Lights!

Kicking off the holiday season, 2014

This year we were delighted to join the Thanksgiving festivities at the Smoyer/ Myers house. Chris, as always, cooks up a storm; and the company, as always, couldn't be better.  The day after, we launched a mini-Thanksgiving meal at our house for just us three = homemade rolls, my mom's macaroni and cheese, beets, salad, brownies and some turkey.  With good food, good company, a parade, and putting up the tree, our season was officially started!

Watching the post-dinner movie: Christmas Vacation

Macy's Post-Thanksgiving Day Parade, Portland

Crater Lake from the air

Mike has spent most work weeks in Folsom this fall.  One upside?  Views like this on the flights to and from.  You can really tell it is a crater, right?

Bad Case of Stripes

Happily, after more than a week with a real virus that caused a fever and spots, Eleanor was well in time for the school harvest festival and her chance to don a stripey illness.   (This was in part inspired by David Shannon's book, but mostly Eleanor just likes stripes.)

Nashville's Parthenon

Well, after reading so much about the Parthenon in preparation for our trip to Athens, Greece, summer 2013, we were really curious about a few of Parthenon's original but lost features. Especially, the monster sized, gold plated Athena that made her home in the Parthenon (she was the whole reason the building was put up). The descriptions were almost unbelievable.  So, imagine our surprise when we learned Nashville, Tennessee -- self-dubbed "the Athens of the South" --  has not only built a meticulously researched exact scale replica the Parthenon, but also of the Athena statue inside.  What?!?!?  We had to see it.

Lucky for us, we have family we love near Nashville, and also lucky for us, they invite us out for a fish fry every October.  Sadly, we find the trip too difficult to make every year.  But THIS YEAR was our year and we made a special detour to see Nashville's Athena.  All that is left to say is: wow.

These columns are gone from the original, but every architectural history book talks about their unique shape.

Wow, right?  The reality is every bit as outlandish as the historical descriptions.

School Picture Day!

Steph's boob-news: Good news. Confusing advice. Crap choices.

Over the last two months I've had the chef's sampler of what's on offer from the hospital's breast center.  Routine and follow-up mammograms, a stereotactic core needle biopsy, a surgical excision biopsy with wire/dye localization, a surgical follow-up, and an in depth review of my breast cancer risk by a genetics counseling professional.  I've rounded that out, naturally, with a brain busting serving of statistics, medical journal articles, and study reviews.  And as of today, I feel as lost as ever.  So, I've got more work to do and I've got some tough choices to make.

waiting for surgery

I don't normally post to this blog those details of my life that really only have to do with me and my work.  I don't talk about the issue advocacy/lobbying I do, the interesting community organizing I facilitate because of my land-use neighborhood board seat, or the ways I volunteer in the local school.  But as the last month has shown me, my boob-news clearly crosses over into that which effects my whole family and as it appears it will continue to do so, we'd better just start talking about it.

A routine mammogram in July turned up a suspicious clump of micro-calcifications, which led to follow-up mammograms, which led to the needle biopsy.  That produced four pathologies, two of which were concerning: flat epithelial atypia (FEA) and atypical lobular hyperplasia (ALH).  The flat epithelial atypia is somewhat controversial, in that some professionals call it "pre-cancerous" and others don't.  One leading radiologist on the east coast told me via my step-sister Pam Schmid (who, btw, wrote the book 101 Things You Should Know About Breast Cancer), FEA is of concern because when excised, cancer is found 8% of the time.  The atypical lobular hyperplasia is a significant finding in that the ecosystem that grows it also grows breast cancer.  This finding of ALH raises my breast cancer risk 4x.  These findings warranted a surgical biopsy, which happened on Sept 24.

The good news: no new pathologies were found with the surgical biopsy = no cancer!!!

Post-operation follow-up with my surgeon:  No cancer, yeah!  Flat epithelial atypia (FEA) made a reappearance in this biopsy, atypical lobular hyperplasia (ALH) did not.  The surgeon explicitly said a finding of ALH on any biopsy increases my breast cancer risk 4x, and this new biopsy does not lower that risk.  She stated that a careful watch-and-see protocol seemed reasonable for me now.  She mentioned double mastectomy is a choice some women make to reduce cancer risk, and that she would specifically advise that choice if I found I had the BRCA gene.

Genetics counseling with specialized RN:  According to this specialist, the ALH raises my cancer risk 4x, and that places me personally in the "moderate" risk category.  She set my personal Relative Risk for breast cancer at 36% for my lifetime.  One in three women with my risk factors will develop breast cancer.  She advised me to consider a risk reduction measure like tamoxifen.  She stated that 5 years of tamoxifen would have a lifetime lasting effect of reducing my lifetime risk by 86% (this contradicts what I think I've read elsewhere).  She stated that a mastectomy would have a lifetime (obviously) lasting effect of reducing my risk by 90%.  She felt that a watch-and-see protocol was reasonable but risky, and she advised taking tamoxifen to change my numbers.  I voiced my concern with the increased risk of uterine cancer that tamoxifen brings, and she stated that tamoxifen increases that risk by 29%, raising the relative risk to 2.1%, which she felt was acceptably low for the other benefits.  She recommended that I consider meeting with a preventative treatment oncologist. She did not believe my family history warranted the BRCA test (my mom's breast cancer was at 54 and there isn't any ovarian cancer anywhere) so that's good news.  Several things she said seemed to contradict what I thought I'd read elsewhere.  So.  That's confusing.  And, I don't like tamoxifen yet.

What I think I know about boob cancer...
We don't really know what causes it, as 75% of the women getting their diagnosis this year will have had none of the known risk factors.  In contrast, I have quantifiable risk.

There are different kinds of breast cancer, some of it is more nasty, some of it is less nasty.  The "in-situ" cancers in the ducts or the lobes are often well contained to their one feature, and they can be cut out thus ending the presence of cancer. When a cancer pushes out past the contained features, into the breast tissue, this is the nasty stuff.  It is then considered invasive, as the cells appear to travel and they can then show up later, in a recurrence, not only in other parts of the breast but in other body systems.  If these cells quietly float out to other body systems, then it is metastatic breast cancer (MBC).  As I've learned from Pam's experience, the nasty cancer, the invasive kind, can be successfully treated for many years.  But.  If it metastasizes, it always eventually finds a way around the drugs and then it can't be stopped.  It's terminal.  It may be 20 years from first diagnosis to terminal diagnosis, but it appears to always eventually be terminal.  I never understood that before now.

There is no way of predicting, if I do indeed draw that card that produces cancer with my 36% of risk, if I'll first get an in-situ cancer or an invasive cancer.  If I do try to play this hand a little longer, will I get the chance to adjust my strategy and go for a risk reducer later (tamoxifen or mastectomy)? And yet, how much weight do I give these risk numbers when considering drastic measures?  They aren't perfect... in fact, the US Preventative Services Task Force (USPSTF) says risk assessment models have only "modest accuracy in predicting risk for individuals."  Ugg. 

But still,  I'm lucky to have the luxury of these crap choices.