Yoga instructor faces a difficult decision

A few months after Marnie Bacon moved to the Cape in 2022, she had an appointment for a physical with physician assistant Marie Hartley, PA. During the physical, they talked about Marnie’s family history of breast cancer. Her mother was diagnosed with breast cancer at the age of 28 but had tested negative for BRCA1 and 2 about 10 years ago. Since her mother tested negative, Marnie thought she was probably safe.

“Marie Hartley was the one who explained to me that there were many, many more genes on the test panel now,” Marnie said. “She urged me to see a counselor for testing.”

Marnie set up the appointment for genetic counseling at the Cuda Women’s Health Center in November of that year and got the results in December. She learned that, like her mother, she was negative for BRCA1 and 2, but that she had a positive genetic mutation on the CHEK2 gene, which placed her in the high-risk category for breast cancer and a higher risk category for colorectal cancer. She was told that the combination of having the gene and her mother having breast cancer so young raised her risk to almost 50 percent.

“I was referred to Stephanie Ellis, FNP C, the high-risk breast cancer nurse practitioner from Cuda Breast Care Center at CCHC, to further discuss my options,” Marnie said. “At that point I just was totally overwhelmed. The risk felt so heavy now that it was known and I wrestled with it for a while.”

She waited until after Christmas to learn her options. The first option was to do more frequent mammograms and colonoscopies, as well as getting a yearly breast MRI. She would also have to do hormone therapy and other pharmaceutical treatments. The other option was to have a prophylactic double mastectomy.

Her risk of colon cancer was 10 percent higher, so she will be getting colonoscopies every five years instead of every 10 years.

As she walked from her genetic counseling appointment to the other side of Cuda to make an appointment for a mammogram, she had a moment of reflection that she will never forget.

“At this point I had been living with this known risk for a few months and it was just so heavy,” Marnie said. “I thought, how am I going to live for the rest of my life knowing this and having to live so carefully?”

Decision Came as a Relief

As a professional yoga instructor for 25 years, she has always lived a healthy life, doing daily yoga and meditation. She eats well and gets plenty of exercise, but she realized it wasn’t going to be enough to keep her safe.

“When I was actually faced with the facts, I thought, there is not enough meditation in the world to help me stay calm,” she said. “So, it pretty quickly became clear that I had two options that were reasonable. One was I could just live with the now-known threat of a potentially deadly disease hanging over me, or I could just dig in for the strength now and prepare myself for the double mastectomy and in the end lower my risk to less than two percent.”

It didn’t take her long to make the decision to have the surgery because she knew she was never going to be comfortable with the odds of developing cancer. Once she made the decision it actually came as a relief.

“I know that not everybody would make this decision,” she said. “It’s a pretty radical choice and maybe some people would just be better equipped emotionally and mentally to live with it, but I knew that I wasn’t. Through the Cape Wellness Collaborative, I was able to talk to a couple of women who were willing to share with me about their experience. These women told me their stories and told me why they chose that surgery. Even though our stories were a little bit different, it was really helpful to know their thought processes and just not feel so alone in it.”

The Procedure

She met with breast surgeon Naomi Kalliath, DO in March 2023 and Dr. Kalliath was so kind and supportive that Marnie didn’t even consider going to Boston for her treatment. Since Marnie was planning to get married in May, they decided to wait until the fall to do the surgery.

Dr. Kalliath answered all of Marnie’s questions, drew pictures of the procedure and assured her that it was a very low-risk straightforward surgery because there was no cancer present. That meant that she wasn’t going into the lymph nodes or her body cavity or cutting any muscles. She also assured Marnie that the surgery was not associated with a lot of pain.

Both Dr. Kalliath and Stephanie Ellis talked to Marnie about the possibility of reconstruction. Even though Marnie knows that is what many other women choose to do, she ruled it out pretty quickly because it wasn’t important enough to her to go through another complicated surgery. She also decided against wearing prosthetics because when she tried them, they felt hot, heavy and uncomfortable.

Marnie spent a lot of time preparing herself physically and mentally for the surgery, which occurred on November 10, 2023, about one year after her genetic testing. She ate only healthy foods, got plenty of sleep, and kept up her exercise routine as well as her daily yoga and meditation. She also did daily affirmations and visualizations about the emotional aspects of the surgery.

“The emotional part was definitely a lot to get through,” she said. “The good news is that my husband was totally aligned with my decision. He has a really great sense of humor and helped to lighten things up for me and that really helped. And my yoga practice has helped with some healing around body image issues, seeing my beauty from the inside out.”

She also set up a whole care team for herself made up of family, friends and medical professionals. She started seeing a new mental health therapist, a functional nutritionist, a massage therapist and had acupuncture treatments. All of those things helped her both physically and mentally.

On the day of the surgery, she was surprised by how caring all of the staff at the hospital were. She told them how nervous she was and asked for someone to hold her hand as she was wheeled down to surgery. Even though she was already anesthetized, her husband told her the nurse took her hand as soon as he let go of her other hand.

“Everybody was so reassuring and so caring and so compassionate,” Marnie said. “It was like I had a host of angels around me. I didn’t expect to be so cared for in the hospital. I really expected it to be more like black and white. I thought they would be so clinical, but that wasn’t the case. They were very real and very warm.”