One of our patient’s experiences
Noreen Tyznik found it on Thursday, June 1, 2000 at 11:15 p.m., while reaching up to adjust the shower head. She felt it move when she raised her arm. She knew it was different. She knew it was wrong. She knew it didn’t belong there. She was no stranger to either self breast exams or Mammograms, having already had six over the past ten years. She had thought she had felt a lump wShen she was younger, but it had turned out to only be a swollen gland. Still, this had taught her the importance of breast exams. It had also given her the instinct that this lump was not something to ignore. She called her husband Roy into the bathroom immediately, and he encouraged her to get checked out as soon as she could. He tried not show his worry and simply supported her.
Noreen had nightmares all through that first night, “…about running and throwing things off of me. I felt my mind was preparing my body.” She called Dr. Myrna Casing in Stanley the next morning, who saw her right away. A mammogram was scheduled with the Radiology Department at Victory Medical Center for the Following Monday, so Noreen could wait until Roy could be with her. Although the results were read immediately, she was told they were inconclusive and that an ultrasound was needed.
A biopsy was scheduled after the ultrasound, so that the lump, which was 1.9 cm. (about dime size), could be tested for cancer. Noreen met with Dr. Sharon Hayward on the following Tuesday to schedule that surgery. “I just wanted it out. The hospital moved my surgery up to get the lump to the lab in Chippewa Falls earlier so I could get the results as soon as possible.”
Dr. Hayward gave Noreen and Roy the news that the lump removed from Noreen’s breast had tested positive for cancer in the afternoon following the biopsy. Noreen tearfully stated, “I was numb. Deep down, I knew. But the final, ‘Yes, it is,’ was – wow.” Reflecting back to that day, it is still upsetting for Noreen. Roy and Noreen returned home and it was then that Roy contacted their two children.
Noreen and Roy met with Dr. Hayward again later that week to discuss the options. One would be a lumpectomy, where the tissue surrounding the tumor and lymph nodes within the immediate area would be removed. This would be followed by chemotherapy. The third option was a mastectomy with node biopsy, reconstruction, and chemotherapy. Noreen knew immediately that the third alternative was the one she would choose. She told Roy and the doctor that she wanted all of it to be gone, “It was like that tissue, that part of my body, failed me and I wanted it out of me.” Noreen’s foremost concern was whether the cancer had already spread to the lymph nodes. When asked whether she was at all concerned about her appearance after a mastectomy, Noreen said that none of that was a priority any longer.
Decisions were made quickly and within a few days, Noreen was meeting with Dr. Steven Immerman, the general surgeon from the Evergreen Surgical group in Eau Claire, who would perform her mastectomy, and Dr. Joseph Rucker, her plastic surgeon. Noreen found these surgeons to be adept at explaining the different types of mastectomy options and had thought through her decisions. Instead of a saline implant, Noreen chose what is referred to as a tram flap in which stomach muscle is relocated to the breast area. Surgery was scheduled for June 30, less than one month after Noreen had originally discovered the lump in her breast.
The day before her mastectomy, Noreen had what is called sentinel node mapping. This is a test in which a slightly radioactive dye is injected into the nodes surrounding the tumor in order to determine if the cancer had spread outside the lump itself. The nodes which concentrate the dye are referred to as the sentinel nodes and selective biopsies can then be performed. According to Dr. Immerman, it has recently been demonstrated that if the sentinel node is free of cancer all the other lymph nodes will most probably be free of cancer as well.
Noreen’s surgery took about seven hours, a bit longer than usual due to blood loss. Noreen remembers awakening and finding Roy and her brother Norm and his Girlfriend Joan with her. Her first question was wondering what time it was. Her next concern was the results. She then was told that the preliminary test of the nodes was negative, and these results were considered to be 97% accurate. “And then can remember smiling. The node thing was my biggest fear, as to whether it had spread.”
Almost immediately, it was time for Noreen to start meeting with her oncologist, Dr. Clifford Pukel, and other staff from the Oak Leaf cancer center. She started a series of CT and bone scans, and regular care included a great deal of lab work. On July 30, she started her four chemotherapy treatments, one every three weeks, with them lasting a total of twelve weeks. Each was an intravenous chemical drip lasting over an hour. Blood would be drawn before each treatment, and Noreen was given drugs intravenously which were designed to prevent nausea. She was also given injections to help build her white blood cells, as a common side effect of chemotherapy is the destruction of white blood cells.
Noreen was hospitalized for five days after her first chemotherapy treatment due to this side effect. Without efficient white blood cells, her body became more susceptible to infection and she developed a fever. She was given antibiotics and her count came back to normal. She then had to go to Eau Claire daily to have her blood checked. Although Noreen was hospitalized overnight after her second treatment, her white blood count rose to normal levels more quickly due to the cancer treatment staff’s early anticipation and care. Despite the complications, Noreen felt positive about her chemotherapy treatment. “The doctor and staff are so supportive and lighthearted. You forget that you’re there for cancer treatment. They make the patient feel at ease.” Noreen also began attending the Y-ME group, a breast cancer information and support group in Eau Claire.
It was in mid-August that Noreen lost her hair from the chemotherapy. She had been encouraged to get a wig before is happened, so Noreen was prepared when the time came. She wore the wig until her hair grew back. When asked if is was significant to her, Noreen Stated, “It depended on the day. Some days appearances mattered, some days they didn’t.” All through this time, Noreen had the support of her husband, family and friends. “I just want you to get better. Whatever you decide to do, I know I can live with it.” Roy said to her. Noreen’s friend Mary came every day help her with the surgical site. “I had so many people around me all the time. They kept me going, that was such plus. I had someone going with me for every appointment that was so cool. You don*t realize how much people care until something like this happens. Some people complain that in a small town, people know everything. Sometimes, people knowing everything is good.”
Noreen continued with her chemotherapy and also had what she calls “fine-tuning surgery” to make her breasts look realistic and symmetrical again. She experienced an intense, slow recovery which included many restrictions. Through everything, “I prayed a lot, and still do. I also took things day by day. To look at the whole picture was too overwhelming.”
It has now been over one year that Noreen Tyznik has been free of cancer. She continues to have a check-up every three months, but her life is back to normal. Although she and Roy were close before, they are now closer than ever. Noreen now lives with few restrictions. Most importantly, she lives. The decision to have her personal experience with breast cancer published was an emotional one for Noreen. However, she chose to do this because it is her opportunity to stress, “A major message I wish to deliver is early detection is your best weapon. It is what is saving lives. The day I found out I had cancer was the day I got rid of it. With research, hopefully breast cancer will soon be a thing of the past.”
Each year, almost 150,00 new cases of breast cancer are diagnosed in the United State. Noreen would like you to know that women between the ages of 20 and 39 should have a clinical breast examination every three years. Beginning at the age of 40, women should have an annual mammogram and clinical breast exam. Once a woman reaches age 20, she should perform a breast self-examination every month for the rest of her life. For more information about breast cancer risk factors, mammograms, breast cancer screening or how to perform self-exams, contact your physician or the Radiology Department at Victory Medical Center (644-6112). For information about the Y-ME Breast Cancer Information and Support Group, call (715) 839-3956 or (800) 839-3956. Thank you to Steven C. Immerman, MD, FACS, for the Information about sentinel node mapping and VMC’s Radiology Department.