Yesterday, I turned 37, and today I received my final radiation marking the end of my active treatment for breast cancer. Compared to chemo and surgery, radiation was a breeze (just time consuming - every weekday for six weeks!) My skin irritation isn't nearly as bad as I anticipated, so I'll keep applying ointment and watching it peel for a few weeks as things continue to heal. ​

I've been declared "no evidence of disease" and my "active treatment" is over, but something I never realized before going through this myself is that my experience with cancer is still not over. I'll go for follow ups every 6 months for the next 2 years with each of my oncologists (medical, surgical, and radiation). I've started seeing a cardiologist because chemo seems to have slowed down my heart rate (nothing that any doctor seems too concerned about, but not normal for me, so something to monitor and hopefully regulate with medication). I may need physical therapy on and off to prevent lymphedema (swelling in my arm) because of the lymph nodes I had removed. In a week, I'll begin taking a hormone therapy pill, which can come with a variety of side effects. The goal is to continue taking it, or another version of hormone therapy, for 5-10 years to lower my risk of recurrence. After months of low exercise, it's going to take some time to get back to my "normal" self, and with the heart rate changes and some lingering shortness of breath, it could be a challenge.

​I'm starting to understand why cancer survivors talk about "the new normal" after treatment. My body has been through a lot, and will continue to adjust and recover. I'm ready for this phase, and whatever challenges it brings, I'm grateful cancer cells aren't a part of it. ​

Lots to update, but the most important thing is that since my surgery last month, my status is now N.E.D. - no evidence of disease! This means that the surgeon removed all the cancerous cells that could be seen on imaging (the primary tumor, a tiny satellite tumor, and 2 cancerous lymph nodes). The term essentially means the same thing as complete remission or complete response. Doctors generally hesitate to use the word "cured" because they never know if microscopic cells are still present and the cancer may return, but to the best of their knowledge, I am currently cancer-free. 

And yet, my treatment is not over. As I said in my last post, the surgeon removed a few lymph nodes during surgery, and then a few more. With two positive nodes, she wanted to ensure it would be all out and no lingering cancer cells would continue traveling through my lymph system to other areas of my body. She took out a total of 17 lymph nodes, which means I am at life-long risk of lymphedema (swelling in my left arm/side/breast) and need some physical therapy to loosen up the tightness in my arm and armpit (called cording or axillary web syndrome). Lymphedema isn't entirely preventable, but there are things I can do to keep the risk low, and if I do develop it, physical therapy can help lessen any swelling. For now, I'll visit physical therapy weekly until treatment is over and I have gained full mobility again.

I also went for my radiation planning session today, during which I had CT scans done, received 5 small tattoos to mark the radiation area, and learned breath hold techniques to protect my heart during radiation. The radiation oncologist will now map out my treatment and I'll go back on the 24th for a test run. Actual radiation will begin on the 25th for 30 sessions (every weekday for 6 weeks). Because I had a lumpectomy rather than mastectomy, radiation will zap any microscopic cancer or pre-cancer cells that might be lingering in the area unseen. The radiation will also cover the remaining lymph nodes in my armpit, near my collarbone, and in the center of the chest to again ensure there's nothing microscopic left.

​By early August, my active treatment will be over. I'll begin taking hormone therapy pills to reduce the risk of recurrence and will visit my oncologist every 6 months for monitoring. There is a light at the end of the tunnel!

Yesterday was a pretty good day. I received my 4th out of 8 chemo infusions, and it was the last round of AC before I switch to Taxol, which comes with less nausea related side effects. I also won't have to continue taking steroids on Taxol, which may be causing some digestive side effects as well. The chemo drug Adriamycin is commonly referred to by nurses and chemo patients as "the red devil" because of it's toxicity and severe side effects, so I'm glad to put it behind me. The nurse yesterday also told me a story about a patient from Mexico who, upon hearing we call it "the red devil," was appalled. In Mexico, they refer to Adriamycin as "Jesus' blood" because it's healing you. What a much more positive perspective! And it must be true, because my oncologist believes the treatment is working.

I saw Dr. Mintzer for the first time since beginning chemo (he's been out of town the past few weeks). After catching up on my experience and side effects, he gave an A+ as a chemo patient and encouraged me to continue using over-the-counter meds to anticipate the side effects I've been experiencing the past few rounds. He also did a physical exam and said the mass feels "substantially smaller"!!! Hormone receptor cancer tends not to respond as quickly to chemo compared to more aggressive tumors, so the fact that after 3 infusions he feels a difference is very encouraging. He also was unable to feel the swollen cancerous lymph node under my arm, which was previously easy to find. Obviously, I'm really encouraged by this, and it's just the news I need to keep going for the next 2 months.
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Positive thoughts and prayers for energy this week would be appreciated. On top of my typical teaching schedule at the university, I am currently serving on a hiring committee and have a number of extra meetings coming up. I'm sure I could have stepped away from this commitment because of my treatment, but to have been invited to serve in this way as a first-year, full-time Lecturer... I was not about to pass up the opportunity. Cancer may be slowing me down some, but I refuse to let it interfere with every positive aspect of my life. So I'm pushing through. Thus far, I have found after receiving chemo on a Friday, I typically hit a low energy point around Wednesday, so I'm hoping I can take some extra naps to get me through the week. And since I'm still avoiding coffee (doesn't sit well in my system with the chemo)--lots of caffeinated tea!

Once I settled on Penn Medicine for my treatment... it was time for more testing. Throughout November, I had a whole body bone scan, CT scan of the chest, pelvis, and abdomen, and a breast MRI. For someone who has never had a serious illness or injury, this was a lot. Not to mention that I continued to teach a full load of college courses, edit a literary magazine, and co-direct a dance company at the same time. 

The bone scan process was actually pretty cool. Even though I've always been a creative person leaning toward writing and the arts, some aspects of science have always fascinated me. Maybe it's because my older sister studied biology. I have vivid memories from childhood when a crow was leaving its prey in our bird bath to soak and my sister took the opportunity to point out to me the specific body parts of the poor, dead bird: the stomach, the intestines, the heart. Having never personally experienced so much as an x-ray, seeing a live scan of my entire skeleton on the screen beside me was, admittedly, awesome. ​

The bone scan began with a nuclear injection. A nurse took me to a room with a radioactive warning, asked me a series of check in questions, and gave me a quick, painless shot. Then, I waited. For four hours. Rather than driving home, my husband came with me and we sat in the lounge down the hall watching episodes of Grey's Anatomy on my iPad. Once the radioactive material had adequate time to spread, I went in for the scan. I laid on my back on the table and the tech lowered a large, flat, square panel with the camera over my head. The sensors kept the camera an appropriate distance from my body as it passed very slowly from my head to my feet. This process took about an hour.

​Sounds boring, I know, but once the camera passed my face I was able to turn my head and watch on the monitor as the machine scanned my body, outlining every bone. 

The next week, I went in for my CT scans--not my favorite test. Sitting in the waiting room, I had to drink two large containers of mochaccino to prepare for the scan. No amount of mocha flavoring can hide the thick, chalky consistency of the pre-scan beverage. 

The actual scan was easy enough. They started an IV for contrast, and I laid on my back again while a donut shaped camera passed over me, scanning my chest, abdomen, and pelvis. 

And the next day, one final test--a breast MRI. My least favorite. The MRI machines are located in the basement of a brick building, down the freight elevator and through the concrete hallways. After check-in and changing into my ever-so-stylish hospital gown, a nurse led me to a room that could accommodate a variety of patients and put me in the blood draw chair to start my IV.

Have I mentioned that I've hated needles all my life? When I was five, apparently I ran down the hallway from the pediatrician because I didn't want a shot. So suddenly needing IVs left and right seemed less than ideal. And this IV? Hurt. The nurse inserted the IV in the crook of my elbow (why, why would anyone choose the crook of your elbow?) and even though she told me I could move my arm freely, it hurt least to keep it out straight. 

In the MRI room, she pulled over a step stool for me to climb up onto the machine. For a breast MRI, you lay on your belly so that your breasts hang down freely for imaging. As you can imagine, this is not terribly comfortable. 

I stepped up and knelt on the padded platform, then lowered myself into position with my breasts dangling through the two holes. A plastic divider dug into my breastbone. My face rested in a horseshoe shaped cushion like at a massage parlor, but there was no masseuse coming. My arms were raised over my head, Superman-style, at which point the nurse hooked my IV up to contrast dye, tugging and pulling in the process. More hurting. 

With giant headphones over my ears, they moved me into the machine and the MRI began. If you've never had an MRI, go to YouTube and search for MRI sounds. They're obnoxious and loud and anxiety inducing. The headphones played music, and they even let me select the Pandora station, but the machine drowned out the calming Sarah McLachlan music I selected. I tried to just keep breathing, but you also have to lie very still for an MRI, and this meant breathing through my belly, not my chest, in order to keep my breasts as still as possible. After awhile, I realized I was holding tension everywhere. 

Before I could spiral into panic, the sounds paused and the tech spoke in my headphones:
Ok, Katherine, we're going to insert the contrast dye now. You're almost done.

As the dye went in, I actually felt the cold sensation in my arm, then my neck, and moving slowly down my body. They say sometimes you feel like you peed yourself. It's true. Only cold. 

45 minutes later, I'd made it. The testing was over. Another milestone completed.

The best part? All tests showed no signs of metastatic disease, meaning the cancer is localized and has not spread beyond my breast and underarm lymph nodes. With this confirmed, it's full speed ahead to chemo, surgery, and radiation.