Tenacious, ragged, and wild, I never did lose my eyebrows with chemotherapy. It figures, because that was one feature I was really hoping to shed. Nope, they are as stubborn as the German/Italian who owns them. At least, once shaped last December, they stayed in line for a little while.

I’d hoped to be able to start from scratch, as it were. Maybe I would pencil in some sexy Marilyn Monroe brows. Then I’d thought about painting them in Joan Crawford-style, nice and sultry. Joan’s are still a bit heavy for my taste. So I googled “actress eyebrows” for more ideas. That yielded some good ones.

Natalie Portman is a standout in the brows department. I think it helps if you look pouty and reveal lots of shoulder and cleavage. Keira Knightley looks pretty good. But there’s lots of hair covering her face, so it’s hard to get a real peek at what her brows are all about. Scarlett Johansson has eyebrows that are perfectly shaped. Scarlett is very blonde, however. I don’t think those would fit my coloring.

Back at the drawing board, I googled “eyebrows” and came up with a website called “Find the
Perfect Eyebrow Shape for your Faceshape” at http://www.eyebrowz.com/faceshape.htm. First, you have to define the shape of your face. If you’re still unsure after scrutinizing the six basic face shapes, there appears to be some measuring with a ruler involved.

I thought I might have an oval-shaped face, so I clicked on that one to speed up the process. Here’s what I learned: “(The oval face) is considered the ideal face shape. The brows play no role in making the face appear ‘more oval’--it already is oval. The ‘perfect’ brow shape is generally considered to be the soft angled shape. This is in fact our most popular stencil shape, and works beautifully with an oval face shape.”

Now I was really curious. I had no idea stenciling was part of the deal. There were “Grace Kelly stencils” and “Jennifer Aniston” ones. They came with code numbers and bands that went around the head to hold the plastic stencils in place. The stencils were “non-adhesive” and “easily cleaned.” This was all getting very complicated. I decided to be thankful I got to have dainty eyebrows, if only for a short while, and I let it go at that. In my next life, though, it’s Natalie Portman brows all the way.

During my initial consultation with the chief radiation oncologist for my HMO, he mentioned that radiation for breast cancer is now considered “the standard of care” and is an “area where there really isn’t much controversy.”

I asked him for his thoughts on a New York Times article, which I commented on in a blog on January 25, 2010. The article was titled “A Lifesaving Tool Turned Deadly--Radiation Offers Powerful New Cures, and Ways to do Harm.” The Times had reviewed state records in New York from January 2001 to January 2009 and found there were 621 radiation mistakes. Errors included: wrong dose given, wrong patient treated, the beams missed all or part of the intended target. Two horrible deaths that resulted during those years were described in the article. The story reported that New York state has warned medical physicists that an over-reliance on computer programs might be leading to the mistakes.

My radiation oncologist was familiar with the article and called the mistakes “horrifying.” He said, “There’s no way to justify what happened to those poor people in the article. At the same time, to have a mistake like that is exceedingly rare. In my fifteen-year career, I’ve never seen or heard of such a thing happening in the centers I’ve worked with.”

My HMO actually has a rebuttal to the Times article, a copy of which was given me. The rebuttal is a letter penned to the Times by Dr. Tim R. Williams, chairman of the American Society for Radiation Oncology (ASTRO). In fairness, I’m reprinting most of Dr. Williams’ letter here:

“No medical error is acceptable, and the two instances reported in your article on January 24, 2010 . . . are devastating. We regret the suffering the patients and families were forced to endure.

“However, the numbers reported are exceptionally misleading. The story cites 621 radiation mistakes. During that time, we estimate half a million New Yorkers received 13.6 million daily radiation therapy treatments, meaning radiation errors occurred only .0046 percent of the time. We believe your readers should see this context.

“Even one error is too many and ASTRO continuously works to strengthen the radiation oncology safety culture. . .

“All treatments pose risks and patients should discuss them with their doctors. Radiation therapy is a tool no different than a knife in the hands of a surgeon. It should be used only by those with appropriate training and board certification.”

Things are proceeding apace, as they say. I’ve had two meetings in preparation for radiation treatments, which begin in early March and last four weeks. The final preparatory session next week, at the center thirty minutes from my Northern California home, will be a dry run.

The first of my meetings, a consultation with the chief radiation oncologist at the center, was designed to allay concerns about the procedure. The oncologist addressed each of the fears I have. He deemed all of them either “rare” occurrences “extremely rare” or said there is a “one to five percent” chance of having them happen.

And yet, I had to sign a form showing I understood the “possible side effects of radiation therapy treatment to the area of the breast.” Under common immediate reactions the form lists: skin reddening and darkening in the treated area, breast swelling, tiredness, occasional aches and pains in the breast, temporary underarm hair loss. Common long term reactions include: discomfort and sensitivity in the breast, increased firmness, swelling that can last a number of years, shrinkage of the breast, change in skin color.

In the “uncommon” category, short term reactions are skin blistering, peeling, ulceration. The blood cell count can also decrease. In the “uncommon” long term reaction category are: a significant increase in the firmness of the treated breast and permanent mild swelling.

Rare long term reactions include significant shrinkage of the treated breast, lung scarring, and cough. Extremely rare long term effects are damage to the heart leading to heart failure, tumors caused by radiation, and rib fractures in the treated area.

At the end of this first meeting, I was handed a booklet entitled “Advance Health Care Directive Kit.” This kit is full of forms that tell the HMO what the patient wants done, in the event the patient can no longer speak for herself. I see. Thank you very much. I am now in an “extremely rare” frame of mind and believe I will end today’s post here.

Several friends have emailed me, since learning of my bout with breast cancer, to tell me they find me strong and inspiring. I finally wrote to one that I just didn’t see that.

“How can that be?” I asked. “I’ve cried buckets of tears, railed against my fate, been alternately petulant and angry. How is that inspirational?”

My friend wrote back that I’m fighting, which is huge. And I’m sharing my experience, which is inspiring. Hmmm. I guess I have to ponder that one for a while.

I keep thinking of an exchange in German that goes something like this: One party will ask, “Wie geht’s (how goes it)?” The second party, if feeling particularly beleaguered, will say, “Es muß gehen (it has to go).” That pretty much sums it up for me. One step at a time. One day at a time. Things have to move forward.

I can’t imagine folding my tent and deciding not to fight for my life, especially when so many doctors, nurses, oncologists, and physicists are working so hard to save it. Not when so many loved ones are pulling for me and encouraging me.

My husband’s physician told me, back in October 2009 when I was first diagnosed, that I was in a war. I understood it then. But I really see it now. It takes commitment, stamina, and a strong will to withstand all the body must go through. I guess that’s why God visits breast cancer on women. We embody all of those things and so much more!

Be sure to give the strong women in your life a special hug today.

Thoughts About Love

You know you are loved when:

. . . You look like a balding chimpanzee and your husband kisses you without flinching.

. . . Your mother insists on accompanying you to a full day’s worth of pre-surgery hospital appointments when she is ill herself.

. . . Your father, at age 82, drives through a pounding rainstorm to take you to chemotherapy.

. . . Your sister interrupts her hectic schedule to visit you after surgery, and takes the time to write a guest piece for your blog.

When your brother, with whom you’ve never exchanged endearments, hears of your cancer diagnosis and calls to tell you he loves you, that’s more than love. That’s a blessing.

When friends hear of your breast cancer and send flowers, gifts, and cards, that’s love.

When friends knit you caps, send books, invite you to dinner, bring soup, have you mentioned in their church prayers, arrange to have your house cleaned, and take you to see a play for a nice diversion, that’s love.

When friends give of their time to visit, give practical advice, or call to cheer you up, that’s love.

I am surrounded by love. And I am most grateful. I send hugs and love to all of you, too.

Carly Fiorina, former Hewlett-Packard CEO and senate candidate, did some fundraising in my hometown last Friday. Having gone through the surgery and treatments for breast cancer, her hair is still very short.

“This is the look of a cancer survivor,” our local newspaper quotes her as saying. “The blessing of my tough passage with cancer is my faith is stronger, my family is stronger, and honestly speaking after chemotherapy and looking at this in the mirror every day Barbara Boxer doesn’t scare me one bit.”

I understand Fiorina completely. I have no doubt she’s seen the bowels of hell. Nothing can scare her now. As I’m still going through treatments, I haven’t yet reached the state of mind Fiorina is in.

My mother often says that I like to scare myself. I don’t need to do that. My doctors and the research books I consult are doing a bang-up job. My surgeon has already told me that radiation will shrink the affected breast by one bra size. The Stanford oncologist I met with said it will be smaller and firmer. I’m already picturing one side looking like a headlight (complete with the tattoos they’ll give it) and the other being normal. In my mind’s eye, I look ridiculous.

Though not insignificant, cosmetics is the least of my worries. According to Breast Cancer - The Complete Guide by doctors Yashar Hirshaut and Peter I. Pressman, there is much to be concerned about when it comes to radiation:
--Radiation can cause a hairline fracture of a rib.
--Radiation can sometimes injure the lungs.
--If a tumor near the center of the breast was removed, there is a greater likelihood of long-term edema (excess fluid that causes swelling) from damaged lymphatics.
--The breast can be sensitive to the touch for many years. “Episodes of discomfort, aching, and even sharp pain are not unusual.”
--Superficial layers of skin will die, and this will leave a slight discoloration. The skin may darken and thicken slightly.
--“Under certain conditions there have been radiation-induced cancers. People nineteen and younger are at highest risk for radiation-induced cancer. After thirty-five, the risk is negligible.”
--An “extremely rare cancer, hemangiosarcoma, can occur at the site of the radiation treatment to the breast after a lumpectomy. Its presence is suspected when a bruise-like discoloration appears on the breast.”
--When the left breast is radiated, there is concern about its effects on the heart. Apparently, long-term studies show no additional risk of heart attacks with modern radiation therapy.
--Women who intend to nurse their newborns will not be able to with a breast that has received radiation.

I suppose anything billing itself as a “complete guide” has to cover every eventuality. Still, between the book and my doctors, things are sounding plenty scary. My list of questions, as I prepare for my first appointment with the radiation oncologist tomorrow, is long.

My sweetheart gave me roses for Valentine’s Day. It’s soppy. It’s traditional. It’s the first time he’s done that in the nearly seventeen years we’ve been married.

My husband, you see, is a foodie. Anything big, chocolate, red and edible is his first choice for a gift. This year I again wanted roses. I finally got them. The wonderful flower, with its juicy red color and terrific scent, is called a Freedom Rose.

In the evening we went to an intimate restaurant in Tiburon, Calif. From our table in the window I could see the towers of the Golden Gate Bridge punching through the haze that hugged the shoreline. There were few sailboats out on the bay. The wind was absolutely still.

On an outcropping of rock below us, a man was showing a boy how to fish. Their pole dipped. The boy reeled in a crab. They let it go, and left soon afterward. Later in the evening, a man arrived with his two children and a crab basket. They lined the basket with bait and heaved it over the side of the cliff. I’m sure they had good luck.

The evening was memorable for many reasons. Not the least of them was the realization that we hadn’t eaten in a restaurant since September 2009. What with all the tumult after my breast cancer diagnosis, the surgeries and recoveries, the chemotherapy and--along with that--the admonition to stay away from crowds, we hadn’t eaten out in four-and-a-half months. That’s a long time, especially for a pair of foodies.

A good friend from my writers group, Nancy R., is my guest blogger today. She sent me the verse below with this accompanying note: “When you asked for stand-in bloggers, I thought of sharing the following. I think it’s a lovely example of how meaningful relationships are. And relationships are SO important when one is struggling with cancer.”

This is taken from Honey From The Rock; Ten gates of Jewish Mysticism by Lawrence Kushner.

Each lifetime is the pieces of a jigsaw puzzle.
For some there are more pieces.
For others the puzzle is more difficult to assemble.

Some seem to be born with a nearly completed puzzle.
And so it goes.
Souls going this way and that
Trying to assemble myriad parts.

But know this. No one has within themselves
All the pieces to their puzzle.
Life before the days when they used to seal jigsaw
Puzzles in cellophane. Insuring that
All the pieces were there.

Everyone carries with them at least one and probably
Many pieces to someone else's puzzle.
Sometimes they know it.
Sometimes they don't.

And when you present your piece,
Which is worthless to you,
To another, whether you know it or not,
Whether they know it or not,
You are a messenger from the Most High.

The sixty-fifth anniversary of the end of World War II is fast approaching. By mid year a slew of books about the war will flood the market.

My novel, The Still Voice, was targeted for this year. It was not to be. That’s all right. The book will still be here for the seventieth anniversary and for the seventy-fifth. And I will still be here, too.

When people learn that my main character Sophia joins up with the Edelweiss Pirates youth resistance group, they often think the group is fictitious. It amazes me that so many are unfamiliar with the groups within Germany that fought so valiantly against Nazi rule.

The Edelweiss Pirates was a loosely-knit group of thousands of working class teenagers that existed in Köln and nearby cities during WWII. An alternative movement to the Hitler Youth, the Pirates risked arrest, torture, and their lives to carry out acts of sabotage against the Nazi regime. The Pirates provided shelter to German army deserters and escaped prisoners from concentration camps. They raided military depots and deliberately sabotaged war production. In 1944 they killed the head of the Köln Gestapo. Orders to root them out came from Heinrich Himmler himself.*

Both boys and girls were members of the Köln resistance.**

In 1988 the Edelweiss Pirates were recognized as “Righteous Among the Nations” by Jerusalem’s Yad Vashem Holocaust Memorial. The criminal status given the group by the Gestapo was dropped in 2005, and they were officially recognized as “resistance fighters” and heroes.

There were other groups, too. Among them The White Rose is known for its bravery. Several members of this group were beheaded for authoring, printing, and disseminating leaflets critical of Hitler and National Socialism. Their last leaflet reads, in part: Freedom and honor! For ten long years Hitler and his comrades have crushed, squeezed, and twisted these two glorious German words . . . The name of Germany is dishonored for all time if German youth does not finally rise, avenge and atone, smash its tormentors, and erect a new Europe of the spirit.***

The Swing Kids were, initially, an apolitical group of middle class members interested primarily in British and American jazz music. Their counter-culture mode of dress, grooming, and make-up eventually brought them into conflict with the Gestapo. And swing clubs were open to Jewish friends.

The Swing Kids had to listen to overseas radio stations to hear their music. This would have brought them into contact with allied propaganda. It’s thought that some were instrumental in spreading this. “Swing clubs were tolerated until 1940, when a gathering in Hamburg drew alarm when it was attended by 500 youths. After this, jazz appreciation went largely underground. On January 2, 1942, Heinrich Himmler wrote to Reinhard Heydrich calling on him to clamp down on the ringleaders of the Swing movement, recommending a few years in a concentration camp with beatings and forced labor.”****

The Helmuth Hubener Group, led by Helmuth Hubener, distributed illegal transcriptions of BBC broadcasts and antigovernment leaflets. “The Gestapo eventually arrested them. Hubener was executed by guillotine on October 27, 1942, while the other members received long prison sentences.”****

Die Meuten (packs) were found in working class strongholds such as Leipzig. The Leipzig Meuten shared many characteristics with the Edelweiss Pirates, “except they tended to come from more organized socialist or communist traditions. Because of this background, they received more official attention. Between 1937 and 1939 the Gestapo estimated their numbers in Leipzig at 1500. There were complaints that many areas were ‘no-go’ areas for Nazis, due to the abuse and violence meted out by the Meuten.”****

There were many German resistance groups that fought valiantly against the Nazis in WWII. Many paid a dear price for their freedom fighting. I wish the world could know more about them.

*Edelweiss Pirates: dw-world.de/dw/article/0,1441,1391096,00.html, The International Raoul Wallenberg Foundation, metafilter.com.

**Photo: http://www.organizedrage.com/2009/08/edelweiss-pirates-fascinating-account.html

***The White Rose: http://fcit.usf.edu/HOLOCAUST/default.htm

****Swing Kids, Helmuth Hubener Group, Leipzig Meuten http://www.bbc.co.uk/dna/h2g2/A3059255

This afternoon I received a “Certificate of Achievement.” It was given to me by my HMO for “having successfully completed ‘A Course of Chemotherapy.’” High fives all around from the roomful of nurses, patients, and my father. With my fourth and final treatment I feel the lifting of an ominous cloud. The worst is over. The radiation, which begins in March and lasts several weeks, is reputed to be much more tolerable.

As I have fought this every step of the way, I found a cartoon in The New Yorker quite appropriate and shared it with my oncologist today. The cartoon shows a doctor reviewing a report with his patient. The caption reads, “You tested positive for being negative.” The oncologist thought it very funny and asked whether he could keep the clipping. I gave it to him.

Whoever first said, “Everything in life is negotiable,” had it exactly right. After my first chemotherapy infusion in early December 2009, I called my oncologist and asked about the severe bone pain I was having. He told me the neupogen shot (which raises the white blood cell count) was probably to blame. So, he cancelled the shot.

After my second infusion the end of December, the exhaustion and migraine persisted. I remembered the oncologist mentioning the possibility of reducing the intensity of the chemo treatments. He told me there was a small amount of wiggle room, but he did reduce it. What a difference that made. I had many more “good days” following the third treatment in mid January.

Still in all, I realize how lucky I am. I have the support of family and friends. One of the country’s foremost oncologists, Dr. Frank Stockdale, co-founder of Stanford University’s breast cancer program, believes I will be fully cured. There are no children at home to raise, no unreasonable employers making demands. My husband’s employer, in fact, sent me a get-well cookie bouquet when all this began in October last year.

I keep thinking of a woman I met at a seminar last fall. The woman had breast cancer. The woman’s daughter, inspired to get a mammogram because of what had happened to her mother, found she had breast cancer as well. The daughter’s sixteen-year-old son had become sullen and rebellious. His attitude was, “Why are you doing this to me, to our family?” How much more difficult going through this experience is for these women.

During one of my infusions, I sat in a room with a woman who had ovarian cancer. She’d received an experimental drug during an earlier treatment. After four months the disease had returned. I asked about her prognosis. “Not good,” she said and grimaced.

Still in all, I realize how lucky I am.

When friends learned of my diagnosis some months ago, books specifically about breast cancer, and cancer in general, began appearing on my doorstep.

My first thought was, “I’m living this, why would I want to read about it?” I quickly found how useful the books were as I needed answers to so many questions: How to read a pathology report? What treatment options were best for me? How to manage their side effects?

One book mailed to me by a friend is called Definitive Guide to Cancer. It has an interesting little sidebar called “Choosing Safe Skin Care Products and Cosmetics.” The section intrigues me because I learned, at a forum sponsored by the National Institute of Environmental Health Sciences (NIEHS) and the Bay Area Breast Cancer and the Environment Research Center (BCERC) last November, that endocrine disruptors, which influence estrogen production, can be found in plastics and in cosmetics. Too much estrogen in the body can lead to breast cancer.

“Choosing Safe Skin Care Products and Cosmetics,” authored by Myra Eby and Susan Mesko, notes that, “Every day, researchers are learning more about the health risks of certain ingredients found in many skin care products and cosmetics. These ingredients have been found to be the culprit in health problems ranging from allergic reaction to birth defects to cancer.” The article goes on to report that up to sixty percent of a skin care or cosmetic product can be absorbed through the skin and into the bloodstream.*

According to the article, the Environmental Protection Agency (EPA) has identified 5,000 chemicals in cosmetics alone. Several major categories of toxic ingredients are singled out by Eby and Mesko. The first, parabens, such as ethyl-, butyl-, propyl-, and methylparaben, are used as preservatives. These can be dangerous because they mimic estrogen. According to the authors, “Recent evidence indicates that topical parabens have been detected in human breast tumors.” Allergic reaction to parabens is also very common.

Another category includes preservatives such as DMDM hydantoin, imidazolidinyl urea, and quaternium-15, which can release trace amounts of formaldehyde into the skin “causing a toxic effect at the cellular level.”

Fragrances, hair sprays, and nail polish often contain another category of chemical called phthalates. These chemicals have been linked, according to the article, to liver toxicity and genital malformation and are suspected contributors to cancer.

Synthetic colors are bad as well, as they can be carcinogenic. The authors suggest avoiding anything with “FD&C” or “D&C” followed by a number as an ingredient.

I inspected eight makeup and skin care products I own. Six have turned out to be dirty. The blush I use contains at least two paraben chemicals and quaternium-15. I’d been wondering why I coughed so much when I wear it. The Lubriderm lotion I was so happy to discover a few weeks ago contains three parabens and DMDM hydantoin. Even the Aloe Vera gel in my medicine cabinet has DMDM hydantoin. Some of these products, such as the blush, will have to go. But where does one find aloe without the preservative?

*Authors Eby and Mesko are president and production vice president, respectively, of MyChelle Dermaceuticals. The company provides skin care products they consider safe for consumers and the environment.

In the book One Bite at a Time--Nourishing Recipes for Cancer Survivors and Their Friends, author Rebecca Katz has a section called “Pantry Rehabilitation.” The section has a list of healthy staples everyone’s pantry should have and the author’s reasons for including what she does.

I think Katz would be appalled at the state of my cupboards. In with the cereals and the nuts are boxes of pasta, tins of soup starter, and scads of tea and coffee. There are cans of tuna, coffee filters (which I haven’t needed in years), and commemorative bottles of wine from auto racing events. I’m a good candidate for the author’s rehab, so let’s see where she begins.

Not surprisingly, Katz starts with, “Get out the garbage bags. Put the dog in another room . . . It’s time to get down to some serious business.” The idea is to pitch out what you don’t need and to start from scratch. Some of her scratch includes things I would never consume. Two of these items are agar agar (tasteless dried seaweed that replaces gelatin in recipes) and tofu. But some others sound pretty good. Let’s check out a few:

--Brown rice vinegar. Katz says it’s light and clean and adds a mild acidity to foods. I’ve used this vinegar and do really enjoy its taste.

--Dulse flakes. This is a salty, red seaweed that can be sprinkled on salads. It’s high in iron, iodine, and manganese and sounds worth a try for these reasons.

--Olive oil, safflower oil, sesame oil, sunflower oil. These are considered a healthy source of fat.

--Udon noodles. These are Japanese noodles made from wheat flour.

--Stock. Vegetable or chicken stock, which can be purchased in organic form.

--Worcestershire sauce. This one is surprising. The seasoning now comes in organic and vegetarian varieties, and is on Katz’s list.

Tips for food storage and buying the proper kitchen equipment are in this section. There is also a chart showing what fruits and vegetables should be avoided if they’re not organically grown because they contain high levels of pesticide. According to the Environmental Working Group, these include: apples, bell peppers, celery, cherries, grapes (imported), peaches, pears, nectarines, potatoes, raspberries, spinach, and strawberries. This list includes all of my favorite fruits. Drat, wouldn’t you just know that?

It’s amazing what surfaces when one goes through five years worth of research material. My office is newly spiffed up and organized, with all the research from my novel, The Still Voice, filed away.

Whatever did I think the June 2004 copy of The Smithsonian would yield for a book that takes place in Germany during World War II? I can only surmise that the article on coffee, a beverage I love, appealed to me.

There was an interesting quote in the Smithsonian article. Paul Katzeff, the CEO of Thanksgiving Coffee, said organic coffee is a “miserable waste of time--people don’t want to think about their health when they drink coffee.”

I wonder whether Katzeff has changed his mind over the last half dozen years. I tried organic coffee for the first time this past weekend. It was a European blend with a fruity aftertaste. Very nice indeed.

In the book One Bite at a Time--Nourishing Recipes for Cancer Survivors and Their Friends, author Rebecca Katz has this to say about organic foods, “The term organic typically describes food grown without chemicals, including fertilizers, insecticides, artificial coloring, and additives. Growers and manufacturers can claim their foods are organic only if they meet the standards of the Federal Organic Foods Production Act and are certified by either state or federal officials.”

About meat and poultry, Katz says, “Organic poultry is not the same as ‘free range’ products. Organic chickens and turkeys have been fed organic feed, and they haven’t been shot up with antibiotics or growth hormones. All ‘free range’ means is that your bird took a stroll someplace without being cooped up. Organic meat is also raised without drugs.”

Having just seen a segment on the raising of chickens from the documentary, Food, Inc., I plan to spend some time searching for organic chickens. I’d been wondering for some time why chicken breasts have gotten so large and so flavorless. Having seen how they are “raised” in enormous barns--packed into pens with filth and feces and no room to move--and pumped full of antibiotics it’s all become very clear.

The Food, Inc. internet site boasts this good link: http://www.eatwellguide.org/i.php?pd=Home. Click on it, enter your zip code, and you have access to pages of establishments offering good, organic food. The listing includes creameries, farmers, butchers, restaurants, and even bakeries. It’s a quick and painless way to start building a list of organic places to shop.

Speaking of shopping, Katz has a great section in her One Bite at a Time book. It’s called “Pantry Rehabilitation” and offers an interesting list of staples that should be in every healthy eater’s pantry. More on that in my next blog.