Sunday, July 23, 2006

"Good" cancer?

I keep meaning to write about the title of this blog. There are lots of people--lots of doctors--who will say there is no such thing as a "good" cancer. This is a terrible disease and you just really do not want to hear that diagnosis, ever. On the other hand, we can certainly differentiate between a thyroid cancer, which can often mean a bit of treatment and then you go on with your life; and liver or pancreatic cancers, which tend to mean that you will be fighting hard with aggressive treatments for a few months, after which it is possible you may not even be here anymore.

When I was diagnosed with my Stage II-A breast cancer, part of the doctor's first sentence was, "...and we're gonna cure you." That word, cure, stood out prominently. It was wonderfully reassuring, especially coupled with my longstanding sense that breast cancer was a "treat-and-go-on" diagnosis. In the past, I had taken note of famous women who had it, but always those who survived. Betty Ford. Melissa Etheridge. Olivia Newton-John. Jill Eikenberry (who was my age when diagnosed). I always felt like we heard that these women had breast cancer, and then they were treated, and then they stayed around--in many cases, for decade after decade. My own aunt had it and recovered. Because of all this, breast cancer seemed like a mild setback, and I was relatively optimistic.

But it's really all about your perspective. A woman in my support group was devastated by her diagnosis (she's close to my age, and her cancer is not much worse than mine) because she had known several women in her life who had breast cancer, and virtually all of them died. She felt she'd been given a death sentence. And indeed, the bad news starts pouring out once you are paying attention. Linda McCartney, novelist Carol Shields, Wendie Jo Sperber, and Columbian singer Soraya are only a few of the famous who recently died of their breast cancer--the latter two, quite young. I have heard plenty of stories, now, of recurrences and metastasis, and when I found that my own risk of that was 20% even after chemo, I felt a lot of my optimism grow dark.

At this point, the optimism and the darkness take turns dominating my views. But overall, I'm glad I chose this title. I very much hope that the 80% chance that I have no recurrence prevails; I am grateful that I don't have one of the far more serious and worrisome cancers that send people to the Wellness Community support groups on the same night as mine. It is awfully easy to come across information that is terrifying, and to focus on the dangers that might lie ahead. I like having the constant reminder that I once thought of this as a pretty easy thing, and that the odds tell me that, in fact, it really might be.

Sunday, July 09, 2006

Taxol Dayz

Hi folks. I'm happy to report that my relatively long silence reflects a more positive chemo experience. After finishing my 4 cycles of AC (why do they call them "cycles"? I have no idea), I was switched to a drug called a "taxane," which is another of the "big guns" that are directed against more daunting tumors, such as mine. I'm now on Taxol for 4 cycles (1 down, 3 to go--the next is on Tuesday). And I'll take Taxol over AC any day.

The bad news is, I am one of the substantial minority of people who are allergic to Taxol. I've described my reaction before so I'll spare you that again, but now I can look forward to a jumbo dose of Benadryl every time I go in for chemo. (That, coupled with the Ativan they have lined up for the increasing anxiety I feel every time, pretty much renders me a semi-conscious rag doll.) After dose 1, for the first couple of days, everything felt pretty normal. Then on Thursday, I started having aches and pains. Initially, it felt like I'd played some hard hours of volleyball for a few days; my muscles were sore and my bones felt like they'd been used as battering rams. After a while, the pain got more intense.

I just lived with it for about 24 hours, but after a very sleepless night Thursday, and several hours of strong waves of pain on Friday, I called the oncology staff. A few hours later, I downed my first Vicodin, which took the edge off but didn't bring me below the "bearable" threshold. After that, I upped the dose to two Vicodin, and that pretty much wiped out the pain. Two days of constant Vicodin (with accompanying wooziness and inability to drive), one day of sporadic half-doses, and then the pain mostly went away. With no nausea and no other major side effects (a little--very little--indigestion was the only one remaining), I actually started to feel almost normal! True, my energy is still way below par. But being on Taxol--so far--has really been so much better. Even my brain is working a bit better.

In the past week, we've celebrated the 4th of July and our 6th wedding anniversary (on the 8th). Of course, the meaning of "celebrate" is different this year. In our lives B. C. (before cancer), we would probably have gone out of town somewhere for the whole stretch, and engaged in some fun activities (hiking in Yosemite; kayaking and snorkeling at Catalina Island). At the very least, we'd both have played volleyball at the beach or some such active pursuit. Now, I don't think I could last 10 minutes playing volleyball in the sand; my half-hour walks are taxing, and if I try to do too much during a day I just get wiped out--usually in an instant, when I don't expect it.

So on the 4th we had to be contented with fireworks and dinner--not bad, really. The Redondo Beach fireworks, launched from a barge just off the pier, were so close to our house that we walked down to the edge of the marina with Kibble and watched the display over all the tethered boats. It was quite charming and uncrowded, and Kibble didn't show any fear of the explosions--in fact, he didn't seem to care at all, which was great.

I'd prepared burgers, asparagus, and goat-cheese scalloped potatoes, but when Noah went to light the grill and make the burgers, he discovered that our gas tank was empty. So we packed up the food for the next day, and went to the Manhattan Beach Brewery for a late dinner.

Yesterday, for our anniversary, we had dinner with friends Paul and Leanne, who live out in the Valley (but--lucky for them, not for us--are moving back home to British Columbia in the next few months), and Maia. Kibble got to come again, and frolic in the backyard with Paul and Leanne's golden retriever puppy, Brodie. It was a very pleasant evening, and good to spend our anniversary with other people--just as we spent our wedding day.

My mom comes out to visit on Wednesday, for a week. My dad was here just a few weeks ago, too, and a week after my mom's departure, Noah's sister Sarah and her husband Tom will be here. Through the time that remains, for chemo #6 I get a visit from mom, for chemo #7 we get a visit from Sarah and Tom (with a quick trip to SF thrown in), and then I will only have one last treatment before I am done. That light at the far end of the tunnel is getting bigger and brighter, and thanks to the Taxol I feel like I'm picking up speed.

Sunday, July 02, 2006

The meaning of life

Having cancer is like coming to a roadblock with a flashing sign that says “mortality.” Although I should get through this and be fine, nonetheless my life expectancy has taken a hit, and my chances of developing metastatic cancer have gone from less than 1% to 20%. So I have to start thinking about what I want from my life, knowing that I can’t be as comfortable as most people that I have years and years and easy years stretched out in front of me.

Let’s say that I only have 5 more years to live (who knows?). How do I want to live them? Well, two answers: I want to be sure I don’t take for granted the people in my life, and I want to be sure I can say, at the end, “I lived as fully as I could.”

It’s an awkward time to be facing this question. I’m halfway through the trek to tenure, and this is the time when most people at my stage forego having lives to invest in their careers. It’s hard to get tenure without that single-minded devotion, and I could live for another 40 years or more, and if so I will want to establish a solid career. But if I died in 5 years, and all I’d done with my time was sit in front of the computer—well, that would be fodder for regret!

What’s interesting about this, to me, is that this is the calculus that we should all engage in anyway. Having cancer has changed my odds, but it hasn’t touched the fundamental uncertainty that we all have about how long our lives will last, nor the truth that any of us could die, for any number of reasons, at any time. My tenure clock answer today—which should be the exact same answer that I gave last year—is that I will work hard, and strive, and believe that there is a future in which I’ll be well served by seeking tenure. I’ll spend a substantial amount of time working (and thank the stars that I’ve chosen work I find enriching and inherently rewarding). But I’ll also take time off, I won’t kill myself on projects I find soulless, I’ll play volleyball and go on vacations and read books for pleasure. And, with resolution #1 in mind, I’ll spend plenty of my time with people I enjoy—in the past, this was the first to go, when I had “work to do.” Now that response can’t be so knee-jerk.

Everyone faces the same conundrum, really—it’s just staring me down with a bit more intensity. To what extent do we live for the future, and to what extent do we live for today? In fact, we have to do both. It may suck to be reminded of that—but at least I have plenty of time to do something with the reminder.