I have been asked to represent the 2017 Bras for a Cause as Ambassador. Statistically, breast cancer affects 1 in 8 women throughout their lifetime. I was one of those 8. I work in the medical community as a Physician Assistant and have had the opportunity to educate women about the importance of self-breast exams and mammograms. A commonly asked question I hear is, “How will I know what cancer feels like?” In December 2016, I was personally able to answer that question.
Detection of a mass during a self-breast exam can cause alarm, but being a healthcare practitioner and following routine mammogram guidelines, I convinced myself that I was overreacting. In January, I obtained a diagnostic mammogram to prove to myself that I didn’t really feel a mass. The mammogram technician took extra views for the radiologist, but it wasn’t until the ultrasound that I realized something was wrong. The first 5 minutes of the exam seemed routine but the remaining 30 minutes was in complete silence. I watched the screen as she measured two masses. Once completed, she informed me that the physician would be in to discuss the findings. He confirmed my fears. The ultrasound was highly suspicious of cancer and I would be scheduled for a biopsy the following week. I spent the next 5 days in a surreal sense of life. I was angry, sad, scared, and still tried to convince myself that my biopsy would be negative. I have spent the majority of my life trying to live a healthy lifestyle. I reviewed the risk factors for breast cancer and I was considered very low risk. There was no way I could fall into the 1 and 8 category. Two days after my biopsy, the physician called with my diagnosis. Estrogen and progesterone fueled Invasive Ductal Carcinoma of both masses.
I was scheduled with a plastic surgeon, oncologist, radiation oncologist and general surgeon within weeks of my diagnosis. You are asked to make many decisions that will alter your body, your lifestyle, your freedom in such a short amount of time. Do you want a lumpectomy with radiation, a unilateral mastectomy, a bilateral mastectomy? Do you want to stay flat or go through reconstruction? If you reconstruct, do you want a reconstructed nipple, a 3D tattoo or no nipple? You may or may not need chemotherapy. You may or may not be able to work. You may or may not be able to afford your treatments. Do you have a genetic link? Will your children need genetic testing? I choose a bilateral mastectomy with reconstruction because I never wanted to hear “You have breast cancer” again. Three days before my 45th birthday, I had surgery. I woke up with drains hanging from my bandaged chest and a great deal of pain. I wondered how my life had come to this point. What went wrong that led me to a cancer diagnosis and removing both of my breasts. That self-pity came to a screeching halt when my hospital visitors arrived. My best friend’s mother paid me a visit and she was only 6 months out from her breast cancer diagnosis. She was wearing a wig and a beautiful smile. My college roommate also came to visit accompanied by her mother and sister. All three of them are BRCA gene carriers and 2 are breast cancer survivors. At that moment, I was surrounded by such strong, empowering women that have been on their own cancer battles and are surrounding me with their support. I refused to pity myself anymore. God was using me as a vessel to educate about the importance of self-breast exams and mammograms. He was gifting me with personal experience to encourage and support other women through my PA career. My cancer journey will be for the greater good of my patients.
Shortly after my mastectomy, I started the expansion process for reconstruction. The expanders are placed underneath the skin at the time of surgery. Every week, my plastic surgeon placed 50-75cc of saline into the expanders to stretch the skin. Once satisfied with my size, I had to wait three months until the final reconstruction surgery could be scheduled. The plastic surgery visits were the easy part.
The oncologist visits were not. One of the first visits consisted of genetic testing. This is not routine for every breast cancer diagnosis, but I fell into the guidelines for testing. The main genetic mutation is BRCA 1&2 and the most studied. BRCA is linked to breast cancer, pancreatic cancer and ovarian cancer. If you are BRCA positive, you are 80% likely to develop breast cancer in your lifetime. This becomes significant for your family as well. Fortunately, I was not BRCA positive. I did have a BARDS mutation but current research does not change treatment modalities. I was placed in a BARDS database for future use if research ever dictates importance. Another early test that was performed was called an ONCOTYPE score. This is reserved for early breast cancer patients and is used to determine if chemotherapy will provide additional benefits to your cancer. If your score is low to medium risk, then most likely chemotherapy will do more harm than benefit. If high risk, chemo will reduce your risk of recurrence. My scores were 24 and 31, meaning I would need chemo therapy because my risk of recurrence was nearly 60% in 5 years if I did not have chemo and/or take the oral chemotherapy for 10 years. I was prescribed Taxotere and Cytoxan every 3 weeks for a total of 4 treatments. Review of the side effects was quite alarming, but I knew from day 1 that I would lose my hair, eyebrows, eyelashes and most hair on my body. The treatments include oral steroids, IV steroids, IV nausea medication, anxiety medication and antihistamines. You essentially go from climbing the walls from the steroids to the pits of hell lying in bed for 5-6 days. I was given a wearable injection called Neulasta that is supposed to boost your bone marrow production to avoid infections. I developed a reaction to this medication (shortness of breath, low oxygen, lymphadenopathy). Work and germs became a hazard.
Chemo side effects are hard to describe and they are very personalized. Some may have mild symptoms while others have terrible reactions. I stayed in bed for about 5-6 days after each treatment. I experienced hypersensitivity to sounds and light. My joints hurt because of immobility, yet it hurt to get out of bed. No food or drink tastes normal. I remember eating a banana and it seemed as though I was eating chalking paste. The tips of my fingers felt like someone had smashed them all with a hammer. The numbness in my fingertips made it hard to button clothes, use a zipper or open a piece of mail. The second week after chemo was a little better. I was able to do small chores like empty the dishwasher or fold some laundry, but became quickly fatigued and usually ended up back in bed. The third week out was almost “normal,” except for the unrelenting anxiety about the next treatment. Day 14 after my first chemo treatment, I started losing my hair. My head became very sore to the touch and you could literally pull tufts of hair with ease. I encouraged my kids to pull their own tuft so they were part of the journey as well. We ended up having a shave my head party that day and It was quite liberating to take control of my hair loss.
6 weeks after completion of chemotherapy, I had a total hysterectomy to remove the source of my estrogen and progesterone and three months after, I had my breast reconstruction. I have since regained my energy and have resumed my gym routine. My hair, lashes and eyebrows are slowly re-growing. I have started back to work and my “new normal” is starting to take shape. Everyday, I take a small pill called Arimidex which blocks all the estrogen receptors in my body. I have to take this pill for 10 years to reduce my risk of recurrence. There is no guarantee it won’t return in the future, but due to the incredible research, stage 4 breast cancer is no longer a death sentence. It is considered a chronic disease.
This experience has taught me how to love more fully, not to sweat the small stuff, and to embrace each day with a grateful heart. I learned that cancer is ugly, hateful and doesn’t discriminate, but the cancer FAMILY is amazing. We were blessed with incredible friends and family. People held Tshirt fundraisers, my gym (APTx) held numerous workouts and provided fundraising for us and our vet (Dr JP Morris in Noonday) even held a fundraiser for us. Friends provided meals for our family and I received so many prayers and gifts. I even learned what it meant to become “Twitter famous” when my daughter posted pictures of me punching the chemo bell with boxing gloves on. It was shared and retweeted nearly 40 thousand times.
Please remember that the most important thing you can do is monthly self-breast exams. It is best to perform these on the same day of every month, about 5 days after your last menstrual period. You want to use the pads of your index, middle and ring finger and use a light to deep palpation in every area of your breast. It is also important to do this in the upright position and also while lying down and visually inspect your breasts in the mirror, looking for indentations, skin color and texture changes, dimpling of the skin, nipple discharge or nipple inversion. You may not know what you are feeling, but you will become familiar with your breast tissue and will know when something new is there. Routine mammograms are recommended based on your age, family history and risk factors. Mammograms with ultrasound are recommended for women with fibrocystic breasts or dense breast tissue.
The pink ribbon has different meanings to different breast cancer patients. For me, it represents a cancer survivor’s journey through fear, sadness, pain, faith, hope and ultimately, trust. I am obsessively grateful for God, my husband, my children and extended family, my friends, my physicians and all the nursing staff at Texas Oncology for their love and compassion, and to the Susan G Komen organization for providing such a beautiful event at Race for the Cure. It was an honor to be surrounded by such empowering women. If you ever have to face a breast cancer diagnosis, please know it is a survivable journey and you will be supported by the love and prayers of the “Cancer Family.”
Love and Healing,
Days Left to Event - Oct 10th, 5:30pm