ADIEU, OLD FRIENDS

I've been talking about my 60th birthday celebrations which included a party at a kosher Russian restaurant in Queens (man, do those Russians know how to have a good time!), a dinner with friends in Jerusalem, and a dance party in Melbourne last week. But there was something else I did, not exactly celebratory, spurred by my turning 60.

I had my ovaries removed.

I'm not Angelina Jolie, and that won't make headlines. But the reason that I had my hardworking little girlies removed was that I was increasingly afraid that they would go rogue on me. My maternal grandmother was 55 when she died of ovarian cancer; I never knew her. My mother was just 66 when she died of ovarian cancer; my older kids hardly knew her, the younger ones never knew her at all. And here was I, smack in the middle. It's called 'the hot decade'.

About 8 years ago, when genetic testing started, I decided to have the test to see if I had the BRCA1 or 2 genetic aberration. It was done at the Peter Mac (cancer hospital in Melbourne) Familial Cancer Centre, and I have to say that getting my patient appointment card to a cancer hospital already had me sweating a bit.

I made the appointment on advice of a colleague who is a Gynaecological Oncologist, who, when I disclosed my family history in a sort of inappropriate social situation (umm...at my Shabbos table where he was a guest), sort of drew himself upright in his chair and told me to get tested asap.

They have this whole way of doing things there at the Peter Mac. First they told me to go away and think about having the test, and all that it means, and how it might affect my medical and health insurance. And then I had to schlep back and do the test which I had wanted to do at the previous visit. And then they said to come back with a support person when they gave me the results. They also said that they would try to find the 'tumour blocks'- i.e. tissue samples, which would have been taken from my mother 25 years earlier when she was operated on (and diagnosed at the time of surgery; it was a big shock for everyone, surgeon included. He thought he was repairing an umbilical hernia). Since the operation had been done in a different hospital which had since been relocated, I didn't like their chances too much, and in fact they couldn't find them.
So I brought my husband with me when they called me in to give me the results. We were sat in a bleak little room with a box of tissues on the table. The ladies who came in and out of the room, asking us how were were, were very nice and solicitous, which actually made me more anxious. And then the doctor came into the room and, in a roundabout way, which kept me guessing right to the end, informed me that I did not have the BRCA mutation.
Well! The relief! But Doctor Circumspect wasn't smiling; because they did not have the genetic material from either my mother or, of course, my grandmother, they didn't know their BRCA status, so they couldn't actually tell me what my chances were of getting ovarian cancer. And in fact, most cases of ovarian cancer occur in people with normal genes. It's just that if you have the BRCA mutation, your chances of getting cancer are extremely high. (And then my usually slightly more sensitive husband said that we could exhume my mother and thus obtain a DNA sample. Mr Practical. Mr Only Trying To Help. Just..NO.)
So it was really back to square one for me. I sought advice from several doctors and a medical ethicist, and although there was a good case to having the op, it was not really something I wanted to do at that time.

Why not? Mainly because I am a big chicken when it comes to surgery. Stuff goes wrong.
Also, who has time for this? I was busy with kids' weddings and babies and travelling and and and.
And then, maybe my ovaries were still useful! I wasn't having hot flushes etc, but my blood tests did show that I was menopausal. But maybe I was running on empty! The motor was working well enough, why rip out the Oestrogen fuel tank?
And my OB GYN of many years was very keen to do a total hysterectomy, with the kind of insouciance that male surgeons often have. I mean, that uterus isn't doing anything anymore, why not just take out everything.
Poor old uterus. She never did a wrong thing in her life. Never a minute's trouble. I never even had a period pain my whole life. Never bled when she wasn't supposed to. When I wanted to conceive, I did. When I didn't, I didn't. My pregnancies were uneventful, my deliveries uncomplicated. And for all the years of faithful service, you want to just whip her out? She's an innocent bystander! It just seemed wrong. OK, maybe there were some auxiliary lady issues, like a bit of a prolapse here and there, but really, nothing that bothered me. Everything was well worn, but had worn well, so to speak. So, no thanks. Oh, but technically it's simpler to just do a full clearance, and repair this and that and yada yada; and then another GYN started talking about robotic surgery and multiple staged this and that, and FORGETABOUTIT. Not going to. Freaked out.

So for the last 10 years or more, I have been having pelvic ultrasounds and keeping an eye on the ovaries. That's all you can really do. There is no precancerous detection, as there is in breast cancer. Any change means cancer. And although annual ultrasounds sound like a good idea, in fact, ovarian cancer can go from go to whoa in as little as three months. So what's the good of that. Blood test (Ca 125) is non-specific, and I had those too, for all they're worth. And that's the state of the nation, folks. This is why you should buy a ribbon on Ovarian Cancer Awareness Day, because there needs to be more research done, looking for a pre-cancerous marker that would then make screening possible. Right now there is nothing.

So as the years went by, the anxiety mounted. I passed the age that my grandmother died. It felt like a milestone. And as I approached the age that my mother became sick, I felt that it was time to take action. After the last scan, I spoke to the GYN who did it and he heard me out, about the ovaries and the uterus and the prolapse and the robotic surgery and how I just did not know what to do. So he asked, 'What is bothering you the most?' and I answered, 'The fear of ovarian cancer.' So he said, 'Just have the ovaries out and see how you go.' So simple.

Because when you have the ovaries (and tubes) removed, the risk of ovarian cancer is pretty much zero.
And suddenly I knew what to do, and I made the appointment with the original GYN who told me to do it nearly 10 years earlier. After a couple of months' wait, laparoscopic removal, overnight stay in hospital, take it easy for a couple of weeks, no worries. Pain was minimal, took some Panadol; 4 tiny little cuts on my tummy, healed up. On the 3rd day post op, I saw a patient. On the 9th day, I went to an ACDC concert (Amazing BTW).  On the 13th day, danced like a fiend at my 60th. After 2 weeks, back at water aerobics. (Not looking forward to going back to gym, I have been enjoying getting up later than 6am. But.)
So BH it all went well, the pathology results were fine, and I feel exactly the same.

I was afraid of feeling castrated, gonad-less, less of a woman, blah blah. Nothing like it. I'm glad that I can cross off that potential cause of death from my list.

I'd better not be hit by a bus. The irony would be too much.