How many mammograms do I really need?

Last month I wrote about a strange vision problem, one that required an appointment through my medical provider, UC San Diego Health. I was pretty freaked out by this temporary impairment of vision, so getting the appointment nailed down was paramount, and I did a lot of hand wringing until the issue was resolved. Around the same time, I remembered my annual mammogram was due. I decided to line up that appointment too.

UC San Diego Health offers an online service called MyUCSD Chart. I wasn’t exactly sure when I’d had my last mammogram, so I signed on to get the date. In doing so, I discovered my next mammogram was not due for another year. They seemed to have changed the frequency from annual to every two years. I wondered if this had something to do with my insurance company. Then I recalled the recent news story about how the U.S. Preventive Services Task Force had revised their mammography guidelines.

I am now 53, and according to their new guidelines, I should be getting a mammogram every other year. More controversial, I guess, is their recommendation that women wait until they are 50 before they even start this screening process. The Task Force does offer a caveat: women over 40 who feel they need mammograms, should receive them.

I hate mammograms, and I’ve wondered more than once if I could get away with less screening. I was sorely tempted to go with the recommendation in MyUCSD Chart and allow two years to pass before I went in again. I reasoned, I was pretty stressed out over what had happened to my eyes, and I didn’t need to deal with this right now. Yet I also had a letter from UC San Diego Radiology reminding me about my annual screen—I decided to just call them.

My lumpy and dense breasts have received medical scrutiny since I was in my early thirties. I was living in Seattle in those days, and at some point my former doctor decided I needed a fine needle biopsy to determine what was going on with a particular lump. This most painful procedure revealed a cyst. My doctor then recommended I begin having annual mammograms. Monthly self-exams were also suggested, something I ultimately struggled to pull off.

When I was in my late 30s, another doctor—this one on the Oregon Coast—went over my mammogram results and recommended a stereotactic biopsy. I was sent to Eugene for this procedure, which resulted in a couple of chips being placed in my right breast. The biopsy was negative.

This saga of mammograms continued after I moved to San Diego. Because I have dense breasts, I am occasionally called back for a follow-up ultrasound, so it is often a two-shot deal for me. Last year, a follow-up mammogram and ultrasound were recommended. While I was having the ultrasound, the technician chatted with me in a cheerful manner, noting how I had dense breasts and how mammograms can’t reveal everything clearly in my particular case. When the results came in negative, I wondered if I was dealing with too much screening.

So this year I had the same question. Did I really need so many mammograms? I didn’t hate the fact that MyUCSD Chart was recommending every other year for my mammogram. I put in a call to UC San Diego Radiology, happily prepared to say, “Okay,” in the event that the scheduler said I needed to wait another year. However, she put me on the books.

This time, things were different. Normally I receive a letter informing me about the recommended follow-up mammogram and ultrasound. Yet this time they called me the next morning and got me in that day. This time the ultrasound technician offered no commentary as she conducted the session. She did take a lot of screenshots. And this time, she scanned my lymph nodes, something I’d never experienced before.

It was a whirlwind from there. Not long after the ultrasound was over, the interpreting radiologist came in to inform me I had a suspicious mass. A biopsy was scheduled for the next morning. Meanwhile, the radiologist told me a surgeon was on hand and would be willing to talk to me right then. I was barely catching my breath when this surgeon walked in to discuss what would probably happen if the mass was cancerous.

As I waited for my results, I received a lot of advice. For example, I know two former oncology nurses. One is married to a former oncologist. I also communicated with a few breast cancer survivors. It is my impression that people are up in arms over breast cancer screening and breast cancer treatment. There’s a lot to digest, and a lot conflicting ideas about how much screening and treatment is truly necessary. I did tell people the surgeon thought my case would probably require a lumpectomy and possibly radiation. I told them she’d reassured me about the cosmetic side of things. She didn’t think it was likely I would lose much tissue or that it would mar my appearance much. She thought my prognosis was good.

I certainly wanted to collect advice from knowledgeable people, but I found the process upsetting. I was asked how big the mass was (I’d neglected to collect this detail). I was asked about my mother’s breast cancer. What kind did she have? Did she receive genetic testing to ascertain if she had the abnormal genes linked to higher breast cancer risk? I was told, maybe it’s a tiny cancer that will go away. Maybe I didn’t need to do anything. I also learned the trend right now is to save the breast as opposed to jumping to radical surgery. On the other hand, I heard from one breast cancer survivor about how a tiny cancer had been discovered by her doctor. They ultimately cut away a fourth of her breast to treat it. I learned about several women who didn’t want to risk recurrence. They chose a double mastectomy. I ended up with a spectrum of viewpoints and options to consider, but I was no longer reassured (my surgeon had originally done an excellent job in this regard). I worried I wouldn’t make a good decision about the course of treatment I should ultimately follow, if I happened to be dealing with the big C.

I now have the distinction of being the first UCSD Health patient to have a cancer detected by their new tomography process. I went through this imaging session the morning after my routine mammogram (before I was moved into the ultrasound room). As I held still in the usual uncomfortable mammogram position, the machine arced over my breast and took a number of shots along the way. My surgeon showed me how this image compared to an image taken during the original mammogram session. The mass is indeed clearer in the tomographic image. While it has been classified as small (roughly two centimeters), it is not tiny. The possibility of leaving a tiny cancer alone became moot because I have invasive lobular breast cancer and it must be dealt with.

My surgeon also informed me that lobular breast cancer is less common than the ductal variety. It is more diffuse and less easy to detect. She went on to say she couldn’t help me make a decision about my treatment plan until I underwent an MRI to determine if other areas were affected. The test was scheduled for the next day. I had over a week to wait before my next appointment with the surgeon.

Meanwhile, I was lined up to work with a genetic counselor. I had no idea what to expect from this session, though I vaguely thought they would draw blood and quickly test for the two gene mutations linked to higher breast cancer risk, BRCA1 and BRCA2. I felt I needed to know if I was a carrier, because women in this situation often decide on a double mastectomy to reduce their risk of recurrence and, ultimately, terminal breast cancer.

I should note, the possibility of developing breast cancer a second time quickly became the strongest focal point of my ruminations once I received my diagnosis. I figured my surgeon and her team would do a great job helping me to become cancer free—odds of my survival were placed at 90%. But because my father had dealt with three cancers (he died of leukemia), and my mother had struggled with two, I figured this was potentially a first round for me. Yet I could barely stand to think about a double mastectomy.

There’s something about UC San Diego Health that makes me think of the world that was envisioned when I was eating Space Food Sticks and drinking Tang. It has materialized. The medical provider seems to come up with new solutions before your eyes. To my surprise, the genetic counselor went over a list of not 2, but 17 genes they could examine to give me a sense of my risk for recurrence. These genes could also point to other cancers and, no doubt, numerous other problems.

My heart sank when I learned it would take 2 to 3 weeks before they would have my test results. The genetic counselor seemed to notice my impatience, and she asked if I would actually choose the bilateral mastectomy if I did test positive for either gene mutation. At this point, I communicated balking with my entire being. What she said next startled me. She said my test results could also be viewed as evidence that I needed more comprehensive screening for breast cancer once I was cancer free. She said, if I started getting an annual mammogram and an annual MRI, as well as swift treatment for any cancer that might emerge, my odds of survival would be roughly the same as those I’d be facing if I underwent a bilateral mastectomy. Thus if I knew I wasn’t going to choose a mastectomy no matter what my genes revealed, I could go forward with the lumpectomy before my genetic test results came in.

The next time I saw my surgeon, I questioned her about what the genetic counselor had stated regarding more comprehensive screening versus a bilateral mastectomy. My surgeon qualified this information by noting that women in their forties may have a better outcome with the bilateral mastectomy. For me, however, it was more likely to be a toss-up.

It’s been almost three weeks since I had my routine mammogram. In three more weeks, I will receive a lumpectomy. I’m also expecting to undergo radiation therapy. I’ll probably have my genetic test results by then, though I don’t expect to ask for a different course of treatment. In any event, I’m no longer worried about how many mammograms I’ve had in the past—or how many I will have in the future.

 

 

Foggy Lenses

The diagnosis was this: sunscreen bleeding into my eyes and ultimately soaked up by my contacts, which I’d worn for hours in the bright sunlight. That’s what caused a noticeable loss of vision, albeit temporary, after I spent a couple of days in Joshua Tree National Park. I’d thought my contacts were in need of cleaning. This often happens when I drive long distances. My contacts become clouded, and I either clean them at the next rest stop—or replace them with my glasses. But this time, when I finally took my lenses out, I wondered if I had a second pair on, a pair that was foggy. I’d accidently done this once before. It was the first explanation I could think of for the fact that I could not see well with my glasses on.

Denial sinks in quickly when your eyes are threatened. I told myself it wasn’t that bad. How could it be? I tried to drive home and was forced to stop in Palm Springs. I spent the night in a hotel with plans to go to the emergency room in the morning if the problem didn’t clear up (two friends, both former nurses, were on alert). Maybe I should have gone in immediately, but I thought perhaps my eyes were dilated. I thought perhaps I just needed to get to a darkened space, because I’d been in the bright sun for hours. I also thought of snow blindness. Maybe this was like that. After denial comes fear, which blanketed me for a couple of hours until I saw improvement. I was finally able to sleep, and in the morning my eyes seemed fine.

The Oregon Coast, especially during winter break, is the antithesis of the desert. I take my daily walk, summiting Horizon Hill and begin hiking down the other side. The sun rests just above the trees and the dark road. For a brief moment, rays hit my eyes at an angle making it impossible for me to see anything but black where the road should be—how it descends sharply and becomes treacherous on a frosty day. I walk a little further and can make out the pavement, the dark conifers on either side—still presences—and the lack of sunlight beneath them. This same forest buffers the upcoming curve. What cannot be seen in the depths where trees are is loudly present, perhaps beckoning.

I have been given the go-ahead to wear my contacts on a limited basis. I should not apply sunscreen above or around my eyes. Instead, I should wear giant sunglasses in the sun and a hat. Regular doses of fish oil and rewetting drops have also been prescribed. I am glad to have these tiny lenses back—I prefer wearing them when I’m active. Roughly halfway through winter break, however, one lens develops a tear. I have neglected to throw a backup pair into my toiletry kit, something I rarely forget. I am stuck with my glasses until I return to San Diego for the new semester.

I am walking down the other side of Horizon Hill and the rain I’ve been warding off with a slicker begins coming down with a vengeance, drenching me. I put on gloves, the hood (of a hoodie) beneath the hood of my waterproof garment. My pants, defenseless, quickly become soaked. And my glasses are so steamed, it is easier to continue without them, seeing through the astigmatism that prevents my natural view from being sharp. As I continue, rainwater streams around my feet, flowing down the steep incline. Some freshwater will make it out to sea.

Stripped of my wet clothing—now hanging from a ladder, the back of a chair, and the bathroom door—I am cozy in dry sweats and a long-sleeved T-shirt. I put my glasses back in place, recline on the couch, and pause to look out the window. The rain is washing the glass clean, turning into long rivulets that stream downwards. It drums off roofs, pings back into the air in fat drops. And the rest of the world is a palette of grays, black, white waves, and steel green coming in and out of focus, depending on how the clouds are situated—the fog.

The Manuscript in the Drawer

It is weird to face a former self in the pages of a novel that never made it off the ground. I should say, “selves,” as there are bits of me in every character. I finished the first draft in 1995—the final draft was completed in 1998. I haven’t cracked this book open since the early 2000s. At that time, I couldn’t get past the first few pages. I guess I thought I’d improved. During this more recent reading, I was gentler with myself. I did make it to the end of the story—I’d forgotten most of the plot. While the manuscript is certainly not ready to sell, I found many parts worth salvaging, including descriptions of Eugene, Oregon, and environs, where the book is set.

Some might wonder why I would bother wasting precious writing time redoing something I finished when I was a much less sophisticated thinker, and less adept with my craft. Why not leave the manuscript in a drawer (as a badge of honor) and move on to spark new work born of a mind that is older and wiser? With a handful of new short stories underway, I was actually willing to do just that, but I wanted to give the manuscript one last look before I buried it for good.

As I was going over the story, I experienced a number of emotions, as well as regular cringing. Still, I came away with renewed resolve to continue working on the project. I’ve decided it would behoove me to interact with the younger me, because the younger me had a different voice—one today’s me cannot completely duplicate. I’m now curious to see what an amalgam of the two voices will look like. It might result in a book the older me could never have pulled off on her own.

I lived in Eugene between 1980 and 1988—I pretty much came of age there. I find it a very different city these days. There are lots of new student apartment complexes. The campus exterior, as seen from Franklin Boulevard, is snazzier with its sleek Matthew Knight Arena and a couple of other buildings I don’t remember. The city is now preparing – once more – to host the Olympic Team Trials in Track & Field. I was happy to hear this as a couple of my characters are runners. Eugene has moved into a new phase, but folks still love to talk about how it once was—as I have done in this novel. I’ve decided to further develop the running aspects in the book. I plan to make my characters a bit younger, transforming the genre from young adult to middle grade. Ultimately, I’d like to enhance the humor, while making it more painful and resonant.

I must admit, before I got around to rereading the manuscript, I worried about finding it banal. It does have passages that made my eyes glaze over. What was interesting about looking at the story after all of these years is that certain notes—bits that could be highlighted with the “meaningful” marker—stood out to me in ways they hadn’t before. Aspects I thought would would come off two-dimensional weren’t as flimsy as I remembered, while the stuff I’d tagged to be the heart of the narrative didn’t ring out as well. I’ll probably need to construct a different tale altogether, capitalizing on those places I feel do succeed. I did find my characters more likable than I was expecting them to be. I think I can push them further now, taking them more deeply into their struggles, angst, and happier moments.

My next task is to go over the best draft and identify what I want to retain, as I also note where the story needs to go from this earlier incarnation. I’m still happy with the backdrop. I intend to keep 1980s Eugene alive, instead of moving the town forward and mirroring what it is today. This decision could put me at a disadvantage come time to sell the story, because experts in the children’s book industry – those delineating its various forms – tend to recommend that novels be set in a timeless place—or in a most up-to-date place, one with all the bells and whistles of modern technology, which apparently our kids can’t live without.

I don’t completely agree with this line of thinking. As a child of the sixties and early seventies, I enjoyed reading children’s books set in the fifties, not to mention decades prior to that. I wanted to know what my country was like before I showed up. But this is a discussion that must be shelved until I have something worth defending. Tearing up the old manuscript and building some new scaffolding is my first order of business, now that the new year is looming and there are a few more weeks of winter break and rain continues to saturate the Oregon Coast.

 

 

 

 

Thinking About Yucca

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As we were hiking the Lost Palms Oasis Trail in Joshua Tree National Park, my friend Pam Kersey, who volunteers for the Desert Institute there, told me a bit about yucca plants peppering the desert. She said they really weren’t trees—they belonged to the lily family. “They can live more than a thousand years,” she added, before telling me how they slowly inch into the whimsical poses I could see around me. We immediately agreed, anything capable of contributing to the cycle of life for so long deserves special reverence: Bristlecone Pine, Sequoia, Giant Redwood.

I’d already developed a fondness for yucca, not to mention a number of other desert beauties, but in this moment I felt a renewed sense of awe. I thought about composing a poem in my head focused on what I’d just heard—one I might jot down later. Yet while I ruminated on the yucca’s remarkable lifespan, a mental superimposition landed on my growing ode. The blot, to my mind, was my first exposure to the plant, back in the seventies. I’d never heard of yucca until I watched a television commercial peddling Yucca Dew Shampoo.

As Pam and I continued hiking, the faded memory played in my mind like a badly produced Youtube video: some supposedly indigenous woman (I don’t know if she was actually a Native American) showing off her shiny black hair as she discussed how the yucca had been responsible for this sheen for centuries. I couldn’t help but marvel at the hold my early television viewing still had on me. This recollection seemed more deeply etched than those focused on scenes from my actual life.

Once home, I tried to track down the commercial (on Youtube), but to no avail. I did discover a copy of the ad, however. I’d pretty much gotten it right.

An American Indian shares her secret for rich, healthy-looking hair. ‘My name is Tenaya. For many generations, my people have passed down a secret of a shampoo that kept hair looking rich and healthy… even in the hot, dry desert. Until now, I’ve only been able to share it with a few friends, and I’m happy to have this chance to share it with you.”

I must admit, as I conducted this research, I also stumbled on information about traditional uses of yucca in The Gale Encyclopedia of Alternative Medicine, foremost among them, shampoo and soap. The Yucca Dew ad clearly referenced a real practice—though I found myself hoping the shampoo company hadn’t mowed down these thousand-year-old plants in their effort create the product.

All of that aside, Pam’s lesson made me want to write about yucca, a worthy subject for a poem. Yet I’ve wondered if the commercial ruined the piece before it was begun. My heart was in the right place—I wanted my poem to be about this miraculous plant and the vast landscape it inhabits—but I worried I was incapable of doing it justice. I still can’t untangle the yucca plant from the Yucca Dew commercial. I suspect that will always be true.

The fact remains, I am a poet in a modern world. If I am to do my time and place justice, I must honestly face what this world has done to mind and memory. I can choose to move my lens over some wonder in nature and work from there. I can also choose to ignore any other associations that might come up—tell them to scat! I do feel, however, it would be a mistake to reject these memories completely. For there are many natural resources in this strange brain of mine. All should be considered substance for my writing.

 

Wells, Ken R., and Rebecca J. Frey. “Yucca.” The Gale Encyclopedia of Alternative Medicine. Ed. Laurie J. Fundukian. 3rd ed. Vol. 4. Detroit: Gale, 2009. 2417-2419. Gale Virtual Reference Library. Web. 26 Nov. 2015.

READ

Read-More

Morning sun casts chiaroscuro across the backyard patio. And the palm fronds there are gently illuminated, a look that cannot last. There is little sound, as if the morning were holding its breath. Then one bird sings a line of pretty chirps. A drier throat answers.

I suppose every morning holds promise like this – perhaps time to read – before the day moves into the usual commute, the hours of work. Elsewhere, people from the Middle East continue to pour into Germany. Other news from that same country just in: “Despite a sluggish global economy and political turmoil, official attendance for the 2015 Frankfurt Book Fair rose modestly over 2014.” That’s a good sign, one suggesting people still cherish books, though the students in my school seem to prefer their mobile devices. Those sitting in the student center with an ever-present phone or computer on hand could be reading entire books through one app or another, but I suspect they are not.

When I was a younger librarian, working for the Seattle Public Library, I enjoyed putting up the wonderful READ posters produced by the American Library Association. Each one showcased an impressive portrait of one celebrity or another: Oprah, Bette Midler, Paul Newman, Mikhail Baryshnikov, Miss Piggy, Steve Martin, Maya Angelou, David Bowie, and others. It appears these posters are still being created, but I haven’t seen one in years. I no longer work in a public library, though I suspect there’s more to it than that. Reading entire books just isn’t cool anymore.

I remember parents bringing their children to the library to check out impressive stacks of kids’ books. I’m assuming some families still do this. I remember enthusiastic children asking where they could find another book like A Wrinkle in Time by Madeleine L’Engle or The Watsons Go to Birmingham – 1963 by Christopher Paul Curtis. More recently, I have chatted with at least one high school English teacher willing to admit she has had students in her class who have never finished a book.

These days, I help community college students find the books they need to complete their assignments. They only seem to ask for them if their instructor has specified a book is necessary for full credit. As they stand before the reference desk, they often indicate they are in a hurry. Many assume I can produce exactly the book they need. It is the rare student who applies the critical thinking skills necessary to select their own sources for the paper they are about to write. And I don’t generally notice eager readers browsing the stacks to satisfy their own curiosity. I have wondered, on more than one occasion, how many of them actually read – with comprehension – one entire book during a given semester.

I was expected to read a hefty pile of books each quarter (in high school and in college). I used take exams I would have failed if I had not, indeed, read these books. Sure there were CliffNotes. But my professors were no dummies. They often promised tests – requiring Blue Book essays – that could not have been passed with the help of summaries. Today these exams would almost be viewed as cruel and unusual.

You might sneer and remind me that I am working in a community college. But I have honestly wondered what I would observe if I worked in a university library. Would I find enthusiastic readers browsing the New Books shelves as my generation once did? Would I talk to students hot on the trail of the latest important work about a particular subject? I suspect modern university students expect to find what they need online—the latest everything. Indeed, it seems like younger generations have decided they don’t need to learn how to analyze – stay with, focus on – lengthier tomes. Instead, they cast their nets across the waves of cyberspace and calmly decide the information they retrieve will suffice.

Speaking of my generation—I fall at the tail end of the Boomers—we still talk books. We run book groups, participate in Goodreads, and share our favorites during meaningful talks. While Boomers still hold some sway over some things, I’ve been informed we are out. Maybe that’s how it should be. As a parting shot, however, I challenge today’s librarians, reading teachers, and English instructors to come up with a new READ campaign, one that encourages lengthy (hours of reading) in-depth analysis – downright meditation – on the world’s great books. Sure, today’s young brains are being trained to use technology, and they often demonstrate breathtaking sparks of intelligence as they display what they can do. Imagine the promise of mental ability intentionally geared to move the mouse with ease AND read deeply.

Blackout!

I try to submit a few poems each weekend. Most are simultaneous submissions. To keep this process organized—the submissions, the rejections, the occasional acceptance—I’ve come to rely on Duotrope. “Duotrope is a subscription-based service for writers that offers an extensive, searchable database of current fiction, poetry, and non-fiction markets, a calendar of upcoming deadlines, submissions trackers, and useful statistics…”

In particular, I’ve found it easy to keep meticulous records by using their submission tracker. It is my belief that the efficiency of this system has improved my acceptance rate dramatically. Over time, I’ve developed a list of favorite journals. All I have to do is click on a journal title within Duotrope to see if it is currently open for submissions. I can also retrieve a list of poems I’ve already submitted to that journal, along with a status note for each piece. Alternatively, I can click on one of my poems and pull up the list of journals it has visited.

Last Sunday I was lounging in Starbucks, looking over my submissions to Colorado Review. I noticed I’d accidentally sent them two different drafts of the same poem—both of which were rejected. One, entitled “Blackout,” describes an event that occurred on September 8, 2011. Since dubbed the 2011 Southwest Blackout, it left nearly 6 million people in Southern California, Arizona, and Baja without power. I never placed “Blackout,” but I later drafted a second poem that ultimately became a mash-up, one that included this poem as well as another I never published, “Trona Pinnacles.” I named the new poem, “Scene Change,” and eventually found a home for it, Catamaran Literary Reader.

I continued sitting there, sipping my coffee and idly reflecting on the path “Scene Change” had taken, when the power went out. It’s funny how you don’t notice how loud Starbucks actually is until there is no music, no air conditioning, no beeping, no humming of any sort whatsoever. For a moment the establishment was almost completely still. Then the nattering began. “Does anyone know how long the power will be out?” It was unseasonably hot that day, and customers were quick to speculate: Too many people running their air conditioners!

Of course the Wi-Fi was also out. I wondered if Verizon had been hit, too, because I could not bring up a thing on my phone. From where I was sitting, there was no way of telling just how bad this blackout was.

My drive home from work during the 2011 power outage proved to be a bit wild. Not one traffic light was on—a veritable roadway free for all was in play, though “parking lots” were quickly developing along major freeways. I breathed a sigh of relief when I made it home.

These memories continued to surface as I tried to decide if I should get out of my chair and rush ahead of all the people who weren’t remembering the Great Blackout of 2011. But I had a ticket to “A Walk in the Woods.” I wasn’t ready to surrender it just yet.

Maybe the power will come right back on.

It didn’t. Starbucks lost no time closing up shop. I rushed over to the theater, thinking perhaps it had escaped the darkness, only to hear the same old line from an exiting theatergoer, “The power is out!”

By then, I’d lost my edge. Though my next move was to rush to my car, I ended up staring into the rearview mirror for at least 15 minutes, waiting for a safe moment to back out of my parking space as the entire lot slowly filed out.

Finally, I made my way into the funnel. Once I was released from the parking lot, I managed to drive through the power outage within a matter of blocks. The operating traffic lights in unafflicted areas immediately brought back a sense of order. And my next stop – the supermarket – was blissfully cool. I later learned this particular power outage could hardly be called the Great Blackout of 2015, though 115,000 people did go without electricity for a spell. I’ll never forget, though, the flickering candles people were forced to use back in 2011. I’ll never forget the strange sense of happiness in my neighborhood—how eerie it was, how dark and celebratory.