Breast Cancer and Needles

One of the most unpleasant things about having been diagnosed with cancer, besides the obvious, was the number of times I was poked with needles throughout the treatment period. First the blood tests, then the needle core biopsy, the vaccinations, the IVs, the self-injected Neupogen and then more blood tests.

The needle core biopsy was the least fun. The radiologist shot a hollow needle into the tumor at least six times from some type of needle gun (like a nail gun). Cores of tissue samples were extracted from the tumor to be sent to the lab for analysis. Even though the radiologist numbed the area first, it was still painful. In fact, it’s been over a year since the biopsy and my breast is still tender.

When the results of the biopsy came in surgery was immediately scheduled to remove the tumor, which meant more blood tests, a flu shot plus a pneumonia vaccine.

The day of surgery an IV needle was placed in my vein and another needle was used to inject a radioactive dye in my breast for the sentinel node biopsy. The hospital staff kept me supplied with warm blankets and gave me lots of attention. Just before surgery the nurse ran something through the IV to relax me. I felt pretty good by the time I was wheeled into the large white operating room.

After waking up in the recovery room I had to wait for a couple of hours until the anesthesia wore off before I was released. At home the next few days I experienced headaches from the anesthesia, but otherwise I felt great.

A couple of weeks later I was feeling very optimistic while I was waiting for the results of the biopsy. When my surgeon, Dr. Carmen Hudson, walked in with a serious look on her face and asked me if someone had accompanied me to my appointment, I knew something was up.

She first apologized for not getting a clear margin when she removed the tumor and informed me that I would need another operation that would involve removing my areola and nipple. I told her that it was only decorative anyway since I'm not planning to have any more children. She laughed and then got serious again. She said, "I'm so sorry. The biopsy revealed a microscopic amount of malignant cells in one of your lymph nodes."

“Does this mean that I’ll have to have chemotherapy?"

She said, "Yes, most likely." She told me that the standard course of action was to also remove the remaining underarm lymph nodes for further examination to make sure that they were cancer free. However, she said that she didn’t think it was necessary since the malignant cells in the sentinel node were microscopic in size and the other two nodes were cancer free.

In my research, I read that often times malignant cells found in the sentinel node, especially if microscopic, can travel there via the needle during a needle core biopsy. I also knew that chemotherapy was usually recommended if cancer traveled too far from its point of origin.

More blood tests, another IV, more needles.

This time, I requested a twilight anesthesia instead of a general because the general took too long to wear off. Dr. Hudson scheduled the "clean-up" surgery (her words) in Kaiser’s out-patient clinic at St. Vincent’s hospital, instead of the main operating room.

Similar surgery, but without the frills. My next pre-surgery room consisted of a bed with drapes on a track for privacy in a barracks-like room.

My nurse anesthetist was a short, stocky, very mature German woman who spoke with a thick accent. Earlier, Diane spotted her in the hallway pounding on a door saying, “Open ze door. I need drugs NOW!” We later figured that she was really a closet comedian, using her demeanor to entertain the patients.

After I was given something to relax me (another needle) my nurse anesthetist told me to walk to the operating room. When I asked, “Aren’t you going to wheel me in?” She said,“Nope, you can still valk, can’t you? So get goingk and HURRY. Ze docta est r-r-r-ready.” It was like a scene from a Frankenstein movie. I wondered if I had made the right decision and started to miss the all of the attention I got at the main hospital.

I walked to the operating room and climbed up onto the table. A nurse hooked me up to an IV and I slept through most of the surgery, only waking up once to comment on the beautiful butterflies flying around the operating room.

I woke up again in the recovery room, which was the same "room" I was in prior to surgery. As soon as my eyes opened Dr. Hudson released me and Diane drove me home.

A month later and a couple of days before my first chemotherapy treatment, I had more blood tests and the oncology nurse weighed me to determine the maximum amount of poison my body could handle.

The chemotherapy regimen my oncologist ordered for me was Dose Dense ACT. One of the greatest benefits of the Dose Dense ACT regimen is that it’s given over the course of four months instead of the usual six. This reduces the chances of side-effects, primarily cardiovascular damage. The dosage is given every two weeks rather than every three.

Since two weeks isn’t enough time for white blood cells to regenerate enough to be in the safe range, I had to give myself injections of Neupogen for several consecutive days beginning a few days after my chemotherapy treatment because it was during this time that my immune system was its lowest.

Before each chemotherapy treatment, I had to have a blood test to make sure that my white blood cell count was high enough to proceed with the chemotherapy.

The day of my first chemotherapy treatment I opted to have the chemo cocktail delivered via a vein on the back of my left hand rather than having a port installed in my chest. The ports can sometimes cause infections.

Minutes before my first chemotherapy treatment I was given steroids to help me tolerate the chemo drugs. It caused my legs to be restless and I couldn't lie still, so I was given another drug to counteract the first one.

The nurse found a good vein right away and inserted the IV needle. She set the chemo drip to enter my vein slowly so that it would be easy to stop, should I experience a bad reaction to the drugs. It went smoothly and so I scheduled another appointment.

Before they released me I was given some anti-nausea medication, which didn't help me keep down the rich sauce-laden French food that I ate following the chemotherapy treatment.

A few nights later I had to start the Neupogen injections and asked my sister, Diane, and son, Lance, to watch, to make sure that I did it correctly. I took the Neupogen out of the refrigerator 30 minutes prior to injecting the drug and filled a disposable syringe after the Neupogen warmed up. I pushed the air out of the syringe, sterilized my chosen entry site with alcohol and held my breath. Pinching the fatty skin between my thumb and fingers, I inserted the needle at a 45-degree angle, then slowly pushed the plunger of the syringe until the Neupogen disappeared.

The little fatty ring around my waist was my first point of entry... and second... and third, but when I began to worry about the possibility of hitting a vital organ, I switched to a new site... my not-so-fat thighs.

During my second chemotherapy treatment, I was assigned a different nurse. After two failed attempts to insert the IV needle properly and causing a vein to collapse, I asked for another nurse, which I continued to do for each of the remaining chemotherapy treatments.

During the Taxol stage of the chemo treatment, I came down with pneumonia, despite the vaccination, and had to have more blood tests, plus an x–ray of my chest, and a prescription for antibiotics. When the bottle of antibiotics was empty I had another blood test to make sure that my immune system was strong enough for more chemo.

I still can't stand the sight of a needle, but compared to chemotherapy, an occasional blood test is a piece of cake. The Neupogen injections were inconvenient but necessary to keep my white blood cell count up. I imagine that from now on needles will always be a part of my life (at least for routine blood tests), like it or not.

Join the Race for the Cure

Last year at this time I signed up for the 5k walk in the Susan Komen Foundation Race for the Cure. I had recently undergone two surgeries. The first to remove the lump and the second to remove more tissue, including my nipple and areola, in order to get a clear margin. I was healing fast and didn't have any pain or complications from the surgery and I was ready to get some exercise, especially since it would be for such a good cause.

My sisters and a couple of friends met me at a breast cancer awareness seminar at the Rose Garden arena a couple of weeks before the Race to register for the event. At first I was hesitant to enter the race as a survivor because it meant wearing a pink tee-shirt instead of white and I didn't want to be labeled. If others happened to see me wearing a pink tee-shirt at the televised event, my secret would be out. So I took both a white tee-shirt and a pink tee-shirt, just in case.

At one of the seminar booths a woman asked me if I was a survivor and I said, "I hope that I will be." She said, "When were you diagnosed?" I told her that I found out the beginning of August that I had breast cancer, but that I hadn't started treatment yet. She said, "Well, you're here now and you're alive, so you're a survivor."

I looked around the room at all of the women, most of them "survivors." There was a certain sisterhood--like a click or a club into which I was being initiated, but didn't belong. They all smiled and welcomed me and asked me if I wanted to volunteer for this or that or to join a Dragon Boat team comprised solely of breast cancer survivors. All of a sudden I was a member of a group that I didn't feel any connection with and I certainly wasn't going to display my private illness to the world, least of all to a group of women who seemed to be acting strong outwardly when I knew that deep down inside they must be as frightened as I was.

The day of the race I donned my pink tee-shirt and joined my group, which included my two sisters, a niece, my sister-in-law and a few close friends. One of my friends, Pam Brugger, is also a survivor so the two of us led the pack with our pink baseball caps, bright pink tee-shirts and big white athletic shoes. There were literally thousands of women participating in the Race-- a sea of pink and white moving over the streets of Portland. And there were just as many spectators cheering us on with music, shouts of joy and words of encouragement. When I experienced the overwhelming support of those in the race and on the sidelines, who gave up their weekend for the cause, I was moved to tears. I was proud that I was doing something to help protect others from the deadly disease.

But when the race was over and my team and I drove to a lunch spot a few miles away I took off my pink tee shirt because I didn't want strangers looking at me with pity and I didn't want special treatment by the restaurant staff. Besides, pink isn't my color. Yes, it was about me again. I was in total denial.

In retrospect, I am so glad that I joined the Race for the Cure. I realized that it really wasn't about me after all. It was about finding a cure so that other women (1 in 7) won't have to join my exclusive club.

The 2007 Komen Race for the Cure is coming up September 27. Don't forget to participate by entering the race or donating money to the cause.

Delay breast cancer surgery until after your high school reunion

Cheryl & Butch - High School Dance  Cheryl & Butch -  High School Reunion

When my surgeon gave me the option of a lumpectomy with radiation or a mastectomy I chose the lumpectomy because I wanted to preserve as much of my petite-size breast as possible, plus she said that the survival rate was the same for a lumpectomy with radiation or a mastectomy. She also told me that even though the tumor was located just under the nipple, she thought she could save the nipple and areola or at least try.

Since I didn’t really know how much of my breast would be taken during surgery or what the healing time would be, I asked her if I could delay the surgery until after my upcoming high school reunion. I didn’t want to go to my reunion with a tender unhealed breast or no breast. My surgeon said, “Go and enjoy yourself. The cancer took 7-15 years to grow, so waiting 2-3 weeks isn’t going to make any difference at all.”

After making him swear to secrecy I told my friend and former high school admirer, Butch, that I had breast cancer and that I wasn’t sure if I would be able to make it to our class reunion. I told him that if I went to the reunion I didn’t want former classmates pointing at me and whispering to each other, “Did you know that Cheryl has breast cancer?” or coming up to me with pity in their eyes saying, “I’m so sorry to hear about your breast cancer.” Or worse yet, that the men who used to have boyhood crushes on me would recoil in repulsion and ignore me the whole evening. Well, Butch talked me into going to the reunion. He said that people would be disappointed if I didn’t go and that I needed to have some fun.

So I flew to Long Beach and couldn’t wait to see my old friends, knowing that my secret would be safe. Later at the reunion dinner-dance when members of my former high school click singled out some of the others we went to school with and said with pity in their voices, “Did you know that Gerry R. and Tom J. both had knee replacement surgery 3 months ago and that Tom’s wife had breast cancer last year? And look at Sue W. She has MS and we thought she was going to die 5 years ago --- even made her a farewell video, but she’s still here and doing better now than she was at the last reunion … and poor Ray N. had a heart attack and died and Chuck H. had a heart attack too, but was luckier than Ray and is still with us. And….oh, did you hear that Geri D. and Terri A. both died from breast cancer? Who would have thought that would happen. They were both so beautiful.” I joined in with pity and shock in my voice, “Really? How awful!” There was no way that I was going to be put in the same category with the unfortunate and unlucky ones --- the ‘other’ ones. Yes, my secret would remain with me for the next two days---and with Butch, of course. Thanks, Butch. I had a great time at the reunion and didn’t even think about the future. It was too much fun remembering the past.

My advice to breast cancer patients is to do something fun and exciting before your treatment starts because you won’t be able to enjoy yourself for months to come. In fact, it may be the last time you’ll feel normal, so celebrate the moment and don’t worry about the future.