June 6

A year ago today, I was diagnosed with cancer. My own personal D Day.

I am alive, and I am winning this war against cancer.

I went through oncofertility and have 8 embryos waiting till my health and doctors allow it. It took two surgeries and a trip to the ER, but cancer didn't win.

I went through six rounds of horrible TCHP chemo, July - October 2014, which gave me horrible nausea for 10 days, diarrhea for 15, fatigue all the way through, eventual chemo induced peripheral neuropathy, a bizarre eye twitch, a perpetually runny nose, and the occasional rash. I lost my hair, my eyebrows and lashes, (temporarily) my period, my strength, my routine, my social life, significant involvement in my job as a lawyer, and I  had to take a complete leave of absence coaching CrossFit, which I love. I lost 23 lbs, 13 of which was muscle, and then gained it all back plus 20 lbs, after going through chemo- and then drug-induced menopause three times, violent hot flashes included. Sweating in a wig is not fun, but cancer didn't win.

I had surgery on November 18th. Two excisions to get clean margins. Happily, my lymph node was clear too.  But, the scar.  Eventually, mild lymphedema of the breast. I will never be able to have my blood pressure taken or a needle stick on my right arm, but these breasts are mine. Not plastic. And I still look good in a tank top or bathing suit. Cancer didn't win. 

Radiation. 6 weeks, Dec thru January 17. Every week day, including Christmas Eve and New Year's Eve. (I got the actual days off.) Honestly, this was the most stressful and barbaric part of it all. The techs and doctors were great, but you lose a sense of your own personhood every time you lie there like a piece of meat and let your body be nuked, not knowing when or if your skin will start to burn and peel, potentially never to be normal or even close. Worrying that if you take too deep of a breath, that you'll damage healthy tissue unnecessarily. That years from now, the radiation effects will still be lingering, and you'll feel pain and still not be able to put your arm all the way overhead. Every day, bad traffic is more than just traffic - it might be what prevents you from making the appointment that is at the same time, not so bad physically, mentally torture, and medically saving your life. Radiation made me so tired afterwards that once, I was so tired after putting dinner in the microwave, I had to lie down on my kitchen floor and rest in front of the microwave before I had the energy to get up, take dinner out of the microwave and even eat. Still, I never missed a day of radiation. Perfect attendance. Cancer didn't win. 

Now, I am in a clinical trial, the Katherine Trial, for more chemo, called TDM1 aka Kadcyla, which has already been approved for Stage 3 &  4 patients.  It includes Herceptin, which I would have gotten as standard of care, but TDM1 takes Herceptin and adds a molecule of old school chemo that had such terrible side effects that they stopped using it.  Added to Herceptin, it turns into smart bomb chemo. I am nauseous, headachey, and fatigued for three days after my infusion every three weeks, but I get to keep my hair. I have to go through the end of September, but I am making. Cancer is not going win. 

I have started hormonal therapy. Zoladex, which is like getting shot with a pellet gun to jam essentially a Tic Tac under my skin. Every 4 weeks for the next 10 years. My ovaries refuse to quit, so we're figuring that out, but an aromatase inhibitor is next. For 10 years. But, this is just what I have to do. I won't let cancer win. 

I am slowly getting my life back. Doing great stuff at work, back to coaching, and exercise. It's not the way it was before. And it will never be, but I am working on my new normal and making it great. Winning my battles, winning this war. 

I've owed you a post for a while...

And it is coming.

Right now, I am still halfway in the middle of a deep mental exhale re this cancer journey.  A long update post is coming. For tonight, I just wanted to leave you with this--

2014, you were a lot of heartache, tears, and pain, but also love, laughter and hope. I will not miss you.

2015, things are looking up. It's going to be our year.

Thank you to my family and friends who are the continuum between the hard times and the good. I wish you the best for this year and always.

Surgery follow up and pathology report in!

Stitches are out.  We redid steristrips on one incision, but it is OK. My range of motion without the stitches in is pretty good. I may actually have slightly better internal rotation at the shoulder, but going directly overhead hurts at about 15 degrees from vertical.  No need to stretch things out or stress my incisions right now. I am still supposed to take it easy till next week when I can go back to CrossFit.  Yeah,  CrossFit! Per the surgeon, if it doesn't bother me, it's fine.

The post surgery telephone game on the day of was not entirely accurate, but I got the details officially today. Only one lymph node was taken, and it was clear. The wide area excision did not initially have a clear medial margin as assessed intraoperatively, so additional tissue was required all around.  Happily they were able to do it while I was still under so only one tumor incision. There is a slight contour due to loss of volume, but all in all, I am pleased.  The cancer is out and you can hardly tell. After the swelling goes down over the next week, and a year after radiation ends, if I want to have some tweaks made, I can. That said, even with the way things are right now, no one would ever know in a strapless dress, a sports bra or all but the skimpiest of bikinis. And, I don't wear super skimpy bikinis anyway. Radiation apparently works wonders on scars, so they should not be an issue at all!

In terms of the tumor removed, it shrank from 2.7 cm to 1.9. I did not get a complete pathological response, but I still have a lot of treatment left with radiation, Herceptin, and anti estrogen and anti progesterone therapy.  We are still in a good place. At least that is what I keep telling myself.  Blood flow to the tumor was good, so the chemo was really getting in there. There was no evidence of invasion into the blood/lymph vessels or nerves, which is good.  I had worried that because I had a great response during chemo rounds 1-3 and no discernible improvement after chemo rounds 4-6, that my tumor had somehow figured out how to deal with TCHP. I asked if I had a recurrence whether I was likely to still respond to chemo.  My surgeon laughed and assured me that yes, I would.  It is kind of funny, but it is MY tumor so I would not be surprised if it figured out how to outsmart chemo. Hopefully, there will never be a recurrence. 

I also asked about lymphadema prevention, and I got a referral for Dec. 1. I hope it's a non issue, and I think my surgeon thinks it's likely to be a non issue.  Still, I am glad to be going. Better safe than sorry. 

I am feeling pretty good, but with as much as I have been through, I am in no rush back to work.  I am taking all my planned leave rather than going back early.  I feel like letting myself focus on healing and trying to build back up my energy reserves before radiation begins is the right choice. I still don't have nearly the get up and go I did before chemo, and with fatigue being the most common side effect of radiation, I think it is wise not to make myself do too much too soon, even if I possibly could.

Otherwise, I am enjoying the brief warm weather and being, as best as we can tell, finally cancer free!

Bandages off...

My incisions 36 hours after the start of surgery, photo taken just after taking the bandage off for the first time. 

Surgery day retrospective

There was a lot going on yesterday. 

5 am wake up, packed bag with button up top PJ's

5:30 am showered with Hibiclens, a 24h long lasting antiseptic, from neck to waist, as I did the night before.  No deodorant or lotion allowed.

6 am departed for hospital

7 am check in on ground floor of Sibley in surgical suite, gave insurance cards and id's, signed multiple forms, given a patient number so my waiting family could check my progress on the big screen without my name up there for privacy reasons.  Was led back to change into a gown, robe, and socks. Nothing else permitted. No jewelry or underwear.  Urine sample taken, vitals taken, 123/75 BP and 69 HR if I remember right.  Then I was led to a draped area, room 1, and my family could come back, no more than 2 at a time. Various nurses and a PA stopped in. Wendy? Linda?  All lovely. One got my IV started, another got me a metallic cap to keep the heat in on my fuzzy head.

8 am Lymphatic mapping. The nurse came first and did a great job explaining the procedure Dr. Alan Crohnwall would do. The syringes came in a little kit with such little radiation (1 mercurie?) that no lead was required.  The needles were tiny at 27 gauge, even smaller than the ones I used to inject my lower abdomen during the oncofertility process.  They told me that people react differently and that the 4 injections do not always feel the same. The injections are made peri-auricular (?), meaning in and around the nipple at 3, 6, 9, and 12 o'clock.  Injection number 2 at 6 o'clock hurt like a bee sting, but the rest were OK! Apparently this is one type of needle stick that doctors do not practice on themselves/each other.  Ha! In any event, it was not nearly as bad as I imagined.  No one told me I would pee blue for 24h though.  My surgeon Dr. Magnant stopped by and said hello, cheerful as ever and brimming with energy.

9 am a nurse came to get me up to walk me over for the wire localization procedure. I walked across the surgical suite lobby to a room with imaging equipment.  The nurse Cynthia was awesome. Very thorough and precise with the utmost compassion at the same time.  Dr. Schlessinger was just the same. They double checked everything and took a time out to triple check me, my birthday and the procedure before initialling my right (correct)  breast.  Then we took a mammogram and compared it to the one from June.  The mammogram has a grid they use to determine needle placement. I lined up at 9&3/4 and H.  Next, they injected me superficially with a numbing agent, then deeply with lidocaine.  Then they placed the needle.  It is essentially a needle within a needle. The outside one is larger at maybe a 20 gauge, but definitely smaller than the biopsy tool.  The inner needle remains in place and is about the size of an acupuncture needle, although much longer. It has a thicker section, which optimally will be placed in the tumor. Dr. Schlessinger moved the needle a little bit to get it lined up perfectly,  in his words, "textbook."  He was just adorable.  Nurse Cynthia rubbed my back during the procedure like a baby, and at first I was embarrassed but I actually was completely grateful for it.  We took two more shots vertically and horizontally to make sure it was spot on, then the big needle was removed and the inner wire was taped down. About 6" was still hanging outside my body before they taped it, so I did my best not to wiggle around or move it. Yeah, I looked. It was a little surreal to see it hanging out there from my breast, but I was glad it was set.

9:30 am The anesthesiologist and nurse stopped by.  Apparently the tube doesn't go all the way down your throat, but the gas can be irritating. I had no other questions. 

9:52 am I said goodbye to my sister and dad so my husband could come in.

9:59 am They started wheeling me into surgery and I shed big alligator tears as I said goodbye.  In a minute, I was out. Probably because I was crying, they thought it would help me. I was just sad about saying goodbye abruptly. 

11:15 am I woke up with the nurses in recovery. First,  dilaudid in my IV to take the pain down from a 6/10 to a 4/10. Two blood pressure readings,  two ginger ales and about 6 Graham crackers later, I got my clothes back and a nurse helped me put my clothes on from the underwear on up.  An ace bandage in lieu of bra.  I got two tabs of oral Percoset and was instructed to wait til 5pm to take another.  

12:15 pm my family came in to see me. They told me my surgeon had said she took two lymph nodes and they both looked clear.  No word on the exact size of tissue removed from the tumor area though.  Josh filled my prescription for oxycodone /Tylenol and brought the car around.

12:30 pm my nurse wheeled me out, handed me a heart shaped pillow for comfort, and we headed home! Percoset knocked me out, so I had a bit of soup and then went straight to bed.

5 pm dinner, but skipped drugs, just ice

8 pm bed, ice and drugs

2:45 am got up for ice, skipped drugs

6 am ice and Starbucks with my sister, rest of the day in bed resting and occassional snacking. No drugs. Still changing ice, which helps the pain.

I am not quite ready to take off the bandage, but that is coming tonight/tomorrow morning.  I am just so glad I do not feel as bad as I thought I would and nothing went wrong this time.  Overall, I am so relieved to be through this. I was carrying so much stress in my body. I am almost in less pain as my muscles and joints have relaxed from relief of the stress of anticipation.  I am also so glad to have another positive indicator that my lymph nodes are clear.  Overall, I feel like someone took a baseball bat to my right breast. Occasionally I feel the stabbiness of pulling on stitches, so I have tried to keep my right arm range of motion limited to less than 45 degrees and very little weight. I realized that closing my own passenger side door on the Tahoe was probably too much weight for that side.  When I walk, I also try to keep an even gait to avoid any unnecessary bouncing or jostling. 

My game plan is to continue taking it easy and get myself healed ASAP! I have leave through Thanksgiving and Black Friday.  If there is a major event on Black Friday, I will go into work, but that's it.  My follow up is Monday, November 24, and I should get the results of my pathology then.  Before then, I go in for a Herceptin only infusion, round 1/12, on Friday.  Blargh.  I can't wait for it to be over. I am already thinking about having my port taken out early so I can be done with surgery.  Just so glad to be through this huge milestone though. Theoretically, I am now cancer free.  A little more treatment(30 rounds of radiation, 12 rounds of Herceptin, 10 years of tamoxifen/aromatasse inhibitors to go), but the worst of it is over!

THE WORST OF IT IS OVER!

Thank you for praying for me. Thank you for sending good thoughts my way.  Thank you for reaching out and for your kindness in every way.  It helps, it is working, and I so appreciate it.  THANK YOU.

Made it!

Just a quick note.  2 lymph nodes.  Looks like they are clear.  Pain is manageable.  So glad!

It's go time!

Let's do this!