Friday, January 1, 2010

Looking back on 2009 ...

I cannot exactly say that I am sad to have the year 2009 firmly behind me, in the past. After all, it was not the most pleasant of years for me. Sure, I have many positive things to look back upon amongst the negative things that happened. I am very grateful for those positives. Still, I am very happy to leave the negatives behind me and move on, into what I hope will be a better future.
The way DH and I had figured it, 2009 was destined to be a tough, but ultimately blissful year. We had begun, and made great progress, on a tough and somewhat uncertain path towards parenthood. Due to a congenital condition, we knew that it wouldn't be easy to get there. But we had started treatment with determination and cautious optimism. After a slow and disappointing start in 2008, by early 2009 a change of doctors  to a world-renowned expert on our specific problem, and subsequent adjustments to the needed medications had worked miracles and put us in a good position to make our long-held dream come true. We were scheduled for a special IVF cycle in March, one of only four such cycles in any given year, that would hopefully get me pregnant. But of course, that's not exactly what happened...
I do not think I have ever posted the entire story of how my cancer story began. So maybe today is a good day for that, as we're nearing an anniversary of sorts.
Around first few days of the year, DH and I were relaxing at home, playing with the dog as we often do. Despite his advancing age, the dog still loves chasing his ball and will scale any obstacle while pursuing it. So we were sitting on the floor horsing around, when DH suddenly threw the ball over top of me. In blind pursuit, our little 20 lb. Schnauzer mix went after it. But rather than jump over me as DH had thought, the pooch jumped on top of my chest and pushed off from me in a giant leap after that ball. I screamed with pain -- it really hurt, as I was having problems with cysts, anyway. Plus, it would never feel good to have a twenty pound dog jump on your breasts, anyway. Those are sensitive body parts that do not react well to having such force exerted upon them. Anyway, my playful mood passed in a moment (as did the pain, a few seconds later) and I ended the gametime with an admonishment to DH never to tempt the doggie to jump over me like this again. Other than that, I thought nothing much of this incident until a few weeks later.
This incident came back to my mind when the spot on my left breast where the little doggie paws had so forcefully pressed into my chest began to hurt a few weeks later. I could feel a hard, painful lump right in that same spot. Initially, I thought that it was just a big cyst like the ones I had previously developed. So I decided to wait until the end of my menstrual cycle and see if it would go away, as all those previous lumps. But this one was both bigger and more painful than previous lumps -- and it didn't go away at the end of my cycle. I was alarmed enough to see my ob/gyn promptly, but fairly sure that it would be just another cyst, or perhaps some fibrocystic changes like I had previously had. My doctor thought the same, but sent me for a diagnostic mammo and sono, just to be sure.
I called for an appointment as I left my doctor's office, and the mammo place offered to squeeze me in that same afternoon when they heard that I was only 38 and that it was a diagnostic mammo, not just a routine screening. As a matter of fact, they told me to come right on over. So I did, and a little while later, they had squished my boobies between the paddles of the mammography machine. This was soon thereafter followed by a sonogram. The results weren't good. When the radiologist came in to review them with me, he seemed alarmed. Of course, it was probably nothing, but he insisted I schedule an ultrasound-guided biopsy right away -- just to be sure. So I did.
Still, I wasn't that alarmed. I had had fibrocystic changes before, and they always had turned out benign. Actually, when I was twenty-five, I had a lump in my right breast aspirated in a fine-needle biopsy. The doctor told me after she was done with the procedure that she was fairly sure that this was cancer because it was firm and solid. My whole world came crashing down... Yet back then, the pathology report came back as benign fibrocystic changes necessitating nothing but regular ultrasound follow-up. So I was fairly confident that this would come out the same way, and tried not to worry too much.
About a week later, I had the ultrasound-guided biopsy of this big old lump in my left breast. I remember the procedure itself as pretty awful, as the radiologist had to labor hard to get her huge vacuum-assisted needle into that hard lump. It hurt pretty badly, as the lidocaine works only superficially. She also did a fine needle aspiration of an axillary lymph node that was suspiciously enlarged. A few anxious days of waiting later, the pathology reports were back. First I received a call about the lymph node, which was clear. Finally, around seven p.m. when I had given up hope I would hear about the main pathology report that day, the radiologist called me. Much to her surprise, the lump, too, had come back benign with only fibrocystic changes and fat necrosis to report. Whew, what a relief! They urged me to get evaluated by a surgeon, though, just to be sure...
So I did. I'm a good girl, you know, and actually do as I'm told -- most of the time, anyways. In this case, I knew I was scheduled for the IVF cycle a few weeks later, and did not want to risk anything in that long hoped-for pregnancy that would soon become a reality, I hoped. After initial trouble finding a breast surgeon in my insurance network, I found one. He had a really sweet secretary who squeezed me into his schedule (thank you!!!)  after I explained my situation and the time constraints of our special IVF cycle. So I met with the man I came to call the butcher, and explained the dog-story, mammo and biopsy saga to him. His opinion was that it was unlikely to be malignant, but rather a result of the trauma from the dog jumping on me, and removing the big lump (which seemed to take up the upper inner quadrant of my breast by then, would leave a big hole, so he recommended to "wait and see." The rationale was that cancers do not shrink on their own, but fibrocystic changes eventually do.
At any other time, I probably would have followed his advice, since I was neither particularly eager to have any surgery, nor to be left with a big old scar on my neckline and an ugly old crater in my chest. However, I was not about to wait this out and in the meantime -- finally -- get pregnant, just to find out in that delicate situation that this thing is growing after all -- or maybe even cancerous -- and needs to come out during pregnancy. So against the doctor's advice, I pushed the butcher to take the lump out. After all, I told him, you'd think they'd have the technology to fix those craters in this day and age... He told me oncological surgeons didn't, but that plastic surgeons might, and referred me to a colleague. This is how I met my boob man, who not only saw me right away, but also suggested that he could do a breast lift at the same time the butcher took out that lump, where he could fix the 'defect' the butcher would leave behind.
On March 17, with just days to spare before the beginning of our IVF cycle, I went into surgery to have the lump removed and the crater fixed at the same time. This was to be my very first general anesthesia ever, so I was glad that I had a wonderful anesthesiologist, the sleep man, who was nice, caring, and funny, but also had experience with IVF (he and his wife had twins through IVF). But the morning of the surgery, during one last pre-operative examination the butcher felt that the lump had grown since the week before and got very nervous. He even wanted to nix the breast lift and cut right into the lump, effectively doing an old-fashioned surgical biopsy. The last-minute chaos was overwhelming. I didn't understand why they couldn't find out right in the OR whether this thing was cancer and how much of me they had to cut out. Thankfully, the boob man convinced the butcher to stick with the original approach with the prettier incisions, and let him fix the defect. I was so glad.
They did the surgery, and as I was barely waking up, I saw the butcher and DH coming towards my bed in the recovery room. There wasn't much mincing of words: the intraoperative pathology consultation (ha! that was a possibility after all...) had shown that my worst fears had come true. This was cancer after all...
It was awful news. However, I had had a few weeks to ponder and research the possibility of cancer and its implications, though, so to everyone's surprise -- not the least of which my own -- I immediately started telling the butcher that nobody was going to give me chemo or do anything else that might threaten my fertility before we had a chance to turn that IVF cycle into a fertility preservation cycle in which they would not implant any of the embryos, but merely freeze them for future use. DH was apparently quite impressed with how I started bossing the butcher around and telling him what I needed and what was important to me, even as I had barely woken up from anesthesia. People tell me I can be quite forceful and demanding sometimes...
Anyway, this is how my cancer story began. Life hasn't been quite the same ever since. As you know, that cancer turned out to be a 3.1 cm by 2.5 cm by 2.5 cm lesion of triple negative invasive ductal carcinoma, a particularly aggressive form of breast cancer. I was very lucky that I insisted to have that lump removed right away, even as there seemed to be such a reasonable and "probably benign" explanation for it. If it hadn't been for that, who knows how long it would have been before I was properly diagnosed. In the meantime, that cancer might have grown further, spread, and done all other kinds of nasty things to me. This thing grew fast, so the sooner it was removed, the better. I'm one lucky pup I didn't listen to those doctors that time...
Those of you who have been kind enough to follow my blog as I have progressed through my cancer journey know, that initial lumpectomy had positive margins and was followed by a mastectomy a few weeks later. Then came our IVF fertility preservation cycle, which produced those precious twelve frosties that are waiting for us in cryostorage. This, in turn, was followed by eight dose-dense cycles of grueling chemo -- and since last September, a gradual return to 'normalcy' (whatever that may be...).
As you can see, I have been very lucky in this whole sordid TNBC tale. Reading over this story now that I have written it down for the first time, it sounds quite unbelievable, actually. As I went through my various treatments, I have further been unbelievably lucky in that I have experienced such great love and support from not only DH, my extended family, as well as friends both old and new as they have helped usher me through the inevitable highs and lows of my treatment. I feel very blessed and privileged to have such a wonderful support system -- and there were many times I needed it during this past year.
Thus looking back onto the year 2009, I am full of gratitude for all those lucky and good things that have happened to me. Naturally, I am also a bit wistful, for the year did not bring us that baby we had hoped for due to this TNBC "bump on the road." Going through those six surgeries, the chemo, and my various hospitalizations has been difficult and challenging at times. But those tough times have also taught me to find greater strength inside myself than I ever thought possible. Yet I know very well that without the support and the many kindnesses so many people have shown me during the course of the last year, I could not have pulled through as I did. Thank you, all. It means much to me.
Well, I am hoping that there will not be any more difficult chapters in this my TNBC story and that I will not have very much to write about other than how my recovery progresses (and my hair keeps growing back -- more about that soon). So let me wish you all a very happy, and most of all a very healthy 2010!!! May the new year be full of life, love, laughter, and happiness for all of us, and short on all those things that kept me blogging throughout 2009.