Today I'm Scared...

I think it hit me again. In two days, I'll be having the surgery and I'm really scared. Even David came over to me with a hug, crying, saying how he can't think about it or talk about it without crying. He is so frightened. While cognitively we both know that the initial pathology is very optimistic, until we get the surgical pathology back, we will still doubt, and then after that, just knowing that the "enemy" has visited and has the ability to return will always haunt us. It just sucks!

Meanwhile, our house isn't going anywhere. The new house will be ready in 3 weeks, and the market continues to suck. The money I want to put into the house will be worth nothing by the time we go to settlement the way the market is. It makes me wonder if we're getting a message from a higher authority about all of this.

On the positive side, the women who are my work project team leaders have taken all responsibility away from me this week and told me they are managing things and not to worry. I should just concentrate on me. Who can ask for anything better than that? Yet I hate so much not to maintain control of things.

Rachel will be coming in this afternoon for the holiday. I can't wait to see her. She always makes me laugh, and heavens knows, I can use it right now. She will stay until after the surgery to help us and keep David company while I'm having the procedure. I worry so much for my David. He's my life!

L'Shana Tova to my Jewish friends who are reading this. I pray we all have a happy and HEALTHY New Year!

David's Good News

It's finally over. David's cardiac catherization showed no heart disease. In fact, the cardiologist offered to switch his cardiovascular system with David. David has to rest for the weekend and not drive or lift until Monday, but that's a small price to pay for the results of the test. Now it's on to further explore where it's GI or musculoskeletal, the other options causing the pain.

While we were there, I ran into one of my former managers who is now the head of the cardiac cath lab. We caught up on old times, and I remembered that she is also a breast cancer survivor - 10 years out for her. Her recommendation was to do all I can on this first shot since it's the best shot I'll get. I'm inclined to take her direction, particularly after reading about all the people that have recurrence who opted out on some of the offered treatment.

Pictures and More...

Last night we celebrated David's 56th birthday. It wasn't the same without the girls, but I prepared a meal I knew he would like and topped it off with a baby birthday cake. He really liked it!

Since the breast cancer diagnosis, I had talked about taking pictures of my boob in its present state before the surgery. So last night, David took out the digital camera and we took pictures at every angle, covering up my face, just in case, g-d forbid, someone should ever find these pictures. I can ASSURE YOU that they will never be fodder for the Internet. hahaha

In turn, I took pictures of his chest since tomorrow he's having his cath and if for some reason there is more involvement than a simple stent, he'll end up with a bypass and change the look of his chest forever. We had some real giggles taking the pictures, and it was a fun way to cope with the stress!

Meanwhile, today I'm a mental wreck worrying about David's procedure tomorrow. We aren't dealing with a stomach flu, but rather, a potentially life altering problem. And David isn't one to complain easily. He'd rather keep everything to himself so I know he's feeling bad. And after all these years being together, we're so interdependent that anything that affects him, also affects me. The good and bad of long time loving relationships.

So..if you're reading this, say a few extra prayers tonight for David. Thanks.

Just When You Think It Couldn't Get Any Worse...

On my way to work today, a young man slammed into the back of my car and cracked the #$% out of my right bumper. G-d, do you think you can pick on another family? We've had just about as much as we can take right now.

Mental Health Checkup

Only 8 days away from the lumpectomy and 4 days until David's cardiac catheterization. Having gotten a pre-op checkup of my lungs, bloodwork, cardiac and respiratory status yesterday, I also thought this would be a good time to do a mental health checkup. For some reason, I wasn't sure I was reactnig appropriately to all the news. I really haven't cried all that much. I can stop thinking about our troubles when I'm busy, and am finding myself a lot more worried about David than myself. So...I made an appointment with my psychiatrist, whom I had visited in the past, but had not seen in the past 18 months. Today was the day!

When he asked me why I was there, I repeated everything I said above. We went into all the activities in my life within the past 18 months, including our plans to move. Fifty minutes later, I walked out with a pronouncement of excellent mental health - even more so than my last visit 18 months ago. He was pleased that David and I were reducing the commute and house maintenance stress in our lives by moving. He said my reaction to this illness was on par, basically because I really have no statement of the future until I get the results and talk to the medical oncologist. He further emphasized that he would be more upset if I were totally unwired at this point. Not that I should not be disturbed and concerned, but since I received "no sentence" at this point, why angst over the unknown? Makes sense to me.

So...I've conquered another checkpoint. Going to the dentist today for my 6 month checkup as planned. That's enough doctors until David's procedure on Friday. Then we start again. Here's hoping that Jewish New Year brings a happy and healthy one to the Klein family.

Enjoying the Weekend

Since David found out he has to have a cardiac catherization next Friday, he's been as interested as I've been in keeping himself busy enough not to have too much time to think about it. So this weekend was chockful of activities.

On Friday night, we enjoyed dinner with my cousin Billy, his fiancee Randy, and his son Chad. We giggled through the entire meal as we reminsced about family history. It felt wonderful just to belly laugh.

On Saturday, we went to see the new movie, Righteous Kill, with De Niro and Pachino. We weren't disappointed. David thought maybe we should go to another movie immediately after that one, but I wanted to go home. I was mentally drained and wanted to rest a little. On the way, I thought it might be fun to go out with friends for dinner, and asked Sharon and Barry if they'd like to join us. We had such a good time munching over chinese food and talking about the usual subjects. It's wonderful to have such good friends!

Today, I went to the luncheon, saw the new house on the way home, and yes, they're really starting to put it together. The oak stairs and railing are in. The oak mantel and marble insert is in the fireplace and all the electrical outlets were covered with plates. How exciting, and I got to see all that through the windows! Now if only we can sell our house. David spent the day relaxing and then headed off to his Dad's place, finally telling him everything that was going on. As expected, he didn't say anything and life goes on.

Tomorrow is work...but we'll both be glad when Friday comes and David can finally have his procedure. Only 10 days till the lumpectomy. Time...please move fast.

Stepping Out with Breast Cancer Luncheon

Today I had the privilege to attend a beautiful luncheon focused on raising funds for the breast centers at North Arundel Hospital (now called Baltimore-Washington Hospital) and Anne Arundel Hospital. A few months ago, before my own diagnosis, my college roommate Lynn, sent me an invite since this topic is near and dear to both of us (both of our moms had died from breast cancer). I had put it aside not sure what I wanted to do since it was taking place an hour away and with our house for sale, I was never sure when I would be called to action to get the house ready and the dogs out the door. Lynn reminded me about it last week and after all that has been going on, I decided it would be a good thing. Lillie Shockney, a breast cancer survivor and director of the Hopkins Avon Foundation Breast Center was going to be the speaker.

What a beautiful thing to hear that 14 women (those that belong to this group) put on such a fabulous event! There were multiple vendors, all donating a percentage of their sales to the cause and over 150 women attending the event. Every table featured pink flowers and mylar pink ribbon and celebrate the cause balloons. There were lovely "goodie bags" for every guest and the lunch was delicious.

Lillie was a dynamic speaker who made us laugh and cry with the story of her personal journey. As a fellow nurse, there was so much I could relate to. When I left today, I felt energized again to move forward toward the next steps in getting this all behind me. Many thanks to Lynn for reminding me of the event. When I wear the cap she gave me, I will always know that there is love and strength supporting me every day through this heinous process.

Finally Good News!

After chasing down the breast MRI results, the news was good! There are no new places of concern. That means the lumpectomy will go as planned and we can start moving forward on getting this nasty stuff out of me!

Friendships and Family

Calla Lily - Flower of Friendship. When I look back at my life, I have been very blessed to have had long lasting friendships, most stemming from my childhood. If you think about it, childhood friends accept you as are. After all, they knew you when you were most vulnerable. They knew when you had pimples before you discovered great makeup and Clearasil. They knew you when you fell on the playground, where they helped pick you up, dust off the asphalt grime, and take you to your teacher or your mom to wipe tears and get that band-aid that seemed to solve everything.

They knew you when you got your first bra, met your first boyfriend...you get the picture. There is little energy expended in being anything other than who you are. They don't care what car you drive, how big your house is, or how much money you earn. Yet, they do worry that you and your family are happy and well. These friendships are indeed precious and in our transient materialistic culture, quite rare.

I am also blessed to have met new friends along the way, too through work, play, and community activities. To all of my friends, I extend my sincere thanks and love for your telephone calls and emails. They mean more to me at this time than you'll ever know.

Love,

Jo Ann

Monday 9/8 - Visiting the Surgeon

We were lucky enough to get an appointment with the surgeon one business day after the diagnosis. I cannot express enough how important this was to us. The uncertainty was making us crazy. Rather than repeat all the detail again, I'm including an email I sent to our many friends and family members:

Dear Friends and Family,

For most of you, this is an update and for some of you, this will be the first news you will hear about this. Last Friday, I was diagnosed with ductal carcinoma of the left breast (DCIS). I was lucky to get an appointment with the surgeon today and David and I spent 3 hours with her. Dr. Lauren Schnaper, at GBMC, explained very thoroughly how very lucky I am that the cancer is NOT invasive, is a VERY LOW grade and it's about the best scenario you could hope for, if you have breast cancer. I'll be having an MRI before the surgery, since Dr. Schnaper noticed an area on the mammogram that she did not like, and I'll most likely end up with another biopsy before the surgery scheduled for Wednesday, October 1. Yes, it is the second day of Rosh Hashanah, but it is the first appointment I could get since she wanted lead time for the biopsy, if it was needed.

Based on the results of the MRI, if everything is a go and the pathology doesn't change, I'll be having a lumpectomy. After that, I have an appointment with a medical oncologist. Apparently, this kind of cancer and the fact that the biopsy was reactive to estrogen and progesterone responds very well to an oral hormone therapy drug, Tamoxifen. You take it for five years, if you can put up with the side effects, and it reduces your risk of a second episode is reduced by 50% according to the latest studies.

In some cases, women with this diagnosis also have radiation, but the surgeon says it's a one shot deal and you have to weigh whether you would take that route now or save it in case the cancer did return, and you really needed it for a more invasive cancer. Because there hasn't been a lot of research years focusing on DCIS, since it has only become a diagnosis since mammograms came on the scene (approximately 1989, according to the surgeon), they don't have a lot of filtered research. Meaning, that they haven't taken the time yet to determine if women with my low stage of cancer would do just as well without hormone therapy and without radiation as someone who has a more complex grade of DCIS. Those studies are yet to come. In the meantime, you have to look at what's out there and make decisions and the surgeon says it's really tough to know how much is just enough but not too much. Considering my mother was diagnosed at 55, a little more than one year older than me and with an invasive cancer (she had node involvement), and that my maternal grandmother had uterine cancer and her sisters had female-related cancers, I've requested a genetics counselor follow-up, which I'll set up when the dust settles.

Otherwise, David and I are very encouraged that we are very very lucky and in good hands! My angel is watching over me once again! Thanks, as always, for caring and being wonderful family and friends. It makes it so much easier to have those you trust and care about to share these moments with.

Love, Jo Ann

Catching Up - September 9 - 17

It's been a whirlwind week. Between trying to sell our house, keeping our house spic and span on a daily basis just in case someone wants to see the house, maintaining our busy job responsibilities, and living through this diagnosis, it's been draining.

On Monday, September 15, I had the breast MRI. At first, the tech looked at my zaftig rear and wasn't sure it would fit in the closed MRI, but I proved her wrong...with even room to spare! I can finally appreciate what back pain is after laying like a lox in a very awkward position for 35 minutes. Imagine this...you are on your belly with your breasts hanging through holes in the table. Your head is turned and smashed flat against the table with a small pillow for minimal cushioning. Your arms are straight ahead and your knees are slightly bent with legs elevated on a pillow to keep your breasts hanging as low as possible. Add the loud sounds associated with the MRI with the heat it produces along with a radioactive substance coursing through your veins, it isn't exactly like sipping Mai Tais with little umbrellas on a beautiful beach!

Yesterday, September 16, I had a meltdown while talking with Carol on the phone. No matter how old I am, there are just times when I really miss my mother and wish I were a young child again so that she can take my life over and make it all better. With all the support, there is still that missing link, and no way to bring it back. As a result, the tears just started flowing and flowing. It was the cry that I had been holding back since diagnosis day. Poor Carol bore the brunt of that one, but it was "safe" to cry with her and she understood. Afterwards, I felt much better and legitimately tired. Sleep came fast.

And so it's been 2 days since the MRI and the results are not back yet after being told they'd be ready, and I would be called. It's so maddening!

Off to bed...

2 Days after Diagnosis

Most of the evening of the day of diagnosis was spent combing the Internet for treatment recommendations. The most common treatment was lumpectomy with radiation and Tamoxifen (if the tumor was estrogen receptor + or progesterone receptor +). The radiation kills rogue cells, and the Tamoxifen works to block the regeneration of new cancer cells, by blocking the ability to absorb female hormones, their "food" source. Essentially, the Tamoxifen puts you into a menopausal state, which believe it or not, at age 53, I would happily welcome! Imagine buying female products with my GRAY hair. In fact, I pretend they're for my daughters...hahah.

The best part of the day was knowing that Rachel was coming to spend the weekend with us. I knew she would keep me busy. The more I thought and the cancer, the worse I viewed my future. So on Friday night, we talked a bit about the cancer. But on Saturday, we had a day where there was not a waking minute to think about anything but having fun. We went out to breakfast, went to a morning movie, went shopping for a gift, went back to the movies again, and ended the day going to a family affair for the entire evening! It was wonderful not to dwell on the big black cloud.

On Sunday, 2 days post-diagnosis, we went to the annual bichon frise dog bash in Hayfield, Virginia. The joy of watching 200+ bichons (see the picture if you won't know what a bichon frise looks like) running off-lead in a controlled fenced portion of the park was beyond words. Our sweet dogs, Daisy and Giovanni blended right in, and it was a fun day talking about the dogs with like-minded owners, who didn't think we were nuts to be so in love with our pets. In fact, Daisy and Giovanni, as lap dogs, have been a wonderful source of comfort.

On Monday...David and I were scheduled to the see the breast surgeon...more later.

The Beginning...Last Installment

I was emotionally drained after talking with my family, but knew that my father had been waiting for the results. We don't have a particularly close relationship, but since my mother died, I have taken on a lot of responsibilities in regard to his bill payment and medication management. His reaction was benign, and because he is not a nurturing person, I had no expectations that he would be particularly concerned about how I might be taking the news. Even though cognitively I knew he would react this way, it still hurt emotionally, because I simply cannot fathom how a parent would not be overtly concerned about a sick child.

My brother, the pathologist, was the next phone call. He has always been matter of fact, not particularly tactful, and always eager to show you how smart he is. With his photographic memory, I'm happy to have him on my side to interpret information. However, if I were looking to him for comforting support, I'd be in a heap of trouble. His comments to me were "You've passed the surveillance, which you knew you'd had a 30-80% risk due to Mom. So now it's time for you to lop off both your breasts and get a reconstruction. They'll tatoo nice nipples on you too." Nope, this was NOT what I wanted to hear at that moment of time, and after I advised him of the same, and stewed a bit, knowing that I should have expected that insensitive comment, I moved on to call my friends.

It was only the week before that one of the "people" in the group of friends I had hung out with over the years, had a serious health problem. One of the husbands (56 yo) had a heart attack, but after a stent and some rest, he was doing great. I was really the first one to have the big C. Being young (I still consider 53, as young, and so do the breast cancer statistics), no one wants to think we could be hit with anything of a serious nature. After all, we don't feel old. Sometimes, I act and feel like I'm a child, as my family can attest, so surely I shouldn't be experiencing anything as serious as cancer at my age!

One of the positive outcomes of this experience has been that some people I knew in my past (relationships and jobs) have stepped forward, after finding out about my diagnosis through mutual friends, and have called me and sent beautiful supportive emails, chockful of positive thoughts; each reminding me that my world is really much larger than I thought, and the power of their prayers and their kindness will go a long way in helping me beat this challenge.

My college roommate, Lynn, who lost her Mom to breast cancer, one month after my mom died of breast cancer, has been particularly active in Breast Cancer Organizations and fund-raising. She has been a rock of support as I continue to wait for results and my surgery.

Today's Lessons Learned: Love and friendship cannot be purchased with insurance, even with the best possible plan. It is something that is built and nurtured, and if this blog does nothing else, it should remind everyone reading that you should remember to keep that friendship garden nourished and growing.

The Beginning Continued

The next call was to my children. I am very lucky that my daughters have also become friends as they've blossomed into adults. Carol, the oldest and now living in Chicago, has always been pragmatic, ready to tackle any challenge put in her path. Rachel, the youngest who lives an hour away, has always been the comical child. The one that couldn't sit at the dinner table without doing somersaults on her chair, hanging with her head down, just to get a rise out of us. She is also very sensitive, a little more anxious than Carol, and always seeking answers, even if they don't exist. Both girls (aren't they always going to be my little girls?) are smart and beautiful (doesn't every parent say that too?), but most of all they are caring and loving, and as a family, we have always been very close. That's why I knew these calls were going to be the worst.

I had told the girls about the need for a biopsy and the facts that 80% of the time, biopsies are negative. That didn't quell their fears. They had friends who had lost their mothers to breast cancer, had experienced my mom dying from breast cancer, and they were frightened! Carol called me early the day after the biopsy to find out if the results were back. I promised I would call as soon as I had heard. So, now I had to call her and frankly, I was scared to death. She was the easy call, because I knew she would take the information, synthesize it quickly, and ever the planner, would ask for the next steps. No doubt, she was shaken to the core. I could hear the trembling in her voice, and, as a mother, I could never stand my children to be sad. After all, aren't we only as happy as our saddest child? Here I was struggling with my emotions, as well as my family.

Carol had just moved back to Chicago a few weeks before to return to the University of Chicago for her MBA. She was so excited, and I didn't want to put a damper on this very exciting time in her life. She felt torn, and asked if she should come home. I told her she was being ridiculous, but it was a sweet gesture, and I was touched. I knew if I said yes, she would have been on the next plane.

With a promise that I would call her back later, I called Rachel. Rachel had just graduated from Cornell University with her Masters in Engineering (I'm such a proud mama), and had been working at her first "real" job for only three weeks. She had recently moved to Northern Virginia, and was having a blast with her friends, her job, her apartment and her social life. It doesn't get better than that! And here comes Mom, to put a big hole in the happy balloon. As expected, Rachel was full of questions and only wanted to hear positive information. more later....

The Beginning

There is always a beginning to every story, a prequel, and multiple epilogues. This is my story, dedicated to my wonderful family, my support and anchor - my dear sweet husband and best friend of 31 years, David, and my two beautiful daughters, Rachel (24) and Carol (27).

On Friday, September 5, 2008, my world was rocked. I received the diagnosis I had been dreading ever since my own mother was diagnosed with breast cancer 25 years ago: DCIS Left Breast, .3 cm, Grade 1, micropapillary.

Should I say I was surprised? Not really. After I saw the mammogram that led to the additional mammograms, ultrasound, and stereotactic biopsy, all in the same week, I saw the "explosion of the microcalcifications". This mammogram seemed to match the mammograms with the same diagnosis on the Internet.

When the radiologist shared the news, very tactfully, and in a kind way, I was numb. My body started to shake, and the tears welled in my eyes. Luckily for me, I was in my work office, and the door was closed. I could be emotional in the privacy I so desperately needed.

My first reaction was to go online and look up everything he said on one of the great breast cancer websites I had found earlier in the week. The pathology was clearly explained (http://www.breastcancer.org/symptoms/path_report/). Then when I felt I was armed with the answers that I knew my family would seek, I called my husband.

David, as expected, was very sad. He assured me that "we" would do what needed to be done to get well again. He was definitely part of the team. For years, I had asked him what he would do if I lost a breast like my mom. And for years, he replied that nothing was more important than my health, and whatever needed to be done should and would be done. After all, as partners for 31 years, we had made a pact that we would love each other for better or for worse, in sickness and in health. He's the kind of guy that would never break a promise, nor reneg on a contract. But, in truth, we are still in love with each other, have a lot of fun together, and after all these years, still "like" each other too. He is the one constant that I know will always be my side no matter where this journey takes me.

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