Torta di Mele - Apple Cake

Once again this fall, Mark and I are volunteering to cook a meal for 65 - 70 of our dear friends on Wednesday nights. Our church has something called "Midweek Connections" that is full of classes & activities for all ages. Families are able to come straight from work for a meal and the evening ends with a short service (unless you stay for choir). We are always asked to share our recipes so I thought, "Why not Blog about it?".

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September 14, 2011

Turkey Meatloaf with Feta and Sun-Dried Tomatoes

Ina Garten's Meatloaf

Souperior Meatloaf

(recipe on the back of Lipton's Beefy Onion Soup mix,

substitute cooked quinoa for bread crumbs)

Hash Brown Potato Casserole

Green Beans Provencal

Cucumber Salad

Torta de Mele (apple cake) with Creme Anglais

Texas Pecan Pie Bars

Brownies (Ghiradelli mix - the best!)

When our girls were little, we would occasionally have a backwards meal with dessert first. So, since I've already posted about the Texas Pecan Pie Bars, I decided the Apple Cake, or in Italian - Torta di Mele would be next.

If I had to choose something for the last meal of my life, this cake would be at the top of the list. It is my future son-in-law's favorite and everyone else I've made it for raves about it. The first time I had Torta di Mele was in a little restaurant named Trattoria Pallotta, in Assisi Italy.

Tip to eating in Italy - eat where the locals eat. This is one of those places. They had a tourist menu where you get your choice between 1 of 2 appetizers, 1 of 2 Main Courses, and 1 of 2 Desserts. For dessert, Mark and our 2 friends chose the fruit & cheese plate. The Torta de Mele sounded too good to pass up, so I went with that. Good choice, GOOD CHOICE!! I rarely take photos of food I order in a restaurant but when this was brought to the table, still warm from the oven, I whipped out my camera:

"Puoi darmi la ricetta per favore?"

Each bite just melted in my mouth it was so moist. The flavor was not too sweet, and the texture was light and airy. I HAD to have the recipe! My gourmet friend Patty has been known to ask the chef of a restaurant to share their secrets, but I never had the courage, until that moment. We lived in Milano, Italy from '92-'94 so I knew some Italian. It had been 12 years and I was a bit rusty but all of a sudden the word "ricetta" - recipe, came to my head. When the waitress returned, I pointed at the plate and butchered together some kind of a sentence as politely as I could. She nodded and headed towards the kitchen. She came back smiling, with a scrap of paper in her hand. "Grazie, molto grazie, per favore grazie alla chef", I thanked her over and over again. I hoped she understood. This is what was on the paper:

TORTA di MELE 

180 C, per 35 - 45 minuti

4 uovi

2 etti di burro

3 etti di farina

3 etti di zucchero

succo - 1/2 limone

succo - 1/2 arancia

2-3 mele

una bustina Lievito dolce

This can be found at Amazon in a package of 10,

but I have started using baking powder instead.

Notice anything:

1. The directions are missing
2. NO mention of what size pan to use
3. Italian measurements (1 etti = 100 grams)
4. and yes, it's in Italian. At least that was easy because I was used to that.

Here is what I came up with:

Apple Cake

• 4 eggs
• 14 T. butter - room temperature
• 300 grams flour (about 2 cups)
• 300 grams sugar (1 1/3 cups + 1 teaspoon)
• Juice of 1/2 a large lemon (or all juice from a small lemon)
• Juice of 1/2 a large orange (or all juice from a medium orange)
• 2 large Braeburn apples (or 3 medium)
• 2 t. baking powder (or 1 pkg of Italian sweet leavening if you can find it - see above)

Pre-heat oven to 355 degrees (F). Grease and flour a 10" round cake pan.

1. Cream together the butter and the sugar:

2. Add in the eggs, blending after each one:

3. Blend the flour and the baking powder (or leavening packet) together. Italian flour is different than American flour. Once I've weighed the flour, I sift it 2 or 3 times. Slowly add to the batter until it is blended in:

4. Peel and chop the apples. I like to have a mixture of coarsely and finely chopped pieces. Mix the lemon and orange juice into the chopped apples. Fold into the batter until well mixed:

5. Pour into prepared pan:

6. Bake for at least 45 minutes or until golden brown and an inserted toothpick comes out clean. The first time I made this I set the timer for 35 minutes and it was far from done. I kept adding 5 minutes at a time until finely at an hour, it was ready. Sometimes it is done in 50 minutes, I think it depends upon the amount of apples you use. Let cool for 10 minutes and remove from pan:

The cake is at its best when served warm, but tastes great no matter what the temperature. I have served this with a warm butter sauce, but I think it was served in the restaurant with Creme Anglaise. One option is to spoon either sauce over the cake and then sprinkle with powdered sugar.

Creme Anglais 

Ingredients

• 1 cup heavy cream
• 2 teaspoons vanilla extract
• 4 egg yolks
• 1/3 cup white sugar

Directions

1. Whisk together egg yolks and sugar until smooth.
2. In a small saucepan, whisk cream and vanilla together over medium heat until you see bubbles forming at the edges.
3. Remove from heat and, slowly whisk 1/2 cup of hot liquid into the egg mixture.
4. Gradually add egg yolk mixture back to remaining cream mixture, whisking constantly.
5. Continue to cook, stirring constantly, until the mixture coats the back of a spoon.

I fell in love with Assisi and it wasn't just because of the Apple Cake. When we visited 5 years ago, it was late fall. The skies were so blue and the air was so crisp. Most cities in Italy are a bit on the grungy side, but not Assisi. It was stunningly beautiful. I found some of the pictures and thought I would share them with you. Hope you enjoy. But first one more look at the cake I made today. By the way, I bought the plate it is sitting on in Deruta - a little town just outside of Assisi. I could spend a week there shopping for ceramics ... but that is another post entirely!

Also posted on:

Purple Wedding Invitations

A year ago, my youngest daughter and I were in the middle of a whirlwind of wedding planning. Her fiance is in the Army and was stationed in Italy, but deployed to Afghanistan. They wanted to get married during the time off he had after deployment, but the timing of that was uncertain (and we didn't want to lose deposits if things changed). Finally, we had a date - and 4 months to put it together! It was a crazy, but fun-filled time and we did it. (Even though I was still putting zippers into Bridesmaid dresses the morning of the big day!!)

We did everything ourselves except the cake, the BBQ dinner, and the bridal bouquet. Our oldest daughter is getting married in May so I am starting all over again. It brought to mind the invitations we made for Kelly's wedding - 250 of them!! I'm sharing pictures of them now, and will post a tutorial in the near future. By the way, can you guess what her favorite color is?? Hope you like them!!

King Ranch Casserole - Project Pastry Queen

I was so excited to see that King Ranch Casserole was this week's Project Pastry Queen recipe. It is one of my favorites, true comfort food. Even though I grew up in Texas, I never had it as a child since my Dad did not like cheese. (Yes, we had lots of meat and potatoes!). Its namesake, The King Ranch is a National Historic Landmark in South Texas that began in the 1860's. Today, it covers 825,000 acres which is larger than the state of Rhode Island! The ranch does not lay claim to this popular dish, and the history is kind of muddy. This makes sense, because what are ranches in Texas famous for? Ask Oprah ... BEEF!

The basic recipe helped to sell our house back in 1996. It had been on the market for months, and every time a realtor wanted to show it our family was asked to leave. When a realtor called one afternoon, asking to show the house again, I was in the middle of making this casserole for dinner. I told him to bring them over, but we were going to be there. Guess what? They bought the house. The reason? When they saw me cooking in the kitchen, it made them feel at home. They could envision their family living there. What do realtors know??!!

Every recipe I have made (or seen) calls for using cans of cream of mushroom and/or cream of chicken soup. Using a rotisserie chicken makes it that much easier. The Pastry Queen recipe calls for stewing your own chicken, making your own stock and ... NO CANS OF SOUP! I was up for the challenge. Fair warning: If you make everything from scratch, this recipe is time consuming, plan accordingly. 

I have never roasted a poblano chile before, that was the first step. Next time I will roast them till they're a bit blacker. When preparing the chicken and the stock, I wanted more flavor. I added some garlic, onions and bay leaves to the water. I made this the day ahead since it is easier to handle the chicken when it is cool. I discarded the fat from the chicken broth to make the dish a "little" healthier.

The cream sauce is made by sauteing onions, peppers, mushrooms and garlic in butter. Stir in some chili powder and cayenne pepper. Add flour to thicken the sauce and whisk in chicken stock and then some cream. Finally stir in the diced roasted poblano chiles and add a can of Rotel tomatoes. The cream sauce should be thick.

Construct the casserole like a lasagna, substituting corn tortillas for the noodles. Layer tortillas, half the sauce, half the chicken and 1/3 of the cheese, repeat. Finish off with one more layer of tortillas and the rest of the cheese.

The recipe calls for using 18 tortillas and making it in a 9" x 13" casserole dish. I had enough chicken and sauce to make it in my 10" x 15" baking dish and I used 24 tortillas. I served this with a mixed salad with "Ranch" dressing and black beans, but you could do refried beans if you prefer.

This casserole was amazing!!! Next time I will try using a rotisserie chicken to speed things up but I will never go back to the canned soup version again! Jody has the complete recipe at Savory to Sweet. Be sure and check out other versions at Pink Parsley, A Gilt Nutmeg, and Homekeeping Adventures.

My Breast Cancer Story - Part IV

(. . . You can find Part III here)

Over 182,000 women were diagnosed with Breast Cancer in 2008 and over 182,000 stories could be told. This is just one of those stories.

After passing my Chemo 101 class, I got my first infusion on January 20, 2009. Highlights of the day:

• My BFF Glenda drove me and stayed through the morning.
• The nurses and technicians in the infusion room were wonderful.
• I did not have an allergic reaction to the poison drugs of choice.
• Husband Mark brought me my favorite lunch. 

The surprise of the day came that afternoon when I awoke from a nap to hear a nurse say, "Alice? She's right over here". I looked up and saw a stranger, but when she said "Hi", I recognized my friend Dolise. We had only previously talked by phone - she was a former patient of Dr. Spiegel's and had become my mentor when I was deciding upon the DIEP Reconstruction. She had brought me a care package filled with goodies - I couldn't believe it. Shortly after she left, it happened again. This time it was Laura, another Dr. Spiegel phone/mentor friend & angel - she too had brought a care package! (I learned that's the kind of thing cancer sisters do for one another.) How wonderful to finally meet them in person. The day that I had been dreading had been turned upside down. Before I knew it, my friend Kay arrived to drive me home and I left the infusion room that day feeling like a queen, and very blessed.

Me, Dolise & Laura

I treated them to brunch a week after my first chemo!

After I found the cyst on October 1st, I was not allowed to exercise.  

• First there was the fear the cyst would rupture, 
• Second there was 6 weeks of recovery after the hysterectomy/lumpectomy
• Third, 6 more weeks of recovery after the mastectomy/reconstruction. 

Before Christmas, January 21st was my "Exercise Release" date from Dr. Spiegel and I had been looking forward to a run. With the change in my treatment plan, I was not about to let getting chemo the day before stand in my way. Karen, my friend and running coach, told me about a new running class - it started the 21st - perfect. I knew about the positive effects of exercise for those going through chemo. plus I looked at this as the first step in regaining control of my life. I took it easy, doing some of the warm-up and then managed 1-1/2 SLOW miles around the track. It felt free and liberating!

The second day after each treatment was always the worst, I called it Puny Thursday. Thank goodness for the advancements made in nausea medication however, because I never had to hug the toilet. I just had no appetite and a queasy feeling that lasted for 36 - 48 hours. The first Friday afternoon I felt good enough to go on a 12 mile bike ride. For the rest of the 2 1/2 weeks of recovery, things went back to normal as I waited for treatment #2.

This was taken on Puny Thursday #4.

My cats, Benjamin(striped) and Franklin(black) would not leave my side.

I believe they could sense something was different on those days.

I stayed in bed a lot on Puny Thursdays.

It didn't take long to settle into a routine. My treatments consisted of:

• Week 1: Taxotere, Carboplatin, Herceptin, Neulasta shot
• Week 2: Herceptin only
• Week 3: Herceptin only
• Repeat for a total of 6 times/18 weeks
• At the end of 18 weeks, a triple dose of Herceptin every third week for the rest of the year

The side effects for Herceptin, my miracle drug, were minimal. Mostly I felt as if I was coming down with a cold. It is a monoclonal antibody that targets only the cancer cells, unlike standard chemo which targets all fast growing cells. So after 18 weeks when I only had infusions of Herceptin, my hair started growing back. There is a small chance for cardiotoxicity and I had to have a MUGA scan every 3 months to monitor my heart.

I've been blessed with a full head of hair so the thinning wasn't too noticeable until after TCH treatment #2. By week #4, what was left of it (not much) 
needed to go and I had already arranged for James, a very good friend to come by the house to do the shaving honors. Mark wanted to join me in solidarity but I said no. I could avoid a mirror if I wanted to, but every time I looked at his bald head it would be a reminder I did not need.

Thanks James!

Wig shopping and trying to look happy

James thought I would have a good cry after he left, but I didn't. Maybe it was because my pity party over the hair loss had already come and gone. I think the Pollyanna in me was returning because I kept reminding myself of all the money I was going to save on haircuts and shampoo. Also, showering & getting ready in the morning was so much faster!!

Treatments #2 and #3 came and went and the nausea was just slightly worse. The fatigue however, lingered longer each time. As the weeks went by, a horrible taste developed in my mouth. I would have to rinse with a salt solution before I ate. I'm blessed with a husband who loves to cook. Mark did his best to make things that were healthy and delicious. I felt bad when he worked all day, came home and cooked dinner, and then I had no appetite or nothing tasted right. HE WAS MY ROCK!! (love you honey!!)

Shortly after my fourth treatment on the last day of March, I got a call from my brother in Houston. Our 88 year old Dad had a stroke and he could no longer swallow. We made the decision to call in hospice. At the end of February I had gone there to help move him into a nursing home. His Parkinson's had progressed to the point where his caregiver could no longer take care of him at his home of 46 years. He passed away a few days later after the family was able to say goodbye. Dad knew about my cancer, but I never told him about the chemotherapy. I didn't want him to worry. I still miss his laugh and his twinkling eyes. He was my Hero.

One of the last pictures I took of my Dad, March 2009

My fifth treatment was 10 days later. The stress of losing my father combined with a bad sinus infection made this one the worst so far. There was no gradual increase in the symptoms, it was like they tripled. The reason they give you the BIG drugs once every 3 weeks is to give your body time to recover. Well, #5 took the full 3 weeks.

May 5th was the sixth and last treatment and I was dreading it. I woke up that morning thinking, "Okay, let's just get this over with." The fifth one had been awful and I was expecting this one to be worse. I even asked Dr. Kampe if he could just put me in an induced coma for the next 3 weeks. Nope, not possible! I longed for it to all be over, for life to get back to normal. Yet, it was hard to remember what normal felt like. In the infusion room, the routine began again as the nurse accessed my port for the IV. The chemicals started dripping into my veins. I thought of the Danskin Triathlon coming up in a month and had to chuckle. I remembered how "excited" I was the previous fall to become a survivor so that I could start right after the Elite Athletes this year! Back in January I had high hopes: My plan was to train for my 4th Danskin while going through Chemo. It turned out to be wishful thinking.

To pass the time, I got out my laptop to check my email. Going through my inbox I noticed one with "Mamma Jamma Ride" as the subject from Team Survivor. As I started reading it, the dread I felt when I woke up that morning was quickly being replaced with hope:

• There was going to be a new bike ride in town (hmm, I love to bike!)
• The Texas Mamma Jamma Ride (clever name, I like it!)
• Team Survivor was one of the beneficiaries (great, they could grow and reach more women!)
• Breast Cancer Resource Center is one of 9 other beneficiaries (oh my gosh, this is a way I can Pay it Forward to thank them for the support they have given me!!)
• The ride date was October 10th!! (I can do this! I thought it might be next month but it's not. I CAN DO THIS!! I'll have time to get back in shape!!)
• Oh, there's a website already, I wonder what the ride distances are? (13, 27, 45 - doable, 70 - hmmm, 100 - wow, could I??)

I was so EXCITED!! I told every nurse that checked on me all about it. I called Mark to tell him to put it on his calendar. All of a sudden, I wasn't thinking about the 3 weeks of side effects that lay ahead, I was seeing the light at the end of the tunnel. I had a new goal to look forward to. My mood brightened and I was feeling better. Little did I know I then, but I had found a new passion for my life. Oh, and by the way, treatment #6 was easy - compared to #5 that is!! My new frame mind made all the difference...

As a way to pay it forward for those who have breast cancer right now but don't know it, please help me raise much needed funds for cancer services. You can visit my donation page here:

http://fundraisers.mammajammaride.org/alicemueller2016

... Part V continued here "The Light at the End of the Tunnel"

My Breast Cancer Story - Part III

(. . . You can find Part II here)

Over 182,000 women were diagnosed with Breast Cancer in 2008 and
over 182,000 stories could be told. This is just one of those stories.

I sat in silence as Dr. Kampe talked to me about chemotherapy because I was in complete shock. I was barely processing what I heard. "Wait a minute" I thought, "How can this be??  My mind started racing ... the tumor was only 3/4 of an inch ... no cancer in any lymph nodes." I pointed out where the pathology report said the results were a positive outcome and told him the breast surgeon said I would not need chemo.

"Oh dear, I've never seen THIS before, they really got this one wrong", he said as kindly as he could. "HER2+ is a very agressive type of breast cancer."

The plan was to double check the pathology report (maybe I was really HER2-) and send a tissue sample for the Oncotype DX Test. I tried to absorb it all, but this was like an out of body experience. Dr. Kampe recalculated my 'statistics'. When I arrived at his office that morning, I thought my chance of recurrence had been 2%, now it was 33% - IF I did nothing further. Chemotherapy and Herceptin would cut that in half to 17% and hormone therapy would lower it even further to 9%, or in other words - 91% odds of a 5 year survival. The choice was clear.

I know 91% is a great number, I know there are thousands of women lined up to trade with me. All I could hear in my head were the first numbers I was given by the radiologist before my biopsy (90% of the time calcifications like mine were "nothing"). That didn't turn out so good, I was in the 10% category then, why wouldn't it happen again? This time the Pollyanna in me was nowhere to be found.

It was hard telling my family (they were all home for Christmas). There were tears and lots of hugs. I had a 2 day personal pity party as I thought about the events ahead of me:

• "I'm going to be bald for my nephew's wedding" 
• "I'm going to be bald for my High School Reunion"
• "I'm going to be hugging the toilet"
  

then the real thing to be worried about ... 

•  "I'm going to have poisons put in my body"

Instead of things coming to an end as planned, I was heading deeper into Cancerworld: cat scans, bone scans, MUGA scans, a port-a-catheter and Chemo Class 101. There was also more reading to do. You see when I checked out all the books from the Breast Cancer Resource Center in the fall, I skipped over the chapters on Invasive Tumors, Chemo Side Effects, HER2+ (Human Epidermal growth factor Receptor) and my treatment drugs of choice TCH - Taxotere, Carboplatin & Herceptin.

When it came to researching HER2+, I learned to be careful and look at the date of what I read. Anything earlier than 2006 said the same thing:

". . . more aggressive disease, greater likelihood of recurrence, poorer patient prognosis, and decreased survival compared to women with HER2-negative breast cancer"

Scary stuff, but more recent literature revealed that Herceptin had turned that diagnosis upside down. The best thing I read was a book written by Robert Bazell, HER-2: The Making of Herceptin, a Revolutionary Treatment for Breast Cancer. According to a review of the book by the Journal of the National Cancer of Institute:

"Bazell makes it clear from the beginning that Herceptin's story includes the realities of breast cancer patients and the activists who support them, without whom this drug would have landed in the proverbial dust bin of history. His unvarnished account of Herceptin's development discloses the issues every American should understand as they try to grapple with the question of what is taking so long."

So here I was, reading about a drug that could save my life, and I learned it's development was a series of dumb luck coincidences - like finding a needle in 1000 haystacks. Then, Herceptin almost didn't make it through clinical trials. It's development had stalled until 1989, when the mother of a senior Genentech VP was diagnosed with breast cancer. Miraculously, the go ahead was given and it still took until 1992 for the first clinical trial to begin. 

Words can't describe how I felt. My wonder drug 

might have been delayed, or never even produced at all.

I highly recommend reading this. Here's more from an Amazon book review:

"...throughout there are the stories of the heroic women with advanced breast cancer who volunteered for the trials, risking what time they had left on an unproven treatment. Two years after she underwent a mastectomy and chemotherapy, Barbara Bradfield's aggressive breast cancer had recurred and spread to her lungs. The outlook was grim. Then she took part in Genentech's clinical trials for a new drug."

Okay, I'm a crier. I cried when I read the book, I cry every time I watch Living Proof - the movie they made about the book, I'm crying now as I write this. I'm happy to tell you that Barbara Bradfield is still alive today, and disease free. No one else in that initial trial survived, that's how sick they were. But it is thought because her cancer had such high HER2 levels, the Herceptin responded. Remember that Oncotype DX test I mentioned earlier? My results came back and the HER2 levels were off the charts. My oncologist believes that indicates my cancer will respond to Herceptin just like it did for Barbara.

I have played the "what-if" game about when my cancer was found - partly due to my negligience in getting a mammogram. (see Part I). When I learned about the timeline of the FDA approval for Herceptin, I was blown away:

• 1992 - Phase I clinical trials began
• 1998 - FDA approval of Herceptin for metastatic, HER2+ breast cancer
• December 2000 - Enrollment of two Phase III clinical trials for the adjuvant treatment of early-stage HER2+, lymph node positive
• November 2006 - FDA approval of Herceptin for early-stage HER2+, node positive breast cancer
• January 2008 -  FDA approval of Herceptin for early-stage HER2+,  node negative breast cancer (MINE!), in conjunction with harsh chemotherapy drug Adriamycin associated with cardiotoxicity (also known as the red devil)
• May 2008 - FDA approval of Herceptin for early-stage HER2+, node positive and node negative breast cancer in conjunction with a less cadiotoxic chemotherapy regimen of TCH .................. MY CANCER TREATMENT
• By October 2008, the 10 year anniversary of the first FDA approval, more than 420,000 women with HER2+ breast cancer have been treated with Herceptin worldwide. 
  

It took almost 30 years from the time Robert Weinberg first identified
 the HER2 gene in 1979 to the time Herceptin was approved by the FDA
for my specific cancer - barely one year before I would need it.

What if I had my mammogram 3 years earlier (when I was supposed to), and they had found my cancer then, I would not have been given Herceptin, and I believe my cancer would have metastasized without it.

I met Sheila on the Her2 Forum. Her cancer story stood out because we were about the same age when diagnosed - and our tumors were similar in type - but hers was smaller and found in 2002. Her treatment was surgery only; her cancer was caught early, she was lucky. Less than 18 months later, it had metastisized. For the last 8 years she has gone through at least 7 different treatments. When one becomes ineffective, she begins a new one. She is one of the bravest woman I know ... this could have been me ... what-if. (UPDATE: I'm sad to say that my friend Sheila passed away in December 2012. I miss her deeply. You can find more of her story here.)

What if I had procrastinated for another year, or 2, or 3? Would I be here today? Perhaps, but I think I'd be facing a different prognosis. PLEASE, please, get your mammograms annually and do self-exams in between. 1 in 8 women will get this dreaded disease in their lifetime. The odds of survival are great if it is found early. BREAST CANCER IS NOT A DEATH SENTENCE ANY MORE, BUT LEFT UNTREATED IT IS ALWAYS FATAL.

Herceptin is my wonder drug. If it weren't for the scientists who worked so hard to persevere, and if it weren't for the brave women who went through clinical trials I believe I would have metastatic disease right now and would be facing a completely different outcome. I like to think that cancer has changed me for the better. First though, I had to get through chemotherapy...

"Be kinder than necessary, for everyone you meet

is fighting some kind of battle."
...Sheila's favorite quote - and now mine. 

As a way to pay it forward for those who have breast cancer right now but don't know it, please help me raise much needed funds for cancer services. You can visit my donation page here:

http://fundraisers.mammajammaride.org/alicemueller2016

...Part IV continued here "My Chemo Cocktail"


 

My Breast Cancer Story - Part II

(. . . You can find Part I here.)

Over 182,000 women were diagnosed with Breast Cancer in 2008 and over 182,000 stories could be told. This is just one of those stories.

My quiet life was about to become one of doctor appointments, paperwork, blood tests, and screenings. I had 15 appointments and saw 3 new doctors in the first month alone.

Everybody's Cancerworld is different depending upon your diagnosis. The worst breast cancers have already metastasized before they are found. I was fortunate; mine was Stage 0, non-invasive, and my oncologist gave me an excellent prognosis. Grateful doesn't begin to describe the fact that I had 2 treatment choices and neither involved chemo:

1. a lumpectomy followed by radiation,
2. a mastectomy

I researched my options, got first and second opinions and decided on the lumpectomy. Two weeks before my surgery, a complication arose. On a visit to my OB/GYN, an ultrasound found a suspicious cyst the size of a grapefruit on one of my ovaries. Quickly, a hysterectomy was added to the scheduled lumpectomy -  giving me two surgeries for the price of one. Any cancer is scary, but the thought of ovarian cancer was frightening.

I knew going into the operating room I'd be in recovery by 4:00 - if all went well. If the cyst turned out to be cancerous, it would be closer to 6:00 because lymph nodes would need to be removed. Coming out of the fog of anesthesia I glanced at the nurse's watch -- it was 6:30 -- my heart sank and my fear rose. My husband Mark and my friend Susie were waiting for me after I left recovery. 

• Upon seeing them I sighed and said, "I guess I've got the BIG 'C'." 
• "What are you talking about" Susie said, "It's not cancerous!!".  Surgery ran long because the cyst was fused to my bladder and they had to call in a urologist. It wasn't even attached to my ovary! Oh...that's why I have a catheter.

 Two days later, the surgeon gave me more good news/bad news:

• Good news - final tests confirmed there was NO ovarian cancer.
• Bad news - only 1 of the 6 margins from the lumpectomy was cancer free. I would now need a mastectomy. 

My reaction? WHO CARES if I have to lose another body part, I DIDN'T HAVE OVARIAN CANCER!! I was ready to celebrate!

Now I had to make a decision about reconstruction. Implants weren't for me, and I did not want the TRAM or LAT flap surgery that involved sacrificing my abdominal or shoulder muscles. Nothing set well with me until I learned about a new procedure called DIEP Flap reconstruction. The surgery was relatively new & complicated - it involved microsurgery and required a skilled surgeon. But, it was less invasive than other options. I held my breath as I scanned the list of recommended plastic surgeons:

• Austin - no
• Houston - YES! ... Dr. Aldona Spiegel. She was highly qualified...     (700 DIEP surgeries to date), 3 hours away, I had family there.

DIEP (Deep Inferior Epigastric artery Perforator) Flap Procedure

With this decision came more blood work, x-rays, a cardiologist appointment, a stress test, an echo cardiogram, and several trips to Houston. Unfortunately, Dr. Spiegel didn't have an opening until March and my breast surgeon recommended the mastectomy sooner than later. When her nurse said there had been a cancellation I grabbed the date: December 11th, two weeks before Christmas. The mastectomy would immediately be followed by the reconstruction. Another 2 for 1 BONUS!

Over Thanksgiving, I had a lot to be thankful for but I felt guilty when it came to my cancer story. I was about to get rid of the belly fat from 3 pregnancies in a 'paid for' tummy tuck-like operation AND get 2 new, perky "girls"; without having to go through the trauma of chemotherapy and radiation. Most are not so lucky, it didn't seem fair.

The surgery lasted 6 hours and I spent 36 hours in ICU. Actually, my left breast spent 36 hours in ICU and the rest of my body went along for the ride. They needed to monitor the 'flap' every hour for proper blood supply. I was able to get out of bed and walk the halls the next day - bent over. After 4 days I left the hospital and stayed with family (sleeping in a recliner). December 18th my drains came out and we drove back to Austin.

Doppler wire inserted into the reconstruction site

to monitor the blood flow in my new breast.

All goals were met, I can leave the hospital!

Christmas that year was wonderful! All 3 girls were home and there was not the typical hustle and bustle. For the first time EVER, all presents had been bought and wrapped before my surgery. We had time to eat, watch movies, eat, play games, eat, put together puzzles, and eat some more!

Christmas Eve 2008

Two weeks after surgery

The pathology report from the mastectomy was supposed to be available before I went home to Austin. On December 21st, I still had no news so I called the doctor's office in Houston. I was told the report was in and he would be calling soon. Christmas came and still no word. The phone rang on December 26th and it was Dr. Baker. I could hear kids in the background and learned that he and his family were driving to Missouri. He was making a special call on his own time to give me some good news and bad news. 

• Bad News - they had found a SURPRISE 2 cm. invasive tumor in the breast tissue they removed. In a moment I had gone from Stage 0 to within 0.001 cm shy of being Stage 2.
• Good News - I was ER+, PR+ and HER2+. According to the report, all positive outcomes meaning still no chemo. The doctor had given me a special gift, that of a worry free Christmas. 

The day before New Year's Eve I went by myself to see my oncologist. After the usual hello's, he dropped a bombshell. 

"Looks like we'll be adding chemotherapy to your treatment after all". 

It turned out there was a major mistake on the pathology report. Being HER2 positive does NOT have a positive outcome. It doubles the chances of a recurrence because of its aggressive nature. Without chemotherapy, there was a 1 in 3 chance that my cancer would return as a distant recurrence ... as Stage IV ... meaning it might spread to my lungs, liver, brain, or bones ... there is no Stage V. This was the one time I should not have gone to my appointment alone...I cried the whole drive home. I would soon read many sentences that had "HER2" & "poor patient prognosis" in the same sentence...

As a way to pay it forward for those who have breast cancer right now but don't know it, please help me raise much needed funds for cancer services. You can visit my donation page here:

http://fundraisers.mammajammaride.org/alicemueller2016

...Part III continued here "Herceptin, My Wonder Drug"