Sisters

Sisters...

I've been thinking about Olivia this week. Perhaps that is because of Piper's birthday, but for whatever reason, she's been on my mind. Olivia did not think much of Piper and Piper adored Olivia. She wanted Livie to play with her, and regularly Piper tried to snuggle with her. We did make some progress before Livie died. This photo sums up their relationship to me. This was taken in April, 2007 and is one of my favorites. There are so many captions for it in my head...but what I would like to think it is a photo of is Olivia showing Piper around the big world. In actuality it was probably Livie trying to get away from her, the little pest.

The Growth Velocity of a Great Dane Puppy

Today is Piper's birthday...she's is a year old. Days like this make you stop and think about change. For Piper, there has been some BIG changes. Great Danes grow an incredible amount in their first year of life. A typical Great Dane puppy is born at a weight of 1-2 lbs. Piper and her nine siblings were all of 'average' size as Danes go. When we picked her up to bring her home she was about 15 pounds and about 12 inches at the shoulder. Today she is about 95 pounds and 30 inches at the shoulder. I am guestimating her weight since neither of us can pick her up to weigh her so we have to wait until our next vet visit for an 'official' weight. These puppies must achieve the equivalent growth in one year that a human adolescent experiences in 18 years. Amazing. No wonder she naps so often...

In honor of Piper's birthday here are a couple of photos:

This photo was taken on April 2, the evening after my first chemo.

This photo was taken in November.

Many people thought we were nuts to bring a new puppy home the day before beginning chemotherapy. We've always been a bit impulsive and this was no exception. Piper was my constant companion during these couple of months. We regularly napped on the couch and she seemed to know when it was okay to play and when it was time to be still. She has been a bit of work, and yes, she has cost us a tremendous amount of money this year but I am so thankful to have her.

Happy Birthday Piper!

2008

When I was little, I remember thinking about how old I would be at the turn of the century. I couldn't imagine being that old...ever. And now here we are, beginning the 8th year of that century and yes, I am that old. As 2007 ended, I spent the last few days thinking about the year that had been. Inevitable I would imagine. That is what formal endings encourage us to do. To take inventories and make plans.





So here I am...on New Year's Day with a cup of coffee (Norwegian coffee...yum) in front of the fireplace~pondering the year that was and thinking about what is to be. My intitial response is to be happy that 2007 is over and in many ways I am. It wasn't the best year for me or for us. Being diagnosed with cancer will taint one's perceptions a bit. While the surgery and the chemotherapy wasn't a great deal of fun for any of us, there were some true gifts in my diagnosis.

I survived. I know that sounds contrite but you have to understand, I've had a pretty easy life. I have not been faced with significant personal challenges. I haven't had many hurdles to overcome and pretty much what I have wanted in my life I have gotten. I have achieved many things personally and professionally. I have been more than comfortable, I have been blessed. So here in the divine plan, I was tossed a challenge which was more than I had ever been given before and I survived. A friend commented on my courage. I don't think of myself as particularly courageous. I do think of myself as someone who just deals with what is there. And that is what I did with my cancer. I just dealt with what was handed to me. And I didn't do it alone. I could not have done it alone. I found tremendous support and encouragement in my partner, my sister and niece and in my family of friends. Each time I see the oncologist, I get great news. My CA27-29 continues to go down. A CA27-29 is a tumor marker that is found in the blood of patients with breast cancer. It is used in conjunction with other screening to check for recurrence. It can also be elevated by cancers of the colon, stomach, kidney, lung, ovary, pancreas, uterus, and liver. Like your golf score, a low number is better. I will continue to see the oncologist every 3 months this year. I don't want to ever have to deal with cancer again in my life but I know that if (and when) I am challenged with it again, I will survive.

Professionally I have had a very good year. I am teaching more online and going into school less. That is a wonderful thing. There is nothing like going work in your jammies. I am waiting to hear about a formal promotion at St. Kate's to Associate Professor and am becoming involved in more of the technology work going on at the college. I managed to finally pass my acute care certification exam as well. Perhaps this coming year will find me in the ED less and at home more. My work colleagues (all of them) have been a wonderful support for me as well. A beautiful tree grows on our property that serves as a daily reminder of the incredible group of women I work with.


My family has provided me with a solid base to continue to grow. I am looking forward to celebrating our 12th anniversary this summer. Can you believe Mary and I have been together for that long? Who knew what could become of an online ad... Our family has grown this year with the addition of Mark, Erin, Matt and Ashley. My sister Pat and Mark are so happy together! His kids are great and we are looking forward to spending lots more time together! My mother and Bob are doing great too. Bob got a new knee in November and is already more active than he was before the surgery. With the addition of Bob to the family came his son, Rob. He joined us for Christmas this year. I am not sure that he really could appreciate our loud family but here was there with all of us.

All of the kids are getting old. We have or will be celebrating several important birthdays this year. Sam turned 16 in December and is looking forward to getting his license. Alvin turns 21 on January 4 and is looking forward to...well you know! Tal Christian turns 18 in March. We are looking forward to another summer with him. We weren't sure that he would want to come to the US this year but he does. Silje with be 28 this year and Halle will be 11 soon. No more little ones in the family. The parents of all of them got a bit older too, but we won't discuss that!

I have also had the opportunity to reconnect with some friends that I had lost relationships with. That has been bittersweet in many ways. While you do get the gift of that relationship back, it can be difficult to understand and embrace the behavior that caused the rift. But true friends can forgive each other. And true friends can re-establish new relationships that are wonderful and supportive and loving. There are a couple of people on my list for renewal this year as well.

So what will 2008 bring? Good question.

I suppose one answer is MORE! But not too much...

There is more surgery in my future as I look forward to a hysterectomy on March 5. I have been having some rather significant side effects of my tamoxifen and a hysterectomy will take care of that. I am hoping for more good lab results and a continued decrease in my tumor marker.

I am expecting to become more involved with technology work at St. Kate's and am hoping to continue to work more online and less in person. I like working from home. So does Piper and Kaja.

I am planning on more time with friends and family alike. In the winter we both work more in preparation and anticipation of the summer. This summer Mary planned her vacation time to allow her to be off for nice stretches of time. I will actually have some vacation time to use myself. You will most likely find us aboard Ron...or whatever we finally name our old boat. I know we will be spending every free moment this spring working on the boat. Mary has been reading everything she can on restoring older boats. We are planning to paint the whole thing before it gets put in the water for the summer and I would like to spend Memorial Day weekend cruising the river with friends. I am also planning on more hockey, skiing, knitting and just time with those I love.

Then there are the usual New Year's resolutions: lose the 10 pounds I've gained since chemo, save more money, be a better person and orchestrate world peace. Sure. I'll be working on those too.

When I consider everything that has happened in the past year, it is difficult to sum it all up. Sure there were challenges but there were gifts and these were more abundant than the challenges. 2008 will be the same: some challenges and many gifts. Without a crystal ball I can't know what lies ahead. But I know that whatever comes my (our) way, I (we'll) manage it. And I will be here, on New Year's Day 2009 hopefully 10 pounds lighter and content with a life well-lived.

Happy New Year to my dear friends and family.

May 2008 find you ready for the challenges as well as the gifts that await you.

Just when you think you have control...

Just when you think you have developed some control over the events of your life, something happens to remind you how wrong you are.

My hair was growing. All summer if grew, fractions of inches per week. It was coming in, all over my head and thick. Before I went to Phoenix, I got a haircut. Mostly to trim things up, keep things even, etc. A couple of weeks ago, on a Wednesday I noticed a couple of flipped up ends. No big deal...hair is like that. When I got out of the shower the next morning, I had curls. Not a few. They were all over my head.

This is cancer's way of reminding me who is in charge.

If you haven't seen me with curles, here's a visual for you.

Brillo pad.

Poodle.

My mom's perm in the 80s.

As an adult, I have never had curly hair. My mom alledges I had curly hair as an infant but that remains to be proven. But today...I have curly hair. Gray and curly. Like a brillo pad. Or a poodle.

Mary looks at me and reassures me that the curls are going away...that the back is not as curly as it was...that I look beautiful.

The nurses I work with tell me my hair is great...or fantastic...or like some model from J.Jill. I just flipped through their catalog and saw no one who looked like me. Gray, curly hair is something our grandmothers have. Models and our friends do not.

With the approach of Halloween I guess I can approach this in two ways. It can be an opportunity to be something that I am not (a character, a costume) or something that I am. I guess it depends on whether you are a glass half full or half empty kind-of-person.

Each morning I check. Is it still curly? Then I remember that I am thankful to have hair. To be on this side of my cancer. To be able to worry about hair.

Then I rejoice.

A Grand Slideshow

The Dark Place

A couple of weeks ago I ran into a colleague at Children's who was diagnosed with breast cancer two years ago. We started talking. We were never close, just colleagues. Immediately we started comparing note: diagnosis, stage, treatment plans, surgeons and oncologists. It is amazing to me that when you meet another survivor, the talk quickly becomes the intimate details of your personal course with the disease. Kind of like women needing to share birth stories I guess. Or perhaps it is because an unspoken understanding exists. Whatever it is, we were standing in the professional staff lounge talking. She had just had her annual check and things were going well. She then asked me if I ever went to the Dark Place...that part of your mind that thinks about the other side of the statistics. You know, the 1% of women with my kind of cancer and treatment who still die from the disease...the Dark Place.

I had to admit to her that I traveled there from time to time but really tried to avoid thinking about that. Call it denial if you'd like but I am not planning to be that 1%. But what if I am. What if that sore spot on my chest is a metastasis? I had my 6-month visit with my oncologist last week. Here was pleased with how well I am doing. All labs and cancer markers (CA27-29) returned to normal and in the case of the cancer marker, dropping like it should. We discussed routine examinations, CT scans and the need for chest x-rays. He told me he isn't too sold on doing alot of routine diagnostics. When I asked him more about this, he (essentially) told me that early diagnosis of breast cancer complications doesn't really change much except that you start your treatment 'weller', before the cancer makes you too sick. I didn't find this very encouraging or comforting at all. What I heard him say is that if I experience a recurrence, there isn't much to be done about it. He also told me that most recurrences are diagnosed within the first two years after treatment.

I left the appointment with Zander feeling relieved that things are well for right now. By the time I got home, I was in the Dark Place pondering the question of how I should live my life knowing that I have a greater chance of dying young. I don't know that I have answered that question yet. I know that I need to keep myself living in the moment, doing my best work and giving my best self whenever possible. But there is so much more that I want to see and do in my life.

For a start, I went on a mini-adventure yesterday. I am in Phoenix right now, to attend the National League for Nursing's Education Summit. It begins on Wednesday but I have been here since Saturday. Yesterday I drove up into the mountains through Sedona and Flagstaff and on to the Grand Canyon. It was a long, and sometimes boring drive that I am so glad I decided to do! Standing at the edge of that canyon helped put me into perspective with the rest of the world. I am such a little part of all that is around us and came before. The natural beauty around us is incredible.

I felt so fortunate to stand there and take this all in. Taking time to just be and observe is not something that I do well or often. I am tooooooo busy for that. I am so glad that I took that time yesterday.

So how does the Grand Canyon tie into the Dark Place? On the drive down the mountain last evening listening to some good music and sipping some good coffee, I reflected on the day. It was an excellent adventure. I began to think about how fortunate I am.

Today I am healthy and have the means to enjoy some travel and new experiences. To do that and enjoy all that I have, I must stay in the light. Going into the Dark Place limits my vision. It interferes with my ability to see what is all around me. It limits my life experience.

I am sure that I will venture into the Dark Place again from time to time. I am hopeful that my visits are short and needless. I hope that I will have the ability to travel back into the light and all there is for me.

A ps on my excellent adventure. It was missing one essential element: Mary. To have her experience this place with me would have made things more interesting and exciting. I miss her.

Reflections on 3 Days

It's been quite a number of day since my initial breast cancer diagnosis. Some of those days were very difficult and painful. Others were easy physically but emotionally trying. The days that I spent working with the Breast Cancer 3-day were quite enlightening. An important transition occurred for me this past weekend. I am still not sure that I can quite articulate it but I am closer.

I made a transition from patient to survivor this weekend. Up until last week, I viewed myself as a woman with breast cancer. Being among thousands of women this past weekend helped me to rethink how I view myself...One of the questions asked over and over was "Why did you become involved?" When asked this, I started out by saying "I have it." But then I began to think more critically about this response. I was diagnosed, had bilateral mastectomies followed by chemo. I have been cleared by my surgeon and my oncologist. I don't HAVE it anymore, I HAD it. I am no longer a patient, or as some would like to think, a victim. I am a survivor. I got through it. I am done with treatment. I am back to school and work in the ED and soon, hockey. I am returning to my life as it was before I was diagnosed...or at least as much of my life as I can because I know that my life will never be the same again. Having lived through a cancer diagnosis and treatment permanently alters one's life and perspective.

Today I am a survivor of a disease that still kills thousands of women, and some men, each year. While it has not quite been six months since my diagnosis, I have undergone some incredible transformations. Seeing myself as a survivor is just one of them. Each day it seems as though I learn something else.

The 3-Day Walk

This past weekend was an incredible experience for me. I cannot yet, put my feelings into words. At this point, I will just share some photos...

Luck Revisited

When my cancer was diagnosed, well meaning people told me I was lucky because it was diagnosed early, that my lymph nodes were not involved, that I had health insurance. While their sentiments were true, and I know, well-intentioned, I did not feel lucky. What was lucky about being diagnosed with cancer? What was lucky about losing your breasts and undergoing chemotherapy?

Today, nearly six months after my diagnosis I am able to consider my luck in a different light. Yes. I was fortunate that I was diagnosed early, that my lymph nodes were not involved and that I had great health insurance. I was also fortunate to have a very supportive network of family and friends and I was very fortunate to have a relatively easy time though my chemo. What I am most fortunate to have is have had the opportunity to enjoy the summer and turn 49. I also have a different attitude toward returning to school this year. Typically I begin to dread the start of school. It means the end of sleeping late, reading fiction and wearing flip flops. This year it signifies that which is normal...being able to go to work.

I am also fortunate to be able to participate in the Breast Cancer 3-Day walk. The walk officially starts tomorrow and there are estimated to be 3,000 walkers. I have volunteered to be a part of the medical crew and am assigned to work in the main medical facility 'in camp'. Today I have a training session to attend and am very excited to do my part. Look for an update next week.

So back to luck. It's all in how you define it. And today, I feel lucky.

You've missed the boat...

The first Taste for the Cure is a wonderful memory. 19 guests, a beautiful summer evenings and lots of food and wine. The second cruise schedule for August 21 is FULL! So if you were thinking of coming, you've missed the boat...literally. If you RSVPed before today, you've got a spot.

Another Taste for the Cure

Here's another opportunity to join the fight against breast cancer. As many of you know, the Breast Cancer 3-Day walk is fast approaching. Another one of our friends has made the commitment to walk: Shelly Swenson. She needs to raise $2200 in pledges to participate and she needs your help... so due to popular demand:


Another Taste for the Cure!

Who: You and your guest(s).

What: Wine-tasting party.

Where: Aboard Mary and Mary's boat on the beautiful St. Croix River.

How: Bring your favorite bottle of wine to share and a $20 (suggested) donation. Appetizers and non-alcoholic beverages will be served. If you don't want to do the tasting part, just come along for the ride!

When: Tuesday, August 21 at 7 pm. We will return to the dock by 10 pm.

If you can't make it for this fun and relaxing evening, you can still contribute funds to Shelly by clicking: https://www.kintera.org/faf/donorReg/donorPledge.asp?ievent=202293&lis=1&kntae202293=5EACAE5F978F4B7286199A78D874C5A4&supId=57913367

If you are intereseted in participating, please contact me at mackenburg@comcast.net or Shelly as soon as possible. The cruise is available to a limited number of guests. Be one of the cool kids and join us!

Taste for the Cure

Here's your opportunity to join the fight against breast cancer. As many of you know, the Breast Cancer 3-Day walk is fast approaching. One of our friends have made the commitment to walk: Noelle Olson. She needs to raise $2200 in pledges to participate and she needs your help...


Taste for the Cure!

Who: You and your guest(s).

What: Wine-tasting party.

Where: Aboard Mary and Mary's boat on the beautiful St. Croix River.

How: Bring your favorite bottle of wine to share and a $20 (suggested) donation. Appetizers and non-alcoholic beverages will be served. If you don't want to do the tasting part, just come along for the ride!

When: Sunday, August 5 at 7 pm. We will return to the dock by 10 pm.

If you can't make it for this fun and relaxing evening, you can still contribute funds to Noelle by clicking: https://www.kintera.org/faf/donorReg/donorPledge.asp?ievent=202293&lis=1&kntae202293=FFC2FA8F52264292AA2E9A15FDA5C52F&supId=174202004

If you are intereseted in participating, please contact me at mackenburg@comcast.net or Noelle as soon as possible. The cruise is available to a limited number of guests. Be one of the cool kids and join us!

That which doesn't kill us makes us stronger...

Those words have become our mantra this week.

First, a cancer update. My hair is growing back (appears to be gray, just like it left) and I feel great. The fatigue is gone and I am able to work my shifts in the ED without too much chemo brain. I still doubt myself at times and double check my drug calculations but that's about it. Tamoxifen does have a few side effects. Most notable are the aches I feel and the hot flashes. The aches is bone pain and isn't enough to stop me from doing what I want but is enough that I feel it. In fact, yesterday I noticed that I didn't hurt and realized I had forgotten to take my drugs in the morning. I am also becoming an expert on hot flashes. I am having 2 kinds: flashes and flashettes. The flashettes happen many times per day. They are short episodes of "boy, I am really hot right now" and aren't too big of a deal. The flashes are not so good. These last longer and a more significant with feelings of nausea, light-headedness and profuse sweating (like change your clothes). Fortunately these only happen every couple of days or so. Taking prescribed medications regularly does help to reduce the side effects so I faithfully take my Tamoxifen hoping that the side effects will begin to subside.

Yesterday Mary and I had to make the very difficult decision to put our Great Dane, Olivia to sleep. About a month ago we noticed she just didn't seem like her usual self. We took her into the vet for the first time on June 21. From there we have had multiple vet visits, x-rays and CT scans, lab tests, and IV fluids. The diagnosis=diskospondylitis. This is an infection of the disks of the spinal column usually caused by a bacteria or a fungus. We spent the last 10 days of her life giving injected antibiotics as well as potent oral ones. She did not respond to them and we watched her grow increasing disabled. The last time she was able to walk on her own was July 5. Since that time she became increasingly paralyzed, incontinent of urine and stool and her back paws were cool to the touch during the past couple days. We took her in yesterday knowing what we were likely to have to do but hoping in our hearts that our trusted vet could suggest one last thing to try. Unfortunately, disease won and Livie went to sleep with her head in Mary's lap...her favorite human on the earth.

Mary and I often reflect on how lucky we are. We both have great jobs we like, a home we love and the ability to do pretty much as we want. We get to travel and enjoy our friends and family. But we have felt challenged this year. First the loss of Greta then my cancer and now Olivia. Losses. Certainly not on par with a death but challenges nonetheless. Sometimes I wonder if several "smaller" challenges are more difficult to manage than one big one. It feels like we have recovered from one and then are faced with another. Hence, our mantra for the week. That which doesn't kill us makes us stronger.

OK...we are strong enough for now!

The 3-Day Walk

The Breast Cancer 3-Day is coming up. Haven't heard of it? It is a 60 mile walk held over 3 days to raise funds for breast cancer research. It is sponsored by the Komen Foundation (the same foundation that sponsors the Race for the Cure) and is held in several cities across the country. The Twin Cities walk is being held August 24-26. I have signed up to participate as a medical volunteer this year...I wasn't sure I would be up to walking 60 miles by the end of August. My friend Shelly Swenson is walking and her team "Treasured Chests" will honor me on their t-shirts. Perhaps you would consider donating to Shelly in her efforts to raise $3000 for the cause. You can do this easily online by following this link:
https://www.kintera.org/faf/donorReg/donorPledge.asp?ievent=202293&lis=1&kntae202293=00188B7D806E4C6DBE472D414A8E08E5&supId=57913367

Many thanks to everyone is their efforts to find a cure for this disease!

Back at Work

I've been back a work for a full week now, completing 5 full 8-hour shifts! I know that doesn't seem like a feat to most people but coming back from an illness, it is a big deal and I am proud of myself. I haven't been very productive in the evenings (I've been working day shifts thus far) but that's ok too. Who really cares if the folded laundry is sitting on the dining room table and dog toys are everywhere?

Returning to work has been an interesting experience. Somewhere in my mind, I thought I would just come back like nothing had happened. That wasn't the case. The first day I was greeted with a beautiful floral arrangement from some of my co-workers (THANK YOU Kellee, Donna, Masha, Marsha and Kristen!) and lost of people surprised to see that I looked so well. Like me, many people have the idea that people with cancer look awful and I guess I don't. I am still bald though and the stares and second looks continue.

Because of the nature of our work, I don't often work with the same group of people more than a day or two in a row. That means each time I come to work I am asked the same questions. Of course they start out with "How are you?" but what people really mean is "How ARE you?" Thankfully I am able to answer truthfully that I am doing very well. But I have to admit (this is hard to say without sounding snobby) it's getting old. Each time someone asks me that or wants to hear more about my treatment, status and prognosis (again, because they really care about the information) their questions bring everything back up for me. Returning to work was a turning point for me. Coming back to this place where I have a certain level of expertise and satisfaction allowed me to put an ending point on my cancer treatment. It was done~see...I'm better and I'm back to my usual self. But the questions push me backwards a bit. Just a bit each time but when you've worked in a place for 27 years, you know a lot of people!

I know this will decrease with each shift I am here. It has been a good week. I have been very happy to be back doing my job with my chemo brain dramatically improving. Perhaps I just had to start using my brain a bit more! And as always, the patients are delightful. Yesterday I had a very philosophical discussion with a 6-year-old girl who has leukemia. She was in for a twisted ankle and had just had a chemo run the day before. She still had her hair and we talked at length about why she had hair and I didn't. Enlightening.

And that is why I love my job.

Going back.

Today I get to do something that alot of people don't like to do...go to work. I am going back to work in the emergency department (ED). I haven't worked a shift since February 13, right before my mastectomies. That is a long time to be off and yet, seems like just yesterday in many ways.

Lots of women with cancer work throughout their treatment. Our friend Liz is a firefighter with Mary who did this. She moved to a "quiet" station, tried to avoid direct contact with sick people and rested when she could. Even my oncologist encouraged me to work during my chemo, and I did~at the college. But I couldn't do both. There was no way I could avoid direct contact with sick people as that is the very nature of our job in the ED during the winter months.

There have been some benefits to being away from the ED. Certainly the most obvious is being off during the busiest time of the year. But being away has given me the time I needed to recuperate and heal, to stop and rest when I needed to and to wallow in my self-pity without having to be nice to anyone else when I wanted to. But I think those days are behind me.

I have missed being in the ED. When you really think about work, it is an important place we go to socialize. We get a certain amount of esteem and hopefully, respect from our work. We feel a sense of satisfaction, challenge and reward for our work. Sure, some days are better than others and some days, I would rather not go but overall, I like my job and have missed it.

Today I also move from being the patient to being the health care provider. I am on the other side of the chart providing rather than seeking the medical care and advice. I'll be the one with the pen in my hand, listening and trying to figure out how to best help my patient. That frightens me. I worry about chemo brain. I worry about making math or medication errors. I worry about making the right or the best decisions for my patients. Today...I will double and triple check everything. I will doubt myself and everything I think I remember. Thankfully I am working with physicians that I trust and respect, who I know will not think less of me if my questions seem silly or dumb. They will help me.

Today...I am going back to work. Today I feel like a survivor. Cancer is becoming a thing in my past, something that I have dealt with. Of course I will think about it and worry about it and it will touch my life again but returning to work is helping with my that perspective. I am finally moving on. I am doing something normal...I am going to go to work.

Coming back.

I have finally confirmed what I had always thought was true...a weekend on the river will cure whatever is ailing you.

We spent the long weekend on a houseboat on the St. Croix. A HUGE rented houseboat with a group of wonderful women we are fortunate enough to call friends. We left the dock on Friday afternoon with plenty of food, beverages and high hopes for great weather. We were not disappointed! Ok...a bit of rain on Saturday but that just caused us to move from the table out on the front deck to the one inside.

But soon we were back out there, sitting around the table. The conversation didn't even stop. It just paused long enough to refill beverages and get settled again. By Saturday afternoon the sun was out and it was getting warmer. Sunday was an incredibly beautiful day. We had difficulty keeping up with moving our chairs to maximize sun exposure, reading, napping and chatting. We ate some wonderful meals (THANKS Pam!) and enjoyed some nice bonfires on the beach.

During the weekend I didn't nap...except for a short one on the beach. When we got home on Monday evening, I was beat and ready for bed early. But yesterday I was struck by something. I feel like my old self. In fact, as I thought more about the weekend, I felt more like my old self over the weekend too. Perhaps it was being in a place that I love, doing something that I love. Perhaps it was feeling the warmth of the sun on my skin. Perhaps it was being among a group of wonderful women. I am not sure what the reason for this feeling was and it is not important to me to figure it out. What is important to me is that I feel it.

At several points during the last few months, I wondered if I would every feel like myself again. I hoped so but was afraid there wasn't an old self to feel like. I worried that my cancer and its treatments would somehow alter me as well as my physical self. Who would I become as a cancer survivor? Would the assets of my personality be enhanced or would the deficits become more prominent? Much of this remains to be seen. What is clear right now is that I am slowly returning. The veil of cancer is lifting away and I feel as though I am coming back. And for the days of this past weekend, I forgot I had cancer. Oh sure, I had to put sunscreen on my bald head. Oh...and there was the debate in my head about whether you are topless if you take your shirt off and have no breasts, but aside from that...I forgot. I was just me. Who I am right now, enjoying myself. And it felt great!

Decoratively Bald

This week I got a new tatoo. Not a permanent one, a temporary henna tatoo on my head! Long before I was bald I found a website called Chemo Chicks (http://www.chemochicks.com/home.htm) where they sold different types of products for women going through chemo therapy. One thing they have are stencils for temporary head tatoos. I ordered one along with the henna kit. Finally this week I went to see my friend Chuck (my hair guy) and had one applied to my bald noogin.

The first step was to transfer to my head. Some eucalyptus oil first then the ink from the paper transferred to my head.

From there, Chuck used a small plastic applicator to trace the pattern with henna.

After that the henna stayed on for 6 hours. I was able to wash it off later in the evening and I was left with an iteresting and intricate pattern on my head. It should last a week or so and is a fun alternative to being bald!

It's over.

My chemo is done and it's time to feel better. That's what I think but apparently that is not what my body thinks. I was under the misguided assumption that I would finish my chemo and feel better and be done. Today is 8 days past my last treatment and I feel awful again. Thankfully Mary is home and let me sleep for hours.

I just finished talking to Lucy, one of my favorite Children's Hospitals and Clinics pharmacists. I wanted to know more about the pharmacology of my chemo drugs, doxorubicin in particular. That seems to be the one that has the most significant side effects. She kindly informed me that it takes 21-28 days after your last treatment for your body to completely clear the drug. Great. My last treatment was May 14. Some not so quick thinking (chemo brain) and I figure it will be mid-June before this drug clears my body completely. I am assuming that I will continue to feel crummy and tired until then. I am also assuming that it will take a while before my hair comes back in, although I am getting used to being bald and don't even see the stares of people any more!

Here's the other thing that is over~chemo night dinners. A nice tradition came out of my chemo schedule, dinner with Mom and Bob. I should be more clear. Mom and Bob came over each Monday afternoon that I had chemo and cooked dinner for Mary and I. Sometimes Pat and Mark would join us as well. It became something that I looked forward to...visiting with the two of them and a great "mom" dinner. This is a photo from my last chemo dinner: roast beef and mashed potatoes. What says Mom like mashed potatoes?

Another thing to check off.

I can check another thing off on my list for breast cancer care. Yep. I am done with chemo! I finished yesterday. My sister and my niece were there with me when Wayne pulled out my IV and announced to the room of patients getting chemo that "Mary is done with her chemotherapy!" It was wonderful to hear these words announced. I walked out of there with a spring in my step and a congratulatory coffee mug.



So...what is next? I haven't really thought too much about the next phase of my care. I was really trying to take it one step at a time. Right now, I have a month off from 'cancer care' with no appointments scheduled at all. Hopefully, I will recover easily from this last chemo and will see my hair start to come back in. I am returning to work on June 1 and for those of you who know how stubborn I am, you know I will be returning to work on June 1! I may still be bald, but hey...it's been said I have a nice head!



When I go back to the oncologist in June, I will be started on Tamoxifen. This medication comes in a daily pill that has been used for more than 20 years to treat patients with advanced breast cancer. It is now commonly used as an additional therapy following primary treatment for early stage breast cancer. It works by suppressing the production of estrogen-a hormone made by your ovaries which promotes the growth of cancer cells. Sometimes tamoxifen is called an "anti-estrogen" and helps prevent the original breast cancer from returning. Like any drug, there are positives and negatives to being on tamoxifen. Some women experience a lowering of their blood cholesterol levels and slower bone loss (osteoporosis). But...tamoxifen does have side effects (NCI, n.d.). In general, they are similar to the symptoms of menopause including hot flashes, headaches, fatigue, nausea/vomiting, vaginal dryness and/or itching, and skin rashes. Weight gain is another side effect (ACS, 2006). Tamoxifen also increases the risk of uterine and endometrial cancer In one study, women who took tamoxifen had more than twice the chance of endometrial cancer. Data from one large treatment study also found there is a small increase in the number of blood clots in women taking tamoxifen; and are at increased risk for developing cataracts, corneal scarring and retinal changes in the eyes. Tamoxifen has also been known to cause liver cancer in lab rats but this has not been documented in humans. It can cause liver toxicities in humans though and in one study was associated with gastrointestinal cancer (NCI, n.d.)



By my read, this is not a great drug to be on. The question becomes: Do the benefits of tamoxifen in treating breast cancer outweigh its risks? According to the National Cancer Institute (n.d.) the benefits of tamoxifen as a treatment for breast cancer are firmly established and far outweigh the potential risks. But I keep going back to this question: if I have to take a drug for the next 5 years that has so many side effects, why not just remove the problem-the ovaries. They are the organs that produce that estrogen that the tamoxifen is suppressing. From there I think, why not remove the uterus too...and any other useless organ that can just become a haven for cancer cells?



Of course I had to ask Zander, the oncologist this question. He said it was an option but the surgical risks may be greater than the benefits it I was able to tolerate the tamoxifen. Not getting the answer I wanted, "oh...great idea! Let's schedule you for surgery" I had to ask Chara, the oncology NP. While she gave me more information about tamoxifen and long-term use (more than 10 years), she essentially agreed with Zander. So we decided on a 1-year trial of tamoxifen. If I'm having problems with it, off to surgery I go. If not, stay the course.



So what else is store for me? Visits to the oncologists every 3 months. These will include blood draws for a blood tumor marker called CA27-29. This marker is found in the blood of most women with breast cancer. Typically it will remain at a stable level, somewhere less than 34. I will have it drawn and observed over time. An increase in the level of this marker can be a cue that my breast cancer has recurred or I have developed a cancer of the colon, stomach, kidney, lung, ovary, pancreas, uterus or liver (medicinenet.com, 2006). These cancers will also cause an increase in CA27-29. During my visits I will also have a chest x-ray or a chest CT scan to look for recurrence in the bones of the chest. That is one of the more common sites of breast cancer recurrence.



So much to look forward to! I will do it all. I want to be able to look back knowing that I took every step I could to treat my cancer and increase my chances for a long and health life. I've still got quite a few things to do. And tomorrow, we are going to look at a boat.


References


American Cancer Society [ACS] (2006). Hormone therapy. Retrieved May 15, 2007 from
http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Hormone_Therapy_5.asp?sitearea=

Medicinenet.com (n.d.) Definition of CA27-29. Retrieved May 15, 2007 from http://www.medterms.com/script/main/art.asp?articlekey=39199

National Cancer Institute [NCI] (n.d.) Fact sheet: Tamoxifen: Questions and answers. Retrieved May 15, 2007 from http://www.cancer.gov/cancertopics/factsheet/Therapy/tamoxifen