Hell and Back-a breast cancer story

Hell & Back is a memoir by pediatric ENT (ear, nose, throat) physician Tali Lando Aronoff, M.D. who finds her perfect life upended in ways she never imagined would happen to her.


The sorrows of death compassed me, and the pains of hell gat hold upon me: I found trouble and sorrow.


Psalm 116:3, KJV, public domain


Wife and mother

Just based on the title, you know this isn’t a happy story.

The main character, Tali, seems to have the perfect life. She is a pregnant young woman with a husband who adores her and two beautiful children. They have good jobs, a nice house, a nanny who is good with the kids. She has a loving and supportive extended family.

Then her father is diagnosed with an incurable brain tumor. She develops life threatening preeclampsia. She has an emergency caesarean section, delivering her baby prematurely.

Then she finds a lump in her breast. It is cancer- that has already spread.

Oh, did I tell you she is a physician with a busy surgical practice?

Hell & Back: Wife & Mother, Doctor & Patient, Dragon Slayer

by Tali Lando Aronoff, M.D.

Hell & Back is not a novel. It is a memoir by pediatric ENT (ear, nose, throat) physician Tali Lando Aronoff, M.D. who finds her perfect life upended in ways she never imagined would happen to her.

(By way of disclosure, I have never met Dr. Aronoff. After reading about her, I asked for a complimentary copy (PDF) of her book in exchange for a review. This blog post has affiliate links which will help fund this blog if a purchase is made. )

Doctor and patient

A physician’s illness can be awkward, both for us and for those who take care of us. Other doctors may assume we know more about our diseases than we do and fail to give us the same information they would give to “real” patients. We, on the other hand, often try to help them out by diagnosing ourselves, or minimizing our symptoms because we don’t want to bother them, or seem like complainers. Either approach impacts our care negatively.

But being a physician can be an advantage and it certainly was for Dr. Aronoff since she had friends who specialized in breast surgery, oncology (cancer), radiation therapy, and plastic surgery, all of which she would need. Recently out of training,  they had the most up to date knowledge in their fields. They helped her get to the right doctors, including getting appointments quickly.

But being a physician didn’t spare Dr. Aronoff pain from her mastectomy and the expanders (used to make room for eventual breast reconstruction). She still had to cope with  the debilitating side effects of chemo- fatigue, nausea,appetite loss, and hair loss- all the while caring for 3 small children.

A physician’s friends and family may assume that because we are healers, we are brave, strong, and can take care of ourselves. Dr. Aronoff found her closest friends understanding and supportive, and many went above and beyond, driving her to appointments, taking her kids to activities, and bringing meals.

“The naked truth”

When she lost her hair, she tried wearing wigs and found them uncomfortable so opted for scarves instead. This made her illness obvious, so when she went out in public people noticed her. She described becoming a “Synagogue Celebrity”, with people in her community posting sightings of her on Twitter because she “looked so good”.


“I smiled at praises..inside though, I was slipping, retreating into myself. But I didn’t dare let them see. With time and practice, I learned to navigate and embrace the dichotomy. I realized that projecting courage may not reveal the whole truth, but it’s not always a lie either.
Eventually, as the months passed, I regained my courage, I still had fight in me. So, I saved the naked truth for a handful of my trusted few.”

Daughter and doctor


Dr. Aronoff shared a poignant yet humorous moment celebrating Chanukah with her extended family while in the middle of chemotherapy that made her nauseated and weak.  She knew this would be the last time they would celebrate with her father, who had a terminal malignant brain tumor, so she made the 3 hour car trip to her parents’ home.


“In the glow of candlelight, I watched my father from the corner of my eye, burning his image onto my brain. I knew in my gut it would be the last year we’d celebrate together. We sang the ancient chant Hanerot Halalu about the miracle of the small jug of oil that burned for eight days. My family sure as hell needed some miracles these days too.”  

When the evening was over, they loaded the kids into the car for the long ride home.


“Alex (her husband) and I smiled at each other optimistically, anticipating a smooth ride back home with sleeping children. I hugged everyone goodbye and kissed my father lightly on the cheek. And just when I thought I was in the clear…(her daughter) Scarlett leaned over and vomited all over me!”


Who should read this book and why

Despite pieces of levity, this book is serious and hard hitting at times. Dr. Aronoff does not mince words, nor does she shy away from frank talk about intimate issues and raw emotions. If 4-letter words offend you, you may not want to read this book.

Dr. Aronoff’s book outlines the basics of diagnosis, staging, and treatment of breast cancer but I don’t think she intends it as a definitive patient guide. She does not imply that her experience is what other breast cancer patients should expect; rather she emphasizes that every patient’s journey may be different.

If you have had breast cancer, you may or may not identify with her experience. If you have not had cancer, her experience may motivate you to get a screening mammogram, explore your genetic risk, and consider what you can change in your lifestyle to decrease your  risk of getting breast cancer. (I’ll include some references for this at the end.)

“Dragon Slayer”

I won’t leave you hanging; this story has a happy ending. Dr. Aronoff is now disease free, and back working at her practice.She is a “survivor” but the threat of a recurrence will always loom over her. She may never know for sure if she is “cured”.

I invite you to visit her website to see photos of her before, during, and after treatment, and to read a sample chapter of her book.

Interlude-Women’s Cancer Stories

Dr. Eleonora Teplinsky talked to Dr. Aronoff for her podcast series Interlude. Listen to the interview at the above links.

Check out these breast cancer resources

Breast cancer screening

Understanding your breast cancer risk


Breast cancer is not exclusively a women’s disease, it happens to men also.

Risk factors for breast cancer in men

The Susan G. Komen Foundation offers this printable resource

Coping with a Breast Cancer Diagnosis


Informacion en espanol- Cáncer de mama

Shop To Fight Breast Cancer! Every Purchase Helps Give Free Hospital Mammograms To Women In Need!

(This post contains affiliate links which, by paying a commission if used for a purchase, help fund this blog. )

sharing the HEART of health

Again thanks to Dr. Aronoff for giving me her book and sharing her story with all of us. I think we all have learned something that might help us or someone we know.

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

To start following Watercress Words , use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn. Thanks so much.

                              Dr. Aletha 

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Mammograms-who, when, and why

breast cancer screening reminder-who needs it and when #BreastCancerAwarenessMonth

During Breast Cancer Awareness Month I want to remind you of physician recommendations for screening. Currently, the only test recommended for screening is mammography.

a woman having a mammogram done by a technician
image used courtesy of the Public Health Image Library, CDC

No other test has evidence that its use will decrease breast cancer deaths, although they may be useful for diagnosis in women who have breast symptoms.

These guidelines for screening  apply only to women at average risk of breast cancer, which is most women. They do not apply to women who have ever been diagnosed and/or treated for breast cancer, or to women who currently have symptoms related to their breasts, such as a lump, pain, discharge, or skin changes.

Guidelines for screening come chiefly from two organizations- The American Cancer Society (ACS) and the United States Preventive Services Task Force (USPSTF). Other organizations such as the American Academy of Family Physicians (AAFP) , of which I am a member, usually follow their recommendations .

 guidelines from the ACS

  • Offer annual screening to women age 40 to 44 years.
  • Perform a mammogram annually in women 45 to 54 years.
  • Perform a mammogram annually or every other year starting at age 55 years.
  • Continue screen mammography as long as a woman’s overall health is good, with a life expectancy of 10 years or longer.
  • Routine breast exams by either the patient  or a physician are not recommended.

 guidelines from the U.S. Preventive Services Task Force (USPSTF)  

  • For ages 40-49 years, individualize the decision to screen every 2 years
  • For ages 50-74 years, screen every 2 years
  • For ages 75 years and older there is no recommendation.

Both organizations recommend that physicians discuss the decision to screen or not to screen with patients and base the decision after considering possible harms versus potential benefit.These are guidelines for physicians to apply to each individual patient, not hard and fast rules.

a mammogram image
a mammogram revealing a breast cancer image source- National Library of Medicine, Open-i

Screening guidelines  are not used for high risk women- women with 

  • a history of previous breast cancer or ovarian cancer
  • a suspected or confirmed genetic mutation , BRCA, known to increase breast cancer risk
  • a history of radiation to the chest
  • a close family history of breast history, usually meaning parent, sibling, child, grandparent, aunt/uncle, or first cousin.

Breast cancer in young women can be hereditary.
graphic courtesy of the CDC, U.S. Department of Health and Human Services

Screening guidelines also do not apply to women with breast symptoms suggestive of cancer.

  • a lump in the breast or axilla (armpit)
  • pain, especially in only one breast
  • nipple discharge
  • persistent rash or skin changes over the breast

These women need appropriate diagnostic testing which might include

  • mammography,
  • ultrasound,
  • MRI, 
  • biopsy. 

Here are sources for more information

Breast Cancer

“Both women and men can get breast cancer, though it is much more common in women. Other than skin cancer, breast cancer is the most common cancer among women in the United States.”

Mammography 

“You should talk to your doctor about the benefits and drawbacks of mammograms. Together, you can decide when to start and how often to have a mammogram.”

Screening Guidelines

“Mammograms are not perfect tests. They can miss some cancers, and they can find lesions that may look like cancers but are not actually cancers (false-positive results), resulting in additional testing and procedures. They can also find very low-risk cancers that would never have caused any health problems if they were never found or treated (overdiagnosis).”

Breast cancer screening benefits and harms 

“Each woman also has different personal values, especially toward the idea of unnecessary medical tests and treatments.

Talk to your doctor if you are younger than 50 years and have questions about whether you should get a mammogram.”

 

 

 

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When should a woman have a mammogram?

You may have heard that the American Cancer Society (ACS) has published new guidelines on breast cancer screening. The last guidelines are 12 years old so it is time for an update based on current understanding of the value versus the risk of breast cancer screening.

According to the report published in JAMA, screening mammograms can reduce deaths from breast cancer. Breast exams done routinely do not decrease mortality.

These guidelines apply only to women at average risk of breast cancer, which is most women.

They are not used for high risk women- women with 

  • a history of previous breast cancer
  • a suspected or confirmed genetic mutation known to increase breast cancer risk
  • a history of radiation to the chest
  • a close family history of breast history, usually meaning parent, sibling, grandparent, aunt/uncle, or cousin.

Screening guidelines also do not apply to women with breast symptoms suggestive of cancer.These women need appropriate diagnostic testing which might include mammography, ultrasound, MRI, and/or biopsy. 

woman having a mammogram
photo from Medline, National Library of Medicine

In summary, here are the new guidelines from the ACS-

  • Offer annual screening to women age 40 to 44 years.
  • Perform a mammogram annually in women 45 to 54 years.
  • Perform a mammogram annually or every other year starting at age 55 years.
  • Continue screen mammography as long as a woman’s overall health is good, with a life expectancy of 10 years or longer.
  • Routine breast exams by either the patient  or a physician are not recommended.

These are guidelines for physicians to apply to each individual patient, not hard and fast rules. Some physicians may choose to follow the guidelines of the U.S. Preventive Services Task Force (USPSTF)  

  • For ages 40-49 years, individualize the decision to screen every 2 years
  • For ages 50-74 years, screen every 2 years
  • For ages 75 years and older there is no recommendation.

Both organizations recommend that physicians discuss the decision to screen or not to screen with patients and base the decision after considering possible harms versus potential benefit.

And while breast cancer is the second leading cause of cancer death among women in the United States, it is treatable and the chance of long term survival is high.

Here are sources for more information

Breast Cancer

Mammography 

Screening Guidelines

Breast cancer screening benefits and harms