Chemo Day 1-2=NO GOOD!

Apparently, I fall into a category that is high risk for post-Chemo nausea. The strong correlation between pregnancy nausea and post-Chemo as well as my age make me more susceptible for experiencing severe nausea.  I kept hearing things like "You'll do great with it." and "The worst days are day 2-5". So when we finished up at 5:30 pm with my treatment and I started feeling pretty strong nausea by 9 pm, I was a bit surprised.  The nausea worsened to the point that there was no question we must go to the ER. I was hooked up to an IV and given anti-nausea medications which allowed about 50% improvement at most, but at least I was able to sleep. We were discharged from the ER at 4:30 am and it wasn't until about 12 noon yesterday that I started to feel like a human again. Blake went to work on about 1 hour of sleep and my parents and aunt took wonderful care of the kids at their house. My mom then took me to see Dr. Garg's Nurse Practitioner, Julie who prescribed an additional anti-nausea medication for me. I already had a few drugs to take but I think I was just beyond the point of return on Wednesday evening. They have a plan for my next round of Chemo but I must admit that I am scared to death considering what I just experienced. The goal is to keep me out of the ER for the future especially as I will be immunosuppressed.  Please pray for that as well as my continued improvement from this bout of nausea. I am slowly gaining strength but continue to be mostly in my bed. 

Above and Beyond

 "Whatever you do, work at it with all your heart, as working for the Lord, not for men" 

Colossians 3:23

There is a tendency in all of us to just go through the motions of whatever job it is that we have been called to do.  However, I (as a Breast Cancer patient) have the unique opportunity to experience the amazing good that people are willing to do.  I am not just referring to my friends and family who have poured out so much love to me, but I am also talking about those that are working in positions that required their paths to cross mine over the last few months.  I think back to the compassion that I felt from the two sonogram techs, Jennifer and Amy as they told me that I likely had Breast Cancer at the very beginning of my journey.  I remember the commitment of my Nurse Navigator, Amy V. as she has made herself available to me at all hours of the day in an effort to let me know she is walking alongside of me from the beginning of this journey to its end.  I realize how completely blessed I am that I have Dr. Garg as my Oncologist because of his amazing blend of intelligence and compassion for his patients. Then I think about the wonderful staff at Asbury Community Christian Preschool who are not only taking extra care in helping our son, Koa as his mommy is going through some changes but also took the time to make me a quilt to comfort me during my chemo treatments. I recall our electrician, Troy who came out to help us with what we thought was an electrical problem but has committed to helping us get our Air Conditioning working again. And lastly, as I sit in my special warming chair receiving my first chemo treatment, I am so grateful for a staff of caring nurses at the Infusion Center that work to make me as comfortable as possible. I chose physical therapy because I wanted to spend time with people that had a need and to make a difference in their lives.  Because of this journey I have been on the receiving end of that and can’t express the effect that it has had on me. I pray that this is a lasting impression that I will carry with me as I return to work. I pray also that those reading this would be reminded of the importance of the position they hold (and grateful to have one). Whether you are a mom of young kids, a healthcare professional, or salesperson, you have the opportunity to minister to people no matter what line of work you are in.  

 As I mentioned, I am writing this as I receive my first Chemotherapy treatment. I realized that I failed to update CaringBridge about our decision. We decided to go with the most aggressive treatment possible, which is the TAC regimen. I will have six treatments every three weeks, which will go through mid-January.  My treatments are about 4 hours long and include various anti-nausea medications followed by the three Chemo drugs Taxotere, Adriamycin (“Red Devil”) and Cytoxan all given through an IV. For now I am grateful for a few hours to just sit and relax with Blake in the midst of a busy week of appointments.  As we continue along the journey, we will just pray for minimal side effects and that my body stands up well to it. 

Sucker Punch

One of my sweet friends described it best. Yesterday felt like a "sucker punch"-one of those blows that catches you completely by surprise and knocks the wind out of you. My OncoType Dx Score came back very high, actually higher than my Oncologist expected. The positive of that is that there is no question that Chemotherapy is needed and will in fact reduce the recurrence rate of my cancer by about 20%. The bite comes in the fact that the Oncologist is now torn between giving me the chemo regimen (TC) we discussed during our previous visit and the one that does include Adriamycin ("The Red Devil"). So now the decision becomes ours to make. We plan to ask some more questions and make a final decision by tomorrow. Please pray for this decision. Whichever Chemo regimen it will be does begin on Wednesday 9/28.  

I struggle even writing this entry because I like to always be as positive as possible. I have had a rough 24 hours as the reality of Chemo has been setting in. I don't think I entirely know why God has allowed this sucker punch but I think He wants to know "Kara, do you really mean what you are writing in this journal? Does your hunger to know Me and be transformed by Me exceed your dread of suffering?" So I go back to a conversation that Blake and I had with some mentors/friends of ours in which I was asked "Would you trade this experience to have everything the way it was before your diagnosis?"  My answer at the time was beyond a shadow of any doubt "NO." It was "No" because of how I have experienced God in a completely new way.  It was "No" because my relationship with Blake is different.  It was "No" because I see life with a whole new perspective. The fact that the Cup wasn't taken from me and that the Cup might be worse than I anticipated means He is not finished with me. The transformation is not complete, and that is what I will cling to.  

May This Cup Be Taken From Me

I had a bit of trouble sleeping last night.  Some of this I attribute to some increased pain and difficulty finding a comfortable position.  Most of it I attribute to being anxious. This morning we will meet with Dr. Garg and hear the results of the OncoType Dx test. As I mentioned before the results help us to determine if Chemotherapy is a necessary treatment for my breast cancer. 

As I was lying in bed I couldn't help but think of Jesus in the Garden of Gethsemane just before He was to go to the cross. Matthew 26:39 says, "Going a little farther, He fell with his face to the ground and prayed, 'My Father, if it is possible, may this cup be taken from me.'  I have prayed this prayer this morning. I don't want to be nauseous (I had enough of that being pregnant). I don't want to lose my hair. I don't want to have tingling in my arms and legs. I don't want to be too fatigued to take care of my kids. I don't want to have to rely on other people for another 3-4 mos. I want to get back to running and getting stronger. Father, if at all possible, please take this cup of Chemotherapy from me.

The most important part of the verse, however, comes next.  'Yet not as I will, but as You will.'  I have also prayed this for this morning.  I know that only He knows what it best for my body. Only He knows what I still need to learn in this process. Only He knows if there are other people I still need to meet. Only He knows!  That is enough for me because I know how the story ended after the Garden of Gethsemane. Jesus went to the cross for me so that I can have the hope that I have and death no longer has its sting.

Our Bright Beauty

Today we celebrated the 2nd birthday of our baby girl, Kalea Mei. Her name means "Bright Beauty", and to us, she truly is. She brightens my days with her infectious smile and loveable nature. Some of my favorite moments (just before surgery when I didn't have my lifting restrictions) were those quiet moments just before bed when I would hold her in the rocking chair and sing songs to her. She would rest her head on my chest and it was one of the greatest feelings in the world.

However, if you have spent any time with her lately, you may have experienced that she is in fact a two year old.  She is trying to figure out the world around her and how she fits in. She wants what she wants and she wants it NOW. She definitely does not want to be told what to do. She believes she should have and be able to do exactly what her big brother has and does. She is quick and stealthy when it comes to getting into things she shouldn't. (Blake refers to her as a "ninja") Her tantrums usually involve objects being thrown across the room.  

As I was spending time watching her this morning and praying for her, I had a neat revelation. Aren't we all just a bunch of 2 year olds?  We all want what we want and we want it NOW.  We don't want anyone telling us what to do. We are so busy looking around at what other people have and do and feel like we need to have/do the same. We think we can be slick and not be noticed when we want to get into some trouble. And lastly, there are days that we get so angry that we feel like throwing things across the room. This journey I am on reminds me that I must continually surrender my will to God. Without Him, I am just a "terrible two" year old.  

Then I was reminded of one of the great promises in Zephaniah 3:17 "The Lord your God is with you, he is mighty to save.  He will take great delight in you, he will quiet you with his love, he will rejoice over you with singing." Although, our sweet Kalea can be a fiery pistol at times, we (as her parents) take such delight in her and rejoice over her daily. God is the same way about me!  I love all that I am learning as I walk along this journey!  

I also wanted to just include a quick update on medical stuff. Yesterday was my first appointment with the physical therapist who specializes in Lymphedema management. Her name is Donna, and if I can be so bold to say this, P.T.'s are just the coolest people. She opened up a whole new world of P.T. for me and Blake as she shared all of her knowledge about lymphatic drainage and treatment for post-mastectomy patients (ME!).  It was really strange but cool at the same time to be the one on the treatment table; and I have no doubt that this whole experience will serve to make me a better physical therapist. I really look forward to seeing her again next Wednesday.  

We will also meet with Dr. Garg next Wednesday to go over the results of the OncoType Dx test and make decisions about my Chemo regimen. Many of you have said you will specifically be praying that I do not need Chemo. Although I appreciate those specific prayers and encourage you to continue praying them, as I stated above I realize I need to surrender to God's will even if that means I will need the Chemo. There may be more for me to learn and more friends to make that aren't possible without going through Chemotherapy.  

Thank You Doesn't Seem Adequate

Well, I guess Satan must have read my last journal entry and figured he should press a little harder. Yesterday was Blake's first day back to work, the day I have been dreading for two and a half weeks.  He has taken care of the kids and me so well since my surgery that I feared that I would really be helpless without him. But then my girlfriends and my mom stepped up! They are creating a schedule among them to cover all the hours while Blake is gone from the house for each week. On top of that, we continue to have delicious meals being brought to us 3-4 times a week. If that weren't enough, I have neighbors and friends continuing to walk over, text, email, sign my guestbook and call me to check up on me. I have had my house professionally cleaned as a gift. We have had offers from people to keep my house clean by running a vacuum or scrubbing my tubs, do my nails, knit a hat for me and share books about dealing with Cancer and growing closer to the Lord. I have a team of people forming to walk/run the Race for the Cure in support of me. Oh I can't forget to mention, one of my dear friends that is planning my daughter's 2nd birthday party. I even had a friend help give me a bath the other day. See, when I focus on this stuff, there is no room in my mind for the thoughts that Satan wants to put there. The trivial stuff like ants in my house, an electrical problem, medical bills, and my frustration over watching everyone having to do everything for my kids and me fades into the background.  All I need to know is that I am loved-loved by my Creator and loved by all of you! 

We are so very grateful for all the ways that we have been cared for!  I am a little behind on my thank you notes (and probably will be for a while), but please know we are SO grateful. You are the hands, feet, ears, eyes, etc of Jesus to us (1 Corinthians 12:12-27). I am so blessed by the opportunity to visit with people that I may not be visiting with if I were not on this journey as well.  You are all keeping me going and helping me "resist the Devil" as I go.  

Resist the Devil

There is a chemotherapy drug that is often used in the treatment of Breast Cancer called Adriamycin.  It is better known as "The Red Devil" because of its red color. Perhaps it has also been given it's ominous nickname because of the fact that in addition to the many general side effects of chemotherapy, Adriamycin also has the potential to cause damage to the heart. I have been reading a little bit about the effects of this type of chemo and was fearing that this drug would be part of my chemo cocktail. Yesterday (Thursday) was our first appointment with the Oncologist, Dr. Garg.  I was anxious about this appointment because I kept feeling like he would be delivering my "Chemo Sentence".  Once again, God "WOW"ed me with his faithfulness through this appointment. 

The three of us (Blake, my mom and I) were all very impressed by Dr. Garg's knowledge and dedication to Oncology (evidenced by his sharing that his mom was diagnosed with Ovarian cancer). I feel so blessed that he is the one chosen to be my Oncologist as I will be under his care for at least the next five years. He began our meeting by explaining in great depth the meaning of my post-op pathology report. He explained that there are many positive aspects to the pathology report: 1. My surgeon was able to get the two tumors out (they originally thought three) and the sizes of them were 1.8 cm and 1.4 cm which are not particularly large.  2. There are good margins around the cancer (in other words, they do not feel there is a threat of cancer near my chest wall) 3. My cancer is Estrogen and Progesterone Receptor Positive and Herc 2 Neu Negative (in other words, I am opposite of Triple Negative). 4. There is no cancer in the lymph nodes. 5. I have Stage 1A Breast Cancer (almost the lowest possible stage). However, there are two aspects of the pathology report (the Nottingham score and Ki-67) that concern him and they involve how aggressive the cancer may be.

After explaining the pathology, he states that because the cancer is Estrogen and Progestrogen Receptor Positive, I will take a drug (in pill form) called Tamoxifen for five years and this is a good thing. It will have it's own side effects which aren't fun, but it is very effective in reducing the recurrence rate of the cancer.  He says that because of the specific pathology results I have mentioned, it would be best to order one more test on my tumor cells called an OncoType Dx test that will provide more information about whether he would offer me Chemotherapy. In case you missed that, he said there was a question about whether I would need Chemo!  Needless to say, this came as a huge shock to me.  At the same time, he gave us the impression that his feeling (from his experience) is that the results of the test will show that I would benefit from Chemotherapy. We have been prepared from the very beginning that Chemo would be a part of this journey so if the results of this test show otherwise, we will Praise the Lord with all that we are. But the truth is, I am already praising Him with all that I am because Dr. Garg said there is no need for me to have "The Red Devil"! If I do need Chemo, it will involve one treatment every 3 weeks for a total of 4 treatments (3 month duration) and my cocktail will include drugs that will likely have the common side effects of chemotherapy but will likely be more mild.  

With all these thoughts of "The Red Devil", I can't help but think of the Devil that scripture speaks of, the Devil that Pastor Greg spoke of last week during his sermon. 1 Peter 5:8-9 tell us that the Devil is alive and well in this world, and he is out to tempt and deceive us. There are many days that he has attempted to deceive me about this journey I am on and steal my joy. But as Greg mentioned I am trying to resist the Devil with scripture and prayer as part of my every day.  And when I have days like yesterday and today, it makes it even easier to resist him.  

Today we met with the Plastic Surgeon during which he injected more saline into my expanders and removed the two remaining drains.  I had expected the expansion which again is pretty uncomfortable; however I was not expecting that my drains would come out because of how much fluid still seemed to be draining into them.  Dr. Chappell, who is also head of the Wound Center at AAMC, was confident that the risk of infection was too great to keep those drains in place.  Although, I am a little worried about where that fluid goes now, I was not going to complain about getting rid of the drains.  They are no fun!  And thankfully the removal of the drains was not nearly as painful as it was last week. He also checked my incisions and feel that everything looks "really good". I will continue to come near to God because He most certainly feels near to me!

James 4:7-8a "Submit yourselves, then, to God.  Resist the devil, and he will flee from you.  Come near to God and He will come near to you." 

Friends and Traditions

There are two things I love in life and therefore, pour a lot of my energy into: traditions and friends.  I believe traditions allow for beautiful memories to be made for us and for our kids. And most of my closest friends I have, I have had for at least 15 years. However, there is one friend that I have had since the very first day of kindergarten at Annapolis Area Christian School making this our 29th anniversary of being friends.  Her name is Stephanie and she currently lives in Augusta, Georgia with her sweet husband, Billy and two beautiful daughters, Caroline (4.5 y.o.) and Katherine (2.5 y.o.).  Our years of being best friends that lived in the same state were cut way too short when her family moved to the Atlanta area the summer after our sixth grade year. When you hear that quote "You look like you just lost your best friend", that was literally me the day she moved.  However, God has faithfully sustained our friendship to this day, and every summer our families have the tradition of meeting in Carolina Beach, NC for a week's vacation. Our vacation with them was planned for this week and we should actually be there with them right now.  

Within our tradition of spending a week together in NC every summer, we have other traditions that have become part of our time together. The husbands always spend the first night of our trip doing the grocery shopping which proves to be very drawn out and comical. (We have two of the most tight-fisted husbands when it comes to money!) We also take the kids and ourselves out for ice cream at least one night to our beloved Squiggly's. We visit an authentic Carolina BBQ spot called Jackson's for their hush puppies, pork plate and sweet tea.  And of course, I would be remiss in failing to mention our newest tradition of getting breakfast from the famous Britt's donuts. (If I close my eyes, I can almost taste them melting in my mouth!) I remember one of the most disappointing realizations that came with my diagnosis was that we would not be able to go on our long-awaited vacation with our dear friends and these traditions would be left unfulfilled for this year. Just as it true with every aspect of this experience, this time we spend with our friends and the traditions we have come to love mean all the more.  And we anxiously await next year's trip when I am hopefully well enough to travel and enjoy all these things again.  

True Beauty

I realized that I have not written much about the Reconstruction part of my surgery so I thought I would fill you in on a few of those details, as well as update you on our most recent follow up with the Plastic Surgeon, Dr. Chappell. The good news about this visit with Dr. Chappell was that I was able to get two of the drains removed and the reconstruction/incisions look just as they should at this point (not pretty to the inexperienced eye but evidently just as they should). The not so good news about this visit was that I experienced a significant amount of physical pain. I was caught extremely off guard by the intense pain that came with him pulling the drain from the right side of my body. Following this, he injected saline into the expanders that lie behind my Pectoralis Major muscles. As one might imagine, this leaves me feeling a fullness/tightness across my chest with occasional spasming of the muscles as they react. I don't tell you this to complain but share with you the exciting advances in medicine and specifically what they can do when you must have your womanly parts removed.  

I will follow up with Dr. Chappell on a weekly basis from here.  The hope (and fear) is that I will have the two other drains removed next week when we see him.  During my weekly visits with him, he will continue to inject my expanders with saline until they get to the desired size. Following Chemotherapy, I will undergo an additional surgery in which he replaces the expanders with implants which will also be held in place by the Pec muscles.  As healthcare professionals, this stuff intrigues us but we realize it might not be as interesting to others.

I believe that the fact that we are healthcare providers has served a valuable purpose in all of this, but I also need to be honest in saying that I continue to struggle with the reality that this is my body. Looking at myself in a mirror continues to be a process as I am flooded with emotions/fears of how I will look at the end of all of this. My hair will grow back but will my body be still attractive? Then God meets me at that emotion/fear with a sweet reminder in Proverbs 31:30 "beauty is fleeting; but a woman who fears the Lord is to be praised." and in 1 Peter 3:4 that the "unfading beauty of a quiet and gentle spirit is of great worth in the Lord's sight".  Then He also gives me great comfort in the unwavering love of my sweet husband who continues to take such great care of me.