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PLASTIC SURGERY NEWS, SURGERY NEWS, COSMETIC SURGERY NEWS Current NEWS  |
Battling breast cancer
Chemotherapy, radiation, surgeries take a toll - as well as the worry
By VICTOR GRETO / The News Journal
She looked winded when she entered the room.
But Kim Bishel, 36, dressed in a running suit and tennis shoes, was breathing evenly as she sat down at a table in the Helen F. Graham Cancer Center on the campus of Christiana Hospital.
Her hand occasionally traced the strands of her dark, thin hair.
"I am really tired," she says. "But I still haven't let it change my life."
Sitting next to her, Dave Bishel, a 43-year-old ex-Marine, agrees with his wife. "We take it for granted she's going to be OK," he says of himself and his two children, Aubrie, 14, and Tyler, 11.
Although Kim Bishel and her family have tried to retain the comforting rhythms of their lives despite her diagnosis of breast cancer 10 months ago, she has inevitably changed.
As have the lives of the thousands of Delawareans who struggle with breast cancer, including Cheryl Wesley, Julie Ann Turner and Donna Grazal.
Each tries to live her life close to the way it was before diagnosis, supported by a web of family and friends and support groups.
But, individually, they have changed. Fighting for your life will do that to you.
There is a battle-weary wisdom to Kim Bishel, who seems at peace with the ever-present possibility of the disease's recurrence, and even death.
Her new perspective and maturity happened fast.
In April, she walked 39 miles in two days at the Walk for Breast Cancer in Washington and raised $1,800 for the cause. Believing she was in perfect shape herself, she did the walk for a friend of a friend.
Two weeks later, she was diagnosed with breast cancer.
A week before the walk, a pea-size lump at the top of her right breast caught her attention, but she didn't think much of it. She had had breast implants put in the summer before. After the walk, some doctors told her not to worry about the lump, while others urged her to get a biopsy. Five days after her biopsy, she was diagnosed with breast cancer. The lump had grown to the size of a golf ball.
Bishel had two types of breast cancer. One type was centered in the lymph nodes of the right breast, which can infect other parts of the body; another was centered in her breast's lobes, which contain groups of small glands that produce milk. The latter required a mastectomy.
Shortly after her right breast was removed, she made the painful decision to have her left breast removed. It was not an easy decision. But she was determined.
"I wanted it off," she says. "I didn't want to go through it all again. The chances were pretty high that I would get it there, too."
Bishel has lost her hair and gone through chemotherapy and radiation; the former causes persistent fatigue and nausea, and the latter occasionally causes third-degree burns.
Because her cancer is exacerbated by hormones, she takes medication that affects her body's production of estrogen. The side effects have given her a glimpse of one aspect of her future: menopausal symptoms, including hot flashes and restless, often sleepless nights.
Only minutes before she walked into the room at Christiana Hospital, she had received one of the last radiation treatments she hopes she'll ever have.
Like a soldier who has survived several tours of duty, she looks both weary and relieved. "It's a good thing," she says. "I know I'm not going to give up."
This week, she begins preparing to take part in this year's walk, scheduled for April 30 and May 1.
It will not be easy.
Fear of recurrence lingers
Breast cancer never goes away, says Cheryl Wesley.
Even after chemotherapy and surgeries, even after breast reconstruction, even when there's no sign of it.
Wesley's right breast was diagnosed less than three years ago. She has had a lumpectomy (a surgery in which the cancer cells and tissue around them are removed, but not the whole breast). She underwent weeks of chemotherapy. And, finally, she had a mastectomy.
She also has had a lumpectomy on her left breast, but the lump there was benign.
"The longer you go without a recurrence, the better you feel," the Middletown mother of three says. "You try not to talk about it so much with your family, but internally you still think: 'Am I going to die from this? Will it kill me?' "
That nagging fear shaped her decision to get a mastectomy instead of enduring more radiation treatments.
"I wasn't concerned about breast preservation," she says. "Once you have cancer, that's the least of your concerns. You want to do everything in your power to control a recurrence. I would have been willing to sacrifice both."
Wounds penetrate beyond the skin
Breast cancer diagnosis and treatment are followed by physical pain and discomfort. But there are also deep psychological effects of breast cancer.
"From the female point of view, you feel you're not pretty enough," Wesley says. "A breast that has no feeling, no sensation - you don't want to be touched there."
That feeling is exacerbated when you lose your hair, she says. "But you get through that with a supportive husband who doesn't treat you any different."
It also is hard on her children, especially her 5-year-old daughter, Hunter, who panicked when Wesley's hair began to fall out. The child has fixated on God and death ever since, she says.
"I was really careful when I was diagnosed," she says about telling her children. "I told them that people can die of cancer, but I would do everything in my power not to leave them."
Diagnosis hits young woman
If you're young and making plans for the future, being diagnosed with cancer is like hitting a wall while sprinting.
At 30, Julie Ann Turner found out she had breast cancer when she was alone; her surgeon had called her with the results of a biopsy.
"All I honestly remember is being scared and crying," she says. "Nausea. Absolute fear. What did I do to deserve it?"
The cancer in Turner's right breast had formed in the milk ducts, and wasn't confined to one area. She would have to have a mastectomy, followed by chemotherapy.
It was May 2000. She was to be married in September.
"We talked about postponing the wedding," she says. "But I said I don't want to be bald and have one breast for my wedding."
Her fiance, Markquis, finagled the arrangements. They were married by a justice of the peace and spent four days in the Bahamas on their honeymoon. The day after they returned, the day after her 31st birthday, Turner had a mastectomy.
After chemotherapy began, Turner's long, light brown hair began falling out. The loss of her hair hit her harder than she imagined it would. She cried inconsolably. But her husband and his friend both shaved their heads in support.
Regardless, at times Turner would not speak to her husband, and was prescribed antidepressant medication. Like Bishel, she took drugs that gave her menopausal symptoms, and then took another drug to eliminate those symptoms.
After the mastectomy, she had a breast implant. Because of its different shape, she had her other breast reconstructed to match.
"It's the new me, a different me," she says. "I have a lot of scarring. I have little to no sensation in the skin over the implant. Part of my sexuality went away in that area."
But she is dealing with it, she says. "I'm more feminine now than before I got sick."
She plans on working on having a child in the next few months, five years out from her diagnosis.
Wearing a snug-fitting, white ribbed sweater in the conference room where she works, she says, "You'd never know it, would you? That piece of flesh is not about what makes me a woman."
Overlooked issues
Doctors and surgeons rarely delve into the psychological effects breast removal and cancer have on most patients, including their sex lives, says Dr. Diana Dickson-Whitmer, who has been treating breast cancer patients for more than two decades.
At Christiana Care, she diagnoses breast cancer for two to three patients a week. That takes its toll, but telling the patient that she doesn't have cancer, which happens five times more often, more than compensates.
"I love what I do," she says. "Most of the time the answer is there's not a cancer."
But the doctor also wrestles with other psychological surprises. One patient, whom she had been treating and following for 12 years, had a recurrence of cancer. Six years before, the patient had a successful "tram flap" reconstruction. To perform the "trans-rectus abdominis muscle flap," a surgeon removes skin and fat from the abdomen to form the breast, also sculpting the skin to resemble a nipple. Dickson-Whitmer had assumed before the recurrence that her patient was doing well.
"In the course of talking to her about her options," she says, "I discovered her husband had not slept with her since six years before, when she had the mastectomy and reconstruction." She had seen her often over the years, "and I didn't know that, and didn't ask. I was horrified."
The psychological impacts of breast cancer sometimes begin even before diagnosis.
When Donna Grazal was 18, her mother, 46, died of breast cancer.
Last year, Grazal turned 46 and was fighting her own breast cancer, diagnosed nearly a decade before. It has recurred three times since. Like herself nearly three decades ago, her daughter turned 18 the same year Grazal turned 46.
"Last year was a tough year for me," she says. "I have three kids, my mother had three kids. We were both young mothers who didn't put our health first. The parallels were frightening."
As a young nursing student, it took Grazal years to get over her mother's death.
When she was diagnosed 10 years ago, she was living in England with her husband and three small children. But the pain of her mother's death lingered so much that she did not tell her father she had cancer when he visited her family.
But when she began treatment a month later, she told her father the news over the phone.
"He dropped the phone and started crying," she says. "I never saw him again." He died a few months later.
His funeral was a turning point in her life. Unlike what her mother did, Grazal resolved to put her health first, before her husband, even her kids. "I've learned to take better care and think of myself first," she says. "If I don't, I won't be here for my family."
It has made a difference.
She has been getting chemotherapy for two years. Since her diagnosis a decade ago, she has endured a lumpectomy and survived three recurrences of the disease in her lymph nodes. She must treat it continuously with chemotherapy so it does not become worse.
"My life is so full of doctor appointments and CAT scans, and I get so sick of that," Grazal says. "I joke about it, but I feel my body is 20 years older than it is. I can live, but there are times when there's not a lot of things to laugh about."
One doctor told Grazal she was like a vine that needs frequent pruning, she says.
But like a pruned vine, she looks healthy.
"I look fantastic in my wig," she says. "I'm just this wonder woman. If you saw me, you'd never know there are serious problems going on with me."
Marching on
There are no guarantees about breast cancer. It may recur at any time. And the side effects of treatments can be minor or devastating.
During the final week of Kim Bishel's radiation treatment last week, radiation caused third-degree burns over a large chunk of her body, including parts of her chest and back.
Her two remaining radiation treatments are now scheduled for this week.
The painful burns have been a setback, but she plans on continuing to work out at the gym.
She now works out twice a week, but hopes to work her way up to five days a week soon after the last radiation treatment. Her goal is to walk several miles a day until she reaches the 26-mile mark.
Next month, 10 days before this year's Walk for Breast Cancer, she will receive two new breast implants.
By then, her still youthful body, battered by radiation and chemotherapy and surgeries and drugs and the periodic mental punishment of self-doubt and despair, will be poised to walk.
"I'll be ready," she says. "Promise."
http://www.delawareonline.com/newsjournal/local/2005/03/06battlingbreastc.html
