And my world goes 'round again....

So, how am I?  How was the surgery?  How is the recovery?  Is it what I expected?

I am just now writing after a week...that should be your first clue.

But, I suppose that I should begin with my expectations.  Based on my research, and advice from friends, I really didn't know what exactly to expect, because as we know in this house, all too well, "Everyone is different...it all depends."  Some warned me to be prepared for 2 days to generally recover, some 2 weeks.   All, however, advised me to keep ahead of the pain with narcotics.  Okey dokey.

I sort of expected that I would feel pretty crappy over the weekend, and I was not disappointed.  I have had four children, and have bounced back well from each of these deliveries, so I thought that I would recover from this pretty quickly with this too.  I gave myself until Monday for drugs. 

Monday, I took less drugs, but as I got tired, and started feeling crappy, I took another Percocet and went to bed, which seemed like a sound decision.  I was still sore, but my incisions were looking good...the bruises had become green and yellow, a vast improvement over the black that they were. I knew that each day would be better. This part was pretty much to my expectations.

My concern though, was the headaches that I kept getting.  Over the weekend, I thought maybe I was getting a sinus infection. As the week began with the same headache, I became concerned that it was perhaps narcotic withdrawal. I should mention that despite the fact that this is more than the 10th surgery in 2 years in this household, we do not have a lot of experience with narcotics.  My kids just don't take them outside of the hospital setting. Hell, Brent hardly takes them outside of the OR anymore, tough cookie that he is.

My sister actually said to me in the hospital, "Don't try to be Brent...take the drugs!" Okey dokey.

But these screaming headaches, that Tylenol didn't begin to touch, this is not what Percocet was prescribed for.  By today, I called my OB's office, assured them that I had no concerns about infection, explained that my abdominal tenderness was improving, but inquired about the headaches.  I was hurting pretty bad.  Like an ice pick in the eyeball kind of bad.  I thought about amputation...at the neck.

My choices per my OB were:

1. Go to the ER for evaluation. (ummm...I cannot drive yet because of that surgery thing last week, and I was fairly certain that I was not looking an aneurism, or brain tumor, although with LFS, weird things do happen.  For example, I personally know 2 different people who are left with half a pancreas.  TWO. How many do you know? With LFS, nothing is beyond the realm of possibility, and I would not presume to know the limits of Gods sense of irony with regard to our family.)

2.  I could wait 2 hours and then take 2 more Percocet, to try to knock out the headache completely, as though it were a migraine. Stay in the dark, keep it quiet.  I have never had migraines, but thought this might be hormone, or lack of hormone driven change.  Also a contender.

3. Or, I could try coffee.

Clouds part, the sun shines, angels sing in jubilation.

If my brain were firing on all synapses, I would have figured this out sooner.  I drink coffee every day. Truth be told, quite a bit of coffee.  I hadn't had but half a cup since last Thursday because my stomach is queasy, which coffee would aggravate. And, I keep taking drugs that make me only want to nap, because my head hurts so much.  You are noticing the vicious cycle too?

I brewed up a pot, took some Zofran, washed it down with a cup of Joe, and Bob's your uncle.  I feel like a million bucks.  It wasn't narcotic withdrawal, or surgery, but caffeine withdrawal that was kicking my butt.  Yes, I am done with the Percocet now.  :)

All of the questions I had to answer about vitamins, prior experience with anesthesia, health history, cancer...blah, blah...nothing about my caffeine intake, which is probably not medically relevant generally speaking.  But, I think that the last time I 'quit' coffee was when I was pregnant with Olivia.  She is 5.  Both she and coffee make my world go 'round.

So, the moral of the story, boys and girls, is that you should call your doc right away if things seem at all wonky.

And drink lots of coffee. 




I

Making room for the good: Olivia's first day of school

It was raining. 

Thundering, actually, which is the only thing that Olivia fears, a fact that I had dutifully noted on the “all about me form” that I filled out for her kindergarten teacher. 

But today was the first day of school for my youngest daughter, and the excitement in her as she bounded down the stairs before 7am, negated all anxiety about the thunder.  She dressed and ate breakfast, brushed her teeth and I helped her with her hair.  She put her lunch in her backpack and put on the sign that Kindergarteners wear around their neck on the bus to help direct them like the precious package that they in fact are. (There is a return address label on her, incidentally) Then, we waited nearly an hour for the time when the bus was due to arrive, with varying degrees of patience.

Olivia announced that she would not, of course, bring her special green blanket. 

She loves an umbrella, but dislikes thunder.  Today, she was not even a little troubled by the thunder boomers.  We grabbed an umbrella and walked to the bus stop where she sang, rather loudly “The sun will come out, tomorrow!”  A neighbor closed her window as she belted out the finale.  Probably because it is chilly today.

Then the bus rumbled down the street, and she was gone.

 

 

It is raining.

But I have a cup of coffee and a quiet moment before I continue to clean out the basement, discarding things that are broken and passing along toys that are no longer used.  I have neither had the time nor the inclination to evaluate the detritus of our lives.  The answer for nearly two years, when asked about an item has been “put it down in the basement and I will deal with it later.”  Well, later is now. 

I am happy to report that Brent has been cleared from Infectious Disease.  Neither he, nor Lauren, will return to hospital until mid October for scans, a break not experienced here in nearly two years.  So, I have both the time and the inclination now, to deal with those mundane, everyday things.  It is a luxury that I have not enjoyed, and somehow, I am looking forward to it.

There is something nostalgic about parting with items that are worn, and no longer useful.  There is a longing in a way, for the time past, when life was maybe simpler, or had more possibilities.  Despite this, I have always been pretty good about finding new homes for things that we no longer use, clothing we have outgrown.  And, I have always felt lighter after such purges.  I never have regrets, and feel that the process makes room for more useful things that are suitable for our current lives. 

You cannot embrace the present, if your hands are clinging to the past.

It is still raining, but harder.

Olivia is off on her new adventure, excited about the possibility of making new friends.  While there is part of me that regrets the details of her preschool years, it being a picture far different from the one that I would have painted for her, she is a happy child.  And I am grateful for this.  There is part of me that worries about the future, the thunder, and her fear. (As a very loud clap of thunder crashes outside my window, making me jump!)  She will be fine.

So, today I will make room for the good things in our current life by passing along the relics of our former one.  I am sure that there will be some conflicting emotions in this, sorting through our past, leaving open spaces, spaces which initially feel empty, but make room for our future. 

And on Thursday, I will continue to do the same sort of thing, but on a more personal level.  I will have surgery, ironically enough, exactly two years to the day of Brent’s diagnosis.  I feel that it is a fitting end to this chapter in our lives.  The kids are cancer free, and I will have finished everything that I can for my geneticist. 

I am making room for the good that is to come.  Because, as Olivia so musically declared, "The sun will come out Tomorrow!"

Today, I will pour myself another cup of coffee and dive in.  I will wait to hear of Livvy's new and exciting experience when the bus returns this afternoon, regardless of the weather.  Arms open to her, and to our future.

Figuring it all out

Well, I will finally know the answer.  The doctors always ask the same questions.  You would think that I would be better prepared.

"What is the first day of your last period?"   Today.  7/31.  I always had to guess at the doctors office before, not really sure, and make something kind of plausible up.  Unless Mother Nature has a surprise, this is the definitive answer.  For all time.  My ovaries come out 8/29.

On the one hand, this is a very good thing.  An end to discomfort and inconvenience, both physical and emotional.   I joked with my LFS friends that I am trading up in a way...cranky and irritable only every 3 months for scans, rather than the more traditional waxing and waning of my emotions on a monthly basis.  

I will be limiting my cancer risk.  But more important to me, by having these various tissues sampled and studied, I will hopefully discover what that overall risk actually is.  Less organs, more information. Information is good, and these organs can only go bad.

These answers might, in a way, provide some guidance with regard to our children.  Should I have mutation in my breast tissue, for example, but have not developed breast cancer, this could suggest that our mutation isn't one that runs aggressively in breast cancer.  Each LFS family mutation is different, and some families run brain tumors, or are rife with breast cancer, always with the sprinkling of other malignancies, of course. Of course.  

We are fortunate to have a short LFS story, because we haven't had a lot of cancer up our family tree, which would be difficult in obvious ways. But the flip side of that is that we have no family history.  Many screenings are slated to begin a few years before the earliest family onset of a particular cancer.  We have a giant question mark, which is its own challenge.  

I am a giant question mark, unto myself.

So, this surgery is a good thing.  

However.

I am not an automaton, devoid of emotions about this.  I did look up menopause to figure out what I will be abruptly jumping into. Plunging into that change will be no picnic. It doesn't alter my thinking about this, but it does pinch at my heart a bit.  How could it not?

I had Olivia just before I turned 39.  I felt comfortable playing volleyball and hanging out with friends much younger than me who also had little ones.  While much of the past few years have been a nightmarish blur for me, this surgery seems to be fast forwarding me to 50.  What the hell happened to my 40's? 

There is something about my corporeal identity that my girl parts seem to represent.  I am a wife and mother.  This is what I am, and what I do.  Somehow, as irrational as it sounds, I feel like this identity is somehow threatened, evidenced by the fact that my uterus and ovaries are now unnecessary, and are in fact a problem worthy of such effort, to eliminate them.

I have mentioned that there is often a disconnect between my head and my heart.  My head always wins, but my heart usually makes a good showing. This would be a prime example. 

It is my choice to have this surgery.  But among my menu options, while this seems to be the best one, it still is complicated.  Everything with LFS is more complicated.

What is simple (and obvious) is that I won't look different as a result.  Brent will always have giant scars and a limp, having lost his entire right hip bone. Lauren has a special part in her hair, one that most other girls do not have, a scar from ear to ear.  This is reminder of her losing a piece of her mind, literally, while I was losing mine in a more figurative sense. It occurs to me most of my closest friends with LFS have had mastectomies. 

These losses are externally apparent and naturally bring identity challenges in all sorts of areas, complete with looks, and questions.   I won't have those sorts of challenges. However, while I might not look different, I do know that I will feel different.

When I got my tubes tied, I felt 'broken' for a while,  understanding that again, I chose to do it, and the broken part, in fact was the whole point.  We didn't want more children.  I didn't want more children. (Hello?!! We were already a Nation, as things stood. I was no spring chicken).  But it was still difficult, somehow.  I chalked it up to postpartum hormones back then.

And maybe I should just chalk up this current mental battle to my ovaries giving me one last hurrah of hormones, simply because they can. A parting gift to remind me that there are always good things to be found with the bad.   It all in where you focus.  Sometimes, it is just hard to focus at all.

Like before tomorrow's scans.  

Next month, I will be done with PMS, in order to be in a better position with LFS.

A week full of thoughts of surgery and support

We find ourselves quite unexpectedly at home.  Brent's first surgery went so surprisingly well that they decided that he might spend the next couple of weeks in Ohio, rather than the Big Apple.  There is an abundance of blessings to be found in this statement.  

I am responsible for giving him IV antibiotic three times a day (with a 2 hour drip for each dose) until we return for his next surgery.  I am praying that this antibiotic regimen clears the infection.  None of his cultures grew anything, despite the graft being obviously infected, so we are hoping that this measure of going broad in spectrum, as well as deep in coverage (6 weeks) will wipe it out.  Whatever 'it' is, which is unknowable at this point.

I finally sorted out things with MSKCC, and our plan it to return to NYC in a bit over 2 weeks for the definitive surgery.  It is unclear at this point, exactly what form that will take, but the surprises have been good for the past month.  We are praying that they continue to be good.

As I waited for the appropriate time to hook Brent up to his IV (or unhook him...I forget which) on Tuesday night, I checked in with my LFS friends online.  The Internet is a blessing, especially for support in something like Li-Fraumeni.  With an estimated total of 400 people in the US with this genetic disorder, I would not have likely had the opportunity to meet anyone like us, with the same challenges and similar worries.  We would be essentially alone.

I remember when we initially learned about LFS, back when Lauren was first sick, some 8 years ago now, I had read about families with LFS in medical journals, but those were written for clinical use. There are no names, of course, and details about the patients are limited to age, sex, diagnosis and outcome.  The stories of these families are devastating from a medical perspective.  It was a very tough read, with little encouragement to be found, especially with the worry that we might be just such a family.  There was no sense of warmth, of hope, of connection.  It was written for a researcher, not a patient... or a parent.

When we discovered nearly two years ago that we in fact had the p53 mutation, initially, I went back to reading articles in medical journals, when I had the time. Fortunately, (??! ...that doesn't seem quite right!) I was pretty busy just helping Brent through chemo and then surgery...and follow up chemo, dealing with Lauren's brain tumor (which by comparison, seems like an acute issue)  and generally trying to keep the wheels from falling off.  I didn't have much time to seek further information or support...or offer it.

The omnipresence of Facebook and social media has been something that I have been very slow to embrace.  I am not sure why some folks find it necessary to share photos of their lunch...when it is utterly mundane fare from Taco Bell. But, it is not all bad.  In the last 6 months I have stumbled into a private support group of similar "mutants" as we refer to ourselves.  And consequently, this rather Amish girl has become grateful to Mark Zuckerburg, for indirectly making possible these connections with fellow LFS patients and, by extension, this support.  

Talk among my LFS friends on this particular evening centered on the various reconstruction techniques and options after a mastectomy, with much advice being offered.  I must confess that the technical talk is all a bit beyond me, having zero experience with breast cancer, and in all hope, I should like to keep it that way.  But several things struck me.  First, should I ever find myself in Alabama, for example, I absolutely know who I would stop and have a drink with, knowing that all of my cancer and genetic jokes would be appreciated.  These ladies have a wicked sense of humor.

Second, if I found myself in California, I know who I would rely on for advice on hospitals or doctors. This group has a wealth of information and medical experience (so wish that were not the case). But, they are willing to share their personal trials in very generous ways, in order to help others find the solution that is right for them.  

 

Reconstruction, for example, while it might seem like an obvious choice if available, might not be right for some.  Or the timing might not work, given recovery requirements.  How it is achieved technically, if chosen, is varied as well...and makes a big difference.  These considerations can be sorted through, with folks who have a practical understanding of what it all means.  That sort of advice is invaluable.

With LFS, we have a host of considerations that others do not, and likely cannot fathom...in medical treatment, in family dynamics, in finances, insurance, life perspective...the ways that cancer invades your life is not so different from the way it can take over your body.  I really try to keep it in check (umm...as I blather on and on about it here).  I clearly have varying degrees of success with this. These ladies have similar understanding of this effort at balance, and I am grateful to them for their openness and honesty about all of the consequences.

Besides, in having them scattered across the world means that at 3 am, should I find myself awake and worried about something, someone is likely to be awake somewhere.  And support, understanding and reassurance is easier to reach for, when you know that you are not disturbing someone's sleep.  I have been glad on more than one occasion, that Hawaii has a 5 hour time difference.

I woke up Wednesday morning to hang Brent's antibiotic, thinking about a dear friend who was to have surgery that day.  I was hoping that she had clean margins and was praying for clear nodes. This was for her second episode of breast cancer, not relapse, but rather a different kind of breast cancer than her original, nearly 10 years ago.  Double primary...it makes me want to swear. Kind of a lot.  And she does not have LFS, incidentally, not that it even matters.

My own surgery had been scheduled for Thursday (as if I could afford the time for such recovery) I cancelled it when we thought that we would be in NYC for the summer.  My ovaries will keep for a bit longer, and my geneticist currently has some other tissue to work with for a while. I hope to keep her busy this fall with more samples, and come up with some answers for what I should be doing. 

But presently, I am just very happy to be back home.  I am glad to be with my family, and to step away from the hospital scene, as much as is possible, with a fridge stocked with bags of Vancomycin rather than bottles of summer Corona.  I am trying to have normal conversations, about other peoples vacations, or children's activities, remodeling projects, because our take on these subjects is a bit different:  We vacation at Ronald McDonald House, my daughter is at oncology camp this week, and our remodeling project this summer is in my son's hip. 

I find that I make OR reservations more often than dinner reservations these days.

We will get closer to normal, but just not this summer, apparently.

Trust from dizzying heights

Greetings from 7,000 feet.  It is beautiful today and Brent and I are on our way to NYC, courtesy of Angel Flight.  I cannot say enough how blessed we are to have this kind of help.  We are going to change planes in Williamsport rather than in University Park, so that another patient can get a ride home.  It is amazing to me, the coordinated generosity of so many pilots.   

With this bit of time, I thought that I might tell you about my plans.  I met with my OB on Thursday to talk about surgery.  He is putting in for pre approval from my insurance company, which I am hopeful will go through. (Although, if it doesn't, I have programmed my case manager's phone number into my phone...I have someone on the inside who might help me with the appeals process if need be). If denied, I will appeal.

I really, really like my OB, who delivered Lauren and Livvy.  I actually have a piece that I wrote some time ago, that I will post later about picking doctors.  I feel like I have to run it by both Drs. OB and and Ortho before I do, as I refer to them by name, and out of deep respect, would like their permission before I post it. But I digress.  

My point is, that I would really, really, really like to use my OB for the surgery...it would be our last hurrah together, as I will have no parts left for him to annually check when it is done.  I trust him, and well, he is my guy for such things.  Should insurance deny coverage, I would need to have surgery at UH, where incidentally, my guy does not have privileges.  I would have to use someone else.

Because, given that the Ramers are sort of the goose who laid the golden egg for UH, I would be in a better position to work out something financially with them for of all things, removing my eggs.  If I didn't have irony and snark, you might as well cut out my tongue as well, because I would have nothing left to say.  You have been warned...this is going downhill from here.

So, if I get my wish and have the surgery at Southwest, which is affiliated with UH, but not in fact owned by them, I will need to get my girl parts shipped across town.  Last time that I needed to do something like this (who ever needs to do something like this?!!) Dr. Peters, my kids oncologist, was kind enough to drive across town with a box of dry ice and swing by FEDEX on his way back to UH, sending one biopsy off to Toronto.  How's that for service above and beyond the call of duty?

As my local geneticist is taking the lead on this one, having developed an essay that will detect our p53 mutation to within 2%, international shipping will not required this time, thankfully. So, I need a local medical currier...which we are thinking might end up being Dan.  "Honey, can you pick up the dry cleaning, and drop off my ovaries?"  Seriously, who makes arrangements for the transport of their own organs, outside of their body?  

I need to be sure to get a doctors note for my dear husband, in the off chance that he gets pulled over.  (I know more than a couple of doctors...which one is the best for such a thing?)  Because "What is in the box?"  could be a very awkward question to answer, when it is in fact, pieces of your wife.  Probably should rework the phrasing of that answer.

In case you missed the memo, I have a weird life.

So, the actual surgery...  You will remember that I was looking to have multiple biopsies done.  I went in to this talk with my OB with a particular idea...kind of a buffet or smorgasbord of my organs...take a little sample of each while you are in the neighborhood.  So, after a little geography lesson...there is sort of the continental divide in you belly (diaphragm) which makes loads of things out of easy reach if you happen to be doing a pelvic surgery.  Damn. 

But, there is the liver and spleen in the area (ooh, goodie!). However, given their vascular nature, they have the tendency to bleed ...and not stop.  I was advised that this was a very bad idea. Usually, such biopsies are done with CT guidance, which is a bit more than 'just taking a bit while in the neighborhood.' 

I have said that I would never presume to tell a pilot how to fly or a surgeon how to cut. (Writing of a surgeon as sit next to a pilot)  While I really am committed to finding some answers, I am not wanton.  I do in fact listen.   I may be crazy, but I am not stupid.   But I was bitterly disappointed, nonetheless.  

Bowels will be biopsied by GI in a separate procedure, the details of which I will be sure to keep to myself, and for which you will thank me, heartily.

Which leaves my tubes and uterus.  

"Are you planning on having more children?"

Umm.. No.  (Thinking, I would remind you that you are taking out my ovaries....and we talked about this you when you tied my tubes several years ago)

With extreme patience, and a hint of irony, "Do you plan on carrying a child for someone else?" (In my spare time?  with my spare energy?  With my 44 year old parts and sketchy genetics hovering around in the background?  Not likely.)

At which point he explained that really the only thing that my uterus could bring to me in the future was cervical or uterine cancer.  He could biopsy them, but really, it makes infinite sense to remove them.   

Dan will need a bigger box.

As I left to schedule it, an opening was available for Thursday.  As in this Thursday.  I feel odd, having been anxious and prepared to do this surgery for 6 months now, but Brent is doing hyperbaric oxygen treatments every day....and this would be the day after we return from New York.  Seems like a lot, and so waiting until the next slot in June makes more sense.  We go in June at this point.

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.

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Flight number two...chatting with our pilot, I learn that he is from Maryland and works for NIH.  I kid you not.  We exchange IRB stories, naturally.  

The weather has changed dramatically, and we fly in solid clouds, which I have never done before.   I think that he said to within 800 feet of the ground, which he preferred was much higher, naturally.  I had no idea, sitting next to him, how disorienting it could be.  You must completely rely on your instruments, as instinct will help you not at all.  I have no doubt as to how JFK Jr got into trouble, because what you feel and what the instruments tell you do not jibe.  If you are accustomed to following your instincts, this sort of flying is a recipe for disaster.  

I am trusting in the experience of this pilot.  I trust the experience of my doctor, and of the doctors that we are traveling to New York to see.  Hoping that we all get on the ground soon...and safely.

Keeping up with the Jolies...or the Joneses

After hearing what we have to do, people often say that they feel that their worries or problems are not worthy of mention. The Ramers have it way worse than they do.

I was thinking about this today as I drove home from dropping the kids off at school and Olivia was still sort of waking up, so not actively talking my ear off as she customarily does.  Without having each American flag along the route pointed out to me, I quietly said my prayers and counted my blessings, as is my habit in such rare moments. And I thought about this notion of comparing our lives to that of others. 

I remember once, shortly after we moved here, Brent went to play with a friend who lived in another neighborhood.  When he returned, he exclaimed that they had an enormous house: beautiful and so big, that he got a little lost at one point.  Would we be buying a house like that someday?

I told him that I had no intention of moving for quite some time.  Our home was perfect for our family, with room for my mom, who has since moved in with us.  We have a wonderful neighborhood and live in a fantastic school district. I pointed out that there would always be someone who had a bigger house.  There would always be those who made more money.  We cannot measure our worth on this scale.  You cannot gauge your happiness in things, or in comparative terms.

I think that this idea translates beyond material things, actually.  I think you cannot find happiness comparing your life to others, your problems, your blessings…any of it.

I wrote recently about how I felt that Angelina Jolie might help bring some understanding of genetic predispositions to the general public, which then might translate to a better understanding of LFS…a place we could start our explanation from, without going all the way to the beginning.  (This often results in looks of confusion, disbelief, or best yet, a glazed over, vacant stare.) Given her giant celebrity status, she could bring attention to genetics and cancer, the way that Michael J Fox brought a public awareness and appreciation of the challenges of Parkinson’s disease.

It was interesting to hear from my LFS friends, and my friends that are breast cancer survivors (and for the record, there is some overlap here).  I was surprised at how aggravated some were with this whole business.  To me, it was as simple as someone famous, taking a strong preventative stance and providing some good PR, for lack of a better term, in sharing her personal story about cancer and giving some attention to genetic predisposition syndromes.

I suppose that because I seldom listen to the radio and never turn on the news, I probably missed a large portion of the ignorance out there (confirming the wisdom in keeping my TV off). So, I can understand the frustration of my friends with every idiot who failed to understand Angelina Jolie’s decision, or of what breast cancer brings. And further, by the fact that they felt compelled to confirm their ignorance by opening their mouth or commenting on the internet, denouncing her decision, one that most folks in this position happen to agree with.

But even if we didn’t agree, it is her body, her health, her decision…not public domain.  That, to me, seems pretty obvious.  And I could easily understand how difficult it might be to listen to such comments, and want to defend against such nonsense…maybe in violent frustration.

But what really surprised me was the reaction of some to the facts of BRCA, and Jolie’s decision to have surgery, thus nearly eliminating her risk.  Apparently, this was received with much public support, lots of “brave” and “courageous” accolades.  I personally do not have a problem with these adjectives, but some breast cancer survivors found this objectionable, which I found curious, until I listened a bit more.

I believe it is the opportunities that Jolie has been afforded that makes it difficult for some to drape her in laurel leaves as a ‘champion.’  Because she certainly has blessings in this life:  Financial independence such that she can hire help with laundry and kids; a platform from which to speak and a voice that people pay attention to; access to the very best doctors and the money to pay them without needing to  duke it out with an insurance company; genetic knowledge in advance of a diagnosis, one that afforded her the opportunity to chose a mastectomy, and careful reconstruction, when others had the same procedure forced upon them with a diagnosis, further insult to follow in the form of a chemo and/or a radiation chaser; Angelina’s ability to overcome her ‘genetic liability,’ (the way those with LFS cannot) and likely avoid cancer altogether. 

Let’s just say that there were strong feelings about all the gushing and hoopla among some LFS friends as well.  LFS is like playing in the major leagues of cancer.  Jolie just got called up and these vets were not necessarily impressed with the rookie.  She hasn't faced a fastball, the screwball...the curve. Does she have any endurance?  She hasn't got the experience, and some out there are making her MVP.

I was bewildered. 

While Jolie is genetically cursed with a mutation (BRCA) that she was wise to both respect and address as she has done, those same genetics blessed her with extraordinary beauty, which is partly why we are still talking about this…she is in the movies and we are Americans.  Forgive me for stating the obvious. 

And that twist sort of hacks some regular people off, especially those who have the yin of crappy genetics, without that yang of that exceptional beauty…which has led to her status, her platform, her financial ease, all of which are enviable.

But if I had had cancer, had this surgery thrust upon me, fought my way through chemo, through radiation, learned of my devastating genetic diagnosis which cannot be surgically mitigated, and struggled to care for my children while fighting with the insurance company like a superhero, or madman…I might not have warm and fuzzy feelings about this Johnny-come-lately who had done none of this, and who people pay attention to because of her beauty.  I can see how that would be irritating.

Well, now I get it.

From that perspective, she might not seem so much 'brave,' as logical, pragmatic and resourceful…using whatever is available to her.  And she has much available.  I do not personally begrudge her the resources.  Believe me when I say that I use whatever I can find to get through.  I count my blessings.  I know that I have many.

But ultimately, I think that it comes down to understanding the fact that there will always be those better off than you, and there will always be those worse off.  Using a dear friend’s description, LFS is 'the mother of all cancer syndromes.'   And thus, genetically, we are the top of the heap, cancer-wise.  We are the most exclusive club, but the sorority that no one rushes. No one has greater cancer risk than this small, scattered group of families from all over the world.

They struggle, anonymously for the most part, for generations, losing significant portions of their family.  They want help.  They want solutions.  They want a voice.  They want research dollars.  They want to be heard.  Mostly, they desperately want a cure. 

I am a newbie, without any sort of LFS perspective, or heavy oncological baggage in my family.  I lost my father to kidney cancer, although I have been assured that this was not LFS related.  It counts toward my cancer fear factor, this loss.  But it is not in the same league, not even close, to the stories of my friends, who have lost so many…children, siblings, cousins, parents, aunts, uncles… 

I have a different perspective.  A different story.  We all do.

I am grateful that Angelina Jolie shared her story.  She still garners my sympathy and admiration, because she seems to be a pretty private person when it comes to her family.  In sharing this, she has helped others, and I view it as a measure of generosity, this giving of her privacy, a treasure that she seems to hold dear.  The same anonymity that others find despair in, might be exactly what she craved as she went through her procedures, skulking around and hiding from the paparazzi.  You have to take the bad with the good, and we all have different challenges. 

I try not to compare my life, or situation to others.  This is simply my story.  And I try to do the best with what I have been given, and relate compassionately to those who cross my path.  I look with much gratitude to those who have helped me, which includes the insight and support from a beautiful group of strong women from all over the world, each rivaling any character that Angelina Jolie might play on the silver screen.  They are bad-ass in real life and deserve equal time, even if you do not know them and they never happen to grace the cover of People Magazine.

Just saying.

Angelina Jolie and LFS

Angelina Jolie made all kinds of news yesterday.  I am not a tabloid reader, and I have been far too busy this week to do more than a mad dash into the grocery store, where I otherwise might have stumbled across the latest Hollywood gossip while waiting in line.  

But even I, in my nearly Amish status, am aware that she had a double mastectomy, and breast reconstruction. (My FB page is littered with breast specialists and geneticists, representing every hospital and cancer organization that I am "friends" with...and there are many.  They are all talking about it.) She announced this fact in the Op Ed section of the NY Times, giving details of her family history, her genetics, and the surgical options that she selected, understanding the implications of the former two.

In my world, which has been electronically expanded to include folks with LFS from all over the world, such a drastic and radical decision is not that unusual.  I am acquainted online with many women who, given their family history, devastated by breast cancer, and their LFS status, have taken the same aggressive and strong preventative position that she has. Many more among them are contemplating this same measure. I applaud them all. It is fierce, and beautiful, regardless of common ideas about beauty and femininity. 

Angelina Jolie has a genetic predisposition to ovarian cancer (which her mother suffered with) as well as breast cancer. A  BRCA 1 mutation will significantly increase the likelihood of her developing breast cancer, somewhere between 54 and 87% over the general population, as I understand it (especially in rare disorders, numbers and studies vary, kind of a lot) and ovarian cancer between 40 and 50%.  These are some giant, scary numbers put in front of anyone. Even if you look only at the low end of that risk, it is significant.  Losing her mother to ovarian cancer makes this information much less theoretical. Given her personal experience with it, I suspect that there were some sleepless nights involved for this poor woman.

There was something in Ms. Jolie's statement that I read, that suggested to me that the double mastectomy was perhaps not the end of her medical to do list, but rather, just the beginning. She 'started' with the higher risk and more complex surgery, which sounds to me like an oophorectomy might be next, to take care of the ovarian risk.  I would love for her to get in line, right behind me.

I have very recently had my research approved by the IRB, to determine the extent of the mosaicism of the p53 mutation (LFS) in my body. It is known that the mutation is at least in my ovaries, and as they have completed their usefulness (I have four children and am over 40) I believe that it is time that they go, before they go bad, go rogue, misbehave...pick your favorite cancer euphemism.

Then, by this research, we can begin to learn if my risk is limited to germ cells or if I have a global risk.  This is an important bit of information, not just some idle curiosity about my innards. I need know if I should be screening, like my children are. It sort of matters. A lot.

I do not want to, in any way, minimize the seriousness of a BRCA mutation, but LFS is like BRCA...on crack. While LFS carries a similar elevated risk for breast cancer, we also face increased risk of brain, lung, adrenal, colon, bone...every cancer out there is fair game...every cancer out there is our game, and the odds are higher for us to play in every single one of them.  The female LFS carrier has a 90% chance of developing cancer by 60... Ninety percent.  

Stew in that for a minute.

The difference with LFS is that there are few risk reducing measures to be taken.  While BRCA patients can choose to live without breasts or ovaries in order to reduce cancer risk, (again, not minimizing the difficulty in arriving at such decision, or in taking such measures) but for LFS, bones and brain cannot be eliminated proactively.  My kids have parted with a bit of both, but that, naturally, comes after the oncological fact.  We scan, and we screen.  We do what we can to catch it early, our experience being that a small cancer is more easily managed than giant throbbing tumors (And we have had both).

So, aside from the red carpet, the international humanitarian missions, the galas, and waking up to Brad Pitt every day, Angelina really isn't so different from me.  (Ok, that is snarky). But in truth, if you peel away all of that, which really doesn't matter to me (except for the humanitarian stuff), she is a woman who knows that the genetic odds are not treating her kindly, and she really wants to be there for her 6 kids.  She is willing to go to some extraordinary lengths to take care of herself, so she can do just that. I believe that I can relate to this.

And also, I am sure, because she is a smart woman who has surrounded herself with some smart doctors, she is thinking about whether to test some of her children. Certainly, her love for them does not take into account biology...half of her children are adopted, I believe.  But while her love is blind to personal genetics, in this case, the biology does in fact matter.

And I can certainly attest to the angst that comes with wondering if you unknowingly gave your child the crappiest gift ever...and wondering if should you find out?  And what would you do about it, once you did find out? My prayer for her, or anyone who decides to test their children, is that they have the reassurance of a negative result.  Because, a positive one brings other difficult decisions...many of them.  And worries.

But also, as Angelina Jolie publicly proclaimed and demonstrated, some power. And that power to act, to decide, even when the choices are tough, that is the blessing we have in this day and age.

I return to that 90% number for ladies with LFS...and what we might do to make Lauren's life the fullest, in every way.  She has had two cancers by the tender age of 9...and while we feel that this has been more than enough, the research indicates that she might not be done.  What will Dan and I do with this information? I will let you know when we decide, but I can assure you that we have thought about things, been forced to think about things, things that the average parent of a 5th grader never contemplates, and likely cannot remotely understand.

So, with their giant stage, I am glad that the Jolie-Pitts have shared some of their story, if only because the public at large will now have some notion of what genetic predisposition syndromes like BRCA are, and consequently, might have a better chance of understanding LFS a bit better.