Wednesday, January 26, 2022

Happy Thanksgiving, You Have Cancer

I found out I might have cancer as I was leaving a theater after a screening of Joel Coen's The Tragedy of Macbeth. This was only the second time I had been in a movie theater since March of 2020. (The first was the day before, at a screening of another black and white Oscar contender, Belfast.) I was checking my email on my phone, and results of the mammogram I had the week before were available to view.

I had no hesitancy opening the results. I had been having mammograms every year since I turned 40, and had never had anything suspicious show up. I was expecting the usual report that always sounded vaguely insulting, that my breasts were "almost entirely fatty," and "unremarkable," and they had found nothing requiring further imaging.

Instead, I read this: 

There is a new mass measuring 4 millimeters with indistinct margins in the middle region of the right breast lower outer quadrant at 7 o'clock.

I immediately went cold. I read the words again and again. I had to stop and catch my breath. My mind instantly went to the darkest places. I was supposed to meet a friend for lunch, as this was the beginning of my Thanksgiving break, a week free from work that I had planned to fill with lots of fun. But I knew I would not be good company, and cancelled. And when I got home, I of course consulted Dr. Google, and found out the words "indistinct margins" are a not a good sign. This wasn't likely to be a benign cyst.

I was able to book a second mammogram two days later, the day before Thanksgiving. Everyone at the breast center was very kind, and tried to be as reassuring as possible. They assured me it was very small, and there was no way I could have felt it during my self exams, so it wasn't something I had "missed." The second mammogram results led to an ultrasound, and that led to the recommendation that I get a biopsy, which they were able to do that day.

It's nothing if not disconcerting to watch a giant needle poking around in your breast, which, through the magic of an ultrasound, you can, as it's also what the doctor is watching as he directs the...specimen grabber?...into the tumor. When it snips off a bit a tissue, it sounds like a staple gun. He also leaves a tiny bit of titanium inside the breast, so the area of the tumor can be more easily found if new images or surgery are needed.

At this point, the doctor seemed pretty sure it was not a benign tumor, but couldn't tell me much about what to expect as far as treatment was concerned until I got the results of the biopsy, which, because of the holiday, would be the following week.

So, I went into Thanksgiving pretty sure I had cancer, but absolutely no idea what that actually meant.

Things happened fast after that, and the timeline is a little blurry in my mind. A few days or a week after the biopsy I got a call from a nurse at the breast health center. Results were in. Invasive ductal carcinoma, stage 1a. The cancer was also hormone positive, but I would need to wait at least another week to learn final results on whether it was also HER2 positive. Regardless of those results,  I would need surgery, and was quickly scheduled to meet with a surgeon.
The surgeon confirmed the tumor was very small, about 6mm, but I was still given the choice between lumpectomy or mastectomy. I asked why, if it was small enough to be removed via lumpectomy, anyone would opt for a mastectomy instead. She said there are many reasons for that. For instance, some women prefer the peace of mind of not worrying about a cancer ever coming back in that breast. But ultimately, percentage wise, the longterm outcomes for my type of cancer are the same with either lumpectomy or mastectomy.

I opted for lumpectomy, and decided to schedule the surgery for January, primarily for insurance reasons (I have shitty insurance and I had not met my high deductible for 2021, and it was going to reset for 2022, so would rather the majority of my costs come in 2022; it's confusing, I know. Insurance fucking sucks. Single payer NOW!), but also because I wanted to get through Christmas without having to deal with any surgery and recovery. 

The results of the HER2 tests would determine what my post surgery treatment plan would be. If it was negative, I would be looking at radiation treatment, followed by hormone therapy for up to 10 years. If it was positive, I'd be looking at all of that, plus chemotherapy. So of course I was hoping it would be negative for HER2.

But of course it was positive.

I found that out December 10th. I had been reluctant to reach out to women I know who've also had breast cancer until I knew what I would be facing, treatment wise, so I would know what kinds of questions to ask, but also because it didn't seem fair to ask women who've had to go through chemo questions if I wasn't going to have to go through that too, if that makes any sense. But the minute I found out the cancer was HER2 positive, I wanted to talk to all of them. And they were all super supportive, informative, and kind. Cancer can feel very lonely, but knowing women who have gone through similar has made dealing with it a little easier.

I waited until after Christmas to tell more people about my cancer. I wanted to get through the holidays not having to talk much about it, and also didn't want to bum people out during Christmas. Cancer is a huge bummer! It's also kind of exhausting to talk about. You want to let people you care about know what you're going through, because you need all the support you can get. But it is also emotionally draining to explain it to people over and over. (Which is one reason I am writing this all down to share!) But I also don't want people to be afraid to talk to me about The Cancer. It's a big part of my life now!

OK brace yourselves because this part is a little gross. I had surgery on January 4th. I was nervous going in, because the last time I had to go under general anesthesia - the kind that requires a breathing tube, the whole works - I got really, really sick coming out of it. I told my surgeon this. I told my anesthesiologist this. Despite that, I wasn't given any anti-nausea drugs before the surgery. I'm not sure if any were given during the surgery. I do know what they gave me after the surgery didn't do shit, and I was vomiting for hours. Any time I had to move, I got nauseous. Wheeling me out of the recovery area and into a room, puke. Going to the bathroom, puke. Putting on my clothes, puke. And the added bonus was there was nothing to puke except bile which had turned blue because of the dye they injected into my breast before the surgery.

Once I got home, the puking stopped. Thankfully. But I still felt dizzy and queasy the rest of the week. I had the surgery on a Tuesday, and I didn't feel better until the following Monday. And I still get kind of dizzy just thinking about it all!

The surgery removed the tumor and some surrounding tissue, along with a lymph node, so I had two incisions. There was not a lot of pain afterwards and I didn't need more than Tylenol to control it. I'm happy about that because even though the doctor did give me the good stuff for pain, the good stuff usually makes me nauseous, and I didn't need any more of that in my life! I still have to wear a bra all the time now, even when sleeping, because it's really only painful when my boob is swingin' free. (Showering is probably the most painful thing to do right now, so I avoid it. Which means you should probably avoid me right now.)

A week later I got the pathology results from the surgeon: no evidence of cancer within the tissue surrounding the tumor, and no evidence of cancer in the lymph node. Clean margins and clean nodes. Huzzah! Finally, some good news! That meant there would be no need for further surgery, which is something I really, really didn't want to deal with again.

Those results did not change what my post surgery treatment would require, but I wouldn't know exactly what the timing of that would be, or what type of chemo I would need until I met with an oncologist, which I did on January 19th.

I liked her a lot. She was very kind, didn't rush through the appointment at all, was patient with my many questions, and even laughed at my dumb attempts at levity. I am getting a second opinion, just because that seems the smart thing to do, but unless the second oncologist says he has a secret miracle drug that will cure me instantly, I am sticking with the first oncologist.

Her recommended treatment plan is to start with Taxol + Herceptin for 12 weeks. The Taxol will be given weekly, and it will be combination of Taxol + Herceptin once a month. After the 12 weeks, it will be monthly Herceptin for nine months. I will also likely need a month of radiation after the chemo, and then many years of hormone centered medication to suppress estrogen and progesterone since my cancer feeds on hormones.

There is no good chemo. All chemo is terrible. It is literally poisoning your body in the hopes it will help you live longer. But from what the doctor said, what I've read, and what I've heard from people who have gone through rounds of it, Taxol is one of the less brutal kinds of chemo. I'm still probably going to lose my hair. It's still going to make me feel terrible. But I am hoping it will not be so debilitating that I will have to stop working completely or live a life of abject misery for three months. 

When I first got the diagnosis, I had a difficult time dealing with it. I couldn't talk about it without crying, and I had a hard time concentrating on anything but the worst case scenarios. I felt like I was in a constant state of panic, and it was exhausting for weeks. But eventually, I felt calmer. Talking to friends who've gone through it helped. Therapy sessions helped. And getting past each hurdle helped.

Of course I am still scared. I'm terrified about the possible side effects of treatment. I am terrified of dying! My biggest fear is dying. If someone tells me they are not afraid of dying, I just don't understand that. Are they not afraid of anything? Because aren't most fears based in a fear of dying? Afraid of heights? Then you're afraid of FALLING AND DYING. Afraid of flying? Then you're afraid of CRASHING AND DYING. I don't understand!!

But that is neither here nor there, because I am not going to die. I need to believe that. I need to believe I will get through this horrible, horrible year, and come out of it ready to live many more years that are, hopefully, not as horrible. I didn't think 2020 and 2021 could get much worse, but here's 2022 knocking on the door saying, "Hold my beer!"

But somehow going through two terrible years feels like good practice for the year ahead. Social distancing, avoiding crowds, masks, sanitizing my hands constantly, that's all stuff a cancer patient in treatment should do, and it's all old hat to me now. In some ways, it's a good time to get cancer (it's never a good time to get cancer) because people around me are all used to these things too, and won't look askance if I continue to wear a mask whenever I leave my home.

I know it's going to suck. But I have supportive family and friends who I know will help me when I need it. I've lived a pretty great life so far, and if one terrible year of beating cancer is the worst thing to happen in it, I'll consider myself damn lucky.