And so it begins…again

Sunday, March 22, 2020. My meeting with Dr. Park and her colleague Dr. Xu (pronounced “shoe”) was enlightening and kind of creepy. COVID-19 was clearly top of mind for everyone Steve and I came in contact with. As we passed through the front doors of UCSF, we were met by a team of face-masked and gloved caregivers sitting behind a table. They vetted us with a series of health questions…do you have a fever, a dry cough, been out of the country, etc. Our answers were “no, no and no, etc.” Our reward was a yellow sticker they placed on the top of our hands deeming us worthy to enter the facility.

In the patient waiting area of the Radiation Oncology department, everyone was complying with the 6-foot radius plan of social distancing. The atmosphere was somber in spite of the fact it was St. Patrick’s Day, normally a big party day in San Francisco. I had worn my green-striped socks hoping to lighten the day I knew was going to be dominated by cancer and COVID-19. No one noticed the socks, but whenever I greeted a staffer with “Happy St. Patty’s Day!” the response was typically one of surprise accompanied by an “oh yah” smile since they clearly forgot it was a holiday. Distraction mini-mission accomplished.

Soon my name was called, and we were led to the examining room by a young woman named Lenny. She asked if she could bring us anything to drink. So as not to disappoint Steve said, “A beer.” We all laughed, and I added, “Alcohol is a disinfectant, right?”

When Dr. Xu entered, she kept the requisite distance and greeted us with a wave rather than the customary handshake. We talked a bit about the creepiness factor and how the trip to UCSF was made in record time due to the lack of traffic on the roads. Even the Golden Gate Bridge was empty, making the drive into the City seem a bit apocalyptic.

Then we got right down to business, reviewing my recent history and discussing my top two concerns: ONE. If I agreed to radiation, was there a chance of re-radiating tissue that had been bombarded 20 years ago? If so, what were the increased risks? TWO. Was it really wise to even consider radiation right now given my compromised immune system and the number of people I would come in contact with? After all, I would need to stay in San Francisco during the week (driving 6+ hours a day, 5 days a week over a 5-week period for what would amount to a half-hour treatment would be too exhausting), and where would I stay? What would the additional exposure be? UCSF patient housing isn’t even available now. Dr. Xu listened attentively. She discussed the area they would radiate. And although there would be some overlap from 20 years ago, it would be minimal and would not involve any vital organs. As for traveling and local accommodations, she agreed that postponing the radiation at this point in time was a likely option, but one that would need to be discussed and approved by Dr. Park and Dr. Rugo.

After a quick consult with Dr. Xu, Dr. Park and her nurse joined us. We revisited all my concerns. And Park gave me some statistics about my chance of a recurrence with and without radiation. It was then, I decided it was in my best interest to proceed with radiation, but not now. COVID-19 makes it too risky. Next, Park and Xu meticulously examined the landscape of my breast and pectoral area, carefully noting the rise and fall and texture of my skin. They considered the area where radiation would extend across my pectoral area and above my collarbone continuing partway up my neck. I was reassured that the long term damage to the tissue that might be re-radiated would likely only be discoloration and thickening of the skin. So I guess my future as a sexy senior centerfold model is definitely out.

All in all it was a great meeting. The newer, more targeted radiation techniques reduce the risk of damaging healthy tissue. If I were able to have radiation now, they would have me taking the oral chemo Xeloda on the days I’m treated (Monday thru Friday) and not take it on the weekend. But with radiation on hold for at least a month, the plan is to start taking the Xeloda right away. The dose is two 500 mg pills with food, twice a day, 12 hours apart. The regimen is 7 days on and 7 days off. On day 6 of my 7-days off, I will get labs done at the local hospital. The lab reports will be sent to Dr. Rugo. Soon after, she and I will teleconference to discuss the results and any side affects I might be experiencing.

Yesterday was my first day back on chemo, and it made me a little sad. I’m not sure what to expect as far as side effects go. The most common is hand/foot syndrome causing redness, swelling, and pain on the palms of the hands and/or the soles of the feet. Sometimes blisters appear. I can expect fatigue and a compromised immune system.

After I took my first dose, I sat outside on the edge of the front deck catching a little fresh air as I tried to embrace the fact that I was once again taking poison to kill cancer cells that may or may not be running around and partying like maniacs in my body. I wasn’t happy. More like borderline depressed. It was then I looked down and could not believe what I was seeing.

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The biggest 4-leaf clover I’ve ever seen in my whole life. I don’t find 4-leaf clovers. That’s my mom’s deal. I don’t even recall how many times I’ve been with her when she’s looked down and said, “Oh, look what I found! A 4-leaf clover.” She’s always been lucky that way.

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I’m taking this amazing clover as a sign. A sign of good fortune to come. A sign that I’ve made the right decision. A sign that in all the madness that is the world right now, we can expect some miracles along the way.

The miracle is to walk on the green earth in the present moment, to appreciate the peace and beauty that are available now. —Thich Nhat Hanh

The plan

Monday, March 2, 2020. After my appointment with Dr. Rugo last Thursday, Steve and I were talking about how much calmer we feel compared to last year. It seems remarkable given the fact that this recurrence happened only 6 months after my last treatment ended. I know why.

sunflower-heartLast year it was all about shrinking the cancerous nodes (or having them completely dissolve) to a point where it was safe to remove the largest one sandwiched between my large and small pectoral muscles. While enduring weekly chemo treatments, I remained inhabited by the cancer as it stubbornly refused to disappear. I just wanted them out of my body. I felt like I had no control. The cancer did finally shrink enough that surgery was worth the risks it presented. Finally, nine months after my diagnosis, the offending nodes were removed. The surgery was followed by 6 weeks of even nastier chemo treatments to obliterate any lingering scouts.

Still the cancer came back. This time it was very small and situated on top of the pectoral muscle, making it easy to remove. There was a palpable sense of urgency by my entire medical team. The surgery took place only 3 weeks after I was diagnosed. Three nodes were removed and only one presented with cancer. This time it feels like we are ahead of the game. It feels like a win. It feels like I have some control.

The plan. Beginning in April I’ll start oral chemo. I am once again being asked and strongly encouraged to do radiation. Both treatments can be done at the same time. I should be done with it all by the end of September. So, I’ve agreed to meet with the radiation oncologist later this month. This time I’m seeing Dr. Park as Dr. Yang is on maternity leave. Dr. Park is the Radiation Department Chair. My images from 20 years ago indicate that lymph nodes under my arm were not radiated. My concern is the nodes in the pectoral region since that is where the largest tumor was, and that it is where the recurrence was located. I need reassurance from Dr. Park that this area was not in the radiation zone back then since radiating in the same place twice is a no-no.

I’m almost healed from the surgery. Right now I feel strong and as healthy as I can be under the circumstances. I’m not looking forward to chemo, but I don’t want the cancer to come back anytime soon. So we continue the fight and stay on the offensive.

Our strength is often composed of the weakness we’re damned if we’re going to show. —Mignon McLaughlin