Into the chemo battle we go

It has been 5 days since my wife's first chemotherapy and so far, so (mostly) good.  The results of her final test showed she has an intermediate chance of recurrence so, once that was determined, her oncologist felt it was time for chemo. 

I went with her the first day and it was, all things considered, uneventful. We parked the car, signed in, got our parking ticket validated (valet parking, $4 all day) and went right in. Before long, she had her IV dripping into her chest and, with a little help from IT, got the WiFi working on my laptop (so I could work and save my time off) and her tablet. We saw the oncologist, nurse and resident for a quick chat, and then, before we knew it, a nurse was pumping the red devil into her. At that point she had me take a picture of the "poison" going through the tube so she could show it to the friend who loaned her her fight like a girl breast cancer shirt (which I thought was a karate shirt before this).They even gave her lunch (I had to head out to the cafeteria, next time I will check out the sushi place around the corner). Aside from feeling a little lethargic and dozing off while we waited in the radiology department after as we waited for the nurse to check her PICC port, she felt fine. She even went to work the next morning, though she had to return to the cancer institute in the afternoon to have her blood counts checked (pre-planned appointment).

What has been more amazing is that she has not had, as of yet, some of the followup symptoms she was warned about. While she hasn't felt 100%, and has complained of chemo brain fog and a yeast infection she hasn't had the nausea or fatigue that we were warned about. A friend confirmed that there will be weeks where she feels 100% after treatment and will go to the mall that is halfway between our house and the hospital to go shopping and other weeks where she will stop at the mall on the way home so she can take a rest. It helps that she has been drinking all the recommended water, eating right and still managing to go to the gym -- though taking it a little easy. 

I, on the other hand, have not been eating and drinking right. I still find bouts of anxiety popping up for no reason, especially later in the evening when my work is done and the children have gone to bed. Unfortunately I have always been one to go to food when stressed and have been making some unwise late night snack choices. While I have corrected that over the last week, I still seem to be enjoying/needing a nightcap too often now. I go to my own doctor this week for my annual physical and will see if he can prescribe me something to help me take the edge off.

I could go on about all the drugs she has to take now to function, but I will leave that to the medical sites. There is so much going on when I look at her medicines in the tray on our kitchen counter that I am bound to get them wrong. Instead she counts down the days left until the mouth sores appear, the digestive problems start, and her hair starts to fall out and does whatever she can while she can. Once she has to really start taking it easy, the new countdown to when she can resume all normal activities will begin.

It's chemotherapy time. Oh joy, rapture!

Just got off the phone with my mother-in-law who was calling to see how things were. When I told her that we had just received the word that my wife's chemotherapy for breast cancer will start tomorrow morning her first question was "how long does she have?" Nothing like a little optimism, though, all the fears she conveyed aren't any strangers to me these days. Basically, she asked me everything she hasn't wanted to ask her daughter. Will my wife die in a few years? How many fewer years will she live? Will I outlive my daughter? I lost my mother at 18 and it affected me deeply (our children are 7 & 11, and, on a side note, I lost my father at 20 that put me into a depression for several years that I didn't even notice at the time), what about your children? Is she ready for it? How likely is a recurrence (who knows)? You know chemo is poison (yes)? Are you scared (hell yes!)? As my wife has been saying we are doing all we can now so that, if there is a recurrence, we will at least know she did everything possible. 

Basically, aside from doing her best to remain healthy during and after the treatment, and getting checked constantly, whatever happens with her breast cancer recurring  will be out of our hands. I have to admit, there is something kind of relaxing about that. While long term the results may be good, they may also be bad. There is nothing more, at this time, that we can do, aside from hope that this treatment works and she has at least another 40 years (I'd say the odds are good, the cancer was estrogen fueled and when this is done, she will be in menopause meaning no more estrogen). And sometimes you need to make peace with that.

But those worries are for another day. The sun is still shining, the plants are still green and winter is still a long time away. Amazingly. the changes in our eating and exercise habits over a year ago coincide quite nicely with what is recommended for her going forward. For now she is reasonably healthy, probably healthier than many 41 year old mothers of two children. For the moment, she is at the gym, getting in her last heavy cardio/ weights workout for at least the next 7 days. The saltines, water bottles and sports drinks are ready. There is no peace to be made today, we are at war. Tomorrow begins a new chapter as she begins the next round of the battle.

Doxorubicin, cyclophosphamide and paclitaxel for breast cancer chemotherapy, oh my!

Her hair is cut short. Her chemo bag is packed. The PICC line is in. Her eReader has been loaded with books. The cancer institute's WiFi and valet parking have been checked out. The laptop lapdesk has been purchased. Child care has been almost taken care of (since we don't have a precise chemotherapy schedule yet we have a lot of contingency plans set up). I guess we are ready.

It has been almost 2 moths since my wife was diagnosed with what we later discovered was Stage I breast cancer with a very aggressive tumor (and I've blogging about it ever since). Due to the aggressiveness of the tumor (pathology report showed a high mitotic (cell division) rate and weird nucleus), she has decided to take chemotherapy instead of just radiation treatment, even though her margins were clear and her lymph nodes negative after her surgery. She likens it to killing an ant hive found in your house. Though the exterminator killed the hive (the tumor), there still may be a few ants  wandering around the house (microscopic cancer cells in the bloodstream) that could cause havoc later. As she put it, it was bad enough telling our children she had cancer now, it would be worse telling them in a few years that it had come back and she hadn't done everything possible to make sure that wouldn't happen. I worry what the chemotherapy will do to her health, both short and long term, but I don't really see any good alternatives.

Doxorubicin, cyclophosphamide and paclitaxel, oh my! doesn't have quite the same ring as "lions, tigers and bears, oh my!" but it does invoke that same level of fear as it did when Dorthy exclaimed those words in  the Wizard of Oz. My wife will be part of a NSABP Protocal B-49 phase III clinical trial where she will be taking a combination of doxorubicin and cyclophosphamide once every other week for 4 cycles (8 weeks) followed by paclitaxel once a week for 12 weeks for her chemotherapy. These are all chemotherapy drugs that have been used for quite some time, the trial is playing around with dosages, seeing if there can be changes. Though this treatment will be rougher than average, she is happy to be in the aggressive trial, and the followup procedures for the next 12 years, as it hopefully reduces the risk of recurrence, but it sure looks like it will take a lot out of her. Fortunately she is young (41) and her heart is strong (according to the tests she had done to see if she could be in this trial).

The thought of chemo is obviously getting to her already. The other day, while taking the children to a movie, she raided the theater's candy section eating more junk in an hour than she has eaten in a month (she was amazed her weight was the same when weighed at the hospital yesterday). Then she went shopping like a mad person to get a birthday gift for one of my daughter's friends that she had forgotten about before arriving home and noticing the 7 on the invitation wasn't for the date of the party but for the friend's age. She told her mother over the phone that she wonders what will happen when the drugs really begin to affect her mind. She keeps expressing fears that she won't be around to see our children grow -- many of the blogs we've found don't have happy endings, which makes sense as the ones with happy endings stop writing pretty quick for obvious reasons.

It's getting to me too, I found my pants were a bit snug the other day. Not really surprised, I've been over doing it with late night snacks lately and I've noticed the wine rack is looking a little depleted (it had been filled with small bottles from Trader Joe's, those can get knocked out with a few glasses). Fortunately, for both of us, we also enjoy taking our frustrations out at the gym and there was a nice 45 minute spin class at the Y last evening to battle our food sins. Today will be an hour on the treadmill I think.

She is upset that she won't be able to do any heavy exercising the weeks she has treatment (blood vessels can rupture from pressure). And she may have to readjust her FMLA paperwork from intermittent. Fortunately we have emergency savings for when/if her leave becomes unpaid. She also decided to get a wig for when her hair falls out, not so much for her but our 11 year old and 7 year old children, who have become noticeably more clingy and are looking to take advantage of our slightly reduced disciplinary standards (Dad, May I have ice cream? Yes. May I have a glass of diet soda? Yes. May I have a cookie? Now, wait just a damm minute!)

Yesterday she had the outpatient procedure to get a PICC line implanted in her chest for her chemotherapy infusions (better than getting stuck with a needle each time). It was a quick procedure that she watched being done on YouTube beforehand (amazing what is available online). She remained awake for, we spent more time waiting in post-op. We talked. She is obviously worried, not so much for the short term, which is looking OK, but for the long term. She is hoping this treatment gives her at least 12 more years (the time frame of the clinical trial), if not more. 12 years would get our youngest into college, at which point I could sell our house (which will be paid for by then) if something happens to my wife (or vice verse as I will be in my mid-50s in a dozen years and something could easily happen to me) and we don't have her income anymore to help our children. We both have substantial life insurance policies but now I am realizing we may be under-insured if something happened to one of us while our children were still young -- I don't know how I'd save for college on just my salary while the children were still young, especially, as a single parent, I would have to make sure I stayed in a non-traveling, flexible work position. She threatened me by demanding nothing happen to me as she doesn't think she can do this herself.

It is interesting how the mundane gets in the way of all this. While waiting for her prescriptions to be filled, I wandered over to the office section of the store and purchased a laptop lapdesk so I can work while waiting for my wife -- trying to conserve time off for more pleasurable activities, or for times when I really need it. She checked out a web site of things to do before chemotherapy and quickly made appointments with her OB/GYN and dentist. We are constantly updating our phone calendars to see if anything bumps into various doctor appointments. Long term plans are non-existent these days. Short term plans are questionable.

At least we are discovering who our friends are. The amount of the support we've been given has  been overwhelming. One neighbor baked cookies for us. Another took our children into her home before 6:30AM yesterday (we had to be at the hospital at 7) and drove our children to camp. One friend has offered to take our son to Six Flags Great Adventure  (near here). Another friend will take our daughter to the shore tomorrow.  Another will have our son over for dinner. Another from our temple will watch our children all day if we have to get chemo on a non-camp day (all these friends have children around our childrens' age, which is how we became friends with them). Our son's karate school, which is a few blocks from the last friend says our son can hang out at the school during morning classes if he wants.

A lot of scary things are about to happen to our young family and I hope we can look back on these days in a year and think, one bump over and done with. But I will tell you the most scary thing I've seen recently, my wife's hospital bill from the day of her surgery -- over $26,000, almost all covered by insurance fortunately, that was only for that day. Looking at the statements from the hospitals she estimated her insurance company has already spent over $50,000 on her and she hasn't even started the chemotherapy yet (plus the years of aftercare). I am getting a better understanding of how easily it is for the middle class to fall  into poverty due to one little medical disaster. Though we are in the top 10%, which with NJ's high cost of living is truly middle class, a $50,000 medical bill would sting. And we're lucky -- we have 401ks we could deplete and a house not underwater that we could sell (we were smart enough not to listen and buy more house than we could afford at the time -- now that we could afford a bigger house we see no need to do so, we were also lucky enough to have bought our first co-op in 1997, just as the NYC area market started to take off). Fortunately we have good insurance and, looking forward, at least for now, don't need to worry about lifetime insurance caps or an inability to get coverage due to what is now a preexisting condition. But that can always change. Man plans, God laughs.

Breast cancer doesn't care if you don't get a mammogram because you are under 50

The number of women in their 40s undergoing mammograms has declined after the U.S. Preventive Services Task Force recommended that women delay regular breast cancer screenings until age 50, over their previous recommendation of age 40. Fools.With something like 1 in 8 women getting breast cancer women are crazy to not get mammograms/MRIs no matter their age. As I have recently discovered, breast cancer doesn't discriminate against the young.

My 41 year old wife has been getting mammograms annually for several years due to a family history. Sure enough, this year, a lump was found that was cancerous. She had a lumpectomy and is now preparing for chemo (Stage I tumor was very aggressive, 8 of 9 on Bloom-Richardson scale). And my wife was lucky. A 40 year old woman in my wife's office, who didn't have a family history of cancer, went for her first mammogram last month. Not only was breast cancer found, but it had spread into the chest. Hopefully it has been caught in time.

Now imagine if either of them hadn't had their mammograms at 40/41. While my wife would have had one due to family history anyway, her co-worker would not have had one under the revised standards. Then what?