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How I Saved My Own Life
by Pamela Kramer
Woman's Day, April 2, 2002
It's all too easy to shrug off a strange-looking
mole or an odd pain in your chest. You may tell
yourself that most of these abnormalities turn out
to be nothing anyway. But the truth is that we need
to be alert to the signs of dangerous illnesses and
willing to seek medical help, scary as a diagnosis
might be. You know your body better than anyone
else, and early detection and treatment can stop
many diseases from progressing. Let our stories
inspire you to take charge of your health. The life
you save may be your own.
Being Alert to Changes
Two years ago, at age 38, I was tempted to ignore a new
dark-brown mole I noticed on my lower back. After
all, the spot looked small and harmless. But since
malignant melanoma took my mother's life when she
was just 50, I decided to play it safe. I made an
appointment with my dermatologist, who removed the
entire mole for biopsy. Later, the doctor called
with the pathology report: melanoma in situ.
She explained that the spot was thin and probably
hadn't begun to spread. Still, I would need a wide
local excision--a minor surgical procedure to remove
tissue surrounding the area where the mole had
been--to ensure the cancer wouldn't return to the
same place or spread to other parts of my body. I
was going to be fine, she assured me, but should
have head-to-toe skin checks every three months for
two years, and every six months for the rest of my
life.
Even though I had nearly all of the risk factors for
malignant melanoma, including red hair, fair skin
and freckles, I never dreamed that the mole on my
back would be deadly. The diagnosis was a loud
wakeup call that I need to be even more vigilant
about checking my skin for changes and having any
new or unusual-looking moles or spots removed and
biopsied right away. Because of the aggressive
nature of melanoma and the poor response to
treatment once it has spread, early diagnosis is
crucial.
I made an appointment with an oncologist who
specializes in melanoma at the University of
Colorado Health Sciences Center--the same doctor who
treated my mother. After he reviewed my pathology
report and gave me a thorough exam, he confirmed
that the mole had been removed before it had an
opportunity to grow and threaten my health. He also
pointed out that I had probably saved my own life.
Surviving a health crisis: I got as much information
as I could about melanoma by going online and
reading books. Getting the hard facts was
frightening, but it was also empowering because I
felt I was taking control of my situation.
How to Save Your Life
*Know the risk factors of melanoma. Although no one is
immune to the disease, people with a family history
of melanoma, many moles on their body, fair skin
that burns and freckles easily, light blue or green
eyes, or blond or red hair are at increased risk.
Those who had several blistering sunburns during
childhood are also at risk.
*Avoid sun exposure, especially between the hours of 1 0
A.M. and 4 P.M., when the harmful rays are
strongest. Protect yourself with long sleeves and
pants, and a wide-brimmed hat. Always use a
sunscreen with a sun protection factor (SPF) of 15
or higher, and apply liberally, uniformly and
frequently.
*Examine your skin head to toe at least once every 3
months in a full-length mirror. See your doctor if
any new or existing mole is asymmetrical; has
borders that are scalloped or have notched edges; is
a color that contains varied shades of brown, tan or
black; or is larger than 6 millimeters or 1/4 inch
in diameter. If your doctor thinks the mole is
suspicious, a biopsy should be performed.
Leaving Nothing To Chance
In April 2000, Lorren Schroeder, then 47, was
performing a breast self-exam when she noticed a
small pucker on her left breast. "It looked just
like a dimple that some people have in their
cheeks," says the teacher's assistant and mother of
two boys in Colorado. "Nine years ago, when my
mother was sixty-six, she developed breast cancer. I
was told not to worry since she wasn't in her
thirties or forties, but I'd read a lot about the
disease."
In fact, Lorren had adapted a self-exam technique she'd
read about in a medical reference book. As she stood
in front of a mirror, she held her arms straight out
in front of her chest and pressed the palms of her
hands together. This compresses the pectoral muscles
of the chest wall and causes abnormalities in the
breast tissue to create dimples in the skin. "I'd
read that a dimple in the breast could be as serious
or worse than a lump. That stayed with me," she
says.
The next day she saw her nurse practitioner, who quickly
scheduled Lorren for a sonogram. "I could see on the
screen that it was deep and had irregular borders,"
she says. "I I knew it wasn't good."
A core biopsy revealed invasive lobular carcinoma, a form
of breast cancer that can be difficult to detect by
touch or through mammography. It usually doesn't
form a hard mass, but rather a slight thickening of
the breast tissue. Four months earlier, her annual
mammogram had been normal. "I had no pain, no lump,
no nipple discharge," she says.
After a lumpectomy and radiation therapy, her prognosis is
good. "My surgeon was able to remove all of the
cancer and said it hadn't spread to the surrounding
lymph nodes," says Lorren, who also received
chemotherapy and the hormone-blocker tamoxifen to
decrease her risk of recurrence.
"If I hadn't discovered this tumor and it had been
left to grow, it could have been dangerous," she
says. "Now all my friends and coworkers check their
breasts for dimples."
Surviving a health crisis: "Take time for yourself,"
says Lorren. "I occasionally met a friend for dinner
or went to a movie. I even checked into the Holiday
Inn a few times. I arrived back home feeling so much
better."
How to Save Your Life
*Breast cancer is almost always curable if detected
early. Have a clinical breast examination by a
professional each year and perform a thorough breast
self-exam each month. Don't forget to check for
dimples. If you find an irregularity or something
that feels abnormal, contact your doctor
immediately.
*Have a mammogram once each year if you are 40 years
of age or older. "Mammograms pick IIp the majority
of breast cancers when they are still too small to
be felt or to cause any changes in the outward
appearance of the skin," says Marilyn Leitch, M.D.,
medical director of the University of Texas
Southwestern's Center for Breast Care, in Dallas.
Turning to New Technology
Peggy Smith, a 46-year-old mother of three in
Nashville, Tennessee, didn't panic when she had a
slightly abnormal Pap smear. As a cytotechnologist
who examines Pap smear slides for cell
abnormalities, she thought the result was likely due
to infection or inflammation, and would clear up on
its own.
After a second abnormal Pap test, her doctor
performed a colposcopy--a visual examination of the
cervix-and biopsy to rule out cancer. "When the
report came back negative, I was thrilled. I wanted
to hurry up and have one more child," recalls Peggy,
then 40.
The lab where Peggy worked had recently adopted new
Pap smear technology called ThinPrep, an
FDA-approved Pap test that is significantly more
effective than the conventional Pap smear in
detecting cervical abnormalities. Instead of putting
the Pap sample directly on a slide, the doctor
places the cervical cells in a vial of liquid
preservative. At a lab, the solution is filtered of
any blood or mucous, making it easier to examine the
cervical cells on slides.
When Peggy went for her next Pap smear, she asked her
doctor to use a ThinPrep vial in addition to a
conventional slide. When she took both samples back
to the lab and examined them under a microscope, she
was shocked. The conventional slide appeared
slightly abnormal, just like before, but the
ThinPrep slide showed markedly atypical cells that
came from high in her endocervical canal. "When you
see abnormalities like this, you worry," Peggy says.
She went back to her gynecologist with the results,
and the doctor performed an endocervical curette, in
which cells are scraped from the endocervical canal
and biopsied. This procedure was followed by two
biopsies, and part of her cervix was removed. But
when a follow-up ThinPrep Pap revealed a high-grade
endocervical lesion, Peggy's doctor recommended a
hysterectomy.
During the surgery, doctors found, high in her
cervical canal, a rare form of cervical cancer
called adenocarcinoma, which tends to be more
aggressive than the more common squamous-cell
carcinoma. Fortunately the cancer had not spread,
and Peggy didn't need further treatment.
"I feel sad that I can't have another baby, but I
also realize how very lucky I am. My doctor said
that if the cancer had not been found, it would have
progressed quickly," she says. "It's great to be
alive."
Surviving a health crisis: "Let others help you,
even though it's not always easy to do," Peggy says.
"My sister took care of me and watched my little
one. My two teenagers pitched in and did their own
laundry."
How to Save Your Life
*Ask your doctor to use the ThinPrep Pap test, which
is more effective than the conventional Pap in
detecting cervical abnormalities, says Javier
Magrina, M.D., chair of the obstetrics and
gynecology department, division of gynecologic
oncology at Mayo Clinic Scottsdale in Arizona. "Many
larger labs have already switched to it."
*Have a ThinPrep Pap test every year for the rest of
your life, or once every three years if you are
past-menopausal and have never had an abnormal Pap.
"Pap tests aren't one-hundred percent accurate, but
if you have an abnormality and get a false negative
reading there's a chance that your next Pap will
pick it up," Dr. Magrina says.
Taking Matters into Her Own Hands
Claire Bukzin was 50 when she first began waking up
in the middle of the night with a tight feeling in
her chest, shortness of breath and pain radiating
down her left arm. "I felt like I was having a heart
attack," says the mother of three and head of
development and marketing for three assisted living
centers in New York.
Claire described her symptoms to her internist, who
referred her to a cardiologist and gave her this
warning: Most doctors don't pay attention to this
type of pain in women.
The cardiologist took the first in what would be a
series of heart tests over the next few years. An
electrocardiogram revealed a heart murmur and a
congenital defect in Claire's aortic valve, but he
said not to worry. Subsequent tests, including two
thallium treadmill stress tests that involved
injecting a radioactive substance into Claire's vein
during exercise, also showed irregularities.
"When I asked, 'Why does this pain persist?' he replied,
'My job is to rule out heart problems. I can't tell
you what it is.'"
In October 2000, after a severe angina attack,
Claire made an appointment with her internist. While
waiting in the examination room, she spotted her
patient file and opened it. " As I was reading the
reports, it dawned on me that all my tests said
irregular, irregular, irregular. I said to the
doctor, 'Something is really wrong here. Take a look
at the reports and see if you see what I see.' All
of a sudden he saw the pattern, too, and said, 'We
need to send you for an angiogram.'"
A small tube is inserted into a blood vessel, then
all the way up to the heart. Once in place, a dye is
injected through the tube and into the coronary
arteries, followed by an X ray. The angiogram
revealed severe aortic stenosis, a narrowing or
obstruction of the aortic valve that is usually
present at birth, but gets more acute with age. H
not corrected, the condition can be fatal.
Her only hope was to have open., heart surgery to
replace the defective valve. During the procedure,
her heart stopped twice, and doctors had to operate
again two days later due to complications.
Claire still struggles with some breathing
difficulties, but she is back at work and relieved
that the uncertainty about what was wrong is now
resolved. "I almost died because there was such a
delay in diagnosing my condition," she says. "Deep
down I always knew the pain was coming from my
heart. It's clearly out of my own persistence that
I'm here today."
Surviving a health crisis: "Have faith in the recovery
process," says Claire. "I knew that I still had a
lot to give, a lot to do and a lot of wisdom to pass
on. I was confident that the universe still wanted
me around."
How to Save Your Life
*Don't delay seeing your doctor if you experience
chest pain that radiates to either arm, the back,
shoulder, stomach or jaw; shortness of breath or
difficulty breathing; or unexplained weakness,
fatigue or anxiety.
*Make sure your doctor fallows up irregular heart
test results with further, more involved tests.
Doctors sometimes disregard irregular or
inconclusive results from the treadmill cardiac
stress test, which produces more false positives in
women than in men.
*Seek a referral to another doctor if your doctor
discounts your symptoms, says Gladys Velarde, M.D.,
a cardiologist at Strong Memorial Hospital in
Rochester, New York.
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