Leave it to Fleener--Day One

Today is hard, and I think it's harder because I know so much from last time.  I've been through the valley of the shadow of death and come out on the other side once, and I don't want to willingly go there again, especially so soon after my last visit.  I'm already weakened physically from radiation and emotionally from the frustrations and questions of why this is starting again so soon.  On the day of my first chemo in 2013, I was nervous and anxious and unsure what would happen, but went in strong and determined, with a fighter's fearlessness.  This time, I'm scared of my diagnosis, already tired and not looking forward to the fight.

But, I'm not a quitter--unless you count gymnastics, ballet, piano, that one AP Calculus class, choir, Sonic, Dillard's, UVSC, a 1,000 calorie daily diet...Well, maybe I am a quitter, but not on the life-and-death kind.  

One thing is sure: I am a fighter.  I've been clawing and fighting my way through life long before cancer reared its ugly head.  I was one of those strong-willed, stubborn children who became an independent and strong-willed adult.  I'm destined to keep on fighting.  

Ready to start?  As ready as I'll ever be:

I've said that cancer converted me....changed my heart, solidified my desire to stand as a witness of God, made me into an optimist, helped me to seek the light in life and to understand that simply keeping the commandments does not me we will have a life free of pain and trial.  My first cancer battle also taught me a deeper faith in Jesus Christ and helped me draw on the power of the atonement, specifically the power of knowing that we are never alone and nothing we might be called to endure is something He has not already taken upon Himself.

Perhaps this time around, I can use my deeper faith foundation as a starting point.  There is never a time in this life when we have done all we can do or learned all there is to learn.

I will continue to to ask what God would have me learn, how I can use my experiences to bless the lives of others, and to recognize and give praise for the tender mercies of His love.


A few tender mercies have already happened today:  Stephen is off this week, so he is able to take Evan to his preschool open house when I can't.  The parking lot in front of the cancer center is completely blocked off, due to construction.  I had too many things to carry that I parked at a dentist's office next door.  When I mentioned to the nurses my concern about being towed, they immediately volunteered to move my car for me!  I'm sitting right next to another Melody, who has 2 grown boys and gave me her card and cell number, should I have any questions or simply want to talk.   I met with a researcher who wants to enroll me in a special study for patients with metastatic HER2+ breast cancer.  That gives me hope that I can assist in possibly helping the lives of others and aiding in research that could even benefit me one day.  I have any amazing support system that brought me to tears with their outpouring of love and positive messages.  It is with your love, prayers, and positivity that I have the strength to move forward and fight.


After reading Facebook posts, comments, messages, and email:

Even though I'm scared, upset, weakened, and wanting to quit, I will fight on and carry on with faith.  Cancer picked the wrong girl, and I'm going to kick its butt.

Here's today's cancer kicks!

Today I had blood drawn for research purposes, a bag of steroids, a bag of Benadryl, and a bag of a nausea medicine before the real stuff.   Then, it's Perjeta and Herceptin to target the Her2 receptors and Taxotere, the "real" chemo of choice for this time around.  Let the next round of the fight begin!!!!

Goble This Cancer---Last Day!!!!

I did it!!!  All ten days of radiation are completed!!!  I am so tired already and not looking forward to starting chemo on Monday.  It's been an exhausting summer.  Last time I went through chemo, I think I was much stronger to begin with.  I already feel weakened and broken down by the challenges of life prior to diagnosis and well as the effects from radiation.  Hopefully I can rest and recover a bit over the weekend and be ready to go on Monday!  

Peace out, MBC robe!  I hope to not need you again.

Goble This Cancer--Days Eight and Nine

The esophagus irritation started on Wednesday.  It's painful and irritating, like a combination of terrible heartburn and swallowing an ice cube.  Luckily, I was able to meet with Dr. Goble a day early and start a new prescription that I take before meals and at bedtime.  It is a mixture of Lidocaine, Antac, and Benadryl, and helps with the burning and discomfort while eating, but adds to my already high level of fatigue.  I also do not have much of an appetite---probably because my body knows it will be in pain to eat.  At least I'm winding down to the end of this part of treatment, and this esophagus pain might elevate over the weekend, but should continue to get better after that.  

On Thursday, Emmy was able to go with me again, as we had a date to get pedicures with friends immediately after.  I'm glad she was able to drive because I seem to always feel tired!  Only one day left!!!!

Goble this Cancer--Days Six and Seven

My little twin sister is in town!!!  She gets to help me cross a million items off my to-do list, and she also serves as an eye witness to return and report to my mother that radiation truly is a quick and {nearly} painless as I claim it is.

At this point, if you are not ready to hear potty talk, especially from a girl in a tiara, just go about your day knowing that radiation is going well.  I'm just a little tired and nauseous every now and then.

It's my birthday, and I'm hoping to give birth to a food baby today.  Let me back up.  I remember the first time I was taking Zofran for morning sickness and NO ONE explained to me the side effect of constipation.  It may be a mild side effect for some, but for me..........let's just say, I would rather give birth without an epidural than go through that again.  Also, unless you have had an experience in taking a large amount of prescription pain killers, you might not know that these also have a side effect of messing with regularity.  I am currently taking both Zofran and a large amount of pain killers.  If you're not picking up what I'm putting down, this is causing MAJOR back-up.  As in, I have been taking a *gentle* laxative every night in anticipation of this undesired side effect, have added in Mirolax, prunes, an incredible amount of water, and other fruits, and.........nothing.  It has not been a fun few days.

Maybe today is the day, as wishes are supposed to be granted on birthdays.  If not, I've been warned promised "EXTREME DIARRHEA" will start next week with the start of chemo.  Perhaps the extreme in the opposite will actually even me out and get me back to normal.  This negative side effect just might help keep me regular!  That's something to look forward to.

Sorry for the poop talk from the party princess, but I'm just trying to keep it real here!

Goble This Cancer---Day Four & Day Five

Nothing about Day 4 went as planned.  Already, I'm being taught early to have patience and learn to go with the flow.

I planned for a friend to watch the boys so Michele could drive me to treatment.  Getting everyone up, dressed, and out of the house before 8:30 is a chore in itself.  After doing that, I received the call that the radiation machines weren't working, and the technician was on his way from Houston.  Change of plans = breakfast at Chick-fil-a!!!!

That gave us time to relax, play around, and have full bellies.   

My friend mentioned that I could still bring the kids over and go and run a few errands, so we did.  When it was getting close to lunch time and we still hadn't heard from radiation, we planned to get the boys and get some lunch.  Of course, when we were almost there, the call came that the machines were working.  We drove all the way back in the opposite direction and waited for me to receive treatment.

On the way, Dr. F called to check in.  She wanted to ask me personally if I wanted to meet with her next week before starting chemo, or if another appointment was just a pain.  {She gets me!}  I was able to ask a few questions: When will I lose my hair?  Day 15, 16, 17.  So, I have to get going on planning my head shaving party!  I also WILL have some nausea meds and steroids to help my body take on the chemo.  Since I was on my way to radiation anyway, Dr. Fleener just asked if I could stop by after and get set up with my packet of chemo information.

Radiation was fine, but I wasn't feeling great.  I think it was a mixture of fatigue and motion sickness.    I ate too much for breakfast, which I'm not used to and didn't feel like eating lunch.

Dr. Fleener's nurses showed me where I'll go for chemo and fixed me up with my folder, my calendar, information, and the names of all the nurses.  While I was waiting, I ran into people I recognized from church, and was able to have I nice chat about how terribly unfair this cancer is!  I don't think it's a coincidence that I needed a little support and love while I was waiting.  I'm not ready for this to start again, but it's happening.

All of this took longer than planned, and I was supposed to be home to meet the new cleaning service that will be taking care of our home during this.  Thankfully, Stephen was there to meet them, and I was able to get the boys and get home in order to show the ladies where things are.  {Stephen had planned to come home to take a nap.  Even his plans were upset by the events of the day!}

The boys were spending the night with Grandpa and Grandma, so Stephen and I got to have a date night and.......crazy idea.......we were in bed by 8:00 and didn't have to worry about getting up to fix a "glitch" with a movie or be bugged by kids.  It was the perfect date.

Day 5 started well.  It was so nice to sleep in and not have to worry about breakfast or kids in the morning.

Then, the nausea/motion sickness/fatigue began to set in.  I had radiation at 12:30, and wasn't feeling well at all.  It was all I could do to make it home and grab a bucket before the first vomit of Cancer 2.0 happened.   This is the "real" of this blog.  It's not all smiley and happy.  Sometimes you vomit and cry and your mascara runs down your face, and all you want to do is stay in bed all day and watch Project Runway and HGTV even though you have to be a mom.

We might be having cereal for dinner.

At least I'm halfway done, and I don't have to do this again for 2 more days.  

Leave it to Fleener

My talented, intelligent, witty brother, Brandon, came up with the "Tuesdays with Naqvi" series title for the posts I wrote during my first battle with cancer.  I asked him to think of something catchy to use for this second phase.  I love his idea, and it becomes more and more applicable as the weeks go on. 

Remember my former oncologist's first response to possible legions in my bones?  In case you could have possibly forgotten such insanity, let me remind you: she tried to convince Stephen and me that it was ARTHRITIS!!!!  With my medical history?!!!??? And she being my FREAKING ONCOLOGIST????  Strike that: former oncologist.  The arthritis excuse was the final straw, the nail in the coffin of my Tuesdays with Naqvi.  Now, I "Leave it to Fleener."

Over and over I receive confirmation that this choice is the right one for now.  For instance, last night, Naqvi called me with the verbal report of the pathology of my tumor---the results from the biopsy I had last week.  I have "minimal ER positivity, PR negativity, and high HER2 positivity."  Interestingly enough, before Fleener had ANY written reports other than my first MRI, she predicted that this time I would most likely be HER2 positive only.  Her reasoning made perfect sense.  I have been taking Tamoxifen for over a year now, which blocks estrogen, and has been proven to prevent the regrowth of ER+ tumors.  If an estrogen-blocking drug was on board and yet my cancer has spread so aggressively and with such speed, how could it possibly be estrogen positive?  And, what do you know?  Fleener's predictions were correct.  In addition, Naqvi's major concern for me starting radiation was the damage to bone marrow, which would make chemo much more difficult later on.  Wouldn't you know that I looked back on my notes with my appointment with Fleener, and I wrote down, "minimal radiation to prevent damage to bone marrow."?  I think this lady knows what she's doing.

It might be hard for the award-winning, "big city" oncologist, with the AMAZING cure rate to admit, or maybe she just doesn't want a 2 percenter to like me to taint her positive results, but there can be incredible doctors outside the MED Center. Also, I really did have legitimate concerns for pain.  It wasn't explained away by something easy like wearing an underwire bra or side effects from my surgery.  It was CANCER RETURNING!!!  As little as any of us want this to be the truth or want to accept it, it is what it is.  There is no denying it. And I need someone who is going to get on it and fight for me, personally, and not for the statistics.  

Speaking of beginning the fight, today during radiation, I got a call from Fleener's office.  Instead of calling back, I walked over to her office.  Goble and Fleener have worked out my plan: I'll begin chemo after completely my 10 days of radiation.  That means the hard part starts on August 31.  It's coming up, and I have faith that the next phase will be fine if I "Leave it to Fleener."



P.S.  I'm healing up after surgery.  Today, I was able to shower and might just try to sit at the edge of the pool while the boys take a little swim!  Here's how the scars are looking today:

Goble This Cancer--Day Three

I'm 30% done with radiation!  It's zooming by.  

Several people have asked about how radiation goes for me.  It's different than what I expected and probably different from others' experiences.  I am having minimal radiation and only in one specific spot in order to protect the one area of my spine that is bulging 25% or so toward my spinal cord.  The radiation step is not what is going to kill the cancer in me; it is only to protect my spine, control pain, and cancel the growth of the cancer in one of the most vulnerable spots.  For all these reasons, I have an extremely short time of actual radiation and have not experienced damage, irritation, or burning to my skin.  This is a surprise, as my only frame of reference for radiation is in the choice to have or not to have it in the treatment of breast cancer.  I remember one of the negative factors was the damage that would be done to my skin.  My plastic surgeon was grateful I had not undergone radiation, as it would have made his job much harder and my skin more difficult to work with and heal.  So far, this radiation treatment is minimal, therefore allowing the most strength in the bone marrow in preparation for chemo.  

Here is the radiation room:

    

I get up on the table, resting both my head and legs inside foam pillows.

Gig 'em, Goble!!!!

After this, my techs raise the table and move it back, so I am directly under the machine.  Using my tattoo markers, they carefully slide me back and forth, forward and backward until I am perfectly lined up.  Finally, they leave the room.

Using monitors and computerized controls just outside the room, the techs scan me to check my placement.  Sometimes, the bed is adjusted, up/back, forward/down---whichever way sets me up perfectly.  Then, the circular plate that is above my head rotates under me.  I hear a whirring for about 30 seconds.  The plates rotate back to the starting position, the bed inches completely forward, and it's time to go!

I always need help sitting up, as that has been the hardest position for me since all of this has started.  I've ALWAYS been so great at sit-ups, which has saved me over the years in physical fitness tests, as running was quite the challenge in school.  To be physically in so much pain that I cannot sit up from a lying position has been a major tell-tale sign of a problem.  It's frustrating to need so much assistance with something that has always been easy, but the techs are always so kind and understanding.

Three days has zoomed by, and so far I've had no negative side effects.  At least, I haven't noticed anything negative, especially since I've been too busy with retail therapy!
    

Goble This Cancer--Day Two

When I left the hospital after my surgery, I noticed it was only 9:00.  Instead of going all the way home and coming back for radiation later in the day, I figured it would be just as easy to head to the other side of the medical center and wait for radiation.

I scanned in, got dressed, and actually ended up waiting because they were running a bit behind.

Day #2 was just as easy as before, once I finally got in.  Get on the table, line me up, scan for correct placement, and the machine whirrs and rotates for a few minutes.

Done and home before I know it!

Two treatments down, 8 to go.  This part is easy!

Port

I had the first case of the day to have my meta-port placed.  The good thing about the first case of the day is that it runs on schedule.  The bad thing is you have to be up and at the hospital EARLY!  I am NOT a morning person, but I'll take the first case in order to get in and out and on with my life.  

As usual, even with warnings about being a hard stick, the nurse had to do two IV's.  I guess I'm just destined to be a pin cushion before surgeries.  This is my best "girl, please!" look.

Everyone on the internet is over here posting their last beach day photos of the summer, sitting looking out at ocean tides rolling in on sandy beaches.  I'm posting my view of Bair Paws socks looking at the soothing vanilla hospital wall.

Then Stephen was able to stop in and cheer me up before he had to go start his case.  I love the pink ribbon OR cap, for good luck!!!

Then, my "friend," the Versed, came on board to help me feel nice and ready for surgery.  I remember very little after that, other than a nice, deep sleep.  I deserved it after waking up before the sun!

Steve and Timee came to hold all my belongings and wait for me to come out of surgery.  

Before I knew it, I was back and being forced to wake up.  Then, some grape juice, graham crackers, my discharge papers, a wheelchair, and out!  

This port was placed a little differently than my other one.  Dr. P used the same larger incision, but place it higher up and with a smaller, new incision on my neck.  At this point, what's another scar when you have so many?

I'm sliced and diced and ready for the chemo battle to start.....as ready as a person can be.  How thankful I am for being able to receive my drugs through a port and not to have to be subjected to an IV stick each time.  To avoid that, I'd go through surgery any day of the week!  

Goble This Cancer: Day One

Today I had my first ever radiation treatment in my battle against cancer.  I didn't know exactly what to expect, and it was even quicker and less painful than I had imagined.

First, I received my scan card.  From now on, I simply scan in to register myself, go through the door, find my robe, get changed, and wait to be called.    

The techs came to get me.  I laid down flat on the table, and they positioned me according to my tattoos.  When everything was lined up perfectly, they took an x-ray to check for precision.  The machine moved around me and made a subtle noise.  Then, I was told to hold still and breath normally during the radiation.  I didn't feel anything or see anything except the movement of the machine, and before I knew it, my five minutes were up! 

It's an in-and-out procedure--quick and painless.  I'll have the same appointment time everyday, unless something comes up, and I can easily change.  I'll meet with Dr. Goble every Thursday to check my progress, will have regular lab check-ups, and will be done in 10 days.  

That's about it.  The first day of battle was an easy one.  Too bad it's just going to get harder from here.  

Marking Session

Today I got five new tattoos to add to my collection.  These are nothing special, just 5 small dots, the size of a freckle.  

I met with Dr. Goble again today and explained some of the challenges with yesterday and some concerns from Dr. Naqvi.  He assured me that it IS cancer and they will only do a minimal amount of radiation and only on the T7, T8 spot where the bones have sustained the most damage.  He wants to reduce pain, but to also prevent this from messing with my spinal cord.  

I'm ready to get going.  Even thought Dr. N wants me to have a second opinion, I feel great about our current plan.  I've heard from 2 radiologists who specialize in backs/spines and they both recommended the exact treatment as Dr. Goble and his partner, Dr. S.  

In preparation for my first radiation, I had to have ANOTHER CT scan to determine the placement of the marking dots.  This way, I will also be placed at the same location on the table and the radiation will be able to be directed to the exact spot.  

After the scan, I was marked with a pen and then given 5 tiny tattoos.  There are 3 down the middle of my chest and one on each side to level.  They also marked the tiny tats with a paint pen to help with positioning for the first time, and so the tattoos would not get lost or confused with an actual freckle!  Here's what 2 of these spots look like when they were done:

I also get my very own pink fleece robe to use each time for my sessions!  Bring it on! 

Nothing about this is easy or expected.  I thought I was on my way to living a normal life and loving being  a survivor.  Now, the unexpected has happened, and way too quickly since the last battle.  I still feel much more at peace today.  

Doctors are very knowledgeable and have their specialities, but at the end of the day, they are all PRACTICING medicine.  A certain treatment might have a high rate of success, but nothing is EVER 100%.  There was supposed to be a 98% chance my cancer wouldn't come back, but it did.  There might be certain things that can't be explained, and I'm going to have to be okay with that.  One doctor might follow one plan, while another would try something differently.  It doesn't mean that either one will work with my individual body and all the other factors that could be affecting my case.  Just as in EVERY pregnancy is different, even for the same women, doctors can only give us the average expectations.  I have to press forward and understand that there is not ONLY one option in this battle and if I pick the wrong one, it's all over.  I won't give up fighting as long as there's even a chance of beating this thing.  

We will all have difficult times.  There are trials that we can't explain and might affect us from no fault of our own.   When we face them without fear, we are strengthened.  

What the......WHAT?!?

Today did NOT go according to plan.  In fact, last night as we were going to sleep, I said to Stephen, "the worst thing that could happen is if Dr. Naqvi comes up with something completely different than Fleener.  Then, where will we be??"  Well, I guess I have to do things the hard way.

We had planned to have a second opinion with Naqvi and to also ask her HOW THIS WAS MISSED?????  When we got there, we found out that the office hadn't received any of the scans or reports.  WHAT?  I have been in contact with both doctors on sharing information!  Well, I had copies of the CT scan of my brain and of the original MRI.

Based on those, Dr. Naqvi wasn't convinced.  She came in and questioned everything.  "How do they think this is CANCER?  What are they basing it on?  It could be arthritis."  (At this point, this is pretty much how we felt:)

Are you serious?  ARTHRITIS!!!????  HOW IN THE WORLD would arthritis be in all of my spine and other bones without joints, like the sternum, and NOT in....um....my hands?

I did agree with some points she made such as, we should have a biopsy done to figure out the pathology and to know exactly what we were dealing with.  She thought I was crazy for scheduling radiation markers and initial appointments with a surgeon to place my port.  "No, no, no, no!  You don't even have the proof!"  We need blood work, MRI with and without contrast, and a biopsy.

She left to call to make STAT orders, since it is quite difficult for me to come back and forth from College Station to Houston for MORE tests days in and days out.  I used this extra time to call Fleener's office and have them fax over the PET scan report.

Naqvi came back in and asked what I was taking for pain control.  My answers didn't meet what she felt I needed.  "That's not strong enough.  We need to get you on something better."  I found this interesting, as for the PAST TWO check-ups, I've been complaining about pain that "feels like it's under my breast, like it's IN MY BONES!"  And, she wasn't concerned and actually talked me out of refilling my Lortabs and going down to Tylenol 3.  Ironic that this same drug SHE PRESCRIBED is now not strong enough.  Hmmmmm......apparently I wasn't playing around just to get more pain meds!  In preparation for the tests of the day, I got a pain shot and Naqvi even asked if I wanted some valium or Xanax to calm me for the MRI.  I'm fine.

Just then, my PET scan reports came in.  I hadn't even seen the official report, only received the explanation of it over the phone. The findings say that there is correlation made with the MRI I already had.  "Extensive hyper metabolic skeletal lesions are seen, including the spine, pelvis, proximal femurs and humeri, bilateral ribs, scapula, and sternum.  There are hyper metabolic mediastinal and bilateral hilar lymph nodes.  No hyper metabolic axillary or internal mammary lymph nodes, pulmonary nodules, liver, or adrenal lesions are seen.

There is physiologic activity in the FI and GU tracts.

The CT scan used for attenuation correction demonstrates no evidence of pleural effusion or ascites.  Numerous lytic lesions are seen in the skeleton.

Impression:
findings are consistent with extensive metastatic disease.

We were waiting at the check-out desk when Dr. Naqvi read this, and it seemed as if her theory of this being anything BUT cancer was starting to become doubtful.  "Well, let's HOPE I'm right and this is NOT cancer."


We headed down with orders for blood work, a prescription for 100 Lortab, and check-in papers for a STAT MRI.

Then, the FUN part started.  At the registration desk, we were told it didn't look very promising for us to get in to an MRI today, as they had 2 sedation cases scheduled.  We could check in, but might be waiting for 5-6 hours!!!  We checked in at imaging and tried to be extra kind to the ladies at the desk.    I kept hearing a phone call about STAT orders for "Copper."  (surely they mean COOPER?!)  Shortly after that, one of the nurses came out to explain they had a "cancelectomy," as in the sedation case was cancelled because the patient ate this morning!  That meant, I was in!!!!  All we needed was to find the radiologist, Dr. Polacik and have him come talk to me.  When Dr. P came out, he was questioning why we needed this test done, especially because Dr. Naqvi had also faxed over orders for a chest CT.  We showed him our previous reports and started to explain the story of this crazy summer and how we got here.  Even after seeing evidence of the previous studies, he was still inclined to back up Naqvi and has reservations about the findings.  Until he looked down and noticed Stephen's AGGIE RING and that unspoken bond of the Aggie Network kicked in.  We suddenly had an "in," which came in handy for the rest of the day.

I went back, changed, and waited.  Finally, it was time for an IV----my least favorite thing!  I specifically explain that I am a hard stick and that my veins seem like they are great, but roll.  Some people think they are better than my personal experience with EVERY OTHER MEDICAL PROFESSIONAL that has screwed up an IV on me.  He got it in....sort of....and dug around for about 4 minutes until he finally got it right.

The MRI was long, about 40 minutes for each test--without contrast and with contrast.

I was taken into the holding area and waited and waited for my next instructions.

The nurse went out to catch Stephen up, as he was waiting alone for over 2 hrs. with no news up to this point.  She also came back and explained that we were trying to schedule whether to do the CT or the biopsy and if they were both necessary.  She was waiting to hear from the Doctor, but couldn't find him.  (He was actually out talking to Stephen.  After reading the MRI, he had to hear the whole story of why I needed the original MRI and that it wasn't to discover cancer, but to identify fractures or the causes of my pain.) The nurse found him, but didn't want to interrupt, as he was meeting with another radiologist to discuss my case.

Doctor P. found me and explained that, YES, there was a definite need for a biopsy, and we were going to do a CT with and without contrast.

(By the way, I think I might have met my radiation limit for the year in the last 2 weeks!!!!)


I went around to the pre-op area, and Stephen was FINALLY able to come talk to me.  It was after 2:00 o'clock by this time.  {My original appointment was at 9:30.}  They prepared me to go back, after checking with me about a million times to make sure I'm not pregnant!    

The biopsy wasn't fun, but it wasn't terrible, especially with Versed and Fentanyl on board.  Using and x-ray, the radiologist was able to give me local anesthesia and then take a needle to remove a sample from one of my lumbar vertebrae.  It was quick and nearly painless.

I did well with recovery....(look how above average I am!!)....and we were able to get right back for the CT, with and without contrast.

Even though radiologists don't usually go over results, as they send reports to the referring physician, our Aggie friend basically told us he agreed that it was, after all, NOT ARTHRITIS, and that he hoped we would be able to get it under control.  He told the pathologist to check for my breast cancer markers, giving them a heads up on what I have already been through.  Hopefully, this will help us get a better idea of what we are dealing with.  

Oh, yeah.....I also forgot to bring my phone with me today, thinking it would be no big deal, as we would be there and back again by early afternoon.  Instead, I ate a yogurt at 6:00 a.m., and finally got some dinner in me again around 6:00 p.m.  I also had about 100 texts and several phone calls and voice mails, including one from Dr. Naqvi's personal cell phone it looks like it is a significant disease in the bone, and he was really amazed because it was completely clean in March.  His suspicion is that probably before we started, I probably had this in my blood.  She's also concerned about radiation and in radiating the big area because it can affect chemotherapy later on.

After a long, LOOOONG day, I'm only somewhat closer to knowing the next step.  I am grateful for being thorough on getting all the scans and tests to confirm this disease and diagnose it in order to fight it in the best way possible.

I guess I'll keep finding out more each day.  

Treatment Possibilities

Today was information overload!  

I'd rather get started on learning all of my options than stay in the "waiting place," so today was also a good start in the right direction.  

I met with Dr. Fleener this morning and tried to get all of my questions answered.  There are still too many up in the air, but here's a little of what I learned.  Some good.  Some bad.  Some terrifying.  

I will have a combination of radiation and chemo.  There are quite a few options and different combinations, depending on the aggressiveness that I choose to go with.  

Chemo Option One:

This is the most aggressive and the one she recommends.  It is a combination of 3 drugs--1) Herceptin, the drug I already had 52 doses of. 2) Pertuzumab (also known as Perjeta), which is a drug that binds to HER2 receptors and prohibits growth. 3) Taxotere (also known as Docetaxel), a chemo that is more aggressive than the Paclitaxel I received in 2013.  It has the terrible side effects of the "typical" chemo patient: hair loss being the main one, fatigue, and extreme diarrhea.  

If I choose this option, I would receive 6 cycles of these drugs, administered every 3 weeks.  It will take about 4-6 hours each time.   I might have to come into the office to receive extra fluids if the diarrhea is bad enough that I can't keep anything down, to prevent me from ending up in the hospital with dehydration.  

Dr. Fleener thinks this is the best option, as I am young and have an aggressive cancer, which is HER2 positive.  Whenever it comes back around the year mark, that is another sign of how aggressive the cancer is, so we need to be aggressive in the fight.  The effectiveness of this option will be assessed every 3-4 cycles with a PET scan (or CT/bone scan) depending on what insurance will cover.  She hopes to be able to compare with another PET scan, since we already have the baseline results.  

Once we get me in remission, I will continue taking the 1st 2 drugs, the Herceptin and Perjeta for "as long as I'm in remission."  I interpreted this to mean...for the rest of my life AND A LOOOOOONG time!!!!!!

Chemo Option Two:

This would be a drug called Kadcyla.  This is a fairly new drug that is approved by the FDA for treatment of HER2 cancer that has metastasized. It is a combination of Herceptin and a cytotoxic agent.  It works by binding to the  cancer cells and deliver the toxins directly.  Because of this, there is no hair loss or nausea, and it's easier on my body.  The problem with this drug is that it's so new that doctors are still trying to rank the use of it and are still waiting for long-term evidence of its effectiveness.  The side effects would basically just be headaches.  

Chemo Option Three:

This is the least invasive option.  It involves Herceptin with a low-chemo pill called Xeloda. Dr. Fleener didn't talk to me about side effects for this, as I'm sure she doesn't want me to go with the least aggressive option.  

With all three options, I would also receive a bone building drug called Zometa.  It is given with chemo and helps with building bones.  It is often given to patients with osteoporosis, and can help with my case to prevent further damage to my bones and to strengthen them to prevent future fractures.  

Now comes the interesting part.  We need to work with the radiation oncologist, Dr. Goble, to come up with the right combination of chemo and radiation.  If he recommends being aggressive with radiation, I will not get the aggressive chemo right away, but Dr. Fleener would still recommend I start the other 2 drugs ASAP, hopefully next week.  

I asked HOW WE MISSED THIS?  She said she hadn't received any information about the CT scan I had in March, but guessed that the radiologist was looking for signs of cancer in my major organs and might have missed minuscule legions in the bones.  She wondered if we asked them to look again and focus on the bones, knowing what we know now, if they would find anything suspicious.  

I asked about the % of recurrence? We don't have an answer for that until we see how I respond to the chemo. She said, "I have to make it go away first!" If chemo "melts the cancer away," (Dr. Fleener used this imagery quite a few times), that is a good sign.  If it seems to work like it's supposed to then I have better odds at keeping it contained.  

I asked about the % of my chances of living 5 years, 10 years, or 15+ years?  "Do you REALLY want to know?  Patients and spouses come in all the time asking that and they say they really want to know.  Then, I tell them, and they wish they hadn't known."  I wanted to know.  Knowing is half the battle, right?  "The average is 3-5 years.  I'm not saying that's how long you have to live.  I'm just saying that's the average.  All I can tell you is the average, but we don't know now where you will be.  It depends on getting that cancer to melt away.  Young people tend to do better.  We need to see how well you do with treatment and go from there."  

 I asked about restrictions for exercise and diet.  There aren't really any.  She wants me to be mindful of eating a healthy diet, but during chemo, you just need to get down what you can get down.  Stay hydrated.  Drink water.  If all you can get down in liquids, try to drink Gatorade for the calories.  When she told me there were no restrictions for exercise, I was shocked.  "You mean, you would tell me it's okay to run?  I have spinal fractures!"  I'm just supposed to "listen to my body" and do whatever I feel like doing.  And NO HEAVY LIFTING!   

I can stop taking Tamoxifen.  She hypothesizes that my cancer now is probably not ER+, as I've been taking an estrogen blocking drug for over a year now, and the cancer still came back.  We might try to do a biopsy of my bones to check for the receptors of this cancer again to be completely sure were are fighting what we think we are fighting.  In the meantime, because there are negative side effects of Tamoxifen, the benefits do not outweigh the side effects.  DELETED! 

I asked about the use of essential oils, since I've already received several questions about that.  Dr. Fleener said she is not a 100% believer in the use of essential oils.  She said if I want to try some for certain benefits of relieving side effects, that would be fine, as long as it is applied topically.  Even though some citrus essential oils have some positive effects when mixed with water, since chemo (and radiation) can irritate my esophagus, we don't want to add more acidity.    

I made an appointment to meet with a doctor to plan a time to put in another port and the tentative plan is to start one of my chemo options next week.

Next, I walked to the other side of the building to meet with my radiation oncologist, Dr. Goble.  He was able to get me in and have a good consultation.  Last week I met with the semi-retired doctor, so Dr. Goble had read through all the notes, but hadn't had a chance to really study all of my scans.  He did say that the most likely area of focus for radiation would be T7 & T8 (thoracic area of my spine) because those are the locations of my compression fractures, the highest areas of pain, and the most obvious areas of legions.  In order to start radiation, I have to have a "marking session," a 30-45 minute assessment to determine and mark the exact location of my radiation.  Using a CAT scan of the area, they will focus on the correct spot and mark it with---TATTOOS!  I'll have 3 more tats to add to my cancer collection soon, one in the center of the area to receive radiation and 2 leveling marks, to help with the correct placement every time.  

My treatments will most likely be 2-3 weeks of 15 minute sessions, Monday through Friday.  As often as possible, they try to give me a set radiation time, so it's easy to remember and schedule around.  Then, once a week I meet with the doctor to monitor my progress and answer any questions.  They will follow my blood counts closely, mostly checking the WBC and platelets.

The side effects of radiation are minimal.  I can have some pain and discomfort in my esophagus and possibly difficulty swallowing and eating.  I will have some mild fatigue.  The severity of these side effects could be magnified by the combination of aggressive chemo, so Dr. Goble and Dr. Fleener will work together to come up with the best option to balance out the side effects and to get the best results.  

Tomorrow I meet with Dr. Naqvi for a second opinion and more information overload.  I will get copies of all of my reports and get a disk of all of my scans, so we have something to compare further scans to. 

I am leaning toward the aggressive treatment.  I don't want to go through all of that again, but I am not afraid of it.  I feel peace in knowing more information today than I've known all week and to have a plan, even a fraction of a plan, to move forward.  I do not like hearing the average life span of 3-5 years, but as I've told several people----I've always been above average.  

I am a fighter.  I will not give up.  I will exhaust all options.  And, in the end, it is all in God's hands.  He will use doctors to help me, but none of us know when our time is up.  All we can do is keep trying, keep pressing forward, enduring our trials well, and keep praying to know which paths to follow.

I leave you with an inspiring message of hope that came my way today.  Whatever you are dealing with, don't quit!  Keep trying and praying and carrying on.  You will not fail.  

     

Fear and Fighting

I am not a person who does well in the "Waiting Place." {Dr. Seuss, "Oh, the Places You'll Go.}  It's the place where people are "just waiting." Unfortunately, I've been stuck just waiting to learn more about this cancer returning and waiting for the fight to begin.  I'm waiting for more information about my treatment, for answers on how this happened, what I can do about it, and how long I can expect to live by fighting.  The waiting and not knowing leaves time to think about the hardest part of cancer this time: that there is NO CURE!   I still have so much left to do to fulfill my role as wife and mother and "to live so that [I] can touch the hearts, build the hopes, and teach mankind," as my patriarchal blessing promises.

Sunday was one of those days that hit hard.  I was emotional, even while trying to stay strong.  I don't mind talking about cancer to anyone, and I don't feel awkward about sharing with others and comforting and mourning with those around me.  We all have "stuff" we are dealing with, whether it is out in the open and easily seen or silent and personal.  For some reason, the stress of waiting and the emotions from the unknown hit me all at once on Sunday, and I cried....a lot.

Part of these emotions came from not knowing how much time I have left.  I have so much still to do---my Bucket List is long, and many of the items on there revolve around my family.  I don't want to leave them without their wife and mom.  We were learning about how the role of parents is ordained of God.  Specifically, the discussion about roles of mothers hit me and brought into focus how much I still need to do to fulfill this role.  Ezra Taft Benson taught that, "[mothers] are...the very heart and soul of the family." My family is the reason I will fight.  I will fight for the rest of my life, but I don't want to think about this life being cut short.  "A child needs a mother mother than all the things money can buy."  {Sermons and Writings of Ezra Taft Benson, 217.}  Even though I've heard the comfort that "if you can fix it with money, don't worry about it," this time around, I don't know if we can fix it with money, and that scares me.

Having cancer return at Stage 4 isn't scary because I'm scared to die; I'm scared to not have the time or energy to be a mother, and I don't want to leave my children and husband alone too soon.  This fear was right in my face when our lesson specifically listed out what should be done to be an effective mother, from Ezra Taft Benson.   The first was, whenever possible, to "be at the crossroads when your children are either coming or going." How can I be there, if I'm not here?  It's terrifying!  Second, "take time be a real friend to your children.....Third, take time to read to your children.....Fourth, take time to pray with your children.....Fifth, take time to have a meaningful weekly home evening....Sixth, take time to be together at mealtimes as often as possible....Seventh, take time daily to read the scriptures together as a family....Eighth, take time to do things as a family.....Ninth, take time to teach your children....Tenth, take time to truly love your children."  {Ezra Taft Benson} If you hadn't noticed,  all of these roles of motherhood require us to "take time."  What if time is the very thing I don't have in this world?  How am I going to make as much time as possible when I don't know how much time I have left?  THIS is the scary thing about cancer, specifically stage 4, and these are the very things I need to fill my time with, whatever time I have.

Stage 4 cancer, something that has no cure, is scary.  I'm afraid to not be able to leave enough of my influence with these little souls who have been sent to my life.  But, I am going to fight.  I will "not go gentle into that good night."  I will "...rage, rage against the dying of the night." {Dylan Thomas} I am a fighter and will face this fear with all I have.

I leave you with a quote my mother-in-law found me, one that summed up my emotions from that day.  "There is no living thing that is not afraid when it faces danger.  The true courage is in facing danger when you are afraid." {L. Frank Baum}  May I push out fear by showing "true courage" in the fight of my life.        

PET Scan Results

The radiation oncologist called me today with the results of my PET scan.  We have a second miracle!

The scan shows the bone metastases that we already knew about.  In addition, there are several lymph nodes in my chest with activity, which is a suggestion of cancer.  However, the scan shows NOTHING in my lungs or liver!

Beyond the extra lymph nodes, these results add nothing new to the list of areas we already knew about.  It is not great that there are a number of bone metastases, but this is good news.  Most often, the type of cancer I have returns to those 3 areas--brain, liver, and lungs.  Have no cancerous activity in those major spots is a relief.  No worse news is good news these days!

Thank you for your prayers, thoughts, messages, concern, suggestions, and love.  Now we wait for my appointment next week before knowing anything further into the battle plan.

Radiation Oncologist

On Wednesday morning, I had my first appointment with a radiation oncologist.  This was something completely new to me, as I never went the radiation route the first time around.

After turning in the small novel of paperwork, I met the wonderful nurses, who were very sweet and personable.  The doctor was also kind.  However, the PET scan report wasn't in, so I was disappointed with the overall appointment.  I felt like it was almost a waste of time because I don't know much more than I did last week without the report from the latest scan.

We talked about plans in probabilities.  IF the cancer is just in my bones, it's something that is quite frequent, and they deal with it all the time.  MOST LIKELY I will have localized radiation for 3-4 weeks, 5 days a week, but that depends on the findings from the report.  More than likely, I won't have too many negative side effects from the radiation.  My skin will have minimal damage, and most people only complain of fatigue.  IF cancer is all over my body, radiation isn't as effective.  They are most effective in localization, and he predicts they will focus on my back--around the areas in my Thoracic that are also the sites of my fractures.  This will help with pain and also on prevention of the spread of cancer and on preventing further potential fractures.  

He suggested that I see a neurosurgeon for a consultation on possible bone strengthening measures.  This is contradictory to what my pain doc said about his discussion with the head radiologist who compiled the report on my MRI.

 I was able to see the pictures from my MRI, especially the large, dark, cancerous spots on the vertebrae with fractures.  Again, I kept thinking about how thankful I am that I fell and was able to catch this before it got completely out of control.

Overall, I came away with the feeling of needing more--more information, more answers, more of a plan.  It looks like I will have to wait.

PET Scan

Often getting an IV is the worst part of any medical procedure.  This was true, once again, for the PET scan I had on Tuesday.  I warned the tech that I am a hard stick.  Either she didn't believe me or thought her skills were that good.  She stuck me and dug around until she got it.  Then, when she tried to push that lovely radioactive tracer into my vein, it blew.  Try #2 on the other arm failed miserably.  "Have you had anything to drink today? That could be why your veins are being to difficult."  {Well, aren't you used to that, since in order to prepare for this scan, I wasn't able to eat or drink for 6 hours prior? Duh!}  Thankfully, she called in reinforcements, and I finally was able to be radioactive once again.

After the injection, I had to sit in a chair and wait for my entire body to absorb the tracer.  After a 45 minute nap, it was time to move to to the machine.  First, I was scanned with my arms above my head, then with my hands down by my sides.  The total scan was about 25 minutes of lying still in a cold room, listening to the hum of the machine.  Another quick nap, and I was ready to go.

On the way out, the 2nd tech was very comforting.  She apologized for things not going smoothly, but I assured her that it wasn't just them--I'm used to it happening!  I was told to not hug my babies and to keep them a few feet away from me for the rest of the day to prevent my radioactive state from passing on to them.  That was another reason to be grateful that the boys are away at Summer Camp Midland.

Now to just wait for the results to help us make a battle plan!

Angels Among Us

Many of the tender mercies we receive are because of the kindness of others.  Already I have been so blessed by the outpouring of love from those close to me, but am constantly amazed at the way that trials and suffering can connect us, even when we are strangers.  Our experiences do not have to be exactly the same for us to learn empathy and to mourn with those who mourn and comfort those who stand in need of comfort.

This box of "happy thoughts" was placed up in my closet when I heard those amazing words---"You're Cancer FREE!" last year.  I had kept it open as a place to keep all the cards and kind words of encouragement when I was fighting the first round.  I pulled it out again and have already added more cards and uplifting words.  Thank you to those friends that have offered uplifting words and to the anonymous letter from a caring 9 yr-old.  I have a feeling I'm going to need a bigger box!

We experienced the first of what I'm sure will be many blessings from the kindness of strangers last weekend.  On Saturday night, Stephen and I were able to got out on a date.  We went to a movie and zoned out.  It was much easier to get lost in the tension of whether or not Ethan Hunt will complete another impossible mission rather than focusing on cancer.  Afterwards, we went to the Outback to get a few appetizers and talk.  Of course, we were crying over our wings and tuna.....and cheese fries, coconut shrimp, and Dr. Pepper.  (I have cancer......do I REALLY need to go without fatty foods and my favorite soda?)  It started to get late, and I think our server was ready to close out her section and go home.  She kept coming by to ask if we were alright (not really) or needed anything else (a new body?).  I joked that everyone must think we are breaking up!  She brought the check and came by a few times, saying she could take it whenever we were ready (hint, hint....give me the check so I can go home!!) A few minutes later, she returned, put down a ripped up credit card receipt and this note:

Stephen had written a note with his tip, telling her sorry that we took so long and we were not trying to be rude, by we had just found out that I had stage 4 breast cancer.  She told us that she believed in the power of positive things and that here is one thing to get us started on the journey.  They comped our whole meal!  Thank you, Rachel F.  There is still good in the world!  I tell you, this cancer thing is far-reaching.  It allows us to be angels on earth and lift others in their times of need.

To those of you who have already given so much of your time, love, and prayers, I thank you.  To those I don't know who have been touched by reading this blog and perhaps sending it on to others, I hope my journey of faith can help you find yours.  To those who will be following along or giving service in my name or for countless others, thank you.

There are miracles all around us!  

A Range of Emotions

I've been going through several steps of the grieving process for the last few days.  There was the initial shock/denial upon first hearing that the MRI found metastatic legions in addition to the fractures we were trying to find.  (This can't be!  How could this have happened?  Are you serious???)

I've been angry.

How in the world did my doctors miss this?  I did EVERYTHING I was supposed to do!!!!!  I even went BEYOND with further preventative measures than I HAD to do.  I had a bilateral mastectomy, which was supposed to give me a 98% removal of breast tissue and therefore a 98% chance that my breast cancer would not return.  I took Tamoxifen, even when I hated the side effects!  I stuck to my low-calorie diet almost religiously---Dr. Naqvi wanted me to only eat 1,000 calories/day, and I stayed around 1100.  I gave up sodas.  I started working out almost everyday.

How could ALL of those doctors missed this???  I've been to the ER 3 times in 2 months.  I've been in the hospital.  I've had ultrasounds, surgeries, follow-ups, assessments, and MY ONE-YEAR CANCER-FREE appointment!!!!  It took a FALL and a follow-up trip to a pain doctor for SOMEONE to suggest an MRI.  Shouldn't there have been red flags going off?  I have a history of breast cancer, for crying out loud!!!!  How did that CT scan I had in March not find ANY signs?   Why didn't anyone connect the dots that all of this pain---especially in someone who has a crazy high pain threshold---should set off alarms?

I feel frustrated that I have worked so hard to fight and become a survivor, only to have one good year  and have to start all over again.

I've been sad.  Mostly the sadness surrounds my family.  I don't want to leave them alone!  I have so much more that I want to do!  I want to teach my boys to be hard-working, honest, caring, considerate, kind, funny, intelligent young men.  I want to prepare them to go out into the world and do something great with their lives.  They are so young to be without a mom--so young that I'm afraid they will have no real memories of me as the years pass, only those fuzzy memories that are just from pictures and stories you've been told.  My boys need me!

I'm sad for Stephen.  How hard it is to be the spouse of a terminally ill person.  He wants to be supportive and helpful, but he needs support, too.  He's scared and angry and sad, too.  We have so many goals and dreams.  How will we fit a lifetime of experiences into such a short amount of time?  How will he find the time and energy to take over being both dad and mom?  How will he stay strong for the boys when he is alone and grieving?

After the tears stop, all these emotions go back to faith.  No one knows how much time they have left to live.  We don't even know the full scope of my disease.  I could live 5 years or perhaps up to 15, or much less.  At this point, we are all just guessing.  When it comes down to it, there are ways to make every moment--every second of every day count.  There are small miracles and silver linings in every day.  Instead of focusing on the anger and sadness, I am looking for the tender mercies.  I am understanding how little control we have over this thing we call time, and that all we can do is rely fully on the power of faith and the promise of our Savior that when we take his yoke upon us, there is nothing we can't bear.  

I also feel grateful and happy.  I am reminded of that feeling from my first diagnosis.  I was sad and angry and scared, but also felt peace and love.


Friends and family step up in times of great need.  I have an amazing support group, and I can see how that will only get stronger and larger as this journey continues.  How can I not feel blessed when I've already had so many acts of service and kindness and I've only been re-diagnosed for 5 days? It's an overwhelming outpouring of love, and I am so grateful.
 

I have not quite dipped into depression and am not yet trying to bargain with God, but I haven't reached a level of acceptance.  Yes, I have this.  No, I'm not happy about it.  I haven't yet cried all my tears, but I am going to fight with all I have to overcome this----AGAIN!  I keep trying to channel the strength and determination of this girl.  I did this once, and I can do it again!  Never give up.  Never stop improving!

P.S.  The first time around, I was driving home from one of the early appointments with my doctor and heard the song Try, by Pink.  That became a theme and an inspiration for my battle, to get up and keep trying.  Today, driving home I heard a song called Fight Song, by Rachel Platten.  I think that will be my battle cry for this time around.

The words are amazing, and the music is quite empowering.

Like a small boat
On the ocean
Sending big waves
Into motion
Like how a single word
Can make a heart open
I might only have one match
But I can make an explosion

And all those things I didn't say
Wrecking balls inside my brain
I will scream them loud tonight
Can you hear my voice this time?

This is my fight song
Take back my life song
Prove I'm alright song
My power's turned on
Starting right now I'll be strong
I'll play my fight song
And I don't really care if nobody else believes
'Cause I've still got a lot of fight left in me

Losing friends and I'm chasing sleep
Everybody's worried about me
In too deep
Say I'm in too deep (in too deep)
And it's been two years
I miss my home
But there's a fire burning in my bones
Still believe
Yeah, I still believe

And all those things I didn't say
Wrecking balls inside my brain
I will scream them loud tonight
Can you hear my voice this time?

This is my fight song
Take back my life song
Prove I'm alright song
My power's turned on
Starting right now I'll be strong
I'll play my fight song
And I don't really care if nobody else believes
'Cause I've still got a lot of fight left in me

A lot of fight left in me

Like a small boat
On the ocean
Sending big waves
Into motion
Like how a single word
Can make a heart open
I might only have one match
But I can make an explosion

This is my fight song (Hey!)
Take back my life song (Hey!)
Prove I'm alright song (Hey!)
My power's turned on
Starting right now I'll be strong (I'll be strong)
I'll play my fight song
And I don't really care if nobody else believes
'Cause I've still got a lot of fight left in me

Know I've still got a lot of fight left in me

The First Miracle

 I have never been more happy to hear that my brain is "unremarkable!"

We got the results of my CT scan on my brain today. 

Findings: ventricles have normal size and position. There is no evidence of mass, hemorrhage, or infarct. On the postcontrast study, no abnormal enhancement identified. 

This is the part that needs more clarification:

Small metastatic lesions may not be apparent by CT and if there is clinical concern of beau. Metastases, recommend MRI with and withou tgadolinium.

Review of bones of the calvarium show normally aerated paranasal sinuses and mastoid air cells. There is no evidence of lyric or blastocyst osseous process involving the bony calvarium. 

Impression: Unremarkable head CT

 I have the next test tomorrow, a PET scan of my full body to see if cancer is anywhere below my unremarkable head. 

Thank you for all the prayers, fasting, happy thoughts, and love. We have our first miracle, and there is no reason we can't hope for more!

Love you all!!