Ok, so it is Friday and I have been a little tardy getting something out to you this week but that isn't my only true confession.  It has been a busy week at work and home (even though my kids are grown and gone).   I have determined that life is a roller coaster and just hang on as there are many highs and lows.  When I hit a downward trend, I find myself sitting back and isolating and insulating myself rather than making a bridge and reaching out although I have many friends that I am blessed with and could spill the beans but each and everyone of us has problems and I don't feel I want to add to their burdens.  Having confessed that, I will then say that when I finally realize that I need to unload the beans and talk that in the long run, I feel better is someone just listens. Please don't give me answers but listen and provide insight as to what I am really saying.
  Support groups, your healthcare team, your nurse navigator or the person you select, let them be your support rather than isolating.  Yes, I said it and I know I am preaching to myself on this one.  I read a recent study that talked about just that, social support does matter in terms of physical outcomes.  This study was done with Kaiser Permanente and their research-based  study provides the evidence that social support helps with physical symptoms.  The more you were able to discuss and engage in conversation, the better able to cope with their symptoms (was the result) as opposed to those patients that didn't.  Now I don't think that is an earth shattering revelation but if it speaks to you right now, it may hit your awarenss button.  We are talking about your quality of life and I could see the validation in the their results that support groups, or an individual from your team or family and friends will help in the long run. 
  I have found that when I hit those lows that it is time for me to push myself and get out and interact with others and laughing and talking is one of the best medicines out there.  Also stated in this study that women that didn't receive, had a lower quality of life. 
  Women are living longer and being cured of breast cancer, it is imperative that we look at quality of life and what will help improve it.  I have often put a funny movie in and sat with a patient that just doesn't seem to open up, or make a silly joke or a funny story seems to pop out when I can see the cocoon going up with a patient. So look for your positive support and if you are having trouble, maybe you too have a true confession that you are isolating and it is time to get up and out an

  As a person looking for answers, you might want to consider an assessment of breast cancer risks, screening, and risk factors and how to reduce your risks of having breast cancer.  Angelina had a first degree relative with breast cancer- her mother.  Also in consideration is a gynecologic and breast surgery history as well as and radiology history.  You should  be prepared to give a detailed medical history including when you started your menstrual period, age when you had your first child, age at menopause, any surgical history related to gynecology, any breast biopsies, any personal history of breast cancer and race and genetic testing done in the family.

  Many will find that there may be a history of breast cancer in the family but having said that, only 5-105 have a hereditary predisposition toward this disease ( American Cancer Society)  Those carrying the BRCA 1 or BRCA2 gene should seek counseling about preventive steps to reduce their risk which during their lifetime is 36% to 85%.  Estimates do vary according to age.  Women that are past childbearing age are usually counseled to have a prophylactic oophorectomy (removal of ovaries).  Added consideration for more frequent screening and possibly a prophylactic hysterectomy may also be considered.
Those having the prophylactic mastectomy can reduce the risk of breast cancer in high-risk women by 95% and those having a prophylactic oophorectomy  can reduce the risk by 80%-90%.

  As a woman, we  have no control over heredity and genetic makeup but we need to look at what  can be done to help reduce your risk which includes: not smoking, limit alcohol intake, exercise, eat fruits and vegetables and reduce the amount of red meat you have, also work on reducing stress and interventions to help with stress, get enough sleep and do your routine screenings.  Angelina took control and is taking the steps she feels she needs to for her own situation. Knowledge is power and with that comes responsibility to find what works best for you.  With that control in your hands, I say- Make it a great day! S

Disclaimer: This website is for informational purposes only and is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of any medical institution.

Jolie's Disclosure Applauded and Cautioned by Docs

One of the defining moments in the history of breast cancer occurred in 1974 when the first lady, Betty Ford, spoke openly about her mastectomy, lifting a veil of secrecy from the disease and ushering in a new era of breast cancer awareness.  Now four decades later, another leading lady - the actress Angelina Jolie - has focused public attention on breast cancer again, but this time with an even bolder message: A woman at genetic risk should feel empowered to remove both breasts as a way to prevent the disease. Ms. Jolie revealed on Tuesday that because she carries a cancer-causing mutation, she has had a double mastectomy.        

But some doctors also expressed worry that her disclosure could be misinterpreted by other women, fueling the trend toward mastectomies that are not medically necessary for many early-stage breast cancers. In recent years, doctors have reported a virtual epidemic of preventive mastectomies among women who have cancer in one breast and decide to remove the healthy one as well, even though they do not have genetic mutations that increase their risk and their odds of a second breast cancer are very low. (NY Times)

"It's important to make it clear that a BRCA mutation is a special, high-risk situation," said Dr. Monica Morrow, chief of the breast service at Sloan-Kettering. For women at very high risk, preventive mastectomy makes sense, but few women fall into that category, she said.

Other physicians were less than comfortable with the marketing aspect of Jolie's care. Pink Lotus -- a "comprehensive and integrative breast center" in Beverly Hills where Jolie had the procedure -- is currently running a large ad on its homepage that promises full details of Jolie's treatment and urges visitors to follow the center on Facebook and Twitter to get the story as soon as it posts. (MedPage Today)

Make it a great day! S

Finding out you have breast cancer is difficult, deciding what will be the best treatment for you is even more difficult another.  The ONCOTYPE DX test would help me determine what my individual risk of recurrence would be.    There are many factors involved in making the decision but getting the most information you can will help in planning your treatment.  Reviewing my medical history, my age, the size and grade of my breast tumor, whether my tumor cells had estrogen receptors and what surgical procedures would be done and including the margin width as well as my treatment preferences and the result of my Oncotype all went into making the decision for my treatment.  This test helps measure a group of cancer genes in your tumor and the results strongly predict whether cancer may come back in the same breast.  My score helped me assess the risks and helped me to make my treatment decision along with my healthcare team.  This helped tailor my treatment and helped identify if I was low risk or high risk for recurrence.

The test is performed on a small amount of tissue that was removed during my original surgery.  I did not need additional surgery or procedures  to get the Oncotype Dx Test.   The Oncotype Test was ordered  before I start treatment  as it is intended to help determine how likelyit is for my  cancer  to return.  My Doctor ordered the test for me but you may ask your doctor  about getting the test done.  Results from the test will be returned between 7-10 days and are sent to your doctor so it can then be interpreted for you and discussed and your questions answered.  It is always important to find out if your insurance will cover the test as insurance plans vary.

For me, having this tool helped in my decision making and I proceeded with chemo and radiation.  I wanted to be as pro-active as I could and do everything I could to help make sure that my cancer did not come back.   This test helped ease the burden in making decisions, and in turned helped make it a better day.  As always you are the captain of your ship and you are and should be an active part of your healthcare team and be a part of the decision making.  I hope this information will enlighten your path and you will make your decisions as you see fit.

Disclaimer: This website is for informational purposes only and is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of any medical institution.

  This year is the first year, I have no mother or mother-in-law to celebrate Mother's Day but having said that, I am thankful for having had them in my life and all the others that have mothered me along the way. My sister, who has shown me what a true lady is and how to carry yourself and how to be a great hostess and a model of a good person, my best friend. who has listened to my ups and downs and supported me with love, and food, and friendship and guidance for well over thirty years, for an amazing lady named Marnie that exemplified what an adoptive parent is and sheltered me and kept me close in her heart since I was a teenager, for Ruth that showed me what a good nurse does and how to be a professional, for Suzie, who is always there for me and we laugh and cry together, for Pinky that would give me the shirt off her back and now is facing her own battles with cancer, for so many friends and acquaintances who accept me for who I am. The list goes on and on and I could not get through the day without Lisa, Marsha B and Marsha C, and Lisa Q and Shelley and Mollie and Betsy and Sue and Marianna and so many more.
  So all those of you that are mothers out there and for those of you that have mothered others, bless you all.  I am who I am because of your influence in my life.  I love you all and thank you from the bottom of my heart and I will say, I will always need you in my life.  Know that you do make a difference and on this mother's day, be kind to yourself.  Now, I am going to sign off as one son arrived home and surprised me as I didn't expect him and I look forward to spending some time with him and enjoying the blessings of m five children that I helped raise and all the others I had an opportunity to b

I thought it was time to bring some information on ONCOTYPE DX.   Eight years ago when I was going through my breast cancer treatment, I had the Oncotype Dx test done. At that time I had no idea what it was and even less understanding of what to do with the information.  I truly appreciate the information it brings on either side of the spectrum but for me the waters were a little bit muddy as I fell in  the intermediate category and was given the choice of whether or not I wanted Chemo. Now to be honest, I don't know anyone that really wants Chemo but after thought, prayer and talking to others that had had breast cancer I finally came to a decision that was right for me.  Although I was intermediate, I did decide to do the chemo as I didn't want any look backs down the road that I would end up saying, should have, could have, would have.    I wanted to make sure I did everything I could to make sure that my cancer did not come back and that took me to the path of receiving chemo. Knowing I had taken all the steps to help ensure that was a relief for me mentally.  I had put on the suit of armor and had covered all my battle plans.  This was the decision that was right for me.  I bring this information to you just for your awareness and understanding and will continue to MAKE IT A GREAT DAY.    S



Oncotype DX®: The Oncotype DX test may be helpful when deciding whether additional
(adjuvant) treatment with chemotherapy (after surgery) might be useful in women with
certain early-stage breast cancers that usually have a low chance of coming back (stage I
or II estrogen receptor–positive breast cancers without lymph node involvement). Recent
data has shown it may also be helpful for patients with positive lymph nodes.
The test looks at a set of 21 genes in cells from tumor samples to determine a 'recurrence
score', which is a number between 0 and 100:
· Women with a recurrence score of 17 or below have a low risk of recurrence (cancer
coming back after treatment) if they are treated with hormone therapy. These women
would probably not benefit from chemotherapy.
· Women with a score of 18 to 30 are at intermediate risk and some might benefit from
chemotherapy.
· Women with a score of 31 or more are at high risk and are likely to benefit from
chemotherapy in addition to hormone therapy.
The test estimates risk, but it cannot tell for certain if any particular woman will have a
recurrence. It is a tool that can be used, along with other factors, to help guide women
and their doctors when deciding whether more treatment might be useful.

Disclaimer: This website is for informational purposes only and is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of any medical institution.

  Where do you look for answers and hope when you are facing the word, CANCER?  There is a fine line between too little information and too much. I recall, even as a nurse, that when I heard the words breast cancer that almost all the information they were relaying to me at the time, just seemed to float off into the air and I only grasped a small portion of the information they were telling me including all the tests and appointments that were to follow.  I do remember immediately saying that this wasn't going to be my end.  That was a conscious decision on my part as the words kept coming.  I was devastated and yet almost numb to what it meant to me at the time. The unknown of what to follow took me to the things that were familiar: the last patient I had that had cancer, what my grandmother looked like after her mastectomy, a friend that lymphedema.  My big question remained was how to find hope and fight the negativity inside myself as well as others who thought they were sharing and helping by telling me how their mother had suffered and died from breast cancer, or another person who relayed how her best friend was so sick during her chemo and all the reactions she had experienced.  I decided then and there to cut the negativity out completely. If a person couldn't be positive, I moved on or asked them to not discuss that with me.  I believe in positive thinking and finding a happy medium as we can't always be up with the daily processes we have to go through but if I knew I could limit that negativity and fight back by being positive, well then dag gum - I was going to do it.  My vanity fell away very rapidly and I could have cared less if you saw me with a wig or with a naked head after my hair was gone. Really, it is only hair!  I did experience some pain but I will say that I have gone through worse and I am not a great candidate for pain control as most of those meds either make me goofy or give me a reaction so I also decided different techniques to deal with the pain would be in order.  I often called my cancer, brussel sprouts as I hate brussel sprouts and I could visualize throwing those brussel sprouts out and being rid of them(Cancer).  I prayed, ALOT and put it in my higher power's hands that his will be done.  I also bargained on some days that if I got through this treatment, I would cut out eating junk. I will admit I am better at this but not completely weaned from the stuff.  I found hope through those that had gone before me and looked and acted normal and had 20 years of survivorship under their belt.  Hope came from friends, family, and specifically my spouse who stood by me through it all. The times I could sit still during treatment, the crying of exhaustion and wanting the end of the treatment and of having to deal with this all and my lunacy at laughing at the silly things. People would ask if I liked being bald, "Really- yes, it takes me far less time to get ready in the morning."  Now honestly, isn't that one of the dumbest questions you ever heard! 
  My hope may be that I am cured or it may be that I go to heaven when my time is near and who knows when that really is.  My hope and faith keeps me strong and even at the weakest moments, I know that I still have hope.  I can see in others, the faith that we all need and want. I can see the peace and serenity in holding on to hope and I can see that love is what binds it all together. Whether today is my last day or ten years from now,  I will share each day as a blessing and give the love I receive back two fold.  My hope is that if you need it, you will open yourself up to receive it and make it a great day!. S

  At the conference I attended in Las Vegas, one of the topics involved the power of words.  One of the things that most impressed me is that words, even well meaning, can have a negative effect. It is not that I didn't know it before but I realized that I have to really look at what I am saying and how it is received more than ever before. Just because I am a survivor doesn't mean I have all the answers which I often repeat. I don't know that there is a right or wrong way of doing things or getting through treatment but we all do our very best. I know that losing my hair was not as traumatic for me as it is for some women and trivializing the effect of hair loss is detrimental.  Hair does grow back within 6 months after completion of treatment but I have had women who have contemplated about not having chemo so they wouldn't lose their hair.
  You will hear people ask if you smoked and we do know lifestyle choices raise your risk but the perception is that you are to blame for your cancer.  How many times have you heard, that there is a war on cancer- that meaning  their will be a winner and a loser.  The power of those words that a person lost their battle to cancer fails to portray a positive image.   We also hear that screening doesn't save lives for those that have cancer.  One of the ones that are often heard is, " at least you caught it early or you are down with treatment now go and live your life."  
  When there is a recurrence, it is better to say that we are restaging the disease rather than it is back again.  Fear of recurrence is always there and usually hits about six months after completion of treatment.  After you have completed your treatment it is hard to go back to your every day life.  There may even be a period of loss as your support systems through treatment are gone and your safety net removed and you may not come back for 3 months.  Your friends no longer see a critical element in your cancer as you have completed your treatment so now you are supposed to be NORMAL.  There is another word that can give you pause as what exactly is normal?   As a team, we as healthcare providers need to be aware of the words we use and also to be consistent and use words that they know and use every day.  Using medical jargon can also put the patient on defense as they may be too intimidated to ask. 
  My husband used to tease my that my dog was not very smart and even though he was joking, it hurt me(even though it is a dog) that he referred to him as stupid.  The power of words!   So when you are talking with someone dealing with these issues, think about the words that you use and sometimes just sitting and listening may be the best medicine of all.  So with that I will sign off for today and say,

  So some mornings I come in and get all my things together for the day and I have an inspiration for this blog and other days I find something new /interesting to present and some days, I just wait for divine intervention.  Some days it takes something like a cup of cappuccino to jump start my brain and today is one of those and no, I forgot to get a cappuccino ( liquid candy bar in a cup).
  I spent last evening with the AMISH discussing health issues and concerns and the conversation then led to what is happening right now in the world with the bombings and such.  I was totally shocked that they were so in tuned with what is happening now in our world considering they don't have television or telephones.  Their simple lifestyle does give you pause for thought.  I never go into these communities that I don't have a crowd slowly gather and we just sit and talk. There is the absence of video games for the kids and phones ringing, and no visible watches or name brand jeans. As I oogled over one brand new baby, we discussed immunizations and  found with some interesting conclusions including that half of the community was immunized and half were not and that would even be in the same family.  They are very much inclined to do herbs and chiropractors as first line intervention.  We talked about the role of preventive medicine and routine testing and the absolute need for immunizations.  We even talked about nutrition and their use of supplements.   It always leads back to personal concerns and how to get care for what is happening in their lives now.  They are a hard working group with  a very loving attitude and a great sense of humor but very indoctrinated to keep to the simple life although they won't have phones in their homes, they will have one on their porch or use a neighbors.
  With all the recent activities in the world, it gives pause to just keeping it simple.  Life should not be this complex and construed.  Our goal should be to love one another and of course, the Golden Rule of do unto others as you would have them do  to you...(paraphrased).  Which when you look at it all is back to basics and what our country was founded and guided by, faith!
I can't predict what is coming nor can I tell you what time you have here on earth but I do know if we don't slow down and care for one another and turn back to that faith, that we are spiraling downward fast. What does this have to do with cancer, nothing and everything!
  We can't help you if you can't help yourself!  We give you chemotherapy and you ask for a break to go out and have a cigarette.  You don't eat right and never include fruits or vegetables and you drink too much and don't exercise but yet you think a magic pill can fix it all.  I wish it could but we have to look within ourselves, our lifestyles, our stress, and what can we do to make it better. No, I am not blaming you for getting cancer but I am saying you can help yourself to make it better.  So this morning is a simple reflection of what I perceive has been happening and what lies ahead in some aspects.  We have to turn to our higher power, and help those around us and treat ourselves better. Start today by mak
 

  It is often mentioned that cancer is expensive and to be honest, do any of us really know what the price tag is for what we are doing and experiencing?  I firmly believe in mammograms and I realize the need for ultrasound and Breast MRI.  I don't know all the price tags but the ones that I am aware of, it is staggering.  Keep in mind that you have doctor visits ( and that means co-pays) you have testing and retesting and follow up.  That doesn't even include the biopsies, surgeries and possible recurring surgeries as well as a port placement for your Intravenous needs.   I recently heard of a new line of treatment that will possibly cost $10,000 a treatment and I know that eight years ago when I was going through treatment, I received an injection to help boost my white blood cells and at that time it was close to $2,000 for each injection.  We are living longer with cancer and treatment can and often continues for long periods of time.  This doesn't even touch the surface of the personal cost, emotional cost, and what it can do to a family financially and otherwise.

I doubt that any of this comes as a surprise and yet do we ever sit down and consider all of what is involved to give that patient the best prognostic outcome?  I know that if I have a concern tomorrow that is valid and substantiated clinically that, my health team will work to find answers and what is next in the plan of my care.  I have had a few scares and am relieved that we took the steps early and happy to find out that all was good.  I don't know of any patient that has completed treatment that doesn't go back to their health care provider for their check ups, without trepidation and fear and has a great sense of relief after the appointment is over and they get the all clear.  What has the cost been to you or your family if you have someone in your family that has cancer?  What fears to you harbor and what thoughts do you have and how do you look at your future and what do you do to be proactive?

All I want, is a cure.   You can't go anywhere that you aren't touched by cancer:  a sister, a friend a relative of your brother-in law.  You name it, we all have someone close to us going through the throws of cancer.  None of us grow up saying, yes, I want a divorce by the time I am 40 and yes, I will have breast cancer and yes, life goes on.  So what do I mean by all this, we all think we are invincible until the other shoe drops!  Take care of yourself and your possible future needs now.   The cost of illness can be forever and just as I brought an umbrella today as it might rain, know that we might someday be experiencing things that we never thought would happen and so