I’m the Clean Up Woman.

I confess, I have had a hedonistic month. Though hardly going off to war, I’m taking a step into the unknown and have chosen to celebrate life and the close of 2007, with a bang. I have (in true form) dined, danced, partied and playfully taken the month by storm. Locked and loaded, wild, flirtacious, fully-awake, shaken and stirred.
Today, the clean-up crew comes in with the big drip holiday cocktail. I am armed for chemo with good friends, well-wishes and the confidence this “insurance” will benefit me. For my well-being, I have packed reading to inspire me and music that makes me feel alive. Marvin, Missy, James, Otis, Chaka, Wilson, Alisha, Nelly, Prince, Tom, Bob and Toots (will all be there).
My toast today, like this special cocktail, holds a bit more meaning: To my unconventional family and amazing array of friends; to my unbroken spirit and strong body (that just keeps saying, "GO, GO, GO"); to music that rocks me every day; to places I’ve yet to travel; to permission to be fearless; to my endless creativity; to breaking rules and never holding back; to starting over; to the men I’ve loved and those I’ve yet to meet; to cleaning up and clearing out the past; and to my health.
Happy New Year!

Chemo 101

I’ve been schooled in chemo and there were very few surprises. As I have said regarding tumors and treatments: what you know based on one person’s experience may not apply here. Treatment can vary depending on the type of breast cancer, how large the tumor is (or was, from my vantage point), and how far it has spread. Several different types of chemo are used to treat breast cancer.
The drugs used in chemotherapy are called cytotoxic drugs because they kill cells. Duh, cyto=cell, toxic=poison. The drugs circulate through the bloodstream, killing both cancer cells and some healthy cells.
I’m told the combination I will receive will be easily tolerated. Actually, I was told “you are healthy, you’ll have no problem”. Cool. I will arrive at the Sutter Cancer Center, have blood work, speak to my oncologist, and receive Taxotere and Cytoxan via a drip in the vein. I'll be relaxing in a recliner—can you imagine B.K. in a Lazy Boy? I’ll get an anti-nausea drug prior, then half hour drip on one of the drugs, one hour of the other. No need to alter my diet. I stay on my vitamins (no herbal supplements). No dental work or flossing during my treatment course (sore gums). Common side effects are nausea, bruising, fatigue, cold hands and feet and possible fever. Big emphasis on drinking loads of water (dehydration). Blah, blah, blah.
A bit of familiar perspective here: how many Sunday mornings have we opened our eyes, slight hangover, and considered the cells we may have killed on Saturday night? Nausea, fatigue, needing water…uh huh, oh yea.
My first treatment will be New Year's Eve. Yea, I know, but there was a need to back the time frame out from a business trip to NYC in early February, and coordinate with my oncologist’s schedule. And quite honestly, there’s just something about kicking 2007 out with a bang that seemed appropriate. I will bid adieu to cancer as 2007 dies off. I will welcome 2008 as a transformative year of change.

Preemptive Strike.

I need to shed The Hair. Can’t exactly explain it, except to say, there just can’t be any attachment to The Hair. So, last week, on a whim, I found an available stylist and ordered it cut short.

Lions and Tigers and Chemo—oh my!

I’ll cut to the chase. Friday, I was back to the Sutter Cancer Center, where they park your car for free. The third floor is the Sacramento Center for Hematology & Medical Oncology—SCHMO for short. No shit, they call it “SCHMO’’. I met my medical oncologist Dr. Rahatgi, a small, round Indian man with a voice like a melody.
50% of women who have the Oncotype DX test come back with a score in the intermediate range; between the score of 11 and 25, mine is 18. Smack dab in the middle. What this means is no one can tell me whether I should have chemotherapy, or not. Radiation and aromatase inhibitors, which decrease recurrence and increase survival rates significantly, offer weighty percentages. Chemo offers another small piece of insurance. I ask the kind doctor the obvious question, “if I was in your family, would you suggest chemotherapy? He shrugs; there isn’t clear data for the answer I’m looking for. There is a trial (randomly assigned to chemo, or not—no obvious incentive here) that will provide that answer in 5, 10 or 20 years. For now, this decision is all mine. Chocolate or vanilla? Bachelor number two or number three? Bald and weak or, well, you get the picture.
I call two experienced cancer-chicks. Both say that cancer survivors worry about recurrence; do I want to second-guess my survival by not giving myself the best chance? I also am assured I will get through chemo fine. My gut has an answer that my head doesn’t want to hear.
Further reading points out that Taxotere-Cytoxan (the chemo of choice for breast cancer treatment) bestows a 24% improvement in overall survival over the previous chemo used for my senario. I’m, well, impressed. With radiation, drugs (aromatase inhibitors, Arimidex will be mine for 5 years) and chemo, I’m knocked to nearly 90% no recurrence stats. I cry. I party. I decide. Sign me up.
The bright side: the chemo will be 4 treatments over a 12-week course; the treatments are about an hour and a half; and nausea is managed with drugs given prior to chemo. Yes, I'll lose my hair but I’m pretty sure I can put aside vanity for a few months. Think of the money saved on these pricey (but fabulous) haircuts. I will be fatigued. I will kick the crap out of cancer and see that it never shows up here again.
Oh, and Santa, I'd like several hats this year.

http://www.medpagetoday.com/tbindex.cfm?tbid=1030
http://www.medpagetoday.com/HematologyOncology/2005SABCSMeeting/tb/2308
http://professional.cancerconsultants.com/oncology_main_news.aspx?id=35701
http://www.breastcancer.org/treatment/chemotherapy/index.jsp

This ain’t no disco...

The cancer is gone, my medical team is in agreement on that. Today is the day for decision, and frankly, I am a bit apprehensive. I am now at the brink of choosing a treatment that will assure the best outcome—that cancer (the tiny group of ne'er-do-well cells that ambushed me) will not return.
I have a medical oncologist and a radiation oncologist vying for my attention. But, science will determine who I'll be seeing on a regular basis, I'm just along for the ride. Ms. Badass takes a back seat, and waits.

Setting the record straight.

There is a rumor going around that I am “fighting cancer.” No way, not so. No fight, skirmish or brawl here. No rumble or roughhousing. Not even a pillow fight. For me, this is not a battle, and the vocabulary implying this is, like war, a win or lose situation simply doesn’t work for me. I have heard from, and read about, too many people that were thankful for what [surviving] cancer brought to their lives—that their lives and relationships were elevated and redirected as a result of this abrupt, unpredicted, and life-altering “gift”. Did anyone ever say that about a war?

Giving thanks.

There is something quite wonderful that has come out of this experience. I have recently heard from four college girlfriends that I have not been in touch with for over two decades. The news of the c-word has traveled fast and they have contacted me to share their concern for my health. Though our lives have taken us in diverse directions, the thread of love and respect remained intact.
As some have come to find out, I do not take friendship lightly. I may cling (with crab-like claws) to people I have connected with and retreat when perceived expectations of loyalty and integrity are not met—my shortcoming. I offer a blanket apology to all who have stumbled blindly into that frailty.
I know I am strong, independent, and able to survive anything. AND, I am learning not to brush off lightly the loving support offered to me every day in actions and words. Today, I am exceedingly grateful for my many friends and family, past and present, distant and near. You all enrich my life.
I love you.

The saga continues…

Saw Dr. Lisa today. Negative nodes* and clear margins, no more surgery needed—all good. Terrific news…but why aren’t we celebrating yet?
Just when I thought I would have all the information needed, I learn there is another BIG piece missing. Oh yea, my recurrence score.
Frustrated with the low accuracy of the previous (and still used) risk analysis, a more conclusive lab test has become available that uses the unique gene expression profile of a person’s tumor. This is targeted for recently diagnosed, stage I or II, node-negative, and estrogen receptor-positive patients. That rings a bell. Oncotype DX is a diagnostic test performed on the tumor tissue that quantifies the likelihood that early stage invasive breast cancer will return, or recur, and assesses the benefit from chemotherapy. This test may, or may not, be covered by insurance. Bottom line is whether my tumor expresses the genes, which will put me at risk for recurrence. High risk=chemotherapy. Low risk=radiation alone. I have chosen to proceed with this test and will wait another two weeks for the results. Since radiation follows chemo, nothing else to be done at present. Needless to say, I can relax a bit knowing the cancer is out of my body and have postponed my next haircut until I meet with a medical oncologist to discuss results. Positive affirmation: low recurrence score.

*I thought of another point regarding the lymph node evaluation. Positive lymph nodes (showing cancer cells) doesn't necessarily mean there are microscopic cancer cells elsewhere in the body. And, if the lymph nodes are negative, it doesn't mean the cancer hasn't spread elsewhere, 20-30 percent have spread even with negative nodes. Sounds like a crap shoot to me. This is why we rely on examining the characteristics of the tumor (the biomarkers), and the gene expression profile of the tumor. This is all making sense, right?

The wah in wahoo

Surgery, is behind me. The week following is uncomfortable, not painful. I want to exercise. My mind and lower back would be happier (not to mention my aging butt) if I could move my body. Until I am cleared for take off though, I’ll try not to screw this up while my body heals.
Come on, you are wondering what I’m facing in the shower, right? Ok, read on…the girls are still here and looking surprisingly familiar. My sister on the left is swollen, think breast feeding without the sore nipples. No bruising, stitches or loss of, well, tissue. The tumor was deep, so there is plenty of breast above to cover the area removed. Stitches are internal and will dissolve. I have two small incisions neatly steri-stripped, one under the arm and one off to the side where they nabbed the culprit. Again, I have no complaints and remain optimistic about what I’ll hear on Wednesday.

It's Halloween and I'm not a bit scared.

It was NOT a bad day. Kim picked me up at the crack of 7…I had packed her a cancer-crew bag with snacks, a newspaper and magazines. We snapped a photo of me with my shirt lifted and jumped in her car where she had the seat preheated for me (note to self: butt warmer in the next car). Our first stop was the Breast Imaging Center for a wire localization. This delightful procedure involves numbing (oh yea?) the breast and inserting, make that, FORCING through dense tissue, a needle that will guide a wire into the center of the enemy cells. This is a ultrasound guided procedure and I am watching this horror flick on the monitor. I am the topless star.
The end of the wire is sticking out of my breast when they are done and it is carefully taped in gauze for the trip to the hospital. But first, I wait patiently in a room with a plate of just baked chocolate chip cookies that I cannot touch as I’m being starved for surgery. This is an evil test and it doesn't please me. Several mammograms later to record the wire’s position, I am handed my films and sent on my way. Kim is waiting and smiling (well, she did get coffee) and keeps that smile in place all day.
Cut to the hospital. Discussions of directives, emergency numbers, signing and dating and we are escorted to the outpatient area by a woman in a Mrs. Santa outfit. She dryly tells us, “I’m very confused”…we think she just got more interesting.
Nurse June comes to retrieve me asking for Mrs. Hughes. I inform her that was my mother and if she wants me, she’ll need to use another handle. June wins me over later as she maintains my dignity by holding the back of my gown as I make several trips to the restroom (the IV must be full of beer). Nurse Angie brings me warm blankets and rubs my feet as an apologetic tech struggles to stick the needle in, yeeouch, I’d be a lousy junkie. Kim comes to sit by my side and we flirt mercilessly with the adorable nuclear medicine tech that has come to roll me (there will be no more walking at this point) to my next new experience. Radiation isn’t supposed to be a good thing, right? Wrong. One of the benefits of getting breast cancer today is the Sentinel Node Biopsy. A few shots of radioactive fluid (again, needle in the breast) will find it’s way to the sentinel node. While in surgery, with the help of a tiny Geiger counter, Dr. Lisa will track the fluid. That node and a couple others (not the entire flock) will be singled out removed and tested for those pesky cells that have escaped the breast. The procedure, like the others thus far today, is mildly uncomfortable for a brief time. Doable.
We giggle our way back with Mr. Adorable through the halls to our waiting stall. Dr. Lisa comes in to chat. She is a cool as a cucumber, honest, approachable, positively positive. I trust her completely. Our next visitor is Mary the breast cancer advocate. Again, another woman I am proud to have on my side. She gives, in laywoman’s terms, complete explanations on every question or point I need clarity on and I want to know excruciating details on everything. I have no anxiety or trepidation; this is actually feeling like a good experience.
Being the shameless women we are, we tease, cajole and flirt (again!) with the stunning anesthesiologist. Come on, who doesn’t want to talk about drugs? He promises me a good ride, and no nausea. It just keeps getting better. After a little IV cocktail to relax me prior to the big sleep, I say “see you later” to Kim and head to the waiting hands of my surgeon.
Recovery room. Eyes open, and I am miraculously wide-awake. Dr. Lisa is telling me my nodes look clear (final pathology report will be here next week). I feel like dancing, all is right with the world. I gaze under the blanket at my now throbbing boob—she says to me, “it's still there.”

2nd Appointment with Dr. Lisa Guirguis (Oncology Surgeon) October 16

MRI results—good news. We are only looking at the one tumor, in only one breast. She asks me what I want to do. "I dunno, how about a lumpectomy?" I am scheduled. A golf ball portion of me will be taken out aiming for clean margins around the small tumor. I have it to spare. Party on.

MRI. October 11

Dr. Guirguis orders an MRI to determine if there are any spots of concern in the other breast or overlooked in the one with the known tumor. Incidentally, the size is a Stage 1 (1.2 cm), another good feature, but there are many other factors which can alter that initial clinical staging. It's all about getting as much information as possible. Now, I will wait for a second meeting with the surgeon and then, likely, choose to schedule a lumpectomy. In recent years, the goal is toward breast conservation—lumpectomy plus radiation has proven to be as effective as a mastectomy. Mastectomy is still appropriate for large tumors or several sites of cancer in the breast but the goal is to hang on to what we have.

At the time of surgery there will be a sentinel node biopsy to determine if the cancer is in the lymph nodes. More pieces of the puzzle to find out “what kind of cancer is it?” In between, it's a waiting game. I am going to survive (because I say so) and grow stronger from this.

Ultrasound Guided Biopsy. September 19

I had no idea of what was to come. Having talked to a friend AFTERWARDS with a similar experience, we felt like women should be warned well in advance. Dense breasts, who knew? Although my breast was numb, the pressure from the ice pick, I mean, needle being shoved, with brut force (to get through the dense tissue) became so invasive by the time sample 16 of 20 was being extracted the tears started running down my face. I lay there, eyes darting from the pinched face of the doctor (clearly not liking what she was seeing) to the monitor giving me full view of the ice pick penetrating the black shadow in my breast. One hour, or two? It seemed like an eternity. Next, the metal chips to mark the biopsied locations were inserted (insult to injury) and mammograms recorded my new permanent shrapnel. Last, I was bandaged tightly with ice packs pressed in my bra and sent off to the waiting room where I burst into tears.

I have what???

It was time for my annual check-up and mammogram, so when I saw my doctor, Dr. Barbara Hayes, I mentioned a slight discomfort in my breast (yea, you can see where this is going). She recognized this could be cause for concern and scheduled not only a mammogram but an ultrasound as well.
Mammograms can get an “F”, mine did. If there isn't a breast imaging specialist reading your film, the reports can be wrong. What I now know is, to get your mammogram at a facility specializing in breast imaging. The Ultrasound I had showed some suspicious spots, which led to a biopsy (horrible procedure), which led to a call the next day from Dr. Hayes. In a 3-minute conversation I heard the words infiltrating ductal carcinoma. Holy shit. I couldn’t hold a pen to write it down.
Every minute of everyday day for the next week I felt the sting of those words. After a week of fear, miraculously, my focus shifted to I’M GOING TO GET THIS BEHIND ME.
I am clear that fear doesn't serve me. If I hadn't gone through this with two close friends, I would NOT have known what to do. I knew who to call and what action to take. Eleven year breast cancer survivor and dear friend, Susanne, immediately delivered the latest edition of Dr. Susan Love’s Breast Book. I called and annoyed the newly referred medical office of Dr. Lisa Guirguis to get me in pronto to meet the oncology surgeon...make that, MY oncology surgeon.
Dr. Guirguis is cheerful and down to earth, I like her. The tests came back from the pathology on the cancer, and she's still cheerful. Are surgeons cheerful? Analysis on the estrogen and progesterone receptor came back positive—a good thing as that indicates the tumor is sensitive to hormones (responds well to drug therapy), is slightly slower growing and have a better prognosis than tumors that aren’t.
The FISH test, a more definitive test, shows Her-2/neu is negative, my cancer is NOT over-expressive (not of an aggressive nature) and this is a good thing too. I’m smiling.