Marla Crider Memorial Service

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.

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...

Marla, smiling through
chemo treatment #7

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. 

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 4^th 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.

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?

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.

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 2^nd 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 Houston for a consult and alternative treatment plan.”  And, there it was. 

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

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.

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.”

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.

Here we go again - Marla receiving Zometa treatment.

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.

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?  

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.

She assured me that Dr. Yuen is a phenomenal plastic and reconstructive surgeon - probably one of the best in the country.  He’s also chief of the plastic and reconstruction surgery division at UAMS, which speaks volumes about his skill and experience.

“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.

Next, he pulled up the PET scan report.  Dr. Makhoul very matter-of-factly told me that there was a one centimeter spot on the stem of my right lung.  At that very moment, one touch of a bird’s feather would have knocked me to my knees.  Don and I just looked at each other.  Neither of us could talk. We were stunned at what Dr. Makhoul was telling us. Before I could collect my thoughts and ask questions, Dr. Makhoul immediately cautioned me not to jump to any conclusions.  He said the spot was more than likely scar tissue from a recent bronchil infection.  From your lips to God’s ears, I whispered under my breath. 

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. 

Needless to say, there is a proverbial elephant in the middle of the room, and it will continue to be until Don and I see Dr. Makhoul again on April 11 for the outcome of the second PET scan.  Whether or not I have reconstruction surgery on April 14 is still to be determined and an example of why cancer survivors never stop praying, nor should their friends and family members. 

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.

2013 - A Retrospective

Marla's new hair

It’s a new year; however, I can’t help but reflect on the past twelve months, and why wouldn’t I? After all, the past eight months have been like no other in my life.

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.

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.

Breast cancer is not a death sentence, but it will change the survivor’s life forever.  The mind and body are always on alert and tend to overreact to routine aches, pains and any unusual responses to normal stimuli. No matter how hard we try not to, we can’t help but wonder if the cancer has returned. Perhaps, in five or ten years without a re-occurrence, we survivors can live a normal life void of fear and angst.  I look forward to those days.

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

Pre-chemotherapy, I was blessed with a thick mane of dark brown hair peppered with grey streaks.  Three months after my last treatment, my inch-and-a-half-long locks are mostly silver and very curly.  At birth, I inherited my mom’s dark brown tresses but the new growth is very similar to my brothers’ salt and pepper hair that was once coal black, a trait from our Cherokee genes. For the first time in my sixty years, my brothers and I share the same hair color and style – beguilingly silver and closely cropped.  It’s too early to tell if my “fifty shades of grey” are permanent or temporary, but we should know for sure in a few more months.

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.