Into the ring again

By now, most of you know that my cancer has returned; it has spread to some lymph nodes in my chest wall and collarbone, and into my lungs. All this news came in bits and pieces, and was a complete shock to me.

I had that dreaded, "It's cancer" conversation with my surgeon on December 2, 2014, while I was at work. I had seen Dr Carr the week before to follow up on a suspicious lymph node above my left collar bone. The node was first discovered in June at an oncologist appointment. This was supposed to be a routine appointment, and so it was, until he found an enlarged lymph node. He wondered about it, but then quickly wrote it off as nothing to be concerned about. I pressed him for further testing, which he did. I was referred back to my family doctor, who sent me for an ultrasound. At every step, I was told that everything checked out fine. I had nothing to worry about. To follow up, I was to see my GP in 3 months, and she would send me to the surgeon for assessment if the lymph node was still enlarged. It was a bit bigger than it had been in the summer, so off I went to see Dr. Carr on November 26. He did a needle biopsy and called me with the results the day before I left for my trip to Montreal with Lucas.

That was a hard bit of news to swallow! I was orienting at at new unit that day, so I didn't know anyone very well. Someone asked me how I was doing and I passed off my glazed look as being tired. I went for a lunch break and then I called Norm. I told him my news, but decided I wouldn't say anything to anyone else until I got back from my Montreal trip. I wanted to have a fun time away without every conversation being about cancer. I especially didn't want Lucas to worry about me when he was supposed to concentrate on competing. 

The trip was great. Peggy met us there and we toured around Montreal. We even made it to Québec city. Lucas and Sarah had a good experience at the Skate Canada Challenge and will compete again in Kingston at the Nationals! I'm so glad I kept quiet about my problems. 

I arrived home on Tuesday, December 9 and had my biopsy on the 10th. At this point, I was hoping for a lymphoma diagnosis, not a breast cancer recurrence. Apparently, that would have been easier to treat. I also had a CT scan on Friday the 10th. That was to see if the cancer was anywhere else. Of course, I was hoping that it was just in the one lymph node. No. I found out that there were multiple nodes affected, as well as a 3.5 cm tumour on my chest wall, and at least 14 spots on my lungs. Oh, and it wasn't lymphoma. It was definitely recurrent breast cancer with metastases in the lung. Crap. Very big pile of crap. 

I saw my oncologist, who happened to be my old oncologist from my first time with cancer. She's a very proper older lady who wears skirts and Oxford shoes. She retired sometime after I saw her in 2009, and now is back for a locum. She looks just the same but now she's wearing Skechers. She set me up for chemotherapy to start promptly on Christmas Eve. Surgery won't be of use now because of the extent of the tumours. The plan is for chemo to work its magic, and then have a CT scan in a few months to assess the progress.

Chemo is going pretty well. I've had three sessions so far with minimal side effects. The only bothersome symptom is a bit of tummy trouble. The first three sessions were in Victoria, a two hour drive from home. Now that they have room for me in Nanaimo, I'll have my sessions at the hospital there, starting this Thursday. 

I will end this post on a positive note:

1. My bone scan came back clear,

2. I kept my hair for 3 and a half weeks after my first treatment. I noticed a few strands of hair on my shirt this morning, 

3. I'm still working, and I am so thankful for that. I love my job and I especially love my coworkers, 

4. Norm is coming home more often, and will be home this Friday,

5. I have fantastic, caring children. 

Would you like one lump or two?

I thought up the title to this post last night while I was stewing about the phone message from the surgeon. The receptionist had left a message for me to call the office on Wednesday, but for some reason, I missed the message and only saw it last evening. Of course, I assumed the worst. Based on what I imagined I saw on the screen while getting my mammogram, I was sure I was going to get a call saying that a new lump was found. I had it all mapped out in my head - more chemo, the PICC stays in, no swimming this summer, I'll shave my head again. OK, all settled, I have big shoulders; I can manage this too.

I thought my morning post would be to tell you my crummy news. I imagined everyone's thoughts. Well, I am happy to report that I DO NOT have new lump. I don't have any lump. In fact, there was no evidence of calcifications either. Who knows what I saw on the screen? Maybe it was scar tissue. Maybe it was someone elses' breast. I don't know. I'm doing a happy dance this morning and the tune is "I'm on my way from misery to happiness..." by the Proclaimers. Don't get me wrong - I have not been in the "misery" catergory, but today surely is a good day.

FYI: the reason the surgeon's receptionist called was to give me the date of my surgery - June 11. 41 days to go.

5th treatment

Tuesday, April 14

I know I should have posted this before, but life got in the way of writing. The week in question was a busy week. Rosalie had an MRI scheduled for her knee the same time I was scheduled for my blood work. Wanda, my second self,and personal escort came along to make sure Rosalie got in for her MRI on time. As soon as I was finished, I rushed up to the imaging department to fine Rosalie. Shortly after I arrived, she was called to get changed.

She was not impressed with the giant baggy pants. They are one size fits all, made to accommodate the largest man. She is 9 year old girl who is very sensitive to how her clothes fit and feel. I could sense disaster coming, but Wanda was able to cheer her up and make her feel OK. Off we toddled to the big fancy room. I thought that I had had an MRI before, so I did not explain it correctly to Rosalie.


She had to lay on the table perfectly still. Check. She could pick a radio station to listen to with big comfy headphones. Check. The machine will make a very loud banging noise. EEhh - not good. Wanda and I received ear plugs and the noise was disconcerting to me. Rosalie did all all right at the beginning of the first 5-minute session, but she was getting uncomfortable towards the end. I couldn't hear her, but she was mouthing "how much longer?". The technician came in and helped her calm down, and gave her a face cloth with which to cover her eyes. After that, she was much more calm and did manage the next two sessions fine. It helped that she was imagining the machine as a giant doughnut.

That part off the day being over with, we went downstairs for my pre-chemo appointment with Dr. Dunne. The complaints from the last session were reviewed and then we were released. When I got home, I received a call from Dr. Cameron's office (Rosalie's orthopedic surgeon) asking for her to come to his office the next day. She mentioned the word, "urgent". After some give and take with her, I was able to get an appointment at 8:30 am, right before chemo.

Wedensday, April 15

Why did she say the appointment was urgent? I have learned to hate that word. No worries, though. The doctor saw her, went over her MRI results, and everything checked out. She has a lot of fluid on the knee, a bruised bone, and torn cartilage. Since she's young, she should heal without any medical intervention. He even gave the OK for her to join the Track and Field club. What a relief that she will be fine. Thank you, God.

The next day was chemo and Evelynne joined me for this one. She and I played "Apples to Apples" with a volunteer. What a good game! We had the junior version, but there is an adult version and it meant for 4 - 10 players - perfect for our entire family and parties. We also played "Snakes and Ladders 3-D" - very fun! The volunteer really took to Evelynne and offered her every snack available. She had cheese and crackers, a Popsicle, juice, and ice cream. All in all, it was a pleasant way to spend time.

Saturday April 18

A weekend of skating, in Port Alberni this time. Lucas skated in his singles event, in a new level this time and placed second. Just he and I went for the drive, so that was nice. We stopped for a giant ice cream cone and went to the waterfront. Port Alberni is in the centre of Vancouver Island, 50 kms from the east coast and 95 kms from the west coast, but is on an ocean inlet that flows all the way to the open Pacific on the west coast. It's a beautiful spot, nestled in the mountains.

I decided to skip the cone, but Lucas enjoyed his!

My son and I

The team - Kanon and Lucas

Korin, Lucas, Yuzuki, and Kanon

"I hate getting pictures taken, Mom. Will you please hurry", although I don't think he said the "please".

Sunday April 19

The whole family drove up the next day for the 8:00 am pairs event. Lucas had to be there by 7:00 am, which meant we had to leave by 6:00 am. You can imagine what it's like getting 4 kids out of bed at 5:30, to be on the road by 6:00 am. Not easy. They snacked on the road, and we got there in plenty of time. They skated really well, and received the gold medal. I love watching them skate.

Now you will remember that I had chemo on Wednesday. Day 5 always seems to be the start of my troubles. Guess what day Sunday was? By the time the kids skated, the results were posted, had the medal presentation, I was famished and beginning to get kind of shaky. We drove off in search of food, and I felt a bit better after that, but was starting to get very tired. I slept some on the way home, ate lunch once we got home, then climbed right into bed. I thought I would have a little nap, but slept the afternoon away. I could not open my eyes, nor could I move out of bed even if I had wanted too. It wasn't a feeling of being tired, more like completely drained of every energy cell. It's a strange feeling. It lasted most of the way through Monday as well. I got out of bed to do errands with Norm, but stayed in the car most of the time. I was up and at 'em by Wednesday, and saw Dr Carr on Thursday (those details are in the previous post).

Sunday April 26

Victoria had a soccer tournament on Salt Spring Island this last weekend. Norm took her for the Saturday games, and the family plus Grandma came on Sunday. She played so well! What a tough girl. Victoria really took a beating on Saturday, doing a crash onto her shoulder and getting kicked in the shin. She can get up from a fall faster than anyone I know and is able to beat the person who caused the fall to the ball. Their team was playing up a year, so all these girls had already hit their growth spurt. Vitoria has not - she is small for 11. A lot of girls from the other team are already 13 and very big. That did not matter to my small, quick daughter. Her team played two games on Sunday morning and we were able to explore the Salt Spring fro the afternoon. Another gorgeous place, but expensive. At the farmer's market, someone was asking $18 for a loaf of lemon poppy seed bread. Crazy. It's an island populated by both hippies and the wealthy. Since we don't fall into either of those categories, we will visit again, but could never live there. 18 bucks for a loaf of bread- can you imagine the house prices? We walked along the waterfront, near Ganges, and vowed to come back with our boat to tour through the Gulf Islands. It's a beautiful area. Here's a link if you want to see what I'm talking about: http://maps.google.com/maps?t=h&hl=en&ie=UTF8&ll=48.862633,-123.49288&spn=0.039356,0.111237&z=14

And some pictures:

On the ferry, heading toward Vesuvius, Salt Spring.

Looking East from Ganges Harbour

Monday, April 27

A very nice weekend, and back to business on Monday. Victoria felt that she didn't get enough exercise over the weekend, so she and a friend, along with Norm and Rosalie, rode their bikes to school, a distance o about 7 km. They also rode back the long way, another 12 kms, then she had soccer practice that evening. By then, she was tired.

Tuesday April 28

I had my mammogram yesterday. They did both breasts, and next week, I will have an ultrasound only of my unaffected breast - the left one. I have a bad feeling about the mammogram. I peaked over to the screen and I swear I saw a lump. The images of both breast were up, so I don't know what I was looking at. The technician asked me a couple questions that made me think, uh, what's up now. Maybe it's just scar tissue, I don't know, but I'm not going to get all crazy about it yet. Dr. Carr will phone if there's anything, and so far the phone has not rung. My ultrasound is next Thursday, so all will be revealed by then. In the meantime, I am going to see the cardiologist in Victoria today for him to go over the previous tests I had on the 26th of March. I am looking forward to a nice drive with Wanda, and a visit with Joelle and Claire.

That's all for now. Cheerio.

another couple tests

The test I had last Friday - a complete bone scan came back perfectly fine. It does not show any metastases in the bone or any other problem. Even my foot problem does not show up. 

The next test I have to have is called a MUGA scan. This one examines my cardiac function, specifically by looking at health of the left ventricle. It is explained below. 

This is something I was not prepared for. I knew about the surgery and the upcoming chemo, but the sheer volume of tests, scans, needles, blood work, etc has surprised me. I should be entitled to my own parking stall at Nanaimo Hospital by now. People are starting to recognize me and call me by name. As nice as they all are, I'd rather be meeting these people on the sidelines at a soccer game or at the mall.

Doctors have developed strategies to minimize the risk of damaging the heart muscle with certain chemotherapeutic drugs. These strategies include: avoiding the drug altogether in patients who already have heart disease; keeping the total dosage given to each patient below a certain “threshold” value; and monitoring the patient’s cardiac function by means of the MUGA scan.

The MUGA scan (MUltiple Gated Acquisition scan) is a noninvasive test that produces a moving image of the heart. From this image, the health of the heart’s major pumping chamber (the left ventricle) can be assessed.

A MUGA scan is performed by attaching a radioactive substance, Technetium 99, to red blood cells, then injecting the red blood cells into the patient’s bloodstream. (The level of radiation to which a patient is exposed during this test is considered minimal.) The patient is then placed under a special camera (a gamma camera), and with some fancy computer manipulation, a “movie” of the beating heart is made. From this moving image, the MUGA scan gives an accurate and reproducible way to measure the ejection fraction of the left ventricle.

preliminary results

The surgeon just called with good news. The tissue surrounding the tumour that was removed is clear and there is no cancer in the lymph nodes. There still is the concern of the calcifications in the milk ducts and these have shown to be pre-cancerous. My cancer is both estrogen and progesterone receptor positive, so I am a good candidate for tamoxifen. 

Dr. Carr is going to discuss my case with the cancer agency in Victoria today with regards to my treatment plan, although he does still think I will need the full course of chemotherapy and radiation. The tumour itself is high-grade (because of the growth rate), but the cancer is considered stage 1. The staging could change based on the official results, but Dr Carr does feel confident in these preliminary results. 

The only thing I am waiting for is the results of the HER2neu (A positive HER2 test performed on a breast cancer means that the tumor has genes that are not normal. Cancers with too many copies of the HER2 gene or too much HER2 protein tend to be more aggressive and can be treated with an antibody to that extra gene's protein). 

The short version of this story is that I can keep my boob, but will still loose my hair. 

See below for an excerpt from www.breastcancer.org for a explanation of tamoxifen and estrogen receptors. 

Tamoxifen has very weak estrogen activity. When you take tamoxifen, it passes into your bloodstream, joining all kinds of hormones, nutrients, oxygen, and other molecules as it circulates through the tissues of your body. If breast cancer cells are present, tamoxifen flows around them as well. If these cancer cells have estrogen receptors (about two-thirds do), tamoxifen slips into the receptor "locks," filling up a space that would normally be taken by the body's natural estrogen.

Because tamoxifen is such a weak estrogen, its estrogen signals don't stimulate very much cell growth. And because it has stolen the place away from more powerful estrogen, it blocks estrogen-stimulated cancer cell growth. In this way, tamoxifen acts like an "anti-estrogen."

Tamoxifen may also take the place of natural estrogen in the receptors of healthy breast cells. In that way it holds down growth activity, and possibly stops abnormal growth and the development of a totally new breast cancer. By blocking natural estrogen from getting to the receptors, tamoxifen is helpful in reducing the risk of breast cancer in women at high risk who have never had breast cancer. It also can help women who have already had breast cancer in one breast by lowering the risk of a new breast cancer forming in the other breast.

results of the biopsy

Dr. Carr phoned late on Monday the 10, but I wasn't home to get the message. I phoned him at the hospital first thing on November 11th to get the results. Cancer it is. Well, I was prepared for that. 

His receptionist will be phoning me in the next few days to set up a date for surgery. Analysis of the lump and surrounding tissue will take a couple weeks, then I will be off to Victoria for a visit with the cancer centre there. If the tissue and lymph nodes are clear then that cold be it. He really didn't say one way or the other. If those calcifications also show cancer then I will be scheduled for a mastectomy. 

Although everything is spinning right now, I am reassured by this. To me, it's a sign that all is well with the system in Nanaimo. 

biopsy and ultrasound

In between the appointment with Dr. Carr and the biopsy, I had time to stop by the house with my puppy. Mom and I played with him and noticed how he was squirming on the floor and scratching his ears. I thought it was because his ears were aggravated by the vet cleaning them. Wrong. I checked on him again a few minutes later and his eyes were almost swollen shut, and both his ears and lips were swollen. I called the vet and was told to bring him in right away. Oh great. I was just about to leave for the hospital. I packed up the dog and sent Mom to the vets (not knowing where in the world she has to go) and off I went for the biopsy. All throughout the appointment, I was worried about Hershey. Poor little guy. 

First I had a chest x-ray, then was off to the ultrasound department where I also had a biopsy. It's kind of like getting your ears pierced but not as fun. When that was over, I drove to the lab for some blood work. 

I phoned Mom and Hershey was fine. He had a reaction to the vaccine and after being given an antihistamine was OK to go home. 

Whew. That was the end of a very long day.