‘My Pink Ribbon’

October is Breast Cancer Awareness Month. It’s a time when it seems you hear about breast cancer everywhere you turn. Pro football teams play their October games wearing pink shoelaces and cleats, chin straps, wristbands, and helmet decals. Even the game balls have pink ribbon decals.

The public relations campaign to get us thinking about breast cancer has been quite effective. But with all the attention to the issue, most are still not aware that men can, and do, get breast cancer. I say this from first-hand experience. In June 2010, after a seven-mile run near my home in Anderson, Indiana, I noticed a swelling in my left breast, and, when I massaged it, I felt a palpable lump.

I didn’t think much of it at the time, but I was concerned enough to have it checked by a surgeon I’d seen a year before for a minor procedure. When I arrived at his office two weeks later, I showed him the swelling and he did a fine needle aspiration (biopsy) of the lump right on the spot.

An hour later, the report came back. I’d tested positive for breast cancer. I was still in his office, stunned, as he informed me, “For men, there’s really only one option—a complete mastectomy.”

Feeling numb, I said “OK” and scheduled the surgery for four days later. Then I had to go home and tell my wife, Elise, whom I had not told about the lump or the doctor’s visit because I hadn’t wanted her to worry.

At the appointed time, the surgeon removed my entire left breast. He also took four lymph nodes. Afterward he biopsied the nodes to see if the cancer had spread. The test came back positive for one of the nodes. Not a good sign. The surgeon told me that because he’d found cancer in that first node, it was very likely that the cancer had traveled elsewhere in my body.

Up until then, stunned though I was, I hadn’t worried too much. Now, it was different. I started thinking about dying. I began reading everything I could about breast cancer. One of the first stories I found online was about a 28-year-old British man who died after a four-year battle with breast cancer. And here I was, in my 60s. But, I reminded myself, 
I was quite healthy. I have been a runner all my adult life. I’d quit smoking 18 years earlier. I rarely drank alcohol.

I ate nutritious foods almost all the time. Plus, there was no history of breast cancer in my long-lived family, which included two older sisters and my 92-year-old mother never had cancer.

I returned to the hospital for surgery two weeks later, this time to remove nine more lymph nodes. About a week later, I went with Elise to the doctor’s office to learn the biopsy results. I felt very nervous as we awaited the verdict.

Amazingly, all nine lymph nodes tested negative. Elise and I both found ourselves weeping tears of joy. It was like having a death sentence commuted.

The follow-up treatment wasn’t so terribly bad, all things considered. I made it through 49 chemotherapy and radiation treatments over the next eight months. Throughout that period, I never experienced fatigue, nausea, or missed a day of work. My oncologist told me I was lucky; only about 10 percent of his patients breeze through treatment with so few side effects. Yes, I lost my hair and my fingernails, and I had some digestive problems, but I was indeed lucky.

I like to think some of my success with the treatment has to do with three decisions I made early on. First, I decided to be candid about my cancer and discuss it with anyone who was interested. Second, after reading the excellent Life Over Cancer: The Block Center Program for Integrative Cancer Treatment by Keith Block, M.D., a Chicago oncologist, I decided to eliminate red meat and dairy products from my diet. Block points out that the Japanese, for example, have significantly lower rates of cancer than Americans and eat significantly higher amounts of seafood. Summarizing several studies, The Physicians Committee for Responsible Medicine at cancerproject.org concludes, “Even within Japan, affluent women who eat meat daily have an 8.5 times higher risk of breast cancer than poorer women who rarely or never eat meat.”

I began eating broiled or baked fish six or seven days a week combined with lots of beans, fresh fruits, vegetables, and nuts. I also started taking whey protein, flaxseed, and fish oil supplements.

Although some oncologists advise against strenuous exercise during chemotherapy, my third decision was to continue running and weightlifting, something I had been doing for more than 25 years. Block says, “My own clinical experience … has repeatedly confirmed the therapeutic benefits of exercise for people with cancer. Even walking … for three to five hours a week is correlated with a 50 percent decline in mortality from breast cancer.”

There’s also something else—a strong foundation of spiritual support. In his book, Block encourages meditation, spiritual disciplines, and connection with a loving community or support group. I try to spend time every morning in prayer, meditation, and reading the Psalms and other Bible passages. I know I could not have survived my year of treatment so easily without my faith and dozens of supportive friends in our a loving congregation at at St. George Orthodox Christian Church in Fishers, Indiana. And Elise’s prayers, cheerful outlook, and daily encouragement also made a tremendous difference.

When the treatment phase came to an end, I celebrated by running the Indianapolis 500 Festival Mini-Marathon, the largest 13-mile race in the country. At 7:30 a.m. on May 7, 2011, nine days after I finished radiation treatments, we were off. When I finished three hours and 28 minutes later, I ranked 26,307th out of 35,000 runners. Of course, I didn’t care where I placed. I was a winner. I ran another half marathon in October 2012 and, as you read this, I will be running another one. I plan to complete at least one half marathon a year for as long as I am able. As Robert Frost wrote, “The woods are lovely, dark and deep. But I have promises to keep and miles to go before I sleep.”

Related: Men and Breast Cancer: The Facts

Hospice Girl Friday | ‘Survivor’s Guilt’

Devra Lee Fishman’s dear friend and college roommate, Leslie, died from breast cancer one month shy of her 46th birthday after a four-year battle with the disease. Being with Leslie and her family at the end of her life inspired Devra to help care for others who are terminally ill. Each week, she documents her experiences volunteering at her local hospice in her blog, Hospice Girl Friday.

Before my friend Leslie died, I thought hospice was for old people with cancer. According to the Hospice Foundation of America, approximately two-thirds of hospice patients are over the age of 65, which means that one-third are younger than 65. And while many are diagnosed with cancer, I’ve seen just as many patients at my hospice with pulmonary or heart disease, neurological disorders, Alzheimer’s, AIDS, or complications from any number of health issues.

When I check the census at the beginning of each shift I get a quick overview of the current patients: their names, diagnoses, ages, and dates of admission. Also listed for each patient is the name and relationship of the main point of contact. All of this information is helpful as I prepare to make my rounds. I always look at the ages of the patients first, hoping to find that they are older than I am–preferably much older. That way I won’t have to think about my survivor’s guilt–how it could just as easily be me instead of them. But every week there is at least one patient my age or younger (I am 53), and every once in a while, all of the patients are. Those days are the toughest.

One recent Friday there were five patients: a 52-year-old woman with lung cancer; a 33-year-old woman in a diabetes-related coma; a 46-year-old man with HIV/AIDS; a 49-year-old man with end stage kidney disease; and a 51-year-old woman with breast cancer. I felt my stomach start to roil when I read the census. I would have preferred to stay at the volunteer desk and not see any patients for my entire shift, but I swallowed my survivor fear and made my rounds.

My first stop was room five, the woman in a coma. Her mother was there and said they were both fine for the moment so I moved on to the 46-year-old man in room six. He seemed to be sleeping so I tip-toed out and walked into the room of the 52-year-old woman with advanced lung cancer.

Her name was Laura, and she was sitting up in bed when I walked in. She was rocking back and forth with her palms on her lower back and watching The View on her small flat-screen TV. I read in the volunteer notes that she used to be a dancer; she looked tall, lean, and muscular, but she was also bald and jaundiced from her cancer and chemo treatments. If I didn’t already know her age, I would have guessed she was in her 70s. Cancer–or the treatment–does that sometimes. I noted a pile of peanut M&M packets on the nightstand next to her untouched breakfast tray.

“Peanut M&Ms are my favorite candy,” I said to break the ice after I introduced myself. Focusing fully on the patient was difficult because I kept thinking: She’s younger than I am. I could be in that bed.

Laura glanced over at the stash. “My boyfriend keeps bringing those because he knows I love them. I just don’t have much of an appetite anymore.”

I wanted to have more of a conversation with her, and asking about her boyfriend would have been my next move, but when a patient mentions some sort of physical symptom like a loss of appetite, it’s important to try to find out if he or she is experiencing any other discomfort. The nurses visit as often as they can, but a patient’s comfort level can change minute-to-minute so I always try to help by passing along any time-sensitive observations.

“How are you feeling otherwise? Are you comfortable?”

“Pretty much,” Laura said. “My back still really hurts.”

That explained the rocking. Back pain is a common complaint with lung cancer patients, but should be fairly easy to fix so I said, “I’m sorry to hear that. I’ll tell your nurse.”

“Why are you sorry?” she asked. “It’s not your fault. I’m the one who smoked.” She said this without the slightest note of self-pity or anger.

“Fair enough,” I said, trying to sound as neutral as she did. My ‘sorry’ was meant to be empathetic instead of sympathetic, but I knew to follow her lead and then drop it. There was a pause between us, and before I could stop it, a feeling of relief rushed in along with the thought: Maybe I wouldn’t be in that bed after all because I don’t smoke.

On the days when the patients are younger than I am, I marvel at the randomness with which we move through life, as though we’re all playing one big round of musical chairs, dancing around one moment and eliminated from the game the next.

On those same days I also feel a deeper empathy for the patients and their loved ones, and I’ve often sensed the same from the hospice nurses and doctors. I know that cancer, diabetes, HIV, and other diseases do not discriminate by age, yet sometimes I wish they did. I see too many hospice patients who just seem too young to die–possibly because I feel like I am too young to die–and it feels unfair that they could not find a chair when the music stopped. Then again, I have no idea what age is “old enough” to die, so I continue to work through my survivor fear and do my best to help all of the patients in my hospice find some comfort at the end of their too-short lives.

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