Radiation: The Daily Grind

"It's easy!"
"It's a piece of cake!"
"It's nothing compared to chemo."
"It's nothing compared to surgery."

These are all quotes from doctors and nurses regarding radiation. True to form, I'm here to tell you that radiation is not easy. Radiation is not a piece of cake, and you cannot compare chemo to surgery anymore than you can compare radiation to chemo or surgery.

Radiation is it's own form of hell.  Henceforth, I intend to mostly show, not tell the daily grind of radiation therapy. Most of what you will find here is told in pictures, some of which are graphic and show the charred female breast, so reader beware.

Every morning I wake up at 5:30 am, get dressed and wait for my Godfather or husband to drive me to radiation.  In the beginning, I mostly drive myself, but as the burns and nausea increase with time, so my husband and I decide it's better for me not to drive.

At precisely 7:15am Monday through Friday, I enter the sliding glass doors of the Radiation Oncology unit of Hoag Presbyterian Hospital.  With the exception of "mapping" appointments, where they literally map the target area with green lasers, so they know exactly where to burn you each day, the appointments roll on 15 minute increments. For efficiency sake, each patient is issued a badge with bar code that is to be scanned upon arrival for check-in.

Without speaking to or even seeing another human being, I walk toward the woman's locker room.  As long as it's Monday, I pause to weigh myself on the carpeted floor scale, report my weight on a slim piece of paper and drop it in what looks like a raffle ticket box.  of course, I haven't won anything, as my weight is still well below normal or healthy.

From there, I enter the locker room, remove my clothing and jewelry and don a fabulous blue hospital gown and wait for the sound of "Mrs. McCarthy" to come over the loud speaker.  When I got married five years ago, I thought I could never become tired of hearing the sound of "Mrs. McCarthy." I was wrong.

I actually 'liberated" one of these
gowns from the facility,
so I could burn it in a bonfire on the beach.
A burn for a burn!

Next, I walk into a large, cold room, remove the top half of the blue gown I just changed into and cozy up to my metal slab.    

The machine is actually pretty amazing.
It pivots 360 degrees so that it's beams can enter the patient from underneath if need be.
The metal slab rises and lowers in compliment with the "big finger" as I called it.

The radiation tech, sometimes male, then positions me using my very own contoured pillow, lovely stickers (in lieu of tattoos) and green laser beams. I note that some of the techs are male because it seemed to deeply offend the modesty of some of the women in the locker room.  Obviously, I was the exact opposite.  By this stage of the game, I could not give two shits about who saw or handled the Frankenstein tissue on my chest.  I just wanted to survive.  I digress...

Anyhow, it's very important to precisely radiate the targeted tissue each time.  Every time I lay on this table, I thanked God for his many blessings and ask for the warm beams of light to come inside and heal me. Boy did He answer my prayers!  
 

With the exception of fatigue and some nausea, I tolerated the first two weeks with relative ease. As you can see, week three became tougher. They targeted three areas of the breast. Rather than shoot the radiation beams directly into your chest like a sword, which would necessarily radiate the heart and other organs, the beams transverse the tissue.  If you follow the blue lines to my collar bone, you will see another area targeted.  That particular beam went from the cleavage area up to and through the collar bone, leaving burns on the front and back of my trapezoid.

This particular radiation beam traversed the breast along the incision line closest to the tumor point of origin (Left Breast, 3 O'Clock). During surgery, they removed 8 lymph nodes, some near the collar bone, but most from the arm pit, thus the beam and thereby burns extend well up the under arm.

 

Week 3
The skin under the arm begins to turn
a dark, dark brown. Much like the charring of
a marshmallow over a campfire.

Week 4
Increased swelling, fatigue and nausea
You feel exhausted, like you've spent the entire
day in the sun, drinking alcohol
and need a nap before you get sun stroke and vomit.
*Without the fun of enjoying the sun and a drink of course!

Week 5
The burns intensify on my back
Showers become all but in impossible
unless I keep the water cool and below
the waist. Cool baths are preferable

Week 5
More blistering, pain, fatigue, and nausea.
By this point, we were dressing the wound with wet dressings and mesh 24 hours a day.

Week 6
Probably the worst of the burns and pain.  While continuing radiation on the 3 areas,
Dr. Kim spends Wednesday mapping the
"boost area".

Week 7
The last five sessions target the "boost area" only.
This is where the tumor WAS. As you can see, the burns around the boost area are already fading somewhat. The body truly is amazing!

Here are some of my favorite staff members from Hoag Radiation Oncology. Radiation is not a piece of cake, it is not easy, but I made it.  With the help of my wonderful doctors, nurses, friends and family, I made it.  You can too!

Love,
Tiff

Celebration

Some of us call our cancers by their official names, "ductal carcinoma", "lobular carcinoma", or by their more common lay terms such as "breast cancer", or "thyroid cancer".  Then, there are those of us who decide to name our cancers.  We put a name and a face on our opponents.  For me, thinking of my cancer as the Banshee helps me visualize what I'm up against.  It's also an ever-present reminder of what lurks in the shadows.  As far as anyone can tell, I am "cancer free".  The banshee is silenced... for now.  However, the odds are 30% in favor of her making a return and a TKO.

I am blessed. I am lucky.  There are those of us, many of us that don't ever get a reprieve. They don't ever receive the  tenuous joy or respite of being deemed "cancer free."  There is only living with cancer, doing your very best for as long as you possibly can to stave off the hungry wolves.

By now, you are probably confused by the title of this post, seeing as how the first two paragraphs probably have you wanting jump off the nearest building.

There is so much darkness in cancer, in fighting cancer, in living with and dying of cancer.  The Banshee is a formidable adversary. So, what do you do? You celebrate! You celebrate every victory, every tie; you celebrate every damn day that you don't let the darkness and fear overcome you.

I lost a good friend and neighbor to cancer last year.  There isn't a day that goes by that I don't wish I could  take back all my advice on everything from health to sleep management; all my little pearls of wisdom about life and just let him do his thing.  You see, I did the same thing to Ray that everyone does to me now and it drives me absolutely crazy!  

When he celebrated life, he did so in a million seemingly frenetic ways: cleaning his yard and ours, smoking cigars, drinking margaritas, walking his and other neighborhood dogs at 2:00 am, toasting the sunset in the small park atop our neighborhood every night.  He never slowed down, until he did. What I never understood, what I could not have know  is that he was celebrating. Ray was living, he was enjoying life to the very last.  When he had the energy, he used it, and then some. God love him, he made damn sure he and everyone else around him enjoyed every bit of his energy.

Unfortunately, the mind isn't always stronger than the body, and he would have to lie down and rest.  Sometimes it would take hours, days, or weeks of sleeping and couching-it before he could come out into the world and light it up again.

During the flow period of this tide, I always urged caution, restraint, rationing energy and moderation; above all be moderate. Be moderate in your drink, your food, your exercise, etc. What I didn't realize at the time, was that I was not only asking him to be someone that he wasn't, but I was also asking a man at the precipice to stand back, take heed, and waste what little energy, time and life he had left.  I was asking him to moderate life. Why? So, he wouldn't have a hangover; so he could get more sleep, so the next day wouldn't be as hard, wouldn't be as fun, wouldn't be as enjoyable.  After all, everything in moderation, right!?!  Bull shit!

I was the queen of moderation: I rarely drank to excess, I frequently found ways to avoid party situations or found excuses to leave early, I never did any serious drugs, I never had one night stands, never, never, never... Always the good girl, getting the good grades, being the team player, always eating healthy, and always exercising.  When my family and friends drank soda, I drank water, when they ate candy, I ate raw fruits and vegetables.  Where did a life of moderation, caution, and responsibility get me: breast cancer at 34.

You're damn right I push it now! I ran 4.6 miles today at an 11 minute per mile pace.  While this distance and time is a joke to my former self, the self that loves marathons.  Today, it is a huge accomplishment.  For the last 3-4 weeks, I've been running most mornings with my very heavy almost-four year old son. Should I be pushing my body this hard, this fast!?!  I don't know, but for God's sake, please stop asking me in that judgmental tone that makes it crystal clear that the question is reciprocal.  Leave me be! Running along the beach in the early morning light of a new day with my son is a little piece of heaven on earth.  Words fail to express the love and gratitude I have that God gave me one more run, one more run with my son, and another beautiful run on the beach.  It takes more out of me than I'd like to admit.  When the rush of energy, adrenaline, endorphins, and serotonin ware off, I am left fatigued.  The kind of mind and body fatigue I only ever felt after 16+ mile training runs. The kind that require a nap for recovery.  

I push it in other ways too.  I pushed it last weekend when after a long and tiring week of work at work and work at home, I accepted two offers to go out on both Friday and Saturday nights with my husband and friends.  I had the energy, so I used it and then some.  I had the opportunity to enjoy time with my friends and husband, to enjoy life, to laugh, to be merry, to CELEBRATE, so I took it.  Gone are the days when I am going to pass up on any opportunity to live and love with my friends and family out of fear of needing a nap or having a hangover.  I am done with moderation.  When I am tired, when my energy is spent, I will lie down, I will sleep, I will rest, but I will do it begrudgingly, not because I want to, but because my body is tired at a cellular level and I have no other choice.

Whether it's laughing and crying over too much wine with friends, or running too far too fast with my son, I am living, I am enjoying every second of this beautiful life.

No one with chronic, possibly terminal disease can win.  Yes, that is a double entendre.  Once you get the "cancer free" title or once the "active treatment" phase is over, most folks expect you to just get on with it, to just be over it, to just be back to "normal".  So, you do your damnedest to be the Tiff of old, large and in charge.  Then comes the chorus of folks saying you're doing too much, you need to rest, you need to work yourself back up slowly.  You know what they say about opinions!?!

So, let me get this straight... it's ok for me to spend what energy and time I have on cleaning the house, cleaning clothes, cleaning the yard, paying bills, cooking, working, working, working, but it's not ok for me to spend some of my energy and time on actually living?

 I know this all sounds a bit whiny and immature.  I want my cake and I want to eat it too.  You're damn right I do.  I've earned every celebration, every nap, and every vacation.  This insidious disease and its treatments are tough.  The Banshee takes, and takes, and takes.  She breaks the strongest of hearts, minds, spirits, bodies, and dreams.  

This disease demands a lot of caregivers.  Thank God for my family and friends.  I am grateful, I am, but as my Aunt Kathy said "if given the choice between the role of the caregiver and the role of cancer victim, which would you chose?" So many have given so much to help me fight and recover, but I am still recovering.  Please give me a break and let me go through what I am going through without judgement.  If you no longer want to help, it may hurt, but I understand.  I am still on a physical, mental, and spiritual journey that I don't fully have my head wrapped around yet.

Some days I feel great, I feel like I can take on the world,  The fabulous Tiff can take my kids to disneyland all day, and dance all night.  Trying to live life fully takes its toll and means that other not-so-fabulous days are tough.  Sometimes the not-so-fabulous days hit regardless of my daily or nightly activities.  My body and organs have taken a serious beating.

I'm doing my best to find a balance, a way to balance the need to celebrate each day, each good test result, each milestone, with the obligation and responsibility I have to my family and work. 

If I need to lie down, I will, but don't expect me to stay there for long and try not to judge me for living a little less moderately, a little less cautiously. 

Surgery... The Tracks of my Tears

I have written, deleted and re-written this post at least three times.  I'm not sure why it is so difficult to write about my surgery on September 25th, 2014.  Nor can I figure out why it has been so difficult to write about everything that followed.

Of course, I have a few theories:

1) The event(s) including and surrounding my oncoplasty were traumatic. Living through it once was hard enough, let alone reliving it to share.  I know... like the rest of this hasn't been tough!?!  

Thanks Kirsten (-;

2)  I still struggle with how much to share.  FYI, I am going for it... I always end up going for it.  Herein, I will share the good, the bad, the ugly and grotesque.  Please, do NOT let your children view the images in this post without your consent and explanation.  In talking with other fighters in hospital and doctor waiting rooms, I found many women still shudder at the lack of modesty and privacy afforded breast cancer patients, while others, like myself, find the exact opposite.  I see my breasts as a body part, like any other appendage, joint, organ, bone, etc.  They broke and they needed fixing.  I took my turn with them, as did my husband and children.  Now they belong to science and posterity. I am neither ashamed nor proud.  They are just breasts. 

3) Memory loss.  Chemo brain is a real thing!  The Andriomycin, Cytoxin, and Taxol (ACT) portion of my treatment is designed to kill or disrupt rapidly dividing cells; disrupt them by making it difficult or impossible to attach to one another and replicate. ACT does not discriminate my rapidly dividing cancer cells and my brain or any other high metabolic organ cell.  In this way, chemo is a Utopian-like drug.  It is indiscriminate. 

4)  I can't remember... Ha!

On September 24th, my husband and I went to Hoag for the pre-op insertion of guide wires.  HELLO!!! Apparently, the doctors want to know exactly where to cut!  In my case, chemo (thankfully) worked really well, and the tumor disappeared on all scans. So, how were the doctors supposed find the tumor and lymph node areas without point of references and a map?

Coiled guide wires under tape & bandage

Have you ever de-boned a fish? Could you take an x-ray to find a few different 1mm tags or titanium markers inserted during biopsies, then slice the fish open, find the 1 mm markers, remove them and other "bad" tissue, then sew it all back together so that the fish was better than before?  This is what my amazing surgeons were able to do.  However, in order to do so, they needed to use ultra sound and MRI imagery with contrast to insert titanium guide wires into my breast and underarm at the exact location of my metastatic tumor and lymph node sites.

Writing on the wall. Dr. Silverstein marks several points of reference, the date and his initials

It hurt! Even with a great deal of local anesthetic, it hurt. Because I was the first surgery scheduled on the 25th (7:00 am), the guide wires had to be placed on the afternoon of September 24th.  Rather than going to the expense of keeping me in the hospital overnight, comfortable on pain meds, they sent me home.  While I did have pain and sleep meds to help, the discomfort and anxiety was too great to sleep. You gotta love medicine dictated by insurance! 

        

At 5:00 am on the 25th, Graham and I walked onto the surgical floor of Hoag hospital (2nd floor).  You could cut the fear and anxiety in the small lobby with a knife.  After an all too brief wait, I walked alone into a curtained staging area, undressed as ordered, and waited for the anesthesiologist to come and alleviate my worries with a tap of the vein.  

I don't know if I actually remember anything about the 48 - 72 hours post-surgery, or if I simply recall the stories, pictures, and videos shared with me in the days and months since surgery.  Either way, thanks to the shared stories of others, I know I was surrounded by people that truly love and support me.  
   
      

My cousin Melissa and fellow cancer sister.  Nothing like a little solidarity to get you through surgery.  PS She has survived four major cancer-related surgeries since her stage 4 thyroid cancer diagnosis at 23!  You are my hero Melissa!  I love you!

As the haze began to dissipate, I noticed something very strange.  Besides the Frankenstein-like patchwork of tissue that remained, my left breast and areola were left substantially larger than the right.  My oncology surgeon, Dr. Mel Silverstein once described my plastic surgeon, Dr. Nirav Savalia, as "a true artist".  High praise indeed from such a notable surgeon.  Yet, I was left lopsided?  

Who says size doesn't matter!?!

On or around day 4, (I don't remember, as I was on a lot of pain medication), I went in for the first of many post-op appointments.  Dr. Savalia, my plastic surgeon) stood silent, head cocked, with a friendly, patient and sympathetic gaze as I muttered unintelligible questions regarding size and pain. 

Apparently, he told me all about the size differentiation he would deliberately leave behind at our pre-op appointment.  I have no memory of the discussion, but my husband assures me it took place.  In any case, he is an artist and he was right... the left breast was larger than the right for good reason: radiation therapy shrinks tissue like ice water shrinks a man! 

  

Ahhhh... relief! I was prepared to get all new, smaller bras, but I was not prepared to get bras with two different cup sizes! 

Dr. Savalia and I at our first post-op appointment    

The fact that the size differentiation was intentional provided fleeting relief.  Soon enough, I could trace the tracks of my tears over the suture lines, which were covered, for the time being at least, with surgical tape.

The steri-tape makes the suture lines look innocuous enough until... removal of the tape reveals a thick, dark, keloid surgical map and a post surgical infection in the right Breast suture line. 

Once I reconciled that the size differentiation would not be lasting, I began to focus on the pain and healing process. As you can see from the photos above, the Oncoplasty cuts make an anchor-like track with a large anchor bottom stretching from armpit to declotage where the underwire of a bra digs into the fold at the bottom of the breast. That's right, no more underwire bras for me, not EVER!  From the bottom of the anchor, the doctors cut straight up to the areola and use a tool affectionately called the "cookie cutter" to stamp out my areola, leaving the overall diameter and circumference substantially smaller than my post breast feeding areolas (bonus!).  

On the left side there is a break in symmetry at the bottom of the anchor (as you can see above),  The surgeons deviated from the bra wire cut and jogged up into my arm pit in order to remove the tissue around my former tumor, sentinel and secondary lymph nodes.  Eight lymph nodes were removed in all. 

The result: breasts that are roughly 70% smaller, areolas that are 40-50% smaller and a patchwork of tissue marked by thick, purple, keloid suture lines. 

The fallout from surgery was extensive. Besides being much more painful than expected, I could not lift my arms for quite some time. It was six weeks before I could lift my arms over my head or hold my babies.  I got stir crazy and overly ambitious around week 3.5 and decided to tidy up the house.  While bending over to pick up a toy, I popped an internal stitch on the suture line under my left arm.  There is no comparison to the acute pain radiating from deep within. The only relief, time.   

Knowing that radiation therapy would flatten and minimize the scaring on the left side, my plastic surgeon suggested some silicone tape called Rejuvenation for the scars on the right side.  The tape is similar to steri-tape or surgical tape in the sense that it adheres to the skin for 2-3 weeks and is not meant to get wet oily from lotions or oils.  Unfortunately, the tape began to fold on the cleavage end of the scar on the right breast.  The fold allowed air to get under the tape and rubbed the two sides of the suture line together.  This perfect little storm created an infection.  The infection dug a worm-like "tunnel" into the layers of flesh beneath, which needed to be drained.  I will never forget that smell.

Like much of my journey through cancer, the biggest challenge is managing the effects of treatment. For instance, you have surgery, the anti-scarring tape causes an infection, you take antibiotics, then you find yourself falling further down the rabbit hole of consequences.  Three weeks post antibiotics, I lay in the fetal position with severe chills, body aches, fever, vomiting, and diarrhea.  The nausea could not be controlled with any of my pharmaceutical or herbal remedies, so I knew I was in trouble.  

Five days in the hospital and $33,000 later, it was determined that the antibiotics caused gastroenteritis, colitis, and created a weakened immune system ripe for C.diff (short for C.difficile). C.diff is a so-called super bug that is resistant to antibiotics.  It is found in hospitals and other highly sanitized environments.  I figure I picked it up going in and out of the Radiology wing of the hospital everyday, but who knows!?!

Either way, I was allowed one day off of radiation, and even though I was kept in isolation, they wheeled me down to radiation in my bubble every day for treatment.  You can look at this phenomenon in two ways: the hurt, tired, sick, and pessimistic side of me looks at this as torture; a commitment to killing me or getting as close to it as possible without actually killing me.  The retrospective, supposedly cancer-free, and post-treatment side of me appreciates the doctors' and nurses commitment to my treatment and steadfast determination to kill the cancer no matter how sick and tired my mind, body, and spirit were.  Honestly, I still go back and forth.

As always, my family got me through it.  Melissa got my doctors on the phone in under 15 minutes and determined a plan of action to get me safely to isolation at the hospital. She repeatedly warmed blankets up in the dryer to try and get some heat into me.  She is my rock.  My husband, Mom and Dad managed my work, home and children.  My Godfather was there; he's always there... to pray for me, to pray with me, to take me to appointments, to feed me, to watch me sleep. My breast cancer sister Kirsten was there to visit, cheer me up, and sneak some champagne into isolation! Neither Melissa nor Kirsten let the fact that their immune systems are weakened from their own cancer treatments (not to mention the rest of their bodies and souls), deter them from braving the potentially infectious hospital environment to comfort me.  This is what my angels do.

It's been four months since surgery. As I look to finally finish this post, I hope to put this chapter of my life in the past where it belongs.  While some physical effects remain: scarring, numbness, stiffness in my arm and shoulder, I am confident these will fade over time.  Some effects are lasting.  Losing lymph nodes means I will never again have my blood pressure or blood drawn from the left arm, and I will always need to use a compressive arm band and gauntlet on my left arm and hand when I travel or lift heavy things.  I will always worry about lymphedema and endeavour to prevent it.  

However, I will live on and I will do so without hearing the wail of the Banshee!

               

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