For those just joining us... FAQ

I haven't been all that public about my medical condition, In fact, I probably wouldn't be saying much about my situation to anyone, except that my need for chemo is making it pretty obvious that something is going on. So... for those who are just learning about my situation, here are the answers to some of the questions you might have:

Chemo? WTF? What happened?
Yeah, I know. Let's take this in pieces.

What kind of cancer are we talking about here?
I was diagnosed with Stage 1 breast cancer back in late May. Part was contained or 'in situ,' part was what they call 'invasive,' which sounds scarier than it is in my case. For me, "invasive" means that some abnormal cells had strayed just outside the "in situ" area, kind of the way your cat might step onto the porch when you open the front door. From what the tests are saying, my cat never left the porch. (Good kitty!)

Don't they do surgery and radiation for this kind of stuff?
Yup, and those are part of my treatment plan, too. I had surgery in early July to remove the tumor and surrounding "margin" tissue, along with a couple of "sentinel" lymph nodes that would tell us if the cancer had strayed from the breast to another part of the body. (Lymph is apparently the New Jersey Turnpike of transmission routes, without the occasional truck fire near Exit 8.) The good news was that they got the whole tumor, the margins were clear of any cancer, and the lymph nodes showed no sign of cancer either. Looking at it that way, the prognosis is really, really good. My oncologist went so far as to say that I'm "cancer free."

So if you're cancer free, what's with the chemo?
Here's where it gets interesting. At biopsy, the docs do tests on the sample/tumor to see if the cancer is hormone receptive or if it's what they call "HER2 positive." Based on the results, they'll put you on a drug regimen to lower the chances of recurrence. 

My biopsy showed that the tumor was highly hormone receptive, which is good - they'll eventually put me on Tamoxifen pills for five years, maybe longer. However, the HER2 test results were inconclusive, so I had to wait until they tested the tumor after surgery.

Sure enough, my tumor was one of the 20 percent of all breast tumors that came back HER2 positive. That means that there were abnormal cells that were sending out aggressive "growth" messages to other cells, meaning a heightened chance of recurrence. There's an IV drug for that, herceptin, which I'm getting every three weeks. But as my oncologist explained, they also don't know if there's some infinitesimally small, unmeasurable-by-current-methods bit of cancer that made a break for it and is hiding somewhere in my body, just waiting for its chance to make a move. They haven't done any studies on treating women just with the herceptin and not chemo, so we're playing it safe and dosing me with both.

That's why I'm on chemo.

How does chemo work? 
I'm getting infusion by IV. Basically, they stick a needle in you, attached to a saline drip, with a series of smaller bags containing drugs. My treatment team is giving me anti-nausea drugs and steroids to start, and then I get two different chemo drugs and the herceptin, one after the other. In total, it takes about three hours for everything to drip through. While I'm there I get to sit in a comfy recliner with a personal TV, read, surf the web on my laptop or luxuriate in the sounds of the yenta across the room kvetching about her daughter-in-law.

I get to have six "rounds" of this over the course of 18 weeks, starting August 10. The first day of the round is when I go in to get a blood test, talk to my oncologist and then get the chemo treatment. On Day 8 and Day 15 I go back in for toxicity checks - they draw blood and I check in with the onco to talk about the results and any side effects I'm feeling.

As far as how it works in the body, you'll have to ask someone else. All I know is that it's knocking out any cancer cells that are hanging out there. 

How do you feel?
Like the weather in San Francisco, it's always changing. Unfortunately, I can't take the advice of George Carlin, who said, "If you don't like the weather, move."

At this writing (August 26), I'm good. I'm in the middle of the third week after my first chemo treatment. This first round has been the shakedown cruise of sorts, giving me a road map of how my body will react to each treatment. I won't mince words: it's been tough, not so much physically as mentally and emotionally. The not-knowing how I'll feel on a given day is infuriating. It makes it very hard to plan a social life without looking like a total flake half the time. I'm very fortunate to have clients who are understanding that sometimes I'll have to take a meeting by phone rather than in person.

The most predictable side effects are those that would hit the more sensitive tissue of the body: mucous membranes of digestion and the mouth. They can give you drugs to help you with nausea, gastrointestinal malfunctions (no more need to be said) and mouth sores (yuck). What they don't really prepare you for is the assault on your senses of taste and smell. For about a week after treatment, everything but the blandest food tasted like crap, I constantly had to drink water to get the metallic taste out of my mouth, and my pores were exuding this icky metallic sweet smell that infused my clothes, bedding and seemingly everything I touched. Showering a lot was a very good idea.

Those who have been nagging me for years to stop drinking Diet Pepsi can rejoice: it now tastes like the stew of chemicals it is. And not pleasant ones. Haven't had one in over two weeks.

Are you still working?
Absolutely. I'm not totally laid out, and I can still think. Writing assignments are always welcome!

Wait a sec... I'm still stuck on the surgery. Last time I saw you, you looked the same. Did you get work done?
I knew someone would bring this up. I was very fortunate in that the amount of tissue they took was about the size of a lima bean, maybe a bit more. And it's in an area that doesn't really affect the contour of the breast. Yes, there's a scar, but it's not like they took a divot out of me. Thus there was no need for reconstruction. In a couple of years, it probably won't even show (My surgeon is a rock star!). As a dearly departed friend of mine once observed:

What's the deal with the naked mole rat?
Total non sequitur. Have you met them, though? They're fascinating. Neither a mole nor a rat. And hairless.


  1. Always with the funny metaphors. This FAQ was riddled with them.