Catching up on the important things.....

Even though it has only been two short weeks since I finished radiation and just over two months since finishing chemo, thankfully both feel like distant memories.  Sometimes I love that my short-term memory is poor!  Seriously though,  there is so much (that I want) to do and even more to look forward to, that I hardly have time, energy, or desire to dwell on the past and am instead focusing on the future.  That said, I don't want to downplay how difficult these past five months have been.  Anyone who has been there, done that knows what I am talking about.......

Moving on.....Since finishing treatment, the past two weeks have been filled with catch up.  Not the bad kind of catch up like cleaning the house, running errands, or doing any of the other life tasks that have taken a backseat since I started treatment in July.  That can wait.  Instead, I have been catching up on FUN!  First up, was a trip to St. George.  I have been looking forward to this trip since, well, July.  It was to be my first trip out of town since starting treatment last summer, however as my skin reddened, burned, and became painful from radiation, I was concerned that I would not be able to mountain bike as planned on our trip.  Fortunately, my poor, radiated skin healed quickly and just in time for me to throughly enjoy our trip and feel "restriction free".

The human body never seizes to amaze me with its capacity to heal.

Above: my burns (almost) at their worst.  A few days after this photo was taken it blistered and became so tight that when I raised my arm it felt like my side would split open....fortunately it didn't!

One week after finishing radiation, my skin was healing beautifully.

Our trip was amazing.  Five fun filled days of mountain biking and visiting with friends.  Needless to say, I came home very satisfied.....and tired.  and unfortunately practically photo-less.  Here is one sweet video of me finally cleaning a techy downhill on Zen.  I proceeded to do it 4 more times!

This weekend, I was back at it, spending three consecutive days riding/racing my BMX bike.  It started with a race Friday night, clinic Saturday, and then another race on Sunday.  Lots of my mountain bike race pals came out to join in on the fun.

I'd consider myself closer to a beginner than pro BMX racer, but I somehow walked away with a trophy and.... lots of muscle soreness!

Giant trophies make me feel like a kid!

If you remember from my last post, this was also the week of me going into ovarian shutdown and starting a new medication.  Well, recent lab work indicated that two rounds of chemo have put my estrogen levels at nil, so no Lupron (ovarian suppression) shot was needed.  Apparently my body is already essentially in menopause.  Although this makes me want to say a giant boooooo, on the upside it is also reassuring because I seem to be tolerating low estrogen levels fairly well (i.e. I haven't gone (too) crazy yet).  Additionally, I was given the go-ahead to start my new long-term medication (Arimidex) and am happy to report that I have not noticed any significant acute side-effects.  On the downside,  I did receive some bad medical news this week.  My recent Dexascan (bone density scan) revealed that two rounds of chemo has resulted in osteopenia (bone weakening).  While I find this quite annoying, especially since one of the primary side effects of Arimidex is further bone weakening, I am taking action.  Research shows that high stress weight bearing activities can reduce and possibly reverse osteopenia.  Bring on the plyometrics, jump rope, and trail running!  All in all, I continue to optimistically look toward the future and a return to the life I so desperately want.

Up next, oophorectomy (ovarian removal) scheduled the end of January.  Even though my estrogen levels are low, my oncologist wants insurance that they remain that way.

You can bet I will be overdosing on fun until then!

Radiation recap

6 weeks, 30 treatments.  Done!

I was prepared for radiation to be hard.  It was.  Just the scheduling alone was hard.  Balancing 5 days/week treatments with work, exercise, and taking care of my health was overwhelming in and of itself.  Add to that the side effects that increasingly crept up as treatment progressed, and....well, let's just say I am very happy to be done.

My axilla (armpit) was burnt the worst

You can see by the burns on my backside 

that radiation goes through your entire body including organs

Typical of myself, I pushed the limits as much as possible throughout treatment.

Six weeks is simply too long to neglect life.  I was determined to work, exercise, and take care of my body as best as possible.  While this definitely presented challenges, it was better than the alternative, and I did learn a few things along the way.

Here is what I learned:

1.  Some people may be good at flying by the seat of their pants.  I'm not one of those people.  Maybe it is because I like to accomplish a lot in a day.  Or perhaps because of my lack of control over my health situation right now.  Or even the fact that I have had over 60 medical appointments this year alone and get tired of my life revolving around appointments.  Regardless, the time of my daily radiation treatment could make or break a day for me.  I learned this quickly as initially my radiation schedule was very inconsistent, didn't jive with my daily routine, and sometimes would be changed on short notice.  Once we figured out and were able to maintain a more consistent schedule, my energy levels increased as well as my overall mood.  I am embarrassed to admit that there was one day I was downright cranky at my radiation appointment.  I suppose I am allowed to have an "off" day, but (medical providers and patients take note) my mood improved substantially as my radiation schedule improved.   A little flexibility from the hospitals part can make a BIG difference in a patient's mental well-being.  I was fortunate that the amazing staff at Huntsman was willing to work with me to come up with an acceptable schedule.  My point?  Find a radiation schedule that works for you, and if your schedule is not working, don't be afraid to speak up and change it!

2. Move.  Are you noticing a theme from previous posts here?  I always, always, ALWAYS felt better after exercising.  To be efficient, I would often ride my bike to treatment or take Dizzy with me and hike and/or run before or after treatment.  An added benefit is that the increased circulation and body heat generated from exercising helped keep my arm and shoulder loose.  I also found that as my underarm (see photos) became more irritated and raw, my cycling position with my elbows out was one of the most comfortable positions to be in!  Additionally, exercise is good for the lungs and may help prevent/reduce damage from radiation exposure.

A little mountain bike video

3. Along the lines of exercising the lungs, I utilized a Sports Lung and Incentive Spirometer (breathing tools).  My lung exercise regimen was to use the Sports Lung morning and night for 2x10 reps and the Incentive Spirometer after treatment for 10 reps.  I don't know if this made a difference in protecting my lungs, but I do know that I did not develop a cough or sore throat during treatment which is a common side effect due to radiation exposure.

3.  Take a break.  Sometimes 15 minutes of closing my eyes was enough of a rest for me to get through the rest of the day energized.  

4. Lotion.  I certainly didn't figure out a magic formula for preventing radiation burns (once again, see photos, I got burned straight through my body) but I do know that keeping the radiated skin moisturized was helpful.  The routine that worked for me was to use organic AloeVera immediately after my treatment.  Other lotions I experimented with throughout the day included calendula oil, calendula lotion, coconut oil, and beeswax.  My rule of thumb was simply to keep the radiated skin moist throughout the day and night, although my radiation oncologist didn't want any skin care products used for four hours prior to treatment.

5.  Stretch the arm and shoulder.  The exercise physiologist at Huntsman told me that throughout treatment and for the REST OF MY LIFE it is recommended that I stretch my radiated shoulder twice daily!  

4. Take care of the lymph system!  Women who have had a sentinel lymph node biopsy are at risk for lymphedema which is an incurable swelling of the arm that can become quite significant and debilitating.  This risk is increased by axillary lymph node dissection and then increased even more by radiation.  Since I have had it all, I am taking preventative measures very seriously.  I strongly recommend seeing a lymphedema therapist (usually an occupational therapist or physical therapist with specialized training in lymphedema) prior to starting radiation.  Baseline arm measurements can be taken, lymph massage can be taught, and a compression sleeve can be ordered.  I do a quick manual lymph drainage massage every single night to help support lymphatic flow and I have been wearing a compression sleeve while exercising.  I plan to continue this regimen post-radiation.

This is what lymphedema looks like (not my arm).
Fluid gets 'stuck' in the arm due to damaged and/or removed lymph nodes.  

6.  Get a compression sleeve.  A medical grade compression sleeve can be ordered through your lymphedema therapist.  This should always be worn when flying as the pressurized airplane cabin exasperates lymphedema symptoms.  Additionally, you may want to consider wearing a sleeve while exercising.  Since I don't have any active symptoms, I wear a more comfortable sports compression sleeve while exercising.

Sports compression sleeve 

7.  Breast massage:  My plastic surgeon recommended that I massage the radiated breast for five minutes twice daily to try to reduce scar tissue build up from radiation. 

8.  While everyone's skin/tissue responds differently to radiation, most women have some sort of reaction.  I was hoping to fall in the no reaction group and everything was looking good for the first three weeks.  However, week four my skin started to get red and by week five I had legitimate burns especially to my axilla.  By week six, my axilla was tight, tender, and peeling.   Not wanting to be slowed down, I found some creative ways to dress and exercise that reduced irritation to this tender area.

Here are some dressing tricks that brought me comfort:

1. For the first four weeks I wore a Patagonia camisole instead of a bra and/or sports bra.  This camisole absorbed sweat, provided some (although not a lot) of support, and was very soft against my skin.  Sometimes, when not exercising, I would wear a tight cotton tank. While providing even less support than the camisole, these tanks were soft against the skin, and since there was no built in bra, did not rub the skin under my breast which was the first area to become irritated.  
2. By week five, I could no longer wear tanks as a base layer.  No matter how soft they were, they rubbed my axilla which by this point was severely burned.  For work, I wore layers.  A nice wrap sweater over a cotton long sleeve shirt (even short sleeve shirts as base layers rubbed my axilla) worked very well.  For exercising, I wore snug breathable baselayer.  While this provided minimal support, it was better than nothing, and not exercising was simply not an option!  
3. A camelback to carry water on bike rides was out of the question as it also rubbed burned areas, so I used a fanny pack to carry extra water bottles.  Not ideal, as it sometimes slipped and needed to be tightened, but better than nothing.
4. When things got really bad, I used Mepilex dressing to protect the skin and reduce chafing.  

Many people think once radiation treatment is done, breast cancer treatment is over.  This is the case for some, but not for me.  I still have a few more hurdles.  On December 2nd I will get a shot (Lupron) that temporarily (for 3 months) suppresses my ovaries.  If I tolerate ovarian suppression satisfactorily, and don't, in my oncologist's words "Go crazy", I will be having yet another surgery (my sixth in three years) to have my ovaries removed.  Oophorectomy (removal of ovaries) eliminates the estrogen in the body produced by the ovaries.  I will also be starting a new long-term medication, Arimidex, which blocks production of estrogen by other sources including muscle and fat.  Since my breast cancer was fueled by female hormones, it is the consensus that reducing these hormones in my body provides me the best chance to live a long, cancer-free life.

I admit, having another surgery looming in the future as well as the thought of being forced into menopause at 38 makes me sad.  So, to bring a smile to my face, I will end this post with a funny story and happy news.  Most funny stories in our household involve Dizzy, our dog.  The other day I was running with Dizzy on the Shoreline prior to my radiation appointment.  He has been so good at staying close to me when off leash, however on this day he sprinted around a corner and instead of waiting like he usually does, he was gone.  I ran up and down the trail calling and looking for him.  No luck.  A few minutes later I got a telephone call from the valet parking guys at Huntsman.  Apparently, my naughty puppy ran down the hill to the hospital and right up to valet parking.  I was called and Dizzy was valet parked inside the hospital.  How's that for service? 

The happy news is that I am heading to the desert next week for a mountain bike filled holiday.  My first trip out of town since starting chemo in July.  Yippie!

Health Monitor: Breast Cancer Guide

I was recently interviewed and featured in the Fall edition of the Health Monitor Breast Cancer Guide.  The magazine is distributed to cancer facilities nationwide and is packed full of useful information.  I am quite flattered that some of my chemo tips were included in the magazine.

Athlete's Guide to maintaining fitness during chemotherapy

Back in 2011, I wrote this post: Tips for Staying Fit and Healthy While Undergoing Chemothreapy.  I can say with 100% certainty that not only was I able to maintain health and fitness during chemo in 2011, but I was able to build and regain a very high level of fitness post-treatment.  Women often speak of their new "normal" after undergoing breast cancer treatment.  My new "normal" was healthier, fitter, and stronger.

May 2013 (Photo: Anna Pocaro Photography)

That was until my axillary recurrence this May and four more rounds of chemo followed by radiation.  Between chemo, radiation, and surgeries, I have spent 1.5 of the past 3 years undergoing active cancer treatment!  Based on my unwanted, however increased experience with maintaining health and fitness while undergoing chemo, I am expanding my list of tips.

11 Tips to Staying Fit and Healthy During Chemo:

Tip #1:  Move!  While it is easy to justify laying on the couch when you feel crappy, there is a time when you just need to get up and start moving.  Start with a walk and stretching and build from there. I absolutely guarantee it will make you feel better.

Getting out and moving with my pal, Dizzy

Tip #2:  Take your anti-nausea medications.  I'm not a big fan of filling my body with potentially unnecessary medications, however it is hard to stay active if you are hovering over the toilet, and once the nausea sets in, it is difficult to overcome.  Stay ahead of the nausea and take those darn anti-nausea meds....at least for the first few days after treatment.

Tip #3: Nutrition.  Indulging in a sugary treat feels good for about 30 seconds.  Eating a well balanced meal helps you feel good all day.  Cooking healthy can be time consuming, however with experience and planning it becomes quite manageable, and certainly worth the effort.  I plan a dinner menu for a week at a time and build a shopping list.  While creating the weekly menu does take time, I save time at the store being more efficient and don't waste precious time by avoiding last minute trips for missing ingredients.   When planning my menu, I schedule meals that require more prep for less busy evenings and make enough for leftovers to last 2 or 3 more meals.  The rest of the nights of the week, healthy meals are prepared in less than twenty minutes.  

Tip #4: Don't be afraid to exercise routinely.  Research shows that women who exercise during chemotherapy experience less side effects from treatment.  If nothing else, let that be your motivation.  Chemo side effects suck!

Tip #5: Combine cardio, weights, and stretching.  My chemo exercise regimen included cardio at least 5 days/week to increase circulation, flush toxins out of my body, and help maintain my cardiovascular fitness.  According to one of the exercise physiologists at Huntsman, cycling is one of the very best activities for increasing circulation.  Convenient for me!  The duration and intensity of cardio should be dependent on fitness level prior to starting treatment and remember that even when you are moving slowly you are still moving faster than if you were on the couch!

I also included a weight/core workout 2-3 times/week.  This is especially important for women undergoing chemo and even more important for young women.  Chemo causes hormonal changes simulating menopause which puts us at significantly increased risk for osteoporosis and bone fractures.  A solid whole-body weight program can help maintain bone integrity.  Additionally, maintaining muscle mass helps burn fat more efficiently.  No fancy gym membership is needed.  All of my exercises were done with 8 or 10 lb. hand weights, a 10 lb. kettle bell, therapy ball, and a weighted vest.  My favorite exercises were a variety of squats, lunges, jumps, and kettle bell swings-I prefer whole body moves as opposed to focusing on single muscle groups as they are more efficient when time crunched.

Squeezing a weight workout in the comfort and convenience of my home

My core program focused on both abs and back extensors.  Additionally, side planks were done every single session.  Maintaining shoulder stability and mobility is especially important for women who have undergone breast surgery and radiation.

I also incorporated a short stretching session every single day with an emphasis on shoulder mobility and tight cycling muscles.   

Tip #6:  Plan ahead for workouts and keep a training log.  Fitting workouts in may seem overwhelming, however it too is manageable with some planning.  Although I love riding my mountain bike in the mountains, somedays in order to squeeze a ride in, I would resort to riding the foothills near my home.  Additionally, when possible, I would ride my bike to doctor appointments and always to chemo.  Not only was I squeezing a workout it, but I was arriving to the hospital relaxed and with a smile on my face!   Weight workouts and stretching can easily be done at home.  A solid weight workout can be done while dinner is cooking and stretching has become part of my nighttime wind-down routine.

You can see my 2013 chemo exercise log here.

Tip #7:  Make a list to help with time management.  I found that while undergoing chemo I became more easily distracted and if I didn't have a plan in place for the day I could burn hours doing......nothing.  A simple list of daily tasks helped me stay focused, relaxed, and productive.  Ha!  This is even helpful when not undergoing chemo! On my daily list I may write specific workouts to accomplish, errands I need to run, and food I want to prep.  

Tip #8:  Make exercise fun.  Do something you enjoy with people you enjoy.  Many of my rides turned into social events.  Talk about multi-tasking; I was able to socialize with friends while doing something I love AND exercising.

Riding with one of my favorite buddies

Tip #9:  Pay attention to how your body feels, but understand what it is telling you.  For example, while undergoing chemo I learned that even after a restful night my body often felt sluggish in the morning.  If I didn't know better, I would probably think that I needed more rest, but most of the time a morning workout helped improve my energy throughout the day.  Make sure to get plenty of rest, but don't be afraid to push yourself.

Tip #10:  Protect yourself from illness/infections.  Frequent hand washing is imperative to reduce risk of contracting colds and flu.  While It may seem impulsive to wash your hands multiple times daily, I did this and was fortunate to not experience a single cold while undergoing chemo even though I work in public schools and did not get Neulasta to support my immune system.   Additionally, mountain biking is an inherently dirty sport.  While mountain biking, scratches from tree branches, scrub brush, and tall grass are imminent.  To protect my skin and decrease my risk of infection, I wore long socks and arm coolers.   Despite my precautions I still sustained a fair share of small skin abrasions.  I would shower right after my rides, use tea tree oils on cuts, and fortunately I did not experience any infections.

Mountain biking in CEP arm coolers and tall socks to help protect skin from abrasions

Tip #11:  Finally, allow yourself to feel empowered by taking care of your body.  Know that while maintaining fitness and healthy nutrition you are doing your best to protect your body from cancer and help it to tolerate treatment better.  

October 2013

Other tips:

1-Coconut oil:  Chemo makes skin dry, scaly, and delicate.  In my opinion, coconut oil is the best all natural skin moisturizer!  I used it all over my body especially on my hands, feet, and hairless head! 

2- Mouth care: Chemo can cause mouth sores and tooth sensitivity.  A soft toothbrush and sensitive tooth toothpaste made a big difference.  Additionally, brushing my teeth after every single meal helped reduce mouth sores and the metallic taste that chemo causes.

Tom's Sensitive:  My favorite chemo toothpaste

3- Buff head band:  I tried trendy scarfs, but found that my Buff headband looked just as chic, was simpler to put on, and cooler when temperatures were warm.

4-Don't force yourself to eat your favorite foods or foods that are essential to a healthy diet (like kale) on your bad chemo days.  A strong aversion to these foods, referred to as the "scapegoat effect", may develop.  On these bad days, when nothing tastes good, eat foods you are willing to part with.  I was able to break my addiction to cereal by eating it on my bad days!

6-CEP compression:  I remember from 2011 the heavy feeling in my legs every morning.  Athletes call this lactic acid buildup.  Wearing compression sleeves on my legs during the day helps them to feel so much better.  This morning lactic acid buildup lasted a full year after I finished treatment in 2011 and it has returned since finishing my second round of chemo in September.

Radiation update:  Four weeks down, Two to go!!!!!!  Radiation post to come soon!  

Radiation: Week One-Down

Well, I survived my first week of Radiation and so far everything is going smoothly.


Radiation really is a quick process.  I arrive to Huntsman, check-in, go to the dressing room, change into a gown, get called back, get positioned, get radiated, change, and then leave.  On Tuesdays my appointments are a bit longer as I meet with my radiation oncologist for an exam and consult.  One other day each week, x-rays are taken to make sure my positioning (ie body organs have not changed location inside my body) is still spot-on.  That said, it still takes a small chunk of my day that could be spent doing something more fun and it is mentally exhausting to feel like a patient every single day.
For this reason, Shannon decided that I get a surprise at the end of every week I complete radiation.  This week I got a climbing training board.  I guess he thinks I need to work on my pull-up:)

Additionally, scheduling has been a bit of a nightmare while trying to maintain a steady work schedule, but I have a tentative schedule through November 27th, although the final treatment date has not yet been completely determined.

As for side effects, nothing significant yet, which I think is pretty typical.  From what I understand, skin burns and fatigue usually set in later in the process.  That said, I am taking incredibly good care of my skin.   That means taking off my sweaty sports bra right after a workout, not wearing a camelback or backpack that may rub on the irradiated skin, and lots of lotions!

The Fall riding has been spectacular!

Honestly, I feel the best I have felt since before I started chemo back in July.  Since I refuse to wear a heart rate monitor at the moment, my ride efforts have been based solely off perceived effort.  I do sometimes ask Shannon what his heart rate is to get an idea of what my perceived effort is versus his effort.  We can already tell that I'm recovering and regaining strength since finishing chemo as Shannon's heart-rate was a solid 10-20 bpm minute higher on yesterdays ride than it usually is when we ride together, while my perceived effort was the same as it has been throughout treatment (conversation pace).

It is amazing how resilient the body is!

More photos can be found here!

Plan to survive radiation

Radiation starts Monday and I have a plan in place to hopefully help me not only survive, but to thrive over the next 5-6 weeks of daily treatment!

Radiation works by damaging the DNA of rapidly dividing cells (ie. cancer cells) hopefully resulting in cell death.  Unlike chemotherapy that is a systemic treatment targeting all rapidly dividing cells in the body; radiation therapy is a localized treatment that targets specific areas.  For me this will be my chest wall, axillary lymph nodes, and supraclavicular lymph nodes.

My two primary goals while undergoing radiation are to 1-Support the treatment in being as effective as possible and 2-Protect healthy tissue (skin & lungs) that are exposed to radiation from damage.

After consulting with my Nutritionist this week, here is some of what I learned:

General diet guidelines while undergoing radiation include:
-Double protein intake
-Maintain stable blood sugar
-Eat cooling foods
-Boost intake of spices

Other potential strategies to improve the efficacy of radiation therapy (Note: All of these strategies have some supporting research, although I am going to refrain from going into detail)

-Improve Tumor Oxygenation: This can be done through diet, supplementation, and improving circulation.  One strategy that I plan to employ to increase circulation immediately prior to my radiation treatments is exercise.   Free and effective and can easily be done by riding my bike to treatment!  Other options include a jog on the shoreline (located right behind Huntsman), running up/down the huge flight of stairs outside of Huntsmen, or even a short spin on the stationary bike in the Wellness Center which is just down the hall from the radiation wing.  Deep breathing and taking warm baths also increase circulation although deep breathing is contraindicated during the actual  radiation treatment as increasing lung volume may increase radiation exposure to lung tissue.

-Depleting Tumor Glutathione Levels:  According to my nutritionist, and backed by some research, whey protein supplementation appears to make tumors more susceptible to effects of cancer treatment (chemo AND radiation) by depleting glutathione while boosting levels of this protective nutrient in healthy cells.  Whey supplementation also helps me meet my increased protein needs during treatment.

-Sensitizing cancer cells to the cytotoxic effects of radiation:  Spices that reduce inflammation in the body may increase efficacy of radiation therapy.  Some examples include: basil, clove, curcumin, ginger, oregano, rosemary, coriander, nutmeg, parsley, turmeric, cinnamon, cumin, and licorice.

-Fostering cell death through ingesting selenium.  3-4 Brazil nuts/day provides an ample amount of selenium to meet daily therapeutic levels of selenium.

Dietary strategies I am employing to meeting my second goal of protecting healthy tissue include glutamine supplementation, licorice tea, tumeric, and 2-3 servings of organic soy daily.

Ever hear of Dal?  Well I hadn't until my nutritionist suggested I make some with Mung Beans.  

Dal is an Indian soup with loads of nutritional benefits.  Mine is made with Mung beans because Mung beans appear to reduce side effects of radiation.  I also made mine with tumeric, cumin, garlic, ginger, spinach, and some organic bone broth to boost immunity.  I am freezing these individual servings so that I can have one small bowel each day I receive radiation treatment.  

Additionally, radiation can have adverse affects on skin.  I am armed and ready with an arsenal of skin care products including Aloe Vera, Calendula lotion, Coconut Oil, and Carolla's Beeswax.

Surely one of these will be effective!

With my plan in place, I am feeling confident as I start this next phase of treatment.   Additionally, my team at Huntsman continues to blow me away with their extraordinary care.  They truly go above and beyond in working with me so that I understand and feel confident in my treatment plan.

In other news, Friday was three weeks from my final chemo treatment.  Instead of going in for an infusion, like I have been doing every three weeks since July, I underwent an echocardiogram and bloodwork to see how my body is recovering from chemo and  I received the best possible news.  My echocardiogram revealed an ejection fraction of 69.  These results indicate that my heart sustained absolutely NO acute heart damage from chemo.  What a HUGE relief!  On Saturday, instead of feeling like dirt like I would if I had chemo the day before, I rode hero dirt in Park City for three hours.  It was amazing!

 ~7500 feet in October.  Sweet!

 Rippin' Glenwild on the 429

It was raining Aspen leaves today!  

Radiation

I have learned over the past few years of dealing with cancer that when something scares me, instead of  turning my mind off and not thinking about it, I do the opposite.   Some may call it hyperfocusing.  I like to call it an effective coping mechanism:)  So with radiation looming in the near future, it was time to finalize a plan.  My week went like this:  meet with radiation oncologist, have a little freak-out, bury myself in 'research', come to terms with my treatment plan.  Phew.  Exhausting!

Without boring you with details, it all comes down to this:  Benefit versus risk.  The benefit of treating cancer aggressively is that hopefully it will never, ever come back (although there are no guarantees).  The risk of more aggressive radiation treatment is radiation exposure to my lungs and possibly my heart, not to mention the 'other' things it does to your body.  Lung fibrosis and heart damage are not side-effects that an athlete, or anyone for that matter, wants to experience, however neither is another cancer recurrence.  But, it is what it is, and you can bet that I will be doing my damnedest to protect both of these highly valued organs.

First up, I have an appointment with my nutritionist next week.  We will be changing my nutrition/supplement plan to support me through radiation.

Additionally, even though I am pretty sure that there is not any research to support the use of an incentive spirometer and/or powerlung to prevent/reduce lung fibrosis during radiation, that isn't going to stop me from using both!

Incentive spirometer

Powerlung

Speaking of lack of research, I think more research needs to be done on supportive care while undergoing treatment for cancer.  But, that is a topic for another day.....

The icing on the cake this week is that I became the proud bearer of four new tattoos.  As cool as that sounds, these are not sexy nor even bad-ass tattoos, they are to permanently mark my body for radiation fields.  I suppose that is pretty bad-ass; I hope my new tats will make the radiation fields very precise and help avoid all my favorite organs.  

So, radiation starts October 14th.  It is a total of 25-30 treatments, 5-days/week, for a total of 5-6 weeks.  While side effects vary from person to person, by the end of treatment I can expect some pretty significant burns to my breast, underarm, shoulder, and back as well as cumulative fatigue.  Just the thought of going to the hospital 5days/week for 5-6 weeks is exhausting in and of itself.

That said, I hope to make the most of my non-treatment time.  And since the best thing you can do to combat side effects during treatment is exercise,  you can bet I will be out on the bike, hiking, running, and lifting weights as much as I can!

I should be done with treatment just in time for Thanksgiving.  My reward?  My first trip out of town since I started treatment for this recurrence back in July and also my first "vacation" to our condo in St. George.

I can't wait!

Race to my first haircut 2013!

As I wake up from my chemo coma, it is finally REALLY starting to kick in.  I am done with chemo!  Holy crap!  I am done with chemo!

Now, as I mentioned in my last post I still have a long journey of treatment ahead, but I also have a lot to be thankful for....like....I am done with chemo!!! 

Additionally, as trivial as it may sound, I am really looking forward to my hair growing back. Not only do I look a heck of a lot cuter with a head full of hair, but with the weather changing, it is just plain cold!  

Here is what I remember regarding hair growth from my first round of chemo in 2011:

My head hair started falling out about 2.5 weeks after my first chemo infusion.  The rest of the hair on my body eventually disappeared as well-although i managed to salvage some eyelashes and eyebrows.  This time around, my head hair once again started falling out about 2.5 weeks after my first chemo infusion.

Even though it appears as though I still have a good amount of hair, it was falling out in chunks.  

So we shaved.  Much less traumatic than waking up to a pillow full of hair and finding hair in my food!

The rest of the hair on my body has thinned but overall has been a bit more stubborn.  I still have quite a bit of arm hair and leg shaving is still required at least once weekly!  Annoying!

Back in 2011, if I recall correctly, my hair started to fill in a bit at about 6 weeks after my last chemo treatment.  At 8 weeks I had a super, duper short buzz and from there my buzz kept getting longer.  It took almost two years to have a solid ponytail.

I finally had my coveted ponytail when I was diagnosed with my recurrence and here I am, September 2013, back at square one.  

Regardless, even though waiting for hair to grow is more boring that watching paint dry, I'm pretty excited about it.  So each week I will document my minuscule hair growth here.  That is....until I too get bored with it:)  

Without further ado, here is where I'm at September 23, 2013:

Ironically, today, while waiting for acupuncture, the theme song to Top Gun came on.  I felt pretty bad-ass with my aviators.  But, I digress...

Let's see how fast that fuzz grows!  You can follow my hair journey here!  

Chemo, Round Two, ding, ding, ding. Done!

My week went like this:

Thursday riding beautiful Fall trails in Park City with one of my favorite gals:

Friday sitting in the infusion room:

Friday evening: the post-infusion crash.  AKA: kitty-cuddle time.  

Friday (infusion day) started off less than ideal.  Shannon had returned from Interbike, a cycling tradeshow, late Thursday night.  He was whipped.  I was to be at the hospital at 9:20 AM for labs and IV placement and I wanted, actually NEEDED, to ride my bike in to start the day off right.  Unfortunately, with all the bikes I have, none were functioning very well.  My dualie's front brakes were toast, Shannon had schleped some parts off my race bike so it didn't even have brakes, which left me with my townie, road bike, or cross bike.  I figured I'd take my cross bike as it would still allow a little bit of dirt therapy on the Shoreline.  Unfortunately, halfway to Huntsman, my rear derailleur cable broke and I was stuck in my hardest gear.  I single-speeded it on the road the rest of the way and arrived a tad bit grumpy.  Chemo and broken bikes on the same day don't mix well with me!  Oh well, all is good now.  My bikes are being worked on as I type and should be up and running beautifully by the time I am ready for a spin!

Infusion day was uneventful.  This is always a good thing.  The IV nurse easily hit a vein-phew I made it through chemo without requiring a port!-, labs were drawn, IV was placed, and I was on my way to meet with my medical oncologist.

Lab results came back sufficient for me to proceed with treatment:

Blood Counts	Target Ranges	Chemo#1	Chemo#2	Chemo#3	Chemo#4
WBC	4-8	4.18	3.43	3.17	3.23
Lymphocytes	>1 in treatment	2.5	1.6	1.3	1.0
Neutrophils	>1 in treatment	2.5	1.6	1.4	1.8
Monocytes	<.56	.3	.4	.4	.3
Eosinophils	<.24	0	0	0	0
RBC count	3.9-4.5	3.94	4.18	4.14	3.9
Mean Corpuscle Volume	<98 in treatment	94.6	92.2	93.6	92.8
Platelets	150-300	168	276	262	230
Protein Status
Hemoglobin	13-14	12.9	13.6	13	12.6
Albumin	4-5	4.0	4.3	4.4	4.5
Total Protein	>6.6 in treatment	6.6	7.1	7.2	7.1
Electrolyte Balance
Sodium	140-144	140	138	141	139
Potassium	4-4.5	3.5	3.4	3.6	3.6
Chloride	100-106	108	104	106	104
Kidney Health
BUN	13-18	15	9	11	10
Creatinine	.7-1.1	.63	.72	.65	.62
Calcium	9.2-10.1	8.8	9.1	9.5	9.5
Oxidation
RBC Distribution Width	<13	13	13.2	13.8	14.7

My interpretation:  My WBC count and Neutrophils went up.  Yeah!  Actually, my Neutrophils are the highest they have been since my first treatment.  This is great news.  My oncologist attributes this to the extra three days between infusion #3 and #4.  I'm sure this helped, but I am also convinced that my nutritional support was a factor as well.  As per my Nutritionist's recommendation, I increased my Astralagus intake, focused on increased Vitamin C through food (think Red peppers, kale, broccoli, strawberries), and made an organic, grass-fed, bone broth stock that I used for soups and just poured over rice and quinoa dishes.  Regardless, WBC counts are good, with the exception of lymphocytes which seem to be down a bit.  Not sure what to think about that one.... Additionally, my RBC, hematocrit, and hemoglobin are all down a bit as well.  Not surprising as I have reached the end of my chemo treatment, my body has been through a ton, and perhaps it is in need of a bit of a rest.  Regardless, I will be working to increase these values as well.  I am already using a Whey protein supplement and Chorella which both help support RBCs, but will be adding beets to my RBC boosting regimen!  Any yummy, simple, and of course healthy beet recipes are appreciated.  I also noted on my labs that my RBC Distribution Width has been slowly creeping up.  As far as I know, this is indicative of oxidative stress on my body.  Well duh, I just finished four hard-core (as everyone keeps reminding me and I try to ignore) chemo treatments.

So now I am done with chemo.  I AM DONE WITH CHEMO!!!!  Back in 2011, I considered my final day of chemo the day that I finished cancer treatment; it was a day to celebrate.  While completing chemo for a second time is definitely worth celebrating, I still have a long journey ahead.

October 1st I meet with radiation oncology to come up with a final radiation plan and to get measured in preparation for treatment.  October 11th, I will have an echocardiogram to see the (hopefully) lack of damage to my heart from chemo.  The same day I will have labs drawn for final clearance to start radiation.  I am roughly anticipating starting radiation on October 14th.

Over the past two years I have been diagnosed with cancer twice, had five surgeries, two rounds of chemo, am about to start radiation, and have no clear idea of when my cancer treatment will ever, if ever be done.

That said, I am still optimistic for the future and I found this gem of a research article that gives me additional hope.  It is well documented that breast cancer treatment causes weight gain, muscle loss, and osteoporosis, not exactly performance enhancing for a wannabe elite cyclist!  What a downer!  However researchers at Oregon Health and Science University found that women who underwent treatment for breast cancer and participated in a progressive weight training program maintained lumbar spine and total hip bone density!!!  The control group participated in a twice weekly flexibility program  and significant BMD (bone mass density) was lost in this group.  Additionally, women on Aromatase inhibitors (yep, that will most likely be me), gained more bone-free lean mass than women who were not.  Okay, just like I don't exactly fit the demographic of women with breast cancer, I don't exactly fit the demographic of women studied in this group (mean age 60, BMI-29, and body fat %~40%)  Regardless, it still gives me hope.  Hope is good!  The study can be found here:  Breast Cancer Res Treat. 2011 Jun; 127 (2): 447-56.

Weekly workouts and photos can be found here and here!