Badass no more?

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When I was diagnosed with stage 3 breast cancer and decided to announce that on Facebook, I also started using the hashtag “team badass.” One of the terrible things about my diagnosis was knowing that other people would worry about me.  The knowledge of that broke my heart.  I didn’t want people to worry about me, and I could only imagine their fear.  My husband.  My mom and my dad.  My sister.  My friends who had gone through cancer.  My friends who had known Angi.  I remembered how that felt, and so I reminded you all how tough I was by deciding on the moniker “team badass.”

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Me and Wonder Woman, badasses. Right?

And I also wanted to remind myself who I was.  A year of treatment?  Fine.  I was going to put my head down and badass my way through it.  Surgery.  Chemo.  Radiation.  Two more surgeries?  Extra biopsies and scans?  Bring it on.  I was going to keep working full time and being tough on opposing counsel and, you know what, I was going to train for a marathon too.  And I did.  And now all of the treatment and surgeries are over, and so I figured I’d go right back to being my normal badass self.

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I had no idea how round my face was from the steroids.  But still wearing my badass head protector!

I mean, I had heard about “the new normal.”  And I even understood at some level that physically I wouldn’t be 100% right away, and that mentally I might still be a little foggy.

But here’s what I didn’t understand:  I’m emotionally raw.  I’m aware of my vulnerability in a way I wasn’t before.  For the past year, I’ve been given so much grace and so much love and at some level I’m afraid that all of that is going to be taken away.  That people are tired of me and my “cancer journey.”  That my co-workers are sick of me being out of the office or being too fatigued to stay late.  That my friends and family are tired of doing things for me.  And more, that my wanting those things — wanting love and grace and people to take care of me — means I’m not such a badass after all.

But you know, I didn’t use the hashtag “badass” on that first Facebook post, or on my subsequent posts about cancer.  It’s always been “team badass.”  I don’t know why I did that, but maybe there’s a lesson in it for me. Maybe it’s okay to need other people, to lean on my family, to allow my friends to support me, and even to ask opposing counsel for an extension of time when I need one.  Maybe keeping my team around me is in fact the most badass choice of all. #teambadass

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The “last” surgery – boobs!

I put last in quotations because I don’t want to jinx it — at this point, who knows?  But 360 days after my first cancer related surgery, the sentinel lymph node biopsy, it was time for my last one:  reconstruction of my breasts.  From most people’s perspective, this should have been a fun surgery.  I don’t want to even tell you how many comments I got about a “free boob job” or to “make sure I picked good ones.” (Let’s put aside that surgery is never “fun.”)

Luckily, I also had friends who had been through this before and let me know that it doesn’t work like that:  you most likely don’t get porn star boobs after cancer.  Reconstructive surgery is totally different than augmentation — with augmentation, you have something there, you’re just adding to it.  In my case, I don’t even have nipples, let alone breast tissue.  You might also recall that there was a lot of worry about my skin and how thin it was – it could only stretch so far.  We did make the decision at the beginning of the process to put the implants over the pectoral muscle – my plastic surgeon, Dr K, said most of his patients who are active, like me, are unhappy with the movement of the implants when they go under the muscle.  He said they would shift around every time I lifted weights, and I definitely didn’t want that.

So there were still a bunch of options though – round versus teardrop versus saline versus silicone versus smooth versus textured, and that’s not even mentioning size.  But again, a lot of this was out of my hands because we had to deal with the skin I had and how much it was able to stretch, as well as my somewhat unlucky combination of a wide ribcage and a short torso. My plastic surgeon, Dr. K, told me he was going to take in two different implants and see which one worked the best.  A Christmas surprise!

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Textured round on the left, smooth on the right.

Well, he ended up taking and trying FOUR different implants before settling on what are called “gummy bear” implants:  teardrop shaped, textured, silicone.  He said the round ones he tried were up to my collarbone, so while they would have given me better projection (read: a bigger rack), they would have made me look heavy and dumpy and the skin distortion would have been visible under a v-necked shirt.  I ended up with 690cc in each implant, and they come with a ten year warranty which for some reason makes me laugh.

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These are the kind I ended up with.  I don’t know if life is more beautiful, but hopefully I am?

The surgery itself wasn’t terrible, but it was still surgery.  A week out I’m still pretty sore and nowhere near ready to start running again (Dr K said a week to a week and a half, so maybe I’m just a wimp). I have been able to walk a bit and I’m almost off pain pills, but not entirely.  The incisions are tender and the implants are kind of achy.  I also had my port out at the same time, which is another incision but not really bothering me. I do have a little extra soreness on my left (cancer) side, where Dr. K said he broke up some scar tissue probably from the lymph node dissection.

So how do they look?  Well, I don’t know.  I hated them at first, and now I think they look okay.  You really aren’t supposed to judge for at least three months, so I’ll see what Dr. K has to say at my follow up.  I’m disinclined to make any changes for at least a year anyway — I want to lose some more weight, they need to settle and the swelling needs to go down, and I need to just get used to them.  It’s pretty common for people to be unhappy with their appearance immediately after cosmetic or reconstructive surgery — after my breast reduction and lift, I actually cried the first time I looked in the mirror.  It’s just weird to see yourself looking totally different than you are used to.  This time, I guess I kind of understand “you get what you get.”  I still have 100% confidence in Dr. K and that however these end up will be the best he could do in the circumstances.

And with that, I’m done with the planned “year o’ cancer.”  Although, it turns out that it’s not that easy to jump back into your previous life.  More on that in my next post!

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Ovaries schmovaries

(Don’t worry, this will be a picture-free post.)

When my oncologist agreed with my Google-assisted suggestion that the hormone suppressing medicine they give post-menopausal women works better than the medicine  they give pre-menopausal women for my particular brand of breast cancer, the obvious question was the best way to either put or keep me in menopause.  Chemo had put me into what they call “chemo-pause,” but a lot of women’s ovaries start up again after chemo is over.  I suggested that surely at my age (48) I had to at least be really close, but she said based on family history and medical background she would guess I had at least seven more years left before I would have naturally gone into menopause.  The medicine they give post-menopausal women, which are called aromatase inhibitors, flat don’t work in pre-menopausal women whose ovaries are working.  So we needed to be sure mine were turned off.

The first option was to have a shot to suppress my ovaries.  This wasn’t a good choice in my mind for two reasons:  one, my doctor said they still couldn’t be sure it would work and even if it did we would never know when I entered menopause naturally (so we wouldn’t know when we could stop the shots) and two, the shot would require me to go see my oncologist every month for the next 7-10 years.  I like my oncologist, but I spend enough time there.

The other option was to have a bilateral salpingo oophorectomy, which is a pretty fancy sounding way to say they would surgically remove my ovaries and my Fallopian tubes.  Clearly, at my age, I’m not using them anyway, so I chose that option immediately.  Also, even though they don’t think there’s a link between ovarian cancer and breast cancer in the absence of the BRCA gene, it does remove the possibility that I’ll ever get ovarian cancer.  My oncologist told me there was no real rush, but she wanted me to do it this year. (Me too, for insurance reasons.)  I had to wait until treatment was over, and due to down time wanted to wait until after the marathon and the half-marathon I had already planned.  But I needed to fit it in before the exchange surgery I also wanted to do this year.

So, two weeks after Wine and Dine, we checked in for a day surgery at the same hospital where I’ve had all of my treatment so far.  I’ve had the same gynecologist since moving back to Dallas, but she hadn’t seen Tony since the last time she performed surgery on me almost 15 years ago, so we caught up over a little chit-chat. Then she told us what would happen and left while they prepped me for the OR.  Luckily everything ran on time and we were able to start at 12:30 as scheduled.

Afterwards, she told me I was a “model patient” and that everything looked great.  There was a small cyst on one of my Fallopian tubes, but she said that was normal.  I found out today that the pathology report came back clear for all of the removed parts, so while I wasn’t really worried, that was good news.  There was one issue with the surgery from my perspective though: I woke up from anesthesia wide awake, not groggy, still in the OR, freezing cold and in a ton of pain. My doctor had warned me that I would probably wake up with a severe hot flash, so I was glad that didn’t happen, but wow that really hurt.  The anesthesiologist even told me “sorry about the pain, but you woke up a lot faster than I thought you would!”  They gave me demerol and morphine until the pain eased up.  Still, that was weird and I will be discussing it with my next anesthesiologist.

Compared to everything else that’s happened, for anyone who might be facing this surgery, it was really pretty minor.  Three tiny incisions that are healed over already.  I was cleared to run up to a mile today, two weeks after surgery, and I could have been back to work within a week to 10 days if not for Thanksgiving and the medical appointments I’ve had all this week.  The hardest thing has been that I have been very, very moody.  Part of that is probably coming off of pain pills and part of it is not being able to work out, but some of it is the change in hormones.  My doctor says it should even out within a few weeks — whether or not that means I even out to being a jerk all the time remains to be seen!

Next up — the surgery I hope finishes my breast cancer treatment!

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Disney Wine and Dine Half Marathon Recap

When my friend Chrissie and I signed up to run the Wine and Dine Half Marathon at Walt Disney World, I wasn’t sure if it would be a fun victory lap after Chicago or a back up plan in case treatment prevented me from marathon training.  Luckily, it turned out to be the former and it was so much fun!  The fun started with my Tigger costume, which was the skirt I wore as Anger last year, ears, a tail, and a shirt that my husband helped me create.

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As you can see, Disney races start at o-dark-thirty so that they can be finished and WDW can reopen the roads for the people who are just trying to get to the Magic Kingdom.  This is the first race I’ve run there that wasn’t during January’s marathon weekend, so the crowd was smaller but it still started at 5:30 — meaning we needed to be on a bus from the hotel at 3:30. On the plus side, the race was the night of the time change so we got an extra hour of sleep!

Chrissie and I got on the bus easily and hung out in our corral in the Magic Kingdom parking lot for a while, and sometime around 5:45 our corral (E) was announced and we were off! I did notice that there were less characters out, less high school bands, and no pirate ships.  Still, Disney knows how to put on a fun race and there was a decent amount of course entertainment.

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The first part of the race was pretty boring — it was apparently a new course for the Wine and Dine half but was planned to let us run through the new Pandora land in Animal Kingdom.  I felt really, really good as we headed out past the water treatment plant and into AK from the back, but I could tell I was going to lose Chrissie so a couple of minutes in we agreed on a meeting spot and she ran on ahead.  I was running about 13:30s, which I thought I wouldn’t be able to maintain but felt good enough that I just went with it.

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I don’t usually stop for pictures during races, but made an exception for Pandora (also, there was only one person in front of me in line).

After AK, we ran down the road to Hollywood Studios (if you’ve run the marathon at WDW, this was basically the last half of that course without ESPN) and through the streets of that park, which were already starting to show their holiday colors.

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I promise I was not trying to get in these people’s photo op.

Then, we ran down around the boardwalk — it gets narrow here, so I usually am forced to walk but I managed to dodge people and keep running, though it did slow my pace.  At one point we ran over a bridge and my right toe caught on a screw sticking up causing me to trip and say “Oh shit!”  Luckily I didn’t fall and there were no children in the immediate vicinity.  Oops.  Tigger has a potty mouth.

After that it was a quick trip through Epcot — my favorite part, you get to run through all of the countries and on this occasion scope out which kiosks you might want to check out later.  There are something like 35 specialty kiosks from different countries for the Wine and Dine festival, and hey we just ran a half marathon, right?  So we definitely indulged in a variety of food and drinks that afternoon and night.

Final time was 3:00:01 which has to be my funniest finishing time ever.  2 seconds away from sub-3?  But overall it was probably my favorite Disney race ever, and it was 26 minutes and 39 seconds faster than the half I ran on September 16 of this year, so that’s 2 minutes per mile improvement in a month and a half.  Not where I used to be but so much better than I was – and I intend to improve from here!  I may never be a great runner but I can be the greatest runner I’m able to be.

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You mad, bro?

So if you read the article about me in the Dallas Morning News, you’ll know that my initial reaction to my diagnosis was anger.  You also might assume that I’ve spent most of my adult life angry, being a trial lawyer and all.  Well, I’m not angry about my diagnosis any more, and I never understood lawyers who were actually angry rather than just zealously advocating for their clients.  My clients are sometimes angry, but I’m just arguing a point.  I don’t think it’s healthy to take the job too personally.

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 Me dressed as Anger.  Not actually angry.

Yet, the end of active cancer treatment means you have time for a lot of emotions to come to the surface.  There’s a little bit of PTSD involved.  Many people get depressed, or anxious, or cry for the first time.  Me?  I’m angry.  Angry in a way that surprises me.  Any enough to join a support group at my local Cancer Support Community and tell them with  sense of bewilderment, “I’m just so angry.”  (The other members of the group assured me I was perfectly normal.)

So if I’m not angry about having cancer, what is it about cancer that makes me angry these days? I’m so glad you asked.  In no particular order:

  • Cancer ruined Halloween for me, at least for the last 2 years.  Last year I was waiting for the biopsy results and not in the mood; this year I was in the mood and had costumes picked out and then I got a fever at the last minute and had to miss all three parties to which we were invited.  Yay.  Third year’s a charm?
  • Cancer ruined pink for me.  I love pink. If there’s a color choice and purple isn’t an option, I’ll choose pink every time.  But now every pink thing I buy feels like a statement about breast cancer.
  • “Save the boobies” or “save the tatas.”  You know what?  I couldn’t save those.  But hopefully I managed to save my life instead.  Why is it only breast cancer that focuses on the body part and not the cancer?  No one talks about saving the livers, or the lungs.  You don’t see men marching around with signs to “save the balls.”
  • That 30% recurrence rate that no one wants to talk about or hear about.  Ignoring it doesn’t make it go away.  Ignoring the women living with stage 4 cancer doesn’t make them go away, either.  (And unlike “Julie living with metastatic breast cancer” in the Ibrance commercial, most of them had to give up their careers to focus on their health and constant treatment.)
  • The stupid Neulasta on-pro commercials.  Notice all of those people have their hair?  What’s up with that?  And why do they all live in huge, gorgeous houses?  Heck if I lived there I wouldn’t want to leave my house either.
  • The lady who came to talk to my cancer transitions group (which I love) last week and said “Oh, I’m not supposed to call you cancer patients, I’m supposed to call you group members.”  WTF?  Are they hoping we’ll forget that we had or have cancer even though that’s the whole reason we’re there?
  • My cast.  OK, that isn’t directly related to cancer, but I was just getting better from chemo neuropathy and radiation fatigue and the cast means I’m back to constantly dropping things and having trouble eating dinner without using my fingers.
  • That fever I mentioned getting over the weekend?  No one knows why it happened. I have to call the oncologist if I have a fever over 100.5 (mine was 101.2) but then they were just like, “huh, weird.”  I know they’re not magicians, but it’s frustrating.
  • And along those lines, people who are sent home to die because their oncologists, even at MD Anderson, have run out of ideas.  Not mad at the doctors, mad at the universe on that one I guess.
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I’ll take all of the above?

  • People who tell me I’m lucky that I got breast cancer because it is a “good” kind of cancer.   In some ways it is, but it’s cancer.  Not feeling super lucky.
  • Still not feeling physically or mentally ok.  Apparently that may take another year (or even longer depending how the hormone blockers affect me).  Yay.
  • Everyone assuming that I am 100% back to normal and feel fine because treatment is over.  I don’t know that I’ll ever be back to the normal I was before.  But I’m certainly not there now.
  • The saying “your new normal.”  Yeah, it’s new.  It’s not fucking normal.
  • (Sorry for the potential TMI on this one.)  Turns out cancer is really bad for your sex life.  Between surgery, no feeling in my breasts, chemo, radiation, immediate menopause, and now hormone blockers….
  • People who insist that cancer patients or survivors or whatever always have a positive, sunny, grateful attitude.  Is this specific to breast cancer?  Because it’s annoying as hell.  It’s cancer, not a pink slumber party.
  • People who insist that all cancer patients are warriors, or fighters, or whatever.  I chose the title badass for myself, but some people don’t want to be warriors, they just want to get healthy in a quiet way and not think of their current life as a constant struggle.
  • Health insurance.  And I have a good policy, but who has time to fight over coverage of a wig or appeal the denial of payment to the anesthesiologist your doctor chose on your behalf?  Seriously, between this and the appointments, y’all, it takes SO MUCH TIME to have cancer.
  • Doctors being too positive and hiding the true outcome/side effects/statistics.  I had to be clear with a couple of them that I wanted the truth, not what they thought I could handle hearing.  I’m an adult, don’t treat me like a child.
  • People trying to sell me shit with faux science.  No, I’m not interested in Gerson therapy, homeopathic medicines, essential oils to cure cancer, or coffee enemas.  You do you.
  • Cancer.
  • Cancer.
  • Cancer.
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Chicago Marathon Recap

So, let’s talk about how the marathon went!  (Spoiler alert:  I finished.)

Our wave of the marathon started around 8:30 but you had to be in your corral by 8:10. We agreed to meet my friends around 7:30 at the CES race day resort.  Side note – one of the best things we did was find and hook up with Chicago Endurance Sports.  They offer a virtual (and in person) training plan for the marathon and this “resort” with food, energy gels, and indoor bathrooms before the marathon, and more food, massages, and an open bar after the race.  I didn’t use the training plan both because I have a fabulous in-person coach (and because treatment meant I needed an adjustable plan), but they were super nice and the resort was fantastic.  I was even able to pay for Tony to be able to access it once the race started so he could eat and drink too.  I was too late to enjoy it afterwards but I did get a beer.

Anyway – it was a little cold when we left our VRBO (which was on the Gold Coast and gorgeous, and cheaper than a hotel), so — as you can see by my stylish ensemble — I wore the throw-away clothes I had brought with me and of course sported my pink cast for the broken finger.  I figured pink was the right choice since it was October, and Tony decorated the cast the night before for a little extra flair.  Once we all got there, used the restroom, and grabbed water and mini bagels, we went back downstairs to meet Tony who told us to strike “runner poses” before we left.

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I am pretty sure none of us actually look like this when we run.

And with that we were off to wait.

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Can you see us crossing the street?

We split up at this point because Holly and Courtney were in a faster corral and had to go in a different gate. After we got through security Chrissie and I sat on a hill for a while before lining up which was a mistake as I ended up with So. Many. Chigger. Bites.  I also managed to get three stains on my shirt from anti-chafe gel I remembered to apply at the last minute.  Of course the stains are visible in all the race pictures.  So off to a great start!

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Ready to go!  Stains and all! But at least I lost the purple sweats.

Finally we were moving and I said goodbye to Chrissie as she ran on ahead.  We pretty quickly crossed a bridge over the river which had red carpet laid on top of the metal bridge pieces.  This happened I think 8 times during the course of the race and wasn’t all that comfortable to run on.  Since I had fallen while running 2 weeks before the race, leading to the aforementioned broken finger, I was extra careful on those sections.  I saw Tony for the first time somewhere between mile one and two and wish I had pulled out my phone to take a picture of him and all his signs – he had four as well as a backpack full of stuff I might need – body glide, extra headphones, and even an extra watch.  He was definitely the MVP of spectating that day!  But he did get a shot of me.

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I look bemused because my husband is running backwards in front of me.

I’ve always heard that you run the first ten miles of a marathon with your head, the second ten with your legs, and the last 6.2 with your heart.  I decided I should follow that advice as I was feeling really, really good at the start and was worried I’d go out too fast which people always warn against.  At the same time, I know that personally I can also mess up by going out too slow and then finding it hard to pick up the pace later on.  My watch pace, I knew from a little research, would be way off particularly the first few miles thanks to the difficulty in picking up GPS signals downtown.  So when I noticed I hit mile 2 about 15 minutes after mile 1 according to the clocks on the mile markers, I decided to try to stay with that pace for as long as I could.  I was doing pretty good for these first ten “head” miles – I did have to pee around mile 5 and stopped to hug a guy wearing a “free hugs” shirt so I lost almost 3 minutes that mile. I half-tried to make that time up, but didn’t push too hard knowing it was still early.  I saw Tony again with Holly’s and Courtney’s husbands between miles 7 and 8.  They told me Holly and Courtney were doing well but that Chrissie had stopped around the 10k mark (turns out she was fine, the tracking mats just dropped her for some reason until around mile 19).  Tony went to go pick up our rental car from the airport at this point so I knew I wouldn’t see him for a while.  Time to buckle down and keep running.

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(Apparently I really like to wave at race photographers.)

It was a warm day and the temperatures were rising quickly.  The miles blend together but I know somewhere around 12 or 13 I felt like my stomach was kind of sloshy – the water cups they were handing out (which I always take, while avoiding the Gatorade that gives me heartburn) were pretty full so I started drinking half a cup instead of a full one.  I also stopped at a medical tent around here for some Tylenol which took longer than I thought it should have.  When I fell and broke my finger I bruised my hip pretty good and even though we had taped it, my left hip was definitely achy.  By mile 14 it was tingling, which is usually a “stop running” pain, and after my sacral stress fracture last year I’m usually very strict about those.  But – it was mile 14 of the marathon!  I decided to run through the tingling and hope it went away, which it did after a couple more miles. My legs and the rest of me were getting really tired, but I kept reminding myself “second ten you run with your legs” meaning I had trained for this and just had to figuratively put my head down and push through.

 

Somewhere in this section I noticed the discarded cups weren’t being cleared as much as they usually are in races, and while the wet sponges they handed out around mile 16 felt fantastic, they were pretty hazardous to run around because people dropped them wherever.  This is a problem with being in the back of the pack!  The situation got worse later on, particularly with banana peels, and after slipping on an energy chew I ended up walking through some of the post-aid-section parts of the race just for safety reasons.

At mile 18 I saw Tony again and took some body glide from him because the gels in my pockets were starting to cause my shorts to rub on my legs.  The other guys had just left, he told me, because Holly had to stop around mile 22.  Tony was going to sit down and have a burger and a beer and I’d see him at the finish. I told him I had 2 more hours, at least, so he should take his time.  Not long after, I got a text from Holly that she had gotten really sick and had to stop at the mile 22 medical tent.  Courtney was finished by now and Chrissie was at mile 21.  I was too tired to really focus on these facts and I had always known I’d be last of the four of us anyway, so I kept on going.

Around mile 19 some wonderful person was handing out orange slices and grapes which were fantastic.  Not too long after that, the pace car passed me and they started dumping the water tables and pulling the timing mats from the course.  Luckily the volunteers still held jugs of water to refill water bottles, and spectators were handing out water as well, so I made it to the end with plenty.  Good move to keep water available on such a hot day.  I stopped again to pee at mile 20 even though I didn’t think I needed to (and I didn’t) – I’m not sure why I did that other than a vague concern about hydration or hyponatremia.  Possibly my brain was just trying to get me to stop for any reason it could come up with.

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Mile 22 – in pain but still waving!

At mile 22 my hip pain came back as stabbing, and I knew that meant I needed to walk.  I had managed to run up until that point other than a few steps here and there to talk to Tony or get through some of the street debris.  But I didn’t think much more running was in my future – the last 4 miles were probably 60-65% walking. A couple of miles later I could have sworn I saw the mile 24 sign, but then it was gone.  Luckily for me I saw a Team in Training coach I knew from Dallas right at that point who told me that indeed it was mile 24, they had just pulled the sign. I managed to get past miles 25 and 26 just as they were taking the signs down, and they did leave the final timing mat so everyone could get a finish time.  The removal of those timing mats worried Tony though, who texted me to be sure I was okay when the tracking app showed me stopped at mile 20.

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Yeah, this is how I felt near the end.

I mentioned above that you run the last 6.2 miles with your heart.  At mile 20, I decided to dedicate each of the last miles to someone and focus on them during that mile to keep my mind off the race.  Miles 20-22 were for Courtney, Chrissie, and Holly, respectively, my friends who ran the race with me as part of #teambadass.  Mile 23 was for my friend Angi aka Bubbles, whose leukemia diagnosis started me running in the first place and who I believe saved my life by getting me healthy enough for my own cancer battle.  I cried a little of course thinking of Angi, but told myself to Bubble Up and keep going.  Mile 24 was for the wonderful support group I’ve met in an online Facebook breast cancer group, some of whom are stage 4, some of whom still can’t exercise without pain, some of whom are fellow runners, and all of whom have taught me a lot about what it means to come out the other side of treatment.  Mile 25 was for my husband who spent the whole weekend getting me ready for this marathon and doing everything he could to make sure I wasn’t stressed and everything went perfectly, including leaving the room two mornings in a row before he had even had coffee (if you’ve met him, you know this is a big deal!)

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And the last .2?  That was just for me, to celebrate being alive and NED.

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I cried and ran all the way across the finish line (and then thanked my lucky stars that my watch and phone did NOT die during the race because they wouldn’t let Tony into Grant Park to meet me so he had to verbally direct me back to the race day resort).  Had a beer, took my clinical trial medicine that Tony carried all day so I wouldn’t miss a dose, and then met our friends for the celebratory champagne.  I was tired, of course, but so happy to have made it across the finish.

When I signed up for Chicago, I had hoped to run it in 5:15 or less.  Of course, I wasn’t exactly planning on a cancer diagnosis at that time, and I finished in 7:03:17.  Which, it turns out, was a 35 second personal best.  So while I don’t recommend surgery, chemo, and radiation as a training method, it worked out okay after all.  I can’t wait to see what I can do next.

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Five Finger Death Punch to Cancer

So, the plan ever since we found out that I was stage 3 (not stage 4, which would have taken away surgery, or stage 2, which might have taken away chemo) was for us to do four steps to get rid of the cancer and stop it from coming back:  1) surgery; 2) chemo; 3) radiation; and 4) Tamoxifen/Arimidex, which are two types of endocrine therapy —  drugs that prevent the cancer cells from binding to the estrogen in my body. I’m on Tamoxifen now because I’m still technically pre-menopausal despite chemo effectively throwing me into menopause; I’ll switch to Arimidex, the post-menopause version, after I have my ovaries removed next month, because it’s more effective for my type of cancer.

But right around the time I finished radiation I got a voice mail from my oncologist which I didn’t fully understand, something about a clinical trial and Ibrance and they were just opening a new protocol and she thought of me immediately.  I made an appointment to go in and see her, and it turns out that Eli Lilly had been working on a CDK 4/6 inhibitor to compete with Pfizer’s Ibrance (they run ads for Ibrance on TV, featuring “Julie who is living with metastatic breast cancer”).  US Oncology was participating in a brand new clinical trial for Eli Lilly’s similar drug, abemaciclib, but you had to have a certain type of cancer and be in a very particular place with treatment in terms of radiation and the endocrine therapy.  They wanted to compare recurrence rates between people who only took the endocrine therapy with people who did endocrine therapy and abemaciclib.

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Not really my type of music, but I admire their style.

I just so happened to be in exactly the right place in my treatment, and hearing how excited my doctor was about the drug, (and after being assured I could drop out of the study if I received the trial drug but found out the side effects were too severe) I signed up right away.  I was the first patient signed up for the trial at my oncologist’s practice, and we later learned I was the first participant in the entire U.S.!  It’s not a blind study, but I had to wait over the Labor Day weekend before I could be randomized into one of the two study arms.  Luckily for me, I was chosen to take abemaciclib!  We successfully added a step 5 to our plan.  Take that, cancer!

So, how does it work?  Beats me.  Okay, so from what I understand, a CDK is a “cyclin-dependent kinase.”  CDK 4 and 6 are particulars types of CDKs.  A CDK tells your cells to keep dividing – usually in adults, most of your cells don’t need to reproduce so their reproduction is kind of “turned off.”  One of the things that happens in cancer is that the cancer cell’s reproduction switch gets stuck in the “on” position, and in breast cancer it’s CDK 4 and 6 that they think cause the switch to get stuck.  So by inhibiting these CDKs, any breast cancer cells hanging around won’t be signaled to reproduce and they’ll die off.    Now, interestingly, you do need your bone marrow to keep reproducing new blood cells and your digestive tract’s cells are constantly reproducing.  So one of the tricks is to make sure those cells don’t get turned off when they turn off the cancer cells.  (I have no idea how scientifically valid that explanation is, but that’s my understanding of how it works.)

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This is a breast cancer cell dividing.  Looks pretty, is actually ugly.

When I started on abemaciclib it wasn’t yet FDA approved.  Last week it was approved for certain stage 4 patients and given a name – Verzenio, which I think sounds like something I might order at a tapas place or maybe a brand of wine.  They also gave it a price tag of over $10,000 a month (which is in line with both Ibrance and the other drug in this class, Kisqali, but is still pretty ridiculous, right?).  Luckily since I’m in a clinical trial I get it for free.

They told me I might have some fatigue and diarrhea from the medicine, but so far I haven’t had much of either.  Of course, there’s no way to test what it’s doing, but I’ll take it for 2 years and then they’ll compare recurrence rates at 5 and 10 years out, so we’ll see.  I’m just happy to have one more tool to use to fight the beast!

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