Responding to Nancy’s point ‘s blogging challenge:

1. I lived at home till about 25 and then picked up and moved alone half way across the globe.

2. I have circled around the earth once.

3. I can burp on request.

4. I can read four languages.

5. English is not my first language.

6. I hate mathematics

7. I draw and sketch.

8. I don’t know how to swim but recently started to learn.

9. I am allergic to Adriamycin

10. I hate peeling potatoes and cutting cantaloupes

11. I cannot stand the smell of a boiled egg.

12. I dont have my gall bladder.

13. I enjoy talking to strangers and make friends easily

14. I enjoy traditional Pakistani and indian food and cook it too

15. I dont have a  middle name

It’s a rather typical spring day in the Midwest. The sun is out and it appears deceptively warm. It’s the kind of day that you want to step out without the much needed jacket in this part of the US. The wind however is blowing making it feel much cooler.
My kids and I want to go to the “lake”, a small made lake in our neighbor hood, for a “treasure hunt”, what an adult would call a nature walk. It’s a quiet Sunday, the neighbors are perhaps at church or having dropped of the kids at grandparents house are out at the mall.
My almost 8 and 4 year old are armed with buckets to save the “treasures’ in. It is serene and relaxing by the lake. Ducks and geese are making haphazard tangents, some novice fishermen trying their luck. Being in touch with nature feels so good.
My kids scan the shrubs and brush looking for treasures.
My son screams with excitement, and he has found a bottle cap. Nothing fancy, just a white plastic bottle cap. My daughter now gets more vigilant.
We see the remains of the “controlled burn” of the brush around the lake. Yes any uncontrolled unhampered growth is a lot of trouble, who knows more than a cancer survivor.
I hear my daughter celebrating a beautiful rock she found. At 4, everything is amazing and full of wonder. Rocks, pebbles, odd shaped stones are all treasures. Blessed is a life that sees stones as valuable and this innocence is so precious.
Before cancer, I may have spent this Sunday obsessing about what to cook, mulling over what summer camps to sign up for and organizing the house but post cancer I am out walking with my kids looking for treasures. I realize that they are learning with me to embrace nature and appreciate life. It makes me smile.
They aren’t at Kumon or at a gymnastics class or learning some craft but they are learning a skill, which we adults sign up for in retreats, letting go and relaxing, finding pleasure in everyday things that are all around us.
My daughter spots a turtle and there is sheer excitement in her voice. It’s a small turtle sitting on a branch sprouting out from the lake.
By now their buckets have an unidentifiable shiny object, a half burnt Sippy cup, a ball and something they are calling a “fishing thingy”.
A mom is pedaling with her son on their bikes. We point out the turtle to them.
She remarks ” Look (son) we are going so fast , we are missing out on all the good stuff!”
I agree. Cancer has slowed me down but the slowing down is not so bad either.

I was quite confident of my decision. February 23rd 2015, I was scheduled to get my prophylactic oophorectomy ( surgical removal of ovaries to reduce future risk of breast cancer).Everything had been set up. Time off from work, pre-op physical and tests, extra help were all on the calendar.
I had mulled over this procedure in the last few months. I had read about it, heard about it, thought about it . The overarching paradigm: I need to do everything possible to improve my survival rate.
Right from the diagnosis, I had carefully used my medical training and knowledge to fight this dreadful disease. I had read many books, narratives and accounts. I had researched online. I had talked to my medical colleagues . As I received treatment, I was becoming more and more familiar with the disease of breast cancer, its nuances, landscape of treatment and controversies. For me, conquering the disease meant soaking up all I could find about it.
“Know thy enemy!” I said to myself.
Of course , it had its down side too. I would read about metastatic, stage 4 disease which would be scary and stressful. The disability and the vision of death would become overwhelming . But I would confront my fears and cope the best I could. I knew the survival rate of my cancer stage, Stage 3, 70 percent five year survival rate. I also understood that five year survival rate counted those women who still have the disease but remain alive even after five years of being diagnosed. I understood the grey of medical statistics.
I had been waiting for the new data to be presented at the San Antonio Breast Symposium in December 2014. That data which was supposed to be helpful in determining if there is actually increased survival advantage with ovarian suppression( suppressing their function that is).
Breast cancer and ovaries are an intimately connected topic. Breast cancers are classified according to the type of receptors that the breast cancer cells carry.
The kind of breast cancer I have is called “ER and PR positive”(ER stands for estrogen receptors, PR for progesterone receptors). This means that the cells, the cancer cells, have receptors to which female hormones, Estrogen and Progesterone will attach. Ovaries produce these hormones. Simple way to understand, the more the hormones, the more the risk that they will make the cancer cell proliferate.
Granted the assumption is that chemotherapy and radiation , after surgery, would have destroyed all the cancer cells which is what would “disease remission” be, but when it comes to a diseases like cancer, it requires every possible intervention and the end goal is always improved survival.
I had read the paper carefully, looked at the numbers and utilized my medical knowledge of statistics to come to terms with my decision. But I am not an oncologist. The subtleties of oncology is still something I don’t quite get in detail. The data from the trial hinted towards suppression of ovaries as a way of reducing that chance, slim but nonetheless a chance.
Sad truth of the life of survivor, coming to terms with odds, probability and the chance.
So I checked into the cancer center and waited to be called in for my appointment with my oncologist.. This was the first time I was meeting her since the data was presented. I was expecting this appointment to be clear and precise where she would celebrate my decision and I will go get the surgery done and move on.
The appointment didn’t go as I had expected it to.
My oncologist is a compassionate doctor. She is immensely likeable and human unlike the stereotyped detached oncologist. We talk about handbags and shopping and socks, woolen socks as she proficiently examines me every time, with sure hands and glowing confidence. She has a cheerful demeanor, and an optimistic disposition both highly desirable for a medical oncologist and she is a woman. I had read this study about how female physicians on average spend more time with their patients than male physicians do.
She is warm and engaging but never tells me what to do. Sometimes it gets annoying when it comes to sorting things that I don’t understand fully. I am not sure if she opts for this approach because I am also physician or this is her general style. Perhaps I get a nice blend of both.
She had been aware that I had scheduled the surgery. She opened the conversation by this very direct statement,” I don’t think you should do the surgery”.
I was taken aback. I muttered, ‘But didn’t the data suggest that getting the ovaries out improves survival?’ I asked.
What following was a conversation that left me befuddled and unsettled.
In my mind, getting the ovaries out was the clear way of improving survival. She however started talking about quality of life.
A lot of medical conversations, especially in the lives of those afflicted with cancer , rotate around the phrase, “quality of life”.” quality of life” that we seldom think about when we are healthy. Quality of life that becomes so relevant in terminal illness scenario. Quality of life which should be the essence and focus of all alive.
” Do you realize what abrupt menopause will do to you at your young age?”.
But I want to live long, my mind replied.
“Have you thought about the potential effects menopause on the quality of your life?”
No, I hadn’t. Once you have cancer, you get so obsessed with preserving life and staying alive that you transiently stop considering the quality of days you have.
The warrior terminology makes you want to defeat it at any cost.
Is all cost worth paying? I have already done aggressive treatments, mastectomy, harrowing cycles of chemotherapy and radiation that left my skin peeling. Isn’t that enough? In my quest for increased survival and conquering cancer, what I had left on the curbside is considering about all the things that really matter to me.
She then rattled off a list of all the things that could go wrong. “You feel well right now, you are recovering but after the surgery you can gain weight, your cardiac risk increases, you can have hot flashes, depression and other things your husband won’t be happy about”.
I have stayed fit and within normal weight all my life. The idea of acquiring pounds in exchanged for longevity didn’t seem fair. The image of myself obese with a weak heart and depression shook me up.
As she was talking, my mind was processing the phrase ” quality of life”. What do I want? More days? or more quality? Why do I have to make that choice to begin with……
Would I be fit and happy like I am now or trade in all of that for a minuscule increase in survival.
I asked her if she could give me a percentage increase in survival if I did the surgery and she said she couldn’t. So should I knowingly give up my ovaries with a great likelihood of suffering in exchange for an undetermined chance of reduction in recurrence ?
If I don’t get my ovaries out and experience a recurrence, would I blame myself for not doing everything I possibly could have? Would I feel guilty about it as I would say bye to my kids and family.
My mind was working, in all angles and in all directions.
Untimely menopause, another surgery, quality of life, cancer.
If I had the genetic mutation of BRCA 1 or 2, the decision would be easy. There is a 50% reduction in cancer risk after ovary removal in high risk women with BRCA mutation. I did not have that.
Chemotherapy shocks the ovaries, they are stunned. No one knows if they will “wake up” and start producing estrogen and progesterone that my breast cancer cells have receptors for. Or they have completely quit working for good.
Circulating levels of estrogen and progesterone will “feed” the cancer cells. My lab tests tell me I do have enough of the hormones in my body. But oncologist considers this unreliable to decide if I am in menopause or not. Never mind that I have not menstruated in the last 18 months. Still medical doctors cannot confirm if I am indeed in menopause or not.
I want to scream, I am not a lab rat, I am a person, a whole person. I question, how much do I have to give up to stay alive?. I am taking Tamoxifen , the medicine which prevents estrogen from binding to my cells. That is a lot of treatment right there. My aunt with breast cancer took that medicine for 5 years, she is here 30 years later, cancer free.
I have just started to return to some normalcy where I can get through a day without taking a nap. I have even started to flirt with the idea of regular exercise. Can I afford mentally, another disruption, another recovery, another pause? My kids are seeing me recover and be a mother again. I am reconnecting with my life.
Do I opt for that marginally increase in survival and risk a lot elsewhere? I thought and thought.
” You could do medical suppression as well, we will give you an injection every months until we are sure you are in menopause”.
The effects of suppression of ovaries with the injection would be identical to surgical removal , the only caveat, ovaries once removed cannot be put back in while I can refuse the shots should I be really miserable with the menopause symptoms.
I suddenly felt that enough is enough. I had walked in here with a date for the surgery but here I am thinking about this from an entirely different perspective.
I told the doctor. “I am taking this year off. No surgeries, no shots.”
I want to live this year recovering. I want to be strong and healthy , as much as my body will allow. I want quality of life. A year of peace and recovery. I will table this decision for next year. A year , I know, is an arbitrary time line. But it means at least one birthday, one anniversary and one birthday for each my kids and husband. It means one Christmas and new year where I am not dealing with severe direct effects of cancer treatment.
I am taking Tamoxifen and I will hope for the best. So for now , just let me live my life.
The chances that I will be happy are 100% because I feel that it’s the right decision for me for now. The other odds and statistics, I will review after a year.

(Here is the link to the post I wrote about the plan to get the ovaries out earlier http://ppg.xwc.mybluehost.me/website_445c9d4e/2014/12/17/why-i-am-planning-to-get-my-ovaries-out/)

What I Have Learned
February 6, 2014 · by Uzmamd · in Breast Cancer

I read a Buddhist saying last night “The teacher appears when the student is ready.” In the learning of life, I believe I was ready when the cancer arrived.

I am sure you have heard cancer survivors say that they have learned a lot through this journey. Some even go to the extent that they would do it all over again and not change a thing. I wouldn’t say that – I would jump at first opportunity for medical science to say “You are cured.” Or even, “We are sorry, it was all a big mistake.” But if it has chosen me, I accept and embrace it.

I was reflecting on if and what I have learned. First and foremost, having cancer is like having knowing how to ride a bicycle, its something you never forget….perhaps have a few moments where it escapes consciousness but it always there. Being diagnosed with a potential life threatening illness carries many lessons. Certain lessons are deep and meaningful, certain shallow and practical like – how to take off the winter hat without dislodging your wig. How to adjust your prosthesis in Target without anyone noticing. Or, how to quickly glance in the mirror for disappearing eye brows and fill them in without other gals noticing. How to look good to feel good. How to style and wash wigs. How to apply fake eyelashes. I have learned that fuzzy socks are very comforting and that spray on lotion is a useful product. I have learned that life is as wonderful with one breast as with two. And that mastectomy swim suits are not all matronly. And that a newly shaved head itches a lot.

I have learned that kind words, spoken or written have magical healing powers. That when some people speak, they are merely exercising their glossal muscles and what comes out of larynx should be ignored as sound of working machinery. That gifts do convey a lot of love and thoughtfulness and that flowers are an awesome way to brighten someone’s day. I have learned that a sugar buzz can fix melancholia on certain days (donuts for breakfast are a new discovery for me), that beautiful fragrances can be uplifting even when food doesn’t taste good. I do carry in my chemo bag, two bottles of essential oils, lemon and peppermint. Smell of fresh citrus is life reaffirming and anti nausea. Every chemo morning I wear a sweet, floral fragrance to perk me up. But because smells also evoke memory, I know that I will no longer use that perfume after tomorrow.

I have also learned that wearing a thick eyeliner hides missing eyelashes well and two strokes of blush makes a world of difference in whether you look dead or alive and that without eye brows and lashes, my eyes look pretty reptilian. I have learned that a good nurse can make a world of difference and that people generally are inclined to help if they are able to.

I have learned the friends can fill your heart with joy and sometimes strangers can convey surprising warmth. I have learned that you don’t need much in life, the key is to appreciate what you have. However, on certain days a little shopping spree doesn’t hurt. I have learned that having a positive self esteem in the best asset to have and that believing in yourself is the best belief. However, on days that you are unsure, faith can fill in blanks very effectively. I have learned that love attracts love, compassion attracts compassion, and that life has to be dealt with on a daily basis. If each day, I can say honestly to myself , I did something useful, the count of months or years doesn’t matter. Making others happy is sometimes the only way to have a good day. I have learned that one can live with fear. That it is possible to not give fear power over your life, to not give disappointment value over hope and to look at the rainbow and ignore the clouds. It is possible to ignore pain in pretty much any body part given the right state of mind. That taking medication for sleep isn’t failure of my being. I understand the phrase “Time and tide waits for none.” I have seen hope, in its most advanced and rudimentary forms. And that if there isn’t a tomorrow, there is a later.

I have wondered what “kicking cancer’s butt ” really means, and I have learned that it means holding your head high and not being afraid of death. Living every day with grace, dignity and hope. That is what makes someone kick cancer’s butt; otherwise everyone is getting mostly the same treatment and care.

I do think however that it would be quite therapeutic if the cancer center had a bean bag labeled “cancer” that patients could kick with all their might at the end of treatment. Wouldn’t that be cool?

If life is a deck of cards, in my deck I received a card, that is called the “Cancer Card”. A recent post in New York Times enlightened me on the power of the “Cancer Card”. Apparently it is the ticket to freedom, to withdraw from responsibilities and to do pretty much whatever you want.

I am thinking, why didn’t any one tell me this ?.

I would be happy to give it away, but I don’t see anyone wanting it.

I have kept the card, just like all the others, as a reminder of how precious every moment of life is. It turns out as the author claims, it is something that you can flash to get your way.

I guess anything in the world is open to manipulation. Religion is, authority is , why not cancer?

Cancer survivors symbolizes mortality to those who are free of cancer, they remind them that death is inevitable and because of that perhaps lives touched by cancer are given special privileges.Sometimes for sympathy, sometime in empathy but mostly because people are kind.

I will say I have been on the receiving side of much kindness and love. More so after cancer, those who value me as a person.

I see my share of manipulation in the practice of medicine, sometimes for pain pills , sometimes for disability, sometimes for the heck of it. I have seen it all. However underneath all of it, is the desire to be validated, accepted and acknowledged.

If only we can provide that to each other, without others needing to extract that from us, perhaps most will not manipulate.

Life ,eventually, is about accepting what you are given, turning it into what validates you, moving forward with a keen concern about others that are walking along you.

This holiday season, lets tolerate each other, validate each other and own what we need to do and fulfill our duties and eat some cookies. Happy Holidays to you all!