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Wednesday, July 30, 2014

A Great Day

Today is a great day.

Yes, there's the fact that it's a beautiful, clear, blue-skied day outside - crisp, clean, a day that might inspire poets, a day when I'm just truly glad to be alive.

But that's not all.

Today I made a fantastic discovery.

Today I discovered I cannot write this blog while listening to Andrew Lloyd Webber.

Okay, that's not fantastic - I would love to be able to concentrate while listening to Sarah Brightman singing 'Love Changes Everything' at 20000 decibels.  Alas, it is not to be.

Today I also took myself off for a DEXA Scan.  According to the promotional literature, 'A DEXA is a unique scan that provide details on both your absolute (i.e. whole of body) as well as regional body composition.'

Here is what I look like under the scan - a kind of middle-aged alien with a very lean chest and in bad need of a chiropractic adjustment (hahaha):

It wasn't really that surprising that I am still considered to be 'lean'.  However, as lately I have struggled with loving my new dumpier, grumpier post-menopausal body shape - the kind that can't fit into some of my old dresses and where deposits of cellulite routinely horrify - it was surprising to learn that I am in the 8th percentile of body fat, meaning that there are 92% of women of my age group who are less lean than I am.

It was not surprising that I am smack bang in the normal weight range.  I knew that.  But it was also surprising to hear Adam, the nice boy who ran the scan and who turned out to be a highly experienced dietitian, tell me that it was unhealthy to focus on any more weight loss at my age.

 'It comes down to if you want to be skinny and have what you think might be a fabulous body - or your long term health,' he said.  Apparently, for me, the danger is that, as I am now on the other of that hill leading to decrepitude, enfeeblement, disability and possibly, uncontrolled farting, my obsession with calories means I may have too much weight loss as I age with various nasty consequences.

Also, I discovered that I am starting to have some loss of bone density.  The joys.

I'm leaner than most haus fraus.  Hooray!   But that's not such a fantastic discovery either.  It means I can continue to pander to indulge in the chocolate biscuit or three (a weakness as long as I can remember), guilt-free.   Other than that - it's no big deal.

The most fantastic discovery is this.

Today I received a phonecall from my sister Fiona to report that Queensland Health has officially ruled that we are unlikely to carry the BRCA Gene.  Not the 'Braca' Gene (which is how we BC'ers pronounce it).  Not the 'Brica' Gene .  Not even the Brica-Brac gene which, I have heard, may lead to a fetish for haberdashery.

This means that neither of us really qualifies for gene-testing - which is the next step in this process.

Our hunt for answers as to whether or not we are candidates for the BRCA gene began 18 months ago - and I believe it was all instigated by Fiona's health team.  

It seems a long time but, really, that's the time it requires for the system to establish whether we are even candidates for the test.   This has required an arduous process of securing the full suite of the my close family's medical records  - including my mum's siblings!

Our family tree therefore has been painstakingly plotted and an array of forensic assumptions and algorithms have been applied by genetic scientists.

As a result, Fiona received some detailed information about the lay of the land.  Here is what I know based only on Fiona's phone call today.

The unlikelihood of carrying the BRCA gene has been established in part by the fact that:

A.  We had identical cancers - lobular not ductile (representing only 10% of all breast cancers).  That is, we are already in a minority.
B.  Both my mother and aunty were diagnosed with breast cancer after the age of 60.  Apparently if they had been younger, it places us at a higher risk.
C.  However, this means that my sister Nicky remains at high risk and must be vigilant in having yearly - yes, yearly! - check-ups.


D.  Nicky's three daughters will need to have regular check-ups from the age of 40.

But here is the best news of all, the news that has lifted a weight off both Fiona and my shoulders.

E.  We are told that the sons of women with breast cancer are at a 50% higher risk of prostrate cancer.  However, partly because we have had the lobular type, our sons are at no greater risk than the general population.

That is a huge relief as I have to admit harbouring a tiny bit of guilt at the wealth of possibly disorders and diseases I might have genetically passed onto my kids (my Dad's family have not exactly been long-living) :-)   At least we can sift the ole Prostrate Cancer from the murk of my complicated gene pool.

But it's an even bigger relief when you realise what it really means to Fiona and I, or any woman with a diagnosis of breast cancer to be absent of the BRCA gene.

Most of you will have heard of this gene, but how is it relevant?

The BRCA1 or BRCA2 gene basically increases a woman's chance of developing breast and/or ovarian cancer.

These two human genes produce the proteins that help repair damaged DNA and therefore play a role in ensuring the stability of the cell's genetic material (tumour suppressor proteins).

If you have a specific inherited mutation in these genes, you're at increased risk of breast, ovarian and other types of cancer.  These mutations account for about 20-25% of hereditary breast cancers but only account for around 5-10% of all breast cancers.

If fate finds a succession of family members struck down with the disease, as my mother, Fiona and I have, then health professionals will consider the chance that this gene may exist in the family.

That's because it places you at a much higher risk of ovarian cancer, a cancer that is extremely hard to detect.  In Australia, the overall five-year survival rate for ovarian cancer is approximately 43% (compared to 89% for breast cancer).

You can see why Fiona's health team believe it was worth examining the likelihood that we carried these BRCA genes.

Their absence means is that both Fiona and I can hang onto our ovaries.   There is no need for total hysterectomy or hysteria, in other words.

I for one, am immensely pleased as I am rather attached to my ovaries.  Oophorectomies, as they are called, have consequences of their own and I am glad to have avoided another operation.

So for now, Fiona and I and our respective families can breathe easy.  You might even say we are oopho-joyed!

Today really is a great day.