Category: No Hill For a Climber, Loraine’s Breast Cancer Journey

No Hill For a Climber, Wrapping Up Week 3 of Radiation

Loraine is now close to wrapping up her third week of radiation treatments for her breast cancer, and there are three more weeks to go. Sometimes it feels as if we will never get out of the hurry up and wait mode of thinking.

Getting her into her treatment protocol seemed to take forever because of her struggle in healing after the staph infection had set in. She is almost halfway through the treatments, and now we find ourselves somewhere between hurry up and wait. We would like for the treatments to be done and over with, but the waiting mode of finding out how successful radiation will be is akin to watching a slow moving hand on the clock.

It feels as if we have been through hell over the last year. Last March, we took in and cared for Loraine’s brother Howard who was morbidly obese, had Hepatitis C, cirrhosis of the liver and advanced liver cancer. We were thankful to be able to care for him despite the complexities that came with caring for a terminally ill loved one who was also slipping into different stages of dementia depending on if he was taking his medications as prescribed. Then, Loraine was diagnosed with her breast cancer last fall which significantly increased our level of stress. January 6th, Loraine had her double mastectomy, February 23rd, we lost Howard to his illness; Also in February, Loraine’s staph infection where her left breast had been reared its ugly head. But through it all, even with the great stress we have been under, we still feel blessed with our lives. Through our battles so far, we have been shown great love and compassion from family, friends, co-workers, and even complete strangers who have come into our lives. Loraine’s care team have been beyond phenomenal in their compassionate care and treatments. And, despite the Corona Virus shutting down our economy, we have both been able to keep working full time and have not become too overwhelmed with our medical bills we have received. If anyone has a right to lay down and lick their wounds, it might be us, but we refuse to do so. We are fighters, and we will conquer all that life has to throw our way. We may feel stressed, but thankfully, our sense of being blessed far outweighs that emotion.

Almost halfway through!

Treatment 14 of 30 today.

Before Loraine ever began her radiation treatments we were told the side effects would be pretty mild, and possibly there would be none at all. Well, the side effects are certainly nothing compared to that which can come from chemotherapy to say the least. But, the the side effects are certainly there for her. And with each treatment she undergoes being more intense than the last, we can anticipate them getting worse over the next three weeks of treatments. Thankfully, chemotherapy is not being planned for now.

Loraine has been working full time through her treatments, but now has reduced her workload to part time as of this week because of the fatigue that is associated with her radiation treatments. Fatigue can make it hard for one to keep a normal routine. However, it is best for her to still get in some type of activity each and every day. Activity keeps the body more fit and the mind less stressed than what would come from laying around and licking wounds. My sweet wife is a true fighter, you will never find her feeling sorry for herself.

Loraine has always been fair skinned and sunburns easily. With her radiation treatments, he skin is now becoming pink, like it has sunburn. Because of this, they place a special blanket over her during the treatment to act as a second layer of skin to mitigate the burning of her skin. To help with this at home, she has to apply aloe vera cream multiple times per day to ease the irritation she is now experiencing. I wish for her sake the irritation would end with her treatments, but, the skin reaction from radiation therapy is usually the worst 1 or 2 weeks after radiation therapy ends, and begins to heal after that point. The healing often takes 3 to 4 weeks. I wish she could have been through with all of this before summer time arrives here in a few weeks.

Besides fatigue and burning of the skin, Loraine is developing fibrosis where her left breast had been. This also comes with the territory of radiation treatments.  In addition to treating cancer, radiation therapy alters tissue composition, making tissues thinner, harder and more brittle. Radiation following surgery creates changes to the surgical scar to make it harder and denser, as well as creating fibrotic tissue around the scar. In radiation-induced fibrosis, a key issue is prevention, with the primary approach being use of proper doses of radiation therapy and techniques that minimize the radiation exposure for normal tissue. We feel truly comfortable that Loraine’s care team are doing all they can to minimize any and all side effects which come from her treatments. Everyone on her team are more than compassionate and caring. We feel blessed that she is in the best of hands and will get through this with minimal issues compared to what can be experienced by some.

With cancer of any type, every day is a learning day. I sometimes wish I did not have to know all that I have had to learn, but feel blessed to be able to share our experience with others in order to help them. It helps us to focus on our blessings rather than on our stress. We feel fortunate to be in the position we are in and fully realize how bad life can be for others in the same boat. Therefore, we know to never take life for granted as it can be radically changed for the worst in the blink of an eye.

Live life to the fullest and work towards being the best and healthiest you that you can be.

God bless and thank you for the prayers, and for following along with Loraine’s journey.

 

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No Hill For a Climber, The Journey Continues

Monday, May 4th, after four long months, Loraine’s battle against breast cancer is finally going into its next phase. With all that has transpired since her double mastectomy it seems like an eternity has passed. Hopefully we can put most all of this behind us once she has completed her course of radiation treatments. Of course, there will be regular monitoring for a recurrence over the next five years.

What are radiation treatments, and how do they help?

I find it amazing that a source of cancer for many is also a treatment protocol to kill cancer for others. Whoever came up with this concept was certainly thinking outside the box. Radiation therapy for breast cancer uses high-energy X-rays, protons or other particles to kill cancer cells. Rapidly growing cells, such as cancer cells, are more susceptible to the effects of radiation therapy than are normal cells.

Beside killing cancer cells, radiation is also utilized post surgery to help prevent recurrence. It can also be used to provide relief from pain and other symptoms of advanced breast cancer

Radiation therapy for breast cancer may be delivered in two ways:

  • External radiation. A machine delivers radiation from outside your body to the breast. This is the most common type of radiation therapy used for breast cancer.
  • Internal radiation (brachytherapy). After you have surgery to remove the tumor, your doctor temporarily places a radiation-delivery device in your breast near the tumor site. He or she then places a radioactive source into the device for short periods of time over the course of your treatment.

You need to know going into this battle that removal of the entire breast is usually not enough in itself to rid you of breast cancer. A mastectomy does not eliminate your risk of having a recurrence in the remaining tissues of the chest wall or lymph nodes. Therefore you need to be prepared for these treatments. Unless chemotherapy is planned, radiation therapy usually begins three to eight weeks after surgery . However, if chemotherapy is planned, radiation usually starts three to four weeks after chemotherapy is finished.  Loraine’s course of treatments will include one radiation treatment a day, five days a week over a span of six weeks. Spreading out the sessions helps healthy cells recover from radiation exposure while cancer cells die.

Will there be any side effects from the radiation?

Of course there can be side effects, we are talking about radiation right? Loraine was instructed to have an aloe vera gel to apply to her skin with the first treatment to mitigate the effects of burning of the skin, which would be similar to getting  a sunburn.

Side effects from radiation therapy will differ significantly depending on the type of treatment and which tissues are treated.  We are told, side effects tend to be most pronounced toward the end of the course of treatments. Once her treatments are complete, it could be several days or weeks before side effects clear up. I sure hope she does not experience prolonged effects, life has been hell already in battling the  staph infection that caused the four month delay in getting here.

Common side effects during treatment may include:

  • Mild to moderate fatigue
  • Skin irritation — such as itchiness, redness, peeling or blistering — similar to what you might experience with a sunburn
  • Breast swelling
  • Changes in skin sensation

Depending on which tissues are exposed, radiation therapy may cause or increase the risk of:

  • Arm swelling (lymphedema) if the lymph nodes under the arm are treated
  • Damage or complications leading to removal of an implant in women who have a mastectomy and undergo breast reconstruction with an implant
  • Rib fracture or chest wall tenderness, rarely
  • Inflamed lung tissue or heart damage, rarely
  • Secondary cancers, such as bone or muscle cancers (sarcomas) or lung cancer, very rarely

Why has it taken so long to begin Loraine’s radiation treatments?

Before Loraine was healed from her double mastectomy, she had a very bad and deep staph infection settle in where her left breast had been. After three months of intensive treatments and thousands of dollars in additional medical bills later, we have finally whipped it with antibiotics and daily cleaning and dressing, and weekly doctor appointments at Saint Luke’s hospital’s wound care center. The wound from this infection was quite ghastly to say the least, and seeing it at it’s worse was not for the faint of heart. But, we got through this. To add insult to injury though, is Loraine’s physical therapy was put on an indefinite hold because of how serious the infection was. And then came the COVID-19 virus and the physical therapy center was shut down…

Post mastectomy physical therapy aids in the overall recovery process by focusing on regaining strength and increasing the range of motion for the shoulder and arm. Early intervention by a physical therapist can help women regain full function following mastectomy surgery, regardless of whether or not a woman has had reconstruction.  Because this rehabilitation therapy is a specialized protocol, it gets tailored to each patient’s specific needs.

Although I have a strong  working knowledge of physiology for strength training, I have no expertise in what is required, or good, for post mastectomy therapy. Size, location and the type of mastectomy are important considerations when choosing the type of therapy. Exercises to maintain shoulder range of motion and arm mobility are important in restoring strength and promoting good circulation. This is far beyond my scope of experience and I would be worried of either causing more harm, or just causing unnecessary pain with little to no positive results for her. Our bodies are meant to be in alignment.  When we live and move in non-optimal alignment, serious orthopedic injuries can occur.  Breast cancer survivors can often develop painful neck and shoulder impingement.  Physical therapy involves myofascial release which is a type of medical massage.  Focus is placed on gently releasing tension along thickenings of fascia and scar tissue.  Releasing this tension restores posture and alignment.  It also relieves knots and painful areas in all parts of the body. Loraine has been suffering quite a bit of pain as a result of not being able to get in for this necessary therapy.

If you’re being treated for breast cancer, it’s important to find a licensed massage therapist who has experience with breast cancer patients. Since many cancer centers are connected with programs offering massage therapy, ask your doctor for recommendations. If you are not trained in this, leave it to the experts.

  • If you have had lymph nodes removed, the massage therapist should only use very light touch on your affected arm and the area around the underarm.
  • If you have arm lymphedema, the massage therapist should avoid the affected arm and underarm areas completely. Traditional massage therapy can worsen lymphedema. A massage therapist who has experience with breast cancer patients may already know this, but it’s important to make sure he or she understands.
  • If you have arm lymphedema, your arm and underarm area should be treated by a different kind of massage especially for lymphedema, called manual lymphatic drainage. Look for a physical, occupational, or massage therapist trained and certified in manual lymph drainage to treat your lymphedema.

Breast cancer sure throws you into a huge learning curve to say the least. There is so much we have learned, yet I wish we never had to in the first place. We knew that a double mastectomy would be painful, but we were not prepared for the pain which has come afterward. Loraine has been diligent in keeping up with her exercises the physical therapist has given her, but the  other therapy components which she has not been able to get to has lead to great suffering on her part. Loraine is a very tough woman who never complains about her aches and pains. It is heartbreaking at night to awaken to hear her crying in her sleep because of the pain she experiences as a result of not getting the myofascial release therapies. Usually after a surgery, pain subsides with time. In her case, the pain has become worse. She called me on the road the other morning in tears because it was hurting her so badly. I never felt so helpless in my life in not being able to bring her any comfort. Even if I had been home, I could not have made it better. Hopefully, now that she has healed, and the COVID-19 pandemic seems to have the curve flattening, maybe we can get back to the business of getting her better. Thank you to all who have kept us in your prayers and positive thoughts.

God bless and thank you for reading.

No Hill For a Climber, It’s a New Day to Move Forward

The last year has been tough as hell for my dear wife and I to say the least. We took in her brother who was terminally ill with Hepatitis C, advanced cirrhosis of the liver, and liver cancer. To add to the complexity of his illness, he had developed hepatic encephalopathy which created different states of dementia from day to day. Hell, sometimes it varied from hour to hour depending on if he was taking his medications as ordered. Friday, February 21st, I took Howard to his final doctors visit where he was advised to receive hospice care. Two days later, he lost his battles.

To add insult to injury in helping Howard battle his diseases, Loraine had went for a mammogram last September and a lump was discovered in her left breast that turned out to be cancerous. Skip ahead to January 6th this year, Loraine underwent a double mastectomy where it was discovered the cancer had also spread to one of her lymph nodes. By February we believed she was healing just fine and dandy when her awful staph infection set in…

Time has gone in slow motion ever since.

Loraine’s radiation treatments were to begin as soon as her incisions from the mastectomy were fully healed. To see a loved one going through this, you want the treatments to begin as soon as humanly possible, but healing has to take place first. If you are not fully healed, the radiation treatments will only serve to interfere with the healing progress. Obviously, we do not want that…

I used the picture above that I took not long ago early one morning while out on the road. It was a beautiful sunrise that morning despite the bug splatters on my windshield. The beautiful sight of the sunrise through the bug splattered windshield illustrates what life is looking like right now. We know that with Loraine now being healed and cleared to begin radiation treatments, we have been through a living hell getting her to this point.

Numerous doctor visits…

Numerous treatment protocols…

Daily wound care at home…

Frustrations and depression as it seemed she would never get healed…

Thousands of dollars in medical bills already…

Dealing with the tragic death of a loved one in the middle of it all…

It seems forever since I last posted an update on Loraine, although it has only been a little over a month. It seems that besides fighting to get her healed, the whole world as we know it has turned upside down as a result of the COVID-19 virus causing chaos all around us. Although we refuse to live in fear over this virus, we know that with her being immunocompromised, we must take precautions with how we live and interact with others. And of course, as luck would have it, now that Loraine has been cleared to begin her radiation treatments, many doctor offices are either closed or greatly limiting the people they see and treat. I get this, but we need for her to begin receiving her treatments as soon as possible. It has been about six months now since her diagnosis. We are waiting now for a return call from the radiation oncologist’s office to set up treatment dates. This oncologist was one of the first people Loraine called on Wednesday after being cleared, we hope to hear something before the end of the week. Once we hear back and get a date and time confirmed, before her first treatment session, Loraine will go through a radiation therapy planning session (simulation), in which her radiation oncologist will carefully map her breast area to target the precise location of her treatments. During the simulation:

  • A radiation therapist will assist her into a position best suited to target the affected area and avoid damage to surrounding normal tissue. Sometimes pads or other devices are used to help you hold the position.
  • Loraine will have a CT scan so that the radiation oncologist can locate the treatment area and normal tissues to avoid. She will have to try to relax and remain as still as possible to help ensure consistent, accurate treatments.
  • A radiation therapist will be marking her body with tiny permanent tattoo dots. These marks will guide the radiation therapist in administering the radiation.
  • The dosimetrist, radiation physicist and radiation oncologist will utilize computer software to plan the radiation treatment she will receive. Once the simulation and planning are completed and multiple quality assurance checks are done on her first visit, her radiation treatments will begin over a course of five days per week over a six week period.

For all the thoughtful prayers and positive thoughts lifted up on my dear wife’s behalf, I am truly grateful and humbled.

God bless and thank you.

 

No Hill For a Climber, March Progress

Today is March 18,  seventy two days have passed since Loraine’s double mastectomy and she still has not healed enough to begin her radiation treatments. She had been healing just fine until a staph infection reared its ugly head and her radiation treatments had to be put on hold. After a course of strong antibiotics and weekly visits to a wound care specialist, we find ourselves now facing yet another infection. This one came as much or more of surprise than the first one had. Each week her open wound has been checked by the wound care specialist. He would cut out dead fatty tissue along with a tissue called fibrin. Fibrin is a corrupt matrix of cells which must be removed in order to facilitate healthy healing of a wound. Thankfully, Loraine has started her daily hormone treatments despite the delay in her radiation treatments which we had been hoping would begin in the next couple weeks. Now, we await lab reports so that she can begin another round of antibiotics. Oh the joy…

The last half dozen months have been such a learning experience for Loraine and I both. There is so much information that comes with a breast cancer diagnosis that it is extremely difficult for every topic to be covered, and for you to actually be able to absorb it all. It will make your mind spin round and round. It is our sincerest hope that by my writing about our shared experience as a man and wife, that we can help others in their difficult journey too. One thing which we never knew about before hand is it is not uncommon after a bilateral mastectomy for a woman to suffer pain in her sternum. When you ask about pain after breast cancer, you might get a vague answer, Loraine has. For some  women, sternum pain is a normal part of recovery.  This is true for many women, but not for all. For those experiencing sternum pain after breast cancer, Costocondritis may be to blame.

What is Costocondritis? 

Costocondritis is inflammation of the cartilage that joins the ribs to the breastbone. Also known as anterior chest wall pain, Costocondritis causes discomfort in the chest wall around the breastbone (or sternum) and sometimes is severe. Loraine experiences pain ranging from mild to severe. The pain wakes her from sleep quite often.

Costochondritis is a common problem in women who have been affected by breast cancer and acts up in a similar way to arthritis. The pain may be mild to severe with tenderness over the anterior chest and may radiate to the back, shoulders, stomach or arms. Pain is often aggravated with coughing, lifting, straining, sneezing and deep breathing. Flare ups can be triggered by over-working your arms, lifting, sweeping, or over extending. Pain can be constant or intermittent and can last for several days to multiple months or years.

We never heard about Costochondritis anytime before her surgery, and Loraine has not yet been diagnosed with it. Her pain could also be simply from all the manipulation of pectoral muscle tissues being pulled and stretched during surgery. We hope and pray her pain is resolved soon, my poor wife has been through so much already…

No Hill For a Climber, Fighting To Heal

Loraine and I truly hope that by telling our story of her battle against breast cancer that we may help others who may be facing the same. There is a plethora of things about this terrible disease that we had no clue about, every day seems to be a learning experience. With what seems to be every day, we are faced with new challenges that we never dreamed of in the past.

Nothing about breast cancer treatment ever seems to move at the speed we wish it would. Even though from the time of diagnosis until Loraine’s double mastectomy was only a couple months, those months seemed to drag on and on, you just want to get that shit out in order to begin further treatments. Yet, further treatments such as radiation and chemotherapy cannot begin until a woman has healed from her mastectomy. Loraine’s underwent her mastectomy on January 6th, it is now February 27th and we have no earthly idea when her radiation treatments can begin as she is not fully healed as a result of the infection which had set in quite deeply at her left incision.

Loraine still has a ugly, angry looking hole in her chest that seems to be getting bigger by the day. Literally, you could place a small stack of quarters into this hole, it is scary looking and not something anyone who is squeamish could adequately care for. The good news is, it is actually not infected any longer. We went to Saint Luke’s today for wound care, the doctor was out sick with the flu, but the two awesome nurses who have been involved in Loraine’s wound care were still able to clean the wound out and dress it. They told us that despite how ugly it looks, it is common that deep wounds like this can appear to be uglier before they get better as the underlying and exposed fatty tissue has to die off before healthy skin tissue begins to grow back over the hole. The surrounding skin and underlying tissue looks healthy, Loraine has been on antibiotics and we clean and dress her wound every day. Apparently we are doing a good job. What looks like puss to her and I is actually the dying fatty tissue which we have been removing every day after she has bathed. I wash out the wound with sterile saline solution, remove the dead fatty tissue and then repack it with a collagen and silver dissolvable packing called Prisma, then re-bandage the wound until the next day when we repeat the process.

Loraine had a visit with her medical oncologist last week. Dr. Satteli had her go ahead and at least begin her hormonal treatments since there was no need for further waiting on this course of treatments that will last the rest of Loraine’s life. Dr. Satteli suggested a skin graft may be necessary to get the wound fully healed in order to begin the radiation treatments. I have to wonder if that would heal her any faster than waiting on natural healing. I really hope Loaine does not have to undergo another surgical procedure anytime soon, it seems she has been through enough already. I will be getting answers for this question Tuesday when we go back to see the wound care doctor, hopefully he will no longer be sick next week.

Cancer is a tiresome bitch. While we are very optimistic that Loraine is going to beat this, every day can still be a grind. Doctors appointments every week so far, and there will be many more going into the future. We have had daily wound drain care for the first three weeks after her mastectomy, and now we have daily care of this wound created by the infection. Thank God I have good insurance to cover a good portion of our expenses that we have incurred thus far. Each day we get up and are thankful for the life we have, even with these kinds of setbacks. We know there are others out there who have life much harder than we. We know from experience that you can never take your good health or life for granted, all can change on the drop of a dime. Therefore you must live a humble and grateful life and appreciate all the blessings which do come your way. Cancer is a bitch without a doubt, but it has also introduced us to some of the most caring people we have ever met. We can always look up at a cloudy sky and get down and out because of a gloomy day. But we can also look up at that cloudy sky with the knowledge that soon, the sun will be burning back through to give us the days we can fully enjoy. I love the old adage about how some can view a glass of water as half empty or half full depending on their perspective. What many of those people miss, is that same glass is refillable. We fight the good fight each and every day. The best rewards in life come from the hardest fought battles.

Be healthy and well, never let life take you down without first giving it a good hard fight.

No Hill For a Climber, The Infection

Hurry up and wait!

It appears we will be in this holding pattern for maybe the next couple of months until Loraine has healed from her mastectomy enough to begin her radiation treatments. She has had a set back with a deep infection to her incision that was discovered by the wound care specialist that Dr. Butler had referred her to a few weeks back. For all intents and purposes, Loraine’s healing appeared to be coming along fine, there was some dead skin at the incision site, but that was not unexpected and did not look abnormal to either the surgical or medical oncologists that had been seeing her. Dr. Butler, the surgical oncologist thought it would be a good idea to have some of the dead flesh removed by the wound care specialist, Dr. Matson, solely as a precautionary measure to facilitate a speedier healing process. There were no indications of a deep infection from the outside when Loraine went to see Dr. Matson, therefore it was quite the surprise to find out there was actually a very significant infection brewing under the surface within the deep tissues. Visually, there was no indication of redness, swelling, pus or any type of foul smelling discharges from her incisions. We had thought radiation treatments would be able to be started within the next couple of weeks. It is just another thing learned when dealing with breast cancer I guess..

It has been about 4 weeks ago that Dr. Butler prescribed Loraine Silvadene which is a cream that is supposed to help prevent and treat wound infections. She prescribed this solely as a preventive measure as there were no indications of infections in Loraine’s incisions. We applied this cream daily after Loraine’s showers before applying new bandages over the incisions. It turns out that Silvadene is not a medicated cream that Dr. Matson thinks should be used on these types of wounds as according to him, it inhibits the healing process instead of helping it along. When Dr. Matson cut away the dead skin from Loraine’s incision, there was a very foul smell and a bunch of pus lying underneath. He told Loraine to quit using the Silvadene and to now use SilvaSorb on the site instead. He told Loraine that he wished doctors would not prescribe the use of Silvadene on these types of wounds as it slows healing. I only bring this up, not because I think Dr. Butler was wrong in prescribing the Silvadene in the first place, but to give you information to bear in mind should you ever be presented the same situation. You might want to inquire whether the doctor means one or the other, since the names are so similar and the the two medications are both silver based and do similar jobs. Breast cancer, or any type cancer for that matter, is a great learning experience as you will be faced with so many unknowns. While we always knew infection was a possibility, we did not expect the extent of this one Loraine has been hit with. Dealing with this type of thing is not for the timid or those with a weak stomach. Whether you are prepared or not, these types of things just have to be dealt with in the home.

I have to admit, the first dressing change after the dead skin from Loraine’s incision was cut away revealing the infection was tough. There is a hole that you could fit a quarter into that is at least one fourth of an inch deep. The underlying muscle tissue is exposed along with fatty tissue and pus which must be cleaned out with sterile saline solution before applying SilvaSorb ointment and new bandages. I do not have difficulties in seeing sights like this on others, yet seeing it on the love of my life was quite hard. Changing these dressings and nursing the wounds is not a job for the squeamish at all. Once I clean out the pus, I find myself scared to death of causing Loraine any type of pain as I spread the SilvaSorb into that deep pit. Loraine has dealt with serious infections and bedsores in her work as a home health care attendant, but this was too much for her to bear looking at. Therefore, nightly dressing changes has been my job before leaving to work in the evenings. I can’t blame her one bit.

Today’s visit with the wound care doctor.

I took Loraine to see Dr. Matson this morning to have the wound looked at. The doctor took measurements and pictures which were entered into her records and compared with last weeks. Fortunately, the wound is a little smaller yet still has a long way to go before being fully healed enough for her to begin radiation treatments. After  the measurements and pictures were taken, he then cut away dead fatty tissue and debrided the wound. Thankfully, they used a good numbing gel and Loraine does not have full feeling there yet, It looked painful. And then, smart guy me, I just had to stand where I could watch and did not notice that I was standing on the seat controls that raise, lower and leans the seat. I felt like a real goober when the doctor looked at me and told me I was standing on the control. I was so enthralled with watching the procedure that I did not notice the seat was rising as he was trying to work on her. He was friendly enough, but I know it probably had to chap his ass this happened. I know it would mine. Lesson learned is to keep my ass back. Once he was through with debriding the wound, the nurse packed it with a new medicine that he wants her to use instead of the SilvaSorb. This looks kind of like a bandage except it dissolves when in the wound. It is a collagen and silver based medicine. I hope we see more healing next week, the week after and after…

Most women do not get infections after mastectomy.

From BreastCancer.org

  • More than 1 in 20 women (a little higher than 5%) developed an infection at the site of the incision after breast surgery.
  • The risk of infection was different depending on the type of surgery that was being done:
    • 4% for mastectomy with no reconstruction
    • 12% for surgery with implant reconstruction
    • 7% for reconstruction surgery using skin and/or muscle from the belly area
    • 1% for breast reduction surgery

When you are preparing yourself for a surgical procedure, odds are you are only thinking of getting fixed, or getting your diseased parts removed from your body. There is an overwhelming amount of emotions that will flood your mind when dealing with breast cancer, it is almost impossible to think of everything you might need to ask the doctors involved in your care team. If surgery is a part of your treatment for breast cancer and you’re concerned about the possibility of infection, talk to your doctor about:

  • How often infections occur after the type of surgery you’re having in the hospital you’ll be using.
  • How that infection rate compares to the infection rate at other area hospitals.
  • The possibility of your surgery being done as an outpatient procedure or with a short hospital stay after surgery. Many infections after surgery happen because of germs in the hospital environment.
  • The steps that will be taken before, during, and after surgery to reduce the risk of infection. For example, some doctors recommend that people scheduled for surgery use a special washing procedure before coming to the hospital. Other doctors may prescribe antibiotics before or during surgery to lower the risk of infection.

It’s important to remember that most women having breast surgery will NOT develop an infection. If an infection does develop, it usually can be treated successfully with antibiotics. Together, you and your doctor can develop a plan that is the best for YOU.

No Hill For a Climber, Radiologist Visit

Stand down from the Alert 5!

Most of my military career was spent in Naval Aviation, nine of those years in helicopter squadrons with Search and Rescue missions which meant that we were always at a heightened state of readiness – Alert 5, Alert 15, and Alert 30. These alerts are the time we would have from receiving word to launch our alert aircraft until they had to actually be airborne. Alert 5 being the highest state of readiness meant we would have 5 minutes from getting the order to launch and getting an aircrew in the air for a rescue mission or to respond to hostile situations. Alert 30 was a more relaxed readiness posture, but you still had to be prepared for the worse case scenarios to arise. Cancer is like being on an alert status, it keeps you on edge because this evil disease can ramp up and down with a swiftness…

Loraine and I got up this morning still under an Alert 5 status in our heads. Her radiology appointment was this morning, so while we were excited to be getting an idea of what her treatments would be, there was still the trepidation of venturing into the unknown. I have said that cancer can take you on an emotional roller coaster ride, but in between those rides there is little down time in our house as we also having been caring for Loraine’s brother Howard for the last year. Howard has Hepatitis C, advanced cirrhosis of the liver along with liver cancer to boot. With two in the house with cancer, we have our hands full. Just when that emotional roller coaster we are on creeps back into the loading station, it launches again before ever coming to a complete stop.

To help ease the stress this morning I made us a special breakfast of steel cut oats cooked with Saigon cinnamon, nutmeg, and  ginger. I added butter and Swerve brown sugar substitute to the oats and then drizzled a little sugar free maple syrup over the top. This would have been even better if I would have had some chopped pecans to add to it.

Once Loraine and I had eaten, we ventured off to Kansas City to meet Dr. Boersma, the radiology doctor who will be doing Loraine’s radiation treatments.  Once there, we were taken back to an exam room almost  immediately by a wonderful nurse who spoke very glowingly about the doctor. This kind woman really helped to settle our nerves by filling us in on as much information as she could. We are so thankful for all the thoughtful doctors and nurses we have encountered thus far.

The treatment plan.

Dr. Melisa Boersma gave me a good vibe as soon as she entered the examination room. My thoughts that she was truly down to earth was solidified when I noticed that she was wearing cowboy boots. Having lived in many different places, I know the idea of a woman wearing cowboy boots might sound strange, but here in the fly over country of the American mid-west, this is a  sign that you are dealing with a straight shooter who has a very kind soul.

After an examination of Loraine’s incisions, Dr. Boersma began discussing the treatment plan on her part. It could not be said exactly when radiation treatments can begin because as of that moment, we still had not received word on the OncoType test results. Additionally, chemotherapy, if required would have to be completed before radiation can begin. But at least we now know how this part of her treatment will be done.

Loraine will be undergoing External Beam Radiation treatments. It is amazing how far medical science has come with computer technology. For all the times, I have thought technology is advancing too fast, I am also very thankful we have brilliant people who have been able to figure these things out. On her first treatment visit, there will not be any radiation involved. The first visit will be a dry run where the doctor and her technicians essentially get Loraine and the equipment all calibrated to each other in order for the radiation beam to be focused exactly where it needs to be with each and every visit that will be five days per week for six weeks in duration once they begin.

As custom motorcycle builders will create a jig in order to build frames that have true alignment, Doctor Boersma is essentially creating a jig for Loraine.  To do this, Loraine will get three small tattooed dots in specific locations in order to get her body properly aligned for treatment. These tattoo’s will be nothing more than permanent marker points where steel beads will be stuck as guidance points for placement with a CT scan. Once the beads are in place, she will be placed into a CT Scan machine where the team can position her body. Her body will be in the exact same position with each treatment, there will be zero deviations of positioning, all the reference points will be stored in a computer for each use that is specific to Loraine.

Following what I will call the initial set up visit, Loraine will receive the treatments that are essentially like a powerful x-ray. Getting her positioned and the equipment set up will take longer than the procedure itself.  The total time for each treatment visit is scheduled for only fifteen to twenty minutes maximum. Once her treatment is done for the day, she will be able to return to work. I’m sure her gracious employer will be happy about that! Prestige Home Health Care is owned by a wonderful couple, I cannot speak highly enough for them.

With external beam radiation there are very few side effects to be expected. There may be a decline in appetite, and a general feeling of fatigue, but this is not a sure thing. What is to be expected is once the course of treatments are coming to an end, there will be some skin irritation much like a sunburn. The doctor told us, this is actually a good sign that the radiation treatment is going as planned and the beam is hitting it’s target every time. There are a couple creams available to help with this, one being aloe vera based. Essentially, she might need a glorified sunburn ointment.

Dr. Boersma was very thorough and answered all of our questions. We left feeling good about the treatments, but still had the question hanging over our heads about whether or not chemo or hormonal treatments would be the order of the day. After the visit we were able to relax our posture to an Alert 15 status. We were able to rest a little easier but the doctor visits were not over for the day, we still had to do a follow up visit with Dr. Butler so she could examine the incisions once again.

Alert 30 Assumed!

After a brief nap, Loraine and I began our drive over to see Dr Butler. On our way there, we got a call from the medical oncologist, Dr. Satelli, who gave Loraine the good word we have been waiting for.

Praise God above, our prayers were answered!

The OncoType test results are back and Loraine will be able to undergo hormonal therapy treatments rather than having to do chemo-therapy! Of course we are not out of the woods yet, but this is great news for us. Chemo is such an ugly treatment with all the sickness involved. Being real about it, chemo is akin to poisoning the body to kill off cancer cells. Chemo kills cancer and healthy cells alike. The difference being that cancer cells cannot repair themselves as healthy cells are able to. We are very thankful that Loraine will not have to go through such an ugly treatment protocol. The next part of this good news is the hormonal treatments can be given at the same time as radiation treatments. She does not have to wait much longer now for treatments to begin! All that is required now is Loraine needs to be fully healed from the surgery, and she is getting there.

Once at Dr. Butler’s office, she examined Loraine and as a precautionary measure recommended she see a wound care specialist for her incision. The incisions are healing fine, but with some of the dead skin that comes from a flap type wound, she wants a wound care specialist to trim back some of the dead skin and to give her specialized ointments to help with further healing. The last bit of good news for the day is Dr. Butler released Loraine to return to work once she has seen the wound care specialist. With radiation and hormonal treatments, my dear wife can be able to get her life back to as normal as possible under the circumstances. She will be able to work during these treatments, where should she have had to undergo chemo-therapy, there is no way she could have worked. My sweet wife has been a hard worker her entire life, and she is not one to ever sit still. I cannot help but to believe that with the grace of God, and life returning back to normal, she is going to kick this third cancer in the butt good and hard. Loraine is a fighter, she is a damn tough woman. She will prevail in this fight!

We are so thankful and blessed.

We are so thankful and proud of how our daughter Jennifer and our three beautiful granddaughters have come through during this time of need. They have brought meals to us that we can heat in the crock pot to ease our stress. And, to keep Grandma’s spirits high, they have been making arts and crafts together. I love seeing my girls enjoying each other the way they have been. I only wish our daughter Molly and  granddaughter Nishi were here too. As it is, Loraine gets calls daily from Germany, we know that if they were closer, they would be here too.

In life, we can be knocked down. Then to add insult to injury, we can be kicked before we get back up. Sometimes cancer can feel like a steel toed boot smashing into the ribs when you are down. But, the pain of cancer is greatly mitigated by a faith in God, and the loving support of family and friends. To all who have checked in on us, and kept us in your thoughts and prayers, we love each and every one of you. God bless, and thank you for reading.

David

No Hill For a Climber, First Oncologist Visit

“Hurry up and wait!”

“Hurry up and wait” has been a military mantra that has existed since the beginning of time. I had hoped when I retired from the military that I had left that mindset permanently behind me, Hell no, it appears that “hurry up and wait” also applies to the medical community when it comes to dealing with cancer.

A lump, or abnormality is found during a routine doctor visit – hurry up and wait to get in for a mammography.

Mammography confirms the presence of a lump – hurry up and wait to get a biopsy done.

The biopsy has been completed and the pathology reports are returned – hurry up and wait for a mastectomy which is performed by a breast oncology surgeon.

The mastectomy was expertly performed, which is followed by three weeks of more waiting in order to hurry up and see another oncologist on the treatment team for a treatment plan.

We saw the oncologist today to learn we will be waiting for more pathology testing to be done and treatment will have to wait until Loraine has fully healed from her mastectomy. And now, we also have to wait a short time to see the radiologist who will be doing the radiation treatments that are necessary before either chemo or hormone treatments.

There is a lot of “hurry up and wait” when it comes to cancer. While the diagnosis is scary as hell and you want the cancer removed and or treated “right now”, it does not work this way. All this being said, Loraine’s cancer treatment team of doctors and nurses are phenomenal. I am only relating this information to you in order that you can know before hand, should God forbid you ever receive a cancer diagnosis, that there is a process that has to be followed. Treatment is not done right away, surgeries have to be completely healed, pathology’s have to be completed. Successful treatment requires that all the proverbial ducks are in a row, and none are straying. We want answers and treatments right now, there is a fear that comes with not knowing what the future holds. The “not knowing” can make time stand still when you have to “hurry up and wait” between visits with the treatment team. As afraid as we might be, we have to place our trust in the wisdom of the physicians involved. Our sense of urgency is obviously going to be high, but the professionals on the treatment team see these kinds of things every day when they report to work. I am quite thankful to say, Loraine and I are completely comfortable with her treatment team, and they have our full trust that they are going to take excellent care of her.

After a biopsy has been performed, a pathologist examines the tissue microscopically to check for cancer. The pathologist will make a report that provides information that helps to describe the breast cancer and helps you and your oncologist to make decisions regarding your treatment options.  The pathologist helps to determine the stage of the cancer by a system called TNM: the T describes the type and size of the tumor; N is for the number of lymph nodes that have cancer present, and the letter M signifies that cancer has spread outside of the breast and regional lymph nodes. The pathologist also determines several characteristics of the breast cancer that help the oncologist to formulate treatment options and make predictions about the risk of spread. These include hormone receptor status, tumor grade, growth rate, margin status and HER-2 expression (normal versus over-expression).

Loraine’s breast cancer is a ductal carcinoma  which means it originated in a milk duct. Her cancer involves Non-invasive (In situ) and Invasive cells. The tumor was 3.8 cm, or about the size of a golf ball. For a better understanding of the two types of cells:

Non-invasive (In situ) cancer cells stay inside the milk ducts or milk lobules in the breast. These cells did not spread into or invade normal breast tissues.

Invasive which most cancers are, break through the small area where they start and then venture into normal breast tissue or other areas around the breast. Sometimes, these cells spread to other parts of the body through the blood or lymphatic system.

Because the margins were negative, it appears no more surgery will be required. Good lord I hope not. As Loraine likes to joke – never take a nap at Saint Luke’s North, they steal body parts from you…

Tumor Grade

Tumor grade compares cancer cells to normal breast cells, Based on the comparisons, a “grade” is given to the cancer. Note: The “grade” is not the “stage”.

Grade 1 (low grade or well diferentiated) These cancer cells still look like normal cells. These cancers tend to be slow growing.

Grade 2 (Intermediate/moderate grade or moderately differentiated) These cancer cells do not look like normal cells. They appear to be faster growing and they tend to stick together.

Grade 3 (High grade or poorly differentiated) These cancer cells have irregular shapes and and stick together. They tend to be fast growing.

Loraine’s cancer is “Grade” 2

Lymph Node Status

Loraine’s cancer has spread to one lymph node and these cells have extra-capsular extension which means the cells were coming outside the lymph node.

Whether or not you have cancer cells in the lymph nodes which drain from the breast is one of the most important pieces of information about the risk of cancer spreading. In general, negative lymph node status is better than positive, and a low number of positive nodes is better than a higher number.

Hormone Receptor Status

Loraine is positive for both Estrogen and Progesterone.

Normal breast tissue has receptors for estrogen and progesterone. A breast cancer that is hormone receptor positive for either Estrogen or Progesterone means you may benefit from hormonal therapy. Most hormonal therapy is in the form of oral drugs. A breast cancer that is negative for Estrogen and Progesterone will not benefit from hormonal therapy.

HER-2 (neu) Expression Status

HER-2 is a promoter gene that helps control how cells grow, divide and repair themselves. Twenty five percent of breast cancers over-express HER-2 and these tumors tend to grow faster and have a greater likelihood to metastasize. Loraine’s IHC, or ImmunoHistoChemistry test came out negative. This is a good thing!

Where we are right now.

Surgery has been completed with the removal of both breasts in their entirety. Loraine is in high spirits and is healing nicely, my dear wife is a tough one! Being as the cancer has spread to a lymph node, radiation is a given for the next step in this journey. However, no treatments can begin until she has fully healed from the mastectomy.

Tissue has been sent to a lab in California for further analysis, or testing called OncotypeDX. Once this testing has been completed, we will know for sure whether she can receive hormonal treatment or if she will have to endure chemotherapy. Hopefully she will only have to do the hormone treatments. If you have never heard of hormone treatment here is how it works in layman’s terms: Cancerous cells that have formed because of Estrogen are unlike normal tissue cells. Think of a normal tissue cell like you would a room in your home with maybe one or two doors leading into it, you have better control over who or what enters that room. Cancer cells that are a result of hormones, are akin to that same room in your home except that it now has several open doors allowing bad players to invade your space as they please. The hormonal treatment cuts off the hormone production which then slams all those damn open doors closed to the bad guys. The bad guys will find themselves evicted with hormone treatment.

Physical Therapy

Tomorrow morning we will head to the physical therapist office for Loraine’s first therapy session and also to pick up her compression sleeves. Unfortunately, she will likely need to wear compression sleeves the rest of her life in order to prevent lymphedema from occurring in her arms and hands. This is a risk anytime lymph nodes have been removed. The other component to combating lymphedema is a healthy diet and weight loss, and then weight management along with light exercise.

We still have many days of “hurry up and wait” ahead of us, but the future should be less stressful as we are now armed with more information that we had been. The not knowing, second guessing, predicting outcomes and everything else that comes from a lack  of full knowledge is maddening to say the least. Hopefully now our stress levels will continue to drop as we lean forward and drive on.

To all our family, friends and others who have expressed their love and support, we are eternally grateful to each and every one of you. God bless, and thank you for reading.

 

No Hill For a Climber, Fight Back Damn It!

Cancers of all types are an evil bitch that will destroy your quality of life and rob you of every bit of your dignity if you allow it. Cancer is an equal opportunity offender and does not give a damn about your race, gender, sexuality, religion  or socio-economical back ground. Cancer does not give a shit who or what you are, it takes out the rich among us as rapidly as it takes out the poor. It will kill those who have lived the healthiest of lives and spare those who did not. Often, there is no rhyme nor reason to who it affects and why. There is nothing right nor fair about cancer, you might have never touched a cigarette in your life, yet find yourself dying with lung cancer. You may have never touched a drop of alcohol in your life, to only perish from liver cancer. Sometimes we might get a form of cancer simply because of an unlucky draw of the short stick. As  powerless as we might feel against the ravages of cancer, there are still steps we can take in order to improve our quality of life should we or a loved one become afflicted.

You are not entirely a helpless victim!

As if cancer is not enough of an insult to the human body, many of the treatments are akin to rubbing salt into a wound. Many treatments can be debilitating by making you even sicker than the disease the medicines are designed to help slow down or cure. If you have been diagnosed with any type of cancer, it is imperative on your part to maintain your immune system the best you possibly can.  The tricky part is cancer cells develop from our own cells, therefore our immune system doesn’t always know that it should attack them. Sometimes the immune system knows that cancer cells shouldn’t be there, but more often our immune system doesn’t notice cancer cells. Cancer cells can even turn off the immune response so that the immune cells don’t attack them.

You can fight back!

Common sense would dictate that if cancer can trick our immune systems when they are healthy, then it could really run roughshod over your body if your immune system is weak. Our immune system gets weakened when the cancer itself or treatments like chemotherapy or radiation therapy, affects the bone marrow. Blood cells are made in the bone marrow and when it’s affected by cancer or its treatment, the number of blood cells that are made are lower than normal. When blood cell counts are low, the body can’t fight off an infection very well.

Your first line of defense is to choose a healthy lifestyle.

Following general good-health guidelines is the single best step you can take toward naturally keeping your immune system strong and healthy. Like any fighting force, the immune system army marches on its stomach. Healthy immune system warriors need good, regular nourishment. People who are malnourished are more vulnerable to disease. Every part of your body, including your immune system, functions better when protected from environmental assaults and bolstered by healthy-living strategies such as these:

Don’t smoke

Eat a diet high in fruits and vegetables.

Exercise regularly.

Maintain a healthy weight.

If you drink alcohol, drink only in moderation.

Get adequate sleep.

Take steps to avoid infection, such as washing your hands frequently and cooking meats thoroughly.

Try to minimize stress.

Regular exercise is also one of the pillars of healthy living. It improves cardiovascular health, lowers blood pressure, helps control body weight, and protects against a variety of diseases. Just like a healthy diet, exercise contributes to general good health and therefore to a healthy immune system. It may contribute even more directly by promoting good circulation, which allows the cells and substances of the immune system to move through the body freely and do their job efficiently.

A cancer diagnosis may leave us feeling helpless. There is little we can do by ourselves to stop the progression, therefore we must place our faith and trust in doctors and other medical professionals to heal us from the ravishes of cancer.  If you do not want to feel quite so helpless, then make it a point to be proactive in the treatment of your disease. The doctors and their staffs will do all they can medically for you, therefore if you want to be cured, you must stand up and do your part of the fighting too.

You have choices to make.

You can choose to live as healthy as you can by eating a nutritionally sound diet. You can choose to follow your doctor or nutritionists orders by eating or not eating foods as they have directed.

You can choose to try to keep your body as physically fit as possible under the circumstances. Getting to and staying at a healthy weight is important to reduce the risk of cancer and other chronic diseases, such as heart disease and diabetes. Being overweight or obese increases the risk of several cancers, including those of the breast (in women past menopause), colon and rectum, endometrium (the lining of the uterus), esophagus, pancreas, and kidney, among others. Being overweight can increase cancer risk in many ways. One of the main ways is that excess weight causes the body to produce and circulate more estrogen and insulin, hormones that can stimulate cancer growth.

You can choose to maintain a healthy mindset and a fighting spirit.

You can take actions to protect yourself from getting cancer in the first place.

The evidence for this is strong. The World Cancer Research Fund estimates that about 20% of all cancers diagnosed in the US are related to body fatness, physical inactivity, excess alcohol consumption, and/or poor nutrition, and thus could be prevented.

No Hill For a Climber, Understanding the Pathology Reports

With a cancer diagnosis it often seems as if for every question that gets answered, a half dozen more will pop up. At times, I’m not too sure if my over active and inquisitive mind is a blessing or a curse. By my very nature, I am compelled to fix problems, and to do so, it requires that no stone is ever left unturned. By obtaining answers to my multitude of questions, it helps me in thinking through further questions that must be asked, even if the answers to them are going to be difficult to hear. I am an optimist by nature, but I am also a realist. I would much rather know uncomfortable truths than to be comforted by gentle sugar coated platitudes designed to make me feel better. Sugar coating fixes nothing, ever.

Loraine and I have been caring for her brother Howard for the last year who also has cancer. He has liver cancer that is now at a pretty advanced stage. There is only one treatment protocol even being considered for him now, and it it damn scary to say the least. On top of this, I have a very demanding  trucking along with my continuous toils on my website. I must be careful in not conflating problems that arise with his illness over problems that have arisen with Loraine’s when I am fatigued. So far, this has not been too much of an issue, but I am often mentally and physically exhausted. I do not have a regular sleep pattern because of my job, plus my PTSD has made me a chronic insomniac for several years now. Actually, I have not had good sleep for a few decades now. It is what it is I guess. We are more prepared for personal battles than we sometimes give ourselves credit for.

Pathology Report

Sentinel lymph node, left, biopsy:

    • Metastatic carcinoma involving one of one lymph node.
    • Carcinoma is 4 mm in greatest dimension
    • Extranodal extension is present.

A few lymph nodes were removed from Loraine’s arm pit area on both sides during her bilateral mastectomy. This was done to confirm if the cancer has spread outside of the original tumor. One small breast cancer mass measuring 4 mm was found to exist in one of her left side lymph nodes. While this was not something we wanted to hear, we are thankful no other cancer was found in any of the other lymph nodes. We already knew from the first visit with Dr. Butler that if cancer was found in the lymph nodes, then radiation treatments were definitely going to happen, with a possibility of chemotherapy too. We will know further treatments once we have seen the oncologist and radiologist on the treatment team here soon.

Extranodal extension simply means the cancer has metastasized.

Left breast, mastectomy:

    • Invasive ductal carcinoma and ductal carcinoma in situ, completely excised
    • Lymph-vascular invasion is identified.
    • Fibroadenomas

My younger sister passed away from adenocarcinoma of the cervix, therefore seeing “adenoma” used in any term associated with breast cancer was terrifying to me. Thankfully,  fibroadenoma’s are  noncancerous tumors in the breast, that could still require some form of treatment for some women. These lumps are actually fairly common, yet they should still be taken seriously.

Invasive ductal carcinoma (IDC), also known as infiltrating ductal carcinoma, is cancer that began growing in a milk duct and has invaded the fibrous or fatty tissue of the breast outside of the duct. IDC is the most common form of breast cancer, representing 80 percent of all breast cancer diagnoses.

Ductal carcinoma in situ (DCIS) is the presence of abnormal cells inside a milk duct in the breast. DCIS is considered the earliest form of breast cancer. DCIS is noninvasive, meaning it hasn’t spread out of the milk duct and has a low risk of becoming invasive. DCIS is usually found during a mammogram done as part of breast cancer screening or to investigate a breast lump.

While there is no good cancer, it is a relief to know that what was found in Loraine’s pathology report is that hers is both an early form (DCIS) and the most common (IDC) and treatable forms. Ladies, never ever forget, early detection saves lives. If you find a lump during self examination, get yourself to a doctor and have it evaluated. Your life depends on it.

Axillary contents, dissection:

    • One lymph node negative for malignancy

Right breast, mastectomy:

    • Fibroadenoma, measuring up to 9 mm in greatest dimension.
    • One lymph node negative for malignancy.

The pathology findings was followed by four or five more pages of medical jumbo mumbo that only a doctor can make sense of. Kind of like legal documents where five hundred multi-syllable words are utilized when only 50 common words would suffice. By explaining in common layman’s language to you what the reports mean, it also helps to bring myself to a more clear understanding of what we are facing.

Loraine and I have humongous challenges in the future ahead of us. We know that by the very nature of cancer there will be a mixed bag of good days and bad. With cancer,  you might find humor in topics that others will not know not know how to respond to. We might laugh when others might cringe. We have even cracked jokes about her getting a variety of prosthetic bra sizes to keep people guessing Loraine’s cup size. I have seen the comeback of a fierce fighting spirit in my dear wife that reminds me of why I fell in love with her in the first place. This same ferocity is how she survived the difficult years of my military career. As tough as my assignments might have been, I can still appreciate the hardest job in the armed forces belongs to the spouse of a service member.

This coming Tuesday, the drains should be all removed and Loraine will be able to begin returning to some of her normal activities. Her faith in God above has kept her spirits high, and it has been a chore to keep her from over doing it during the last two weeks of recovery. Nothing will keep my sweet heart down, we will beat this.