Finale

Today marks the day one year ago that I discovered the lump. Due to the discrepancy between the Jewish and Gregorian calendars, the Hebrew date of discovery is some two weeks away, marking also Israel’s Independence and 60th birthday.

Regardless of the culture that defines the time period, the completion of the seasons’ cycle behoves me to reflect on the last year and to take stock - what is called in Hebrew, a heshbon nefesh.

For sure, the discovery of a life-threatening disease and its aftermath makes its mark on one’s life on a physical, emotional and mental plane. How could it not? Death had been way down the road and here it was threatening to take up residence right next door. Initially, the changes were primarily physical, while the soul and the psyche struggled with the existential import of what the body was forcing them to endure.

One year later, the physical remnants of that horrendous diagnosis are mellowed but extant. My breast bears the faintest scar, which will no doubt continue to fade over time. It is still swollen from the radiation, though to my eye, grown obtuse from over-familiarity with its contours, the swelling is barely discernable and to the casual eye, is a perfect match of its twin (perhaps it is necessary to point out that I am using a turn of a phrase because no casual eyes have in fact been scanning my breasts). Ironically, the breast, despite being the source of all the trouble, is the least physically affected part of my body. Rather, my left arm, with its lymph node population reduced by 15, is still sensitive in that lying on it or moving it beyond still unascertained boundaries causes pain, or at least, discomfort. Some areas of my upper arm are still numb and it is uncertain whether normal feeling will ever entirely return to it. I continue to heed the warnings of various medical practitioners and in my exercise class, I lift weights only with my right arm and limit my left arm’s participation in various other exercises. In a way, this vigilance seems a little specious as I use no such discrimination when picking up my granddaughters or the groceries, all of which are individually much more than the mere one kilogram of an exercise weight.

I am certain that for most of my adult life I have experienced physical discomfort in various areas of my body which I have ignored, subliminally secure in the knowledge that a twinge is here today and gone tomorrow. However, as I have written earlier in this blog, there is little the body can serve up nowadays that is not processed by a mind still bewildered by the trauma that befell me, as a possible new symptom of the disease that will not go away. Some symptoms are more worrisome than others but their disappearance within a few days reassures me that the body is merely shifting and adapting its aging parts, rather like a house settling in for the night.

To all appearances, the disease has indeed gone away - but there are still those moments when I am conscious of the sword of Damoclese that hovers over me, threatening my sense of well-being and confidence in the future. Part of the reason for this lapse in absolute optimism lies in the years during which the cancer was slowly and insidiously invading my body while I proudly perceived myself as a woman of robust health. Under the circumstances, a cancer diagnosis can be compared to a demonic harlequin gleefully intoning na nanna na na. And now that the disease has been scooped out of me, I choose to continuously question the validity of my perceived health and latch on to each and every bodily quirk as the disaster of the moment rather than enjoy the knowledge that the robust health that I had once believed was mine but was not, is now indeed mine to enjoy.

I once asked Sigal, my surgeon, when I can stop worrying about metastasis and her answer was between five and 10 years, an answer that had value for its truthfulness, but was not one designed to induce equanimity.

Control of my equanimity and restored confidence is totally mine and I spend most days dealing with life with nary a thought of cancer and its attendant unpleasantness. At times, I even find that I have to remind myself in a resolute manner that I’ve had cancer, because it still seems to be so very impossible. Such reminders unfortunately do tend to curtail whatever plans I had been happily in the process of forming until the fear recedes. During the last year, I have heard and read about so many cancer stories, mostly breast, that I realize that not having had to undergo chemotherapy places my experience at a totally different level than those who lost their hair and spent 10 days out of every month vomiting. Sometimes I wonder if my survival would be more assured if I’d suffered more - and then I quickly crush the thought and focus on being grateful that chemo had not been necessary.

I’ve often been asked during this last year how having cancer has changed me as if change were a prerequisite for recovery. In fact, as far as one woman, an astrologist, was concerned, any failure on my part to dig deep, dig true into my psyche would constitute an invitation to the loathsome little green cells to return - although she didn’t say how I was to accomplish this, nor how I would know when I had completed digging. But there has indeed been a change in my weltanschauung and that is simply a relaxing of my erstwhile, fondly held superstitions, nurtured and refined over a lifetime, and used as a source of reassurance. My superstitions had simply let me down. I had gone through all the time-honored rituals and I still had cancer. A thought that began as a whisper and became a clamor finally convinced me that neither numbers nor incantations have the power to change what has already been set in motion. I can now quite happily relinquish these nonsensical props and enjoy the sense of liberation their absence brings. I can also save on my annual astrological forecast bill.

My zeal for healthful cosmetics and toiletries has relaxed somewhat - not because I don’t believe that it is preferable to use products that do not contain known carcinogens but because of the difficulty of finding products that do not contain any toxins at all. It seems that the cosmetics industry cannot fulfill its mission to maintain soft and clean bodies and hair without using at least some toxins but while the ingredients are listed openly, their quantities are not. When I turned to the web to guide me on the relative safety of different products, I was distressed to discover that the shampoo and soap products of Pantene and Dove respectively contain very high levels of harmful toxins.

Nowadays, when I scan the ingredients of a shampoo, I’m looking for sodium lauryth sulphate or sodium lauryl sulphate, which began life as an industrial degreasant and garage floor cleaner.

This substance is found in virtually all personal care products, even those sold in health stores and purport to be superior to common or garden toiletries one buys at the supermarket or pharmacy. In fact, I was disappointed to find that the health store that seemed to answer my need to smear only healthful substances on my body, teeth and hair, stocks pretty much anything in addition to the quasi-healthy stuff, all of which contains some ingredient with a long and chemical sounding name. What is the point of inundating lip salve with plant extract if it also contains petrolatum?

(The jury is out on how dangerous sodium lauryl sulphate is; this site gives a good overview: http://www.health-report.co.uk/sodium_lauryl_sulphate.html).

I’m still eating goat’s and sheep’s dairy products but I believe that it won’t be long before these too will be subjected to hormones and/or antibiotics, as they become more popular (thus rendering the products less healthful, in which case they will become less popular).

Occasionally, I eat cheese derived from a cow, always accompanied with the comment that I do not wish to be a fanatic. Otherwise, my eating habits haven’t changed very much. I ate healthily BC, and although all the mounds of broccoli, almonds and apples I devoured were ineffective in keeping cancer at bay, I don’t see any reason to start wolfing down Big Macs. My major culinary sin, it appears, is enjoying burnt food - aka toast, crispy barbecued chicken - as the heterocyclic amines (HCAs) that are produced are known carcinogens.

But nobody really knows - not the doctors, not the drug companies, not the intrepid medical reporters who go out there and tell you to swallow vitamin E for its antioxidant components and then a year later tell you that vitamin E supplements might in fact kill you. The body is one mighty mystery, the last frontier for human discovery where the firmly held beliefs of yesteryear are the idiotic notions of tomorrow. To all intents, purposes and statistics, I will survive cancer and die in a freak accident 30 years from now. Within the realm of current knowledge, the doctors can be more or less confident that this is where my story ends.

This time last year I celebrated by 60th birthday and I was in the process of completing plans for a year-long celebration when fate intervened and determined that I would spend the past year acknowledging my life in a totally unexpected way. Although I would have preferred it had been different, not all the experiences of the past year were negative. Writing this blog has been an intrinsic part of the cancer experience as by verbalizing all that happened to me brought the fear that at times bordered on hysteria under control. Many a time I was able to distance myself from the unpleasantness of treatment, for example, by formulating the sentences that I would later add to my blog. In fact, it seems that in many cases, breast cancer triggers a woman’s creative juices. I’ve attended a play by a woman who interjected song into her monologue of discovery, treatment and recovery. Another woman detailed her cancer story in comic strip. And there are, of course, numerous poems, books and blogs on and by the subject.

It’s time to wrap this up. I’m focusing on new ways to express myself professionally. I’m looking forward to building the extension we’re adding to our house. I’m eager to welcome more grandchildren into the world. I’m anticipating with enthusiasm spending time with my family and friends. In short, let Gabi be right when she said that the cancer was a detour in my life - because I’m feeling pretty gung ho about life right now and want nothing more than to just get on with it.

Appointment Looming

The countdown to my next appointment with the oncologist on April 13 begins. The appointment was arranged shortly after my last visit to Dr. Sarid so I was surprised to receive a second referral in the mail, shortly after the first had arrived. All the details, date and time, were the same, but the name of the doctor had changed. When I inquired, I was told that Dr. Sarid has left Rambam and that my new oncologist was a resident. I must admit to feeling slightly abandoned by Sarid, despite never having formed that close relationship with him that all the self-help books recommend. But there was something about having an oncologist whose name was Sarid, which in Hebrew means 'survival.'

My new doctor is a year behind Gabi. I hope that her lack of experience is counterbalanced by the desire to perform twice as hard - rather like those Avis ads from years ago.

I've been so involved with this disease, that it's with a slight jolt that I realize that this time last year I was still ignorant of what was growing inside me. The date of discovery was getting closer, though.

Hypochondriacs Forever

As I’ve written elsewhere in this blog, a cancer diagnosis renders every twinge, ache and slight abnormality suspicious. A headache is never just a headache; a pimple is never an innocent zit, but the harbinger of a new disastrous malaise. In the last few months, I’ve submitted my body and its organs to a slew of tests, which have served to eliminate any specific cause for anxiety. I am now reassured that my heart is in good condition (despite a mitral valve prolapse which I’ve been aware of for over 20 years), and that my carotid arteries are clear. Sometimes, a worrisome symptom - one that has me scouring the internet and obsessing about - just disappears over time, such as the discomfort I felt on the right side of the effected breast whenever I drew a deep breath or moved in a certain way. I can now dismiss the pain in the back of my neck once an X-ray showed no signs of cancer in my upper spine. The one test that would soothe my deep-seated fears doesn’t exist; despite a preponderance of advanced technology, there is still no way to know for sure if any of the little green bastards broke away from the primary tumor and is even now, wending its way to my bones.

Still, ever vigilant as all good hypochondriacs are, I became aware of a sense of swimminess in my head, which, as others seemed to be experiencing pretty much the same thing, I put down to a virus. It persisted on and off however, and was joined by a vague feeling of dizziness. This nebulous sense of instability was particularly pronounced in the office when I finished reading my email and playing the M-W Word Game of the Day and conscience would force me to begin working. Occasionally, when eating, I had the impression I would fall if I were to try to leave the table - though I never fell. Naturally, it didn’t take long before I was convinced that a tumor had taken root in my brain.

Imagine my joy to discover that the cause of all this lightheadedness was a lack of symmetry in my hearing. Prior to this revelation, I had undergone a horrendous ear-cleaning operation. The ENT doctor poured some liquid into my ears and when the liquid began to foam, vacuumed deeply entrenched wax from them. I was reminded what real dizziness feels like. What was truly remarkable was how seriously the doctor took my complaint and proceeded to send me for a hearing test, which revealed the lack of auditory symmetry, and an electronystagmogram (ENG), a test that measures eye movements, and checks the level at which the eyes, inner ears, and brain maintain balance and position. The ENG is scheduled for next week, but the truth is that ever since the revelation of my auditory asymmetry, I’ve been feeling just fine.

The reason for the imbalance is still to be ascertained. According to the technician, it could be a lump of wax, some fluid or something scientific-sounding that I didn’t catch. I confided my fear of a cancerous lump in my inner ear to my ENT doctor and again, remarkably, he assured me that he understood where I was coming from, but that ear cancer is so very rare, he’d never even seen a case. Of course, he is so very young.

I'm Fine

The absence of any entry for over a month can be interpreted to suggest that something seriously untoward has upset my life’s rhythms or that, conversely, life is too normal to warrant any entry at all. Happily, the latter is the case. Life has indeed changed since I received that horrible diagnosis, but, after all these months, it is obvious only in the details. I swallow Tomoxifen each morning instead of an HRT pill. I drink yoghurt derived from the dairy products of goats, rather than that of cows. In addition to the calcium tablet I’ve taken for many years, I now swallow two vitamin E capsules, drink green magma, chew a calcium pill and release four drops of vitamin D onto my tongue. (I gave up the black cohosh because it wasn’t making a dent in the frequency or intensity of the hot flushes.)

Vitamin D is the latest weapon of choice in the war against cancer. Various studies support the contention that vitamin D helps protect against many forms of cancer as well as other diseases. As a blood test revealed that I do indeed have a vitamin D deficiency, I’m happy to chew the pill and drink the drops to prove the theory.

Doctors' Visits

Over the last few days, I completed a battery of tests and check ups with a coterie of doctors. An appointment with Sigal, the surgeon who operated on me in May and was the original bearer of bad tidings, finally put to rest any lingering fears of IBC and I am now convinced that my swollen breast is due solely to the radiation therapy. To celebrate, I bought some new bras. Ironically, the afflicted breast is rounder, more firm and generally nicer looking than other one, which is smaller and tends to droop.

However, by the following Sunday, I was ready for additional reassurance from my oncologist. Dr. Sarid did the usual pummeling, poking and prodding and pronounced me lump- and IBC-free. He explained how the tissue had been fried and the molecules rearranged and that it could take not just months, but even years for the swelling to subside. Now that IBC is off my mind, I can go back to obsessing about metastasis. Dr. Sarid agreed with me that the threat of metastasis is everpresent, which was not very comforting. It's incredible that our advanced technology hasn't yet developed any means of honing in on aberrant cells en route to wreaking havoc in the body's vital organs.

My next appointment is in three months' time.

I also had an appointment with the endocrinologist, who has added vitamin E to my daily intake. My morning routine now includes swallowing Tomoxifen, black cohosh, vitamin E - which serves as a major antioxidant - and a glassful of green magma.

Despite some pressure from the social workers, I have resigned from the breast cancer support group. It suddenly seemed absurd and wasteful of precious evening hours to spend time traveling to and from Tel Aviv just to discuss cancer with people who are not my bosom :-) buddies. There's a sense of artificiality in meeting once a week with a group of people with whom the only unifying factor is that we've all suffered from the same disease. There is a limit to how much one can talk about it.

Breathing Freely

My mammogram and ultra sound results are back and everything is OK. For about an hour before Nachum phoned from the Herzliya Medical Center with the good news, I was incapable of coherent thought and did nothing but play mindless games on the computer. Working was impossible. As a bonus, it appears that my bone density test actually shows improvement in my thigh bones.

Battery of Tests

I have begun a battery of tests preparatory to my next appointment with Dr. Sarid on January 13. Yesterday I had the dreaded mammogram, which was particularly painful on my afflicted, still-swollen left breast. I also had an ultra-sound, the test which had confirmed the presence of cancer only eight months and a lifetime ago. I’ve decided to throw in a cardiologist and a dermatologist in addition to all the other tests I’m doing for a full and comprehensive inspection of all my body parts. Because Tomoxifen can cause cataracts, I’ve also checked my eyes and happily, they are in good condition, apart from a few annoying floaters that have been around for a while.

Support Group

I joined a support group through the One in Nine organization and the weekly meetings began a few weeks ago. Strangely, I was first interviewed by the two social workers for suitability; apparently, having had cancer does not automatically qualify one to join a support group. From among the seven or so women who apparently also passed muster, I was particularly struck by the wide range of cancer experiences. Three of them have had radical mastectomies - one woman, with a tumor half the size of mine, but with a higher oncotest rating, had opted for chemotherapy and a full mastectomy.

This is the first time I’ve joined a support group and I wasn’t sure what to expect. The overall rationale is that as fellow sufferers, we can say things to each other that only we can understand or appreciate. Now, after four or five meetings, we’ve exchanged our cancer stories and added some personal information. The social workers, who monitor the meetings, occasionally pipe in with an observation or two. I’m not sure what their role is; whether it’s to guide our chat in a certain direction, to summarize what we’ve talked about in order to draw conclusions or if they are just there to lend an air of officialdom to the proceedings. Some bonding should be taking place and indeed some of the women have formed friendships ‘after hours’, but at the last meeting I had an acute feeling that, as a group, we really didn’t have that much to talk about.

Unfortunately, I know enough women with whom I can discuss the different angles of our cancer and even those friends who have not personally experienced the disease are there for me to offload an angst or two. Add to that the fact that I don’t get home until after 10.30, I have good enough reasons to consider resigning.

Seventh Sense

The medical establishment is my first line of defense in my personal war against cancer, but once that's covered, I'm open to anything that alternative treatment has to offer, even if on the face of it, it sounds outlandish. I would hate to find myself in a position where I failed to avail myself of some remedy only to discover too late that it was key to a complete recovery.

Some weeks ago, a colleague told me how a woman called Sigalit, using a method taught to her by a cardiologist who’d gone looking for the soul, had helped her, so I made an appointment.

Dr. Nader Butto is a cardiologist at the Rabin Center. He has “...developed an energetic method that tracks down emotional conflict (and its state) which has caused the energetic block and that has eventually evolved as a physical illness. This unique method opens the energetic block and washes the body with a flow of life, energy, and vitality.” (See a demo.)

Sigalit began by examining the palm of my right hand and asking me what had happened eight years ago. My mother had died eight years ago amid circumstances that still cause me feelings of guilt, not least because the opportunity to have been a better daughter to her is forever gone. Sigalit also noted that I had undergone an emotional experience five years ago, although under happier circumstances with the birth of my first grandchild. She told me that the turmoil of my mother’s death had been the trigger for the cancer, which, based on the number of documented cases of cancer which appear to have been accelerated by a profoundly emotional experience, seems a reasonable assumption

Treatment consisted of me lying down with legs bent and slightly apart. I was to inhale through the nose and exhale through the mouth. Sigalit dug her fingers deep into my diaphragm which was extremely painful. Apparently, this is the location of fear and she waited to hear the click which would indicate that fear had flown my body. She pressed her hands at points above my breasts, which was also quite painful, and circled her hands over my head. Occasionally, she gently slapped my legs, which should have been shaking uncontrollably by now, but were hardly quivering. At a certain point, she suggested calling it a day and told me she wouldn’t take any money. But I was determined to get as much out of this as possible so we both strove valiantly on.

However, apart from a small flutter, my legs remained obdurately steady, although they were getting extremely uncomfortable being held in a somewhat unnatural position. At the end of the session, we acknowledged that nothing of any significance had taken place, that my fear remained invulnerable to exile. Sigalit gave me a few exercises to do which would open some chakras and a book called Cancer as a Turning Point by Lawrence LeShan. The book is excellent.