Star Wars meets Nadir

Here I am, a week after my first treatment.  It's been interesting.  You know, you step out on this journey and it's somewhere you've never been before.  Others have gone before you, even people you know, and can tell you what it's probably going to be like.  That's the thing though... probably.  Really, no two people react exactly the same to chemotherapy, even the same regimen of chemotherapy.  It's really scary stepping into the somewhat unknown and knowing that each day can bring something new.  Sometimes that something new is really hard, sometimes it's manageable.

The last week for me has seen several side effects from the chemotherapy.  Some of them are directly related to the drug, others are a result of my state of mind.  For the first two days, I was really lucky I think.  I had virtually no side effects.  The best way I can describe the first two days is just a feeling of something off.  It's not something I could put my finger on or really describe.  I didn't feel bad, but I knew something was not quite right.  They included drugs in my IV to combat nausea when I received my treatment.  One was supposed to last 24 hours, the second was supposed to last 72 hours.  I guess they did because I didn't have any nausea and even now, I can say I've had very little this last week after those drugs exited my body.  I went out Saturday and tried on some wigs.  Typically, with the treatment I'm having, my hair will start falling out around day 14.  I posted the photos on Facebook to get some feedback from family and friends.  I will share the photos here as well:

Wig 1:

This long, highlighted brown wig received a lot of positive feedback.  However, from my reading on forums with women that have taken this journey, I doubt I would wear this wig very much.  I may get it for "just in case" or special occasions, but I'd like to see it in different colors first.

Wig 2:

This short blonde wig didn't receive as much positive feedback, but some really liked it.  From what I've read, I do know the shorter wigs will be those that I will most likely prefer.  As one friend put it:

"I can personally guarantee that once you're in the rough phase of chemo, you will reach for the short wig every time (or scarf if it's faster to put on). You are about to take a path that means you need to make your daily life as easy as possible."

So, this is what I have to consider and why I will most likely go with a shorter wig for daily use, but I most likely won't go this blonde (maybe).

Wig 3:

This short light brown wig has the color that feels most natural for me, in my opinion.  It had some positive feedback as well, but it's just a little TOO short, I think.

I did not try any scarves (they did not have them at this shop) or turbans, but plan to do so.  I need to make a decision soon as the momentous occasion will happen within the next week.  I have also read that most likely (see this recurring theme here?) the first several days after it starts coming out, my scalp will be very painful and I won't feel like putting anything on it.  I also know I'm going to be very emotional about it.  I already am if I spend any time thinking too hard about it.  I was emotional on this day when we started trying these wigs, but the ladies at the Merle Norman shop in Hiram, GA were SUPER nice and supportive.

Late Saturday and into Sunday, some body aches began and continued for several days in different parts of my body.  Those have gone away as of now and in their place, I have a really annoying rash that I keep telling my self NOT to scratch.  I'm trying really hard.  My mouth is also pretty off.  The best way I can describe it is that sensation when you've burned your mouth on something really hot.  It's like the feeling you have afterward.  So far, I'm lucky that I don't have any mouth sores, as sometimes that can be a side effect as well.  There are a few other things going on that are relatively mild as well, but manageable.

One thing I was pretty excited about this week was the premier of Star Wars.  I bought my ticket on Fandango weeks ago and was looking forward to hanging out with friends and fellow fans and seeing this super awesome movie.  I went to see my medical oncologist on Wednesday for my 1-week blood work.  You see, there is this period in chemotherapy treatment called the nadir.  For my treatment, it is on days 10-14 after treatment and is the period at which my blood counts (red blood cells, platelets, white blood cells) reach their low point.  The blood count showed my red blood cells and platelets at acceptable levels, but my white blood cells were lower than they wanted.  The reason this is a concern, as many of you are aware, is that our WBC's are the first line of defense when fighting infection.  My doctor told me to immediately start taking the antibiotic they had given me (Cipro) twice a day and to come back in on Monday so we can check the blood counts again.  He also said that going forward, I will be receiving the shot to boost my white blood cell counts with each treatment.  We were hoping to avoid this for a couple of reasons: 1) It's very expensive, 2) It has its own rather unpleasant side effects. 

The other bad news...I asked the doctor about attending the movie.  He asked when I was going, then said, "Well, you will have three rounds of the antibiotic in your system by then.  As long as you wear your mask, use your hand sanitizer, and avoid anyone sick, it should be okay."  I tried a trial run at lunch since I needed some groceries.  I put my little mask on and headed off to Publix.  It was emotional because I felt so self-conscious.  I also found that those masks are HOT.  I kept fogging up my glasses and trying to adjust it over my nose.  After that experiment, I realized going to the movie was out of the question so I regretfully cancelled my ticket and stayed home.  In this case, the force was not stronger.

The funniest thing to happen this past week came from one of my former professors at UWG.  On the photo album I created on Facebook for my wig looks, Dr. B suggested I "Go Anime!"  He further went on to suggest that "There's always a chance you'll get superpowers out of this, so best to be prepared and look the part".  So, what do you think, is one of these me?

\

You just never know...

Lights... Camera... Action...

... or in my case:

Treatment... Side-effects... CURE!

I know it's been almost a month since the last update.  I am very happy to say that the results from the sentinel node biopsy were not nearly as grim as previously stated.  I've thought back over what I and my sister heard post surgery and I really have no good explanation for the disparity between what we heard and the actual outcome.  BUT, the good news:

... I did not have 3 nodes test positive

... I did not have 30-40 nodes removed

According to the pathology report, confirmed by my oncologist, the first sentinel node (which is the first lymph node into which the radioactive solution drained) did test positive.  It contained a tumor about 4mm in size, so pretty small.  Due to the 1st node testing positive, they performed the axillary dissection to remove the tissue containing the related nodes.  Post-surgery, they determined that tissue contained 12 additional lymph nodes... and NONE of those tested positive for cancer.  YAY!

I had to deal with the annoying drain tube for just over 2 weeks.  It was finally removed November 30.  Thankfully, my employer (Greenway Health) has been fully supportive through this whole process and I was able to work from home during that time.  I want to send a HUGE thank you to them and my team members in Carrollton, GA and Alachua, FL for their support.  A second HUGE shout-out goes to my sister, Jana, and my cousin, Tonya.  They made sure I had easy to heat / prepare food those first few days after surgery.  I finally returned to the office on December 1 and was happy to do so.  Working from home full-time is not for me.  I got tired of the walls of my home and I missed the interaction with my co-workers in Carrollton - they are such a fun bunch to work with!

While most of the pain is gone, there are some residual effects from the surgery including some remaining numbness and lack of 100% range of motion in that shoulder.  Some of the numbness may likely be long term, but I'm working on the range of motion all the time.  I'm about 95% there.  The incision is healing wonderfully and the hole where the drain tube was connected has closed and is healing just fine as well.  For the rest of my life, however, I'm going to have to be extra careful with my right arm, to prevent injury or other damage.  What would be a mild or inconsequential injury in most cases could turn into something very serious since I am missing those lymph nodes in that area.

Now that we have all the information and I'm almost fully healed from the surgeries, it's time for action.  Because one node did test positive for cancer, my oncologist stated that my cancer has been classified as Stage 2 and we have a plan to fight it: 1) Chemotherapy, 2) Radiation, 3) Tamoxifen

Part 1:

Part 1 will be chemotherapy.  I will receive 4 treatments at 3 week intervals.  My first treatment will be this upcoming week on Wednesday, December 9.  Because I will only be receiving 4 treatments, I will receive the infusions via IV instead of having a port.  This is good news since there are drawbacks from using a port, including scarring and risk of infection.

My chemotherapy will consist of a combination of 2 drugs: Cytoxan and Taxotere.  The side-effects are expected to be typical and include nausea, low blood counts, fatigue, and hair loss (among others).  The nausea can begin as early as the same day, though I will receive medication in the IV to help with this as well as receiving a prescription to take once I am at home.  The hair loss will begin 2-3 weeks after the first treatment.  It will grow back once the treatments are complete and may even come back with a different color and/or texture.  It will be interesting to see how mine grows back. :)

During this time, I will see my oncologist weekly so they can keep check on my blood counts and make sure they are staying within acceptable ranges.  I will also have to be very careful to avoid any situations that might compromise my immune system or make me ill.

At this point, I'm hoping to be able to continue working during this stage, but we'll play it by ear as we see how this first treatment plays out.  Again, I am so very blessed to have a job and an employer that allows me to work from home when needed.  If the side-effects for me are a worst case scenario, I do have short-term disability compensation available.  We are going to pray very hard that I don't have to use this.

Part 2:

Once the chemotherapy is complete, there will be several weeks of radiation.  This will be received daily during this time period.  I have confirmed that we are going to set this up so I can receive these treatments in Carrollton instead of in Austell.  Since I work in Carrollton, traveling to Austell on a daily basis once we get to this point would have definitely been an issue.  But, once we get started, the treatments themselves take very little time each day - just a few minutes.  I'll have more information on this stage once we get closer to it.

Part 3:

After the radiation is complete, I will be on an oral medication called Tamoxifen for 5 years.

Wow... that sounds like a lot of negative huh?  A bunch of people may think so.  I know the next few months are going to have some hard times.  You know what though?  I received a poem at my surgeon's office that very clearly sums up how I feel:

As always, thank you all for your thoughts, concern, love, and prayers.  The next few months are going to be interesting and challenging, but...

Friday the 13th

Friday the 13th has long been regarded as an unlucky day stemming from various roots according to an article from National Geographic.  For my part, I've always joked around about it without ever really giving any credence to the phobia and I maintain that belief today.  I find it hard to grasp that my God would set aside a specific calendar day as being "unlucky" for all of mankind.  That being said, I know many people do suffer real consequences from this phobia to the extent that it affects their lives.  It's not my place to judge or condemn anyone about anything just because I don't feel the same.  There is a quote I found many years ago that sums up my feelings very well.  At the time, it was attributed to Mother Teresa (and in many places, it still is).  However, at the website maintained by the Mother Teresa Center, it is a quote that falls under the category "significantly paraphrased versions or personal interpretations of statements Mother Teresa made; they are not her authentic words."  It says:

According to my faith, it's my job to love. (1 Corinthians 13)

I chose the title I did because many will look back on yesterday and whether you attribute it luck or not, it was not a good day.  

First and foremost, the horrific acts violence that tore through Paris, France once again demonstrated that evil is free and loose in our world.  When I finally turned on some news late Friday evening, I was devastated and heart-sore.  My prayers and thoughts go out to everyone touched by those senseless acts of violence that were perpetrated by individuals from an organization that seems to have evil at its very core.  I can think of no cause or belief so great as to justify the slaughter of innocents.  All I can do is pray that this evil will be stopped.

The other reason yesterday was not a good day is that I received some news that is not good.  I had my sentinel node biopsy at Kennestone Hospital.  They discovered that three of the nodes had tumors that tested positive for cancer.  Based on that information, they performed an axillary lymph node dissection.  I'll be honest, I think I tuned out a little bit after that due to the disappointment from the three nodes testing positive plus still coming out of the anesthesia.  My sister said Dr. Robbins said they removed between 30-40 lymph nodes as part of the axillary dissection.  It is my understanding they will test these nodes and I will find out how many showed signs of cancer when I meet again with my oncologist on Monday, November 30.

I won't lie, I was very disappointed by this news.  I was hoping to get out of this with treatment consisting of radiation and tamoxifen only.  With this news, at best, we will be adding chemotherapy to the mix.  The battle is going to be a little harder than I was expecting.

I am also having some uncomfortable side effects from the surgery.  Due to the scope of what they had to remove, there were some sensory nerves involved.  I have some significant numbness in my underarm and back of my upper right arm.  Post surgery, I had quite a bit of pain in this arm as well.  It is some better today, but not completely gone.  In addition, I have a drain tube that I have to deal with for a little bit.  Because of this, I am trying to sleep in my recliner to keep from accidentally crushing it or crimping the tube from lying in the bed.  It and the numbness in my arm make showering an interesting affair.

In the famous words of a former co-worker, "It is what it is."  So now I take it one step at a time.

Google Maps GPS Navigation

Okay, I know this post isn't about Google maps or GPS, but by the end, you'll understand.

Today, I met Dr. Soltan and the staff at the Cobb office of Georgia Cancer Specialists.  What a fantastic group of people!  From the very beginning, everyone was positive, upbeat, and friendly.  Further, there was virtually zero wait time when I arrived for my appointment.  My appointment was at 9:45 am and I think Angie and I were in and out by 10:45.  During this time, I filled out my paperwork, they took my vitals, drew some blood, and I met with Dr. Soltan while he went over the results of my pathology report.

One thing I didn't mention about Dr. Soltan previously is that I did not randomly choose him.  This is not the first occurrence of breast cancer in my family.  My Aunt Gail and two of my cousins, Tonya and Avonda, have been through this as well... successfully!  Dr. Soltan guided Aunt Gail and Tonya along the paths to their cures.  We lost my wonderful aunt this past June, but by that time she had been cancer free for over a year.

So, what did Dr. Soltan tell me?  My cancer is hormonal.  Right now, the men out there are thinking, "Well, duh.. isn't everything associated with women hormonal?"  That's not *quite* what that means guys.  In this case, it means that the cancer (in my case) has some of the same hormone receptors that exist naturally in the breast cells that listen for the signal to grow.  My estrogen receptor score was 70% and my progesterone receptor score was 95%.  From cancer.gov:

Hormone-sensitive breast cancer cells contain proteins known as hormone receptors that become activated when hormones bind to them. The activated receptors cause changes in the expression of specific genes, which can lead to the stimulation of cell growth.

The plan here (at this time) is to attack this with the oral medication Tamoxifen.  The goal is to starve any cancer cells left of the estrogen and progesterone they crave.  Notice I said "at this time"?  Since I have not yet had the sentinel node biopsy (this will likely occur sometime in the next couple of weeks), we don't yet know if the cancer has spread beyond the breast.  Treatment plans right now are tentative pending the outcome of the node biopsy.  I will see Dr. Soltan again about one week after the node biopsy.

Will I have to have chemotherapy? If the node biopsy shows signs of cancer, yes.  Further, even if the biopsy is negative, they will still perform something called Oncotype DX to test my risk factors.  If this test comes back with a low risk (and no cancer in the nodes), chemotherapy will not be needed.  If it shows high risk, then even if the nodes are negative, we will still do chemotherapy.  If it is intermediate, Dr. Soltan and I will discuss it.  In addition (if I remember correctly - my notes aren't very clear on this), I think I will have some localized radiation at the area where the cancer was found.

All this being said, Dr. Soltan is extremely optimistic regarding my outlook due to how early this has been caught and the fact that it exhibits such high hormonal receptor numbers.

After we left Dr. Soltan's office, Angie and I went to a wholesale silk florist in Austell where she has purchased some flowers previously for Aunt Gail's grave as well as for our grandparents.  I saw several things I want to buy for Mom, Dad, Gramma, and Grandaddy's graves for Christmas.  We were a bit rushed since I had to get over to Kennestone Hospital for my MRI, but we are planning to go back this weekend when we have more time.

Once I got over to Kennestone, I grabbed some lunch then signed in for my MRI.  This was the first MRI I've ever had and I have to say, it wasn't too bad.  I was on my stomach for this test, instead of on my back, so it was a bit uncomfortable.  However, I had no issues with the enclosed space at all.  There is a bit more to this to tell that, honestly, is pretty funny, but it's not family friendly or safe for work so we won't go there.  The test took about 30 minutes in all.  I'll get the results from this when I go back to see Dr. Robbins next week.  I'm thinking that we will also schedule the node biopsy during this visit.  After the MRI, I met with a Nurse Navigator and we talked for a while about different resources available to me and she gave me some reading material and some other stuff.

By this time, it was about 3:30 and I opted to do a little shopping at The Outlet Shoppes at Atlanta.  I bought a couple pair of shoes from Naturalizer and when I came out, I saw that Yankee Candle was having a sale (you guessed it, I couldn't resist).  The drawback here is that now, it was about 4:30 and I knew I was going to get caught in traffic on the way home.  By the time I got down I-75 to I-285, it was pretty bad.  I got off at Cobb Parkway, then to Windy Hill.  It wasn't much better, so I pulled up Google Maps on my phone and told it I wanted to go home (it knows my address - how cool is that?).  Once I turned it on, I started getting turn by turn prompts from my phone.  I saw parts of Smyrna that I have never seen before, to my knowledge.  At one point, it carried me through an area that had a one-lane bridge followed closely by a one-lane covered bridge.  All in all, it was a fairly nice drive and I'm glad I got to see it (or what I could see since it was dark).  That is a drive I would have never made without the technology that lives in my phone, so thank you to my Galaxy Note 4 and Google Maps GPS.

Blessings to all and thank you for your thoughts, prayers, and support.

The Day After...

No... I'm not referring to the 1983 movie.  Yesterday, October 29, 2015 at approximately 5:00 pm eastern, I learned I became 1 of 8.

Before I get started, I first want to say that my reaction concerning this diagnosis and my attitude are mine only.  Hearing this news affects all of us differently.  I don't expect anyone to have this same outlook, nor do I intend this blog to be construed as a judgment of others who react differently.  It's not.  Furthermore, I am a Christian, if this notion offends you, that's okay.  You don't have to share my faith.  I promise, I'm not going to force you.  But I do ask that any comments be respectful.

There.. that's said.  So, how did I get here?

Well.. I was born a poor, orphan child... wait wait.. no, that's not right, wrong story.

The truth is, I've had a very happy, healthy life.  I am currently 45 years old and never had any serious illness.  I've been very blessed.  I have a wonderful family and a bunch of fabulous friends.  When it came time for me to have a baseline mammogram and then start having regular mammograms, I did so.  The kink came at the end of 2011 when I was laid off from my job in banking and lost my health insurance.

For three and a half years, I went without that regular screening while I went back to college to prepare for starting a new career.  In June of this year, I went to work for Greenway Health as an Associate Software Engineer.  In late July, I began getting caught up on my health screenings.

My gynecologist, Dr. Lisa Ortenzi, ordered my mammogram as part of my routine annual exam.  A few days after the scan, I received a phone call stating they wanted me to come back in for a follow-up scan.  They saw a couple of spots they wanted to get a better look at.  They said they would take some more pictures and the radiologist would read them while I was there.  If it was warranted, they would go ahead and perform an ultrasound to get an even better look.  As you can guess, we did do the ultrasound that day as well, confirming there was a definite area of concern.  You might remember, however, I said there were two spots?  One of them turned out to be perfectly normal, a lymph node.

Following this, I had my first appointment with Dr. Angela Robbins at The Breast Center on August 26.  We scheduled a biopsy for September 2.  The area they were concerned about was not very large and I think the general consensus was that the result would come back normal.  One week later, I went back into her office for the results only to be told they were not back yet.  The local pathologist sent the sample off for a second opinion from The Mayo Clinic.  Well, I was a little displeased (okay, yes... I was more than a little displeased but we won't go into that) since I had taken time away from work for this appointment, only to be told the results were not yet back.  We scheduled another appointment for a week later (trust me, I called this time before I went to the appointment to make sure the results were there).  This time, the pathologist from The Mayo Clinic said the findings were inconclusive.

Well, phooey!  I still didn't have any answers, but it was at this point that I began to realize this was probably going to be the real thing.  The only thing we knew for sure at this point was that the sample showed evidence of abnormal cells.  Dr. Robbins said whenever they find that, they want to get it out.  Even though it might not be cancer, there is a greater likelihood of it becoming cancer.  We scheduled a lumpectomy for October 23 at Kennestone Outpatient Pavilion.

From the day of my biopsy and through all of my visits to this point, my cousin Angie was right there with me.  She drove me over bright (or not so bright as it was still dark out) and early that Friday morning for my surgery and she was my "Responsible Adult" afterward.  Apparently, if you have surgery involving anesthesia, you don't get to stay by yourself (I live alone, you see).  They want a "Responsible Adult" to stay with you for 24 hours after surgery.

For the most part, the surgery went very well... except for the blown vein during the first attempt at the IV which left a very ugly and painful bruise on my left arm.  The pain from that bruise was further compounded when they tried to put the blood pressure cuff ON TOP OF IT when I went into the operating room.  Um... thank you... no... that's not going to work.  I think I startled the anesthesiologist when I sang out, "Nononono... we are going to have to move that cuff."  He immediately deflated it and moved it to my upper arm.  All was well.  The anesthesia started trickling into my IV and I fell into the bliss known as anesthesia sleep.  If you've ever had surgery, you probably know what I'm talking about.  There is nothing else like it.

Almost a week later (yesterday), I went in for my post-op follow-up and to get the results (and yes, I again called ahead of time to make sure they were there!).  The good news: they removed the whole tumor.  It was about 1.5 cm in size.  The bad news: it is breast cancer, more specifically, ductal carcinoma in situ with microinvasion.  You know what that is, right?  Yeah, I didn't either.  From breastcancer.org:

• DCIS-MI (DCIS with microinvasion) means that a few of the cancer cells have started to break through the wall of the duct. This is considered to be a slightly more serious form of DCIS.

According to the site linked above, all DCIS are considered stage 0.  Now, you and I know that sometimes the internet isn't always right (shocker... I know).  Anyway, I'm not saying this information is wrong, but I'm going to wait for my oncologist to tell me the correct stage.  What I do know is that the pathology report states that the tumor is a Grade 2.  Also from the same site:

Grade I (low grade) or grade II (moderate grade)

Grade I or low-grade DCIS cells look very similar to normal cells or atypical ductal hyperplasia cells. Grade II or moderate-grade DCIS cells grow faster than normal cells and look less like them. Grade I and grade II DCIS tend to grow slowly and are sometimes described as "non-comedo" DCIS. The term non-comedo means that there are not many dead cancer cells in the tumor. This shows that the cancer is growing slowly, because there is enough nourishment to feed all of the cells. When a tumor grows quickly, some of its cells begin to die off.

This is where things stand as of today, October 30.  I have an appointment with an oncologist, Dr. Soltan, next week on November 4.  On that same day, I will also travel to Kennestone Imaging Center for a breast MRI.  We are also trying to get an appointment scheduled to discuss Genetic Screening.  In addition, we will schedule a sentinel node biopsy in the coming few weeks.

How do I feel about all this?  The same way I felt before this started.  Physically, emotionally, mentally, I feel FINE (though some may debate the mental part).  Nothing has changed.  I'm not going to collapse in a puddle of worry and fear.  Breast cancer is a highly treatable form of cancer, especially when caught early, which this has been.  I still have to get up Monday through Friday and go to work.  During this time of year, I have football to watch (Hallelujah!) on the weekends, plus Monday night, plus Thursday night.  I have bills to pay (more now than a few weeks ago, admittedly), groceries to shop for, a house to clean.  The world hasn't come to a screeching halt because I have been diagnosed with this disease.  Do I acknowledge that this is a serious disease? Heck yeah!  But so is influenza, pneumonia, and so many other treatable diseases that can also kill.  I am going to follow the plan set out by my doctors and do what I need to do.  I am going to give praise that this was caught early and that I have more prayers being offered up on my behalf than I will ever know.  I'm going to put one foot in front of the other each day and let my Redeemer take care of the rest.

Blessings and love and if you (or the lady you love) are due for a mammogram and haven't yet done so:

NFL.com/pink