I'm A Mutant

The Exorcist

I can't believe that it's been over a month since my last post.  I've just been so busy working, dealing with family issues and trying to maintain my sanity in the face of the usual chaos that I haven't had time to vent about all things BRCA.  But if you think that being a mutant and everything that goes with it, has just completely faded into the background well, sadly, no such luck. 

The saga continues:  About a month ago, I noticed a hard ridge, a lump but not quite a lump, at around 3 o'clock on my right reconstructed breast.  Now I knew, of course, that the chances of this being anything other than fat necrosis were slim to none but nevertheless, no mutant wants to live with a hard lumpy ridge in her breast of unknown character, even after a double mastectomy. 

So I called my doctor at the Cancer Bodega for an appointment.  Dr. LGR is a gynecologist/oncologist, not a breast surgeon.  So she's in charge of the mutant lower half, not the mutant upper half.  Faced with a ridge-not-quite-a-lump in a post-mastectomy BRCA mutant, she had to admit that she did not know what to do.  She does not have a lot of patients who had the type of reconstruction I had (which produces lots of fat necrosis), so she referred me to her colleague at the Cancer Bodega, a noted breast surgeon of some repute.

So off I went to see the celebrated doctor.  Let's call her Dr. Bulky and Bossy.  Nuff said.  Regular readers of this blog (both of you) will know that I'm a suspicious and difficult patient who doesn't especially like doctors, particularly paternalistic types who order me around, so every encounter with a new doctor is a challenge for me.  Dr. B & B examined me and immediatly located the ridge/lump.  She then nodded to her physician's assistant, said something about an "FNA", the physician's assistant said something about the "22 gauge"  and before I knew what was transpiring Dr. B & B had plunged a long needle into the ridge and was violently poking around in there for a while.  She then sent what she had extracted to the lab and within 24 hours, it was confirmed - fat necrosis.  Once again, the mutant escapes from the cancer center more or less unscathed. 

If only this long, tedious, and boring story could end there . . .

After the fine needle aspiration (the "FNA"), Dr. B & B sat down with me in her office to have a "conversation".  I use that term loosely since B & B did most of the talking lecturing. It was one of those encounters that you review in your mind later wherein you hear in your brain all the things you should have said,  but didn't.

To wit:

Dr. B & B: "You have a BRCA mutation which puts you at the highest risk for breast cancer.  A BRCA mutation gives you a lifetime risk of b cancer of anywhere between 50 - 85% . . ." (Droning on imperiously about risks, prophylactic surgery, blah, blah, blah)

What I should have said: "Are you fucking kidding me??? I've had a prophylactic bilateral mastectomy and a prophylactic bilateral salping-oophorectomy. Do you really think I don't know all of this???? I've been dealing with this shit for eighteen months.  I probably know more about BRCA at this point than you do so cut the patronizing doctor crap and just get to the point."

What I did say: "Yes, mmmmmmmmm."

Dr. B & B:  "You had nipple-sparing so all I can tell you about that is that the risks associated with nipple sparing are unknown, we just don't know."

What I should have said:  "Well, yes, technically that's true, but the theory of evolution hasn't been conclusively proven either.  Nevertheless, there are preliminary studies which are tentatively supportive of nipple-sparing mastectomy for prophylactic mastectomy patients including a very recent study published by Memorial Sloan Kettering Cancer Center, a very conservative institution that is now routinely offering nipple-sparing to nearly all of its prophylactic patients.  These studies have shown that although some risk of breast cancer remains after the mastectomy, the risk of cancer actually originating the nipple area is negligible. So I don't think it's right for you to try to scare the bejezzus out of me because I had nipple sparing and it's a moot point anyway since I already did the thing and you're not going to be cutting off my nips anytime soon so what exactly is your point?"

What I did say: "Yes, I understand, mmmmmmmmmmmm."

Dr. B & B:  "Even if the hard area turns out to be fat necrosis, which I fully expect it to be, it should be excised.  A negative fine needle aspiration is only 92% - 96% accurate meaning that some of the time, the fine needle aspiration misses a cancer.  Let's not forget why we down this road of prophylactic mastectomy which was to avoid cancer so we have to be extra vigilant with you."

What I should have said:  "First of all, we did not go down this road.  We only met five minutes ago. I went down this road. You weren't anywhere on that particular road.  And please don't tell me the reasons I went down this road which should not, in any case, be oversimplified.  It took months and months to make the decision to undergo the mastectomy and no, I was not willing to do anything under the sun to avoid breast cancer.  Rather, I made a careful cost/benefit analysis and I decided that if I could get a good reconstruction, such that I would look the way I wanted and expected to look both in and out of the clothes I love to wear, and furthermore, if I could be relieved of the burden of medical surviellance such as regularly having to listen to people like you tell me that every little twitch in my boobs might be cancer so it has to be constantly poked, prodded, biopsied, videotaped and made to spit wooden nickels, then the risk reduction obtained by the surgery would be worth the pain and suffering, the logistical headaches, and the loss of sensation. Simply: (1) Getting out from under the constant medicalization of my life, and (2) obtaining an excellent cosmetic outcome, were very important to me.  And no, I don't apologize for my vanity - just because I'm a mutant doesn't mean I have to be deformed. So if you think that I'm going to allow any kind of exorcism on my beautiful right reconstructed breast that may end up resulting in a giant unsightly hole, to get rid of a harmless wad of dead fat, then you're crazier than the love child of Christine O'Donnell and Glenn Beck. 

As to the statistics that you quoted regarding the accuracy of fine needle aspiration, by your own admission, these apply to non-mutant ordinary women - you know, the kind who actually have breasts.  They do not apply to women who have had double mastectomy with full breast tissue pathology (negative for malignancy, by the way) less than a year ago and autologous tissue reconstruction for whom fat necrosis is as common as pimples on teenager.  What is the accuracy of a fine needle aspiration in ruling out cancer under those circumstances???"

What I did say: "Yes, I understand, mmmmmmmmm."

Dr. B & B:  "And we have plenty of good plastic surgeons here who can do the excision and advise you about what can be done if there any loss in volume in the reconstructed breast so you don't have to hop on a plane to New Orleans."

What I should have said: "I made three trips down to New Orleans, took three months off from work, spend a month in drains, not to mention the drainage of my bank account, and all of that to get the breast reconstruction I wanted from the doctors I wanted to hire. And I'm not sorry I did all that because I DID get the reconstruction I wanted which would not have been possible locally even in this great big city of our that is chock full of great doctors because the hip flaps I had done are only being done by about five practices nationwide and there was no other adequate source of fat on my body. So let me relieve you of any ambiguity here: Under no freakin' circumstances is anyone ever going to touch my girls other than Dr. Sullivan in New Orleans. Got it?"

What I did say: "Yes, I'll think about it, mmmmmmmm."

And we left it at that.  I'm going to call Dr. Sullivan to solicit his thoughts.  

But for now the ridge-not-quite-a-lump of dead fat is being left where it died.

 

No Shit Sherlock

Prophylactic mastectomy is major surgery that carries major risks of both life threatening and life altering complications.

Duh.

I'm not usually in the PSA business and stating the obvious isn't my idea of fun. But it seems to me that we sometimes lose sight of the fact that, contrary to some of the propaganda on certain message boards, not everyone emerges from a prophylactic mastectomy and reconstruction unscathed and with gorgeous boobs that they absolutely love, love, love.

My own experience with prophylactic bilateral mastectomy ("PBM") may also contribute to a false impression that PBM is a pretty straightforward exercise in replacing one set of boobs with another. Or as a commenter on a message board so blithely put it, "it's kinda like changing the stuffing on a throw pillow. Like an extreme breast reduction".

Uh no.

Yes, I had a PBM and I was truly fortunate to have had no complications and excellent cosmetic results. For me, everything went according to plan - PBM with immediate hip flap reconstruction followed by a "stage 2" revision surgery four months later. I was hospitalized for both surgeries for the exact number of days predicted by my doctors. I took off from work for exactly the number of weeks I was instructed to do so and I resumed all other activities on schedule.

But many of my fellow mutants in arms have not been so fortunate. Teri lost the flap on her right side to necrosis, had the flap replaced, and then developed life-threatening blood clots in her lungs. Kaycee lost an expander to a horrible infection just a few short weeks before her exchange, forcing her to have to undergo expansion all over again. Megs' "one-step" didn't exactly work out that way.

You are all very brave fellow travelers. Get well soon everybody.

Despite my high satisfaction level with the outcome of my PBM, I have been very careful in this blog to maintain my sensitivity to the daunting ambiguity that mutants encounter when faced with these decisions. I remain highly conflicted about all of this.

Sometimes I receive emails from newly diagnosed mutants who are considering PBM. I don't really know what to say. I would not presume that what I did is right for anyone else. I can't pretend that doing this is easy, obvious, a no-brainer. Things can go wrong. Very wrong. 

But I can offer  empathy, some degree of understanding and my willingness (or perhaps my need) to act as the contrarian in all of this.

I really hope it's the salmon

Well the deed was done at 7:00 AM this morning.  I am now stretched out languidly across the sofa licking my wounds whilst staring aimlessly out the window.  For some reason my eyes can't stop following the fly bashing itself repeatedly into the corners of the window frame.  I feel an urgent need to put it out of its misery but I can't be bothered to get up. 

The surgery itself was kinda nerve wracking.  I had to be at the hospital, which is about 45 minutes away from my home, by 6:00 AM.  I didn't sleep at all last night and I was basically starving.  The hospital where I had it done is a large, busy, urban institution - a stark contrast to the "boutique" type hospital where I had my mastectomy.  In a place like that, you get processed on a conveyor belt - a helpless scrap of raw material in a very efficient surgery manufacturing plant.  All that time in the holding tank just served to increase my anxiety.  I was finally walked into the OR, which was as cold as a refrigerator, fully awake and alert.  I really didn't need to have a good long look at all of the medieval looking torture instruments that were shortly going to invade my tender flesh.  (When I had my mastectomy, they put me out in the holding area so I never actually saw the inside of the OR - a much better approach, in my opinion.) 

Although the staff were all polite, it quickly grows tiresome to have a steady stream of nurses, administrators, residents and doctors coming through and asking the same exact questions over and over again - name, date of birth, health history, and "tell us why you're here today".  The anesthesiologist was impressed when I said " prophylactic bilateral salpingo-oophorectomy."  "Okay, now spell it", he replied.  "Oh, is this one of those anesthesiologist tricks where I start spelling it and by the time I'm in the middle I pass out?" 

I made it to the second "p".   

I woke up with a very sore tummy and a raspy voice, but otherwise none the worse for wear.  The very lovely drug dealer  nurse came by and gave me a highly satisfactory cocktail of morphine and Demerol followed by a percoset chaser.  First one's free!  It was almost enough to make me forget about what had just happened to me.  I was up and around by about 10:00 AM and I went home at noon.  I could have gone sooner but I had to wait for Boy Toy to get to the hospital to collect me.  

I haven't had any hot flashes, my vagina is present and I don't think it's turned to beef jerky, I have all my hair, I haven't gained 30 pounds and I can still regularly identify all of my children by name with about 90% accuracy - just like before. 

So I guess I really haven't experienced any major metamorphoses.

Although I do find myself with a strange desire to sharpen my nails on the furniture and say mean things to Boy Toy just for the fun of it. 

I wonder if we'll be having chicken or salmon for dinner.

Maccheroni and Cheese

I've only told a few close friends about my condition, as it were.  For the most part, I try to maintain my social life "pre-mutant" reserving my mutant rants for this blog.  

 

But masquerading as a completely ordinary non-mutant human can be quite challenging.  I went out to dinner with a group of girlfriends on Wednesday night.  Just your typical red wine and overpriced pseudo-Italian food gabfest. (Rabbit ragu????) But my heart really wasn't in it.  It was just so hard to muster any enthusiasm for S's anecdotes about her recent destination wedding.  (Do I really care that your sister forgot that she was supposed to give a toast and everyone, i.e., just you, was mortified?) Was I really required to listen in rapt attention as A described the petty argument that she had with her husband over her toddler's Halloween costume?  (She wanted a bee, he said that was too girly, so they settled on a duck.)  

 

And when they asked "So, Dee, what's new?", I know that I am supposed to say amusing things like, "Oh, C has discovered that she loves to take off her diaper and run around yelling 'Caca!'" or "Well, it turns out the my new boss really IS a total asshole." 

 

I'm NOT supposed to say things like "Actually, I'm a mutant and my insurance authorization for a double mastectomy came through this week so it looks like this is really going to happen."  Cuz that's not funny.  That's just awkward. 

 

But since the authorization came through, I haven't been able to focus on much of anything anything other than the fact that I can't believe I'm actually doing this.    

 

Am I actually doing this?

 

 

It's okay to be angry.

For the past few weeks I've been wondering why every pink tchochke hanging in a store window seems to trigger my gag reflex.  Then there's the post-adolescent with the chirpy voice who keeps calling me from Cancers-R-Us to ask if I want to join a support group.  For some reason, I've had the irresistible urge to tell her to go fuck herself.

Then I came across this article that Barbara Ehrenreich wrote in 2001 and it all crystallized for me.

I generally avoid support groups and message boards because I came to realize early on that being angry is not politically correct in those circles.  The majority of the posts on the message boards tend to concern the minutia of surgery (which is admittedly useful information) but where is the collective outrage that so much medically sanctioned mutilation ought to provoke? 

Pink isn't a very angry color is it? 

So this blog is my support group. 

My support group of one.

Where I get to be as angry as I am.  Where I get to feel exactly how I feel.

And if you're the girl from CRU who keeps calling me  . . . .

I know you mean well. . . .

But if you call me again, I'm going to have to tell you to go fuck yourself. 

Update and Some Tentative Decisions

I know that I've been neglecting this blog lately.  The main reason being that life, as they say, goes on, and I have had very little time and mental energy to devote to all things BRCA. I have some careers issues that have to be resolved, I'm thinking of selling my house and I had to get the Freeloaders, a/k/a my children, back to school in one piece. 

 

The thing is that as I've been less focused on all things BRCA, I've begun to feel so much better.  Not just mentally, but actually physically better.  All of my mysterious aches and pains seem to have gone away. I've been running 10 - 15 miles a week, sleeping well and I have had no panic attacks in quite a while. 

 

I was supposed to go see another specialist a few weeks ago but I canceled at the last minute.  I'm not a slow witted person and at this point I seriously doubt that there was anything new to be heard on this subject.  I may change my mind about that in the future but despite the fact that I really don't like Cancers-R-Us as an institution, I think Dr. Statistics (my "surveillance doctor") is an okay guy, so I decided that I will stick with him and my regular gynecologist, Dr. Lucky, for the time being.

 

I did have another appointment with Dr. Lucky and we talked again at length about the issues.  I genuinely enjoy her outspoken nature and overall wackiness.  As an ordinary gynecologist who spends most of her time delivering babies rather than treating terminally ill cancer patients, she was understandably less alarmist and pushy about the whole oophorectomy deal.  I told her that I was tentatively planning on waiting until I was 45 to have my ovaries out and she was okay with that.  

 

So here is what I plan to do (and not do):

 

1.    I will move forward with a prophylactic mastectomy.  I have begun taking steps to have this done in early 2010, as soon as February, if I can iron out all of the insurance and logistical issues.

 

2.    I am keeping my ovaries for the time being.  I have an appointment for my next ultrasound and CA-125 with Dr. Statistics in December.  I will discuss all of this with Dr. Statistics then.  But assuming that my CA-125 is still very low (my last one was 4) and my ovaries look good, I am not planning on oophorectomy in the near future.

 

So that's it for now. 

 

I will update on the mastectomy process as I get going on this but for now the endless whining about my endless indecision regarding my ovaries will hopefully stop.  

 

I'm just going to have to find something else to whine about.

 

Shouldn't be too difficult : )

 

(Yes, the Angry Mutant actually smiled!) 

The (F)Utility of Genetic Couseling - Part 2

In part 1 of my rant, I covered the confusing nature and overall uselessness of so-called genetic counseling prior to being tested for a BRCA mutation.  Part 2 of this rant covers the confusing nature and overall uselessness of so-called genetic counseling following a positive BRCA result. 

This will be a short rant because everything that there is to say on this topic has been perfectly said by Masha Gessen in her book, Blood Matters, which, if you have any interest in BRCA whatsoever, I urge you to read.  However, if you haven't gotten a hold of her book, the gist of her take on genetic counseling is that, in the case of BRCA mutants like me (and Masha), the genetic counselor has a self-contradicting mission.  On the one hand, the counseling is supposed to be "non-directed" - that's a pseudo-psychological term for saying that the counselor is not supposed to tell you what to do.  But on the other hand, there is a widespread medical consensus about what a BRCA carrier should do - i.e., she should get her ovaries out.  So it comes down to the counselor telling you what to do while pretending to NOT tell you what to do.  

The result is a confusing pas-de-deux of Orwellian doublespeak. 

In my case the conversation with my genetic counselor, Y, went something like this:

Me:  Okay, I understand that I have these risks.  So what should I do?

Y:  Well, we will give you some referrals for different doctors to speak to who can help you decide.  (Hands me a list of doctor names under the heading "Risk-Reducing Salpingo-Oophorectomy.")

Me:  But I'm not sure that I want surgery.

Y:  Oh in that case, you may want to start with one of these doctors.  (Hands me another list of doctors under the heading "High risk ovarian surveillance.") 

It is at this point that I began to suspect that I had been a victim of a classic bait-and-switch.  Before genetic testing, there were "options", but after, there was only surgery. 

Me:  Well, at what age do women generally have this surgery?

Y:    (Avoiding looking me in the eye.) Most have it as soon as they know they don't want to have any more children.

Me: (now visibly upset) What?  Well, I really don't know what I'm supposed to do.  I hadn't really considered that I would have this surgery now.  I mean I'm only 40. 

Y:  Yes, I understand.  It's a difficult decision.  But we can refer you to our counselor (i.e., a psychotherapist) and I think that after talking to her things will fall into place for you within a few months.

"Falling into place" being a polite way of saying "get over yourself and sign up for surgery". Basically, I was to understand (without being explicitly told) that I SHOULD have surgery ASAP, that it was a medically necessary as removing a gangrenous toe, but of course, it was ALL 100% MY decision. 

The (F)Utility of Genetic Counseling: A Rant In Two Parts

Part 1:

Just in case you thought the Angry Mutant was going soft in her old age, I thought I'd come back around to the original purpose of this blog, i.e., arbitrary rants at fate, the universe, doctors etc. . . Today's victim of choice: certified genetics counselors, or "CGC"s.

In case you are wondering if you should pursue genetic testing for a BRCA mutation, perhaps my experiences on this psychedelic road trip, as described in this blog, may serve as a cautionary tale.  Despite the widespread belief that "genetic counseling" is some sort of panacea that will save us all from winding up with information about ourselves that we are not prepared to handle, I'm here to tell you that "genetic counseling", in its current form, is factually informative at best, and shilling for Myriad at worst, but it is certainly NOT "counseling" as we colloquially understand the term.  It most certainly will NOT assist you in obtaining the self-understanding necessary to making the decision about whether you should have testing and if you do have testing, it will not certainly not assist you in obtaining the self-understanding necessary to know what to do with that information.  If the totality of this blog, in all of its redundant and circular ruminations and aggravations, has any coherence, it stands for the proposition that dealing with information about your genes is likely to be a long, hard slog that you may have to endure over months or even possibly years. 

I hasten to add that the genetic counseling that I had was top shelf at a major cancer center that is supposedly one of the best in the country at this stuff.  And this is certainly NOT intended as a personal attack on the woman who did my counseling.  Indeed Y was a very caring, sensitive and knowledgeable person and I am certain that the content of my counseling session was well above professional standards.  The problem precisely lies in the content itself.  Prior to my test, Y spent over an hour with me.   But she did most of the talking and most of what she said can be best described as a "data dump".  She shared with me all kinds of statistics and BRCA arcana ranging from the current controversy over whether BRCA women should use HRT following oophorectomy to the statistical risks of breast cancer after a woman has a prophylactic mastectomy. 

The risk statistics are so imprecise that they are practically meaningless.  To wit:  The estimated lifetime ovarian cancer risk for a woman who is BRCA1+ (like me) ranges from 20% to 65%, so doctors tend to split the baby and call it at 45%.  So which is it?  Does it even fucking matter since for non-mutants the lifetime risk if about 1.5%? Are numbers like this supposed to be useful in trying to make a rational decision about how likely it is that I will die of a terrible disease?  Trust me - THEY ARE NOT.

But back to my original point.  All of this data dumping is academically interesting but BEFORE I had tested positive for the mutation, it was all rather abstract.  The problem with data dumping is that the process of throwing out dozens of facts distracts from the most salient facts.  And all facts are NOT created equal.   Y could have saved us both a whole lot of time (and me a whole lot of misery) if she had just emphasized ONE fact, and here it is:

IF YOU TEST POSITIVE FOR A BRCA MUTATION AND YOU ARE OVER THE AGE OF 35, YOU WILL BE UNDER TREMENDOUS PRESSURE TO HAVE YOUR OVARIES REMOVED ASAP.  IF YOU ARE NOT PREPARED TO HAVE YOUR OVARIES REMOVED (AS IN NOW), YOU MAY WISH TO RECONSIDER GENETIC TESTING AT THIS TIME.

Of course during genetic counseling oophorectomy is mentioned.  However, the genetic counselor kinda throws it out there with a certain caginess.  Somewhere in the middle of the data dump the genetics counselor will say something like "if you test positive for a BRCA mutation, you will be offered the option of oophorectomy."  Well that doesn't sound too bad does it?

Do want sprinkles on top of your ice cream cone? They're optional.

What they don't explicitly tell you is that (i) the other options suck, (ii) your doctor will scare you shitless until you agree to this "option" and (iii) you will be probably be so scared shitless yourself that you'll feel like there really isn't any other option. 

The upshot of all of this is that if you all you want to do is "surveillance", you don't need a positive genetic test.  Most high risk surveillance programs for women will accept patients based on family history alone and that history is usually enough to get the insurance companies to pay.  In my view, the only thing a genetic test is useful for is if you really do want to go the full surgical route. 

But it is important to understand that in and of itself, the test result will not help you make the decision about what to DO if you haven't already made it. 

In other words, you should have your decision tree firmly in hand and be prepared to execute on it before you let them stick that needle in your arm in the first place.

I don't want to scare you but . . . .

I have decided to take control of the situation.  I really need to come up with a game plan so that I can get on with my life.  So, as a first step I called Dr. I-Don't-Want-To-Scare-You-But's office to arrange a second consultation.  Dr. IDWTSYB is a well known surgeon who specializes in gynecological oncology.  He is the guru of minimally invasive surgery, the Roger Federer of the laproscope. 

 

Now it must be stated for the record that Dr. IDWTSYB is a kind, compassionate, soft-spoken doctor who patiently answers your questions and looks you straight in the eye when he talks to you.  I have no reason to doubt his sincerity or his intentions.  I met Dr. IDWTSYB for the first time three weeks ago to discuss the details of my castration.  Oops, I used a naughty word.  The medically correct term is bilateral salpingo-oophorectomy.  He showed me a coloring book type drawing of a female's body below the navel and began circling all the organs that now have bright red targets painted on them.  Ovaries: Out.  Fallopian tubes: Out.  The uterus can stay.  I expressed my usual degree of distress and horror at the prospect of losing most of my perfectly healthy internal female bits, at which point, DR. IDWTSYB earned his new moniker.  Please feel free to insert the relevant phrase as applicable.  These are direct quotes:

 

"My sister-in-law has breast cancer.  Trust me, you don't want that." 

 

Really???? And here I was thinking this entire time that a bout with breast cancer would be a great summertime distraction.

 

"Osteoporosis is the least of your problems."

 

"Sometimes women wait to have the surgery and then we open them up and find an abdomen full of cancer."

 

"If you get ovarian cancer, it will ruin your life.  Even if we can cure it, you'll spend the rest of your life worrying that it will come back."

 

And finally, while looking me straight in the eye, without being asked: "If you were my wife, I would be begging you to have this surgery."

 

The thing is, I'm not his wife and even if I was, it would still be MY decision.

A Medical Success Story

I have just discovered the divine Masha Gessen.  She is a BRCA1+ writer who detailed her experiences dealing with the "options" in a series of articles that appeared in Slate .  Basically, she has articulated everything that I am feeling perfectly except that her writing is so superior to mine that I think you should read it all for yourself here and quit this blog immediately.

Here are some highlights along with my commentary:

There is a maddening disconnect between the cutting-edge science of oncogenetics and the barbaric state-of-the-art response to the discovery of a mutation: Hack everything off before it goes bad.

I often find myself filled with cold rage at a medical establishment that has written enough articles patting itself on the back for having "solved" the problem of BRCA mutations by propyhlactic surgeries.  They tout these surgeries as a medical "success story" and blather on and on about how prophylactic surgery (oophorectomy in particular) has gained "widespread acceptance".  Yah.  If you point a gun at my head and tell me to hand over my wallet, I "accept" the proposition that I'm going to lose my money.  Compliance out of sheer terror and a lack of alternatives is NOT acceptance.

It's not that I'm not terrified of cancer. Most women are, even those who didn't watch it kill their mother. But I also can't fashion an easy attitude toward the prospect of heart attacks, strokes, and broken hips.

Masha baby, you are right on the money here.  So far I have consulted two different doctors and neither one of them has really been able to squarely address the issue of collateral damage following premature menopause.  When I raised the issue with Dr. Statistics, he dismissively waved his hands like he'd heard this all before (and I'm sure he has) and told me "the biggest threat to your life is breast cancer and ovarian cancer."  The other doctor, Dr.I-Don't-Want-To-Scare-You-But, put it this way:  "Osteoporosis is the least of your problems."  Basically, I am to understand that my life expectancy is already so compromised because I am a mutant that even if the oophorectomy shaves 10 years off my life (statistically speaking, of course), ovarian cancer would shave 30, so I'm still net up 20! 

Now that's a medical success story, isn't it????