Thursday, March 30, 2017

Perfect 10 Miler at Mt. Brilliant

Before I was diagnosed with DCIS breast cancer I had signed up for the Perfect 10 Miler on March 18th.  I had run the 10K last year & it was a beautiful course.  I wanted to maintain my higher run base throughout the winter & thought this would be a great race to keep me training.

My original plan was to start ramping up around the first of February & maybe even add a spring half marathon to the schedule.  Well, then 12/21 came along & plans changed.  I only had a basic idea what my treatment plan would be but no idea how quick or slow I would move through the process.  I decided to start my ramp up on the last Saturday of the year, 12/31. I put together the below plan & was able to stick to it with the exception of the week post surgery.

WeekTuesThuFriSat SunTotal
2/25/20171.5 (Was 4)4Rest5.3 (was 9)Rest4
3/11/20173Walk 2Rest10Rest13

After the surgery I did switch to a longer walk interval.  Pre-surgery short runs were on a 4 min run / 1 min walk interval & long runs were a 3 min run / 2 min walk interval.  The week after the surgery I walked the entire distance.  2 weeks post surgery I did a 4 min walk / 1 min run interval.  I had to use an ace bandage to keep the girls from bouncing. For my last long run I did a 4 min walk / 1 min run for 8 miles again with the ace bandage.  I felt pretty good until 6 miles then my legs were dead.   I believe that was a side effect of doing the 2 week food test.  The 2 week test will eventually get it's own blog post.  I originally planned to start the test after the Quarter Horse but decided to start it sooner.  I wanted to be done prior to starting radiation & since I had already reduced my run volume I didn't think it would hurt too bad. 

A March running event is always a toss up weather wise.  It could be cold/snowy, wet/windy, sunny/warm or any other combination. The morning started promising.  It was partly sunny in the low 40's.  My plan was to continue the 4 min walk / 1 min run for as long as I could. The first part of the race is on Huffman Mill Pike but the last 7 miles are within the horse farm.  The back half of the course is hilly & of course the wind picked up for the last 3 miles.  Thankfully there was no rain but man the wind was brutal.  I was also grateful that Audrey & I did the entire race together. 

After one last hill to climb I crossed the finish line 3 weeks post lumpectomy surgery.  FU cancer!

Sunday, March 26, 2017

DCIS Non-Invasive Cancer - My Story

I started getting mammograms when I turned 40.  I had several in the following 2 years due to calcifications they wanted to monitor.  When I switched to annual exams I managed to skip 3 years.  Part of it was time flies by & part of me felt that mammograms would always find suspicious areas that would require me to return for follow up mammograms & ultrasounds which would end up being nothing.  So when I was called back in November for a follow up mammogram I didn't think too much about it.

The Diagnosis:

I had my routine screening mammogram on November 17th.  They called me back for a 3D mammogram on December 8th & told me that I had 2 spots that needed biopsied.  Well, that was different but I still wasn't worried.  Honestly, I was more concerned about getting the biopsy before the end of the year since I had already met my deductible.  Yeah, seriously, I thought that. I have a high deductible plan and knew a double biopsy would not be cheap.

They were able to get me in on December 19th before we left for my birthday trip to Chicago.  If you have never had one, a stereotactic biopsy is not a pleasant experience.  You lay face down on a table & you are raised up like your car at the mechanic.  Unfortunately, there is not a hole for your face in the table like at the chiropractor.  You have to turn your head to one side which for a couple minutes isn't a big deal but after 20 minutes is pretty miserable.  There is a hole for your breast to hang through the table.  The doctor will give a local anesthetic prior to starting.  They use imagining equipment to pinpoint the location to get the sample.  Each biopsy took about 20-30 minutes.

I didn't think they would have the results back until after the holiday but they called me on December 21st.  We flew into Chicago that morning & had just checked into the hotel.  The nurse was quick & to the point.  She told me the 9 o'clock location was non-cancer but the 6 o'clock location was DCIS non-invasive breast cancer.  Uh, yeah, heart drops into stomach.  Really did not expect that at all.  The nurse was great & spent time on the phone with me explaining exactly what DCIS was & what the next steps were.  She explained that this was a Stage 0 cancer & that it would be OK to not immediately jump into action.  Her suggestion to me was ask around for doctor suggestions & to call back after Christmas to get a surgery consult scheduled.

That afternoon I texted & emailed several friends for surgeon recommendations.  My plan was to get some recommendations & research them when we returned home.  I gave myself that day to process the information.  The next day was my birthday & I really wanted to forget the diagnosis for a few days.

When we got home from Chicago on Christmas Eve I had this pamphlet waiting for me.  I originally told Steve I would wait until after Christmas to read up on DCIS.  Well, that went out the window when I saw this pamphlet.  So yeah, I spent Christmas Eve on the couch reading up on DCIS. Fun times!

Surgical Consult:

I polled 8 of my local friends to see if they had any suggestions on surgeons.  Luckily most of them did. Several of them are either currently in healthcare or have relatives that are.  So it boiled down to two doctors at Lexington Surgeons.  The two doctors were Dr. Rogers & Dr. AJ.  I gave the nurse the two doctors & told her whoever had first availability I would meet with.  I ended up with an appointment with Dr. Rogers.

The surgical consult was on January 16th.  It started with a breast exam followed with a conference room meeting.  It was Dr. Rogers, a nurse navigator, my husband & myself.  The entire visit was about 90 minutes.  The doctor did a thorough job explaining the typical treatment process for DCIS non-invasive breast cancer.  Since there is so much research on breast cancer the treatment conversation was very straight forward. He reviewed the biopsy results with me.  My hormone receptor status was estrogen & progesterone positive which meant that I would be a candidate for hormone therapy after surgery.  My next steps were to meet with a genetic counselor & get a breast MRI.  After we had these results we would confirm if the lumpectomy was the correct route to take.

The nurse navigator took all the notes for me.  She sent us home with all sorts of reading material & various support therapies.  She also arranged getting the genetic counselor & MRI appointments scheduled and eventually the surgery.

Big Book on Breast Cancer
Just some of the brochures they sent me home with

Genetic Counselor:

The counselor meeting was the next morning, January 17th. We went over my family history of cancers which did include colon & breast cancer.  She explained that about 10% of breast cancers were genetic but the majority were not.  I decided to have the testing done regardless.  They drew blood work to send out for the test.  The results took about 3 weeks to get back.  In my case it was good news, I did not have the genetic marker for breast cancer.  If I did, the conversation around lumpectomy vs mastectomy would be more difficult.

Breast MRI with Contrast:

This one was entertaining to say the least. Well, I can say that now.  When the nurse first took me back she noticed I had surgery in 2001 to remove my left kidney.  Her reaction went something like this, 'hmmm, contrast is processed through the kidneys, we typically don't do kidney function tests unless you are over 50.  You are 46...' I jumped in & told her I just had creatinine tests in October and all was well.  That satisfied her but planted the seed in my head.

Moving on, now I am have my IV installed by another nurse when the first nurse is explaining what to expect.  She tells me that if I need to pull out of the tube for any reason I will have to come back & re-do the test.  This got me thinking to the last MRI when I had a panic attack & had to be pulled out of the tube.  Uh-oh I thought.  About that time the second nurse doing my IV tells me to stop making a fist.  Instead, without realizing it I start pumping my fist.  Oops, that makes blood leak out everywhere.  Oh Em Gee, the blood.  I tell the nurses I am feeling dizzy.  The next thing I know I am waking up, going where the hell am I??  Oh yeah, I am at the imaging clinic about to have a breast MRI because I have cancer.  Shit.

This was my lowest point in all of the treatment to date.  The nurses were great.  They got me cleaned up, changed my gown & gave me some sprite to drink. They told me I was their first fainter. Yay me! After a few minutes I was ok enough to get the damn test over with.

For a breast MRI you lie face down, face & boobs in a hole.  Much more comfy than the biopsy table.  They do some mirror tricks so you are looking at the main room instead of a dark hole.  This was super helpful for me.  At the beginning of the 3rd or 4th scan I started to feel the panic rise up but thankfully was able to quell it with some deep breathing & focus.  The rest of the scan was uneventful.

I went to work for a couple of hours afterward but ended up heading home after lunch to sleep it off.  Like I said, this was the lowest point of all my treatment.

They called me with the results the next day.  They found nothing new on the left breast but found a spot on the right.  They sent me for an ultrasound but they couldn't see anything of concern.  I do get to go back for another MRI in 6 months. This probably would have been the case either way.

With the Genetic testing, MRI & ultrasound results all back I was now able to get the lumpectomy surgery scheduled.

Lumpectomy vs Mastectomy:

When I was first diagnosed there was a part of me that felt I should just have the mastectomy and be done with it. That would eliminate future mammograms, worry & headaches.  At the end of the day the data just didn't warrant such a radical surgery & although I am not a very vain person it was hard to wrap my head around.  The lumpectomy surgery was a very easy decision to make.

Lumpectomy Surgery: 

Since this was a stage 0 & no lymph nodes were to be removed the surgery was outpatient. I scheduled first available which ended up being a Friday, February 24th.  Surgery prep was no big deal, no eating or drinking after midnight.  The first stop on the morning of surgery was the breast center.  Since the tumor couldn't be felt they placed a localized wire to help guide the surgeon.  This was inserted using the same technology as the biopsy.  It took about 30 minutes to get everything in place & yes, you leave with about a foot of small gauge wire taped to your breast.

I am not sure if all breast centers are like this but this one has a gowned waiting room for all the ladies to hang out waiting for their appointment.  You have no idea what people are in for.  Some are there for initial screening mammograms, some are call backs, some for biopsies & some, like myself, are waiting for a lumpectomy.  So while I was waiting, two women starting talking about the wire localization procedure I was about to have.  They went on & on about what a horrible doctor they had & how she didn't use any local which caused them horrible pain.  It wasn't just a quick discussion, they went on for at least 20 minutes.  I finally asked them to stop because they were wearing me out.  I told them I was about to have the same procedure & their response was 'oh, I am sure you will have a different doctor'.  I just shook my head & turned away appalled at their behavior.

When the tech called me back I told her what was going on.  I wanted someone to be aware that someone was really bad mouthing one of their doctors.  Maybe the story was true but the bitching was so excessive I had a hard time believing it.  Some people just love to dramatize things.

Once I had the wire in place the tech walked me over to the outpatient surgery.  We got to outpatient around 10:30AM.  I was called back to pre-op around 11AM where they got me all hooked up to IVs, heart rate monitor, etc.  Steve was able to come back & hang out until they took me in for surgery around noon.  Once in the surgery room things moved fast.  They get you on the surgical table, lay your arms out, hook up all the monitors & tell you to think of really nice thoughts.  The next thing you know, the post op nurse is waking you up in the recovery room.  Crazy.  The surgery took about 30 minutes. That post anesthesia grogginess is funny. I remember asking the nurse 3 times if I had stitches but could never remember the answer.  I was in recovery for about an hour before they had Steve get the car.  They wheeled me out & we were home by 2PM.

When we got home I made chicken noodle soup & barely finished eating it before climbing into bed to sleep it off.  They gave me a couple doses of pain meds before I left the hospital so the pain was minimal.  Later that evening I took another pain pill but that was the last one I needed.  I spent the weekend chilling at home.  I went back to work on Monday.  Still pretty tired but not in much pain.

The incision is about 3 inches & no stitches.  Glue & heavy duty tape was used to close the site.  The tape stayed on for 2 weeks before I finally peeled it off.  It probably would have stayed on another week if I didn't peel it off.

I had the follow up with the surgeon a week later.  He looked at the incision & reviewed the pathology results.  They got all of the tumor but on one side they had what was called inferior margin.  Not too concerning but depending on what the Radiation Oncologist said they may recommend another surgery.  Next steps were to get my Medical Oncology & Radiation Oncology appointments scheduled.

Medical Oncologist (aka major turning point in treatment process):

Lexington Surgeons arranged both my Medical oncologist & Radiation oncologist appointments.  First up was the Medical oncologist.  Baptist has several medical oncologists but my appointment was with Dr. Ari.  This was the appointment I was most apprehensive about because the discussion would be around hormone therapy.  Since my cancer was strongly estrogen positive I was assuming they would recommend hormone therapy.  I had absolutely no interest in taking hormone pills for the next 5-10 years.  I am going to get to menopause sooner or later.  I would prefer it to be later & not pre-maturely force the issue.

Dr. Ari was amazing.  He really took the time to explain his thoughts on DCIS, the treatment options & the typical treatment paths. He sketched it all out to help the conversation. He explained his view on DCIS non-invasive cancer.  He had a hard time calling it a cancer since it had a 99% survival rate.  His point being that people can get to awful-lizing the situation.  Being told you have cancer can mess with your head, even when it is a stage 0 cancer.

Dr. Ari's Sketch
He reviewed the Tamoxifen clinical trial results with me & explained what they meant.  At the end he told me I could take it or not.  For a higher stage cancer patient he would have strongly recommended it but for a Stage 0 he said he would support my decision either way.  He even said the thing I had been thinking, 'you will be watched like a hawk with MRIs & mammograms every 6 months'.  I didn't want to deal with the side affects to slightly improve my odds of reoccurrence.  Looking at the data again as I write this post, I am even more convinced I made the correct decision since I am doing radiation (radio therapy).  Looking at this chart, there really isn't much of a difference between RT & Tam+RT.

B24 Trials
I really thought the doctor would say to take the hormone therapy, monitor the side affects and deal with them accordingly. This would also mean lots of medical oncologist appointments over the next several years. I was so happy to find out this was going to be a one & done session! It really turned things around in my head.  This wasn't going to be a long, drawn out process with a constant reminder (daily pills/side effects) of this diagnosis.

Next step is Radiation Oncology which I am going to break out into a separate post.

Since this is really a fitness blog I have to post at least one race picture.  I did the The Perfect 10 Miler at Mt Brilliant 3 weeks post lumpectomy.  I will save the details for another post but here is me crossing the finish line:

The Perfect 10 Miler Finish.
Read the radiation post HERE


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