Survivor: Cancer

Days after 1st chemo

Day 1 after chemo:

I woke up feeling quite normal on Saturday. Lavina came in the morning to make me some fresh fruit juices. But around lunch time, after I heated up some soup, the nausea feeling started to overpower me. I had to lay down and rest. I puked several times and slept for most of the afternoon and did not have any appetite. At night, Sharon and Jed came. Sharon came to help me with my Neupogen shot (she’s a pharmacist), making sure that I was doing it correctly. It was tough poking myself. Have I mentioned that I’m a big chicken when it comes to needles? It’s going to take me awhile to overcome the fear. I hesitated, but finally did it. I successfully gave myself my first Neupogen shot.

Day 2 after chemo:

No puking, just felt really really tired and sleepy and had absolutely no appetite. Ivy, Esther, Vivien came to make some more fresh fruit juices, helped me wash my hair (I couldn’t shower for 72 hours after the portacath placement), helped us with groceries shopping and prepared a delicious dinner. The food smelled really good, but I just couldn’t seem to eat anything. Later on, Sharon and Jed came again to help me with the self-injection. This time, I was doing it in front of all the girls. I hesitated again, this time, longer than usual. I was sweating and just couldn’t put the needle in. So I put the needle down, took a breather, got angry, took off my glasses and quickly did it. After I poked myself, I felt much better. I went downstairs and chow down a huge asian pear and some chocolates.

Day 3 after chemo:

Today I feel much better and well enough to go to work. Siang drove me though. My appetite also improved and I had a somewhat ‘normal’ dinner, some cold chicken noodle and fried rice. Not my usual portion, but at least I was able to eat.

I still dread about the moment when I have to do self-injection. Logically, this should get easier, but for some reason, it seemed harder and harder each day. The more I think about it, the more I feel sick. I have to do this for 3 months. Please pray that I’ll maintain a good attitude about the self-injection and be brave. Please also pray that the discomfort caused by the portacath will be gone soon. Thanks!

start of a love-hate relationship :)

Adriamycin/doxorubicin. Gotta love it cos it kills those pesky cancer cells... hate it cos it kills ya at the same time too, just slower. This stuff must be nasty... I'll see if we can sneak a pic of the nurse next time.... all gloved up, long sleeve sweater, shielded up in front with some big yellow poncho thingy as she shoots that stuff into Annie.

Annie psyching up...

.. the stuff.... also known as "red devil".

... will enter via the portacath put in from the morning's surgery done by Dr Hickman (yep, the guy that invented the Hickman port etc. He was really nice.).

(pic below linked from Bard website, the maker of the port in Annie's left chest that leads up to her collar bone and then into her vein and into her right atrium of her heart)

My first dose of chemotherapy

Just as I was starting to feel ‘normal’ and fully recovered from the last surgery, it’s time for another surgery and chemo…

The day started with a shower with the medical soap they provided for patients to use before surgical procedures. It reminded me of the day when I was showering before my mastectomy… …

We arrived Seattle Cancer Care Alliance at 8am, checked in at the lab for blood draw, then headed upstairs for the portacath placement procedure. A very nice nurse, Karen, came to greet us, making us comfortable in the pre-op area and explaining everything very carefully to us. However, the challenge came when it was time for her to prepare me for IV. My veins like to hide and were not cooperating. She poked me twice but couldn’t get in. She then put some heating pads and wrapped my arm with a few warm blankets, hoping my veins will become bigger and more prominent. She solicited help from another nurse, Barry. Barry inspected my arm for a little bit, he looked a bit puzzled and decided to put some more heating pads and warm blankets around my arm. After awhile, he finally felt a good vein and got it!

My surgeon is Dr. Hickman. He looks like he’s in his late 70’s. Everyone told me that he’s REALLY good. He’s done the portacath placement procedure thousands of times, he even invented another medical device called the Hickman. I believe I was in good hands, but couldn’t help but wondering if his hands would be shaking during the surgery coz he looks really old… … He was like a grandfather, very gently and patiently explaining the procedure to us, and taught Siang how to properly access the portacath in case we were to travel to some remote places.

There was no general anesthesia. They called it ‘conscious sedation’ instead. There was music in the operating room, a mixture of Hawaiian and elevator music, I guess that’s part of the conscious sedation. I was asked to lie down in a very awkward position, but after the sedation nurse gave me ‘half a glass of wine’, I fell asleep. I was glad I did. When I woke up, I could tell that it was towards the end of the procedure, and felt some pressure on my chest as they finished up the business. I stayed in the recovery area for about an hour and was asked to head upstairs for my first round of chemotherapy.

Before chemo starts, I was given three different kinds of pills, one was supposed to make me relaxed, the other two was supposed to help with any nausea. As one oncology nurse was pushing the Adriamycin through my portacath, another nurse was teaching me how to do self-injection. I’ll have to inject Neupogen (the white blood cell booster shot) myself every night before I go to bed. The nurse gave me a video to watch and then demonstrated in person by poking herself! Bless her heart! After watching her, it was my turn…. The needle is not that big, but poking myself is not fun at all. I hesitated, but finally did it. I guess the drug that relaxed me helped a little bit…

Afterwards, we went to a Korean restaurant for dinner, but I was so tired that I was literally dozing off at the dinner table… … For the most part, I felt ok, just really sleepy after chemo. I had to turn in early and say goodbye early to mommy who left for Taiwan that night. Thanks to Jed/Sharon/Nat/Viv who came late at night to accompany my mom to the airport.

who says you can't face danger with pink

yeah. might as have fun, be silly and look hilarious if one's trying on hats. cancer be afraid... be very afraid.. here comes the pink headed huntress with the green gun!

Treatment Plan

I’ve returned to work on May 3. It was a bit tiring, mostly from having to get up early again in the morning. I was so used to sleeping in and taking naps during my days off. :-) I’m able to drive myself with not much problem. Yesterday, I also returned to my first step aerobics class since surgery. It was therapeutic to be able to resume my normal exercise.

During these two weeks, Siang and I also struggled with some hard decisions, trying to determine whether we should proceed with chemotherapy or not. Both oncologists we met recommended it. The tricky thing is my prognosis is sort of in the gray area. My lymph node status is negative, tumor margin is clear. I had a mastectomy hence no need for radiation. According to statistics, there’s a 67% chance that I’m already cured.

However, due to the tumor size, my age and the tumor growth rate, both doctors categorized me as high-risk. There is a chance that there’re microscopic cancerous activities going on in the rest of my body that cannot be detected via any medical screening. Also, because my projected life span is much longer than the average breast cancer patient, there’s a higher probability for the cancer to reoccur in the future.

We know for certain that hormone therapy would be beneficial because my tumor is ER/PR receptor positive. Hormone therapy would increase my cure rate from 67% to about 77%. The docs believe that adding chemo on top of hormone therapy would increase the % to about 83%. However, most of the statistics currently available are not that relevant to patients in my age group. The long-term side effects of all the drugs known today might be incomplete b/c most of the patients who took the drugs do not live beyond 25 years after chemo.

It was hard trying to weigh the benefits and risks. Is it worth all the side effects? Would I be cured of breast cancer but left with low quality of life because of all these other potential problems that come with these potent drugs? e.g. leukemia, endometrial cancer, heart damage, infertility, early menopause, the list goes on… But what if there is really microscopic stuff going on and I miss out on the chance to clean everything up?

My geeky husband was trying to calculate probability. I almost wanted to dig out the Excel decision tree model I learned in school to help me decide. :-) But life is never that simple and clear-cut. The only thing we can lean on is for God to guide us through.

We met with the oncologist at the Seattle Cancer Care Alliance again this past Thursday. After a few clarifying questions, we felt a bit more comfortable about going forth with chemotherapy. For now we’ve decided to go with the following treatment:

For those of you who are in the medical field --

Chemotherapy (3 months, start on May 21):
12 weeks of dose dense AC + Neupogen
Adriamycin – administered weekly intravenously
Cytoxane – daily orally
Neupogen – injection I give myself everyday except on chemo days

Hormone Therapy (2.5 -5 years):
2.5 years of Zoladex (monthly injection, start 2 weeks prior to chemo)
2 years of Aromatase inhibitor (start after chemo is completed)
maybe 3 more years of Tamoxifen (depending on whether we want to have kids or not)

I have already received my first shot of Zoladex. This is a shot into the fatty tissues in the belly. Its function is to temporarily shut down the ovarian functions and minimize the amount of ER/PR production. Unfortunately I stumbled across a picture of the Zoladex needle a week ago. It is no ordinary needle. When I saw the nurse, the first thing she warned me was this was a very thick needle, but she said I did not have to look at it. She had to find some good fat in my belly for the shot. I’m thankful that I have plenty of good fat in that region for her to choose from. An ab with 6 packs would not do me any good in this case. The nurse gave me a shot of numbing medicine first before poking me with the Zoladex needle. I closed my eyes the whole time. Now there’s a big bruise on my belly. It wasn’t too bad, I think I can take that… but as I imagine I have to do this once a month for 2.5 years…. that’s 30 shots in total. Wait, plus the numbing medicine, that’s 60 shots. Wait, plus the daily Neupogen shot I have to give myself when chemo starts, that’s another 72 shots, a total of 132 shots into my belly. Nice… Hopefully the Neupogen shots would not give me bruises, otherwise, my belly would be very colorful… … I might as well try to create some sort of tattoo for fun.

Prayer Requests:
(1) God will strengthen my body in preparation for chemo. I’ve lost 7 lbs after surgery, I was told to gain some weight before chemo starts, but not too much. :-)
(2) Before I receive my first dose of chemo, I’ll be having another outpatient surgery to implant a catheter under my skin for ease of drug administration and blood draw. Please pray that the surgery will be smooth and successful.
(3) Continue to pray that I’ll regain my arm/shoulder range of motion and restore my strength. I’ll have my first meeting with a physical therapist this Tuesday.
(4) Pray for peace for Siang and all my loved ones.
(5) I’ll be drawn closer and closer to God and experience His grace on a deeper level.

'Three times I pleaded with the Lord to take it away from me. But the Lord said to me, "My grace is sufficient for you, for My power is made perfect in weakness." Therefore, I will boast all the more gladly about my weaknesses, so that Christ's power may rest on me. That is why, for Christ's sake, I delight in weaknesses, in insults, in hardships, in persecutions, in difficulties. For when I am weak, then I am strong.' (2 Corinthians 12:8-10)

Decisions...

Annie's going through decision making on the type of treatment, dosage, which "cocktail", etc to have. We'll probably know by Thursday evening and will keep all posted. Please pray that God's peace and wisdom be in the decisions and choices that'll be made.