" /> The Merits of the Case: June 2007 Archives

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June 29, 2007

Going Under the Knife....Again

My surgeon called me yesterday to tell me that he had consulted with my radiation oncologist and that he thinks I am a candidate for the partial-breast radiation. This means that the tumor in my breast was not too close to the skin or to my chest wall, both of which would preclude that form of radiation. If the MRI results are also favorable and show no more cancer, the next step would be to schedule yet another surgery to have a balloon catheter placed in the tumor site.

The surgeon said that usually when he performs this surgery it is within a couple of weeks of the initial lumpectomy so the site is still open. Because it’s been a month and a half since my lumpectomy, the tumor site has healed and he’ll have to re-open it in order to insert the balloon. I’m trying to not dwell too much on that because it sounds awful. And I am certainly not looking forward to yet another surgical recovery. But the benefit is that I would only have 5 days of radiation instead of 6-8 weeks, and the gain of 5-7 weeks is very attractive to me.

If the MRI results show any cancer in either of my breasts, we will continue on with the whole breast radiation and I’m fairly certain that a mastectomy will be indicated in that case. It looks like either way I will be having at least one more surgery—the only question is when and how extensive it will be.

June 28, 2007

Test Post

Hi this is Karly, Kim's daughter. I will be posting to give you updates during her treatments if she's not feeling up to it. Hopefully this will be my first and last post!

June 27, 2007

A Thousand Words

I have finally set up a photo gallery. You can see the evolution of my hair (so far) over the last 6 months and photos of various family members by clicking here. There's also a permanent link over on the right.

June 25, 2007

The Mist Begins to Part

Today I had a second appointment with Oncologist #1. I was feeling pretty confused with what I saw as a lot of conflicting information and I was hoping that he would help me put some structure to all of it. And he did.

I still don’t know exactly how the radiation will work out, but at least I have a clearer picture of my chemo plan now. If I end up having the partial-breast (5 day) radiation it might push the plan back a week. I will be going back to the oncologist’s office next Tuesday for a teaching appointment, where I will meet with a nurse and go over in detail what my treatment appointments will be like. The oncologist and I chose Thursday, July 12th as my official chemo start date. The treatments will be every two weeks and will take 2-3 hours.

I chose Thursday because I thought that doing it on Thursday would give me several days to recover before class on Monday night. That works well for the summer, but I don’t know what that means for the fall semester. Right now I’m scheduled to have classes on Tuesday and Thursday next semester. The doctor said that once we start it’s difficult to switch the day of treatment since we’ll be doing the dose dense treatment. I have no idea what I’m going to do about classes, but I’m just kind of shoving that all to the background as much as possible right now and hopefully I will figure it out before August.

I will also need to have a shot of Neuplasta on Friday 24 hours after my chemo treatments. The Neuplasta helps your bone marrow recover from chemo faster so that you’re ready for the next dose in two weeks rather than in three weeks. (The standard time between treatments with a “regular” dose is three weeks.)

My next medical procedure is an MRI, which I have scheduled for this coming Monday. This was recommended by all the doctors that I have seen and as of today is the best imaging technology available to make sure that there is not more detectable cancer in my breast. If there is more in there, I will probably need the whole-breast radiation rather than the partial radiation. In the meantime, the radiation oncologist is consulting with the surgeon to determine whether the location of my tumor precludes partial-breast radiation. If these things fall into place and we determine that I can move forward with partial-breast radiation, I think it will push the chemo back a week or so.

I’m glad to have some definite dates and to feel like I can finally end all the suspense and waiting that seems to be involved in much of this. On the other hand, I’m not looking forward to diving in to all of this.

June 24, 2007

Clear As Mud

I went to see a radiation oncologist on Friday. The visit went well, but was very long. My appointment was at 1:00 p.m. in the afternoon and I didn’t leave the office until 4:15 p.m. Once again, I am just going to give the highlights here. Feel free to ask if you have any questions.

I thought when I started these rounds of appointments that everyone would agree on my treatment and that we would just go ahead and get it started. As it turns out, however, every appointment has added new information to the situation and nothing is straightforward or simple. The radiation oncologist I met with was recommended by Oncologist #1. He is nothing if not thorough, and explained everything to me in great detail. He spent a lot of time answering all my questions and making sure that everything that he was telling me was very clear.

He said that he would agree with the recommendations of the other oncologists, except that he questions whether or not Taxol is indicated given my diagnosis. He also suggested that I might be eligible for a shorter, more intense and localized form of radiation that would take place before the chemo. (This is called MammoSite and is a partial-breast radiation technique as opposed to a whole-breast treatment.) Several things have to fall into place for that to work, and we have to figure those things out soon. Otherwise, his recommendation is the standard 6-8 week radiation treatment which will begin 3-4 weeks after my chemo treatment ends.

The radiation treatments are five days a week, Monday through Friday, at the same time each day. One of the major side-effects of the radiation is fatigue. This concerns me, and I wonder how in the world I’m going to be able to fit daily radiation treatments into my schedule once the fall semester begins and how I’m going to be able to handle law school classes if I’m exhausted. I don’t know the treatment schedule for sure yet, but it looks like finals will fall right in the middle of radiation treatments to top it all off. I have to admit that I am getting more and more worried about how I’m going to be able to handle school and cancer treatments. I’m trying not to worry about it too much until I know exactly how this is all going to fall into place.

Tomorrow I meet with Oncologist #1 again. I originally thought that I would come away from that meeting with a pretty definite schedule and treatment plan. Now I’m not so sure that will happen. I’ll update when I can to let you know what I find out.

June 21, 2007

Hair, Part II

My hairdresser, who as many of you know is my friend and neighbor first and my hairdresser by happenstance, cut off more of my hair last night. A lot more. I went to see her intending to have her give me an intermediate hair cut…a little bit shorter than it was but basically the same style…as part of my plan to transition into short hair. But I didn’t really love the intermediate cut, so I had her cut off more of it. And it’s really short. I’m not sure I was ready for it to be quite this short. Every time I walk by a mirror or a window and catch a glimpse of my head, it kind of takes my breath away.

It’s an odd feeling because I didn’t sit down in the chair excited about getting a new hair cut like I usually do, but instead I felt resigned to taking the next step. Although I like the cut, I’m not feeling that confident just-had-your-hair-cut feeling that usually follows a new style. And it turns out that there was a part of me that thought that maybe this wasn't really going to happen and that maybe it was all just a surreal dream or something. I think I was kind of hoping that one of these doctors would say, "You know, you're okay now and you're not going to need chemotherapy." Each time I see my hair this short, it makes me realize that this is really happening. The shock of it also makes me keep thinking about what’s next. I can’t help but wonder how much more difficult it is going to be when it’s all gone.

I'm considering putting together a photo gallery of hair pictures so that you can see the evolution. I'm not sure yet if I'm going to be able to post them here, but I'm thinking about it.

June 18, 2007

The Glass Is Half Full or The Funny Side of Cancer

I know, I know. It’s not really funny. But actually, when you’re in the middle of it, it can be. At least there are some humorous moments. So to counter the serious nature of this blog so far, here are some of the things that I have found funny.

(Pssst…Mom! You can skip the next couple of paragraphs if you want to!)

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I keep hearing stories about women who have gone through chemotherapy and lost their hair, only to end up with heads full of thick, gorgeous, curly, to-die-for hair when it grows back in.

Additionally, I have read quite a bit about the wonders of reconstructive surgery for women who have mastectomies. If I do end up having a mastectomy, I am quite sure I would follow it up with reconstructive surgery.

In thinking about these possible end results of cancer, I mentioned to Randy that it might not be all bad….I might end up with great hair and the breasts of my dreams. Randy, always thinking about the bottom line, asked me if I would consider the breasts of his dreams. I reminded him that the breasts of my dreams and the breasts of his dreams were quite certainly very different breasts. I also let him know that the breasts of his dreams are probably going to have to remain in his dreams.

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I’ve also been thinking about the fact that my chemotherapy treatment might be coming at a perfect time to help with my Halloween costume. If we are lucky enough to be invited to a costume party this year, I may be able to go as Telly Savalas. A lollypop, a pinky ring and a nose prosthesis, along with my lack of hair, should complete the look perfectly.

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Dealing with cancer treatments each day has brought new discoveries about my abilities as well my limitations. Between the lumpectomy and the lymph node surgery, I ended up with fairly limited use of my left arm. It is getting better each day and I expect to fully recover, of course, but for awhile I found that I couldn’t do everything exactly like I could before the surgery. For example, soon after my lymph node surgery I decided to attempt my regular exercise routine. The walking was no problem, but I knew that my light weight lifting was going to be difficult and painful with my left arm. (And indeed, I was under doctor’s orders not to use it to lift things for awhile after surgery.) I decided that I would attempt a modification of my normal routine using only my right arm. This was easy enough to do until I came to the push-ups. But always up for a challenge, I thought I would give one-armed push-ups a try. As I began to push myself up from the floor using only my right arm, I quickly realized that there was no way that I was ever going to be able to do a one-armed push-up. I’ve scrapped the push-ups until both arms are available to keep me from landing on my face on the floor.

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I have found myself telling all the medical professionals that I come into contact with that I am a law student. I’m pretty sure that subconsciously I think that if they know I am a law student, they will be much more cautious with my treatment for fear of potential lawsuits later. It doesn’t seem to be working out quite the way I want it to, however; no one really seems to be too terribly worried about my ability to sue them for anything.

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A couple of weeks ago I bought one of these t-shirts. It’s a humorous way to advertise breast cancer awareness and I have enjoyed wearing it. The first time I wore it was to the grocery on a recent Saturday morning. I got some interesting looks from fellow shoppers, but the best reaction was from a store employee in the baking aisle.

After we had passed one another heading in opposite directions, I heard him call out from behind me. He said, “Save the what?” I sighed as I turned around, not relishing having to explain the meaning of the word “ta-tas.” I smiled at the gentleman and said, “Save the ta-tas,” hoping that would be enough to clarify things for him. He, in turn, enthusiastically pumped his fist in the air and said, “Finally! A cause I can really get behind!” Both of us started laughing uproariously as we continued on our respective ways down the aisle.

June 17, 2007

Shining, Gleaming, Streaming, Flaxen, Waxen

I had a lot of my hair cut off a couple of weeks ago.

I have had a fairly short haircut for the past several years, but last winter decided that I was ready for a change so I decided to grow out my hair. I didn’t know how long it would last—I figured that I would wake up one day and it would be driving me crazy and I would end up getting it cut short again. But I was doing pretty well, and my hair had just started to reach past my shoulders. I was able to put it in a little ponytail when I worked out and I was starting to look around at some longer hairstyles to try to figure out what direction I might want to go in style-wise. It looks like the universe had other plans for my hair, however.

Losing my hair during chemotherapy, for some reason, is one of the most difficult things for me to face. Give me surgery and medicine and nausea and barium drinks if you must, but please don’t take my hair. I keep hearing recommendations to have your hair cut short just before you begin chemotherapy treatments, for several reasons. One is that it is easier psychologically to lose chunks of very short hair than it is to lose pieces of long hair. Another reason is that by cutting your hair yourself, you are “losing” it on your own terms rather than waiting for the chemo to do its worst.

Both reasons made sense to me, so when I saw my hair dresser a couple of weeks ago I told her that I’d like her to cut it relatively short. My thought was that if I start now and gradually go shorter over the next several weeks, it will be easier to go really short just before chemo starts.

It was difficult to watch her cut those first long, blond pieces from the bottom of my hair. She kindly carried them over to the garbage rather than letting them fall on the floor. The longest part of my hair falls to the middle of my neck in the back now. I wasn’t sure at first that I would get used to it very quickly, but I like it. It’s a familiar style and one that I like and have worn in the past, so that makes it easier. And I’ve had super-short hair before, so hopefully when I cut it yet a little shorter it won’t be too shocking for me—or for anyone else.

Of course, just when I thought I was handling it all pretty well, I caught a couple minutes of a recent Today show. Fittingly, one of the stories featured on the show was about a salon in Connecticut that caters to women who are going through chemotherapy and who are getting ready to lose their hair. Watching it didn’t make it any easier to appreciate my short hair--which is long compared to that of the women shown in the story—knowing that I might have it only temporarily.

When I was at the oncologist’s office I flipped through a head covering catalog for cancer patients they had sitting on the desk. There was a wide variety of head coverings shown in the catalog: many styles and colors of scarves, hats and wigs. I found it hard to look through the catalog. It wasn’t quite like looking through the bi-monthly Ann Taylor advertisement brochure and I didn’t dog ear any pages to mark the things I just “had to have.” I don’t want to lose my hair and I don’t want to shop for scarves and hats.

I’ve been thinking a lot about the industry that has grown up around this need for head coverings for female cancer patients. It’s quite easy to find companies all over the internet that sell a variety of wigs and scarves and turbans and other head coverings for women who have lost their hair because of chemo. But you never hear about similar offers for men. I can only conclude that it is because it is perfectly acceptable—and indeed it’s fashionable these days—for men to be bald in our society. Men must mourn the loss of their hair to chemotherapy just as much as women, but the rest of the world handles their hair loss completely differently from that of women.

I recently read a story about a woman who never let anyone, even her husband, see her bald while she was going through chemo. She even covered her head at night while she slept. I’ve also heard about women, such as those featured in this book, who proudly sport their bald heads throughout their chemo treatments, covering them only to protect them from the cold or sun. I have no idea how I’m going to handle it once I actually lose my hair, but I hope that I can be even half as brave as those women.

June 14, 2007

Another One Down

Today I met with Oncologist #2 at Rush-Presbyterian in Chicago. This was my first experience with a big university/big city doctor’s office and it was definitely different from what I’m used to. They were very efficient and business-like and much less personal than the smaller offices and hospitals that I’ve been dealing with so far.

The doctor, however, was amazing. She was also business-like and efficient, but had a very calm, confident, and reassuring bedside manner. Her name is Dr. Cobleigh and as I’ve mentioned before she is well-known and very well-respected in the Chicago area (and maybe in the country). Unlike Oncologist #1, she let me tape record our conversation. She was deliberate and thorough and I felt as if she would have spent as much time with me as I needed, no matter how long that might have been. In reality, our time together was only about 45 minutes. (Additionally, her husband is a federal prosecutor in Chicago. Interesting that my oncologists all have attorneys in the family, isn’t it?)

Once again, I’m just going to give a summary of what Dr. Cobleigh recommended rather than recording every detail here. If you have questions, just let me know! Essentially, she agreed with Oncologist #1’s recommendations of a chemo treatment of Adriamycin and Cytoxan followed by radiation. She also recommended genetic counseling and possibly genetic testing based on my age and the fact that my (also young!) cousin had breast cancer. (Jenny, we need to talk about that soon!) The difference was that she also recommended the addition of another chemotherapy drug called Taxol. Interestingly, she suggested the consideration of a dose dense chemotherapy treatment, which means four doses of AC every two weeks instead of every three weeks followed by Taxol every two weeks for an additional four doses. This would extend my treatment time from nine weeks to twelve weeks (not including radiation time). I am definitely not thrilled about that, but the subsequent decrease in the risk of reoccurrence is worth the additional three weeks, I think. Based on how I feel about Dr. Cobleigh’s expertise and knowledge in this area, I tend to think that her recommendation is probably the way to go. I have a little more research to do before I make the final decision, including discussing her recommendations with Oncologist #1.

Dr. Cobleigh also cleared up some confusion that I had about my pathology report...it turns out that my cancer was both ductal carcinoma in situ and infiltrating ductal carcinoma. She also let me know that my cancer was Stage I, which I kept forgetting to ask the other doctors.

It was good to confirm Oncologist #1’s opinion and to find out that we are on the right track as far as treatment options. I’m not excited about the extra weeks of baldness and nausea, but in the grand scheme of things it is probably the way to go. This was a long, exhausting day and I’m feeling a bit mentally fried right now. I’m going to try not to think about any of this for the rest of this evening and revisit it tomorrow after a good night’s sleep.

June 07, 2007

The Dating Game

I had my first date with Bachelor Oncologist #1 today. He asked me lots of questions about myself and my interests and then we had some scintillating repartee about all the things he could do for me. Then we had a lovely dinner and saw a movie.

Okay, it didn’t go quite that way, although he did ask me lots of questions about myself and my health history and cancer experience. I felt like the whole visit went really, really fast. I didn’t feel like he was rushing me, but there was just so much information to take in and I kept feeling like I couldn’t write fast enough and at the same time process everything he was telling me. Randy was with me, so at least there was another pair of ears there. I asked the doctor if I could record our conversation, but he said that his lawyer recommends that his patient conversations not be recorded. (His lawyer, I suspect, is his brother, who is a litigation attorney in Chicago and also, coincidentally, a Loyola Law School alum.)

I don’t exactly have a treatment plan…or rather, I have a treatment plan but it’s just the barest outline of one right now. I will skip some of the details here in the interest of your time and internet bandwidth, but if you have specific questions feel free to ask.

Basically, Oncologist #1 thinks that my case indicates a common chemotherapy treatment of Adriamycin with Cytoxan (“AC”). (Unfortunately, I have now added those two words to my word processor’s dictionary.) This regimen typically starts four weeks after the last surgery, which for me means right around the end of June. My tumor was negative for both hormone receptors and HER-2 (this is good!) which means that another common chemo drug, Herceptin, is not indicated. (That’s good because Herceptin is commonly prescribed indefinitely.) The AC is administered intravenously once every three weeks for four administrations. That part of treatment, therefore, will take about nine weeks.

There are side effects to these drugs. As expected, I will lose my hair. The Adriamycin can cause heart problems and the Cytoxan can cause bladder problems. The drugs can also cause nausea, mouth sores, fatigue, and low white and red blood cell and platelet counts. I have to watch for fever, which combined with low white blood cell counts can be the sign of a bacterial infection and requires immediate hospitalization and treatment. There are various medicines that can help with the mouth sores and nausea, for example, but in general none of this sounds like very much fun. I may have none of these side effects, or many of them, but will probably have at least some of them.

Oncologist #1 also thought that radiation may be indicated in my case. I will be making an appointment with a radiation doctor to talk about the possible radiation treatments. It sounds like my choices might be to start a two-week radiation treatment before chemo begins, or to do one after chemo that takes six weeks. I will know more about that once I’ve seen the radiation doctor.

I also spoke with him about genetic testing. It is much more complicated than I originally thought because there are many difficult decisions that flow from the results of genetic testing, such as decisions about whether or not to remove your breasts and/or ovaries. I will be revisiting those subjects soon, but first I have to wrap my mind around the rest of this information.

At the end of the appointment, the doctor asked me if I had thought about getting a second opinion. I told him that I already had an appointment with Oncologist #2 and his reaction was quite heartening. He obviously respects this doctor and basically said that he would agree with whatever she said. That made me feel like I definitely chose the right person for a second opinion. That appointment is set for a week from today.

Next steps: Other than the second opinion, in the next couple of weeks I will see a radiation doctor and get an echocardiogram to make sure my heart can take the Adriamycin. I will then return to Oncologist #1 in two weeks and we will determine the exact plan of attack, including when, where and how. I will also begin to think about genetic counseling and depending on how I’m feeling about everything else I might make an appointment with a genetic counselor.

I am feeling pretty overwhelmed by all of this information right now, and I am just trying to figure out what it all means, how it will all work, and how I can fit it all into my schedule. I’m still not exactly sure what this means for my class schedule or how much help I may or may not need. Those might be questions that I will only be able to answer with time and experience, however. I’d prefer to have it all planned out, but I’m learning very quickly that I don’t really get to plan any of this out. Cancer, apparently, pretty much has its own schedule and as much as I’d like to be, I am not the boss of it.

June 02, 2007

What You Can Do For Me

Based on the reaction I’ve received about the end of my previous post, I want to expand on those thoughts a little more.

One common thread running through every one of your phone calls and e-mails and cards and kind words is your offer to help. You all ask me, “Can I do anything?” Well, I can finally answer your question. I know what you can do.

If you are a woman, learn how to do a breast self-exam; and then do it. Pick up the phone right now and schedule an annual mammogram if you haven’t done it yet. Take a few hours off work; get a sitter for the kids…whatever you need to do to make the time. Don’t put it off.

If you are a man, make sure that the women you love--your wife, mother, sister, daughter, friend--are keeping a close eye on their breast health. There is no cure for breast cancer—the only way to get rid of it is to find it and to treat it.

As Americans we need to get over our discomfort in talking about breasts in order to keep an open dialog about this. If it's out of sight and out of conversation, it's out of mind. Join me in keeping the conversation going.

And don’t make the mistake, as I did, of thinking that it can’t happen to you. It can. By all accounts I should be at a low risk for breast cancer. I have three children and I had them before I was 35. I breastfed all three of them. I’m no health nut (as those who have seen my proclivity for martinis, champagne, and decadent chocolate desserts can attest to), but I live a healthy lifestyle—I exercise regularly and eat lots of fruits, vegetables, and whole grains. I drink very, very little caffeine and I avoid NutraSweet like the plague. I have never smoked, I’m only 41, and I take calcium and vitamin D supplements. And yet I have breast cancer. (There is the possibility that my cancer could be caused by a gene. I will eventually have genetic testing done to determine if that is the case.) But whether it’s caused by a gene or not, the point is that you can’t do anything about it until you find it. And to find it you must look for it by doing monthly self-exams and by having annual mammograms. I found a lump in my breast by accident...but if I had been doing regular self-exams I probably would have caught it sooner.

If you want to do something for me, please do this: be vigilant about breast cancer. Do it for all the people who love you, but most of all, do it for yourself. I don’t want anyone I know to ever have to go through what I am going through.

I posted these links yesterday, but I think they're worth reposting:
Click here for a link to an online video from the Susan G. Komen foundation about how and when to do a self-exam.
Click here for an article from breastcancer.org about how to do breast self-exams.

In addition, click here for a printable PDF file containing BSE (Breast Self-Exam) instructions.