Tuesday, December 10, 2013

Cancer Free - Yippee!

Marla Crider, UAMS, breast cancer, invasive ductal carcinoma
Marla Crider with her new friend,
Ms. Coco Chanel
Thanksgiving has come and gone, and December has made an entrance like a confused lion –
70-degree temperatures one day, and 28 degrees the next with sleet and snow.

Oddly, the Thanksgiving holiday continues to be front-of-mind nearly two weeks after the fact, rather than the ever-present Christmas season. Never has “turkey day” meant so much to me than it did this year – the year in which I endured a breast cancer diagnosis, 4 ½ months of chemotherapy, and a double mastectomy. Instead of just once a year, which seems to be the custom for all of us, I now give thanks everyday for my blessed, cancer free prognosis. 

I was fortunate enough to spend Thanksgiving this year with my family in northwest Arkansas, where more than a dozen loved ones gathered to express their own blessings.  A few months ago, my nephew, Lane, and I talked when he was in Little Rock on business.  I mentioned to him that my mom, Happy, made me promise to never let the Crider family holiday dinners become a thing of the past.  Since her death in 2006, we had all been lax in gathering to share our lives, especially me.  Between my job responsibilities and sharing holidays with Don and his family in Dallas, I hadn't pushed to spend equal time with the Crider clan in Fayetteville.  No longer will that be the case.  Had it not been for the amazing support and physical presence of my brothers and sisters-in-law during my health crisis, I’m not sure my recovery would have been nearly as successful.  I encourage my friends and colleagues to never, ever take for granted the family bond that could mean the difference in sickness and good health, or even life and death.  I know from whereof I speak.

On October 11, my breast cancer was eradicated, when my rock star surgeon, Suzanne Klimberg, strategically removed the diseased tissue from the right breast, and as a precaution, the left breast tissue was removed, as well.  After only 24 hours in the hospital, I recuperated at home with the help of my physician mate, Don. 

For more than a week following surgery, I managed to maneuver around the condo with the bulky drain tubes attached by a single stitch under each arm.  Showering was especially challenging.  I had minimal arm movement; therefore, I had to have assistance.  Trust me when I say that romance and intimacy are not emotions you think about when you have a partner in the shower with you under these circumstances.  It was an awkward and frustrating experience that was, fortunately, short-lived.

About a week after the surgery, Dr. Klimberg called me with the pathology report.  My heart raced as she began sharing the results.  She explained there were a number of “hot” spots found in the right breast tissue that were only weeks, if not days, away from turning into full blown cancer.  That was the bad news.  The good news was that the sentinel node dye test conducted during the surgery indicated the cancer had not spread to the lymph nodes or other parts of the body.  Praise the Lord.  And, the left breast showed no signs of cancer, whatsoever. 

Before we concluded our phone conversation, Dr. Klimberg said she and the director of the genetics department at UAMS had conferred and they both agreed that I needed a genetics work up because the pathology report confirmed the dreaded triple negative diagnosis.  Since the type of cancer I had was aggressive with no known drug available to deter a reoccurrence, it's important to find out how my cancer diagnosis might affect my family members.  According to Dr. Klimberg, the type of cancer I had could mean my brothers and nephews might be at risk for prostate and colon cancer, while my great nieces could inherit the gene that caused my breast cancer.  The genetic work up would serve as a cautionary road map for my family to review and share with their own doctors. 

It should be noted that only 15% of women diagnosed with cancer are triple negative. The majority of women with cancer are in the hormone receptive category. These women are prescribed drugs, such as Tamoxifen, to be taken for years after chemotherapy and/or surgery as a means to disrupt another episode of cancer.

Ten days after my surgery, I returned to UAMS for a follow-up visit to have the drain tubes removed.  Since Dr. Klimberg was in Florida attending a breast cancer conference, her resident, Dr. Tummel, had the chore of cutting the stitches holding the tubes in place. The left tube had dislodged from its original internal placement during the surgery and hurt like the dickens when he pulled it out.  Fortunately, there was no problem removing the right tube. I suddenly felt as free as a bird without the drain tubes and plastic receptacles attached to my side. I was almost giddy with excitement to move my arms – ever so slightly - without restrictions. Dr. Tummel carefully examined the surgical incisions and said everything looked good, including my very swollen and dark nipples that Dr. Klimberg surgically re-positioned in anticipation of the forthcoming reconstruction procedure.  Don had mentioned to me that he was concerned the right nipple “may not make it” because it appeared to have restricted blood flow.  After everything I had been through, there was no way I was going to tolerate even the thought that my nipple was going to reject being moved and stitched into its new location.  Dr. Tummel was more positive and thought it might take longer to heal but the nipple would survive.  Another appointment was made for me to see Dr. Klimberg the following week.

That night, I was anxious to try sleeping on my drain-free side, but I couldn't.  There was still too much swelling and pain when I tried to roll over. Apparently, if and when I slept, it would have to be on my back, which ached constantly from the surgery, as well as my inability to take the pressure off of it when in a horizontal position.  It was another five days before I could roll onto my side. 

A few days later, I had an appointment to see my oncologist, Dr. Makhoul.  While I trust him implicitly, I was rather apprehensive about seeing him.  He stated during the last appointment that another round of chemotherapy might be in order, depending on the findings of the post-surgery pathology report. 

When Dr. Makhoul entered the exam room, we greeted each other with an affectionate “long time, no see” hand shake.  He immediately logged on to the computer and pulled up my file.  He quietly read through the pathology findings, which seemed like an eternity.  Finally, he turned to face me and said he was comfortable with the report and “at this time” did not recommend further treatment.  What a relief!  He scheduled a follow-up PET scan in February to confirm there were no hot spots in other parts of my body.  But prior to the scan, he requested I have a colonoscopy because I was still experiencing digestive issues.  Dr. Makhoul mentioned the questionable spot on the colon that was identified on the first PET scan performed months earlier.  He was an amazing doctor and I was his patient and would do whatever he suggested.

Two weeks and two days after my surgery, I was cleared to drive and was provided a written release from Dr. Klimberg to return to work.  My colleagues seemed surprised to see me; after all, it had only been a couple of weeks since I had undergone major surgery. Never the less, I was glad to see them and more than ready to get back into a routine. 

On the second day of my return to work, I was scheduled to see Dr. Klimberg again, this time to have the stitches removed. I was anxious to be one step closer to normalcy.  When my surgeon strolled into the exam room, we quickly began bantering with each other, which had become a habit with us.  She was anxious to review her surgical handiwork and see how I was healing.  She poked and prodded where my breasts used to be and took a closer look at both nipples.  She was pleased with how the left one was looking.  The right nipple still gave her reason for pause but was not so concerning that she thought it would have to be removed.  She told me to dab antibiotic ointment on both nipples to keep them soft and free of infection.  It would also help them slough off the dead skin, which was the reason they appeared dark and “dead.”

The good doctor and I chatted up a storm as she removed the stitches.  It was a good thing that I was still numb from the surgery and couldn't feel her digging around in the incisions in search for stray threads. While we were talking, I asked Dr. Klimberg when she wanted me to make an appointment to see Dr.Yuen, the plastic surgeon who would reconstruct my breasts in a few months.  She determined that I should see him on the same day that I see her again – January 14.  She wanted me to completely heal before Dr. Yuen had a chance to scrutinize her work.  Without saying so, she was still annoyed with him for not considering doing the reconstruction while I was already on the operating table, which is the routine for most non-diabetic patients.  The longer the surgery is delayed, the more likely there will be skin wrinkling.  Even though Dr. Klimberg performed a new technique to prevent that type of result, she was still concerned.  She wanted Dr. Yuen “to get on with it.” I’m not sure who is looking forward to the forthcoming appointment with Dr. Yuen more – Dr. Klimberg or me.

Ms. Coco Chanel
Since the surgery and recuperation had gone so well, I decided that I deserved a treat – a new kitty.  Having to put down my 22 year-old pet, Ms. Fluffy, the day after my first chemo treatment was, perhaps, the most difficult part of my cancer journey.  It was time to bring a new furry friend into my life. The Sunday after Thanksgiving, I stopped by PetSmart “just to look” at the adoptable cats.  When I walked out of the store, I was carrying a sack of cat toys, a new litter box, Purina cat food and Ms. Coco Chanel – an elegantly attired, three year-old female feline with a shiny black coat, fashionable white-tipped paws and piercing green eyes… just like her new mom.  We bonded immediately.  It has been one week since her adoption and there is no question that she was meant to be.