A Change of Life

The following post is about surgically induced menopause. Guys, don't say I didn't warn you! If you can't handle the hot flashes, get out quick... before it's too late! 

Menopause. Eeeek. Talking about the Change of Life is NOT something I planned to do at this stage of my life. Honestly, I thought I'd be heavily pregnant right about now with Baby #6, not sizzling in Hot Flashes and losing my memory, motherly charm, and youthful skin and bones. According to most things I've read, menopause occurs around age 51 in most Western Women. The ovaries no longer respond to the controlling hormones released by the pituitary gland of the brain. As a result, the ovaries stop releasing an egg each month and no longer produce the female sex hormones estrogen and progesterone. With the plummet in hormone levels in the bloodstream here come  the symptoms of menopause. In a typical woman, this is a gradual process. Over time, a missed period here and there, hot flashes etc.. I don't speak from experience on that one because, well, you know. Women who need to undergo complete removal of their ovaries, either as a preventative measure or as treatment for cancer or other diseases of the ovary, enter what's known as, Surgically Induced Menopause. Some treatments, such as chemotherapy for breast cancer, can also cause menopause. Surgically induced menopause is completely different from "normal" menopause. It's not gradual or natural. Premenopausal women who experience surgical menopause have more intense and sudden symptoms and therefore the emotional impact of induced menopause is significantly more intense than natural menopause. It just happens, BOOM!, the second you're out of surgery, BAM! Hot flashes!  That's what I remember first, waking up feeling hot and like my cheeks were tingling and flushed. Thankfully, it was the end of July, and the air-conditioning in my room, at Shaare Zedek hospital, worked well.

So, why am I writing about this? Menopause is probably one of those subjects that most people don't really want to talk about. It's ovaries and hormones, and some of the symptoms are pretty inappropriate topics for polite and proper conversation.... but you know what?! I would have really liked to know about all these unpleasant things that were going to happen to me back in July, 2012. I'd heard of hot flashes and learned about the risks of diminished bone density and increased risk of heart disease. Nobody told me that I'd lose my mind or experience bouts of extreme depression and memory loss let alone intense morning sickness and nausea, headaches, and joint pain. I'm 37 not 60. I'm not ready for any of this.

There are treatments to ease the effects. Anti depressants and HRT aka hormone replacement treatment. I refuse to take anti depressants. HRT is great, in theory, but for now it's not working. There are hormone patches, creams, and pills... all of them can increase risk of breast cancer. The risk depends on the woman and her own personal risk factors. Obviously all of this requires multiple doctors and experts and trial and error. I'm still in the trial and error phase.

The point of this post is to help get the information out there. Less than two weeks ago, Angelina Jolie, did a huge service to women at risk for hereditary breast and ovarian cancer. By sharing her story,  maybe a thousands or even hundreds of thousands of women at risk will take charge and consider genetic testing. Perhaps women with gene mutations will feel encouraged and inspired to consider taking steps to prevent cancer, like AJ did. I didn't know. I was clueless. Lots of people have taken to social media, Facebook, Twitter, everyone has an opinion on the subject. Some response is very negative and it's painful to read and experience the thought processes of others but I say GREAT! People are aware and discussing an issue that I didn't even know existed a year ago! Talking is awareness. The fact that this issue is in the mainstream media, lead by one of the world's most beautiful and recognized woman, is nothing but positive for women at risk for ovarian and breast cancer. "With this publicity and her speaking out, I have a feeling there will be increased requests [for BRCA testing]," Sandra M. Swain, MD, president of the American Society of Clinical Oncology, told Medscape Medical News.  I want people to know that early, surgically induced menopause is a serious challenge. It's not Cancer. It's not life threatening but it's life changing and it can be a debilitating ailment when it's not managed or balanced. Sadly, due to risks of other cancers, many women are not at liberty to take HRT and are left to suffer through the sometimes crippling side effects. It's a real thing and something to think (talk?) about.

Rapunzel has left the building

Life happens. That's not a cliche because whether you actually move yourself or stand still... There's nowhere to go but onward, into the future. I remember when I was a little girl, many "grown-ups" said it was rude to ask a woman her age yet my mother never hid hers. She was a young mom and has always looked even younger. I remember on one of my mom's birthdays, I wondered if she was afraid of getting "old" (she was probably all of 30...) and my mom declared, "well, it sure beats the alternative!". And that was that. My mom is a happy person, young in spirit, heart, and mind. I always knew that every year of life was something to be proud of and I will follow her and never hide my age.  I hope to be a proud "old" woman someday!

I muse a lot about being happy and about living the choice of  "just being happy". Happy about nothing.  Happy about myself, about my life, my choices. Leading a happy life requires teetering on a fine line sometimes.  I don't think it matters where you come from, how much money you have or how healthy you are, at any given stage or milestone in your life, you choose the path to the right or the path to the left. There's plenty to cry about and fair reason to be mad or upset and sometimes you really do need to cry it out or punch a pillow but the sadness (or anger) doesn't need to stick around.  I was given this life which included a Cancer Detour. There was CANCER and then surgery and then there was chemotherapy. In truth, I didn't have a choice. I had to have chemotherapy.  I had to go through that "yucky" time. I had control of fewer things than I was used to. I let go and let more people in than ever before and I found a lot of new friends and rediscovered old friends. I had to lose my hair. I lost a good part of a year of being healthy and in charge. That element of losing control leaves a mark and all of a sudden, the constant preoccupation with treatment and balancing killing-cancer with not-letting-the-treatment-kill-me is over. Time to move into the next stage which is, regrowth; the rediscovery of everything. Regaining control of my life.

Today, I did something so unrestrained and invigorating. For a while now the hair has been growing back like baby hair yet gray. I know it looks different. Even with my head covering, everyone I see remarks at the growth and it's a huge change from bald! My family and many of my women friends know that I had long, dark, thick hair, down to my waist, before I had it cut and donated it to Zichron Menachem. People who know about chemotherapy and the after effects tell me that my hair will grow back "better than ever" or "it'll grow back and be long as it was in no time".  It's true, the body is a miraculous vessel that rejuvenates and rebuilds but maybe I've moved onwards and that fertile, breast feeding mother, with the Rapunzel hairdo doesn't exist anymore. She was alright. She was cool. She's in there somewhere... Just not exactly the same. Honestly, part of me is afraid to grow the Rapunzel-do only to (G-d forbid) relapse and need chemo again. I don't know if I could handle a second head-shaving party with the festivity that I did the first time. Let's not go there. My close friend, Efrat, introduced me to her hairdresser today.  I could've let my hair grow. I could've waited around for it to change or not, or I could've tried to dye it back to my previous color. The whole hair thing is all somewhat superficial. Hair color. Hair style. I keep my hair covered most of the time anyways and it's always tucked away in public. With hair this short, some of it always peeps out as careful as I strive try to be to cover it up, it's out there making a statement. She recently finished chemotherapy or something happened to this woman in her thirties with the wispy gray hair. Perhaps the only statement is the one in my head? I dunno. I decided to do something completely uncharacteristic of me. Very bold, drastic, and yet so liberating and empowering! I decided to have my hair peroxided platinum blond and neatly trimmed. One year ago, there's no way I would've considered this look! No way! ...and now here I am. Just another choice, frivolous, yet something about it feels optimistic, hopeful, different, and happy.

Hair itself is nonessential and cosmetic, its not alive, it's symbolism is physical. Symbolically, hair represents the ideas and thoughts that are growing out from the psyche. Hair loss can symbolize abandoned ideas, loss of creativity, helplessness, loss of power or control, and loss of energy. Loss. Loss. Loss.

When you think of losing hair it's usually a manifestation of a very stressful situation... something that people say when they feel like they're losing their grip; "pulling hair out" or "losing hair" due to stress. Don't forget the story of Samson, who lost his strength and his life. Hair is so much more than dead cells sprouting from thousands of follicles all over the body.  Women of various religions hide it. The loss of hair symbolizes loss of strength, illness, and old age as does graying of the hair. On the optimistic side of hair, in dreams, hair and hair changes hold powerful subconscious messages and imagery. If you dream that you make drastic changes to your hairstyle, according to the celestial "science" of dream interpretation, it means that you are taking a progressive, new approach to an issue in your waking life and what a fabulous idea that is!  Why not? No better time than now to make a positive external change to mirror what I feel on the inside.

If Ovaries Could Speak

It was dark and foggy. No moon. No stars. The air had a misty tang to it and his footsteps echoed faintly as he paced himself, staying close to the walls, avoiding the beams of light from the streetlights. He tugged at the dangling drawstrings, with a gloved left hand, pulling the soft fleece snugly over his ears and hiding his profile in the black hole of his hooded sweatshirt. The young woman's silhouette, framed in the well lit window, was visible from the street. Her willowy arms moved animatedly. She appeared to be speaking on the phone. She was definitely alone in the house.  As he approached, he could hear her voice traveling towards him from an open window; the way in. He slipped the heavy metal cylinder from his pocket and secured it into place and slipped soundlessly through the open window. Moments later, a muted shot, and she was gone. Forever. Another hit by the "Silent Killer".

Give me a break. There's no such thing as a "Silent Killer"... Well, maybe in the movies or on TV or written into a riveting mystery novel but not in Real Life and certainly not of the cancer variety. Ovarian cancer is often referred to as a "silent killer" and since May 8th is the first World Ovarian Cancer Day, I'm dedicating this post to raising awareness about ovarian cancer, the gynecologic cancer with the lowest survival rate. On this day, ovarian cancer awareness organizations from across the world will aim to have a singular focus and message for ovarian cancer and its symptoms. Ovarian cancer is NOT a silent killer and many groups have taken to calling it "the disease that whispers".

According to, OvarianCancerDay.org, ovarian cancer is diagnosed annually in nearly a quarter of a million women globally, and is responsible for 140,000 deaths each year. Statistics show that just 45% of women with ovarian cancer are likely to survive for five years compared to up to 89% of women with breast cancer. Those are some pretty miserable statistics. And what's the deal with the silence and the whispering? As a woman, I can say proudly and with confidence that I'm on pretty good terms with myself. In tuned. In touch with my body. I know when I don't feel well and I definitely noticed when my ovaries started "whispering" to me. The only thing is, I couldn't quite pinpoint where the "whispering" was coming from and what it meant. As I've written about before, I knew something was wrong for many months and I visited many doctors. No one identified or connected all the "whispering" symptoms as any kind of imminent threat to my health let alone my life or cancer.  So lets be clear about ovarian cancer, it's NOT a silent killer unless you ignore what your ovaries are trying to tell you. The signs and symptoms are subtle. Learn them. Maybe you will save someone's life, or your own. More importantly, take this moment to internalize this: be your own advocate. If something is wrong and you KNOW something is wrong, don't give up. Not everything shows up on a routine blood test. Listen to your body. Get it checked. If going to the gynecologist for your annual check-up gives you butterflies or having your breasts examined makes you squeamish or the thought of a camera snaking through your colon makes you put off sharing your symptoms with a doctor... imagine the regret you'll feel (G-d forbid) discovering advanced stage cancer has invaded your body.

So, what are the signs?
According to cancer.org,  recent medical studies show symptoms often do exist for ovarian cancer, even in its early stages. The most common include:
 bloating
 pelvic or abdominal pain
 trouble eating or feeling full quickly
 urinary symptoms, such as the need to go urgently or frequently
nausea
fatigue that doesn't get better with rest
irregular cycle
irregular bleeding
Trouble is, these symptoms are relatively common and associated with a number of different health problems, from irritable bowel syndrome to urinary tract infections. They are more likely to be due to other, less serious problems. But if you have these symptoms almost daily for more than a few weeks, report them to your doctor right away. When ovarian cancer is found early, while it is still confined to the ovary, about 93% of patients live longer than 5 years after diagnosis. Unfortunately, only about 20% of ovarian cancers are found at this early stage.
See a doctor if you have persistent symptoms like the ones described above, and get regular women’s health exams. While most early ovarian tumors are difficult for even the most skilled doctor to feel during a pelvic exam, an exam may help identify other cancers or gynecologic conditions.

Get in touch with your family... know your history. World wide, 10-15% of ovarian cancer cases are caused by genetic mutations and in the Ashkenazi Jewish population, those numbers are astoundingly higher. Lifetime risk estimates for ovarian cancer for women in the general population are about 1.4%  compared with 15% to 40% of women who have a harmful BRCA1 or BRCA2 mutation. Genetic mutations that can cause breast, ovarian, and other cancers can be passed from mothers AND fathers to both daughters and sons. Women with a mutated BRCA1 or BRCA2 gene have a lifetime risk of between 36% - 85% of developing breast cancer by age 70!  The ethical debate over whether to-test-or-not-to-test are rampant. With the main preventative option for ovarian cancer being prophylactic risk-reducing salpingo-oophorectomy (removal of healthy fallopian tubes and ovaries), let's just say it's not a very appealing or attractive option. As of May 8th, 2013, doctors and scientists have yet to discover or develop viable tests, tools, or magic balls to adequately detect or screen for early stage ovarian cancer. Likewise, treatment options are limited. So, yes, if you want my personal opinion, I say wipe the sand out of your eyes and get genetic counseling. Get the guidance you want and need from an experienced and well-trained genetic counselor who can help you make your choice about genetic testing, surveillance, and prevention of genetic cancers.

Back to that, "Silent Killer", the one with the gun and the silencer... you know you're going to lock your windows and doors tonight before you go to bed. Forget the killer... surely you have homeowners insurance? Car insurance? Health insurance? The best locks and coverage you're ever going to get is taking your health into your own hands. Listen to your body and trust your inner voice. Eat healthy, exercise, stay proactive about your own health, and don't put off those not-so-fun recommended medical check-ups... oh, and choose happiness. The rest is all in G-d's hands.