new treatment guidelines for some women with early stage breast cancer? is it me, or does anyone else hear kenny rogers singing his song, " the gambler"?

last night on the cbs evening news, i heard a report about the possible change in treatment for some women with early stage breast cancer. the study was reported in the new england journal of medicine- the gold standard of medical journals,  in my opinion. there was not enough information,( for me )  so i went to the cbs news website and listened to the report again. from what i could gather, was that in women with early stage breast cancer, and considered to be very low risk- tumors that are estrogen receptive, no lymph node involvement ( i assume, do not quote me on this one), and small size tumors, chemotherapy may not be the answer. instead of the traditional chemo cocktail, these women were given an estrogen blocking drug only. the recurrence rate was less than 1% after 5 years. this is a major breakthrough in treatment, i think.

i think that early detection of breast cancer is essential, of course, in order for this to be a viable treatment option. and i still think that it is a bit of a, as kenny rogers would put it,  gamble. of course i believe that treatment for every cancer is a gamble to some degree . it is crucial for the patient to gather as much information as possible and get second opinions, if possible, before deciding on what treatment may be best for them. this refers  back to what i am always saying- everyone needs to be their own  best patient advocate. research, research, research and ask plenty of questions along the way.  no one has a crystal ball, unfortunately, so no one is certain that the choices that are made today will be the correct ones, as far as treatment and recurrence are concerned.

in my case, for example, i was not certain at first if i would need chemotherapy. my general surgeon said that he usually could tell a patient if they would be needing chemotherapy or not. he said in my case, he had absolutely no idea what the oncologist would say. ( figures, right?). the staging of breast cancer has changed dramatically from what it once was. no more just stage 1,2,3,4. now there are many factors to consider- is it estrogen/progesterone receptive? how large are the tumors? what type of breast cancer is it? are the lymph nodes involved? etc, when i asked my oncologist what stage i was in, he just looked down and shook his head. he said that it was not cut and dry any longer. all i could pin him down on, and believe me i tried, was that i was at " moderate risk" and yes, i would need chemotherapy.

i also read a study about patients who have had  thyroid cancer and then were diagnosed with a second primary cancer. this was a study that was conducted in taiwan ,with a population size of about 19,000 patients. two things struck me, almost literally. first, for patients who had had thyroid cancer, there was a 33% increase in the risk of a second primary cancer, breast cancer being one of the " choices". another horrifying result of the study was that the median survival rate after the diagnosis of the secondary cancer was only 4.7 years. (the full article title is: second primary malignancies following thyroid cancer: a population based study in taiwan, eur j. endocrinol 2013. 169.577-85)
after freaking out a little bit, i realized that several facts, that i needed to consider, were missing from this study. what stage thyroid cancer did these patients have? how was it treated? what type of cancer screening did the patients have? what stage was the second primary cancer and how was it treated? health care in taiwan, i assume, is different than health care in the united states. i am not saying one is better than the other, just different.

i think that all  cancer treatment is a gamble. the best that  anyone can do is to gather information and make, what we think, is the best decision for ourselves. no one has all of the answers. i decided to be aggressive with my breast cancer treatment, and my physicians agreed. i have my big thyroid cancer check up in a little over two weeks. you can bet that i am going to discuss the article on thyroid cancer and second primary cancers with my endocrinologist. one of my doctors told me that i have " the most positive attitude" about my cancer. i think that it is important to be positive, but at the same time, realistic. who knows what the future holds for any of us, but all of us need to make our time count and enjoy every minute of it.

well, my last surgery is what you might call a "farsee"

a long, long time ago, when my husband and i were younger, we went back pack camping. i had an old back pack, that was so uncomfortable. it hit the small of my back with every step that i took, and after a while i began to ask- like a little child on a long road trip would ask - how far is it to our camping site? jeff would reply," oh, it is just a farsee away. see those trees up ahead? just a little past that." as you might imagine, this " farsee" kept moving forward a little- every time that i asked.

today, i went back to my plastic surgeon. i wore one of  the button up blouses that i usually wear to work, just to see how things look now. i asked my husband's opinion, and ever the diplomat, he said you look just great, sweetheart. the nurse thought that i looked fine,too. the blouse fit well, without that little gap about the third or fourth button down. most of the  women reading this blog will know exactly what i am talking about. i really hate trying on a blouse and it fits everywhere except that one button that has a gap large enough to give someone a peek at your bra. the surgeon said, well, we could add some saline to give more " forward projection", but if you are o.k. with things, we will just stop. HOORAY!!! no more saline filled needles in my chest. my chest is still tight, and i feel phantom breast pain( this is so weird) on occasion, but just knowing the " saline stops here" makes me happy.

i thought that i would be having my last surgery, to remove the temporary saline inserts, and insert the permanent silicone implants, in october. the surgeon sort of hinted at that time frame. turns out, it will not be in october, but will be in november.  the surgeon said that i needed more time for my blood work to come back up to " normal" as well as more recovery time  from other side effects of the chemotherapy. the oncologist filled out my paperwork on my medical leave of absence. part of it was a paid leave, which i really appreciated,  but i am now on unpaid leave. when i looked at the paperwork, and this was before i started the chemo, i almost laughed at his end date. i told jeff,  " look, sweetie, he put down that i needed to be out until the end of december! how funny. i know i can go back before then!". famous last words, as they say. now i know that i will indeed need this much time off. the receptionist told me that it generally takes about 2 weeks to schedule the last surgery . after my visit on october 26th. if all goes well, it will probably be the second week of november before i will be able to have the permanent implants inserted. also, the surgeon said that it takes about one or two weeks to recover from this surgery. i will spare you the details of this surgery. it is same day surgery, though, so unless something happens, i will be going home the day of the surgery.

i did get some good news about the surgery, though. the plastic surgeon said, " your double mastectomies were a 10 on a scale of 1-10 as far as pain goes. this last surgery will be about a 3 or 4."  yippee, i guess? i do handle pain way better than nausea, though. i know that i will have a little nausea from the anesthesia/pain medicine in the hospital, but it will be short lived , unlike the nausea with chemo. yes, i am still having nausea from the chemo. i thought that there was something wrong with me, but i have read that other women have this problem,too. at least it is not an all day event, like before. and some days of course, are better than others. so i am getting there. slowly making progress. my last surgery, as well as my recovery from chemo, is a "farsee". and i can almost see it now.

this blog is a 2-fer or as they sometimes say, a bogo

right before i started my unexpected journey with breast cancer, i was anticipating my six month check up for thyroid cancer. i am a five year survivor from that, but still have to go every six months for ultrasounds, blood work,etc. because my thyroid cancer was the "aggressive type" and two of the tumors had spilled out into my lymphatic system. my big thyroid cancer  check ups occur every april and october like clockwork, that is until this year. in march of this year, i had the infamous screening mammogram, then the 3d mammogram, then of course, my cascading domino path to breast cancer.

so, i did not get to have my april thyroid cancer check up this year. i have the one for october already scheduled, but i have to work in another surgery to finish my breast reconstruction in october as well. around the first of this year, i noticed a change in my overall health. i was exhausted- and i do not have to tell anyone with thyroid issues, much less those of us who are missing a thyroid, how exhausted we get. but this was somewhat beyond that. also, i had begun to lose a little weight without trying( for a change). my allergy to sulfite preservatives had gotten a little bit better for a while, but was now back with a vengeance. in other words, i knew something was wrong, but i honestly thought that my thyroid cancer had returned somewhere. to say my socks were knocked off when i got my breast cancer diagnosis is putting it mildly.

one of the first things that i asked the surgeon after my operations was if there were any thyroid cancer cells in my breasts. this is how thyroid cancer spreads. some rogue, or sarah palin if you will, cells migrate to another place in your body to cause mayhem, and well, cancer. he said no, that all of the cells were breast cancer cells. i suppose that is good news. if the thyroid cancer cells did not move to my breasts, i can probably assume that they have not taken up residence somewhere else in my body. of course i will not know for sure until my check up next month, but i am hoping for the best.

i have personally known of three people who have had thyroid cancer, then had breast cancer. is this a coincidence? are they somehow related? a bogo, so to speak? there has been no research, to my knowledge, to prove any connection between having thyroid cancer and then breast cancer . one of my thyroid cancer books tried to dispel a rumor that the treatment with the I-131 could cause breast cancer. i mean, it is not like we thyroid cancer patients really have a choice. the I-131 is the only treatment drug so far that is available to kill any thyroid cancer cells that escape the skilled hands of our surgeons. the advice that the author gave in her thyroid cancer book, was to get the I-131 treatment, but be sure to get regular mammograms- a good idea anyway.

now that i can see the light at the end of the breast cancer tunnel, i have started to ponder what news my october thyroid cancer testing  will bring. as i have said before, if you have breast cancer you have more support and understanding from the general public. sad to say, but some people do not know where the thyroid gland is located or what it affects ( everything) in the body. thyroid cancer happens to be the fastest growing cancer now. in a few years, it is supposed to top colon cancer in the amount of people who have it. i really  appreciate all of the support and love that i have received during my breast cancer journey. losing both of my breasts was one of the most traumatic things that has ever happened to me. chemotherapy was one of the roughest things that has ever  happened to me. that said, i wish that thyroid cancer patients were afforded more understanding and compassion.

someone told me that after reading my blogs, they thought that maybe thyroid cancer was indeed " the good cancer". i disagree. no cancer is anywhere near a good cancer. there are challenges, heartbreak, and life changing events that come with any cancer. i am praying that someday we can treat all cancers successfully. until then, we need to keep searching for cures, and most of all make sure that we treat ALL cancer patients with compassion, respect, and loving care.