Saturday, December 30, 2006

Getting Better... Or Worse...

The swelling has gone down even more, but the skin is still quite purple. I was able to raise my hand above my head and stretch my arm out completely without any difficulty for the first time since this mysterious swelling started ten days ago.

I know the infectious diseases specialist is going to attribute this reduction in swelling to the antibiotic drips she put me on, but I think this is not an infection, but bleeding caused by ripped scar tissue. The swelling had started improving before I was put on the IV drip, so I doubt it was the antibiotics.

Now I have a new problem. I was giving my right arm and chest muscles a rest so if this WERE ripped scar tissue, I could let it heal. So I was doing everything with my left hand, which was pretty hard since I’m right -handed. But now that I have a catheter in my left hand, all wrapped up in a bandage, I can’t use my left hand at all and have to do everything with my right hand, which I’m not supposed to be using. So treating it as an infection is making it worse for me if it turns out to be ripped scar tissue instead. Lordy, I just can’t win!

Friday, December 29, 2006

Infectious Diseases Specialist

I went to see the infectious diseases specialist that my reconstruction surgeon recommended. I was hoping that this doctor could say for sure whether or not this is an infection. She couldn’t. But she said we should treat it as an infection anyway and prescribed higher doses of antibiotics to be administered intravenously. So now I have to go to the hospital three times a day to be put on an IV drip for the next three days.

I told the doctor that the swelling had gone down quite a bit overnight and perhaps that’s due to my using the right arm and chest muscles less over the past few days. So maybe it’s ripped scar tissue after all and not an infection. I also pointed out that I haven’t had a fever the entire time this has been going on, but she said that not all infections are accompanied by fever. She said ideally, she’d like to put me in the hospital for 4-5 days and put me on IV drips of both antibiotics I’m now taking orally, but since I don’t want to spend my holiday in a hospital, we’ll try me on the 3-times-a-day hospital trips for just one of the antibiotics to start and see what happens.

So now I’m getting:
Augmentin - 1.2 gm by IV drip, three times a day.

This infectious diseases specialist knows infections. So she’ll treat this as an infection, whether it is or not.

A friend of mine told me about a Japanese saying: If the only tool you have is a hammer, everything looks like a nail.

Thursday, December 28, 2006

Swelling Getting Worse

My radiation oncologist and reconstruction surgeon have both seen the CT scan films now. They showed me the fluid around the implant on the right side. But we still don’t know what’s causing it.

Meanwhile, the swelling and discoloration have gotten worse, and I have sharp needle pains all around the area. I’m still taking the second set of antibiotics -- day four now, as well as ibuprofen for pain.

The recon surgeon says he’s more convinced now that I ripped some scar tissue inside, which led to some bleeding and hence, the fluid build-up shown on the CT scan. He says infection is a less likely scenario, especially since it’s not responding to any of the antibiotics, but just in case, we’ll treat it as an infection. He told me to go see an infectious diseases specialist and booked an appointment for tomorrow.

The radiation oncologist said the discoloration of the skin (dark purple now) is “worrying” him. The fact that this is worrying him is worrying me.

There’s some good news: the CT scan shows the implant on the left, non-cancer side sitting pretty -- just as perfect a boob as anybody could ask for.

Wednesday, December 27, 2006

No Cancer in Lungs!

I saw my radiation oncologist today. We’ve gotten hold of a written report of my CT scan, which says no sign of cancer in the lungs. Very good news. The bad news is, the report says there has been damage to my right lung from the radiation -- at the apex, which was expected, but also in the “anterior middle lobe”, which was not expected -- at least not by me. I’ll have to ask my radiation oncologist later why the middle of my lung got zapped.

The report also says there’s fluid all around the right side implant -- under the implant as well as above it. Hence, the swelling. My radiation oncologist says he doesn’t know what’s caused this fluid build-up. My surgeon had said earlier that the swelling was edema (swollen tissue), NOT fluid, based on an ultrasound, but the CT report says it’s fluid. So which is it? The radiation oncologist says he’s not sure, based on the written report; he’ll have to see the actual films from the CT scan.

This still leaves the mystery of why I have this swollen, purplish-red mass on my chest where the cancer used to be. It hasn’t gotten any better since we switched antibiotics three days ago. This leads me to believe that it’s not an infection after all, since the likelihood that my body doesn’t respond to three different antibiotics is pretty slim. My pedestrian guess is that I ripped some scar tissue inside my chest with all the heavy lifting I did during our move. The fact that it’s only happened on the right side and I’m right-handed supports my theory.

We’ll have to wait to get the CT scan films, I suppose, and see what else it can tell us.

Monday, December 25, 2006

In Limbo...

I had my CT scan yesterday morning to see if the swelling in my chest is due to a recurrence of cancer. The radiologist rushed the results to my oncologist, who promptly went on holiday without telling me what the results were. Aaargh! She won’t be back until January 3rd!

I’ve tried calling my doctor on her mobile number, but she’s not answering. I can think of two reasons for not telling me the results:

1) It IS cancer, but there’s nothing that can be done about it until after the holidays, so she’s not telling me anything until after she returns in January.

2) It is NOT cancer, so there’s nothing to be done about it but keep on the antibiotics she’s already prescribed. No new course of action is needed so I don’t need to be told the results of the scan.

Or, she has no idea what it feels like for a cancer patient who is worried about a recurrence to wait for the results of a CT scan. How can this be?!?!?

Well, if there’s nothing that can be done now, there’s no point in worrying about it. I’ve accepted that it could be a return of cancer, and if that’s the case, I’ll go back on chemotherapy after the holidays. Going bald again might be better than this absurdly curly hair I have growing back now anyway. For now, I’ll just deal with the pain and discomfort of this mysterious swelling in my chest with antibiotics and pain relievers.

Sunday, December 24, 2006

Four Doctors and a CT Scan

The swelling and discoloration of skin on my right chest have gotten much worse despite three days of antibiotics. I’ve been to see four doctors today: my medical oncologist (chemo doc), radiation oncologist, surgeon (who solved my last medical mystery), and reconstruction surgeon.

The two oncologists and one of the surgeons still think it’s most likely an infection, but the infection is under the implant so the antibiotics are having a hard time getting to the site. Apparently, this is because the tissue under the implant has formed a protective layer against the foreign body, so the antibiotics can’t penetrate to the infected area as well. Or... I’m resistant to this antibiotic. My oncologist has put me on two new antibiotics now:
Augmentin - 625 mg. twice a day
Dalacin C (Clindamycin) - 300 mg. 3 times a day

So the two oncologists are still treating it as an infection, but they say we need to consider it might be cancer again. The cancer cells might have come back in the chest wall muscle or in the skin above the implant, or both. So they sent me for a CT scan.

The surgeon did an ultrasound of both breast implants and said the swelling on the right side was edema (swollen tissue) and not fluid.

The reconstruction surgeon thinks it’s mostly likely ripped scar tissue inside the chest cavity from overexertion. That ripping might have caused bleeding and swelling. Or it could have caused an infection. If the infection invades the implant cavity, fluid would form around the implant and could break through the skin and ooze out. But this usually happens just after surgery, not two months after, as in my case. If this is what’s happening, I’ll have to have another surgery to remove the implant. If it’s just ripped scar tissue, it can heal on its own if I limit use of my right arm and chest muscles. But just in case it IS an infection, I should go along with my oncologists and take the prescribed antibiotics. He says it’s unlikely it’s a recurrence of cancer.

Bottom line: nobody knows for sure. Looks like an infection or ripped scar tissue or both. Very slight chance it could be cancer, but highly unlikely. But we’re all just guessing here. Let’s just treat it as an infection and see what happens.

Saturday, December 23, 2006

Infection? Tissue Scarring?

After the big scare Tuesday, my oncologist put me on an IV drip of antibiotics the following morning. She said it was an infection -- it was red and swollen. The chest pains had stopped, but the swelling and redness got worse. She sent me home with a 7-day course of oral antibiotics but the swelling kept getting worse. Now the right side is bigger than the left and it’s bright red and quite painful.

The oncologist wants me to go back for another infusion of antibiotics this morning.

I also talked to my reconstruction surgeon yesterday and he said it could be an infection (cellulitis) of the soft tissue above the implant, which would be fixed with antibiotics. Or it could be an infection of the chest wall or tissue under the implant, which could require surgery to remove the implant. I don’t really get this -- why wouldn’t antibiotics get the infection no matter where it was? Or the third option is it could be damaged tissue from too much movement and heavy lifting over the past week. We’ve just moved into our newly renovated house, so I’ve been lugging heavy boxes, packing and unpacking for the past week. If it’s damaged tissue, the surgeon says I would just have to let the chest and arm rest and it would heal itself gradually.

The big relief is that neither my oncologist nor my surgeon has mentioned the possibility of it being a return of cancer. I did a Google search for “chest pain radiation breast cancer” and got a lot of information about the pain being a sign of cancer cells in the lining of the lung, chest wall, or rib area. That was the big scare. So compared to that scenario, a chest infection or tissue scarring seem like very welcome options.

Wednesday, December 20, 2006

Chest Pains, Scary

While I was mopping the floor today, I felt a sudden, strong chest pain on the right side -- the side that had the cancer and radiation treatment. The pain was so strong I couldn’t breathe properly -- every time I inhaled, I’d get a shooting pain deep in the chest. I waited it out for about half an hour, taking small, shallow breaths, but it didn’t get any better so I called my oncologist. I could barely get the words out because I couldn’t breathe and she was a bit alarmed and wanted me to meet her in the hospital emergency room. But I told her I thought it was just nerve damage from the radiation therapy and maybe I’d take some pain medication at home and see what happened.

I took a double dose of Aleve, an over-the-counter pain reliever, which is unusual for me because I don’t believe in taking pain relievers. I usually just try to sleep off any headaches or body aches. But those pills did the trick and within a half hour, I was able to breathe a little better, as long as I took only shallow breaths. And by the evening, I felt back to normal.

I’m just glad the pain was on the right side and not the left. If it had been on the left, I would’ve thought I was having a heart attack. The chemotherapy-Herceptin combo I had damages the heart, so I’ll always have to worry about my heart giving out. Although I think what happens to people with this drug combo is the heart just suddenly stops beating. Is that what a heart attack is? Not sure.

This was the first big scare I’ve had since my cancer treatment ended. I guess I can look forward to more of these as the long-term side effects of the chemotherapy and radiation creep up on me. Apparently, these side effects can pop up years, decades down the road, so escaping from them for the first few years doesn’t mean I won’t get them later in life. Just one more way that cancer stays with you forever.

Thursday, December 7, 2006

One Year Anniversary

December 7. A date that will live in infamy. Roosevelt meant Pearl Harbor. For me, it was the day I was diagnosed with breast cancer, exactly one year ago today.

I’ve read that cancer patients have the highest rate of recurrence within the first year. I wonder if that’s the first year after diagnosis or after end of treatment? The often-quoted five-year survival rates are for five years after diagnosis. If it’s the same gauge for recurrence, then I’m doing pretty well not to have a recurrence at the one-year mark. So hooray.

In his book, Lance Armstrong said that after cancer, the biggest day of the year for him wasn’t his birthday or Christmas, or any other national holiday. It was the anniversary of his diagnosis. I can see why. Each year that I’m alive after diagnosis is a year that... well, I’m still alive.

Armstrong also said that living after treatment was almost harder than going through treatment. I feel the same. At least when you’re going through chemotherapy, radiation therapy, and surgery, you feel like there is active battling against the cancer cells. But after all that’s over, it’s just a waiting game to see if and when the cancer cells will recoup and come charging back at you. This is why things like my diet, vitamin supplements, and exercise are so important to me. These are the only ways I can actively fight the cancer cells.

I know some people think it’s silly to believe vitamins can help save my life. It’s true that there haven’t been any studies showing a positive impact of diet supplements on cancer patients’ outcomes. But it just makes sense to me that boosting my immune system with nutritional supplements will give my healthy cells a better chance of beating back cancer cells. I don’t need a scientific study to tell me that. There was no scientific evidence that diet and exercise had any impact on cancer until earlier this year. I thought that was a no-brainer as well.

I realize that no amount of spinach, pills, or exercise is going to keep me cancer-free. But they can certainly improve my chances of being able to fight again. Think of all the battles that would never have been won if generals said, “We’re outnumbered; we don’t have enough weapons; our men are malnourished and weak; we’re outflanked” and then turned around and went home. I’m sure they didn’t even have that choice. Neither do I. I can’t turn around and go home. There’s no home for me anymore. Pre-cancer life is gone forever. So I’ll stay and fight, no matter what the chances.

So happy anniversary to me. I’m still alive. What a feat it is just to stay alive!

Cold or Cancer?

I’ve had a bad cold for about a week now. It started off as a sore throat, then came body aches, loss of voice (hard one for me!), and a teeny-tiny fever (38 C). The body aches -- legs, back, head -- stopped yesterday, only to be replaced by coughing fits which leave me a bit wiped out. Each time I cough, my chest hurts, sometimes on the side where I had radiation, but mostly just beneath the sternum, right where the rib cage ends. And to top it all off -- thick, green mucus. So I’m guessing it’s a bacterial infection.

I haven’t been to the doctor, because I’m pretty sure she’ll say the same and put me on antibiotics. But I want to try to get rid of this myself, without more drugs. So I’ll wait it out a few more days and see what happens. The good news is, the body aches have stopped. I spent almost 48 hours after the Singapore Marathon in bed, hoping to sleep off the aches. It worked. So maybe the coughing and mucus will go away in a few days.

I’ve had two doctor appointments this week that I’ve cancelled -- one with my surgeon and the other with the reconstruction surgeon, both for follow-ups. But I thought I’d wait a few days to get over my cold first. Plus, I don’t want any more doctor bills piling up until we have more funds in the bank!

So here’s the thing about having something as innocuous as a cold. In the post-cancer world, a phlegmy cough could be a sign of fluid build-up in the lungs due to cancer cells growing in the lung lining. Aches deep in the leg bones could be cancer spread to the bones. Headaches could be brain tumors. Most likely, it’s just a bad, persistent cold. And even if it IS cancer spread, a few more days of waiting to see isn’t going to make the outcome any worse probably. Plus, it’s highly unlikely that cancer’s come back so soon. Although the highest percentage of recurrences happens in the first year... and tomorrow will mark my first year since diagnosis. Nope. Pretty sure it’s just a cold.

Monday, December 4, 2006

Singapore Marathon. Sort Of...

Today was the Singapore Marathon, which included a half-marathon and a 10-kilometer run. My Dragon Boat teammates and I signed up to do the 10K run, but we were supposed to walk the whole way. I’m not supposed to jiggle my expensive new boobs around for a few more months, so I signed up to walk.

We all started the walk together, but most of the ladies decided to run parts of it, and I thought I could do a bit of running as well. But my teammate, Kate, who’d just turned 66 years of age and had two bad knees was hobbling along the best she could. She said this was her birthday gift to herself -- to actually walk 10K. So I decided I’d walk with her the whole way. She was so proud of herself for finishing, because I could tell she was having a hard time toward the end. I was tempted to run the last few kilometers, but I figured I could do a real run next year.

I also met a blind runner from Kenya. He ran tied to another runner, who acted as a sort of guide. I guess the guide-runner had to hold back to allow his blind partner to keep up with him. It must’ve been hard on both of them. I met the blind runner, Henry, while we were collecting our race entry packs from the sponsor. We chatted about our kids (he has a 3-year-old boy), and how naughty they are. We joked and laughed about the kids. I only realized afterwards that I didn’t get to tell him how amazing I thought he was for running a marathon when he couldn’t even see. Think of the difficulty just keeping your balance when running blind! I’ve seen him in ads put out by the marathon’s sponsor, Standard Chartered Bank. Someone told me later that he wasn’t always blind. Before he lost his sight, he was a marathon record-holder. Wow. What sheer guts to keep running. His little boy is going to be very proud of him when he grows up.