Puppy Therapy

Today was Herceptin Wednesday, and my visits are starting to follow a routine - vitals, doctor exam, infusion - which I am becoming a pro at!

I brought another friend with me this time and after vitals, I was placed in an exam room where Dr. Sara, Debra the nurse practitioner and Dr. Dy the fellow came in to see me.

They did a physical exam (adding three boob flashes to the count) and Dr. Sara said he is continuing to see a difference - even since last week.  WOOHOO!  Before treatment started, you could feel the tumor distinctly; Dr. Sara likened it to a rock under the skin.  It was very dense and it made it easy to measure during my first appointment, which Dr. Sara did so he could keep track and monitor it as treatment progressed.

Today, the tumor was so soft that it could no longer easily be measured.  It is clearly dispersing.  In addition, the doctor can no longer feel the swollen lymph node under my arm. 

Last week, Dr. Sara remarked that after the first chemo treatment, they are mostly interested in how your body (not necessarily the cancer) reacts to the drugs, i.e. whether you have an allergic reaction, experience side effects, etc.  So he said he is "very pleased" to see such a difference in the tumor after just one chemo treatment.  I told him I was very pleased too!

This is all very encouraging and I am very excited, but I'm trying to be careful about not getting TOO confident, since I am still far from the end of the road.  But at least I know I'm going in the right direction.

Dr. Sara also told me that from here on out, I will no longer have to get the Herceptin weekly.  He had said from the start that the weekly Herceptin treatments would be just in the beginning - I wasn't quite sure exactly how long it would be, but today I found out not long at all.  I will still be getting the same amount of Herceptin, but all at the same time instead of doled out over three weeks now.  Next Wednesday is the next full chemo; after that my next treatment will be full chemo three weeks following.

After this very encouraging meeting with the doctor, I was given my recliner in the Infusion Suite.  The nurse hooked up my IV (in my hand; no creative needle sticks today) and after some saline, I was given the Herceptin - just a 30-minute drip today.

During my infusion, a woman walked into the Infusion Suite with a dog!  I was surprised to see a dog in a hospital, because I assumed that was not allowed, but she turned out to be a volunteer.  Her dog Quincy, a Yorkie-poodle mix (is that a Yorkie-poo?), is certified as a therapy dog.  He even wears a very official-looking jacket and everything.  Quincy's owner lives in the neighborhood and brings him to the Infusion Suite every Wednesday and Friday to visit with the patients - a form of Puppy Therapy, if you will.  Although unlike music therapy, there is not a whole "Puppy Therapy" department in the hospital dedicated to this; Quincy and his owner are volunteers.

Quincy's owner asked me if I'd like a visit from Quincy and even though I am not typically a "pet" person, I could not resist.  He was very cute and very friendly.  He sat on my lap while I pet him and chatted with his owner and my friend, and Quincy seemed to charm some of the other patients as well.

I also had a visit from Bernardo, the music therapy guy, who was going to come by for a song or two, but my visit was so short we ran out of time.  I told him next week I would be there all day and my parents have been practicing and were ready to take on their instruments again!

So, now my sights are set on next week.  Since this will be my second full chemo, it means that I can expect to start seeing some hair loss in the days and weeks following, so I am trying to mentally prepare myself for this.  I know it will be hard, but I have to keep reminding myself that it's only temporary, and it's a small price to pay for all the good the drugs are doing, which we are already starting to see.

I am also trying to prepare from a practical standpoint as well.  I am all set with my first chemo cap, which my Mom knit for me.  Here is me trying it on:

Pretty cool, huh?

I am also planning on going wig shopping this weekend, so stay tuned for more modeling shots to come!

Chemo Junkie

Yesterday was a good day.  I had my second Herceptin treatment.  My sister Sara has taken to calling these "Herceptin Wednesdays," since I will get this treatment every week now, at least to start.

I had a friend come with me and we made our way to the reception area where I signed in.  After a few minutes they called me for vitals, where they took my blood pressure, temperature and weight, just like last time.  If they are going to weigh me every week, I really think I should start laying off the brownies!  And even though Dr. Sara said that I can continue to work out normally, the truth is that I haven't been to the gym since my diagnosis.  But those weekly weigh-ins just might get me to start!  (I also don't understand why I always seem to weigh at least 5 pounds more in doctor's offices than I do at home.  I even take my shoes off and everything.)

After vitals they put me in an exam room and this is where it gets real exciting.  Dr. Sara came in with a fellow I hadn't met yet (and by "fellow" I mean a doctor who has completed their residency and is in specialty training; not a "fellow" like some random guy), who Dr. Sara said was familiar with my case.  They did a physical exam (that's 2 boob flashes to add to the count) and... here comes the exciting part... Dr. Sara said that he's ALREADY STARTING TO FEEL A DIFFERENCE!!!!  He can tell from the physical exam that parts of the affected area are "softer" than they were last week, a sign that last week's chemo is doing its job and the tumor is showing signs of shrinking.

I was so excited when he said this that I said, "Alright, I'm ready for more!" and he said I'm going to turn into a "chemo junkie."  Ha!  But my attitude is "bring it on."  Anything to get this cancer out of me.  I would go every day if I had to.

Is It Normal To Feel Normal?

It has been four days since my first chemo treatment, and so far I feel... fine.  Really normal, actually.  I got up and went to work the next day, just like any other day.  I have not felt tired or sick to my stomach or anything out of the ordinary really.

It's funny, because I keep expecting to not feel okay, and so I've been a little paranoid about every little thing.  That first night after chemo, as I was reflecting on how normal I felt as I was trying to sleep, I suddenly became aware that I was really warm.  At first I didn't think anything of it, but then my mind started churning, and I remembered that the nurse told me to call if I developed a fever of 100.5 or higher (because it could be a sign of infection) and then I thought - oh no! do I have a fever?  So I got up and took my temperature.  98.3.  I think the problem was too much flannel.  

I had a similar experience when I first found out I had cancer, but hadn't yet had my first official doctor's appointment with the breast surgeon or oncolologist.  That first weekend, I started noticing that my right arm was sore, and I suddenly became convinced that the cancer was spreading down my arm and I would soon be an amputee (yes, I know how ridiculous that sounds).  But then my friend - who is a physical therapist - suggested that maybe I was subconsiously tensing my arm to protect the affected side, and that was why it was sore.  Turns out she was right because once I made a point to relax it, it was no longer sore.

Before I had my first appointment with Dr. Sara where I learned what chemo was all about, I had some pretty antiquated ideas in my head.  I kept thinking of that old Julia Roberts movie from the early 90s where she plays a caretaker for a cancer patient who is violently sick for much of the movie.  But that was 20 years ago, and luckily, it's not like that anymore.  There have been many developments in anti-nausea drugs to prevent this, and one of these was part of my "pre-meds" on chemo day (in addition to a prescription they gave me to take for two days following).

Of course, there are many different variations of chemo which produce varying side effects.  Dr. Sara said that on a scale of 0 to 10 as far as how bad chemo side effects can be, with 0 being no side effects and 10 being absolute hell (because I guess there are some that are still hellish), my experience should be about a 4.  I can handle a 4.

It's important to mention here that the intensity of chemo side effects has absolutely no correlation with how the chemo is working.  A person can have no side effects while the chemo is effectively doing its job in killing the cancer cells, and the reverse can also be true.  I learned this in the "Chemotherapy and You" book they gave me on Wednesday, which, despite its cheesy title, is actually quite helpful.

So what can I expect?  Well, I will lose all of my hair.  I have heard that this doesn't always happen to everyone (and I do tend to have a lot of hair), but Dr. Sara seemed pretty certain that this will happen to me.  He said that when it starts to happen (usually after the second treatment), it will be shocking and traumatic no matter how prepared I think I am.  I will probably cry.  I will wake up in the morning and there will be clumps on my pillow.  Or I'll take a shower and it will look like a small animal is scurrying around in the water at my feet.  Once it starts falling out, most people take matters into their own hands and shave their heads.  Dr. Sara said this is good thing to do because it makes you feel empowered - that you are taking control of the situation.  You shaved your head; it didn't fall out.

To prepare for this, many people choose to cut their hair short before starting chemo.  There are a couple reasons for this.  One, quite practically, it's easier to try on wigs when you have less hair (and I've been advised to get a wig BEFORE my hair starts falling out).  Second, it makes it at least a little less traumatic (and easier to clean I would imagine) when it does start falling out, if there is not as much to lose.

I took this advice and got my hair cut about two weeks ago.  Here is me before:

And here is me now:

(Special thanks to my stylist Rita for giving me my new 'do!)

Liver Biopsy Results & First Chemo Day

On Monday morning, I got another unexpected call from Dr. Sara's office telling me he wanted to see me that day.  I kept it together on the phone, but inside I was freaking out, because again, I didn't have a previously scheduled appointment.  I knew it could only be about one thing - the liver biopsy results.  Then, my Mom called his office to see if it was something they should drive up from central Jersey to go to with me, and the office said "probably yes."  Eeks.

At 3pm, we went to the hospital, a little nervous about what we were about to find out.

I will cut to the chase here: the liver biopsy came back positive for cancer.  This means that my cancer is now stage 4 (previously it was stage 3).  The doctor said that stage 4 used to mean "incurable" - in which case they would have given me chemo to hold it, but it couldn't be cured.

Obviously this was not the news we were hoping for, but please note he said used to (see how I bolded AND italicized it for emphasis?).  Nowadays, they have so many advances that stage 4 does not necessarily mean incurable anymore.  He even said that the testing was so advanced that this small spot on my liver may not have even been caught a few years ago, so it is good that we caught it now.

So, how does this change my treatment?  Not by a whole lot actually.  I will still get my full chemo regimen every three weeks as originally scheduled, but I will now be getting Herceptin every week, at least to start.  The hope is that the chemo will completely clear up the spot on my liver, as well as shrink or hopefully get rid of the tumor in my breast completely.  Then, I will eventually need surgery on my liver.  The good news is that because the spot is so small (only 10 millimeters) and because of where it's located - in a pretty accessible spot close to the skin - the surgery should not be a major big deal, and will likely only require a small incision.  Also, the liver is the only organ in the body that regenerates itself, so when they cut a piece out, it will grow back on its own.  He actually called up my CT scan on his computer and showed us the spot on my liver so we could see it.  It's kind of weird to see your internal organs on a computer screen, but it was interesting nonetheless!

The cancer in my liver is the same as the cancer in my breast.  Most likely the cancer cells found a blood vessel to attach to and that is how it traveled to my liver.  But because the cancer is the same, that means that it will react the same way to the chemo.  Sometimes, they find a totally different cancer elsewhere in the body, not related to the first diagnosis, but luckily this is not the case with me.  Also, sometimes they do scans and find the cancer in many places - multiple lesions on the liver, in the bones, in the brain, etc.  So although my cancer is stage 4, in my mind it's a very early stage 4, and it could still be much worse!

Taper Gene Girl

(Note: no taper-leg jeans were worn in the making of this blog post.  I just really like the Kings of Leon.)

During my first appointment with Dr. Rosenbaum Smith, my breast surgeon and the self-described "captain of the ship," she advised me to make an appointment with their in-house genetic counselor, so that I could be tested for the breast cancer gene.

Her reasons for suggesting this were three-fold: one, my young age is reason enough to get tested; two, the results could help guide surgery decisions (i.e. if I have the gene, I almost certainly would go for a double mastectomy as a preventative measure from developing cancer in the left breast); and three, the results could have implications for other members of my family.

When we made the appointment, they gave us a little "workbook" to fill out with detailed questions about my family history.  This was helpful because Mom and Dad had some time to make some calls to make sure we had as much accurate information as possible.

With regards to breast cancer, and cancer in general, I have very little family history.  My paternal grandmother had breast cancer, as did one of my Mom's cousins.  My father was diagnosed with prostate cancer 10 years ago (he is fine today, although he is currently in a clinical trial to keep those pesky increasing PSA readings at bay).  Other than that, to our knowledge, no one else in our family has had any kind of cancer.

The session with the genetic counselor was very interesting.  First, she asked us a lot of questions about our family history. Then, she explained the background of the breast cancer gene, how common it is and what the implications are if I have it.

Change of Plans

First of all, let me say that I have the most amazing friends and family EVER.  All of the comments, emails, etc., I've recieved since I launched my blog (and really since the start of this whole thing) have totally humbled me.  I feel very blessed.  So thank you, because you rock.

It has been an eventful couple of days.  Yesterday, I was scheduled for a MUGA scan at the hospital at 10am.  My sister likes to call this a "Muggle scan," and frankly, I prefer this name, though sadly, it has absolutely nothing to do with Harry Potter.  It's a test that measures the strength of my heart muscle, which is needed because one of the side effects of Herceptin (the drug they made the movie about) is that it weakens the heart muscle.  More on that later, though.

At 8:30am I got a call from Dr. Sara's office telling me that he would like to see me today and asking if I could come in after the MUGA scan.  This immediately freaked me out because I wasn't supposed to have an appointment with him, so I was worried about why he suddenly wanted to see me.  In addition to the abdomen MRI I had on Monday, I'd also had a brain MRI, because breast cancer can spread to the brain and he wanted to make sure it was clear.  So when I heard he wanted to see me yesterday, I was very scared that he was going to tell me the cancer was in my brain.

Luckily, I had asked a friend to come to the MUGA scan with me, and I was very grateful I'd done that because talking with her while in the waiting room kept my mind from reeling with all the scary possibilities of what news awaited me (thanks, Bern!).

Back to the MUGA scan... It's actually kind of a cool thing they do.  First, they draw blood.  This was easier said than done, though.  Let's just say that "oh sh*t what a mess" is not what you want to hear when someone is drawing blood.  I didn't watch because I was afraid my reaction would make it worse, but I think a valve or something broke and blood went everywhere, since they were frantically cleaning my arm.  They apparently fixed the problem, but couldn't get any blood to come out, so they ended up having to draw it from my hand (that's 2 needle sticks added to the tally). 

Anyway, after the blood had finally been successfully drawn, they treated it with some kind of radioactive isotope for about 30 minutes.  Then, they put the blood back in me, and I went under the "camera" (though it didn't look like a camera), and they take pictures of my heart, tracking the radioactive blood as it pumps through it.

After the MUGA scan, we went up to the 11th floor to see Dr. Sara.  First thing he said was that my brain MRI was clear - WHEW!  I do not have brain cancer, what a relief.  However, the abdomen MRI was a bit inconclusive.  There is a lesion on my liver (which we knew) but the MRI could not definitively say it is not cancer.  Dr. Sara said that it might be an adenoma, a benign lesion which can occur in women who take oral contraceptives.  But, I needed a liver biopsy to be sure.

He had already scheduled the liver biopsy for the following day (today), and chemo therefore got pushed back from Friday to next Wednesday, February 10th, since he wanted to give me a bit of recovery time after the liver biopsy.  Hence, the change of plans.

So, today my sister (who had come up from Maryland to visit me and go to what was supposed to be my first chemo treatment with me) and I woke up early to get to the hospital at 8am for the biopsy.  Sara had come prepared to show her support in a pretty awesome way (FYI she's 8 months pregnant):

Testing... Testing... 1..2..3...

In the last couple weeks, I have a LOT of tests: 2 biopsies, 3 blood tests, 3 MRIs and 1 PET/CT scan, and that doesn't even count the mammogram, sonogram and various physical exams I've had.

All of these tests have served to give my docs - and me - more info on exactly what we're dealing with, so they can determine my course of treatment.

I have a "large irregular mass" in my right breast.  The biopsy showed that the mass consists of both ductal carcinoma in situ (DCIS) and invasive ductal carcinoma.  DCIS alone is considered stage 0 cancer and does not spread.  Invasive ductal carcinoma is the one to be concerned about since that is the kind that spreads. 

So, has it spread?  The sonogram did show that I have a swollen lymph node, but I had a separate biopsy of that lymph node that came back "inconclusive." My breast surgeon, Dr. Rosenbaum Smith, said hopefully it's swollen because the lymph node is doing its job and trying to keep the cancer out.  My oncologist, Dr. Sara, did a physical exam and he said that the swollen lymph node did not feel like a "typical cancerous lymph node" to him.  So, in my mind, there is a little war going on in my lymph node... the cancer is trying to spread, but the lymph node is fighting valiently to keep it out.  Come on, lymph node!!!

Luckily, my PET/CT scan, which scans the whole body, did not show any signs of cancer anywhere else in my body.  Woohoo!  It did pick up a little spot on my liver, but the docs say that it does NOT look like cancer and is most likely a hemangioma, which is kind of like a birthmark on my liver.  Who knew you could have birthmarks on the inside of your body?  Just to be sure though, I had an MRI on my abdomen yesterday.