By Andy Weddington
Friday, 27 November 2009
"Courage is the art of being the only one who knows you're scared to death!" Earl Wilson
Thirty-two years ago Meat Loaf released a tune called, "Paradise by the Dashboard Light." Included in the lengthy hit song was a radio broadcast of a baseball--make that "baseball"--game. The clever play-by-play was called by Phil Rizzuto (yes, one and the same--the all-star shortstop for the N.Y. Yankees and voice of the Yankees) and you had to listen closely to appreciate the gist of the song. It was about base-running alright but not on the diamond. The "game," as called by Rizzuto, went like this: "Ok, here we go, we got a real pressure cooker going here, two down, nobody on, no score, bottom of the ninth, there's the wind-up and there it is, a line shot up the middle, look at him go. This boy can really fly! He's rounding first and really turning it on now, he's not letting up at all, he's gonna try for second;...here he comes, he's out! No, wait, safe--safe at second base,...holy cow, I think he's gonna make it!..."
Twenty-nine years after Meat Loaf's release, Kelly Rooney (1963-2006)--a wife and mother of five, lost her courageous fight against breast cancer. An inspiration to family and friends, Kelly kept a sense of humor during her ordeal and coined the breast cancer fight battlecry, "Save 2nd Base!" While crafting this Commentary I could not help but wonder if Kelly was a Meat Loaf fan and maybe owned a copy of his classic 1977 album "Bat Out of Hell." I bet she did.
After reading the opening paragraph, I suspect most readers had a flashback or two to younger days and fond memories of a little "experience" by the dashboard light. Good times for sure--maybe even paradise. Well, wrap up the smiles and set the memories aside. It's time for the business of today's Commentary. Though a bit long this week it's important. Bear with me.
Not quite two weeks ago an independent panel of government-appointed "experts" forming a task force released new recommendations addressing breast cancer early detection and screening techniques. Their alarming, polarizing views contradict long-standing, proactive measures advised by the American Cancer Society--who, by the way, has not changed their position. More about the task force shortly.
Less than two years ago the only thing I knew about breast cancer was it happened to other people. And rarely to anyone I knew--even then I had no true understanding for the hell of a breast cancer diagnosis. Today I feel capable of giving a breast cancer seminar--at least from the perspective of a treatment program manager and round-the-clock caregiver.
Late afternoon on the first Friday in March 2008 breast cancer was no longer something that happened to other people. An oncologist walked into the treatment room where my wife and I were seated and, looking as if he'd seen a ghost, told my wife her biopsy results indicated breast cancer. There was no mistake. We were dumbfounded. Then in shock. Then angry--but that passed quickly. All those emotions occurred within a minute or two. The doctor was in the room only a few more minutes and did not offer details. He handed us the report and told us sometimes the news he has to deliver is not so good but much is known about breast cancer and it's curable. He implied we were lucky. Then he suggested the sooner moving forward with treatment the better and left the room.
That evening Marine Corps training kicked in and my mission began. With biopsy report in hand, I sat at the computer and began researching breast cancer. First, the macro. Then every confounding word, acronym, abbreviation, and number on my wife's two-page lab report. Not only was she going to fight breast cancer, we were going to fight it and there was not going to be a single element of the battle I did not completely understand.
I learned our diagnosis was an aggressive form of breast cancer commonly referred to as "Triple Negative"--a malignancy not driven by hormones but triggered by genetic defect. From what I read, not especially good news. A glimmer of good news was it was Stage 1 borderline 2. An appointment with an oncology surgeon within a week confirmed my research. And she also confirmed a tough fight ahead and flagged my wife's records as "Urgent." Within a week our primary oncologist echoed the surgeon's assessment and seconded the recommended treatment protocol; an aggressive one. Clearly, the two skilled women knew exactly what they were doing.
I will not take time to elaborate on grueling chemotherapy that stripped my wife of nearly every single hair on her body (there were a few hardy survivors), turned her skin a sick pasty white, left her with an equally sick odor that soap and perfume could only momentarily mask, zapped the spark from her eye and her energy, and, at times, despite powerful aprepitants, caused unimaginable nausea.
Nor will I address the ordeal of a bi-lateral mastectomy, emotional acceptance and healing, painful physical rehabilitation, or the interesting conversation with a plastic surgeon who made it clear reconstruction is not a procedure--it is a challenging, uncomfortable process over an extended period of time that requires commitment. That conversation still lingers with us.
Nor will I bore you with program manager and caregiver duties orchestrating medical appointments, mixing batches of L-Glutamine daily to combat neuropathy, carefully watching--day and night--for signs of adverse reaction after day-long chemotherapy sessions, cooking plain broiled chicken and O'Brien hash browns twice a day for nearly two straight months because it was the only food my wife could stomach (to this day, I can't stand either smell), and sundry other responsibilities I am trying my damndest to forget. Slowly they fade.
Thank goodness for family and friends whose notes of encouragement and gifts helped keep our sense of humor. Defiant T-shirts lightened up the clinic on chemotherapy days--"Cancer Sucks," "This is My Cancer Fightin' Shirt," and everyone's favorite, "Save 2nd Base!"--Meal Loaf would love that one. And thank goodness for sketching; it helped time pass and eased my mind.
Now for the essence of what I learned about breast cancer--at least the top six.
One: Breast cancer is an epidemic--the second leading cause of death in women. Annually, in the U. S. alone, more than 200,000 women will be diagnosed and 40,000 will die. One in eight women will be diagnosed at some point during their life and age is not a discriminator--the disease strikes the young, the middle-aged, and the old. So, the odds are pretty damn good someone in your family will be stricken with the disease.
Two: Breast Cancer steals second base.
Three: Breast cancer is not breast cancer is not breast cancer is not breast cancer is not breast cancer. Get the point?! First question when hearing someone has breast cancer, "What type?"
Four: As there are many types of breast cancer there are as many treatment protocols. Every case is different--because people are different. And, doctor's have as many differing opinions as to how to treat--ultimately leaving the course of treatment up to the patient. Therefore, the second question, "What's the treatment decision?"
Five: Regardless of type and treatment, breast cancer is serious business. It kills. But it's curable--sometimes.
Six: And, oh by the way, men are not immune to breast cancer.
Ten years ago, through self-exam (stomping my foot three times--loudly), my wife--not yet 40--detected a lump. A mammogram confirmed a suspicious mass and biopsy was inconclusive. The doctor recommended erring on the side of caution with surgery. The word "cancer" had not been mentioned and frankly it never crossed our minds--at least not mine. After all, cancer attacked others. The lump was benign--as expected.
Ten years later, again through self-exam (again, stomping my foot three times--loudly), my wife detected a lump--in the same location. A mammogram confirmed a mass. An ultrasound indicated something was not quite right. The doctor advised keeping a close eye on it and reporting any change in size, etc. In less than two months, through self-exam (three loud foot stomps), the lump was growing and fast. Another ultrasound confirmed significant growth.
After biopsy the doctor told my wife he was 99.9% certain it was nothing to be concerned about but core tissue samples would make certain. "See you tomorrow," he said. That tomorrow was the last Friday in March a year ago. Doctors do not know everything--he was wrong; 100% wrong.
My wife is alive with an excellent prognosis because she was conscientious about regular self-exams (three loud foot stomps), regular mammograms (three loud foot stomps), and did not ignore the lump (three loud foot stomps). She caught her aggressive form of breast cancer early.
About two weeks ago the dopiest news of the year hit the streets. And, surprise, surprise, it came from a government task force--as mentioned in an opening paragraph. In case you missed it, The U. S. Preventive Services Task Force (whose position influences coverage of screening tests by Medicare and many insurance companies) recommended:
1. Most women in their 40s should not routinely get mammograms.
2. Women 50 to 74 should get a mammogram every other year until they turn 75, after which the risks and benefits are unknown.
3. The value of breast exams by doctors is unknown. And breast self-exams are of no value.
Now, let me be clear. I do not hold a medical degree. My "medical" training includes basic first aid for Marines tending to minor injuries incurred while living and training in the field, immediate care of some battlefield wounds, and how to administer CPR and apply the Heimlich maneuver. That's about it. But, to my credit, I hold an undergraduate degree, a Masters, and more importantly, a whole bunch of 'simple, North Carolina, small town boy' common sense.
From my recent experience and perspective, the task force's "suggestions" are just plain dumb; especially the conclusion "And breast self-exams are of no value." It is difficult, no check that--make it "impossible" for me to believe even a half-wit would have their name and credentials associated with such a moronic statement. Unless there was "incentive" for lending expertise and influence. Certainly not outside the realm of possibility. So, whether the task force membership was "incentivized" or it's an instance of wrong-headed group think, their recommendations are dumb. Really dumb.
How ironic the group is called "The U. S. Preventive Services Task Force"--with an emphasis on "Preventive Services." Though they cite some sort of data behind their recommendations, remember the quip, "Lies, damned lies, and statistics"--popularized by Mark Twain. In humor rests much truth. And anyone with an understanding of nonparametric statistics knows you can shape numbers to support anything. Finally, is not the timing of the task force's announcement suspicious considering the president's rush to reform healthcare? Draw your own conclusions.
The majority of independent medical experts I've heard interviewed about the task force's work agree, if followed, the recommendations will increase the death rate of women dying from breast cancer. Comforting, but that conclusion is common sense. In fact, polls taken after the task force's news release indicate, women, by some 76%, intend to ignore the recommendations. Smart ladies.
I've heard the nonsensical arguments supporting the task force. One in particular being to reduce "false positives"--preventing anxiety, stress, fear, and panic of 'poor' women who wait a few days or maybe weeks for a biopsy result. Sounds reasonable. However, anxiety, stress, fear, and panic do not cause cancer; breast or any other kind. "False positives" and "false negatives" are the expected consequences of imperfect testing and all things human. Get over it. The benefits of preventive screening and testing have proven to save lives.
Women, what would you prefer to hear from your doctor? "Mary, I apologize for the delay between biopsy and results but the news is great...you do not have breast cancer." Or, "Mary, you have breast cancer. And, it is not good...it's aggressive and advanced--Stage 4. You could have detected this mass through self-exam and we could have addressed it immediately. I am sorry."
If the latter, you can add "anger" in front of anxiety, stress, fear, and panic following diagnosis. And, "hearty congratulations," now you can enjoy all five emotions for you now have a problem to sweat.
Self-exams, mammograms, ultrasounds, advanced imaging, and most importantly--biopsy (there's those three loud foot stomps again), saved my wife's life. The biopsy was particularly critical because it not only confirmed breast cancer but was the only way to identity it as an aggressive type. Had she neglected the first line of self-defense--self-exam (three loud foot stomps), her prognosis would most definitely not have been as good. In short, a lump detected at home triggered a life-saving process. Now one year of quarterly blood checks under her belt she remains cancer-free.
Self-exams are of no value? Nonsense! I am far too much of a gentleman to use the language I'd really like to use opining about the value of the government task force.
Men, by all means, encourage the women in your life to regularly conduct self-exams. Think breast cancer can't happen to them? Or affect you? Think again!
Women, trust your instincts--they are our innate survival mechanism; listen to them. Any abnormality should be checked, without delay, by a doctor. Something bad will not get better by ignoring, hoping, wishing, meditating, praying--or drinking. A second opinion is a good idea. And remember, if it's cancer, you won't know if aggressive or not until biopsied. Delays can be deadly.
Is my wife's good fortunes from self-exam the exception? Not by a long shot. Famous and not-so-famous women are coming forward, in hoards, every day with testimonials that self-exams and regular screening saved their lives. With each passing day the task force looks more and more foolish.
The government's assault--albeit an initial probe--on breast cancer early detection and screening is only the beginning to degrade (socialize) American healthcare. There is no reason quality of care must be sacrificed while intelligently reforming the healthcare industry. But haste has us recklessly heading full-speed ahead in a dismal direction. A train wreck is inevitable. Marginalizing healthcare appears to be one objective of the reigning party's grand scheme to drive our country to mediocrity and that, in turn, will make us all vulnerable--as to healthcare and otherwise.
This rush to overhaul healthcare without a bipartisan solution reminds me of an axiom every good Headquarters, U. S. Marine Corps Action Officer learns after working as lead on a few complicated projects: "You want it bad, you are going to get it bad." In other words, intervene to rush and circumvent the deliberate staffing process--designed to ensure thorough work before fielding, the result is going to be garbage.
The president wants healthcare reform bad, rest assured we're going to get it bad. And that is not good. Not good at all.
Please help provide free mammograms. Hit the pink box labeled, "Click Here to Give--it's FREE!" You can click once per day--it only takes a moment to help fight breast cancer. Add the link to your favorites. Please pass it on. http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2
For fighting breast cancer with humor, ala Kelly Rooney, or as the site promotes, "pink with a wink" visit: http://www.save2ndbase.com/