Let's Talk About Exercise

I’ve known for a long time that the human body, or at least this one, needs a certain amount of movement to function, and even more to thrive. 

Studies have shown a link between high BMI and mortality/disease free survival from breast cancer. Adipose tissue is a source of estrogen, so it makes biological sense that if you have an estrogen-sensitive tumor and lots of tissue making estrogen, it’s not great for recurrence risk. 

I was diagnosed with breast cancer while training for my 5th Ironman. I was logging 12000+ meters of swimming and hours of biking each week - and I have breast cancer. I chose to see the power of exercise as what kept my cancer from spreading wildly, and the reason it wasn’t more aggressive. 

I got up and walked the day after my double mastectomy, and every day since. I went into it with a month of core and upper body strength work to recover faster. Yesterday, I did a plank for the first time in a month - and almost cried it felt so good. 

Some of the most badass breast cancer warriors I know are runners, triathletes, hikers, and yoga instructors. I believe the physical and mental strength of challenging yourself to be faster, go longer, or stretch farther is what makes them survivors. 

When I asked my oncologist what, if anything, I could do to prevent my cancer from coming back (besides hormone therapy), she said unequivocally “Exercise. Minimum 3 hours a week.” No problem, doc. 

I’ve come to terms with the fact that my body won’t be the same after menopause, on meds, and that it won’t be ready for the St. George 70.3 or Ironman Coeur d’Alene. I’m OK with giving myself time to heal, but exercise is definitely going to be part of that healing. 

I hope to be at the starting line of more than one local triathlon this year, and to see some friends at IM Boulder 70.3 in August. I am learning patience, respect for my body, and renewed appreciation for the benefits of exercise. 

Let's Talk About Estrogen

Breast cancer comes in a few flavors - there’s the cell type it comes from (85% from the ducts or 15% from the lobules). It can have lots of receptors for hormones such as estrogen and Her2, or be receptor negative. The type of cells and their receptors are what guide treatment and whether or not hormonal therapy is warranted (this is different than chemo therapy).

My cancer cells were 100% estrogen and 99% progesterone positive - meaning they are highly sensitive to these hormones, like watering a plant. I’m Her2 receptor negative. 

So though the actual tumor was removed, I’ll spend the rest of my life trying to prevent any rogue cancer cells that snuck away from lodging elsewhere in my body and coming back as stage 4 metastatic breast cancer. I can’t water the plants anymore, so any sources of estrogen and progesterone have to stop. 

If I was younger or wanted more kids, my choice would be to block estrogen receptors on my cells (tamoxifen) and to shut down production in my ovaries (lupron). Instead of taking 2 drugs to preserve ovaries I don’t need, I’ve opted to have them removed instead. 

April 9th the hormone factory ovaries will go, and I’ll be in instant menopause at age 45. No more estrogen means lots more hot flashes, night sweats, mood swings, decreased libido, and vaginal dryness. Sounds fun. It also means increased risk of osteoporosis and cardiovascular disease - and a much lower risk of breast cancer recurrence. 

Another surgery, another part of my womanhood gone, and another sacrifice in the name of disease free survival. 

Post-Op Mastectomy Day 15

 Post-op day 15: surgical follow up. Fortunately, one of my drains was pulled! (Pictured, for the curious - the entire white part was in my chest.) 

Unfortunately, I already have some cording and lymphedema on that side, so it’s time to start stretching and PT. The right side drain is still in, because it’s still draining. 

I can (and should) start doing “breast” exams (technically scar exams) in 8 weeks, but I’ll never need another mammogram or breast MRI. Clinical surveillance and annual visits to the surgeon are all I need as far as the mastectomy goes. 

I left the CU Breast center feeling more hopeful and optimistic than I’ve been in weeks - my surgeon gave me the green light to get back to training, and if I don’t have pain, to race Ironman Coeur d’Alene in June. If it happens, I plan to be at the starting line. Just the thought of it changed my whole mindset. Hope is a powerful force. 

Next in the cancer fight: ovary removal on April 9th. PT and lymphatic drainage. Putting my arms above my head, and washing my own hair. Enjoying the feeling of hope - it has been a minute since I had that feeling. 

Wilderness medicine, knots, and cancer

 When wilderness medicine and surgical oncology meet - drains, knots, and carabiners. Normally knots and carabiners make me think fondly of climbing ice, rock, and mountains. Now they tether my drains to my lanyard so I can shower. 

Post-op day eleven and my drains remain, still putting out too much fluid to remove. The scars are otherwise healing well, and I’m up to almost two hours a day of walking. 

The next step on this journey is more surgery: I can’t have an estrogen-producing organ and an estrogen-receptor positive cancer, so to lower the chances of this cancer coming back, I have to get rid of my ovaries. 

I could get rid of them chemically, suppressing their function with drugs that would induce menopause, along with a bunch of other side effects, or I could get rid of them surgically. I choose the latter. Apparently this reduces my risk of recurrence further than drugs would, and my oncologist seemed relieved at the ease with which I was willing to part with more of my body parts. 

So in a span of less than four months I’ll have lost 2 breasts, 2 ovaries, my fertility and my hormones, and be put into immediate menopause. What I have gained is hopefully years of disease free survival, a cancer free body, and a whole new perspective on what it means to be a woman, and to be alive. 

Four Years Ago Today

March 5, 2017 - four short years ago, we took this photo in Cozumel, on our first dive trip and a rare non-racing vacation. I don’t think I’ve ever laughed so hard or had so much fun.

March 5, 2021 - post op day four from a bilateral mastectomy. Life sometimes changes in an instant, sometimes more slowly, but nothing is a guarantee and no one should be taken for granted. Now more than ever, I know each day is a gift. 

Today’s gift came in the form a phone call from my surgeon - my pathology results are reassuring and my lymph nodes have no signs of cancer, which means I dodged the radiation bullet for now. Ted the 3.4 cm tumor is gone, with clean margins and no signs of spread. My right breast was a healthy sacrifice in my fight against breast cancer. 

Before they put me under on Monday, anesthesia told me to visualize a happy place, and I went to Cozumel in my mind. @beewood17 I hope we can go back for real soon. For today, I can breathe a little easier knowing there’s no radiation in my immediate future. 

Post-Op Day 3

 We scored a free treadmill that has been a lifesaver for getting me moving. Walking feels like heaven.

Plastic drains tunneling under your skin and sucking out fluid feel less heavenly. They have to stay in until the output drops below 20cc in 24 hours x 2. These things are damn painful. My left arm, where 4 lymph nodes were removed, feels swollen, tight, and like a small evil elf is stabbing me in the armpit. Other than that, the pain has been minimal.

I flat out cried when I took off the bandages and saw the Frankenstein-esque remains of my body. I am grateful the tumor is gone; I am sad about the carved up remains of my self. Every time I look, it gets a little easier. 

Next up: awaiting the pathology of my lymph nodes that will determine whether I need radiation. Awaiting further testing of the sample for an oncotype score that will determine whether I need chemotherapy. Hoping the drains can come out next week. Trying to keep up with walking, healthy food, hydration, and gentle stretching. Working hard to slow down my body and my brain, neither of which likes to be slow. 

Home After Mastectomy

Still feeling a little loopy from the meds, but not in a lot of pain (probably because the nerve blocks haven’t worn off). 

Using my race belt to hold my JP drains in homemade pockets. Using a wedge pillow to make a nest for sleeping upright. Taking scheduled Tylenol and ibuprofen like a good patient. Staying hydrated with amazing juices from @poppiesforprince 

Thank you all for checking in on me, and more importantly on @beewood17 who needed it today. Thank you to my amazing surgeon, anesthesiologists, and nurses. I feel like a huge weight has been lifted, and even though surgery doesn’t cure cancer, I sure am glad we got that fucker Ted removed. At least I have some peace knowing that it’s not sitting there, spewing micrometastases into my other organs, and the primary tumor is gone. 

Now time for rest, recovery, dealing with drain output, and sleeping upright. Physical therapy, stretching, and moving so I can back to my new normal as quickly as possible.