Nothing Can Scare Me Now: Managing Breast Cancer So It Doesn't Manage You

2010-04-17T18:25:00.000-07:00

April 17, 2010

I’ve just returned home from lunch at San Francisco’s Cliff House with a wonderful friend. Her treat, to help me celebrate my new life without cancer. The Cliff House restaurant is on the ocean and is a scant few blocks from where my friend grew up. She reminisced about playing in the surf at Ocean Beach with her brothers. Their legs would get so cold they would run home and sit on a bath chair under the hot water of their shower until the feeling in their legs returned.

We walked through the little windmill park across from the beach. The tulips were still beautiful, though nearing the end of their bloom. My friend talked lovingly of visiting the park with her mother when they were both much younger. Her mother has since passed away. My heart aches for her being without her mom. They were so close.

My friend asked a lot of questions about my experience with breast cancer--about feelings and treatments. I was happy to answer them. It helps to talk about it now, to get everything out before I suppress it, lock it away forever.

My friend has a sister-in-law with whom I feel some kinship of late. The sister-in-law had a double mastectomy last year. I’ve heard so much about her, though we’ve never met. I hope we do get to meet up one day.

I know my husband thinks I’m a frenzied bundle of activity these days. I say yes to every outing and am making many plans. I’m sure I will slow down in a while. Right now I want to create as many happy memories as I am able, as fast as I am able. I want to get healthy, grow stronger, be beautiful. I want to see old friends and make new ones. I want to shove the horror of the last six months far below the surf of Ocean Beach. Let the waves carry every bit of sadness far out to sea.

Yes, today was a wonderful treat. I loved letting the fresh air, the waves, and the love of a friend wash over me. And I let the waves carry my tears out to sea.

2010-04-02T06:42:00.000-07:00

Mother brought me roses the other day. And so my six-month bout with breast cancer ends as it began, with pink roses from my mother. The color is her favorite.

I used to love the color pink. It reminded me of satin ballet slippers, a baby’s cheeks, plum blossoms in springtime. And, of course, Mom.

Last October, “Breast Cancer Awareness Month,” the color was everywhere--from supermarket displays to T-shirts on marchers in San Francisco. Professional football players wore pink ribbons on their helmets. Their gloves were pink. So were their shoes. I liked it for a while, even after my diagnosis. Then, I couldn’t see pink ribbons without bursting into tears.

Well, there are no tears this Good Friday. Break out the bubbly. It’s my last day of radiation and then I am sprung. There is one more serious decision to be made--whether or not to take an estrogen-suppressing drug for five years. I don’t want to think about that today. I will think about it tomorrow.

Those who know me have wondered aloud how such a private person could put something so personal as her battle with breast cancer on the Internet. The first day, I published a blog to let my far-flung circle of friends know what was happening. And I needed the moral support. The second day, I wanted to thank everyone who had so warmly come to my side. I was going to stop there when my surgeon said, “I think you could be helping a lot of people.” So I persevered, not only with the blog but in my not-so-private war against cancer.

There is much more to be said, of course. I’ve learned about ways to navigate through surgery, chemotherapy, and radiation, which I will share. There is much to be said about thwarting cancer to begin with and preventing its recurrence. There’s more to be written about the emotional side of the disease, the friendships that have deepened, life after cancer, and regaining one’s health and equilibrium.

I do believe anyone who has been diagnosed with cancer, gone through its surgeries and treatments, has seen the bowels of hell. I will not be looking for that yellow bus. Nothing can scare me now.*

*This blog will soon be transformed into a manuscript titled Nothing Can Scare Me Now: A Survivor’s Unvarnished Look at the Emotional Side of Breast Cancer. With hard work and good health, it should be finished this summer. Wish me luck.

2010-03-29T07:07:00.000-07:00

The radiation center in the San Francisco Bay Area, where I go for treatments, is giving out a pinup calendar. This one is pretty cute. It’s called Pinups for Purpose and features local breast cancer survivors as models.*

Like most people, I choose a calendar based on the photos used at the holidays and on my birth month. Imagine my surprise when I flipped to the month of August and saw a male model! His name is Burt. He’s standing in a stream holding a fishing rod. And he’s just snagged a silver-polka-dotted pink bra.

The photos are the work of Jeanette Vonier, a photographer whose mother is a two-time breast cancer survivor. Ms. Vonier has posed her subjects in 1950s vintage settings because, “The women in vintage pinups seem to retain some innocence. They find themselves in common situations that everyone can relate to with humor.” Money raised from the calendar’s sale is given to many charities. Two of these are: “To Celebrate Life Breast Cancer Foundation” and the “Sutter North Bay Women’s Health Center.”**

There is a short biography of each of the models at the beginning of the calendar. What strikes me is the common thread running through their stories. One woman sees cancer as the “biggest gift” of her life, forcing her to slow down and take stock. Another talks about it being a “gift of time, awareness and empathy.” Still another views it as a “positive and life changing experience.”

I keep thinking of something I just read in the book Breast Cancer - The Complete Guide. The authors, doctors Yashar Hirshaut and Peter I. Pressman, write, “No sane person would choose to have breast cancer or, having had it, would say it was an ennobling experience.” I’m mystified. How can one look back on breast cancer as a “gift.”

I suppose we all want things to happen for a reason. What if getting cancer is just bad luck? Some might say it happened “to make one a finer person.” Well, what if one was a pretty fine person to begin with? Or, perhaps it happened so one would learn to “stop and smell the roses.” Hey, I’ve stopped for plenty of roses over the years. Nope, at the moment there seems to be no rhyme or reason for having been stricken with breast cancer. Maybe, when time has softened the experience, I will see the why of it. I suppose that I, too, would like to think it happened for a reason.

*Pinups for Purpose: http://www.pinupsforpurpose.com/

**To Celebrate Life Breast Cancer Foundation: http://www.tocelebratelife.org/

**Sutter North Bay Women’s Health Center: http://www.ucomparehealthcare.com/

2010-03-23T09:22:00.000-07:00

A few days ago my husband and I were surprised by a generous gift. The owner of his company had two tickets for a winemaker dinner, which he could not attend. So he gave the tickets to us.

The evening was hosted by the founders of Williamson Wines in Healdsburg, Calif.* The winemakers chose the Solbar, a Michelin Star restaurant in Calistoga, as the site for their dinner.** I cannot speak for the wine, as alcohol does not agree with me, but the meal was nothing short of fantastic. My husband can speak for the wine. He says it was very good indeed.

We arrived home from the Solbar at one o’clock the next morning. The company was that enjoyable, the evening that memorable. When I asked my husband what his favorite memory was, he told me what he’d told his boss. “The best part was seeing my wife laughing and having a blast. I haven’t seen her do that in six months.”

Sometimes my husband, a man who is not so expressive, amazes me. As a foodie, I definitely thought he’d mention the stinging nettle soup or the foie gras confit with poached apricots. As a lover of good wine, I thought he’d talk about the Sovereign, which Bill Williamson poured toward the end of the evening. Bill has bottled only one hundred magnums of this wine, for public sale, at $1,000 per bottle.

Upon reflection, I have to admit I have not been on the happier side of the emotional scale in quite a while. There is a range of feelings that accompanies breast cancer. Laughing with abandon is not one of them.

In their book Breast Cancer - The Complete Guide, doctors Yashar Hirshaut and Peter I. Pressman talk about there being no “particular program” for coping with the emotions of breast cancer. “No sane person,” they write, “would choose to have (the disease) or, having had it, would say it was an ennobling experience. Nobody who has had a grave illness, or who has lived through the experience of surgery, or who has worried about the effects of powerful treatments, would mouth such a platitude.”

Hirshaut and Pressman note that most women experience their highest levels of depression and anxiety right after surgery. How right they are. Until that point, they say, “There has been an enormous amount to get through from the time they first realized something was wrong, through the period of evaluating their choices and making decisions, through the surgery itself. Now they must face picking up their lives again and also coping with whatever further treatment has been decided upon.”

Of course, then come the fears that must be faced before each treatment begins. And the worry about their immediate and long-term effects. And knowing that family members nearby and time zones away are worrying as well.

“Everyone reacts differently to trouble,” write doctors Hirshaut and Pressman. “There is no ‘correct’ way to cope with or get over an experience as trying as breast cancer.” But, according to the doctors, “women are in fact coming through it with intelligence, sensitivity, and a very moving gallantry.”

Why is that not surprising?

*http://www.williamsonwines.com/

**http://www.solagecalistoga.com/

2010-03-18T12:55:00.001-07:00

The gamut of emotions I’ve experienced since being diagnosed with breast cancer is very typical, from what I’ve been able to discern. One thing I’ve done that, apparently, is not typical is that I’ve not joined a support group.

I use the word “apparently” because my women friends always seem surprised when I tell them I haven’t joined up. “Why not?” they ask in almost startled fashion.

The answer isn’t so easily summed up. In the beginning, I suppose, I didn’t want to feel any weaker than I already did. And going to a group of strangers for support not only felt weak to me, it seemed cold.

There was a time, during the worst of the chemotherapy treatments, when I thought about finding such a group. But I didn’t have the strength to go. When I did feel better, I wanted to surround myself with healthy, upbeat people who could take my mind to a happier place.

Had the chemotherapy gone longer than three months, I think I would have sought out a group with like experiences. It had become wearying, explaining to family and friends what was happening with me before I could get a hug in return. That was all I wanted most of the time. No advice. No sympathy really. Just a hug.

In Dr. Susan Love’s Breast Book, she writes: “Sometimes, when you’re having chemotherapy, the people who were supportive in the beginning start to dribble off.” She hit that right on the nose. People who were there when I was diagnosed, and through two surgeries, began to fade away when chemotherapy began. Who could blame them? As the patient, I longed to get on with life, get back to “normal.” According to Dr. Love, when the interest from others fades, that’s a perfect time to find a support group.

Dr. Love talks about a “peculiar sort of funk” that sets in when surgeries and treatment end. She notes that support groups can even be sought out then. I hadn’t considered that. With the end of my treatment scant two weeks away, I find myself with a litany of questions that are, apparently, very typical:
--Am I cured?
--When there is no more chemotherapy or radiation going into my body, are the cancer cells waiting to coalesce and strike?
--My body betrayed me once, will it again?
--Will there be after effects from the treatments that will cause trouble in the future?
--What can I do with diet and exercise to reduce the likelihood of recurrence?
--The oncologists at my HMO are sure to want to push me into taking a hormone suppressant. What of the side effects and after effects from these?

I have talked with women who are in touch, seventeen years later, with friends made in their support groups. There is much, I hear, to be said in their favor. Once the preoccupation with treatment is behind me, I may yet join one. It’s been a traumatic whirlwind and it might be good to discuss it with people who have been there.

The American Cancer Society has a nice online article that goes through the things to consider when searching for a group. According to the article, “Some needs are best addressed in a support group. Examples are the need for information, such as how children typically react to a parent’s diagnosis, how to explain your diagnosis at work, or how to communicate better with your doctor. The intensity of your feelings about a situation will also help you to decide about attending a group. You may feel so upset about your situation that the idea of discussing it with others makes it worse.”

Here are a few links to support groups for those who might need one:
--American Cancer Society
http://www.cancer.org/docroot/ESN/esn_3.asp?sitearea=ESN

--National Cancer Institute
http://www.cancer.gov/cancertopics/wyntk/breast/page13. Information specialists at 1-800-422-6237 and at LiveHelp (http://www.cancer.gov/help) can help locate programs, services, and publications.

--Susan G. Komen
http://ww5.komen.org/breastcancer/support.html. Breast care helpline at 1-877-465-6636 for more information. The breast care helpline provides free, professional support services to anyone with breast health or breast cancer questions or concerns.

2010-03-17T08:04:00.000-07:00

Over dinner a few nights ago, a friend in my book club asked me how my radiation treatments were going. I told her, “So far, so good.” She volunteered that, one day, what is currently the standard of care for cancers of all types will seem arcane.

As my friend is a microbiologist running her own firm, I asked what she thought future therapies for cancer might be like. “Maybe a regimen of pills and shots,” she volunteered.

We both agreed that a vaccine would be nice. However, as the causes of cancer--especially breast cancer--still seem a mystery, a vaccine will be difficult to develop. One can dream.

In Dr. Susan Love’s Breast Book I found this tantalizing mention of vaccination: “We have always dreamed of finding something distinctive about the cancer cell and developing a therapy specific to it. We would then give the antibody, kill or control all of the cancer cells, and do little or no harm to the rest of the body.”*

In a section of the book called, What Is Coming, Dr. Love describes ongoing research. She says promising new findings are “already in the pipeline. It’s not fantasy; it’s a question of how soon we’ll know what to do with our knowledge.”

What she wrote next really surprised me: “In the future breast cancer may be as treatable as high blood pressure and diabetes are today. These diseases can be effectively treated by controlling the symptoms with medication without totally eliminating the underlying disease. The rehabilitation of the cancer cell may be an effective treatment so that the patient, while still having cancer, will be alive and well.”

“Even better,” Dr. Love goes on, “we will be able to stop breast cancer at its source--destroy the cells lining the milk ducts where all breast cancer starts. In this way, we will be able to prevent it all together.”

As Dr. Love notes in the dedication of her book, “We are working hard toward the day when our daughters and nieces will never have to hear the words ‘you have breast cancer.’”

Wouldn’t that be just fantastic?

*Dr. Susan Love's internet site: http://www.dslrf.org/breastcancer/

2010-03-13T08:28:00.000-08:00

I have now been zapped by a linear accelerator for five days running. One week of radiation therapy down, three more to go. So far, this breast cancer treatment has been much easier to withstand than chemotherapy, for which I’m glad.

Sometimes I think about the story a friend of mine told me. She’d planned a dream vacation to Alaska with her sister. When treatment for an aggressive cancer weakened her sister, there was some debate over going forward with the plans. But the sister wasn’t sure about her chances for survival, so the trip was on. My friend ended up making the arrangements, driving their rented motor home, and handling all the details during their vacation. Her sister, so independent in the past, seemed incapable of doing anything.

I know how easy it is to feel like an invalid, a victim. Friends and family can be very kind after learning that a loved one has been diagnosed with serious illness. People offer to bring meals, drive the patient wherever she needs to go, and take care of the house. When one is recovering from surgery, or felled by chemotherapy, it is easy to accept.

The time does come when the patient feels better. And yet, the invalid mindset persists. “I’m still weak, how far can I drive? How much exercise can my body safely do? Should I push myself or should I rest? Should I make my plans or take a pass for now?”

I had the invalid mindset for about two weeks. Now my mind has flipped in the opposite direction. Oncologists say the effect of radiation is cumulative. Fatigue can set in fairly soon. So I want to get everything on my list accomplished at once. All I missed out on during the surgeries and chemotherapy must be handled now. Plans for my own dream vacation must be fast tracked. The outline for the non-fiction manuscript I am writing must be done yesterday.

What lesson from my illness have I forgotten? It went like this: Family and friends first. All the rest in good time. How quickly one forgets.

2010-03-10T12:55:00.000-08:00

This past weekend my hand must have brushed across my head a thousand times. It was so automatic, I didn’t realize I was doing it. On Sunday afternoon my husband finally said, ever so matter-of-factly, “Your hair is growing back.”

“Really?” I asked. “So that’s why it feels different. But I can’t see anything.”

Sure enough, when I inspected my head in the mirror I could see peach fuzz about an eighth of an inch high. Poking through the few strands of hair I never did lose through chemotherapy, the new hair is totally white. Doctors tell patients that the new growth can come in completely grey. It can take up to two years for the full pigment to come back.

There are other signs of rebirth. I managed to hold onto my eyelashes (some women lose those, too). But the lashes that had fallen out before my chemotherapy regimen began had created open spaces. Now there are tiny stubs where the lashes are coming back.

The first sign of regrowth I noticed was in the fingernails. They’d turned red and looked a bit brittle during the time their growth was interrupted. Now, near the cuticle, there is a quarter-inch of healthy color where they are growing out.

It’s odd to see the body regenerate. My husband likens it to watching a baby’s growth. The hair coming in. Cutting the first tiny fingernails. Observing the little one for every sign of maturation, of becoming a real person.

The difference is that a baby doesn’t know what’s happening. Adults do. I doubt I’ll ever take my full head of thick hair or my healthy fingernails for granted again. Lord, please make them grow as fast as you can!

2010-03-09T08:49:00.000-08:00

I had my first “zapping” under the linear accelerator yesterday. It took all of ten minutes, eight for positioning me in place and waiting for the machine to move around, and two when the radiation beams were actually on.

The $2.5 million-dollar linear accelerator is huge. My husband was impressed at the alacrity with which it circulated around the table I was lying upon. I noticed that, when the beams were on, everyone scurried from the room and my husband was shooed out. I wonder why it’s safe for me to be in there, yet others run out? I will have to ask the oncologist about that when I see him.

My husband drove me to the radiation center, which is not far from our home. We had no idea whether I’d be uncomfortable or fatigued afterward. As it turned out, I felt fine. I understand that, with this treatment, the effects are cumulative. “Sunburn” at the treatment site, tenderness, and fatigue are the most common side effects.

I have to say that this whole breast cancer “episode” feels a bit like being in a science fiction movie. The director says, “This is what you have. This is what we do. This is how long it takes. If you want to live, you’ll get with the program.”

We all want to live, so we get with the program. The radiation routine will last four weeks, after which I will be sprung. Yippee. In the meantime, there is an oddball list of dos and don’ts I’m to follow. The “dos” include good nutrition, hydration, light exercise and adequate rest. Also, I’m to report any new or worsening side effects to the doctor. I’m to use mild soap, wear comfortable loose clothing, and keep the treated area out of direct sunlight.

The list of “don’ts” starts with not using deodorants containing aluminum. (The aluminum can burn under the radiation beam.) No underwire or sports bras. No vitamin A, C, or E supplements. No lotions, creams, or powders before treatments. No shaving in the treated area. No excessive rubbing.

None of these is difficult. It’s just remembering to do, or not do, what the doctor recommends. I’m sure that, by the time the routine becomes second nature, it will be over. Meantime, I thought I’d include a photo of the linear accelerator. Impressive, is it not?

2010-03-07T10:07:00.000-08:00

Some statistics you never forget. In my mind, I am cured of cancer. The tumor’s been removed. I’ve had chemotherapy. Yet, according to oncologists, there is a twenty to forty percent chance that cancer can return to the same area without radiation treatment. It’s too bad because I’m close to feeling “normal” again and would just as soon skip this next phase.

But twenty to forty percent is a large number. And so I start radiation treatment Monday. With trepidation at all the things that can go wrong. With fears of long-term after effects and immediate side effects. Lying under the gigantic linear accelerator where I had my “dry run” last week.

The chief radiation oncologist at my HMO told me that doctors have tried to cherry pick cases, those with good prognosis, to see whether they could get away with doing no radiation. No one’s been successful at that, apparently.

Radiation shrinks the odds of local recurrence (in the same area) to five percent, the oncologist told me. Put another way, the chance of preserving the breast with radiation is close to ninety-five percent. “In terms of cosmetic outcome,” he said, “it’s hard to beat keeping what you have. Put that together with our ability to cure you to be the same, breast conservation is a very good choice. That’s the reason for doing the radiation.”

I asked why the whole breast has to be zapped. Why not just beam the area where the tumor was removed? It seems there has been some research in that department. According to my oncologist, the option is interesting but likely will not become standard because the cosmetic outcome isn’t as good. There is more fibrosis and a denseness of the area that is treated.

We discussed other forms of treatment. Radiation can be delivered from inside the breast through an array of needles. Evidently, women haven’t been clamoring to have this procedure because it is more invasive. However, there are studies that show it is effective. And the array of catheters in the breast is only there over a three-day period.

Another form of radiation therapy is delivered at the time of surgery. A balloon, through which radiation is delivered, is sewn into the lumpectomy cavity of the breast. This is a fairly new procedure, so not enough data is available on its effectiveness. “On top of that,” said the oncologist, “it’s probably only treating about a centimeter of tissue around the cavity.”

A couple of journals, Radiology Today and Medical News Today, have reported on another technique that appears to hold promise. Called intraoperative electron radiation therapy (IOERT), it is “the application of electron beam radiation directly to a tumor or tumor bed during surgery,” according to Radiology Today.

Not everyone is a candidate for the IOERT technique. But what a blessing for those who can make use of it. The tumor area is radiated while the wound is open. The surgery to remove the tumor and the radiation treatment are, potentially, done in one day. Any microscopic cancer cells near the area of the tumor can be hit while they are most vulnerable. Healthy skin that might be radiated with conventional external-beam radiation can be spared.

Of course there are obstacles. Most operating rooms are not equipped with mobile electron linear accelerators. And transporting a patient in the midst of an operation to a shielded area where there is a conventional linear accelerator presents risks and challenges. Then there is the high cost, which helps explain why few hospitals are equipped to administer IOERT therapy.

Still, some of these new techniques show a lot of promise. I can only hope that, one day, the notion of going to a cancer radiation center every day for four to ten weeks will seem arcane. And wouldn’t that be a blessing?

2010-03-05T10:38:00.000-08:00

One of the grandsons, twelve-year-old Stephen, called me last night. He wanted to know how I was feeling with my breast cancer and hoped I would be okay. I told him I was fine and would be fully cured. He allowed that that was good, then asked whether I wanted to hear about the snail races. Absolutely.

Stephen explained that his brother had set up two tracks for several snails to “run,” one lane with foil and another with sandpaper. It took seven to eight minutes. Eventually, one of the snails did make it to the end of the track. I grinned as he told me all the details in his breathy, little-boy voice. Snail races sounded like a lot of fun.

We talked about the Olympics. Stephen loved watching Shaun White, naturally. As Stephen snowboards, that is what he wants his profession to be. He’s targeting the 2014 winter Olympics in Sochi, Russia. That’s great. Goals are good to have.

Stephen told me about his dog, a labradoodle named Indy. The dog is hypoallergenic, he said, which is good because Stephen has a few allergies.

I asked about school, of course. Stephen loves it and his teacher. The best part, he said, is fixing up old bicycles to give away to kids whose parents can’t afford bikes. Stephen and his classmates have learned to spiff up the used bikes pretty well.

“Would you like to hear a fun fact I learned today?” Stephen asked. “The continent of South America is moving at the rate your fingernails grow every day. One day, maybe two billion years from now, South America will be a separate continent.”

That’s pretty cool, Stephen. And so are you, kiddo. So are you.

2010-03-04T07:45:00.000-08:00

No one knows what causes breast cancer. There are many factors that are believed to elevate the risk. According to the The National Cancer Institute’s booklet What You Need To Know About Breast Cancer, there are a number of “risk factors.” I’ve reproduced the list from the booklet, for the most part, here:

--Age: Most women are diagnosed with breast cancer when they are over sixty years old. The chance of getting the disease increases with age.
--Personal history: Having cancer in one breast increases the risk of getting it in the other. Having certain types of abnormal cells in the breast also increases the risk.
--Family history: If a mother, father, sister, or daughter had breast cancer a woman’s chance of getting it is higher.
--Genes: Changes in certain genes, such as BRCA1 or BRCA2, increase the risk.
--Radiation therapy to the chest: Women who’ve had radiation therapy to the chest before age thirty are at increased risk.
--Race: Caucasian women are at higher risk than African American, Hispanic, Asian, American Indian, or Alaska Native women.
--Breast density: Women whose breasts have more dense and fatty tissue are at higher risk.
--Weight: Women who are overweight after menopause are at increased risk.
--Physical activity: Physically inactive women may be at higher risk.
--Alcohol: Studies suggest the more a woman drinks, the greater her risk.
--History of DES: Some pregnant women were given DES in the United States between about 1940 and 1971. Women who received DES are at slightly higher risk.

Reproductive and menstrual history:
--The older a woman is when she has her first child, the greater the risk of her having breast cancer.
--Women who’ve never had children are at higher risk.
--Women who began the menstrual cycle before age twelve are at risk.
--Women who experienced menopause after age fifty-five are at increased risk.
--Women who’ve taken menopausal hormone therapy for many years are at higher risk.

2010-03-03T08:44:00.000-08:00

When the body is otherwise healthy, it is easy to dismiss symptoms that something might be going wrong. More than three years ago, there was a brief period of time when I noticed a wild pinching sensation in the OFB (offending body part). The pinching subsided, then came and went. Over time, I got used to it. After the cancerous tumor was removed from my breast in October 2009, the pinching disappeared. Lesson number one, listen to what your body is telling you.

The National Cancer Institute (NCI) has produced a booklet called What You Need To Know About Breast Cancer. In one section, the booklet notes that early breast cancer usually has no symptoms. As the tumor grows, it can change the look and feel of the breast. I’ve listed the common changes from the booklet here:
--A lump or thickening in or near the breast or in the underarm area.
--A change in the size or shape of the breast.
--Dimpling or puckering in the skin of the breast.
--A nipple turned inward into the breast.
--Discharge (fluid) from the nipple, especially if it’s bloody.
--Scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin at the center of the breast). The skin may have ridges or pitting so that it looks like the skin of an orange.

These symptoms are often not due to cancer, according to the booklet. Another health problem could cause them. Any of these symptoms should be evaluated by a woman’s doctor so they can be diagnosed and treated.

The NCI recommends that women in their forties and older have mammograms every one or two years.

2010-03-02T10:14:00.000-08:00

The great food experiment continues. As sugar turns to fat in the body, and is also known to feed cancer (once the body has cancer), white refined sugar has been jettisoned from my house.

I do still like things sweet, so I’m taste-testing several sweetener alternatives I recently picked up at the market. The favorite, by far, is Gipson’s Golden Blackberry Honey. Raw and unfiltered, it comes from Santa Rosa, Calif. It’s delicious. But it does add its own flavor to beverages.

If the blackberry flavor isn’t one that’s desired in tea or coffee, what else will work? There are the traditional ersatz sugars, such as Equal, Splenda, and Sweet ‘N Low. Plenty of people swear by these. They’re not my favorite, so I’ve checked around for other products that might work.

There is pure cane sugar, washed and raw, from C&H--the people who bring us the white refined stuff. It comes in a resealable bag and contains molasses naturally. It does the job of the white sugar, but is a bit less sweet.

I’ve tried a brand of raw cane sugar called Full Circle. It is organic, also comes in a resealable bag, and calls itself “demerara” cane sugar. It’s a product of Brazil and Paraguay. The internet site http://www.wisegeek.com/ maintains that the sugar is named after a colony in Guyana, which first began producing and selling it in volume. According to the site, “To make demerara sugar, sugar producers press sugar cane and steam the juice of the first pressing to form thick cane syrup. The cane syrup is allowed to dehydrate, leaving behind large golden brown crystals of sugar. Because demerara sugar is not heavily refined, it has a rich, creamy, molasses-like flavor which enhances baked goods.”

My last pick is Light Agave Nectar. I haven’t yet used it. A quick taste reveals that it has a very different flavor. We’ll see how it does in tea and coffee. It’s a product of Mexico, is organic, and is extracted from the agave cactus plant. According to the label, it is twenty-five percent sweeter than sugar and has a low “glycemic index to prevent a spike in blood sugar.”

So far, to be honest, the sugar that does the job best for me is the cane sugar that comes from C&H. Breaking off the sweet stuff is hard to do.

2010-03-01T08:54:00.000-08:00

The Olympic flame has been extinguished in Vancouver, British Columbia. For sixteen days we were treated to spectacular athleticism, stunning beauty, and the raw power of sport. It was marvelous to watch and to feel, however fleetingly, a kinship with so many countries around the globe.

Years ago, when I skied with a ski club, I would feel great excitement at the time of the winter games. I could only imagine what it would take to push the body to that level of competitiveness. This year, watching from a body depleted by illness, I had a different perspective on the games.

I watched skiers popping through the mogul field and wondered what their knees would be telling them years hence. I saw bobsledders eject onto the course and wondered what that was doing to their backs. I listened to the list of injuries athletes skated, skied, and raced through and thought how terrific to be at an age where it was possible to forge through injuries in that fashion.

All in all, the games were an amazing spectacle. The heights snowboarders reached were incredible. The speed at which bobsledders hurtled down the track were amazing. Who will ever forget the image of a figure skater sending kisses to the heavens after a performance following her mother’s sudden death? Who can forget the U.S. goalie’s collapse on the ice after hockey team Canada sent the winning puck into the net?

How quickly the games got to be an old friend. I shall miss their company and the lift to the spirit they provided.

2010-02-28T09:17:00.001-08:00

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.

2010-02-26T13:45:00.000-08:00

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.”

2010-02-25T10:14:00.000-08:00

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.

2010-02-21T08:46:00.000-08:00

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.

2010-02-17T07:46:00.000-08:00

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.

2010-02-16T09:43:00.000-08:00

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.

2010-02-15T10:09:00.000-08:00

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.

2010-02-11T08:43:00.000-08:00

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.

2010-02-09T14:29:00.000-08:00

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

2010-02-08T15:06:00.000-08:00

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.

2010-02-03T11:50:00.000-08:00

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.

2010-02-02T09:32:00.001-08:00

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?

2010-02-01T12:09:00.000-08:00

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.

2010-01-29T09:24:00.000-08:00

My favorite aunt, Maria, who lives in Munich, Germany turned ninety-five on January 26th. The mayor of Munich sent her a wonderful gift box. According to my aunt, once citizens reach a certain vintage that’s something the mayor’s office does.

Aunt Maria was very excited about the box itself, with an image of her town’s gothic city hall on the lid. Even better, the gift was from the Dallmayr Delicatessen, which caters to über-expensive tastes. Champagne, chocolates, and cheeses were among the many goodies packed inside.

I’m happy for my aunt and glad that everything is going well for her. In 2007, when I last visited Germany, I had a chance to talk with her about her experiences during World War II. She told me many interesting tales. A few have made it into my novel, The Still Voice, in one fashion or another.

I remember recording her stories as we sat on the patio of the Angermaier restaurant in Rottach-Egern, Bavaria. The restaurant is her favorite and she celebrated her ninety-fifth there this week. My cousin emailed pictures he took of the day. How different it looks covered in snow.

Aunt Maria, daughter-in-law Heidi, daughter Ingrid in front of Angermaier

When aunt Maria was fourteen, she lived with her family in Wiesbaden. Word went out to the schools from the city’s Staatstheater (opera house) that youngsters were needed for the Kinderchor, or children’s choir. My aunt and another girl were chosen by their music teacher for their beautiful voices. Aunt Maria is proud that the opera’s general director sat in on the Kinderchor during rehearsal. He wanted to make sure he approved of all the voices under his direction.

My aunt sang in such productions as Hansel and Gretel, Peterchens Mondfahrt, and Der Evangelimann. Once, she got paid twenty-five marks for a performance and bought her mother a coat. Aunt Maria would’ve loved to have gone on with her career. But voice training lessons were beyond the family’s means at the time. I can still see her baking in her kitchen and singing away. Her father used to call her “theater doll,” because she loved all things theatrical.

Aunt Maria was twenty-nine and living in the country when the Wiesbaden Staatstheater suffered damage in a terrible bombing on February 2, 1945. In the fall of 1947 the opera house finally reopened. City Mayor Hans Redlhammer acknowledged the citizens’ attachment to the building and proclaimed its revival a symbol of the city’s recovery. I know the restoration contributed to aunt Maria’s emotional recovery, too.

2010-01-28T09:25:00.000-08:00

Just when I’d gotten used to Facebook and Twitter, along comes something completely different. It’s called a “vook” and is exactly what one would expect it to be--a combination of video and book. The product is a multimedia software application produced by a company of the same name. The first offering is a “cookvook” that displays text along with forty-five short videos of cooks preparing their favorite dishes.

Call me a traditionalist, but I cannot see myself surrounded by kindles, vooks, and “iDevices.” I much prefer the regular old book with its tantalizing title, alluring promotional jacket, and printed words coming alive on the page.

They say you can tell a lot about someone by what they read. On my desk right now I’m surrounded by four planning guides for Greece. I have a book lent me by my father called Ludicrous Laws & Mindless Misdemeanors--The Silliest Lawsuits and Unruliest Rulings of All Times. I’ve been meaning to read Tom Clancy’s Debt of Honor, so that’s here. A friend lent me a paperback called The Know-It-All.

The Know-It-All is interesting. It’s non-fiction and is an account of one man’s reading of the entire Encyclopaedia Britannica from a-ak through Zywiec. There is much humor in the account. Somewhere along the line the author and his wife find time to get pregnant. The baby is born after the reading is done. The book is fun and does not need to be read from A to Zed.

Then there’s A Thousand Splendid Suns by the author of Kite Runner, which I loved. I started to read A Thousand Splendid Suns but have set it aside. I read through chapter seven, at the end of which the main character Mariam is presented in marriage to a total stranger. She’s fifteen years old. Her new husband is in his mid forties. Mariam is a harami, the illegitimate progeny of a lowly stone carver’s daughter and a rich man married to three wives. I read to chapter seven when I remembered what the Taliban did to “fallen” women, those who are prostitutes, illegitimate, or have committed a crime. Sure enough, on page 327 Mariam is in the bed of a pickup truck on its way to Kabul’s Ghazi Sport stadium. On page 329 she kneels in her burqa in front of a male member of the Taliban, bows her head one last time, and is shot to death.

I admit to skipping around in the book. It’s something I often do, check the ending to see whether I can deduce how the book will be written to lead up to it. I skim to see how relationships are established, what motives are worked in. When the plot seems fairly linear and predictable, I will put a book away. A Thousand Splendid Suns was that, linear and predictable. But that’s not why I did not finish it. I was becoming emotionally invested in Mariam. I could not bear to read about her hard life, her sad end. I remember what the Taliban has done to Afghan women.

2010-01-27T09:57:00.000-08:00

“The Oak Tree”

A mighty wind blew night and day.
It stole the oak tree’s leaves away,
Then snapped its boughs
and pulled its bark
until the oak was tired and stark.
But still the oak tree held its ground
while other trees fell all around . . .

The weary wind gave up and spoke,
“How can you still be standing, Oak?”
The oak tree said, “I know that you
can break each branch of mine in two,
carry every leaf away,
shake my limbs, and make me sway.
But I have roots stretched in the earth,
growing stronger since my birth.
You’ll never touch them, for you see,
they are the deepest part of me.
Until today, I wasn’t sure
of just how much I could endure.
But now I’ve found, with thanks to you,
I’m stronger than I ever knew.”

This inspiring message, believe it or not, was on a Hallmark greeting card given to me by my mother. Mom added an inspirational message of her own, and made my day.

2010-01-25T12:50:00.000-08:00

There’s always something to worry about. Just a few weeks shy of my first radiation treatment, comes this article in the Sunday New York Times: “A Lifesaving Tool Turned Deadly--Radiation Offers Powerful New Cures, and Ways to do Harm.”

The gist of the article is that operators of radiation machinery can rely too heavily on the computer-controlled devices. When the software acts up, improper data is fed in, or warning signals are given out by the system, operators don’t always check for, or catch, the mistakes. A review of state records in New York found there were 621 radiation mistakes from January 2001 to January 2009. The errors included: wrong dose given, wrong patient treated, the beams missed all or part of the intended target.

The personal stories cited in the article included two where egregious errors were committed. One resulted in a man’s head and neck being over-radiated. He died of his horrible injuries after two years of suffering. The second left a breast cancer patient with a burning, gaping hole in her chest. She too died in terrible pain.

Even when everything is done properly, Dr. John J. Feldmeier, a radiation oncologist at the University of Toledo and a leading authority on radiation injuries, estimates that one in twenty patients will suffer injuries, according to the Times piece. Most of these are “normal complications.”

I wonder whether these complications include the organ damage and radiation-induced cancer that can be caused and might not show up for decades.

A diagram of an Intensity Modulated Radiation Therapy (I.M.R.T.) machine accompanies the Times story. The image is daunting. The individual silhouetted on the table looks like a tiny doll being swallowed by an enormous maw. The I.M.R.T. machine is likely not the type that will be used for my treatment. However, I do like to engage in anticipatory worrying.

I’ve checked the http://www.breastcancer.org/ web site to find out more about radiation therapy. Online, the doctors suggest asking questions I would never have thought of. A sample: Does the radiation oncologist use 3-dimensional treatment planning systems? Are there certified physicists involved with the planning? Is there a certified dosimetrist?

I had to look up “dosimetrist.” Turns out it’s just like it sounds. A dosimetrist, according to http://www.cancer.gov/, “determines the proper radiation dose for treatment.”

And we’ll leave it there for now.

2010-01-23T09:36:00.000-08:00

The sun is trying to come out over Northern California. A valiant, though faint, effort following a week of wicked storms. My father drove me to my third chemotherapy treatment in a downpour this past Tuesday. (I’ve learned the hospital calls these treatments “infusions.” I must get with the jargon here.)

It had to be a labor of love, my father’s driving through sheets of rain from his hometown fifteen miles away. Then, too, sitting and waiting through my four-hour infusion can’t have been fun. I would think, since he’s been through his own chemotherapy at the HMO we belong to, he’d run in the opposite direction. Actually, I think he likes to flirt with the nurses. He knows them all.

One of the oncology nurses is a neighbor of mine. I reminded her that, when she moved in across the street and told me of her profession, I said, “Ew,” and gave a little shudder. She nodded. “And now,” she said, “here we are.” Yes indeed, here we are.

“One day soon, this will all be a blip on the radar,” my nurse-neighbor told me before my first infusion in early December 2009. This week, my sister sent me a card with much the same sentiment. “One day soon, this will be a memory,” she wrote. One day . . . soon.

The memory plays interesting tricks. A friend told me how well she’d handled her own chemotherapy for breast cancer some years ago. Days later she confided that she’d been so weak at one juncture, she’d needed a blood transfusion. Ah yes, someday soon . . .

I know I make an impatient patient. But being in the middle of this cure for cancer is painful, sad, and all consuming. There is no way to dress it up. One day soon cannot come soon enough.

2010-01-20T07:06:00.000-08:00

When I first told people about my breast cancer diagnosis, waves of wonderful things arrived in my home unbidden. There were cards, flowers, a cookie bouquet, and a food basket. As time went on, there were gifts of homemade soup and a housecleaning, given by a neighbor and friend. Caps, first knitted by one friend, then another, then purchased by a man who works with my father at Guide Dogs for the Blind appeared. I especially like the cap from the 2008 Beijing Olympics. It even fits!

Books about cancer arrived on my doorstep and appeared in my mailbox from out-of-state. My initial reaction to these was, “I’m living this. Why would I want to read about it?” The question was quickly answered as I wanted information about treatments, side effects, and how to read a pathology report. Two of the books are well-thumbed through, another remains to be explored.

There is a book, one I picked up at my HMO shortly after my diagnosis, that I set aside and did not intend to read. It’s title, “I flunked my Mammogram!”--in pink and complete with exclamation point--was just too off-putting. It seemed to trivialize such a devastating disease. I’ve since picked it up and determined it must be intended for the younger reader. It lays out topics in a basic, clear form. There is a page for notes after major sections.

“I flunked my Mammogram!” has this to say under the heading What Exactly is Cancer?: “In its simplest terms, a cancer cell is a cell that just doesn’t know when to stop dividing. All cells have a natural lifespan, but sometimes a cell just won’t die when it’s time is up. The cell may have been altered by some outside factor, or in the case of inherited cancers, a mutation to its genetic code may have been passed down from earlier generations, causing it to keep dividing and growing. Cancer just doesn’t appear overnight; it takes years to develop to a detectable stage.”

Under the heading of Prevention?, the mammogram flunking book says breast cancer cannot be prevented. “Not yet, and maybe never.” However, researchers are focusing on diet and on specific vitamins and minerals that appear to have a “cancer-preventive effect.” Exercise is again recommended. The book notes that studies have shown that regular exercise can lower estrogen levels. Estrogen has been linked to breast cancer. “Fat cells store estrogen. The less fat you carry, the less estrogen you store--and the less potential stimulation of breast cancer cells.”

So the shunned “I flunked my Mammogram!” book, authored by Dr. Ernie Bodai, MD, and Richard A. Zmuda, has its place. Maybe it’s just the title that wants changing.

2010-01-18T09:00:00.000-08:00

When my father had chemotherapy years ago, he grew thinner and thinner. He still is thin, to this day. At the time of his treatment for colon cancer he said food “tasted like cardboard.” He had to force himself to eat.

When I heard I’d need chemotherapy, I’d hoped for a little weight loss. I could stand to lose a few pounds. I haven’t lost a single one. My appetite is still there, though I’m not sure why. Most foods have a bitter aftertaste to them. This past weekend I made fresh crab, homemade cocktail sauce, an accompanying salad with avocado, bell pepper, and crab meat. Such work. Such a wonderful meal. Such a bitter, nothing taste to the crab. I wondered why this was so and looked online.

From www.cancersupportivecare.com/diet comes this answer to the question about food tasting different: “Both smell receptor and taste bud cells are rapidly dividing cells. Many cancer chemotherapy agents act by killing off rapidly dividing cells, including these receptor cells. Bitter and metallic tastes are intensified possibly causing food aversions whereas sweet tastes tend to be tolerated well. Metallic and bitter tastes are usually perceived in foods such as meat (from the amino acids) and flavors like soy sauce.”

The web site offers some recommendations to enhance the flavor of food while undergoing chemotherapy. Suggestions include:
--Sweeten food with healthy alternatives such as fruit juices.
--Use fruit sauces with meats.
--Serve fruit nectars with meals.
--Enhance the flavor of meat, chicken or fish by marinating with fruit juice or sweet wine. Serve with a fruit sauce, such as mango or sweetened cranberry sauce.
--Try colder foods to eliminate smells. Cold foods can be good sources of protein and calories.

Somehow, I cannot see serving fish with a fruit sauce. But the other suggestions are definitely worth a try.

2010-01-17T13:48:00.000-08:00

It’s taken about two months for me to go from believing the organics label is simply a way for grocers to charge more, and the health aids label is just a “buncha bunk,” to becoming a convert. All right, I’m not totally converted. But my feet are pointed in that direction.

It started with the nurse educator at my HMO who told me that most toothpastes contain alcohol. She recommended some that are alcohol-free and suggested teas to aid with digestion.

From there, I looked for foods to build up the white blood cell count in order to fight colds and infection. I found a few of these: beef, broccoli, cauliflower, spinach, pumpkin, carrots, and shitake mushrooms.

The best discovery was free-range chicken eggs. Just two of these makes a fluffy omelet so large it’s hard to consume in one sitting. My husband also brought home a second type--brown, fertilized eggs--this weekend. He cracked a couple of them open for breakfast and said, “Whoops, there’s a feather. Here comes the beak.” Funny man, my husband.

We wondered whether fertilized eggs are consumable. Here’s what http://www.sciencebuzz.org/ had to say: “If an egg has been fertilized, then the embryo inside has already divided several times but remains a group of unspecialized cells (at the time the egg is laid).” So yes, a fertilized egg is edible.

I’m not so convinced when it comes to the organic lettuces from the supermarket. The pre-washed spinach and the butter lettuce packaged in plastic, complete with roots, tastes the same to me as the “regular” lettuce.

A restaurant I discovered in Oakland, Calif. last summer served salad with the most wonderful lettuce. According to the restaurant, some nice ones can be had from these organizations, which often sell through farmers markets: Coke Farm, Star Route Farms, Blue Heron Farms.

I'm liking the "raw" sugar over the refined white sugar. It seems to sweeten without being too sweet. And I am a fan of milk soaps, another new find. These help keep the skin from drying out, though the scent is a little odd.

It is fun and interesting to try these new things, whether or not they become a permanent part of our lives. I’m looking forward to discovering more. Please comment on this blog if you’ve found some healthy foods you especially love.

2010-01-15T13:03:00.000-08:00

In the final chapter of their book, Breast Cancer - The Complete Guide, doctors Yashar Hirshaut and Peter I. Pressman address the social issues of breast cancer. I’ve excerpted a few of their observations in today’s blog because they speak to my heart.

The authors open the chapter with these questions: “If, as we have learned, one out of eight women in America will develop breast cancer during her lifetime, why aren’t we doing more about it? Why isn’t this a primary national concern? Why aren’t more effort and more money being put into the problem?”

According to the authors, in 2003 the National Cancer Institute (NCI) had a budget of $536 million for breast cancer research, and the Department of Defense (DOD) allocation was $150 million. Since then the NCI’s budget has increased only slightly and the DOD allocation has dipped. “Despite the significant funds (for breast cancer research) it remains under funded . . . Each year, innovative research proposals are submitted to the NCI for approval. Of those accepted as worthy of support, there is at present only enough money to fund twenty percent. Each grant not funded represents an opportunity lost.”

The role that exposure to toxic agents in our environment may play in causing breast cancer is attracting scientific interest and funding. According to the authors, one causative factor being reinvestigated is a “possible link between breast cancer and insecticide residues that may have entered the food chain and water supply.”

The authors, whose book was published in 2008, had this to say about mammography. “More women than ever are aware of the importance of following an early-detection screening plan: regular mammograms supplemented by breast self-examination and an annual examination by a physician. The proportion of women over forty who get regular mammograms has increased, but we still have not reached all women who should be screened.”

According to the doctors, breast cancer research should have “higher government priorities for funding.” The National Breast Cancer Coalition, headquartered in Washington, D.C., is especially effective in articulating the need for public action. Also effective are the efforts of the Susan G. Komen Foundation in Dallas, Texas, which has become a “major nongovernmental source of breast cancer research funding.” The foundation’s website can be found at: http://www.komen.org

Doctors Yashar Hirshaut and Peter I. Pressman question whether we, as a nation, have the commitment to eradicate breast cancer. “Certainly women have it . . . women who have had breast cancer . . . or whose close friends or relatives have had it. And if we add to that number the men whose wives and sisters and girlfriends and mothers have had the disease . . . it means that a very large proportion of our population has a stake in a national determination to beat breast cancer. Whether we can mobilize to achieve this goal remains to be seen.”

2010-01-14T09:27:00.000-08:00

Every so often a favorite author disappoints. Such was the case for me on reading Pat Conroy’s South of Broad. It isn’t merely the errors in chronology and detail (more on these in a minute) that disappoint. It’s the story itself.

Conroy sets his story in his beloved Charleston, South Carolina. He trots out the usual dysfunctional families, the abusive father, and downtrodden mother. His setup intrigues until one reads what caused the brother of the protagonist to kill himself, and one thinks, “Oh, not that cliché. Please.”

The unique bond among the main characters pulled me through the story. There were clever moments. The writing was lyrical, beautifully done in the best Conroy fashion. But, there were things that disturbed me as a reader and a writer.

Conroy begins with a prologue that is a five-page love poem to Charleston. Never mind that literary agents are telling new authors that prologues are passé. More to the point, nothing of interest happens in the prologue. It shows the main character, Leo, as a boy on his paper route. This gives the author his vehicle for providing back story and expounding on the loveliness of Charleston. There’s not more to it than that.

Agents tell new authors, too, that a novel’s action must begin immediately. The reader, they say, has to be grabbed and held from the first sentence. South of Broad’s first forty-five pages are filled with nothing but descriptions and back story. It is not until page forty-six that the real action begins.

New authors are also told to keep characters to a minimum. Evidently, the poor reader cannot grasp more than a few characters at a time. This is a “rule” I’ve never liked. I thank Conroy for flouting it and introducing a fistful of characters in the first chapters of his book.

Sadly, there are several errors in South of Broad. I say sadly because with an author of Conroy’s stature and an editor, Nan Talese, who has won awards for excellence in editing one just wouldn’t expect to see these kinds of mistakes:
--In the first pages of the book, an adult tells Leo he would be attractive save for his horrible glasses. Throughout the story, Leo is called “Toad.” At the story’s end, a priest tells Leo he is just too ugly.
--Early on in the book, Leo says he is doing something “just after three.” Six pages later, on the same day, he is going somewhere at the “noonday hour.”
--In one chapter Leo meets someone on a San Francisco cable car. A few chapters later, Leo recalls meeting the individual in an alley in San Francisco.

To some readers these are minor mistakes. But they are enough to throw a reader out of the story. And sloppy editing isn’t something I’d associate with the Conroy-Talese team. All around, between the usual dysfunctional characters--many so over-the-top one has trouble believing in them--and the sloppy editing it’s hard to recommend South of Broad.

2010-01-13T08:57:00.000-08:00

On December 22, 2009 I started to lose my hair. Not in great clumps, but strand by strand. And I have a lot of hair. Christmas Day my sister said to me, “Why not just shave it off now? Then you won’t have it all over your pillow.”

Well . . . It’s my hair and my pillow. And my vanity, I suppose. I wasn’t prepared to see myself bald. I’m using the past tense because today . . . well, I’m nearly there.

Part of my reason for letting the process follow its natural course was morbid curiosity. I’d heard from breast cancer survivors that their hair came out in clumps. Mine did not. I did have the burning scalp I’d heard about. And my hair felt like bits of stiff thatch. The texture was strange and the feeling of straw pricking into the scalp uncomfortable. When I reached up to touch it, I had it in my hand in pieces.

I’m still losing hair. I have a very thin covering over the back of the head. My hairdresser has always told me I have enough for two people. Women, usually older and with thinning pates, have stopped me on the street to exclaim about it being so thick and wavy. I’m counting on being able to grow it again quickly and thickly.

Women taking chemotherapy for breast cancer lose their hair because the chemicals used damage the cells that cause hair growth. Doctors Yashar Hirshaut and Peter I. Pressman had this to say about hair loss in their book Breast Cancer - The Complete Guide: “This is the side effect that causes women the greatest sadness. At a time when they are extremely vulnerable, their appearance may be radically changed, and their illness given a visible and very upsetting public manifestation. But every strand of hair will grow back.”

When it does grow back, I’m told, it usually has a nice luster. It can be more curly. Sometimes it’s a different color. I’ve already put my order in for red hair this time. And while I’m at it, I’d like my eye color changed to green. Oh, and could I please be about five inches taller, too?

A friend recently told me that, with my good cheekbones, I looked just fine with next-to-no hair. She was being exceedingly kind. When I look in the mirror, a wizened little old man looks back at me. I know the face of Star Wars’ Yoda when I see it!

2010-01-12T09:39:00.000-08:00

A dear friend of mine believes the human body is amazing. It knows when to send signals it is sick and often heals itself. A woman’s reproductive system knows when to start up and how to shut itself down. It’s a miracle.

To which I say, “Tosh,” or something to that effect. If the body were so miraculous, it would never get sick to begin with. Life is filled with illnesses that come unbidden. When the reproductive years end at forty, the body begins its steady decline. We are programmed to fail from the day we are born.

What I find amazing is how the mind governs the body during its tenure on earth. The feats of physical endurance and Olympic accomplishment are incredible. The inventions, the literature, the artistic and technological wonders created by the human brain are astounding.

Just the other night a documentary about the Berlin Airlift aired on one of our public broadcasting stations. The airlift, begun in early summer 1948, lasted nearly eleven months. During that time, Allied planes flew more than two million tons of food and fuel to Berliners whose Soviet occupiers blocked delivery of supplies to the city. Think of the creative minds that conceived of doing such a thing.

At the moment, there are two exhibits in San Francisco museums that are testaments to some of the greatest wonders of the world. The King Tut exhibit speaks to the great minds who architected ancient Egypt. The Cartier exhibit shines a spotlight on some of the most beautiful pieces of jewelry ever conceived by artistic minds.

Last Christmas, my husband and I went into an Apple Computer store to look at iPhones. The iPhone and its ilk are the latest technological wonders of our time. Think of the brains behind the brilliance of these little devices.

Yes, I think the mind trumps the body on most occasions. Of course, the best of all worlds is achieved when the two are able to work in concert. May you have an especially brilliant day today.

2010-01-10T11:45:00.000-08:00

On the morning of my cancer diagnosis in October 2009, my husband called from his appointment in another part of our county. He asked whether I wanted him to forego his afternoon meeting and come home to be with me. “No,” I said. “Stay with your normal routine. I don’t want our lives to be defined by breast cancer. This is not who I am.”

How naïve I was. Every conversation these days begins with, “How are you feeling?” Much of the time the news is grim. The two weeks following chemotherapy treatment are marked by bone pain, running migraine, and extreme fatigue. I just begin to feel better when the next treatment begins.

Life these past few months has been about missing things: a friend’s surprise sixtieth birthday party, hearing Condoleezza Rice speak at our local speakers’ series, gatherings over the holidays with family and friends.

I am midway through the chemo treatments (two down and two to go) and have already “lost it.” My husband asked one evening how I was doing. “I’m lonely, bored, and unproductive,” I said, “and too sick, tired, and ugly to do anything about it.” Then I burst into tears.

A booklet from the National Cancer Institute, Chemotherapy and You, notes that, “At some point during chemotherapy you may feel: anxious, depressed, afraid, angry, frustrated, helpless, lonely. It is normal to have (these feelings). After all, living with cancer and getting treatment can be stressful. You may also feel fatigue, which can make it harder to cope with your feelings.”

I have to laugh at the booklet’s suggested remedies. “Relax,” it says. Well, when a patient is knocked flat with pain there’s not much else to do. The next suggestion, “exercise,” is also laughable. When there is not enough energy to cross the street, there is not enough strength to exercise. “Talk with others,” is on the list. That one I’ve done to death. “Join a support group,” the booklet advocates. Heck, if I were well enough to drive myself to a support group I’d drive myself to lunch with a friend instead.

I keep reminding myself that I am only temporarily missing out on things. I am fighting for a rich long life, which will be filled with scores of memorable moments. I pray the fight ends successfully and soon so the whining can end and the living can resume.

2010-01-08T09:11:00.000-08:00

If there is a positive side to illness, it’s being able to catch up on reading. I’ve just finished Loving Frank, a novel about renowned architect Frank Lloyd Wright’s love affair with a woman named Mamah Borthwick Cheney.

While I found the book intriguing on several levels, it was an odd read as well.

First, the intrigue. When the Frank Lloyd Wright exhibit came to the Marin County Civic Center years ago, I served as a docent. I gave tours of the civic center, a Wright-designed building. I answered questions in a Usonion House erected on the grounds for visitors. Wright’s Usonian was made of inexpensive concrete blocks and was designed as a kind of “custom” home for everyman. In Loving Frank it was interesting to read about the person behind all the wonderful art and architecture.

Author Nancy Horan also managed to soften Wright’s edges. Anyone who has studied the architect comes away believing in his brilliance and finding him arrogant and egocentric. He was both, but Horan brought forth more of his many-faceted personality.

I appreciated every historical aspect of Loving Frank, which runs from 1907 to 1914. Horan researched and wrote her book over a seven year period. She captures all the nuances of the era in perfect detail.

During the five years I wrote my historical novel, The Still Voice, I took great pains to be faithful to the culture, customs, and language of the time. Set in Germany during World War II, my story spans the years 1939 to 1948. Everything about the era, from music, literature and dress to thought and politics, had to be just right.

What made Loving Frank a strange read for me was being at odds with the main character, Mamah, at times. I can understand her feeling stagnant in her life and constricted by the role women had in the early 1900s. But throughout the book, I couldn’t help but feel sorry for the husband and children she deserted to carry on her clandestine love affair with Wright.

It’s also odd to read a story when one knows the ending. The story of the madman who put an end to the lives of seven people (Mamah and her children included) at Wright’s Taliesin home, and burnt it to the ground, is well known. It’s to author Horan’s credit that she holds the reader’s interest to the end, even when the outcome of the story is well documented.

2010-01-06T12:17:00.000-08:00

Today marks the Feast of the Epiphany. It falls on the twelfth day after Christmas and is the religious observance of the three kings, or wise men, visiting the infant Jesus. It marks the end of the holiday season and the start of a collective optimism being put forward for a better New Year.

A wise woman I know, my mother, once gave me a little book called Up Words for Down Days. It’s filled with philosophical quotes and funny ones. I thought I’d share some of the comments on health from the book. The author, Allen Klein, gives this definition of health, “freedom from disease or abnormality,” to kick off the category.

The secret of health for both mind and body is not to mourn for the past, nor to worry about the future, but to live the present moment wisely and earnestly. -- Buddha

To be healthy, wealthy, happy and successful in any and all areas of your life you need to be aware that you need to think healthy, wealthy, happy and successful thoughts twenty-four hours a day and cancel all negative, destructive, fearful and unhappy thoughts. These two types of thought cannot coexist if you want to share in the abundance that surrounds us all. -- Sidney Madwed

Be careful about reading health books. You may die of a misprint. -- Mark Twain

It’s no longer a question of staying healthy. It’s a question of finding a sickness you like. -- Jackie Mason

My doctor said I look like a million dollars--green and wrinkled. -- Red Skelton

He’s turned his life around. He used to be depressed and miserable. Now he’s miserable and depressed. -- David Frost

The greatest healing therapy is friendship and love. -- Hubert Humphrey

The mind is its own place, and in itself, can make heaven of Hell, and a hell of Heaven. -- John Milton

The power to heal is in you, and nonetheless there is a tendency in our culture to project onto other people and to want them to heal us. -- Andrew Weil

2010-01-04T11:47:00.000-08:00

Scant days into the New Year and my thoughts are turning not to resolutions but to estrogen. Not very forward-looking I suppose, but it’s been on my mind since I learned some weeks ago that the tumor in my breast was one-hundred-percent estrogen positive. The oncologists seemed to like this as it means that--after the surgeries, chemotherapy, and radiation--the body will respond to an estrogen suppressant. This will increase the probability that I will be cured of cancer. Surely a good reason for celebrating the New Year.

And yet, the extent to which doctors have remarked on the high degree of estrogen in the tumor sticks in my craw. Here’s why: I’m remembering the early part of this decade when I took soy supplements to manage the side effects of menopause. Billed as “natural and dietary,” these products were, and still are, sold over the counter. They are FDA approved. I must say, the caplets and powders, which contained soy isoflavones (or phytoestrogens), worked like a charm. The hot flashes were kept to a minimum during the time I used these.*

When I first researched these products, not much information was available. Today, a quick internet search yields this from http://www.healthcastle.com/: “Studies found that soy could become ‘pro-estrogen’ in women with low levels of natural estrogen. In other words, concentrated soy supplements may add estrogen to the body and hence increase breast cancer risk in post-menopausal women.”**

Then there is this quote from a paper posted online by the Department of Food Science and Human Nutrition at the University of Illinois in Urbana-Champaign, Ill.: “The estrogenic soy isoflavone, genistein, stimulates growth of estrogen-dependent human breast cancer cells in vivo.” The tests are with mice at the moment. However, the implications are not good.***

As if further proof is needed to show what excess estrogen does in the body, there was the news in December 2009 of a study linking alcohol consumption to a recurrence of breast cancer in women. The study, funded by the National Cancer Institute, showed that drinking three or more alcoholic drinks per week seemed to increase the risk for breast cancer recurrence.

The study’s lead author, Dr. Marilyn Kwan of Kaiser Permanente in Oakland, Calif., noted, “It has been suggested that alcohol could increase the risk of breast cancer by increasing estrogen metabolism and circulating levels of estrogen, thus promoting growth of the tumor.”

I suppose anyone who has had cancer will ruminate on what could’ve caused it. I know the soy supplements are still popular, and they help a lot of people. Still, had I to do it over, I would run as far from these products as I possibly could. I hope anyone considering taking them works closely with their doctor before picking them off the store shelf.

*Soybeans are rich sources of phytoestrogens called soy isoflavones. Specific plant estrogens in soy include daidzein and genistein. http://www.drugs.com/drp/estroven-caplets.html

**http://www.healthcastle.com/soy-breastcancer.shtml

***http://carcin.oxfordjournals.org/cgi/content/full/22/10/1667

2010-01-02T09:22:00.000-08:00

People like to tell me stories of their friends who’ve survived breast cancer. “She’s more beautiful than ever,” they’ll say. “Fit. Glowing skin. Gorgeous hair.”

I can understand the urge to remake oneself in the wake of this ravaging disease. I have the desire myself, though I’m not yet mid way through the treatments.

Senator John Kerry’s wife, Teresa Heinz, revealed last month that she is being treated for breast cancer. “Chemotherapy is serious,” she said. “It’s very painful. And it’s very destructive of people’s--most people’s--lives for a while, anyway.” How true that is.

There is nothing in the world to prepare a woman for the ugliness of breast cancer. First, there is the angry red eyebrow-like scar above the most personal of organs. There is the slit under the arm where the lymph nodes were removed. There’s the hair, coming out in tufts. Then there’s the body, weakened from surgeries and recoveries and the destruction of chemotherapy. Too depleted for any real exercise, the body grows flabbier by the day.

Food must be taken as the system needs nourishment. Yet, digestion can be painful and many foods leave the throat feeling sore.

There is the wider fallout as well. Family and friends grow weary of hearing the story. The writing, or whatever work one does, suffers. And the home, once well kept, could use a good scrubbing.

Yes, I understand the need to rebuild one’s body following the war with cancer. Though, at the moment, I’m too spent to do much about it.

2009-12-30T10:00:00.000-08:00

It’s two days following my second chemotherapy treatment and I am deep into a migraine. A more apt description, perhaps, would be to say that the top of my head is on fire. I am pink from the steroids that must be taken with the treatment. And my hair, which started coming out on Christmas Eve, is falling out strand-by-strand-by-strand. It is time for a second guest blog. This one is from my friend Kathy C. I met Kathy twenty-three years ago when we worked for the same publishing house. She is a freelance writer and has covered everything from travel to parenting.

It is very difficult to write this blog entry because I do not feel worthy to be stepping on this page. I mean, it is my dear friend Juli’s blog, after all, and her story and her suffering. But here goes . . .

My initial idea for this blog item was to post a mini collection of insights from women I know who have survived cancer (and I know more than a handful). I e-mailed them and expected an overwhelming response filled with encouragement and pithy quotes. But I only heard from one person, two others I never got a response from, and the last friend told me she just could not write about the topic at all.

It was just today that it occurred to me that breast cancer must be the most intimate, awkward, and shocking disease out there. It hits with little to no warning, and it hits the most female part of a woman’s body, and it makes some people feel very uncomfortable to know someone with breast cancer because they don’t know what to say or they wind up saying something quite stupid.

From that minute sampling of friends who didn’t write back to me, their non-response spoke volumes about the aftermath of cancer and how emotional healing will take some time. I have the utmost respect for women going through the torture of “treatment” and Juli, your continued openness about what is happening to you and how you feel about it seems to be excellent therapy to release that complex array of feelings associated with this.

What you write about, Juli, helps me and many others to understand what you are going through. The rawness of it all is painful for me to read about, but I thank you for sharing your soul. I hope your blog opens the doors to more women, especially those who are having a difficult time coping. I hope that this blog will encourage other cancer patients to give themselves permission to rant and cry online and laugh as well. Thanks, Juli, for being real.

2009-12-28T07:42:00.000-08:00

I’ve asked friends to fill in for me during the “bad” days of my chemotherapy treatment. This is one of those, as I’m going in for my second session. On these days I’m not only too distracted to write, I’m completely wired as I’ve been told to take five steroid pills the night before. The steroids have to do with the body being better able to absorb the chemicals.

Susan K., a friend and colleague since the mid 1980s, is today’s guest blogger. She is currently managing editor of a Northern California magazine called South Bay Accent.

It’s hard to fill in for Juli since this is clearly meant to be her voice. But I can’t help but think of her during all the controversy about changing the frequency of mammograms. Count me in as one who is upset that the test is being minimized. I’ve had a mammogram every year since my late thirties even though I have no close relatives with breast cancer. As my doctor said, why not? This is a disease that doesn’t just depend on family history or environment. It seems to silently sneak into people of all walks of life and at any age.

Why wouldn’t you want to find out early? I had a false positive one year, and it was tough, having to go in for extra tests, with that pit in my stomach, wondering if my luck had finally run out. Fortunately it hadn’t. But in a strange way, that fear made it even more obvious to me, even more important, to continue the annual routine. What if I had been diagnosed? Just like wearing a seat belt, the test lets you hedge your bets. Sure you might still drive into a wall, but at least you’ll survive to drive another day.

I was shocked at Thanksgiving when my friend Anne, a big-wig lawyer at Kaiser, launched in on how unnecessary annual mammograms are. She said that frequently the cancer would just go away by itself if people didn’t know they had it. Her argument was that the test creates more surgeries that are in themselves more dangerous than the disease. Even my friend Kara—a mellow jewelry maker from wine country—joined in and supported Anne’s opinion. I felt betrayed by the sisterhood.

I asked Kara if she had any friends with breast cancer. No, she said. But when Kara started imagining how she’d feel if any of her friends, several of whom were seated around the holiday table, developed cancer, she suddenly wasn’t so sure of herself.

Juli’s not the first person I know who’s had breast cancer, but I can hope she’s the last.

The problem with the new recommendations is that they do sound too much like another insurance industry ploy to cut costs and reduce benefits. The same day the mammogram recommendations made the news, I got my yearly letter from Blue Cross, telling me that in order to serve me better they’re raising my rates, this time by a whopping twenty-five percent. Does having too many tests lead to higher costs? Perhaps. But I’ve always had ridiculously high rates because years ago I was diagnosed with high cholesterol, and I take Lipitor. Apparently, from the insurance perspective there’s nothing worse than to be diagnosed early and to take steps that minimize future serious consequences. The message is that ignorance is bliss. Oops, sound familiar?

Yes, medical recommendations change all the time. But to pretend that it’s better not to know, that it causes too much stress for us poor women to handle—that just sounds paternalistic. I have my annual mammogram next week. Wish me luck. I just hope Anne and Kara never put off having a mammogram.

Juli, all the best to you.

2009-12-23T13:47:00.000-08:00

My father likes to say, “Everything happens for the best.” He’s had five major surgeries, one of them for cancer, in five years. And he still says that.

One day I mean to ask him what he took from each of his surgeries that was for the best. In the meantime, there’s something indomitable about that kind of spirit. Father still does volunteer work, still works out at the gym. He whistles and sings, tells jokes, and sends funny stories over e-mail. This month he celebrated his eighty-second birthday.

Dad and my husband are alike in their outlook on life. They have a curiosity about the world, an eagerness to see what new invention, what fun thing, lies around the corner. More than that, they have kind hearts, a willingness to extend a hand to a neighbor, to help a friend or a stranger in need.

It’s an attitude I should like to carry into the new year. I will make more time for friends and more time to be a friend. I will try to carry the Christmas spirit with me year round, for Christmas is not what parties we attend or what gifts we give and receive. Christmas is a warmth, a generosity of spirit we keep forever in our hearts.

So let me not bemoan my health at Christmastide. I will enjoy the lighted drummer boys who stand at the gate of a neighbor’s house. I will savor the last of my mother’s delicious stollen bread and look forward to her spritz cookies on Friday. I will delight in the presence of all my family members who, somewhat worse for the wear this challenging year, are intact and happy to celebrate the season together.

Merry Christmas Everyone!

2009-12-22T11:18:00.000-08:00

Three days before Christmas I called my oncologist. Is it possible, I wanted to know, to reduce the intensity of chemotherapy? I described the symptoms following my first treatment: four days of bone pain, fatigue to the point of not being able to cross the street, and the two-day migraine that flattened me. The doctor said these were side effects of the neupogen shot I’d been given to raise my white blood cell count. On the next go-round, December 28, 2009, we’re going to try not giving me that shot. I hope it works.

I’m thinking, in particular, of the two-day migraine I experienced. At its worst, I realized I had no medicine in the house to treat a migraine and was too incapacitated to fetch it. I had a doctor at my HMO telephone the prescription into the pharmacy. My mother picked it up and delivered it to my bedside.

When my mother arrived that day, we both burst into tears. “Two days ago I was trying to have a day of normal activity,” I told her. “It’s so frustrating. One normal day lands me in bed with migraine.” She hugged me, then sat and chatted for a while about everyday things.

Others in my life have provided me with exceptional stability and good humor during my bout with breast cancer. But I cannot imagine going through it without my mother as my friend. Some years back, a dear friend of mine lost her own mother. “When that happens,” she said, “you’re never the same.”

The women on my mother’s side live into their nineties. My grandmother reached the age of ninety-one. My mother’s sister, my aunt Mary, is ninety-four. I hope my mother lives well into her nineties. I am, in fact, counting on it.

2009-12-21T13:13:00.000-08:00

I’ve just finished reading Boats in the Night. A slender but stirring volume, it’s about the Danish resistance to the Nazi occupation of their country during World War II. The book is special because it was given to me by a Danish friend whose own father was a resister. The central figure in Boats in the Night is a man who today, it turns out, resides in the same Northern California town I do. His name is Knud Dyby, and he is ninety-four.

The story begins on the ninth of April, 1940 when German army units cross into Denmark. German paratroopers land throughout the country. A German merchant ship full of soldiers docks in Copenhagen. All this happens at 4:15 a.m. while the Danes are asleep. To avoid casualties, Denmark’s King Christian X and his government capitulate. A negotiated occupation exists from 1940 to 1943 during which Denmark assumes the role of “model protectorate.” Acts of sabotage to damage the German war effort are routine at this time.

The resistance takes hold in earnest in late 1943 when word leaks out that Danish Jews will be rounded up and transported to Nazi concentration camps. The Danes are able to negotiate safe harbor for the Jews in Sweden. It’s getting them across the channel to safety that’s treacherous, and where Dyby plays such an important role.

Dyby serves as a go-between who arranges passage for Jews and resisters hunted by the Germans. He helps skippers prepare their boats to secretly transport the Jews. Should the Germans catch them and their human cargo, all would certainly be killed. Dyby even makes one boat passage himself. By war’s end, most of Denmark’s 8,000 Jews have been rescued and sent to freedom.

There’s a photograph in the book of Knud Dyby pointing to his plaque on the commemorative wall in the Avenue of the Righteous of the Nations at Yad Vashem in Jerusalem. His eyes look like they’ve seen much. In the book’s final pages, he recalls his resistance friends and colleagues who died during the war: “They are dead now,” he says. “I speak to their memory.”

I learned, as I researched my novel, The Still Voice, that those gentiles who helped the Jews during the second world war are called “righteous.” In my story, Sophia and her fellow Edelweiss Pirates never consider themselves righteous. They know what they are doing is right and, like Dyby, they keep on doing it.

2009-12-18T09:57:00.000-08:00

May your days be merry and bright . . . My head hits the pillow filled with the strains of Christmas music. In my dream, I’m standing in the shower. The songs of the season are piped in. Suddenly, I’m wrapped in a black sticky shroud. It’s my own hair, and it’s melted over my body. Such are the happy holiday dreams of this chemotherapy patient.

Every breast cancer patient comes to know that the most widely used chemotherapy drugs cause hair loss. What she also comes to know is that losing one’s hair usually follows the second treatment in the cycle. My second treatment is December 28, 2009. Wild horses will have to drag me back.

A friend told me that her mother, a licensed psychotherapist, practiced something called desensitization to lure her to the second chemo. In psychology, desensitization is used to lessen someone’s fear of a situation by exposing them to it either in reality or in their imagination. As my friend and her mother lived some distance apart, her mother “conditioned” her by telephone. She’d spend twenty minutes having her daughter visualize a beautiful garden. The next twenty minutes, she’d have her picture herself taking the chemotherapy. So it went, back and forth until she felt able to keep going.

As I have no psychotherapist in my hip pocket, I’ve chosen to visualize the Aegean Sea. My husband has promised me a trip to Greece when this is all over. I’m already planning it in my mind. The Aegean is a deep blue-green. I’m on a sailboat, in a new swimsuit, with a figure better than I had in my twenties. I’m a golden brown. And I’m sipping bubbly drinks while munching raspberries and brie. A white shroud, made of a light chiffon, shields me from the sun’s rays. Breast cancer is in the distant past, an evil cast out of my life forever.

. . . And may all your Christmases be white.

2009-12-17T14:05:00.000-08:00

When I started this blog, I was reaching out for moral support after my breast cancer diagnosis. When I wanted to quit writing, my surgeon told me she thought it was helping a lot of people. So I’ve stuck with blogging. It’s been tough to do since the chemotherapy regimen began. I’ve been vertical two days out of the past ten.

I keep thinking about the main character in my novel, The Still Voice. Sophia contracts scarlet fever at a regional sports fest in 1941. Highly contagious, she winds up in the hospital over Easter. This is the scene with Sophia in the hospital during the holiday. Her mother Brigitte, and sister Petra, have come to visit. Sophia is trying not to feel sorry for herself:

They both looked so pretty, Brigitte in her blue knit suit and Petra in her apple green dress with lace collar and cuffs. Sophia squinted through the tempered glass to bring them into better focus.

“Happy Easter, honey,” said her mama. “We brought you something. The nurse will bring it in to you.” She held up a basket brimming with colorful eggs.

Squinting, Sophia could make out a stuffed rabbit and an oversized lavender bow. Easter was the second most important holiday in Germany, after Christmas, and one of her favorites. She thought of the year they’d spent it at Petra’s, sitting in a kitchen filled with crocuses and daffodils, learning how to decorate eggs with liquid wax. Afterward, when they’d dyed the eggs, the wax designs had popped out against the richly colored shells.

“Did you go to church?” she asked.

“We went to the Marktkirche,” said Petra. “We said a prayer for everyone. My prayer for Hans was already answered, of course. He’s been transferred to the campaign in Greece. Much safer. I’m so relieved. We miss you. How are . . .”

“The organ in the Marktkirche is so beautiful,” said Brigitte. “You can hear it loud, and with the choir . . .”

Petra peered through the door at her sister. “How’re you feeling, Sophia?”

“I’m getting better. Where are you having lunch?”

The answer was as she’d expected. The family would gather at the home of her brother’s in-laws. She tried to refocus, not feel sorry for herself. “We had to hide in the basement when the bomb fell. Did you see where it landed?”

Brigitte pinched her lips together. “Near the train station. Couple of houses were slightly damaged. No one was hurt.”

Sophia recognized the look in her mother’s eye. She wasn’t being truthful about no one being hurt. No matter, she doubted she was ready for the truth.

“Sis, are you listening to me?” Petra interrupted her thoughts. “When you’re released, you’ll come stay with me in Wieseck. The country air will be good for you. Would you like that?”

She nodded. “I’d like that. After I finish school.”

“Of course,” smiled her mama.

Her visitors chatted a while longer and wished her a full recovery. Then the nurse brought in her basket, and Brigitte and Petra disappeared down the long corridor to the stairs.

Sophia set her gift on a tray at the foot of her bed and walked to the window. Four floors below, she saw her mother and sister standing on the patio near the hospital fountain. They waved and blew kisses. She waved in return, her cheeks wet with tears. It was Easter, and they both looked so pretty.

2009-12-16T10:14:00.000-08:00

I had an uncle I never knew. His name was Helmut, and he was an older brother of my mother’s. Helmut served on a German destroyer off the coast of Norway during World War II. He lost his life in one of the last sea battles of the war when an English destroyer fired on his ship. Helmut is buried in a mass grave somewhere near Bergen. Mother tried to find the site during a visit to Norway some years ago. The Norwegians were not so eager to divulge information. Mother never found his grave.

Once, when Helmut came home on leave from the war, he presented a snapshot of a beautiful Norwegian girl. “This will be your daughter-in-law one day,” he told my grandmother as my mother looked on. The story of his visit led to this scene in my novel, The Still Voice. It takes place in 1941. I think it’s appropriate for Christmas.

Brigitte shoved a cookie sheet into the oven, wiped her hands on her apron, and went to join her daughter in the living room. “Oh,” she glanced at the advent wreath on the end table near her chair. “Sophia, would you be so good and bring the matches in from the kitchen? I just sat down.”

Sophia brought in the matches and lit one of the four candles on the wreath. “Advent is late this year, don’t you think?”

“Why do you say that?”

“Because the first Sunday is already the seventh of December.”

“Speaking of late,” a crafty smile came over Brigitte’s face, “I need to change if we’re going to look at windows.”

“No rush.” Sophia looked, puzzled, at her mama. “We can go after coffee time. In fact, downtown’s nicer when it’s dark out and everything’s all lit up.”

Her mother flitted into the bedroom to change clothes. Sophia inhaled deeply, taking in the aroma of baking Pfeffernuß (peppernut) cookies.

On the sixth, St. Nicholas Day, her mama had filled the shoe she’d left in front of their bedroom door with Lebkuchen (gingerbread) and Zimtsterne (cinnamon star) cookies. They were both in an unusually festive mood, she thought. Probably because they loved Christmas.

“Aren’t you going to change?” Brigitte emerged from their room in her best dress.

“Ma, it’s just window shopping.” Sophia got up from her chair and started for the bedroom when a knock at the door stopped her.

“Would you get that?” asked Brigitte. “I have to turn off the oven.”

There was the sly smile again. Sophia went to answer the knock.

“Wolfie!” She threw the door wide open and flung her arms around his neck. “No wonder Ma’s been grinning like a monkey all day.”

“I told her to keep it secret,” beamed Wolfie. “I wasn’t sure until the last minute if I’d get leave.” He handed his mother a paper sack. “I stopped to get chestnuts.”

“They’re still warm,” said Brigitte. She poured them into a bowl, sat at the table, and cracked one open.

“Ma, in your best dress . . .” frowned Sophia.

“You have to eat them warm,” said Brigitte. “Sit a minute. There’s plenty of time for shopping.”

“Actually,” said Wolfie, “I made us a reservation at Café Maldaner, so we shouldn’t fool around too long.” He split open a chestnut with his thumbs. “These are good.”

“Tell us about Norway,” said Sophia.

He unfolded his wallet and laid a snapshot in front of Brigitte. “This will be your daughter-in-law one day.”

“Let’s see.” Sophia leaned across the table. “She’s as tall as you.”

“Almost,” he beamed. “She’s classic Norwegian. Very blonde. Long legs. Her name’s Finna.”

“So, this is the one.” Brigitte nodded. “And she will live in Germany?”

“I think so,” said Wolfie. “As for Norway, what a clean, beautiful country . . .”

“Will you have to go back soon?” asked Sophia.

“Yes,” said Brigitte. “How long do we have you for?”

“My leave is quite generous, actually,” said Wolfie. “I have until the twenty-eighth. I’ll miss your birthday, Sis. I’m sorry.”

“That’s all right. I’m just glad you’re here for Christmas.” She hoped her disappointment didn’t show. People were usually around for her birthday as it fell on New Year’s Eve. She wondered why the navy needed Wolfie over the holiday.

“We’ll have fun.” He handed Sophia a peeled chestnut. “Any word from Max?” He looked, meaningfully, at his mother.

Brigitte clasped and unclasped her hands. “No. We just hear on the radio that our ‘men are fighting bravely on the Eastern Front.’ Of course, we know it’s a very cold winter.”

“I’m sure he’s fine,” said Wolfie. “When the war is over, I want to show you Norway. Bergen is a nice harbor. It’s the second biggest city after Oslo. Green. Brick buildings everywhere. Ma, I know how you love brick. And the fish market! You should see all the types of fish . . .”

While Wolfie waxed on, Sophia changed clothes, making sure to bring out her fox muff.

“I remember that muff,” smiled Wolfie when she came out of the bedroom. “You’ll need it, too. It’s quite crisp out. Are we ready?”

The threesome linked arms as they sauntered toward the medieval city center.

“Wolfie,” asked Sophia, when they’d stopped at a Glühwein (mulled wine) stand near the Marktkirche, “what’s the Bruno Heinemann doing in Norway?”

“We’re there to keep the shipping route open for iron ore from Scandinavia,” he said. “Ah, there’s Hertie up ahead. I always like their window.”

Standing in front of Hertie, Sophia didn’t know where to look first. There was a train that carried Santa through an elaborate village, a rotating Ferris wheel, and a hot-air balloon whose bountiful basket rose and fell with little puffs of air. Everywhere, white lights twinkled and reflected off glittering snow.

“See how everything moves,” laughed Brigitte. “Even the angels turn around the top of the pyramid.”

“I hope Helga has her pyramid out this year,” said Sophia. “Hers is fantastic.”

“That reminds me,” said Brigitte, “Helga wants us to be there at six o’clock, Christmas Eve. She’s putting up Rebeka and Georg, of course. I can’t believe she’s offered to put up Petra and the twins.”

“There’s not much choice, is there?” asked Wolfie. “She can hardly send them packing.”

“It sure is different with the men gone,” said Brigitte.

“What am I?” asked Wolfie. “Cold potatoes?”

“No.” She took her son’s hand. “You said you wanted to stop at Hettlage. We should do that before they close.”

Wolfie’s former coworkers were as glad to see him as he was them. His onetime boss recommended several items for Sophia, including boots and mittens. For Brigitte, there was an assortment of coats. One after another, Hettlage’s employees stopped by to visit.

“Bergen is beautiful,” Wolfie repeated to each one. “It’s west of Oslo . . .”

“Wolfie, how about this one?” Brigitte modeled a black cloth coat.

“Isn’t there one with a fur collar?” He turned to talk with a former colleague. “Now, Tromso is much farther north . . .”

“That’s Petra’s style,” said Brigitte. “Anyway, there aren’t any. I’ll take this one.”

“We’re having record cold this winter,” said Wolfie. “No furs?”

“Can I have this?” Sophia was captivated by a blown-glass ballerina.

“Boots would be more practical,” said the saleswoman.

Crestfallen, Sophia put the ballerina down.

“If she wants the little figure, we’ll take it,” said Wolfie. “It’s Christmas, after all.”

“Hettlage isn’t the same without you, Herr Brandt,” said the saleswoman as she folded Brigitte’s coat in tissue paper. “What’s it like?”

“Well, Norway is . . .”

“No,” said the young woman. “Serving on a destroyer. What’s it like?”

“The war has gotten serious,” said Wolfie. “More than that, I’m not allowed to say. I do miss the pretty girls, like yourself.”

The saleswoman blushed as she handed them their purchases.

“Thank you for my present, Wolfie,” said Sophia as they cycled through the revolving door.

“You’re most welcome. Now, on to dinner.”

“Just like old times,” said Sophia. She and her mother linked arms with Wolfie for the walk to their café.

As they passed Karstadt, they stopped to press their noses against its display window. A sleigh ferried Saint Nicholas above a small village where lighted wreaths twinkled red and green in the shop windows. The bell in the chapel tower swung to and fro and, everywhere, flakes of shimmering white snow contrasted sharply with the brown slush under Sophia’s feet.

“Come, you two,” said Brigitte, “I’m hungry.”

At Café Maldaner, Sophia dawdled near the display shelves at the front, where tins of tea kept porcelain Santas company. The host appeared and led the trio to a table below the carousel horse.

“I’m famished,” said Wolfie. “Everything on the menu looks good.”

“I know what your sister and I are having,” said Brigitte. “Let’s order.”

“Ah, Mama,” said Sophia, “I’d like to choose my own.”

“Well, little Miss Independence,” said Brigitte. “You have a few days to go yet before the stubborn teenage years.”

Wolfie cupped his mother’s hand in his. “Let her go. There’s our waiter. Make up your minds.”

When the waiter had taken their order, Wolfie turned to his sister. “I’m amazed by your letters. Ballet, acting, singing. How do you keep up with it all? Have you thought of perhaps focusing on one? Actually, if you chose one to excel in, you might get ahead faster.”

“Let her have fun,” said Brigitte. “She’s just a kid. Maybe she won’t end up doing any of those things. Maybe she’ll be an executive secretary.”

Sophia scowled. She loved her family, but on this they needed to butt out. She was going to be a ballerina. Or perhaps a famous soprano like Erna Sack, the German Nightingale, who sometimes stopped in at the Baba Bräu restaurant. She hadn’t yet decided which.

***

2009-12-15T09:02:00.001-08:00

The fact that one of the drugs administered for my chemotherapy, Cytoxan, is a derivative of mustard gas intrigues me for a couple of reasons. The obvious first is for the mere fact that something so toxic is used as a medicine. The second reason takes some explaining.

In researching my novel, The Still Voice, I spent some time boning up on the first world war, or the Great War. That sounds like a paradox as my story is set during World War II. However, one cannot study the second world war without looking at the first as the seeds of WWII were sown in the Great War. And it was the Great War that saw the first use of mustard gas.

It is commonly believed the German army was the first to use nerve gas. In fact, it was initially deployed by the French against the Germans in August 1914. Germany learned well, though, and became the first to use chemical weapons on a large scale.

Mustard gas was first used by the German army in September 1917. It took twelve hours to effect its victims and blistered their skin in big mustard-colored pocks. The eyes of those exposed became sore, and they began to vomit. The gas attacked the bronchial tubes and caused internal and external bleeding.*

So onerous was the use of poison gas that in the Geneva Gas Protocol of the Third Geneva Convention, signed in 1925, the signatory nations condemned it as uncivilized and agreed not to deploy it in future wars.

As a child growing up in Germany during WWII, my mother remembers her own mama receiving instruction in putting on a gas mask, then donning the mask to run through a gas-filled room. The Germans were that afraid, so many years later, of that type of warfare. My mother was to receive the training at a later date. It never happened. And nerve gas was not deployed as a battlefield weapon in WWII.

So how does a mustard gas derivative work as an anti-tumor drug? It is used to treat breast, ovarian, and other cancers by damaging the DNA of the cancer cells when they are in their “resting phase” (not dividing). Because Cytoxan disrupts their division, the cells die. However, since the drug cannot distinguish good cells from bad, it affects normal cells in the blood, mouth, digestive tract, and hair follicles. Cytoxan is said to have a less drastic effect on the normal cells because they “divide more slowly and are better able to fix DNA breaks than cancer cells.”**

One of my friends received the same regimen I am getting. She is a sixteen-year cancer survivor. Evidently, it works.

*Source: http://www.spartacus.schoolnet.co.uk/FWWgermanA.htm
** http://breastcancer.about.com/od/chemotherapydrugs/p/cytoxan.htm

2009-12-14T09:45:00.000-08:00

The week following my first chemotherapy treatment was pretty much a lost one. There were a few debilitating days and a few with little energy, save for the mind racing with “was gonnas.” I was gonna decorate a bit more for Christmas. There was the sturdy box I was gonna buy for the present I’m bringing to my book club gift exchange.

I am pleased with the things that did get done. Though it felt silly to put our tree up right after Thanksgiving, my husband and I did. Now, I’m grateful to have it to look at. I bought gifts and wrapped them earlier than ever. The cards were sent out three weeks ago. I’ve never gotten them out so soon.

This coming week is one for rebuilding strength. I’m still learning things that will carry me there. For example, I was surprised to learn from the chemotherapy nurse that the toothpaste I use for sensitive teeth has alcohol as an ingredient. Apparently, most toothpastes contain alcohol. For someone with an intolerance to the stuff, like me, it’s good to know of a “safe” toothpaste. It’s called Tom’s of Maine.

The nurse also surprised me by recommending teas to help with digestion, constipation, etc. Imagine an HMO suggesting tea. The brand I’ve tried is called Traditional Medicinals. I still giggle when I think of the night my husband and I brewed their “Smooth Move” blend. Try it sometime. It works.

Lotions to keep the skin from drying out have always been too much of a bother for me. They’re necessary now as the chemo is a dehydrating agent. One lotion that quickly goes into the skin and is fragrance-free is Lubriderm. Of all the designer moisturizers, I like this plain one best.

The Whole Foods supermarket chain has an article on its website that’s useful, too. It lists foods that build the immune system. Shitake mushrooms have been found to increase white blood cells, and these “shrooms” are very yummy. Beef is a source of zinc, which helps white cells and antibodies reproduce more quickly. Bacteria found in yogurt helps fight the bad bacteria in the digestive tract. The Whole Foods article can be found at http://www.whole-food-supplements-guide.com/foods-that-build-your-immune-system.html.

Yes, siree. It’s good to be back among the living. I look forward to seeing you around the neighborhood.

2009-12-11T10:19:00.000-08:00

Of all the possible side effects from chemotherapy, the one I wound up with following my first treatment was bone pain. The pain is caused by one of the chemical agents in the chemo, Taxotere, and an injection of a drug called Neupogen. The Neupogen shot boosts the white blood cell count so the patient is able to fight off infection. Interestingly, Neupogen is made using the bacteria E coli. I’d received two of the three scheduled injections following chemotherapy when I told my oncologist that the bone pain was debilitating. Thankfully, he cancelled the third shot before I received it last night.

Funnily enough, it was a story about cancer of the bone, told me by one of my sisters-in-law, that reinforced the wisdom of taking chemotherapy. A woman in my sister-in-law’s circle had not had chemo following her bout with breast cancer. The cancer returned to her bones. I know how painful that would be.

When the surgeon reports she got all of the tumor out, the lymph nodes are clear, and tests show no metastases elsewhere in the body, that does not mean the cancer is gone. When I met last week with Dr. Frank Stockdale, co-founder of Stanford University’s Combined Modalities Breast Cancer Program, he noted that the average woman with stage one breast cancer has a twenty-five percent chance of it recurring anywhere in the body. A woman with a high grade tumor such as mine (grade three), has a one-in-three chance of having it return within a ten-year period. That makes the case for chemotherapy. Period.

Dr. Stockdale noted that in Europe, surgery, radiation, and hormone treatment only would be given for a stage one tumor less than two centimeters in size. I asked what sort of results Europeans are getting with this. “They’re willing to accept a fifty percent reduction in risk of recurrence,” he said, “where in the U.S. we’re getting a seventy percent reduction in risk. So they’re willing to accept that. There are lots of reasons. Some are economic and some are philosophical.”

I asked Dr. Stockdale about long-term damage to the body from chemotherapy. “You have to realize,” he said, “you only get four treatments. Most of the toxicity that is long-term is in the cumulative phenomena. It’s total dose related. The cumulative doses for the treatment your doctor has recommended for you are tiny.”

Only four treatments. I wish they were already behind me.

2009-12-09T09:53:00.000-08:00

Two days after my first chemotherapy treatment, muscle fatigue has set in. I feel as though I’ve exercised strenuously and pulled every muscle in the body. The one thing my husband and I didn’t purchase for me was the powder that helps deal with that. Ah well, such is life in Chemo City. I asked friends to fill in for me on days like this. One such is Julie P., a woman I met when we worked for the same publishing house twenty-some years ago. Julie went on to work for the Los Angeles Times and Forbes Magazine. Today she lives and freelances in San Francisco, Calif.

I’m filling in for Juli while she’s having chemo treatments. I was touched that she would ask.

I have to confess, my reaction when I heard of Juli’s diagnosis was all too standard: shock that a friend—a contemporary—had cancer. After all if Juli, who had been healthy, took care of herself, and looked at least ten years younger than her actual age, could get cancer what about me? Compared to JC, I’m a slacker. Mine was a typical boomer reaction, both narcissistic and delusional. (How can we get sick? We’re not that old.)

Never mind that the Bay Area reports a higher than average rate of breast cancer, one that scientists still insist is mere coincidence. And that cancer runs in both my mother and father’s families. My paternal grandmother died of pancreatic cancer when she was only forty-seven. Her daughter, my aunt, received a clean bill of health at her annual physical only to discover a few months later that cancer cells in her cervix had spread to liver and would kill her before the age of fifty. And, six years ago I cared for my mother, a non-smoker, who was terminally ill with lung cancer. Her longtime doctor had said her coughing spells were due to asthma; by the time cancer was found she had only months to live.

So I have more than a passing acquaintance with cancer. I have seen the terror in the eyes of those who are diagnosed, how it devastates the body, and I have felt that strange mixture of relief and grief when a loved one dies of this ugly disease. I remember when a hospice doctor asked me if my mother had made peace with death. The man was young and earnest and I liked him. But his question made me angry. No, she hasn’t made peace with it, I told him. She wants to live and she thinks if she prays hard enough she will have a miracle and be spared. The young doctor backed away. I don’t know whether he was shocked by my answer or the ferocity with which it was delivered. He wanted my mother to have a tidy end. As her daughter and one of a clan of fierce women, I knew she would not go quietly.

So how do I explain that I had my first mammography this year at the age of fifty, even though my health insurance would have paid for screenings after forty? I rationalized that since no one in my family had been diagnosed with breast cancer, I was safe. I have since discovered that most women diagnosed with breast cancer have no family background of the disease. Juli who is more sensible than I when it comes to her health, caught the cancer in its earliest stage and her prognosis is good. I will cheer her on as she undergoes treatment and I will take better care of my own health. I will not let my dumb luck run out. I owe it to my husband, a kind and loving man, and my nine-year-old daughter who has yet to hear all the stories of our fierce women.

2009-12-08T11:48:00.000-08:00

When I was a child my family lived for a time in northern Maine. Once in a while little carnivals would come around. Pitched in a field on the edge of town, their amusement rides were rickety, their animals bedraggled, and their trappings slightly tatty. We loved every bit of it.

One thing I recall in particular were the “sideshow” exhibits, which are probably illegal today. They featured—invariably—the bearded lady, a two-headed boy, and pygmies with snakes. I expected, on my first day of chemotherapy for breast cancer, to feel a bit like the sideshow freak. “Step right up. See the diseased lady hooked up to the IV. Watch her dance around the room in delirium.”

Well, yesterday’s treatment wasn’t anything like that. From the start, the nurses and doctors were all fun and cracking wise. Everyone on the floor was there for the same purpose and was extremely kind. My husband, with his relaxed sense of humor, stayed with me all day. And it was a long one. We were there nearly six hours.

I did get off to a rocky start, I have to admit. When my nurse couldn’t find a good vein for the IV and had to remove it, I cried. My oncology doctor came in and asked how I was doing. “Terrible,” I told him. “I hate every bit of this, every step of the way. I still resent that this has happened to me.” My husband lightened up the mood by telling a funny story. When the treatments began we were all smiling. That’s the kind of day it was--up and down.

The actual treatments through the IV were all in clear bags and looked like gels. The slow drip began with a saline solution to flush things out. This was followed by Pepcid, to guard against acid reflux from the chemo. The next drip-drip was a mixture of steroids and sleep agent (go figure). Actually, the steroid was to reduce inflammation in the body. The sleep agent was to relax the patient for the chemotherapy drugs, which were delivered last. Along the way, the nurse explained a lot of things, gave me a two-pocket folder of information, and sent in a pharmacist to explain the raft of pills I was to take home. So far, the day after chemo, the only pill I’ve taken is Tylenol. Hooray!

I am a bit woozy, my face and neck are flushed from the steroids, and I’ve visited the bathroom a few more times than normal. I also keep looking around in a sort of paranoia. When do the other possible symptoms show up? The doctor talked about mouth sores, discoloration of skin and nails, hair loss, nausea, vomiting, rash, fever, fatigue, fluid retention, low blood cell counts, shortness of breath, poor appetite, bladder irritation and bleeding.*

I’m to use an electric razor, so as not to nick the skin and cause infection. I’m to avoid crowds and gatherings where I might catch a cold. Yet, the nurse said they don’t want me to “live in a bubble.” Ha! And happy holidays to you, too!

*Today's blog may contain more information than some want to know. I’ve included it because part of the reason for the blog is to help anyone newly diagnosed with breast cancer. One really has no idea what to expect. It is, indeed, a life changing event.

2009-12-06T08:27:00.000-08:00

We are fortunate, here in the San Francisco Bay Area, to have access to some of the most brilliant minds and research centers in the world. This week, I was lucky to be able to meet with Dr. Frank Stockdale, co-founder of Stanford University’s Combined Modalities Breast Cancer Program in Palo Alto, Calif.

The time spent with Dr. Stockdale, whose focus has been on breast cancer for the past forty-two years, answered many questions, raised even more, and went by much too quickly. I would’ve loved to have spent some time asking why, for example, the incidence of this cancer is high in some parts of the country and not in others. Much of what we discussed had to do with my particular case. But there were some items of broader interest.

I asked why breast cancer comes. Dr. Stockdale said, “Most, eighty-five percent, are sporadic. There is no reason.” This much researchers do know: The mammary glands are stimulated to grow with the estrogen (menstrual) cycle. After the cycle, the glands regress. After so many cycles of growth and regression, little errors in the DNA can creep in. These errors are replicated each time the glandular cells grow and shrink back. The end result can be cancer—the more cycles, the more years of growth and regression, and the higher the chance for errors to creep into the DNA.

I wondered whether birth control pills could cause breast cancer. Doctor Stockdale said there is no evidence to suggest they have an effect on breast cancer. He said, “They do probably prevent cancer of the ovary.”

Can a breast cancer patient ever really be cured, I wanted to know, or is there always a chance it will return? His answer was, “There’s always a chance it will come back. But you markedly reduce those chances by taking treatment now. If you look at the national data on deaths from breast cancer, since about 1985 they’ve been going way down. The only real explanation for that is adjuvant treatment because the disease is the same disease.”*

“I think you’re going to be cured,” he told me. “Your chances are approximately between eighty-five and ninety percent. That’s pretty good for a serious disease.”

Thank you, Dr. Stockdale. I’m glad for the opportunity to meet with you.

*Adjuvant therapy usually refers to hormonal therapy, chemotherapy, radiation therapy, or immunotherapy added after surgery to increase the chances of curing the disease or minimizing symptoms. Source: www.healthsystem.virginia.edu/uvahealth/peds_oncology/glossary.cfm

2009-12-05T15:11:00.000-08:00

A good neighbor, Chris, is of Dutch ancestry. She’s been following the fears I have posted on this blog related to undergoing chemotherapy treatment for breast cancer. She sent me the message below through e-mail. I shall take it to heart.

One of the last things my dad wrote (he died at age 93) was found in a notebook. My brother framed it, and I have it on the wall in my office. The saying, in Dutch, seems to rhyme and so Dad must have remembered it from somewhere (he had a pretty good memory for such things). I asked the priest at St. John’s in Ross, Calif. if it was a biblical reference about God not allowing us to bear more burdens than we could undertake. But the priest said he was not familiar with such a reference, and Fra Bart had a fantastic memory. I have a bible with cross references for specific words and I could not find anything quite like this saying under “burdens.”

“Een mens lijd dikwijla het meest,
door het lijden dat hij vreest,
dus heeft hij meer te dragen
dan God te dragen geeft.

Een leed dat is, is niet zoo zwaar
dan vrees voor allerei gevaar,
en komt het eens in huis
dan help God altijd mee te dragen naar zijn kruis.”

“A person's burden is often heaviest
for the suffering that he fears
thus he has more to bear
than God can give.

A sorrow that is, is not as heavy
than dreading all sorts of peril,
and if it once comes home
then God always helps one to bear the cross.”

2009-12-04T07:52:00.000-08:00

I asked several friends in my writers' circle to guest blog for me as I recover from chemotherapy treatments. Though my treatments begin next week, I find myself too agitated and unfocused to compose much today. So I'm running the first guest blog. It's from my friend Keri, an award-winning reporter I met seven years ago.

Today I started a new program, “29 gifts in 29 days (www.29gifts.org).” I have to give away something—anything—to someone else at least once a day for twenty-nine days. And I’m supposed to journal about it, and also keep a “gratitude” list.

I won’t go into why I would need such a program—that’s probably a topic for my own blog (soon to appear at www.KeriBrennerCommunications.com). Suffice it to say that my daily life’s “background soundtrack” has been focusing too much lately on what I perceive as my lack or failure or problems. By focusing on giving, I hope to turn off the negative feed and instead add juice to the part of me that is abundant and has something to offer.

So Juli, my dear fellow writer friend for the last seven years, the first gift goes to you: this blog post. You invited me to be a guest blogger for The Still Voice while you are recovering from chemotherapy, and I agreed. So the timing of this gift feels perfect.

Juli, I am so struck by your clear and passionate writing, as well as by your courage in facing your breast cancer diagnosis head-on and with a determination to be proactive in your treatment and your research. But, even you had some doubts about my e-mail recommendation that I was “sending you white light.” What was that, anyway, you asked?

Here’s my best extremely technical scientific answer: white light is the opposite of worry. I’m not sending you worry thoughts; I’m sending white light.

In my understanding of the world, thoughts are the energetic seeds that grow the stuff of physical reality. If your thoughts are full of worry, then you create more worry in the world. Thoughts of white light are for love, good health, abundance, happiness and joy.

I tell my mother in Philadelphia this all the time. When she says, “I’m worried about you,” I tell her, “Don’t send me worry; send me white light.” It took a while to convince her. But now, she does.

And so, in turn, do I to you.

2009-12-02T06:35:00.000-08:00

Recently I e-mailed a friend that beginning chemotherapy treatments on Pearl Harbor Day felt like going to one’s doom. She wrote back, “No, no, no. Pearl Harbor Day was the beginning of our fight against the enemy. Look at it that way.”

I can’t help it. When the treatment prescribed for a condition spawns whole books on likely side effects and how to manage them, I still say it feels like doom. The National Cancer Institute (NCI) has produced one such publication. It’s called Chemotherapy and You. This little book lists nineteen potential side effects. Here they are:

Anemia
Appetite changes
Bleeding
Constipation
Diarrhea
Fatigue
Flu-like symptoms
Fluid retention
Hair loss
Infection
Infertility
Mouth and throat changes
Nausea and vomiting
Nervous system changes
Pain
Sexual changes
Skin and nail changes
Eye changes
Urinary, kidney, and bladder changes

According to the booklet, some types of chemotherapy cause anemia because they make it harder for bone marrow to produce new red blood cells. The red blood cells carry oxygen throughout the body.

As my regimen calls for shots to be administered to boost the white blood cells, I think the white cell count is more of a worry. White cells are part of the immune system and fight infection. Apparently, about seven to fourteen days after treatment, the white cell count will be at its lowest. Fatigue and depression are common around this time. After this drop in the white cells, their numbers improve until the count is nearly back to normal. Then it’s time for the next treatment. This is, according to my oncologist, part of the reason why taking chemotherapy puts people on an emotional roller coaster.

Appetite changes can occur due to nausea, because the chemotherapy can make the mouth and throat feel sore, or because the recipient is depressed or tired. Ways to manage this include: Eating smaller meals or snacks instead of three big meals a day; drinking milkshakes, smoothies, juice, or soup; and using plastic forks and spoons. This last one surprised me. Some kinds of chemo leave a metal taste in the patient’s mouth, according to the NCI. Eating with plastic can help decrease the metal taste. Cooking in glass pots and pans is also said to help.

I’ve dealt only briefly with the first two side effects, and already I’m scaring myself. I’ll write about the other side effects another time.

2009-12-01T08:51:00.000-08:00

A friend recently gave me a Reader’s Digest cookbook called Eat Well, Stay Well. There is a two-page table in it that lists foods that fight illness. Of course, the foods that fight cancer are of interest to me, so I’ve listed them here:

Orange and yellow vegetables, which include tomatoes, red bell peppers, and chilies.
Dark leafy greens.
Cabbage family vegetables (broccoli, Brussels sprouts, cauliflower).
Garlic and onions.
Orange fruits (apricots and nectarines), citrus (including red grapefruit).
Berries, grapes, watermelon.
Whole grains.
Legumes (especially soy) and nuts.
Seafood.
Lean poultry.
Low-fat dairy products.

According to the table, the foods on the above list supply beta-carotene, lycopene, indoles, ellagic acid, other phytochemicals, folate, vitamins C and E, calcium, selenium, and omega-3 fatty acids. I’m the first to admit that about the only thing that’s familiar to me in all this are the vitamins C and E, and calcium. Okay, I have heard of omega-3 fatty acids (found in fish). But as for the rest, I will look up indoles and ellagic acid at a later date.

Somehow, it doesn’t seem right. I’ve eaten copious quantities of most everything on the list (save for watermelon, yuck), and I’m not so fond of broccoli. But I’ve consumed more than my fair share of the rest. Never smoked, don’t drink, take walks every day. Eat healthy, live healthy, die anyway. Or get cancer anyway, as the case may be.

I think, had I known that I would end up with breast cancer in my middle age, I might have done some wilder things in my youth. Maybe I would have smoked pot or dropped acid. Naw, probably not. One can’t fight one’s own nature—especially if it’s a conservative nature. But I could have shopped more often, laughed more loudly, and done more things with wild abandon. Come to think of it, I still can. Once this cancer war is won, watch out world here I come!

2009-11-30T12:37:00.000-08:00

Pigeons were out in abundance at San Francisco’s Union Square on Thanksgiving weekend. Herb Caen called them feathered rodents. That’s the thing I miss most in the San Francisco Chronicle, Caen’s column. With his tidbits, political jibes, and assorted oddities, he made every reader feel like a city insider. Caen was known to favor three-dot journalism. I have to say the three dot business is a handy way for putting random thoughts on paper . . .

Random thought #1 . . . Other things I miss are the holiday windows on Union Square. It used to be worth a trip into the city just to see them. There were magical animated wonderlands. There’d be kittens and puppies either vying for attention or hiding from view. The merchants didn’t even try this year. Their windows were filled with merchandise: evening gowns, jewelry, perfumes. There was nothing to evoke the season’s magic for the children. Nothing to delight the child in all of us. It left me feeling sad.

Sodden thought . . . Next Monday, Pearl Harbor Day, I start my chemotherapy treatments for breast cancer. I assume the one word is comprised of two: chemicals and therapy. The night before the first session, I’m required to take five steroid pills so the body doesn’t swell like a balloon. For five consecutive days afterward, there will be shots to keep up the white blood cell count. It’s obvious that chemotherapy is toxic to the system . . . Doesn’t sound very therapeutic to me.

I’m sure whoever first said, “The cure is worse than the disease,” had cancer treatment in mind. It’s all very brutal for the body and distressing to the soul. I can’t help but think that, if more men got breast cancer, a cure would be closer at hand. At least they’d find a way to deliver treatments that wouldn’t cause the recipients to lose their hair. Talk about adding insult to injury.

Radiation treatment follows chemotherapy for me. Only two weeks ago, Jeanne Rizzo, president and CEO of the Breast Cancer Fund, mentioned at a public forum that a less risky method is needed to screen for breast cancer because x-ray radiation is carcinogenic. Why, then, is the body bombarded with radiation in an attempt to keep the cancer from recurring? I don’t get it . . .

There is plenty I’m not “getting” today. That’s what makes this a three-dot day . . .

2009-11-27T09:06:00.000-08:00

The holiday season is upon us and with it comes the opportunity to see the San Francisco Ballet’s stunning production of The Nutcracker. When I see the television ads for it, I think back to the local ballet school I attended as a child in Germany. We put on The Nutcracker every year. Not that I had much talent. My mother, who attended Tanzschule Bier, a feeder school to the prestigious Wiesbaden Ballet in Germany, was the real ballerina. She danced with Tanzschule Bier as a young girl, before World War II destroyed everything.

In my novel, The Still Voice, the main character Sophia dances in The Nutcracker. Afterward, her mother Brigitte and sister Petra join her backstage. I thought I’d share that scene from the book today, in keeping with the season.

Tanzschule Bier prided itself on its Nutcracker ballet. Preparation for the Christmas holiday favorite began with new choreography, exacting rehearsals, and embellishment to an already lavish set. Sophia had practiced nonstop over the past three months and arrived at the studio well prepared for their one December opening.

The Biers were in a dither. Herr Bier had choreographed The Nutcracker’s “Waltz of the Snowflakes” for four girls. His wife had rehearsed it that way. This afternoon, hours before their opening performance, the lead snowflake had called in sick.

Thrust into first position, Sophia was full of confidence with one breath and tremulous with the next. While the couple revised the choreography for a trio of girls, she warmed up for the evening’s recital. When the new arrangement was in place, the wife led them through the steps until she was satisfied.

After Frau Bier had gone, Sophia ran through the routine alone. Clad in her practice leotard, her hair pulled back in a chignon, she imagined herself as delicate as the bone china cups in the Hettlage store window.

“Five, six, seven, eight.” She slowed to count out a difficult step, watching her feet in the mirror as they swept deliberately across the hardwood floor. When she had it, she resumed dancing to the phrases flitting through her head, then started for the dressing room.

On her way, she stopped to peek through the curtain. The house was starting to fill up. Unable to spot her family in the commotion, she closed the curtain and left to put on her makeup.

She was dabbing on blush when a gasp from the audience told her the performance had begun. She smiled at the reaction. Local craftsmen had carved a sumptuous and colorful set for the opening Christmas Eve scene. The company had hoped it would delight.

Sophia rocked her shoulders in time to the merry overture. When the downbeat for the march sounded, she hummed along: “Tum tata tum tum tum tum tum . . . tum tata tum tum tum tum tum . . . la da, la da, la da da . . .”

“Soph . . .”

Fellow snowflakes Steffi and Monika, the Biers’ daughter, appeared at her elbow. Could she go through the new steps with them one more time?

They rehearsed until the “Departure of the Guests,” then changed into their stiff, silver-and-white tutus. Monika helped Sophia pin her tiara in place. Then, hands and backs arched, they waited in the wings for their music.

Like wind-driven flurries, the trio whirled downstage. Oversized, tinseled flakes shimmered from above, reflecting the blues and purples of the spotlights. Fluffy theater snow swirled beneath their feet.

Sophia tilted forward on her right foot, on pointe, while extending her right arm upward. She stretched her left leg and left arm behind her. In this, the arabesque position, her body created a long, fluid line.

Using her arms for momentum, she executed a series of pirouettes. She was careful to focus, stage right, on one spot—and to snap her head quickly back to the spot as she completed each turn—so as not to become dizzy.

She spiraled and twirled in time to the music, weaving in and out of patterns with the onstage ensemble, like a splinter of ice in flight.

A subtle change in tempo brought out the principal dancers. The snowflakes guided them offstage to the Kingdom of Sweets. The curtain came down behind the players. Sophia was breathlessly in heaven.

When the second act began, she was beguiled by Tchaikovsky’s music for the “Arabian Dance” and his soaring composition for the “Waltz of Flowers.” Enthralled, she watched the performance from backstage.

When the last strains of the “Sugar Plum Fairy” pas de deux (dance for two) had dissipated, Sophia hurried onstage with the rest of the company. She held hands with the corps, blinked in the lights, and bowed. There were four curtain calls, flowers for the prima ballerina, and a standing ovation.

Sophia thought of the great companies of Europe, which often included youngsters. The famous Fanny Elssler was twelve when she became a professional. Marie Sallé debuted in London at age nine. There were the three “Baby Ballerinas” of the Ballet Russe de Monte Carlo, who’d reached stardom at the ages of thirteen through fifteen. Dared she hope to be in their company?

She was changing in the dressing room when the ballet mistress came in, followed by Brigitte and Petra.

“The performance was just beautiful,” gushed Petra. “The dancers. The costumes. The sets. Of course, the music is always wonderful.”

“You were so graceful,” said Brigitte. “My daughter, the ballerina.”

“There were several who were exceptional,” said Frau Bier, diplomatically. “But,” she said in a half-whisper, “Sophia is one I will recommend to the Wiesbaden Ballet.”

“Oh, wow,” beamed Sophia.

“Don’t get a swelled head,” said her mama. “You still have to help me clean house on Saturday.”

2009-11-24T08:31:00.000-08:00

I asked family and friends for guest blogs, as I thought voices other than mine would be refreshing in this space. My sister Deborah is my first guest blogger. Here is what she had to say:

When my sister Juli wanted me to guest blog on her site regarding her cancer experience, I at first thought it would be interesting. Now I feel like a ghoul participating in her illness. However, most people with blogs who have cancer are all about themselves. It’s kind of nice that my sister is interested in the family point of view. I have had numerous surgeries (not for cancer) and I kept telling her that it was only sleep. Juli told me that, before her lumpectomy, she had panic attacks about being attacked with knives. The surgery and pain meds. are the best part. Recovery is what sucks. My sister has never had surgery so she was very scared.

When I called our mom on October 9, 2009 and she said Juli had cancer, I did not want to believe it. I dropped the phone at work and cried and cried. My boss had me go into a quiet room to regain my composure. I was able to work the rest of the day. A friend from work said “Sorry for your loss.” I told him no one died. Actually I said, “My sister has cancer. No one died, you idiot!”

October 26, 2009

When I went to see Juli in recovery, her first words were, “Do I look like shit?” She did, but I said she just had a procedure. Juli cried and I held her hand. She said, “Why’d it come. I didn’t do anything.” I told her Dad had cancer. She reminded me that our dad smoked. He didn’t have lung cancer. But in Juli’s medicated state, her answer justified her meaning at the time. She was hungry and asked for food. The nurse brought graham crackers and apple juice. When Juli became nauseous, the nurse took the food away. Juli kept saying, “They took the food awayyyyy.” She reminded me of the kittens I rescue and nurse back to health. I wanted to wrap her in a blanket and make her feel safe, but that was a dumb idea. Juli is a grown person not a little cat. I noticed the word “Yes” on her breast. I guess that is where the incision was made. I told Juli, “Hey, biker tattoo.” I don’t think she caught the humor at the time.

Juli was going to have Thanksgiving this year. I know she is not strong enough for that so I am putting together a nice turkey dinner. We will meet at our parents’ house, which is closer for Juli. I just have to keep Mom out of the kitchen. I want to present a nice meal, which means an excuse for getting my hair and nails done also. You can’t present a lovely feast without looking lovely. I told my sister that when she figures out what treatment she will have, I can take her to the beauty college for a facial and massage. The students do very good work as it is part of their grading. We just need to wait to see how Juli will feel from day to day.

The sad part is Juli and I did not start to spend more time together until we got older. The last time we did something fun was window shopping and lunching in Sonoma. When I got up at the restaurant, I spilled water on her pants. They were white and she worried about them staining. That spill seems so trivial now. We still had a good day. I remember taking the ferry to the San Francisco ferry building with all of the shops. We window shopped and enjoyed the stores with their funky tchotchkes. The best time is when we saw the Bonesetter’s Daughter opera together. I never thought my favorite author, Amy Tan, would have an opera. Juli and I had such a beautiful day at the premier. I’m looking forward to more adventures with Juli. I hope she realizes that the strongest medicine is the will to survive. If she refuses to give in, she can beat this.

I love you, Juli.

Deb

2009-11-23T08:48:00.000-08:00

Doctors are testing everyone for vitamin D. It’s the latest thing and, apparently, we are all deficient. My husband, our neighbors, me, none of us has enough. We can get it from the sun, of course. But according to the nutritionist with my HMO, the sun has to be high in the sky for that to work. Peeking-through-the-clouds winter sun doesn’t count.

I asked the nutritionist about food sources of vitamin D. Here are a few: Cod liver oil, whole eggs, mackerel, milk (fortified with D), mushrooms, salmon, and tuna fish.

Too little vitamin D is thought to be a contributing cause of cancer. Though sometimes, it seems like that’s said about everything “under the sun.”

My original intent in seeing the nutritionist was to get some ideas to help withstand the treatments for cancer. While I was there I picked up some tips for better living overall.

We talked about fatty foods. In general, plant fat is better for people than that from meats. And we shouldn’t have trans or hydrogenated fats. Sources of good fat are unsalted nuts, olive oil, and avocados. Since fats can decrease the efficient function of the immune system, the nutritionist suggested less butter, cheese, and sausage. Julia Child would have cried; she loved all three!

One thing Julia Child would have adored: Five to nine servings of fruit and vegetables a day are recommended. I don’t know anyone who can stop to eat that often during a given day. But I got the point. Eat more fruit. Eat more vegetables.

There was the usual admonition to consume less sugar. It is cumulative in the body, and one should have under 12 grams (three teaspoons) a day, including what is consumed in food. Corn syrup and high fructose corn syrups are also bad. The recommended daily sodium intake was up to 2300 milligrams a day. This sounds like plenty, until one realizes that a teaspoon of salt holds 2400 milligrams.

There was the recommendation to eat more whole grains, brown rice, and sweet potatoes (the latter are full of vitamin A and beta carotene).

Red meat once a week is all right, so long as it’s lean. And while everyone is enjoying their turkey this Thursday, we should remember to eat the white breast meat as the dark meat found in the legs and thighs is fatty. That works for me.

2009-11-19T13:12:00.000-08:00

Last night I attended a community forum sponsored by the National Institute of Environmental Health Sciences (NIEHS) and the Bay Area Breast Cancer and the Environment Research Center (BCERC). The event was held in Sausalito, CA. What I learned can be found at the very tip of a monumental iceberg of research information. I thought I’d share the more interesting findings here.

Keynote speaker Dr. Linda Birnbaum, director of the NIEHS and the National Toxicology Program, spoke of the environmental triggers of breast cancer. She noted that it is a “major killer of U.S. women, and it’s an equal opportunity killer.” Contributors to breast cancer, she said, are obesity, stress, environmental toxins, and exposure to such chemicals as PCBs, dioxins, and BPA.*

Other factors being studied as possible causes of breast cancer include:

Chemicals used in beauty salons.
Exposure to diesel fumes.
Endocrine disruptors, which influence estrogen production. These disruptors can be found in plastics and in cosmetics.
Synthetic estrogens.
Flame retardants, which are used in everything from furniture to computers.
Certain pesticides.
Exposure to truck exhaust.

Dr. Birnbaum, and six distinguished panelists who joined her on the dais, addressed a wide range of possible causes of breast cancer. They did note that it is difficult to pinpoint any one cause because there are a number of different types of the disease. Panelist Jeanne Rizzo, president and CEO of the Breast Cancer Fund, noted that radiation is a carcinogen. For that reason, and others, mammography is not the best way to screen women. According to Rizzo, a less risky, non-invasive method of screening is needed.

Interestingly, it takes twenty to thirty years for breast cancer to develop in women. This is why one study is now following girls in puberty. Researchers want to know what “environmental factors contribute to early puberty and which exposures that occur in puberty may increase breast cancer later in life.” Parents are urged to encourage their daughters to maintain a healthy weight, exercise, and avoid using plastic products where possible. (Source: Puberty, Breast Cancer, and the Environment. A report from the BCERC.)

After the formal presentations, I approached panelist Janice Barlow, executive director of the Zero Breast Cancer organization. I wanted to know whether Marin County’s water supply is being studied, because the incidence of breast cancer is so high in Marin. She told me a study expected to be released in the spring of 2010 has identified five neighborhoods in the county with uncommonly high numbers of women with breast cancer. And yes, the San Francisco Bay Area water supply is of interest because of the prevalence of serpentine rock over which our water flows. Serpentine rock contains cadmium and asbestos, known carcinogens.

For more information on this forum and breast cancer research, go to: http://bayarea.bcerc.org/ and http://zerobreastcancer.org/.

*1. PCBs--PolyChlorinated Biphenyls, a mixture of up to 209 chlorinated chemicals. Although PCBs are no longer produced in the U.S., PCBs are still found in the environment. The manufacture of PCBs was stopped in the U.S. in 1977 because of evidence they build up in the environment and can cause harmful health effects. (Source: http://www.medterms.com/script/main/art.asp?articlekey=19548)

2. Dioxins--Dioxins are environmental pollutants. They have the dubious distinction of belonging to the “dirty dozen”—a group of dangerous chemicals known as persistent organic pollutants. Dioxins are of concern because of their highly toxic potential. Experiments have shown they affect a number of organs and systems. (Source: http://www.who.int/mediacentre/factsheets/fs225/en/index.html)

3. BPA--Bisphenol A is commonly abbreviated as BPA. As the building block of polycarbonate plastic and a component of epoxy resins, BPA is used in thousands of consumer products, including food packaging. Research suggests that BPA exposure may contribute to the epidemic of breast cancer now and in the future. BPA exposure has been shown to interfere with chemotherapy treatment for breast cancer. (Source: http://www.breastcancerfund.org/site/c.kwKXLdPaE/b.2638145/k.1E45/Chemical_Fact_Sheet_Bisphenol_A.htm)

2009-11-18T16:11:00.000-08:00

Sometimes we wonder where our donated dollar goes. Is it used wisely? Does most of it go to administration or does a healthy chunk go toward research? I can only speak for my little corner of the world, but I would like to put in a nice word for a program offered by the American Cancer Society (ACS).

The national program is called “Look Good . . . Feel Better.” The ACS bills it as a public service for cancer patients, “helping them cope with the appearance-related side effects of treatment.” I don’t have those issues yet. But according to the doctors, chemotherapy patients often lose their hair after the second treatment. When my hair falls out in clumps toward the end of this December, and the eyebrows and eyelashes begin to disappear, I believe I’ll be very glad I attended today’s seminar in Marin County, California.

The session was presented in two parts: Wigs, turbans, and hats for the newly bald, and make-up and skin care for the chemo patient’s suddenly over-sensitive skin. Both appealed to a woman’s vanity. But there was a lot of practical advice as well.

I had no idea that the skin becomes so sensitive to sun with chemotherapy that plenty of people can’t stand to be outdoors (even in winter sun) without being covered up or using creams to block the rays. Moisturizers, in general, were recommended because the skin dries out. Drinking lots of water to stay hydrated during the chemo months was also advised. I didn’t know that a sun block with SPF-15 is better for the skin as it is lower in chemicals. And I didn’t know that synthetic wigs can be cut, styled, and thinned. Now I do.

The ACS provided a goodie bag with lots of nice creams and make-up products. They also offered wigs, scarves, hats, pajamas and robes free of charge.

The ACS offers telephone-based education programs, a support network, and programs on nutrition and on managing cancer-related fatigue. Complimentary or reduced-rate lodging for patients traveling more than fifty miles to treatments is offered, too.

An especially valuable service provided by the ACS has to do with transportation. Volunteer drivers donate their time to take patients to appointments and return them home. This is a lifeline for people who become so fatigued with various treatments they cannot drive themselves. Imagine having to drive to radiation treatment five-days-a-week for six weeks and feeling too weak to do so. Even when friends and family offer their help, there are times when they can’t be there.

I have no affiliation with the American Cancer Society. Based on my experience today, I think they are doing a world of good. Their phone number is 1-800-ACS-2345. It operates twenty four hours a day.

2009-11-17T08:06:00.000-08:00

The other night my husband said, “Sometimes, when I’m in another part of the house, I hear you cry. It makes me feel sad because I don’t know what hurts. And I don’t know what to do.”

Naturally, hearing him tell me that made the tears flow all the more. It was such a beautiful thing for him to say.

How do I tell him that the tears are not so much about what hurts? There is still some pain remaining from my cancer surgery. It stems from the area under the left arm where the lymph nodes were removed. As I work to regain full mobility in the arm, pain shoots from the inner elbow to the shoulder. But that gets better every day. It’s not why I cry.

How do I tell him that it’s more about fear of the unknown? What will the chemicals used in chemotherapy do to the good cells in my body? Will there be permanent damage? How sick will I be? Will the radiation treatments that follow shrivel the targeted body part like a prune? The recommended five-year hormone treatments sound lethal. Will they give me uterine cancer or osteoporosis?

How to let him know it’s about loss of control? It’s about giving up half a year of one’s life to fight a disease, then changing one’s lifestyle forever to keep it in check.

How to tell him it’s about feeling like an alien on the planet? Marked. A leper.

How to tell him? Instead, I blurted out, “I don’t want to lose my hair.”

His response was as I’d expected. “It will grow back.”

Yes, of course. It will.

2009-11-16T10:06:00.000-08:00

The number thirteen is lucky in Germany. Being of German-Italian ancestry, I’d hoped this past Friday the thirteenth would bring some good news from my HMO’s oncologist. In short, I was hoping he’d recommend radiation treatment only following my breast cancer surgery. No such luck. Chemotherapy and radiation are both on the list.

I learned that oncologists use a software program called “Adjuvant! Online” to help them with their recommendations. The program, combined with a patient’s history, pathology slides, blood work, and mammography film, are the main tools employed. But let’s face it. When a pathologist grades a tumor as highly aggressive (grade 3) chemotherapy is going to be in the mix.

My tumor received a grade of 3, and my case seemed fairly straightforward. So I was beginning to question the need for a second opinion. Then this line in the paperwork given me by the oncologist caught my eye: The need for chemotherapy among women with hormone receptor-positive, node-negative breast cancer is controversial . . . That is my profile.

I went to the www.uptodate.com internet site (from which the oncologist had printed the papers he’d handed me) and learned that whether or not to recommend chemo for women with my profile is a major area of controversy. The benefits, according to studies conducted by the National Cancer Institute (NCI), are small.

What the NCI studies do recommend is hormone therapy. My oncologist recommends it, too. There are two standard types. One blocks estrogen in the body from telling cells to grow. The other inhibits the body’s estrogen production. The problem? One recommended drug can lead to blood clots and uterine cancer. Potential side effects from the other include arthritis and osteoporosis.

I am glad I’ve stuck with my decision to get a second opinion. But I can’t shake the feeling I’ll come away from it more muddled than ever. This whole business of selecting the proper treatment is a gamble. Anyone for a game of Russian roulette?

2009-11-10T09:11:00.001-08:00

I’ve been trying to decode the pathology report from last month’s breast cancer surgery. Given to me in advance of this Friday’s oncology appointment, I know the experts will go over it with me in detail. Already I’ve found some things I need to bring up. I like to engage in anticipatory worrying.

I understand the part about “no tumor seen in sentinel lymph nodes #1, #2, #3, #4 left axilla.” This is the most fantastic news. No cancer in the lymph nodes. But what does it mean when a node is “hot not blue?” Or what about the node that’s hot and blue? Then there’s one that’s “not hot not blue.” It’s all very mysterious.

I wonder, too, if I should be worrying about this note on the report: “Middle of tissue fell out with processing.” Did they lose something important? I gave up some body parts I was busy using during that surgery. I hope they didn’t misplace them.

There are two bits on the report that look quite serious:
--The removed tumor was grade three. According to Dr. Susan Love’s Breast Book, left on my doorstep by a generous friend, tumors are usually graded 1, 2, 3. The higher the grade, the more aggressive the tumor.
--From the looks of it, at least a portion of the tumor was comprised of comedo cells. Those sound nasty. They are cells that are stuffing the breast duct and are more aggressive.

What does all this say for the future? Oncologists base the treatments they recommend on these reports along with attendant slides, x-rays, and blood work. The forms of treatment, radiation and chemotherapy, are not to be taken lightly. Neither are the drug therapies recommended for the ensuing five years. Somehow, as helpful as Dr. Love’s book is, I cannot read much of it without becoming nauseous.

I’ve decided to give up my decoder ring for the rest of the week. It’s time to have some fun before this illness wraps me completely in its tentacles.

2009-11-09T08:46:00.000-08:00

It’s one month to the day since I was diagnosed with breast cancer. I have two surgeries behind me and treatments ahead of me. The shock and trauma to the body and psyche remain fresh.

Details from Friday, October ninth stand out in sharp relief. I was sitting in the chair I’m in now, typing on the same computer, waiting for the results of my biopsy. I remember looking at the clock at 9:50 a.m. “Please let them call me in the afternoon,” I thought. “If they call then, it’s benign. The morning calls will be to people needing appointments for surgery.”

At 10:05 the hospital was on the telephone. “We have your results. The slide came back from pathology marked ‘IDC.’ You have invasive ductal carcinoma.” I wrote down the details of my appointment with the surgeon. I hung up the telephone and let out what would be the first of several primal screams.

The irony of being diagnosed during “Breast Cancer Awareness Month" was not lost on me. There were many coincidences that day. My husband happened to be working from home (a rarity) before keeping an appointment with his own physician. I called him with my news just as he was walking into his doctor’s office. I learned later that my husband’s blood pressure shot so high that his physician did not proceed with a scheduled physical. “This might not be the best day to do this,” said his doctor. “Let’s talk about what’s going on at home.”

There was another irony. I’d skipped my mammogram screening the previous year and thought I might wait until the spring of 2010. I felt fine. Life was good. Why put my upper body through torture? My husband and my primary care physician both harped on me to get a checkup. I went to please them.

When the radiologist called after my initial screening, she had to browbeat me to come back. (I thought she was seeing a benign area on the x-ray that had been discovered years before.) I could almost feel her hopping up and down on the other end of the phone. This did not bode well. So, I went back for another mammogram, an ultrasound, and a biopsy.

The people who browbeat me into getting a mammogram saved my life. Maybe there’s a woman you care about who is tempted to skip her yearly screening. Please don’t let her do it.

2009-11-06T11:33:00.000-08:00

The HMO that I belong to is being very thorough. So am I. Between the two of us, my post-cancer life will be well researched.

There are appointments to be kept and lists to be made. My surgeon wants to check her work. The HMO’s oncologist will recommend a course of treatment. (His opinion will be one of three.) The nutritionist will recommend a diet to be followed during treatment and beyond.

Meeting with the nutritionist was my idea. There are so many urban legends, and myths, about substances that cause or feed a body’s cancer that I’d like an expert to help me sift through them.

Among the urban legends is an email currently in circulation and entitled: “Cancer Update From John Hopkins.” When I read the email sent by a friend, I thought, “Shoot me now.” According to the report I could not drink tea or coffee, take sugar, or eat chocolate. Milk, according to the list, was out. So was red meat. Then a red flag went up. The institution’s name was misspelled. It is called Johns Hopkins, with an “s” after the word John.

I went to the Johns Hopkins internet site and found that the “cancer update” is a hoax. So I’ve taken the liberty of copying some of the institution’s real recommendations here:*

“While there is such a thing as tumors that produce mucus, the mucus made by a tumor does not result from drinking milk. And eating less meat, while a good choice for cancer prevention, does not free up enzymes to attack cancer cells, explains cancer prevention and control expert Elizabeth Platz.

“Moderation is key, says Platz. As part of a balanced diet, sugar, salt, milk, coffee, tea, meat, and chocolate—the foods the ‘Update’ calls into question—are all safe choices, she says. The real concern with many of these, particularly sugar, is that it adds calories to a diet and can lead to obesity, and obesity is a major risk factor for cancer. A balanced nutritious diet, healthy weight, physical activity, and avoiding alcoholic drinks may prevent as many as 1/3 of all cancers. Platz recommends eating at least five servings of fruits and vegetables per day and limiting red and processed meats, like hot dogs.

“Several Johns Hopkins experts participated in the World Cancer Research Fund - American Institute for Cancer Research report Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective, published in November 2007, which is considered by cancer prevention experts to be an authoritative source of information on diet, physical activity and cancer. Their recommendations for cancer prevention and for good health in general are:
1. Be as lean as possible without becoming underweight.
2. Be physically active for at least 30 minutes every day.
3. Avoid sugary drinks. Limit consumption of energy-dense foods (particularly processed foods high in added sugar, or low in fiber, or high in fat).
4. Eat more of a variety of vegetables, fruits, whole grains and legumes such as beans.
5. Limit consumption of red meats (such as beef, pork and lamb) and avoid processed meats.
6. If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day.
7. Limit consumption of salty foods and foods processed with salt (sodium).
8. Don't use supplements to protect against cancer.”

*This is the link to the Johns Hopkins site: http://www.hopkinskimmelcancercenter.org/index.cfm/cID/1684/mpage/item.cfm/itemID/1016

2009-11-05T12:02:00.000-08:00

I will never forget my father’s eyes when he came home after colon cancer surgery. Chocolate brown with long dark lashes, they were saucer huge. But it wasn’t so much the size of his eyes as it was the look in them. It was haunting. I asked him once whether he’d noticed. “No,” he said. But others noticed, too.

“Where else will the cancer spread?” his eyes seemed to say. “How bad will the treatment be? Will family and friends treat me differently?”

His fearful eyes made me want to hug him, though my father is not the hugging kind. Instead, I watched a tape my brother once made. Old and grainy images of our family, some dating to the 1950s, flitted across the screen. There were plenty of holiday gatherings, good food and drink on the table. Smiling relatives were in abundance. There were images of me as a four-year-old getting a ride on my father’s shoulders. Daddy’s girl.

I spoke with my father this morning about my upcoming oncology appointment. “Everyone’s cancer is different,” he said. “Listen to what they tell you. Ask good questions. Once you decide on a course of treatment, follow it to the letter. Bring a good book to read if they recommend chemotherapy. You’ll be sitting there quite a while.”

Thanks Dad. And thank you for letting me ride on your shoulders.

2009-11-04T10:57:00.000-08:00

I’m convinced the second day after a surgery is the worst. The relief that the surgery is over has dissipated. The mind races with things to do and places to go. The body is unwilling to cooperate. In short, it’s a down day.

I recently read an interview with author Barbara Ehrenreich in the San Francisco Chronicle. Diagnosed with breast cancer ten years ago, she became angry at “exhortations to be positive . . . because it will make you better. It was either smile or die.”

According to the article, Ehrenreich realized that “positive thinking was more widespread than she’d imagined. It was not only touted as a force against breast cancer, along with cheerful pink ribbons and stuffed bears, it was fundamental in our self-image and national character.”

Ehrenreich has written a book called Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America. It explores what Ehrenreich calls America’s happiness industry, which she believes is partly responsible for everything, writes her interviewer, from “our slide into war to the economic crisis.”

I have not met Ms. Ehrenreich, nor have I read her book. Already, I love this woman. No one is cheerful every hour of every day. It’s not natural. And I agree that constantly promoting positive thinking can be counterproductive.

For example, I worked for a time in the marketing department of a software company. From gatherings in its conference rooms to lunching in break rooms to one-on-one meetings, cheerleading for the company and its products was not only encouraged, no other outlook was tolerated. The atmosphere was not healthy. Personnel problems could not be addressed because they often were not acknowledged. The marketing department would tout new product features in company brochures while software engineers were expunging those very features because they did not work. How positive is that?

A positive attitude can go a long way toward bettering one’s health and even growing our economy. But I do agree with Ehrenreich that “relentless positive thinking is something from which we must be weaned.”

2009-11-03T12:00:00.000-08:00

Bringing Julia Child’s book My Life in France with me into surgery yesterday was probably not the brightest thing I’ve ever done. Her descriptions of France are wonderful; her detailed recollection of meals eaten in the 1940s is astonishing. However, instructed as I was to eat and drink nothing before my operation, I grew lightheaded when I came to the passage about sole à la normande. She calls it “a poem of poached and flavored sole fillets surrounded by oysters and mussels.” Yum!

I was having my second surgery for breast cancer in eight days. The first one removed the tumor. This second operation was to create a larger margin around the tumor site to prevent the recurrence of cancer. As the scheduled time for my operation stretched from 1:30 p.m. to 3:00 and finally 5:20, I had visions of crêpes flambées and tasty fromages flitting through my head.

Mind you, lying around on a gurney awaiting surgery for four hours is not all peaches and cream. I howled when the nurse inserting the IV couldn’t find a vein. (It took three tries, and wow did it burn.) She took my face in her hands when I burst into tears. “It’s okay to cry,” she said while she held me.

“Why so many of us?” I sobbed. “Why does it happen?”

“The good news,” she said, “is they’re getting closer to a cure.”

We discussed that for a while. Both of us were angry, knowing that too many research programs exist to perpetuate employment for scientists. There is too much scrambling for grants and duplication of effort when there should be more focus on a cure. One in eight women worldwide will have breast cancer. Every thirteen minutes a woman will die because of it.

The nurse and I both noted something else. Of the thirteen women I’ve spoken to about their own experiences, eleven have been stricken in the left breast. The nurse, one who travels “on assignment” throughout the country, has noticed the same. “Why,” she said, “is it always on the left?”

Nobody can say. And wouldn’t you know it, I’ve come to that portion of Julia’s book where she describes roasting a full-breasted duck with minced shallots and wine. How’s that for an ending to today’s blog?

2009-10-30T15:21:00.000-07:00

Gallows Humor

Five days following surgery for breast cancer I was finally able to remove the last of the bandages. I’m convinced the hospital uses super glue to make them stick. Likewise, I was able to scrub the word “yes” from my shoulder. The word was printed there, with purple ink, to indicate the correct body part to be operated upon. I should have left it there. I have to go back for more surgery November 2, 2009.

The reason for the second operation is good. The top edge of the margin, where the tumor was, is only one millimeter. It should be at least two. The surgeon wants to take out more tissue to guard against recurrence of the cancer. I’m calling it my one millimeter operation.

Following this past Monday’s surgery I was a colorful mess: Orange from the antibacterial scrub. The purple word “yes” written on my arm. White bandages. Green, red, and purple bruises around the area of the incisions. I will not miss being a rainbow.

I’m already thinking of the radiation treatment, which I will likely have to undergo in the next few weeks. It is said to shrink the breast by one bra size. Where does one shop for a bra with mismatched halves?

Now for the cliché parade I’ve been seeing in the past few weeks: Hang in there. Keep on keeping on. That which does not kill you makes you stronger. Better safe than sorry. You’re doing great. You’ll be fine. Think positive. Relax.

A sharp-eyed friend noticed I posted a blog this morning, which I’ve taken down. Too serious. I’m more fortunate than so many who have more advanced stages of cancer, and I know it.

2009-10-29T12:41:00.000-07:00

I’ve finished up reading The Guernsey Literary and Potato Peel Pie Society. What a delightful book! I’m so glad I picked it up the day before my surgery. It saw me through and then some. Of course, the subject matter, the occupation of the Channel Islands by the Germans during World War II, immediately captured my interest. My own novel, The Still Voice, takes place in Germany during the war.

I laughed out loud when I came to this line from the central character’s publisher in the Guernsey story: “Strings of anecdotes don’t make a book.” The first draft of my manuscript was a string of anecdotes culled from relatives about their wartime experiences. A book they did not make. Several drafts later I had San Francisco author Adair Lara critique the manuscript. She sent me an email, effusive with praise and including several pages of suggested changes--some of which I even took! She did write: “You have two books in one. You must change the ending.”

I’ve changed the ending. But I do still love the original, as it winds up with the romance that flourished between two people who became my parents.

There is one anecdote from the original ending that is dear to me. When my parents met in Wiesbaden in 1947, my father owned a huge shepherd dog said to have been a member of Erwin Rommel’s Canine Corps. My father would tuck love notes to my mother into Ivan’s collar. The dog would walk them from my father’s office to Mother’s home. One day, a friend of my father’s saw Ivan board a bus. Apparently, the dog had previously ridden the bus with his master and figured out a quicker way to deliver his notes! When the driver told Ivan, “Not you. People only,” Ivan bounded to the rear of the bus and climbed aboard. A smart but lazy character, that was Ivan.

If I ever get to write a second book, I hope I can include the romance that flourished in the rubble of WWII--and, of course, Ivan.

2009-10-28T11:15:00.000-07:00

My favorite aunt, Maria, is ninety-four and lives in Bavaria. As I reside in Northern California, the distance between us is great. I miss her terribly.

I love the image I have of her in my mind. She’s sitting at the dinner table, eyeglasses dangling from one hand, the other hand wiping tears of laughter from her eyes. So often full of silliness, my aunt Maria loves to laugh.

I’ve managed to keep her near me by patterning a character in my novel, The Still Voice, after her. Like my aunt in her younger days, the character is a member of the Wiesbaden Swim Team. She’s adventuresome and pretty fearless.

Maria survived World War II living in a small town about an hour northeast of Wiesbaden. A story she loves to tell happened after the war was over. Her husband, imprisoned in a POW camp, had escaped and hitchhiked home from the Russian Front. He had her open a surprise he carried with him--a tin of bacon he’d managed to pick up along the way. She worked the metal key around the edge of the tin. When it sprang open, the bacon was full of maggots. What did she do? She squeezed the maggots out into the kitchen sink and fried up the bacon. The grease, she said, would make good oil for cooking!

Desperate as those times were, my aunt never lost her sunny outlook. One of her favorite sayings is, “Every day is a gift from God.” As a fifty-year breast cancer survivor, she has every right to say that.

This morning her son and my favorite cousin, Dieter, called to see how I was doing after my breast cancer surgery. I had to admit it’s a cranky day. The incisions burn a bit. My throat is sore from having had a breathing tube stuck down it. I feel weak. As I complained, I had to remember this operation saved my life. From now on, every day is a gift from God.

2009-10-27T07:54:00.000-07:00

Three little elves left flowers and cards on my doorstep last night. My heartfelt thanks to them, and I wish I could join them at our book club meeting tonight. The spirit is more than eager. The body is feeling puny.

I’ve come through Monday’s surgery pretty well. I’m now a one-day breast cancer survivor. It’s a sisterhood I never aspired to join. Since my diagnosis, I’ve discovered we are legion. From the admitting nurse who checked me in to the nurses who cared for me, many had stories of their own to share. They held my hand and calmed my fears. I owe them a great debt of thanks.

There was good news yesterday, too. The HER2 test result, which indicates the aggressiveness of the cancer, was negative. That news, moments before surgery, gave me great relief. There was even greater relief afterward. The surgeon told me my lymph nodes were clear. It will be a few days before the final pathology report. But things are looking up.

A great big hug to my family who has been there for me and came to me right away in the recovery room. More hugs to surgeon Marla Anderson and her wonderful crew. And smiles all around to my book club friends. I think they’d be happy to know I spent the preoperative part of yesterday reading The Guernsey Literary and Potato Peel Pie Society. It’s a marvelous book given me by a friend in my writers group.

As writers doing our solitary work, we tend to feel all alone. I know now I need never feel that way again. For today it’s back to some rest, that cup of coffee denied me before surgery, and my book. I can hardly wait to read more!

2009-10-23T09:19:00.000-07:00

What the human being can adjust to is amazing. Two weeks ago I was devastated at being diagnosed with breast cancer. Now I’m ready for my surgery. The tumor has to come out so the healing and the treatment can begin.

That doesn’t mean I’m not angry at having to go through it. Because I am. It doesn’t mean I’m not scared stiff. Because I’m that, too.

I’m looking at a rock sitting next to my computer. It’s painted with a pink ribbon and the word “courage.” I chose this rock among several on the breast care coordinator’s desk when I was at the hospital. It spoke to me as courage is the theme of my novel, The Still Voice. Years ago, when I began the research for my story, I was visiting a neighbor who handed me a book. “You’ll find this interesting,” she said, “as you’re questioning how the very young can be so daring as to stand up to their government.”

The book was called Conscience and Courage: The Rescuers of the Jews during the Holocaust. Its author is Eva Fogelman. There were a number of articles that interested me in that book. One in particular noted that, in rare instances, a young person has a keenly developed sense of justice. More likely, the youngster has an older role model in a parent or sibling. My character Sophia’s role model is her much older brother Max. The bond between the two is one I love because it is drawn from my mother’s relationship to her brother, who was twenty years her senior.

I was motivated to write The Still Voice because of family stories I’ve heard throughout my life. I’d heard many as a young girl living in Germany, and more when I visited in 2007. The stories do not grow richer over the years. They gain an added perspective. I suppose when I reach the age of ninety-four, like my aunt Maria in Germany, the year I had breast cancer will have better perspective. Right now, I can’t put how I feel about it into print. This is not a profane blog.

2009-10-22T08:19:00.000-07:00

An exquisite little glass pumpkin arrived on my doorstep yesterday morning, a gift from a dear friend in my writers group. It was a magical start to an intimidating day. I spent five hours of it in a series of preoperative meetings at the hospital.

It’s all such a jumble. There were forms to fill out and co-pays to pay. There was an electrocardiogram and two blood pressure checks. Results from more tests were in. Everything looks perfect. I’m the picture of health. Couldn’t the breast cancer be a misdiagnosis? No, it’s all too real. My surgery is scheduled for October twenty-sixth.

I told my physician I expect to spend the twenty-four hours before the operation alternately fainting and vomiting. She told me to listen to the “affirmations CD” the hospital has provided. Apparently jumpy-as-a-cat, Type A persons are not welcome on the surgeon’s table.

The soothing affirmations CD, it turns out, can even be listened to over headphones during surgery. It’s remarkable what’s available these days. I learned that sprays for the tongue can be had to relieve anxiety and help with sleep. I’ll be looking for these in the supermarket today as I wake with panic attacks every night. I have a mortal fear of being cut open with knives.

I asked the surgeon about the chance of cancer recurring with a lumpectomy (tumor is removed) compared with a mastectomy (takes the whole breast). The treatments, she said, are equal. With lumpectomy, the percentage of recurrence stands at between eight and ten. In mastectomy, the percentage is about four. But when cancer returns in the area where a breast has been removed, it will be closer to the bone and more dangerous.

I am blessed in so many ways. I’m an excellent candidate for a lumpectomy. I have a surgeon with a fantastic reputation, someone who is sharp and nice--a rare combination. The survivability for my type of cancer is high. And I have a supportive network of family and friends. Thank you all for being there.

2009-10-21T08:29:00.000-07:00

People really don’t know what to say on hearing bad news. The reactions to my telling family and friends about my breast cancer diagnosis range from touching to amusing and just plain odd. I thought I’d write about some of the responses today.

One friend called to cheer me up and told me about her own health issues. She concluded with, “Of course, I can’t imagine getting your diagnosis. I haven’t had anything that catastrophic happen to me.” Thanks. I feel better now.

Another friend wanted to analyze my medical condition. Later she sent me an email and parroted some of the things I’ve written in this blog back to me. That was odd.

Much of what’s happened has been beautiful. In all our lives, my brother and I have never exchanged words of endearment. When he learned of my diagnosis he called to tell me that he loves me. My husband said, “When you love your wife, you do everything you can to help her through it.” My mother brought roses and baked me a cake with plums I’d given her from the produce mart.

Some of the emails I’ve received have been eloquent. I’d like to share a few of them:

“I wanted to let you know that you continue to stay on my mind and in my heart. Sometimes I speak my thoughts out loud to you; just know I am sending you constant thoughts of love, care and healing. I hope you can feel my thoughts embrace and hold you with tender love.”
--Cheryl H.

“I am so sad to hear of your recent news. I read every word you posted on your blog. You are an amazing writer and I can’t wait to read your novel when it goes to press. Sophia intrigues me. I was deeply moved this morning reading your story and the courage and tenacity you are exhibiting facing your cancer. I’m rooting for you.”
--Tracey R.

“You are probably saying what so many women think but are afraid to say and I appreciate it so much. With your wonderful gift of writing, you are telling others that it is okay to have those feelings, to cry and to be angry. I have only been able to imagine what someone just hearing that you have breast cancer can be thinking, now I can know and thank you for that. I think your blog will help many. My best thoughts and prayers.”
--Sue O.

Then there was the friend who called to tell me of her double mastectomy. I should keep blogging, she said. It was good that I was reaching out. I asked whether she’d told anyone of her diagnosis. “No,” she said. “People have a tendency to write you off.”

Nobody had better write me off. If they do, I’ll come back and haunt them.

2009-10-20T07:13:00.000-07:00

Lately I’ve been talking to the offending body part. “What’s the matter with you? Why are you turning on me? What have I done to you?”

I’m curious whether others who receive a diagnosis of serious illness talk to the affected organs or limbs. At least I can see mine. I can’t imagine directing questions to a pancreas or spleen. Where would you even look?

Doesn’t matter. I’m not getting any answers.

They say the first thing a woman does when she’s diagnosed with breast cancer is to question how she might have gotten it. Which of life’s choices could’ve led to it--garden pesticides, household cleaners, birth control pills, children/no children, hormone replacement therapy/or no HRT, alcohol, smoking or second-hand smoke, our drinking water?

Some years ago a survey was done in Marin County, Calif. because the county’s incidence of breast cancer is so high. I had to laugh at some of the theories that surfaced afterward. One of them postulated that the women of Marin drink more alcohol and are more apt to subscribe to HRT. Well, a liver dysfunction has prevented me from drinking alcohol these past twenty years, and I never had hormone treatments. Let’s broaden this research.

On November 18, 2009 there is a community forum to do just that. It will look at the connection between breast cancer and the environment. I hope I am strong enough to go. The forum will be held from 7:00 to 9:00 p.m. at the Cavallo Point Lodge in Sausalito. The keynote speaker is Dr. Linda Birnbaum, director of the National Institute of Environmental Health Sciences and the National Toxicology Program. The event is free, but they want people to register at http://www.zerobreastcancer.org/. (The site also gives seven ways to reduce the risk of getting breast cancer.)

Maybe I will see you there.

2009-10-19T09:39:00.000-07:00

I declared a moratorium on discussing breast cancer over the weekend. I’ve spoken nonstop on the subject since my diagnosis ten days ago. I’ve talked with survivors and researched it on the internet. I’ve met with my surgeon and my husband’s physician, a man who generously gave of his time to answer lingering questions. Sometimes we can know too much.

I have to think of the German people during World War II, the era in which my novel, The Still Voice, is set. As the war progressed they were told less and less. In fact, while German soldiers were dying in Russia by the thousands, Hitler’s Propaganda Minister Dr. Joseph Goebbels gave speeches proclaiming how well the war was going. Of course, the truth filtered out in letters the soldiers mailed home. No wonder Goebbels’ radio broadcasts became known as “Clubfoot’s Fairytale Hour.”

In the spring of 2007 I stayed a week in Wiesbaden, Germany with a childhood friend of my mother’s. On a walk through their old neighborhood, the woman pointed out a jail near the street where my mother had lived as a young girl. “We thought the Jews were being held in that jail,” she said. “Can you imagine? It has seven cells.”

Wiesbaden’s Jewish population stood at its highest in the 1920s, at a little over three thousand. By the start of the war, their number had dwindled to twelve hundred. In 1942, the city’s remaining Jews were deported to death camps. The citizens of Wiesbaden were told the Jews were being resettled in Theresienstadt--a spa city to which they could retire in safety.

Sometimes one can know too much. I wonder what course World War II would have taken had the German people known more.

2009-10-16T08:05:00.000-07:00

This morning I’m thumbing through a little book that dates back to 1896. Its German title translates to “Solace for Troubled Hearts.” It was my grandmother’s, and I can see by the worn brown-speckled cover that it was much used.

My grandmother did not have an easy life. She worked on a farm in Bavaria alongside her parents and several siblings. When she was old enough, she became a nurse in a hospital in the big city of Wiesbaden. She endured World Wars I and II. She met her husband, a handsome mounted patrolman, while working at the hospital. They say when you marry someone beautiful that you never have all of them; part of them belongs to the world. From what I understand, my grandfather spread himself around fairly well.

In my novel, “The Still Voice,” the main character’s mother Brigitte quotes from the Solace book now and again. On one particularly hard day, she reads this quote to her daughter, Sophia: “I will pray. God will give. From him, all things flow. Light and joy, solace and life, as though from a bountiful sea. I will pray. God will strengthen. Should I encounter stormy skies, prayer will still my soul. I will pray. God will save . . .”

Reading through this slender volume makes me feel closer to my grandmother, gone almost thirty years now. I often wonder which passages were her favorites and wish I shared her strong faith. It is sometimes hard to believe there is a God. Why would a God visit the scourge of cancer on this earth? Why would a God make the children in the slums of India and Africa suffer so?

There are too many things for which we have no answer. I do know that my beautiful pragmatic grandmother would not have tolerated these maudlin musings. She loved to laugh. She lived to the age of ninety-one. I’m sure she would say that her namesake granddaughter will, too.

I will pray. God will strengthen. Should I encounter stormy skies, prayer will still my soul.

2009-10-15T09:17:00.000-07:00

Last weekend I spent an afternoon with a wonderful friend whose husband works for Genentech. We talked about the advancements in cancer treatment the company has made. I’ve taken the opportunity to investigate Genentech’s web site. I scared myself pretty good.

According to Genentech’s research, more than 192,000 American women will be diagnosed with breast cancer in 2009. More than 40,000 will die from the disease. Women with HER2-positive breast cancer are at a “much higher risk for early recurrence and death as a result of their disease, compared to women with HER2-negative breast cancer.” My HER-2 results came back “undetermined” and have been sent to a San Francisco lab for further analysis. I should know the results one week from today.

There is plenty to worry about, and naturally I’ve been obsessing over every bit of it:
--I worry about the drugs administered before surgery as I have a dysfunction in the liver that prohibits processing alcohol of any kind. Lately my system has reacted badly to the most common cold medicines (anything with Sudafed is out). Even prescription eye drops caused headache, nausea, and rapid heartbeat.
--I’ve spoken with a woman who underwent two surgeries on the same breast, the second one much more radical, because “clear margins” weren’t obtained with the first surgery. Getting clear margins is critical because it means the cancer cells in the tissue surrounding the mass itself have all been removed.
--I’m afraid the surgeon will want to prescribe Tamoxifen, which is standard practice for women with estrogen-positive tumors. Tamoxifen blocks the growth of cancer cells. Its side effects include: blood clots, strokes, uterine cancer, and cataracts. Other than that, piece of cake. Whatever side effects there are, I know I can expect to have them in spades.
--I worry about which treatment method to choose following surgery. I’ve known one individual who had only radiation following her surgery. Her cancer returned, and she passed away within a year. Everyone I know who has had some form of cancer, and chemotherapy thereafter, has survived many years. The very thought of chemotherapy makes me shudder.

My father, who had colon cancer at age 78, is my role model. He is a survivor and will be 82 this December. Everything has to turn out well for me. My father has already signed me up for the breast cancer walkathon in October 2010.

2009-10-14T08:02:00.000-07:00

The response to my blog yesterday was overwhelming. I’m grateful to everyone for the telephone calls and emails of support. I thank the neighbor who raced to my door to deliver a hug and a good dose of humor, both so important. I’d also like to thank a breast cancer survivor in my book club and her husband. Their calm solid advice in those first hours following my diagnosis was critical to saving my sanity. Though, they say writers have no sanity. But that’s a discussion for another day.

It’s amazing to me how many women in my small circle have had breast cancer: three in my book club, two neighbors within a stone’s throw of my house, a close friend’s sister who had a double mastectomy this June.

The surgeon who will operate on my tumor tells me the survival rate is now eighty-five percent.
She called me yesterday with good news. My chest x-ray shows the lungs are free of cancer cells. The blood work shows the liver and bones are clear as well.

There are so many medical terms I never thought I’d have an interest in or need to know. My HER2 report came back undecided and has been sent to a lab for more analysis. According to the Mayo Clinic, HER2 stands for human epidermal growth factor receptor-2. If the HER2 report is positive, that means the cancer is more aggressive.

I’ve been thinking of the hours I spent researching osteomyelitis, a bone infection I gave to the main character in my novel, The Still Voice. How dry that research was compared to what I’m looking into now. Still, for my character Sophia, the news that she had osteomyelitis in her foot was no less devastating. Imagine being a young girl in a prestigious dance school—a feeder school to a major ballet company—only to be told you should not dance. That story is taken from real life. It happened to my mother.

Ironically, Hitler’s Propaganda Minister Dr. Joseph Goebbels suffered osteomyelitis when he was a boy. An operation on his left thigh was unsuccessful and left that leg shorter than the right. He was crippled for life.

That’s all for today’s report. Its focus is more medical in nature than I’d intended. The content will probably be different every time, and it will come out on a semi regular basis.

Juliane C.

Summoning Courage

2009-10-13T08:31:00.000-07:00

Welcome to October. My favorite month of the year. It's now five days since I've been diagnosed with breast cancer. I'm yet another woman in Marin County, California with the disease. It's epidemic, and I feel like a statistic. I'm trying to summon the courage I've given Sophia, the character in my novel, The Still Voice. Sophia experiences many hardships growing up in Germany during WWII--some of them at the hands of the Gestapo. She joins the Edelweiss Pirates to fight the Nazis, to avenge what happens to her as a young girl.

I don’t feel courageous this morning, October 13, 2009. When my husband’s alarm woke us both at four thirty I was babbling, “There’s a yellow bus. I could step in front of the bus, and it would be over.” He saw it as foolish talk, for which I’m glad. I don’t want to step in front of the school bus that circles through our valley every afternoon at three o’clock dropping off schoolchildren. Though it certainly would simplify things. There’d be no more looking for an agent or publisher. There’d be no facing a battle with cancer.

I thought it would help my morale to talk about it with friends and family. It has. Now I’m talked out. I don’t want surgery and radiation. I don’t want to know if it’s spread to my liver, lungs, lymph nodes or bones. I don’t want to worry if I should have chemotherapy, too. I just want my life back. I want to revel in writing every day, finding the perfect words for my story. Why me? Why this? Why now?

I’m starting to cry again, and have to stop writing. I’m sure I’m the world’s biggest baby. Millions of women have faced breast cancer with the courage of my Sophia. I’ve never written a blog before. I wonder why I’m doing it, except for the fact that I’m a writer. It’s what I do.

Juliane C.