Knitted Knockers and Related - Doc thought the wording in my letter sounded good, so Sam printed it off on their letterhead. We dropped by the office Friday afternoon to get the signed original.

The latest rendition of the most recent pathology report had come in, so Sam made a copy of that for us as well.

Since Gloria had been told to not drive for a couple of weeks to assure her chest wall heals fully, I have been chauffeuring her around. When we got to Doering’s office, I sent her in by herself. But she was only inside a couple of minutes when she texted, telling me that Sam had something she wanted to show Gloria. After a bit, my better half emerged from the building carrying an envelope, which I presumed held the letter, and a small plastic package with something pink inside. She was also sporting a big grin. The package contained - Are you ready for this? - "Knitted Knockers."

Gloria found this as funny as I did. On the other hand, I know that many women are pretty shaken when they receive the news that to save their life, the prudent thing to do is to remove one or both breasts. The fact that an organization had formed to provide prosthetic ones free of charge was pretty cool. Naturally, I had to see what I could learn about how that came to be. It was all laid out at www.Knittedknockers.org.



Gloria and her "Knitted Knockers"

In addition, a former colleague and his wife sent a Superman shirt and a friend on the West Coast sent a package from “Bosom Buddies” (bosombuddiescharities.com) with a whole raft of things.

Some women wrestle with drains for weeks, but the special shirts Gloria received were good even though she had drains only two days. Those shirts were very soft against the skin and are constructed with varying types of closures along the seams. After surgery, it is not recommended for the woman to put her arms over her head, so pullover tops are a no-no. But these shirts fit nicely, yet are silky smooth with some seams of Velcro and a primary one with a zipper.

Two of the Bosom Buddies items

Out on the Town - Well, not exactly. Gloria finds that she still gets tired quite easily, yet when she heard that Miriam and daughter Mariya were taking granddaughter Diana to "Boo at the Zoo," Gloria decided to join them. Unfortunately, Saturday evening was about one day into a multiple-day rainy-day period. But that didn’t seem to hold them back.

The report of the 21st did not have the results of the cancer’s markers that are used to treatment and prognosis. This temporarily "muddied" the waters as there was a question if another attempt should be made to gather additional armpit nodes on that side in an effort to obtain more information on whether this new cancer had spread, and if so, how to treat it.

By Friday, the analysis of three of the four markers had been completed. The ER one came back at 100% - as high as can be scored. While that sounds bad, it’s actually good. That means that it is almost certainly highly dependent on estrogen to grow, so using agents that block estrogen from reaching the receptors or blocking the receptors’ reaction to estrogen will probably terminate the cancer's growth.

The PR marker came back negative, meaning the cancer is not dependent on progesterone to grow. That sounds good, but is probably bad. If it was positive, blocking progesterone would likely serve to make life hard for the cancer. Since it was negative, the cancer doesn’t need progesterone, so it cannot be starved by withholding the hormone or blocking its effect.

Perhaps the most interesting was the Ki-67 marker. It is a measure of how many cells were duplicating at the time of testing. If 15% or more of the cells are dividing, the cancer is more likely to be fast growing. If less than 10%, it is probably slow growing, so low is normally seen as better. Gloria’s came back at less than 1%! That means growth was very, very slow. This newly discovered cancer well may have been in the breast for 10 years or more, its small size allowing it to evade the radar of the mammogram.

More About HER2: - A subtlety about HER2 not previously mentioned because it wasn't important in those earlier cancers is important in the case of the third tumor. As you may recall, HER2 - Human Epidermal Growth Factor Receptor 2 - refers to both a gene - a portion of the DNA - and the protein it creates. Genes are used as patterns to create the proteins that are what our cells are made of. This particular protein promotes cell growth and prods blood vessel growth to bring nutrients to support that growth.

A common situation with cancerous cells is the HER2 gene creates too many of these proteins, leading to rapid growth. Like so many aspects of biology, this is an essential activity for continued life, but too much of a good thing becomes a bad thing! A positive HER2 rating means there is too much. At one time, this was associated with particularly lethal cancers. But treatments targeting this process have pretty much turned that situation around, making these easier to treat than those that are negative.

The subtle aspect has to do with that "too much of a good thing becomes a bad thing" comment. For breast cells to live and reproduce normally, they must have the HER2 gene that creates indirectly the corresponding protein. The usual test is performed by adding a staining agent responsive only to the protein. Four grades are assigned and exemplars are used to compare with the results. This evaluation method is a source of problems. Since it involves comparing the examples with the stained breast tissue and deciding to what degree the test material is stained, evaluation is not as reliable as say counting something as with the other markers. The test becomes subjective.

But difficulty arises when there is a fair degree of staining, but not overwhelming. Since the judging is subjective, these are assigned an EQUIVOCAL rating ... a fancy way of saying, "I don't know." This is the situation with the newly-discovered cancer in the left breast.

The normal procedure then is to perform a FISH - fluorescence in situ hybridization - test. This involves a pretty cool procedure - meaning it is slower, more costly, but definitive - that establishes whether a mutation has occurred that resulted in a doubling of the HER2 gene. If there are two where there was to be only one, too much growth should be expected. If not, well, there still may be something going on that results in too much of the corresponding protein being created.

Now What? - Given the slow growth rate of this third cancer and the fact that it appears to have been removed in total, a consultation by Doering with the oncologist and a another colleague led to an assessment that this new one will be treated as just an interesting anomaly, and the treatment for the right breast cancer will be what is focused on.

A Few Final Random Comments:

- There is one apparent contradiction that constantly reappears in the treatment of cancer. The very defining characteristic of a cancer is it grows too much. Many treatments focus on the fact that rapid growth requires resources to build these additional cells. If poisons are circulated, the cancer cells may, in a sense, "eat" themselves to death. The conundrum is that a fast-growing cancer left untreated is the most life threatening, but also is generally the easiest to kill as it takes up so much poison. In contrast, the slow growers will take a long time to cause problems, yet can be the hardest to stamp out.

- The next day after Kris arrived in Malta, she sent a photo taken from her hotel. She titled it, "View from our rooftop swimming pool." Gloria looked outside here at home, took a picture from our deck and sent it to Kris, titling hers, "View from our deck!"

Fron Choir Members at South Stack

- Those who know her know how much Gloria enjoys languages, but has confessed that the Welsh language is a real challenge for her. Its roots are in the Celt language, which is also the basis for the Irish, Scottish and German. The song in the video - of which only a tiny bit is sung in the video, was written in 1983 and Fron choir member Gareth Owen kicks it off. It recognizes the attempts to expunge both the Welsh people and their language. Roman emperor Magnus Maximus, whose rule began in 383 is mentioned as sort of a starting point in these efforts. The theme is basically this: 1600 years has passed and we are still here.

Comparable words in Welsh and English follow: