What All Does Chemo involve?

Well. I've been learning way more than I ever wanted about chemo, so I thought maybe I'd enlighten you, and let you know what's new here.

Short story: not much is new, ha! 

That's not entirely true - I am drain free which feels amazing because it was getting really uncomfortable and irritating. I'm still on really limited restrictions - no driving for another week, no lifting over 7 pounds for a while longer. Which puts my kids about 22 and 33 pounds over my limit, so that's fun. I go back to the surgeon in 2 weeks, and she will "ease my restrictions some" at that time. She's, ahem, quite particular about her rules, but if that gets good results, then I'm all for it!

I met with my oncologist yesterday and had a chemo learning day. I didn't know that's what it was going to be, or I'd have taken another set of ears, but it is what it is. Here's the plan.

5/29 - minor outpatient surgery to have the port installed. This will be on my left side, slightly under my collar bone, and will appear as a raised spot under my skin. This means that chemo injections won't hurt, because I'll have some numbing cream. The alternative would be an IV each time, and those aren't fun, so this is an excellent alternative. It shouldn't be uncomfortable or anything on normal days in between infusions.

6/4 - chemo starts. This will be a long day. In addition to the infusion of each medication one after the other, I will see the pharmacist, nutritionist, my oncologist... Maybe that's all. I will receive 4 c-fighting medications, plus some good stuff like Benadryl and anti-nausea meds. 

I'll be getting 4 medications via my port. Two are chemotherapy, two are targeted treatments. There's 6 rounds of this, every 3 weeks, and then I'll continue to do just the targeted therapies for the remainder of a year, still in the 3 week intervals.

Chemotherapy refers to a group of systemic medications that target all fast growing cells. That means that c-cells take the hit, but so do normal fast growing cells like hair follicles, mouth cells, and cells of the digestive tract. This is why hair loss and nausea are so common. 

Also, white blood cells (WBC) take a big hit, because they're also fast growing. To combat this, I will receive a little stick-on injector called Neulasta. 27 hours after chemo starts, it will beep and then give me an injection to boost my WBC and protect me from getting sick. So, all these cells get attacked by the medication, but healthy cells can repair themselves and grow back, whereas c-cells cannot. 

That's the basic mechanism behind chemo.  I'll receive two of these - taxotere and carboplatin - 6 times, every 3 weeks. Maybe soon I'll take the time to give a little more info on them, but if you're curious in the meantime, chemocare.com is a concise resource that my nurse gave me.

The other two infusions I will receive are Herceptin and Perjeta. These are smart therapies, not technically chemotherapy, in that they both focus on one feature of the specific c that they found in me. See, my case is Her2 positive. Normal cells include a Her2 gene that acts as a receptor for a protein of the same name. This protein tells cells to divide. In c-cells, there are too many copies of this gene, so it's saying divide-divide-divide-divide. The two smart drugs block this receptor, which prevents the c-cells from dividing. 

Now remember that I said normal cells have Her2 genes, and thus use the her2 protein. So, there are some side effects from that, but they're generally well tolerated and not as extreme as the chemo side effects. I will take these injections for a full year - 4.5 months in combo with the chemo, and then 7.5 months on their own.

I will go to the medical center for about 6 hours, every 3 weeks, for 6 cycles. Then, when it's just the targeted therapies, the infusion will last about 60 minutes. These won't require blood work each time (like the chemo does) so I'll be able to receive them at the Baytown hospital instead of making the drive.

And now you know all there is to know about what I'm going to go through! Not really, but it's a good start.

Oh, and because I've been asked this several times: my hair will definitely fall out, around 2-3 weeks after I start chemo. So that's around 6/18-6/25. Any more questions? Please ask. I truly don't mind. This is more scary because of the unknowns, so if I can make it less scary by answering questions, then that's a good thing.

How can you help me? Keep on praying. Jay is doing well with what he knows, but I'm sure that there's so much he doesn't get yet! Also, I may need a ride to and from chemo a couple of times when James works. It'll always be on a Monday. And those who have brought food while I have been recovering... That's been amazing, and I can't thank you enough. 

Picking Out Clothes

She is clothed with strength and dignity, and she laughs without fear of the future.

Proverbs 31:25 NLT

Since my surgery, I've been living in borrowed button down shirts that are big enough to not restrict/bind, and long enough to cover up the little belt that holds my drains, and soft enough to lounge around in. That translates to borrowing Dad and James's shirts, which have been super comfy, but not the cutest.

Monday, I got one drain out, so I am a bit less bulky, and so Tuesday, I started borrowing some button downs from my mom. I can't tell you how much better I feel being able to wear something feminine and cute, and I didn't even realize I was feeling frumpy.

I went to Faith Chicks Bible Study on Tuesday, and part of the verse above popped into my head, so I wrote it down - "She is clothed with strength and dignity." It was pretty irrelevant to what was being taught, but I know that God's word is never irrelevant to life, especially when it just pops into your head like that. I don't know about you, but I feel that when that happens, it's not just some random thought, but God speaking his word to me and reminding me of his promises.

Anyway, I got distracted there.

"She is clothed with strength and dignity." The verse doesn't say she's a strong and dignified woman. It says she's clothed with those features. That means that she woke up that morning, and she decided that the outfit she wore that day was going to include strength and dignity.

I read once that The Proverbs 31 Woman is not meant to be an impossible standard that we should hold ourselves to and strive to attain each and every attribute described there. Rather, it is meant to be an inspiration to me, as a woman, to draw from each feature as I have need. That means in some seasons, I'll be the one helping the poor and needy, sometimes I will focus on caring for my household more, and then there will be times that I am more industrious outside my home.

In the season I am in right now, I choose to get up and get dressed and put on strength to get through each day, each side effect, each set back. I choose to walk this walk with dignity, with my head held high.

*I* am not strong enough to fight this battle.

*I* am not graceful and dignified when faced with, well, all of THIS.

But, *I* am not walking this walk alone. God is with me every step of the way. And one of the tangible ways I feel him carrying me, is through you - your love, support, help, kindness. And because I'm not alone, I can make the choice each day to be clothed in strength and dignity. And hopefully a cute shirt.

Life Isn't Too Short. Or Too Long.

We've all said it: Life is too short to _____. Fill in the blank with whatever unpleasant task you're faced with.

On the other hand, we always think we've got all the time in the world to get around to doing "That Big Thing" you've always wanted to do.

But the truth is, life isn't too short, and it isn't too long. Life is exactly as long as you need it to be - you just don't know how long that is. God has laid every day out for us - maybe not what we'll do every minute, because of course there's free will, but He knows exactly how long we'll be here before we get to be with him.

I'm not going to say we should live like every day is our last day, because frankly, that's depressing. But, what if we lived like every day is our *best* day?

I don't mean that every day is filled with vacations, or relaxation, or excitement, or whatever it is that makes you think of your best days. But, what if your attitude matched a day of relaxation? Your outlook reflected a beach view? Your smile mirrored the excitement and anticipation of a new adventure?

Those are the kinds of changes you can make, right now, no matter what's on your calendar or what you just can't find the time to do.

How?

Well, I can't answer that question for you. For me, it means filling myself with the good stuff: Spending time with people who make me smile. Watching happy TV shows. Listening to praise music. Reading books with happy endings (and also happy middles, ha). Writing down good stuff - scripture, quotes, song lyrics, etc. When I'm full of the good stuff, it fuels me. Gives me the capacity to handle a temper tantrum or a bad report. ***Disclaimer: I might be the one tantruming, and I definitely cry at the doctor's office. But then I pick it up and move on, because I am diligent about only the good stuff going in the fuel tank.

And let's be real - I'm also talking about the big, concrete stuff. What one thing do you wish you could stop doing, but feel like you just can't? Stop it. Or find a way to make it better. What one thing do you keep putting off until you get around to it? Start it. Take one tiny baby step of it, and then another.

This, right here, this is the life I have. It's pretty darn good, even with the roller coaster of a diagnosis trying to cloud things up. I'm going to make today my best day, and then I'm gonna do it again tomorrow.

And PS, I decided while I'm at it, I'm gonna make it my best hair day, too. Because, why not? 

Game On

Well, today was a big day, and I'm kind of exhausted from it. I'm going to start my update with 2 Chronicles 20, verses 15-17, because it's been a huge comfort and guide to me.

          Do not be afraid or dismayed because of this great multitude,

          For the battle is not mine, but the Lord's.

          Position myself, 

               Stand still, and

                    See the salvation of the Lord, who is with me!

First, I saw one of my surgeons for a follow-up, and they're happy with how things are healing. I got a big warning that as I start to feel better, I need to really continue to take it easy. The more I move, the more drainage I have in the drains, the longer it takes to get them out, and then everything is slowed down. Yes ma'am, I will take it easy.

Then, I met with my oncologist, Dr. Patel, to discuss pathology from surgery and to set up a game plan. This was a mentally exhausting appointment, but I really love her. Remind me sometime to tell you how I found my treatment team... It's a pretty neat story.

Anyway. This post is probably going to be long and overwhelming, because that's kind of how the appointment was.

First up, we discussed the pathology in depth - there's anatomy & biology that come into play here. Some of this I already talked about, but here it is again. You'll probably need to go google some things, or if that scares you (because google scares me), feel free to ask - I truly don't mind, and I didn't know what all this junk meant before going through this either.

Anatomy:

The majority of the c is DCIS, but there were 3 small masses, plus the one lymph node, of invasive c. These measured 3mm, 1.5mm, and 1mm. Look at a ruler - that's really small. Under the old staging method, this would have put me at Stage 2A, because of size and lymph node involvement.

Biology:

The pathologists give the c a grade to measure aggressiveness: 1, 2, or 3. What they removed from me was grade 2, or intermediate.

Next, they look at how fast it's dividing, which is the ki67 rating, and that can be from 5-100%. They found this to be 80%, which means it was reproducing pretty fast - faster than they would have expected for a Grade 2 situation, but keep reading, because it's not really that big of a deal.

I want to pause all the detailed sciencey stuff and talk for a second. You see how I said "the c" and "what they removed" and "they found"... I want to be clear on something. This isn't "my cancer" or "my tumor" or "my" anything. I am not claiming it, because I am not keeping it. Yeah, it was there, I'm not denying facts, but I just wanted to let you know that it's not "mine." If I slip, I need you to call me out and remind me that this is a journey I'm on, and a battle I'm fighting, but it's not "my" cancer!

Up next is the most important thing for Biology: the markers. Estrogen (ER), Progestin (PR), and HER2. All three of these are positive for me, which is excellent news. While it means that we are fighting a more aggressive c, it also means we've got more tools to fight with. ER+ and PR+ means that the c feeds on those two hormones, so we block them, and it starves. Kind of like Superman and kryptonite. HER2 is a protein that tells the cell to divide. Being HER2+ means that the cells have a lot of little receptors on them for this protein, so it's getting the message to divide-divide-divide-divide. So, we hit it with two blockers, and it stops dividing. Starve it, stop it from growing, and we win!

They now look not only at the anatomy, but also the biology - and the tools we have to fight - to determine the stage. Because of all of this, I'm at Stage 1A. Dr. Patel says that this type of c, with all these features, has a cure rate of 90-95%.  THAT is something I will claim!

So..... what does all of that mean?  Here's the game plan:

1. Recover from surgery.

2. Start chemo, sometime around the beginning of June. This will be every 3 weeks, for 6 rounds... so, 4.5 months.

3. Recover from chemo for 2-3 weeks.

4. Radiation, for 4-6 weeks.  (Remember that pesky lymph node? Yeah, even one positive lymph node means radiation.)

5. Recover from radiation for 6 months or so. It's important for the skin to really heal well.

6. Reconstruction. This is a two-surgery process, about 4 months apart, and we will plan for it after we're all done kicking the c to the curb.

Altogether, we're talking about 16 months or so, if I did the math right.

Whew, that's a lot, I know. So.... what do you want to know?

Here's how you can pray for me:

1 - We haven't told Jay yet. Pray for guidance for us to know what to say, and peace for him, because he's such a sweet sensitive guy.

2 - Strength & peace as we continue this journey. It's a marathon, not a sprint, but God is a good good father and he sustains us!

Psalm 34

I will praise the Lord at all times.
I will constantly speak his praises.
I will boast only in the Lord.
When I feel helpless, I can take heart in him.
Come, let me tell you about the Lord's greatness.
Let me exalt his name forever.
I pray to the Lord, and he answers me.
He frees me from all my fears.
When I look to him for help, I will be radiant with joy,
and no shadow of shame will darken my face.
In my desperation I can pray, and the Lord listens.
He saves me from all my troubles.
The angel of the Lord is a guard.
He surrounds and defends me, because I fear and respect him.
I can taste and see just how good the Lord is!
Oh, how joyful I am because I take refuge in the Lord!
As his Godly people, I need to fear and respect the Lord,
Because when I fear him, I have all I need.
Even strong young lions sometimes go hungry,
but when I trust in the Lord, I lack no good thing!
Come and listen with me, and we will learn to fear the Lord.
Here's how I can live a life that's long and prosperous:
Keep my tongue from speaking evil, and my lips from telling lies.
Turn away from evil. Do good.
Search for peace. Work to maintain that peace, when I find it.
When I do good, the Lord's eyes watch over me,
and his ears are open when I cry for help.
The Lord hears me when I call to him for help.
He rescues me from all my troubles.
The Lord is close to me when I am brokenhearted,
He rescues me when my spirit is crushed.
I will face many troubles,
but the Lord comes to the rescue each time.
For the Lord will protect my bones,
because I am his righteousness,
and not one of them will be broken!
The Lord will redeem me because I serve him.
When I take refuge in him, I cannot be condemned!

A really smart man once told me that when I read the Bible, and see the promises of God, I need to put my name in there, because that's God talking to me.  So, I did that here, with Psalm 34.  If you read it in your Bible, it's not going to read like this, but man, what amazing promises are right there, for me, just because I trust God!! When God tells me all of that, does it even matter what the doctor has to say?

Surgery

The game plan for treatment involved surgery first, and "we will see" after we get the pathology of the tissue removed during surgery.  I was initially scheduled for surgery on April 18, but I have done such a wonderful job of teaching my children to share, that they shared their icky colds with me and so I had to postpone to the next week.

The purpose of the surgery was to remove not only the mass, but also the calcifications, because the surgeon felt that those were most likely tiny dots of c. All of that measured 7 x 6 x 4 cm, and if you've ever seen me, you know that I didn't have that much to spare in that region, so it was never a question of lumpectomy vs mastectomy. 

On April 25, I had a single mastectomy on the right side, along with a sentinal lymph node biopsy, and the beginnings of reconstruction.  My breast surgeon, Dr. Lim, was able to achieve negative margins all around. That's good - it means all the edges of what she took were clear for c. She also took three lymph nodes, including the sentinel node and the nearest two, to sample.  During surgery, they did a quick look under a microscope and saw c in one of the lymph nodes.  This means that the DCIS had changed again and that there was at least some invasive c present, but we wouldn't know how much until final pathology results were back.

As a result of seeing c in a lymph node, the surgeons switched gears mid-surgery and put in a tissue expander. This is sort of like an implant, but they can change the amount of saline that goes into it. They did this, because having c in a lymph node means I'll do radiation after I recover from surgery, and the expander is, I guess you could say, the most durable temporary reconstructive measure they can do. Our initial plan had been to do a more permanent reconstruction technique called DIEP that I'll explain another time, but it uses abdominal tissue to rebuild a breast. But, that's not compatible with radiation, so we will do that down the road.

They sent all of the tissue they removed, and the three lymph nodes, and looked through all of it to see what exactly was going on in there. Final pathology came back today, and was almost all great news. 

1 - All margins were negative - meaning, no more surgery will be needed to take c that they "missed" around the edges.

2 - Still only one node had any c, which is great news and means they won't do any additional surgery to remove more lymph nodes. Removing lots of lymph nodes can lead to arm swelling and discomfort, called lymphadema.

3 - Most of the c they found when examining all of the tissue was DCIS - there were only very tiny dots of invasive c, measuring 3mm, 1.2mm, etc. So, that is good news in that there wasn't much invasive - we knew right after surgery that there was at least some invasive, because of the lymph node, so hearing that there's not much is a good thing.

4 - They tested the c for "markers" which helps them understand the biology of it, and therefore how to treat it. This is Estrogen Receptor (ER), Progestin Receptor (PR), and HER2 positive. This one is tricky... having all three receptors positive means it's a more aggressive form of c, but also means that it will respond better to chemo.

I'm feeling really good post surgery.  Less than a week, and I'm off of my pain medicine and just in the "uncomfortable" stage. I can't lift my right arm higher than 45 degrees, and I can't lift more than 7 pounds (have you seen my two kids? they're considerably more than 7 pounds!), and I have two drains which kind of gross me out. But, I'm feeling better each day, and I'm blown away by how kind and helpful everyone has been. I'm bummed that we're looking at radiation and chemo, because initially my oncologist had thought we'd just need to do surgery and then be done. But God is good, and He's got this under control. I'm just along for the ride.

Shell Shock

How did we even get here? 

January 15, I found a breast lump. I didn't think much of it, because I'd just stopped nursing Luke the month before. But I made an appointment with my OB, who also thought it must be nursing-related. She referred me to a breast center for a mammogram and an ultrasound. 

That appointment was March 9. The radiologist there was looking at all the images and said, "I'm very concerned about this. There's a mass (which is what I had felt, that measures 3.8 x 3.3 x 1.6 cm.  In addition to that, there are calcifications (which look like sprinkles across the images) that measure 7x6x4 cm. We're going to bring you back in a week or so for a biopsy of the mass and also this one lymph node that looks suspicious. Here's how biopsies go, blah blah, do you have any questions?" 

I said, "When you say 'very concerned,' what do you mean by that?"

"Oh, I'm very concerned that this is a breast cancer mass. Now, did you have any questions about the biopsy?"

Um no, no questions at all, thankyouverymuch. 

So fast forward to March 19, when I went to MD Anderson for my biopsy. They also redid the imaging, because they like to have all their own tests. Before I even got the results, the diagnosing doctor said she's confident that it is breast cancer, and she'd call in a couple of days with the results.

The short story: the lymph node biopsy came back negative, but the core biopsy of the mass came back as Ductal Carcinoma in Situ (DCIS). This is essentially stage 0 breast cancer, meaning it had not spread out of the ducts. She even said that it's not technically cancer, but precancer. 

What does all that even mean?! Here's an explanation of how I understand things: you've got normal cells in your body. They're going along, dividing and making new cells like they're supposed to. One day, something messes up in the reproduction process and a change occurs. Now, you've got an abnormal cell. It's dividing a little faster than normal, and being weird, maybe looking a bit strange, but it's not cancer. As these new abnormal cells continue to reproduce, another change happens, and they become DCIS cells. Now, they're cancerous in that they divide much faster than normal cells and crowd out the healthy ones by stealing all the nutrients, but they lack the ability to go anywhere else in the body. Hence the "in situ" part of the name - they have to stay in their original place, the ducts. As these cells grow and reproduce, another change happens and they become invasive cancer cells - they now have the ability to spread. 

So, that's my diagnosis and a little lesson for you. And from here on out, I'm not typing out 'breast cancer' and 'cancer' all the time. Frankly, I just don't want to give it that much attention. So, you'll see bc and c showing up a lot, and you can just know what they mean.