Tag: port-a-cath

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Three Month Follow-up with My Oncologist

As I said in my previous blog post, I have had some struggles recently. I have been trying to write about what has been going on, but it has been challenging to put it into words. I am still not prepared, but there may never be a good time, so I may as well start to talk about it.

I had a check-up with my oncologist back on the 7th of January. I didn’t write about my appointment right away because it was an unusual appointment, not my usual, “Yes, I am doing fine on my medication. My sleep is improving, as I am averaging just one night a week, where I am still awake at 5 or 6 am, instead of several nights a week. I am still fighting fatigue…blah, blah, blah…”

My bloodwork has improved to where all of my levels are normal except for my red blood cell count, it’s still low, and unfortunately, it may be my regular reading from now on. It’s not terribly low at all, 4.18, where 4.20 to 5.40 is a normal range. But being even slightly low, I can feel it, so hearing that I might not ever be in the normal range makes me terribly sad as I hate feeling this way. I asked if there is anything I can do, that some cancer patients say that they take iron to fight the fatigue. My PA said that I could take iron, but she cautioned me that it could upset my stomach, so I should take it only every other day to start if I decide to try it. She also said that she had heard that there is a liquid version that might be easier to take, but she hasn’t seen it, so she wasn’t even sure where I could get it. I am on the fence about taking iron, so for now, I am not doing it.

My PA explained that one of the essential readings they are looking at when I come every three months is my Hgb or hemoglobin. Low hemoglobin levels usually indicate that a person has anemia. There are several kinds of anemia: Iron-deficiency anemia is the most common type. This form of anemia occurs when a person does not have enough iron in their body, and it cannot make the hemoglobin it needs. High Hgb is known as polycythemia. This means you have too many red blood cells. Polycythemia vera is a cancer of the blood in which your bone marrow overproduces red blood cells. With polycythemia, a blood test also shows a high red blood cell count and high hematocrit. So low or high Hgb would be bad for me, it would mean I am either anemic, which was also a concern during my chemo treatments, or I have cancer in my blood. My Hgb is a little low, only one point from the lowest acceptable level, but nothing to worry about for now.

Now for the tough part…for most of my appointment, I cried a lot. It was hard to talk about, even with my PA, whom I adore. I kept looking away from her while I was talking and crying; I was embarrassed. Why was I crying? It was a lot of things, but mainly the fact that I have had an overwhelming feeling of guilt recently. Why do I feel guilty? As it is, it’s hard being a cancer survivor, and for me, it is tough because I have always had a great deal of empathy for people, but now it includes other cancer patients. Recently quite a few people I know, through various ways, are dealing with having a cancer recurrence. I feel guilty because I am still doing well; I am OK for the most part. They are experiencing my greatest fear, and I am feeling guilty because it isn’t me. It is also a reminder that my breast cancer was incredibly aggressive, and it could return at any time.

It is easy for most to say, “don’t live in fear, don’t worry about it,” but honestly, someone who says that to me clearly doesn’t understand how horrifying it is to go from barely needing to see a doctor to countless scans, blood draws, chemotherapy, radiation and four surgeries in a matter of fourteen months. All three of my doctors, my cancer treatments, everything I went through saved my life without a doubt, but it also damaged me in every way. I don’t know if I will ever be myself again, many cancer patients tell me that I won’t be, but I am doing everything I can to defy that future.

At the end of February, I will reach the second anniversary of my first appointment with my surgeon when I was diagnosed with breast cancer. In many ways, I can’t believe that it has been that long already, and in other ways, it feels like it has been a lifetime.

Thank you for being here; it helps to know that people care enough to read my blog, that the information I am sharing helps other cancer patients and their caregivers, and it helps me in more ways than I can say.

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Fatigue & Depression

I have been going through quite a bit of fatigue and depression lately. I am still experiencing fatigue almost every day, so when I do have a burst of energy, I make sure to take advantage of it. On days when my entire body is hurting, I try to remind myself that I had my 4th surgery not that long ago, so I don’t need to be so hard on myself when I just want to rest. Resting has become another problem in the form of not being able to sleep properly. It is not out of the realm of possibility for me to be awake until 2 or 3 in the morning, sometimes even later, at least a few nights a week. I realize that fatigue is linked directly with depression, so I am beginning to understand how everything I have been dealing with within the last few months is all part of the same problem.

Not all of my depression is linked to breast cancer, but most of it is. I was talking to a breast cancer patient the other day, and she was asking me how long it has been since I had finished each portion of my treatment. I hadn’t thought about the timing of everything in a while, so as I was answering her questions, I was surprised that time has passed much quicker than I thought. It has been 11 months since my last chemo treatment, 7 months since my last radiation treatment, and 4 months since my previous reconstruction surgery; at times, it feels like a lifetime ago, but when I am having a bad day, it all seems like it happened yesterday. Even with all of that time passing so quickly, my body and mind are still healing. I have been experiencing what I thought were some of the side effects that I had at the end of chemo again, but chemo ended almost a year ago, so I am beginning to realize that some of them are symptoms of depression, as described below. Luckily, we are going on vacation soon, and the timing couldn’t be more perfect. I need a break; I need time away from everything that has been hurting my heart and soul lately, and I need to get my mind and body back on track, and I will!

Depression may be a side effect of breast cancer and fatigue is often a symptom of depression. Some people may have a tendency to depression, which treatment can make worse. At the same time, fatigue itself can lead to depression. Not knowing why you feel drained week after week, and not knowing that this abnormal feeling is normal for many people going through treatment, can make you depressed.

Treatment for breast cancer may leave you feeling sad, tired, or depressed. These feelings are complex conditions, resulting from and affected by many factors: your cancer diagnosis and treatment, aging, hormonal changes, your life experiences, and your genetics.

If you’re abruptly going through menopause 10 years earlier than you naturally would, with a quick lowering of hormone levels, you may experience feelings similar to postpartum depression.

Sadness is a natural part of your breast cancer experience, something you need to express and move through. If you don’t allow yourself to feel sad and grieve, the unresolved grief gets in the way of feeling better and getting better. You may be having hot flashes and trouble sleeping. You may be feeling overwhelmed or even debilitated. All of these factors can lead to fatigue and depression.

How can you tell the difference between fatigue, sadness, and clinical depression? The symptoms of clinical depression include:

  • an inability to cope
  • an overwhelming feeling of helplessness and hopelessness
  • inertia
  • an inability to concentrate
  • memory problems
  • panic attacks
  • loss of pleasure in what used to make you happy
  • lack of interest in sex or food
  • sleep problems

If you think you’re depressed, talk to your doctor. If your doctor doesn’t have experience treating depression, ask for the name of an accredited psychotherapist. Together you can sort out if what you’re feeling is depression or extreme fatigue. Therapy can help you feel supported and allow you to talk about what’s bothering you. Antidepressant medicines can help ease feelings of sadness and anxiety and help you feel better. An accredited psychotherapist with experience treating depression can help.

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Follow-up with My Surgeon

On Wednesday, I went to see my surgeon to go over the results of my mammogram and to have him take a look at my breast implants and surgery site from my surgery that was just about four months ago. When he came into the exam room, he said that yes, I have some small cysts in my right breast, but that he is 0% concerned about them. I asked him if the cysts could turn into cancer, and he said no, they wouldn’t as they are benign. I asked him if anything needs to be done about the cysts, and he said that we do not need to do anything concerning them; they will most likely go away with time. He said that he is very pleased with the images from my mammogram and ultrasound and that everything is clear and looks great! {He explained to me when he ordered the mammogram that we had to wait for at least six months after finishing my radiation treatments to do it, or the images would be cloudy, so that is why I had to wait so long.}

Next, he took a look at how I have healed from my last surgery and how my breast implants are settling in. Everything is looking good so far, but my chest has not finished settling into place, meaning that the area under my left breast, in particular, has not dropped down and rounded out, it is still somewhat flat. It takes time for the internal part of the chest to heal and for the implant to get into place, so there is nothing to be alarmed about; my body just needs more time.

We do have to watch for a complication from my breast implants. It is called Capsular Contracture, and it is a breast augmentation complication that develops when internal scar tissue forms a tight or constricting capsule around a breast implant, contracting it until it becomes misshapen and hard. When my surgeon put my breast implants in, he added donor tissue to help prevent this complication from happening, but that doesn’t mean that it won’t happen anyway. He said that if it does happen, I will need to gauge my level of pain, watch for distortion, let him know that I have a problem, and that I am in pain that I can’t bear. He explained that some patients would have a severe case of Capsular Contracture and have very little pain, while others would have a milder case and have horrible pain. He said that if the pain is too much for me, I need to tell him to fix it, meaning I will need to go into surgery and have my implants removed. Whether or not I would need to have a new set of implants put in or have them left out is hard to say; it just depends on the circumstances. Being the excellent surgeon that he is, he told me that this could happen when we were discussing the option of breast implants. I told him that it was worth the risk to me as I was feeling very out of proportion after my first reconstruction surgery. I wanted to feel like me again and not the stranger staring back at me in the mirror.

The reason why we were even discussing this horrible complication on Wednesday was that he pointed out that the implant in my left breast is much firmer than the implant in my right breast during my exam. The firmness is caused by the 25 radiation treatments that were part of the breast cancer treatment performed on my left breast. So, it is already firm, and I need to watch it and check to make sure that I don’t have any harder areas that could indicate a problem is developing.

Unless I notice anything in the meantime, I will not go back to follow-up with him until six months from now. I have fewer appointments with my oncologist and surgeon these days, a real sign that I am healing and adjusting to life after breast cancer. 💕

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My First Mammogram in 18 Months

On Monday, I had my first mammogram in 18 months. Once my temperature was checked, I signed the necessary paperwork, and then I went over to the registration area. I noticed while going through the process of registering that the paperwork from my surgeon ordering my mammogram, said to do an ultrasound “if medically necessary.” I prayed that I would not need an ultrasound because I knew that meant that they saw something during the mammogram and would need to take a closer look.

The breast center that I go to, which is in the same building as my surgeon and oncologist, takes terrific care of me. I barely waited for 5 minutes before the nurse came to get me to take me to the back so I could change into a gown. I love the gowns there, they are pre-heated, and so are the blankets! It’s the little things I guess, anything to feel more comfortable when you are waiting to go in to have your breasts smashed in a machine. I was incredibly nervous because I couldn’t help but think about the last time I had a mammogram; when the results said that I had a mass that was “highly suspicious of malignancy.”

When I went back for the mammogram, the first task we needed to take care of was to go over everything I had been through concerning my breast cancer and treatment. It was hard to recount everything from the number of treatments to how many surgeries I have had, what type of surgery it was, and when everything occurred. It was hard to go through the details, not because I couldn’t remember them but because I could, and it was just so much to go through in a short period of time. Even now, when I start thinking about everything that has happened, I get depressed, and sometimes I am brought to tears. I am lucky to be here, and I know that, but that fact doesn’t take away the memories and pain of every blood draw, surgery, and treatment that I have endured.

I didn’t realize how different the process of a mammogram would be with breast implants, so it was a shock to go through what seemed like twice as much imaging. First, I had a regular mammogram, and the standard trays were used with the usual amount of images being taken. But since I have breast implants, I had to have extra imaging done with my implants being pushed up and out of the way. I won’t lie, it was painful to have the edge of the metal platform jam into the scars under my breasts, but it was necessary to be in that position to move my implants out of the way. Once we had finished the mammogram, the tech had me go back to the waiting room while the doctor looked over the images. I waited for a few minutes, and when I saw the tech come back, I was hoping that it was time to leave, but no, the doctor asked for a few more images. So we went back to the mammogram room, and she took two more images, and then sent me back to the waiting room.

I waited for a few more minutes, and then a different and very pregnant tech came to get me. I noticed right away that she was taking me into the ultrasound room, and I immediately got upset. She told me not to worry and that this was normal, but I knew better. She only imaged my right breast, the side where I did not have breast cancer. Once she was finished getting more images, she took me back to the waiting room while the doctor took a look at the ultrasound images. After a few minutes, the mammogram tech came to take me back to the mammogram room for one last mammogram image of my right breast. Now my anxiety is starting to kick into high gear! “What did they find? Do I have cancer in my right breast now? I can’t go through everything again!” My mind was racing, and I wasn’t going to calm down until I knew what was going on. Still, at the same time, I truly appreciated that they were taking their time to make sure that they were able to see and identify what was showing up in the images and give my surgeon and me accurate information.

This time instead of taking me back to the waiting room, the tech had me wait in the mammogram room while the doctor took a look at the last image. She said that I might have to go back to the ultrasound room with the doctor so she could pinpoint the area that was causing concern. Sure enough, I went back into the ultrasound room, and the tech did some measuring and marked an area with a pen for the doctor. The doctor came in and took a few extra images, looked at everything carefully, and then told me that I have some tiny cysts in my right breast, but they are benign, there is no sign of cancer! 😊

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Breast Cancer Growth Rate

I came across this article recently and it was really shocking to me. I have always understood that breast cancer grows by cell division, but I had no idea of the timing from when it starts to when you can feel a lump in the breast like I did. I know that the information below is scary, but I am posting this to inform my readers because I truly believe that when it comes to breast cancer, early detection and information are key. If you won’t listen to me, listen to a doctor who makes it clear in the article below that a yearly mammogram is so incredibly important. As you know, I also believe that a monthly self-exam between mammograms is just as important. I don’t want anyone to go through what I have been through in the last 18 months, so if I can help just one reader understand the importance of mammograms then I have done my job.

Speaking of mammograms…my last mammogram was before my first surgery in April 2019. Now that I am over six months out from my last radiation treatment it is time to finally have a mammogram done to make sure that cancer has not come back. My surgeon explained that we couldn’t have a mammogram done any sooner than now because the radiation causes the images to look cloudy. So, next Monday I will have the mammogram done that my surgeon ordered back in February. I am scared, to say the least, but I am trying to have faith that all of the chemo and radiation treatments killed any tiny cancer cells that may have been too small to detect after my first surgery.

Ask an Expert: Breast cancer growth rate

From the expert staff of breast cancer research at the Robert W. Franz Cancer Research Center at Providence Portland Medical Center:

Like a lot of cancers, breast cancer grows by simple cell division. It begins as one malignant cell, which then divides and becomes two bad cells, which divide again and become four bad cells, and so on. Breast cancer has to divide 30 times before it can be felt. Up to the 28th cell division, neither you nor your doctor can detect it by hand.

With most breast cancers, each division takes one to two months, so by the time you can feel a cancerous lump, cancer has been in your body for two to five years. It can certainly seem like a lump appeared out of nowhere â€“ especially if you or your doctor have recently examined your breasts and not felt anything suspicious â€“ but in reality, cancer has simply doubled that one last time necessary to be noticeable. By the time you can feel it, a breast tumor is usually a little more than one-half inch in size â€“ about a third the size of a golf ball. It has also been in your body long enough to have had a chance to spread.

This sounds scary, but what it really underscores is the importance of regular mammograms. These screening tests can usually detect breast cancer when it’s about one-quarter inch in size or smaller – a year or more before it would be detectable by hand. Mammograms also make possible the early diagnosis of some pre-cancerous conditions and early-stage cancers that appear as tiny calcifications (microcalcifications) on mammography but aren’t detectable by physical examination.

It’s important to realize that there are two types of mammograms:

A screeningmammogram is performed in cases where there isn’t any known problem. This type of mammogram is used for annual exams.

A diagnostic mammogram is performed when there is a known problem that requires careful evaluation. Diagnostic mammograms provide much more extensive images than screening mammograms, such as views from additional angles and compression, or blow-up, views. Often an ultrasound will be done in addition to the mammogram if there is a palpable lump. Make sure you receive a diagnostic mammogram if you’ve found a lump.

Once a breast cancer gets big, every doubling is significant. If you find a lump, see your doctor as soon as possible. Don’t settle for just a mammogram if the mammogram doesn’t find anything. The next step should be a screening ultrasound, and if those results are indeterminate you need to get a biopsy. Ask your doctor for these tests if he or she doesn’t schedule them.

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How Do You Tell People That You Have Cancer?

Telling people that are close to me that I was diagnosed with breast cancer was a very personal and difficult decision. I am sure you are thinking that I am crazy for saying that and I would have agreed with you when I was first diagnosed, but I don’t agree now. Why wouldn’t a patient want to tell their family and friends? Or, what would make a cancer patient regret telling them? It will probably surprise you to know that I have spoken with some cancer patients that didn’t tell anyone, or that after the fact, they had wished that they hadn’t.

Family members, friends, and co-workers are never comfortable hearing that someone they know and care about has received a breast cancer diagnosis. It is a hard subject to discuss and every cancer patient knows that to some degree once they start telling people that they have cancer, the flood gates open with questions and in some cases blame. It is sad but true that sometimes out of fear, people are ignorant enough to ask a cancer patient what they “did or didn’t do to get cancer”. I can tell you that I was blaming myself early on. I was sure that it was my fault, that I had done something wrong and that is why I ended up with breast cancer. I know now that it was ignorant of me to blame myself. I didn’t do anything to cause my cancer, cancer chose me.

Sometimes people stay away because it is easy for them to assume that since someone they know was terribly sick during chemo, that you will be too; or someone they know did not survive breast cancer, so you won’t either. Understandably, they are afraid to be close to you because they think that you will die and it will hurt more if they step into the reality of your cancer so if they don’t talk to you, it isn’t real. I have found myself reminding people that I am still me, that every breast cancer patient’s experiences and outcomes are different, even if they have the exact same diagnosis. So many factors go into how a patient will respond to chemo and radiation treatments as well as undergoing multiple surgeries like most of us do, so it is impossible to predict what will happen. I am happy to say that I am doing well now that I am well over a year out from my diagnosis…I am a survivor!

I didn’t tell anyone right away because my husband and I were in shock and we needed to process what was going on. I also had my first biopsy to go through and I wanted to have the specifics of my breast cancer before sharing the information with anyone. Just a few weeks later once all of the test results were back, I told my family and close friends first through phone calls and private messages. As the news spread of my diagnosis, some people reached out to me immediately and others often times the people I wanted to talk to the most, stayed away from me, not knowing what to say. I can’t blame people for distancing themselves because I understand how hard it is to hear about the pain, endless doctors’ appointments, and everything else that I had to endure both physically and mentally for months on end. I also understand that people think that they would be bothering me or burdening me if they wanted to talk about things that they are going through, but if that is what they are thinking, they couldn’t be more mistaken. Right now, especially while I am laid off from work, I need my friends and family, I need to connect with people.

Being diagnosed with breast cancer has taught me that we never know what tomorrow will bring. Putting off spending time with the people that we care about and love should not be left until tomorrow, or next week or when we think we will have time because time is not on our side. {Yes, I know that the virus we are all dealing with is not helping bring us together, face to face, but there are other ways to communicate.} Sometimes the choices we make will only bring us to feelings of regret in the future, and sometimes it is too late to go back to the cherished moments we should have had with those that we love and value.

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