Tag Archives: breast cancer

w00t! ESCAPED from yesterday’s miasma

Managed to break free from yesterday’s craziness and finally finish Chapter 2 for the Boob Book. Not gonna rehearse today’s little triumph because it’s described in detail over here.

More of interest to the writerly set: The word count for the introduction, two chapters, and two appendices is right at 10,600.

The chapters plus the intro average 2800 words apiece. The appendices (all two of them): 1090 words each.

So, if those numbers stay consistent throughout, the 11 chapters and 5 appendices should add up to a total word count of just under 40,000 words.

That’s not very long; one would like to be closer to 80,000, for a book-length work. However, there’s a glossary — heaven only knows how long that will run. I found a large cache of definitions at a government site; ergo in the public domain. I’ll probably use most or all of those, which will inflate the word count significantly. And as we speak, I have 21 pages of references, single-spaced, set up in Chicago style. That stands at 4874 words just now.

So the references alone push the word count to around 45,000 words. If the glossary comes in at around 3,000 words (???), that would make it 48,000. Add an index, maybe another thousand words (counting numbers as words…). Hm.

Well, they say shorter is better these days, moderns not being much on reading. We shall see.

Spent this afternoon studying and outlining downloads from Kindle Unlimited, by way of building the new racy-novel enterprise.

My goodness, there’s some bad writing out there! These things are awful. Full of dangling modifiers (some of them truly hilarious), typos, unidiomatic language (“grinded”; “withering” for “writhing”; and on and on), lapses in point of view, characters dissolving pointlessly in laughter, eye-glazing clichés…

Oh, well. Clearly literature is not what people are buying the things for. 😀

A few of them do display fairly workmanlike writing, and some are even done with style and humor. But even those self-consciously deploy tried-and-true tropes. There’s quite a sameness to these things, especially where the female characters are concerned:

The female character almost invariably is said to be lonely: either she describes herself as lonely, explicitly, or some other character observes or speculates that she’s lonely.

As the story unwinds, the woman is “rescued” in some way from an unhappy relationship with a former husband/boyfriend. Male lover(s) sex is better, kinder, hotter, more positive all the way around.

Female character yearns for change or sometimes simply for an outrageous spree.

She often is described as feeling self-conscious or insecure about herself.

Attraction is immediate, as you’d expect in such short pieces – the characters lust after each other at first glance.

Men are described as “gods”

Men are often described as cooking or doing some other domestic activity; this seems to be part of his appeal or at least a repeating trope.

Hm. We’ll redact some of these other observations, lest the young, the impressionable, or the tender be reading. Suffice it to say that all the way across the board, a kind of monotony reigns.

It explains why some very, very silly things rise to the top in this genre. Like the series about the woman who gets it on with Bigfoot.

Heee! Yes. That one is said to be authored by a SAHM who home-schools the kiddies.

And that factoid also explains something. I suppose.

How Long Will It Take to Write This Book?

Finished chapter 1 of the Boob Book today, and started on chapter 2. With all the research done, it took about a day and a half to write the first chapter.

So I’m wondering how long it will take to compile the 800 pages or so of research material that’s stacked up on the table into a single coherent book.

The book will have nine or maybe ten chapters (depending on whether I decide to break one of the projected chapters into two) plus six short appendices.

If nothing gets in my way, I can get through about a chapter in a day, or maybe two days. Chapter 1 is 2800 words, not an unreasonable amount to crank in one day. Some chapters will be shorter. But let’s say that realistically it takes two days to write a chapter: that would give us about 20 days to write the main body of the book. Each appendix should take less than a day, although the glossary may be lengthy. So maybe a day apiece for those?

That adds up to 26 days: about a month.

But, of course, as a practical matter “nothing gets in my way” will not happen.

My best paying and most reliable client just resurfaced, asking if I’m up for more copy of his. This is a guy that you don’t say “no” to. Probably not even if you wanted to…but most certainly not when he pays you so handsomely to read such entertaining material.

The online summer course is just heading into its most intense period, with three major rafts of stoont papers about to fly onto my desk.

The Latina studies journal is in full production. We’ve moved a set of academic papers but not seen the reviews, the creative work, or any of the front & back matter.

And I should be preparing my fall courses as we scribble.

We await the artwork for the next two installments of my self-publishing empire, and I’m in the process of laying out 18 serials of the Fire-Rider story, which I also will convert to .mobi files and post on Amazon. All of these will need to be marketed, something that I find quite the challenge.

The proposed porn empire awaits. My friend and I are still studying the possibilities. But to make that work will also require cranking at least 3,000 words every day or two.

As soon as I finish chapter 2, I’m sending a proposal to one of my former publishers, for whom (some years ago) I once wrote a best-seller. Unfortunately, like most other American publishing houses it has changed hands and been consolidated into unrecognizability; as far as I know, none of the old editorial crew persists there. But still, I hope reminding them of that former glory will at least get someone to read the proposal. And once anyone with even the vaguest sense of marketability sees it, it will sell.

The median advance on a single book deal today is around $25,000. That’s more than I need to live on for an entire year.

So if a publisher manages to offer even a modest advance, I intend to stand down from teaching for at least a semester, and to farm out the editorial work to subcontractors. Even if it only takes a month or two to draft the Boob Book, I may need the time for rewrites; but it looks unlikely that an advance will get me out of enough work to let me give my undivided attention to the Boob project.

But…if a miracle happens and I can move the thing to the publisher within two or three months, then if I don’t teach and I farm out the editorial jobs, I’ll have another three or four months in which to get 20 existing bookoids online and to begin experimenting with sales of racy fiction.

It looks like a phenomenal amount of work. But around here, that’s nothing out of the ordinary. I already work any 18 hours of the day I choose, by and large for poverty-level wages. It would be mighty nice to work 18 hours of the day for something resembling a middle-class income.



Boob Book Progress

Despite a generally frenetic work, medical, and social schedule (last week something took me out of the house every single day!) and despite the start of a new Eng. 102 section, I’ve managed to make a fair amount of progress on each of the book projects in hand.

One of the appendices for the Boob Book, “How to Read a Scientific Paper,” is finished. With that and the introduction in hand, now all I need to do is write one reasonably substantial chapter and a prospectus, and I’ll be ready to start peddling the thing.

Which chapter remains to be seen. In the order of the draft chapter outline, the first chapter discusses DCIS vs. actual invasive cancer. The next goes into the considerations a woman needs to make when faced with the question of whether to do a lumpectomy (or repeated lumpectomies, which occur in about 48% of cases) or to elect a mastectomy.

However, in the chapter outline as it stands, the book does not go into the controversies over mammography and screening. This is pretty fierce stuff, and when you look hard at it, pretty disturbing. Because the push to screen all women — some circles would like to see girls having mammograms shortly after their first menstrual period — is so ubiquitously advertised, so harmful to so many women, and so controversial, I wonder if I should include some discussion of it.

I didn’t put that subject into the original draft outline because one of the book’s underlying assumptions is that the reader already has a diagnosis, and so the question of whether to subject herself to repeated mammograms is moot. The book is intended as a tool for women who have to cope with an existing diagnosis of DCIS or early-stage invasive breast cancer. So the whole pink ribbon flap is really beside the point.

What I’ve got as my first chapter is hardly the stuff of television documentaries. However, the chapter on reconstruction certainly is. If I skipped over the first several chapters and went straight to the one on deciding whether or not to have reconstruction, that would get an editor’s attention.

I have some seriously controversial things to say on the subject, which parallel Gayle Sulik’s observations about the money motives behind the pink ribbon movement. My line of thinking focuses on the profit centers that drive the pressure put on women to agree to implants and major surgery to create fake breasts.

It probably would make sense to do that: cut to the liveliest controversy. The table of contents will make the rest of the book’s direction clear.

There’s a lot of material here. I just need to get to work on it!

Research Blues…

Here we are, on the way to writing the Boob Book, swimming through dense swamps of academic research by way of compiling something to say and maybe even getting it right. Each new research report and serious news report points me in the direction of some other paper I really ought to read. The pile of print-outs now numbers about 800 pages…and counting.

Plowing through all this material, reading it carefully, and annotating it, I’ve reached page 701 and probably will get through another 50 pages today. But of course…this morning I stumbled across this little gem:

Rastelli, Antonella L., Marie E. Taylor, Feng Gao, Reina Armamento-Villareal, Shohreh Jamalabadi-Majidi, Nicola Napoli, and Matthew J. Ellis. “Vitamin D and Aromatase Inhibitor-Induced Musculoskeletal Symptoms (AIMSS): A Phase II, Double-Blind, Placebo-Controlled, Randomized Trial.” Breast Cancer Research and Treatment 129, no. 1 (August 2011): 107-116. doi 10.1007/s10549-011-1644-6.

Damn! A randomized study on a BIG topic and the thing is dated 2011! How the hell could I have missed this?

WhatEVER. I’ve got my sticky little hands on it now and will be reading it within the next day or two.

As dry as it sounds, I’m finding this stuff extremely interesting. It’s so fascinating, as a matter of fact, that once I’m launched on a study session, it can be difficult to tear myself away from it.

And it makes me regret that I was born 40 years too soon. I always loved the sciences and, as a little girl, craved to grow up to become an astrophysicist. Over time I came to find the life sciences more interesting. But come the 1960s, when I entered college, neither field was, shall we say, welcoming to female students. Oh well.

In any event, the project feels a lot like writing the dissertation, only considerably more engaging.

Reading the research on breast cancer, DCIS, breast cancer treatments, and the breast cancer industry can be surprisingly disturbing, too. I’ve found it’s wise to limit the number of hours spent working on this stuff to about four a day — otherwise, it can really ramp up the stress level.

As an example… One of the most startling revelations this little project has uncovered has been the very negative effects radiation therapy has when applied after the “immediate reconstruction” procedure that is widely hawked to women who have mastectomies. “Immediate reconstruction” entails inserting a saline or silicone implant under the chest muscles during the same surgery that removes the diseased breast.

If the woman has an invasive cancer, then even after a mastectomy she will be subjected to radiation treatment. (Many women who do not have invasive cancer end up with mastectomies: a large enough DCIS will do the trick, as well the presence of a mutated gene that hikes up your chance of developing breast cancer as high as 70%). But radiotherapy hugely increases complication rates when it’s done after cosmetic surgery (which is what “reconstruction” is, boys and girls). The unsightly and often painful results can lead to repeated new surgeries and extended misery.

Overall, if you think you’ll need radiation therapy — or if there’s even a chance that you will — you’re better off to wait on the reconstruction until after the radiotherapy is done.

I came across images illustrating said stark fact in a review of recent research, what we humanities PhD’s would call a “survey of the literature”:

Rozen, Warren M. and Mark W. Ashton. “Radiotherapy and Breast Reconstruction: Oncology, Cosmesis and Complications.” Gland Surgery 1, no. 2 (August 2013): n.p. http://www.glandsurgery.org/article/view/662/712.

Doctors don’t tell you this when they propose that you should undergo a mastectomy. When mine first suggested that she felt getting rid of the boob was the best course of action, in the same breath she said “but we can do an immediate reconstruction while you’re on the table.” As though everything would then be said and done.

Well. Not quite.

Nor was I told, during the eight months or so that we attempted to excise the criminal DCIS from my dainty little boob, that the radiotherapy they intended to subject me to after the lumpectomy could cause the scar to contract and hideously deform the breast they were trying so valiantly to save.

Actually, I was given a choice between going with lumpectomy, radiation, and aromatase inhibitors or having a mastectomy and being done with the whole effing ordeal. WonderSurgeon indeed had managed to excise the entity to fit the 2014 ASTRO/SSO guidelines. These say that “no ink on tumor” suffices and that wider margins of tumor-free tissue make no difference in survival rates. But she wasn’t buying the new guidelines and felt strongly that the better part of valor resides in wider margins.

Being the incurable skeptic that I am, every time the woman opened her mouth I resorted to my research tools. And yea verily: I easily found research studies that were just freaking NOT THAT OLD suggesting — convincingly! — that wider margins = better results.

After learning what radiotherapy can do to a gifted surgeon’s work of art, I am so glad we elected to go ahead with mastectomy. And…after learning how much can go awry with “reconstruction” — and how often — I’m also mighty glad I elected to go flat.

Even though I was assured that a mastectomy would mean no radiotherapy and no hormone therapy, something else was left unsaid: Naturally, the excised boob would be carefully studied by a pathologist, and if any invasive cancer showed up after all, none of the above would apply.

Obviously, it would be good if the Writer never had a dog in this particular fight. When you’re this close to it, reading the research surely can raise your blood pressure.

But…having lived the application of all that research, I’ll have plenty to say about it and what I have to say should be pretty lively. This is going to be a great book. Good reporters by their nature have high blood pressure. 😉