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surviving

breast cancer

Rally the

Troops

Breast cancer patients are logging onto the Internet to seek comfort and guidance from those that already have fought the good fight

Wednesday, October 3, 2012 Page 1B-12B


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Wednesday, October 3, 2012 • Page 2B

A number is applied to each diagnosis, but what does it mean? Here’s, a simple guide to understanding the stages of breast cancer, what they mean and the types of treatments to expect. By Lindsey Romain CTW FEATURES

On a Scale from 0 to 4

A breast cancer diagnosis is overwhelming enough on its own. But throw in the new terminology family and patients must comprehend to process and understand the disease, and that overwhelming factor is ramped up tenfold. One of the hardest to grasp concepts can be the “stages” of breast cancer. Doctors use stages to classify the progress of the cancer, as well as the origins and prognosis. From zero to four, each stage can be broken down into even more categories and types, depending on factors like size, the involvement of lymph nodes and whether or not the cancer has spread. Here, Dr. Lise Alschuler, a naturopathic physician, author of “Five to Thrive: Your Cutting-Edge Cancer Prevention Plan” (Active Interest Media, Inc. 2011) and breast cancer survivor herself, walks us through each stage. Stage Zero Many people are unaware of the very first stage of breast cancer, stage zero. Considered a pre-cancerous condition, “not all of it goes on to become cancer,” Alschuler says. While patients may still be offered treatment such as radiation or a lumpectomy, Alschuler calls this more of a “wait and watch” period, before an official diagnosis can be con-

Stages of breast cancer Continued on page 2B


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Wednesday, October 3, 2012 • Page 3B firmed. Stage one “The main difference between stage zero and stage one is that [the cancer] is now invasive,” Alschuler says. A stage one diagnosis means that a group of cells have been mutated enough that they are able to grow into a tumor. Stage one tumors are considered fairly small – less than two centimeters in the greatest diameter. At this point, they have not spread to the lymph nodes, or if they have, there are only microscopic cells that have moved. Stage two There are two types of stage two breast cancer: type A and type B. In type A, the tumor is larger than type B, but there are no cancer cells in the nodes, or cells are in the nodes but on the same side as the tumor and in small numbers. In type B, the tumor is between two to five centimeters, but there is more lymph node involvement. There is also a rare type of B with a large tumor but no node involvement. Stage two is still considered early stage breast cancer, according to Alschuler, meaning it’s a potentially curable disease. But it does still involve aggressive treatment, she says. When a sample is taken through a biopsy, the pathologist will give a grade to the tumor. “The higher the grade, the more aggressive,” Alschuler says. Not everyone with the same stage is treated the same. At stage two, the treatments differ; a patient may undergo chemotherapy, or a mastectomy, or maybe just radiation. “The intent of the treatment in these stages is to cure because it hasn’t spread yet,” Alschuler says.

Stage three A stage three diagnosis indicates a fivecentimeter or larger tumor. The tumor is on the same side as the lymph nodes where it has spread, usually in the armpit area. There are more nodes involved, typically more than three, usually four to nine. Sometimes in stage three, the tumor has grown deeper into the chest wall or up into the skin, affecting different types of tissue. At this stage, a different type of breast cancer may be on display: inflammatory. “Inflammatory breast cancer is a different type of cancer cell,” Alschuler says. “It tends to be more aggressive, and more resistant to treatment. There are not as many effective treatments available for this type.” The cancer is still treatable at stage three, but it generally has a greater degree of risk for reoccurrence. It’s more aggressive than the other stages, with systemic treatment. Alschuler says it’s very rare that doctors wouldn’t recommend chemo at this point. Stage four Stage four, the final stage of diagnosis, is the most serious and the most progressed. Any size of tumor or lymph node involvement can appear at this stage, but the main indicator of stage four is that the cancer has spread, typically to the bone or liver. Alschuler says to expect very aggressive treatment at this point. “The treatment is typically sequential at this stage,” she explains. “You’ll go through an initial round of treatment, get a break, then go back into it. It’s about managing the growth so people can live with the disease as long as possible.” While this may be the final stage of diagnosis, Alschuler points out that, rare as it may be, a full recovery is still possible.

Each year, more than 200,000 new cases of breast cancer are diagnosed in the U.S.

During the exam, the breast tissue is pressed between two plates, and two images are taken of each breast.

The best prevention is an annual screening mammogram starting at age 40. Your physician may recommend it sooner if you have a family history of breast cancer or other risk factors.

Many women report that this procedure can be uncomfortable, but not painful. A radiologist reviews the images for abnormalities or changes in the breast tissue.

Mammograms help identify breast cancer as it’s developing. Early detection allows cancer to be treated when it’s the most curable and before it has the chance to spread. Most often these cancers are too small to be detected by breast exams alone. Mammography is considered to be the “gold standard” in breast cancer detection, and the procedure usually takes just 1520 minutes.

It’s not uncommon for some women to be called back for additional imaging, such as a special view mammogram, ultrasound or Breast MRI. This is simply to reevaluate changes that may be occurring in the breast. Most insurance companies will cover the cost of a yearly screening mammogram in full. Those without insurance or the means to pay can contact organizations established to help them.

573.761.7000

© CTW Features

From the Mouth of a local Survivor Meet Theresa Otto

By Linda trest Gasconade County Republican feature writer

Last November, Theresa Otto, 48, of Owensville felt a lump in her breast while showering. As she tried to examine the lump more closely, she couldn’t find it again and felt relieved. The next day it was there once more, noticeably bigger than the previous day. With no insurance, Theresa had no idea what to do, or where to turn. Luckily, she knew enough to ask for help - from her mother MaryAnn, who came to stay with her during the ordeal that was to follow. Theresa’s first decision turned out to be one of her most important: She asked for help. For more on the importance of not taking this journey alone, see a related article on page 4 of today’s Gasconade County Republican. SYMPTOMS Theresa experienced a severe chemical reaction to a bug spray that she and her family used in August of 2011. Her symptoms, itching and gummy eyes, headaches, severe pain in her ear, a “foggy” brain combined with a feeling that something was just not right. With no health insurance, Theresa was reluctant to go to a doctor, but finally made an appointment. Before that day arrived, she suffered a seizure. When she was able to see a doctor, they determined that she may have suffered a chemical reaction to the bug spray, which contained a high concentration of DEET, which is the substance Theresa believes caused the reaction. As she recovered from the worst of these symptoms, Theresa’s life went on. She continued Theresa Otto • Continued on page 11B

Mammograms Save Lives Maybe Yours

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Wednesday, October 3, 2012 • Page 4B

Build Your Own Breast Cancer Army By Renee Lee CTW FEATURES

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aura! Jane! Laura! This went on for a few minutes because Laura forgot to ask Jane what room she was in on the sixth floor. The two went on screaming until they found each other in the hall. Then, it was like something out of a movie, Laura says. The two hugged, and cried and laughed at the same time. They reached over and touched the tufts of hair on each other’s otherwise bald heads. Just as everything else they’d shared as “breast cancer sisters” during the past 11 months, at that moment both women similar amounts of re-grown tufts of hair on their heads. Breast cancer survivor and lawyerturned-rock-musician, Laura Roppe, turned to an online forum the day she got diagnosed with triple-negative breast cancer. The next day, as if a private prayer had been answered, Jane Barker from Sheffield, U.K., wrote that she had been diagnosed with exactly the same type of breast cancer on the same day. The two also went on to start their chemotherapy treatments on the same day.

Support from friends, family and community are an integral tool in the fight against breast cancer. Many are taking their illness to the Internet, creating online support groups on Facebook, Twitter, blogs and forums While Roppe also had what she called “flesh and blood” friends and family that supported her, she found one of her biggest sources of support online. Roppe, of San Diego, is just one of many people now turning online to social media sites like as Facebook, Twitter to seek support when a diagnosis of breast cancer is found. Many women are starting online groups to unite all of their friends and family, which makes sharing information easy, fast and effective. It also makes connecting with strangers going through the same thing easier, something that can be a source of both strength and information for women that often feel alone and isolated. “Just being diagnosed the same day as someone doesn’t ensure a lifelong bond,” Roppe says of Barker. “We were meant to be sisters, though. We bonded over our love for the BBC version of ‘Pride and Prejudice’ and I called her ‘My dearest Jane.’”

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A ‘Real Sisterhood’ Schmitt acknowledges two websites in the front of her book: breastcancer.org and breastcancer.about.com. She got information on what would be happening to her body, asked questions and received answers full of support and love. On the other side of that however, some people expressed their negativity through the forums Schmitt read. She certainly wasn’t about that. “Something I kept telling myself, was even though I didn’t want to go through all of this there were so many others struggling and many worse off than me,” Schmitt says. “I learned from my mom not to have a pity party. I chose to not let cancer run my life.” Schmitt has a blog for her book, 4MarchForth.com, and created a Facebook page for it. She’s hoping to move to the point where she can share a weekly tidbit with others to foster a community of support. Both Schmitt and Roppe are huge pro-

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Roppe chronicled the emails she and Jane sent back and forth in her book “Rocking the Pink: Finding Myself on the Other Side of Cancer” (Seal Press, 2012.) Marci A. Schmitt, from Chandler, Ind., turned online to find information and support and wrote “March Forth” (Outskirts Press, 2011) as a way to provide support for others battling breast cancer. Schmitt was diagnosed in January 2009. Her mother had passed away from breast cancer in 2004, and she went on to lose her father-in-law and brother to cancer in the years surrounding her own battle. After talking to another survivor who went on to give talks around the country Schmitt hung up the phone with one goal in mind: Write a book and provide support for others in her shoes. She wrote and wrote until she couldn’t think of anything else to write, Schmitt says, and it was a full year until she told anyone she’d written the book, not even

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Wednesday, October 3, 2012 • Page 5B ponents of support groups, whether they be online or in person. “It’s a real sisterhood,” Roppe says. “You know you’re not alone, and when you’re talking to people who have been there you’re free to be honest and you can share things you can’t share with others.” Roppe is currently still part of a Facebook group with 150 women who share the common thread of all having had triple-negative breast cancer. The Best Support Sometimes, friends just need to let you know they’re available, Roppe says. People would drop by, bring a magazine, drop off some chicken noodle soup or send an email to check up, she says. Having people treat her “like a normal person” was very important. She recalls a moment when a friend asked if she had seen the previous night’s “American Idol.” When it’s not all about cancer and mortality, you can begin to feel human again, Roppe says. During her journey through cancer, Schmitt says she and her husband learned to accept help

from other people. About three times a week, whether it was a friend or family member, someone would bring over meals for the family, which includes sons Corey, 16, and Clay, 13, and a stepdaughter Lindsay, 29. Schmitt’s biggest pieces of advice for friends and family members who aren’t sure how to act in front of a cancer-stricken loved one? Don’t come with pity in your eyes, Schmitt says. And don’t talk about other people you’ve known who have died. That’s the last thing anyone with cancer wants to hear, she says. Roppe recalled the very worst days when she was in the thick of chemotherapy and love from her kids carried her through. “I would feel little tiny lips kissing my bald head,” Roppe says of her daughters Sophie and Chloe, who were in third and first grade at the time of her treatment. “Then they’d squish into bed with

“It’s a real sisterhood. You know you’re not alone, and when you’re talking to people who have been there you’re free to be honest and you can share things you can’t share with others.” — Laura Roppe, survivor

me and I could feel their warmth.” On the Other Side of Cancer After it was all said and done, Schmitt had two mastectomies and has now been cancer-free for three years. She’s going on quarterly visits and has been scanning clear, and is taking things one day at a time. Roppe currently has no evidence of disease, and it’s been that way

for the past three years. Just weeks before the diagnosis Roppe signed a record deal with a London-based record level, achieving a long-time dream of hers. The diagnosis left Roppe with what she calls in her book, a “victory” in the sense that she quit her law job and dedicated herself full-time to music. “I followed my heart, my voice,”

Roppe says. “Don’t wait until you get cancer until you do what you really want to do.” The question everyone has after reading her book, Roppe says, is “What about Jane? How is Jane?” Barker, forever Roppe’s breast cancer sister, also is in recovery and is doing great, Roppe says. © CTW Features

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Confronting Fears About Reconstruction

To reconstruct or not to reconstruct – it’s one of the toughest questions a woman faces following a mastectomy. Here’s the information needed to make an informed decision

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Fears About Reconstruction By Jeff Schnaufer CTW FEATURES

A

t the age of 44, Michele Rakoff discovered she had breast cancer. She recalls being “not well informed” by her surgeon about her options for breast reconstruction. “I was rushed into making a quick decision and was not given the opportunity or the suggestion to have a second opinion,” Rakoff recalls. “Within four days of my diagnosis, I had a simple mastectomy with no reconstruction.” After the surgery, Rakoff began investigating the possibility of having reconstruction, educating herself. She decided to have breast reconstruction six months later. That was in 1988. Today, Rakoff serves as executive director with the Breast Cancer Care and Research Fund in Los Angeles, Calif., developing a mentoring program for newly diagnosed patients so they can speak with trained, educated survivor mentors. “It has been 24 years and as the result of my experience, I always remind women that a diagnosis of breast cancer is not an emergency,” Rakoff says. “They have time to get a second opinion, do research and speak with well-educated advocates who can share their own experiences.” Reconstruction is one of the toughest decisions a woman faces following a mastectomy. According to a Colombia University study, fewer than one in four women with invasive cancer opt for the immediate reconstruction of their breast. More than one in three with early stage cancer got the procedure. The biggest predictor of whether or not a woman got reconstruction was insurance coverage. Ultimately, it’s a personal decision. But many fears can get in the way of making the best choice. We asked a few experts to weigh in on the validity of these fears.

Fear #1: I have to decide right away because reconstruction can only be done immediately following the mastectomy.

“Incorrect,” says Dr. Christy Russell, a spokesperson for the American Cancer Society and associate professor of medicine at the University of Southern California. “They can always have a delayed reconstruction.” “One can do a delayed reconstruction. But if one can get it together and really make a decision up front, there’s some

economies of scale, so to speak,” says Dr. John Link, author of “The Breast Cancer Survival Manual, 5th Edition” (August, 2012, Holt Paperbacks), director and founder of Breastlink Medical Group, a comprehensive breast cancer treatment group in Orange, Calif. There are a variety of types of reconstruction, he says. One is a silicone implant. The second type is where fat and skin are brought in from somewhere else to create the new breast. The third option is a hybrid of both. “When the breast implant is put in after the mastectomy, it eliminates an added surgery,” Link says. “In our practice, 90 percent of women have immediate reconstruction. Those women who deny it are more likely to do it because of age or underlying health issues like pacemakers, severe obesity, diabetes or heart failure.”

Fear #2: If I have to have radiation or chemotherapy, I can’t have reconstruction until it is over.

“Each person receives different treatment and depending upon that treatment, a decision should be made with discussions between the woman and her health care team,” Rakoff says. “Women should be informed that radiation does have an effect upon the skin and can limit the reconstructive choices.”

Fear #3: It is too dangerous to have reconstruction when you have an aggressive form of cancer.

“No,” Russell says. “Even if women are dying of breast cancer, they deserve to have any type of body they want. You just have to make sure a patient is healthy enough to go through the surgery.”

Fear #4: If I don’t have reconstruction, I’ll never feel like a ‘woman’ again. “There are many women of all ages who have chosen not to have reconstruction and are beautiful, sexy women,” Rakoff says. “I know several who were diagnosed in their 20’s, married after breast cancer and had children. They and their partners feel they are lovely, wonderful “women”. Fears about reconstruction continued on page 8B

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Wednesday, October 3, 2012 • Page 8B

Fear #5: Reconstruction is a vanity decision – I should just be grateful my cancer is gone.

“Absolutely not,” Russell says. “This is all about doing everything you can to try to even out the chest wall, not only for physical appearance but to even out the weight on the chest and stop back problems.” Following a mastectomy, Russell says women with large breasts “get very unbalanced. They start leaning in one direction.” “The whole process of being treated for breast cancer is difficult enough,” Link says. “There’s no reason a woman shouldn’t try to feel good about herself at the end. There should be no guilt about trying to become as whole as possible.”

Fear #6: If my cancer comes back, it will be easier to detect if I don’t have reconstruction.

“Absolutely incorrect,” Russell says. “Women who get a recurrence on the skin, it looks like a mosquito bite in the skin. It’s very, very easy to detect.” “Local recurrences occur less than 10

percent of the time,” Link says. “When they reoccur, they are almost always on the surface.”

Fear #7: My partner won’t be as attracted to me if I don’t have reconstruction.

“I have a lot of patients who have not had reconstruction and they are still functioning normally sexually,” Russell says. “Many of them said the fact that they developed a life threatening illness changed the relationship both emotionally and sexually. It was a wake up call to the marriage. My advice is to know how you use your body sexually before you go into these surgeries” At the same time, Russell points out that the breast is a sexual organ. A mastectomy will deaden sexual stimulation in the skin over the removed breast. And getting a new “breast” from reconstructive surgery will not improve sexual stimulation, either. “There is always an adjustment period after breast surgery and discussions can help,” Rakoff says. “Many couples find it helpful to get professional counseling. Your partner should love you for who you are.” © CTW Features

“I was rushed into making a quick decision and was not given the opportunity or the suggestion to have a second opinion.” — Michele Rakoff, director Breast Cancer Care & Research Fund, Los Angeles

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Wednesday, October 3, 2012 • Page 9B

In Sickness & In Health By Renee Lee CTW FEATURES

After Marsha Dale called her husband, Marc Silver, at work to tell him she had just been diagnosed with breast cancer, she thought maybe she had reached the wrong husband. Silver’s first reaction? “Ooh. That doesn’t sound good.” He recalls hanging up after the conversation and staying the day at work. Silver wasn’t looking to be callous – he didn’t know how else to react. He reacted, he said, by not reacting. This was Labor Day weekend 2001, and it wasn’t until they visited with doctors and Silver heard the word “mastectomy” that he sprung out of denial. Silver, an editor at National Geographic, and Dale, a high school teacher, live in Chevy Chase, Md. During his wife’s treatment, Silver found himself desperately wanting a book that gave advice to breast cancer husbands. In spring of 2002, as Dale finished up her active treatments toward what had been Stage II cancer, Silver drafted a book proposal. His book, “Breast Cancer Husband: How to Help Your Wife (and Yourself) During Diagnosis, Treatment and Beyond” (Rodale

Books) was published in September 2004. Silver’s book tells the story of his family’s battle with cancer, but he also interviewed nearly 100 couples and found that everyone coped with breast cancer differently. “You’re in a daze,” Silver says. “You get hit so hard and sometimes you don’t know why you’re reacting the way you are.” Silver recalls the first time he cried after his wife was diagnosed. “I was driving around doing errands and listening to Ray Charles. All of a sudden I heard these strange sounds in the car and I was like, oh my God, I’m crying.” Silver says. “I remember I didn’t tell my wife about it – I was afraid she’d think ‘Whoa, he’s losin’ it.’” When dealing with cancer, you can feel like all the humor flies out of your life, Silver says. Hair was a sensitive issue for Dale once she started losing it, but the couple found a way to sneak in some humor when it came to wigs. “We were at the wig shop, and I said ‘Honey, will you try on some for me?’” What ensued was a dress-up session of Dale modeling a big blonde Dolly Parton-style wig and one that made her look like Elvira from the 1988 film “Mistress of the Dark.”

Silver and his wife found it was a lot easier to laugh at cancer than to constantly be afraid of it. Silver and his wife have been together now for more than 30 years. Dale was able to share any thoughts, whether good or bad, with her husband. As Silver says, if she couldn’t share them with him, whom could she share them with? Being a caregiver to a sick loved one comes with its own burden. Silver recommends caregivers also take some time off to take care of themselves. Silver talked to some wives who said they would call their husbands’ friends and ask them to go out with him to make sure he was getting time for himself as well. Other advice Silver has for caretakers? Take all the help you are offered from friends and family. It’s also very important to go to doctor’s appointments with your wife, Silver says. You become part of a team, and you can listen and help discuss treatment options. Dale eventually had lumpectomies in both breasts and underwent chemotherapy and radiation therapy. At the end of treatment, Silver says his wife gave him a “solid B” for his efforts as a

breast cancer husband. “She gave me a B, but she’s a tough grader, so I have no complaints!” Silver says. © CTW Features

After a rocky start, breast cancer husband, Marc Silver, learned how to support his wife during one of the most trying times in her life, and the lessons he learned taught him to be a better husband and caregiver

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Wednesday, October 3, 2012 • Page 10B

Negative, Negative, Negative

One of the most invasive forms, triplenegative breast cancer is difficult to treat and accounts for 10 to 20 percent of all breast cancers. Today, however, it doesn’t have to be a death sentence. Here’s what you need to know

October is

Saluting Survivors Encouraging Awareness Remembering Loved Ones During National Breast Cancer Awareness Month, we stand together in our support for a cure and our support for the women who are faced with the disease. By encouraging breast cancer research and raising awareness of the importance of early detection, we can all help save lives. For more information about breast cancer prevention, early detection and support for a cure, please visit the National Breast Cancer Foundation online at: www.nationalbreastcancer.org.

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By Anna Sachse CTW FEATURES

F

rom a scientific standpoint, triple-negative breast cancers (usually invasive ductal carcinomas) are those whose cells lack estrogen and progesterone receptors, and do not have an excess of the HER2 protein on their surfaces. Because the growth of the cancer isn’t supported by these hormones or too many HER2 receptors, it doesn’t respond to common hormonal therapy (such as tamoxifen) or therapies that target HER2 receptors, such as Herceptin. Anyone can get triple-negative breast cancer, but it is more likely to occur in premenopausal women, says Patricia Prijatel, author of “Surviving Triple Negative Breast Cancer” (Oxford University Press, 2012) and founder of the Positives About Negative blog (HormoneNegative. BlogSpot.com). In addition, although African-American women are less likely to get breast cancer than Caucasian women, if they do get it, they are more likely to get triplenegative. While this group of cancers is not hereditary, Prijatel notes that it does have a strong association with the BRCA genetic mutation, which is hereditary. “The correlation works one way, but not necessarily the other,” she adds. “Women with the genetic mutation who get breast cancer are most likely to have triple-negative breast cancer than other forms, but women with triple-negative breast cancer do not necessarily have the mutation.” Other studies have found that women with triple-negative were younger at the onset of menstruation, on average had more children (at least three) than non-triple-negative women, they were less likely to breastfeed for more than four months, and they were more likely to not breastfeed at all if they had at least three children, Prijatel says. Another risk factor she finds intriguing is related to metabolic syndrome – a combination of risk factors such as high blood glucose, high blood pressure and abdominal obesity, plus problems like low “good” cholesterol, high “bad” cholesterol and high triglycerides. “Women diagnosed with triple-negative breast cancer are much more likely to have metabolic syndrome than those with other forms of breast cancer,” Prijatel says. “Some research suggests that

insulin resistance might be associated with triple-negative breast cancer.” Although triple-negative isn’t a good candidate for hormonal therapy, it can be treated with surgery, radiation therapy and chemotherapy. “In fact, some research has shown that chemotherapy is more effective for triplenegative than for hormone-positive,” Prijatel says. Knowing that triple-negative breast cancer is a family of diseases, the goal going forward is to understand the genetic makeup of the individual tumors that respond to treatment. “So, a treatment may only work on 5 percent of triple-negative tumors, but if we can identify the 5 percent, then we are making good progress,” Jones says. “Also, now that from a genetic point of view these cancers are no longer black boxes, we can also learn from other tumor types. (Our) study, for example, sug-

gests that a drug used for malignant melanoma might be useful in a small subset of the triple-negative cancers. Of course, this would have to be rigorously tested, but it’s an excellent lead already.” If you have a strong family history and the BRCA mutation, you have several options. The most extreme is a mastectomy and salpingo-oophorectomy to remove ovaries and fallopian tubes. Less extreme and more in our control are exercise and diet modifications that can help reduce the risk of all forms of breast cancer and a batch of other illnesses, including cardiovascular disease and diabetes. “In general, this means at least five servings daily of fruits and vegetables, with an emphasis on cruciferous veggies such as broccoli, kale and cauliflower; complex carbohydrates, such as whole grains, seeds and nuts; and little or no trans or saturated fats,” Prijatel says. “I would save alcohol for special occasions only – and keep it to one drink at those times.” © CTW Features


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Wednesday, October 3, 2012 • Page 11B

Meet Theresa Otto • continued from page 3B her job of cleaning houses. In early November, as she was showering, she noticed a lump about the size of the knuckle of her little finger in her left breast. When she tried to examine it further, she could not find it. She was relieved. The next day, it was there again, this time the size of an acorn and she could find it each time she tried. With no insurance, she did what most women who have this option would do— she called her mother, MaryAnn who lived in Georgia at that time. Her mother’s help and that of her friends - became crucial to Theresa as she geared up for the battle of her life. Very soon, MaryAnn came to Missouri to stay with Theresa until she was no longer needed. DIAGNOSIS/TREATMENT Finding the best course of action, or even a doctor diagnosis you, can be overwhelming, especially when you have no insurance. Theresa’s mom, after diligent research, was able to connect her daughter with Fischel Ellis Cancer Center in Columbia. Within two weeks, Theresa was diagnosed with breast cancer and she was able to ask the question that had haunted her during the weeks of uncertainty since she discovered the lump: Am I going to die? A team of experts was assigned to Theresa to help her make an informed decision on her treatment and recovery. One team member’s job was to help point Theresa to support for those without insurance. Winding up at Fischel Ellis was one of the best possible things that could have happened to Theresa. “They educated me about breast cancer and my options, I don’t think a doctor alone could have done that. Education kept me sturdy throughout this,” she asserts. Theresa chose a lumpectomy, which is removal of the lump itself plus a small section of breast tissue. This procedure, which was done in December of 2011, is the least invasive and least painful of the options presented to breast cancer patients. Following the lumpectomy and the biopsy of the mass, it was determined that there was still more cancer in the breast. In January, Theresa had a mastectomy, which involves removal of the breast and to varying degrees, the chest muscles and lymph nodes. In her case, only one lymph node needed to be removed. If it had shown signs of cancer, the doctors would have kept removing nodes until they found one that was cancer free. Theresa did not need chemotherapy or radiation treatments. Throughout this process, Theresa was driving - or being driven - about 360 miles each week to various appointments in Columbia. Her car quickly needed new tires, which of course she could not afford.

She had to give up her house cleaning jobs, but all of her clients assured her they would wait for her return. “If it had been a regular job, I’d have lost it a long time ago,” she points out. She was not eligible for unemployment since she was unable to work. Her boyfriend, Mark, had a seasonal job and was also not working, so money became a serious issue. Theresa received food stamps for this period and friends and family helped as they could. “Get help, wherever you can find it,” is Theresa’s most important advice. The unbelievable exhaustion makes it especially hard for women to navigate this disease on their own. “There were days when I was so numb from fatigue that I would have just slept through some important appointments,” Theresa remembers. “Mom would get me out of bed, put clothes on me and lead me to the car saying ‘You can sleep in the car.’ If she had not been there pushing me, I would have skipped the whole thing.” AFTERMATH Theresa had to learn to live without her left breast. That may sound relatively easy after all she’d been through, but it still meant some adjustment. In almost every position in which a woman holds herself, her breasts determine they way she holds her arms. The larger the breasts, the more this factor comes into play. At-home exercises were prescribed for Theresa to help her regain her strength and to teach her upper body to function without all of its parts. Although usually kept hidden, losing a breast is no less traumatic than losing any other body part. For women whose breasts are a key component in their definition of femininity, Theresa recommends they receive counseling to help themselves feel whole and attractive. She also recommends counseling for those who are very vain about their clothing, because the loss of a breast - or two - will make a dramatic difference in the clothing choices available to you. Theresa once enjoyed wearing low-cut tops or getting dressed up for special events, but now her choices in clothing are more limited. Under Medicaid, which Theresa is now on, patients may receive one prosthesis per year. Her first one fits poorly and is much larger than her existing breast, but she must now wait another year before getting another that she hopes will prove to be a better fit. For the moment, she doesn’t wear one, or uses one that her mother has fashioned out of pillow stuffing. In any case, no matter what she wears, the left side of her bra rides up and down or sometimes twists to the side. Following the mastectomy, Theresa was

left with an angry-looking, curved scar across the left side of her chest. The redness is now mostly gone, leaving her with a smooth, flat chest area that looks much like the rest of her abdomen. The first time she had sex after the mastectomy, she was very worried about Mark’s reaction to the scar. He has assured her it doesn’t matter to him and everything in that department has now gotten easier for her. Reconstruction of the breast is available to some women. Theresa was not a candidate for reconstruction for two reasons, she is a smoker and her slight build does not have

the necessary body fat which doctors need for the new breast. But she’s okay with that. “My family became even more important to me,” Theresa says. Her mother was there for her every step of the way as she went through the initial tests and surgeries. After her mother returned home, her father came to help. “After my mom got me physically stronger, my dad came later and built me up spiritually,” Theresa remembers. That faith may be one of the reasons that now, less than a year after finding the lump, Theresa is doing so well.

Walmart is featuring select merchandise from ten suppliers in our stores. They include: Kimberly Clark, Nabisco, Kraft, Johnson & Johnson, Pfizer, Lewis Bakeries, Kelloggs, Bimbo Bakeries, Prairie Farms and Snyders-Lance. A donation will be made to benefit local breast health initiatives purchases from this list. (See store for details.) In addition you can pickup a pink CFL light-bulb today for your home or business to light up the night in October and show your support for breast cancer research. In 2011, a $95,000 donation was made and the Power of the Pink program helped provide over 160 mammograms to uninsured and underinsured women. Help us make 2012 even larger.

Hwy. 28 East • Owensville • (573) 437-4156 Open 24 Hours A Day Pharmacy (573) 437-4158 Pharmacy Hours: Mon.-Fri. 9:00 to 9:00; Sat. 9:00 to 7:00; Sun. 10:00 to 6:00


Most Complete THE

CANCER CARE IN THE AREA

Complete cancer care means not only diagnosis and treatment, but other supportive services such as psychosocial support, nutrition, physical therapy, and wellness programs. These services are available right here, under one roof. That means less travel, less wait time and better recovery for our patients.

Patient Sherry Schwartz (left) with Dr. Raonak Ekram at the Goldschmidt Cancer Center

(573)632-4800 1432 Southwest Boulevard • Jefferson City, MO

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