2 Year Cancerversary

January 27 - the day the cancer came. Specifically, Wednesday Jan 27, 2021 at 3:05 PM. The phone rang. The radiologist was calling. "It IS cancer."

January 27, 2023 - two years since that call. My entire life perspective and outlook changed on that day in 2021, and two years later, I still haven't managed to put breast cancer in the background. On a shelf. In a box. Far far away from my mind and my heart. Maybe next year, or the year after that...or maybe never. 

Two years into this journey I can honestly say I've learned - a lot. More about cancer biology and pharmacology than I ever wanted to know. More about myself as a patient, a physician, a mom, and a wife. While this day is not a celebration by any means, it is a marker of time passing, and a reminder that no one is guaranteed anything in this life. 

Two years ago today my life clock started ticking down a little faster - and yes, the threat of reduced life expectancy and early death has definitely changed the way I want to be on this Earth for whatever time is left. I no longer have tolerance for anything that is either wasting those minutes, or making them more difficult. I have a deeper appreciation for small moments, little gestures, and presence. I am ever conscious of spending my time wisely. 

I death-cleaned my house during these two years: decluttered the mess, packed up the family heirlooms, and trashed anything I didn't want my husband or daughter to have to deal with later. It was cathartic, I love my de-cluttered space, and I love knowing I can tie up loose ends before I'm desperately clutching the ropes. I wrote letters and cards to be given in the future, in case I'm not here to give them in person. I wrote my obituary, so my husband wouldn't have to. The rabbit/virgo is very pleased with this organization; the cancer patient, not so much. 

The cancer patient needed to make an even bigger leap, a bigger change, a harder transition. Today I am resigning my position as an associate professor at the University of Colorado School of Medicine. This was not an easy decision or choice, but cancer doesn't care about ease or choices. Two years after diagnosis, I can see that decades of night shift work were clearly carcinogenic (night shift is classified as a carcinogen in some countries), and bad for my health. Two years after COVID, practicing front-line medicine in the US has become a nightmare for many providers, and the patient in me finally said "Enough". 

This transition will be almost as painful as cancer - I've been an academic clinician for 15 years, and it's all I've ever known professionally. I am both terrified and excited: the rabbit and the cancer patient. I don't know what's coming next, and that makes me uncomfortable, but I know that this is the right decision for my health, both physical and mental. 

On my 2 year cancerversary, I am retiring from academic medicine. It has been an amazing career, one of which I am proud, but it's time for me to move on. From night shifts, from a broken health care system where there is little joy in practice. My daughter, my husband, my rescue pups - these are my joys, and the things I need to prioritize in my life. And my SELF. No one ever wrote they wished they'd worked harder or longer on their tombstone, and at the end of days, no one looks back on diplomas and resumes as their accomplishments. So maybe a little thank you to cancer for giving me the push I needed to make some big changes. But only a little. The rest of it has been shit, cancer, so feel free exit stage left and never come back. 

 

The First Cell - Why We Aren't Curing Cancer

     Twenty-one years ago, I graduated from medical school. I learned a lot of things, including a bunch of things about cancer. Cancer scared me before I understood what it was, because it took my grandmother away from me. Cancer scared me even more when I learned about it in medical school, because it is a sinister, brilliant  disease. I learned the names of toxic drugs and cell receptors and various terms that I rarely thought about in the subsequent 21 years while I practiced emergency medicine. 

    Then I was diagnosed with breast cancer. Almost 2 years ago exactly. Surely something - anything - had changed in those intervening years. My screening mammogram had failed to diagnose my invisible tumor, and we still don't have any better screening to find it, but OK, surely at least the treatments were better? Surely leaps and bounds had been made in understanding cancer biology and disease? 

    I was horrified to learn that the more I read, the more I felt like a second year medical student with Harrison's Internal Medicine textbook open on my lap. There had been very few breakthroughs in understanding tumor biology. The same drugs we were using twenty years ago, we were still using now. My "other" type of breast cancer, invasive lobular cancer, despite representing 15% of all breast cancers, accounts for less than 0.5% of breast cancer research. 

    And yet -  how many BILLIONS of dollars have been poured into cancer research in those 20 years? (NCI alone spends $6.4 billion per year.) We measure success in the extension of lives by weeks or months - instead of stopping malignant cells from becoming cancerous tumors in the first place. We implant human tumors into mice and expect them to act like they do in humans. We focus on "battling" cancer once it has presented itself, but for the people living in Purgatory like me, we cross our fingers and hope for the best. No one cares if I have circulating tumor cells, because if we found them "it wouldn't prolong life anyway". Maybe not. But an 18 month lead time on the beginning of the end would be a big gift - a gift of time before decisions are made about treatments. Time to travel, to quit a toxic job, to reunite with loved ones. To experience what remains of good physical health, whatever it looks like now.

    Today I finished reading "The First Cell" by Azra Raza. She is a hematologist/oncologist who put into words and verified all the things I feared: we really haven't made much progress in understanding cancer. Imagine if there was a pill I could take, like antivirals that prevent HIV from becoming AIDS, that would prevent rogue cancer cells from becoming tumors. We have turned HIV into a chronic, manageable disease within my lifetime - I took care of men dying of AIDS in the 1980's in New York, when we knew nothing about it. Cancer has existed as long as there have been cellular organisms - for all of humanity's lifetime, anyway - and we haven't made truly meaningful progress outside of screening. Billions of dollars. If you want to understand how that's possible, I highly recommend this book. It was vindicating as a physician, but terrifying as a cancer patient. 

    

2022 in Medals and Numbers

Cycling: 4362 miles (209,956 ft of ascent!) 

Running: 331 miles (basically stopped for a few months due to a knee injury) 

Swimming: 264,169 yards

1975 - the year of my birth, the year of the Rabbit. I am a rabbit - I avoid confrontation and conflict, I enjoy routine and safety. Rabbits do not cope well with change or drama. Breast cancer brought both. 

2022 started off well - one year cancer free, working on breast cancer advocacy. I went hours at a time - sometimes even a day - without thinking about breast cancer. 

Sadly, the universe decided not to stop at breast cancer in giving me yet more change and drama. Since October, my professional life has been in upheaval, and I am facing so much loss - career, retirement plans, health insurance, maybe even my home...all while being in one of the darkest places of my life mentally. The last 3 months have been as difficult as anything breast cancer threw my way - maybe even worse. Cancer never made me want to crawl in a hole and not come out - quite the opposite: I wanted to leap out of whatever holes I was stuck in and start really living. 

Cancer made me sign up for Ironman Alaska, and cancer is what makes me exercise like it's a prescription for medicine. I did pretty well this year for a post-menopausal, osteoporotic, double mastectomy 47 year old - until my anxiety and depression derailed my exercise. I went weeks without swimming. I didn't sign up for any races, and wondered if I ever would. The numbers above then really reflect everything until October - since then, other than daily yoga, even exercise has failed to bring me joy. 

Well, I have no choice but to leave the safety of my rabbit hole, and start living. The kick in the ass I need to make change is going to really hurt for a while, but I hope it's only to find a bigger, better, safer rabbit hole. 

Last Race of 2022 - All the Feels

 

So many emotions yesterday - racing the inaugural #monarchtriathlon in Kingman, AZ. 

So grateful for @shestronginc for celebrating and honoring women who have braved cancer. This was a really tough bike course with 4000+ ft of climbing in 30 mph headwinds. I was honored to place third overall - and all day long thought “Take that, breast cancer.” It was so moving to see others out there on a similar journey. 

Thank you @brandy.ramirez for making this possible, for this awesome medal - with a removable charm, and to @runtrimagfor the beautiful #shestrong kit and cap.

@beewood17 you are the ultimate race volunteer and spouse support. So grateful today. 

#fuckbreastcancer #lobularbreastcancer#lobularbreastcanceraliance #triathletewithcancer#racingagainstcancer #racehardware #fuckmenopause#cancerdidnotbreakus#doublemastectomywithoutreconstruction#noboobsnoproblem #teamsfq #teamvpa #biscaycoaching

Monarch Triathlon - All Women, All Touched by Cancer

 Numbered and ready to race the inaugural #monarchtriathlon - thank you @brandy.ramirez@shestronginc for making this possible. 

Racing for all my cancer warriors out there, lost loved ones, and raising awareness for the @lobularbreastcanceralliance 

#lobularbreastcancer #racingagainstcancer#fuckbreastcancer #lobularbreastcanceralliance #teamsfq#teamvpa #biscaycoaching #teamshestrong#doublemastectomywithoutreconstruction#noboobsnoproblem #flatandfabulous #aestheticflatclosure#triathletewithcancer #vegantriathlete #hopingfornowind

The Grace Project - Healing Through Photography

The incomparable @charise.photography taking my photo for the 800 goddesses grace project. Around 800 women are diagnosed with breast cancer EVERY DAY in the US. She is documenting 800 survivors on their journey. 

So grateful for this incredible opportunity to be shown in my topless, breastless, scarred, post breast cancer body. So many women struggle after cancer treatment to find their beauty and femininity again - I'm so thankful for projects like this that remind us scars are beautiful too. 

Thank you @flat_out_love for making this possible, and to my friend @jeniferhughs for the hand-dyed from lichen pink scarf💕

Thank you as always to @beewood17 for being the most supportive spouse ever - scars and all. 

#thegraceproject #800goddesses #lobularbreastcancer#doublemastectomywithoutreconstruction#aestheticflatclosure #noboobsnoproblem #flatandfabulous#healingthroughphotography #breastcancerawareness#fuckbreastcancer 

@flatclosurenow @flat_out_love @notputtingonashirt

International Flat Day

 

#internationalflatday

Celebrating with my flatties on the worlds largest flat top mountain in Grand Lakes CO. Photographs with @800goddesses sharing scars, and tears. 

Time for aesthetic flat closure to be a routinely offered choice post mastectomy.

#aestheticflatclosure #notputtingonashirt #flatandfabulous#noboobsnoproblem#doublemastectomywithoutreconstruction
#fuckbreastcancer #flatisanoption #flatisachoice 

@flat_out_love @notputtingonashirt

Lobular Breast Cancer Alliance

 

I had a less common type of breast cancer than the standard ductal/no special type: invasive lobular carcinoma (ILC).

It represents 15% of breast cancers, but only 0.5% of breast cancer research published annually. At that rate, there's little hope that if I have a recurrence in my lifetime that there will be a breakthrough to save me. 

LBCA - the Lobular Breast Cancer Alliance - is the only advocacy organization in the US dedicated to improving detection, treatment, and research into ILC. As a board member, I can speak to their efforts personally, and have seen the results of their grants, patient advocacy, and research agenda advance the cause immensely. 

I'll be racing my last triathlon of the year in Kingman, AZ on Oct. 22 (more later on that) - it's for cancer survivors, and I am raising funds for LBCA. Please consider a donation if you want to make a direct impact in the lives of lobular breast cancer patients. 

https://lobularbca.wedid.it

#invasivelobularcarcinoma #lobularbreastcanceralliance#lobularbreastcancerawareness #ihavelobularbreastcancer#thinkbeforeyoupink #fundraisingforresearch

Think Before You Pink

 #thinkbeforeyoupink …the concept that one can be thoughtful before buying a bunch of pink shit and breast cancer t shirts and ribbons. 

Thoughtful enough to make sure your well intentioned money is going towards real research, advocacy, and patient support. Thoughtful enough to donate to organizations with demonstrable records of making change in the lives of breast cancer patients, survivors, and caregivers. 

So think before you pink this October. I’m personally raising money this month for the Lobular Breast Cancer Alliance - the only organization dedicated to advocating for my type of breast cancer in the US. 

#breastcancerawarenessmonth #breastcancerisntpink#lobularbreastcanceralliance #lobularbreastcancer#doublemastectomywithoutreconstruction #flatandfabulous#noboobsnoproblem

A Record of My Suffering

One year and eight months ago I woke up without my breasts for the first time. This is a photo of the logs we kept of my wound output into my drains, and my round the clock NSAIDs. 

I had one of those drains in my chest for almost a month, dutifully recording my every drop of output. 

Breast cancer isn’t pretty, and it isn’t pink. It was a big surgery with a long recovery. I found these logs cleaning out my filing cabinet - and I threw them away, glad that chapter is over. But they are a reminder of so much loss, so much fear, and a lot of strength. 

#breastcancerawareness #breastcancersurvivior#fuckbreastcancer #doublemastectomy#doublemastectomywithoutreconstruction#noboobsnoproblem #aestheticflatclosure #flatandfabulous#breastcancerisntpink #invasivelobularbreastcancer#lobularbreastcancer #lobularbreastcanceralliance

Breast Cancer Awareness - In Case We Forgot

 

October is upon us - time for another onslaught of pink ribbons, fundraisers, and the triggering of Breast Cancer Awareness Month. 

Once you've had breast cancer, you are unrelentingly, constantly aware of it: my "treatment" might be just an oral pill, my surgeries might be over, but I am not free of cancer. I won't know for 20 years if my body is free of cancer, and I can say with certainty that my mind is never, ever cancer-free. 

So expect a lot of posts this month, and a lot of feelings. I'll try to limit the pink - it was never my favorite color, and now it is full of loaded associations. 

Today is Oct. 1, so #feelitonthefirst ladies - time for your monthly reminder to DO YOUR BREAST SELF-EXAMS. Get to know your boobs, so you can know if they are changing. I felt my own lump, that my mammograms missed, so I am forever grateful I did those exams. 

#breastselfexam #breastawareness #breastcancerawareness#fuckbreastcancer #doyourselfexams #breastcancerisntpink#breastcancerisntpinkandpretty #lobularbreastcancer#lobularbreastcanceralliance