Depression makes its sneaky return?

So for the past four nights I’ve found it very difficult to sleep. I have always suffered from insomnia, but usually Trazodone helps take the edge off, and the fatigue from all the treatment has really kept me sleeping. The last few nights I have averaged 5 – 6 hours, and that’s not solid – that’s on and off. That may sound fine to some but as someone who really needs 8, I’ve been struggling.

Additionally, my appetite has suddenly tapered off to nothing, which is VERY unusual. I didn’t even eat a cupcake at Conor’s birthday! Finally, I have been feeling very lackluster – no motivation, no desire, lots of guilt. Couldn’t get a sitter to go a friend’s event last night and felt terribly about it; have a sitter tonight for plans I’ve really been looking forward to, and now have no desire. So now I’m wondering: is my depression returning?

Of course, it could be all the chemicals still in my system, or my hormones readjusting. (More on that later, actually; hard conversation with Dr. K on Wednesday [re hormone treatment] that could be contributing to the blahs). It could also be that I have been battling a cold and am now having GI issues. Or, finally, the insomnia could of course be causing me to feel depressed – it wouldn’t be the first time.

Regardless, I am nervous, and in that curious depression quandary of feeling desperately lonely but not wanting to talk, of wanting company but not wanting to interact. And I’m just trying all the while to act normal in front of the boys because I don’t want them to be children who grow up remembering “When Mom had one of her spells!” I’ll just try to stay aware and if things degrade I’ll talk to a psychiatrist about my meds.

As far as hormone treatment, we met with Dr. K Wednesday and of course he strongly recommended I do the once monthly Lupron shots. I told him no, and he was – I guess probably just concerned, but of course I felt it was disapproving. He asked if I could tell him why, just so he knew, and I started crying as I described the hot flashes, night sweats, wrinkles, roughening of the skin around my jaw, weight gain – all of which happened while I was on Lupron during chemo. I told him I had no problem with growing old, no problem with turning 45, but that I’d like to do it in seven years, when I turn 45. He understood and was supportive, and we agreed to talk about it again down the line. Complicating things for me is the fact that a friend’s mother had breast cancer roughly ten years ago, and she did the full course – chemo, radiation, and hormone therapy – and it has now metastasized. So it’s all a roll of the dice anyhow.

After we left I realized it’s not just the symptoms I don’t want – it’s the daily reminder of those symptoms. That I had cancer, that I can have it again, that it could kill me. I mean it’s always going to be at the back of brain anyhow, but I don’t need to be reminded three times a day when I take the Gabapentin to combat the hot flashes (which by the way I am now off of, yay), as well as every fucking time those hot flashes occur.

The other day I went in to get sugared and it was an aesthetician I hadn’t met before, as mine is out sick. She asked me about my cancer and treatment and when she found out I was through, she remarked, “So you beat cancer.” Which, I am sure she was trying to be nice, but no. No I haven’t and honestly I can’t help but think that I won’t really have “beat cancer” until I die of something else. On the plus side, I told Julian this and it’s led to all sorts of great jokes, like me on my death bed and my last words being, “Suck it, cancer! Heart disease wins again!” (Julian’s: “Yes! Hit by a car! Take that, cancer!”)

Starting Monday, Julian and I are going to try to do a 10-day green smoothie cleanse. I am doing it to get rid of all the poison left in my system and to try to be healthier – I’m hoping it might also help with my joints (which are terrible, and contributing to my depression). He is doing it because he is supportive and amazing. Dr. K gave it the thumbs up so I’m hoping for the best.

This turned out to be a long, rambling post, but I guess I had a lot inside me. Happy Saturday – get out there and live.

And away we go.

It’s been a day of tears. I’m going to be brief.

• Tuesday, 12/8 – Portacath insertion in the am (see here if you want to know what that is). Local anesthetic and “something that makes me sleepy.”
• One week recovery time.
• Wednesday, 12/16 – First chemotherapy session at 8am. Three and a half hours of TC chemo drugs administered through the portacath at Swedish Cancer Center.
• Saturday, 12/19 – Travel home to visit family for the holidays.

Sometime 3 – 5 days after the chemo administration I should start to experience the side effects. The immediate ones – flu-like symptoms, aches and pains, nausea – last 4 – 5 days. The hair loss, of course, will last more or less the course of the treatment.

Dr. Kaplan said the first week I will feel bad, the second week a little better, and the third week back to normal – at which point I get another treatment. I will have the drugs administered every 3 weeks for a minimum of 4 cycles. If I tolerate it well, he would like to do 6 cycles – which will take me right up to and through my birthday.

That’s really all I have to say right now.

Also one last thing. There is a shot they can give you called Neulasta that will up your white blood cell count to counteract the likelihood of getting an infection during chemo. Apparently, my insurance doesn’t cover it, so my option is to go without or to give myself a daily shot of another medication to do the same thing. THANKS, PREMERA.

I am scared.

I am scared I am scared I am scared I am scared I am so damned scared.

I don’t know why I just – I am having like a fear panic attack. I am supposed to be going out with a friend tonight and my hands are shaking and I am nauseated. I assume it’s because I will be seeing the doctor tomorrow and finding out my treatment schedule, but I don’t know why that should scare me any more than what I already know. Still.

I am so scared.

I’ve never known fear

I hate this. I HATE this.

So here I am. I feel great, my wounds are healing. They cut out the cancer. It’s gone. …right?

I’m being a mom, I’m being a wife, I’m getting ready for the holidays, I’m organizing, bill paying, cleaning, dog walking, I’m living my life the way I always have. I’m a firecracker.

And they tell me, “Do this, just in case.” And, “Also do this.” And the thing is, I feel great, and those things will make me feel horrible. Each one has not only side effects during treatment that make life less livable, less enjoyable, but also potential long-term effects. Cosmetic effects – shrinking and firming of the breast, permanent hair loss, skin discoloration – and scarier, more devastating internal effects – more cancer (it’s called cyTOXan for a reason), loss of fertility, permanent menopause.

So I feel great, I think the cancer’s gone… but just in case. Just in case, I should risk my mental, emotional, and physical health for a possible positive outcome. The doctors say, the statistics say, the people who love me say – do it, just in case.

Would I rather regret something I did, or something I didn’t do? What if there end up being no regrets at all? Or what if the treatments take away my sparkle?

Oncotype DX Results

Agh okay so I don’t feel like blogging this. I don’t know why, just not feeling it. So it will hopefully be pretty short and succinct.

My Oncotype DX results finally came back. My Recurrence Score Result is 22 (out of a possible 50) which puts me just above the low range in intermediate. Good news/bad news situation. Let’s do bad news first and get it out of the way.

BAD NEWS
They don’t know what to do with intermediate peeps. Low means chemo won’t have any effect on you; high means chemo has definitely decreased recurrence rates in the majority of patients in that group. Chemo on intermediate patients helps some and doesn’t help others. Researchers are still working on identifying what the factors are that cause the difference, but they don’t know yet. So being that I am intermediate, it is now our choice to do chemo or not – and it may or may not have any impact on whether or not I have a recurrence of cancer.

GOOD NEWS
My cancer is/was high grade – it got a score of 8 out of a possible 9. (What can I say, even my cancer aims for the stars.) With that in mind, me getting a low intermediate result on the Oncotype test is really amazing! It could have easily come back high grade, which would have meant definitely chemo, definitely hormone treatment, and STILL a possible recurrence. So we’re in pretty good shape!

We met with a final doctor today, Dr. Ellis. She was GREAT and is also in Dr. Kaplan’s office. I think we’re going to stick with Dr. K – I really liked his manner. He was very easygoing and essentially gave the impression that all of this is a formality to me recovering 100%, which just really put me at ease. That said, Dr. Ellis was the first one to see my Oncotype results so she was the one who gave me her best ideas for my treatment. I called Dr. K afterwards and we chatted and he is basically of the same mind, although we have an appointment scheduled with him for next week to formulate a solid plan.

It looks like (and again this is just a rough guess right now) I may be able to avoid Tamoxifen (which my gut says I should do), IF I do 4 cycles of TC chemotherapy accompanied by Lupron to suppress my ovaries (and, according to Dr. K, help preserve my fertility). Plus of course the radiation. This would mean 3 months of chemotherapy – one administration of the drugs every three weeks for four times total. Typical side effects that you probably already know about, plus the added benefit of it possibly sending me into permanent menopause (although Dr. K thinks at my age I may make it through just fine).

I think that’s pretty much all the data I have right now. I am nervous and scared but also glad we can finally move forward with this. I am second guessing myself all the time and sometimes the overwhelming amount of information we have – and don’t have – makes me just want to say, “Screw all the treatments, I’ll take my chances.” But I have to do what I can to make sure this doesn’t take me down, for my family. I guess the most annoying part is they cut out a very small, very early lesion – along with a perfectly good lymph node! – so I feel like I am cancer free. So WHY do I have to do all this additional crap that’s going to make me feel, well, like crap? I feel good now, why do things that make me feel lousy?

Just things I have to deal with, I guess.

Waiting and changing

So the reason I haven’t posted anything cancer-related lately is there has been nothing to post. We met with that medical oncologist who made me really unhappy and he sent away for the Oncotype DX test, and there was an insurance snafu, so the results are not back.

In the meantime I made appointments with two other medical oncologists, both recommended by other women who have been through the breast cancer wringer. We met with one today and I cannot even begin to explain the difference. I left the last appointment feeling defeated, worried, unhappy, helpless, and judged. I left this appointment feeling supported, understood, heard, hopeful, healthy, and capable. Where the other doctor basically presented us with statistics and a one-size-fits-all treatment plan, this doctor (also a male) was flexible, agreed that the treatment should be my choice and fit with my life, and cited numerous examples not just of women delaying taking Tamoxifen but also of using a totally different drug, Lupron. He also noted my history of depression and stated that these drugs are contraindicated for depression – something the other doctor didn’t notice/mention – and said that would be a concern and something we’d have to keep a close eye on.

This doctor has mannerisms and phrasing that were so familiar and reminded me so much of my Dad that I finally asked him where he was from. He told me New York City, and when I told him I was from Philadelphia, he said, “Oh you’re not a Phillies and Eagles fan are you?” and snarled disparagingly. LOVE.

Several times during our meeting he touched my hands or my shoulder gently and reassuringly. Everything about him was the polar opposite of what I experienced with the other doctor and I actually cried during this appointment as well – from relief.

I have been walking around for the past two weeks with a gray cloud over my head, feeling fearful and depressed about the future, uncertain how my life was going to play out at the hands of medical professionals. After meeting with this doctor I feel in charge of my treatment, the hows, whats, and whys, and like I have a partner in my care plan, instead of someone who will dictate what I should do and show disapproval if I do not agree.

Could not be more grateful. Really looking forward to moving through this now instead of dreading it.

Update on timeline

I talked to my doctor. He has no problem moving things forward, but here’s the catch.

I need to have an MRI before I can have the lumpectomy/axillary lymph node removal. The most accurate MRI results will not be till at least day 7 of my menstrual cycle, which is not until the second week of October. What does having an MRI before then mean? Potential false positives, i.e., areas of shading that appear to be cancer but are not. What happens if the MRI turns up (false) positives? Additional biopsies.

The biopsy SUUUUCKED and I do not enjoy the thought of having additional, possibly unnecessary biopsies. BUT I also do not enjoy the thought of chemotherapy, or twiddling my thumbs for another two weeks while I ponder the lesion growing in my boob.

With that said, MRI has been moved forward to 9/30, and results should be available 24 hours after the procedure. After that, doc says the lumpectomy/axillary lymph node removal (which from now on I’m calling ALNR because come on) can be scheduled fairly quickly.

So now, MRI in a little over a week. Fingers crossed for good (and in this case, “good” means “negative”) results so we can just go ahead and get this sh*t out of me without any further testing.

Hurry up and wait

This is the new scarf I bought myself. It has skulls. I am not doing a good job of smizing here.

I’m kind of dreading writing this cause it’s going to be long and boring. I’ll try to make it as concise as possible.

So, first and foremost, the doctor told me my cancer is a Stage I, approximately 8mm wide, and that currently we are looking at treatment for a cure – i.e., this is not life-threatening. It is invasive ductal, which is the type that approximately 75% of breast cancers are. It is high grade, which means it is fast-growing/spreading. He said I am very lucky I found that benign lump, as the two spots they identified because of it are not palpable, and in a year from now, we’d be looking at a very different situation.

From the scans they have so far, my lymph nodes appear clear, and the two spots in my right breast – right next to each other – that were identified appear to be the only abnormalities.

Now it’s just basically test, wait, make a plan, repeat. I had the blood test for BRCA today. The results for that may take up to three weeks to come back. They’re important, though, because as it stands right now, based on the limited information we have, the course of action would be lumpectomy to remove the spots, removal of several lymph nodes in the area of the spots, and then examination of the removed tissues. IF the lymph nodes are clear, which the doctor expects them to be, the next step would be radiation therapy, and possibly hormone therapy with tamoxifen. Hormone therapy is recommended if the tumors are ER+, which mine, based on the biopsy, are. Okay, digressing. IF the BRCA test comes back positive – which it could, although the percentage of women who have it is fairly low – the general recommendation is a double mastectomy. So we have to wait for those blood test results to form our treatment and surgery plan.

Now as I mentioned before, I am getting the MRI on October 6. The doctor actually immediately mentioned moving it forward, in spite of the MRI lab’s suggestion that it has to be done between days seven and 10 of my menstrual cycle. He said they tend to follow that recommendation because it’s when they get the clearest results, but he wasn’t sure if maybe we should do it sooner. He then went on to say that in actuality, it might not make any difference, since we have to wait till the BRCA results come back before we can do anything anyhow. In the end, he called the radiologist and asked for his recommendation. He said that the problem with doing it at another point in my cycle is that the results would be less accurate, and there was liable to be more shadows on the MRI that appeared to be something they weren’t, which could lead to more biopsies, etc., or could hide things that were there. He said in the end, the radiologist and he discussed what they would do if it was their wives, and they agreed they would want the most accurate results, but he left it up to me. I agreed with them. So October 6 it is.

Ai yi yi, okay, so where am I. Okay, so, once we have the gene results and MRI results, we can formulate an actual treatment plan. Again, back to based on what we know now, it appears that the treatment plan will be lumpectomy and lymph node removal (an outpatient procedure), followed a month later by 6 1/2 weeks of radiation. IF the lymph nodes come back positive for cancerous cells, then I will also have to have chemotherapy. In spite of all this scary stuff, it’s the tamoxifen that really scares me. I guess it’s a drug that prevents estrogen from entering the breasts. Side effects can be like menopause, I cannot get pregnant or nurse on it, and I have to take it for FIVE F**KING YEARS. This is the one part during the consult where I cried (to be fair, I’d taken two Xanax beforehand, so maybe I would have been bawling the entire time otherwise). I would very much like another baby, and I would ESPECIALLY very much like to breastfeed another baby. That said, I’m just going to try to roll with the punches here, cross the bridges as we come to them, and accept that God has a plan and it’s the right one.

I think that’s all the info I have now! This is such a super bummer because to be honest I NEVER liked the way my boobs looked and I thought having kids would only make it worse, but ever since I had them I actually like my boobs more. So I’m finally into them and now I guess they’re like, “Too little, too late, lady. This is what you get for years of shit talking.”

In conclusion, here’s a nice thought from my friend Annie and my fave actor Donal Logue. With Declan Murphy on my side, I can’t lose.

Also, Happy 71st Birthday, Dad! Thanks for the heads up, buddy.