6-week anniversary

To celebrate my 6-week anniversary since my last chemotherapy infusion, I got to visit my oncologist today.  Overall, the appointment was a breeze.  I had blood drawn for labwork, a physical exam, and I got to ask my rather short, but always interesting, list of questions.

Today's appointment reinforced what I am feeling; that I am doing well.  I am happy to report that my labwork results look really good!  Everything continues to be in the normal range and my red blood cell and hematocrit levels are creeping up closer to my personal baseline in February.  No wonder my energy levels are increasing.  I am not scheduled to see my oncologist again until December!

The past six weeks have gone by pretty quickly.  I have spent the summer nurturing my body and hitting all of my favorite singletrack up in Park City.  It has been nothing less than sweet!  I have also spent a good amount of time watching and supporting at bike races.  I genuinely enjoy doing this and seeing fellow racers, especially women, achieve their personal goals.  That said, I get bummed that I'm missing out on the epicness (is that a word?) of the experience, especially when I see high quality ultra-endurance events.

There were two such events that I got to watch this summer.  The first was the PC-50. This 50-mile race in Park City (part of the Utah State Championship Series) somehow found 50-miles of super-fun singletrack to link Park City Mountain Resort to the Canyons.  I've ridden most everything up in Park City, but this course found some gems that I have never been on.  Since my husband (along with 3 others) promoted this race, I got to see first-hand how tirelessly they worked with the highest priority being to make it an excellent experience for the racers.  Based on the racer vibe at aide station #2, the race was a huge success.  It should also be mentioned that the payout was HUGE and deep.  The fastest male and female went home with close to $1000 each!

Steamboat appears to be mountain living at its best

Another super cool event that Shannon and I traveled to was the Steamboat Stinger. This 50-mile race was also a first year event held in Steamboat Springs, Colorado and was promoted by, you guessed it, Honey Stinger.  The town seemed genuinely excited to host an ultra-endurance mountain bike race, the race promotion was slick, and the course stellar.  I definitely want to return next year!  Even though I didn't get to race this event, I did achieve my goal of completing a 25-mile lap with 4000 feet of climbing....rather easily.  We also had a great time staying with great people and meeting some new friends.

My attention is now turning to my final reconstruction.  Next week, I meet with my plastic surgeon to reveal (and I do mean reveal, as in I have changed my mind quite a few times and he probably has no idea what I'm thinking:) my final reconstruction decision.  Surgery is scheduled for August 15th.

and if you haven't read enough already, here is a link to a blurb that Gene Hamilton with BetterRide (skills training and coaching) posted.  I attended a BetterRide clinic last fall and it completely changed and improved my riding technique.  I continue to do my 'drills' and am hoping to see big payoff when I start racing next year. Gene found out about my diagnosis last week.

(lack of) Hair

I did not lose all of the hair on my head during chemotherapy.  Only about 75%-90% of it:)  The funny thing is that the hair that I did keep kept growing.  It made for an interesting look for a while.  Well, I have finally shaved it (again) in hopes that my hair will grow in more even.  I am starting to see some little hairs burst from the follicles.  Very exciting stuff!

I really do not mind the simplicity of not having hair.  I'm really not a big fan of styling, and now I can seriously take a shower in less than 2 minutes which leaves a lot more time for things like.....blogging.  I even think I look pretty good bald (ok, so I exaggerate); but I definitely look more bad-ass than I've ever looked before.

Honestly, though, I am very self-conscious about not having hair.  Even though I strut around my house hatless all the time; I have not gone out in public without something on my head.   I think it is because the bald head is like announcing to the world that I have (had) cancer.  I realize the irony that I write a blog about my experience with cancer, yet I don't want to go out in public and be thought of as that poor girl with cancer.  Interestingly, I must be good at not looking like I just finished chemo as not once has a stranger asked me a question about my headwear or treated me like I was sick.  I like that!

So, without further ado, here I am:

I'm trying to look as bad-ass as I can.  Notice the rain drops and cloudy sky.

Profile of my bald head.  Notice the beautiful blue skies.  

This is 15 minutes later; storm passed, sun out, need sunglasses.

I really wanted a more professional bald photo with beautiful scenery in the background, but we haven't really had time for that, and thankfully I'm running out of bald time.  Our deck will do!

Not related to hair, but warranting mentioning, my body seems to have adjusted to the Tamoxifen.  The muscle cramps seem to have gone away.   Yeah!!!!!

I also had an incredible acupuncture appointment yesterday.  Today, I feel like a rock star.

Little White Pill

Monday I started Tamoxifen.  This little white pill will be part of my breakfast for the next five years.  I already have a love/hate relationship with this pill.  On one hand, it is very effective.  Tamoxifen blocks the actions of estrogen, and since my breast cancer is estrogen receptor positive (it requires estrogen to grow), it reduces my chance of distant metastasis, local recurrence, and new breast cancer by about 50%.   On the other hand, it is a medication, and like any medication it has side effects.  I know many women who take tamoxifen with little to no side effects (I'm hoping to fall into this category), but then again I have heard horror stories as well.  I have had significant muscle and joint cramps/aches this week.  I did get out for a nice bike ride yesterday and a good hike today; exercise seems to help.  But not for long.  I'm hoping that as my body acclimates to the new medication, that the annoying discomfort subsides.

Another new consideration is that I need to consciously avoid soy and flax products.  Both soy and flax are very strong phytoestrogens and they may compete with Tamoxifen for estrogen receptors thus reducing effectiveness.  I realize that soy is in just about everything making it next to impossible to completely avoid, but I am going to make an effort to avoid foods with soy listed on the ingredient label.  I certainly don't want to be taking this medication only to reduce its effectiveness by eating the wrong food.  This may not sound like too big of a deal, but do you know how hard it is to find an energy bar that does not have soy OR flax?  I have been scouring labels, to no avail, please let me know if you have any suggestions.

***Blog Amendment: After consulting with the nutritionist at Huntsman, it appears as though flax is potentially okay to have in my diet even though it is a very strong phytoestrogen. Although there is no current research on humans, according to an article from the American Institute for Cancer Research, flax had an enhancing effect for Tamoxifen when tested on mice***

Besides this, I have been keeping myself surprisingly busy for being off work.  or maybe I'm just good at wasting time?  I have been exercising (almost) every day and worked my way up to a nice, easy 3-hour bike ride on part of the PC-50 course last week.  My current motto for exercising is to keep the efforts at conversational pace.  This is allowing me to maintain some fitness, reap the therapeutic benefits of being on my bike, and not overtax my body as it recovers from chemo.

One of the bigger creek crossings in the PC-50

I have also continued with my plant-based diet.  Last week's theme was cauliflower and quinoa.  I now have 3 really good recipes with cauliflower, one that includes salmon (ok, so not completely vegan, but pretty close).  As for the quinoa, I did not have as much success.  One of my recipes wasn't clear on how to prepare it and it ended up being undercooked.  The other, quinoa and veggie stuffed bell peppers, was pretty good....not great.  To top it off, I finally bit the bullet and purchased a Vitamix blender today.  One of my co-workers has generously 'loaned' me hers since February.  She called me today to say that she saw them at Costco for $100 off (hint, hint).  The sale is for 3 more days, so if you're thinking about getting a Vitamix..........

This really is a green smoothie.  It has loads of Kale and red cabbage.  It also has protein powder, MILA, banana, strawberries, blueberries, and blackberries.  

Next week it is off to Steamboat I go.  I can't wait to explore some new trails.

Dizzy loves to hike.  He doesn't love to come....

Food

I am 12 days out from my last infusion and just finishing up with the week where my immune system is weakest.  Once this week is over, I really feel like I will 'officially' be on the mend from chemotherapy!  My poor body has been through so much since February and my goal for now is to nourish my body and help it heal.

Over the past few months, I have accumulated quite the library to help me do just that.  Up until now, Shannon has taken primary responsibility with cooking healthful meals for us.  Since I'm done with chemo and have a few weeks off work, I have decided to take over the cooking duties and become (more) proficient at our new style of eating.

Some of our anti-cancer cooking resources

Even though I have 'no evidence of disease,' I will never know for sure if I have been 'cured' of cancer.  The one thing I do have control over is how I take care of my body.  Basically, we are focusing primarily on a plant-based diet.  Even the Nutritionist I consulted with at Huntsman recommended a plant-based diet.  This is not to say that I can not/do not eat any animal products.  I'm still eating quite a bit of greek yogurt and I do occasionally sprinkle some low fat cheese on my food, however the literature (I have read) strongly supports limited animal product as part of the anti-cancer diet.  In support of our new diet, Joel Fuhrman, M.D. writes in Eat to Live that countries that get the greatest percentage of their diet from unrefined plant foods have the lowest percentage of deaths from heart disease and cancer and David Servan-Schreiber, MD, PhD recommends that "the anticancer diet is made up primarily of vegetables and legumes prepared with olive, canola, or flaxseed oil, or omega-3 butter, herbs, and spices.  Unlike the traditional Western diet, meat and eggs are much less prominent; they are served as accompaniments in small amounts".  

The second staple to the anticancer diet is reducing sugar/white flour - foods with a high glycemic index.  It is common knowledge that when sugar is consumed blood glucose levels rise rapidly and insulin is released.  Insulin release is accompanied by IGF (insulinlike growth factor) whose role is to stimulate cell growth.  Basically, according to Servan-Schreiber, sugar (indirectly) nourishes tissues and makes them grow faster and essentially serves as fertilizer for tumors.   Pretty good reason to reduce sugar intake!

I definitely still have room for improvement at implementing this diet, but it does seem to be getting easier especially as I become more proficient at preparing meals.

How does this fit in an endurance athlete's diet?  I'm not quite sure yet, but there are successful elite level athletes who are vegan so I'm confident that a modified vegan diet is possible.  

Here are some yummy meals I cooked up this week.  I'm not very good at following recipes, so usually I start with an idea from one of my cookbooks and then wing it.  

I can't remember exactly what I put in this, but it looks like pinto beans (cooked in a slow cooker) topped with sauteed kale, corn, mushroom, red onion, olive oil and garlic.

Black bean, yam, spinach, onion, garlic, and sprinkled mozzarella cheese on a whole wheat pita.  This meal had 26 grams of protein!

2 egg whites (see I do eat some animal product) topped with sauteed kale, mushroom, red pepper, and green onion makes for a yummy breakfast.

The very best breast cancer fighting foods (According to Servan-Schreiber in Anti Cancer): kale, broccoli, cabbage, cauliflower, brussel sprouts, scallions, leeks, and garlic.  Our fridge is usually loaded with this stuff, although I need a good cauliflower recipe.

And of course, the requisite Dizzy photos:

Dizzy likes to watch me do yoga and I guess he thought he would try out my mat.  He is now almost one year old and is earning more house privileges although he did chew up Shannon's flip flops this week:)

**I suppose I should have a disclosure that this anti cancer diet is what I feel is right for me at this moment.  I am in no way suggesting that I have any idea what the best diet is to prevent cancer**

Certificate of completion

Yesterday I was awarded my certificate of Chemotherapy completion and a nice fuzzy blanket for completing 4 rounds of TC (taxotere,cytoxan) over 9 weeks. Even though when I finished my final infusion, I really just wanted to get the hell out of there, my eyes swelled up with tears as the Huntsman infusion room staff presented me with my certificate and sang me a song. I am so happy and relieved to be done and I hope that the next few weeks go smoothly. Basically, the drugs given to me yesterday will be in my system for around 3 more weeks and then my body will officially be able to start healing.

Overall, my final chemo infusion was pretty uneventful. I started a few hours earlier than usual which meant that I was on the bike a little after 7:30 AM to ride to the hospital. It was a beautiful morning and it felt so good and empowering to ride in. A little dirt therapy prior to a long day in the hospital works magic on the mood. My long day started with an appointment with my plastic surgeon. Over the past month, I have been busy consulting with 4 different plastic surgeons; I think I have a pretty good grasp on ALL of the options available to me and am getting closer to making a final decision. I am tentatively scheduled for this surgery the middle of August at Huntsman. I promise to do a complete post on this.

After meeting with the plastic surgeon, it was on to having an IV placed, blood drawn, and meeting with my medical oncologist. My oncologist is out of town so I met with her nurse practitioner and nurse. My labs came back almost great. Red blood cells, white blood cells, liver, and kidneys all appear to be maintaining levels and functioning very well. My bilirubin was slightly high, which (I think) indicates that my liver is working extra hard to metabolize the chemotherapy drugs, but I was cleared to go on to the infusion room later in the day.

During this appointment, I had a lot of (what I thought) were interesting questions for the oncologist. First, I wanted to better understand how my red blood cells are affected by chemotherapy. Basically, my bone marrow (which produces white and red blood cells) is being suppressed by the chemotherapy drugs. The Neulasta shot I take the day after infusion helps with white blood cell production, however does not help with red blood cells. My bone marrow will be suppressed for approximately 3 more weeks and then it takes up to 120 days for my red blood cells to be replenished. Even though my red blood cells are considered in the normal range right now, they, along with my hematocrit values are significantly lower than what they were prior to chemotherapy. I hope that as my levels improve, my strength and speed on the bike improves as well. 120 days is a looooooong time!

I also discussed with my oncology NP my final reconstructive surgery. She recommended to wait 7 weeks from today for final reconstruction. Although waiting this long is not ideal (drags out the process), I am willing to wait to make sure my body is completely recovered from chemotherapy prior to surgery. I am tentatively scheduled for August 15th. Recovery from this surgery should be fairly quick, and I should have absolutely no restrictions after 3 weeks.

Today's actual infusion was uneventful. I was given the IV benedryl first which immediately put me to sleep and once again I slept through most of the infusion.

Now that I have finished chemotherapy, I get a 3 week break before I start Tamoxifen. This medication is pretty mush as effective as chemotherapy in reducing my risk for local and/or distant recurrence. Tamoxifen is an antagonist of the estrogen receptor in breast tissue. According to Wikipedia, "Some breast cancer cells require estrogen to grow. Mine is estrogen receptor positive. Estrogen binds to and activates the estrogen receptor in these cells. Tamoxifen is metabolized into compounds that also bind to the estrogen receptor but do not activate it. Because of this competitive antagonism, tamoxifen acts like a key broken off in the lock that prevents any other key from being inserted, preventing estrogen from binding to its receptor. Hence breast cancer cell growth is blocked". I will take a daily pill of Tamoxifen for the next 5 years!

In the meantime, I haven an appointment at the Cancer Wellness House for Therapeutic Touch on Monday and my weekly acupuncture on Tuesday. I plan to meet with the naturopath to work on completely detoxing my body after about 3 weeks. I'm also looking forward to a highly recommended detox acupuncture appointment. Also, since I have the next 6 weeks off work, I plan on scheduling free appointments for therapeutic touch, massage, and craniosacral therapy at the cancer wellness house.

Hair update:

I'm also looking forward to my hair growing back in. I still have quite a bit of 'fuzz' on my head, but I plan on shaving it down and taking some photos before it starts growing back in. As for other hair, I have so far kept my eyelashes and eyebrows. My leg hair has thinned significantly but grows quite long. I actually had to shave last week. I haven't lost a single arm hair, son of a......it hurts whenever they take my IV out. How long will it take for my hair to grow back? Who knows. I can't believe how slow Shannon's hair has been growing back though!

The Chemo training plan

The first week of June 2010, I rode my bike 9 hours 15 minutes. That was including a Saturday 5.5 hour training ride in preparation for Lumberjack 100 two weeks later.

Here is my training log for the first week of June 2011:

(Note: Yes, I still keep a training log. I have documented every workout since I was diagnosed in January)

Monday: Mountain biked from house-up drycreek-shoreline trail-to city creek- home.

1 hour 45 minutes. Endurance pace.

Tuesday: Work day. 1 hour hike with Dizzy in Round Valley (watched part of the Midweek race).

Wednesday: Work day. Rest day/no workout.

Thursday: Work day. Craniosacral treatment. Mountain biked on Shoreline for 1 hour. Endurance pace.

Friday: Mountain biked on Shoreline for 1 hour 15 minutes. Endurance pace. Acupuncture.

Saturday: Mountain biked Corner Canyon. 1.5 hours. Endurance pace. Upper extremity/Core workout.

Sunday: Mountain biked Glenwild. 2 hours. Endurance pace.

Even my over-achieving self admits that this was a pretty good week (my highest volume since February) for being two months into chemotherapy. The only pathetic part is that I don't have a single photograph. Obviously I'm not doing any sort of hard efforts or ultra-endurance rides, and I do fatigue easily (I nap after every ride), but I really feel like I am maintaining at least a little bit of fitness. More importantly, I think that the consistent moderate exercise is helping to cleanse my body of toxins and allow me feel the best I can under my current circumstances.

Up next is my last week of work before a 6-week hiatus for summer break.

Oh yeah, my FINAL chemotherapy infusion is this Friday too. I am so ready to be done!

Officially 75% done

There is a light at the end of my chemo journey. It is faint, but it is shining brighter every single day.

Infusion #3 side effects so far have been really similar to infusion #1 and infusion #2 side effects. The only difference was that I had a super low grade fever over the weekend. I actually bore myself talking about it, but just as a reminder, mostly to myself, Sunday and Monday post-infusion suck. I know that Sunday and Monday will be my bad days, but somehow seem surprised each time when the fatigue sets in and food tastes like cardboard. So far, I seem to have bounced back nicely and have once again been enjoying life.

The weather has been drop-dead gorgeous in Salt Lake and I got out this morning for a perfect ride.

A beautiful day in Salt Lake City

I really wanted to ride up Millcreek Canyon to Pipeline and Rattlesnake Gulch, but since this is my low immunity week there are two things I'm trying to avoid: rattlesnakes and bees. Actually there are a million things that I'm trying to avoid, but for my ride's sake I stuck to rattlesnakes and bees. Since there are frequent rattlesnake sightings on Rattlesnake Gulch (hence the name), I opted for a more chemo 'safe' ride on the Shoreline. I'm usually bored to death by the Shoreline this time of year, but since chemo has restricted me to the road every third week, it was a treat to ride some dirt.

It was warm enough to sweat a little today

At the bottom of the 'grassy climb' on Shoreline.

As for the light at the end of the tunnel, my final infusion is scheduled for June 17th. I won't consider myself officially 'done' with chemo until the first weekend post-infusion when I start to feel more like myself. After that, I have my final reconstruction surgery (date to be determined). There will be a few weeks of restrictions after this surgery, so unfortunately more downtime. This may be a good thing, though, so I don't go too crazy and overdo it as soon as I am done with chemo. I know my body will need time to recover from chemo; I hope I have the willpower to give my body that time. As for final reconstruction, I am still in the process of deciding what I am going to do, and since it is an elective procedure I am not in a huge hurry. There are lots of options, options are good, but make the decision a bit harder, especially for a person who has a tough time making decisions. I will do an entire post on my decision making process when I am ready.

As for post-chemo plans, I am ready to start making some. We have not traveled since the weekend before my mastectomy in March. I think that is a record for consecutive weeks spent in Salt Lake City. I am ready for some trips! We are planning a trip to Steamboat in July and Wyoming in August. Perfect timing to get a break from Salt Lake's high desert summer heat! In the meantime, I hope to spend the next two weeks enjoying our mild weather and rippin' some trails.