Oncologist Appointment on Monday June 20th

I was pretty wiped out when I got home from my appointment on Monday, so that’s why I am just now updating you. Each appointment is usually about 2 hours long, from checking in to leaving, and depending on how I am feeling on that particular day, it can take a lot out of me. Below is an explanation of what happened during those two hours. 

When I check in, I fill out a short form with my name, arrival time, if I have been recently hospitalized and if I have changed my insurance. I give the staff my name, birth date, and the short form. The staff person goes into a drawer and pulls a file with two more forms for me to fill out, hands me a clipboard, and they put a hospital bracelet on me. I sit in the waiting room, which is almost always pretty full, so about 16 to 18 people, both patients, and caregivers. The first form is a general form asking about any recent side effects, hospital stays, surgeries, medications, allergies, and what questions I have for my doctor. The second form is a suicide form with a few questions about self-harm and caregiver abuse. It is sad that such a form exists, but it is a reality for cancer patients, especially older patients. I fill out both forms, keep the forms with me and return the clipboard to the check-in area. This process is done every time I have an appointment.

Next, I am called back to the lab area, where I hand the tech my completed and signed forms. They weigh me, take my temperature, blood pressure, and oxygen. The tech then asks me about my pain level and if I am constipated, both common issues while undergoing cancer treatment. Last, the tech draws two vials of blood, puts them in the machine for processing, and walks me to the exam room. To give you an idea of how big this office is, there are eight doctors and twelve exam rooms.

Everything is very efficient, so I rarely have to wait longer than five minutes before my Oncologist’s PA comes in and hands me the results of my blood panels. I see his PA almost every time I have an appointment, and every other time I am there, I see both my Oncologist and his PA. On Monday, the PA said that everything looks good considering the treatment plan I am on. My white and red blood cell counts are a little low, but nothing to be overly concerned about. My ANC is low again but not too low, so hopefully, it will stabilize as I continue my treatment.

The last part of my appointment is when I go back to the chemo treatment room to get my injections. This is generally the longest part of my appointment because the medicine for my injections isn’t ordered from the pharmacy (which is in-house) until my Oncologist or PA has seen me and approved for me to get my injections, which is determined by my blood panel results. Once my nurse gets the injections from the pharmacy, she warms them because the medication is so thick, so this adds on extra time for me to wait, but it is an important step. Once the injections are sufficiently warmed, I am taken into “The Shot Room,” and I am given my injections which take several minutes due to the amount of medication. I mentioned on Monday that I have a lot less pain and discomfort after my injections if they massage the area after taking the needle out. By massaging the site of the injection, they help the medication disperse quicker. My nurse thanked me for letting her know that info and said she would pass the word on to the other nurses. Patients are often scared to speak up about even a minor issue, and it doesn’t need to be that way. I have learned to be very open no matter how embarrassed I might be because I know that after coming to see my oncologist and his staff for over three years, they want me to be open, honest, and, most importantly, not to suffer in silence if something is causing me issues. So please remember, you are your best advocate when it comes to our healthcare system!

So what is next? I started back on iBrance on Monday after having a much easier time on the lower dose. On July 11th, I will have my PET scan to check the size of my tumors. Hopefully, they will be smaller, which means that the medications are working. On July 18th, I will go back to my oncologist’s office for my monthly appointment and get the results of my PET scan. My husband will go with me on the 18th but not on the 11th. Unfortunately, I am used to PET scans now, so he does not need to go with me.

Take care, everyone!

Appointment With My Oncologist

When I had my appointment with my oncologist on August 5th, I was hoping that my red blood cell count would finally be in the normal range, but it isn’t quite there yet. I wasn’t too surprised as I have been tired lately and not feeling the greatest. At this point, nothing but time will help, so I am trying to be patient.

I am still having a lot of issues with my memory. It seems like only my short-term memory is being affected, but it is starting to drive me crazy. My oncologist asked me if I am still “fuzzy,” and I said that yes, I am still having issues. So, I am taking a week off Anastrozole to see if it helps clear my head or not.

Once I have my next appointment in December, I will finally be on a different schedule with my oncologist. I will switch from seeing him every three or four months to every six months. I am making progress, and it feels good!

Birthday Trip 2020

Mood: Exhausted 😴

A few weeks ago, my husband and I were finally able to get away and take our annual birthday trip. This particular trip had been rescheduled a few times due to my chemo treatments last year, and the resort we wanted to go to, not opening when scheduled due to the pandemic.

It wasn’t easy to travel internationally during the pandemic, but it was well worth it. We had to get a COVID test within ten days of arriving in Jamaica, and within three days of arriving, we had to go online, fill out a form for each of us, and send our COVID results in for approval. So, time was short, especially to get the test results back and sent in. We didn’t hear anything back after a little over a day, and we started to panic, so we called our travel agent to see if she could help. It just so happens that she has a contact at the Jamaica Tourist Board, so she got in touch with her, had us send some information to her via email, and we had our approvals the day before we were scheduled to leave by 6:30 am the next morning. Whew!!

I am not going to go over all of the details of our trip because this isn’t a travel blog; it’s a blog concerning everything related to and revolving around my breast cancer. So, something happened while on our trip, and to say that my reaction shocked me is an understatement.

A few days before we left, I let my husband know that I was not ready for the trip as far as my energy level was concerned. I had been battling fatigue, and I still am to this day, so I was concerned that the trip was going to wear on me far more than it did back when I was healthy. But I needed the break as I had recently been under a lot of stress, and it felt like everything I was dealing with was becoming far too much for me. We all have our breaking point, right? Well I was very much on edge, and I knew that I was headed for a mental breakdown if I didn’t get away to relax and destress. As it turns out, I was right; about halfway through our trip, I was already physically exhausted even though I kept my activity level much lower than I usually do while on vacation. But I powered through because we had some wonderful surprises during our trip that made everything we had to go through to get there, worth it!

So two amazing things happened during our trip! The first was getting to see and spend time with a few employees from the resort we were supposed to go to. Because the original resort didn’t open on time, there are several people from the entertainment department that are traveling around and performing at some of the resorts that are open in Jamaica. We have been friends with these amazingly talented people for years and years, and they are like family to us. We hadn’t been able to see any of them in two years, so I was super excited when I found out that they would be at the resort we were going to. So we had a family reunion of sorts, and we were able to have lunch together quite a few times and find a little bit of time to spend together on the nights they were at the resort to perform.

It was amazing to get to spend with our friends, and it made me so happy! But, at some point during the trip, I don’t remember precisely when, out of nowhere, I had a complete breakdown. Sadness suddenly overcame me, and at first, I didn’t understand why. I was embarrassed because an employee saw me start to cry and walk away from where we were seated, and she followed us out of concern for me. It was very kind of her to check on me, but I was overcome with grief and sadness, not a good moment for me, especially while on vacation in my favorite place in the world. I remember feeling like I did when I was diagnosed with breast cancer. I asked, “why did this have to happen to me? why me?” while crying my eyes out. It was painful because I remembered how things were two years ago when I saw my friends. Life was normal two years ago; life was good, or so I thought. The reality is that I already had breast cancer in September 2018, but I didn’t know I had it; there were no signs of it at that time. I eventually calmed down and enjoyed the rest of our trip, but my breakdown was a harsh reminder that it had not been that long since I found the first tumor and started down the long road of fighting cancer.

Our friends & family in Jamaica

The second amazing thing that happened was getting to see two more of our friends from the scuba diving department. My husband is a Master Diver, and a considerable part of our trips involve him diving twice a day, every day. As with our friends from the entertainment department, we have known most of the dive crew at our favorite resort for years, so they are also like family. My husband received a curious message from a friend the day we arrived in Jamaica, and we didn’t understand what he meant until a few days later when he arrived at the resort to dive with my husband! It was an incredible surprise to see our friend and find out that he was staying for the week to dive specifically with my husband. Our friend lives in Ocho Rios, where our favorite resort is located, and that is one and a half hours from where we were. The next day our friend’s boss arrived at the resort and had lunch with us! So we had another friend of ours came to see us, and that was another wonderful surprise! It was great to see my husband so happy and enjoying his week with a dear friend and having a few surprises along the way; it absolutely made his trip!

All in all, we had a wonderful trip, and it was great to get away and relax somewhere besides home. The next time we can travel and see some of the people we love, I will not be surprised if I have the same reaction; in fact, I will be expecting it. I am human, after all, and I have a very different outlook on life after everything I have been through.

Cherish your family and friends, and stop taking people for granted because someday, they might not be there anymore.

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.

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! 😊

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 – especially if you or your doctor have recently examined your breasts and not felt anything suspicious – 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 – 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:

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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