The Hard Questions

I went out with a friend tonight and was confronted by the impact of my situation.  The vastness of the word CANCER.  The fear.  The sadness.  The inextricable link to death.  Tonight, when I reached out to a friend for comfort unrelated to my illness, I realized that though I've begun to heal my wounds, escaping the impression this disease has left on me and those around me will be much more difficult.  No matter how much I try to ignore it, pretend it didn't happen and move forward, I am bound by the scars this process has left on me and the questions that linger in the air around me, unspoken, like silent veils subtly obscuring the person I really am.  These are the questions that the people who care about me are afraid to ask.  Frankly, these are the questions that we are afraid to ask ourselves.  So here I go.  I'm going to ask them for all of us and get them out of the way.  

Will the cancer come back?  Has it spread?  Will I have children? If I do have children, will I live to see them grow up?  If someone loves me, will they be left lonely?  In a nutshell, will I die?

Well, the truth is, I don't know.  Just like everyone else, there is no way for me to predict the answers to these questions.  All I know is that I've done everything in my power to prevent it from coming back, and that's all that I can do.  But does this mean that now I shouldn't pursue a normal life?  That I should be afraid to love and be loved for fear that I may not be around as long as other people?  Should I stop dreaming and striving and envisioning my future because of the possibility that it may be cut short?

There are no right answers to these questions, but if there is anything this experience has shown me is that I cannot sustain an existence clouded by death.  I have to believe in the possibility of love and life and a future or all my hard work will have been in vain; and if having cancer means that these basic elements of life are no longer available to me then the question no longer is will I die, but when.  

The reality is that the only thing that separates me from everyone else is that now there is a visible threat to my life.  Most people my age get to blissfully ignore how delicate our bodies are, living life with a sense of immortality, which allows us to take the necessary risks to succeed.  My biggest flaw is that I, because of my age, confront people with their mortality, reminding them that if I can die, so can they.  Unfortunately though, that innocence is no longer available to me.  I cannot ignore the fact that my body can and will at some point falter.  So what's the remedy?  What do I do?  I cannot go back and erase what has happened.

The only answer is I have to live, and not just live, but live well.  Otherwise, I'll never be able to lift the veils that have hung themselves over my spirit this past year.  So 2009, here I come, 'cause frankly, I'm freakin' tired of this shit! (I know, I know, really poetic, it's the menopause, I swear).

Thanks as always for reading.

Crawling out of the trenches,

DT

Foobs, Hormones and Me

Well friends. It's official. I'm officially foobilicious, and you'll be happy to know that they are nice and smooshy. Just ask one of my parent's friends who actually reached out and touched one (amazing how many people want to fondle you, especially women, after a boob job). Even my medical team is giving them rave reviews. As for me, I'm just happy that my PS stuck to the plan and held himself back from giving me triple Ds. Now I just need to get some nipples (why do I feel uncomfortable writing that word???), and I'll be good to go (in case you were wondering, this process involves some tattoo artistry, so maybe instead of a nipples I'll just get Betty Boop and Jessica Rabbit, the animated queens of voluptuousness, tattooed on my chest).

So what's next? Well, fortunately, the hard stuff is done! My hair is growing in, my blood count is going up and my scars are starting to heal, so watch out normal life, I think I'm getting my mojo back. Unfortunately, my treatment is not completely over. In order to explain this, we need a little pathology lesson. You see, within every large category of cancer (i.e. lung, breast, etc.), there are different types of cancer, manifesting themselves differently from person to person. This is why, when you start hanging around women in the halls of the Cancer Club, you'll start hearing terms like triple negative, triple positive, high grade, low grade, Stage I, IIA, IIIB, Her2+, ER+, PR+, blah, blah, blah, blah, blah. All of this is enough to make your head spin, so I'll try to break it down as best I can from a lehman's point of view (please visit one of the many cancer sites or your medical professional if you want the accurate professional explanation).

The stage, as many of you know, indicates how advanced your disease is. For instance Stage I cancer is a tumor smaller than 2 cm with no lymph node involvement. The grade indicates how close your cancer cells look like normal cells, so Grade 1 indicates cancer cells that still look somewhat like normal cells, whereas Grade 3 indicates cancer cells that have extreme mutations and have stopped looking like normal cells (i.e. no nucleus, etc.). ER+ means your cancer cells have estrogen receptors, making them sensitive to estrogen levels in your body, and PR+ means your cancer cells have progesterone receptors, making them sensitive to progesterone levels in your body. Finally, if you're Her2+, it means you have an over-expression of the Her2/neu proteins on the surface of your cancer cells. From what I understand, on normal cells, the Her2/neu proteins communicate with the nucleus of the cell to let it know when to divide and regenerate itself. If your cancer cells have an over-expression of these proteins, it essentially makes your cancer more aggressive because these proteins keep telling your cancer cells to divide and grow. So if you're triple negative, it means that your ER-,PR- and Her2-. A triple positive would be ER+, Pr+ and Her2+. Did you catch all that? I think I just went cross-eyed just writing this.

So what am I? I am a Stage IIB, Grade 3, ER+, PR- and Her2+ (how lame is it that I have all this memorized), which means, I had a 2.2cm nasty little tumor that looked very little like normal cells, had some estrogen receptors and an over expression of the Her2/neu proteins. So what does this all mean and why is it important with regard to treatment. Well, here is your answer. You see, if your cancer is triple negative, the only treatment options you have are surgery, chemotherapy and radiation. If you are estrogen and/or progesterone positive, it means that you can add hormonal treatments to your toolbox, and finally, if you're Her2+ you can add this fancy wonder-drug called Herceptin to your arsenal (Herceptin specifically targets the Her2/neu proteins, making it one of the most targeted cancer drugs on the market). So, since I'm ER+ and Her2+, it means, on top of surgery and chemo, I have to continue taking Herceptin and start my hormonal treatment (I didn't have to do radiation, thank goodness).

Now luckily for me, Herceptin, unlike chemo, doesn't have so many side effects. The only real effect I've had is that I get a little tired the day I take it (oh yeah, and I have to check my heart every three months because it can cause heart damage, but we try not to think about that). So like chemo, I have to go in every three weeks to get an infusion of this drug, but other than needing to pass out early that night, it's no big deal. Like I said, wonder-drug!!

So all we have left is the hormonal treatment. Well this is a little trickier. The good thing about hormonal treatment, is that it reduces your chance of recurrence by 50%. This is huge because, let's face it, who wants to go through all of this again. The bad thing is, like any hormonal treatment, there are side effects (ladies, I know you know what I'm talking about). Now usually, pre-menopausal women, like myself, are given Tamoxifen. Unfortunately for me, studies have shown that Her2+ cancer is resistant to Tamoxifen, so I clearly need a different solution. Unfortunately, all the other hormonal breast cancer drugs on the market can only be given to post-menopausal women, so what is a girl like me to do?

Well, drum roll please, PUT THE GIRL INTO MENOPAUSE (cue in marching band and confetti)!!!! Um, wait, excuse me??? Put me into what??? You mean that thing that causes women hot flashes, mood swings and general craziness in their fifties??? That phase that takes you from being a child-bearing dynamo, to um, well, barren?? And I have to do this for five years, and then I may, or may not come out of it, meaning I may or may not be able to have children naturally and I may or may not have to go through MENOPAUSE TWICE!!!!!! Um, EXCUSE ME. I know I joined the cancer club and membership comes with its entrance fee, but I'm pretty sure that this is not what I signed up for. I mean, I thought I just had to get through the surgeries and chemo, and that was it, hasta la vista Big C, welcome back mojo.

Oh well, I guess its worth it so my hypothetical children can have a mom who lives long enough to see them out of the nest, walk down their own aisles and have their own hypothetical children. And I guess it's somewhat a relief to have your biological clock put on pause when you're a single girl in your 30's. Kind of takes the pressure off, but STILL! Just makes you want to stomp your feet, hold your breath and just....aargh. Ok, ok, at least it's not chemo and it's not cancer and there's no knife involved. But honestly, aren't I allowed a temper tantrum? Well I guess being that I'm now officially a mature adult (you get to say that when you're in menopause, you see), that would be unseemly. But just in case I break out into a childish rage, or accidentally snap at you, please be kind, I'm just going through menopause. In the meantime I'll just wait with bated breath for my first hotflash.

Thanks as always for reading.

Straight from the trenches (surrounded by preemptive fans),

DT