The fight of her life

Posted on 08 Oct 2009 at 8:35pm
By David Taffet | Staff Writer taffet@dallasvoice.com

Friends, family and a focus on the future help Dallas attorney Barbara Rosenberg deal with breast cancers

SETTING A GOAL | Barbara Rosenberg was determined to recover from surgery in time to attend the Democratic National Convention held in Denver in August, 2008. Once tghere, she was chosen to introduce Sen. Hillary Clinton at a meeting of the Clinton delegates. (Courtesy Barbara Rosenberg)

Barbara Rosenberg was used to political battles.

After Gov. Ann Richards appointed her justice on the Dallas Court of Appeals in 1992, she fought for re-election and defeated Judge Jack Hampton. But in her 1994 race, she was defeated by Joseph Devany, who lied about his age to qualify to run and was later removed from office.

She served as a visiting judge from 1999 to 2003, and today she is appellate coordinator for the Dallas city attorney’s office — so politics remain a big part of her life.

But in 2001, Rosenberg began a different sort of battle — one that she couldn’t afford to lose.

“I always got my mammograms regularly,” said Rosenberg.

During one routine exam, her gynecologist felt something different.

“It was not a lump,” she said. “It was like a line. He said, ‘This is a little odd. I’m going to send you for a diagnostic mammogram.’”

Diagnostic mammograms differ from screening mammograms in that they look in one area for something specific. When that test proved inconclusive, Rosenberg had a sonogram that found something deep, near the chest cavity.

Sandy Horwitz, Rosenberg’s partner, is a nurse practitioner at Presbyterian Hospital. She said that sometimes a cancer changes the way the breast feels.

A regular self-breast exam can be useful even if a lump isn’t found. If the tissue feels different than usual or if one breast suddenly feels unlike the other, something irregular may be happening, Horwitz advised.

Rosenberg said she doesn’t know if the line the doctor felt had anything to do with the cancer or if it was a fortunate coincidence that brought about the sonogram. A biopsy revealed a stage 1 cancer about a centimeter long.

She got the results of the biopsy by phone after 5 in the evening.
“You need a surgeon,” she said she was told.

Because she had recently dealt with a friend’s breast cancer, she knew a surgeon she trusted. However, because of her insurance, she needed a referral from a primary care physician.

In the morning, her doctor reviewed the test results and gave Rosenberg her referral. The surgeon saw Rosenberg at noon on Friday and scheduled the lumpectomy on Tuesday.

“I was ready to get it out,” she said, and in less than a week from diagnosis, the cancerous growth was removed.

Although there was no history of cancer in her family and it was caught early, tests found it was an aggressive HER2 type of malignancy. Rosenberg began two series of four infusions once every three weeks, followed by a series of radiation treatments.
The chemotherapy was done on Friday afternoons. Over the weekend, she said, she became sick. But come Monday morning, she always made it back to the bench.

The radiation treatments, when they began, took about 15 minutes and were done five days a week for six weeks. Rosenberg scheduled those at the end of the day for minimum interference with her work routine.

After her treatment ended in April 2002, Rosenberg’s medical follow-ups included a mammogram or sonogram every six months.

Then in 2007, Rosenberg took the BRAC test, a new genetic analysis that identifies a defect on a gene. A positive result indicates a very high chance of developing breast and/or ovarian cancer and a greater chance of recurrence.
Rosenberg’s doctors recommended she have a hysterectomy.

The presidential primary season was in full swing and Rosenberg was actively working with the Clinton campaign in Dallas. Despite her fully committed political season, she had the hysterectomy in April 2008, timing it between the senatorial district convention and the June state convention.

At the state convention in Austin, Rosenberg was elected to be a Clinton delegate to the national Democratic convention in Denver. That week, she also had an MRI. The news wasn’t good.

They found another cancer in her other breast, one even smaller than the first that would not have been discovered on a mammogram.

“I had another cancer in the other breast. I was going to need major surgery again and I wanted to get to the convention,” Rosenberg said. “I talked to my doctors and they said I could have the surgery and I could be at the convention four weeks later.”
Rosenberg had a double mastectomy and reconstructive surgery.

Doctors used latissimus muscle (lats) to rebuild the breasts because the usual options weren’t available. Because of the earlier radiation that affects the elasticity of the skin, she said, an implant would be difficult. Reconstruction using fat taken from the stomach area was not possible because of her recent hysterectomy.
Rosenberg said the reconstruction was the most difficult of the surgeries.

Although Horwitz was able to take a week off to be with her partner, Rosenberg needed additional help. So her 80-year old mother came from Houston and stayed through the recovery.

Horwitz recalled, “Barbara’s mother said, ‘I’ll be here as long as you need me.’ I said, ‘Rose, you’re going to have to help Barbara in the shower.’ She said, ‘Well, I saw that butt a long time ago. I’ll see it again.’”

Rosenberg stressed how important a good support system is both emotionally and physically. But she said she didn’t seek out a group like Gilda’s Club because she already had so many people around her.

Part of her strategy for recovery was to focus on future plans rather than on her illness. She was determined to make that trip to Denver in August to cast her vote for Clinton.

A month after the surgery, Rosenberg did attend the Democratic convention.
On Wednesday at the convention, Clinton caucused with all of her delegates to release them to vote for Obama. Rosenberg was selected to introduce Clinton for that meeting.

Although pictures of the moment show Rosenberg beaming as she introduced Clinton, she said, “I was weaker than I looked, and I needed someone with me.”

So she obtained a floor pass for Horwitz for the week.

“Sandy was with me the whole time,” Rosenberg said.

Horwitz had been by her partner’s side since the first diagnosis. She said her first concern had always been Rosenberg’s health. With the second cancer, she thought about her partner’s self-image and comfort.

Rosenberg said that she thought about whether to do reconstruction at all, and even worried that she was not being feminist enough by deciding to have the procedure.

She said she chose reconstruction “because I didn’t want to look at my body and think I looked sick. I thought if I saw my body without breasts, it would always remind me of my cancer.”

She chose reconstruction, she knew, for the right reasons — not to be attractive to someone else, but to see beyond the cancer.

Today, Rosenberg visits her doctors semi-annually. She pursues an exercise routine to improve mobility of her arms and comfort as a result of her reconstructive surgery.

Many survivors take the drug tamoxifen to avoid a recurrence. Rosenberg does not because her cancers were not the more common hormone-sensitive types the drug prevents.

One of the hardest things about dealing with breast cancer, she said, is that when you’re diagnosed, you feel fine. Despite that, every woman should learn breast self-examination, she said, and be checked by a doctor regularly.

Horwitz echoes the recommendations of the Susan G. Komen Foundation: At age 20, begin clinical breast exams once every three years. Women over the age of 40 and those with a family history of breast cancer should be screened annually.


BRAC TEST

BRAC testing for risk of contracting breast cancer has been widely advertised on television over the past few weeks. But while the ads encourage testing, they do not adequately explain what the test finds or who should be tested.

What is the BRAC test?
The test finds specific mutations on the BRCA1 and BRCA2 genes. Women with a positive test are more likely to develop breast and ovarian cancer or have recurrences of cancer than those without the gene.

How much does it cost?
The BRAC test costs more than $3,000. Some insurance policies cover part of the cost. Because of the cost, most limit testing to those in risk groups.

Who should consider testing?
• Jewish women of Eastern European decent have the greatest chance of testing positive.

• Norwegian, Dutch and Icelandic women also have higher frequencies of BRCA1 and BRCA2 mutations.

• Women diagnosed with breast cancer under age 40

• Women diagnosed with ovarian cancer

• Women with two immediate relatives diagnosed with breast cancer before 50

• Women with breast and ovarian cancer in the family

• Women with three or more relatives with breast cancer or two or more relatives with ovarian cancer

• Women with a male relative with breast cancer (which accounts for less than 1 percent of breast cancers).

Anyone who falls into an at-risk category should discuss BRAC testing and other cancer screening with their doctor.

Barbara Rosenberg introduces Clinton at delegate caucus at Denver Democratic convention
http://www.dallasvoice.com/artman/publish/article_9682.php

Barbara Rosenberg defeated Judge Hampton who sparked outrage when he equated gays to prostitutes in defending killer’s lenient sentence
http://www.dallasvoice.com/artman/publish/article_9961.php

This article appeared in the Dallas Voice print edition October 9, 2009.

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