Happy Thanksgiving

I have so many and so much to thankful for... where do I start?

I am thankful for today.  If this year taught me anything, it has taught me that every minute of this life with every loved one is prescious, even the tough ones. 

I admit that I am still wonderfully human. I get angry with the lack of peace in the world.  I get impatient with my children expressing their frustrations. I am full of oxymorons and paradoxes. 

Despite my many faults an imperfections, I am loved and protected by so many angels, both heavenly and earthly. Thank you!

What now!?!

On Wednesday, November 12th I started my day like any other. I woke up brushed my teeth, washed my face, dressed Jimmy and myself for our 30 minute trip North to Newport Beach for radiation treatment. 

Among the multitude of chemo and surgical symptoms yet to fade, early morning nausea Is one of my least favorites. For some inexplicable reason, radiation therapy seems to exaserbatte the nausea. Some days more than others. 

Unfortunately, as the day dragged on the nausea became worse and gave way to vomitting, diarrhea, headache, chills, fever and extreme body aches. 

Despite my feeble protests, my cousin spoke with my oncologist and they agreed I needed to head to the ER.  So, here I sit, waiting for more test results. Out of an abundance of caution, I am in isolation until I can produce enough of a stool sample to be tested. Hopefully, the BM sample will rule out CDIFF then they can start tapering down the multitude of antibiotics and anti fungals Drugs I am currently on. 

 In the meantime, the doctors and nurses here at HOAG are amazing. They keep me comfortable with chamomile and mint tea, morphine, adivan and lots of sleep. 

 Huge thanks to Mom and Dad for minding the kiddos, and to Niño, Kirsten, Mom, Dad and Graham for running over clean cronies, flowers, and goodies. 

Prayers and positive energy are much appreciated. 

More to come... 

Love,

Tiff

Once more unto the breach, dear friends...

Once more unto the breach, dear friends once more; 

Or close the wall up with our English dead!

In peace there's nothing so becomes a man

As modest stillness and humility:

But when the blast of war blows in our ears,

Then imitate the action of the tiger.
~ Shakespeare

Last Wednesday, October 15th, I met my Radiation Oncologist for the first time.  Dr. Kim is a very tall Asian man with soft, kind eyes. He spent over an hour explaining every detail of the radiation treatment that will consume my life for the next six plus weeks. 

Hopefully, Dr. Kim was unaware of the fact that I was probably still drunk for my 8:15 am appointment. I pray that he couldn't smell the alcohol leaching from my pores or the remnants of my time spent over the sink, emptying the contents of my stomach. I look back on the previous night; the night I drank the guts of two bottles of Chardonnay by myself, and ask "why did I do that?"

The answer is simple. The same reason I went and got my nails done before my radiation mapping, (more on that later), appointment on Friday the 17th, knowing full well that it would probably make me late or miss the appointment all together.

The answer: sabotage. The truth is... I am fucking exhausted. I mean, bone tired. I have hit the runner's proverbial "wall" more than once during this marathon and I've already pushed through.  I have been through hell and I'm barely clawing my way back up into a life that is almost recognizable, almost tolerable. A life that doesn't include copious amounts of drugs for everything from pain to constipation.  Managing the side effects of chemo and surgery alone could keep the pharmaceutical industry thriving!

I've had it! I'm tired, and I don't want to go through radiation. I don't have anything left in the tank. I don't have any reserves. I don't have anything left to give. I just cannot get my head around the additional exhaustion and fatigue and I can't  seem to get geared up for the inevitable burns, blisters, allergic reactions, etc. 

Don't worry, what intelligence remains will win the battle between head and emotion. I will put one foot in front of the other for as long as I must until the "active treatment" phase of this war is complete.     

Dr. Kim was kind enough to share some of my scans with us.  The following is a side-by-side view of my PET/CT scan before chemo on the left and after chemo on the right:

As you can see, the pre-chemo picture on the left has a large bright light on the left breast. That light represents an area of high metabolic activity, my large highly aggressive tumor. A few months later the scan on the right doesn't have anything lighting up. So, we know chemo works. 

The pathology studies on all eight lymph nodes, and the abundant breast tissue removed during surgery showed "no remaining carcinoma or metastasis." So, we know oncoplasty works. 

What about radiation therapy?

Well, I eventually made it to the mapping appointment. The technician had a consent to treat form all filled out and ready for me to sign. Luckily, I caught the word "tattoos" at the end of the procedure line. I asked if the tattoos were permanent and absolutely necessary. She said they were. However, after pressing her for alternatives to permanent tattoos, she finally acquiesced that it was possible to mark the skin with markers and cover the markings with stickers that would prevent the ink from rubbing off and last for approximately 2 weeks. 

Despite my obvious relief at this news, the tech continued to pressure me to get the tattoos because "it's much easier for the techs". Finally, I lost the plot and and explained to her in an elevated and clipped tone that I had enough scars and permanent reminders of this ordeal.  I told her that none of this has been easy for me, so I wasn't too concerned if her job included changing some stickers 2-3 times during my six plus weeks in radiation therapy. Thus, she saw my tiger imitation.

  

Begrudgingly, the tech placed me on a cold, hard CT table and lined me up so that green lasers traversed my chest three times. Once the doctor approved my body positioning and the positioning of the beams of green light, the tech marked my skin with bright blue ink in the places where each beam of radiation will enter and exit my body.  There are 12 markers in total, which would have meant 12 tattoos!  When I released I would have had 12 tattoos I nearly went full blown tiger on her.  Luckily for her, I am too weak and too damn tired. 

Today, I go "once more unto the breach, dear friends...".  Wish me luck and please continue to pray.  As of today at 1:15 pm, radiation beams will replace the green laser beams and attack any cancerous cells that remain,  I am scared... twice bitten by chemo and surgery, twice shy about radiation.

With Gratitude,

Tiff

October 1st

October 1st....

Yes, it's the beginning of breast cancer awareness month, so the whole world seems to be coated in Pepto Bismol pink. Puke! 

Anyone know which month is dedicated to thyroid cancer awareness, so I can look forward to the entire Today show crew being draped in Teal, Purple and Fuchsia!?! I digress...

Yes, October 1st is also one of my very favorite persons' birthday (A, you know who you are).

And, yes today marks the day that I am no longer battling breast cancer, but am now an official BREAST CANCER SURVIVOR!!!!  

For those of you who know anything about aggressive cancer, the five year clock starts ticking .... NOW!!!

At approximately 10:30 am this morning, Dr. Mel Silverstein handed me a 6 page pathology report that basically said NOTHING!!!  The eight lymph nodes and multitude of skin and tissue samples removed from my breasts during surgery all came back negative.  In other words "no carcinoma detected" and "no metastases remaining".  

Dr. Silverstein - my Surgical Oncologist, Oncoplasty pioneer, teacher, and friend. 

This is, without a doubt, the best of all possible outcomes (a sly wink to Voltaire here). 

With my husband and son at my side, I was basically handed back my life.  The chemo worked so well that the cancerous cells were ALL dead before they even cut me open.  

Seeing as how my 60+ year old doctor held me just as tight, just as long, and shed almost as many tears as myself, I knew I was an exception to the rule of aggressive tumors.

I am happy. Of course, I am happy.  I am ecstatic! But, what next!?!  Well, five more weeks of surgical recovery, followed by radiation therapy five days a week for six weeks.  

Then what!?!  Yes, the air is fresher, the sun is brighter, and my children are that much more precious.  I get it, but then what!?!

How do soldiers coming back from war do it? How do sole survivors of tragedies resulting in huge losses of life do it? How do you go on!?!  

Obviously, you go on with a great deal of respect, gratitude, love and humility.  But, how in God's name, do you begin to thank the soldiers that lost their lives before you, the doctors that spent their entire life's work to see one case like mine, or the family, friends, and acquaintances that put their own lives and families on hold to make sure me and my family were well taken care of!?!

My prayers, and the prayers of so many have been answered, now what!?!

I guess I go back to living, but the angels over my shoulders have cheeky grins on their faces, and so do I as I lay my head down to sleep.  The cheeky grin comes from knowing what would be said and done at my funeral without actually having to die. It's a warm and comforting feeling. 

I have made some terrible mistakes.  I have wronged people, I have hurt people, but if I can continue living as good a life as I have led these first 35 years, and get even close to the same outpouring of love and support for my family as I have had in the last five months, I will live this life and leave this world with my head held high and with a cheeky grin on my face.

For now, I am not going anywhere! Thank you for your help slaying the Banshee! There will be no wailing here. 

With Love,

Tiff

Almost there

Forgive the lack of sophistication in my writing this evening, but stage 3+ breast cancer really sucks! Tonight, I have no pithy one-liners or extended metaphors with which which to entertain.  All I have is a simple update.

The oncoplastic surgery went well last Thursday.  The doctors were able to remove all of the cancer-exposed tissue, reduce the size of both breasts and shape/ lift the remaining tissue into what are going to be some nice perky chi chi's. 

  

I see all three members of my medical team tomorrow. We will review the pathology reports, which will tell us once and for all whether or not the chemo completely eradicated the cancer before surgery, or whether there were some living cancer cells remaining.

Either way, I will begin radiation therapy in the middle of October.  So, we are two-thirds of the way through my treatment plan, and so far each step proves a little less physically challenging than the last, but equally as effective. 

However, the mental and emotional toll is catching up to me, my husband, and very young children.     

Chemo Vs. Tiff... and the Winner is...

In a shocking and unprecedented upset over eight rounds... the winner by TKO is Tiffani "the Banshee Slayer" McCarthy.

Last week I had an MRI with contrast, Ultra Sound, 3D Mammogram, PET Scan and CT.  They all confirmed what Dr. VanderMolen thought might be possibile... "there are no remaining metastasis."

This one is for you Bean!

The techs, radiologists, and doctors would not have been able to find the offending tumor or lymph nodes if not for the titanium markers placed during my biopsies. The hope is that when they remove lymph nodes and the area where my tumor once lived, they will look at the tissue under the microscope and find that all the cancer cells are already dead. This phenomenon is called pathelogical remission. Fingers crossed!!!   

This is very good news for a number of reasons:

1) Long term prognosis.  While there may still be cancer cells left in my body, they are too few and disparate to show up on any scans, which means that if they do ever reappear in am organized way, my doctors know that the chemo combination of ACT (Andryomycin, Cytoxin, and Taxol) is highly effective on my particular kind of cancer.

2) Surgical options. Knowing chemo was successful made my decision to go with oncoplasty rather than a full bilateral mastectomy much easier. Tomorrow, I will undergo what I hope will be my first and last surgery.  Fingers crossed.  My surgical oncologist pioneered this procedure. It is technically considered "breast conservation", but in reality it is more like lymph node conservation, which is important for quality of life. 

My surgical oncologist and plastic surgeon will work simultaneously to remove the cancerous area of my left breast, sentinel lymph nodes, and any other lymph nodes that might be affected.  For symetry, my plastic surgeon will remove the same amount of tissue from the right side, remove a great deal of skin from both breasts and hitch them up. It is essentially a lumpectomy with a breast lift and reduction. 

Many of my friends and family may not understand this decision. The impulse to just "get rid of them" is a strong one. I, myself would have consented to a full bilateral mastectomy the day I was diagnosed if a surgeon had been in front of me. However, IN MY CASE, there is no statistical advantage. Therefore, I chose to go with the less radical, painful, and  aesthetically jarring surgical option. Let's hope the docs are right and it will also be less  emotionally and mentally traumatic.    
  

Celebrating with family and friends after my 8th round victory!

I love my crazy cousins. 

Melissa (cousin) and I were close enough without having to go through cancer together, but thank God I have her to help me get through this. 

Love my little brother Harrison. 

Niamh (pronounced Née-ve). Our beautiful 11 month old.

Jimmy - my handsome 3 year old. 

Ding ding! Toasting the 8th and final round!

My chemo taxi driver... Niño John (Godfather). 

Carrie, my infusion nurse an total bad ass! 

Hubby

Why all the pictures? Well, while the last three weeks post chemo have been riddled with tests, tests and more tests, I think it's important to pause and celebtate the victory. Equally important, is to reflect upon the toll of the war, not just on me, but my loved ones. 

These are just a FEW of the many special friends and family that are always in my corner. Thank you! 

The side effects of chemo may not be gone. They may not ever go away completely, but I am still floating like a butterfly and stinging like a bee!

With Immense Gratitude,

Tiff

  

The Fear...

Coming off chemo is a lot like the Monday, maybe the Tuesday or Wednesday, after a really long music festival weekend. You're not really in much physical pain anymore, but you just know deep, deep down that you've done a lot of things, said a lot of things, and DONE a lot of things you probably shouldn't have, or otherwise wouldn't have; not in your right mind of course. Which is exactly what you keep telling yourself as the flashbacks get more vivid and last longer. 

It's called "the fear".  Fear of what you may or may not have done; fear of what you may or may not have said; and most of all, fear of going forward without all the details or facts. 

How do you go back to work on Wednesday and chat with the chick from engineering, or as you dubbed her on Friday night in the base tent... Holly Golightly, since the last you saw her was go...ing... behind the big bloke down the back... sure it's all rain and muck anyway... no one will notice. 

What you don't want to think about is the fact that her name for you could be... would probably be... far worse. If you could only remember of course! Oh the sweet and painful haze. 

Well, just like Coachella, Burning Man, Oxygen, or Electric Picnic, you know you HAVE to do it... so too, you have to deal with the fear of what you have done and what you have still yet to do. 

It astonishes me to think it possible to debase myself further than I have at a music festival. Sadly, chemo puts any previous attempts at debauchery and dehumanization to shame. 

Once you get past the physical torture of headaches, body aches, nausea, vomiting, constipation, diarrhea, starvation, and glutinous indigestion you are left with the psychologically impairing fear of ... "oh God... what have I done... oh God... now what do I say... Oh God... what do I do!?!"

So, as most of you know, my 8th and hopefully my last music festival (AKA chemo treatment) was administered last Tuesday. Never should have consented to chemo on a Tuesday. "He died of a Tuesday. His stockings were torn", or so my Grandfather Tony told me. I digress...

So, what's next!?! You'd like an answer.  Well, so would I. Just like I would love everyone to stop misusing serious elements of proper grammar for dramatic effect ... (-; ... it's just not going to happen. 

(If you get all five of those and forgive the missing one, pat yourself on the back.  You are a bonafide grammar geek and language snob). 

Not to mention the hanging parenthesis... totally unacceptable. I digress...

The truth is, I am scared to death. So scared in fact, I am hiding behind linguistic puns to avoid putting words to my fear. 

Most of the time I am grateful for the kinetic, frantic pace at which I have transitioned from breast-feeding goddess mother to Gia-like chemo patient. 

However, as I move away from the effects of chemo, which is what I now know, on to next steps, I pause. 

I pause to shudder at what I have been through and cringe to imagine that I am only one-third of the way through the "treatment" phase of this process. On deck: surgery, then radiation. 

To save time, here is what the next week looks like:

Monday:

10:15am -  Dr. VanderMolen (medical oncologist). Take CBC's and review. Confirm PET scan date/ time. 

* Don' forget to ask him whether or not it's normal for my thumb and big toe nails to be turning black and falling off. 

* Be sure to let him know that I've only had one BM followed by 7 rounds of diarrhea since last Monday. 

* Show him two-week old cut on shin, which is not healing or scabbing. 

2:45pm - Dr. Ramirez (OBGYN). Attempt to sit for physical exam to figure out why it feels like I've grown a new hymen when I try to have intercourse with my husband. 

* Don't forget to ask about the Mojave Desert that is my vagina and what I can do about that, which doesn't involve steroids or hormones. 

* While I'm at it, I might as well ask her for ideas on how to be a wife to  husband when I've got the Mojave Desert between my legs, a bacterial and fungal Isla Vista in my mouth, and hands and feet as numb as the political class in this country. 

That's just Monday...

Tuesday:

MRI

Ultra Sound

Mammogram

Wednesday/ Thursday:

PET Scan

Friday:

8:15am - Dr. Silverstein (Surgical Oncologist). Review pathology and updated scans. Discuss bilateral mastectomy versus oncoplastic breast conservation. 

* Don't forget to ask for an excel spreadsheet-like break down of the percentage rates of local recurrence, systemic recurrence and survival rates at 1, 2, 3 and 5 year intervals for 35 year-old, white/ Hispanic, triple-negative ductal carcinoma patients with 3+3+3=9 (highly aggressive) cancer. 

* And, that, ladies and gentlemen is the crux, the point, the fork in the toad, the belly of the whale if you will. 

The following Monday - Dr. Savalia (plastic surgeon): 5:00pm - tell him which surgical option I've chosen, oh and ask for his opinion. 

* be sure to ask him if he can remove excess skin from under arm and trapezoid area due to chemo-induced   weight loss at the same time as he removes two-thirds to all of my breast tissue, lymph nodes, muscle, skin and nipples. That'd be grrrrreeeeeaaat... thanks!

So, before we can remove my post-two-baby flab, we need to get back to my fork in the road, my belly of the whale. 

From my growing, but still myopic understanding of my diagnosis and treatment protocol, there is no clear cut answer to my question: which surgery is best, bilateral mastectomy or oncoplasty? 

Here are the rough numbers, as I (a layperson with chemo brain) understands them. Of ALL patients with ALL forms of breast cancer, only 10-15% have "triple negative" breast cancer. Of that 10-15%... 80-85% of those women are African-American. The remaining 15-20% are Caribbean, Hispanic or White. The "White" portion of that group "tends" to be young/ pre-menopausal between the ages of 27-35. 

Do you get why my head is about to explode!?! To say that I am in the rarest of the really rare, rare group might make sense... maybe!?!  Now, try to find pertinent data on that sub, sub, sub group on which you can base a life or death decision on. 

Don't forget to factor in my pathology, chemo progress, tumor size, carcinoma grade, staging, etc.

Then, weigh carefully the fact that the percentages are so close on local recurrence, systemic recurrence and survival rates for mastectomy versus oncoplasty that there is no margin of error.  Oh, except for the fact that survival rate goes down IF... IF you make it to five years on the mastectomy. It seems that the survival rate goes down after five years with the mastectomy because they've removed a ton of lymph nodes, which is your body's waste management system.  I guess it's not good enough to build Rome if you do it without a sewer. 

Now, decide... mastectomy or oncoplasty? There is no statistical difference in the outcomes of the two surgeries in as deep as the data available shows.  Meaning the data is not taken from my sub, sub, sub type.  My decision, which can mean life or death depending on my own set of intangibles, is based on Snowden-like meta data from a group consisting of ALL breast cancers. This does not sit well. 

Tell me I'm being melodramatic... I dare you!?!  

Hence, the FEAR. I see the Banshee in the not too distant background. She has a cheeky grin on her face and a single finger brushing her smug lips.  She's begging me, taunting me to make a decision. She wants to wail. 

Here's to hoping and praying I make the decision that keeps her filthy mouth shut!

Anyone have a Chrystal ball? Surgery is scheduled for the 23rd. Don't forget to send me your lotto numbers. 

Thanks,

Tiff

Blood, Sweat, and Tears

Blood, Sweat, and Tears...                         August 18, 2014

My friend and former colleague on the Hill used to end phone conversations with fellow downtrodden members of the minority with “keep the faith” or “fight the good fight”.  I think about that line and the man who said it nearly every time someone asks how I am doing.  I’d like to make Charlie proud.  I’d like to say that I’m fighting the good fight and keeping the faith.  I’d like to say that while I may have lost a couple of battles, I am winning the war, and the sweet spoils of victory will be mine.

I can’t say any of those things, because they just aren't true.  The truth is I am getting my ass handed to me.  I can’t “fake it ‘til I make it” as my beautiful cousin once advised.  All anyone has to do is look at my face or hear my voice to know the truth.

Blood…

The first cycle (4 treatments) of chemotherapy included a cocktail of Andryomycin and Cytoxin among other drugs, including anti-nausea meds and anti-histamines.  I thought they were pumping me full of “pre-chemo drugs” in vain attempt to ward off the brutal side effects, but my inner cynic knows the truth.  They pump me full of anti-nausea drugs and antihistamines so my body won’t fight the onslaught of the offending cell-killers by ridding itself of the “medicine”.  My medial team is well versed with the body’s natural reaction, which is to reject any toxins or anything foreign by way of vomiting, diarrhea, etc.  Essentially, the body responds with an allergic reaction to the onslaught of cell-devouring drugs pumping into my veins. 

My belabored point is this, these drugs work so well at killing my cells, that they kill more good cells, such as red blood cells and white blood cells, than I am able to live without.  As if mouth sores, thrush, early onset menopause (yes, menopause at 34), and vacillating between extreme constipation and shit-my-pants diarrhea aren't enough of a carnival ride, a blood transfusion became necessary on Thursday, July 24th.  

My blood levels were so low that I became anemic and nutropenic, meaning I did not have enough white blood cells to fight any kind of infection or enough red blood cells, platelets, hemoglobin, etc. to heal from any injury.  Let’s put it this way… I have bruises on my arms from simple blood tests that were taken over four weeks ago.

Blood of my blood…

Luckily, my Uncle Eamonn and Cousin Shannon were in town from Atlanta and able to direct donate their blood in my name.   Despite the state of my blood levels, my team decided to move forward with round five of chemotherapy, which switched to a new drug called Taxol, on Monday, July 21^st.   Ironically, my uncle and cousin were simultaneously giving blood that would be pumped into my arm less than 48 hours later.  Both during and after this process, a question began to plague me: are they killing me to keep me alive or keeping me alive to kill me?  I still don't have an answer to that one.

Uncle Eamonn and Shannon donating blood on my behalf.  Thank you! I love you guys!

Sweat….

Fighting breast cancer via chemotherapy comes with many side effects.  Some are well known due to their dramatization in film and television.  Hair loss and vomiting are usually the first to spring to mind.  As discussed, in previous posts, the nausea can be controlled with marijuana and morphine derivatives such as Phenergin.

However, when most people think of hair loss, they are primarily horrified with the loss of hair on the head, which can be traumatic for some women and men.  The loss of the hair on my head didn't bother me much.  In a way it has been liberating.  The weather is too damn hot for scarves or wigs.  Particularly given the fact that one of the not-so-oft discussed results of chemo is early onset menopause.  With the heat of summer and hot flashes, I choose me, and right now that means bald. 

To be honest, hair loss has it's perks!  It's not like male patterned baldness, where I lose the hair on my head, but it starts growing like a weed out my ears, nose and bum!  Conversely, I am delighted not to have to shave my underarms, legs, or those annoying long hairs on the knuckles of my big toes, (ladies, you know exactly what I am talking about!?!). 

I suppose it’s the same reason I don’t often wear make—up.  While it can be fun to get dressed up and accentuate this or that feature for my husband, it is a false portrayal of self and that’s always bothered me. 

I have scars on my face, now a pleasant reminder of a carefree adolescence and far simpler time.  Years of summers spent on Lake Havasu and a lifetime at the beach are evidenced by the beautiful brown sun spots and freckles dotting my face, shoulders and chest, reminding me of a childhood filled with water skiing, snow skiing, swimming, surfing, riding bikes, riding motorcycles, roller skating, playing cops and robbers, and drinking from hoses with my cousins.  The crow’s feet at the eyes and lines bracketing my mouth are a result of years of laughing and smiling, a gift from God in my opinion.  I cherish each and every “flaw”.

Thanks to my Dad, I have a beautiful smile and a contagious laugh that can prompt an entire room to laugh with me, sometimes at me.  Hey, at least they’re laughing.  Without hair, my eyes, cheek bones and smile are large and infectious.  Why hide and sweat beneath wigs, hats, and scarves?

This is the perspective cancer has granted, and I am grateful.  When you’re suddenly faced with your mortality; health, not looks quickly take precedent.

However, I must admit I mourn the loss of my nose, eye lashes, and pubic hair.  Yes, go back and read the last line again if you must.

Imagine for a moment, the loss of an extraordinary amount of weight in a very short time frame (The Chemo Diet), combined with the loss of all pubic hair.  I stared appalled at the sight after showering one day.  What happened to the curvy mother goddess that had just grown two human beings inside a strong and fertile female body?  The answer: gone; from woman to 10 year old girl in just a few weeks.

   

As for the nose hair… well, the body’s natural response to the onslaught of intravenous toxins is to rid itself of the offending chemicals by any means possible, hence the vomiting and diarrhea.  Well, one of the surprises shouldn't have been a surprise at all.  Just like an allergy to offending pollen and unusual flora or fauna, the sinuses and eyes weep in vain attempt at ridding itself of the cell-munching toxins.  

Well, when you don’t have a single nose hair to act as a dam of sorts, the watery mucus comes streaming out without provocation, usually at the most inopportune times.  This may not sound like a big deal, but combine the runny nose, blood-shot weepy and crusty eyes, bald head, IV tracks and bruises on my arms, and skinny frame.  You are left with the likes of a junkie that would do Spike Lee and Guy Ritchie proud.

Tears…

It just got real…

Since my diagnosis, I was consumed first with finding the very best medical team in the country to treat my disease.  With that checked off the to-do list, in large part due to the research and efforts of my Nina, Terri Gallardo, I quickly became occupied with managing the side effects of chemo, as well as the added side effects caused from managing the first set of side effects, abd so on.  To say it's been a painful and exhausting journey thus far is akin to comparing a stubbed toe with the loss of a foot. 

However, managing side effects has been a difficult and welcome distraction compared to the direction I now find my mind drifting.  With one more chemo treatment remaining, I can’t help but think about what comes next: surgery, radiation, Isie’s wedding (-: then more surgery, and possibly more chemo.   None of that would bother me if I hadn't starting reading up on my odds of recurrence and survival.  

Since this process began, I intentionally avoided reading up on such things.  I figured I would find the best damn medical team in the country and let them worry about the details.  However, the more organizations and foundations that become aware of my condition, the more disturbing studies I receive and thus, the more fear creeps into my psyche.

There was no hiding from the potential eventualities of a cancer diagnosis when my friend and neighbor passed away a few weeks ago.  

Ray...

"Concert in the Kitchen"

Ray would hold and sway Niamh for hours. One day he handed her back to me and said "I can't get too attached. I won't get too attached.... Never mind, giver her back to me, I'm attached and I love her.  I just don't want to leave her."

Ray and his little snow bunny princess Niamh

Ray loving Niamh the night she was born

Ray lived, laughed, loved, and shared until his very last.  I miss him dearly and promise to endevour to fight this disease with as much piss and vinegar, laughter, and love as Ray.  For the record, Jimmy asks to see his "DaDa" every day, Graham still can't get used to working in the garage late at night without you banging on the garage door in search of a beer to share, and I don't know if I will ever open a trunk full of groceries and not expect you to come bounding over to help me inside. We love you and miss you everyday.  I will see you soon... not too soon though...    

Chemo seems to have quieted the Banshee for now.  My oncologist cannot feel a tumor of any size in my left breast, nor can he feel my sentinel nodes in my left underarm.  This obviously points to a more optimistic prognosis, but is by no means a promise of a permanent cure.

My Banshee’s wail may be silenced, but she is still there trying to find her voice, while I work my ass off to suppress it, like a toddler at Mass.

In loving memory to our friend and neighbor Ray.  

Tiff

Episode 4

"Let's start from the very beginning, a very good place to start...," excuse me while I enjoy my Fraulein Maria moment.  

The original intent for posting on the Banshee, informing friends and family about my diagnosis and prognosis.  With a family as large as mine, I thought it best to keep everyone updated in one centralized place.  The idea was to spare Graham or me from repeating the same sad story over-and-over.  I also hoped to prevent the nasty game of telephone or text, which inevitably distorts facts and exaggerates details.

Lately, writing or even thinking about what I might write next, has become more than just a means for continuing to update friends and family on the ups and, lets face it, mostly downs of breast cancer and breast cancer treatment.  Writing, even planning to write, is cathartic, a mental and emotional outlet, a means of venting, part of how I choose to process, name your 90's psycho-babble cliche.  

To be honest, I loathe talking on the phone.  I am a big believer in non-verbal communication, and as many of you know I talk with my hands, even my whole body if I am on a good one.  Thus, I often feel inept getting my point across over the phone and equally void of sufficient feedback.  

Between fighting breast cancer, potty training a 3 year-old, and teaching a 9 month-old how to walk, I am too drained to respond to every text, e-mail, or private message.  

When I do respond, I have so much Mommy-guilt it is ridiculous.  In my anxiety-riddled, A-type head I think to myself: if I am well enough to be chatting, texting, e-mailing, facebooking, house-cleaning, or working, I should be downstairs helping my friends, family, neighbors, and nannies raise my children.  

The result, I don't update the Banshee near as often as I should even though it is a more efficient means of disseminating my truth, my story, my reality without having to spin that record for everyone that loves and cares for me after each doctor's appointment or chemotherapy fumble.  Doing so once to Mom, twice to Dad, and a third time to my husband is depressing enough.

Why the all the excuses?  Well, my sweet friend from high school, Eleonora, sent me a private message this evening.  Like so many other old friends and new friends before her, the sweet message is filled with lots of love, concern, support, curiosity, encouragement, and lots of questions. Three things occurred to me: 

One, everyday someone or something such as Eleonora's message reminds me that I am truly blessed.  I am surrounded by amazing people, angels really.  The support from family, friends, neighbors, acquaintances, and people I never knew or barely knew, is incredibly powerful and life-affirming.  Their love and support humbling.  

Then, of course, my Irish-Mexican Catholic guilt kicks in and after chronicling all my many faults and numerous life-mistakes, I start to wonder if I really, truly deserve all the kindnesses and blessings bestowed upon me on a daily basis.  With humility, and let's face it, a bit of desperation, I resolve to not to think about whether or not I deserve the support of all these angels, and just humbly accept it with an open heart and immeasurable gratitude.

Two, I really need to keep my angels better informed.  Therefore, I promise to update The Banshee more regularly.       

Three, As Fraulein Maria sings "Let's Start from the beginning..." I need to go back to the beginning.  I started The Banshee with diagnosis and prognosis, but not much about how I arrived there.  Understandably so, most of my female friends and family have at one time or another expressed curiosity and concern about how I contracted breast cancer, how I found it, and of course why?  

Embedded within these messages are deep threads of concern for self-preservation. It is scary to think a young contemporary, healthy and fit should contract such an aggressive form of cancer.  It's even scarier to read all about the hell that is breast cancer treatment.  If the roles were reversed, and I was reading Eleonora's Facebook posts and blogs about her battle with breast cancer (God-willing, this NEVER happens), I would be scratching my head wondering how someone so healthy and active could possibly contract breast cancer.  If I'm forthright, my very next thought would skip to wondering how the hell I prevent catching that train ride.

To date, I have not addressed these concerns with the exception of my doctors as we explored possible risk factors.  Truth be told, I don't want to scare everyone, but if it prompts one of you reading this silly little blog to start checking your breasts... not just tonight after you finish reading this... but on an on-going basis, then it's worth your fright and my annoyance with repeating the story yet again.  

Therefore, consider this Episode 4 of my Ulysses.  Unless you're a whole lot smarter than me, reading Episode 4 first is essential if you've got a chance in hell at understanding anything going on in the first 3 Episodes.  Not that I'm comparing myself to the genius of James Joyce... ah forget the humility bull shit! You know what I mean! 

Episode 4

Niamh (pronounced Nee-ve), was born on October 21st, 2013.  Like my son before her, I chose to breast feed Niamh. Incidentally, breast feeding is second in pain only to chemotherapy.  Yes, I remember pregnancy, labor and delivery, crashing my motorcycle, and fracturing my back and neck.  I often tend to draw comparisons between pregnancy and infancy with breast cancer.  For example, women love to share the gory detail of labor and delivery, but no one ever tells you how much nursing your child, even your second child, will hurt for the first 4-6 weeks. All the literature tends to prey on Mommy-guilt by listing all the benefits for you and baby, yet conveniently leaving out the cracked and bleeding nipples, referred nerve pain, blocked milk ducts, flu-like joys of mastitis, hours of fun hooked up to an udder-pumping machine, etc.  I digress...

However, one of the many benefits happens to be a dramatic reduction in the percentage of breast cancer in women that chose to nurse their children. Well, we've always known I was special.  Nursing two children did not prevent breast cancer in my case.  Nor did being an athlete my whole life, running an average of 40-60 miles per week, drinking alcohol moderately, drinking 3-4 liters of purified water per day, or eating all organic meat and produce.  This is the one time in my life I can say without guilt or hesitation, I did everything right.  After watching my Nana die of the disease, I went out of my way to prevent cancer, specifically breast cancer.  I read books and scientific papers on the bloody topic.  I drank soy protein shakes with whole flax seed everyday for 14 years, because a UCLA research study I read showed a huge reduction in breast cancer among those cultures that ingest whole, unrefined flax seed, soy beans, soy products, and ate a healthy more Mediterranean-like diet.   

As most of my fellow breast feeding Mommas and their partners can tell you, breasts get large and lumpy while nursing.  When your milk "comes in", it fills the milk ducts, or glands, making the breasts larger, harder, and lumpier.  It is often necessary to knead or massage the breasts while nursing or pumping in order to completely empty all the milk ducts. Otherwise, Momma faces possible engorgement, embarrassing leaking, and ultimately mastitis (an infection of the milk ducts, which causes severe breast pain, and flu-like aches and pains).  

The one thing I must admit is the fact that I never gave myself breast exams.  In fact, the only time my breasts are ever physically examined is at my yearly OBGYN appointment or when Graham feels frisky. 

When I first started nursing Niamh, I noticed what I thought was a knot or blocked milk duct on the left side at approximately 3 o'clock.  It seemed to get larger before nursing, then smaller after nursing or pumping, but it never completely disappeared.  

Around the end of March, or beginning or April, I noticed my "blocked milk duct" growing significantly.  So, I ignored it.  What else do you do, but make up excuses and non-breast cancer explanations for it!?!

I figured I would either be able to work-it-out myself or come down with mastitis again, take some antibiotics, and all would be well.  The truth is, I was working overtime to bury my instincts and gut feelings.  

I told myself "I'm far too young for breast cancer".  I'm healthy. I only eat organic. I'm not overweight, I nurse my children, I don't drink soda or anything with aspartame, nor any other drinks or foods that include ingredients I can't pronounce, I run marathons for Christ's sake!  I never smoked. I don't drink to excess, (not since college anyway).  I don't have a family history of breast cancer, except for my maternal grandmother, who was postmenopausal and enjoyed 30 years of HRT (Hormone Replacement Therapy).  HRT is known to cause breast cancer with prolonged and/ or excessive use.

Finally, my "blocked milk duct" was so large that I let my step mom feel it to get her opinion as an ultrasound tech that often moonlights at the Mission Hospital Women's Wellness Center.  She seemed concerned by the size of the lump and strongly recommended I let her give me an ultrasound, or go to my OBGYN for a referral to the Women's Wellness Center.  So, of course, I ignored her.  What else do you do when you're trying like hell to deny the possibility no matter how plausible or remote.  

A few more weeks went by, but I could not stop thinking about and touching my "blocked milk duct".  Feeling frustrated that it would not go away no matter how many hot shower massages and warm compresses I applied, I finally picked up the phone.  

On Monday, April 21st, I went to see my OBGYN who said "my gut feeling is that it is not cancer, but more likely a glandular adenoma."  I was so relieved. Glandular adenoma didn't sound like a party  It is a condition whereby a milk gland starts growing out of control and can't always be treated without ceasing to nurse or an outpatient procedure.  However, "out an abundance of caution", she sent me to the Women's Wellness Center for an ultra sound.  

On Friday, April 25th, a truly lovely woman named Lynne gave me a breast ultrasound, and told me everything I needed to know with her facial expression.  She sent the image to the in-house radiologist who ordered an immediate mammogram.  After 15 minutes of that medievalesque torture device, the doctor reviewed the images and decided I needed and immediate biopsy.  Being late Friday afternoon, most of the staff were either physically gone or mentally checked out, so the biopsy was scheduled for first thing Monday morning.  

Before leaving I asked the doctor what his gut feeling told him.  His response, "...if it's a glandular adenoma, it's by far the largest I've ever seen.  It is nearly 7cm or roughly the size of a cutie orange.  My fear is that it is cancer. The anomaly is large, it has irregular borders and it is solid, meaning there is no fluid or fibrous material going through it like a cyst for example."  Coming from a man who only reads breast imaging and pathology all day, I knew I was looking at some bad news.  In my mind, that was the day I was diagnosed with breast cancer.   

Monday morning they performed an aspirating biopsy.  After that pleasure cruise, there was nothing to do but wait two days for the pathology results, which of course confirmed what I saw on Lynne's face five days prior.  

The truly scary part, there are no answers to the questions everyone really wants to know.  How did I get breast cancer? I don't know. I have ZERO risk factors.  Pathology found that my cancer is triple negative, meaning my cancer is not driven by, nor can it be treated with hormones (estrogen, progesterone or HER2). Therefore, being on birth control pills for a number of years was immediately ruled out as a possible cause.  Genetic testing proved that I do not posses any known breast cancer genes, such as BRCA1 or BRCA2.  So, for once, I can't blame my parents, their genes or my heredity. Damn!

One of the most difficult things for me to wrap my head around is that there are no answers to "why or how?"  Like death and taxes, it just is. I don't wear deodorant anymore and I only eat grass fed beef now instead of just organic beef, but where does that end?  We can't possibly take out all the plastics and chemicals in our lives.  We have to drink water and eat to survive, no matter how much garbage is in it or processing involved from field to table.  It seems impossible to escape the environmental stresses we put in and on our bodies everyday.

So, the moral of the story and my Public Service Announcement for the night is this: TOUCH THYSELF! Get familiar with your breasts. Learn how to check your breasts and teach your partner how to examine your breasts.  Yes, teach your partner to give you breast exams.  Why not let your partner give you a breast exam?  They'll enjoy it, I promise!  You will feel less awkward feeling yourself up.  Your partner will probably be more thorough.  Unless you are dead tired or have an newborn in the house, it will probably lead to a happy ending in more ways than one!   

Cheers!
Tiff

PS Please keep the prayers, cards, messages, phone calls, texts, food and small gifts coming.  I may be too tired or mom-guilty to respond right away, but they really do brighten my day, inspire me, and help me keep the faith.  The depth of my appreciation for all of you and your generosity is boundless. Thank you.

Here are a few pictures from my cancer binder.  I put a few of the many gifts and notes of encouragement on it.  I promise your words and gifts do not fall on deaf ears or an ungrateful heart.  These are a small fraction of the gifts, notes, cards, etc. that I keep readily visible around my home and in my purse to remind myself there are a gaggle of angels behind me that are counting on me and helping me to fight the good fight. 

Front

Binder

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