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Melanoma and Beyond

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It has been a year since my melanoma diagnosis. My next body check is not until March. I just put away my melanoma black bracelet. It has been seven years since treatment for a rare papillary serous uterine cancer caused by an aromatase inhibitor that treated my breast cancer. It has been eleven years since my stage three thyroid cancer and breast cancer diagnosis. Milestones. I have also had several basal cell cancers. All these cancers were onetime events.

I thought my number was up with the melanoma. But I have come to the conclusion that my body doesn’t screen out new cancers very well. But then, I have had no repeats. No metastasis. It is better at preventing recurrences. I am grateful for that.

The treatments were brutal for each cancer. I always felt cured when I was done. I realize that it only takes one cell to start the whole thing going again. I have learned to live with that. A new cancer can be just around the corner.

At the same time I was dealing with the cancers I have been managing a relentless rheumatoid arthritis (RA). The inflammation from it has caused a severe atherosclerosis. I continue on.

As people age their body’s defense system declines making them more susceptible to cancer. It is best to keep all the checkups for each.

My cancers seem to come five years apart except for the first two. That said. I have until 2028 before the next one is due. All we can do is wait and see.

Chemo 2018, uterine papillary serous carcinoma

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It is almost a month since I had a robotic radical hysterectomy, and it has been four days since I had my first chemo. I feel pretty good all things considered. Additionally, a minor surgical procedure placed a power injectable SMART PORT under my skin connected to a catheter that was threaded into my jugular vein and down to my superior vena cava creating fast access to my body’s circulation.  It is not as bad as it sounds. Sloan Kettering has a PDF that explains the procedure. My skin has been tender, but the lidocaine ointment works and relieves the discomfort.

My RA is complaining with all joints hurting morning and again evening time. Walking hurts my feet even though I have custom shoes and custom triple layer inserts.  I am glad I take methotrexate injections, Plaquenil and meloxicam. I take 6 mg Medrol and can boost the dose into a dose pack if needed. So far, I am holding steady.

With RA I think it is important to move. Aerobics are nice but not practical in my situation. So, my old routine of activity alternated with rest works well. I read the Washington Post over coffee and then make breakfast. Next is the activity of showering and dressing. Showering and dressing is an activity when in cancer treatment or in an active flare (some of us are in a variation of a flare all the time.) Next is a short rest period with rereading Mukherjee’s book, Gene, or writing a letter to a friend.

Next activity for me is to check the garden. Fill the feeders and the bird bath. Water the container plants. Next will be a rest period while I check email and google something I’m researching, or I just watch the local squirrel munch on the zucchini plants. He is an incorrigible, determined squirrel. It has taken me this long to realize he is the culprit eating the zucchini.

My cancer is uterine papillary serous carcinoma. It is a very aggressive subset of endometrial cancer affecting 5-10 % of those with endometrial cancer. It behaves similarly to ovarian cancer which also affects the serous cells. Tamoxifen can cause it. My immune system is compromised with RA. Close relatives who have colon cancer match genetically. My brother had colon cancer.  Serous cancer was isolated in 1982. Before then it was lumped in with endometrial cancer. It has a high death rate whereas endometrial cancer doesn’t.

Treatment is aggressive surgery, six cycles of Taxol/ Carboplatin, and brady cuff vaginal radiation. For me that should finish it off. However, you never know with this cancer.

My oncology nurse, Trisha, recommended that I premedicate with the Zofran. I have done so. Nausea is light, but I have no appetite. Protein shakes will probably be the answer.

It is almost two months since my diagnosis with this cancer, my number three. Initially, I was scared. At the time I understood that once again my world would be consumed by things cancer. It is. Tomorrow, I see my hair stylist, Audry, who has experience with cancer patients. She will chop off my hair very close to my head. Hair loss starts about ten days into this chemo. It is better to cut it than have it come out in clumps. My Cathy sent me an adorable cap of daisies on a pink background. Tomorrow I will start wearing it.

My summer and fall have been mapped out for me. I know what to expect. I know where I stand. I will be immersed in this cancer in my life. I am good. I am okay with it.

Metastatic cancer and a PET scan

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Yesterday I had a PET body scan (Positron  emission tomography) . The scan searched for metastasis of my melanoma. I was brought to a small room. Told to sit. The technician started an IV. She  left it untethered. Told me not to move. And left the room. She returned with a metal syringe that contained a radioactive substance called a tracer. The tracer collects in areas of the body that have higher levels of metabolic  or biochemical activity as do cancer cells. She injected the substance, withdrew the IV needle and gathered up the contaminated equipment. Another technician came in the room to take it away.

I was told I would stay on the reclining chair for an hour while the radiated tracer is absorbed by my body. She brought me a warm blanket to keep me  comfortable. When the time was up, I was told to empty my bladder, take off my glasses, bra  and shoes.

When you are being treated for cancer, being a plodder is helpful. Suspend the analytical mind. Just do as you are told. Keep going.

The machine looks like a big donut where a narrow bed slides in and out of the donut hole. This machine was not loud and was open so wasn’t scary. With a pillow under my knees, a warm blanket and a wrap to hold my arms in, the process took about fifteen minutes.

Now is time to wait and wonder what will be next. Will Dr. French call and say, “Good news!” or will he call and discuss the need to do another biopsy? I’ve been through this before.

It is not easy. If it is more cancer, I will do what has to be done. But I will be scared. Metastatic melanoma is not a good thing to have.

I am expecting the good news scenario. There is nothing unusual going on in my body. I will maintain my optimistic attitude.

Melanoma and bracelets

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There is a company called Choose Hope. It has color coded cancer. I have wristbands for each of my cancers. They were eventually put away after I put my  uterine cancer to bed five years ago. I have gotten them out with my newest cancer- melanoma. I have added a black wristband for the melanoma. I have also added a pink camouflage hat with the black melanoma ribbon.

It is a process for me. Adapting to another cancer diagnosis.  

My first thought was that this melanoma is going to kill me. Is my time up? After all this is cancer number five. Time passes. I dealt with the surgery. Tests. Wound care. Bought my hat and my wristbands. In a few weeks I will have a full body scan and my concern will be settled for the time being.

I will be grateful for a negative report but if it is positive, I will manage the next step. It is not about fighting cancer. It is about making choices and being grateful for any good thing that comes along.

Melanoma post-surgery

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The last two weeks have been very hard for me. It is true that three weeks ago I spent twelve hours undergoing a medical procedure that included five hours in nuclear med looking for a lymph node related to my melanoma. Finally, one was chosen. The right one? Who knows.

Then in the surgical suite I had a a two-step surgery that  included removing chosen lymph node and then flipping me over for a deep, wide, long incision to remove any trace of melanoma cancer cells.

After twelve hours we went home.

Dr. French called to let me know they did not find melanoma in the node they decided was the sentinel node. Relief. My melanoma odyssey is new and a bit overwhelming.

My wound continued to bleed. Not serosanguinous drainage but thick dark blood. My son was instructed to pack the wound with iodoform and then  dress it. A daily process. Finally, it is improving. The rest of the wound is healing well. The wound under my arm has done well. Internal stitches plus surgical glue.

Why do I feel like this story is not done? I know melanoma likes to return. Yet, once surgery is done, so is treatment. If there had been melanoma in the lymph node, there would be more treatment. Not now. The sentinel node on the left would have to do. The curious node on the right was up against the internal jugular and too dangerous to remove. I wonder of this was where the cancer went? Time will tell.

I suppose it becomes a waiting game. Waiting to see it show up in another location. The treatment reminds me of  Wack a Mole. Another sighting. Another treatment. By the time it shows up in the brain, there is little to do except palliative care as Jimmy Carter knows. I hope this is not my destiny.

Melanoma surgery day

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Yesterday was my melanoma surgery day. I arrived at seven and I spent the morning in nuclear medicine. The goal was to find the prime  lymph node that connected the cancer to the lymph glands. If there were cancer cells in this node, metastasis would be a possibility. Cancer cells can metastasize through the blood but the cells are not as strong as cells passing through the lymph glands.

The process took all morning probably because the node was found on the left underarm. The cancer was on the right upper back. My right underarm lymph nodes were affected by surgery for my right breast cancer. They figured it out and were finally done.

My son and I went to the third floor next. Surgery. Once settled in bed a variety of medical people lined up. An IV was started. A brief interview with the anesthesiologist. Introductions by the residents. The OR nurse. I enjoy meeting the future doctors. My doc stopped by and led the way to the OR suite.

A room full of equipment and people in masks. They put a mask on my face but the sedative going through it didn’t work. Probably a lower dose because I am older. Normal dose has always worked in the past. The anesthesiologist  injected me with something and I was gone. Once asleep they move me to the operating table. The anesthesiologist  inserts a breathing tube and starts anesthesia.

Next was the surgery . Four plus hours of it. I was placed on my back to remove the lymph node. Then turned face down for surgery on my back. The incision was four inches by two inches.

I woke up in the recovery room with a giant bandage on my back. They had given me 800 mg of Tylenol IV so I was comfortable as I could be. They rolled me to another room. Where I had juice and then dressed in my loose old clothes sans bra, minimal. Instructed. Packed in our car. We left the hospital at seven. Twelve hour day.

So good to be home. Francis. My bed. I slept well. So here we are, day after surgery. I added Tylenol to my normal dose of Tramadol. I’m sore, a little congested and happy to stay near my bed. I can’t sleep during the day although I long for nightfall.

In two weeks stitches come out and I hear the rest of the story. It is good to be a plodder when you have cancer. Don’t think too much. One foot in front of the other.

Deadliness of skin cancer

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Cancer has a new face. The deadly world of skin cancer.  My first looked like a Bindi worn by women from India. It was on my forehead between my eyebrows,  a basel cancer.  Easily removed.

 Next were two biopsies on my back. The one that pinched had to be sent to a national lab. That one turned out to be a melanoma.

That is where I learned that all skin cancers are not the same. My melanoma was deep. A bad sign. Melanoma moves through the local lymph tissue and it moves through the blood stream. Once it moves away from its initial site, it continues to move through the body setting up home in distant sites.  It becomes very difficult to remove.

It becomes a fatal cancer. It is scary. To this point I have felt lucky. Stage three thyroid cancer, breast cancer, and a rare uterine cancer caused by the aromatase inhibitor that I took for the breast cancer. After a list of treatments for each. I survived. I wonder if I will survive this time. Maybe my number is up.

Before surgery, I will have the sentinel node, lymph node nearest the cancer site, mapped and marked with needles. Sounds painful. I was told that I can apply a lidocaine cream before the procedure.  We will see how adept the tech is with  this procedure. Will this be another painful ordeal? And then surgery is next. The big unknown.

I suppose this is where a cancer plodder has an advantage.  One step at a time. Head down. Do as I am told. Survive and hopefully be done with this.

Return or New

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For several years I have avoided thinking about my experiences with cancer. I have had breast cancer, stage three thyroid cancer, and uterine serous cancer. Rare and caused by an aromatase inhibitor that was part of the treatment for breast cancer. I knew each cancer could return.  Maybe they all could return at the same time. Something I doubt. Each cancer treatment was invasive and thorough.  By the end of it I felt cured. This threat of recurring cancer seemed like a distant possibility. Nothing to worry about.  It seemed to be a distant thing. So, I was not worried.

So, something entirely different happened. My rheumatologist sent me to the VA  dermatology clinic. The big pimple on my forehead biopsied as basil cell cancer.  It was removed by Mohs surgery. All was well.

Then I had another visit. This  doctor checked my back and found two spots to biopsy. Even with a local anesthetic,  one of the  stabs with the knife  really hurt. On hindsight it probably was the deep one.

Next, I received a call from the doctor saying that she had sent the biopsy to the national lab. Time passed. She called to say I had melanoma, and it was very deep. It was 1.5 millimeter. Anything over 1 millimeter is not good.

Next was a surgical consult. The doctor asked questions. The concern was it might have metastasized. I left with a date for surgery and a new fear.

What if it had metastasized? That means it would probably be fatal. Maybe over a few years.  There was no cure. All the treatment is palliative care to shrink tumors and improve quality of life. So, I spent a week reading everything I could find on melanoma.

Malignant Melanoma, sometimes shortened to melanoma, is 2% of all skin cancers. Malignant Melanoma causes 70% of skin cancer deaths. Once it reached stage four, metastasis into the body, there is no cure.

I have worried more over this cancer. I feel that although I have had four other cancers, they were not fatal. I did not fear dying.  My fear is that it is my turn. My turn to be treated for cancer only to find it return and return until there was nothing left. And by the end of it all, there is  only the desire  to rest and have peace.

I worried. And I worried some more. Then I realized I have no symptoms that hint at metastasis. I felt as though I was good. No worries. The stage of the cancer is not determined until the surgical results are evaluated.

My worry and my research brought me to the conclusion that I had done everything that I could. So now is not the time to worry. I will move into my favorite cancer patient role as  a plodder. I work on one step at a time. I do what I am told to do. I have confidence in my doctors to do their best for me. And I will see what happens. I will let you know.

RA and release from cancer memories

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published on 2022-01-08 on Marys arthritis

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It has been three years since my last cancer. Through the surgeries, the chemo and the invasive radiation, I plodded along one foot in front of another.  And in all those moments,  I  was slowly being ground down into nothing. And at the same time I felt nothing. I kept my head down and did what was expected of me. I was exhausted. Bald. Drained. Gutted (literally). Nothing left. The daily reminder was a port in my chest waiting for the next infusion of chemicals.

Some would say I was lucky. I didn’t feel lucky. I felt that what I was no longer existed. I was so glad when that year was done. I wouldn’t have to hold on so tightly. I wouldn’t lose any more of me.

Lately I have been thinking about that time. I am no longer numb. I can feel those lost feelings now. My memories make me feel sad.  I mourn for the me that was and the time lost forever. Like waking up and realizing the dream was reality. I felt the pain of realizing I had cancer. I felt the pain and loneliness of treatment. I was no longer required to suppress my feelings. It was painful but it was also a relief.

My body  also has rheumatoid arthritis. And in spite of my cancers and the complications of one thing or another, it is  the one thing that is a constant in my life. Rheumatoid arthritis might not  kill me but it certainly makes me live with a pain wracked body. Every joint in my body is affected.

So, I suppose it is the RA that dampened my response to the cancers I have had. Having cancer treatment and RA flares at the same time is rough. Suppressing the whole experience was one way of living through it. My cancers are gone for now and I can finally feel relieved.   I expect that I have another year or two before another cancer shows up. It may be a repeat, but more likely, it will be a new one. However, in another year or two I will have regained my strength and my mojo. It has taken longer this time.  I will be able to handle whatever comes. After all this time I am finally recharging

Saying goodby is hard to do

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I found this little story on my web page marys arthritis. It brought back memories. I thought I would share.

I said goodby to Susan today.  She has had a very interesting time of it.  Her life was full.  No one can ask for more.  I knew her for a brief period.  I was glad of it.  It was an important period in her life as well as in mine.

I met her at a cancer support group.  She was angry as she had recently learned of a serious metastasis.  I had had a whirlwind bout  with a diagnosis of RA and sequentially two cancers.  I was trying to process as well as she.

I saw her as the chemo failed and as she was denied her favorites of swimming and yoga.  I saw her as the last chemo drug failed.  She lost her anger and frustration.  She seemed to mellow.  Then she moved on.  She became engaged in planning her exit.

The last day in our breast cancer group, we made bracelets.  She gave me hers.  She used red beads as I was wearing red that day.  We had our final hug.

She has been on my mind since.  Today was her memorial service.  It was amazingly wonderful.  I loved her and will miss her.  Today as I said goodby, I still had her with me.  She has her own special place in my heart.