A glorious day from start to finish

Dawn on the North Bay hills, with no smog, no fog, just clear and bright -- well, it reminded me of the inspirational nature of the world around us. (I guess you see I'm feeling great today.)

There's something about early morning light that enhances the many shades of green.

I met with my old friend Michael Rubenstein for breakfast and heard his daughter just had twins! Mazal tov to them all.

A very interesting coincidence at work in Mill Valley today - we received a postcard from a local elitist quasi-medical establishment which provides, among other services, thermography for use in diagnosing breast cancer. It works with temperature differences, not x-rays, and the photos on the postcard were convincing. What I saw were 'hot spots' on 3-dimensional pictures showing where cancer appears.

While I would never rely on this test as the only diagnostic tool, it may well be cutting edge and therefore its use could only help. I am waiting to hear the price.

Understand that Mill Valley is home to maaaaany wealthy (some also famous) people. The folks I see are extremely well-groomed. Their children are clothed in only the finest - for God's sake, there is even a store devoted to doggie couture. Still it's Marin, so health is a high priority - but it's so easy to look good when you're pampered and rich. I have never seen a famous person, but I'm keepin' my eyes peeled for Bonnie Raitt. I adore her music.

I was busy in the morning and again all afternoon, with sweet women at work keeping me focused on my strength, my courage, my organizational skills and how loved I am.

Lisa, my afternoon co-worker, presented me with a beautiful black leather-bound journal. I will write in it before bed, intimate thoughts not to be shared. Names and telephone numbers will be in there as well, and notes from all appointments and phone calls.

Many long chats during the drive back to Oakland, and then it was time for yoga. Hugs, kisses, smiling faces, and hard yoga. Great stretching and strength-building moves, relaxing when all is said and done. And as Ellen, our yoga teacher, was wrapping up, she told me that the group had raised some money to get me some gifts. Gift certificates for a 90-minute massage (eat your heart out) and services at a local spa. To say I feel loved doesn't even come close.

I am still with about-t0-get-a-cold symptoms, but tylenol has been helping and I know I'll have a great night's sleep.

Please don't expect the next post before 8 pm on Tuesday. Oh, in the Jewish culture Tuesdays as considered better days to do special things - because it was on Tuesday, the third day of the week, that "it was good" appeared twice in Bereshit (Genesis).

It sure was dark early tonight

I guess the time change hits everyone hard. Heshy's party was fun, but I couldn't participate fully - I feel just enough sick that I want to stay in bed. Plus the stress adds to that, I suppose.

Anxiety, stress, irritability, headache - it's all part of the package. Try as I might, my joie de vivre is nowhere in sight. Perhaps after meeting Dr. O'Neal on Tuesday there will be less worry. So many questions - what's the stage? How about an oncologist, chemo, more surgery, maybe mastectomy? A full report can only help. But those statistics, now they're even to scare anyone to death.

A new lump that was discovered 2 weeks ago today has not gone away - it's under my arm, solid and worrisome. I must tell Dr. O'Neal about that too.

Kids should not have to worry about their mother. My kids are worrying, which makes me wonder how they'll feel if I am much worse before I get better. Assuming I get better.

No one can really tell if the symptoms I am feeling are related to the cancer inside of me. A virus my body is fighting? All in my head? So why have I felt this way consistently for weeks now?

Tomorrow morning I will head to work at the butt crack of dawn (thank you, Emma, for that phrase) and work all day. Though I've missed only one week of yoga I feel as if I've been away for months. Monday night is yoga, then home, fed and into bed. Tuesday I'll take the kids where they're going, have a nice breakfast, then meet Dr. O'Neal.

The detailed nature of my work will keep my mind off the big elephant in the room. And yoga will help me find my center - if it's still hiding I'll keep looking anyway.

As I was heading up a nearby street during Heshy's party to set up one of the activities, I suddenly heard sounds I could not identify. Looking up I noticed a group of birds - don't ask me what kind of birds, I haven't a clue - taking flight. It was the flapping of their wings that got my attention. I watched as they moved together, round and round above my head in unison, six times exactly, before they flew away.

Saturday night - Shavua tov (it means 'good week')

More information received today about the biopsy, although just some, not all.

The estrogen/progesterone receptor test was negative, which likely means that Tamoxifen is not in order. The Her2new test was also negative, that's the one about Herceptin, that drug we've all been reading about lately. So none of that either, it seems.

One bit of a plus about the estrogen/progesterone receptor test result is that perhaps they won't be in a rush to remove my ovaries. Cancer treatment concurrent with full-on menopause? I don't think so.

Since Avi is in San Francisco this weekend with his best friend, Asher, he got some lovin' there from old and dear friends. They now notice that he's a real teenager, and he's got it goin' on.

I was supposed to go out with my friend Liz and her toddler daughter tonight, but I'm still feeling under the weather and can't get the energy to do it. I did walk to and from shul (synagogue) today, only 1.6 miles roundtrip, better than nothing.

Walking yesterday was very therapeutic. Being out among Oakland's residents, walking the familiar streets in the cool fall air, moving my body . . . well, I felt renewed and reminded of the contentment and beauty all around me. I was especially impressed yesterday by a group of young people, in their 20s or so I think, Ethiopians who've settled in the Grand Lake area. Their open hearts, their happiness, their pleasure at being together - this all touched my heart in a special way. They've all known sorrow and want, they've all had hard journeys to this place, and still they smile broadly at each other and at me. If only I could capture their joy. I must add those faces to my collection, for they have granted me a respite from worry.

It's ironic that everyone who sees me says how great I look. (Listen, there's no way to soft-pedal that statement, I'm humbled by it.) I'm proud of the way my body has shifted and shrunk some while I've been making better nutritional choices and exercising. If only the way I look now could have some impact on the way a small army of rogue cells is out to get me inside this better body.

I've been getting the feeling that things are going to start moving a lot faster with my treatment. After Heshy's birthday party tomorrow I'll be in full gear for the next set of appointments. And I'll be working, but cautiously searching for ways to keep my clients but not do the work myself.

I've created a list of tasks I'd like done that I cannot do, and I'll be providing contact info to all on this blog about whom to contact. The overwhelming response of the varied and farflung cast of characters (and I mean that in a good way) I call friends has warmed and comforted me.

Harriet told me something today that made me chuckle, so I'll share it to close -- she did not attribute it, but told me that someone said "Between Judith and cancer, cancer should be scared."

Approaching shabbat

I'm trying to stay busy, and that seems to work fairly well for my mood. Along with walking the 2 miles to my Oakland office this morning, and catching up with phone calls to family along the way, I'm feeling better, and my number now is a 6 or so. Much improved.

My friend Sarah has provided me with tons of info about doctors and therapists at Kaiser in Oakland. I've tried to make appointments with limited success, but at least the process is begun.

I have an appointment on Tuesday 11/1 to see Dr. Kelly O'Neal, a surgeon at Kaiser in Oakland, after which I will meet with Rachel Whalen, the breast care coordinator there. I will have a list of questions a mile long and hopefully will bring along someone who will agree to be my point person and come to every appointment with me. Still searching for that point person, stay tuned on that score.

I am taking copious notes and carefully documenting everything. This provides me with some comfort and will be useful in the future, I'm sure.

I have asked that people who pray ask for continued strength and courage for me.

Avi will be spending most of the weekend with his best friend Asher in San Francisco, which means he'll be at Beth Sholom this Shabbat. I expect he'll get lots of hugs . . . I think he could use them.

I'm fresh out of witty things to say at this point. Thank you for encouraging me to keep this blog going, it's been wonderfully cathartic for me.

Next post will be after Shabbat ends on Saturday night, which this week will be at about 7pm.

On a scale of 1 to 10 . . .

At our house we have a way of asking 'how are you?' with a scale, with 1 being awful and 10 meaning you feel great.

This morning I'm at a solid 3.5.

After sleeping on what I learned yesterday, I now realize that Kaiser doesn't coordinate care for patients like me, and that I'll have to drive this bus the whole journey. Today, in addition to working as usual, I'll need to make sure the biopsy results get to the right party, find an oncologist, arrange for a second opinion outside of Kaiser (and in addition to Kaiser), blah blah blah.

Oh how I wish this could be done without me, all of it. Ridiculous, I know.

blue is the right color.

A quick review of today's dr. visit

In no particular order, here's what happened today:

I asked if my general malaise, which has been present since before I found the lump, is in any way connected to this cancer. The answer: Quite possibly, some people report 'not feeling well' as the first sign that something was amiss.

I asked when and through whom the oncologist participates. This answer was more vague: It depends on the surgeon. Since Dr. Shaw and I had already discussed the fact that I'd be moving my care to the East Bay, she knew there'd be a different surgeon on the case. Some surgeons like to complete their part of the process before bringing in an oncologist, others do it differently.

Of course the final results of all the tests on the tumor will drive the process, but it's important for me to advocate for myself and, perhaps, be a squeaky wheel to have all my care coordinated.

Particularly, Dr. Shaw said that the test for estrogen/progesterone receptors would show if I'd be likely to benefit from beginning Tamoxifen. The Her2New test would suggest, if it's a positive result, that Herceptin might be in order here.

Although the tumor was only 1-1/2 cm. long, she said it was "poorly differentiated which means it is very aggressive." Her words. And that it might be appropriate, again depending on the results of the testing that's being done now, to have Neo-Adjuvant chemotherapy, which is used before testing is even complete, or Adjuvant chemotherapy, used 'just in case.'

Dr. Shaw told me that her plan for me, just for my information at this point, would be to operate again (after I'm completely healed from the lumpectomy, and the recovery is going smoothly), to remove more breast tissue to get clear margins, and to do a sentinal node biopsy. This biopsy will determined if there is any reason to believe that cancer cells may have spread. If the sentinel node biopsy is negative then I'd just be facing radiation and the possibility of chemo.

But it is up to Dr. O'Neal to give me her opinion, and I'll be getting all my medical ducks in a row before I see her -- I'm planning to coordinate with the lab in SF to assure that my biopsy results go to the correct doctor, I will be talking to an oncologist-friend in Kaiser SSF who might help me sort this out, and I have my films with me.

I'm exhausted, it's been a long day, and I'll write more tomorrow about Heshy's birthday and the ships outside the Golden Gate.

Oh, ending on a very positive note - I've got clearance to exercise my tuchus off. Yoga, walking, the whole thing. Yippee!

Who turned on the rain and tears?

Well, it was bound to happen, and I knew once it started there'd be very little I could do about it.

Rain is lovely, it makes things cleaner and it's a nice change from all that irritating sunshine. Last night as I was snuggling with Heshy, all of a sudden the tears started, and honestly I couldn't swallow them quickly enough for Heshy not to see them.

He's quick, and he's always saying what's on his mind (gee, I wonder where he got THAT from) so he told me to 'stop making those faces right away.' I tried as hard as I could, because, well, obviously I don't want him to start seeing me sad. But it's impossible to think about him, the youngest of them all, and not worry. Even if all I'm facing is a torturous year of medical crap -- still, today's his 8th birthday. He needs to concentrate on finding new ways to drive us nuts, discovering more gross crawly things in the garden, and figuring out better techniques for getting out of his chores.

Somehow, with no idea where the strength came from, I stopped 'making those faces.' And then he and I agreed that worry is pointless, since I'll be just fine.

I hope God was listening.

Hot tea, rainy day

Early morning in Mill Valley, it's raining outside my office window.

I'm still waiting to feel the impact of yesterday's news: invasive breast cancer. Lots of questions come up: Is there any connection between the about-to-get-a-cold feeling I've been having for several weeks and the cancer? When will I be able to resume my walking and yoga? Should I be taking some kind of drug(s) now?

One thing is for sure -- I need to move the center of operations for this project to the East Bay. The only reason I started out in San Francisco is because my ob/gyn, the same one who has been my doctor for 10 years and delivered Heshy, is in San Francisco. Find breast lump = call gyn. Dr. Sapan examined me, referred me to the Dept. of Surgery, and I was assigned Dr. Shaw, who is new to Kaiser and comes with quite a reputation in the field of breast health.

A post-op appointment with Dr. Shaw is scheduled for Thursday, tomorrow, the 27th (also Heshy's 8th birthday) and I'll review the situation with her carefully, taking lots of notes. Hopefully she can help me find the best Oakland Kaiser doctor to take over my care.

I like Dr. Shaw, she and I have a lot in common. She's frank, she's confident, and she's Jewish. Enough said.

Last night at Beth Jacob it was easy to move from friend to friend telling the bad news. Most everyone knows several women who've recovered from breast cancer and many have survived for decades. God knows that the science of treating breast cancer has exploded in the last few years, just in time for me. Just since I found the lump there has been something new published about a new use for a current chemo drug.

Still feeling fit, strong, healthy and confident. Worry not . . . I think it'll take a lot more than this to finish me off!

Results are in

I have invasive breast cancer. The surgeon just called. That's all I know right now. Next surgery will be in a few weeks when I have healed, and more info about the cancer will come by 11/1.

The interminable wait

Damn, this is so hard. All day Monday I kept hoping that one of my Kaiser contacts would be able to squeeze some information out of those hard-working people in pathology. Wouldn't it seem obvious that those who are waiting to know whether or not they have cancer would go to the front of the line?

But Monday ended and no news yet.

My pity party resumed for a time early Monday evening. So I decided to try to go to sleep as early as I could, thinking that the time would pass more quickly that way.

In the dark, clutching the teddy bear I call 'Mama' close to me so she could support the weight of my breast (which looks and feels like it's been in a car wreck!), I try to use my customary visualization technique to fall asleep. I imagine a room, I'm in the room, and it's filled with everything I've been thinking about. One by one I picture each issue, tell it to leave, and it exits through the single door. As the room clears and I make my mental list for the next day, I am alone, there is fresh air, the sound of waves gently lapping against the sand, and off I drift.

Monday night's imaginary room just had waaaaay too many things in it to empty, too many to consider. So I began to think about each and every person in my life who is 'in' on this drama, and as I picture their faces looking at me, they are joined by others they know, and soon I am surrounded by wonderful, kind and loving friends and relatives smiling at me, hugging me, praying for me.

It was in this most divine state of mind that I fell asleep last night.

Sunday is drawing to a close

Avi's birthday sleepover was last night, and I'm thrilled to report that it did not have any impact on me whatsoever. I feel just fine, with the exception of a slight cold, and seem to be recovering from surgery very nicely. I plan to get a good night's sleep and get up to go to work tomorrow, as usual.

So the question lingers: malignant or benign? I'm prepared for the worst, since so much of what's happened up to now has been fairly bad, so I can't even imagine hearing that the mass is benign. Needless to say, it would be very welcome news.

My sister Sheila flew up from Palm Springs to be with me this weekend, and she assured me that she's there for me in whatever way I need her.

All I can say is stay tuned, check back often, and I promise I'll keep this blog up to date.

The surgery (not for the faint of heart)

Back to Thursday, 10/20. When I registered in the mammogram/ultrasound department, there was much confusion among the administrative personnel about the procedure for which I had been scheduled. Turns out that the appointment was scheduled incorrectly, but since there was surgery planned they had to squeeze me in (pun intended).

The first stop was in an ultrasound room. Cathy sat with my things where she could see me and see the screen of the ultrasound machine. Since my appointment was made inadequately, the technician was unprepared for me, and I had to explain exactly what I was there to have done: In order for my surgeon to know that the mass she was removing was indeed included with any other tissue, a tiny metal thread the width of a strand of hair, was to be inserted into my breast and into the mass. With that information and the other details like which breast was the 'bad' breast (although I honestly loved them both equally and always will) , the technician started the process.

Along with Cathy I watched the ultrasound screen as the mass appeared. When the technician was satisfied that she had located the correct position of the mass (and I guess she worked out that she was on the correct breast . . .), she left to get the radiologist who would be inserting the metal strand in the mass. Being in a kinda crazy mood, I began introducing myself to the doctor, introducing the doctor to Cathy, and I told this doctor that, since I was sure his first name wasn't Doctor, I would be calling him John. John Rego, it turns out, is a member of the other shul that's about a mile from our house, Temple Beth Abraham, a Conservative shul.

He made some comment about our mechitzah, the divider in an Orthodox shul between the men and the women, and we bantered back and forth having a good ole time. Then he numbed the area, warned me when he'd be sticking the needle in, and, with the help of the technician, located the mass and threaded the needle through it. On the screen we could all see the mass, and now we could see the process clearly - even the indentations of John's fingers could be clearly seen. What will they think of next?

When the metal thread was in place he cut off the part of the thread that was still sticking out of my breast, leaving about an inch or so for the thread to be taped down to my skin. This was to ensure that the thread didn't get lost in my breast. On to the mammogram room.

Now Cathy and I had just seen obvious and clear, hit-you-in-the-face sort of evidence that there was something growing in my breast. But when my breast was placed on the plate in the mammogram room, nothing appeared except the metal thread! I had had more than one mammogram in my life, but this setup was altogether different, because the x-ray image appeared continuously on a monitor when my breast was placed on the bottom plate. So we could see, really SEE, exactly what was going on. Cathy remarked about the lack of proof of the mass on the mammogram, and pondered how many women must be thinking they're healthy when they have 'clean' mammograms. Two pictures were taken, and once the technician was confident that they had everything they needed for my surgeon, I dressed, took the folder with the pictures, and headed to the 2nd floor surgery dept.
We met up with Neela in the surgery dept. I checked myself in with the woman at the reception desk, handed her the films, and told her I was having a great day so far. (I am confident she thought I had lost my mind.) Neela, Cathy and I sat in the quiet waiting room and chatted until I was summoned by a nurse. "Can my entourage join me for the procedure?" I asked her. She slowly shook her head 'no,' and she let my friends know that I'd be done in about an hour.

I was led to the surgery room, a small room with lights and supplies available like in any operating room, but within the clinical office and examination rooms. Not even 'outpatient surgery,' more like the we'll-just-take-care-of-that-in-my-office sort of place. The surgical nurse prepped the area with betadine, then the doctor arrived. There was soft music playing in the background, and Dr. Shaw went to work on my left breast. She explained each step as she worked - opening up the skin, cutting through the tissue (with small scissors, what a strange sound to hear!), locating the 'area of concern' within the tissue, etc. As she worked we talked about all sorts of things - lots of issues about breast cancer, plus details from our lives. Even the surgical nurse chimed in, saying her son was floored when he attended a bar mitzvah party that was black tie, all that for a 13-year-old boy. When I was all sewed up and they were finishing with me, I asked to see the tissue that Dr. Shaw had removed from my breast.

This was both fascinating and disgusting - the removed tissue took the shape and approximate size of three scrambled eggs (now that's a lot, I thought), and was composed of some ugly yellow fat globules, whitish breast tissue and the mass. As I watched Dr. Shaw cut the mass in two - it seemed like it was thicker and denser than the surrounding tissue, having a color I'd describe as very pale yellow, she said, "This doesn't look good," after which she rushed to provide all sorts of caveats about her remark. The tissue went off to the lab, I got up and dressed, and when I emerged into the waiting room I was feeling quite chipper and happy. Cathy and Neela, my yoga friends who accompanied me to that day, were absolutely amazed that I had my composure and sense of humor intact.

Candle-lighting time is nearing

and I am going to be shutting down the computer for Shabbat. I spoke to my surgeon today, no results yet (not expected yet either, but it doesn't hurt to try). She said it sounds like my recovery is going well.

Except for some medication-related fatigue, I feel great - and I wish I could be walking already, but I'm staying put. I will not be at Beth Jacob tomorrow, but I do expect to be there on Monday evening for Simchat Torah.

Your prayers and blessings provide the gentle comfort I crave. To all who read this, family and friends, have a wonderful Shabbat and stay tuned.

About that nasty lump under my arm

Sorry, I was just reading the 2nd one and realized I'd not addressed that lump.

As I said I would, I told everyone I saw at Kaiser yesterday that I had found another lump. I'm sure some of the folks thought I was simply oversharing, but I've learned that at Kaiser you just never know who IS exactly the right person to tell.

In the operating room when I saw Dr. Shaw I reminded her about it, she examined it, and declared it to likely be simply an enlarged lymph node doing it's job fighting infection.

A fun day - even on the way to surgery!

I spent a few days before the lumpectomy visiting the dark place that makes me worry about my kids. It wasn't an every-minute-of-the-day thing, but periodically when I was alone and not busy I'd go there and quietly cry.

Big surprise on the day of surgery - I woke up feeling great, determined to spend my time pursuing my own brand of happiness. After taking the boys to their respective early AM locations, checking email and putting myself together, I left home on foot wearing the most comfy clothes I own. A special scarf Marshall and I had found years ago at a crafts fair was around my neck - woven of every bright color, with soft-as-silk fringes.

Off I headed down the street and toward my favorite local place to eat - the Merritt Bakery and Restaurant. As I sat down at a small booth and ordered my breakfast, I pawed through the contents of my backpack and arranged my ad hoc workspace. One side of the table held the food, the other side the work. I paid bills, organized papers, ate every bite of the food (and it was really delicious, as usual), then headed to BART with 2 hours (waaaay more than enough) to wend my way to Kaiser in San Francisco for the operation.

By this time the sun had appeared, and my walk around the shorter end of Lake Merritt to the BART station was glorious - if you've never seen the view from the Civic Center side of the lake, I highly recommend it. Runners and walkers of every possible age, size and ethnicity were out in full force. Some had ipods and others cell phones. Many exercised alone, some with their children and/or pets or companions. We all smiled at each other and acknowledged the beauty of the day and the location.

As I approached the BART station and pondered purchase of a one-way ticket (Neela from yoga would be driving me home after surgery), I reluctantly left the sidewalk, the fresh air and my beautiful city for the dark tunnel of BART. As luck would have it, the correct train was actually sitting and waiting for my arrival, or so it would seem, and after I settled in my seat off it sped to San Francisco.

Weather can be very different in San Francisco from Oakland, so I was prepared in layers for the possibility of cold, foggy and maybe even windy conditions. But my luck continued, for emerging from the BART station I found the sort of weather that walkers like me adore - sunny and brisk. The streets were filled with workers on their lunch hours, many of whom sat on broad steps near Market Street, soaking in the sun and relaxing. This setting had an irresistible pull on me, so down I sat. No one here knew me, and I didn't have to worry that a dear friend's worried face would intrude on my contentment.

I began my City walk on Post St., home to Villeroy & Boche, the Williams Sonoma flagship store, windows filled with gems, and highly polished young men and women. It had been years since I'd had the time and freedom to wander from jewelry store window to jewelry store window, imagining myself the owner of a fabulous new ring or necklace.

As the time for my appointment approached I found the correct bus stop on Geary, boarded the bus, and got to Kaiser with time to spare to find Cathy, another yoga friend, waiting for me as planned.

I can't imagine what thoughts were going through Cathy's head as I bounded into the waiting room, hugged her tightly, and began telling her about my journey to, well, get cut open. Feeling exuberant, remarkably optimistic, healthy, strong and wise put a spring in my step and a smile on my face.

The lumpectomy

Things went remarkably well today, and I feel strong and brave. I have a lot to write about, which I'll try to do tomorrow. Right now my bandages and I are headed for bed.

I expect the first results by Wednesday.

The background and up to 10/20

In mid-September, 2005, I placed my hand on my chest for effect and my fingertips noticed that something below the surface of my left breast just didn't feel right. A lump the size of half my thumb was examined by Dr. Yisrael Sapan, my ob/gyn who delivered Heshy, and he referred me to Dr. Jennifer Shaw, a surgeon new to Kaiser who's been specializing in breast health for decades.

Dr. Shaw sent me for a mammogram and ultrasound. Neither this mammogram nor the preceding one in November 2004 showed any abnormality, although the technician noted that my left nipple was inverting. Not a good sign.

During the ultrasound the lump was quite clear. A first for me, the radiologist came into the room and told me to expect surgery to remove this lump, cancer or not.

Back to Dr. Shaw, who explained that a needle biopsy could not be done because the area of concern was a smaller bit of a larger growth and could easily be missed.

Last Sunday, the 16th, I found a second lump under my left arm. I reported this to Dr. Shaw who asked me to remind her that she wants to examine it today, 10/20, as I am scheduled to have a lumpectomy and biopsy. I've been told that the initial malignant/benign report should be available in 4-5 days, with the final results taking a full 10 days.

When I go into Kaiser today I will be having a needle inserted into the 'area of concern' in the mammogram dept., and then to the surgery dept. where the lumpectomy will be done under local anesthesia in Dr. Shaw's office. I intend to tell everyone medical person I see that I have a second lump.

Two women from my weekly yoga class will be with me today, so I'll not be going alone.

We've got to start somewhere

This is all new to me . . . three weeks ago I found a big lump in my left breast