Keep Calm and Chemo On

It has been three weeks since my first chemotherapy infusion and I'm going for my second in the morning. I've been feeling pretty good this past week, almost normal.

I didn't start feeling bad until about three days after my first treatment, but right from the beginning I felt very odd, just strange and surreal. If you've seen the Lord of the Rings movies, picture the scenes where Frodo has the ring on his finger. That's the visual that comes to mind when I think of how I felt  for about the first week to ten days: like I was not quite in the real world, not quite in the land of the living. It was a struggle to focus my mind or my eyes. I heard roaring and ringing in my ears and they pulsed and throbbed. After a few days I felt random sharp, stabbing  pains in my head, jaw, throat, ears, back, pelvis, legs. 

I had an awful taste in my mouth and foods and beverages tasted odd. I've been a coffee drinker for over forty years and love a good, strong cup of freshly brewed coffee. Now, I can hardly taste coffee and the taste that does come through is off somehow. I did experience some nausea, but the anti-nausea medication they gave me with the chemo seemed to keep it in check. Of course there was fatigue, which didn't become debilitating, but I've been told to expect that to get worse with successive treatments. I had stomachaches and GI symptoms I won't go into detail about.

But after about the first ten days, I began to feel progressively better. It's good to know that this won't be four months of solid misery. I'm very thankful that so far I've been able to work and go out with Rick and the dogs for our daily walks.

About two weeks after the first treatment, my hair slowly started coming out, so Rick buzzed my head for me, but I still have a lot of stubble that hasn't fallen out yet. I wear hats or "buffs" except when I sleep now.

I've learned that there are scores of different chemotherapy drugs and regimens geared to different types of cancers and patients. The side effects and experiences can vary widely. I am being treated with two drugs: Cytoxan and Taxotere. I will have six treatments at three week intervals. The drugs are administered one at a time by IV into the port that was placed under the skin beneath the left side of my collarbone. Each treatment takes about three hours.

Just before I began chemo, we got the results of a blood test my oncologist had ordered that showed that I would have trouble metabolizing the drug, Tamoxifen. Taking Tamoxifen for five years was going to be an important part of my treatment plan to help prevent recurrence of my cancer. My tumor was strongly estrogen receptor positive and Tamoxifen is very effective in preventing recurrence of this type of tumor for most women. There is another class of drug I may be able to take instead, but we decided to table that decision until after I've completed chemo and radiation.

For now, knowing that Tamoxifen has been removed from my arsenal of anti-cancer weapons, it seems even more important to persevere through my chemo treatments. I'm confident that I can, with God's help and with the support of my wonderful husband, family and friends.

Looking Forward, Looking Back

Here at our house, we didn't exactly ease into the new year. As we entered 2013, we already had our dog, Zoe's orthopedic surgery date on our January calendar, as well as Rick's consultation with a surgeon for hernia repair, and we were waiting for results of a breast biopsy I'd had two days after Christmas. 

I got my breast cancer diagnosis on January 2, Rick had his surgery on January 11 and we took Zoe for hers on January 16.

Zoe the day after her "femoral head ostectectomy"

On January 24, one of our cats, who we adopted from the shelter a year ago, went missing. We've plastered the neighborhood with flyers, posted her picture on lost pet websites and contacted the shelters, but still no sign of Sasha.
 

Last week, which was the last week of January, Rick had his followup with his surgeon on Tuesday and got a good report after two weeks of trying to remember not to lift anything over ten pounds and laying off running, which was making him stir crazy.

The next day, Wednesday, I had lumpectomy surgery. 

Friday, Rick and our son, Paul, took Zoe for her followup and to get her 21 surgical staples removed. She is doing well, but still needs a lot of rehab, mostly in the form of daily walks. It will probably be another 5-6 weeks before she's fully recovered and we can consider surgery on her other hip.

Also on Friday, I got a call with the best news possible from my pathology report. The margins of tissue around my tumor were free of cancer, as were my lymph nodes. It was such a relief to know I wouldn't be going back for a second surgery.
 

Me with Kelly and my dad on Saturday after my surgery

Our daughter, Kelly, has come and gone. We had a wonderful weekend with her and look forward to our younger daughter, Erika, arriving late tomorrow night from Iowa. 

I've also enjoyed visits from my dad and from my friend, Jennifer, a breast cancer survivor twice over.

It was wonderful to go to church yesterday to worship the Lord with dear friends, who've been praying for me.

We're having gorgeous weather, perfect for taking Zoe out for walks and for Rick to gradually resume running.

I am driving again and going on short outings and errands, resting a lot, and using over the counter ibuprofen and acetaminophen as needed for pain. I have prescription pain medication, but haven't taken that, or felt I needed to, since my first night home.

Next Tuesday I'll have my two week followup with my surgeon where I expect to get more detail from the pathology report and a referral to a radiology oncologist. I plan to return to work Wednesday of next week, so my appointment with the oncologist will be sometime after that. 

I can't start radiation treatments until I'm completely healed from surgery, which probably won't be before the end of February. I think I'll most likely have radiation treatments five days a week for five to seven weeks. At some point, probably after radiation is finished, I'll be starting on the anti-estrogen, drug, Tamoxifen.

But for now, I'm just looking forward to a week of enjoying Erika's company and, if the forecast is correct, more beautiful weather. 

Flowers from my employer

WHAT WE KNOW SO FAR

So today Rick went with me to consult with the breast cancer surgeon. Perhaps I should backtrack a bit to say how I chose this surgeon. Initially when my gynecologist gave me the results of my biopsy, he gave me a list of surgeons he recommended, so my first step was to check my medical insurance provider roster and all those surgeons were on it. My next step was to talk to a friend who has had two experiences with breast cancer, one recent and one about eleven years ago. She had a different surgeon for each, but recommended both of them, Dr R and Dr K. Again they were both on the insurance roster, but only Dr R was on the list from my gynecologist. Then I called my primary care doctor, who specializes in internal medicine. He only recommended one surgeon, Dr. R, so I called to make an appointment with him. Then, I went to get my hair cut. I told my hairdresser about my diagnosis and to my surprise she asked who my surgeon would be and expressed approval when I told her. She is between my two daughters in age and told me that Dr R did her mother's breast cancer surgery about four years ago. I have researched this doctor's credentials, education, awards and recognitions and learned that he's quite renowned. All along I had also been praying that God would help me in the choice of a surgeon and I believe He did. 

Rick and I both liked the surgeon very much and felt that we had a good rapport with him. He showed us all the images from my mammograms and ultrasound and went over the pathology report from the biopsy with us. He explained everything very thoroughly in a way that answered most of our questions before we even asked them, but he also took time to answer the remaining questions we did have. 

Here's what we learned today:

My breast tissue is so dense that it's impossible to rule out the possibility of more cancer in either breast without MRI, which means I need an MRI before mastectomy can be ruled out. I'll have the MRI on Monday and the surgeon will call me when he gets the results. 

If no other tumors are found, then we'll schedule a lumpectomy. That would be done as an outpatient. The doctor would remove the tumor plus a margin of tissue around it. He would also remove one to three "sentinel" lymph nodes, more if those look suspicious for cancer. I would go home the same day. Statistically, there would be about a twenty percent chance that the margins around the tumor would not be cancer free and I'd hear from the doctor about two or three days later and would go back in to have more breast tissue removed. Lumpectomy is always followed by radiation and I'd probably start that two to four weeks after surgery.

If more cancer is found in either breast, then I'd be looking at mastectomy and reconstruction, which would not need to be followed by radiation. 

After surgery I'll be seeing an oncologist, who will have access to the pathology report on the tumor and the lymph nodes. The possibility of chemotherapy seems unlikely, but will hinge on whether cancer is found in the lymph nodes and to what extent. One thing I do know is that the tumor is ER (Estrogen Receptor) Positive, which means the drug Tamoxifen is in my future, since at the age of fifty-seven I'm still not quite postmenopausal. I'll probably be looking at five years on that or two to three years followed by two to three on another drug once I am postmenopausal.

All in all, I still think the prognosis is very good and I thank the Lord that my cancer was detected early, my tumor is small and slow growing, I have access to good medical care and I am blessed with a wonderful husband and supportive family and friends.