After All This Time

After all this time, scanxiety is still a bitch. It will be 8 years since diagnosis in October for me, and I’m impatient with myself. I’m soooooo jaded about EVERYTHING in cancer world (and elsewhere) yet I can’t seem to be jaded about my own fear.

Some annual mammograms are worse than others. I was tense last year, but not very much. I kind of figured it would “all be OK” and it was. This year I’ve had some pain on my right side, around the breast and under the arm. That would be the other side—my cancer had been on my left. I’ve also had some nagging throat/gland pain, so my paranoia is quite high. So naturally, as you can imagine, I’ve been a massive asshole for the past month or so. Super irritable. Quiet. Too much in my own head, up my own ass. What little “acting upbeat” energy I mustered, I saved for my job, and I’m ashamed to say I didn’t manage that quite well either.

When I went for my mammogram a couple of days ago—the oncologist always schedules a diagnostic, not just a screening one—I brought up the pain, and was approved to get an ultrasound too. All is well (with that; my throat issue will be dealt with next week). Two things struck me so hard during that hour or so it took to do all of this. The first was an idea that maybe I’m good at manipulating this situation. There is a sort of—not privilege exactly—being a former cancer patient. I was believed, there was no question. I know how to phrase it in med-speak: “I’m experiencing pain in the lymph area, and the side of the breast,” I say, so calmly. And they are all over it. It just seems to be in great contrast to things I’ve read (at random, they just seem to pop up in feeds lately) about womens’ pain being dismissed, chalked up to mental/emotional stuff. And while I still carry around a grudge about my first ever mammogram totally missing my giant-ass tumor back in 2010, I no longer mention it in the threatening manner I used to use to let imaging techs know–hey, you fucked up with me before, don’t let it happen again. What a weird status, to be a former cancer patient in the imaging center.

Second thing that struck me was just how much I HATE all of this. I hate the mammogram, it freaking hurts, especially on my left—the impacted side, the nippleless one. I always think I’m going to faint, but luckily I manage to get through. I hate sitting there in the ultrasound room, I hate the gel. I hate going into any medical facility, if I get right down to it. I hate being older so that the likelihood of potential diseases increase each year—any disease—whatever that will force me to take meds, see doctors. Yeah yeah, aging is a privilege denied to many, too many that I’ve known. So I’m not doing the “getting old isn’t for the faint of heart” thing—but, dammit!

When I was making my treatment decisions during that year, I remember a friend advising me to just “chop ‘em off”. So insensitive and I’m still sore about that. But on the other hand, before my diagnosis, I probably held the same view. It was only when faced with the reality that I recoiled from that caviler notion, and decided to take the lumpectomy the oncologist and surgeon recommended—because my chemo had done “so well”! Not sure why I didn’t want to lose my breasts, they aren’t great or anything, and I’m NOT a beauty queen, it was kind of out of character for me, really. Afterward, I was a bit smug, as I read all the articles during my early blogging days saying women were over-treating, jumping the gun in bi-lateral mastectomy, which does NOT increase survivability, does NOT decrease recurrence (cancer very rarely jumps from one breast to the other). I was prideful of a rational decision. But really I was just afraid; of what I don’t know. There are days I regret it. I know full well this is stupid, removal would prevent very little, but when scanxiety kicks in, rationality flies out the window. And I would just redirect my paranoia to other body parts—I’m doing it right now!

(NOTE: I’m not a medical professional, don’t let my confession of regret inform your decision—hell, don’t take ANYTHING I say or do as a factor into a decision—I am the worst, trust me, I’ve lived with myself for 46 years, I repeat, I’m the worst.)

I think I started this blog in 2012, so it is nearly 6 years I’ve been at this. I bet I can find complaint posts from as far back as 2013-14 regarding my frustration with the bi-annual “mammograms are not that great” debate, the cyclical debates about war metaphors, just everything. Feels like I’ve heard every angle to every argument about a million times. As I’ve said on this blog repeatedly, I’m short on patience. I cycle through things quickly. I get jaded fast before others (new patients I guess) even discover some of this stuff. So now I’m a bit jaded and impatient with myself. So often in the past year I’ve written posts here and on Facebook that cancer culture and the pink shit has GOT to move forward, the stagnation is choking me! Now I’m gagging at my own stagnant self, because I am still reduced to jelly knees when the annual trek to the imaging center arrives.

Longtime readers know, I’ve been absent here because I’ve switched focus to politics in the past 18+ months. But I’ve even been lame with that. Every day is a new low, a new outrage, and I am very burned out. This is not good for someone who has no patience (like, uh, me!). So I’ve been careful on Twitter, on all 3 of my accounts—nothing worse than an angry tweet, screenshots are forever! And Facebook’s algorithm is so stupid I just keep seeing the same stuff over and over; I do little 1 minute scrolls on my phone, but I barely register what I see.

I guess you could say I’ve disengaged a little bit. I needed a distraction for April and May so I concentrated on the end of the TV series “The Americans”, interacted with other fans—it was nice. I needed that escape.

Of course, I cannot stay disengaged for long, real life intrudes. I was stuck in traffic the other day (summer at the beach, y’all) behind this car with a multi-colored ribbon sticker that said “support cancer awareness”. It took all I had to not leap out of the car and shake the other driver: “what the hell does that even mean?!” I was so overcome with hatred for the word “awareness”, for the fact it has lost its meaning. And just a few minutes ago I was trying to listen to the 50 freakin’ podcasts I’ve downloaded on my phone and an interview with Amy Robach popped up. It was only a 15 minute thing (or so—I listen at 1.5 speed or I’d never catch up). But she managed to say every damn cliché known to breast cancer narratives (yes narrative is a damn cliché too). I only agreed with her on one thing: that it can kind of suck that docs tell us our treatment is “our choice”. I mean, I appreciate not having some god-complex-afflicted doctor command me from on high like in the old days, but on the other hand, I am paying for their expertise, because I sure as shit don’t have it. Everything else she said was just a mess. She started right off with the whole cancer makes you a better person myth that is oh so damaging. I would’ve turned it off, but I was washing dishes, and I just didn’t want to take the time to stop, dry my hands, then go back to it. I guess I should reign in my harshness. New patients might find solace in her “story”, others still, who are more like myself—and probably like you if you’re reading this—have to come to their realization in their own time. I can’t just stand up and be like, “hey can we all collectively, as cancer patients, no matter what year of our journey we’re at, just stop with this tired old script?” I want to do that, but then, I’m a bit crazed of late.

quotes-Where-is-my-mind-

Well, I went off the rails a bit didn’t I? This has been a periodic, classic Cancer Curmudgeon word vomit, stream-of-consciousness ramble. It is the written, electronic, blog post equivalent of me poking my head out of the little cocoon I’ve developed, looking around and going “what the fuck?” and diving back down.

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Get There Faster!

TV Re-Runs: Part II – “Friends”

A/N: This is the sequel to the previous post and was supposed to appear a couple days ago. But…I got a nasty head cold in between and am still a little out of it. So, that is why it seems late.

Tired of Pink pushers acting out the SNL “Mr. Short-Term Memory” sketch, I change the channel to another TV re-run: the ever popular, always-on show, mammography. What real TV show seems to always be on some channel? “Friends”! Not that there’s anything wrong with that. Yes, I’m referring to another popular syndicated sitcom. I’m happy both are often on, I like them very much. I cannot say the same for the constant mammogram debate always in re-runs.

I always have a difficult time when the mammography and over-diagnosis debate rears its ugly head. I was under-diagnosed. I received a false negative for my very first mammogram at age 38, which I requested because my 48 year old aunt had just been diagnosed. About five weeks later I was falling down the cancer rabbit hole with a 5×6.6 cm tumor. I’m left distrustful and bitter on the subject. I find it difficult to think about.

So when mammography gets discussed on a wide scale as it has been recently, I lose my temper quickly. The same old nuggets pop out: it is not a 100% accurate method of screening, it results in over-diagnosis and over-treatment, it makes no difference in mortality, blah, blah, blah. Then the articles written about a report pick it apart with paragraphs of numbers and what they mean, to show why the report is to be believed…or not. And so readers have to be wary and recognize that all that is written comes with biases, and as one article implied, some minds will never be changed.

source publicsq.tumblr
source publicsq.tumblr

My emotions make me just register white noise, so the science and evidence is difficult for me. It all sounds the same, and I think, wasn’t this just discussed? One recent article I started to read kind of had the same been there, heard that attitude, pointing out this controversy rises every few years. I was thinking it more frequent—like just last summer? But I think that controversy was removing the word carcinoma, reclassifying screening results—those things that may or may not turn into cancer. There is a real problem with over-diagnosis, I get that. I also get that last summer’s fuss was more about semantics and classification. But, mammography (and other screening methods, for other cancers as well) is still to blame in the matter, because that is how the may-or-may-not-be cancer results are discovered. So in my mind it is just part of the same old mammography story.

chandler

This is when I change the TV channel from SNL re-run to a re-run of the sitcom “Friends”. Remember loveable, cute, not-so-smart Joey Tribianni? He was always a few steps behind Chandler, Ross, Rachel, Monica, and Phoebe. Everyone else would “get” a joke or a point, and have to wait for poor old Joey to catch up. Late in the series’ run, there is a great episode in which Chandler and Joey are in the apartment belonging to Monica’s ex, Richard (sadly Tom Selleck is not in this episode). They find tapes, presumably sex tapes, labeled with female names. They find one labeled Monica. Chandler is instantly mortified, but Joey, well, he takes a bit longer to connect the dots. After waiting a beat, Chandler finally yells what viewers had thought for years: “get there faster!”

“Get there faster” is what I want to scream at researchers and reporters regarding this. Or maybe I wanna yell “get there faster” to everyone because I know the people involved in the endless studies done on effectiveness of mammography have nothing to do with other aspects of cancer—like why it happens, what to do about it, how to make not happen at all. As for those mammograms that find things that never turn into cancer? I guess the people crunching the numbers aren’t involved with solving that problem. I’m left thinking no one is even trying to find that solution. I’m sure it is being researched, it’s just the way that tidbit is mentioned as just one or two lines every time I hear this story, I’m starting to wonder why it isn’t THE story. I’ve read of a similar issue in testing for thyroid cancer. Seems to me determining if something is or is not cancer before treating is certainly a “get there faster” kind of problem.

I know how unfair I’m being with my frustration. I know demanding a solution RIGHT NOW is pointless.

Discoveries and breakthroughs don’t just happen on demand, or just because enough money is thrown at the process. I guess I’m just tired of this particular story grabbing headlines every few months or years…I really cannot tell how frequent it is anymore because I’m just so tired of it. Just like some TV re-runs.

I know other work is being done, in fact I recently saw interesting pieces about treating/preventing recurrence in the area of HER2+, very relevant to me. But that was certainly not broadcast in the mainstream media, as was the case with this mammogram study. Mammography always grabs headlines because it is the only thing the general, non-cancer public knows. Guess that is what happens when something is oversold.

And I know researchers work hard, and cannot think about the individual cancer patients, or potential patients, as they execute tests, analyze data, and all that.

But here’s the thing: I am one of those individual patients and as much as I try to see the big picture, some days I can’t. Some days I can only view everything through the lens of my own experience. So here is my view.

It’s true mammography did not work for this patient, diagnosed under the age of 40. It’s true I’m bitter about that. It’s true that this bitterness is a tiny part of my resentment toward the Pink message (but there are soooo many more things wrong with Pink, just dig around this blog). It is true I am NOT on the “a mammogram saved my life” bandwagon. Rather, I tend to snort each time I get a letter of “no cancer present” after my bi-annual scans: “yeah, heard THAT before.” So there is my bias.

But when the number crunchers start talking about how screening just finds disease earlier and does not change how long a person lives, the person is just sick for a longer portion of life, it is hard to hear. Even though it totally makes sense, it just seems such a hopeless statement to me. I don’t know why.

It is hard to hear these reports without a suggestion for a better method to replace mammograms. I know there are other screening methods debated in health media, but are they affordable and covered by insurance, available to even poor women, myself included? Regarding those options, if they are effective that is, I say get there faster.

While the two incidents have nothing to do with each other, it is difficult to put up with yet another onslaught of Pink rah-rah, this time in the form of the Kohl’s & Komen campaign, right after the latest repeat of another mammograms-aren’t-all-that story. Both just remind me that everything still seems to be in the same stagnate place as it has been for years. I had cancer, there is no news telling me of a reduced chance I’ll get it again. All will remain as it was before. I wonder if there even will be any changes in my lifetime. I don’t want to have cancer again. I don’t want to keep having the same Pink conversation over and over. Everything is just too slow. I want to change the channel from the cable networks that just show re-runs in syndication. I want the current season, but it does not exist.

All these years and it all sounds the same. GET THERE FASTER.

FEAR

I’m sure anyone remotely interested in breast cancer has seen and read The New York Times Magazine. Heck, I reblogged it as a part of ihatebreastcancer’s blog and additional comments. It’s like a reader’s digest version of nearly every article or criticism of breast cancer awareness/marketing/issues I’ve read in the past two years, and I am sure anyone reading this blog is familiar with nearly everything in the article—before even reading it. But that is because we seek out info about breast cancer more than the average Jane. Perhaps the good news here is that this piece is in a non-cancer oriented magazine, so maybe more people will learn some truths about the pink machine. It is odd this is published in April not October. Not complaining mind you, for many of us breast cancer is an every-damn-day-of-the-year-not-just-in-October deal. I admit I am a little worried that a piece challenging the common perceptions of breast cancer is released nearly half a year away from the signature month when the media generally toes the proverbial line. I hope this magazine/article is remembered when October comes and we are drowning in pink, but I am sure pink events and products were in planning stages by November 1 of last year, and it is already too late to turn it around this year. Maybe next year.

I wasn’t going to write about it, figuring everyone else already has, and mostly I agreed with the article. But I had a hard time with the idea of “distorted fears of middle-aged women”.

To be fair, this article is the not the first time I’ve read someone comment that the pink marketing is selling fear to women, scaring them into getting mammograms, interpreting/presenting the stats to make it seems as if getting breast cancer is nearly inevitable if you’re a woman (1 in 8 was really picked on in one book I read), but it really bothered me this time around.

The author admits the fear is legitimate. And I agree that the fear is manipulated for profit. We’re taught to fear cancer so we get mammograms, but reassured that if does happen, it can be treated (thanks, awareness funding from drug companies! YES I’M BEING SARCASTIC)…so I guess fear marketing only goes so far. After all, pink never mentions metastatic cancer, and we should not fear death, cancer patients don’t die, we lose our battle (YES I’M BEING SARCASTIC, read my earlier post The D Word).

But here is the thing: I was not afraid before I got cancer. The pink awareness marketing may drive women to getting mammograms, may intimidate with the stats, but I thought when it happened to me, I’d be much older. I suspect that is the case with many young women with cancer, and I think some women of any age, without cancer, think it will not happen to them ever. They might recite the “1 in 8”, but assume they’ll be one of the other 7. So how real is the fear?

When my aunt was diagnosed in 2010 at age 50, I dutifully went for my annual, asked for a mammogram. The doctor did not detect anything in August. The mammogram performed in September was negative. By October 25, 2010 I had Stage 3 breast cancer. Color me shocked. When my nipple inverted, right after my “all clear”, that was when I had fear, and anger, of course, because the industry system—the pink message—failed me. Some would say that I should be grateful that I was not so full of fear prior to cancer, because detecting my cancer a bit earlier may not have changed treatment much—most likely I’d have still had my nipple removed—but I would like to have avoided the chemo or radiation if an earlier detection made it possible. I am not sure how I feel about all this.

So I ask myself what the hell am I so afraid of right now?

  • Recurrence, duh.
  • Another failed mammogram—misdiagnosis  
  • I’m afraid of wine, of all delicious foods, because I want them, and they allegedly cause cancer and every other health problem.
  • I’m afraid that as a dog walker who walks by pesticide treated lawns several times a day that I am causing a return of cancer, or a new cancer, in myself. I guess I could control that by quitting my job, but then how would I pay for cancer? Which leads to…
  • I’m afraid that if/when cancer comes back, I will not be able to afford treatment, so I will likely die, and there seems little I can do about that. You could say I should not have quit my job which had better insurance (co-pays are sometimes more than twice as much with my new government plan), but honestly, I am not sure I would have survived if I’d stayed in that job, it stressed me so much. 
  • I’m afraid my friends and family will get cancer. Hell, I’m afraid anyone else will—especially young women. Because there is so little REAL investigation into prevention, and the cause still seems to be mostly unknown.  And I blog and fuss and try to learn to be a health advocate because I actively do not want another young woman to go through what I went through, but I know I can’t prevent it. This is helplessness as fear.

Is shock at getting unexpected cancer worse than being afraid prior to getting it? I cannot ever know the answer to that question. I just don’t want ANYONE else to feel that shock, because it does not eliminate the fear that comes after. I mean, now I just have both fear and shock (and oh yeah, anger), and I’m not sure I like that. I don’t know if that is better or worse.

So what about all this alleged fear-mongering perpetrated by pink medical industry? Yes, I do think it is wrong when done just to drive profits. But from where I’m standing, the fear is reasonable….because I got cancer. And others under the age 40, with little to no risk factors will get it too. And no one knows which one of these young women will “get lucky”, because we have no prevention, no understanding of causes. These women should be afraid but they just don’t know it yet. I just don’t know how else to say it.