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My Story: One Year & Breast Cancer
Melanie Bone, M.D.
August 1, 2000... the day I was diagnosed with breast cancer.
August 1, 2002... the day I became a one-year breast cancer survivor.
The Journey Begins
I never dreamed that so much could change in my life over the course of 12 months. In February of 2000 I noticed a swollen gland in my left armpit. It was soft and moved easily - two signs that are generally reassuring that nothing bad is going on. In April, it was time for my mammogram and I requested a sonogram (ultrasound) of my armpit at the same time.
The mammogram was normal and the swollen lymph node did not look suspicious. I agreed with the radiologist to a recheck in a month or two. I noticed that the swollen gland felt a little smaller and when it was re-scanned in the summer it was, in fact, a little smaller. Although the sonographer said the finding was probably benign (non-cancerous), my instincts told me I had cancer.
I scheduled surgery to remove the gland on a day that my family was in Disney World. In my typical fashion, I worked the entire day and then ran down to the hospital for the biopsy. I knew it was bad news when I awoke in the recovery room to the teary faces of my friends and coworkers.
After that, the surgeon's main goal was finding the cancer's primary source. She knew my mammogram was normal. Her concern was that the cancer might have come from another organ. Like many woman, I "knew" my own body and I was certain the cancer was in my breast. The following day I had a total body CAT scan with normal results. Only an MRI scan with gadolinium contrast revealed the tumor deep in my breast. It measured 1.8cm (less than an inch).
The Next Steps
The next week I found myself with my husband, my father (a psychiatrist), my surgeon, and my oncologist in a small conference room discussing my fate. When these two wonderful female physicians examined me I was oddly pleased that they had a hard time feeling my cancer, because I was never able to detect it through self-examination.
From the moment I was diagnosed, I had experienced guilt about my failure to feel my own tumor before it had spread to the lymph node. After all, I had been able to detect such cancers in my patients in the past. How could I have failed myself? The cruel fact is that sometimes - even with all the diagnostic modalities we have - it is impossible to detect breast cancer early, especially in younger patients like myself. We decided it was small and subtle.
Decisions, Decisions a.k.a. Treatment Options
For many women with a new diagnosis of breast cancer, the decisions about treatment - lumpectomy versus mastectomy, one side versus both, immediate versus delayed reconstruction, skin flaps versus implants - can be daunting. This was the only time that my medical knowledge truly made it easier for me to decide. I wanted the most aggressive therapy available. I chose to have both my breasts removed with follow-up chemotherapy, radiation therapy, and then 5 years of Tamoxifen because I felt this option offered me the best chance of a cure. Also, I would never want to have to deal with this same situation again. If the cancer came back it would be in my bones, lungs, or liver, but I would know that I had done everything I could at the outset. I opted to have immediate reconstruction because I was a little concerned that I might never do it if I didn't do it all at the same time.
With a body weight of 100 pounds, I was not a candidate to use my own body fat for any flap reconstruction. I would get implants. Of the implant types, I selected the ones that are inflated through ports that are accessed with a needle. They are partially filled in the operating room and then are "topped off" in the plastic surgeon's office over the next few months. Once the correct size is achieved, the ports are removed through tiny incisions that can be done in the office and the implants become permanent.
Surgery and Kindergarten
Two weeks later, on August 15th, I had my surgery. Eight hours. The anesthesiologist, a dear friend, had placed an epidural in my upper back (like the kind used for labor) and I had little pain. The recovery was easier than I had expected. A week after surgery, the drain tubes under my arms were removed and that helped immensely. I had a goal. My oldest daughter was about to start kindergarten and there was a new parents' party on the 31st. I was there!
Post-Surgery Experiences
I started physical therapy 3 times per week to regain the range of motion in my arm and forced myself to eat a lot to keep up my weight in preparation for chemotherapy. As it turned out, my small tumor was really 6.8 cm, about the size of a silver dollar pancake. According to the pathologist, it was like a spider with a smaller center portion of tumor and leg-like projections in all directions. With a total of three positive lymph nodes, my oncologist informed me that I was a Stage 3A. This meant 6 months of chemotherapy followed by 6-8 weeks of radiation therapy.
Weighing the Options
I agreed to go on a study protocol. No, I was not going to be a guinea pig, but rather I was to participate in a nationwide attempt to compare two drugs currently in use for breast cancer. I could have chosen my drugs without entering the study, but as a physician I knew that patients in studies tended to have a better prognosis. As a resident, I had asked patients to enter studies explaining that it would help both themselves and others in the long run. Faced with the same decision, I felt I had to do the same or I would feel hypocritical. The study was designed to compare Taxol and Taxotere, which are similar but not identical. Taxol can make your fingers and feet numb - a scary thought since I'm a gynecologic surgeon. Taxotere can permanently block your tear ducts and cause you to need corrective surgery. Secretly I hoped I would get Taxotere because as a surgeon I felt that I would rather have teary eyes than numb fingers. I did.
Treatment Begins
The chemo onslaught started September 6, 2000 and ended February 6, 2001. The side effects were pretty awful. I felt so tired it was like walking through a wall of Jello. My taste buds were destroyed. Everything tasted like Styrofoam. I had oral ulcers lasting 2-3 months that would not heal because my white blood cell count was almost 0. I started daily injections of a drug to stimulate the bone marrow to make white blood cells and felt like a horse had kicked me in the hips (the site of a lot of marrow). There were times I was advised to move out of my house because I risked getting a life-threatening infection from my four young children.
Rays of Hope
Lest you think that there were no good times in those months, let me reassure you that there were. First, my husband didn't leave me, as some do under these circumstances. Bill is an incredible father and he acted like a single parent when I was unable to participate. He is a busy trial lawyer, and ended up juggling work with child care, social commitments, and struggling with his own fears. He was instrumental in sorting out some of the details of my practice and my disability insurance. A very funny and optimistic man by nature, he did what he could to inject some humor into our lives.
The children provided an endless source of comfort just by touching me, kissing me and by being children. Educating them in an age-appropriate way was quite a challenge. My husband and I met with their teachers and they were willing to help out by involving the whole class in learning about cancer. We used sources recommended by the counselor at my treatment facility and took advice from other survivors with children.
We were totally open and honest. They knew that I would lose my hair. We had a party at a hair salon, which was owned by a gentleman whose wife had died of breast cancer. While there, the children could all watch me get a really short hair cut. But when the day came to shave off the rest because it was falling out, they screamed at me to put on a wig to cover my "ugly head." Within a week they had forgotten what I looked like with hair. Often, they would fondly rub my bald head.
They pushed my "magic button", the port I had placed in my chest to make it easier for the nurses to infuse the various chemotherapy agents at each visit, and I would honk as if it were a horn.
When it came time for radiation therapy, they each took turns going to the radiation "rocketship" as they called it, to keep me company. In addition to my immediate family, my parents and siblings did what they could to help.
My mom took me to chemotherapy once when my husband couldn't be there and found it a great learning experience. My friends were incredible. They had dinner delivered to my house every other night for months.
My patients were fantastic. They prayed for me, sent me cards and letters, and almost all decided to wait for my return to work for their routine annual exams. Those with problems or in need of surgery welcomed my new partner and kept her busy. She was able to shoulder the burden of my practice until the end of her pregnancy. In January, 2001, she had a baby was back to work in 3 weeks.
Recovery Activities
So what did I do to keep myself occupied during my convalescence? I read all sorts of books - self-help, alternative medicine, spiritual intervention, other peoples' cancer stories, and many junk novels to take my mind off my cancer.
I surfed online and checked out all sorts of neat breast cancer sites. I joined the National Breast Cancer Coalition, Florida Breast Cancer Coalition and the Young Survival Coalition.
In May, with just a shred of peach-fuzz atop my head, Bill and I went to Washington, DC to lobby on Capitol Hill for money to study the links between breast cancer and the environment. I started writing this column.
I started a business called ChemoComforts, Inc., which makes kits to help patients get through cancer treatments easier. I fielded calls from newly-diagnosed women who had questions about treatment options.
Limbo Land
The next stage - the limbo as many call it - is where I am now.
Every backache, headache, stomach upset, etc., makes me worried that the cancer is back. I dread the first round of CAT scans and bone scans that are done once each year to look for any spots.
I take Tamoxifen daily to reduce my risk of recurrence.
While I am in favor of using conventional treatments for cancer, I am not opposed to alternatives. I believe that there is definitely a correlation between stress, immune function, and cancer.
In the last year, I have taken the time to learn about controlling my stress and about enhancing my immune system. There is an enormous array of alternative treatments aimed at stimulating the immune system to fight off any stray cancer cells. It's true that some are better researched than others, however, while Iscador (mistletoe) injections are not in my repertoire, I do take Cat's Claw, anti-oxidants, and have just started to exercise again. These measures will certainly help to keep me strong and upbeat - along with the love and support of my family.
Cancer's Long Haul
The journey of this year, the journey of breast cancer, is one that all too many people take. Just recently it was reported that almost all other major cancers including lung and colon are decreasing in incidence. Breast cancer is increasing. It is epidemic, especially in Florida. With one in eight women diagnosed there is hardly a family that has not been touched by it.
There are now so many organizations nationwide to raise money, awareness, and support that there is an umbrella organization to organize all the others!
The Moral of My Story
Hard as it may be to believe, breast cancer has been good for me. I doubt that I would have ever stepped back to reassess my priorities had it not been for my cancer. I am trying to "name it good." I have a wonderful appreciation for my everyday life and strive to find joy in every little thing.
Currently, Dr. Bone is an officer of the FOGS Board of Directors serving as secretary. She practices medicine in Palm Beach, Florida.