{the crushing of a soul}

Warning for those grammar police out there.  I am posting this without proofreading it.  I will get to that later. :-)

I was going to start this post with something like, “I had a week that was a roller coster of emotions”, but I immediately stopped and thought to myself, BS, it was an elevator that broke free of its cable and crashed to that floor that doesn’t even have a button to the general public.  The floor below ground that can only be accessed from the service elevator. You know the floor I’m talking about, the one you worry about accidentally hitting the wrong button and the doors are going to open and you are looking down an empty stone corridor like in the horror movies.  Dramatic I know.  Let me first say that everybody handles adversity differently, everybody handles their struggles differently, and somewhere out in the world somebody always has it worse than you do.  I know this. I have felt like I have been pretty positive in facing my second bout with cancer. People comment on this a lot.  I try, I really do, because I know that there are healing qualities in having a positive attitude. Even the first time I was diagnosed I can only remember a handful of days (only individual days, not long stretches) that I was pissed off at the world. A few weeks I discovered my breaking point this time around, finding out my treatment plan.  Like my aunt said in reference to medical issues she has faced in the past...it was soul crushing.

On October 29 we had an appointment with my oncologist. We were hopeful going into this appointment.  We had been told several times that “they” thought I would be able to avoid chemo. So, of course wanting to avoid chemo, we had this scenario in our minds. My oncologist began by going over my pathology reports in depth, explaining every number and testing results...strong positive results for estrogen and progesterone, moderate rate of cancer cell growth, clear margins. She had spent a lot of time considering my “case”,which was a bit out of the norm, and talking to my oncology surgeon. She went onto tell me about scenarios when chemo is recommended, about my situation, and then finished with, “I am inclined to recommend chemo.” Every cancer patient knows damn well this is a possibility, but I think until you actually hear that it doesn’t really hit home.  I just nodded and said, “Ok”, and focused on listening intently and taking in everything she had to say regarding treatment...every three weeks for six cycles, 15 weeks from start to finish, several hour treatments with time beforehand preparing to start treatment. A treatment plan and drugs that aren’t on the aggressive side because my situation doesn’t warrant such aggressive measure.  A “milder” plan that doesn’t have side effects that can cause serious medical problems in the future, but there will be immediate side effects that will go away after treatment.  Side effects that include fatigue, nausea, fluid retention, and hair loss.  Hair. Loss. The one thing that EVERYBODY associates with chemo. I’m going to lose my hair.  Tony asked my oncologist about how long after my first treatment would I start losing my hair, about three weeks.  She said by the time she sees people back for their second treatment they have already started losing their hair and by their third treatment they have usually already shaved their hair off. Then there is the knowledge that chemo drugs are going to be coursing through my veins through a port that will be inserted into my chest with a direct line to my jugular vein (more about this later, at this point it has already been placed). That was October 29th. We were sent home to discuss and decide if we would go ahead and take my oncologist’s recommendation for chemo.  We called the office back within an hour and told them we were going to do it.  Really, what other choice could I make.  Like a friend recently said regarding my upcoming Thursday, “Two days until you make a brave choice that is much bigger than you. You've got four others in that house that need a mom.” Those four others are much bigger than I am and they do need me.  My fears are much smaller than them needing me.

Thursday...our appointment with my radiologist. Like my oncologist she said she felt like she already knew me because there had already been so much discussion and reading of my scans and reports trying to figure out the best treatment route. Her decision was absolutely no question, radiation 4-8 weeks following chemo, five days/week for about six weeks. Another “point” in my week, not a “high point”.  She said preparation for treatments starts two weeks prior to my start date for a CT scan to get an exact picture of my anatomy, heart, lungs, thyroid, lymph nodes, etc.  This is necessary because of the part of my body where I would be receiving radiation and the body parts that would be lucky enough to receive radiation in addition to my breast...my heart, my lung, my thyroid.  Awesome. I asked her if the CT scan would pic up the spot on my aorta in hopes of being able to avoid an additional blast of radiation. She said people are always concerned about the amount of radiation they will be exposed to in various tests and rightfully so, but in this case she said the radiation I will be receiving DAILY is 25x that of a CT scan. So basically being concerned about one additional CT scan really isn’t worth the worry. :-/ And, of course, like with everything there are side effects.  Immediate side effects are fatigue, skin irritation and neuropathy.  Those she wasn’t as concerned about, her major concern was for the lasting effects, the long term effects.  The long term effects because I have a long term, because of my age (which she said she considers my biological age at 30 instead of 42 because of my health and being in shape). Because of the area that will be affected by radiation it can cause damage to my heart, lung, and thyroid. She said the damage to my lung will show up in a CT scan, but most people don’t really notice a change in lung capacity, but do to my activity level I may very well notice. The possibility of cardiac disease is now a risk for me, but that is an unknown until 10, 20, 30 years down the road.  Thyroid issues that would have to be regulated with drugs.  It is also know that radiation can cause new cancers unrelated to the original cancer so I will never be in the clear.  I will always have to be on the watch for changes, not immediate, but down the road, 10, 20, 30 years.   Cosmetic changes, messing with my reconstruction on the left side and because radiation weakens the tissue it is possible that it can’t be surgically fixed because radiated tissue does not heal as well as healthy tissue. But, supposedly the benefits of having the radiation to reduce the risk of breast cancer outweighs all of that. I guess all the science and studies confirms that and we have to trust in our doctor who we are comfortable with and we do trust. That doesn’t make it any easier to swallow and wonder what issues I could face in the future.  

So here is my full treatment plan:
Chemo-every three weeks for six rounds beginning November 20th
Radiation-four to eight weeks following chemo, when I have recovered from chemo, five days/week for about six weeks
Tamoxifen-daily for five to ten years

The only way I can describe it is daunting and overwhelming. Because of the lifestyle I live, pretty healthy and active, I have always felt I would live a very long life, right now I honestly don’t feel that way anymore.  I feel like I am going to have a lot of things thrown on my body that it has to fight against and endure, things that I have no control over and in the long run I hope my body can handle it.  Thankfully I am young, strong, and fit. Right now I try not to think about it, but I’m not going to lie, it’s very hard.  It keeps me awake at night and I have trouble falling asleep. My next six months are weighing on my physically and mentally. Like I have told a couple people today, I’m scared and my heart aches.  It’s soul crushing.

Tomorrow I have a “Chemo Teach” appointment.  I meet with the oncology nurses to hear about yet more side effects and to find out what to expect.  How my treatment days will go, how I may feel during treatments, and what the weeks in between may be like.  I will receive an injection the day after treatments to boost my immune system because my white blood cells will take a beating from the chemo.  I was told being young will play in my favor and my white blood cells may respond okay without the injection.  Only time will tell once I get going with treatment and we see how my body handles it.  So Thursday morning I begin the hardest part of my battle of Cancer 2.0 and getting to the other side.  It isn’t going to be pretty, but I have the support of my family and many amazing people around me.  Thank you to the people in my life for that.  There are important healing qualities in that kind of support.  

I have more random topics to type about, but those will be for a later day.  Homework beckons me and honestly, I’m a bit mentally wore out today. However, I knew I wanted to get something posted before I start my new battle on Thursday.  I quick catchup before my Treatment Room Chronicles begin.