variety of things, including a short book called Humor After the Tumor by Patty Gelman. In 2001 this Jewish mother of three daughters in their 20s discovered her lump. She lived in Buffalo, like my friend, and had her treatment at the Roswell Park Cancer Institute. Her treatment took the same course as mine: lumpectomy, node dissection, chemotherapy (same three drugs as me), radiation, and Tamoxifen for five years. During the year that this took place, she sent emails to a large "to" list of friends and family, much the way I use this blog. Although she did not email every single day, she did email at least two or three days a week. As the year was progressing, the idea of putting them into a book came about. At first she resisted it, but somehow it got published. How all of that happened isn't really part of the book, but the main thing is all of the proceeds of this book are a donation back to the Roswell Park Cancer Institute in Buffalo, NY. I want to thank Ellen for sending me the book and thereby making a bit of a donation as well.

The book is humorous, hence the name. Patty Gelman had a huge support system of family and friends, much the way I do, and she kept her sense of humor about this throughout. She had a large Labrador retriever who was often the center of humor. There were only a few emails when she admitted to tears or fatigue. Mostly she seemed much more energized than I have these past few days.

One very interesting, yet somewhat disturbing, thing was at the end of the book. There is an afterward by one of the doctors at the institute. He reminded me of something I had read elsewhere and was told by my own oncologist. I am going to quote part of his afterword here.

"But Patty's story also sobers us with the many shortcomings and frustrations of breast cancer therapy:

*Despite the proven value of mammography, it did not help Patty. Hers was one of the 10% of breast cancers invisible to mammography. (Like mine also was.) It was only found when she noticed a large lump in her armpit from breast cancer spread to her lymph nodes. This is just the situation that we hope to prevent with screening mammograms.

*Patty had to receive chemotherapy. We know that 60 to 70% of women with a cancer spread to the lymph nodes like Patty's actually have cancer spread to other organs, and that this cancer will eventually manifest itself, and result in death. But we have no way of determining who are among the 70% and who are not. Despite normal x-rays and scans showing no evidence of this spread, we know it has occurred, albeit in microscopic amounts, in most cases. The only option is to treat all of these women. (My oncologist made it very clear that not all women need chemo, but there is no way to determine who does and who does not, so everyone with cancer in the nodes gets it.)

*Chemotherapy only helps some of the women who get it. It only reduces the chance of cancer recurrence, and ultimately of premature death, by about one-third. So in Patty's case, the chance of recurrence drops from, say, 60 to 70% to 40 to 45%. In the rest of the cases, the cancer cells survive the toxic chemotherapy drugs and continue growing. We cannot determine in which cases the cancer cells are susceptible to chemotherapy and in which they are not. Looked at another way, almost three-quarters of the women who receive chemotherapy for breast cancer gain nothing--either they weren't going to have cancer recurrence, or the chemotherapy doesn't prevent it. So while it may be life saving, and while women like Patty should take it, we must improve these therapies and apply them only to those who benefit."

I had heard and read all of this before, but it was sobering to read it again. There are many instances of women who never have a recurrence of their cancer. It is mostly attributed to the trifecta of treatment: surgery, chemotherapy, and radiation. However, there are also many women who have recurrences despite the trifecta. The medical community is working hard to find a way to predict who will or will not have recurrences or who will or will not benefit from the rigors of chemotherapy. Although these medical advances are not here for me yet, I feel blessed that the therapy for breast cancer has advanced as much as it has over the last decades. Just a few decades ago, all women were subjected to radical mastectomies with massive lymph node dissections, leading to life long pain, disfigurement, and lymphedema. Now almost no one undergoes that sort of treatment. More women than ever do survive far beyond five years after their treatment. I know that I have many people praying on my behalf that I am one of them.