authors comforting.
Robert M. Gelfand, M.D.
Clinical Assistant Professor of Medicine
Weill Medical College of Cornell University
FOREWORD BY DR. MENKEN AND DR. NOWAK
We are honored to have been asked to contribute to this newest printing of this very special book. In rereading the prior edition, written just a few years ago, we were sharply reminded of the progress we have made in the surgical management of patients with breast cancer. Treatments that were just a short time ago experimental, controversial, or not even conceived of yet have now become routine. As such, we hope that our input as surgeons will be a valuable edition to Dr. Gelfand’s medical input in helping patients to understand their treatment options better, and to navigate this sometimes daunting process.
As physicians, we do our best to educate, guide, and reassure our patients. The surgeon is most often the first breast “expert” the patient meets. His or her empathy, understanding, and approachability are of paramount importance. We often set the tone for the patient’s experience. Our ability to communicate is every bit as important as our surgical skills.
Nothing, however, can be as reassuring as hearing from someone who has made it through the journey. For this reason, we are proud to be a part of what must be considered Debbie Cohen’s labor of love.
Faith A. Menken, M.D.
Eugene J. Nowak, M.D.
INTRODUCTION
I want to talk to you for a moment about Fudgsicles. “Fudgsicles? Are you crazy? I have a life-threatening disease and you want to talk to me about Fudgsicles?!?! Can’t you just help me get through this?”
Yes, believe it or not, I do want to talk about Fudgsicles, as they actually may be very important in helping you get through the next six to nine months of your life. Here’s why.
When I was recovering from my initial surgery, I was bombarded with advice from friends and family about books to read on cancer treatments, in order to be prepared to talk with surgeons, oncologists, and other specialists about the best course of treatment for my disease. This is the new world of health care, and I am the perfect model of the “patient activist.” I wanted to be involved in a true partnership with the doctors to make decisions about my own body and my own life. I was not going to sit there and simply be told what to do. Yet I found it wasn’t all that easy.
When I visited my local bookstore to begin my process of becoming an informed patient, I almost passed out in the aisleway—from terror, not from my illness. The vast majority of books were harsh, clinical reference materials, written solely by doctors, chock-full of terrifying mortality statistics. They talked about how sick I was going to get, either from the disease or from the treatments to eradicate the disease, not how to manage the treatments and get well. The remainder were heroic biographies by cancer patients themselves—some survivors, some not—about their own courageous battles. No thanks, I have my own battle to contend with right here at home. I don’t need to read about anyone else’s right now.
So, I threw away all those books, and started talking to people—doctors, nurses, survivors, whoever would talk to me—and it was amazing what I learned, what similar, consistent information started coming back to me regardless of the source. A flagship example? Before I went for my first chemotherapy treatment, I had three different people—one oncologist, one chemotherapy nurse, and one of the women in my support group who had been through the same treatment regimen—tell me that during the ten to fifteen minutes that the drug Adriamycin is being administered to me, I should suck on ice chips, Popsicles, or something cold. Why? Because one of the potential side effects of that particular drug is mouth and gum sores. But for some reason, sucking on something cold minimizes or even eradicates mouth sores.
Now, where was that book, the book that contained all of that nitty-gritty, practical advice that would just get me through the next six months—the operating guide, the instruction manual, the “how to’s” of breast cancer? It didn’t exist. So, I started an information-gathering process, which I’ve presented here in a package called a book. It contains all those practical “tidbits” of advice gathered from every conceivable source—from breast surgeons, medical and radiation oncologists, and nurses at some of the world’s leading cancer centers; from health care consultants and medical literature; from nutritionists, hairdressers, dentists, and other personal-care professionals; from fellow patients and support groups; and even from plain old books. I personally sifted, sorted, and tested their advice, insights, anecdotes, and even their wives’ tales, then added my own perspective.
So now the book exists, and you are reading it. We don’t know if or why sucking on Popsicles prevents mouth sores—it may be that just as the cold restricts blood flow, it restricts chemotherapy flow to the area—but it sure helps many, many women. And wouldn’t it make those potentially unpleasant, dark, scary moments just a bit more tolerable? I actually prefer Fudgsicles, please, but I was willing to do whatever it took to get me through treatment. But wait. There’s more than that to our discussion of Fudgsicles. This book is not only about advice, but about attitude as well. Fudgsicles bring us back to childhood, back to those carefree, breezy summer evenings when the highlight was sitting on the front porch with our best friend and guessing what time the ice cream man would turn the corner onto our street, ringing his bell and bringing a smile to the faces of all who awaited him. This book is also about rediscovering those slower, simpler moments of life, about recouping that positive attitude from childhood that each day promises something special and something new to be discovered, if only we take a minute to open our eyes and look.
Breast cancer is an eye-opening, life-affirming experience. You may think it won’t change your life, that you’re tough, that you can just keep on going and functioning in the life-is-normal-as-possible mode. But you can’t. As everyone tells you, and as you won’t believe, it will change your life in many ways:
• You will look at life in a whole new way, as something you are lucky to be experiencing.
• You will appreciate every day, just because it is there and has been given to you to enjoy.
• You won’t take your health for granted, and will take better care of your mind and your body, making yourself a priority (rather than your family, friends, job, or other distractions).
• You will be calmer . . . the little things won’t seem to bother you as much.
• You won’t worry about tomorrow as much, but live for today.
• You will draw nearer to the people who bring meaning and fulfillment to your life, and get rid of those who don’t (crises have an amazing way of revealing someone’s true character).
• You will gain extreme clarity . . . about exactly who you are and what you want from your life.
For many women I encountered, this experience gave them the courage to take action regarding major decisions in their lives that they had been postponing or evading—getting out of bad relationships even though they might have been comfortable, leaving dead-end jobs, reevaluating relationships with estranged family members. After all, once you’ve been through breast cancer, nothing else seems quite as ominous or overwhelming.
Yes, there’s no going back. Life will now always be divided into “before B.C.” and “after B.C.” As I sat in my gynecologist’s office, discussing what it meant that my lab tests were returned showing “malignant” cells, he said, “You won’t believe it now, but good things will come out of this.” Yeah, right! Now, many months and many tears later, slowly but surely, I am starting to believe him.
Above all, this book is about optimism. It is about how to look for those good things that will arise out of this experience, about focusing on long-term survival and lifetime plans, and about finding some humor and maintaining a sense of sanity in the midst of seeming chaos. The six-to-twelve-month experience of diagnosis, surgery, and treatment can seem interminably long, like a never-ending marathon, a gauntlet of professionals