Scars worn with pride

Tuesday 25 September, 2007 by Abbeylvr1

On March 17, 2006 I had my yearly mammogram at the local hospital. As I waited for the letter in the mail assuring me everything was ok for another year I received a phone call from my gynecologist informing me my mammogram was suspicious and I was scheduled for a spot magnification mammogram on March 24th.

The nurse assured me this was just a precaution and it was highly unlikely that I had cancer. I arrived for my second mammogram feeling a little anxious but I'd had a mammogram the year before and there was no history of breast cancer in my family so the odds were stacked in my favor. As I was leaving the testing area after my mammogram I saw the technician in the hall and she wished me 'good luck'. I realised at that moment I might be in trouble.

A few days later the nurse called me at work and said the results were 'highly probable for malignancy'. On April 21, 2006, two and half months after my 41st birthday I was diagnosed with invasive breast cancer. What follows is an up close and personal account of my journey through breast cancer and how a 30-minute mammogram saved my life.

The time between the second magnification mammogram and my biopsy was full of anxiety as I imagined all of the horrible possibilities. I knew if this turned out to be cancer, the following months would hold many trials and my life would be changed forever by my experiences.

The first thing the doctors did was take me off my hormone replacement therapy patch. I'd had a hysterectomy in 2000 and was on hormone replacement therapy. At first I refused to stop the hormones because I knew without them I would go into surgical menopause. I didn't want to have the hot flashes, mood swings, and other discomforts of menopause but at my doctor insistence I grudgingly threw my patches away.

On April 21st I had an ultrasound-guided core biopsy. The procedure consisted of placing an ultrasound probe over the site of the breast lump and using local anesthesia the radiologist guided a biopsy needle directly into the mass. Four tissue specimens were then taken using an automatic spring-loaded device and were sent to the lab to be reviewed by the pathologist. I would have to wait 4 to 5 days for the results.

The radiologist performing the biopsy said the lymph node under my arm looked suspicious and asked me to consent to a fine needle aspiration biopsy of the auxiliary lymph node. The sample could be processed in a lab and we would have a preliminary report within minutes. When the radiologist returned he sat beside me and informed me the preliminary test of the auxiliary lymph node was positive for cancer and he was 99.9% certain the core biopsy of my breast would come back positive as well.

He explained the next lymph node the cancer would affect would be the supraclavicular lymph node near my collar bone. He suggested taking a sample to see if the cancer had spread, I consented. The good news was the supraclavicular lymph node was negative. I got dressed thinking "this is not real - I had a mammogram the year before. How could cancer have been in my breast long enough to have spread to my lymph node?"

As I walked out of the biopsy room I saw my husband of 23 years sitting in the waiting area and I walked over and whispered in his ear "I have cancer and it's in my lymph node". The look of shock and confusion on his face mirrored my emotions. I wasn't sure how I was supposed to feel - part of me was just relieved to finally have an answer. Another part of me felt guilty and fear crept up my spine for my daughter - would I pass it down to her?

I didn't know how I was suppose to react but I did know I had a lot of family waiting anxiously by their phones for me to call and tell them it had been a false alarm. I also knew that women didn't go through breast cancer alone and that my news would affect my family. I used the 2-hour car ride home to call my family and friends and tell them that I had cancer and chemotherapy would be in my future. The hardest to tell would be my children and I wanted to tell them in person. I started searching the internet for information regarding breast cancer and what I found was overwhelming.

There are so many different types and stages of cancer. Next, I joined a forum on www.Breastcancer.org I wanted to hear from other women who were going through the same thing as me. I wanted somewhere I could go and research my options and get an idea of what lay a head for me. Over the next couple of weeks I had several more tests to determine the stage of my cancer and to meet with the oncologist. Finally it was official; I had Stage II Invasive Breast Cancer of the Ductual and Lobular Carcinomas.

Not only did I have a mass that I never felt but I had a trail of cancerous microcalcifications running toward the middle of my left breast. Most calcifications are benign and can be seen as tiny white specs on a mammogram. Further testing showed my cancer was estrogen positive, progesterone positive with type HER-2 receptors.

The first visit with the oncologist was overwhelming. He had so much information to explain I was grateful my husband was with me to write things down. The oncologist discussed his plan of treatment and how it would be administered through a central venous catheter (CVC). It is a long hollow tube made from silicone rubber inserted under the skin of your chest into the thoracic (chest) portion of the vena cava (the large vein returning blood to the heart) or in the right atrium of the heart. The tip of the tube sits in a large vein just above your heart. Treatments would consist of a combination chemotherapy regimen. Three months of Taxol (one per week), an additional three months of FEC (fluorouracil, epirubicin, cyclophosphamide) (one every three weeks), and one year of Herceptin(once a week).

Herceptin is a drug that works by interfering with one of the ways breast cancer cells divide and grow. Herceptin attaches itself to the HER2 protein, blocking the message to cancer cells to divide and grow. Herceptin also stimulates the body's immune system to help destroy the cancer cells and reduce reoccurrence. I would receive herceptin along with my other chemotherapy and then alone for another 6 months.

After the 6 month regimen of chemotherapy I would have a segmental lumpectomy with auxiliary lymph node removal followed by 6 weeks of radiation and 5 years of Tamoxifen. As we left the oncologist my head was spinning and I was terrified. As always, my husband was by my side gently holding my hand telling me I would be fine.

I decided to face cancer head on and try to keep things in my life as normal as possible. I had to be strong and be a good example for my 17-year-old daughter. I didn't want my cancer to scare her and I felt guilty enough that by having cancer I had increased her chances of developing breast cancer. I needed her to know that being diagnosed with breast cancer was not a death sentence and chemotherapy was doable.

I began my treatments and continued to work 3 days a week. I knew my hair would probably fall out so I had my daughter-in-law cut my hair short to prepare myself. Three weeks after my first Taxol treatment my hair began to fall out so my husband shaved the rest off. My support system was unbelievable. I received many cards from family and friends letting me know they were thinking of me and I was in their prayers. My 21-year-old son came in the house after he heard I lost my hair and was bald himself. He said "I am going to be bald as long as you are mom". I had never felt so loved as I did that moment.

Even with all the support I felt isolated and depressed I was fighting my own inward battles that I couldn't share with anyone. Exactly 8 weeks into chemotherapy on Monday, July 10th I woke up at 1am shaking and running a fever. About an hour later I vomited several times. I called my oncologist and was told to go to my local hospital. I spent 7 hours in the emergency room. They did the usual chest x-rays and cultures and I was finally given a Zofran shot for the nausea and Tylenol for the fever and sent home.

Tuesday I continued on the Tylenol and was unable to eat. On Wednesday I called the hospital and was told to come to the emergency room ASAP. My husband came home from work and we started our 2-hour drive. When we arrived at 7:45pm I was unable to sit in a chair so my husband found me a couch to lay on until my name was called. We were to discover a short while later my blood pressure had fallen and was 63/41. The doctors went into action and I received fluids and more chest x-rays and cultures were taken. At 10am Thursday morning I was discharged with more Zofran for nausea and antibiotics.

As we were driving back, the local hospital where I went on Monday called my cell phone to inform me my cultures were back from the lab and I had a serious bacteria called Pseudomonas Aeruginosa and I needed antibotics. I told the emergency room doctor that I was now on an antibiotic. He said the antibiotic should work. I spent the rest of Thursday sleeping on the couch. I was so weak and still unable to eat.

Friday morning I woke up and was short of breath. At 2pm the emergency room called and said the cultures they took were back and I needed to get back to their ER ASAP. Once again we started our 2-hour drive. I had a 100.4 fever, was nauseated, very short of breath and coughing by the time we arrived at around 7pm. As I laid in the emergency room around 9pm I began shaking uncontrollably, my fever spiked to 103, and my blood pressure went extremely high. I was exhausted and scared and I watched doctors come in and out of my room trying to decide what medications to start me on before I crashed.

They opened up my IV all the way, hoping the fluids would lower my blood pressure, gave me an oxygen mask and an injection to control the shaking. The doctor explained the shaking was a result of the bacteria being released through my body. As we waited for my blood pressure and fever to lower my husband placed wet towels on my forehead and neck. I could see the worry in his eyes and I knew this was serious and my life was on the line.

After a couple of hours my blood pressure was still not stable so a portable crash cart was taken with me to have x-rays. Finally, I was diagnosed to have pseudomonas within my blood stream that also settled into my lungs causing pneumonia. Pseudomonas is a rod-shaped organism that can be found in soil, water, plants, animals and at hospitals. It rarely causes disease in healthy persons, but infects those who are already sick or who have weakened immune system.

Pseudomonas is resistant to most antibiotics and patients with weaken immune systems have a higher mortality rate from the infection. The infectious disease center was called in to evaluate my situation and decide what drugs of choice would work the best on my body. The doctors weren't sure how I contracted the bacteria so as a precaution they removed the CVC in my chest.

I spent 4 more days in the hospital and 2 additional weeks at home on intravenous antibiotics 3 times a day administered through a PICC, a long, thin, flexible tube known as a catheter. It was inserted into one of the large veins in my arm near the bend of the elbow and pushed into the vein until the tip sits in a large vein just above the heart. My husband was taught how to set up an intravenous drip and gave me my medication at 5am and at 9pm each day. I had a home health nurse that came to the house and gave me the 1pm dosage.

My husband was my guardian angel - he did not sleep during our long trips to the emergency rooms. Instead he watched over me making sure everything possible was done and that I received the best care available. I did not have the stamina nor the appetite to eat and my husband would come home with all my favorite foods and try to spoon feed me but I just couldn't eat. As I began to feel a little better my 17-year-old daughter fixed me peanut butter and jelly sandwiches. I would manage to get half of it down and save the rest for later.

She was left home alone during the time I was in the hospital. When I came home, she knew I was scared to be alone so she would not leave me alone in the house. My mother took off work and stayed with me during the day while my husband went to work. I was terrified and knew my mother was a prayer warrior and if she prayed for me God was sure to hear. I had walked away from God the year before and as I laid there scared I would not fully recover, I gave my heart back to the Lord. I knew God had never left my side and he was carrying me through the darkest days of my life.

On August 6th I had a new CVC line inserted in my chest so I could restart my chemotherapy and go back to work. After I went back to work, I began to catch every little bug going through the office and I developed PVC's (premature ventricular contractions). PVC's are 'extra' heartbeats occurring out of sync with the normal regular rhythm of the heart that feel like a hard thump. The cardiologist ran tests and determined that my heart was in excellent condition and the PVC's were probably brought on from all the stress my body had endured over the last month. These caused my heart rate to increase as well as my blood pressure.

The oncologist and I decided I should take a leave of absence from work to finish my treatments. On August 31st, I finally finished my Taxol treatments. On September 14th, I began the FEC chemotherapy. I was scared of the side effects but anxious to get my treatments over. I developed several mouth sores and was nauseated for days after each treatment. Nothing tasted good and I burped more during those 3 months on FEC than in my entire adult life.

During the time between my first FEC dosage and the second, my niece passed away. On September 30th, I was awakened and told by my husband that my beautiful 24-year-old niece, Ashley had passed away unexpectedly in an automobile crash. My family is very close and we were devastated. I attended the funeral with my surgical mask, turban, and a mouth full of sores but the pain and embarrassment of my appearance was nothing compared to the inward struggle I faced trying to understand why God heals some people and takes others home to be with him. I was the one that had been so sick with pseudomonas pneumonia. "Why did he heal me and take her?"

I finally realised I would never have the answer to my questions and it was my responsibility to live a full and happy life in honor of those that went before me. I spent October and November making numerous trips to hospital. After each chemotherapy treatment, I began to run high fevers. There were many times I wanted to quit but my husband and daughter would tell me 'no' and I would cry and say 'ok'. My oncologist decided the fevers were caused from my CVC line and it needed to be removed. I had my final treatment through a regular IV and I didn't run a fever.

On December 21st I had a segmental lumpectomy and an auxiliary node dissection. Twenty-two lymph nodes were removed from under my arm. The surgeon warned me that there was a possibility I would lose the whole breast if the line of cancerous calcifications were larger than he anticipated. I was pleased to learn after surgery that my surgeon was able to make one three inch incision along the side of my breast by my under arm and drag the breast tissue out from it as well as remove the lymph nodes.

I was discharged from the hospital with an external drain in the surgical area that exited near my incision. The tube helped drain fluid to reduce swelling and promote healing. The drainage tube was stitched in place so it wouldn't fall out and at the bottom of the tube was a bulb that collected the drainage.

My husband was shown how to record the volume collected and how to clean the wound site. He had been changing the bandages at my CVC incision site once a week for the past 8 months so he was a pro at keeping the tube cleaned. Since my surgery was so close to Christmas I had to wait until after the holidays to hear back from the lab to see if the removed tissue had lingering cancer cells. I was relieved when I finally received the news that I had clear margins and I would not need further surgery.

Recovery was painful but I was determined to spend Christmas with my family and participate in the festivities. I felt like I had already missed out on so much I refused to miss Christmas. As usual I had a wonderful support system that helped me deal with the physical pain as well as the emotional side of breast surgery. In January 2007 I went back to work and had 6 weeks of radiation at our local cancer hospital. I sailed through radiation while finishing up my Herceptin treatments. In May 2007 my oncologist said I was cancer free and I could stop the Herceptin treatments. I had completed my year and now it was time to begin Tamoxifen for 5 years.

Tamoxifen is a drug used to slow or stop the growth of cancer cells present in the body. I am still coming to terms with my disfigurement and the emotional and physical effects of not having any hormones at the age of 42. I get scared sometimes at the thought the cancer could come back, but my husband reassures me and reminds me I am alive and cancer free.

I wear my scars with pride. They are a reminder that I fought and won a battle for my life. I think God everyday for bringing me through the darkest valley of my life. I am an avid believer in mammograms. I know my yearly mammogram saved my life. Early detection is the key to a good prognosis.

Updated: 25 Sep, 2007