Community Voices for Health

By: Martianne Stanger

A general oncologist looked me straight in the eyes several weeks before I turned 42 and said, “Don’t. Get. Pregnant. Again.”

A week later, a surgical oncologist concurred with this advice.  She reiterated that the hormones involved with a pregnancy could act as a trigger for me.  She went on to stress that not only should I avoid any further pregnancies, but that I should also have my ovaries removed before Christmas and consider having my breasts removed soon, too.

Dramatic, I know. And confusing.

As my last “cancer” appointment, my gyno-oncologist did not push a prophylactic oophorectomy with the urgency my “new” surgical oncologist did.

So, why all the sudden urgency?  Why all the oncologists?  Why the recommendations?  Do I have cancer?

No.  Not yet.  In fact, I may never get cancer, but the odds are not on my side.

Cheering for Team Cancer

Due to my genes, my age and a few screenings that have come back with “slight concerns”, I am now a part of a team I never wanted to be on:  Team (Maybe) Cancer.  As the surgical oncologist explained, cancer is now a team sport. The team includes   doctors that cut things off, doctors that administer medicine, doctors that advise, patients,  their families who gather as much information as possible, and so many others.

I am now more involved than I ever wanted to be.

About seven years ago, I was a mere cheerleader for team Cancer.  My sister is a breast cancer survivor and, due to geography, I was but a prayerful supporter through her cancer journey – loving her, lifting her and supporting her however I could from afar.

When my sister conquered cancer, I honored her hard-won battle and the battles of all women who have faced breast cancer by joining the Sister Study.  And for several years, I donated hair to various wig-making charities.

Little did I know that I would soon to go from cheerleader to junior team member.

Joining Team (Maybe) Cancer

Several years ago, after I learned that both my sister and my father carried the “breast cancer gene,” I made the decision to be tested for the BRCA2 mutation myself.

Unlucky me has the mutation.  Lucky me has an awesome, supportive husband, a family full of love and a home nearby many excellent physicians. So, for the past few years, I have been holding steady in the care of all of these folks, going about my daily life “as usual,” with pauses for breast MRI’s, blood tests and vaginal ultrasounds.

Admittedly, these pauses have not been the most pleasant or convenient ones, but they have seemed a small hassle compared to surgeries, or worse, cancer.

Now, things are changing.

A Senior on Team (Maybe) Cancer

There are effective screenings for breast cancer, but not for ovarian cancer.  The only accepted ovarian screenings are less than efficient.  In fact, the surgical oncologist I just saw looked me straight in the eyes and told me that I could have ovarian cancer right now and no one would know it.  Despite encouraging test results after my last onco-gynocologist appointment, I might already have cancer and there is a possibility that no one could catch it until I was Stage 4 – too late.

The surgical breast oncologist went on to say that, at 42, I am well beyond the age that allopathic medicine suggests prophylactic removal of ovaries for women with BRCA2.  So, I am gambling not only with ovarian cancer, but also with increased (or at least not reduced) risks of breast cancer.  (Removal of my ovaries, as I understand, will lessen my risk of breast cancer.)

Even though I am years away from becoming a senior citizen, my “advanced age” makes me a senior on Team (Maybe) Cancer.  Thus, the pressure is on to consider some new plays – plays that involve slicing body parts on and off.

To my surgical oncologist, (and, I am sure, to many) the “right” action seems clear.  I must weight the inability to welcome any new baby blessings into this world, the discomfort of premature menopause and the drama of reconstructed breasts against the possible tragedy of not being around to raise the kids I already have and love, the pain of actual cancer, and the frenzy of trying to schedule urgent surgeries for tumor removals.  To many, moving forward with my doctors’ recommendations seems like a “no-brainer”:  Make the calls.  Get the parts removed.

Unfortunately, it is not just my brain involved.  It is my heart.  My spirit.  A small, yet persistent, part inside me that wonders if I am meant to take a different course of action.

Unsung Hero and Most Valuable Player

Because of this, I have been unusually distracted and grumpy as I enter my 42^nd year.  I have a big decision ahead of me.  There are a lot of personal questions stacked in my head:

• Do I continue with the breast and ovarian cancer screenings protocol I am now following?  If so, for how much longer?
• Do I cease the ovarian cancer screenings since the blood tests and ultrasounds are relatively expensive, somewhat inconvenient, and reportedly not very effective?  If so, what do I do instead?
• Do I follow recommendations for prophylactic removal of body parts which will greatly reduce, although not altogether eliminate, my chances of getting breast or ovarian cancer?
• Is there literature that I have yet to uncover, which might help me to make the best decision for me right now, as well as the best one for my whole team – family, physicians and otherwise– in the long run?
• Can my heart, head and soul agree on a course of action?

At the moment, I have far more questions than answers.  Despite the push by my newest medical advisor to undergo proactive surgeries, I am just not ready to act yet.  I need some time to weigh things further with my Unsung Hero and MVP.  I seek more time to talk without interruption with my husband and to seek guidance from God.

Mourning A Child that Is Not

I need a few more nights to sit next to each of my beautiful children, praying, smiling and crying, in turn, as I celebrate their lives, feel sorrow for the way I have been living in the past week or two and mourn the life of a child that has not yet even been conceived.

I love each one of my three children dearly and cannot imagine the world without any of them.  I know they cannot imagine the world without me either.  So I want to be here for them as long as I can.  I want to treasure them, inspire them and enjoy them.  I do not want be the distracted, grumpy mommy I have been since my last two medical appointments.

I also want to honor the love I feel for another child.  For while I know it is crazy, for the past year as my three children occasionally have asked me if I would have another baby, my heart began to say “yes.” Even as money, age and so many other factors have screamed, “No way!” I started to feel that our family is not yet complete.  For lack of a better way to describe it, I have begun to love a child that has not yet joined our family. Because of this, thinking about removing my ovaries breaks my heart.

To be completely honest, I don’t particularly want another child, and the possible complication of conception at “advanced” age, the pain of actual birth, the challenges of nursing, the constant interrupted sleep that babies often bring.  Yet, I have felt that another child wants me… us… our family… our world, much like my youngest child did.

My youngest was a surprise, and, I must say, he is the best surprise I ever experienced.  He reminds me all the time that every child is a gift and that God’s timing is magnificent even when it is not in line with our own.

Because of all this, I mourn. I shed tears about a child who is not even a zygote yet.  As I think about lopping out my ovaries, I think about how emphatically that would hush the whisper I have had in my heart for over a year now.

The Pressure Is On

I also cry because I just plain don’t want to make this decision, but I know I have to.

To be honest, at this point, I am no more ready to undergo preventative surgery than I am to actually face actually cancer if, indeed, ovarian cancer already lurks undetected in my body (or if any other cancer begins to rear its ugly head.)

Barring the chance that I already have ovarian cancer as the surgical oncologist warned, I am a generally healthy person.  I may have four regular doctors and counting, but I am in good physical condition.  If I follow medical advice, I won’t be in the same condition.  My hormones will be different.  I will be subject to all sorts of medicine and unnatural who-knows-what in my system.  I will be stressed by surgery and any possible complications.  However, I will be at a far reduced risk for breast and ovarian cancer.

If I do not follow medical advice, I may get lucky and be one of the few whose BRCA2 gene does not foreshadow a definite bout with cancer. I may remain healthy and be glad that I didn’t start cutting things off.  But I also may not.  I am told that the odds in my favor decrease with every day that passes. It is likely that I will have to undergo surgery and unnatural who-knows-what anyway when the cancer “inevitably” strikes – but it is not definite.

In short, the surgical oncologist did her best to persuade me that prophylactic surgeries would be a win against cancer, but I am not fully convinced.

Cheering Myself On

My membership on Team (Maybe) Cancer put a damper on my birthday.  I did not feel like celebrating.  Luckily, that changed.  As my 42nd birthday unfolded with lots of ordinary moments, I began to focus on the beauty of each.  I felt gratitude.  I shared smiles.  I knew peace for the first time in weeks.

I did not come to a decision. But I did realize that no matter what I choose to do and how my decisions play out, I am alive.  I am here.  I am able to live fully in the moment when I just let go of the stress of decision-making and playing the “if-then” game.

Yes, I need to make some decisions, and probably made soon.  But, this process does not need to weigh me down so much.  My Unsung Hero, my MVP, the rest of the team and I will land upon the “right” plays for me.  Whether these plays involve surgery now, surgery later or surgery never… whether they prevent cancer or defend against cancer… whether they quiet the whisper to welcome new life into our family or simply give me the best medically-advised chances of prolonging my life…  No matter what decisions I make right now, I must remember that all things work together for good.

A Final Note

Please hold me in your prayers as I make my decision.  Know that I hold you in my prayers if you are going through similar decisions.  I may not know you, but I am a teammate.  Here’s to the “right” win-win for every individual and for the whole team!