ENCORE #135! – The Reconstruction Era Part 13: History and Future!

From the first moment my wife discovered she had breast cancer in March of 2011, there was a deafening silence from the men I knew. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…That was four years ago – as time passed, people searching for answers stumbled across my blog and checked out what I had to say. The following entry first appeared in June of 2014.

Today will be a bit of history regarding breast reconstruction and a glimpse into the future.

“Documented cases of breast cancer date back to 6000 BC...George Washington’s mother, Queen Mary, and Nabby Adams (daughter of John (second president of the US) and Abigail Adams) succumbed to breast cancer...Breast cancer surgery was revolutionized by Dr. William Halsted, who popularized the radical mastectomy as the treatment of choice for any woman with breast cancer...the latter half of the 20th century [saw] the modified radical mastectomy...breast conservation therapy...sentinel lymph node biopsy and radiation was developed...[and] the emergence of breast cancer reconstruction.”

Initial attempts at reconstruction were crude, though as the years passed, certain of those techniques finally met adequate technology. For example, in the 1800’s, there were attempts to transplant a lipoma (fat slice) to a mastectomy site. This lead to techniques that were largely unsatisfactory, but were clear precursors to the current successful practice of the microsurgery that allows for TRAM flap reconstruction. As well, initial use of silicone breast implants, the subsequent frenzy that toppled the Dow Corning corporate giant, and the FDA’s recanting of its 24-year ban on the same implants; has led to the use of both saline and silicone implants preceded by insertion of expandable “bubbles” to stretch tissue in preparation for the implant, and cadaver-harvested, cell-free matrix that holds the expander in place.

What exactly does the future hold?

Some possibilities:

“Adipose derived stem cell breast reconstruction...is still considered experimental...” and involves the removal of fat tissue. One half remains as it is, but the other half undergoes a process that concentrates stem cells. This “concentrate” is then mixed with the original fat tissue and injected into the breast. The stem cells take on the characteristics of the fat and grow into fat cells. There is however, good evidence that this procedure is becoming more generally accepted. (http://www.futuremedicine.com/doi/abs/10.2217/17460751.4.1.109)

“skin-sparing and nipple-sparing mastectomy” in which the surgeon removes cancerous breast tissue through a small incision usually around the areola area of the nipple.

In New Zealand, “[A new] tissue expansion...technique allows soft tissue [to be made into a] meshed matrix of connective tissue [where] small amounts of fat can be injected into separate small tunnels.” The method has been in use for 30 years, but this is a new and exciting possibility for reconstructing human breast tissue – with even less invasion of the body than ever before.

The future is not only on its way – it may actually be here!

Resources: http://www.breastreconstruction.org/ReconstructionOverview/breast_cancer_reconstruction_history.html, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884724/, http://www.medpagetoday.com/Blogs/CelebrityDiagnosis/31043, http://www.breastpreservationfoundation.org/skin-sparing-mastectomy/, http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11219885&ref=rss

Image: https://c2.staticflickr.com/6/5527/10893068965_1d328e8f71_b.jpg

BREAST CANCER RESEARCH RIGHT NOW! #73: Lymphedema and Mosquitos and PROTECTION?!?!?

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

Every month, I’ll be highlighting breast cancer research that is going on RIGHT NOW! Harvested from different websites, journals and podcasts, I’ll translate them into understandable English and share them with you. Today: see below for links to several articles.

Honestly, there doesn’t seem to be much research into the effect of and prevention of lymphedema in people who have to deal with it on an everyday basis.

While there are a number of different aspect to living with lymphedema, during the summer in Minnesota, bug bites fairly leap to the forefront.

Given the ubiquitous nature of arthropods biting people who have lymphedema, you’d think there were be a push to find a way to REALLY deal with it in the long term.

But there’s not. According to what I could find, there are only two aspects of the whole bites-n-lymphedema issue: protect and prevent, treatment.

Protect and prevent is all about “shields” and are essentially of two kinds: chemical and physical. (Don’t waste your time with the “sonic bug repellers” – they don’t work (https://www.nachi.org/ultrasonic-pest-repellers.htm)).

First, the definition: “When an insect bites, it injects a toxin into the skin that causes the resulting itching. The reaction in lymphedema-affected tissues to insect bites can be potentially be severe. In response to the bite, there may be a temporary increase in the swelling of the affected limb. Also, it may take lymphedema-affected tissues longer than normal tissues to clear this substance from the body.

“If you have multiple bites on an affected limb, seek medical advice immediately!

Don’t scratch! A cool wet cloth or cold pack will ease the itching and swelling. If the itching is severe, seek medical help. As long as no infection present it should be safe to perform self-massage to help the body clear toxins from this area. When doing this, massage the area above the sting, i.e. closer to the trunk.”

This is the main reason behind taking protective measures for people who have to deal with  lymphedema – to prevent swelling. Another reason is to, of course, prevent the transmission of disease.

The chemical premise of protection from bug bites goes like this:

“The cornerstone of prevention efforts involves the use of effective insect repellents which can significantly reduce the likelihood of bites from mosquitoes and ticks...DEET (N, N-diethyl-meta-toluamide) is the most well studied, and most effective, broad-spectrum repellent against biting arthropods. The World Health Organization and the CDC recognize DEET as the gold standard insect repellent and is the agent against which other repellents are measured…Alternatives to DEET include picaridin (REPEL Lemon based…brand, as well as Wondercide and Sawyer – sold at various and sundry places) and PMD (P-menthane-3,8-diol)…a component of lemon eucalyptus extract that has been shown to have effectiveness and duration of action similar to DEET (Cutter Lemon Eucalyptus is one of many).”

The physical premise for protection lies with clothing:

“…light-colored pants, long-sleeved shirts, and hats also reduce the likelihood of sustaining insect bites…and the application of permethrin, a synthetic insecticide derived from the chrysanthemum plant, to clothing (never directly to the skin) ,greatly improves the deterrence of insect bites…Studies regarding the use of mosquito nets, especially those impregnated with permethrin, demonstrate they are highly effective in preventing bites and stings from a variety of arthropods.” (Sawyer brand of CLOTHING, GEAR, and TENT spray – only! ( https://sawyer.com/videos/permethrin-clothing-gear-insect-repellent/) Not on skin!)

Below you’ll find links to articles and insight into preventing bug bites and avoiding the increased pain and irritation of insect bites, which can only add to the misery of lymphedema.

Resources: https://www.countryliving.com/gardening/g3463/how-to-prevent-mosquitoes/?utm_source=google&utm_medium=cpc&utm_campaign=arb_ga_clv_d_bm_hp_g3463&gclid=EAIaIQobChMI8Km7nr_M6QIVQ77ACh1AyQAyEAMYAiAAEgKhjfD_BwE, https://www.bugbaffler.com/collections/insect-protection/products/bugbaffler-insect-protective-pants, http://www.lymphnotes.com/article.php/id/462/,  https://www.ncbi.nlm.nih.gov/books/NBK537235/, https://www.amazon.com/Living-Well-Lymphedema-Ann-Ehrlich/dp/0976480603, https://lymphnet.org/, https://www.pca.state.mn.us/mosquito, https://odditymall.com/mosquito-blocking-clothing,

Image: https://www.mikeysboard.com/attachments/20180525_113831-jpg.82128/

ENCORE #134! – The Reconstruction Era Part 12: Once More, Lymphedema

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…That was four years ago – as time passed, people searching for answers stumbled across my blog and checked out what I had to say. The following entry first appeared in June of 2014.

You know, it probably seems like I’ve been harping on this whole subject of lymphedema WAY too much.

In the whole SCOPE of things, you might say, this is barely a blip! I mean the cancer is gone, the breasts reconstructed, she looks natural, and we’re even planning on taking part in a public event in which we, for the very first time, publicly acknowledge that she had breast cancer.

We will be walking in our local Relay For Life event. We’ve never done one before. Haven’t done the Susan B. Komen Race For The Cure. Nothing like that. I am on a school faculty team, my wife will be doing a Survivor’s Lap, we will be in front of my students.

Lymphedema and all and, according to her therapist – lymphedema FOREVER.

For those of you who don’t know what lymphedema is: a swelling of body tissue “caused by a blockage of the lymphatic system (vein-like tubes that run parallel to veins and arteries but carry a clear liquid called ‘lymph’), which are part of the immune and circulatory systems. The blockage prevents lymph fluid from draining well, and as the fluid builds up, the swelling continues.”

Specifically as regards breast cancer...hang on, let me point out something to you. GOOGLE breast cancer lymphedema. After three ADS, a cluster of scholarly articles, you come to the meat of the thing, which is a listing of places you can read about lymphedema. My new problem is that few (if any) people talk about lymphedema as a side-effect of mastectomies – in which not only is a breast or both breasts removed – lymph nodes in the armpit are often removed as well

The first article says: “a potential side effect of breast cancer surgery and radiation therapy that can appear in some people” (emphasis mine)

The second article: “Women who have been treated for breast cancer may be at risk for lymphedema in the arm, breast, and chest.” (emphasis mine)

The third article: “Lymphedema is one of the most common side effects of breast cancer treatments.” (emphasis mine)

Finally in the fourth article, we get: “It is common after a mastectomy, lumpectomy or breast cancer surgery and radiation therapy” (emphasis mine)

Do you see the progression there? The first practically guarantees that there won’t be any such thing as lymphedema; that it’s a “potential” problem. [So is water in my basement because we live on reclaimed swampland. But after 20 years here, we’ve never had it. To ME, that’s what a “potential” is.] My wife’s doctor assured her that there was nothing wrong after she rammed her hand into the wall on Thanksgiving Day two years ago. That was the day her arm began to swell as white-blood-cell-laden lymph rushed to the scene to make sure there was no infection after the injury. Once there however, the lymph had nowhere to go because 21 of 40-some lymph nodes – which when compressed, move the lymph – had been taken out during the mastectomy. So her arm swelled and the doctor continued to tell her it was no problem.

The next two admit that lymphedema is a problem, but only a “risk” or “one of the most common” [By implication, there are other side-effects that are more pressing, so don’t really worry about this one...] After she changed clinics, the therapist was appalled and gave us a number of things we could do, including massage that would push the lymph back to the remaining nodes so it could be redistributed. This worked. Sort of. She also prescribed a compression sleeve (that stopped about three inches short of the shoulder) and an oven-mitt kind of arm cover to be worn at night. While things got better, the lymphedema remained obvious and, for my wife, ugly. So things remained for about a year.

We continued to hear that “lymphedema can be cured!” from my sister, who works in a wellness center in a city far south of our home that is world-renowned for its medical center. Kings and presidents have been treated there. The problem was that regular treatment would involve a long, long drive, so my wife began to look closer to home. After half a dozen “referrals”, she finally arrived at a place where not only did people take lymphedema seriously, they also began an IMMEDIATE and immediately effective regimen. The immediately prescribed a tight set of wrappings alternating with heavy gauze, and prescribed a two-piece “body armor” kind of device worn for four weeks. Within two months, the swelling was down, they took measurements, and my wife now has a compression garment that not only fits her hand and goes up and over the shoulder, it’s also hard to see! It also came with a device that helps her get it onto her arm alone!

So we met the people who believed that lymphedema “is common” after mastectomy, who treated it aggressively, and who have in a comparatively short time, won. They were also very clear that this is a FOREVER thing. Health insurance also recognizes that it’s a forever thing because they will pay for TWO compression garments a year. This new one has also helped treat some nagging lymphedema over the breast implant. Once that went down, my daughter and wife discovered that: ““Blinkin’, fix your boobs! You look like a bleedin’ Picasso!”” (From the Mel Brooks movie, “Robin Hood, Men In Tights”)

*sigh*. If it isn’t one thing, it’s another...

Image: https://c2.staticflickr.com/6/5527/10893068965_1d328e8f71_b.jpg

Encouragement (In Suffering, Pain, and Witnessing Both…) #11: Encouragement From Other Faiths or No Faith

The older I get, the more suffering and pain I’ve experienced; and the more of both I stand witness to. From my wife’s (and many, many of our friends and coworkers) battle against breast cancer; to my dad’s (and the parents of many of our friends and coworkers) process as he fades away as this complex disease breaks the connections between more and more memories, I have become not only frustrated with suffering, pain, and having to watch both, I have been witness to the suffering and pain among the students I serve as a school counselor. I have become angry and sometimes paralyzed. This is my attempt to lift myself from the occasional stifling grief that darkens my days…

I can only speak personally of the encouragement I get from my Christian faith.

But because breast cancer and Alzheimer’s Disease is a worldwide epidemic (isn’t that what’s meant by being “pandemic”?), I am certain other faiths respond as well with encouragement.

So, I did some research. Before I go to faith, though, let me give you some numbers:

China: Officially there are 4 faiths in China; but between half and three fourths of Chinese are non-religious

India: Primarily Hindu and Islam (94 percent). The other six percent encompass Christians, Sikhs, and Buddhists and a smattering of others.

South America: More than 91 percent are Catholic, though only half of those consider themselves devout. Roughly 5 percent are Muslims, and the remaining four percent are a mixture of protestant, Judaism, Buddhist, Hinduism, Bahá'í, Shinto, and indigenous creeds and rituals.

So, below please find quotes of encouragement from across the Human spectrum.

We begin with Hindu strength:

“The essence of Hinduism is the same essence of all true religions: Bhakti or pure love for God and genuine compassion for all beings.”

“You are what you believe in. You become that which you believe you can become.”

“From suffering comes the knowledge of suffering. From the knowledge of the suffering comes the solution to suffering. From the solution to suffering comes the ultimate freedom. Suffering, therefore is the teacher and also the cause in which the effect, liberation, is hidden.”

“Whatever happened was good. Whatever is happening is good. Whatever will happen will also be good.”

“Your Strength is how calmly, quietly and peacefully you face life.” Yogi Bhajan.

Comfort from the Koran:

“No disaster strikes except by permission of Allah . And whoever believes in Allah – He will guide his heart. And Allah is Knowing of all things.”

“And We will surely test you with something of fear and hunger and a loss of wealth and lives and fruits, but give good tidings to the patient.”

“When disaster strikes them, say, ‘Indeed we belong to Allah, and indeed to Him we will return.’ Those are the ones upon whom are blessings from their Lord and mercy. And it is those who are the [rightly] guided.”

“Allah does not charge a soul except (with that within) its capacity.”

“The word of Allah is the medicine of the heart.”

  
I’ve shared words of encouragement from Christianity many times, so we’ll conclude with words of hope that have no religious affiliation:

 “You’re like this little blip of light that lasts for a very brief time and you can shine as brightly as you choose.”

“Someone said the pain would go away, but I’m not sure that’s where I want it to go.”

“Ever since I learned we are made of the same stuff as the cosmos, I lost my fear of death.”

“If your grief is an angry child today, try to be as gentle and patient as you would with a child, and give them space to rage.”

“While the concepts and definitions of suffering are certainly man-made and can vary from one person to person, I would certainly say that it is not pointless and that it has to have some biological value. From a strictly Darwinian sense, suffering must provide some benefit. Perhaps it strengthens or enhances the biochemical process that involved kinship and love. This in turn fosters behaviors like: strength in numbers (clans) and cooperation. Or could it be that my suffering allows me to better relate to others who are suffering…”

There you go; be encouraged and share your love with those who are suffering with you or those who suffer as well.

Image: http://www.quoteambition.com/wp-content/uploads/2017/04/encourage-quotes-destiny.jpg

ENCORE #133! – Reconstruction Part 11 – Breast Reconstruction Challenges…

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…That was four years ago – as time passed, people searching for answers stumbled across my blog and checked out what I had to say. The following entry appeared in April of 2014.

While it may seem an obvious choice to some who are outside of the breast cancer community (are there ANYONE who is?) breast reconstruction is not an easy choice.

After months that include radical mastectomy, chemotherapy, hair loss, and recovery, the decision to “go under the knife” again is not one that women take lightly.

Even so, new research shows that more and more women are undergoing the procedure to rebuild what was once there. “Researchers found that 46 percent of patients received reconstruction in 1998 but that figure rose to 63 percent by 2007.”

While this article was informative, from a layperson’s point of view, I find the authors somewhat narrow-minded – perhaps even “ignorant” – about certain things, and that bothers me.

For example, “The study also revealed dramatic variation in reconstruction based on geographic region, from a low of 18 percent in North Dakota, to a high of 80 percent in Washington, D.C. This was largely associated with the number of plastic surgeons working in each state…Any time we see geographic variations in practice patterns, we worry that care is not being appropriately individualized and that patients are not being offered all their options. It’s important to make sure women have all the information they need about breast reconstruction and are aware that it is an option...” (emphasis mine)

REALLY? REALLY? Have any of the authors even visited North Dakota? Clearly not! I actually have friends from ND – and some from DC. As a whole, ND is a very conservative state with a preponderance of farmers and has a frontier attitude. A “I can take it” sort of way of looking at the world. I would say THIS has a larger effect on the number of women getting reconstruction after mastectomies than “the number of plastic surgeons”. Did the authors consider that the attitude of your average NoDak would drive out plastic surgeons; they’d be seen as superfluous parasites. And DC’s plastic surgeons? REALLY? REALLY? In a city where the highest rollers are broadcast nationally and internationally with close-ups and in press conferences on a minute-by-minute basis, plastic surgeons would FLOCK there to make sure our politicians look pretty on TV and in webcasts!

That seems such a no-brainer, it makes me wonder about the rest of the study.

This seeming blindness brings into question another statement: “The researchers also note that more women are receiving implants rather than recreating breasts using tissue from other parts of their body, called autologous reconstruction. Autologous techniques tend to deliver better cosmetic results and higher satisfaction, but it’s a time-consuming, demanding operation that requires a longer hospital stay and recovery time. The researchers raise concern that current medical reimbursement discourages surgeons from offering autologous reconstruction.”

REALLY? Choosing a long, difficult surgery with a lengthy recovery time after…a long difficult surgery with a lengthy recovery time doesn’t seem a natural aversion-reaction by breast cancer survivors and can be more sensibly ascribed to INSURANCE COMPANY PRESSURE????

Hmmm. My further comment here would be that perhaps the authors – maybe even more breast reconstruction plastic surgeons – should cast more widely when interpreting their research data. Even so, the update on the subject was reasonable and even though the interpretation was narrow-minded, the DATA was sound.

Resource: http://www.mcancer.org/news/archive/more-women-receiving-breast-reconstruction-after-mastectomy-study-finds

Image: https://c2.staticflickr.com/6/5527/10893068965_1d328e8f71_b.jpg