For most folks in America, the worldwide Pandemic has radically changed not only lifestyles but for some, it’s the first time being truly exposed to a crisis that involves survival. The daily routine that we have become accustomed to has been radically turned upside down. The simple act of a walk on the lakefront, or meeting friends for a nice dinner or any other get together, has become a behavior that is not acceptable;  indeed in Chicago, it could lead to a fine or even a physical arrest. Our generation is being challenged, historians will record how we are reacting, other countries who look toward our great nation for inspiration and leadership are also watching.

Imagine a few weeks ago somebody suggesting that you will be ordered to stay at home and limit exposure to other humans to practice “social distancing” of at least 6 feet.  No hugging, no shaking hands, and gloves, and masks becoming acceptable attire.  I admit I never heard the words SOCIAL DISTANCING until last week, now it seems it will be in the lexicon for the rest of our lives.

I admit the shaking of hands and the acceptance of face masks was nothing new to me having spent over 3 years in the Far East. The handshake replaced by a simple bow, and the masks being a mundane part of life to prevent the spread of germs (how smart were they)? Being that far away from home naturally, our thoughts were of survival first, but things like the 4th of July, our loved ones, our mates and our cities, towns, and neighborhoods were constantly in our thoughts.  You’ve probably heard that song lyrics (THE GREEN-GREEN GRASS OF HOME).  All those things that can sway one’s thoughts during the hardship of a time of crisis. The difference being we can just look out our windows and sleep in the comfort of our beds and be among our closest loved ones. A rainbow in a storm. Comfort in the presence of a killer, very rare indeed.

There really isn’t much of difference being in a jungle or on a battlefield or smack dab in the middle of a killer virus pandemic — people are creatures of self-interest unless meticulously trained by the military. The need to survive is as biological as thirst. Nobody in America saw this pandemic coming so there is no type of training to revert to. So in this time of crisis, we have to ask ourselves Who are you? Who are we?

Most people are creatures of self-interest. Are we willing to look around us for others who may need our help or assistance? Or do we immediately resort to self-interest and charge over everyone in sight and gather up as much toilet paper and other essentials as possible without a flicker of thought about anybody else’s needs? Principles are astonishing flexible during a time of crisis. One thing is clear, to lose one’s head in a time of crisis is one sure way to become the CRISIS.

We are being asked to stay at home by our leadership, to follow some common-sense guidelines, to keep us and those around us safe from suffering the ravages of a potential killer virus. In other words, we are facing a test, it could be the only one our generation will face together.  Will we accept the challenge, will we refrain from looking to blame, will we set aside tribal politics and realize we are all in this TOGETHER?

“When faced with a radical crisis, when the OLD way of being in the world, and being asked or told not to interact with each other and our realm of nature doesn’t work anymore when survival is threatened by seeming insurmountable problems and individual life-form or species will either die or become extinct or rise above the limitations of its conditions.” (Eckart Tolle) Metaphysis. Tough times will not define us they can and will refine us.  I believe we have the right stuff. Remember those historians. Stand together. We all count or nobody counts.

A few years ago, I began to wonder when automation would reach our Chicago Public Schools classrooms—all classrooms.  With so many online resources available, I thought, “Are people thinking good teachers can be replaced by a machine?”

But this COVID-19 e-Learning situation proves that technology cannot replace good teachers or good teaching.

Soon after schools closed on March 17, parents remembered or realized that learning does not happen by itself.  We cannot not just say, “Go learn!” the same way we tell our kids to do the dishes or fold their laundry.

Teachers quickly realized e-Learning does not mean instruction continues the same was as if we were in class.

Yet, there’s been such a strong movement toward using technology in the classroom that some might wonder, “Why do you need a competent teacher if the technology is doing all the work?”

In order for students to work and learn, they need a competent teacher guiding them to and through material, helping them build positive working relationships with others, with themselves, and intervening when things don’t proceed as planned.  Most importantly, a good teacher shows students how to do something meaningful with the knowledge they gained.

Sitting students in front of a computer won’t accomplish any of those goals.

Good teachers know that posting information and assignments on Google Classroom or sending home worksheets cannot produce the same engagement we witness in a classroom.  One of my book-smart and people-smart students spoke honestly when I asked him about the CPS e-Learning plan before schools closed: “Look, if we like the class, if we’re engaged with the material, and if we value the struggle, we’re gonna do it.  If we don’t, we’re not gonna do it.”

Fair enough.

I doubt many of my students followed the e-Learning plan I prepared for the two weeks we thought we would be out.  I set up something meaningful, manageable and let it be.

However, as we move forward and remain out of school longer, I need to design instruction that builds on what we’ve done since September in a meaningful, manageable way.

On Friday, the Illinois State Board of Education released its Remote Learning Recommendations during COVID19 Emergency.  The suggested time a high-school student should devote to a class per day, according to ISBE, is 20-45 minutes.  So each high-school student with seven classes should devote between 2 1/4  to 5 1/4 hours to school work a day.

That’s fair.

Teachers, according to ISBE, need to “be available at scheduled times to answer student/caregiver questions, provide timely feedback on student work, and provide a range of meaningful learning opportunities that meet the needs of all learners during the period of closure,” among other responsibilities.

As far as grading goes, ISBE’s recommendations “are based upon the principle of no educational harm to any child . . . In place of an ‘F,’ for example, the recommendation is for an ‘incomplete’ that can be made up when the remote learning period ends.”

But good teachers know we can’t set up learning that creates an avalanche of work to be made up if or when we return to school.

Whatever learning experiences good teachers set up for students, we will take into account this unprecedented situation that demands we put students’ emotional well-being first.

Ideally, we want to create reasonable conditions where students continue to develop the five non-cognitive factors that contribute to academic performance, according to a study by the University of Chicago’s Consortium on School Research:

• Academic Behavior: doing homework, organizing materials, participating, studying
• Academic Perseverance: tenacity, delayed gratification, self-discipline, self-control
• Academic Mindsets: A sense of belonging, belief in the value of academic work
• Learning Strategies: Study skills, metacognitive strategies, self-regulated learning, goal-setting
• Social Skills: Interpersonal skills, empathy, cooperation

But we cannot do it all.  Good teachers will fulfill their responsibilities during this difficult time by creating opportunities for our students to engage with, build on, or simply be at peace with the academic experiences we worked diligently to create the last six and a half months.

In February, when I was out of the building at a professional development event, days before students started delivering speeches—a new experience for many—one student snapped at me when I returned: “Where were you, Salazar?! We needed you?!”

I humorously explained that my absence was a way to build their independence with this assignment.  “I can’t do everything for you, ya know?” I explained.

“I know,” she said.  “But just be here! Be present.”

I keep that in mind. And while I don’t envision interacting with my classes of 30 or more students via video conferencing or anything that complicated, I will be present for my students in ways that make professional sense.

All good teachers will–because technology can never replace that trust and faith and dedication.

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This blog post is the 20th in a series about my (and my twin sister’s) preventative breast cancer screening journey that began when we were 30 years old in July 2019. The 1st post is about my first mammogram ever; the 2nd post is about my consultation at Mayo Clinic’s Breast Clinic; the 3rd post is about my stereotactic core biopsy at Mayo Clinic’s Breast Clinic; the 4th post is about my diagnosis with “Stage 0” DCIS breast cancer; the 5th post is about my in-person DCIS diagnosis at Mayo Clinic, beginning thoughts on my surgery timeline, and discovering that my twin sister might have breast cancer, too; the 6th post is about my twin sister’s invasive ductal carcinoma clinical stage 2A breast cancer diagnosis; the 7th post is about my breast MRI and two ultrasounds to investigate “suspicious” spots on my right breast and liver; the 8th post is about my second DCIS diagnosis following a week of MRIs, ultrasounds, and biopsies at Mayo Clinic; the 9th post is about preparing for my twin sister’s chemotherapy appointments, including details about her egg banking procedure in the city; the 10th post is a summary of my sister’s ovarian hyperstimulation syndrome and visit to the emergency room; the 11th post is a summary of my double mastectomy surgery plan scheduled to occur on December 3rd, 2019 at Mayo Clinic’s Methodist Campus Hospital in Rochester; the 12th post is about my twin sister’s first chemotherapy infusion at Mayo Clinic; the 13th post is about foobs, photo shoots and nipple tattoos (my plastic / reconstructive surgery plan); the 14th post is a recap of my successful double mastectomy and immediate direct-to-implant reconstruction operation; the 15th post is about my surgical recovery and day full of follow-up appointments at Mayo Clinic in Rochester; the 16th post is about my one-month-post-surgical-follow-up appointment and preventative baseline ovarian cancer screenings at Mayo Clinic; the 17th post is about a suspicious rash I developed a month after my surgery called “pigmented purpura,” my consultation with a gynecological oncologist about ovarian cancer prevention, and my sister’s fifth chemotherapy infusion; the 18th post is about the end of my twin sister’s six neoadjuvant chemotherapy infusions (TCHP); and the 19th post was about my twin sister’s double mastectomy and reconstructive surgery plan (amid the global outbreak of COVID-19). To keep tabs on new posts, sign up for the “A Daily Miracle” email list at this link.

Here is my sister with her husband, all ready for surgery at Mayo Clinic’s Rochester Methodist Hospital!

My twin sister was diagnosed with invasive HER2+ breast cancer in September 2019. She went through 6 rounds of neoadjuvant chemotherapy–a regimen called TCHP–at Mayo Clinic in Rochester, Minnesota, to destroy her Stage 2A invasive ductal carcinoma breast cancer, from November 2019 to February 2020.

Last Friday, March 20th, she went into the operating room with the same surgeons that did my double mastectomy with reconstruction operation in December 2019. Given my sister had to go through chemotherapy before her operation and her cancer was invasive leading into the operation, we knew her operation wasn’t going to be exactly the same as mine–but our surgical plans going in looked pretty much the same: We hoped and prayed that, like mine, 1) Her operation would remove all of her cancer and 2) That she’d be able to go through with direct-to-implant reconstruction.

The short story is that God answered our prayers!!! (The long story follows in this 4,000+ word blog post.) And the five key takeaways from my sister’s operation and pathology report are:

1) Her double mastectomy removed all of her cancer, including the only cancer that remained following her neoadjuvant / pre-operative chemotherapy, which was two very small spots that were connected to her original tumor!!!

2) There were clear margins and there was no lymph node involvement, so she won’t need radiation!!!

3) Her plastic surgeon was able to do direct-to-implant reconstruction!

4) Because there was some cancer remaining in her left breast at the time of surgery–a 1.1cm spot and a 9mm spot that were initially attached to the original tumor–she will need 14 more infusions of chemotherapy starting every three weeks in May: a new, targeted regimen called T-DM1. Clinical research trials prove T-DM1 after surgery reduces the risk of recurrence of invasive breast cancer by 50% as compared to trastuzumab (Herceptin) alone, so my sister’s oncologist prescribed her with this! My sister’s oncologist calls this “chemotherapy light” because the side effects are minimal compared to what she’s already been through with TCHP.

5) In addition to 10 1/2 months of T-DM1 (14 infusions 3 weeks apart starting in May), my sister will also take a daily dose of Tamoxifen for 3 to 5 years to minimize her risk of recurrence (Tamoxifen manages the amount of estrogen in her system).

Our prayers were mostly answered–while it turns out there was some cancer remaining in her breast tissue at time of surgery, the bottom line is her cancer has all been removed now thanks to surgery and her reconstruction is complete. 🙂 We were hoping and praying for a “complete pathological response” at time of surgery, which means her pre-operative / neoadjuvant chemo would have destroyed all of her cancer, but it’s okay because we know God’s plans are perfect and His timing is never late. So we trust His plans and purposes for “Phase 3,” which is what my sister affectionately calls T-DM1 and Tamoxifen. Those infusions will begin as soon as my sister is recovered from her surgery!

Here is my twin sister with her husband at Mayo Clinic all ready for her pre-operative appointments last week!

Preparing for surgery

My twin sister went down to Rochester with her husband last Thursday for some pre-operative appointments including her sentinel node injections which consisted of six injections in both breasts. The injections were successful! My mom, dad, baby sister, and myself arrived that evening and we got Chick-fil-A to eat for dinner. We called the hospital the night before surgery and found out her checkin time was 10am, which means she was the second case of the day–this allowed her to wake up slowly and have her coffee before heading into the OR!

Here is my sister all ready to go into her sentinel node injection the day before her surgery!

Before heading over to the hospital to drop my sister off for surgery we prayed as a family in the hotel!

Double mastectomy surgery check-in at Mayo Clinic in Rochester

Before my sister headed into surgery last Friday, we prayed as a family in the hotel. (A few of us cried.) Then we headed over to surgery checkin at Mayo Clinic’s Rochester Methodist Hospital across the street! As you can see in the photo below and in the featured photo at the top of this post, I purchased my sisters matching cheetah-print sweatpants from Express. So we wore those to the hospital together with our matching tshirts celebrating our Mayo doctor team 🙂 You gotta have some at least some fun with all of this cancer business, right?!!?

I got my sisters matching animal print pants from Express for us to wear to surgery checkin!!!

Because of COVID19, things were a bit different for my sister’s surgery than they were with my surgery: For example, they only allowed two visitors with my sister in the surgery prep floor of the hospital and in her hospital room afterward (Mayo Rochester changed their visitor policy to zero visitors two days after her surgery). So, instead of the whole family going upstairs, my sister’s husband and I headed up with her to surgery prep.

She answered all of her nurse’s questions and got her IV started with no hiccups or problems. We found out she was the second case of the day as her surgeons were in another operation that morning, so around 11am she was taken away on a stretcher to meet her anesthesiologist in pre-op.

We took her bags of clothes with us and dropped off some papers for a research study my sister is a part of at the Breast Clinic and headed back to the hotel to wait.

My sister told me that she had the same anesthesiologist I had for my operation, and that he remembered me! 🙂 Everyone in the OR told her she was in “very good hands,” and she was happy to hear that.

Surgical updates

An hour after we left the hospital, my sister’s husband got the following text update from the OR:

So we knew her operation was underway!

I tried to work for the rest of the afternoon on my laptop but found myself praying most of the time in an attempt to ward off anxiety. At least I didn’t throw up like my sister did when she found out I was in the operating room in December!

Four hours into my sister’s operation last Friday, her husband got this text message:

And then, a call from my sister’s surgeon:

“The surgery went beautifully. It was a gold star pathology report. No signs of residual cancer in either breast, no signs of cancer in the lymph nodes. Plastic surgery has some work ahead of them now as they’re going to attempt direct-to-implant reconstruction.”

HALLELUJAH!!! ALL OF OUR (and our prayer warriors’!) PRAYERS HAD BEEN ANSWERED!!! WE COULDN’T BELIEVE IT!!!

We cried, screamed, jumped up and down, danced, called family, rejoiced, cried some more, and pumped our fists in the air. I felt like doing the worm but still wasn’t sure if that was a doctor-approved activity for me 3.5 months after my own operation.

We couldn’t stop smiling. Then, at the end of 5 hours, my sister’s husband got this text message:

Followed by a call from her plastic surgeon:

“We are finishing up now. We were able to do the direct-to-implant, and she looks awesome. She’s in recovery now.”

WE COULDN’T STOP SMILING!!! This was all too good to be true!!! All of our prayers–in line with Ephesians 3:20-21, the verse my sister asked us to pray for her–were answered!!! The surgery removed all of her cancer, and her direct-to-implant reconstruction was a success! Here is the text we sent out to family and friends:

PRAISE UPDATE & MIRACLE REPORT!: She is out of surgery and THE CANCER IS ALL GONE!!!!! PRAISE JESUS!!!!! Not only that, but the plastic surgeon was able to do direct-to-implant reconstruction which means her double mastectomy and reconstruction are COMPLETE as of today!!!!!!! No more surgery will be needed!!!!!! Thank you so much for your prayers—in the words of her surgeon: “The surgery went beautifully. It was a gold star pathology report. No signs of residual cancer in either breast, no signs of cancer in the lymph nodes.” GOD IS GOOD!!!!!

Prayers for healing answered!

My sister is going through a devotional called “ROAR” by Louie Giglio in her YouVersion Bible app, and the morning of her surgery, she wrote this note:

“‘Wherever you are today, whatever miracle you need, bring that to Jesus. Lay it before the Way Maker and trust that He is working on your behalf to bring you hope and peace.’ Praying today for no cancer left at surgery and successful reconstruction surgery !!!”

I teared up when I read this, because it showed me (again) how strong her faith was. I knew that no matter what happened, she’d praise God anyway, but to know she had the faith to ask Him to heal her of her cancer entirely AND that He would allow her to have immediate reconstruction was an emotional moment for me. To read this having just received the news that surgery removed all of the cancer was overwhelming. She asked for healing in faith and He’d answered!! Not to mention, this was all in the midst of a global outbreak of COVID19.

Hallelujah!!!

My sister’s husband ran up to the hospital room my sister was assigned to make sure he was there to meet her as soon as she was released from recovery. One of our friends asked if he could videotape her response when they told her she was cancer-free after her operation, so he did!:

Here is my sister eating chicken stir fry 2 hours after being released from surgery, her dinner of choice!

As you can see in the video above, my sister was pretty chatty after she woke up from surgery. She talked so much that she completely lost her voice the day after surgery! The great news is she also had a huge appetite–she ordered a full plate of chicken stir fry and sherbet that her husband fed her that night! Then she took 3 laps around the floor of the hospital. It was awesome! She felt a little nauseous after all of her walking but as you can see in the photo below she was doing just fine when we left her alone for the evening 🙂

Here is my sister at the hospital after we had to leave her the night after her surgery–she talked more than we’ve seen her talk in her whole life and she sent us selfies until she fell asleep! Haha!!

Discharged from the hospital! 

My sister spent less than 24 hours in the hospital after her surgery!!! A member of the surgical team came to see her the night of her operation, and the plastic surgeon and two residents came to visit my sister the morning after her operation to check on her. The plastic surgeon and residents said she’s looking “great,” and said they would be in touch with regard to removing her drains (she has one on each side). Because of COVID19, there was a high likelihood we’d need to remove her drains at home instead of having a nurse do it at Mayo. So her husband got all of the instructions from the nurse before we left: Snip the stitches from the drain in each armpit, and pull the foot-long drain out. He felt confident: “I watched my dad remove some stitches from my knee when I was a teenager so this should be no problem!” (Nervous laughter.) Spoiler alert: my sister’s husband removed her right drain at home today no problem and plans to remove the left one on Monday! So he’s basically a doctor.

My sister’s surgical pathology report: “Cured and cancer free!”

My sister got a call from her surgeon four days after her surgery, letting her know that her pathology report was complete. The mastectomy surgeon told my sister that she was very upset that she couldn’t see my sister to give her a hug after surgery. She also said it was a really good thing they got my sister in for surgery last week because they basically got “shut down” at Mayo this week because of COVID19. Before she hung up, she told my sister that she sends us all her love and will never forget us. (This made us all cry happy tears.) She did say to let her know when we’re going back to Mayo when this is all over in a few months so we can wear our t-shirts and “get a proper photograph.” We got one photo with her a few weeks ago but she wants one with our entire family!

All of my sister’s cancer was removed at time of surgery–so, in the words of her surgeon, my sister is now “Cured and cancer free!!!” Here are the main takeaways from her post-surgical pathology report:

1. My sister is surgically “cured and cancer free!”
2. There were two spots of cancer remaining in her breast that didn’t show up on the frozen pathology report but appeared on the final pathology report. Those two spots were removed at the time of surgery–a 1.1cm spot and a 9mm spot. Both spots were attached to the original tumor, so no new cancer was found (woohoo!)
3. Because there was some cancer left at time of surgery, more treatment will be needed to minimize risk of cancer recurrence.
4. There was no cancer in the lymph nodes!!!!! YAY!!!
5. Her breast tissue had clear, 5mm margins!

The bottom line of all of this means that the doctors and surgeons are confident her cancer has not spread anywhere else in her body!!! We rejoice in that truth!! So, while my sister is now cancer-free, there was some residual cancer in her left breast. At first, the surgical team and frozen pathology team thought the tumor may have been completely gone at time of surgery, but after the final pathology interpretation, they found out that the chemotherapy didn’t destroy all of her cancer before surgery like we’d originally hoped. So the oncologist made a plan to eradicate any and all chances of this cancer ever coming back!

Here is my sister heading home from the hospital with her husband, with her “chest buddy” mastectomy pillow from our friend!

My sister’s call with her oncologist and final pathology report

My sister had a video call with her oncologist on Friday at home because Mayo is discouraging any sort of in-person visits at their clinic in Rochester. According to my sister’s oncologist, my sister’s neoadjuvant–or, pre-operative–chemotherapy was effective in eliminating most of the original tumor: It was over 5cm at the beginning of treatment, and there was only 2cm total remaining at time of surgery! Also, there was only “20% cellularity” of the tumor that remained in the tissue that was removed which was great news. Also, no new cancer was found–both spots were connected to her original tumor!

According to my sister’s oncologist, 75% of HER2+ breast cancer patients who go through TCHP have cancer left at the time of surgery, so this wasn’t a surprise to him. “This is a very good report!” he said.

My sister’s “Phase 3” chemotherapy plan: T-DM1 and Tamoxifen

My sister’s oncologist said “nobody really knows” what’s going to happen at Mayo Clinic in coming weeks amid the outbreak of COVID19, but he’s going to plan for my sister to start T-DM1 infusions at Mayo Clinic in 8 weeks in addition to taking a daily dose of Tamoxifen in 4-6 weeks.

T-DM1 doesn’t cause hair loss!, and my sister’s hair has already started coming back on the top of her head, which is amazing! She will have a visit with her doctor before first T-DM1 infusion, then blood labs before every treatment to make sure her platelet levels are high enough to proceed, which can be done the same day. 

In addition to T-DM1, my sister will start Tamoxifen daily. Tamoxifen is meant to reduce the risk of recurrence for the estrogen-receptor-positive part of my sister’s breast cancer as it blocks estrogen from binding to estrogen receptors on cells in the body. Side effects can include hot flashes; a 1/100 risk of blood clots, which can be recognized through any signs of trouble breathing or swelling legs; and a 1/1000 risk of uterine cancer. Uterine cancer always presents itself with a symptom of abnormal uterine bleeding, which my sister and her doctors will watch out for.

Here are some questions we asked my sister’s oncologist about all of this:

 

Q: “How will you know if the T-DM1 and Tamoxifen treatments are effective?”

A: “When there’s some cancer left at time of surgery after administration of TCHP, there is a meaningful benefit in taking T-DM1 in reducing risk of recurrence. For most HER2+ breast cancer, recurrences are mostly within the first 5 years after treatment. For hormone receptor positive cancers, it can be later. When you’re hormone positive and HER2+, it depends. That’s the driver and why we’re treating both–to try to prevent recurrence in 5 years.”

Q: “So the surgery removed all the cancer, the lymph nodes were negative, and there were healthy margins–but how can we make sure no cancer traveled outside of her breast?”

A: “The purpose of T-DM1 is assuming there was existing cancer in the body resistant to the neoadjuvant chemotherapy. T-DM1 is used to make sure if there’s something flowing around to get rid of all of it. T-DM1 targets HER2+; Tamoxifen targets estrogen.”

Q: “What signs of recurrence should we look out for?”

My sister’s oncologist said that she will be coming in for appointments on a regular basis so shouldn’t worry too much about recognizing recurrence on her own, but that warning signs of recurrence include any new lumps, bumps, or skin changes across the chest wall; back or hip pains that don’t go away; losing all sorts of weight without trying; or being worried you had a stroke with trouble speaking or swallowing.

Q: “What does family planning look like?”

“You will likely be on Tamoxifen for 5 years, and could take a pause to expand your family around 2 years,” my sister’s oncologist told them.

Here’s my twin sister at home enjoying some bright flowers and a card from friends!!! 🙂

Next steps

The best case long-term scenario that we are praying for is: That my sister gets through all of her T-DM1 treatments over the next 10 1/2 months with no side effects!; then she gets through her 5-year-daily dose of Tamoxifen with no side effects; and after that, that she is able to go through the rest of her very long and wonderful life with no more cancer, EVER!!!!! And that she and her husband would be able to expand their family along the way. 🙂

In the short-term, my twin sister plans to go back to Mayo Clinic in Rochester in 8 weeks to do a heart ultrasound, blood labs, an office visit, and her first infusion of T-DM1.

In the immediate future, my sister is healing from surgery, so she’s doing a whole lot of nothing except watching movies and playing SimCity on her cell phone. Because of COVID19, my sister has had to (and will likely continue to!) have all of her surgical follow-up appointments on phone calls or video chats.

That means that today, my sister’s husband (with the help of me, my baby sister, and mom) removed her right surgical drain AT HOME. (Her husband did most of the work and was a CHAMP!) She has some extra swelling on her left side because of the removal of two of her sentinel nodes on that side caused extra swelling, so the plastic surgeon said she could likely have her right drain removed Monday as the swelling decreases.

After her drains are removed, she’s not going to be able to move very much but will stay put for another several weeks!

God is good!!!

We are praising the Lord for the removal of all of my sister’s cancer at surgery and are asking for prayers for complete healing from her surgery with no complications. We are praying especially for protection from COVID19, and that my sister’s “Phase 3” chemo regimen of T-DM1 and Tamoxifen would be completely 100% effective in keeping cancer away forever with no side effects!!!

I’ll post again after my sister has her one-month post-op appointment heading into her first dose of Tamoxifen. Here’s hoping (and praying) there is a treatment for COVID19 by that point and that the virus has started to subside worldwide so that we can get back on to “life as normal”–or as normal as it can be in the midst of beating and treating breast cancer!

In the meantime, we’re remembering the Lord’s faithfulness to us through this challenging time. We find comfort in knowing God has already gone before my sister into and through all of her treatments and has come out on the other side. We proclaim and believe we are going to see a victory over cancer and coronavirus!!!

Jesus is with us every step of the way!!!

This blog post is the 20th in a series about my (and my twin sister’s) preventative breast cancer screening journey that began when we were 30 years old in July 2019. The 1st post is about my first mammogram ever; the 2nd post is about my consultation at Mayo Clinic’s Breast Clinic; the 3rd post is about my stereotactic core biopsy at Mayo Clinic’s Breast Clinic; the 4th post is about my diagnosis with “Stage 0” DCIS breast cancer; the 5th post is about my in-person DCIS diagnosis at Mayo Clinic, beginning thoughts on my surgery timeline, and discovering that my twin sister might have breast cancer, too; the 6th post is about my twin sister’s invasive ductal carcinoma clinical stage 2A breast cancer diagnosis; the 7th post is about my breast MRI and two ultrasounds to investigate “suspicious” spots on my right breast and liver; the 8th post is about my second DCIS diagnosis following a week of MRIs, ultrasounds, and biopsies at Mayo Clinic; the 9th post is about preparing for my twin sister’s chemotherapy appointments, including details about her egg banking procedure in the city; the 10th post is a summary of my sister’s ovarian hyperstimulation syndrome and visit to the emergency room; the 11th post is a summary of my double mastectomy surgery plan scheduled to occur on December 3rd, 2019 at Mayo Clinic’s Methodist Campus Hospital in Rochester; the 12th post is about my twin sister’s first chemotherapy infusion at Mayo Clinic; the 13th post is about foobs, photo shoots and nipple tattoos (my plastic / reconstructive surgery plan); the 14th post is a recap of my successful double mastectomy and immediate direct-to-implant reconstruction operation; the 15th post is about my surgical recovery and day full of follow-up appointments at Mayo Clinic in Rochester; the 16th post is about my one-month-post-surgical-follow-up appointment and preventative baseline ovarian cancer screenings at Mayo Clinic; the 17th post is about a suspicious rash I developed a month after my surgery called “pigmented purpura,” my consultation with a gynecological oncologist about ovarian cancer prevention, and my sister’s fifth chemotherapy infusion; the 18th post is about the end of my twin sister’s six neoadjuvant chemotherapy infusions (TCHP); and the 19th post was about my twin sister’s double mastectomy and reconstructive surgery plan (amid the global outbreak of COVID-19). To keep tabs on new posts, sign up for the “A Daily Miracle” email list at this link.

Filed under:
breast cancer, Daily Miracles, Truth Bomb

Tags:
brca, breast cancer, double mastectomy, mayo clinic, reconstruction

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  Sister Christian is a blogger, reporter, editor and follower of Jesus Christ seeking to find little miracles each and every day. She especially loves finding Jesus in art, music and culture. Learn more about her on Twitter @adailymiracle, and on Facebook as “A Daily Miracle.” Send an email to [email protected] with any comments, concerns or suggestions!

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One of the few positives coming out of a time like this is all of the work being created by artists who find themselves in isolation. When a creative is allotted solitude and time to create, only good things happen. One such artist who’s been productive with his time indoors is Radcliff Music, whose new single, “Quarantine Bars,” sees the veteran Chicago spitter at the top of his game.

The instrumental is incredibly smooth. The humming synth chords are pleasant, making their presence known without overstaying their welcome. The trap percussion sets a firm pace, balancing out the quieter instrumental elements quite nicely.

Radcliff brings his usual dose of hard-hitting lyrical honesty. His easygoing demeanor adds a lot of depth to the heavy subject matter he brings to the table, reminding his peers that he can destroy anyone with ease. Just because the world is effectively at a standstill does not mean that Radcliff is sleeping on his own craft.

“Quarantine Bars” is yet another gem from an artist who’s been at it for years. Radcliff Music has been around the block a few times within the Chicago scene, but that doesn’t mean he isn’t willing to fuck up younger artists on the mic if he has to. Not that anyone is likely to challenge him anytime soon, but consider “Quarantine Bars” a clear warning shot — a sign that he is not to be messed with.

“Quarantine Bars” is now available on Soundcloud. Stream it here: https://soundcloud.com/radcliffmusic/quarantine-bars

Follow Radcliff Music on Instagram @lowliferaps

The criteria for List #1: Toys/objects that do encourage exploration

Your goal is to keep the child active, so get a toy or object that can be played with in many ways. This encourages the child to get creative with the toy or object.

If you can’t quickly name many things a child could do with the toy or object, it’s doesn’t belong on this list. Consider the things I included in this list and what can be done with them:

Cotton handkerchief/ bandana– If the handkerchief (or bandana) is not cotton it is a choking hazard – Can be used to play peek-a-boo with a stuffed animal, hide-and-seek with objects, as a blanket for dolly, can sway with while dancing around, or blown into the air above the head.

Toy cars  – Can be driven around in races, up ramps of blocks (older toddlers) or used to give an object a ride. Exploration happens as she tests how the speed varies on a flat surface (like one of the books) or on a ramp or on the blanket. I suggest cars of various shapes and colors for both girls and boys.

Blocks (or boxes) – A child can use imagination to build towers, houses, a road for the toy car, and many other things. They can be sorted, or a child can use a block in imaginary play with a stuffed animal: maybe it’s a desk, maybe it’s a chair.

Dolls – Can be snuggled, cared for, be spoken with (even if your child is pre-verbal), can interact with another doll, or can be a non-judgmental audience for the child.

Plastic Bowls/ Recyclables  – Can be balanced on a foot, used to sort things, be part of pretend eating, be a hat, be used to feed a doll, or can be used for stacking.

List # 2: Toys that do NOT encourage exploration for ages 1-3

These toys perform the activity and leave your child with few options. Therefore, their attractiveness as playthings ends quickly. Consider what your child can do with these objects:

Jack-in-the-box -pop it a few times, sit on it and break it, and out of frustration out of lack of options, hit a sibling.

Toys that you push on and something appears -pop it up, also good for hitting a sister or brother.

Toys with prerecorded messages – (such as electronic dolls/figures)– play with it a few times, activating every sound, annoy the person working.

Spinning tops -spin it if you can, maybe enjoy the colors, but limited interest, become a potential problem with pointy ends finding eyeballs.

Final Thoughts

So, some final thoughts and reminders:

As I stated in the beginning, make sure the child(ren) is within eyesight, but remember that your role has shifted. You are no longer an entertainer of a noisy child, now you are an onlooker of a satisfied child who is exploring.

Busy, truly engaged children are not bothersome and don’t need to be entertained. Passive toys are better for this purpose, as they draw out children’s imagination and thus stay interesting longer. Toys with lots of bells and whistles will get a child’s attention at first, but then become tiresome.

And remember, more is not necessarily better. My first year teaching I had 10 toddlers, so I put out 10 pretend grocery carts. OY, hectic.

There are many more developmentally beneficial objects/toys you can find, but I’ve written too much, and the blog police might get me. If the toilet paper police don’t get me first!

I  plan to continue blogging more about this topic ASAP. I will do also do older age groups. Let me hear your questions and concerns.

SELF-ISOLATION, DAY 10

Or: RISKY LIVING IN A HIGH RISK GROUP!

Hello my friends and relatives, and anyone who accidentally reads this on my blog, DocRambo. I am sorry if this is kind of boring. I was thinking earlier today that the title I arbitrarily, and kind of logically chose, “Self-Isolation,” would not win a Pulitzer Prize. Not even the Nobel Prize in Literature. Maybe my essay yesterday, Day 9, would have sounded more interesting if I had titled it “Screwing Geese.” It might have gone viral. I might have received phone calls from publishers or movie companies. At least You Tube. Oh God, I think I am getting punchy.

My intention was to start writing earlier. But I am easily distracted. My friend who has the chronic illness; I mentioned her; needed me to run an errand for her. She is on strict isolation and I used to visit her at least once a week and we would eat soup together or sometimes watch TV. So I went by, picked up a package for her to bring to her safe deposit box at the bank. That is more complicated now, which is good. I made an appt by phone, then went to the bank and had to be let in. I touched almost nothing. At her house I just talked from the doorway, into her house, so we did not get close. She cannot afford to catch the virus. Then I picked up some soup from another friend who made a big pot and gave me 3 containers of it. I am doing fine for food. Just that fruits and vegetables don’t last too long. All together I am fine in spite of my risky age-group; living alone with my dog is ok. Just the work bothers me a bit. But someone has to work in the grocery stores. I thanked the mail delivery man from Post Office for coming to work anyway. Said thanks. What about garbage truck drivers? What would you do if no one picked up your garbage? Ever think of that? Maybe put it in your neighbor’s yard. No, my friends are not like that; just a thought.

So, it is late in the day and I have my second wind. Getting serious for a moment, our state and local politicians in Illinois are doing well. It seems that Governor Pritzker is doing all he can to meet the challenge, and Mayor Lori Lightfoot of Chicago really is showing her mettle. Her news conference today was no-holds barred and she said what needed to be said. So, people in groups have been cavorting and enjoying life in groups, which scientists, like women and men who spend years studying to help their fellow humans, instead of partying every weekend, yeah, so really smart people have been telling us SHELTER IN PLACE!! Like really! You see China, you see Italy. Philadelphia, 1918, decided, even though news of the flu pandemic was out, they decided to go ahead and have their parade, full of soldiers, some with the flu virus. Resulted in thousands of deaths. OK, maybe they did not understand the virus that well. Evidently St. Louis was more cautious and had a much better outcome. So some people, Governor Cuomo, Governor Pritzger, our Mayor Lightfoot, are batting 1000 in dealing with a situation that is not their fault. Some government officials not so much. As I have said I am not trying to turn this into a political debate, which is not to say I do not have opinions, or that everyone in government is doing what they should. We are lucky we do have some intelligent and principled professionals like Dr Fauci, to name just one, who knock it out of the park whenever he opens his mouth. By the way (btw to you youngsters), what’s with my baseball analogies? I must be American or something, but I flunked Little League. Seriously. I could never hit a ball with a stick. None of those sports.

Anyway, I had some thoughts today about why people, some, or many, refuse to listen to experts, or refuse to believe that things are really bad. Although I studied for many years, and I read a lot, like, books, of course I don’t know. But, I have opinions. Part of why we act dumb may be our Wild West mentality. Whereby, not all of the USA was the Wild West. But there is some prevalence, not everyone, a prevalence of an attitude that “I can do anything I want, I’m an American!” We are a great big country, almost like an island, a continent for ourselves, so we may feel isolated or insulated, from the rest of the world. But… guess what folks? Times have changed and we really do have to live together. Take responsibility for each other. We can’t just have shoot-outs on Main St. Which reminds me that I have read that gun and ammo stores have  BOOMING sales! Wow, that did it. Some people will maybe send me death threats. Are you planning on killing your neighbor if he or she tries to steal your food or toilet paper? I’m serious. Maybe this goes further back than the frontier days to the cave men. Perhaps they needed to be so protective of their families and tribes because there were so many dangers. And we just have not gotten over it yet. I do not hate people. At least not many. I am only human. But, my God we have to pull together. This is a very minor thing, but I work in a suburb. In Chicago, I believe plastic bags were banned. Some whole countries have done this, in an effort to help the environment. Anyway, whenever I have to help out with bagging, we ask “paper or plastic?” of the customer at the cash register. There is no unified answer. Anyone who reads about the environment at all knows that plastic is a problem. Some want paper, some plastic, and some bring their reusable bags, which I appreciate and generally thank people for doing. One time the man answered “ plastic is fine. I don’t want to save the environment.” Now…I do think we should all try to do just that. No one person can save it, but each in our own way, WE SHOULD TRY TO SAVE THE ENVIRONMENT.” I don’t want to” should not be one of the answers! Well, I am just a low-wage dufus and he was a customer so I did not respond at all. He was just one guy. Don’t know his name so he can’t sue me anyway.

So, I am reaching my ending for the day. I need to finish putting the soup away and doing my dishes, take a shower, do a little meditation, and get ready for tomorrow. No one I know has died from the COVID-19. I do not want anyone to do that, but, many people will die. Then, our society will return to some new kind of normal. But, why cannot we understand that “Normal” should be that we are aware of each other, that the Earth is really a very small planet in an incredibly vast Universe, we need to take care of it and each other!  Please.

Be safe, stay well, believe in the higher powers. We can do this.

David, March 26, 2020

(I added the sub-title after I finished).

Since I love Chicago history so much and we can learn so much about our current and future condition from studying the past, I thought it would be interesting to do a comparison of the 1918 worldwide influenza pandemic and our current CoVid-19 pandemic through the Chicago looking glass.

To be fair, a true side by side comparison is difficult because we are talking about two different diseases and 102 years of separation but there are still a great many similarities and luckily a great many differences.

We have to keep in mind that at the time of the 1918 pandemic the term virus was not even in use.  The medical community referred to the disease as the “Influenza Germ” known as Pfeiffer’s Bacillus.  There were no antibiotics to treat secondary pneumonia infections because penicillin was not discovered until 1928.  There were no anti-viral drugs to slow it down and no ventilators so doctors were limited to supportive treatments.

Population

Curiously, the population of Chicago today is virtually the same as it was 102 years ago.  Chicago currently has a population of 2.7 million which is what it was in 1918.  The population of the United States as a whole was about 103 million which is about 1/3 of what it is today.

The Start and Spread of both Diseases

1918

The first mention of the 1918 flu in the U.S. was in the spring of 1918 within the military.  There is some disagreement among scholars because the flu was so mild.   The flu that hit in the fall (whether mutated or new) in the U.S. was much deadlier.  The world was at war and the censoring of information coming from other countries made it nearly impossible to determine the geographic start of the virus but the first reports came out of Spain since they were neutral during the war and it thus became known as the “Spanish Flu”.

The first accounts I could find in newspapers of the time referred to a steamer from France being quarantined at the port of New York with 25 people suspected of having the “Spanish Influenza”.  The article came out on September 11^th so the steamer had more than likely docked a few days before then.

The first case in the vicinity of Chicago was at Great Lakes Naval Base.  It was reported that the epidemic started on September 9^th and by September 23^rd there were 7,000 cases and 100 deaths at the Naval Base.

Chicago Tribune, September 16, 1918

In 1918 the worldwide spread was caused mainly by the thousands of soldiers moving by ship from place to place.

2020

The first patient to present in the U.S. with what is now called CoVid-19 was a 35-year-old male in Snohomish County, Washington on January 19, 2020.

The first person in the Chicago area was discovered almost simultaneously due to the fact that this Chicago resident had returned from Wuhan, China (The supposed geographic start of the virus) on January 13^th.  She and her husband have since made a full recovery.

One would assume, given the ease of travel internationally as compared to 1918 that the geographic spread of the virus would seem almost instantaneous.  In researching both eras the disease seemed to have spread extremely rapidly and almost simultaneously in different geographic regions.

Similarities in Reaction and Recommendations

Recommendations

While our medical knowledge today is well beyond that of 1918 the initial reactions and recommendations were eerily similar even with 100 years of distance.

Some of the recommendations in 1918 seem very familiar

• Avoid crowded areas like movie theaters and trains.
• Avoid people who are sick.
• Isolate yourself if you feel ill.
• Wash your hands frequently

Some may not seem all that familiar and some even humorous by today’s standards.

• Make sure to take laxatives and keep the bowels moving freely.
• Avoid getting your feet wet.
• Sleep with the windows open at night.
• Keep children warm and dry at all times.
• Eat eggs and milk every four hours.
• Wear a gauze mask and boil it often.
• Cough into a handkerchief and burn it.
• Get as much sunlight as possible (actually, sunlight tends to kill viruses so maybe not such a bad idea)

Once both the 1918 and 2020 viruses started to spread, the governments of both time periods enacted ordinances that closed non-essential businesses and large gatherings and actually threatened arrest of those who would violate the orders.

Misinformation and rumor

Human psychology really has not changed much in 100 years and probably for much longer than that.   Just as in today’s viral crisis, the people of 1918 also had to contend with misinformation, rumor and bogus cures.

Listerine advertised to prevent the flu, The Pantagraph, October 18, 1918.

It is somewhat human nature to want to cling to whatever hope we can.  We have to be cautious, however, and make sure that the “cure” is backed up by science and is not worse than the disease itself.

In 2020 we have seen things appear on social media such as the rumor that snorting cocaine and bleach can cure the coronavirus and we have even seen people die from eating fish tank cleaner because they recognized an ingredient in the cleaner that sounded similar to a malaria treatment that has been mentioned as showing promise as a possible therapeutic for CoVid-19. (chloroquine)

During the 1918 virus,  many “patent medicines” were touting their ability to cure the flu.  This resulted in many sales and few positive results.  It wasn’t as if the government didn’t warn people back then.  They did.  Unfortunately,  panic and desperation can cause people to act in desperate ways.

Chicago doctors in 1918 started prescribing oranges as a cure. The prescriptions caused the price of oranges to skyrocket to .60 cents per pound. (huge by 1918 standards)

It was later learned (in January, 1919) that Chicago physicians had written over 400,000 prescriptions for medication for the flu with 25% or roughly 100,000 prescriptions for opium, morphine, codeine, heroin, and cocaine.

Vick’s Vapo-Rub, that many of us remember being slathered with as kids, touted its ability to help with the flu as well as Listerine.

There were car dealers that claimed their cars contained the cure for the flu because they brought your spirits up.

Sulzer’s Bran Bread was advertising that it could help with the flu by keeping your intestines clear of waste matter.

Kolynos Dental Cream out of New Haven CT claimed that it stood sentry at your mouth preventing the entrance of the flu and that the country of Spain had tripled its demand for their product.

However, The 1918 Darwin award goes to French Lick Springs Hotel Co. in French Lick, Indiana that advertised during the height of the flu in Chicago for people who had the flu to get a room at their hotel where they could recuperate in luxury!  Wonder how that worked out for them?

French Lick Hotel advertises for Spanish Flu Victims, Chicago Tribune, October 30, 1918

The Deadly Differences

While we have been dealing with coronaviruses for some time, we are still learning more every day about this new coronavirus.

According to the CDC, 95% of those exposed to CoVid-19 have an incubation period of roughly 5 days although 1% can have an incubation period of two weeks. (Hence the two-week quarantine recommendations) with symptoms coming on slowly.  A March 10^th investigation by the American College of Physicians agrees. 

Most cases of flu, including the 1918 flu, have an incubation on average between 2 to 4 days with intense symptoms coming on very quickly.

We have the luxury of 100 years of hindsight with the 1918 flu.

The 1918 influenza was extremely deadly.  Estimates of lethality worldwide are somewhere around 2.5 to upwards of 10%.  That means that of the people infected 2.5% to 10% died of the disease.  Most people died within four days of contracting the 1918 flu with quite a few dying the same day that symptoms showed up.  There were many reports of people waking up more or less healthy and dying the same day.

It was also different in that your average flu is worse for the very young and the very old.  The 1918 flu was actually deadlier for those between the ages of 20 and 35!  The reason for this is that the 1918 flu caused such an extreme immune response in those with healthy immune systems that it flooded the lungs.  People who had healthy immune systems literally drowned in their own mucous.  Victims would cough up a blood-stained foam from their lungs and lack of oxygen would turn their faces and hands blue earning it the nickname, “The Blue Death”.

October 1918 was the single deadliest month of all in Chicago.  Roughly 6,700 Chicagoans died in the month of October alone!  The estimates of death in the two months of October and November of 1918 was over 10,000.  Some of the speculations are because death certificates didn’t usually state that the cause was Spanish Flu.  The cause of death was listed usually as pneumonia or bronchial pneumonia.

Chicago had over 625,000 cases from September through November of 1918 which was about 25% of its total population.  Ten thousand deaths during that period would put the lethality rate for Chicago at roughly 6.25%

Historically the average influenza death rate is about .1% and an average of 8% of the population is affected.  Of course, this is taking into consideration the fact that we also have vaccines for the flu.

Right now the numbers on CoVid-19 vary greatly because we are still in the midst of the pandemic and actual statistics will need time to shake out.  These numbers will be different based on age group, geography, and other factors.  Most medical experts agree that CoVid-19 will end up being a more lethal disease than your average flu but many are anticipating a final number somewhere around .2% compared to .1% with the flu but again these numbers are still being compiled.

One thing that could hurt our medical system is that while people generally recover fairly quickly or die fairly quickly from influenza the length of time of recovery with CoVid-19 can be quite a bit longer which results in longer hospital stays and less turnaround which is a big reason that the country is trying to flatten the curve as to try not to overwhelm our medical systems.

There is some consolation if we look at CoVid-19 numbers from the perspective of 2019 – 2020 seasonal flu numbers as compiled by the CDC.

According to the most recent estimates as of the date of this article, there have been between 38 million to 54 million cases of the flu, 18 million to 26 million flu medical visits, 400,000 to 730,000 flu hospitalizations, and 24,000 to 62,000 influenza deaths.

If there is something positive to say at this point (albeit the jury is still out) the current numbers after roughly 10 weeks or approximately 2.5 months of dealing with the onset of U.S. cases the number of cases and deaths are still relatively low as compared with the seasonal flu and if we continue to listen to the medical professionals we may have gotten ahead of it.   As of the date of this article, the number of total U.S. confirmed cases is 85,356 with 1,246 deaths.  (Let’s keep our fingers crossed that this article ages well.)

You can see the daily totals on the CDC’s website here.

Why was this 1918 influenza so much more deadly than others?

The research conducted to come up with this answer is so fascinating and yet terrifying at the same time.  I could not do it justice so you can read the whole story on the CDC’s website here.

In a nutshell, researchers brought the old 1918 flu back to life using frozen samples of tissue from victims.  They recreated the pandemic using mice in a secure facility at the CDC.  The injected some mice with the 1918 flu and others with various other strains of flu.

The researchers found that the 1918 flu went directly and aggressively to the victim’s lungs.  In fact after fours day of infection they found that the amount of virus in the lungs of the mice exposed to the 1918 flu was 39,000 times that of those infected with other strains of the flu!   That is not a typo.  39,000 times!

How did it all come to an end?

 In 1918 Chicago the flu epidemic came in quickly and violently and left just as quickly.  The first case was reported in Great Lakes on September 9^th.  The peak of infections took place toward the end of October and early November.   Levels of disease returned to baseline by the end of November.  From beginning to relative end was about a 3 month period.

One thing that I found very interesting about the treatment of the sick today was something that was touched upon by our leaders in this crisis.  Currently, they are using antibody-rich blood plasma from CoVid-19 survivors in hopes that the antibodies will help fight off the virus.

In 1918 they did almost the same thing.  They didn’t call it plasma but rather a serum made from the blood of Spanish Flu survivors.  I don’t know if this was plasma or direct transfusion but there were personal ads run in the newspapers looking for donors.

Personal Ad for blood of recovered flu victims, Chicago Tribune, October 20, 1918

The final numbers for the 1918 flu are staggering.  The estimates are that over 500 million people or one-third of the population of the world at the time were infected with the virus with the number of deaths being at least 50 million.  675.000 of those deaths were in the United States.  27,000 deaths reported for CoVid-19, as of the date of this article, still sounds much better than 50 million for the 1918 flu. (Let’s hope it doesn’t get to be much more)

We don’t yet know what the final numbers will be in the battle against CoVid-19 but we do know that what we do as individuals can make a huge difference with not only CoVid-19 but will the other respiratory viruses including the flu which can be just as deadly to the most vulnerable.  We know by looking at historical data and listening to the medical professionals that while this is a very serious threat we are probably not looking at an apocalyptic outcome or not even anything close.

By using proper hygiene, avoiding crowds, social distancing and staying home if sick when possible and taking care of those most vulnerable we will make it through this as well.

In addition to the CDC website, there is also a very nifty website put together by the University of Michigan that is specific to the 1918 pandemic.  It is called the Influenza Encyclopedia and I highly recommend it.

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