ENCORE #126! – The Reconstruction Era, Part 4

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 2013.

Nope, STILL not it!

So, my wife is sitting across from me, watching golf, a bit over six days after surgery.

The tubes are still in – four of them for drainage of the surgical field. Two will come out later this week, the other two until the drainage drops to near zero. They are there to clear fluid out that the body floods the incision area with. Normally it’s absorbed back into the bloodstream, but with major surgery, it overwhelms the system. The drains smooth things out and leave less behind for infection.

NOT that we don’t have to be concerned about infection.

And pain.

And maintenance.

At any rate. My wife was actually up enough yesterday to spend time with her sister and sister-in-law in a southern suburb of Minneapolis while my daughter and foster daughter went on a shopping mission to the Mall of America.

She was only able to stay for a couple of hours, but enjoyed herself immensely.

THAT of course, was in the middle of a power outage. The largest in Minnesota history...yahoo. You can bet that THAT induced a bit of neo-panic! That passed, but we’re left with a heat wave now. Several people will be stopping in to see my wife over the next few days and my daughter and I have easily taken on the role of grocery-shoppers and cooks; housekeeping and laundering; lawn-mowing and weeding; dog and cat feeding and grooming – all jobs my wife does with unstinting love.

All-in-all however, we’re surprised that she’s bounced back as quickly as she has. It’s not even a week yet – she went under Monday morning…she JUST said, “I can’t believe I had the surgery!”…even as I typed this. Plus, the surgeon thought she was SO concave chested that she gave her a small saline injection into the expanders – so she came back with boobs!

Even our daughter commented, “You’re showing a little cleavage there, Mom!”

So – stage two…or is it three or four?...seems to have reached some kind of completion. She is recovering and looking forward to the next step: saline into the expanders in order to stretch the skin in preparation for the implants themselves in November or December.

I’ll keep you posted and if you have any questions or comments, shoot them my way and I’ll try and answer them!

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

Encouragement (In Suffering, Pain, and Witnessing Both…) #9: Encouragement Through Recurrence…

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…

We don’t know this from personal experience, but in the past few weeks, three others we know have experienced a recurrence – ie., “When cancer returns after a period of remission…[it] in spite of the best efforts to rid you of your cancer, some cells from your cancer remained...the same cancer coming back after some period of time.”

In an article from the Mayo Clinic, “A cancer recurrence brings back many of the same emotions you felt when you were first diagnosed with cancer…

• Distress – The shock of having cancer come back after you assumed it was gone can cause distress — sometimes more so than your first diagnosis did.
• Self-doubt – You may doubt the wisdom of your past treatment decision…Try not to look backward. Instead, focus on your current situation and what you need to do now to move forward.
• Anger – It's very common and reasonable to be angry that your cancer has returned.
• Fatigue – It's normal to feel that you can't deal with cancer again.

Take heart in the fact that you were able to do it the first time, even though you might have doubted yourself back then. Also:

• You know more now. 
• You've built relationships. 
• You've done this before. 
• Use these experiences to your advantage. They can help you feel more in control when making decisions about your treatment.

Finally, encouragement from the Bible:

“Faith; it does not make things easy, it makes them possible” (Luke 1:37)

“He gives power to the faint, and to him who has no might, he increases strength” (Isaiah 40:29)

“I will strengthen you and help you. I will uphold you with my righteous hand” (Isaiah 41:10)

“The Lord will fight for you. You need only to be still” (Exodus 14:14)

Resources: https://www.mayoclinic.org/diseases-conditions/cancer/in-depth/cancer/art-20044575, https://thegritandgraceproject.org/faith/words-of-encouragement-from-a-cancer-survivor

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

ENCORE #125! – The Reconstruction Era, Part 3

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 2013…

“It appears that the next event is breast reconstruction!”

Nope – it wasn’t...

After the “Get Healthy” step, there was the pre-operation step. That was a few days ago. During that meeting, the plastic surgeon was not ONLY encouraging, but also really helpful.

It put into my mind a scene from one of my favorite movies, “Doc Hollywood”. In it (in case you haven’t seen it), the young (QUITE YOUNG), Michael J. Fox plays a doctor moving from the gang violence and drug abuse of a downtown Washington, D.C. ER.

He gets the chance to interview at a fancy-pants Plastic Surgery clinic in Beverly Hills. During his first day on the job, the owner, Dr. Halberstrom (of Halberstrom’s (Plastic Surgery) Clinic), performing an obvious liposuction, “Nobody likes to admit it, but medicine's a volume business. Ninety-nine percent of what we do is boilerplate surgery. It means we can afford the one percent that's meaningful. Disfigurements, birth defects, hare lips. Cleft palates. You live for those moments.”

This is reconstruction after breast cancer – no movie stars; no facelifts; no liposuction. What nobler cause for a plastic surgeon?

What IS “plastic surgery” and why the heck is it called that?

FIRST off, “In the term plastic surgery, the adjective plastic denotes sculpting, and derives from the Greek πλαστική (τέχνη), plastikē (tekhnē), “the art of modeling” of malleable flesh.”

From that, PS has a noble history, initially being used by the Indian surgeons Sushruta and Charak (in 800 BC!!!) to reconstruct noses for “resolving nasal trauma (blunt, penetrating, blast damage), congenital defect, and respiratory impediment”.

The Romans and the Greeks followed suit, then the British and the rest of Europe. The first American plastic surgeon repaired a cleft palate in 1827. During World War I, a New Zealand doctor named Harold Gillies working in London, invented many of the surgical techniques used in facial surgery today in order to rebuild the faces of soldiers injured in the war.

Two dozen other types of plastic surgery dominate the world today. In 2009, statistics were reliably gathered on plastic surgery for the first time: “The ISAPS Global Survey also establishes several important statistics with regard to the total number of board certified (or national equivalent) plastic surgeons practicing today; estimated to be 30,817. The total number of surgical procedures is projected to be 8,536,379 and the number of non-surgical procedures is estimated at 8,759,187  – bringing  the combined worldwide total of surgical and non-surgical procedures performed by board certified plastic surgeons to: 17,295,557. (This figure does not take into account surgical and non-surgical procedures performed by non-plastic surgeons.)”

As to breast reconstruction: “…dates back to the 1800s with an attempt to transplant a lipoma to a mastectomy site. Several techniques ranging from the ‘walking flap’ of Gilles to the free perforator flap using autogenous tissue for recreation of a breast ‘mound’ have been established and refined. The use of tissue expanders for breast reconstruction has also been perfected over the last three decades. Breast reconstruction, which was once admonished in the early part of the 20th century, has now become a routine choice for women undergoing breast cancer surgery.”

As Spock is wont to say (in both his past and present incarnations), “Fascinating.”

Resources: http://www.prnewswire.com/news-releases/worldwide-plastic-surgery-statistics-available-for-the-first-time-100248404.html, http://en.wikipedia.org/wiki/Plastic_surgery, http://www.ncbi.nlm.nih.gov/pubmed/20574484

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

ALZHEIMER’S RESEARCH RIGHT NOW! 5#: Toxic Tau Proteins Point Alzheimer's Research in Whole New Direction!

From the first moment I discovered my dad had been diagnosed with Alzheimer’s, it seemed like I was alone in this ugly place. Even ones who had loved ones suffering in this way; even though people TALKED about the disease, it felt for me like they did little more than mumble about the experience. Not one to shut up for any known reason, I added a section to this blog…

Every month, I’ll be highlighting Alzheimer’s 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: January 2, 2020…

“…‘amyloid theory’ took another hit earlier [this] week, when a study in the journal Neurology concluded that early declines in memory and thinking among Alzheimer's patients tend to occur before amyloid plaques appear in the brain, not after.”

So what’s it all mean?

It means that decades of pursuit of a way to deal with amyloid plaques – which had proven a dead end countless times – both in research and in effectiveness (after much trumpeting that “This is it!”) like the monoclonal antibody solanezumab, saracatinib, beta- and gamma-secretase inhibitors, verubecestat, sargramostim (Leukine) – has now been declared a REALLY dead end as far as treatment is concerned.

The thing to deal with now is tau proteins…

Which are, what, exactly?

According to Wikipedia, a tau protein “…are proteins that stabilize microtubules. They are abundant in neurons of the central nervous system and are less common elsewhere, but are also expressed at very low levels in CNS astrocytes and oligodendrocytes.”

And now I can do what I do best; translate the doctors!

First of all, microtubules are found in cells. MOST of you remember from high school biology that cells divide – they cut themselves in half to make new cells. Fat cells are REALLY good at dividing (I know from personal experience!) While that’s supposed to break the tension with a bit of self-deprecating humor, it also segues nicely into an explanation of “oligodendrocytes” which is a special cell that makes the “oily” coverings that go over the fibers that connect nerves.

Whenever a cell is ready to split, it has to get its chromosomes in order to that they go to the right places. Microtubules are the “strings” that pull on the chromosomes and pull them apart that the two new cells get the right stuff to grow NEWER cells.

Tau proteins help to make the microtubules work smoothly. You mostly find them in the brain (Duh! If they WEREN’T there, then why would be associated with Alzheimer’s?)

We’ve known all along that these tau proteins appeared to have tangled up in the brains of people who died of Alzheimer’s complications. Most scientists thought that while that was interesting, there wasn’t much they understood about them.

Anyway, in a new kind of brain scan, shows that a buildup of these proteins not ONLY mess with healthy cell division, they also tangle together in places and it appears that “…toxic tau proteins drive brain degeneration in Alzheimer's more directly than the disease's other hallmark, amyloid protein plaques, the study authors said.” Post-doctoral fellow and lead researcher Renaud La Joie, at the University of California, San Francisco, Weill Institute for Neurosciences.

The scans also could allow doctors to predict how Alzheimer's will affect individual patients, by tracking which brain regions have more accumulated tau tangles. “…the location of tau buildup predicted which brain regions would atrophy with more than 40% accuracy, the researchers said. On the other hand, amyloid PET scans could only predict about 3% of future brain degeneration.

“‘Where this abnormal tau builds up, it's evidence that something is starting to go wrong in this brain region,’ La Joie said. ‘Amyloid is very diffuse in the brain. Most patients have amyloid all over the place, including in areas that remain at least healthy-looking and don't degenerate until very late in the disease.’

“The results provide hope that new drugs that target tau tangles will be able to help Alzheimer's patients…”

After this devaluation of the whole “sure approach to amyloid plaques” and the development of failed drugs to attack them, I’m not holding my breath…but I’m not giving up hope. At least for other people who are just now finding out that they or their loved ones may be developing symptoms of Alzheimer’s.

Resources: https://www.usnews.com/news/health-news/articles/2020-01-02/study-might-point-alzheimers-research-in-whole-new-direction

Image: https://www.meduniwien.ac.at/web/fileadmin/_processed_/e/1/csm_shutterstock_142671010_4683b6bf13.jpg

ENCORE #124! – The Reconstruction Era, Part One

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 May of 2013.

It appears that the next event is breast reconstruction!

It’s been two years now since the double mastectomy and shortly, it will be two years since chemotherapy began. My wife now has an appointment to begin the next phase: breast reconstruction.

As is my wont, I am going to ONLY cover the medical side of reconstruction. I WILL tell you that the ultimate choice is your own. We discussed for nearly a year the different types of reconstruction, we researched, my wife talked to dozens of people both online and face-to-face. We consulted half a dozen doctors, changed clinics and changed clinics then went back to the second clinic again. Breast reconstruction is not a decision to be made lightly nor is it to be made quickly. There are ramifications, risks, and considerations; soul-searching and God-seeking. All of these should be part of the decision to yes or no as well as the decision of which or what.

So…I am not endorsing or advising any of the methods I will write on here. I will translate the doctors – as I’ve tried to do all along. This week: Implant-based reconstruction.

First, a clear definition: “Breast reconstruction is a surgical procedure that restores shape to your breast after mastectomy (surgery that removes [one or both] breast[s] to treat or prevent breast cancer).”

The first step after the mastectomy – which may also happen during the mastectomy itself or years later – is that the surgeon lays down a device called a tissue expander.

http://www.allergan.com/assets/images/US/products/tissue_expanders.jpg

The expander is basically a balloon that the clinic will fill with salt water a little bit at a time. The surgeon puts it under BOTH the skin and the muscle and leaves it there. After the surgery to put it in, the person visits the doctor for an appointment where some salt water is injected into it and then left there. It stretches the skin and muscle a little bit. Then the person waits while until the next appointment. Obviously, there will be feelings of the skin being stretched; I IMAGINE that the feeling would be similar to what happens when you get a sting of some sort and your knuckle swells a bit.

In my wife’s case, the surgeon will add something fairly new to support the expander – a “donated human skin scaffold” which will go along the bottom side of the expander.

“Lab-made skin and soft tissue substitutes (in this case) is made from donated skin but it has all the living cells taken out. What’s left is collagen – the same stuff that makes up tendons, ligaments, cartilage, bone, and intervertebral discs (as in “I slipped a disc!”)…Tissue-engineered skin...can be used as either temporary or permanent wound coverings. Other situations in which bio-engineered skin products might substitute for living skin grafts include certain post-surgical states such as breast reconstruction…”

“AlloDerm is a soft-tissue implant fabricated by a proprietary method...”

The surgery to place the expanders and the AlloDerm will take two to four hours and includes new drains to reduce uncontrolled swelling.

In the interest of keeping the posts readably short, I’m going to stop for now and continue next week!

Resources: http://www.mayoclinic.com/health/breast-reconstruction/MY00207,

https://securews.bsneny.com/web/content/dam/BSNENY/Provider/Protocols/B/prov_prot_701113.pdf, http://emedicine.medscape.com/article/879007-overview

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

MERRY CHRISTMAS!

Image: http://rlv.zcache.com/merry_christmas_breast_cancer_pink_ribbon_wreath_4_25x5_5_paper_invitation_card-r016a4eafe02440c1b41ea4fef1f8fd93_zk9gs_324.jpg?rlvnet=1

GUY’S GOTTA TALK ABOUT…Alzheimer’s #27: Dementia? Alzheimer’s? What’s the Difference???

Dad’s diagnosis of Alzheimer’s stayed hidden from everyone until I took over the medical administration of my parents in 2015. Once I found out, there was a deafening silence from most of the people I know even though virtually all of them would add, “My _____ had Alzheimer’s…” But there was little help, little beyond people sadly shaking heads. Or horror stories. Lots of those. Even the ones who knew about the disease seemed to have received a gag order from some Central Alzheimer’s Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this part of my blog…

I came here today to write an article on the difference between dementia and Alzheimer’s. The chart below summarizes it SO neatly, that I’m just going to share the chart today.

However, I’m also going to add a couple of things. First, my mom suffered from dementia due to aging, possibly exacerbated by disease (vascular disease, as she was diagnosed with congestive heart failure years prior to her death) or even mini strokes. An old and dear friend of mine was diagnosed with ARD, AIDS-Related Dementia (“When HIV spreads to the brain, it results in encephalopathy (a disease which affects the brain's function), which causes dementia. The greater the spread of infection in the brain, the worse the dementia symptoms become.”)

The chart above says everything else I wanted to say.

I continue to learn about Alzheimer’s, this hated and fearsome disease that took my father less than a year ago. Let’s hope we can put down partisan differences in Congress and get back to the work of serving the people and fund more effective research on stopping it…if only: https://www.congress.gov/bill/116th-congress/senate-bill/740/text, https://alzimpact.org/press/press_release/id/144

Resource: https://medium.com/aginginbeauty/what-is-the-difference-between-alzheimers-disease-and-dementia-84a571b6b50d, https://www.hopkinsmedicine.org/health/conditions-and-diseases/hiv-and-aids/hiv-and-dementia

Image:  https://upload.inkspire.org/uploads%2F1503370874800-Alzheimer-disease-patients.jpg