Sometimes Life Is Especially Unfair

Very soon after getting my cancer diagnosis, I went online and looked for "cancer diets". You'll be shocked to hear that it's mostly common sense: no caffeine, no alcohol, lots of dark green, leafy vegetables, lots of fruits, and anything with antioxidants. And I've been pretty good. I've pretty much completely dropped the caffeine and alcohol and it's a pain, and a drag, and a bother, but I feel like it's just not that hard to make those changes for the duration of this healing process.

But honestly, I figured I could dabble in caffeine and alcohol after radiation. I mean, why not, right? I'll be better and life should resume. And then stupid Kaiser hospital has to publish this.

Sometimes life is so unfair.

Ready, Set, Go!

What a busy couple of days we've had.

First: we got Emily happily esconced in her dorm room (Anacapa Hall) at UCSB over the weekend. We left home at about 10:30 a.m. on Saturday with a borrowed van (thanks again, Sarah & John!). We hit a bit of traffic around Watsonville, and some very icky rain a couple times, but got to Santa Barbara before 4:30. We managed to wrangle our way on to campus, stopped off at the bookstore (where we picked up Em's preordered books) and then left her bike locked up in front of her dorm. (Emily's room is one room away from this back door to the dorm. Not too shabby.)

After spending a lovely evening at the Ramada Limited and a quick morning visit to the Mission Santa Barbara, we got Emily moved in to her dorm, had lunch with her in the dining commons, and said "see you in five weeks" around 1 p.m. on Sunday. (I didn't get weepy until we were halfway down the hall.) Frank and I were back in Albany around 6:30 last night.

Second: On to today. I had a 10:30 appointment with my medical oncologist. All went well and she said that, as long as my surgeon is okay with it, I can start chemo next week. Finally! Don't get me wrong. I'm not exactly excited about chemo, but I do feel that the sooner I can get started, the sooner I can be on the other side of this, and I'm really ready to get started.

(It turns out I will not be doing the Taxol test. The treatment involved pills and self-injections and Dr. Kuan nixed the whole idea. It was kind of funny listening to her talk to the research department. "That's not a good test. No, you really should just scrap that test. What about this other one? <listening> No. That's not a good test. These are not really good tests." Anyway. We're doing the prescribed 4 cycles of AC and 6 cycles of Taxol, each two weeks apart.)

I scheduled a Monday morning first time infusion for the AC (I'll be there from about 9 till 1 p.m.) and a Tuesday follow-up for a shot of Neulasta (to get the white blood cell count going).

At 2:45, I met with my surgeon. He confirmed what Dr. Kuan told us--the margins were clean and there is no residual cancer in the breast or lymph node area. Yay! He said that, yes, I can start chemo whenever Dr. Kuan is ready. Then he brought up radiation. He talked about the "mammocite" proposal he had mentioned during our pre-surgery consult over a month ago. Mammociate radiation is when they put a balloon catheter into the tumor site and zap you with radiation from the inside as well as the outside, for five days. This greatly reduces the radiation time (from five/six weeks to five days), so that's a plus. On the other hand, there really aren't any long-term statistics for this form of radiation yet and so no one can offer assurances that it will be as effective, in the long run, as the good old six weeks of daily radiation.

If we pursued this form of radiation, we'd need to do it before chemo, and so we really needed to get Dr. Kuan's opinion. I called Dr. Kuan and after some phone tag, we spoke about the radiation. Given my high risk status, she doesn't recommend the mammocite radiation. So, there we are.

We'll start the AC on Monday and then do three more cycles over a period of eight weeks. When that's done, we'll get started on six cycles of Taxol over twelve weeks. Then we'll take a short break and get started on the radiation.

And, in the interest of fair and balanced reporting ;-), I have to say that I am in love with Blue Shield right now. They approved one of the more expensive anti-nausea meds (Emend) and so other than having a liter or so of toxic chemicals in my body next Monday, I should be feeling okay.

University of Casual Sex and Booze

Well, Em says she has heard UC Santa Barbara referred to in that manner. Of course, it was from a friend who was going to an even more notorious party school (not printed here for self-protection).

We're borrowing the Tonkyn's minivan (thank you Sarah & John!) to which they have attached their bike rack, and we're hitting the road tomorrow around noon. We get to move Emily in to her dorm (Anacapa for those of you looking at a map of UCSB) starting at 9 a.m. Sunday.

I've been a bit tired the past couple days and Frank keeps offering to do the trip solo with Em, but I don't think I could stand that. So, I plan to stay with the car while they're unloading and then go park and slowly make my way back to the dorm while they're putting things in the room.

Other than that, I shall be observing and trying not to interfere in the negotiations to fit three young women (and all their stuff) into a room built for two.

Maggie, meanwhile, will be spending the weekend with friends. She has a soccer game on Saturday, around noon, and after that, she'll go to Siobhan Bauer's house, where I know she'll be well tended.

Frank and I hope to get home Sunday before too late so that Maggie gets to bed at a reasonable time. Wish us luck!

Surgery: Double Check

....and just be grateful it won't be a "triple check".

There was some doubt as to whether or not we'd get approval for the port to placed during this surgery and I was starting to feel a bit pouty about the prospect of a third surgery. But, yay!, someone pulled a rabbit out of a hat, and they put the port in place yesterday, during the recision.

The recision doesn't hurt much, but the area where they put the port is pretty sore. I gather they had to move some muscles around to get everything in place.

But, all in all? Things went swimmingly. Surgery started a bit late (I was wheeled in to the OR a bit after noon, rather than at 11:30), but I was home before 5 p.m. and I got to sleep in my own bed (much more restful than sleeping in the hospital).

Thanks to Joanie, Karen, and Dorothy for cleaning our house again yesterday, while Frank and I were in the hospital all day. "Thank you" to Becky for a wonderful dinner. And thanks to my co-workers for the most fabulous box of chocolates (a box made out of chocolate, filled with chocolate), accompanied by the loveliest sentiments.

I will be meeting my oncologist next week to schedule chemotherapy. And in the meantime, we'll be getting Emily packed up and then settled at UCSB.

A New 'Do

I've decided that I don't really want to wait for my hair to start falling out, and then have a sad couple days with long grey hairs wrapping around my brush, etc. So, I took matters into my own hands (well, and those of Paul, at Festoon). I got a short cut I'm calling my Chemo Cut. To be more accurate, it is, of course, a pre-chemo cut, but I would not be getting it if it were not for the chemo, so I still think it's appropriate.

Okay, and now I'm babbling. :-)

So, ta da! Here I am. Freshly shorn.

Monday Recision

I'm scheduled for the recision surgery on Monday, September 17, which is easy for me to remember, as it's my parents' anniversary. (Happy Anniversary, Mom & Dad!) ;-)

I'll check in at the hospital at 9:30 and surgery is scheduled for 11:30. Assuming everything goes well (and remember, we have no nasty lymph nodes to deal with this time around), I should be done by 3 p.m. and then home around 4 or 5 p.m.

Meanwhile, the MUGA this morning was pretty boring. Frank and I showed up at Alta Bates hospital, where we checked in at Nuclear Medicine. I got shot up with some radioactive isotopes and then waited for about 15 minutes for them to circulate through my bloodstream. Then I was put on a narrow bed and had 3 leads put on me for the heart rate monitor. I had to put my left arm up over my head and the kindly nurse, Mark, strapped my right arm around me, so I'd stay nice and still. He positioned the circular scanning device over me and it slowly moved around my heart for 20+ minutes.

Frank asked if he could talk to me and Mark said, "yes, just don't make her laugh." So, at one point, Frank starts to tell me how he's going to prepare the Smithfield ham he just acquired.

Frank: I'm going to cook it the Alton Brown way.
Karen: And what way would that be?
Frank: Well, you braise it in Mr. Pibb.
Karen: Mr. Pibb?
Frank: Yeah, and sweet pickle juice.
Karen: You're not supposed to make me laugh, remember?
Frank: That wasn't supposed to be funny.
Karen: Sweet pickle juice?
Frank: Oh, okay. ......Iraq.

You gotta love him.

2B or not 2B?

Frank and I saw Dr. Kuan today, to go over the pathology report and to discuss chemotherapy. What a long appointment.

First, the details. The CT scan showed the breast lump and the rather large lymph node in my armpit, but that's it. So, yay, we get a zero on the M(etastisis) for the TNM staging for breast cancer. We told Dr. Kuan that Dr. Broderick had said I was staged at 3A (67% survival rate) and she looked confused. She said, no, a T(umor)2 and N(odes)1 meant a 2B. She looked through the pathology report and we talked about lymph nodes that are "matted," which can move a stage 2B to a 3A, but she said the pathology report showed no indication of this, so we're going to take that 2B with no further argument, thank you very much. All in all, given the TNM "score" combined with the fact that the tumor was "high grade" (i.e. aggressive), gives me a 75% survival rate. (But as my oncologist friend, Carla, reminds us, "these statistics refer to large numbers of people, not to individuals.")

After clarifying those details, Dr. Kuan let me know that the cancer center is doing a clinical test on Taxol infusions. If I sign up for the test, my chemotherapy would consist of 4 bi-weekly infusions of Doxorubicin (Adriamycin) and cyclophosphamide [abbreviated AC], and then either 12 weekly infusions or 6 bi-weekly infusions of paclitaxel (Taxol). The benefit of taking part in a clinical trial, of course, is that you have even more doctors watching your condition. So, despite the fact that weekly infusions would be a drag from the perspective of getting on with life, we are considering it.

We got to meet the nurse for Dr. Kuan's practice, Lisa Mune, who showed us how the "port" works for the chemo infusions. You can go here for an image of where the port goes. This port, which is surgically inserted under the skin, enables the nurses to give me my chemo meds and to draw blood without having to find a vein every other week. We're hoping that Dr. Broderick can put in the port when he's doing the recision to get more of the margins (still no word on when that will occur, yet).

But, if you look at the image, you'll note that meds go right into the vena cava, which leads right to the heart. So, to make sure my heart can handle all this (the Adriamycin, the "A" part of the AC, is hard on the heart) I'm having a heart scan (MUGA) on Thursday morning.

Whew. What a day.

On a positive note--I went camping this past weekend with the moms and daughters in Maggie's girl scout troop. There were four girls and four moms in Marin and it was lovely. I came home on Sunday utterly exhausted. But I'm figuring I won't be doing much of that kind of thing for at least the next six to nine months, and I wanted the Maggie time.

Houston, we have a "stage"

My surgeon removed the drain today--yay! I had no idea how much it was irritating me. No, I mean, I know it was bugging me, but I didn't realize how much of the discomfort in my armpit was due to the little plastic tube up there. Now it's out and I feel better already. :-)

Bad(ish) news--the margins on the tumor were a bit close, so he wants to go back in and remove more of the edge around the existing "cavity" (where the tumor was). (The tumor was about 2.5 cm.) Since there definitely won't be lymph node involvement this time, it actually *will* be same day surgery. But, of course, we have to go through the approval process (again) first. So, everyone be thinking positive thoughts along the lines of "surgery next week, surgery next week, surgery next week".

And of the 18 lymph nodes they removed, 3 of them were positive.

This makes me T2 and N1 in the cancer staging. We're assuming (hopinghopinghoping) that the M (metastisis) is a 0. Hopefully the CT scan taken last week confirms this. I'll know more, I'm sure, when I meet with the oncologist on Monday.

The surgeon says they're staging this as a 3A. Not fantastic, but not end of the world, by any means. And, we're lucky enough to live in a nice metropolitan area, with access to extremely fine care.

Meanwhile, we continue to be touched by the genuine help and good thoughts we're continuously receiving. We can't thank folks enough. Please just know how much we do appreciate your thoughts and words.