Early detection & screening – Just do it!

Quotable Quotes

Your breasts are not unattractive. ~ the plastic surgeon

I thought women with big boobs didn’t get breast cancer. ~ Paul

Do you have to do that bald thingy? ~ Silas

I’ve got her breast. ~ one of the four radiologists in the very small room

Do you want to see my boob? ~ cck
YEAH! ~ Ann

PUT ON A BRA! ~ Silas

. . . if needed, breast implants are great! I have one!! ~ my elderly neighbor and 30-year breast cancer survivor

Speaking of implants,
. . . we found Millie’s*  prostheses zipped up in a bowling bag in one of Lucille’s* closets? Now what on earth did Lucille plan to do with those things? Did she save them for sentimental reasons? ~ Linda

* names changed to protect the innocent

PUT ON A BRA! ~ Silas

Bandages off & feeling pretty good

Warning: At the bottom of this post are modest but mildly graphic photos.

48 hours have passed since my surgery, and I was allowed to remove the bandages and shower tonight. Not a single drop of blood or any fluid could be found on the dressings. My skin is red and irritated because of the adhesive, but we were pleasantly surprised at the appearance of the incision areas only two days following surgery. We anticipated extensive bruising; there is very little. We expected a chunk of breast tissue to be decidedly absent; for the most part, my breast appears essentially intact—maybe a bit dented, but I don’t think my bra size has changed a bit.

I haven’t experienced unbearable pain at all. If I allow more than four hours to pass between medication doses, I do feel pain, but it’s more a pang of discomfort than serious physical suffering of any sort. For this, I am very thankful. I do feel weary. I tried to do too much on Friday, but I learned my lesson and rested most of today.

The picture on the left is of the tumor incision. The redness under my breast was caused by the bandage adhesive. The purple above the steri-strips is from the marker the surgeon used to mark my skin during the procedure. You can see traditional stitches under the steri-strips in both photos.

The photo on the right is of the lymph node incision (thus, my stubbly armpit). In this photo, you can see clearly the bandage remnants.

I have all sorts of appointments this week – bone scan, CT scan, follow-up with the surgeon. I imagine the pathology results for the margin tissue and the lymph nodes will be complete when I see the surgeon on Thursday.

Prayer requests:

  • for favorable conclusions of pathology testing, bone scan, and CT scan
  • that I will continue to feel well and heal completely
  • for wisdom regarding ongoing treatment (radiation, chemotherapy, etc.)
  • that I will feel well enough to go to Family Camp with my family next weekend (9/3)
  • for Silas, who had a bit of a rough week at school

Healing & Peace

The Lord turn[ed] his face toward [me] and gave [me] peace.
~ Numbers 6:26 ~

“You’ll probably be on the computer by tomorrow night,” Laura said as I dropped Lily off at her home yesterday. I’m glad I didn’t bet against her prediction.

Twelve hours after arriving at WakeMed in Cary, I’m in my own bed, in my own house, wearing my pajamas, and fully appreciating what my dad calls “Rush Limbaugh medicine.” Having felt hungry all day long, I’m finally satisfied after a delicious meal prepared and delivered by my friend Connie. I’m thankful for Laura and Karen who made sure Lily and Silas were safe, fed, happy, and well cared for today. As always, I’m overwhelmed with the precious gifts that my husband and mother are. They stood (figuratively; they were, of course, sitting) by me all day long, continue to care for me, and have more days ahead of them on nurse and kid duty.

Predictably, there are stories to tell, but I’m not capable of true clarity in my current state. Tales from this endeavor involve squishing, prodding, poking, piercing, freezing, and multiple uses of the word “boob.” A woman who knows my long-time friend Macon was one of the squishers and pokers. Between proddings, she prayed with me. And now my pee is BLUE.

More detailed tests of the lymph nodes and margins (tissue surrounding the tumor) must be completed before they can declare that no further surgical procedures are required. However, we are optimistic. Dr. Hamad removed five lymph nodes, and the preliminary pathology on those was negative.

Your messages, cards, prayers, and friendship have sustained and strengthened me. I am a woman greatly blessed.

Get your girls checked!

Be warned! I will ask you about this the next time I see you.

Have you had your annual mammogram? Has your wife had her annual mammogram? Your mother? Your sister? Your girlfriend? All your girlfriends? Your daughter? Your cousin? The next time I see you, I will ask when your last mammogram was, and if you’ve been remiss, I will make you go!

I had a mammogram in 2009, but had procrastinated on my 2010 check-up. I don’t have any family history of breast cancer. Sure, my father’s sister survived a serious bout with breast cancer. She was approximately 70 years old when she was diagnosed, right as rain after treatment, and died six days shy of her 89th birthday just because she was nearly 89 years old, not from any form of cancer. But she was my paternal aunt, not my mother or grandmother. I wasn’t considered “high risk” for breast cancer, and didn’t the U.S. Preventive Services Task Force or somebody like that  declare that women younger than 50 don’t even need mammograms at all, much less annually? Well, the folks at the USPSTF are STUPID. They also recommended that women between the ages of 50 and 74 have screening mammograms every other year, rather than every 12 months. More STUPID.

I might have died had I waited until I was 50 to have a mammogram. I imagine my tumor would have grown well beyond “tiny” by the time I turned 50; on a scale of one to ten, one being quite small and ten being huge, it would not be a 0.5 in 2014; and I doubt anyone would  have labeled it a “highly curable lesion” if it was allowed to go untreated for the next four years. I still cannot find the lump myself. It was merely a small suspicious spot evident on the digital mammogram, enough to justify a sonogram which prompted the biopsy, and here I am today, diagnosed with breast cancer, with surgery scheduled this week.

And I’ll live happily ever after! I’ll get to see my children graduate from high school and college and get married. I’ll rock my grandchildren to sleep in my arms. And I’ll grow old with the love of my life, my best friend, and soul mate. All thanks to a mammogram when I was 46.

Schedule your annual mammogram now!

The latest – MRI results & a surgery date

My “breast-conserving” surgery (a.k.a. a lumpectomy) is scheduled for Thursday, August 26. If all goes as planned, I’ll sleep in my own bed that night. During surgery, the medical team will also perform a sentinel lymph node biopsy to determine if the cancer is contained in the known tumor.

If I understand correctly, which is always debatable, the MRI results were about as positive as we could have hoped. The tumor is 7 mm which is even smaller than the initial 1 cm estimate. “The enhancement extending anteriorly is more benign in appearance and may represent proliferative changes versus DCIS. There is no other suspicious enhancing lesion seen in the left breast. . .no auxillary adenopathy. . . no marrow signal abnormality. . . no suspicious enhancing finding in the right breast. ” That all sounds positive, right? “Benign” is a good thing. “No” this, that, and the other thing sounds good.

I continue to be grateful for your prayers, words of encouragement, and generous offers of support. If you are interested in helping us with a meal or transporting a Koning child to or from hither and yon, let me know, and I’ll send you the link and login information for the CareCalendar my precious church family has set up.

Prayer requests:

  • for my surgeon, Dr. Sabah Hamad
  • for all the details to fall into place
  • for Paul, Lily, Silas, and my parents
  • for the lymph biopsy to be negative
  • for a smooth, routine surgery
  • for speedy recovery (so I can go to Family Camp over the Labor Day weekend! :-) )

And a little child will lead them

Is God good all the time?

Does God make mistakes?

Is God surprised by our life’s mishaps?

Do our prayers persuade God to change his mind?

This morning during children’s church, I asked the children these questions. My friends Connie, S.K.Y., and I lead children’s worship at our church, Church of the Holy Cross.

I’ve taught on prayer in the past, but I revisited the topic this morning because I really do want the children to pray for me, and because I want God to use my current circumstances to demonstrate His love, mercy, and goodness to others. We talked about the people we pray for on a regular basis. Several children mentioned grandparents who battle ongoing illnesses. Several remembered Mr. Baker and Mrs. Mason, two members of our church who have recently suffered serious health challenges. Others said they pray for the homeless, the victims of natural disasters, and missionaries. I explained that I have breast cancer, the doctors found it in the very early stages, I’m going to be okay, and I want them to pray for me.

Is God good all the time?
Yes. Even when people are sick? Yes. Even when people suffer from the effects of floods and earthquakes? Yes. We may not understand what that means, but God is always good, all the time.

And we know that in all things God works for the good of those who love him, who have been called according to his purpose.

Who shall separate us from the love of Christ? Shall trouble or hardship or persecution or famine or nakedness or danger or sword? As it is written: ‘For your sake we face death all day long; we are considered as sheep to be slaughtered.’ No, in all these things we are more than conquerors through him who loved us. For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord. ~ Romans 8:28, 35-39

Does God make mistakes?
No. Never. Never ever. His love for each of us is far greater than we can even fathom.

“Prayer does not change God, but prayer does change the circumstances of earth. If we approach prayer as if God’s mind needed to be changed, then aren’t we starting out with the supposition that God is about to make a mistake? But if we understand that every thought and intention in the mind of God is good and righteous, then we will enthusiastically cooperate with Him, praying His power and provision onto the earth.”*

I pray that out of his glorious riches he may strengthen you with power through his Spirit in your inner being, so that Christ may dwell in your hearts through faith. And I pray that you, being rooted and established in love, may have power, together with all the saints, to grasp how wide and long and high and deep is the love of Christ, and to know this love that surpasses knowledge—that you may be filled to the measure of all the fullness of God. Now to him who is able to do immeasurably more than all we ask or imagine, according to his power that is at work within us. ~ Ephesians 3:16-20

. . . take in with all followers of Jesus the extravagant dimensions of Christ’s love. Reach out and experience the breadth! Test its length! Plumb the depths! Rise to the heights! ~ Ephesians 3:18, The Message

Is God surprised by our life’s mishaps?
No. He allowed me to get cancer. I don’t have to understand. He’s not running around heaven in a tizzy, with his hands in the air, crying, “Oh no! Carolyn has cancer! How did that happen? She’s so nice. I meant for a bad person to get cancer.”

Even though he was “blameless and upright, a man who fears God and shuns evil” (Job 2:3), all sorts of calamity fell upon Job of the Old Testament, every detail of which God knew about beforehand. God allowed Job to lose every material position he had (which was quite a lot—7,000 sheep, 3,000 camels, 500 oxen, 500 donkeys, and “a large number of servants”); all his children (7 sons, 3 daughters) died in a huge fire; he developed miserable sores all over his body; his wife managed to add to his anguish; and his friends criticized and abandoned him. While Job was hardly silent regarding his misery and suffering, he never doubted his God:

“I know that you can do all things; no plan of yours can be thwarted. . . . . My ears had heard of you but now my eyes have seen you.” . . . the LORD made him prosperous again and gave him twice as much as he had before. . . . The LORD blessed the latter part of Job’s life more than the first. ~ Job 42:2, 5, 10, 12

Do our prayers persuade God to change his mind?
No.

He who is the Glory of Israel does not lie or change his mind; for he is not a man, that he should change his mind. ~ 1 Samuel 15:29

Then why bother? What’s the point then, if God is going to do what he’s going to do anyway? Why pray? As I told the children this morning, we pray to release the awesome power of their Almighty God to accomplish his purposes in our lives and circumstances.

“The purpose of prayer is to discover God’s will, not obligate him to do mine. . . . I could, through prayer, release God’s power to bring about the best possible solution in every situation, because that is always God’s desire. ‘For I know the plans I have for you,’ declares the LORD, ‘plans to prosper you and not to harm you, plans to give you hope and a future’ (Jeremiah 29:11) . . . .

“God longs to do his will in response to prayer. . . . God answers prayer, but he doesn’t follow instructions. . . . True prayer releases his power so that his power can accomplish immeasurably more than we can ask or imagine (Ephesians 3:20). . . . Prayer is not an activity, but a relationship. . . . Prayer is what sets God’s will in motion on the earth.”*

Amen.

That’s the long version (more or less, mostly more) of my children’s church homily. We finished children’s church as usual with an abridged version of the Prayers of the People and the Confession of Sin. That’s when Connie taught the children and me the real lesson of the day.

Consistent with Orthodox Anglicanism, Church of the Holy Cross practices the laying on of hands for healing, as well as for confirmation and commissioning. Before the children returned to the sanctuary for Holy Eucharist with their families, Connie explained this healing ministry of Jesus and his disciples. She said that we and all Christians have been commissioned to continue the ministry of laying on of hands and that our church sometimes has special healing and prayer services that include the laying on of hands. Then all the children came and laid hands on me while Connie prayed for God’s healing for me.

I’m a crier. Mostly over the sentimental or sweet or endearing. I cry over suffering and poverty, over unkindness and cruelty, hearing the National Anthem, watching soldiers hug their spouses and children after an overseas deployment, movies, and Hallmark cards. I have not cried over this cancer diagnosis. Until today. I wasn’t crying because I have cancer. I was crying over the wonder of 19 children, nearly all of whom I’ve known since they were born, laying hands on me and praying for my healing. It was perhaps the most remarkable and precious spiritual experience ever.

Prayer requests:

  • Thank and praise God for the sweet children at Church of the Holy Cross.
  • I have an appointment with Dr. Hamad on Monday at 1:15. I’ll get the results from the MRI, and we’ll make the big treatment decisions. Pray for clarity and wisdom.
  • Details, details, details—carpool, trumpet, guitar, soccer, doc appointments (for people other than me), writing, general appointments, phone calls—it makes me dizzy. Pray for productivity and the wisdom to know what to delegate (and to whom).

* Jennifer Kennedy Dean (2003). Live a Praying Life. Birmingham, AL: New Hope Publishers.

MRIs really are freaky!

“A man who was mad at his wife designed this thing,” commented the radiology technician about the MRI machine before loading me into the ominous chamber. You never see breast MRIs on House, with good reason.

I was instructed to don, not one, but two of those ever-so-fashionable hospital gowns. The first was to open in the front, the second, in the back. Once I was properly outfitted for the procedure, the rad tech poked an IV line into my right arm. Then the real fun began. I’ve never seen (in my not-very-extensive hospital drama experience) an MRI performed any way other than with the patient positioned on his or her back. Breast MRIs are done with the patient on her stomach. Make no mistake; regardless of what may sound like a positioning similarity, no comparison whatsoever exists between a breast MRI and a therapeutic massage.

After removing the backward-opening hospital gown, I was directed to crawl up on the MRI table/bed/gurney thingy and lie face down with my girls hanging down through a special boob contraption (thus, the angry husband theory). Imagine a heifer and the location of her udder, just hanging there from her belly. I felt like a big, miserable, grumpy cow. The technician handed me a bulb and explained I could squeeze it if, at any time, I wanted her to end the scan. In other words, it was the panic button. Lastly, she attached the IV line to something I can only assume was the contrast dye source. I, of course, couldn’t see because I was lying face down with my boobs dangling through the torture device.

Since many people who have MRIs freak out over the claustrophobic nature of the procedure, cold air blows on the patient continuously. I do not have claustrophobia issues, so I was simply freezing. Every time she took a set of images, a loud, droning, incessant beep, beep, beep, beep, beep sounded. The rad tech had given me headphones with satellite radio, but I could hardly hear any music for all the beeping. Finally, what felt like ice water coursed through my veins via the IV, making me even colder than I already was.

As she was extracting me from the machine, the technician suggested that I might need a massage. More accurately, I’d say a chiropractor. As I endeavored to haul my downward-facing self off the table, I grabbed what appeared to be handles for stability and leverage. Consistent with my modus operandi, the darn thing broke. All I could think about was the fact that I had just broken a machine that probably cost half a million dollars! Luckily for me, the technician said that it is designed poorly, that everybody does that, and she easily clicked it right back into place.

Thirty minutes (that felt more like 30 hours) after the whole thing had begun, I was dressing and suddenly gawking at the red indentations across, under, around, and down the middle of my chest. The images were sent to Dr. Kennedy, the radiology oncologist, who will interpret them and send a diagnostic report to Dr. Hamad, the breast doc. I see her on Monday when she’ll interpret and explain the results, and we’ll make treatment decisions.

Prayer requests:

  • for no surprises, that the cancer is limited exclusively to the known tumor
  • for wisdom regarding treatment
  • for wisdom about whether Paul, Lily, and Silas should participate without me in the family camp we have planned in early September (I say they should. I’ll be fine. I have a large, loving, lively “village.” Paul isn’t so sure.)
  • for my anxiety over so many things undone – phone calls, registration fees, chores, writing projects, etc.
  • for Lily and Silas to continue to experience a smooth, positive transition into the new school year, and for Lily, in a brand new school
  • Thank and praise God for the friends and family who are so willing to help us and for Lily and Silas’s schools and teachers who have been amazing!

Diagnosis on August 12, 2010

I have cancer.

I also have great peace.

I’m told I have the most treatable type of breast cancer: invasive mammary carcinoma with dual (ductal and lobular) differentiation. Evidently, “ductal” is quite common; “lobular,” not so much. The tumor is in my left breast, undetectable without a sonogram, virtually undetectable via mammogram. This week, I have appointments with all sorts of specialists to help me decide about treatment. I’m also having an MRI to see if the cancer is anywhere other than the identified tumor.

Paul and I are on the same page–What’s the next step? and Let’s move forward with treatment. Lily, our rational, level-headed 12 year old, doesn’t seem to be worried. She understands that this type of cancer is very treatable. It’s not that she reacted without any concern, but more like, “Thank you for the information. I’ll process these facts and get back to you.” Initially, we thought we’d avoid the c-word with Silas, our anxiety-prone 10 year old, but I blew it when I handed Lily a booklet entitled When Your Parent Has Cancer: A Guide for Teens. Silas, who was sitting right beside her in the car, glanced at the title, and probed, “One of my parents has cancer?!” We spent the next 30 minutes discussing how I wasn’t going die; how not all cancers are fatal if treated early and aggressively; how my doctors are working hard to keep me healthy.

My God who loves me far more than I can comprehend is in control. He loves my husband and children more than I could ever hope to. I may not understand why I have breast cancer, but I know I can trust the one who created me and who went to a whole lot of trouble to redeem me. He could heal me today, or He could use the hands and wisdom of human doctors over the course of weeks and months, just as He faithfully and completely healed Silas’s heart in 2001. And if the cancer is worse than initially thought? He is still in control, and He still loves me. I’ll worry about that scenario later, if necessary. I have no reason to fear.

Prayer requests:

  • continued calm and peace
  • peace and assurance for my family
  • the logistics of getting to all these appointments, the first week of school, volleyball try-outs, soccer practice, and more
  • wisdom as we gather information and consider treatment options
  • total healing
  • for my doctors
  • that I would be an encouragement to others–my friends and family, the medical professionals with whom I interact, other cancer patients

Be strong and courageous.
Do not be frightened, and do not be dismayed,
for the Lord your God is with you wherever you go.

Joshua 1:9

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