Time

Last night we switched the clocks back an hour, but someone forgot to tell the pets.  At 5:40 they started their usual morning assault.  I am their target – they seem to have learned to leave their other human alone.  Henry started off, meowing quietly at first from the safety of the hallway.  Sam, a 60-pound border collie mix, paced back and forth like a child needing to use the bathroom, toenails clicking persistently on the wooden floors.  I froze, remaining as still as could be in my bed, trying not to give any sign that I was aware of them.  One slight shift gave me away and they were both up on my bed, Henry forgetting about the threat of a spritz of water.  I got them to settle for a bit, but after 10 minutes, Henry started to walk across the pillows and onto the dresser and I knew it wouldn’t stop until I got up and let Sam out and gave them both a treat to hold them for a bit.  How to reset their clocks?  You would think I’d remember from year to year, but I don’t. 

So here I am, sitting in bed, wide-awake, pondering time.  Time has been moving at different speeds these past few months.  In August when the doctor discovered a lump in my breast, things moved at warp speed all the way up through my surgery in September.  Since then I have experienced the slow pace of waiting for results and appointments with new doctors to chart the course of further treatment.  The nearly 3 weeks since then have gone at a snail’s pace. 

I have had plenty of time to prepare, if anyone can really prepare, for chemotherapy.  I have spoken with people who have gone through it before me and, if nothing else, I have really learned this lesson: all breast cancers are NOT alike.  We hear so much about the stage of a cancer, but there are so many other elements to a diagnosis.  Just one factor, such as being HER2 positive, can totally separate you from those who share all the other aspects of your diagnosis.

When I was at the hospital last week for tests, I visited the resource center and picked up some very helpful literature on treatment and nutrition. I have been on the phone with my sister, who is a nurse, and on the Internet researching ports (unfortunately not fortified wines, but those quarter-sized objects that are inserted under the skin so you don’t have to have your veins constantly poked for chemo and taking blood).  I have read up on tips for coping with chemo, and discovered, not surprisingly, that everyone reacts differently to their treatment.  Another lesson learned: there is no universal truth about how one will respond to treatment.    

I have gone to a wig shop to investigate my options once I lose my hair. They suggested I ask my insurance company whether they would cover a “cranial prosthesis”.  I did.  My insurance company does not cover the cost of wigs, because it is not mandated by my state.  (Topic for another time: why should an American citizen living in one state have such different rights from citizens living in other states?)

I have gone through ups and downs over these three long weeks.  The downs: losing Maya; experiencing a major case of nerves about chemo; waiting for a free flu shot for nearly an hour at the county health clinic, only to run out of time before they could see me and other minor inconveniences.  The ups: getting my hair chopped very short and liking it, meeting up with friends for lunch, coffee and a movie; being taken out to dinner on Friday night by my dearest friend and having one of the best meals I can remember – lamb shoulder slowly braised with marjoram, fennel and honey, tossed with caramelized onions, wild shitake mushrooms and pappardelle noodles; and best of all, learning that my brother will fly here on Thursday to be with me.

And today, the day before chemo begins, there will be literal ups and downs. I am headed up on the roof to clean the gutters and safely back down when I’m done. I’ll take a quick look at a photography exhibit on frost flowers at the botanical garden, and tonight it’s off to the theater to see Kathleen Turner on stage in the play “High”.  So although I’ve gotten an earlier than hoped for start this morning, thanks to Sam and Henry, I have the feeling that this day will fly by. 

Then it will be the long anticipated tomorrow – a day that is also chock-full, this time with blood work at 8, port insertion at 9, seeing the doctor at 11:20 and finally facing chemotherapy at 12:30.  I hope to stare it in the eye, and let it know that it is not going to get the better of me! 

Maya

Sadly, I have to report that Maya died on Monday night, nearly six months after being diagnosed with nasal cancer. She had a good last day, and surprised me by chasing the frisbee more energetically than she had the previous few days.  Admittedly it was much cooler on Monday than over the weekend, so I shouldn't read too much into her enthusiasm for her last round of exercise.  As always, she wolfed down her dinner, and was her usual bossy self.  She never hesitated to let us know what she wanted and she had a built in clock that caused her to pester us at 10 p.m. each night so she could have one last outing for the evening and get her biscuits before going to bed.  If we lingered too long watching the news, she would speak out with her insistent one note bark.  Ignore her for a few minutes and she would let out another, and another, until the sharpness of her tone could not be ignored.

She had had a couple of minor nosebleeds the last few days, which were easily stopped with a dose of medicine squirted up her nostril. Not something any of us, particularly Maya, enjoyed, but it worked.  Nosebleeds are a common problem with nasal cancer and we had been lucky, with only one major bleed in the spring.  Just after 10 on Monday night, we noticed a little blood, and quickly gave her the medicine, but it didn't do the trick this time. We bundled her into the car and took her the vet's office.  The vet on duty was kind and comforting and so very sweet with Maya.  She was also wonderfully honest about the situation.  It helped that we knew going in there what we needed to do.  It didn't take long and was very peaceful, but I have to admit that it broke my heart to let her go.  She was a great companion and I loved that she had such a strong, determined personality. That was the cattle dog in her. I will miss her more than I can ever say.  May she rest in peace.

I Never Trained for a Marathon!

As we begin phase 2 of my treatment, I have to admit that I am suffering from a case of doctor visit fatigue.  I spent three and a half hours at the medical oncologists’ office on Tuesday, and another two at the radiation oncologist’s on Thursday.  I liked both doctors very much, and each was excellent at explaining my options, answering my long lists of questions, and making me feel as though they had all the time in the world to spend with me.  They were both delightful and had good senses of humor – something I always find helpful!  But after a bit my head was swimming with all the information and I was too tired after Thursday’s visit to write about it, although what I heard that day was not that complicated – at least compared to Tuesday’s round of information.  Instead I took it easy, and yesterday afternoon and evening I even indulged in stretching out on the couch and watching a couple of movies.  (My Life as a Dog and The Big Lebowski – an odd mix, I know, but both good in their own ways.)

Here’s the summary of the plan for phases 2, 3 and beyond:

Next Wednesday I go in for tests and lab work – blood work, an EKG and something called a MUGA scan.  Both the EKG and the MUGA scan look at the heart.  The EKG measures the electrical activity of the heart – or its rhythm.  The MUGA scan uses a radioactive substance injected into the bloodstream to take images of the heart in action.  It allows the doctors to evaluate the state of the heart’s ventricles.  Herceptin, which I will take because my cancer cells were HER2 positive, has a rare potential to cause heart damage. Fortunately this damage is reversible. The baseline MUGA scan of my heart function will allow them to keep an eye on my heart health throughout the yearlong treatment with herceptin.  I will have the scan again several times during the year.

 

I start chemotherapy on November 8th.  That morning they will insert a port under my skin so they don’t have to constantly stick needles into my veins.  This is a good thing, since I’m not always an easy “stick”.  I gave up donating blood years ago because it would take 45 minutes for them to get from me what others gave in 15!  After the port is in I will start the first of six treatments.  I will receive chemo once every three weeks, and, if all goes according to plan, I will receive my last treatment on February 21st.

Phase 3, radiation therapy, starts about 3 weeks after I’m done with chemo.  I will undergo six weeks of radiation and will receive it five days each week, Monday through Friday.  More on that when we get closer.

After that, I will continue on with Herceptin infusions into November, and will take the aromatase inhibitors to block estrogen and progesterone for five years.

Tiring just to read about it, isn’t it?  I started out with what I thought, based upon my early results, might be a short jog.  But now it has turned into something more like a marathon!    

Better Living Through Chemicals (aka the results from my visit with the medical oncologist)

Considering that I have cancer, the news since diagnosis has been relatively good: stage 1, no spread to the lymph nodes and the cancer cells were estrogen and progesterone receptor positive. (That may not sound good to you, but it is in a targeted treatment sort of way). The standard course of treatment for all of that would be radiation and hormone therapy for five years. Not too bad. 

The only wrench in my diagnosis was that I was three for three on the receptor front.  I also tested positive for another receptor called HER2 – the human epidermal growth factor receptor 2.  When HER2 is overproduced it promotes the growth of cancer cells.  It does not respond to the hormone therapy -- or radiation, for that matter.  HER2 positive cancer requires a more aggressive treatment.  So, despite much wishful thinking, I will be joining the ranks of those bound for chemotherapy.  The downsides are fatigue and hair loss.  The upsides, besides helping to keep further cancer at bay, are that they have much better drugs to combat nausea than they used to and I will save money for at least four months, probably more, since I will not need to pay for haircuts.  There is almost always some silver lining, if you look hard enough! 

I’m off to the radiation oncologist tomorrow, and will report on that visit, although radiation therapy won’t happen until the standard course of chemo is completed.

Form and Function

I have to admit that I am tired of filling out forms.  I spent a good part of the weekend working on a form for financial assistance (I have a high deductible) and two sets of forms on my medical history – one for the medical oncologist and another for the radiation oncologist. Two different forms asking for the same sorts of information in two totally different formats, but for two doctors from the same cancer center at an otherwise up-to-date, technologically advanced facility.  I believe that makes these the third and fourth set of forms I have filled out on my medical history since late August for offices that are just several floors apart.  What’s wrong with this picture?  

The White Throats are Coming!

My life isn’t all about breast cancer these days (although I do now have an appointment with the medical oncologist on the 19th). There are other things going on: work – both my consulting work and my part-time job; putting together the monthly photography group newsletter (due to the printers by Monday morning); theater (the local Rep); my neighbor’s 88th birthday celebration (Sunday afternoon); the welcome return of some favorite television shows (The Good Wife, Grey’s Anatomy, Modern Family) and phenology, to name a few. Yes, phenology. And no, it’s not some obscure condition I caught in my travels. 

Phenology is the study of seasonal change and the natural events related to it. It is about the signs of the seasons, or the timing of things like bird and butterfly migration and when certain plants flower from year to year. So, as a person with an interest in phenology, I watch for the arrival of the first monarch butterflies in the spring and when the juncos appear in the fall. I try to notice the last time I see our ruby-throated hummingbirds in autumn before they head for the tropics, or the last of the monarchs before they make their way to a remote location in the mountains of Mexico where they overwinter. It's harder to notice the last of something than a first appearance! I saw a hummingbird and a monarch yesterday – will I see others yet this fall? (Yes – I saw a hummingbird darting about near the feeder moments ago.)

There are organizations that collect data from citizen scientists like me on these seasonal events. One is Journey North, which monitors the movements and life cycle stages of many different organisms. Another is Monarch Watch, which tracks monarch migration and even has a monarch-tagging program. Just a couple of weekends ago we netted and tagged seven monarchs in our backyard!  

One event I look forward to each year is the arrival of the white throats. White-throated sparrows arrive in the fall and overwinter here before returning to their breeding grounds, mostly in Canada, in the spring. Generally I hear them before I see them, and I thought I heard a snippet of one's song, “poor sam pea-bod-y”, on Wednesday. That seemed awfully early. I checked my calendar to see if I had recorded their arrival last year, and I had noted it on October 29th. But then, on Thursday, there it was again – and again, and again – and I heard many a “chink”, the soft call they make as they search about the ground for seeds. So the question is, are they early this year or did I fail to notice them when they first arrived last year? Natural events such as these tend to be a bit more regular than not, so I doubt that there would be such a large discrepancy between their arrival dates from one year to another. This citizen scientist may not be as observant or as diligent about keeping records as she ought to be! I’m sure I can go to other sources and find out. MOBIRDS is the site where birders across the state share their sightings.

Now the next question is: when will the true snowbirds arrive – the dark-eyed juncos? In 2008, they showed up in the yard on November 10th. When will it be this year? Any bets?

Half The Wait Is Over

Yesterday morning I finally got one of the two calls I have been waiting for.  Of course, it came when I was in the shower.  I emerged to find a message from the radiation oncologist's office, calling to schedule an appointment. I called back immediately and got the scheduler's voice mail.  Argh.  I was anxious to get this appointment on the books, and feared we would play a continuing game of phone tag. I was preparing to go to work, so I left both my home and cell numbers and my schedule, hoping to insure a connection.  However, in my recent experience I have found that no matter how many phone numbers I leave, people making appointments tend to use the first one they were given.  So, in a somewhat pessimistic frame of mind, I was sure we would continue to miss one another.  Fortunately I was wrong.  A nice bubbly young woman called back before I left the house. We set an appointment for October 21st.  She was most apologetic that it wasn't sooner and explained that they are completely booked until then.  This seems in keeping with the fact that more than a few people have told me that several friends and acquaintances have been diagnosed with breast cancer recently. One person told me that I was the fifth person she knew of to be diagnosed within a month of one another. It seems to be an epidemic.

There was a lot of noise in the background when I spoke with the scheduler, including two interruptions of cheers and applause. She explained that the cheers were for patients receiving their last rounds of radiation treatment, and they were joined by friends and family to celebrate the event.  Although that's not my style, it was heartwarming to hear.  Also, encouraging to see the light at the end of the tunnel before I even enter it.  Now, if I would only get that call from the medical oncologist's office...