The archives and library of our sister blog, Kindle Nation Daily (KND), are a treasure chest full of good things to read on your iPad--most of them presented free. Of course, just this week past, KND shared with us the latest chapter of Shaken, by J.A. Konrath, with the promise of a final "pre-quel" chapter tomorrow, Monday. The full book delivers on Tuesday. In recognition of Breast Cancer Awareness Month, an annual event in October, KND shares the following excerpt.--Tom Dulaney, Editor, Planet iPad
In this touching, frank and informative memoir, Nicki Boscia Durlester intimately chronicles her transformational journey after being diagnosed with breast cancer. Her story begins with her mother, who was diagnosed with the disease in 1962: a time when breast cancer was only discussed behind closed doors, and long before women took an active role in their diagnosis and treatment.
Nicki provides unique insight into being part of a large Italian- American family afflicted with the BRCA2 gene, and shares poignant stories about her mother and aunts who faced breast and ovarian cancer with extraordinary grace and courage.
Nicki writes candidly about her frustration in finding the right team of doctors as well as the highs and lows of her journey, sharing humor and heart along the way. She puts a human face on the statistics ranking breast cancer as the second leading cause of death of women in the United States.
This deeply moving story of legacy, loss and ultimately survival is told through the eyes of a daughter who shared an unbreakable bond with her mother. As she travels the scary, unpredictable road through her own diagnosis, treatment and recovery, Nicki discovers the most difficult challenge she faces becomes the most spiritually transcendent experience of her life.
Beyond the Pink Moon: A Memoir of Legacy, Loss and Survival
By Nicki BosciaDurlester
Copyright 2010 by Nicki Boscia Durlester and reprinted here with her permission.
On Monday, March 23, 2009, the day after spring break ended, I had a 10:00 a.m. date with destiny. My annual visit with the radiologist always brought back thoughts of my mother. It had been almost thirty-two years since she passed away. At fifty-two, I had lived much more of my life without her. It was hard to believe she was nine years younger than I when she was diagnosed with breast cancer.
As I drove to my radiologist's office I wondered what this year's mammogram would show. The night before, I told Big Al I had a bad feeling. We were lying on opposite sides of our favorite u-shaped couch in our family room.
He glanced over at me with a look of impatience and repeated words he had often said to me, "You've been dying since the day I met you. You're not going anywhere. You'll outlive us all."
I had never found those words comforting, nor was I looking for a response. I just needed to think out loud.
I had been Dr. Pritchard's patient for twenty-two years. Mammogram day had always proved to be lucky for me. A negative test result brought a sigh of relief for another year of good health. For twenty-one years I had received positive news and felt incredibly blessed. But there were some curve balls along the way.
In 2001, when I found out I had the BRCA2 gene, I gave serious consideration to having prophylactic mastectomies. I met with several specialists, including Dr. Armando Giuliano, Director of the John Wayne Cancer Institute at St. John's Hospital in Santa Monica. He was the most direct. He looked me straight in the eye and asked me if I would prefer getting a breast cancer diagnosis someday versus doing something to prevent it now. Profound words of wisdom which I would choose to dismiss. The odds were definitely stacked against me considering the fact that my chances of getting breast cancer increased over time; however, there was also a slim possibility it might not happen. At the time I had two young and very busy children, a business to run, a home to manage, and the list goes on and on. Taking time out for major surgeries, including the mastectomies and reconstruction, seemed daunting. I also knew I would still have a 2-3% chance of getting breast cancer even if I had the mastectomies; much less than the general population, but still at risk. No decision was black or white.
In an ironic twist, I was diagnosed with multiple sclerosis in 1991 and was concerned a major surgery might further compromise my immune system. My MS had been in remission for years and I wanted it to stay that way.
To make matters worse, sadly, my father passed away in 1991 of colon cancer, another genetically linked disease. Removing my colon was clearly out of the question. Just as I would rely on a colonoscopy every five years to screen for colon cancer, I would do the same with the screening techniques available for breast cancer. My gynecologist, Howard Mandel, informed me that breast cancer typically appeared later in the offspring of BRCA2 carriers, so I felt as though I had time to reconsider my decision. At some point you have to get on with your life. But Dr. Guiliano's words would continue to haunt me.
In the meantime, I would be more vigilant about my health. I would have an annual mammogram and ultrasound along with monthly self-breast exams, and visits to Dr. Mandel every six months for checkups. I would also have a baseline MRI with a follow-up three months later to get the closest thing to a 360-degree picture of my breasts. Additionally, I would take a holistic approach to my health and do whatever I could to stave off cancer, including maintaining a positive attitude, a well balanced diet, exercise and healthy lifestyle.
Throw in some acupuncture, vitamins, Chinese herbs, therapeutic massage and cranial sacral sessions and maybe, just maybe, I could beat the odds.
Besides, I had already given at the bank, big time. In 1990, prior to being tested for the gene, at the age of thirty-four, when Ally was four and Matthew only eleven months, I had a total hysterectomy including removal of my ovaries due to my family history of ovarian cancer. I lacked confidence in the limited and unreliable screening techniques for ovarian cancer. I felt like a ticking bomb, and more than anything wanted to see my children grow up.
There is never a free lunch in life. Although removing my ovaries greatly decreased my risk of ovarian cancer, Dr. Mandel told me the loss of estrogen produced by my ovaries could adversely affect my heart and bones. My dilemma was whether or not to take hormone replacement therapy (HRT). At thirty-four, I believed I was too young to be thrown into full-blown menopause. So I took Premarin (synthetic estrogen) and kept taking it for eighteen years.
Every six months when I visited Dr. Mandel for a checkup I would ask him the same question. "Is it safe to be on HRT?"
His answer never changed.
"There are no conclusive studies that demonstrate estrogen alone increases a women's risk of breast cancer. Conversely there have been studies that have shown that estrogen alone can reduce the risk of breast cancer in women who carry the BRCA2 gene."
I have always loved being told what I want to hear, so this sounded good to me. In my heart however, I never felt comfortable taking a synthetic drug. I would later hear differing opinions on HRT from other doctors. If I have learned anything, it's that there is a study and an opinion for everything and they seem to change on a regular basis.
Maddening to say the least. I wish I had trusted my instincts more, but life doesn't come with a rewind button.
As I sat in the waiting room at Dr. Pritchard's office, I officially began the annual freak-out. I said a few Hail Marys and hoped for the best. The technician finally called my name and ushered me into the mammogram room. I never understood why I bothered changing into that flimsy paper cover-up that I immediately removed once the tech came back into the room. I always felt so vulnerable standing there half naked, waiting for this stranger to take my breasts into her hands.
And then the squeeze fest began. She gently placed my breasts on the mammogram machine before pressing down on the cold transparent plate. It always reminded me of a chicken cutlet being flattened under a piece of wax paper; a barbaric process to say the least. The tech took two pictures of each breast with me standing in different positions. When we finished she told me to put the paper gown back on while I waited for the mammogram results from the doctor.
The five minutes until Dr. Pritchard walked in to give me a thumbs up or down always felt like an eternity. This year would be different.
When the door opened it was the technician who announced she needed one more picture of my right breast. A red flag! When I asked why, she nonchalantly said it was due to a scar I had on that side, a remnant from a mole I had removed years before. Okay, I bought that. A few minutes later Dr. Pritchard came in and said everything looked fine on my films. Phew! Another bullet dodged.
I always had an ultrasound to be more thorough and hopefully catch anything my mammogram might miss. Fortunately, my insurance paid for it because of my BRCA2 status. That is the only benefit of being a gene carrier. As Dr. Pritchard moved the transducer (a small hand-held device that resembles a microphone attached to the scanner by a cord) over my right breast, I watched him pause and go over the same area several times. And then I heard the words that changed my life.
"I think I see something here."
* * *
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