A Memorial Service for Marla F. Crider will
take place at 11:00
A.M. (Central
Time) on Saturday,
December 13, 2014 at First Christian Church in Fayetteville, AR.
This blog documents the journey of Marla Crider, a 60 year-old travel professional from Little Rock, Arkansas, as she battles a breast cancer called invasive ductal carcinoma (stage 3). From the moment of her diagnosis, she chronicles her experience. Be forewarned this blog may provide a raw glimpse into the author’s psyche and ability to deal with a life threatening challenge. Hopefully, her honesty and humor will provide advice and help to others who find themselves in a crusade of their own.
Tuesday, November 18, 2014
Wednesday, September 17, 2014
Can Happiness Fight Cancer?
It has been more than a month since I documented my
continuing treatment plan for Stage IV, triple negative breast cancer. In the past few weeks, unfamiliar road blocks
have cropped up, teaching me even more about this insidious disease than I ever
wanted to know. Just to clarify, what I’m experiencing is no different
than what others with cancer endure everyday, it’s just new to me and my battle.
I'll explain...
Several weeks ago, Dr. Makhoul ordered a routine PET scan to
determine how the carboplatin/gemzar chemo cocktail had impacted the small,
cancer-laden tumors in my bones, liver and lungs. After the second dose of the
chemo drugs, we were all elated that the cancer nodules on my head and back had
disappeared. Dr. Makhoul was in hopes
the drugs were having the same effect on other parts of my body.
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Marla, smiling through chemo treatment #7 |
Interestingly, the chemo destroyed some of the old lesions,
which were not detected at all on the scan; however, new ones showed up, mostly
in my spine and liver. Needless to say, I was disappointed that more progress
had not been made, as was Dr. Makhoul.
He suggested that we start looking for new drug trials again, especially
since the idea of going to M.D. Anderson in Houston fell through. Dr. Mak planned to have
his research team investigate various drug trials all over the country to see
if there are trials for which I might qualify.
He said he would call me a few days later with an update.
In the meantime, the good doctor prescribed the third
carboplatin/gemzar treatment. He felt
that even though the results were not as good as we had hoped, it was still
working – slowly - and should be continued while the search was underway for a
drug trial.
My brother, Mike, and sister-in-law Barbara faithfully
traveled to Little Rock, once again, and accompanied me to Infusion 1 for the
treatment. Unfortunately, the chemo
treatment and the medical team that administers it have become routine. Each week, with a nod of the head, we
acknowledge familiar faces awaiting their turn for treatment. We smile and cordially
speak to one another as we patiently wait for the poison concoction to trickle
into our bloodstreams and silently pray that remission, or better yet, a cure,
is just a drip away.
The week following my third treatment, I noticed that the
fatigue was more prevalent than usual. I
actually became winded when I made the walk from the parking lot at work to my
office, which was unusual. Mid-afternoon
became a challenge for me to stay focused and awake. I assumed that the third treatment of chemo
had built up in my system, just as Mr. Nurse Ratched had predicted.
When I returned for my next chemo treatment, a week later, I
reported for the usual lab work to check my red and white blood cells. About 30 minutes later, the charge nurse in
Infusion 1 called my name in the waiting room.
I assumed she was escorting me to a recliner for my treatment. Wrong!
She informed me that my white blood count was very low (neutrophils at
2.1); therefore, Dr. Makhoul cancelled my chemo. In fact, she said Dr. Makhoul was very
concerned that if I were exposed to a cold or other type of infection my immune
system wouldn't be able to fight it. She explained that if I ran any fever over
the weekend I was to call Dr. Makhoul immediately. Well, it was now understandable why I was
experiencing extreme fatigue; it was the low white blood count.
The plan was to stimulate my bone marrow to make more white
blood cells, so Dr. Makhoul prescribed three consecutive days of Neupogen, a
drug that would do just that. The first
injection was scheduled to be given that day – Friday – while I was still in
Infusion 1. The RN, who was preparing to
inject the Neupogen into my belly forewarned me that the main side effect was
bone pain. Well, that’s just dandy –
fatigue AND bone pain. The next
injection was to be given on Saturday morning at UAMS Cancer Institute on the 4th
floor, where multiple myeloma patients receive treatment, followed by another
injection on Sunday morning in the same location.
Over that weekend, I was not only exhausted, but I was
experiencing a lot of bone discomfort that moved from my upper spine to my
lower spine and all places in between. All I could hope is that the pain was
due to my bone marrow making lots of new white cells. The good news is that by mid-week I felt like
my old self – full of energy and a renewed fighting spirit.
I was scheduled for another chemo treatment the following
Friday. When I reported for the routine
lab work, I was anxious to know the results.
About 30 minutes later, I was called back to the infusion room… for
chemo. My white blood cells had
increased enough to get back on track with treatments. I was relieved because every week without
chemo could give the cancer cells a head start.
Bring on the chemo; I’m more than ready.
The following week, the extreme fatigue returned, indicating
that my blood count had dropped again. When
I reported that Friday for the next chemo treatment, I flunked my lab test and,
again, had to take the Neupogen shots to build up my white count. The next five days were filled with
exhaustion and bone pain but my energy level improved by mid-week.
I had an appointment with Dr. Makhoul a few days later. We agreed that I would return to a regular
chemo schedule and the Neupogen shots would automatically follow for three
consecutive days after each treatment.
This plan would keep us on track and prevent any future cancellations of
treatments, which suited me just fine.
During our visit, Dr. Makhoul informed me that his research
team had found two new drug trials for triple negative breast cancer for which
I might qualify. Both trials are being
conducted at Washington University in St.
Louis . Dr.
Makhoul was very excited about one of the trials in particular, which involves
a chemo drug that is currently being used as a treatment by some oncologists
for other kinds of cancer – one that I have yet to experience. After administering the existing cancer drug,
the trial drug would be injected, which should flush the cancer cells into the
bloodstream, making them much more susceptible to being “zapped” by the
existing chemotherapy drug. We learned that this particular drug trial is
taking a three to four-week hiatus to collect and organize the data collected
at this point. When the trial comes back
on line, Dr. Makhoul has submitted my name and case for admission to the
program.
The second trial is brand new and involves testing the
cancer-laden tumor that was extracted during last year’s mastectomy. If the tissue contains a particular mutation,
then I would qualify for the trial and be given a new immunotherapy drug that
would enhance my immune system and improve its capability of fighting cancer
cells. The medical necessity for me to qualify for either of these drug trials
is monumental. As Dr. Makhoul told me several months ago, the plan is to keep me
alive long enough to find a cure for my particular type of breast cancer. While those words are sobering, they are also
my reality. My fingers are crossed and many prayers are being said daily in
hopes of qualifying for one of these programs.
Several weeks ago, someone asked me how I cope on a daily
basis with the knowledge that I have Stage IV breast cancer. My answer surprised the inquisitor. Even though I have a life-threatening
disease, my life is good. I work at a
job that I love and with people that are like family. My responsibilities at the Arkansas
Department of Parks and Tourism help occupy my mind so that cancer seldom
enters my thoughts during the day. I’m a
happy working girl.
In addition, I’m lucky and fortunate to have a loving relationship
with Don, who has been with me during every step of this battle. He interprets
the tests and translates the doctor-jargon that might confuse any other
patient. He talks frankly with me and
doesn't soften the reality that I’m sick.
He makes me happy.
I have a caring family that has committed themselves to
accompany me to each chemo treatment and doctor’s visit, even though they live
more than 180 miles away. They provide me with encouragement and embrace me
with their love and support on a daily basis and that makes me happy.
My support network is hundreds strong and includes friends,
both old and new, colleagues and acquaintances that cheer me on and offer their
prayers when I need them most. They make
me happy.
I’m fortunate to have a remarkable, experienced medical team
that cares for me as an individual patient and not just a number. They are just as concerned about my health status
as I am. They talk me through the
difficult treatments, answer my questions and treat me with respect-and that
makes me happy.
Cancer has taught me much, like loving unconditionally and
not taking myself too seriously. It has
taught me how to be grateful for the smallest of accomplishments and to
appreciate the wealth of support and encouragement received from family,
friends and my medical team.
Make no mistake; cancer is not my friend, yet it is a part of my life. One of the ways I have learned to fight this disease is to not give into it. How do I accomplish that? By being happy!
And that, I am.
Make no mistake; cancer is not my friend, yet it is a part of my life. One of the ways I have learned to fight this disease is to not give into it. How do I accomplish that? By being happy!
And that, I am.
Monday, July 21, 2014
Bumpity, bump, bump.....
Sometimes, it seems, things just aren't meant to be, such as
my July 14 appointment at M.D. Anderson Cancer Institute in Houston .
Several weeks after my UAMS oncologist, Dr. Issam Makhoul,
made the arrangements for me to see the cancer team at M. D. Anderson for
possible inclusion in a trial drug protocol and/or new treatment program, I
noticed six to eight hard, pea-sized nodules on my scalp. Since my appointment at M.D. Anderson was
still more than three weeks away, I decided to call Dr. Makhoul’s office and
tell his nurse, Brenda, about the bumps on my head. It was Friday afternoon.
She told me that Dr. Makhoul was out of town but she would let him know the
first thing Monday morning.
Marla and Don - July 4, 2014 |
After fighting cancer off and on for more than a year, I
knew that the bumps on my head, and now a new one on my back, were related to
the metastatic breast cancer. Having
cancer improves one’s health instincts. More times than not, the least little
change in the body is usually a pretty good barometer that something isn't
right. Late Monday afternoon, I finally received a call from UAMS. It wasn't Brenda, Dr. Mak’s nurse; it was the
good doctor himself, which alarmed me just a tad.
When I answered the phone, Dr. Makhoul wanted me to know
that he had placed a call to M.D. Anderson Cancer Institute to inquire why my
appointment was scheduled more than six weeks after he requested their medical
team see me. He promised to contact me
after he spoke to someone in Houston .
About an hour later, Dr. Makhoul phoned me to share what he
had learned. It seems that M.D. Anderson
recently changed its policy when accepting and scheduling patients. Texas
residents are seen first, followed by patients from other states, then
international patients. Since I’m from
little old Arkansas ,
my appointment was delayed for six weeks, without considering how aggressive
the cancer had become. Dr. Makhoul was incensed that no one from M.D. Anderson
had notified the UAMS oncology department about the new policy, especially
since the doctors there refer lots of patients to them. The oncologist with whom Dr. Makhoul spoke
went on to tell him that I wasn't a candidate for any of the trial treatments
being offered and he encouraged Dr. Makhoul to continue treating me in Little Rock .
Dr. Makhoul told me that we could no longer wait to start a
new treatment plan. He directed Brenda
to schedule an appointment for me on Wednesday, as well as time in the infusion
room for chemotherapy. Things were
moving fast, as they always seem to do with cancer treatment. I must admit that I was actually relieved to
learn that the appointment at M.D. Anderson had been canceled and I was back in
the hands of the doctor I trusted the most. Even Don was satisfied with the
current turn of events. He understood
the urgency and was ready to stand by me, yet again, as I endured another
series of chemo treatments.
As they had done a year earlier, my brothers decided that
one of them would be with me for each chemo treatment. My older brother, Mike, and sister-in-law
Barbara, drove from Springdale in Northwest Arkansas for my first treatment. As I have mentioned before, family support is
key for those of us battling cancer.
Never will I ever be able to verbally express my gratitude and unconditional love for the sacrifices of time and travel mine has provided me.
We all arrived at UAMS for my appointment with Dr. Makhoul
to learn what his plan of action would be.
It was early enough in the day that I only had to wait for an hour
before seeing him. When Dr. Mak entered
the exam room, I was very glad to see him.
It had been more than a month since we had talked about my
diagnosis. The first thing Dr. Mak did
was examine the bumps on my scalp, as well as the one on my back, and
acknowledged what I already knew; the cancer was spreading…quickly.
Back in the Infusion Room |
The plan included a double whammy of carboplatin and gemzar
– two chemotherapy drugs that Dr. Makhoul said had rendered very good results
for other patients. It may seem odd to
be excited about taking chemotherapy, but I was. It meant that I was no longer going to have
to sit idly by while the cancer cells dined freely on my liver, lungs and
bones.
My family, Don and I made our way to the very familiar
surroundings of Infusion 1, located on the first floor at the UAMS Cancer
Institute’s Outpatient Clinic. As usual, the waiting room was almost to
capacity and our wait was long. When my
name was finally called, I almost skipped to the recliner where I would begin
treatment.
How appropriate that Mr. Nurse Ratched would be the RN
assigned to administer the newest round of chemotherapy. He greeted me with a
smile and requested I tell him my current status. When I shared that the cancer
had spread to my lungs, liver and pelvis, he said, “Yep, that’s where breast
cancer likes to go, but rest assured Dr. Makhoul has an arsenal of chemo drugs
to get you back on the right track.” I
was somewhat surprised that Mr. Nurse Ratched was actually trying to make me
feel better. Who knew that the guy was
capable of compassion?
As Mr. Nurse Ratched prepared to start pumping the
intravenous poison into my system, I noticed two new RNs in the infusion room –
both were male. I remarked that it
appeared he was no longer the token male in Infusion 1. He replied, “Yes, I have two new roosters in
my hen house.” I laughed out loud. My nemesis with the questionable bedside
manner had acquired a sense of humor since our first encounter more than a year
ago.
Mike and Barbara shared “sitting” duty, while the carboplatin
and gemzar dripped into my bloodstream, each drug taking approximately 30
minutes. Mr. Nurse Ratched told me the usual side effects from the drugs were
fatigue, constipation, and a possibility that my blood counts might be
affected. Some hair thinning was also possible.
I have determined that side effects are what you allow them to be and I
refused to let them interfere with my daily routine or my job. Dr. Makhoul scheduled me for chemo two
consecutive weeks, then off the third week to allow my body to recover.
Fatigue and a few achy bones were the side effects that I
noticed after the first treatment. Also,
I was experiencing some insomnia. Even
with that, I felt blessed that the side effects were minimal and prayed that
this would be the norm, not the exception.
Treatment number two was scheduled on July 3. My middle brother, Marion, and sister-in-law
Carolyn journeyed to Little Rock
to provide support. Don was expecting 19
family members for the Fourth of July, so we agreed that he should spend time
preparing for the mass of people and leave the care giving duties up to Marion
and Carolyn. Whether necessary or not,
it is always comforting to have family nearby, should something unforeseen
happen.
The most important thing I observed after the second
treatment was that the bumps on my head were all but gone. The nodule on my back was still noticeable
but felt smaller. I was ecstatic. After only two treatments, it was apparent
the carboplatin and gemzar were killing the cancer cells! God bless Dr. Makhoul!!
My miracle worker of a doctor requested to meet with me on
July 18 - week three - to discuss my progress.
This time, it was Mike and Barbara’s turn to make the trip to Little Rock . Since Don’s
ability to walk has become more burdensome, due to numerous knee replacement
surgeries and old sports injuries, I encouraged him to let my family do the
walking, sitting and waiting with me and he agreed.
Mike decided to accompany me to meet with Dr. Makhoul. As
usual, the wait took about an hour. In
his usual hurried state, Dr. Mak entered the exam room anxious to hear how I
handled the first two treatments. When I shared that the bumps were gone, he
almost didn’t believe me. He requested
that I sit on the exam table for a quick check of my heart, lungs and bump
patrol. To say that Dr. Makhoul was
surprised and elated would be an understatement. He was almost giddy.
I told him that I was hopeful the chemo was working as hard
to destroy the cancer cells internally as it had done externally. To determine if that is the case, Dr. Mak
scheduled a PET scan for August 4 that will provide the answer. He ordered the third round of chemo and
confirmed that I am still his poster child for chemotherapy because my blood
work is excellent and the side effects are manageable, which is uncommon for
the type of chemo I’m taking.
Before Mike and I left the exam room, I heard Dr. Makhoul
use the “R” word – remission. He
enthusiastically told me he had several patients who had experienced remission
after receiving the one-two punch of carboplatin and gemzar and I might just be
one of them. I could feel the warmth of
God’s embrace after that comment and even heard a faint “praise the Lord”
coming from the direction of my brother.
As I sat through the 90-minute intravenous drip of my two,
new best friends – carboplatin and gemzar – I prayed silently that the “R” word
would trump the “C” word and become a frequently spoken description of my
health status. I certainly don’t want to
get ahead of the PET scan results, but I keep repeating the word…remission. It has a nice ring to it, doesn't it?
Monday, June 23, 2014
Houston: We Have a Problem
When Dr. Makhoul informed me nearly two months ago that the
triple negative breast cancer had metastasized to my lungs, liver and pelvis,
we made a joint decision to try a powerful oral chemo – Xeloda (zeloda) - as well as a bone enhancer/strengthener
called Zomata that is to be given intravenously once a month.
“The oral chemo has not had any impact on the cancer,” she reported. As I looked at Donna’s ashen, somber face, I knew there was more bad news to come. “Dr. Makhoul is recommending that you go to M.D. Anderson Cancer Institute inHouston
for a consult and alternative treatment plan.”
And, there it was.
Yet again, Don and I silently departed the Winthrop P.
Rockefeller Cancer Center in silence, which was happening much too frequently
of late. It was mid-afternoon and all I
wanted to do was go back to work and focus on anything but cancer. Don asked if I wanted him to stay with me
that night. I explained that I really
needed the time to process the latest results by myself. As a trained physician, he understood.
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M.D. Anderson Cancer Institute - Houston, TX |
I was instructed to take 1,500 milligrams of the Xeloda in
the morning and evening for two weeks with one week off the drug. After week one, the “hand and foot” syndrome that Dr.
Makhoul warned me about had made itself known. Occasionally, the bottoms of my
feet would be so tender that it was a challenge to walk. I learned quickly that
washing my hands in hot water was a no-no and showering in hot water wasn’t
tolerable, either. Tepid temperatures
were the new norm in my life.
During the week off the oral chemo, I could almost hear my
body take a deep sigh of relief. My
hands and feet returned to their usual flesh tone and my digestive system was
craving Mexican food. I now understood why the doctors allowed a one-week
vacation from the Xeloda. I had earned
the time off.
The second, two-week cycle of the drug started off
uneventful; however, at the end of the first week, the hand and foot syndrome
returned with a vengeance and my diet no longer included spicy food. New to the side effect menu was a generous helping
of fatigue. My body and brain were
exhausted by the end of each work day.
It was a challenge when I got home to prepare something to eat or even
muster an appetite.
By the end of the cycle, my hands and feet were extremely
sensitive and tingled night and day.
Diarrhea continued to be my nemesis and the fatigue was ever
present. I was anxious to see Dr.
Makhoul for my one-month, follow-up appointment that coincided with the end of
the second, two-week cycle and hear what he had to say about the side
effects.
My appointment was on May 16. Don and I arrived at UAMS for the required
blood work at 11:00 a.m. We were to see
Dr. Makhoul at 12:00 p.m. From a year’s
worth of experience, we knew we were in for a one to two-hour wait. It was 2:40 p.m. when we finally saw the
smiling face of the good doctor. He
apologized, which was unnecessary. When
you have cancer, you learn patience.
And, if you expect the best doctors to treat you, it is a given that
they constantly run behind schedule because they are providing others with the
same detailed and compassionate care that you are privileged to have.
Dr. Makhoul reviewed the list of my side effects and
explained that I would probably have to start wearing socks and tennis shoes
when my feet were inflamed. Being the
fashion diva that I am, I laughed out loud at the thought of me wearing the
likes of socks and tennis shoes to work.
I would figure out another solution – a stylish solution - to aid my
pitiful feet.
During our conversation, Dr. Mak informed me that he was
scheduling a new PET scan for May 30 to see how the Xeloda was impacting the
cancer. The results would be shared with
me on June 2 but not by Dr. Makhoul. He
was scheduled to be out of town. His
nurse practitioner would deliver the results to me after he reviewed the scans
and read the radiologists comparison report.
Dr. Mak also wrote a partial prescription for two week’s worth of Xeloda
that would get me through until the June 2nd appointment.
After we left Dr. Makhoul’s office, Don and I reported to
Infusion 1 for my monthly, intravenous dose of Zomata. When we arrived at 3:30 p.m., the waiting
area was filled with disgruntled patients, who had been waiting for their
chemotherapy for hours. Apparently, UAMS installed a new, state-of-the-art
patient charting system that drastically slowed down the chemotherapy infusion
process and other out-patient units at the medical center. In addition, the new
system crashed twice earlier in the day, creating a back log of patients
waiting for their chemo.
Finally, I was called back at 5:15 to receive the 15-minute
I.V. dose of Zomata. While I was
exhausted from being at the med center for more than six hours (and most of it
spent in waiting rooms), I actually felt sorry for the Infusion nurses who had
no choice but to listen to people complain about the lengthy delays at the same
time they were hooking them up to the poison that was supposed to cure
them. Trust me; these dedicated health
professionals earn their pay.
For the next two weeks, I faithfully took the Xeloda while
my hands and feet continued to show signs of irritation and even began peeling
“sheets” of skin. I thought I was going to have to take Dr. Makhoul’s advice
and wear socks and tennis shoes, when I found a pair of old-fashioned, “jelly”
shoes that felt like I was walking on a cloud.
They saved my poor, throbbing, peeling feet. The fatigue intensified in
that two week period, as did my constant companion, diarrhea. If I was to adopt
my significant other’s medical philosophy – the worse the side effects, the
better its working - then the Xeloda must really be kickin’ butt for me to
endure these intense side effects. The
next PET scan would tell the tale.
I reported for the PET scan on May 30 after eating a no-carb
diet the previous day/night. PET scans are tricky for diabetics because the
radioactive concoction they inject in the system to track cancer cells is
almost pure sugar. It’s important to
have a fasting blood sugar of less than 250.
When the radiology tech took a blood sample and tested it, my blood
sugar was a whopping 195. Since
finishing chemo last year, my blood sugar has been well controlled and never
that high. I was within the limit, so
they continued with the PET scan, which takes about 30 minutes. While the whirling X-ray machine made its way
up and down my body, I had a lengthy conversation with God. When I left the
X-ray room that day, I was at peace.
Don and I coordinated our schedules and went to UAMS
together for the PET scan results. We had been waiting only a few minutes when
the nurse practitioner, Donna, entered the exam room. She
introduced herself then sat down in front of the computer and pulled up my scan
results. She slowly turned around to
face me and said Dr. Makhoul had reviewed the scans and narrative report from
the attending radiologist and, unfortunately, the news was not good.
“The oral chemo has not had any impact on the cancer,” she reported. As I looked at Donna’s ashen, somber face, I knew there was more bad news to come. “Dr. Makhoul is recommending that you go to M.D. Anderson Cancer Institute in
I was without emotion.
Don rubbed my back, anticipating there might be a few tears. He knows me better than that. I’m in the
battle of my life and there is no time or energy for a meltdown.
I asked Donna if Dr. Makhoul felt he had run out of
treatment options and she was quick to respond, “No.” She reassured me that the reason he wants me
to report to M.D. Anderson is that the facility is a little further along with
research and trial treatments for triple negative breast cancer, which is my
cross to bear.
Donna told me that the referral from Dr. Makhoul was being
sent to M.D. Anderson that afternoon, along with all of my medical records
dating back to my cancer diagnosis in May 2013. She explained that I would get a call from Houston within a few days
with my appointment date.
Marla Crider and Don Vowell |
One of the most difficult things I did that afternoon was
tell my friends and colleagues at the office – the Arkansas Department of Parks
and Tourism. They were waiting anxiously
to finally hear some good news from me.
It wasn’t easy watching Gloria and Savannah
fight back the tears when I shared the results with them. And Linda, who has a
quip for everything, was speechless.
That evening I had to make the dreaded call to my
brothers. The silence on the other end
of the phone was deafening. I told them both that when I travel to M.D.
Anderson, I would like for one of them to go with Don and me. My older brother, Mike, made the decision to
accompany us to Houston .
A few days later, I received a call from my newly assigned patient
liaison, Carneshu, who told me that my M.D. Anderson appointment was scheduled
for July 14. I was stunned that it would
be five weeks before I would report to the cancer institute. All she told me was that the delay was necessary. Later, I learned that all the oral chemo must
be out of my body before the cancer specialists in Houston could/would see me. That explanation didn’t help my eagerness to
get this show on the road, but I had no choice.
When you have cancer, the worst news you can hear is that
the disease has claimed another breast cancer “sister.” I’m dealing with that reality as I write this
blog. My dear friend and former
colleague, Cindy, passed away this weekend after fighting this horrible disease. When I was first diagnosed in May of 2013,
Cindy was one of the first people to contact me and talk me through chemo and
what I might expect. Her guidance was so
helpful. Cindy was only 50 when she
died and a true inspiration to many of us who continue the battle. Ahhh, Cindy… you were like my younger sister
and I could not be more proud that you fought so gallantly and with such
dignity.
These days, I think often about my pending July 14 journey
to M.D. Anderson in Houston and that famous statement from the movie Apollo 13
always comes to mind: “Houston, we have a
problem.” And, boy, do we! Now,
more than ever before, I am very determined that “Houston ” is going to get me back on the path
to recovery. Oh, for the day that I can
yell from the State Capitol steps, “Houston ,
we no longer have a problem.”
Tuesday, May 13, 2014
What Would Happy Do?
This blog is being written on May 11 – Mother’s Day - the
day when we honor amazing women who function as the be-all, do-all, glue that
holds the family unit together day in and day out. Also on this holiday, we
memorialize those who have paid their motherly dues in years past and are now
at rest, like my mom, Happy. Interestingly,
she was born Laura Elizabeth; however, at the age of two, her irresistible
dimples gained her the appropriate nickname – Happy - that stayed with her all
of her life.
My mom was certainly the matriarch of our family. Besides being kind and nurturing, she was an
amazing homemaker, an accomplished cook, a seamstress extraordinaire, and more
often than not, she was also the family peacemaker. In her 90 years on this earth, I never heard
her say a cuss word or talk despairingly about anyone. She was a phenomenal
woman, and if I say so myself, she and my father raised three pretty darn good
kids.
Here we go again - Marla receiving Zometa treatment. |
I remember as a child when I skinned a knee, had a cold, or
endured the measles and mumps, my mom immediately became the family
healer. She always knew what to do when
my brothers and I were sick. I thought
she possessed special powers when she gently placed the back of her hand on my
forehead and proclaimed I had a fever. She
was usually right. Her instant cure for
a cold or cough was slathering Vicks Vapor Rub on my chest at bedtime, followed
by a hot cloth pinned to my pajama top.
The following morning, I was miraculously fever and cough free.
Without question, my mom was an encourager and a positive force
in my life. And she proved to be an experienced “medicine woman” time and time
again. Now, more than ever, I would give
anything to hear her soothing words and feel the soft touch of her hand on my
forehead.
You see, exactly one month ago, on Friday, April 11, my
dedicated oncologist, Dr. Issam Makhoul, looked me in the eye and told me that
the cancer had returned. One day
earlier, I had a follow-up PET scan that revealed a small spot on each lung, my
liver and my pelvis. Needless to say, I was stunned at the news. In two short months, the one centimeter spot that
was evident on my right lung had quickly advanced to other organs, as well as
my lymph nodes. The official diagnosis?
Stage IV metastatic breast cancer.
It was apparent that Don, my significant other and a
physician himself, and Dr. Mak were expecting me to show some type of emotion
after hearing the news. I could barely
breathe let alone cry or kick the trash can across the room. Instead, I told Dr. Mak that we needed to get
a plan in place and get the show on the road.
I knew that if I took too long to think about what I was facing, I might
curl up in a ball on the floor and sob uncontrollably. So, I had no choice but
to be the aggressor in this situation.
Dr. Mak explained that there are more than a dozen types of
traditional, intravenous chemotherapy and a few oral drugs that we could try and shared the pros and
cons of each one. Ultimately, he left
the choice up to me. I decided to start
with an oral drug called Xeloda that requires me to take three, 500 mg. tablets
twice a day for two weeks, then I would have one week off to give my body a
break. Dr. Mak was pleased with my
choice. In addition to the Xeloda, he
prescribed a monthly dose of Zometa to be given intravenously. Since there are signs of cancer in my pelvis,
the drug will help strengthen my bones.
According to Dr. Mak, the most common side effects of the
oral chemo are diarrhea, which can become severe, bone and muscle aches, and a
condition called “hand and foot” syndrome that can cause the palms of the hands
and soles of the feet to become irritated and painful. The good doctor smiled and looked at me when
he said the drug seldom causes hair loss. His declaration made me laugh because
it was the only bright spot in an otherwise crappy day.
Dr. Mak rolled his desk stool in front of me and put his
hands on my shoulders. He looked at me
and said, “Young lady, there are two kinds of Stage IV cancer; the good kind
and the bad kind and you have the good kind.”
He suggested that we would see how I tolerated the oral chemo and, after
three months, another PET scan would be ordered to see how the spots were reacting
to the chemo. Depending on the results,
we would continue with the same drug or try a combination of other chemotherapy
until something puts me into remission.
Don and I asked questions of Dr. Mak for nearly an hour on
that fateful afternoon. During that time, Dr. Mak made one statement that will
ring in my ears for years (I hope) to come.
“Our goal is to keep trying different drug combinations that
will keep you alive for at least five or six years, and hopefully, by that time
there will be a new drug or treatment that could extend your life for another 20
years.” Even though his comment was honest, compassionate and encouraging, it was at that
moment I realized how serious my condition is and that I could die. Talk about a sobering moment!
As Don and I prepared to leave the office, Dr. Mak handed me a
prescription for the Xeloda to be filled the following Monday at the UAMS
pharmacy. In addition, he wrote the
order for the Zometa to be administered intravenously in the comfort of my old
hang-out - Infusion 1 at UAMS, where I would
no doubt see familiar RNs, like Mr. Nurse Ratched and Sweet Cassie.
Don and I said little on the way home. He was still waiting for me to show some sign
of emotion. It never happened. Instead, he could see the determination in my
eyes and hear the confidence in my voice.
My only thoughts were that cancer is NOT going to win this battle.
The following two days were tough. I spent a lot of time contacting family
members and close friends, sharing the latest diagnosis with them. Stage IV cancer doesn’t roll off the tongue
easily, but I learned to say it with optimism, rather than gloom and doom. The most difficult calls I made were to my
brothers. As I shared the results of the
PET scan with them via a phone call, the pauses in the conversation were
deafening. Throughout my journey this
past year, my family has been my strength, my courage and my inspiration. I have
no doubt that they will continue to be during this next hurdle.
When Monday, April 14, finally rolled around, I was actually excited and ready to implement the plan. Ironically, this was the day
I was to have my reconstruction surgery. Instead, I was on the chemo trail again, battling to be cancer free, a requirement before the surgery can be rescheduled.
I dropped the prescription off at the UAMS pharmacy and
walked around the corner to Infusion 1. The tech escorted me to a recliner and I
settled in for the 15-minute infusion of Zometa. Sweet Cassie, one of my favorite RNs, immediately made her way to my
chair and was almost tearful when she saw me.
“Let’s kick some butt,” she said, which was exactly what I needed to
hear.
A few minutes later, I returned to the pharmacy to pick up the
prescription. The pharmacist asked if I had ever taken the drug before. I shook my head “no.” “It’s a great drug,” she said. “And it ought to be; it costs $7,000 a
month.” I was having trouble wrapping my
brain around what she had just told me.
If I wasn’t dealing with a life and death situation, I would have gotten
on my political soap box and ranted that no drug should ever cost that much
money, especially in this country.
Instead, I grabbed my sack of gold, thanked the good Lord that I had insurance,
and headed for the house where I prepared to take my first dose.
After the first week of Xeloda, I had few, if any, noticeable
side effects, which concerned Don. In
his mind, he thinks the chemo isn’t working unless there are side effects. At
the beginning of week two, the diarrhea set in, as did the achy bones and
muscles; however, it wasn’t unbearable, just uncomfortable. When I shared my
symptoms with Don, he cheered. Before I
had time to think about it, I flipped him the bird, which instantly made me
feel better.
I am now in my second, two-week cycle of the drug and, so far,
there have been no signs of the “hand and foot” syndrome. However, the diarrhea has intensified as has
the muscle pain, but it’s a small price to pay if the drug is killing the
cancer cells.
As I battle cancer for the second time in one year, I often
think about my mom. She dealt with
numerous broken bones and hips later in her life and not even during those
circumstances did my brothers or I hear her complain. She would often tell me that when life hands
you lemons, you just make lemonade. And, that’s just what she did… time and time
again. Like mother, like daughter. Her strategy is now my
strategy. Lemonade, anyone?
Tuesday, April 1, 2014
Never Stop Praying
Several months have passed since my last post, which was the
first week of the New Year. If my
chemo-brain remembers correctly, I was still enjoying the afterglow of being
pronounced cancer free, a feat that wouldn't have been possible without my
family and friends encouraging me through months of chemotherapy and life
changing surgery last fall. It is now officially spring, the time of year when
Mother Nature and Old Man Winter traditionally engage in an atmospheric tug-of-war. My fellow Arkansans understand exactly what I
mean…sleet and freezing rain one day and 72 degrees the next. Life can be just as unpredictable.
On January 21, I met with Dr. Suzanne Klimberg, my breast
surgeon extraordinaire. It had been more
than 90 days since she performed the bilateral mastectomy and it was time to
check her handiwork now that the swelling and discoloration had subsided. She entered the small cubicle and seemed glad
to see me… or maybe it was just my chest, sans breasts, she was anxious to
scrutinize.
Dr. Klimberg gave me a quick hug then immediately opened the
cape-like gown that was wrapped around my shoulders. She began pushing on my numb nipples that she
had skillfully moved and stitched to my surgically-designed “flaps” in preparation
for the breast reconstruction that would soon take place.
“They look really good,” she stated as she continued to push
and probe on the old girls. There was a
time when Dr. Klimberg and the other surgeon in my life, Don, were concerned
that my nipples might not survive the trauma of being relocated and sutured to
my skin. She reassured me that all was
going to be okay because my nipples were officially “in the pink.”
Emotionally, I was pleased with her prognosis but a little
nervous when she informed me that I didn't have to see her again for one year
unless her colleague, plastic surgeon Dr. James Yuen, “screws something
up.” I laughed out loud. It was a vintage Suzanne Klimberg
remark. “What could he possibly screw
up?” I asked the good doctor between giggles.
“You won’t even be able
to tell where he tattoos your new breasts,” she said laughing as she opened my
cape one last time to look at what was left of my ta-tas. Tattoos?
Surely she was kidding. I love
that woman. Her humor and skill with a
scalpel made my destiny with breast cancer a tolerable experience.
A few days later, I was scheduled to see my oncologist, Dr.
Issam Makhoul, for a follow-up. Don and
I waited nearly two hours before we were called back to see him. When you are fortunate enough to have Dr.
Makhoul on your team of physicians, you learn quickly not to complain about the
wait.
When Dr. Makhoul came into the exam cubicle, he inquired if
I was experiencing any lingering side effects since completing treatment last
September. Many people might think that
once chemotherapy is over, patients no longer have aches and pains. Not so!
Dr. Makhoul warned me to expect various issues for up to two years after
the last dose of toxins. In my case, I
continue to have ongoing digestive issues, joint pain and two new problems –
carpal tunnel syndrome and tendonitis in both wrists and elbows. My wrists ache badly during the night and
become numb, which disturbs sleep. I
have started wearing splints but it doesn’t help much. Dr. Makhoul said based on other cases the
pain and numbness would probably improve over time. There is no question that chemotherapy can
save lives; however, it comes with consequences.
Due to my ongoing colon issues, Dr. Makhoul scheduled a
colonoscopy for me at UAMS on January 29 to make sure there were no signs of cancer. In addition, he recommended that I have a PET
scan, which is customary three to four months after chemotherapy and for
several years, thereafter. He requested
that I make another appointment with him on February 11 to receive the results
of both tests.
Don and I met with Dr. Yuen a few days after seeing Dr.
Makhoul. Our goal was to set a date for
the reconstruction surgery. I had only met with Dr. Yuen one other time
and had forgotten how different his personality is from that of Dr. Klimberg or
Dr. Makhoul. He is very focused, doesn’t
make casual conversation and asks few questions.
When Dr. Yuen entered the exam room, he took a quick glance under
my gown at the blank canvass Dr. Klimberg left for him to craft a Michelangelo-like
masterpiece. His work would involve implanting expanders underneath each
“flap,” which might also include a little structural engineering to support his
creation.
“She did a nice job,” Dr. Yuen said while poking and
prodding the deep cavity where my breasts used to be. “Well, just don’t screw
it up.” I thought to myself remembering my humorous exchange with Dr. Klimberg
a few weeks earlier.
“What size were your breasts before the surgery?” he
asked. Don immediately responded, “Just
perfect.” But Dr. No-Nonsense didn’t
appear to be amused. I reminded myself
that this guy was going to be a tough audience. He continued with the same line
of questioning and inquired if I wanted to remain the same size. “Maybe,” I
told him, “but I would like to shop around, first. Do you have a catalogue?” Finally, a smile
appeared on his face.
![]() |
Marla leading a breast cancer fundraiser at the Arkansas Governor's Conference on Tourism, 2014. |
With calendar in-hand, Dr. No-Nonsense asked when I would
like to schedule the reconstruction surgery.
As dates crossed my mind, I realized there was no way I could have
surgery until after the annual Arkansas Governor’s Conference on Tourism – a
state-wide event that I am responsible for planning and executing in early
March. Then Don piped up and blurted
out, “After Derby Day – April 12.” Don
and I haven’t missed the final day of live thoroughbred racing at Oaklawn Race
Track in nearby Hot Springs
in more than seven years. Without hesitation, Dr. No-Nonsense reserved Monday,
April 14, for my surgery. I was thrilled.
It had been a long journey up to this point and I could finally see the
light at the end of the tunnel.
Dr. Yuen instructed me to report to UAMS for blood work on
April 10. He told me the surgery would
take approximately five hours and to expect an overnight stay in the
hospital. He warned me that the pesky
drains would once again be a part of my attire for about ten days following the
surgery. Oh, goody. The drains…
$%*7&@#. And just like that
Dr. No-Nonsense left the exam room.
Over the next two weeks, I had the colonoscopy, followed by
the PET scan. Both were uneventful. Don and I met with Dr. Makhoul on February 11
for the results of the tests. Dr.
Makhoul was busier than usual and seemed a tad bit harried when he entered the
room. He immediately sat down at the
computer and pulled up my chart. He
indicated that the colonoscopy was clear and there was nothing to worry about,
which was a great relief.
![]() |
Marla with Andrew McCarthy, actor, director, and award winning travel writer, at the Arkansas Governor's Conference on tourism 2014. |
Don informed Dr. Makhoul that the reconstruction surgery was
scheduled for April 14. I was still
speechless. Dr. Makhoul quickly put a
game plan together. He ordered a second
PET scan to be performed the week before the surgery. If the spot shows any
increase in size or shape, the surgery will be cancelled and a biopsy performed.
Before Don and I left the exam room, Dr. Makhoul made me
promise not to worry about the result of the scan. “I have seen this hundreds of times,” he said
reassuringly, “and it usually turns out to be nothing.”
Don and I didn’t say much to each other after we left Dr.
Makhoul’s office. I could tell he was
alarmed; it was written all over his face.
I asked him to be straight with me and
share his thoughts. Don didn’t deny that
the location of the spot on my lung was his biggest concern. I appreciated his
candor. That’s why I am so grateful that
Don is not only my loving companion, but he’s a great medical sounding board,
as well.
Ironically, it was about this same time last year when my life changed forever. I learned quickly that prayer is about the only thing that can move that elephant from the room.
Friday, January 3, 2014
2013 - A Retrospective
Marla's new hair |
A friend asked me recently if 2013 had been the worst year of my life. I thought about her question for a moment then responded that it had not. Needless to say, she was rather surprised by my answer.
Yes, it is true that I was diagnosed with stage 3, triple
negative breast cancer in May, resulting in four-and-a-half months of
chemotherapy and a bilateral mastectomy in October. Was I frightened when the
doctors confirmed my diagnosis? Of
course. Was I apprehensive during the
chemo treatments? Absolutely. Did I experience side effects and
complications from the drugs that were prescribed to cure me? Yes, and then some. Was I emotionally prepared to have “the girls”
surgically removed in exchange for an extended life?
Uhhhh, does a bear s--- in the woods? So, why in heaven's name was 2013 not the worst year of my life? Simple. I learned to express love more freely, complain less, forgive easily, show compassion, and pray daily. Instead of adopting a “why me” attitude when doctors confirmed I had cancer, I chose to embrace the disease, which lead to a candid self-evaluation and a more tolerant view of life in general. I like to think that I’m a softer, gentler version of myself.
Uhhhh, does a bear s--- in the woods? So, why in heaven's name was 2013 not the worst year of my life? Simple. I learned to express love more freely, complain less, forgive easily, show compassion, and pray daily. Instead of adopting a “why me” attitude when doctors confirmed I had cancer, I chose to embrace the disease, which lead to a candid self-evaluation and a more tolerant view of life in general. I like to think that I’m a softer, gentler version of myself.
When I was diagnosed with the “Big C,” I never expected to
become a lifetime member of a sisterhood comprised of breast cancer survivors. Unfortunately, this sorority has far too many
members, but I have learned that my new comrades are determined, strong-willed
women with a common mission: to support
each other and offer guidance and shared experiences when asked. I am grateful to my “sisters” for their
honesty when I was unsure of what to expect during the treatment process and
their words of encouragement when I became anxious. As a new member of the sisterhood, I plan to
be a sounding board for other women who may find themselves walking down a
similar path. Together, we are all
stronger, and together, we can conquer this insidious disease.
Over the past few months, I have realized that some of the
effects of the chemotherapy are still with me, reminding me of my journey and
that it isn't over. Sometimes, it’s the
small things I notice, like my fingernails that have yet to grow back. They are still stubby and split easily. In addition, my left knee and both
hips ache frequently – a post-chemo ailment that occasionally limits my ability
to rise from the couch or a chair. And I continue to have digestive issues that
will require further investigation later in January.
A few friends were concerned that my long, thick eyelashes
would grow back shorter and thinner, but I’m happy to report that hasn't been
the case. My green “cat eyes” are once
again surrounded by an abundance of black lashes. And my eyebrows are so thick that I recently
had to have them shaped up. What I wasn't
expecting after the chemotherapy was a growth of very light peach fuzz on my
face. Fortunately, it isn't noticeable
unless someone is in my personal space, which isn't recommended if the person
values his/her appendages.
Marla on New Year's Day 2014 with her new friend, Coco Chanel |
It is no surprise that the new year will continue to be filled with oncology check-ups, PET scans and appointments with my plastic surgeon, Dr. Yuen. It is anticipated that the reconstruction procedure will be scheduled in late March or early April, which will be confirmed when I meet with the surgeon on January 14. The journey continues.....
It was in the early hours of New Year’s Day when I heard the
nearby church bells ringing as I watched my new feline companion, Coco Chanel,
play with her ball of yarn. It was at
that very moment when I experienced a feeling of contentment - an emotion that evaded me for months - and hopefulness that
2014 would be a healthy year not only for me but for my friends and loved ones, as well.
Cheers to the New Year.
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