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.

Chemo # 3/4-Check!

Yesterday was a pretty good day for infusion Friday. Woke up and generally putzed around the house before I rode my mountain bike to my first appointment of the morning with the plastic surgeon. My ride on the Shoreline trail was fantastic. I can literally ride dirt to the entrance of the hospital. I think I was also experiencing a 'Floyd' high as I had started my pre-infusion regimen of steroids on Thursday. I haven't felt this 'high' before, but for some reason, I was just giddy yesterday. Shannon was at the hospital waiting for me with the car so we would have a safe place to park my bike for the day.

Can I say, once again, best. husband. ever.

I was visiting with the plastic surgeon because the time is getting closer for my final reconstruction surgery. Yes, I have one more surgery after I finish chemo. As I have mentioned before, a temporary implant was placed at the time of the mastectomy. This gives my breast some shape and it also has a port in it that allows us to inject saline and slowly stretch the surrounding skin and muscle to my final desired size. We have expanded a few times and it seems to me that there may be some leakage. Slow leakage, but leakage none-the-less. This is only saline and is not dangerous to be absorbed by my body, but it does add a possible complicating factor in to my final reconstruction. Yesterday was kind of an experiment. My plastic surgeon inflated the expander himself and I will report back to him in a few weeks if I notice any leakage. Fortunately, if it is leaking, it is happening slowly and since I decided against the DDs we can probably get a way with a few small expansions right before my final surgery and be just fine.

If you're interested in what the expander looks like here is a photo:

The black spot is the port where saline is injected to expand. It is all under the skin so a magnet is used to find the port. Expanders are not the most comfortable of things, they're not soft like permanent implants, but I'm fortunate that my has become quite tolerable and I only occasionally notice it. This is all pretty amazing. I'm assuming that the 'small' size is what is in my breast right now.

This appointment went pretty quickly and since we live so close to the hospital, we were able to go home for lunch and 45 minutes of puppy play time. Dizzy was more into sunbathing though.

At 1:15 we were back at Huntsman for my blood draw, IV placement, and meeting with my oncologist prior to my 2:30ish infusion. My bloodwork all came back in the 'normal' range. I was psyched that my red blood cells and hematocrit were back to 'normal' and this added to my giddiness. White blood cells are holding up nicely thanks to my post-infusion Neulasta shots (these shots cost $7000 each! Fortunately insurance pays for them) and liver and kidneys continue to be working great as well!

At around 2:45 I was called back to the infusion room. Pre-infusion meds took a good 45 minutes. I got more steriods, anti-nausea meds and then we added IV benadryl and an antacid. I had a short reaction at the start of my last infusion, where my throat closed off and I got scared; these additional meds were to help combat that. They seemed to work, but they also put me to sleep. So much for my 'Floyd' high. I slept through most of my infusion. At 6:15 we were done, the IV was removed and we were on our way by 6:30. I was the last patient in the infusion room once again!

Today, as usual, I'm feeling pretty good. I'm being diligent about my post-infusion medication and I just got back from a delightful ride with Lyna on the Shoreline. It is a perfect day and we thoroughly enjoyed it. Now a short rest (for a few hours) and then it is back to Huntsman for my Neulasta shot. Tomorrow, I fully expect to wake up tired and achy, however, as much as it sucks, I must remember that too will pass. As usual, I will not consider myself officially 75% done until after my post-infusion hump week.

This week is looking to be perfect. Not to be selfish, but the weather looks to be crappy on my crappy days and then turn around and be warm and sunny just as my body hopefully starts to turn around as well.

'On the mend'

I was hoping that I wouldn't have to be 'on the mend' until after my 3rd infusion, but unfortunately this week did not go quite as planned. I was recovering from my second infusion as planned until Monday night. A few hours after dinner (Note: a dinner full of steamed veggies that was SUPPOSED to make me strong and healthy) my stomach started to hurt. As I was trying to fall asleep my stomach started to hurt so bad that I actually took one of my anti-nausea pills. Now, over the past six weeks I have NEVER needed an anti-nausea pill except for the mandatory days post infusion so I really wasn't feeling well. I had a terrible time falling asleep and by morning I was achy all over. I felt like I was back to day 2 post-infusion with an upset stomach as a bonus. Needless to say, I never made it into work that day and the highlight of my day ended up being a warm bath. The good news was that I had no fever. In fact, I was questioning the accuracy of my thermometer because my temperature was well below normal. Regardless, this was a relief. Anyone who has undergone chemotherapy has had it pounded into their head that a temperature above 100.5 is considered a medical emergency. Since my temperature was in the 96-97 range, I was not too worried.

Tuesday night my stomach was relieved. I'll spare the details, but it was not pretty. Not as bad as my epic food poisoning incident post Whisky 50 last year, but I did need to stay within 20 feet of a toilet for a couple of hours.

By Wednesday morning I was starting to feel better and ventured into work for a caseload meeting. Once at work I found out that quite a few of my co-workers were out with the flu, so now I'm not sure if it was food poisoning or the flu. I suppose it could be either as chemotherapy messes with your gut AND makes you more susceptible to viruses. Fortunately, I am certain that I am recovering and should be able to proceed with infusion #3 tomorrow.

Overall, I am happy that my body was able to recover relatively quickly from this little set-back and that I was well enough today to sneak a ride in on dirt.

There are a lot of epic cycling events taking place this weekend. My teammate Karen Potter is racing the Tran-Sylvania Epic Stage Race, a 7-day stage race in Pennsylvania. She finished second last year! Gunnison Growler is also this weekend. Shannon and I ventured to Gunnison to compete in this race last year. Locally, there is the Stan Crane Memorial race. This is one of my favorite local races on the super fun Corner Canyon trails. I will not be competing in any of these races, but I will be participating in my own personal marathon tomorrow. It all starts when I meet with the plastic surgeon at 11:15. I still have one final surgery that we will be discussing. Then I proceed to have my blood drawn and IV placed prior to my 1:15 appointment with my medical oncologist. My infusion is scheduled to begin at 2:30 and usually lasts a couple of hours, however I have never started on time so I plan on being at Huntsman through dinner. As has become my routine, I will get a little bit of dirt therapy in the morning.

After that I will be back to week one post infusion. The good news is that I will be 75% done!

No news is good news

Week 2 post infusion 2 seems pretty similar to week 2 post infusion 1. This week I worked, rode my bike, and even did some core/upper extremity work a few times. Don't get me wrong, this is NO walk in the park, however I feel fortunate that so far I am strong and healthy enough to remain somewhat physically active. For this my sanity is happy as well.

I am over being worried about my elevated B12 levels. Both my oncologist and naturopath say, "better high than low". Instead I will focus my worries, because of course I need to worry about something, on my red blood cell count. Prior to my last infusion, my bloodwork indicated that my RBC count was just below the normal range, indicating that I am slightly anemic.

Low red blood cells=anemic=low energy levels=can't ride my bike.

I am certainly not to that point yet, but I don't want to get to that point either. I have noticed that when I get up too quickly that I am dizzy, just like my puppy:) and a sign of anemia. There is not a lot I can do to control my RBCs, however I am trying to get plenty of rest and eat well. The moment of truth will be this Friday when I go in for my 3rd infusion and get a new set of bloodwork results.

Honestly, if this is my biggest worry at this point, I'm pretty fortunate. This is hardly worthy of a post. Like I said, no news is good news.

In cycling related news, there is the possibility that I may do a little bike race in October. This would be strictly for fun (as in I have no intention of 'training' for quite some time), but then again, bike racing isn't fun unless you are going hard:)