6 months-Looking at the numbers

My six-month anniversary for finishing chemotherapy has come and gone.  It is already hard for me to fathom that just six months ago I had days where my resting heart rate was 120 and when I would try to ride my mountain bike (for whatever reason) my spinal column felt like it was going to explode.  The day was marked by a routine (6-month) visit to my medical oncologist.  The appointment was pretty straightforward; reviewed how I am doing since finishing chemotherapy, discussed any side-effects I'm experiencing with Tamoxifen, and we all poked and prodded at that little nodule I found in November.  The consensus with this team is that it is probably a normal lymph node that can be felt because of my lack of adipose tissue in my breast.  I was then reminded to not poke and prod at it.

The Huntsman medical oncology team is great, but the most interesting part of the visit was getting the results from my labwork.

Since I like numbers, I made a chart comparing how my lab results fluctuated over the course of my treatment and recovery from treatment.

	2/1/11 (prior to surgeries and chemo)	5/6/11 (3 weeks after 1st chemo treatment)	5/27/11 (3 weeks after 2nd chemo treatment)	6/17/11 (3 weeks after 3rd chemo treatment)	7/29/11 (6 weeks after chemo treatment)	12/16/11 (6 months after final chemo treatment)
WBC count	5.42	7.01	8.33	6.48	3.63	6.82
RBC count	4.64	3.81 L	4.05	4.03	4.21	4.47
Platelets	285	379	280	277	178	193
Hemoglobin	14.1	11.7 L	12.4	12.2	13.3	14.3
Hematocrit	41.3	33.9 L	35.8	36.0	39.2	41.6
Ferritin						34

Note: My labwork was much more comprehensive than this summary, but these are some of the values I was always most interested in.

Definitions: 

L-Low value

H-High value
Chemotherapy's affect on bone marrow:  Chemotherapy suppresses the bone marrow.   Bone marrow produces cells that become white blood cells, red blood cells, and platelets making people who are undergoing chemotherapy treatment more susceptible to infection, illness, and anemia.
WBC count:  Cells of the immune system that defend the body against infectious disease.  The Neulasta shot I received after each chemotherapy treatment helps the bone marrow produce more wbc. 

RBC count:  RBCs deliver oxygen to the body tissues.  The Neulasta shot has no effect on RBC production.
Platelets:  Platelets help the blood clot.  High levels of platelets may indicate anemia among other things.  

Hemoglobin: Protein in red blood cells that carry oxygen.  Lower than normal hemoglobin may indicate anemia among other things.

Hematocrit:  % of the volume of whole blood that is made up of red blood cells.  Lower than normal hematocrit may also indicate anemia among other things.

Ferritin: Protein found inside cells that stores iron so your body can use it later.  Low ferritin may indicate iron-deficiency anemia.  

Interesting to note:

My WBC count increased while undergoing chemotherapy.  This is because after each infusion I got a Neulasta shot that helped my bone marrow produce white blood cells.  Clearly this shot was effective in doing its job and I didn't have to become a complete germ-o-phobe during treatment.  

I was always interested in the value of my RBC count because the lower my RBC, the more fatigued I felt, and the less I was able to do.  If it dropped too low I would have needed a blood transfusion.  Fortunately it never came to that.

My lab results indicate that at a cellular level my body is back to pre-chemotherapy status!!!!!!!!, I am now most interested in my ferritin level. My plant-based diet is not especially high in iron and my ferritin levels are on the low end of normal.  Because of this, my oncologist recommended I take a small iron supplement.  

Now that my six-month anniversary is in the books I look forward to my seven-month anniversary being celebrated by my first MRI and Sonocine since finishing treatment.  That comes after my little trip to Hawaii with my favorite person in the world though!

Happy Holidays

Fabulous Las Vegas

After my little scare a few weeks ago, I quickly compartmentalized the experience and moved on.....

Last weekend Shannon and I traveled to Las Vegas.  For Shannon it was part work/part play.  For me, it was all play.  How did I chose to spend my time in Vegas?  Mountain biking of course!

The trip started in standard Shannon and Jen fashion.  We left Wednesday night after work and stopped in St. George, Utah for a quick night ride on Prospector.  We soon realized that we left the key for the Rocket Box (our rooftop storage) back in Salt Lake City.  No worries, all of our bike stuff was in the car so we proceeded with a fun spin on Prospector.  Once we were done with our ride we started scheming how to get the Rocket Box open.  I had a personal interest in this because it was all of my clothes that were up there.  To make a long story short, Plan A panned out; we made it to the Las Vegas REI just before closing and they were able to get us a key to open our box.  Phew.

We then drove over to the Wynn hotel right on the Las Vegas strip.  Not typical lodging for a mountain bike trip, but Shannon's conference was at the hotel, so it was convenient and free.  It was pretty comical hauling our bikes through the casino everyday.

 My bike hanging out in the room

Fancy hotel on the strip

Thursday, Shannon was in conference all day, so I was on my own.  Never one to have any difficulty entertaining myself,  I cruised down to Bootleg Canyon with both my bikes.  Yep, the BMX bike made the trip to Vegas as well.  An hour on the pump track at Bootleg was worth it!  Friday and Saturday Shannon was able to do some afternoon riding with me.  We rode Bootleg Canyon and Blue Diamond and while the riding was fantastic, I'm pretty sure our lack of trail knowledge resulted in us missing some epic singletrack.

Bootleg Canyon. We rode till dusk everyday.

Saturday night, disaster struck.  Shannon got sick.  Blah. Our delightful weekend came to an end, at least for Shannon.

Sunday's plan was to meet friends and ride in St. George.  Ride time 10:30 AM.  I woke up plenty early however we got on the road admittedly a few minutes late.  About an hour into our drive I looked at the clock in the car and it said 10:30.  Damn.  St. George is in a different time zone than Vegas.  Because all of our electronic devices automatically switch times, we overlooked this minor detail.  Oops.  We were now running more than a few minutes late and speeding up I-15 wasn't going to make up for this! Luckily, the planned ride had a few different trailheads so I met the group about an hour into the ride and didn't hold them up too much.  Lucky for me too as the riding and company were fantastic.  I rode hard and felt great which was especially pleasing since it was my 5th consecutive day on the bike.

A lot of girl power in this photo!

Never one to want me to miss a ride (or a good time for that matter), Shannon waited patiently in the car, feeling like dirt, while I rode for 3 hours.  He didn't complain once.  I guess I'm on cooking duty this week!

Giving Thanks

I realize that Thanksgiving was actually last week; hopefully the late post has allowed me extra time to reflect on what I am truly thankful for.

If you asked me last Thursday what I am thankful for, I probably would have said the typical (and I suppose some atypical) things like a husband who rocks-he really does by the way-I'm not just saying that, great friends and family whose small and large gestures of support will never be forgotten (you know who you are-thank you), new friends who I only met because of mutual unfortunate circumstances but whose incredible spirt and zest for life helped me realize how great life can be after treatment which allowed me to (on good days) enjoy life during treatment, a warm home, yummy food, a ton of bikes including a brand new to me used BMX bike, a mischievous and energetic puppy who has turned into a great hiking/running partner, a loyal and tolerant cat who reluctantly puts up with above mentioned pup, a head full of hair, increased energy and strength every single week, and of course being healthy.

Saturday night, my perspective changed pretty quickly when I found a small nodule in my left (non-mastectomy) breast.  I tried to stay calm, take a deep breath, and convince myself that it was nothing-stastically 80% of the time it is nothing-but when you have heard the words cancer before there is a new sense of urgency when you find something abnormal.  Admittedly, my mind was racing with every potential scenario.  I had already decided that I was going to get a mastectomy; obviously my breasts were doomed.  I rescheduled my training and race season.  Mastectomy in December, on the trainer two weeks later, mountain bike at four weeks, legitimately training at 6 weeks?  Oh god, would I need chemo?  I was also thinking, perhaps prematurely, what would I do with my work bag?  Certainly a sentinel node biopsy would be done and after this procedure one of the precautions (to reduce lymphedema) is to avoid compression on that extremity.  The type of compression that a heavy work bag slung over your shoulder provides.  I already follow these precautions on my right side....now my left too?

I knew I needed an ultrasound for peace of mind.

So Monday it was back to Huntsman for a mammogram, ultrasound, and exam.  The mammogram and ultrasound found nothing abnormal.  I was not surprised the mammorgram was negative, mammogram has never been a good diagnostic tool for me, but I was incredibly relieved that the ultrasound showed nothing as well.  Phew.  My surgical oncologist and NP were able to palpate the nodule, but only when I was in certain positions.  Specifically, laying on my right side with my left arm over my head.  Anyhow, their best guess is that it is a lymph node, fibrous breast tissue, or part of my pectoralis major muscle.  I was told by multiple medical professionals that because I don't have much adipose tissue, that any normal lump or nodule feels more pronounced.  The best news.  No mastectomy and no need to reschedule my race season.  I follow-up in two months. Another phew!!!  and a deep sigh of relief.

So....I am still thankful for my above typical (and atypical) list.  But I am also reminded in a pretty harsh way that I am mostly thankful, beyond words, that I continue to have no evidence of disease.

On a lighter note, I got my very first post-chemo haircut this week.  Like I said, I am thankful to have hair, even if it is short.

I'm also thankful for my brand new used BMX bike.  This thing is so cool.  It is just asking to be hammered.  Whenever I see it in the garage, I have to ride it up and down the street, and visualize pumping it over BMX jumps.  It is also the least expensive bike I have ever purchased.  It cost less than my first Univega mountain bike that I bought way back in 1994!

My first mountain bike-1994 Univega fully rigid

Brand new to me used Redline BMXer

PS-Huge shout out for the wonderful staff at Huntsman Cancer Institute and although I am very thankful for them, I hope I don't have anymore unplanned appointments with them!

Pedal hard, pump harder

What do closing the door, shutting you out, high/low line, low/high line, pumping, and manual all have in common?  BMX of course!

Last weekend was all about BMX.  I raced Rad Canyon Indoor BMX Friday, Saturday, and Sunday.  The folks over at Rad Canyon put on a stellar series.  I have heard that their outdoor series is the largest in the country!

Why the attraction to BMX?  I'm not sure.  A few years ago I thought about trying it, but my plate was full and it never really fit in my schedule.  So, since I'm currently not officially training - yet- it is perfect timing to try something different.  I also like that I can go race BMX and have no expectations and therefore no disappointments.  Just pure joy of being silly on my (er....a borrowed) BMX bike.  That is a good thing in my life right now.

I've only ridden a BMX bike four times-the same number of times I've raced- but I've quickly learned that there are other reasons to love BMX.  Here are my top 5 reasons:

1. No chamois necessary.  That is because in BMX racing you are either standing up hammering or pumping jumps....for about 45 seconds at a time.  There may as well not even be a saddle because you don't sit on it.  Cross-country mountain bikers often joke that chamois time is training time.  I'm not sure how this equates in BMX.  I had NO chamois time last weekend, so I guess no training time?  In case you're wondering what people do wear.  The cool kids wear the equivalent of cross country racer's sponsor kits but in BMX style.  (Baggy, pull-over jersey with sponsor logos and long, baggy pants).  The super cool kids have their name, nickname, and ranking on their jersey.  Since I'm not cool nor super cool at BMX, I wear jeans and a sweatshirt.  
2. The key to being fast at BMX (as I overheard a 5-year old girl tell her friend) is to pedal REALLY hard and pump REALLY hard.  Sounds simple enough, right?
3. You don't have to be super fit (although I'm sure the top racers are), but if you are not fit, you better have skills and tactics.  I think if BMX racing were a time trial, I'd do great.  Well, it is not a time trial and I apparently don't have skills or tactics.  I get blocked a lot on the parts of the course where I can go fast and passed a lot on the jumps so that I can then be blocked again where pedaling is required.  
4. BMX racing has a way of making you feel really young....or old....depending on how you look at it.  Practice is divided into 13 and under and 14 and over.  They don't card you or anything, but I'm pretty sure that I didn't get mistaken for belonging in the 13 and under group.  On the other hand, Sunday I got my ass handed to me by a 12-year-old.  (In my defense, she is supposedly really, really good:)  In BMX (cruiser-24" wheels) there are no categories for beginners, intermediates, or experts.  It is divided by age-group.  If there are not enough people to fill an age-group, they are combined.  Sunday, the youngest person in my race was 12. The oldest in her 40s.  It was awesome!
5. It appears as though trophies are very important in BMX.  One of the FAQ on the RAD Canyon website is 'How big are the first place trophies?'  In case you are wondering, the answer is...."First place trophies for a regular race are 16-18".  Double points races are larger and triple points can be 36" or taller"!  
6. Okay, I can't limit it to just five.  Finally, BMX is awesome because it is cheap!  The only requirements are that you wear long pants, long shirt, and a helmet.  Easy enough.  Pretty much any bike goes (in the cruiser group), although having a legitimate BMX cruiser bike appears advantageous.  A full-face helmet is not mandatory, but probably a good idea as well.  Races cost $10.

Me & the Park City dirt jumpers.  We were all BMX newbies.  

(Photo Aaron Kruger)

Old people do BMX.  Photo from old guy (&girl) clinic.  

(I'm bottom right, Shannon is back row ~4 from right)

As for how the racing went....since I had no expectations, AWESOME!  I am most proud of the fact that my starts are improving every singe race.  I went from 2-weeks ago being waaaay off the back at the starts, to last Sunday being 2nd (behind that dang 12-year old) until the first big jump where I proceeded to get passed by 3 girls and then shut out in the first corner where I can go fast.  So according to that 5-year old girl, since I can pedal hard, I just need to learn how to pump hard and I will be fast at BMX.  Simple enough!

After cancer.......

It is now over four months since my last chemotherapy treatment (June 17th) and three months since my last surgery (August 15).  I am completely healed from surgery and done with cancer treatment. (although technically I still have 4 years 9 months to go before I take my last Tamoxifen pill).

In general I feel good; better than I thought I would feel at this point in my recovery.  There is a sense of normalcy back in my life as I have started preparing my body, with a bit more focus, to 'officially' start training for the 2012 race season in January.  My atrophied upper extremity muscles (due to surgery) are getting stronger every week.  I would estimate that at this point I have regained approximately 75% of my upper extremity strength.  Every day on the bike is a great day.

As much as I want to move on and look optimistically to the future, I have reminders each and every day of what I've been through and what still lies ahead.

There are physical reminders.  I now have five new scars to add to my collection of scars scattered over my body.  Obviously there is the mastectomy scar, there is also the sentinel node biopsy scar, breast biopsy scar, axillary biopsy scar, and two scars where the drains were post-mastectomy.  I have always been fond of the scars on my body, they tell the story of my life, but for some reason these scars are just....different.  I could do without these five new scars.

I am also adjusting to my new body (i.e. breasts).  I really, really liked my former body.  I liked the way it looked and the way it felt.  I will admit that it is possible I have put my former body on a bit of a pedestal and 'think' I liked it more than I really did.  Regardless, my body is different, and I am working on getting used to it. Fortunately each day my new body is feeling more and more like mine.  I spend a lot less time examining and scrutinizing it in the mirror.  My new breasts are feeling so much like my own that I no longer fear crashing my bike and damaging them.

Daily medication and side effects also make it difficult to put this year completely behind me.  Each morning I pop a Tamoxifen pill.  Tamoxifen is a very powerful anti-cancer medication for estrogen receptor positive breast cancer.  This little white pill reduces my risk of local recurrence (yes, cancer can recur in my mastectomy scar or axillary region) and distant recurrence  (metastasis to other organs/bones) as well as developing a new cancer in my other breast by about 50%.  Pretty significant in my eyes.   It is not without side effects, though.  The most frustrating being hot flashes.  Yes, between the chemo and the Tamoxifen, my hormones are completely out of whack; possibly permanently.  I often get hot flashes at night that wake me up in a hot sweat.  Then I get cold because I am sweaty.  This makes me cranky because not only is it a reminder that cancer treatment has put my 35 year-old body into essentially menopause, but I don't like being awoken in the middle of the night!  The 50% reduction makes it worth it though.

Then there is the fatigue.  I realize that I am fortunate that I have been able to exercise consistently through and after treatment, but there does seem to be some mild fatigue.  It is very subtle and sometimes I am not even sure if it is real, but I do know that after a long day at work my brain is tired and I need a short nap before I can even consider doing my workout.  I have a lot of second guessing in how hard to push myself and how long to recover from hard workouts.....and even when I should start racing seriously again......will it take my body a month to recover from a 100miler?  will I ever be able to recover fast enough to do a stage race again?  will I be competitive?

Finally, there are the doctor's appointments.  Granted, it is wonderful to not have weekly appointments, but routine oncology visits will never go away, ever.  That is because with (invasive) breast cancer you never know if you are cured.  That is, and I'll put it bluntly, until you die of something else.  It can come back in 6 months or 20 years.  Honestly, I don't know where these billboard statistics of 99% cure rate if caught early come from.  My guess, Stage 0 (non-invasive) cancer.  Anyhow, I digress....  Since risk of recurrence (both local and distant) IS greatest in the first 5 years, I am to see my medical oncologist and surgical oncologist every 6 months.  I also alternate mammogram, MRI, and sonocine every 6 months.  My plastic surgeon would also like to see me annually.  Each appointment and test will likely bring some fear in what may be found.  I believe this gives a whole new meaning to 'test anxiety'.

I've recently been looking at photos of me from last year this time.   Even though it was only one year ago, I see a sense of innocence in me in those photos.  I had cancer at that time, but I didn't know it.  To have so few worries, such freedom, I miss that.....

So I have a few more things to think about than I did before I was diagnosed with cancer last January.  Who knows, maybe someday I won't think about these things but in the meantime life is different.  I am different.

In 2008 racing TransRockies was the hardest thing I had ever done.  Many of the days were cold and wet.  I had been battling a foot injury all summer and developed a knee injury on day 2 (of 7) of the race.  When I returned, everything seemed easier.  I thought, if I can finish this race, I can do anything.  In comparison to what I have done this year, TransRockies was cake.  Who knows what I can do now.

RAD

Overall, this week was just rad.

It started with my birthday Monday.  Yep, I'm a Halloween baby.  It was a beautiful fall day and I spent most of it in the mountains.  A great start to my 36th year....

Tuesday I found out that I was selected by Cycling Utah as Female Rider of the Year.  To put this in perspective, the Utah Rider of the Year title has been awarded to Tour de France stage winners in the past.  I am completely speechless about this honor.  Okay, I will say this...  The love and support I have received from the Utah cycling community has helped me beyond words get through this difficult year.  Thank you.  I hope that I can live up to this honor.  I plan to work hard, doing what I love, and return to racing as strong as ever.  Maybe reading my story will help newly diagnosed women to be a little less scared about cancer treatment.  This higher purpose is definitely aiding in fueling my fire now.

Thursday and Friday I started working on my 2012 race schedule.  Somehow, it keeps getting more and more ambitious.  It is certainly not solidified yet, and some of it will depend on how my body responds and recovers from actual training and racing, but so far, in my opinion, it is a perfect mix of my favorite classics and new and exciting events.  I am really, really, REALLY excited.

Today, to conclude an already incredible week, Shannon and I raced BMX at RAD Canyon.  This was my first time on a BMX bike,  I had a loaner, and it did not disappoint.  We participated in a clinic in the morning where I (along with about thirty 10 year olds:) learned some basic BMX techniques such as taking the high/low line and how to survive the starting gate.  I never did master the track-stand (something to work on) in the starting gate and my starts paid dearly, however I had a great time drilling it for the 45 second effort.  I also need to work on my post-race high five and fist bump coordination with my fellow competitors.  I quickly learned that BMX racing is different from mountain bike racing as blocking and cutting racers off is acceptable and even encouraged.  We had so much fun; I will definitely go back.  First I need to sharpen my elbows though:)