BC Becky

Never Thought I'd Want to be a Breast Cancer Survivor

Category: active treatment

  • Decide who you trust

    A friend (Marie Ennis O’Connor) has asked me to blog about something that I’ve learned through my experiences with breast cancer. I went back through my blogs, looking for this story, and realized that I did not tell it. Perhaps it is because it is a learning through reflection, rather than an in-the-moment type story.  An aside – perhaps it is this type of after the fact reflection that makes books about illness different from blogs about illness?

    When I think back about one thing that I’ve learned, it is that treatments change over time but advice is full of ‘old wives tales’ which are often based upon older treatments. This was never more poignant than during my last round of AC chemotherapy. Throughout AC chemo, I had been suffering from nausea. I new from support group that people who tolerated it well only had nausea for three to five days. I had nausea for at least eight days. Given I was on a 13-day cycle, this meant more days with nausea then without. Now, my nausea was never really bad. When I complained to my oncologist, he asked me “when was the last time you threw up?”. Never. My nausea was never that bad, it just lingered.

    The folks at support group (especially those a year or so ahead of me) would talk about different nausea meds. The meds I was on were not the meds that everyone was talking about. I found myself wondering if I should be on different meds? In my mind, a change of meds would mean less nausea. I would tolerate the chemotherapy side effects so much better.

    What I didn’t realize was that these different nausea meds were the old school meds. The meds my oncologist had me on were the new ones. People in support groups, and some of the older chemo nurses, were not familiar with the new meds. The recommendations I was getting about ‘what works’ were ‘old wives tales’, and I bought into them instead of trusting my oncologist.

    For my last bout of AC chemo, I tried a different combination of anti-nausea meds. My oncologist was away, so his nurse practitioner changed my meds (in part because I asked for it). I’m sure that if my oncologist was there, he would have explained that I was on the new meds, but also that they were doing their job. I didn’t know the other option was the older option. I didn’t realize that the folk lore about the effectiveness was in part just because it was the older meds. The new meds had not been around long enough to be part of the lore. With the change my nausea was no better, but the side effects of the meds were much worse. I ended up with terrible mouth sores (so bad I needed liquid morphine to manage the pain). One of my biggest regrets regarding my treatment was that I changed anti-nausea meds for the last cycle of AC chemo.  I had forgotten my own advice. I had forgotten who I had decided to trust (my oncologist), and let the ‘lore’ effect my treatment.

    This tale is meant to be a cautionary one. Not so much about seeking advice, but about remembering that people who have followed this path before you did so at a different time. The treatment options (and side effect management options) available to you today may not be the same ones that were available for someone else a year ago. Although older treatments may work, chances are the newer ones are better. Before changing treatment plans based upon what you are hearing on the net or in support groups, ask yourself ‘is this a old tale’? And finally, decide who you are going to trust, and trust them.

  • Fatigue and my knees

    At one point this afternoon I realized that what I was feeling might just be fatigue – rather than tiredness. I’ve been struggling with a cold all week and that has had me try to take it easy. But when I realized that what I was feeling might be fatigue, I decided that I’d go for a walk up at Alum Rock park. I was reminded of my chemo mantra – exercise helps fatigue. If you are feeling tired, go for a walk, if it gets better, you know it was fatigue and not true tired. That apparently was the case today.

    Walking down to the car, it occurred to me that my knees no longer hurt. I even tried doing some deep squats. Since mid January I have had horrible knee pain … a side effect of too much Cipro post surgery. This was rather comical (and yet sad) when I tried to pee outside the cabin when camping at Big Basin – squatting didn’t work out so well then. One of my deep seated fears has been that the pain in my knees would never get better. Anti-inflammatories would help ease the pain, but it was still present – at least until yesterday or maybe the day before. The knee pain seems to have completely gone away. I can now do a squat or two without pain (going to have to work on strength in that area now). So, I was extra delighted to go for a walk this afternoon.

    It didn’t take long for the fatigue to wear off. It felt wonderful to walk in the woods. I even did the hike up to Inspiration Point. In the end I walked 6.1 km in 1h40min – so it was not only one of the furthest walks I’ve done since chemo, it was also one of the fastest ones. I didn’t even stop to sit and rest (which I used to need to). This bodes well for the Avon Walk – which is only a couple of months away (still need a few more dollars to qualify to walk – donations welcome at this link – http://info.avonfoundation.org/site/TR?team_id=141489&fr_id=2404&pg=team).

    Photo & Video Sharing by SmugMug

  • Catching up with some pictures

    I’m getting a little behind on posting pictures. I took this one of me at my tree last Friday (Feb 6). The area around the tree was a muddy mess filled with construction trucks. It appears that many of the trees in boxes are being relocated to their more permanent homes. Because we have actually had rain, the grounds are green and soft, so the trucks tore it all up and made a muddy mess of it. I had to hop in, take a quick selfie, and leave for fear of trees tumbling down.

    Photo & Video Sharing by SmugMug

    Later that day, in the pouring rain, our friends from Ottawa, John and Alison came to visit. Fortunately our condo has a community room area that we could use, so their grandson had lots of space to roll around and play while we had a chance to visit. It was so nice to see familiar faces :-).

    Photo & Video Sharing by SmugMug

    Over the last week I’ve been doing more biking. I’ve been able to ride my bikes for just over an hour and generally get in about 17 km. I do find that on my foldie my hands get tired, so I’ve been riding my ‘bent more often. The biggest issue with the ‘bent was getting my leg up from the ground to my pedal – which I’m getting better at. I do find myself worrying about balance on it – but clearly not that much, since I took these two selfies while riding (on different days).

    Photo & Video Sharing by SmugMug

    It feels really good to be back on the bike and getting some decent exercise. I’m also continuing with the Living Strong Living Well program at the Y. I do find at times that I struggle with motivation to get out, but once I get there I leave feeling so much better both mentally and physically. So, I try to remind myself of that good feeling when I’m having trouble coxing myself out the door.

    My neuropathy does seem to be improving. As a way to measure, Scott and I went back to the Penetencia Creek trail to walk. Yesterday, I managed a 6.66km walk in the same 2 hours that previously I struggled to make 5km. Walking that bit further meant that we got to explore new areas of Alum Rock Park. It is incredibly beautiful – a real gem – and only a 20 minute drive from our apartment.

    What really strikes me as different is that I recover a lot faster from the foot pains. Previously, I’d not be able to walk or stand again for the rest of the day. Yesterday, after the long walk and a couple of hours off my feet, I was able to stand in the kitchen for over an hour making dinner. It is something that I would have not have been able to do two weeks ago!

    Photo & Video Sharing by SmugMug

     

  • Chemotherapy Induced Peripheral Neuropathy

    Effective treatment of established CIPN, however, has yet to be found. Lastly, paclitaxel causes a unique acute pain syndrome which has been hypothesised to be caused by neurologic injury. No drugs, to date, have been proven to prevent this toxicity.”
    (Wolf et al, 2008, p.1507)

    It occurred to me just yesterday that I need to do more research on chemotherapy induced peripheral neuropathy (CIPN). I have been in denial for a long time about my neuropathy. Not denial about it happening – as that cannot be ignored – but denial about how long it will take to heal. I stopped the Paclitaxol chemo early (Oct 30) because it was causing neuropathy. When I was in Maui after the end of chemo, the neuropathy  got much worse – and that is when I started taking medication for it. It has now been three months since my last chemotherapy treatment, and I have yet to see a significant improvement in the neuropathy. I’m afraid that at some point, I will need to accept it, but I’m still hopeful of it improving.

    The biggest challenge it poses is walking and standing. I can now walk for 30 minutes before the pain becomes too much and I need to sit down. I still do walks/hikes that are about 2 hours long, but I need to stop and rest my feet for about a minute or two every 10-15 minutes after the first 30 minutes. I am, however, getting to the point where I really don’t like the feeling of the pain. I’m not sure if it is because the feeling is changing, or that because I’ve cut out all the narcotic pain killers, that I’m more acutely aware of the pain when it happens.

    Gabapentin, and its newer analogue pregabalin, have been commonly used in clinical practice to treat symptoms of CIPN, in part due to anecdotal information suggesting potential utility.45 Nonethe-less, this NCCTG randomised, double-blinded, placebo-con-trolled crossover trial (n = 115) illustrated that gabapentin was no better than placebo in ameliorating pain (p = 0.18) or symptoms of peripheral neuropathy (p = 0.38). (Wolf et al, 2008, p.1512)

    Case series reports of two67 and ten68 patients have sug-gested that gabapentin can prevent the paclitaxel-induced acute pain syndrome. Despite the data noted above that dem-onstrate that gabapentin does not effectively alleviate the chronic CIPN associated with paclitaxel, the recent suggestion that paclitaxel-induced acute pain syndrome is, in fact, a pro-cess involving nociceptive fibres that, clinically, is distinct from paclitaxel-induced peripheral neuropathy, suggests a potential for the clinical utility of gabapentin in this situation. (Wolf et al, 2008, p.1513)

    In reading about neuropathy, I am told that it can take 18 months to 5 years to improve, and it may not completely go away. I’m generally not impressed with what I read about it. It sounds like little research has gone into figuring out why it happens or how to improve it. Permanent neuropathy was my fear during chemotherapy. At infusion number 6 I was terrified that the damage being done to my nerves was going to be permanent. Turns out,  that I was not wrong to be afraid. The chemo was working at killing at least some of my cancer, but at a cost. One of the sayings in cancer land is that chemotherapy is ‘the gift that keeps on giving’ … in that, for years afterwards you are still dealing with the side effects.

    I did sign up to participate in a clinical trial that seeks to better understand taxane specific peripheral neuropathy. I’ll also be trying out an experimental treatment  – actually, the treatment is a randomized clinical trial, so I have a 50% chance of actually getting the treatment, and 50% chance of placebo.

    I have also signed up to start cancer recovery physical therapy. My first appointment is the week after next. There are so many aspects of my physical health that I hope physical therapy can help (achy joints, a pain in my left foot). There are also some treatments that might help with the neuropathy, although there is no proven treatment. Even the Gapapentin that I take is only seen as “anecdotal” in its effectiveness.

    The good news is that the neuropathy is not an indicator in the outcomes of the chemotherapy (Schneider et al, 2012). That means that the fact that I have neuropathy does not determine whether or not the chemotherapy was effective on treating the cancer itself. I suppose this isn’t actually ‘good news’, rather it is ‘indifferent news’ as it doesn’t really mean anything!

    One of the challenges I’m facing now is planning. I want to plan a vacation. We have a general idea of when we want to go (late May or early June), but I have no idea how I will be feeling. Typically, our vacations involve a lot of activity – hiking, swimming, snorkeling, biking, etc – but I have no idea what activities I’ll be physically able to do. In addition to the neuropathy, I’m awaiting surgery to clean up my scar tissue and fix my open wounds (not before March 17, but hopefully shortly there after). I’m a planner. I like to have things planned out. But I cannot plan anything right now. I’m stuck with living life day-to-day and waiting to see how things turn out.

    My frustration is amplified a bit today because it is raining. We desperately need the rain – actually, more than rain we desperately need some snow pack in the Sierra-Nevada so that our summer isn’t so dry. So, it is good that it is raining, but that also means I cannot get out and bike. Biking is enough work right now when the weather is ideal – so no, I’m not being a wimp by not biking in the rain – ok, maybe I’m being a little bit of a wimp but I have earned it! Hopefully I’ll be back on the bike on Tuesday 🙂

    References

    Schneider, B. P., Zhao, F., Wang, M., Stearns, V., Martino, S., Jones, V., . . . Sparano, J. A. (2012). Neuropathy is not associated with clinical outcomes in patients receiving adjuvant taxane-containing therapy for operable breast cancer. J Clin Oncol, 30(25), 3051-3057. doi:10.1200/JCO.2011.39.8446

    Wolf, S., Barton, D., Kottschade, L., Grothey, A., & Loprinzi, C. (2008). Chemotherapy-induced peripheral neuropathy: prevention and treatment strategies. Eur J Cancer, 44(11), 1507-1515. doi:10.1016/j.ejca.2008.04.018

  • Neuropathy – what’s old is new

    I seem to be going through these cycles. The first time, I called it chemo recall. It is when my body gives me the same symptoms I had during chemo, except that I have not had chemo since October 30!

    Neuropathy is one of those recall symptoms. Today (started yesterday or the day before) it is in my hands. My finger tips to be more precise. The best way to explain it is that it feels like I have hangnails on all my nails, except that I don’t. My nails are just fine (well mostly). My finger tips are also very sensitive to hot water, making dish washing especially challenging. They hurt when I type. Thankfully, I’m pretty good at writing by dictation as well as typing with the flats of my fingers. I’m also clumsy and I drop things.

    At this point, I’m hoping that this new neuropathy pain is a sign of healing rather than a sign of continuing damage. It is the same feeling that occurred when the nerves were dying (or similar enough) so perhaps that is the feeling you get when the nerves start growing back again (ugh)? That’s what I’m hoping. I’m hoping that what I’m experiencing is regrowth of nerves. Only time will tell.

  • Pathology – What it means …

    I’ve gotten pretty good at interpreting what the pathology reports say, but I’m not great at what it means.

    Just before my oncologist walked into the room I said to Scott – “what I’m afraid of is that he will recommend more chemotherapy”.

    My oncologist walked into the room and said that he would be presenting my case at the case conference the next day. The case conference is where all the cancer specialists get together and collectively try to figure out the best course of action. The question was, do I need more chemotherapy after surgery, and if so, what chemotherapy?

    I actually didn’t think to get confirmation as to why my oncologist thought I might need more chemo – but I’m guessing it is because of the R1 results. This is the first time my oncologist mentioned the bilateral nature of my cancer and how bilateral cancer is rare – which is in part why they don’t have clear path for treatment. In addition, they have only been doing neo-adjuvant chemo for 15-years – so again, longer term outcomes are not completely clear. I’m pretty sure that if we were only dealing with L1, the idea of more chemo would not have been suggested.

    The key reason this question mattered now is that it determined whether or not my port would be removed on my upcoming surgery on December 17th. If more chemo is needed, then the port stays, otherwise it can be removed (making the breast and plastic surgeons jobs easier).

    Fortunately, on Friday afternoon I got word “Case conference discussed your case. No more chemo indicated, we will take out your port at the time of surgery. You will be recommended to take 5 years of Tamoxifen after surgery. No more chemo!” I broken down in tears after reading this. 

    So yay on the no more chemo. I’m cautiously optimistic that the recommendation will remain the same after my next surgery when the full breast pathology is available, but I’m still nervous about the R1 result – the chemo didn’t really work on that tumor, does it mean that I’m destined for recurrence? Or will the surgery be enough to kick this cancer?

    Looking back at the data about complete pathological response in neo-adjuvant chemo, the left breast response is good – it was pretty close to a complete pathological response and may very well have been one had I completed the three additional doses of taxol. So that looks good. That fact that I did not have a clear indication of response in the right breasts is a predictor of absolutely nothing (since the tumor wasn’t as big nor growing as fast – complete pathological response isn’t an indicator of prognosis) … that is, it in no way predicts whether or not my cancer will metastasize.  It is pretty much a roll of the dice … only time will tell.

     

  • ‘For now, the chemo is done …

    Yesterday was my last scheduled chemotherapy – taxol. We went to the tree before my first appointment and took the requisite pictures. I had some fun with it.

    Photo & Video Sharing by SmugMug

    Towards the end of my treatment, the chemo nurses sang the chemo song: http://vimeo.com/110530951

    A tear or two did drop from my eyes as they were singing and congratulating me. For the last four treatments, I had been anticipating the moment I finally got to say “this is my last chemo”. The problem is, I don’t feel like the chemo is done. Let’s start with the fact that this may have been my last infusion, but I still have to go through the side effects from the last infusion – so I still have a difficult week ahead of me before I start to recover from the chemo. But also, my treatment isn’t done. I don’t know what the results of the pathology will show. So, for now the chemo is done, but I just don’t know that it is really done. So instead of ‘hey now, the chemo is done’ … it feels more like ‘for now, the chemo is done’ …

    From the treatment perspective, focus is now shifting to surgery. It seems each time I see the surgeons things change a little. I wanted to know from my breast surgeon, where the incisions were going to be and what I could expect when I wake up from the first surgery. The thing is, they do the incisions on the first surgery based upon the second surgery – so they can use the same incision points. Fortunately, Thursday is the day that plastics are at the women’s center, so my breast surgeon brought in my plastic surgeon and the two of them discussed and decided where the best place would be for the incisions. The my surgeon drew on (in ballpoint pen) where the incision will be.

    We then talked about pain management. Prior to surgery I will see nuclear medicine to have an isotope injected to help identify the sentinel node(s) for the sentinel node biopsy. In my case, this will involve approximately 4 needles in each breast, each feeling like a bee sting. Then, I’ll go to mammography center where they will use a mammogram machine and place wires that the surgeons will use to identify where two of the tumors are (current plan is to only remove L1 and R1 – one tumor on each breast). Typically, a local anesthetic is used for wire placement (although it still not pleasant with the mammogram machine squeezing – which is extra not fun when you have port). They don’t usually use any anesthesia for the nuclear injections. Of course, in most cases, women are only doing this with one breast. My surgeon happens to be connected to the head person for pain management in anesthesia (the regional director). Given all the pre-surgery procedures, I’ve been referred to him to have paravertebral nerve blocks prior to the visit to nuclear medicine for the injections. This will mean (in theory) I won’t feel anything around the breast area.

    All my pre-op appointments are scheduled in the morning. Surgery is scheduled for 1:30pm and has been booked for three hours. Then I go to recovery for at least 2 hours (while I wake up). I’m booked for an overnight in the hospital. I’m happy to be in the hospital overnight, as that is when all the surgery related pain meds will wear off – so I’ll have ready access to doctors if needed to help with pain management. We will leave the hospital with written prescriptions for pain meds (actually, I’ll probably send Scott over to the Stanford pharmacy to get the filled – so we will leave with the drugs in hand).

    I continue to be impressed with the little bits of special treatment I’m getting. I’m definitely a squeaky wheel – in that I booked the extra appointment to see my surgeon because I didn’t know where she was placing the incisions – and I wanted to know. I’m so glad we had the appointment, as I have a much clearer picture of how things will work on the day of surgery, and being a special case for pain management will also mean my personal experience will be a little less painful.

     

     

  • Chemo Tourist

    Today I was a chemo tourist. The infusion center I normally go to was full, so they booked me at the new Stanford infusion center in Redwood City. Boy is it swanky. Everything is so shiny and new. It totally does not feel at all the same as the Stanford Cancer Centre ITA.
    Photo & Video Sharing by SmugMug

     

    I thought I had taken a picture looking out from the chair, but it appears I didn’t. The ITA is setup with two infusion chairs in each “family area”. There is a table with games and magazine. Instead of individual TVs there is one large TV.  There were lots of chairs for family members to sit, and each infusion chair had its own table (for laptops or lunch or whatever). You certainly don’t see as many sick people at the Redwood City ITA – in part because the treatment areas are much smaller and more segregated (separated into two people per treatment area). It is a very different feeling. It certainly felt more upscale than the regular ITA.

    If I had a bunch more chemo to go, I’d certain try to get more of them scheduled at the Redwood City ITA (they ran on time!). With only one left, I’m doing my last chemo at the regular ITA because it is my time to say thank-you to all the nurses there. Interestedly, the nurse I had today was one I had a couple weeks ago at the other ITA (she was there on loan for the day). So it was nice to see a familiar face in the new surroundings.

    To brighten my mood the chemo nurse mentioned that my dosage had been reduced – actually she mentioned it, not knowing how much it would brighten my mood. I’m hoping that the lower dose will mean a reduction in the side effects (crossing fingers). It really does make the whole idea of two more weeks of this (one more chemo, but it takes a week to recover) more bearable.  It most definitely cheered me up. Maybe I’ll not feel so bad this coming week 🙂

     

     

  • Oh how easily I forget

    I had three days off of chemo (rather than 7 days between infusions, I had 10 days). In those three extra days, some of the persistent side effects of Taxol began to wear off. I had more energy, less pain, and my mind was more focused. It was easier for me to get out and exercise, and easier to spend time on the computer on tasks that required concentration.

    What has surprised me is just how quickly I forgot about the pains of Taxol. I had forgotten about the shooting nerve pain, the weak and achy joints, the numbness in my feet, and pain in my finger tips. I had forgotten until yesterday anyways!

    We went for a morning hike up on the Sierra open space reserve (about a 30-minute drive from our place). Scott brought his new camera and took some fantastic photos (http://dttocs.smugmug.com/Sierra-Vista):

    I enjoyed walking but definitely felt a lot weaker that I had been last weekend doing the Peak Hike (can’t believe that was only last weekend). Late yesterday afternoon the nerves started to fire off again (I didn’t realize they had stopped until they returned). It was at this point that it occurred to me that the change in infusion days from Monday to Thursday means that my weak days are Saturday and Sunday rather than Thursday and Friday. It means I need to tone down my weekend commitments until this chemo is done (two more weeks!).

    The good news in all this, is that it only took me three days to forget about the worst of the Taxol side effects (yay).

     

  • Groundhog Day

    Last night I was reminded of Groundhog Day – if the groundhog sees his shadow, then 6-more weeks of chemo – if he doesn’t see his shadow, then we are done with chemo. Today is mostly cloudy (figuratively, not literally, its almost always sunny here).

    MRI results are rather encouraging (although I don’t completely understand them) – there is no sign of nodal involvement. The more encouraging line in the results relates to the large tumor on the left breast (L1), which the report says “there is near complete resolution of abnormal enhancement”.  The other two tumors, L2 and R1, have shrunk but are still there – as these were slower growing, it isn’t surprising that they are less responsive to the chemo. The general consensus is that I’ve had an excellent response to chemotherapy and that I can proceed to surgery at any time. Chemo is only needed to maintain until surgery – so if they cannot get the surgery scheduled soon enough then additional chemo is needed.

    The next new bit of information is relating to the surgery. The breast surgeon recommends a two-stage approach – the first being a lumpectomy, sentinel node biopsy (axillary lymph node dissection only if positive biopsy), and devascularization of the nipple and aerola complex. All the removed parts are then sent to pathology for full analysis. In essence, this is the cancer surgery plus devascularization of the nipple area. The devascularization increases the blood flow to the skin around the nipples, reducing the risk of issues with the reconstruction. It also includes a biopsy of the area under the nipple, which determines whether or not the nipple can can be spared. This is done approximately three weeks after the stop of chemo. I’m waiting to hear on dates for this.

    The second surgery is bilateral mastectomy sparing the skin and nipples (only if they are cancer free) with immediate flap reconstruction.  This happens about three weeks after the first surgery (this is tentatively set for December 16th but will likely be earlier).

    What I like about this approach is that we get the cancer out quickly – so it is gone before it gets a chance to grow again. We will also have pathology before reconstruction. It doesn’t necessarily change the surgeries, but it is a consideration (we will have confirmation that radiation isn’t required). It makes the breast surgeon’s part of the second surgery a little easier, but that isn’t the big part of the second surgery. The bigger part is the reconstruction – so the second surgery is still a long surgery (8-10 hours).

    After the second surgery I start anti-hormone therapy (tamoxifen) for 10-years.

    There is also a third surgery that takes place no sooner than 3-months after the reconstruction. This is the “revision” surgery. Once everything has healed from the cancer surgery and primary reconstruction, the plastic surgeon goes back in and cleans up any scar tissue and lyposuctions any extraneous fat pockets.

    So where does this leave me? After all the surgery discussions today, my oncologist still wants me to do one more chemo treatment. I wasn’t willing to do it today (I have mouths sores and I want to give them a little more time to heal). So I have chemo scheduled for Thursday. Depending on when the first surgery date is, this will likely be my last chemo.

css.php