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Journey through the labyrinth -- My breast cancer treatment choices
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A breast cancer diagnosis touches off an intensely emotional, difficult period of a woman's life at the same time that it demands dozens of life-and-death decisions. Cynthia Brouse tells the story of her path and her choices.
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By Cynthia Brouse
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"You know what? I think you're going to be one of those women who just sails through this!" So says my oncologist -- my God, I have an oncologist -- with a practised, satisfied tone. I'll call her Dr. Lee.
She's a maternal, larger-than-life woman with shoulder-blade-length black hair, huge, quizzical eyes and serious eyebrows that betray a hint of having had to help patients choose cancer treatments (in my case, breast cancer) one too many times.
Doctor knows best
I grin stupidly, all the while seeing, as in a corny movie, a hazy picture of my eight-year-old self in a similar office nearly 40 years ago, where an orthopedist is persuading my parents that I need a spinal fusion immediately. The deal-closer comes when he tells them, "If she were my daughter, that would be my choice," and Mom and Dad grin stupidly, too, thinking, what better endorsement? But the orthopedist's daughter is 12, and I will have an eight-year-old's torso length for the rest of my life.
Decisions, decisions. In my parents' day, you didn't make them. That was the doctor's job. But even my parents have wised up; when I got cancer, my mother gave me a book called Priority Patient. "Take charge of your health care!" its cover blared. When cancer strikes, the spectre of death has a tendency to obscure the fact that you're still alive, and you have choices to make, and homework to do.
Research begins
My first round of decisions came after a mammogram showed a high likelihood of invasive breast cancer and I was booked for surgery. I had 10 days to research a field about which I knew next to nothing. The doctor and nurse at the breast clinic had hurriedly handed me a photocopied sheet on what to expect post-lumpectomy (the option of mastectomy was never mentioned): I'd need to do arm exercises; I shouldn't operate a stove (!). As I stumbled out of the office, nearly rigid with terror, the surgeon said, as though it were an afterthought, "Oh, by the way, I should tell you that this is a very curable disease."
How, exactly, wasn't entirely clear to me. I took the nurse's suggestion that I buy something called Dr. Susan Love's Breast Book, often referred to as the bible for women with breast cancer, which opened up a whole new world, not to mention a formidable pile of questions. I skimmed over the tables on life expectancy with one eye closed and headed for "Treatment Options: An Overview."
Learning about lymphedema
I knew that step one was removing the lump as well as a hunk of lymph node-containing flesh in my armpit to determine whether cancer cells were spreading elsewhere in my body. Losing a lot of lymph nodes and surrounding tissue can lead to postsurgical discomfort and fluid drainage, along with the lifelong potential for lymphedema, which can cause pain and swelling in the arm and hand. Or not. "Lymphedema is a real possibility," said the surgeon who diagnosed me. "Almost no one gets lymphedema these days," said the surgeon who actually took out my lump.
But Dr. Love's book mentioned that a newfangled technique called sentinel-lymph-node biopsy could make the question moot. It usually involved removing only one lymph node -- the one that, after blue dye or radioactive fluid has been injected at the tumour site, is found to be the first stop on the way to the lymph system. Though it wasn't standard practice, everything I could find on the procedure said its accuracy rate was high -- but only if the surgeon performing it had lots of experience.
Patient takes action
After a bit of phone tag, I spoke to my surgeon on my boss's cellphone from a storage closet at the open-plan office where I worked.
"Sure," he said. "We can do a sentinel-node excision."
"Have you done very many?" I asked, crossing my fingers.
"I'm part of the North American trial," he replied.
Relieved, after I'd hung up, I thought, if it was as easy as asking, why hadn't he told me about this option in the first place?
Scheduling a lumpectomy according to your menstrual cycle
Other oddities popped up in Dr. Love's book, such as the suggestion that the chance of cancer recurrence could be reduced if the lumpectomy were performed at a particular stage in one's menstrual cycle. Huh? I checked out online medical literature late into the night, along with such links as breastcancer.org and the U.S. National Institutes of Health's cancer.gov, as well as "alternative" or "complementary" websites such as annieappleseedproject.org.
The Toronto office of Willow Breast Cancer Support Canada had tons of info, too. The studies I read showed contradictory findings, natch. By that time, I'd decided I was close enough to the supposedly preferred part of my cycle to simply forget worrying about it.
Tape recorder supports memory
When I woke up in the recovery room, the surgeon sat down beside my bed along with my parents, and I signalled Dad to turn on my tape recorder. The doctor balked; I imagine he was afraid of lawsuits or pesky magazine journalists, but I assured him that my motive was simply the conviction that I'd forget 99 per cent of what he said the instant he walked out the door.
Mom and Dad winced as he confirmed that I did, indeed, have an invasive malignancy. I wasn't surprised; I'd already accepted that part. But I was deliriously happy to learn that no cancer cells had been found in the sentinel lymph node.
Click to continue...
Page 1 of 3
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| 1. Breast cancer essay: Doctors, patients, a lumpectomy, lymphedema, research |
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| 2. Breast cancer essay: Chemotherapy, cancer stages, tamoxifen, flaxseed |
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| 3. Breast cancer essay: Radiation, side effects, menopause, medical studies |
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