Our Life With Breast Cancer

Future of Personalized Cancer Care Is Promising and Near

2011-04-26T11:42:00.000-05:00

Newswise — BIRMINGHAM, Ala. – Cancer survival rates could improve soon with whole-genome sequencing, according to two studies published in the April 20, 2011, issue of the Journal of the American Medical Association that describe the first clinical applications of the high-tech process in patients with cancer.

The papers are remarkable examples of the power that genomic data hold for patients with a cancer diagnosis, according to an accompanying editorial by Boris Pasche, M.D., deputy director of the University of Alabama at Birmingham Comprehensive Cancer Center and professor of medicine, and Devin Absher, Ph.D., of the HudsonAlpha Institute for Biotechnology.

Whole-genome sequencing is a high-tech process that essentially maps a person’s DNA and analyzes it for mutations. This has enabled cancer therapies to evolve from a standard therapy for all patients with a given type of cancer to a slightly more personalized treatment.

“Whole-genome sequencing gives us the ability to screen a much larger number of tumors and correlate them with the outcome of the patient, so it is very likely that our targeted therapy is going to be exploding in the next decade,” Pasche says.

Half of all men and one-third of all women in the United States will develop cancer during their lifetimes, according to the American Cancer Society; and few, if any, do not know someone who has had cancer or died because of it. This new advance could change that.

“In one study, a patient with leukemia had a poor prognosis, but through sequencing, this patient was found to have a gene that showed they would react favorably with a different therapy than originally recommended,” Pasche says. “If patients have certain genes, they may not respond to certain treatments. But whole-genome sequencing gives a full picture of the genetic make-up of the tumor and the patient, and it may allow the physician to target a new treatment.”

Pasche says the unbiased picture of the sequenced DNA enables physicians to look at tumors in a way not possible previously. Even when the technology finally was available, it was too expensive. Now, the cost to sequence a patient’s entire genome and the genome of their tumor is down by more than 100 fold, but still ranges from $30,000 to $40,000.

“Prices are still dropping very rapidly; in the next 10 years, it will cost less than $10,000, and it certainly will be more affordable in the next five years,” says Pasche, who believes having sequencing covered by insurance or otherwise is a work in progress.

At UAB, Pasche says whole-genome sequencing is being used in many projects, most notably in a clinical trial for women with triple-negative breast cancer.

“There is a high degree of expectation with whole-genome sequencing,” he says. “The hope is that it will help survival rates of those with cancer.”

About the UAB Comprehensive Cancer Center
The UAB Comprehensive Cancer Center is among the 40 cancer centers in the nation to meet the stringent criteria for the National Cancer Institute's comprehensive designation. The center is a leader in groundbreaking research, reducing cancer disparities and leading-edge patient care.

EDITOR’S NOTE: The University of Alabama at Birmingham (UAB) is a separate, independent institution from the University of Alabama, which is located in Tuscaloosa. Please use University of Alabama at Birmingham on first reference and UAB on all consecutive references.

http://www.newswise.com/articles/future-of-personalized-cancer-care-is-promising-and-near

Scientists Decoded DNA of 50 Breast Cancer Patients

2011-04-26T11:17:00.000-05:00

St. Louis, MO (Scicasts) - Scientists at Washington University School of Medicine in St. Louis have sequenced the whole genomes of tumors from 50 breast cancer patients and compared them to the matched DNA of the same patients' healthy cells. This is the single largest cancer genomics investigation reported to date, the university claims, and has allowed researchers to find mutations that only occurred in the cancer cells through this comparison process.

The above Circos plot is a visual representation of the genomic disruptions in one of the breast cancers studied. Image by: Matthew J. Ellis, MD, PhD.

This research was presented at the American Association for Cancer Research 102nd Annual Meeting 2011. According to the press report, the researchers uncovered incredible complexity in the cancer genomes, but also uncovered a glimpse of new routes toward personalized medicine.

In all, the tumors had more than 1,700 mutations, most of which were unique to the individual, said Matthew J. Ellis, MD, PhD, professor of medicine at Washington University School of Medicine in St. Louis and a lead investigator on the project. "Cancer genomes are extraordinarily complicated," Ellis continued. "This explains our difficulty in predicting outcomes and finding new treatments."

To undertake the massive task, Washington University oncologists and pathologists at the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine collaborated with the university's Genome Institute to sequence over 10 trillion chemical bases of DNA — repeating the sequencing of each patient's tumor and healthy DNA about 30 times to ensure accurate data.

"The computing facilities required to analyze this amount of data are similar in scale to those of the Large Hadron Collider, used to understand the workings of sub-atomic particles," said Ellis.

The DNA samples came from patients enrolled in a clinical trial that Ellis is leading for the American College of Surgeons Oncology Group. All patients in the trial had what is called estrogen-receptor-positive breast cancer. These cancer cells have receptors that bind to the hormone estrogen and help the tumors grow.

To slow tumor growth and make the tumors easier to remove, patients received estrogen-lowering drugs before surgery. But, for unknown reasons, this treatment does not always work. Twenty-four of the 50 tumor samples came from patients whose tumors were resistant to this treatment, and 26 came from patients whose tumors responded. Comparing the two groups might help explain why some estrogen-receptor-positive breast cancer patients do well with estrogen-lowering drugs, while others do poorly.

Confirming previous work, Ellis and colleagues found that two mutations were relatively common in many of the patients' cancers. One called PIK3CA is present in about 40 percent of breast cancers that express receptors for estrogen. Another called TP53 is present in about 20 percent.

Adding to this short list of common mutations, the researchers found a third, MAP3K1, that controls programmed cell death and is disabled in about 10 percent of estrogen-receptor-positive breast cancers. The mutated gene allows cells that should die to continue living. Only two other genes, ATR and MYST3, harbored mutations that recurred at a similar frequency as MAP3K1 and were statistically significant.

"To get through this experiment and find only three additional gene mutations at the 10 percent recurrence level was a bit of a shock," Ellis explained.

In addition, the team found 21 genes that were also significantly mutated, but at much lower rates — never appearing in more than two or three patients. Despite the relative rarity of these mutations, Ellis stresses their importance.

"Breast cancer is so common that mutations that recur at a 5 percent frequency level still involve many thousands of women," he said.

Ellis points out that some mutations that are rare in breast cancer may be common in other cancers and already have drugs designed to treat them.

"You may find the rare breast cancer patient whose tumor has a mutation that's more commonly found in leukemia, for example. So you might give that breast cancer patient a leukemia drug," Ellis explained.

But such treatment is only possible when the cancer's genetics are known in advance. Ideally, according to Ellis, the goal is to design treatments by sequencing the tumor genome when the cancer is first diagnosed.

"We get good therapeutic ideas from the genomic information," he said. "The near-term goal is to use information on whole genome sequencing to guide a personalized approach to the patient's treatment."

This work builds on previous collaborations between Washington University oncologists and the Genome Institute. In a study published last year in Nature, they reported the complete tumor and normal DNA sequences of a woman with "triple-negative" breast cancer, a particularly aggressive type that is difficult to treat and more common in younger women and African-Americans.

While many mutations are rare or even unique to one patient, Ellis highlighted that quite a few can be classified on the basis of common biological effects and therefore could be considered together for a particular therapeutic approach.

Ellis looks to future work to help make sense of breast cancer's complexity. But these highly detailed genome maps are an important first step. "At least we're reaching the limits of the complexity of the problem," he said. "It's not like looking into a telescope and wondering how far the universe goes. Ultimately, the universe of breast cancer is restricted by the size of the human genome."

http://scicasts.com/bioit/1844-bioinformatics/3584-scientists-decoded-dna-of-50-breast-cancer-patients

Scientists Find Promising Breast Cancer Therapy

2011-04-24T20:48:00.001-05:00

A new combination of drug therapies may prove effective in treating triple-negative breast cancer in human patients, according to a recent study published by researchers at Harvard Medical School and Baylor College of Medicine.

Triple-negative breast cancer is one of three classes of breast cancers and the only one that currently has no readily accessible treatment, said HMS Professor Stephen J. Elledge, the principle investigator for the Harvard lab.

The only treatment option for patients with these tumors is chemotherapy, and the median survival rate for such patients is very low.

The research sought to identify classes of molecules that, when down regulated, cause a cell to gain cancerous properties.

The study, which was published last month in the journal Cell, reported that the absence of a tyrosine phosphatase enzyme called PTPN12 caused human mammary cells to gain cancer-like properties in vitro.

The researchers separately found that PTPN12 was inactive in more than 50 percent of the triple-negative breast cancers tested, showing that the enzyme plays a significant role in this class of breast cancer, Elledge said.

Thomas F. Westbrook, a former postdoctoral fellow in Elledge’s Harvard lab and currently leading the research group at Baylor, discovered the PTPN12 enzyme while still at Harvard.

That enzyme is known to deactivate another group of enzymes called receptor tyrosine kinases that are responsible for cell growth.

So when PTPN12 is inactivated, cells are free to grow and divide rapidly, like cancer cells.

The research group identified three tyrosine kinases that are specifically regulated by PTPN12. These results indicated that the misregulation of these three enzymes could be a leading cause of triple-negative breast cancer, according to the study.

“If we figure out how to inhibit different kinases together, we might be able to treat this disease,” said Elledge.

The researchers tested in mice a combination of two FDA-approved, on-the-market drugs that are already used to treat other cancers and that inhibit the desired kinases. One drug, Tykerb, is known to inhibit two of the enzymes, and another, Sutent, is known to inhibit the third.

The study found that tumors in mice that were treated with a combination of both drugs shrank by more than 90 percent, and life expectancy for these mice more than doubled.

The researchers are now in the process of negotiating with drug companies to design a Phase II clinical trial that will test the new therapy in humans.

Ellidge said, “It may take two to three years to set up a clinical trial and get results, and then we can determine whether there will be a therapy.”

Ellidge said that while the research group has identified some of the kinases that are activated in triple-negative breast cancer, there is still more research to be done in order to understand the disease mechanisms completely.

http://www.thecrimson.com/article/2011/4/8/breast-cancer-ptpn12-research/

New peptide could be effective treatment for triple negative breast cancer

2011-03-02T11:29:00.001-06:00

New peptide could be effective treatment for triple negative breast cancer

Using a mouse model of triple negative breast cancer, they tested the new leptin receptor antagonist peptide and compared it to conventional chemotherapy. The leptin receptor antagonist peptide extended the average survival time by 80 percent, compared to 21 percent for chemotherapy. The peptide was found to be non-toxic even up to the highest dose administered, said Sumacz.

The Disappearing Spoon

2011-02-01T17:32:00.004-06:00

For me, high school chemistry was all about bunsen burner hi-jinx and natural gas flame throwers. I honestly cannot remember a single learning moment from Mrs. Brownstein's 10th grade chemistry class and a solid D on my high school transcript is reflective of that. High school physics was even less appealing...theory without the fun of blowing up shit. College chemistry followed suit and was only a means to an end. Three semesters of physics on the other hand, although somewhat more enjoyable, had the unenviable position of being a Friday 8am class, an equal and opposite reaction to my Thursday night pre-weekend binge drinking. My father, who received his doctorate in chemistry from the University of Birmingham a decade before I was born not only failed to pass along the affinity for chemistry but also any trace of academic acumen. That being said, he was quite fond of pointing out that the pretzels I was eating were made with lye, the same stuff in drain cleaner, the bread I was eating was legally allowed to have 10 insect thoraxes per loaf, and the 7 different layers of plastic needed to make a 2L soda bottle (I think he still has the original prototype bottle in the crawlspace from the late 70s)...tidbits of trivia I pass along to my kids.

So why then, almost 20 years out of college, would you find a printout of the periodic table on my desk this week and an electronic version on my phone? Last week I finished The Greatest Show on Earth: The Evidence for Evolution by Richard Dawkins. Whether it be a mid-life crisis, a reaction to our cancer fight, or some other reason, I began to question my own beliefs. Dawkins' book was one step in reaffirming them but it did leave a hole. Among other things, it delves as deep as DNA, proteins, enzymes, and amino acids but stops short of explaining the genetic code, the transcription process, and why molecules behave the way they do at the atomic level. Dawkins did a fantastic job expaining his assertions in all other areas of the book but I was, probably out of my sheer ignorance of basic chemistry, left wanting more. With that, I went looking for a book on chemistry.

Needless to say, textbooks, acedemia and I don't gel too well. I need some narrative and backstory with my facts. I need it delivered in entertaining, sugary, bite-sized chunks. I'm sure everyone can recall a certain teacher who made the process of learning a real joy. Someone who didn't teach from a textbook but taught from their experiences and love of the subject. Such is a book called "The Disappearing Spoon" by Sam Kean. Fascinating stories of the atrocities of war-time gases, and the people behind them. Petty personal rivalries. The battle between silicon and germanium for our electronic hearts. We all know about Marie Curie but none of us know about the 16 year kid who attempted to build a nuclear reactor in his garden shed. Cadmium, thallium, and mercury poisonings, oh my! Along the way, you learn about protons, neutrons, electrons, shells, valences, spin, isotopes, radioactive decay, and a whole lot more. Information that, in high school or college, likely went in one ear and out the other.

I'm only halfway through the book but am thoroughly engaged and impressed. I am a little closer to understanding nuclear medicine (there is no doubt we fret over its results every 3 months) and a little closer to understanding the cancer that has been a part of our life for 3 years.

Triple Negative Breast Cancer makes the front page in the Austin-American Statesman

2011-01-24T11:49:00.001-06:00

Great news from our local network of doctors.

Austin American Statesman article

"This is the most compelling development in breast cancer in the last five years," she said. "I had a patient come here from Puerto Rico to get access to this trial."

"Breast cancer experts not connected to the study greeted the results with excitement mixed with caution. For a cancer that is difficult to treat, iniparib shows great potential — provided the results are confirmed by the final, phase 3 trial, they said. Patients are still in that trial, and results will be out later this year, Patt said.

Breast Cancer News

2011-01-20T01:06:00.000-06:00

Trio of Drugs May Combat 'Triple Negative' Breast Cancer

In the new study, Johns Hopkins scientists began with a drug called Entinostat, which blocks an enzyme that unfolds DNA, providing regulatory molecules access to genes within and also reactivates a gene called retinoic acid receptor-beta (RARβ). Then, they added a drug called All Trans Retinoic Acid (ATRA), related to Vitamin A, which binds a protein made by the reactivated RARβ gene. Together, the ATRA drug and RARβ gene act as a brake on cancer cell growth.

Sporadic Breast Cancers Start With Ineffective DNA Repair Systems

Ultraviolet light, for example, can cause mutations, but a sophisticated system of nucleotide excision repair (NER) proteins trolls the DNA strands to identify problems and initiate repair processes. The same system repairs damage caused by many environmental carcinogens, including tobacco smoke.

"Even in healthy breast tissue, this system is only about one-fifth as effective as it is in skin,"

Potential New Target for Treating Triple Negative Breast Cancer Identified

Now researchers in Dublin (Ireland) have found that TNBC cells respond to compounds that disrupt the signalling processes of another receptor, EGFR (epidermal growth factor receptor), high levels of which are expressed in TNBC

All The Small Things

2011-01-01T13:05:00.002-06:00

We once again enter the new year with a clean bill of health *knocks on wood*.

Although it wasn't what we expected, we got some good news at the tail end of 2010. After a trip to Johns Hopkins in Maryland, the cancerous ovary turned out to be clear cell, not the non-invasive borderline we had hoped for. The good news is that the tumor was microscopically small. So small in fact that they could count the individual cells. So small in fact that a dissection of the biopsy 1mm to the left or right would have missed the tumor. So small in fact that no one has ever seen a clear cell tumor at such an early stage. So small in fact that there is very little chance that the tumor had spread anywhere. So small in fact that the removal of the tumor alone is all the therapy Linda will require.

A complete PET and CT scan from head-to-toe confirmed what we had prayed for.

On December 13th, we also passed the 3 year mark which is a huge milestone, especially for TNBC survivors.

With that, as folks have dreams and aspirations for bigger and better in the new year, we welcome 2011 and will continue to appreciate the small things.

Merry Christmas

2010-12-19T13:15:00.003-06:00

Yesterday, we enjoyed a perfect holiday Saturday. We woke up late, searched out and found a gluten-free wing joint, went to the movies and saw Tangled, came home to hot chocolate by the fireplace and decorated the Christmas tree.

When I prayed to my God to help get us through the past 3 years, it was a day just like yesterday that I asked for. I am ever grateful for the life that I enjoy and ever aware of how fragile it can be.

May the warmth of the season bless your home and you have the opportunity to spend it with those you love.

Merry Christmas,
John

Third Time Is A Charm

2010-11-10T15:11:00.000-06:00

In families with a long history of breast cancer, there commonly exists an inherited genetic mutation which increase a person's susceptibility to breast and ovarian cancers. These are known as the BRCA1 and BRCA2 genes. From my layman's point of view, these genes are responsible for ensuring that there are no defects in a cell's DNA after that cell divides. If there is, these genes commit cell suicide and thereby prevent it from replicating the damaged DNA further. In people with defects in the BRCA1 or BRCA2 gene, this tumor suppressive behavior is damaged and that allows for the unregulated growth of cells, which is how you would characterize cancer.

Not long after Linda was diagnosed with breast cancer, she was tested for the BRCA1 and BRCA2 mutations and it came back negative. It was a huge relief not only for her but also for our daughter who would likely have inherited this trait also. Had it come back positive, a bilateral mastectomy and complete hysterectomy, along with chemo and radiation, would have been the proper course of therapy to minimize her risk of recurrence.

In the absence of the BRCA defects, and the initial IIB staging, our course was neo-adjuvant chemo, a lumpectomy, more chemo and radiation w/ chemo. However, when the cancer came back a second time in the summer of 2009, a full bilateral mastectomy was the right path to take. At the time, due to the nature of the 2nd cancer, Linda's oncologist suggested that something "odd" was going on in Linda's body which was forming these tumors. Although she was BRCA negative, there may be some other gene defect that science has yet to discover causing the cancer. She suggested that Linda think about a hysterectomy to reduce her risk of ovarian cancer which is closely associated with BRCA+ breast cancers.

Never being one to shy away from a fight, Linda decided to have a hysterectomy in October of this year. We were happy with our allotment of progeny and the baby factory had long since shut down after her first chemo so this decision was purely a prophylactic measure to remove the parts where this cancer could grow.

Two weeks after surgery, on Oct 16th, while enjoying our Saturday morning coffee in bed, we received a call from Linda's ob/gyn surgeon. They found a 2mm cancer in her right ovary. She said Linda must have someone looking out for her because by the time they usually find ovarian cancer, it is too late. Her decision to have the hysterectomy may indeed be the best decision she's ever made (aside from her decision to mate with me of course). Dr M. hooked us up with the city's top ob/gyn oncologist to discuss our next steps and set the appointment for early November.

We met with Dr. T yesterday. The first thing we learned was that this cancer wasn't a metastasis of the breast cancer. Over the intervening 3 weeks, the thought of a Stage IV breast cancer metastasis literally kept me up at night, so it was a relief to hear that. The second thing we learned was that they almost never see ovarian cancers at this early stage. It was so early in fact that they have had a hard time figuring out what kind of cancer cells these are. The initial pathology has identified them as both "border-line" and "clear cell", which according to the oncologist doesn't make sense. They are either/or, but rarely ever both. He has sent the tissue to Baltimore for a second opinion. From our 1 hour long meeting, we learned that "border-line" ovarian cancers are non-invasive whereas "clear cell" cancers are high-grade and aggressive. He believes that the second pathology will come back as "border-line" but can't make a final diagnosis until he gets the results back in 2 weeks. He also believes that even if it is "clear cell", we caught it early enough that it hadn't had a chance to, as he put it, "sprinkle its seeds around the abdomen like a dandelion". In either case, he doesn't think chemo is in our future, unless it comes back as "clear cell" which may introduce that option.

So we sit here and wait to see what our future holds. We have beat cancer twice before, and with Linda's courage and your thoughts and prayers, I have no doubt we will beat it again for a third time.

Thank You

2010-08-03T14:36:00.002-05:00

After more than 2 years of writing about our life, I think the time has come to close the electronic cover of my blog. In a world where a video of someone getting smacked in the nuts gets 3 million hits, my blog's 5,000 visitors seems tiny but it has made a huge difference for me. Hopefully I have helped some people, made others laugh, and made others think. It has been a great outlet for me and I've made some friends along the way and reacquainted with others. Linda has just finished the final touches of her reconstruction and the results are incredible. We have some preventative surgeries in our future but outside that, I am anxious to take what we have learned and move on to the next chapter of our lives. We are not the same people we were on Dec 12 2007 and, for the most part, that is a good thing. It took a while, but I found my God living in my heart where it had always been. You won't read about my God in a book nor hear about my God on the TV and even if I tried, I couldn't explain my God to you. It's all good :)

From the bottom of my heart, I thank you for spending the last 2 years with me online and in my heart.

God Bless,
John

Summer, uninterrupted

2010-06-29T11:04:00.000-05:00

It was July 3rd last year when we learned that the cancer was back. 4 days shy of that anniversary, we learned today that Linda's semi annual scans all came back normal. Hold on a sec...there is no such thing as "normal" when talking about recurrent breast cancer scans. There is "super shitty" and "friggin awesome".

I do declare June 29th to be Friggin' Awesome Day!

Thanks for all your support. You are friggin awesome!

Do the right thing

2010-05-27T12:52:00.001-05:00

The drive-thru at McDonalds was too long this morning so I decided to pull in and order in the lobby. On my way there, I found a $5 bill wrapped in a $20 in the parking lot. I looked around, picked it up and slid it into my pocket. Sweet! As the guy in front of me started to order, he began searching his pockets for 'something'. He told the cashier to wait and ran out to his car to get his wallet and returned to pay for his meal. While we waited for our breakfasts, I asked him if he had lost something outside. In a thick Eastern European accent he said 'I zink I lost twenty-fi dolla'. I reached into my cargo pocket, grabbed the fold of bills between my index and middle fingers and extended it out to him. 'Zank you wery much' he said.

Man that felt great!

So my question is...why the hell did I do that? Don't get me wrong, I'm glad I did, but why? Was it a completely selfish act knowing that it would 'feel better' to return the money than keep it?

Part of my left brain says it is a simple biological event engineered to release a cocktail of endorphins and dopamine that 'feels good'. Over 4 billion years of fine-tuning, evolution has preferred variants/decisions that lead to the preservation of the species and it is that 'wiring' that makes us know what is the 'right' thing to do, because we are rewarded with 'feel good' drugs. Caveman want food, caveman steal food, caveman beat on head with club for stealing food, end of line for caveman (and his potential offspring). I think even Laplace's demon would have a hard time correlating 4 billion years of events with my McDonalds moment.

The other part of my left brain says this is environmental conditioning. 40+ years of personal interaction and societal influences (which themselves have been fine tuned over 10,000 years of civilization) yielded that moment in McDonalds. The meaning of right at that particular moment was a personal one. Someone else may believe the right thing to do is to keep the money. Are right and wrong just shaped personal biases? I hope R v. W is something bigger than that.

My right brain, which has been getting a lot of attention lately, is more confused than the left side but luckily doesn't require the same level of clarity than the left side does to operate properly, nor does it need to adhere to the scientific method, but I suppose that is why we have 2 halves (evolved or otherwise). Good vs evil, right vs wrong, Nacho vs Cool Ranch. Epic questions...none of which was answered in the LOST finale :)

It has taken me 40 years to find Hope, at least I think I found it. Perhaps it will take another 40 years to find Faith and for me, I suspect right and wrong will play a big part of that.

Anyhow back to my McDonalds moment...as I'm driving out of the parking lot in my hail damaged 7 year old VW Jetta, I look in my rear-view to see the guy getting into his late model 7 series BMW. I had to laugh :)

It's All Relative

2010-05-16T10:00:00.002-05:00

Linda: Daddy can install the light fixture when we get home.
Daughter: But Daddy cut his finger on the hedge trimmer. He's laying down.
Linda: I just had my nipples sewn on and I was doing laundry the next day. He can suck it up.

How can I argue with that? I can never be sick again....*sigh*

Fallen Soldier

2010-04-16T12:31:00.004-05:00

Linda just called to tell me we lost another Pink Ribbon Cowgirl today. She was 29.

Linda seems fine, however I am hiding out in my office waiting for my eyes to dry. This shit is fucked up.

829 Days

2010-03-21T19:25:00.000-05:00

It has been 829 days since Linda was diagnosed with breast cancer. Since then, I have shared 829 sunrises with her and 829 sunsets. We have tucked our kids in 829 times and told them we love them (at least) 829 times. I am thankful for every day I get to spend with her. I have stopped asking why and simply accept the gift that is given to us every morning. Tomorrow will be 830 and I will treat the day with the reverence it deserves.

The Wonder Drug: Not Just For Hangovers Anymore

2010-02-16T21:28:00.005-06:00

Incredible news, and applicable to TNBC, which in previous studies wasn't proven.

...It affected both estrogen-positive tumors and those not fueled by the hormone...

Aspirin cuts death risk after breast cancer

Large study of nurses showed 50 percent lower risk cancer would spread

WASHINGTON - Breast cancer survivors who take aspirin regularly may be less likely to die or have their cancer return, U.S. researchers reported Tuesday.

The study of more than 4,000 nurses showed that those who took aspirin — usually to prevent heart disease — had a 50 percent lower risk of dying from breast cancer and a 50 percent lower risk that the cancer would spread.

"This is the first study to find that aspirin can significantly reduce the risk of cancer spread and death for women who have been treated for early stage breast cancer, " said Dr. Michelle Holmes of Harvard Medical School, who led the study published in the Journal of Clinical Oncology.

"If these findings are confirmed in other clinical trials, taking aspirin may become another simple, low-cost and relatively safe tool to help women with breast cancer live longer, healthier lives," Holmes added in a statement.

Holmes and her team studied 4,164 female registered nurses taking part in the Nurses' Health Study, an ongoing analysis of a wide range of health issues.

They started in 1976, looking at who took aspirin, watching for breast cancer and all causes of death until 2006.

Over this time, 341 of the nurses died of breast cancer.

Women who took aspirin two to five days a week had a 60 percent reduced risk of their cancer spreading and a 71 percent lower risk of breast cancer death. Six to seven aspirins a week lowered the risk of spread by 43 percent and the risk of breast cancer death by 64 percent.

Most of the women were taking low-dose aspirin to prevent heart attacks and stroke.

Ibuprofen and naproxen appear to lower risk too

Other drugs in the same class as aspirin also apparently lowered the risks, too. These drugs, called non-steroidal inflammatory drugs or NSAIDs, include ibuprofen and naproxen but not acetaminophen, also known as paracetamol.

But there was not enough data on these drugs to give a clear answer.

The researchers said they are not sure how aspirin and other NSAIDS may affect tumors but it could be by lowering inflammation. Other studies have shown that aspirin and ibuprofen can lower colon cancer risk, for instance.

"Aspirin has relatively benign adverse effects compared with cancer chemotherapeutic drugs and may also prevent colon cancer, cardiovascular disease, and stroke," the researchers wrote. It affected both estrogen-positive tumors and those not fueled by the hormone.

Holmes' team stressed that patients should not take aspirin while undergoing radiation or chemotherapy because of the risk of side effects.

And aspirin can cause stomach bleeding so it should not be taken without a doctor's supervision.

http://www.msnbc.msn.com/id/35426947/ns/health-cancer/

Nothing to report

2010-02-05T09:23:00.000-06:00

All is going as planned, no complications at all. Aside from some minor fix-up tweaks, the results are great. We are eager to get going on a running/exercise plan once we are given the go ahead and Linda feels up to it.

This central Texas winter has been extraordinarily long and cold (by Texas standards) and we are anxiously waiting for spring/summer to arrive. Life is good and it is full speed ahead :)

The Null Process

2010-01-21T12:18:00.004-06:00

If you've spent any time around a PC, at some point you've come across the Task Manager. The Task Manager tells you what processes are running on your computer.

You will probably also have noticed a process called the "System Idle Process" which seems to take up an inordinate amount of processing cycles. The truth is, most modern computers and operating systems *have* to be doing something all the time. When they have nothing to do, they do the "System Idle Process".

Your brain is pretty much the same. I call it the 'null process'. When you are not thinking or processing the task at hand, your brain reverts to the null process. If you were to come by office at around 4:30 in the afternoon, and I'm staring at my desk with a line of spit running from my chin to the keyboard, that would be the null process in action.

Everyone has different null processes and in all likelihood they have changed over time. At age 12 my null process changed from thinking about cartoons, comics, and Star Wars to thinking about other things that occupy a young man's mind...

Actually from age 12 to 25, thinking of vaginas and related accessories (butts, boobs, etc) was pretty much a foreground process the whole time. At 25, I married my favorite vagi...errr...Linda and the null processes started to lean towards family and career. How do we get ahead? Is this the right move? Should we have kids? Should we have more kids? How do we make more money? Getting started is pretty tough, so the majority of the early years were directed toward my career.

Then, around 35, after establishing myself in my career, I started to realize that we were not only supposed to raise kids, we were supposed to raise 'good' kids. That required a shift in priorities and my null processes started to flip-flop

and, I think you know where this is going. On Decemeber 13, 2007, my process table changed forever

and that's how it stayed for all of 2008. When all you do 24x7 is think about cancer, your mind tends to take you to some pretty dark places. What's worse, at least in my case, is there was no outlet. As the caregiver, I couldn't very well burden the caregivee with what I was dealing with. That's when I started writing about it. Sure I was still thinking about it *all* the time, but instead of letting my null process take me to those places where my fears and insecurities live, I instead focused on telling our story and hopefully injecting some much needed humor along the way.

I think 2009 was our way of coping with 2008. Our stated goal for 2009 was to have as much fun as possible and to make up for 2008. We surely did, and I have the scars to prove it! Subconsciously, or maybe consciously, I believe the unstated goal was to keep the null process at bay. If you are busy doing other stuff, the null process never gets a chance to run. When the cancer came back in July, we really overclocked ourselves, far beyond the manufacturer's (and definitely the credit card company's) recommended settings. It really was all cancer, all fun, all the time.

and then, just this past weekend, an interesting thing happened.

It wasn't a huge event, but enough so that I noticed. I think that is a pretty healthy sign.

My stated goal for 2010 is to devote some active and null processes to my career, which has definitely been a background process for the past 2 years. Thankfully, I have had more support from my company than anyone could ask for. 2010 calls for a healthy mix of family, fun and career, and who knows, if I play my cards right...

Breast Reconstruction with Implants

2010-01-15T17:13:00.002-06:00

I found this video on Youtube which is similar to Linda's phase II procedure

Post-op update

2010-01-15T12:16:00.002-06:00

The procedure was a complete success. The operation was about 1.5 hours long and after 24 hours, Linda is already off her pain meds and puttering around the house. Incredible!

Thanks for all the words of encouragement. As you can see in this pre-op photo from yesterday, with her great attitude, it is easy for me to support her in this journey.

Boobaliscious

2010-01-13T17:45:00.000-06:00

Tomorrow is a big day.

Surgically speaking, compared to the mastectomy, this will be a walk in the park. It is an outpatient procedure and Linda will be home tomorrow evening. Recovery is measured in days, as opposed to weeks.

Psychologically speaking, tomorrow is a pretty big milestone and a very important part of Linda's healing, and mine too. Of course she knows I'd love her if she had no boobs or 3 boobs, but having the twins back (even if they are adopted) is a big deal.

Wish us luck!

(I hope this goes without saying, but I'm going to say it anyways. Linda and I tackle most things in life with a smile and a sense of humor. It helps accentuate the highs and take the edge off the lows. I can't imagine doing it any other way. Please don't interpret my sometimes off-color posts as anything less than complete respect for those women and families that have walked in our shoes)

All clear, Happy New Year!

2009-12-28T16:16:00.001-06:00

Thank you for your prayers,

John & Linda

Merry bone scan and a happy CAT too

2009-12-27T21:19:00.003-06:00

Monday is scan day as we try to squeeze in under 2009 deductibles. I thought these were supposed to get easier as time went on, but they seem to be getting harder.

Please send your prayers, positive thoughts, whatever you've got. Let's start 2010 with a clean bill of health!

L@@K - 2 Foobies - NIB - W@W

2009-12-16T17:21:00.000-06:00

Everything is coming along nicely. We stopped in to see the surgeon yesterday and make sure everything is on track. It is. We have an appointment in early January to have the final implants put in.

During every visit to the office, I would always look over at the various sample implants stacked over on the counter. Sometimes I would get up and play with them (I don't think 'fondle' is the right word here). I just figured Linda would be getting a pair of those. So, yesterday, as we discussed everything with the surgeon, he handed me one. When I said "So Linda is going to be getting some just like this?" he kind of chuckled. He said "No, that's the 300ml size. Go grab one of those big ones off the shelf, the 400ml ones". I did. I was liking where this was going. "Now add that to the 300ml one you have in your other hand. That's 700ml. That about right.". Shwing!

Did you know each foobie has a serial number? I guess they use it for recalls and such. Recently however, much to the dismay of her husband, they were used to identify the remains of a missing person. Linda said "There, you can't murder me now". I told her the implants wouldn't survive the wood-chipper.

Pink Glove Dance

2009-12-05T15:09:00.002-06:00

More TNBC News...

2009-11-30T16:22:00.000-06:00

Metformin demonstrates ability to kill cancer stem cells in mice

A positive turn of events for a "negative" tumor

Report Highlights Cancer Advances

University Hospitals begins trial to test vaccine for triple negative breast cancer

Turmeric component curcumin inhibits breast cancer cell proliferation

A Day In The Life

2009-11-23T10:54:00.000-06:00

Telemarketer: Ma'am, I'm calling you today to raise money to help pay for mammograms for women who can't afford them.

Linda: Yes, I donated $xxx.00 a few months back and since then, you've called me *every* week for another donation.

Telemarketer: Yes ma'am. We have 3 levels of donations. $200, $100 and $75. How much can we count on you for today ma'am?

Linda: I donated my 2 boobs to breast cancer. Is that not enough?

Telemarketer: *silence*...how about $50?

Linda: Put me on your DO NOT CALL list!

Telemarketer: *click*

Ding! You are now free to play your cancer card

2009-11-19T14:57:00.008-06:00

Linda's original cancer was staged as "locally advanced". This meant that the cancer had advanced past the breast tissue and had spread to the lymph nodes under her left arm, but not beyond. In treating the cancer, 19 lymph nodes were removed from that side for diagnostic and preventative reasons and the rest of the lymph nodes were irradiated. This left her with a less-than-perfect lymphatic system on her upper left side. I like to think of lymph nodes as gatekeepers which prevent infections from spreading throughout the body and keep them localized. In addition to being extra cautious and trying to avoid injuries (burns, cuts, bruises) on her left arm, we need also be aware of lymphedema.

Lymphedema is a condition where, due to blockages or deficiencies in the lymph nodes, the body can not properly drain lymphatic fluid to/from the affected body part. This can lead to pain and swelling in the limb and once it occurs, it has a tendency to become a chronic condition. It is definitely something we want to avoid. To date, Linda has had no symptoms *knocks on wood* of lymphedema but we are always weary of the potential. Such a case arose on our recent trip to San Francisco. In flight cabin pressure changes affects our bodies in odd ways and one of those is a movement of fluids to/from the extremities. With Linda's compromised lymph nodes, it was suggested that she wear a compression sleeve and glove to minimize that flow of fluids in her arm. She was fitted for both and we were ready to fly...almost. Today's heightened airline security means that the metal detectors at the airport have been set to "extra-sensitive". Sensitive enough that any metal such as a belt-loop, watch or perhaps a metal breast tissue expander port could set it off. With doctors note in hand, we headed to the airport. Turns out Linda's foobs didn't set off the machine.

If you've ever flown Southwest, you are familiar with their unassigned cattle call seating. Basically, 24 hours prior to your flight you can check in online. The earlier you check-in, the earlier you board and the better chance you have in getting an isle or window seat. As a frequent AA passenger, I forgot about the mad online check-in rush that happens @ 23:59 before your flight. Sadly, by the time I checked us in, we were in the last boarding group. 2 middle seats in 2 different rows was not how I wanted to start our romantic getaway and, with no kids in tow (remember: romantic getaway), we had little chance of family preboarding...but we did have the compression sleeve! With the sleeve, glove, some fumbling for the boarding passes, and a little extra gravitas on Linda's part, we left the check-in counter with a medical preboard envelope. I'm okay with the implications on my/our Karma. It's not like we ousted some really sick kid from their seat, we just got to board first...but just in case, on our return, I made a donation to the Humane Society of Williamson County for some balance ;)

And by the way...San Francisco is an incredibly beautiful city and is the perfect place to fall in love again. I recommend it highly.

Save it for a rainy day

2009-11-10T14:19:00.005-06:00

We've all heard of that expression, and many of us live by it. What kind of bullshit advice is that? First off, why would I save for a rainy day? Wouldn't I want to save for a sunny day? Second, if it is considered a bad habit to procrastinate and put off things we DON'T want to do, why is it that we see value in putting off the things we DO want to, or saving money for our old age. If you are lucky enough to see 'old age', and believe me there are no guarantees, you may just find that you are too friggin' old to enjoy the things you always wanted to do. For every 75 year-old tennis playing grandma, I'll show you 10 bitter old men with bad knees or wives caring for their incapacitated husbands. Your golden years are NOW, not some mythical retirement age. Live it, enjoy it, now.

Is this a mid-life crisis? Crisis...no...mid-life...I can only hope. I turn 40 this week and that is very cool. I love my life and all those who share it with me, but I know all too well how fragile all this is. No regrets.

No news is good news

2009-10-21T22:15:00.006-05:00

Foobie expanders are now full. Now it is just a waiting game until we get the Foobie implants.

You only get a finite set of sunrises on this earth so spend them with those people/things that make you happy, avoid the haters, try and make a difference and enjoy every day.

News you can use: Dispatches from the battlefront

2009-10-05T16:13:00.008-05:00

My husband wants to know how big we can make these funbags?

2009-09-29T20:23:00.011-05:00

That was Linda's quote today as she prepared to get the fourth fill of her expanders. No, she didn't actually say that to the doctor, she was just mocking me as we both got dressed this morning. This is what I have to put up with!

She is doing great with no complications. Every Tuesday she stops by the office for a quick visit and a boost of 60 ml per expander. She is up to 590ml but is still a ways off from her final goal. She doesn't know what that number is but will know once she gets there. Who am I to interfere?

I do have to remind her that the expanders are not the final implants and serve a totally different purpose. She knows, but is eager to see more realistic results. Their job is to stretch the pectoral muscles and surrounding tissue. They are flatter and they are as hard as a rock (filled with saline). Once they are filled, they will remain in place for three months while her body adjusts to the stretched tissue after which they are replaced with the final silicone implants. So as it is shaping up, it looks like Santa will be delayed a bit and will be showing up in the new year, just in time for a fresh new set of insurance deductibles and out-of-pocket maximums.

I must of searched the internet for 2-3 hours looking for the right picture to accompany this post. You'd be surprised what shows up when you search for 'huge melons'. As co-survivors, sometimes we must bear this burden silently.

October is Breast Cancer Awareness Month. Feel your boobies and get that yearly mammogram. Don't wait until you're 40, make that appointment tomorrow.

My View of Health Care – Part 1

2009-09-03T23:51:00.020-05:00

Okay, first off, if you think I should pay more taxes because I earn more money, you can probably stop reading now. My goal here is not to change your opinion, but if you are a socialist at heart, what I have to say likely won't resonate with you, but read on if you must. Also, these are just my 'at-the-moment' opinions and do not reflect my family's opinions, nor my employer’s (in fact it may piss him off). The kids are in bed, my wife is entertaining friends and I have run out of celebrity sex tapes to jack-it to. This post is a result of all of the above.

I've lived in a socialized health care system in Canada (for 28 years) and I've lived in a privatized health care system in the US (for 12 years). I can speak from experience. I've tried to educate myself on 'The Obama' plan (no I can't cite chapter and verse) and looked at it from left-leaning opinions as well as what free-market libertarians think. Of course I have biases because I am human.

*** rant-on ***

Okay, you republicans/conservatives/neo-cons, you had your chance. You had control of Congress for more than enough time to effect change. You did nothing but advance your own political agendas. Now that health care is up for public debate, you muddy the waters with propaganda and stupid shit like 'Death Panels'. You get to sit in the corner and shut up. Your opinion doesn't count. Let the grown ups have a sensible conversation about this.

*** rant-off ***

The Canadian System

Depending on which side of the aisle you sit, the Canadian system is either a super successful model for the world or 3 steps from Communism (maybe 2 steps). As with most things, I think the answer lies somewhere in between.

Basically, everyone who pays income taxes throws their tax money into a big pile in the middle of the country. The federal government sets aside some of that ‘general fund’ for health care. Every province gets some of the money to manage their own provincial health care system. How much they get depends on population, voodoo and who's giving whom a reach around on Parliament Hill. This is the 'single payer system'. There is a single entity that pays for your health care, the government. They also legislate how much the doctors can charge for services and what is covered (say what? that doesn't sound right? that sounds like a conflict of interest doesn't it?).

As a Canadian (or resident, legal or otherwise), when you get sick, you go to your doctor. And by *your* doctor, I mean you have 1. Your GP is your primary care physician. You basically have to see him for everything. If you need further specialized care, he'll refer you to a specialist (not unlike a HMO). As the system exists right now, many people do not have a GP (sorry I don't have a quote on the national numbers but it is pretty common). There is a dearth of GPs and a waiting list to find one. You can always go to a clinic or the emergency room so just because you don't have a GP doesn't mean you won't get treated. You will never see an 'explanation of benefits' form or a bill. From a sore throat to cancer, you won't pay a cent. The doctor bills the government at an agreed upon price and the government pays him for his services. No one dies because they can’t afford health care, and no one goes broke because they get sick. It is a reasonable system, but it does have plenty of warts, some serious.

First off, it is pretty expensive. The average Canadian pays 45% if his income back in income taxes (I read this somewhere and know it is pretty close). I don't know how much of that goes to pay for health care, but I'm pretty sure it is a large chunk of it (a basic problem with the 'general fund' approach). In some provinces, it isn’t enough, so they started charging a 1% health premium (it wasn't a *tax* because the elected party promised no new taxes...douchebags!).

Secondly, all that money still doesn't cover it. Not everything is covered. Prescriptions are not covered at all. Your employer may choose to cover you for prescriptions, but that's between you, them, and a private plan. Dental care is not covered. I think teeth are an import part of your overall health but that seems to have slipped through the cracks (just ask the front row of a Rita McNeil concert). More and more treatments are being cut back as costs rise. The government doesn't dictate your treatment to your doctor, but they do dictate what (and how much) they'll pay for. You do the math.

Thirdly, the system is not competitive. Prices are fixed (likely artificially low). If the system worked, we would be graduating or importing doctors by the truckload. Great government health care for all! The fact is there is an extreme shortage of doctors, especially in the rural communities. Governments are closing hospitals everyday. Seriously. An aging population that is going to require more and more health services and we are cutting them back? There are fund raisers every year just to help the Children's Hospital get a few more bucks to help the kids. What the fuck? This is a model for the world?

Fourthly, did I mention the lack of doctors and money in the system? That leads to delays. We've all heard the 'it takes 6 months to get an MRI' quote. I'm not sure if that is accurate, but they definitely aren't next-day like they are in the US. When you wake up paralyzed on your right side, you want that MRI next-day, not next-month. With all the available doctors treating sore throats and cancers, that doesn't leave a lot of room for 'elective' surgery. No I'm not talking about boob jobs and liposuction, I'm talking about 'elective' hips replacements, 'elective' back surgery, and 'elective' knee replacement. The government has deemed those as 'elective'. So you, who just slipped a disc in your back and are bed ridden popping Oxycontin all day just to numb the pain, back of the line for you bub. We'll try to get you to see a specialist in 4 months, then maybe schedule surgery 6 months after that. I shit you not. That *is* the system. But you'll never receive a bill.

Fifthly (is that a word?), with all that hard to get healthcare, it should make for a great market place for entrepreneurs to fill in the gaps. Doctors could open their own clinics, maybe even charge a few bucks extra so you can get prompt service. WRONG! That would be illegal. If you have done well for yourself and have a few extra bucks in your pocket and want to get a mammogram tomorrow, it is off the US for you. You can't buy your own health care in Canada, that wouldn’t be very socialist now would it?

Sixthly (now I know that’s not a word), I’m going to stop railing on the Canadian health care system. It really isn’t all that bad, and it really isn’t all that good. I speak from experience and familial experience. I’ll share some personal stories.

I lived in Canada until I was 28 and was pretty healthy the whole time. Aside from a few visits to get ‘the clap’ cleared up and UPIs (unidentified party injuries), I think I stepped in the doctor’s office maybe twice from age 14 to 28. As a child, we saw the doctor when we were sick. I even had a house call once. Never heard Dad complain about the rising cost of health care. Perfect. Life is good.
My daughter was born in 1996 at an Ottawa Hospital. At the time, I had a good job with the RCMP. My employer provided supplemental insurance carried a ‘room upgrade’ for the recovery room. We were privileged to move from a 4-person ward to a 2 –person ward. Living large! During Linda’s recovery, the family of 6 we shared a room with decided to have a fucking candle-light prayer/séance on the floor of the ward to welcome their new offspring. Not quite the way I had envisioned my daughter's first day. No, it wasn’t a life-threatening event, but it was life-changing. I never looked at socialized medicine the same way again.
I have a relative who had thyroid cancer. Caught it, cured it, great service.
I have a relative who pays into the system and has seen a doctor maybe 3 times in 20 years. The system likes him.
I have a relative who had severe back problems. I think it took him 18 months to get it operated on, and he went home with an Oxycontin addiction for his troubles.
I have a relative who endured 6 months of back pain before seeing a specialist. He rode the morphine dragon for most of it.
I have a relative who had throat cancer. She had surgery, chemo and radiation and is cured. The throat cancer was a direct result of 40 years of smoking. I love her with all my heart, but I wonder if she should bear some of the financial responsibility for her actions. All (tax paying) Canadians had to pay for her treatment and she paid none. I don’t think that is right, but I’m glad we still have her nonetheless.
I have a relative who died from cancer. Diagnosed at stage 4. He was basically told there is nothing we can do for you, please go home and arrange your affairs. It turns out there was a 5-10% chance that an experimental treatment could have cured him. He was never given the option because the Canadian health care system can’t bear the burden/cost of something with a low chance of a ‘return on investment’. Tell that to the family he left behind.

Seventhly, I just don’t think the Canadian health care system can be sustained for a long time. I don’t have diagrams, charts or projections, but logic says we have an aging population, more people taking out of the system, less putting into it, and a non-competitive government environment that stifles innovation and change.

Believe me, I understand what it is to be Canadian (and still am), and the great ideals that entails. The system has great benefits and serious flaws. When trying to figure out what to do with the US health care system, we can’t look to Michael Moore for the truth, nor can we look to Bill O’Reilly. We need to look at real people and how health care affects their life. We all pay for it one way or another; we should demand that it be the best.

Okay, so I didn’t propose any solutions. That wasn’t my intent…yet. My next post will detail this poutine-eating, beaver-tail loving Canadian’s experience with Big Medicine.

Now I have to go work on my other blog post – ‘BJs Prevent Breast Cancer’.

See you soon.

...and the survey says?

2009-08-28T15:51:00.003-05:00

No more chemo!

Dr H, who is very aggressive in her treatment and her 'expert' second opinion in Dallas, who is also aggressive, both concluded that the risks of more chemo outweigh the benefits.

The fact that:

the tumor was small
the tumor hadn't metastasized to the lymph nodes
the tumor hadn't spread to surrounding breast tissue (no vascular invasion)
all ductal breast tissue has been removed (on both sides)
the recurrent tumor had shown a tendency to stay in the breast (which is all gone now)
Linda had a clean bone scan
Linda had a clean CAT scan
Linda had a clean PET scan
and likely several other medical factors all led us to that decision.

So now, we can focus on her recovery and reconstruction and we can try and get back to where we were on July 1 of this year. Living life, loving life and appreciating all the beautiful things and people that surround us.

Another clear PET scan!

2009-08-27T12:52:00.003-05:00

The title says it all. Words can't express the relief and joy I am feeling, so I won't even try.

Recovery

2009-08-16T18:24:00.013-05:00

Linda is recovering very well. She still has limited use of her arms (to avoid stretching healing tissue/muscles) but other than that is up puttering around the house and visiting with friends. It truly amazes me how resilient the human body and spirit is to injury.

I've got to tell you though, it has been a tough week for me, more so mentally than physically. As strong as she has been, it *really* sucks watching her go through this. It is absolutely the best thing we can do to ensure the cancer won't come back, so it is well worth it.

Just look at her, as radiant as ever, and she's even pain-killer free here in this picture taken today. Incredible!

Our son referred to her as "Robot Mommy" as she had an inordinate number of tubes coming out of her chest, sides and abdomen when she came home. She had a fanny pack to carry around the pain pump and Jackson-Pratt drain bulbs. Quite the fashion statement. I removed her pain pump on Tuesday when it ran out, 2 drains were removed on Wednesday and the last 2 drains were removed on Friday. She is now back to having the standard number of orifices. In a couple weeks, she starts filling the expanders, which should take about 4-6 weeks to fill out completely. After that we wait 3 months while her muscles and tissue get used to the expanded size. After 3 months, the expanders are replaced with the final implants, or as they are known in the breast cancer community, foobies (for fake boobies). The results can be truly amazing.

We visited with Linda's oncologist on Friday. In contrast to what Dr H. had expected, it turns out the new cancer was biologically identical to the first cancer. It may not even be a 'new' cancer, just another site of the original tumor. It is still triple negative (ER-/PR-/Her2-), still aggressive (about a 7-8 on a scale of 3-9) , but was only about 1cm. Dr H. gave huge kudos to the radiologist who read the mammogram for catching the almost imperceptible tumor. Kudos indeed!

So what's next? Well, Dr. H wants another PET scan to get a baseline, and if that baseline proves clean, there is a very good chance that Linda will *not* have to do more chemo. Enough so that Dr H. put off getting the port put in. In this 20 month roller-coaster of good and shitty news, not having to endure chemo would definitely be one for the + column. Fingers and toes crossed.

This is a blog that another lady has been kind enough to share.

Breast Reconstruction with Expanders

It has been incredibly helpful for us. The fear of the unknown has been one of the hardest aspects of this journey. By documenting her mastectomy and reconstruction, Lianne has truly given us a gift that is immeasurable. Thank you.

Home sweet home

2009-08-10T21:04:00.003-05:00

Linda came home Saturday afternoon and is on the mend. She even made it outside today for an hour but is back in bed now resting. That 100F Texas heat made short work of her.

Everything is going as planned and we're happy about that. Thank you for all your support.

Courage is the art of being the only one who knows you're scared to death

2009-08-07T18:59:00.006-05:00

I am writing this post sitting next to Linda in our hospital room after a long 36 hours. The surgery went smoothly. Not only is the cancer gone (again), but we laid the groundwork for the next few months of recovery. As always, my superstar was unwavering in her courage.

I've told her many times how proud I am of her. Her response usally falls somewhere between "Well I don't really have a choice now do I?" and "What else am I going to do?". She's right. We don't have a choice. The alternative is simply not acceptable. What she may not realize is that she does have a choice in how she faces our 'non-option'. In this battle, I have only seen chinks in her armor on 2 occasions and they lasted 10 minutes at most. I know there is fear and uncertainty in there, but she has the courage to not let it define her fight. She has never once been a 'victim' in the 17 years I have known her. I only hope that when my 'test' comes, whatever it may be, I will have 10% of the strength she has shown.

I Googled quotes about courage from people much wiser than myself to help me express my thoughts. I came across the one in the title of this post attributed to Earl Wilson:

"Courage is the art of being the only one who knows you're scared to death."

I think that is a pretty insightful quote, but as I finish up this post, I need only look at my wife sleeping next to me for the very definition of courage.

Here we are...

2009-08-05T13:03:00.004-05:00

Not much to say today. I've realized I'm a better raconteur than a color commentator. My mind is a mess right now so words of wisdom and insight are far and few between. I'm a bit scared of the next few days but more importantly, I am eager to get Linda through this. In all, the procedure should take about 6-7 hours with 2 days of 'intense' recovery followed by 3 weeks of at-home recovery. All things considered, Linda is in good spirits. She has received comfort from her 'sisters' who have been through this. It's tough, but nothing she can't handle, I'm sure of it. The other night, I asked her what she was doing, she said she was looking at some nice boobs on the computer. I replied that I've been looking at boobs on the computer for the past 20 years :)

Godspeed babe!

Life Goes On

2009-07-21T13:32:00.005-05:00

As we wait for the 6th, I got to thinking about how this time is different than the first. The first time through, everything stopped on Dec 13. Life was put on hold while we fought the cancer. Batten down the hatches, dig in, fight and wait until we could declare victory and then get on with our lives. At least in my mind it was a case of understand it, categorize it, analyze it, solve it, move on. That's just how my brain is wired and for the most part, that process works very well for me. Unfortunately, fighting cancer is still very much a battle of trial, error and percentages. I have no doubt we will declare victory someday, it is just going to take longer than we had hoped. It has been said many times before that fighting cancer is not a sprint, it is a marathon. I understand that now more than ever.

As we navigate the future, this cancer may be riding shotgun for a bit, but it will no longer drive. Life is good :)

Git er done

2009-07-15T16:24:00.002-05:00

This past Friday we had a visit with Linda's oncologist. Although we don't have a complete pathology on the tumor (that won't be available until surgery), Dr H. has a feeling that this will be a different type of cancer. She suspects this for a couple of reasons. One, it is far enough removed from the original site that this is most likely a *new* cancer, not a recurrence. Two, we bombarded the area with 2 full rounds of chemo and xeloda amplified radiation just 9 months ago. If this were the original type of tumor, it would take longer to recover from that beating. Hopefully this new tumor is E+ or P+ so we have some long term therapy options (Tamoxifen etc) open to us. Know thy enemy!

No matter if it is a recurrence or a new cancer, the breast tissue has proven itself to be problematic. I call them bad boobies, Linda calls them tainted ta-tas. In any case, the proper course of action is surgery followed by chemo (no more radiation as Linda has had her lifetime allotment). We won't know what type of chemo until after surgery and a full cellular analysis (oncotype assay) of the cancer.

We briefly interrupted our 6 days of camping to visit with the reconstruction surgeon yesterday. We discussed the pros and cons of the different types of procedures and pretty much settled on the one we had already decided upon. Unless the boss tells me otherwise, I won't go into the details of the procedure. (I'm pretty sure that if I needed an operation on my junk, I wouldn't want her blogging about the pros and cons either). Of course I'll answer any questions on an individual basis. This blog is not only about helping me but also helping others.

Surgery is scheduled for Thursday, Aug 6th (btw, never have your surgery on a Friday, statistically the worst day for mistakes). Linda is in great spirits and eager to tackle whatever is in front of her (I just follow in her wake). That means we have to cram the rest of summer into the next 3 weeks. I'm off to the Gulf of Mexico tomorrow with the guys for some deep sea fishing and maybe the odd beer. That'll be a welcome distraction. After that, the three Ss of a Central Texas summer await: Schlitterbahn, Seaworld and Six Flags!

Carpe Aestas!

2009-07-06T15:27:00.013-05:00

We had a great Fourth of July weekend. It was quieter than usual but that's just fine. We waited until Sunday to tell the kids about the recurrence. Considering the tears, sadness and fear we experienced this first time around (all of us included), I wasn't looking forward to it. They took the news extremely well and only had a couple questions. Kids are far more resilient than we give them credit for. Honestly, my son was more interested in the episode of iCarly playing in the family room. Their handling of the situation is a testament to Linda's strength and courage during her previous treatments. Aside from a lack of hair and a few down days every 3 weeks, their Mommy was engaged full time in their lives. I don't expect the next few months will prove any different.

We will be meeting with Linda's oncologist this week and will have a better understanding of the recurrence's profile (hormone receptor status and cell histology etc). Linda has been busy today setting up appointments to interview surgeons. Each surgeon has their own preferred technique and each technique has its pros and cons...and here I thought we were experts in breast cancer...no one told me there was a Vol. 2.

Once again we were touched by all the words of encouragement from family and friends. It took me 6 months to start writing about this journey the first time through and only 1 day to post an update this time. This blog is an important part of my therapy. Your prayers and positives thoughts really do make a difference in our lives. Thank you.

There is a good chance we won't be in active treatment until later this month which gives us an opportunity to enjoy more of this great summer. Carpe Aestas!

Another lump in the road

2009-07-03T10:44:00.002-05:00

After a suspect mammogram on Monday and a fine needle biopsy on Wednesday, we were informed yesterday that the cancer is back, right next to the site of the original tumor. CT and bone scans indicate the cancer has not spread beyond her breast which is incredibly good news.

Surgery and most likely more chemo are in our very near future, but as Linda said to the radiologist, "This ain't my first rodeo". God I love her.

Grace and Dignity

2009-06-22T18:12:00.005-05:00

Summer is in full swing here and we are busily making up for the lost summer of 2008. We just got back from a fantastic week on South Padre Island on the Gulf coast of Texas. Good times!

I've noticed subtle changes in Linda's attitude over the past year. From trying new food at a restaurant to attempting to dive to the bottom of a pool to taking charge in situations where should would normally of laid back, she is in charge of her life and enjoying it, really enjoying it, moreso than ever. I am so proud of her. Physically, I don't think there are any long lasting symptoms of surgery and/or chemo. Emotionally, I think she is (we are) well on her way to recovery, however reminders of how fragile all this is are never too far away...

It seems like an eternity, yet it was only 18 months ago. January 2nd 2008 was Linda's first chemo, only 3 weeks after the shock of her diagnosis. We had scoured the internet and read every horror story regarding side-effects of chemo. We had gone through chemo "training" at Texas Oncology. We had signed every liability waiver known to mankind. Linda sat in the chemo chair and I was huddled by her side listening intently to the infusion nurse tell us what to expect. Only Linda knows how she felt, but I can tell you, my fear and apprehension was overwhelming. I was scared shitless. Across from us sat a young lady, about Linda's age, who was dressed very well. She had brownish-red hair, pretty make-up and a pleasant smile. She busied herself working on a laptop while the chemo rushed through her veins. She never knew it, but she became an incredible source of courage for us that day. I knew we would be okay.

Over time, Linda and her became friends. She attended the same young survivor support group. A strange thing about "cancer friends" is that you tend to identify them by their disease. "You know Linda, she's triple negative, stage IIB, node positive and Karen, she's E+P+, stage I, no nodes". I *know* these women are so much more than that, but human nature is to identify with that which you have in common. She was Becky, Her2neu+, stage IV. It turns out her beautiful hair was a wig and she was battling a very aggressive form of breast cancer with the newest drugs available, some still in the clinical trials stages. To look at her you'd never know.

I was in Seattle a couple weeks ago on business and got an early morning call from Linda. Becky had passed away. The news came out of nowhere and messed me up. I still tear up as I type this. Becky is the only woman I have ever known to lose her fight and it brought back a whole bunch of emotions I had conveniently tucked away out of mind. Linda doesn't talk about it much but I know it bothers her. She wears her emotions differently than me.

Becky, the grace and dignity you showed in the face of such adversity will stay with me forever. You made the world a lot less scarier for us and for that I am eternally grateful.

Thank you and God bless,
John

One Year Survivor

2009-04-13T13:28:00.006-05:00

Yes, it has been a while, but for good reason. There is this thing called "life" which seems to be getting in the way of all my efforts to update this blog. Sure, our fight with breast cancer is never far from thought, but of late, it hasn't been center stage. I feel like I need to apologize for not writing sooner, but I'm sure you'll understand why I don't feel so bad.

Triple Negative Breast Cancer has a different recurrence profile than more typical hormone positive cancers. With TNBC, we are at a higher risk of recurrence within the first 3 years. From 3 to 5 years, TNBC has about the same odds as a hormone positive cancer, and then after 5 years, the odds drop off considerably and are statistically insignificant. In a nutshell, if it is going to come back at all, it will be in the first 3 years. With that understanding, you can appreciate how glad we were when Linda's oncologist pronounced her a "One Year" survivor. We weren't quite sure when that milestone was, considering she went through 2 regimens of chemotherapy and radiation from Jan 2008 to Nov 2008. Dr H. put it at the end of Linda's first round, in April of '08. That was a pleasant surprise.

While Linda was cleaning up the other day, she came across a list she had made in April of 08 titled "Things To Do: Summer 2008". Her and the kids had made a list of summer activities in anticipation of her being done chemo. Well, if you've been following this blog, you know that Linda had to endure another 12 doses of chemo throughout the summer and the majority of the list went unfulfilled (Seaworld, Six Flags, Schiltterbahn). It really was an awful summer for our family. That same list is now on our fridge! So, when presented with a choice of dates for her next bone and CT scans, Linda purposefully scheduled them after our upcoming vacation to South Padre Island. Her words to Dr. H..."You're not ruining this summer!".

Keeping a healthy immune system is probably the most important thing you can do to keep cancer away, or even showing up in the first place. That means eating right and exercising.

Linda is taking the following supplements:

Viactiv (calcium)
Turmeric Root Extract
Vegetable Carotenoids (free radical protection) lutein, lycopene, broccoli, spinach, tomato, kale, cabbage, brussel sprouts
CoQ10 (heart health)
IP6 w/ Inosotil (anti-oxidant, fiber)
Multi vitamin
Brassica Tea (SGS, Brocolli) developed by Johns Hopkins
Green Tea (Japanese)

and for exercise, Linda joined a gym and does the following (in some combination) every week:

Zumba / Total Body (2hrs)
Walk/Run (1 hr)
Body Pump / Step Interval (2 hrs)
Pilates (1 hr)
Step / Body Pump (2hrs)
RPM (spinning) (1 hr)
Yoga (1 hr)

I think the thing she likes most about the exercise is that they are group activities. She has some great instructors and has friends that participate as well. Mentally and physically, she is doing all the right things. She is a tough old broad...strike that...she is my tough old broad!

I'm not sure when I'll update the blog next, but I am not gone, just living. If you have any questions or comments, please write. Maybe I can convince Linda to write a guest blog post :)

John

Please stand by....

2009-03-09T23:19:00.002-05:00

...it has been a while but I'll try and get post done this week and update y'all. Thanks for reading!

Triple Negative Breast Cancer Foundation

2009-02-10T11:28:00.004-06:00

http://www.tnbcfoundation.org/index.html

News you can use

2009-02-09T10:51:00.002-06:00

Just a few articles I came across this weekend.

GRB7 overexpression and how it relates to TNBC

Extra Virgin Olive Oil

Tumeric

Book Learnin'

2009-02-05T02:26:00.001-06:00

There was a time in my life when I didn't read at all for pleasure. I refer to that period of my life as "High School". Even less than reading for pleasure, I rarely read the mountain of garbage that the school system forced on me, hence my extended high school career. I'm not sure if I suffered from a reading disorder or a disdain of being told what I should enjoy reading. Shakespeare? Really? You can't possible tell me a) I should be enjoying this and b) this will somehow provide me some long term value. I think it was a combination of both as I'm pretty sure words aren't supposed to bounce around on the page, but I've learned to deal with it over the years. I am also the product of a French Immersion education that has made me illiterate in 2 languages. Boy those 11 years of French are really paying dividends in Central Texas aren't they. My early exposure to reading had made me none-too-keen on all that book learnin'.

Later, in my late teens and early 20s, I had a girlfriend who was really into true crime novels. A natural osmosis occurred during that time and I soon found myself reading those books too. I was reading maybe 2 books a week and by the time our relationship ended, I had amassed quite the collection of serial killer paperbacks from Ted Bundy to John Wayne Gacy. I thoroughly enjoyed reading at that point in my life. Twisted? Morbid? Sure, whatever, but who the hell isn't fucked up when they are 20 anyways (and for all you criminal profilers out there, no I don't masturbate to fire and torture animals...I love animals)

Along comes college where I was trained to read like a technician. Determine facts, isolate declarative sentences, categorize, store, retrieve, and repeat. Definitely left brain activities. I'm sure I learned something along the way, but much of that was purged when I left the exam hall.

The real irony in all this was that my career path would be set not by my understanding of finite state machines or recursive descent parsers but rather my fascination with true crime, more specifically serial crime. My college buddy was working his internship with the Royal Canadian Mounted Police and mentioned to his Sergeant that I was working a mind-numbing co-op placement with Revenue Canada, and because of my interest in serial killers, that I may be a suitable hire to implement an up and coming crime database. That moment, coupled with the proper alignment of the stars and Linda's (my girlfriend at the time) ability to support my sorry ass both emotionally and financially led to my current career.

That was over 15 years ago. How much do I read for pleasure today? Zero. Who the hell has time to read? I have audio books in the car, 500 channels of TV, and reams of internet minutiae (my secret shame is an affection for tabloid magazines...People, US, OK...all that crap...yes I put it out there...cast your stones). Despite being inundated with information, the vast majority of that stuff doesn't seem to stick. I can remember the vivid detail of an Ann Rule crime scene description that I read 20 years ago yet I can't even remember what I watched on Nova on Tuesday (seriously...and it's friggin' Wednesday today!). There is something about the printed page that makes it stick. A friend of mine, who is about 10 years older, once told me "John, there comes a time when you'll have forgotten more shit than you remember". Wiser words were never spoken.

So what does this have to do with breast cancer? Absolutely nothing, and believe me, it feels great not to write about it. I picked up a book tonight and read 1/4 the way through it. I probably could of gone the audio book route, but I figured I'd see if I could stimulate some of those neglected neurons. After about 2 hours, those words on the page were jumping like crazy and I had to put it down. It's a start and we'll see where it goes. Good book.

I still can't sleep so here I am writing this blog at 2am...had I read that much in high school, I'd be fast asleep.

Sleep, sleep, my kingdom for some sleep

2009-01-15T14:19:00.007-06:00

If sleeping was an Olympic sport, I'd definitely hold several medals. I can fall asleep watching a movie, I can fall asleep at the movies, I can sleep for 1 hour, I can sleep for 18 hours, I can drink coffee before bed without issue and I can stay up for 48 hours if needed. If there is one thing in life with which I am truly gifted, it is the ability to sleep. One of nature's small miracles is a 2 hour snooze on a Saturday afternoon. I list napping among my favorite hobbies. I LOVE sleeping.

Throughout high school, I'd often spend my afternoons in detention as I couldn't seem to catch the 8am school bus. Throughout college, an 8am class surely meant an F for that course. I have crafted my career in such a way that my position allows me to come to work at 10am. For better or worse, my life has been shaped by my ability to sleep (and perhaps my inability to wake up). I am perfectly fine with that.

So what is the problem? I can't fucking sleep!!!

This is a recent occurrence but it is driving me crazy. My mind is a complete mess. I can't concentrate worth a shit. My OCD tendencies are accentuated. I haven't slept for more than 1 hour in a row for the past 3 weeks. My nights are filled with restless fits, crazy dreams, and sleep walking (I have slept walk/talked since I was a kid but it is now a nightly occurrence). I've tried green tea, melatonin, beer, and some stronger stuff. Nothing works. I suck at sleeping.

Nothing has really changed in my routine. The day-to-day stresses at work are about the same. I'm not doing anything differently than I have in the past. If anything, I have less stress in my life, considering the stresses of the past year. If I were to put on my Jr. Psychologist hat, is this some sort of post-traumatic-stress reaction? Who the hell knows? Maybe it'll clear up on its own, maybe not. All I know is that I *really* want a good night's sleep.

In all seriousness, if you have any thoughts on this subject, I would really like to hear from you. If you've had sleep issues, how did you deal with them? Did you figure out why you were having them? Were they stress related (conscious or subconscious)?

Psychologists....discuss...

Gene that makes breast cancer spread is found

2009-01-10T13:58:00.003-06:00

Discovery gives researchers a ‘real shot’ at making drug to stop metastasis

http://www.sciencedaily.com/releases/2009/01/090105131216.htm

Wow, this is huge!

A vaccine for Triple Negative Breast Cancer?

2009-01-05T19:16:00.005-06:00

"This is an important study because there has traditionally been nothing to offer women with triple negative breast cancer beyond standard therapy," says Stanton Gerson, MD, Director of the Ireland Cancer Center. "This vaccine trial has the potential to lay the groundwork for a new standard of care for women with this aggressive form of breast cancer."

http://www.medicalnewstoday.com/articles/132965.php

Happy New Year

2009-01-01T13:50:00.004-06:00

I won't soon forget 2008 but I sure am glad to see 2009. 2008 was the hardest year of my life by far and I'm sure Linda would concur. We book-ended the year with Linda's first chemo on January 2, 2008 and a clean mammogram (woohoo) on Dec 31, 2008 (gotta cram in those appointments under 2008 deductibles). We also ended 2008 with 6 days in the most magical place on earth....Disneyworld!

We have been to Disney several times in the past, but this time was particularily special. Next to Christmas, nothing gets Linda jazzed up like a family trip to Disneyworld. We had a really great time. I made a concerted effort to not stress out over the $4 cokes and $100+ meals and just enjoy our time together. I've always been a pretty easy going guy, but my short fuse temper usually gets the best of me. There isn't a better place to test those limits than a capacity crowd at Magic Kingdom on Christmas Day! By and large, I think my new found outlook on life helped me make it one of the most enjoyable family trips we've had.

Linda and I have a 1/2 marathon planned for April and that's our short term goal for 2009. That will give us somewhere healthy to focus our energies. Aside from that, a cancer-free 2009 and beyond would be nice too!

May 2009 bring you peace, love, and contentment.

John

One Year Later

2008-12-17T15:46:00.004-06:00

Life has been crazy busy for us over the past month with work, kids and preparing for our Christmas vacation. I haven't had much time to keep this blog updated. I suspected that would happen, but not so fast. We really are getting back to where we were a year ago (all things considered). That being said, the thought that 'all this' could go away is never far from my mind. Instead of that being a negative thing, I choose to use that as a positive motivator and appreciate everything we do have and how truly blessed we are. We are blessed to have each other, we are blessed to have our kids, we are blessed to have our health (again), we are blessed to have fantastic and supportive family and friends both in our professional and personal lives. I am blessed to have found people through this blog that I wouldn't otherwise have had the opportunity to meet. Blessed by whom/what? I haven't figured that one out yet. I'm working on it, but in the mean time, I don't question...I just accept.

Last Saturday was Dec 13, one year from our diagnosis. We used the opportunity to celebrate with all those who have helped us this past year. We hosted a party and enjoyed the company of our friends until the late hours of the morning. In the depths of treatment, it was hard to imagine what Dec 13 2008 would look like. We couldn't have asked for a better anniversary.

We are taking a well deserved vacation over the Christmas holidays and there is a very good chance I won't be updating this blog until the New Year. So, let me take this opportunity to wish everyone a happy and safe holiday. Merry Christmas to my Christian friends, Happy Hanukkah to my Jewish friends, Happy Diwali to my Hindu friends, Happy Festivus to my Seinfeld friends, and Happy Holidays to all. Everyone, regardless of their belief system, can enjoy the warmth that family and friends bring this time of year. To my old friends with whom I've reconnected over the past year, to the new friends I have made via this blog, and everyone in between...a sincere thank you.

3 month check up

2008-12-03T17:51:00.004-06:00

For the time being, part of our recovery process is being reminded every 3 months that we are cancer survivors. That reminder comes in the form of a combination of cat/pet/bone/brain/mri scans and/or mammograms. Over time, these scans will become less frequent and hopefully less nerve racking, but for the time being, they are often and stressful.

This week I am in Seattle on business and Linda had a cat and bone scan. As real-life begins again for us, scans and doctor appointments are not always 'convenient', as was this case this week. Christmas came a bit early this year and I received the good news today. All clear...again!

I really wished I could have been there this week for her but, at least from my point of view, cancer is becoming less a focus of our life and more an aspect of it. I think that is healthy. Our circumstances and mindset from last Christmas as compared to this Christmas could not be further apart.

Congratulations babe...you kick ass!

A strange feeling

2008-11-21T14:39:00.005-06:00

I don't have much today. No story, no insight, and no words of wisdom...and that's kind of what I'm posting about. I've had a strange feeling of emptiness this week. We've been fighting this for 11 months straight, without any real break. It has defined (and redefined) our life for all of 2008. Almost every emotion and every thought has been about cancer. Most every conversation with family, friends and acquaintances starts with "How is Linda doing?". The highest point and lowest point of 2008 has been about cancer....and now we are done.

I've been looking forward to this week since last December, yet I feel a void. It is truly an odd feeling. I can't quite explain it. For the past year, I've had somewhere to direct all my energy. Focus on the cancer, focus on Linda, entertain the kids so they don't have to deal with it, write a blog entry. Now, although we will never be the same as we were on Dec 12, we have to go back to living. What the hell was that like? I can hardly remember. This cancer has made me a better person, made my family stronger, and made me love Linda more than you can understand. Without the cancer in our lives, will I fall back on old habits? Being an unappreciative asshole. I don't know if I even like 'pre-cancer John'. I'm actually kind of scared.

p.s. - Cancer, if are reading this, this is in no way an invitation back into our lives. Fuck you and thank you (if that makes sense).

A slice of humble pie

2008-11-18T13:06:00.007-06:00

After all Linda has been through these past 11 months, at the first opportunity post-treatment, she got up at 5:15am and ran/walked 3 miles with her friend. No complaints. I, on the other hand, have been sitting on my ass for the past months complaining of a chest cold, shin splints, and/or a bum foot, pretty much any reason to not run. Needless to say I ran this morning. Thanks for the inspiration.

Step out of the vehicle sir

2008-11-14T11:39:00.018-06:00

Today, 11/14/2008, we're done. The last radiation treatment was @ 8:45 this morning and the staff at Texas Oncology had a small celebration for Linda. Very cool. They are almost like family to Linda. I met Linda at Starbucks afterwards for a celebratory coffee before heading to work.

For some reason, I decided to take a different way to work. My usual commute has slowly been infiltrated by traffic lights. I'm sure there is a new one every couple of months. Damn suburban sprawl! The alternative route is longer, but only presents 1 traffic light. You can really fly along 1431. With the sunroof open and Metallica blasting, I cruised along at what some may consider an excessive speed (and what TxDOT definitely does consider excessive). Just as I crested a hill, I saw the telltale sign of Texas State Trooper black and white heading in the opposite direction. Ease off the gas...eyes in the rear view...wait...wait...shit!

Really? Linda's last day of treatment. What a way to sully a great day.

Mr. State Trooper was really playing the part. Mirrored sunglasses and all, although they were more modern than the stereotypical aviator style ones. Intimidating nonetheless. "License and Insurance please". "Step out of the vehicle sir". What the hell...for a speeding ticket? This can't be good.

For once in my life, all my tags, license, and insurance were up to date. Just give me my ticket and I'll be on my way. My inspection sticker was due to expire this month. The jackass who did my state inspection last November put the "11" on backwards, so it jumped out to the officer. As he looked closer, it seems the serial number was garbled. He ran the number back in his cruiser and after about 15 minutes, came back and said the serial number was invalid and that I was in possession of a forged permit. "I'll need to call in my corporal to see how to handle this". Mother %&@^%%#$^&!^. He informed me that with the new emissions testing here in Texas, there are A LOT of forged stickers.

Meanwhile, I sat on the guardrail along 1431 as everyone drove by and checked me out. 2 cruisers were now behind my car, so there was likely extra oogling on behalf of the passers by. Fantastic! Judgmental bastards!

"Sir, we're going to need to issue you a citation". This is getting worse by the minute. I rolled my eyes. "Hold on sir...we believe you, but we need to create a paper trail so that we can prosecute the person who made the counterfeit sticker. You'll just need to subpoena me in court and we'll get this all sorted out". Court? Subpoena? Arrrggg! I wondered for a moment if they'd shoot me if I ran across the field into the trees. Wait a sec...this is Williamson County...first they'd taze me, then they'd shoot me, then they'd taze me again for good measure. Better stay put.

As they peeled off the sticker for evidence, they looked at each other and smiled. "Sir...come here please". Apparently the Jiffy Lube jackass who affixed my sticker didn't scrape off the old one entirely, and left a bit of the old serial number, which overlayed perfectly with the new one. The sticker was good after all, although I was now in possession of a valid, but decimated sticker. I needed a new one this month anyway.

Corporal: Did you write him up yet?
Constable: Yes
Corporal: 3 or a 6?
Constable: 6
Corporal: Make it a 3
Constable: Yes sir

Cool. I'm not sure what 3 or 6 meant yet, but 3 has to be better than 6 right? Were they going to knock some mileage off my speeding ticket? Sweet. This is getting better.

Turns out 6 is a ticket and a 3 is a warning. As an act of good faith for keeping me for a 1/2 hour, they just gave me a warning citation for my speeding. No ticket, no court, AND I didn't have to blow anyone to get out of it! This is back to being a great day!

I tend to be a bit more aware of my karama these days. Was this the scales of fate tilting on my side as a correction for the past year? Or was it another test...do I need to pay this one back? I guess I'll never know for sure where my cosmic tally count sits, but if I try to be a good-egg most of the time, that can't be a bad thing can it?

Linda, I am so proud of you. You are stronger than I ever imagined and you amaze me every day. I will rub your head, bald or otherwise, forever :)

A Moment In Time

2008-11-10T11:54:00.006-06:00

I had one of those moments this weekend. For the 8th year in a row, we went camping at Granger Lake for my birthday. It was fantastic. Linda was full of energy and felt great. It almost felt as if the last year hadn't happened at all.

That moment. As the morning sun began to warm the day, we sat on the beach while the kids played at the water's edge. It wasn't hot, it wasn't cold. The dogs ran up and down the beach sniffing everything they could. We had camped here many times, and walked that beach more times than I can remember, but this time was different. I looked over at Linda and she smiled, watching the kids search for fossils and shells. It was absolute contentment, something I hadn't seen from her in a while. I closed my eyes and burned that image into my brain. No matter what life has in store for us, nothing can take that moment away from me. I know she felt it too. We made the weekend last as long as possible. Neither of us wanted to leave.

It is Monday morning and Linda starts her last week of radiation today. This week is all about the boob. Her neck and underarm are done so this week they 'blast' the site of the original tumor. Good riddance! As far as the numbers go, we have a 75% chance of never seeing the cancer again. In Vegas, those are fantastic odds. You can play those odds all night long and always come out a winner. When you are fighting for your life, anything less than 100% is hard to accept, but that's just how these things work. Regardless, that moment in time on the beach will be mine forever.

New Appreciation of Triple Negative Disease

2008-11-03T14:17:00.010-06:00

A great article regarding the current understanding of Triple Negative Breast Cancer and how to best treat it. If your breast cancer has been classified as ER-, PR- and Her2- (about 15% or all breast breast cancers are TN), then this article is a must read.

"Marina Cazzaniga and her colleagues at Treviglio Hospital, Italy found in the NORA study contrary to other observations, that triple negative patients did not have worse prognosis, in terms of disease-free (DFS) or overall survival (OS), than others in the total cohort of 3515 patients treated in 77 cancer centers in Italy from to 2000 to 2003"

21,000+ turn downtown Austin into a sea of pink

2008-11-03T10:38:00.000-06:00

http://news8austin.com/content/top_stories/default.asp?ArID=223459

Susan G. Komen Race For the Cure 2008

2008-11-02T22:14:00.000-06:00

A beautiful day spent with beautiful people. Thank you :)

Almost There

2008-10-30T13:51:00.000-05:00

Halloween is tomorrow and marks 4 1/2 weeks of radiation treatment. Linda's radio oncologist calls her the poster child for radiation. Other than a general 'tan' in the affected areas, there is no tissue damage. No blisters or burns. No pain!

Only 2 more weeks to go and then that's it. Nothing else to do. No more treatments. I'm sure, after spending the past year actively fighting cancer, it will seem strange doing nothing. Unlike the majority of breast cancers (which are ER+ and/or PR+), triple negative breast cancers (ER-,PR-, Her2-) do not have any long term targeted therapies. It really is just wait and see. No Tamoxifen, no Aromasin, no Herceptin. Although there may not be any active treatment alternatives, there are plenty of passive treatments which include eating right, exercise and most importantly, just living life to the fullest.

This photo was taken last Halloween at our annual street Halloween party. That is pretty much how I looked from 1983 to 1992...not much of a stretch for me :)

What's strange to me is looking at us, 1 month or so before our diagnosis, and not having a clue what lay ahead of us. How our life could change from one day to the next. It is also weird to know that Linda had cancer in the photo (hey...quit staring at my wife's boobs!).

When you're young...you're invincible! When you're pushing 40...err...not so much. When your life is turned upside-down by cancer, everything takes on a 'temporary' feel, and I don't mean that in a bad way. That whole 'stop and smell the roses' nonsense begins to make sense. No, I'm not about to put up a motivational poster in my office, but I do find myself spending more time with the kids, more time cuddled up with Linda watching TV, and more time trying things I wouldn't usually do. How can that be a bad thing?

So tomorrow we will have the 2008 edition of our Halloween party, the kids will run amok in the neighborhood, the parents will enjoy a potluck dinner and we will all have a great time. Life is good.

Happy Halloween!

Race for the Cure

2008-10-21T13:56:00.001-05:00

The whole family has signed up for the Race For The Cure 5K. Linda, myself and the kids will be hitting the streets on Sunday Nov 2nd to help raise money and awareness. We will be running for her local breast cancer support group team. If you'd like to sponsor us, shoot me an email at:

breast.cancer.sux@gmail.com

and I'll let you know how you can. It should prove to be a great day as we give back to the community and friends that have supported us over the past year.

Think Pink!

Getting our groove back

2008-10-15T17:46:00.000-05:00

With less than 5 weeks left in Linda's treatment, things are going very well. Still some tingling in her hands and feet, some general muscle aches, some redness around the irradiated areas and she has some difficulty getting to sleep. Aside from that, our day to day routine is just that...routine. Work, kids, school, cub scouts, football, camping, Halloween decorations...ahhh the beauty of routine. You really don't miss it until it is gone.

Unlike my hometown, where camping is restricted to 3 months of the year, Texas offers camping 12 months of the year (although it is really too hot to enjoy camping in July & August). In years past, we have camped up to 22 times in a year, almost every other weekend. It is our family time free from life's distractions. Our youngest was camping at 6 weeks old. Camping is definitely our thing. The past year has only given us 1 opportunity and that was even limited because Linda had just finished her first chemo cycle. We booked camping for this weekend and I can't be more excited. Cool nights, campfires, hikes, smores and a cold beer for Dad. Oh yeah!

One thing I've learned over the past year is to not take my health for granted. I've been lucky (genetically or otherwise) this far, but I'm sure the next 40 years will be tougher than the last 40 years. So midway through Linda's treatment I started training. Training for what? Nothing in particular, just to be fit. It is my job, after all is said and done, to take care of my family. I can't do that if I can't take care of myself. 1 hour/day, 5 days/week is not that much but makes a huge difference to my mental and physical well-being. When Linda resumes her running, it'll be one more thing we can share and that's always a good thing.

An important change in me, at least psychologically, is the ability to concentrate at work once again. It is not there 100% yet, but at least I am not a zombie anymore, and as our company achieves more successes, I can feel the energy coming back. I have been blessed with a truly unique company and in particular, an incredible CEO who understands that a company is not simply a collection of people, but really an extended family. My extended family. Our extended family. I am surrounded by the best friends and colleagues anyone could ask for and I owe them a debt of gratitude for their understanding and compassion over the past year. Y'all rock!

Root of all evil?

2008-10-06T16:57:00.000-05:00

Very interesting article about leading edge research on cancer stem cells from The Economist.

http://www.economist.com/science/displaystory.cfm?story_id=12202589

"Cancer may be caused by stem cells gone bad. If that proves to be correct, it should revolutionize treatment"

Radiation update

2008-10-06T14:34:00.000-05:00

Linda's radiation is going well. The turn around time from when she leaves the house to when she returns is about 30 minutes. The actually irradiation takes mere seconds. Sure beats the day-long visits to the infusion room.

The Xeloda is giving her some mild tingling in her hands and feet (a known side-effect). Adding low-dose Xeloda isn't a standard practice yet (although it is in clinical trials) but if we get the benefit without any serious side effects, it's a worthwhile venture. There are different phases of a cell's division and the phase in which DNA is transfered is called the "S phase". Xeloda extends the "S phase" which increases the chances that a radiation particle will damage the cell DNA, causing the cell to self-destruct.

Linda is upbeat and her hair is finally starting to come back in. She is starting to make plans for a cruise next fall to Puerto Rico and the Virgin Islands. Making plans a year out is a great sign of her emotional recovery. Una cervesa por favor!

A typical atypical mole

2008-10-03T14:26:00.000-05:00

A few months back, I suggested everyone go to their doctor and get their skin checked. Skin cancer is the most common form of cancer in the US. For once in my life, I decided to heed my own advice. I looked in my benefits package for the closest dermatologist and made an appointment. I think all my doctors have a last name that begins with A or B because they are the first ones in the list. I'm not too picky. I think most guys are like me. If I ever decide to become a doctor, I'm changing my name to Dr. Aaron Aardvark. That'll keep the patients rolling in.

The office happened to be just down the road from where I work and in a well-to-do neighborhood near the lake. I guess that's where dermatologists will find most of their revenue. At first I wondered if I had made a wise choice. It is my experience that a doctor's office usually has a wide assortment of health related pamphlets which adorn the waiting room tables and office walls. You know, the FAQ and self-diagnostic flyers for disease prevention etc. In this office, there wasn't a single skin cancer pamphlet. Not one. There were plenty of Botox(tm), Rejuviderm(tm) and skin bleaching promotional materials, but nothing 'health' related. I found that odd. They already had my $15 copay, so might as well go through with it right?

For the first time in my life, I was older than the doctor. My GP from when I grew up is still in practice in my hometown and is 75. He is older than my parents and they still go to him. I guess it's the 'older and wiser' thing that gives me some comfort. I guess that's just a symptom of getting older. Every second of every day, there are more people younger than you and less people older than you. Don't get me wrong, he's a good doctor, it's just my own personal hangup about being examined by Dr. Doogie Howser. And another thing. These days, I understand that when women go to see a male doctor, a female assistant/nurse is usually present in the room. So when a guy goes to see a guy doctor, is the assistant/nurse thing a common occurrence? I don't think that my doctor subscribed to the same 'lifestyle' that the real Doogie Howser did, so I'm not quite sure why the 20 something year old female nurse was in the room, but there she was. And there I was in my underwear.

As I was seated in the chair, the doctor started on my arm and worked his way around my upper body and head. He methodically dictated where the moles were and what they looked like. The nurse dutifully typed them into the laptop as he went. Then he asked me to stand-up so he could check my 'legs and buttocks'. My mind immediately raced to the morning's decision to put on any old pair of underwear. If I had known that a young nurse would be in the room with us, I'd have chosen some newer underwear with some elasticity to prop up my assets. But to my disappointment (and maybe her's too...who knows), I had chosen some war-torn pair out of the top drawer. I'm sure, as a guy, I had previously played this scenario out in my mind a few thousand times (Dear Penthouse Forum, I never thought it'd happen to me but....), but never did the scene end with 'hmmm...this mole here looks kind of strange'.

So there I was, standing in the doctor's office, my butt-crack showing, my 'junk' sadly doing a wholelotta nothing, and a doctor and nurse staring at my back-side ready to freeze the mole, shave it off, and send it to a lab for a biopsy. What the fuck!!!

As a product of the 70s and 80s, I never heard the word sun-screen as a kid. I never wore sun-screen and in fact, I used sun-tan lotion and once cooking-oil (yes, cooking oil) to intensify the effects of the sun. Sounds completely crazy now but that's just what we did back then. I worked as a landscaper most summers with no protection and no shirt. My yearly cycle would be to have a good burn early in summer, let all the skin peel off, then my tan would get darker and darker as the summer went on. I am the offspring of 2 British parents, so how I ended up with such a dark complexion is beyond me. With my long teenage hair and dark skin, my brothers would call me Pocahontas. I never considered myself a risk for skin cancer.

The doctor said it was an atypical mole. I asked if it was a typical atypical mole. He started talking about the ABCDs of melanoma and what to look for.

A = Asymmetry - mole is not symmetrical
B = Border - mole does not have a well-defined border
C = Color - mole has more than 1 color
D = Diameter - mole is bigger than 6mm

Mine was ABC but not D. It doesn't necessarily mean melanoma, but these things can lead to melanoma. After a long 7 days, the biopsy results were back. No cancer, no melanoma, just a mildly atypical mole (on a scale of mild, moderate and severe). He said "It's gone now, no risk, nothing else to do, just come and see me in a year". Whew!

We live in Texas and my kids are covered from head-to-toe when they go out. It just seems the sun is getting hotter and hotter and more dangerous. I'll get a mild burn after about 15 minutes. We aren't messing around.

So I urge you again, go get your skin checked out. You just never know. When I show up at my appointment next year however, I'm wearing a thong and doing some dumbbell curls in the parking lot!

Breast Cancer Awareness Month

2008-10-01T12:06:00.000-05:00

Linda's port was removed last Friday. Woohoo! In the cancer community, this is a graduation of sorts and quite an achievement. It's nice not to have that reminder there.

To celebrate 'Breast Cancer Awareness Month', Linda starts radiation therapy today. She was tattooed on Monday with permanent marker. She also took her first low-dose of Xeloda this morning. This will continue for the next 6 1/2 weeks. Let's hope she tolerates it well. She's been itching to get back to running but unfortunately, in order to keep the radiation alignment in check, she can't lose any weight for the next month and a half. I have no doubt she'll be running the San Antonio Rock n Roll marathon next year!

Is this normal?

2008-09-24T11:48:00.000-05:00

We celebrated our 13th wedding anniversary yesterday. What a fantastically normal day. I took the day off work, we had breakfast @ Rudy's, went and caught an early afternoon showing of 'The Pineapple Express' (very funny flick), we did some some shopping, got home to get the kids off the bus, cooked up some chicken on the grill, helped the kids with their homework, took my son to his first Boy Scout pack meeting, got 'em home, put them to bed and fell asleep watching Nova.

Honestly, on Dec 13th 2007, I wasn't even sure if we'd see 13 years. I was in complete shock and I had no idea what the 'C-word' meant. Months? Years? Not a clue. What I can say is that I can truly appreciate a normal day, and how blessed I feel to have the opportunity to do all those things. Carpe Diem.

The Home Stretch

2008-09-18T11:48:00.000-05:00

We met with Dr H. on Tuesday to go over the results of the PET scan and brain MRI in person. Again, all clear! There was some minor uptake around the area of the original tumor in the left breast, but that is most likely cells actively healing the site of the lumpectomy. Nothing to worry about but something we will keep an eye on of course.

Next up is radiation therapy. Studies have proven that radiation significantly decreases the odds of re-occurrence. If the original chemo was the cake and secondary chemo was the frosting, then the radiation is the sprinkles. Who likes cake without sprinkles anyways? The radiation regimen consists of targeting the lymph nodes as well as the site of the original tumor. It is administered 5 days a week for 6 1/2 weeks. That's about 33 half-hour visits to the radio-oncologist over the next month and a half. Luckily, Texas Oncology has an office only minutes from home so the commute won't be too bad (we used their downtown office for chemo as that is where Dr H. has her practice). I suspect I'll have a battle with the insurance on this one. Our insurance considers radiation therapy a 'procedure', which has a $0 copay whereas the provider considers it an 'office visit', which has a $15. $15 isn't bad at all, but when you have 33 visits, $15 x 33 = $465, and that's easily worth a trip to Vegas for the weekend. Does anyone out there have a similar experience with radiation, insurance companies, and co-pays?

"An ounce of prevention is worth a pound of cure", or so goes Dr H's aggressive treatment philosophy. Instead of straight-up radiation, Linda will be concurrently taking a very low dose of Xeloda (a chemotherapy) during radiation. This chemo (hopefully side-effect free) will extra-sensitize the targeted cells. Radiation typically damages the DNA of a cell during cell division. Cells are 'programmed' to kill themselves if the DNA is damaged during mitosis. That is natures mechanism to prevent unwanted cell mutation. There is only a very specific window during cell division when the radiation particle can damage the DNA. The role of Xeloda during radiation is to extend that window so there is more opportunity for the radiation particles to do their dirty work. At least this is my understanding from a 15 minute discussion with Dr H. The Xeloda is taken in pill form the day of the treatment so there are no more infusions, and if the Xeloda has undesired side-effects, Linda can simply stop taking it and continue on with radiation therapy as usual.

More good news...Linda is scheduled to have her 'port' removed next week. It is not a big operation but it is surely a nice milestone to achieve. It's been a long time coming!

Blue Skies and Sunshine

2008-09-12T16:14:00.000-05:00

While hurricane Ike pounds our Texas coast, our family has been blessed with Blue Skies and Sunshine!

Official word came from Linda's oncologist @ 4:02pm.

Brain MRI - CLEAR
PET scan - CLEAR

The cancer has not spread and is, in fact, gone!

Thank you, thank you, thank you, thank you, thank you, thank you, thank you, thank you, thank you, thank you, thank you, thank you, thank you, thank you, thank you, thank you, thank you, thank you, thank you, thank you, thank you, thank you!

I'm going to go celebrate with the center of my universe!

John

Karma

2008-09-11T22:22:00.000-05:00

I've talked in the past about my opinion that there is a reason or explanation for everything. Today, the day of Linda's PET scan, something happened to me that I cannot explain. To understand it in context, I have to step back to just over 9 months ago.

A couple days before Linda's diagnosis, she was going about her usual pre-Christmas shop-a-thon. This day, she was at Target picking up some gifts for the kids. For one of his big 'Mommy & Daddy' presents, our son had asked for this huge Tri-Clops remote controlled car (it's pretty cool). If memory serves me correctly, it was about $100. She found one, threw it in the basket with the rest of the yuletide goodies and headed for the checkout. During checkout, one of the items rang up an error and because the error was on the screen, the next 5 or 6 items that were dragged over the scanner didn't register, including the Tri-Clops. Linda pointed out to the cashier that there was an error and after realizing her mistake, she pulled back the items that went through unscanned and rescanned them...except for the Tri-Clops. As Linda loaded the day's booty into back of the car, she thought to herself that the 'Total' was a little light. Sure enough, after checking her receipt, it became apparent that the cashier had missed the Tri-Clops. So here sat Linda in the Target parking lot with a choice. Go home with a 'free' Tri-Clops or return to the store to pay for it. Now before you cast stones, think of everytime your waiter has missed something off your bill (hey...he forgot to charge us for the coffee...cool). Did you bring it to their attention? Or when the shorts you bought at Walmart rang up at less than the advertised price. Did you point that out to the cashier? If you have, then you are a better person than I. Needless to say, Linda decided go home with a 'free' Tri-Clops. Several days later, she was diagnosed with breast cancer.

Were the 2 events related? Who knows? We often joke to our friend, who is a pharmacist at Target, that Target gave us cancer. It has become neighborhood folklore. Over the past 9 months, all of our friends have told us of recently being in a similar situation, recalling that Target gave Linda cancer, and then deciding to do the 'right' thing. It's kind of funny, but it does get you thinking...is there such a thing. Do good things happen to good people (or visa versa)? Does what goes around, come around? Is there a universal balance of good and bad?

So what does that have to do with Linda's PET scan today? Everything!

Linda was done her scans by 1pm. I had planned to meet her for lunch but she was literally still radioactive from the isotope injections and barium smoothie she drank. We thought it prudent not to go out in public for lunch. Instead, we'd make some tacos at home. I stopped of at HEB to pick up some lettuce, tomatoes, taco mix and such as well as some potted mums (one of Linda's favorite flowers) for my Honey. At 2pm, the grocery store is pretty quiet so I was in and out. As I loaded everything into the car, I thought something's strange...that wasn't the right total. Lo and behold, the mums didn't ring up. It was an instant of clarity in a 9-month long haze. You've got to be kidding me? On Linda's PET scan day? Is this a test? I can't explain it and won't even try to. It just happened because it was meant to be, no reason needed. I'll let you figure out what I did with those mums.

Tomorrow will be a sunny day!

Faith

2008-09-10T15:09:00.000-05:00

Diagnosis, fear, anger, love, depression, chemotherapy, anticipation, optimism, isolation, uncertainty, surgery, pain, sympathy, grief, compassion, more chemotherapy, and hope.

It has taken a long 9 months of active treatment to get to this point. Tomorrow is a huge day. I can't even begin to express the feelings I am having. As much as I have been building tomorrow in my mind, it will be anti-climactic as we won't get the results until Friday (at the earliest) or next Tuesday (at the latest). At some point between now and then, we'll learn if we have been able to keep the cancer out of the rest of Linda's body. I'm trying to think of something insightful to say, but I can't. For once, I am at a loss for words.

Thank you to all the people who have sent prayers, positive vibes and/or good will. I may not have a traditional belief system, but I do have faith. I have faith in humanity. I have faith in friends and family. I have faith in Linda. I have faith that good things happen to good people. We have done everything we can and I have faith that tomorrow will be a sunny day.

You go girl!

2008-09-06T10:33:00.000-05:00

Linda attended her support group this week (for young breast cancer survivors) and was saddened to find out her friend, who is a stage IV survivor, discovered brain lesions after noticing some facial numbness. After further discussion with her group, it was revealed that IF triple negative (ER-, PR-, HER2-) breast cancers spread, they statistically tend to metastasize in the brain.

The next day, Linda was at the oncologist's office demanding a brain scan as part of next week's lab work. A PET scan covers the body from the neck down and does not include the head. A separate scan is needed for the head and not typically done unless symptoms exist. Linda left the office with an order for a brain scan on the same day as her PET scan (September 11).

Firstly, I'm glad Linda is back with her group. I can notice a positive change in her demeanor when she attends these meetings. Over the past few months they have occurred during her low cycle and she was unable to attend. She was on her feet for this one and it sure made a difference. Secondly, I am extremely proud of her for taking control of her treatment. She was not taking NO for an answer and was not leaving that office without a brain scan order. Slowly but surely I'm getting my Linda back. You rock babe!

Linda's friend needs your help. Please send your prayers and positive thoughts her way and let's help her get through this difficult time. Thank you.

You booked your PET scan for what day?

2008-09-04T11:43:00.001-05:00

September is a busy month around our household. In addition to new school year activities, both kids have their birthdays in September (Linda is usually in a very festive spirit around Christmas, I'll let you do the math...LOL), and we celebrate our wedding anniversary (13 years) in September also. So that's 3 days out of the month that are off the table for appointments. That leaves 27 perfectly good days to schedule a PET scan. Sept 8th, great, Sept 14, that'd be perfect, Sept 15, fantastic. So when did Linda schedule her PET scan?.....9/11. Uhhhg!

So...for us, September 11th will no longer be a day of sadness but we plan for a day of celebration. The 1st annual 'Clear PET Scan' day.

Advice needed: Preparing for a PET scan

2008-09-02T15:25:00.000-05:00

Linda finished her chemotherapy last Thursday and Labor Day presented us with a nice long weekend to recover. She was definitely exhausted all weekend but was able to putter around the house for a few hours at a time. The primary side effects are wearing off and hopefully by week's end, she'll be up and about for the whole day.

Our next major event will be a PET scan in about 3 weeks, prior to radiation therapy. Linda had CAT and bone scans prior to chemo but that was 9 months ago. Everything turned up clean then, and in all honesty, I didn't realize the implications of the test. This time however, I am all too aware of the importance of the PET scan results. Remember the 'longest 2 days of my life'? I'm pretty sure the wait for the PET results will top those 2 days. It is still weeks away and I am already stressed about it.

A question to anyone who can offer advice: How do you cope with the stress of it? More importantly, how can I help Linda cope with it?

Why are manhole covers round?

2008-08-29T10:31:00.000-05:00

I have been blessed and cursed by an analytical mind. The way I see it, there is a solution to every problem and an explanation to every mystery. We may not see it (yet) but the answer is there. As long as I can remember, my mind has churned at solving real problems as well as trivial pursuits.

The simple task of walking from my home office upstairs to the kitchen downstairs to get something to eat typically involves several billion calculations. First, wait for a time when my computer is busy doing something, don't want to waste spare cycles. Wait a sec, my daughter's field trip authorization form is right here too, but I don't have a pen. Should take the paper with me to sign or should I bring a pen back from the kitchen. Hmmm...where is her backpack? She'll need this form in the morning...I think it is near the front door...what makes the most sense and where should I sign it to be the most efficient. I need a beer too. Import or domestic? That dictates whether it will have a twist off cap or not, which means I may need to think about a bottle opener. Oh I think I left that in the garage last time I was working on a game. Crap, that is way out the way...does my daughter's backpack have a bottle opener on it? That'd be great. I know they make Reef sandals with a bottle opener on the bottom. What a great invention. I wonder if they have a patent on that? Let's Google that, but before I do, let's see why imported beers don't have twist off tops. Is that a law, federal or state? Wonder who invented the twist off top? Remember pull tabs? Those were replaced with the pop-tops we have today. I wonder if you really can buy a wheelchair by collecting a garbage bag of aluminum pop-tops? Let's go hit Snopes.com and find out. Look at that, turns out Thomas Crapper did not invent the flush toilet after all. Funny, in London, manhole covers have the name CRAPPER right on them. How ironic. I wonder why manhole covers are round? Turns out that is the only shape that makes it impossible for the cover to fall down the hole. That's pretty cool. See, there is an answer to everything. Much to Linda's chagrin, my mind never seems to figure out how to incorporate "there is a basket full of laundry here at the bottom of the stairs, maybe I should take it upstairs" into my equations. There may not be an answer for that one...LOL.

If you have a brain wired like mine, you know exactly what I'm talking about. If you don't, then you likely think I'm a bit crazy, and I'm not sure I can disagree. With that as the backdrop, I have been thinking a lot about cancer and 'why?'. Not 'why me?' or 'why us?' but 'why cancer?'. What role does cancer play in the big picture? I can't seem to wrap my head around it.

I can understand a virus. It is contagious, it moves from person to person, typically having a delayed onset of symptoms so that the current host is at least healthy long enough to spread the virus to the next host. I'm sure over that last billion years there have been virus variations that killed their host on contact. Guess what? Host 1 doesn't live long enough to spread to Host 2 and the virus doesn't get to spread its DNA (nature's prime directive). End of the line for that virus' lineage. Natural selection over millions of years makes sense. I can get my head around that.

So what about cancer? It is not a 'modern' disease. Although I'm sure pollutants and man-made environmental factors have increased the incidence of cancer and other disease, they are not the sole cause. Cancer predates man. It has been around for at least 100,000,000 years, as evidenced by recently discovered dinosaur fossils showing signs of cancerous bone tumors. I suspect it was around long before dinosaurs too. Unlike a virus or bacteria, cancer is not a foreign invader, it is home grown. It is our own cells and DNA gone awry. The Human Genome Project has mapped out our DNA and cancer researchers can point to certain genes and say, 'in some cases, this gene X suppresses cell activity Y but in cancer cells, this gene is defective and that, in combination with this protein over-expression Z yields a 34.7% chance of XYZ. That's very cool, but still doesn't explain the 'why'? Is it possible that cancer, like other genetic mutations, is simply part of natural selection and the evolutionary process? Some genetic mutations yield eyes on the front of the head for predators and eyes on the side of the head for prey, and natural selection dictates which traits go on to survive. That makes sense. Are those same genetic mutations responsible for cancer? Well, they've been there in some form for a long time so I have to assume they have some purpose. But what? I guess when we figure out the 'how' and 'why' we will have a cure. There is an answer and there is a cure, we just need to find it.

A Great Day

2008-08-28T14:15:00.000-05:00

6 infusions of TAC .......... $48,000
12 infusions of EP .......... $96,000
days since first infusion.... 240
ringing the bell ............ priceless

Cancer, cancer everywhere

2008-08-27T09:42:00.000-05:00

Okay, I'll admit I'm a bit obsessive/compulsive. Not the 'all shoes in the hall closet must be straight and parallel, separated by no more 2 inches but no less than 1.5' kind of OCD, but more of an intense focus. My obsessions ... errr ... interests have ranged from harmless to productive and most who know me know I usually have a 'hobby' going on. I've busied myself in the garage for the past 6 years (off and on) restoring old video games & pinball machines. Before that, I did geocaching for a couple years, and before that, photography for a year or two. Of course, Linda and the kids have BEEN my life for the past 15 years. My company and my passion for software has also received a good deal of my mind's focus. Although Linda would surely disagree, maybe I'm not all that obsessive/compulsive after all. Up until our diagnosis, it had been a healthy blend of family, professional growth, and solitary hobbies. (Don't get me started on email and Facebook)

Now, my life is consumed by cancer. Everywhere I look, cancer. Every time I think, cancer. I have a hard time remembering what life was like before our diagnosis 9 months ago. I'm sure I was happy about something, angry at someone, sad about something but these days it is all about cancer. I am happy Linda's chemo will be done on Thursday. I am pissed off that cancer stole the summer of 2008 from our kids, I am scared shitless about Linda's PET scan in 3 weeks, and I am sad because...well I am just sad. There are small moments in the day when I don't think about it, for maybe 5 minutes, but invariably the cancer creeps back into my thoughts. Even the exhilaration of plummeting 3-4 storeys down a water slide at Schlitterbahn is tainted by the fact that Linda couldn't come with us because she is extremely sensitive to sun during chemo. That's is OUR park and OUR tradition and the fucking cancer took that away from us. I haven't spent any time this summer in the garage tinkering with pins and my ability to concentrate at work has been haphazard at best. I try my best to keep the big 'what if' thoughts out of my head, but on bad days, they eat me from the inside. I'm sure a psychologist would say these are normal reactions and blah blah blah blah, and I'm sure they are, but that doesn't make them any easier to deal with. True to my OCD tendencies, my life has become cancer.

You know when you buy a new car and as you're driving home from the dealership, all of a sudden, it seems EVERYONE has the same car. It's kinda like that with cancer. It seems every week I learn of someone else whose fighting cancer. My best-man's mother was diagnosed with breast cancer weeks after our diagnosis. A dear friend, who I have a great deal of respect and affection for, was diagnosed with cancer a couple weeks ago. A blog friend's sister was diagnosed with breast cancer last month, and just this morning, a friend from high school related to me that a member of his extended family was diagnosed with breast cancer. It is a club that turns out to be not very exclusive at all. My immediate and extended family has had its fair share of cancer, especially on Linda's side who lost her father to multiple myeloma. Cancer really is everywhere. Do me, yourself, and your family a favor and make an appointment to see your family doctor or specialist today. Do not ignore that funny looking mole on your back, do not put off that annual mammogram, and guys, that 10 second visit with Dr. Finger may seem uncomfortable, but in the end (pardon the pun), you'll be a hero to those who love you.

A tale of 2 husbands

2008-08-20T10:59:00.000-05:00

A quick trivia question:

Your wife has been diagnosed with breast cancer. Do you?

a) bang your videographer
b) offer a $1,000,000,000 bounty on a cure for breast cancer

Former presidential hopeful John Edwards decided that the best way to deal with all the emotions that come along with being a breast cancer husband is to have sex with the woman who was documenting his presidential aspirations. The fact that he is a politician probably means he threw away his ethics long ago, but that doesn't excuse his actions. It is one thing to be a maggot in your professional life and another to be a maggot in your personal one. As much as I revile John Edwards, I can 'understand' his behavior. Surviving breast cancer exerts an enormous pressure on all aspects of your life, including your relationship with you wife, your relationship with others and your relationship with yourself. Bonds that are strong become stronger and bonds that are weak break. In a time of crisis, John Edwards chose to remain loyal to himself and satisfy is own insecurities as opposed to remaining loyal to his family who undoubtedly needed him more than ever. Sadly, having great moral character is no longer a requirement for becoming President, but I suspect his potential nod for veep has been compromised. The 24 news cycle has brought forward numerous talking heads discussing how common marital infidelity is during a health crisis. This may explain it, but definitely does not excuse it.

Mike Dewey on the other hand, a local business man, chose a more productive means to deal with his breast cancer crisis. He started a nonprofit foundation, The Dewey Foundation, and specifically offered a one billion dollar reward for a cure for breast cancer. It is called the Victory Project. You may question his ability to raise/offer $1B, but you can't question his devotion to his wife and family. Did some of the same thoughts and insecurities run through his mind at some point? Does he love his wife and family more than John Edwards? Is he a better person than John Edwards? Likely, yes, and yes. Thank you Mike Dewey for being a 'good guy'.

Terms of use

2008-07-19T13:09:00.000-05:00

As expected, Linda gave me hell for the 'Post Op' post. Hahahaha. It's all good though.

I really appreciate all the positive comments I have received about my ramblings. It really does make me feel good and allows me to get some of this off my chest. One rule of thumb is that you can't talk to me in person about this blog. Emails and comments are fine (and welcome) as I am much more comfortable as a keyboard commando than I am in person. Seriously, I get pretty uncomfortable talking about this and am liable to run away screaming or start sobbing uncontrollably depending on the day. I'm sure you don't want that :)

I've almost caught up to 'present day' at which point my ramblings may get a bit more scattered and less composed as I'd have had less time to think about what I want to say. The blog dates will be more reflective of when I post as opposed to artificially back-dating the posts to get a top-down presentation and flow like I've done up until now.

Thanks again and keep reading...

John

Welcome

2008-06-16T01:00:00.000-05:00

Okay, Facebook has really crappy blogging apps so I've chosen to use Blogger to write my blog, but have them imported into Facebook (where all my friends are) using notes. Let's hope this goes over well. This also let's me share with friends who refuse to join the Facebook Borg.

Knowing how un-anonymous the internet is, I'll try to keep this as anonymous as possible sticking to first names only and no kids names. If someone actually reads this and comments, please follow that rule of thumb. If you are here, you probably already know me anyways.

I've never 'blogged' before, or really shared my feeling publicly for that matter. A recent change in our life circumstances has prompted me to reach out and share our journey. Why blog? I hope it will be somewhat cathartic for me. I hope that someone, somewhere who is in the same situation can benefit from my experience and maybe help me get through this journey too. I also spend a good deal of time discussing our situation individually with friends and family and so hopefully this can act as a means for friends and family to stay up to date with how Linda, the kids and I are doing.

Today marks the 6 month anniversary of our life changing event, so my next post will chronicle how we got from Dec 13 '07 to Jun 13 '08.

The Diagnosis

2008-06-16T00:49:00.000-05:00

Christmas around our house is usually pretty chaotic. Planning usually starts around Nov 1 (Linda has been known to buy Christmas decorations in July). I have 8 huge rubbermaid tubs of 'stuff' to unload from the attic every Christmas, and every Christmas there is a new tub. Lights, reindeer, inflatable snowmen, spotlights...you get the picture. I think Linda makes up for the lack of snow in Texas by trying to cover the lawn with decorations. It is absolutely Linda's & my favorite time of the year. To be honest, we really don't need lights around the house because the glow from Linda could light the world at Christmas.

So the week of Dec 10 was shaping up to be a standard pre-Christmas week. Aside from the gifts that Santa brings, Linda races back and forth between Target, Kohls, JCPenny making sure the kids, and the pets, all have an equal amount of presents (she is really crazy that way). This week, she was finally going to get that mammogram. You see, back in September, Linda had noticed a lump in her left breast, but it would come and go. She saw her doctor who assured her that it was probably some hormone related fibroid mass. She said that when she had a chance, to go get a mammogram so they would have a baseline to measure against. Linda was 38 at the time so within a couple years she would start having yearly mammograms as the literature suggests. The visit to the lab was uneventful (if you can call having your boob squished to the size of a pancake uneventful).

Tuesday the 11th, Linda called me at the office and said her doctor saw something to be concerned about on the mammogram. They asked her to come in so they could do a biopsy on the mass. They call it a fine needle core biopsy. They stick a needle into the mass and with a little 'pop', they suck out a bit of it. They do this a couple times around the area. It is done right in the doctors office.

At this point, I was concerned, but not overly so. There is a history of these masses in Linda's family so this was just going to be one of those. She's 38 years old for Christ's sake. Linda called me after her doctor visit to see where I was on my way home from work. Turns out I was only 3 blocks or so ahead of her so I would beat her home. I met her at the door as she got out of her car and she started to cry.

I actually thought she may have hit a dog or cat on her way home and was upset about it. I really must be a moron because the 'c' word hadn't even entered my mind before this point. Not at all. This was just going to be one of those women-doctor-female-
voodoo things that some pill will take care of. It had always been that way in the past and this would be no different. Well, as you may have guessed, this was different. The surgeon who did the biopsy confided in her that, even before the results of the biopsy (which were due back on Thursday), he was pretty sure this was cancer. Fucking cancer ... and I wasn't even there for her when she first heard the 'c' word. Nice husband eh? Linda drove all the way home from the doctor's office, even called me to make sure I was okay, and never let on. It was only when she got home did she start crying...and my tears weren't far behind. This really sucked. This really, really sucked.

The next 2 days, waiting for the official biopsy, were by far the longest 2 days of my life. There had to be a mistake. I was convinced of it. This was Linda after all. She was training for a 1/2 marathon and was regularly running 10 miles on Sunday mornings. She was in the best shape that I had ever known. Eating well and exercising 5 times/week. For those 2 days, I was a mess. My eyes would well-up in my office, in my car on the way to/from work, pretty much everywhere. I prayed to God to make this better. I prayed to God to give me the cancer instead of Linda. I told God I would go to church every Sunday for the rest of my life if He made Linda better. I talked to God more in those 2 days than I have ever in my life. This may seem like a normal reaction to most people, but you see, I don't have a God. I'd done fine for 38 years without a one, but I can tell you I was looking for one desperately in those 2 days. If He was there, he wasn't listening. We got the lab results that Thursday.

I've probably been called useless several times in my life, but I don't think I've ever 'been' useless...that is until Dec 13, 2007. I'm not quite sure what the right thing to do when the love of your life, the center of your universe, your source of strength breaks down and sobs "I don't want to die". That moment is etched in my mind for eternity. I'm not sure what I said, probably something stupid like "Don't worry, we'll be fine". I do know what I thought though. "I don't want you to die either". This really, really, really sucked.

The initial clinical diagnosis. Invasive Ductal Carcinoma. 2.5cm mass in the left breast. 2-3 lymph nodes involved. Stage IIB. Moderately aggressive histological grade 7. ER-, PR+, Her2-, non-metastasized. In layman's terms, at least to me, a middle-of-the-road breast cancer. It will take some work (chemotherapy, surgery, radiation) to get rid this, but the battle is winnable. (more on the treatment in a later post)

We decided to tell the kids later that same night. I think we did it the the right way. Right for us. All huddled up on our bed, like we've done many times watching movies at night. We all cried. As much as it sucked, I will forever cherish that moment of bonding we all had.

Our journey had been set. We came to accept this was the hand we were dealt and we would get through this as a family. We still had Christmas to celebrate, it is afterall, our favorite time of year. And how did Linda cope...she planned and hosted a Christmas party for all our friends and neighbors...she is a superstar!

The Treatment (part 1)

2008-06-16T00:47:00.001-05:00

Having spent the first 28 years of my life north of the 49th parallel, I, like many Canadians, came to believe that health care in the US was made up of pharmaceutical lobbyists, greedy insurance companies, and long lines of uninsured people being kicked out of emergency rooms because they couldn't pay...at least that's the way they portrayed it in the CBC after-school special I saw :)

Seriously though, it was a big factor for us when deciding to move to the US in the late 90s. We grew up with decent "free" health-care, so moving to a place with privatized medicine and big, bad insurance companies was something that gave us pause for thought. Our first serious experience with it came when our 1 year-old son began losing weight, vomiting 4-5 times a day and regressing in his motor skills. The doctors performed a series of tests for hearing, balance, vision etc. If the word 'cancer' doesn't make your knees drop out from under you, then the words 'brain tumor' when used in reference to your 1 year-old son surely will. All those tests turned up negative and after a few more months, we finally had a diagnosis of Celiac Disease. CD is a genetic auto-immune disease which affects as many as 1 in 122 people, most of whom go undiagnosed and spend a life of unexplained stomach/digestive problems. Because the symptoms of CD often mimic other diseases, mean time to diagnosis is 11 years. After a GI tract biopsy (the gold standard for CD diagnosis) we had our diagnosis in 4 months. The course of treatment was quite simple. Stay away from wheat, barley, rye and oats for life. Considering all the shitty hands we could have been dealt, this was an ace-high flush. 5 years later, our son is a healthy, thriving boy, and except for our references to "good-belly" (food that is gluten-free) and "boo-boo-belly" (food that contains gluten), you'd never know he has CD. I cannot say enough about the quality and timeliness of the health-care we received. From his pediatrician who initially diagnosed him to his pediatric GI specialist who treats him, we have had access to the best health-care and caring professionals the world has to offer.

We wanted to tackle Linda's breast cancer head-on, as quickly as possible, as anyone would. We were scheduled for chemo to start less than 3-weeks after her initial diagnosis. Because there was a spread to the lymph nodes, chemotherapy wasn't an option, it was a necessity. Chemo is known as a systemic therapy because it treats the whole body. Surgery and radiation are known as local therapies because they treat the affected site (her breast and lymph nodes). The only real choice we had here was the order of treatment. Surgery first, chemo second and radiation third or chemo first, then surgery followed by radiation. With the doctors help, we chose the latter because of a couple reasons.

There was a risk that the cancer cells had made their way past the lymph nodes and into the rest of the body. Her diagnostic scans (cat scan & bones scan) had shown the cells hadn't metastasized anywhere else but free floating cells were always a possibility. Early chemo would kill those bastards if they were out there.
Having chemo before surgery (known as neo-adjuvant therapy) also allows the doctors to watch the tumor and see how it responds to the drug cocktail.

With that decision made, next up was the "Power Port". Being an avid gamer, I was pretty sure this was an accessory for my XBox. Turns out it is an under-the-skin catheter that runs from the upper right chest (in Linda's case) under the collar bone and into (or near) the heart. This allows the chemo to be administered at a much quicker rate and to be diffused into the bloodstream quicker due to the proximity to the heart. A standard IV injection tends to "burn up" the veins. Nice thought eh? So just before New Years, Linda had the port "installed" at the hospital during an outpatient visit. Strangely enough they don't 'knock you out' with a proper general anesthetic, they just give you goofy gas (same stuff you get when getting your wisdom teeth out). In true Linda fashion, she managed to wake up during the surgery. Long enough to feel a burning in her chest and hear someone say "...she's awake...", then knocked back out. She has a strange knack of being in the "1%" of the "this only happens in 1% of the cases". This knack is so fine tuned that during our immigration health checkup, she actually got a mild case of German Measles from a rubella vaccine. No shit. She has her own CDC record of the event and was home-quarantined for 3 days. Some crazy odds like 1 in a million. I like to call her "patient zero".

I'm pretty sure there was some discussion about doing tequila shots in her port that New Year's Eve. We were glad to be done with 2007 and looked forward to 2008, especially Jan 2, her first cycle of chemo.

Pick Your Poison

2008-06-16T00:46:00.001-05:00

Chemotherapy, as I see it, is an contradiction. On one hand, it is the culmination of 30+ years of intense scientific study, hundreds of thousands of hours of clinical trials and observations, harvested from obscure sources like rain-forest plant roots and a tried-and-true systemic treatment for many, many forms of cancer with millions of life-saving success stories. On the other hand, it is a poison. Designed to kill...indiscriminately.

Unlike targeted therapies such as Tamoxifen and Herceptin, which specifically attack cancer cells (or at least the mechanics common to some cancer cells), chemotherapy attacks all cells in the body. Usually injected, sometimes ingested, chemo travels to all parts of the body fed by the circulatory system and wreaks havoc wherever it goes. Although it isn't targeted to specific cells, chemo typically targets a specific cellular function or functions and jacks with it in order to cause the cell to die, whether a cancer cell or otherwise. The functions that it most commonly attacks are the cell division functions. Lo and behold, most cancer cells are dividing like crazy, that's what they do. So when the chemo is present in the body, it messes with those cells that are dividing rapidly, effectively killing them, and leaves the other cells (which aren't dividing) alone. So you may ask, isn't that targeting the cancer cell? Not really, because there are other cells in the body that are rapidly dividing too such as cells in the mouth, stomach and intestine, hair cells, nail cells etc. Guess what happens to them? Guess what the major side-effects of chemotherapy are? Wicked nausea, mouth sores, hair loss, blackened finger/toenails. Tingling in your extremities is also common because of temporary nerve damage. Throw in the inner workings of a woman's body (even in a healthy woman, that stuff is balanced precariously), hormones, hot-flashes, eye-of-newt, toe-of-frog...you can understand why Linda's first round of chemo caused some apprehension for both of us.

Chemos often work better in combination, almost like a one-two punch, or in Linda's case, a one-two-three punch. They are chosen based on the type and behavior of the cancer cells present in the tumor. Her regimen: Taxotere, Adriamycin and Cytoxin, collectively known as the TAC regimen. The drugs are administered sequentially in one sitting (takes about 5 hours in all), then repeated every 3 weeks, for 6 cycles.

On Jan 2, we showed up at Texas Oncology ready for the unknown. If you know Linda at all, you know she plans everything to the nth degree. Lists upon lists of things, plans, backup plans, alternates to the backup plans. There is no doubt we could have camped out in the infusion room for a few days with everything Linda brought with her that day. Every imaginable scenario had to be covered. Flood, drought, famine etc. Blankets (both thick and thin), shoes, slippers, sweaters, 2 ipods (one for me, one for her), sandwiches, fruits, vegetables, cold drinks, hot chocolate, books, the latest grocery checkout line finds of People, US, Ok, Star and others (sorry, those are my secret guilty pleasure), a newly acquired day planner of dates/times/schedules/metric conversion charts...oh and yes, a duck.

The duck is an inside joke between her and her girlfriends, who now call themselves her 'breast friends'. At some point in time, it resided in a lakehouse the girls rented for a weekend getaway. But now, over the past year, the duck has been found randomly by one of the girls in their kitchen pantry, bathroom, freezer, tree or other surprise location.

So Linda, facing the greatest uncertainty of her life, still lit up the room with her trademark smile and brought along a duck for a little comic relief in as much to say "Don't worry guys, I'll be fine". If that is not courage, I don't know what is.

The Treatment (part 2)

2008-06-16T00:45:00.000-05:00

The 'infusion room' sits on the top floor of Texas Oncology's brand new building near the center of the city. You park underneath and take the stairs or elevator to the 2nd floor. Linda always chose to use the stairs. To her, it became a benchmark to see how badly the chemo was kicking her ass over the next 4 months. To me, it was just a reminder of how out-of-shape I was. Emerging from the stairwell, you are presented with a large, nicely decorated reception area. To the right, administrative booths and further down the hall, exams rooms. To the left, scheduling booths, a pharmacy and further down, the 'infusion room'.

Unlike what I had expected, it is not a depressing place...and I don't mean the decor or lighting, I mean the people. You'll find people there from every walk of life, and every age: Big burly guys, little old ladies, a young lady listening to her ipod, someone watching Jerry Springer, and a 39 year old woman fighting breast cancer. I think by the time people get to the actual chemotherapy, they are past the initial cancer shock and are anxious to get going with their treatment. Now don't get me wrong, no one wants to be there, but if life's journey sends you down this path, this place seemed to be, at least to me, a place of hope and not despair.

Prior to any treatment, we always saw the oncologist (the cancer doctor). Linda managed to get one of the best oncologists in the city. Although very clinical, Dr. H. has an incredible ability to reassure you. She would always explain what our options were and what we could expect. She directed treatment but never dictated it. She has just the right balance of professionalism and compassion. Blood-work was also a staple of every visit. They had to make sure Linda was healthy enough to poison.

The infusion room has 4 sections. Each section is separated by a half wall. Each section has 8 chairs, with 4 chairs that face the other 4 chairs. It has big windows on 3 of the 4 walls making the room nice and bright. For every 2 chairs, there is 1 overhead TV (above the heads of the chairs that face you). Aside from eradicating the cancer from her body, the primary goal of every visit was to secure access to the remote control for the duration of her stay. There was no way that Linda would allow someone else to control her TV viewing destiny. As you can see in yesterday's photo, even before starting any chemo on her first visit, Linda had already seized control of the remote.

For all the build up, the anxiety about the treatment, the unknown, the first infusion went very well. They hooked up bag #1 (which I think was the C) and it dripped away for a couple hours. Linda really didn't notice anything at all. #2 was the A. This is a bright red liquid that is manually injected into the port by the infusion nurse. Adriamycin has the potential to be very bad for your heart, so they inject it slowly by hand to watch your reaction. The nurse sits there with a big ass syringe and slowly, for 20 mins, injects the red chemo. They call it dessert. If they pump it in too fast, you may get a headache, but that's usually it. After the A was the T. It too dripped away uneventfully for a couple hours. I don't know what I expected, but it wasn't that. I think I asked Linda "how do you feel?" every 10 minutes or so for our entire stay.

Armed with a day-planner-full of anti-nausea prescriptions, we drove home and sat outside that evening as we usually do during school breaks (it was still Christmas break for the kids). The neighbors came by one by one to see us, almost incredulous to the fact that Linda was outside. I doubt the words were actually spoken, but I know Linda and I for a moment thought the same thing..."this chemo stuff is easy"...ohhhh shit!

The Fallout

2008-06-16T00:44:00.000-05:00

New advances in cancer research are not only confined to the prevention, detection and treatment of cancer, but also include huge changes in the world of anti-nausea drugs. Next to the cancer-fighting capabilities, the next thing most people think about when they hear chemotherapy is the debilitating nausea. I know we sure did. As little as 10 years ago, that may have been true but 'big pharmaceutical' has made huge strides in that area. In 99% of the cases, nausea has become a non-event in chemo treatment. Sure there are many other side-effects to chemo to keep you occupied like extreme tiredness, nerve damage, hair loss etc but the nausea, in 99% of the cases, is non-existent.

You may recall how the 1% rule applies to Linda. Man, did she get sick after that first round. The slide from "I don't feel a thing" to "I'm getting sorta crampy" to "Get me the barf bowl" only took about 2 hours. It was full-on. It was so intense that Linda ended up back in the infusion room the next morning to get re-hydrated via IV...and again the next day. Even though Linda was on Kytril, Decadron and Phenergen, three very good anti-nausea meds, the doctors had grossly underestimated the Linda 1% factor. This is the same woman who gets sick reading in a car, sitting sideways on a bus, watching me play a video game and nearly vomits on the 'Barnstormer' kiddie ride at Disneyworld.

After 3 days, Linda started to recover from the chemo as it left her the body. The nausea subsided and Linda was coming around again. I can't really explain what she went through, only she could, but in the big picture, it was worth it. For those 3 days I busied myself doing all the laundry (I was pre-instructed on how not to mix whites & colors), cleaning the house (Honey, the dishes go this way in the dish washer, not that way), corralling the kids, and checking in on Linda every 5 mins. I know I couldn't 'fix' her pain, but I sure as hell could make it easier for her. It's pretty much a blur, kinda like when you bring a newborn home from the hospital for the first time. On the plus side, 'the unknown' was behind us now. The doctors took out the 'big guns' for the next round. Emend, Aloxi, and Ativan and they would prove to be a huge difference, but before we could get to Round 2 we had to face the inevitable: Hair Loss.

Chemotherapy doesn't actually kill the hair follicle (which is why the hair loss is only temporary), it just messes with the hair cells when they are dividing at the root under the skin. Those new hair cells are extremely fragile, so in 2 weeks, when the hair grows up past the skin, it simply snaps off.

Many women choose to shave their heads as an act of empowerment over the cancer. Earlier that year we had watched Robin Roberts of 'Good Morning America', recently diagnosed with breast cancer, shave her head on TV. Little did we know we would be faced with the same situation only months later. For Linda and I, it was a practical matter. There was hair everywhere. On the pillow, in the shower, on the couch. You could literally pull out a chunk of hair just by clutching it. I've known Linda for 16 years and in that time, she has never liked her hair. Too thick, too thin, too curly, too straight, too light, too dark, too gray, too short, too long. As fate would have it, in the months leading up to this, she was finally happy with her hair. Go figure!

Even though it was a practical matter, it was still quite emotional. Linda's friends had suggested she have a hair-cutting party with wine & cheese. It was too personal a thing for her to do that. This was our battle. The four of us, as a family, armed with the Wahl buzz cut kit I has bought earlier that day at Target, began to shave off her hair. The kids took their turn as we worked our way down from a #3 to a #1/2. After 15 minutes we were done. It is the not the physical act of shaving your wife's head that is emotional, it is the realization that you can no longer deny the fact that your wife has cancer. Every morning, we would be reminded of our fight. After a while I think we got used to it, if that is possible. Linda's friends threw her a hat and scarf party. Everything from "pretty hats" to "skull and cross-bone do-rags". Not only did it allow her to cover her head, but it gave her more reasons to buy more purses to accessorize with (someday I should write about Linda's purse 'issues').

This is kind of an aside, but Linda's bald head turned me on. No, not in a gay-Telly-Savalas kinda way. You really can't get much closer mentally, spiritually and physically than shaving your wife's head in the shower.

In public, like it or not, a bald head on a women is like a neon-light saying "I have cancer". You get the strangest reactions from people. Honestly, most people are too busy with whatever they are doing to even notice. Some people will be extra nice and a bit sympathetic. Some people just stare like there is a neon-light on your head saying "I have cancer". One evening we took the kids to Gattiland, an all you can eat pizza place with arcade. As we were eating, a couple sat down next to us and began to eat. He looked over at Linda, whispered something to his wife, she looked over, then they got up and changed seats. Are you fucking kidding me? Hey jackass, you can't catch cancer! For one moment, I wished cancer was contagious because I would have had Linda get up and give that bastard a bear-hug.

In support of Linda's follicly challenged head, some of her girlfriends joined the Sinead O'Connor tribute for a day. Many people wonder what they would look like bald. My genetics predisposed me to some cro-magnon-like appendage on the back of my skull that I like to refer to as the "bottle-opener". Turns out Linda has a very nice melon. Smooth and round. A childhood accident has carved an "L" scar on the back of her head which was hidden for 30+ years. It will soon be covered again with wavy brown hair but for now it serves as a nice monogram.

The Grind

2008-06-16T00:43:00.000-05:00

...and so went our lives for the next 4 months. TAC chemotherapy every 3 weeks for 6 cycles. As is much possible, it almost became routine. With the new anti-nausea meds, the poisonings became bearable.

Wednesday was a visit with Dr H. and chemo day. A quick blood test would make sure Linda was well enough to receive her treatment. I'd leave her in the chair with her blanket and remote control and head off to work. I'd pick her up again around 3pm. One of our friends would make sure the kids got off the bus ok and take care of them until we got home. With no immediate family in town, we really came to appreciate the good will of our friends and neighbors who all wanted to help in whatever capacity. Knowing she'd be out of commission for a few days, Linda would try to finish her chores as it usually took a few hours before the 'blahs' kicked in. By 7pm it was time to tuck her and the kids in for the night.

Anyone who knows me knows that I am not a morning person. My biggest adjustment to the new routine was getting up at 6am to get the kids ready for school and putting them on the bus on Thursday mornings. I never knew people were actually up and about that early in the morning. Who would of thought? Hell if Linda could endure 4 months of chemo, I could surely endure 1 morning every 3 weeks right? They don't just sell those 'Super Dad' coffee cups, you have to earn them! On the agenda for Thursdays was as a quick visit to get a Neulasta shot. Neulasta helps the body create more white blood cells.

By Friday, Linda would usually be feeling better, enough so to get the kids ready for school and bring me my cup of coffee in bed in the morning (did I say that I love her?). We normally took the first weekend after chemo pretty easy. The other 2 weekends of the cycle were the standard 'how do we entertain our kids?' weekends of movies, camping and such. Linda actually had her chemo (and recovery) scheduled around the weekends to make sure the kids and I were impacted as little as possible.

By midweek the following week, Linda would go in to check her "levels". Chemo affects both blood cell types. The red blood cells carry oxygen around the body and when they are low, you feel tired and sluggish. White blood cells fight off infections. Both of theses cells end up being depleted during chemotherapy. About a week after treatment is when you are at the bottom of your cell roller-coaster and although you feel great (relatively speaking of course), your body is very prone to infection. Linda would avoid going to public places during this time and carry a little bottle of hand sanitizer with her.

Compared to round1, rounds 2 and 3 were a cake walk. After the first round, the tumor in Linda's breast and lymphs nodes began to break up and started to feel mushy. After the second round, the tumor was almost non palpable in her breast and nodes. After round 3, you could no longer feel the tumor at all. Just a small crescent shaped bump of scar tissue from the original biopsy. The nature of Linda's tumor made it extremely sensitive to this regimen of chemotherapy. The choice of pre-surgery chemo also began to show its merit as we could see that the TAC was doing its job effectively.

Chemotherapy has a progressive, cumulative effect on the body. You never bounce back to where you were before the round. Although the nausea effects are the same for each round (now under control), the tiredness builds and builds. By the time Linda had 4 rounds, in mid March, the chemo was taking its toll both physically and psychologically. She stayed in bed for 4 days straight after the 4th infusion. She couldn't even stand. She collapsed in tears one day on the bed saying "I can't take this shit anymore". She is a very strong woman but had finally came to accept that this chemo was kicking her ass. Although the physical strain had taken its toll, I believe at this point it was the psychological aspect which really affected her. Her friends, with whom she trained for the marathon, were now running the marathon. Friends were basically continuing on with their lives and she really felt left behind. It was really tough on her. I guess before you come up, you must go down and I think this was the bottom. As a typical guy, I tried explaining logically why she was feeling this way and that, in fact, no one had abandoned her and everyone was still there for her. Well 'logic' and 'woman' go together like oil and water. I think when I simply acknowledged that she had every right to feel this way did she start to feel better. The fact is no one can be upbeat all the time. My 'bottom' would come a couple months later when, after Linda's treatment, I started to acknowledge what a toll this was taking on me.

But before I get into that, Linda was starting to feel better and we could see the light at the end of the tunnel. Linda needed some shopping therapy...and not just any shopping...cranial prosthesis shopping!

The New Do

2008-06-16T00:42:00.000-05:00

Somewhere down in clause 2.2.3, subsection 2a of our medical insurance, under "Durable Medical Equipment", you'll find an entry for a Cranial Prosthesis. Do they really have to call it that? If it just said "Wig", wouldn't every English speaking human understand what it meant. The insurance company website has green fields with trees, patients (sorry...members) laughing, doctors in white jackets and some tag-line about caring, compassion, health...blah, blah, blah. I don't know, it just seems kind of hypocritical to me to talk about all that big corporate compassion shit, and still, they expect you to feel good about getting pre-approval for a "cranial prosthesis" for your wife. Just call it a wig! That way, I can go to the pamphlet (that I had never read up till this point) and go to the index of "Shit I'm covered for", under W, and see Wig = "Up to $500". That'd be so much easier.

Don't get me wrong, our insurance has been fantastic (fingers crossed) and nothing in Linda's treatment has been denied (fingers crossed) and we get to go see who we want, when we want. Still, the word "Cranial Prosthesis" in subsection 2a, under "Durable Medical Equipment" in clause 2.2.3 made me realize that we are just a number in some vast private health-care system and, aside from our team of oncology doctors who really do care about us (more specifically Linda), we are a series of claims and "explanation of benefits" forms to the industry. One of my biggest fears is that someday the insurance company computer will flag us as 'non-profitable' (which I'm sure we already are...I've seen how much this treatment costs) and we will be denied. That day hasn't come, but if it does, we've always got that passport with the Queen and Maple Leaf on it as a safety net.

From the day Linda first lost her hair, the option of a wig was always on the table but it took her 3 months of do-rags before she finally decided she wanted one. I think she just got fed up with all the awkward staring. So with a prescription in hand and a girlfriend by her side, off they went to the wig shop. As a side note, it was a good idea to take a woman along for advice. Don't ever ask a guy if something looks good as he is programmed to always say 'yes', even if it looks like a group of sparrows nesting on your head.

Linda would kill me if I posted some of the photos of the hair she tried on that day. The fact that she thought it'd be funny to have us draw all over her head before she went to the shop is phenomenal. In true Linda form, she thought of the kids and I first and turned what was probably a difficult thing for her into a fun activity for everyone else. (btw I Photoshopped my kid's names out of the photo).

Linda got her wig and wore it for a couple of weeks. She donned the do for a few 'occasions' where a do-rag wasn't quite appropriate. You must realize that in April and May, the temperatures in Texas are already in the low 90s so having a nylon/polyester wig on your head isn't all that comfortable. Also, the hairstyle wasn't quite the same as her own, so Linda never felt comfortable wearing it. In the end, Linda was more comfortable in her do-rag and preferred the awkward looks of 'that lady has cancer' over the awkward looks of 'that lady has really bad hair'.

The Bell

2008-06-16T00:40:00.000-05:00

As you enter the infusion room, there is a small brass bell on the wall to your right. Everyday someone rings that bell. The room is normally pretty quiet so a clanging bell easily gets your attention. That attention is well deserved. Every single person who rings that bell has had their own "Dec 13", a life changing day where a doctor told them they have cancer. Every single person who rings that bell has endured the painful side-effects of some cancer related treatment. Every single person who rings that bells hopes it is the last time they see that bell.

Linda may have missed out on the half marathon she was training for, but on April 16th, she finished the first part of her triathlon. It was her time to ring that bell.

(click 'View original post' if video doesn't display)

Like the big suck that I am, I got pretty choked up that day. Truth be told, I tear up during the ASPCA dog abuse fund-raising ads on TV so tears on my cheek are no monumental event, but this was big. For a small moment, we could declare victory. There are no guarantees in this fight, and Linda still had surgery and radiation therapy to go, but this felt good and sounded sweet.

You can hear Linda at the end of the video clip saying "We did it". From holding her hand for comfort during the first infusion to not mixing whites and colors in the laundry to proudly watching her ring that bell, we did this as a team (even though I was literally the 'water boy ' through most of it). We are stronger because of it and every day I am thankful to have Linda by my side.

With the help of friends and neighbors, we threw Linda a surprise post-chemo party. Friends, kids, presents, cake, and balloons (everything pink of course) were waiting for her when we got home that day. She finally cried.

New girls?

2008-06-16T00:38:00.000-05:00

Months before Linda was diagnosed, one of her good friends was also diagnosed with breast cancer. Linda's reaction at that time was "If I ever get breast cancer, I'd have them both removed, no question about it". She couldn't understand why there was even a question in her friend's mind. Why would she take the chance of it coming back?

A complete mastectomy has pretty much been the de facto outcome for breast cancer over the past 50 years. Today, there are many options in breast conservation treatment (lumpectomy) as well as re-constructive surgery after a mastectomy. There are some cases where a modified mastectomy (either one or both breasts removed) is recommended. In particular, during genetic testing, if the BRCA1 or BRCA2 gene mutation is detected (the "breast cancer gene"), then the odds of re-occurence are significantly higher and a complete mastectomy (and hysterectomy) is often the chosen course of treatment. If the tumor is large or the surgeon is unable to get "clear margins" during a lumpectomy, then the entire breast may also be removed. Clear margins simply means that when the surgeon removes the tumor during a lumpectomy, a biopsy on the mass is performed to ensure that there is a clean margin around the tumor free of disease, meaning that the tumor hasn't spread outside the margins. Another reason for a complete mastectomy is the peace of mind it may bring. Insurance will typically cover all the costs associated with breast reconstruction, or as Linda referred to it, "getting some new girls".

After several weeks, Linda had recovered enough from her last chemo, and the lumpectomy vs. mastectomy decision we had talked about 100 times was finally before us. Modern research has shown that, outside the special cases above, the long term survival odds for lumpectomy vs. mastectomy are the same and the odds for reoccurence are only slightly higher for lumpectomy vs. mastectomy. According to Dr H., since the stats are about 10 years old, before BRCA testing, 20% of those lumpectomies were probably performed on BRCA+ women and therefore the reoccurrence odds are likely skewed. If you factor that in, as well as cases where clear margins weren't achieved and cases where the woman chose not to follow up with radiation treatment, the odds for reoccurence are probably about the same.

Linda's BRCA testing came back negative, which was a huge relief, not only for Linda but also for our daughter (she wasn't aware of the test implications but luckily we can tell her the good news when it is appropriate). Even so, Linda was still contemplating a complete bilateral mastectomy at this point. It wasn't until we were told that Linda would need to wait about 1 year for breast reconstruction that she decided for a lumpectomy. You see, her follow-up radiation would end up damaging any implants that were put in during the mastectomy (something were weren't made aware of until Linda talked with her radio oncologist). So they would need to do the mastectomy, then the radiation, then let the area heal, then do the reconstruction. After everything she'd been through up until this point, and pretty much even odds, the thought of 1 year without breasts is not something Linda was willing to face.

I like boobs just like the next guy, maybe even more, but not for one second did I ever consider that to be a factor in our decision. I'd be lying if I said I didn't think about it. Of course I did. I think about boobs maybe 25-35 times a day, and sometimes they are my wife's :) Seriously, I wanted her to be healthy and happy about her decision whatever it was. As it turned out, we decided against the "new rack" and opted for the less invasive lumpectomy. The boobs I met when they were 24 were now 39 and would be coming home from the surgery which was now scheduled for May 23.

Surgery

2008-06-16T00:37:00.000-05:00

Prior to the lumpectomy, Linda's surgeon Dr. N, ran her through a bunch of imaging tests to plan the operation. She had another mammogram, a PEM (positron emission mammography) and a MRI (magnetic resonance imaging). To the best of my understanding, mammograms and MRIs are visual diagnostic tools whereas the PEM, basically a breast only PET scan, is a biological diagnostic tool. For the PEM scan, you swallow a radioactive isotope (something that emits positrons I assume) in a glucose solution. Cancer cells like to eat sugar, more so than other cells, and therefore after waiting for the glucose/isotope to make its rounds of the body, a PEM scan will "light up" those areas with a concentration of the isotope, likely cancer cells.

Linda's tests showed there was still some traces of cancer in her breast and lymph nodes after her 6 rounds of chemo. We were hoping for what they call a pCR (pathologic complete response) but instead we got a very good partial response. Even with a pCR, you still typically follow it up with a lumpectomy and radiation so the lack of a pCR didn't immediately affect the course of treatment. From the test results, the surgeon knew where and how much to cut.

The surgeon had us scheduled for surgery the morning of May 23rd at St. David's Medical Center. She never asked us if we were Catholic. Should you be Catholic if you go to a St. Something hospital? I don't think we had a choice and I never asked, however I was pleasantly surprised to find out that I didn't burst into flames when entering the hospital that day. Must of been Linda's Christian upbringing that saved us. After the requisite form filling and sign-in procedures, we made our way to the pre-op room. Linda got into her 'gown' while I found something decent to watch on the TV. Over the next hour, several doctors, nurses and orderlies made their way into the room. Each one of them looked at Linda's chart, flipped through some other paperwork, asked Linda her name and date of birth, checked something off their list, double checked her arm bracelet and continued to do whatever it was they were there to do. There must be enough 'guy goes in for a vasectomy, guy comes out without a kidney' stories to warrant all this behavior, but better safe than sorry I suppose.

As one of the orderlies went about his business, he made a remark to Linda about 'making a fashion statement'. We assumed he was talking about Linda's do-rag that she was still wearing. Linda got a bit miffed about the comment. "What the hell was that comment about? Doesn't he know I have cancer? That was kind of inappropriate". She stewed in her anger for about 15 minutes until a nurse came in and said "Honey...you have your gown on backwards...you might want to turn that around". Only then did we realize what the orderly was taking about. Holy shit we laughed...to the point of tears. All our pent up anxiety came out and I'm sure they could hear us down the hall. It was friggin' hilarious and fantastic. Before long, they came and got Linda and wheeled her into the OR.

The 3 hour surgery had 2 stages.

1. Remove what remained of the tumor in her breast
2. Remove any cancerous lymph nodes

The first part was pretty straight forward. Cut out the tumor and enough of a clear margin to make sure you get it all. The lymph node surgery is a bit more complicated. Up until fairly recently, lymph node removal involved what they call an 'axillary dissection'. They basically would go in and remove an entire level (maybe 2 levels) of nodes (there are 3 levels in all) in the hopes they got any cancerous nodes. A 'sentinel node biopsy' is a new technique where they inject a blue dye at the tumor site and see which lymph node the tumor drains to. The first one it hits is called the 'sentinel node'. This is likely the first node you'd find cancer in if it has spread (which we knew it had but were unsure of its state after chemo). They take that node and, during the operation, slice it in half and run a 'touch test' on it. I'm not quite sure what the touch test involves but it determines if there is cancer in the node. If cancer is found, then they go the next one in the chain. If it is found to be cancerous also, then they continue on and take out a chain of them. If no cancer is found in the sentinel node, then they are done and do not take out any more. Why don't you just take them all out and make sure all the cancer is gone? Lymph nodes are an essential part of the body's defense system. All parts of the body drain to lymph nodes (some under your arm, in your throat, in your abdomen etc). If you mess with those areas too much, you risk getting a chronic condition called lymphedema. If you've ever seen someone with a full length compression sleeve on their arm, there is a good chance they have lymphedema.

The only other time I had been in a waiting room was when my son had his Celiac disease biopsy, and Linda was there with me. Now I was alone with only my thoughts. During those 3 hours I must of walked a good 20 miles up and down the halls. At one point I sat down to watch CNN which was on the TV in the waiting room. I was terrorized by some 2 year-old who was making his way around the waiting room. His grandmother would call him back every 5 minutes or so for a refill of juice and Oreos. He fell somewhere between cute and objectionable. It was only after he tried to grab my vending machine dispensed honey glazed donut for the fifth time did I realize he was waiting for his mother to come out of surgery...and grandma was waiting for her daughter. All of a sudden he didn't seem quite as aggravating. I offered him some of my donut but he was no longer interested. Little bastard.

2 hours elapsed and I hadn't heard anything. The dude (by dude, I mean a 20-something guy who was way cooler than me) at the front desk approached me, "Are you John? Dr. N would like to talk to you on the phone". What the hell? A doctor calling me? Is this good or bad? It was in between. Dr. N informed me that the lumpectomy had gone fine and she was confident she was able to get clear margins however the sentinel lymph node tested positive for cancer metastasis as did the second one. Fuck me. I had "paid it forward" with the donut offering and this is the thanks I get. This sucked ass. Dr N. went in and removed 17 more nodes, the pathology of which we wouldn't know for a week. It would be another hour before Linda was out of surgery so I took a walk outside in the 100F Texas heat.

I walked around the block which was under construction, near some shitty student housing and right next to the busiest freeway in the US. Not quite the relaxing walk I needed. As I walked down the frontage road to I-35 I passed an Ethiopian restaurant. It looked like it had gone belly up. No kidding? Nothing says home cooking like bowl of porridge with flies on it. Needless to say I ended up in the hospital cafeteria. I sat there for half an hour eating my sandwich and people watching. I watched a guy come through the checkout line. He had nasty burn scars on every piece of skin I could see. He chatted up the checkout girl like he knew her and had obviously been in this cafeteria many times before. For all the shitty luck we'd had over the past 5 months, I guess "sucking ass" is a relative term.

As I stepped off the elevator into the waiting room, the dude at the front desk informed me my wife was in recovery and I could go see her at any time. I actually said 'Sweet' to him in a pathetic attempt to be as cool as he was. I think I missed it by a decade or more.

After she woke up, we laughed some more about the backward gown. I loaded my semi-drugged-up Honey into the car and brought her home.

Post Op

2008-06-16T00:36:00.000-05:00

Linda healed quite nicely from the surgery. Dr. N did a fantastic job and the only visible indication of the lumpectomy and axillary dissection are a couple very fine 2" scars. They will heal up nicely over time. The neo-adjuvant therapy (pre-surgery chemotherapy) had shrunk the tumor down to nothing and that, combined with Linda's already "ample" boobs made for a truly unnoticeable lumpectomy. Dr N ended up removing an extra 17 lymph nodes in addition to the 2 sentinel nodes for a total of 19.

A detailed pathology of the tumor and nodes was performed off-site and we had the results within a few days. The lumpectomy did indeed achieve clears margins which was great news and as suspected, the lymph nodes tested positive for cancer. The first 2 sentinel nodes still had visible clusters of cells but the next 3 in the chain had diminishing amounts of micrometasteses. Basically, there were cancer cells in those 3 nodes but they hadn't set up shop yet. The rest of the 14 in the chain tested clear for cancer. Also of note is that all the nodes tested negative for ECE (extra capsular extension) which means the cancer cells hadn't broken outside the walls of the nodes...a good prognostic indicator. As important as anything, it was also a great psychological relief for Linda and I to know that the cancer we first saw on Dec 10th was finally out of her body. Linda began to do her exercises to prepare for radiation treatment. She needed to be able to lift her arm over her head which is no easy task after someone has been digging around with a scalpel in your underarm. It'd take about 3 to 4 weeks.

Her recovery was moving along so well that yours truly finally got lucky. If you think "make up" sex is good, it ain't got nothing on "we just got through the toughest thing we've ever had to face" sex and "no action for 6 months" sex. Don't get me wrong, I was a 15 year-old boy once so I could rub one out like a pro, but after 6 months that gets kind of old and you find yourself getting creative. Have you ever heard of The Stranger? Seriously though, I know Linda will kill me for this paragraph but it did feel good to be a normal couple again. That's all I have to say about that.

i feel like i can fly when I stand next to you

2008-06-16T00:35:00.000-05:00

I made this video for Linda to cheer her up when she was feeling her worst.

(click 'View original post' if video doesn't display)

There's something that I can't quite explain
I'm so in love with you
You'll never take that away
And if I've said it a hundred times before
Expect a thousand more
You'll never take that away

Well expect me to be
Calling you to see
If you're OK when I'm not around
Asking "if you love me"
I love the way you make it sound
Calling you to see
Do I try too hard to make you smile?
To make us smile

I will keep calling you to see
If you're sleeping, are you dreaming
If you're dreaming, are you dreaming of me
I can't believe you actually picked me

I thought that the world had lost it's sway
It's so hard sometimes
Then I fell in love with you
Then came you
And you took that away
It's not so difficult
The world is not so difficult
You take away the old
Show me the new
And I feel like I can fly when I stand next to you
So while I'm on this phone
A hundred miles from home
I'll take the words you gave me and send them back to you

I only want to see
If you're OK when I'm not around
Asking "if you love me"
I love the way you make it sound
Calling you to see
Do I try too hard to make you smile?
To make us smile

I will keep calling you to see
If you're sleeping, are you dreaming
If you're dreaming, are you dreaming of me
I can't believe you actually picked me

Blue October - Calling You

Are we done yet?

2008-06-16T00:33:00.000-05:00

So there we were, preparing for the third leg of the triathlon, radiation therapy. Linda had already met her radio oncologist a few times before and this Friday she had an appointment to get marked up so they could target the right areas. Left breast and underarm. They can get pretty precise in their targeting but not perfect. The choices were lose 10% of left lung capacity or 10% of the heart. I don't think it was actually a choice. With Linda's lungs able to take her on a 13 mile run, a 10% loss would not even be noticeable.

Linda called me at the office saying the first radiation treatment was being postponed. When I asked her why, she said the radiation doc informed her that Dr. H wanted to do more chemo. I immediately felt that deep ache in my stomach all over again. What the hell was going on? Linda has a tendency to not ask questions of her doctor (which is one reason why I attend all her appointments with her...except this one of course). This was a Friday afternoon and I went into full panic mode. I must of called Texas Oncology 5 times trying to get through to Dr H. without any luck. I left message after message with her nurse and receptionist. Linda had a scattering of details from the radiation oncologist about what the new chemo cocktail would be, but she "misremembered" the names. I spent Friday night chasing down the drug names on the internet to hopefully gain some insight into why she was getting more chemo. With the drug names being wrong, it took me to places discussing distant metastases, liver cancer and other shit that just made the knot in my stomach tighter. I try to discourage Linda from getting on the net and googling stuff because she invariably finds some story or statistic that makes her sad and depressed. I've tried to explain to her that she is a unique case and all the stats in the world mean nothing and all the stories have no bearing on her ultimate recovery. Of course she ignores me anyways, reads the stats and the stories and gets depressed...and then I do.

The thing that sucked is that Linda and I started running again. No, not 13 miles yet, but 1 mile. An incredibly difficult mile for her but one that felt great. At this point, she almost had full range of motion of her arm and her peach fuzz hair was just starting to grow back. After 6 months of crap, things were finally starting to look up.

Maybe we were too eager to 'be done' with this and put it behind us. Maybe we just wanted our old life back, a life not dictated by tri-weekly poisonings with 'up weeks' and 'down weeks'. Maybe I should have gone to church after all. Whatever it was, it would be a long 48 hours before we would learn why Dr H. wanted to continue chemotherapy.

More chemo

2008-06-16T00:30:00.000-05:00

Current non-surgical treatments for breast cancer can be broken into 3 categories (at least I see them as 3 different categories). Systemic chemotherapy, endocrine (hormonal) therapy and targeted therapy.

Systemic therapy is the classic chemotherapy you probably know and is what Linda went through for 6 cycles of TAC. Current research in this area is trying to discover which cancers cells are more susceptible to which kind of chemotherapy. Not all cancer cells are alike and certain markers in the cell can help determine which drug cocktail works best, if at all. Because chemotherapy is the most disruptive of the treatments to the rest of the body, it makes sense to only follow a regimen, if any, that has the best odds of success.

Endocrine, or hormonal therapy takes advantage of certain receptors on the cancer cell. Some cancer cells 'feed' on estrogen and progesterone. Cells that behave in this way are known as ER+ and PR+. Tamoxifen is a drug taken daily in pill form, usually for up to 5 years after initial therapy. To the cancer cell, it looks a lot like estrogen. The estrogen receptors on the cancer cell get blocked up by this 'low powered' artificial estrogen hormone. Because the receptors are blocked by this fake, the cell can't feed on real estrogen and the cancer cell ultimately dies. Although Tamoxifen and similar drugs have side effects generally related to a women's internal chemistry (bone loss, hot flashes etc), the side effects are not nearly as life disrupting as chemotherapy and can therefore be taken for a long-term insurance policy against the cancer coming back. About 75% of breast cancers are ER+/PR+.

Targeted therapies are where the huge advancements in cancer drugs are currently being made. As little as 10 years ago, a woman who was Her2+ had a significantly worse prognosis than one who was Her2-. These types of cancer cells, which have an amplification of the Her2 gen, are typically resistant to both chemo and hormonal therapies. There wasn't really a treatment option for them. Today however, thanks to our understanding of the human genome, Herceptin is a drug that was developed to specifically target the Her2 gene (I won't pretend to know exactly how it works, but you can Google it and see what a change it has made in breast cancer treatment). About 20% of breast cancers are Her2+. Leading edge research is discovering other genetic 'defects' in cells that can be exploited to kill off the cell or halt cell growth. Understanding how cancer cells acquire oxygen and cutting off their supply (anti-angiogenesis) is at the forefront of cancer research today.

Understanding the nature of Linda's cancer cell is important to understanding the treatment options. The initial biopsy of the tumor indicated that Linda was ER-,PR+ (15%), and Her2-. A pretty rare combination (remember the Linda 1% factor). This meant that Tamoxifen would have limited effectiveness in long term treatment and Herceptin was not a viable treatment option either. Systemic chemotherapy was our only tool to fight this cancer. As fate would have it, cancer cells like these are very susceptible to chemotherapy which is why we noticed an incredible attack on the tumor in her breast. With such great results, why then did Linda require more chemo? Remember those 2+3 positive lymph nodes? Dr H. said that if the cells in the nodes were the same as those in the breast, she would have expected them to be destroyed too, but they weren't. After further analysis of the pathology, it turns out the cells that were left in the lymph nodes were a bit different than those in her breast. They were ER+ (faint), PR-, Her2-. Did they mutate because of the chemo? Were they different to begin with? It was unclear. Now understand that those nodes were removed during surgery, but there was still a chance that cells of that type had escaped into the bloodstream. Without Tamoxifen or Herceptin as a backup plan, and to increase our odds, we decided that another round of chemo was the right thing to do. There was a good chance that with the original chemo, the lumpectomy and node removal, the cancer had already been eradicated from her body, but if a secondary chemo treatment could push the odds in our favor, even just a bit, then it was a worthwhile thing to do.

I talk like 'we' had a choice, where in reality it was Linda's decision. I am in awe of her resilience and strength, not only to fight for herself, but if you know her, you know she is fighting for our entire family. She fights so that I have a wife and that our kids have a Mom. For that, I am eternally grateful and love her unconditionally.

Can you pass the cisplatin and etoposide please?

2008-06-16T00:29:00.000-05:00

I am finding I do most of my blog updates when Linda is in active treatment, and this week has proven to be no different. I sit here typing this on 08/08/08 and have pretty much got caught up on current events. Although I think about our cancer all the time, during down weeks when Linda gets her infusion(s), I think about it every second of every day. I guess writing about it helps take some of the edge off, but it still eats at me. Has it been therapeutic? Somewhat, yes. I can write paragraph after paragraph on how fantastic Linda is, because it is easy, she is incredible. When I write about her, I don't have to deal with my own shit. Someday, maybe, I'll write my 'woe is me' post about the fears, guilt, sadness, anger, and the 'this sucks' feelings that are apparently common to co-surviving husbands, but for now let's stick with the easy stuff.

This week, Linda finished her 3rd cycle of cisplatin+etoposide (EP) chemotherapy. The EP regimen is not typical for breast cancers and is usually part of lung or testicular cancer treatment. Recent studies have shown that platinum based therapies have made a significant increase in the 10-year disease free survival statistics for cancers similar to Linda's. The regimen consists of 4 cycles each separated by 3 weeks (last time it was 6 cycles separated by 3 weeks). This time however, instead of 1 day of chemo per cycle with TAC, EP gives you 3 days in a row per cycle. Day 1 is cisplatin+etoposide, day 2 is etoposide only as is day 3. A shorter overall time-frame as compared to TAC therapy, but twice as many infusions.

Linda tolerates EP pretty well. The first cycle was the big unknown. Side effects are similar to TAC and yes, this usually includes hair-loss. For a while, we thought the Linda 1% factor would leave Linda with her new hair, but there is no doubt now that it'll all go...again :(. I think the lows are a bit lower than TAC but the intermediate recovery seems to be a bit quicker. Because of Linda's nausea issues with TAC, she over-prescribed herself with Decadron on her first round of EP. It is a steroid and she became wired from it, unable to sleep and heard voices. She toned it down for #2 and #3 and they were much better...less crazy!

In 3 weeks we'll be done chemo. Linda says she is ripping the bell off the wall this time. I may give her a hand. Unfortunately, her last cycle falls on the first day of school, usually a big production around our house. Just another fucking reminder that our lives will never be the same. (wow, I just re-read that last paragraph and I think I'm in a funk, probably just my 'male period' moodiness I seem to have acquired over the past 8 months)

Unlike most narratives, there is no ending to this story. We just live life appreciating every day, even the shitty ones. I don't think there will ever be a "You're cured" day for us. It will be in the forefront of my mind for the near future, then maybe move it to the back shelf in my brain, then someday, God willing, we can have a day where we don't think about it.

Since starting this bog, I have learned that I am not alone in this. Many friends I haven't seen in almost 20 years have contacted me and sent their well-wishes and prayers, and it was this blog (and Facebook) that made that happen. Someday, hopefully, our experience will resonate with someone else going through what we are going through. Until then, I will continue to write as we find our way through this journey that fate has chosen for us.