July 11, 2010

Dear Family and Friends,

It has been many months since I’ve written and so many life changing issues have transpired. As you know, we sold our home in Michigan. In March, we purchased and moved into a new one in Florida, said good-bye to our many, many friends and said hello to a few new ones here in Florida.

We feel very blessed to be here and to be a part of Florida Hospital. David heads the cancer program and is initiating new programs and creating the vision to enhance their state-of-the-art cancer program. I’m working at Florida Hospital in a department that looks at quality and safety. Much of this I have learned through my previous work in oversight of a hospital research program. Developing new programs is something I learned through my work in administrating a cancer program.

Once again I’m getting up early in the morning with enthusiasm and a passion for what I do. I wake at 5:25am, exercise using the Wii for 30 minutes (no basements in Florida to hold the treadmill), eat, dress and I’m off to begin work on such things as decreasing hospital infections, efficiencies in transporting a patient from one part of the campus to another and seeking new ways to provide a safe environment for both our patients and our employees. It probably isn’t a surprise to many of you that quality and safety in the hospital setting is becoming a national imperative.

Cancer Time: It’s time again to think about my cancer. I am the type of person that can easily put it out of my mind. I don’t worry about it because I truly don’t think about it. I was diagnosed over a year ago, completed surgery, radiation, and chemotherapy. In August and September of 2009, I started my bi-annual infusion of Zometa, a drug that keeps my bones strong. In addition to Zometa, I take an aromatase inhibitor (AI) daily to eliminate any remaining estrogen in my body. I have no trouble taking my AI because I religiously take the pill with breakfast – a meal I haven’t missed in years.

Here is how AI works:


When no estrogen is present, estrogen receptors remain inactive. However, when estrogen receptors are exposed to estrogen they trigger a chain of events that can cause tumor cell growth and multiplication. Zometa is a form of hormone therapy known as an aromatase inhibitor. It works by reducing the amount of estrogen produced in the bodies of postmenopausal women. Surgery, radiation and chemotherapy are used to remove hormone receptor-positive early breast cancer cells from the body. Even if a woman has undergone one or all three forms of treatment (which I did), a small number of breast cancer cells may remain which is why the AI is necessary.

Since I completed my radiation a year ago June, I’ve had one mammogram. You may recall I wrote about this and how a false positive mammogram led to another biopsy – which was not cancer. That was January 2010. Now, here I am again, prepared for the next follow-up scan. This time I’m to have another magnetic resonance imaging (MRI) scan of my breast. I need that because my original breast cancer was not seen on a mammogram (even after the radiologist knew it was there). Not everyone needs an MRI for follow-up of their breast cancer. Last time I had an MRI it was to help determine that there were no other signs of cancer in my breast besides the one lump.

I won’t go into the details again but please recall I mentioned how the staff appeared to leave the room for an eternity and I actually thought they left to go have lunch! I’m sure they didn’t but this time I hope they talk to me during the scan. It worries me to be alone in a machine such as a MRI.

What the images will reveal (taken from internet source):


I met with a cancer specialist here at Florida Hospital to provide my bi-annual breast exam, order the follow-up scans and the Zometa infusion. Zometa is very easy to get and takes about 20 minutes via an infusion. I need to go to an infusion center at Florida Hospital. I’m hoping to get into one that specializes in cancer patients, routinely administers chemotherapy and hopefully staffs with nurses certified in oncology. Am I asking for much? I’ll keep you posted.

Emotionally – As I mentioned previously, I don’t think about it my cancer. I’m a woman of purpose (meaning I feel necessary and have something to offer) with my family and my new job. The children frequently visit and I stop everything I’m doing to be with them. Perhaps I wouldn’t have done that had I not gone through a life-threatening experience like cancer. I’m not sure. I definitely don’t race through life any longer. I allow myself to be in the moment.

That doesn’t mean I’m not frustrated at times and wish to get ‘on with it’ – so to speak. It took me a long time after the cancer treatment to feel energetic again. That was extremely frustrating. I’m still not at my former weight or stamina however having a routine of early morning exercise, eating well and being of purpose guides me through the day so I’m not so quick to look to tomorrow as I once was.

I know, because I’ve counseled many, some people respond to their cancer diagnosis and treatment by becoming more spiritual. I think I have always been spiritual so I don’t believe it pushed me further along that trajectory however I talk about it more now. I’m so thankful to be at a hospital where I can openly talk about my spirituality and that of others. Can you imagine an environment where you are not shunned for saying to a patient – would you like for me to pray with you? I would have so appreciated that when I was going in for my breast biopsy or having that last MRI.

Finally, I can practice nursing like I was taught at the College of St. Teresa. Man (people) is bio (biological), psycho (psychological or emotions), social (family and community) and spiritual. You know that is how I’ve always practiced nursing and being here is full circle for me. I can now practice nursing in the manner in which I was originally educated and trained.

I’ll write again after my MRI. Thoughts and prayers are with you.

Love,

Veronica

February 27, 2010

Dear Family and Friends,

As many of you know, David has accepted a position at Florida Hospitals and will start mid-March. We have been in a whirlwind of activities selling our home of 20+ years, buying a new home, packing and putting closure to our life here in Michigan. Most difficult for both of us has been saying good-bye to our friends (a broad term that includes our patients, co-workers, the ladies that have cleaned our home over the past 15 years, etc. Just on and on with ties to people that have been so much a part of our lives here).

Yesterday, David had his last day at Cancer Care Associates. He couldn’t sleep last night as he felt all the emotion of someone that has placed his heart and soul into building a program over the past 19 years. We will both miss our Cancer Care Associates life. The staff are remarkable people that believe the mission as much as we do.

Today we pack everything we plan to take from the garage attic and pitch and/or donate the rest. Most everything is down from the attic and spread out on the floor of the garage so that we can open boxes we haven’t looked through in years. David is now willing to give up his medical school books and note cards and I’ve decided that the 22 year old high chair can finally go to someone else. It’s amazing to us what we’re finding in the attic.

Our new home is smaller than our home here in Michigan because it has no basement. This is our fourth home in our married life (now 34 years) and we’ve never owned a home that didn’t have a basement. What do people do with all their stuff? Where do you put the skis, the turkey roaster, the old coffee machine that still works but you can’t make yourself part with? I’m still trying to wrap my head around a house without a basement and the storage issues that will result from a lifetime of being able to store.

What about my career? I’m looking for something at Florida Hospitals too. I’m open to new opportunities but persnickety – does that make sense? I find myself looking forward to the Christian environment that seems to shroud Florida Hospitals. I appreciated the difference in hospital surroundings when working at St. Mary’s Hospital at the Mayo Clinic for my nursing training in the 70’s. Then, it was okay to sit bedside with a patient and pray with them. I’d like to find myself in that kind of setting once again. For the short term, I’m happy that I won’t begin a new position until we are settled in our new place. I need to “feather our new nest” and make this house a home.

Many of you have asked about our children and how they will handle our relocation out of Michigan. First, it is important to remember that our adult children have had trouble building careers here in Michigan and have slowly left the state with no plans to return in the near future. When David was offered the position in Florida, one of the things we talked about was the opportunity it might present to have our children and grandchildren geographically closer. We hope that happens over the next few years.

Last thought today – I keep going over in my mind the phrase “when one door closes, another one opens.” I think that sums things up pretty well for us. Our life here in Michigan is coming to an end however our new life in Florida is just beginning with opportunities and adventures we would have missed out on had we not taken the chance and stepped through that open door.

Our new home in Florida has a beautiful lanai overlooking a peaceful back yard. That’s my image now as I disassemble our home from basement to attic.

Thoughts and prayers are with you.

Love,
Veronica

January 27, 2010

Dear Family and Friends,

Results of the core needle biopsy – NEGATIVE. All is fine. I had to wait a day before the results were back and during that time I thought about what I would do if I had more cancer. How would I react? Every possible scenario went through my head. Now that I have the results, those thoughts still linger. I’ve had trouble falling asleep and I’m waking at 4am.

I do have a special understanding now for those women that opted for the bi-lateral mastectomy versus lumpectomy. Sometimes we don’t get the choice for the lumpectomy and when we do part of the decision needs to include how the follow-up will be handled. Am I going to worry every time I have a mammogram and a calcium deposit looks suspicious?

NOTE TO SELF: Follow-up and Survivorship Issue

• Tests beget tests

~ Most of my friends with a history of cancer always say they prefer to be tested to rule out recurrence but I’m not that way. I don’t want to stick my head in the sand but frankly one false positive test and whew…………..my breast is insulted yet again with 22 X-rays (yes, I said 22), a needle and a tremendous amount of compression...and perhaps harm to some good cells? Who knows?

I have no answer. All I can say is that I’ll follow the National Comprehensive Cancer Network (NCCN) guidelines and try not to drive myself crazy when ‘something’ shows up!

Thoughts and prayers are with you.

Love,

Veronica

January 26, 2010

Dear Family and Friends,

As mentioned a couple of days ago, I had my first post-cancer treatment mammogram. Unfortunately, the radiologist discovered some new calcifications in the same breast so the mammogram was followed by a core needle biopsy. It’s my first core needle biopsy and probably like most cancer survivors, I find myself asking…do I have to experience every type of diagnostic test and cancer treatment known to man? Here’s what I learned about core needle biopsies.

• No preparation is needed. Eat, don’t eat – makes no difference. They do advise not taking aspirin or aspirin like products such as fish oil or Vitamin E for a couple of days prior to the procedure (to prevent excess bleeding) but other than that there is nothing to do in preparation for this procedure.

• The core needle biopsy places a woman on a thin metal table (metal so that the x-ray’s don’t penetrate). There is a hole (literally) in the table so that one breast can hang.

• The technician positions the breast for the radiologist to view the suspicious area (clusters of calcium deposits in my case). Positioning the breast took about 40 minutes. It was more than uncomfortable and a couple of times I actually gasped from the pain. I kept thinking that perhaps I should have taken the Valium when they offered it earlier.

• The facility was fine. I have no complaints. There was jazz music playing the entire time and everyone was kind.

Now I’m in the wait and see period following my first post-treatment mammogram and I’m wondering had I opted for the double mastectomy versus lumpectomy if I could have saved myself this additional grief? Also, is this what it’s going to be like every time I have a mammogram? Wait and see? Oh – I hate that.

I followed up the mammogram with a bone density test and should get the results shortly for this as well.

I’ll keep you posted.

Thoughts and prayers are with you.

Love,

Veronica

January 24, 2010

Dear Family and Friends,

Again – I wait too long to compose an entry for the blog and then have so much on my mind I want to share.

In terms of my ‘cancer’ – I’m now considered a survivor. I’ll soon approach the one year anniversary from my diagnosis. Follow-up for me means that I have a mammogram (every six to 12 months for the next 3 years) and a bone density scan for my Osteopenia / Osteoporosis (every 3 years) on Monday. This will be my first mammogram since surgery and I will confess that I’m more concerned about a false positive result than anything else.

I have the nagging worry in the back of my mind that I could have more cancer but my rational side repeats the statistical odds over and over to quiet that part of the worry. However, the false positive fear lingers and then I start thinking that something else will pop up requiring further testing.

I’m actually hoping for an improved bone density scan. The last one was done several years ago and it showed that my Osteopenia had improved everywhere except my wrists (you may recall my wrist fracture in June 2009). I don’t exercise as vigorously as I did a year ago but I take more Vitamin D and calcium plus I do passive resistance work using my wrists so I’m hopeful that there will be improvement.

Probably the most important information I want to share is that David and I are moving to Florida. I’ve written before how difficult the Michigan economy is for the private practice medical oncologist. The state is burdening physicians with additional taxes, the third party payers (insurance) are reimbursing less for the care provided and the hospitals in Michigan are struggling too so they have fewer initiatives to help. In addition, our kids are leaving the state because they can’t find jobs here.

David was offered a wonderful position with Florida Hospitals in Orlando. I was particularly struck by the hospital's religious base– something that we both appreciated when we met in 1975 at St. Mary’s Hospital in Rochester Minnesota (a Mayo Clinic Hospital). David talked about recently walking into the hospital entrance and seeing a picture of surgeons leaning over a patient and Jesus over the surgeons guiding their work. I want us to work at a hospital like that again. I want God to be a part of everyday work-life not something that is hush-hush and fearful of offending hospital administration. David’s position will be to enhance their cancer program – much like what he’s done over the past decade. I just sent them my own curriculum vitae (resume) and I’m hopeful I can find something within the same hospital system too.

That’s our update. I’ll write more when I get the results of my mammogram and bone density scan.

Thoughts and prayers are with you and your family.

Love,
Veronica

January 12, 2010

Dear Family and Friends,

All is going fine here. My hair continues to grow and I can tell my strength continues to return. It has been seven months now since chemotherapy treatments ended and four months since my last radiation treatment.

I want to talk about the milestone coming up in the next week. I am scheduled to have my first post treatment mammogram and bone density test than once the results are back, I will see Dr. Benitez (my breast surgeon) to go over the mammogram results and start the process of lifelong monitoring.

In regard to the annual mammogram, I’m just not too interested in it. As you may recall, my breast cancer was not discovered on a mammogram and even when they knew it was cancer, they still couldn’t detect the tumor on the mammogram. However, I’m knowledgeable enough to know though that just because it wasn’t caught on a mammogram the first time, doesn’t mean another tumor wouldn’t be caught another time.

The bone density test is a repeat of one I had a couple of years ago when they discovered I had Osteopenia (bone loss). Apparently, 40% of all adult women have Osteopenia and 7% have Osteoporosis. In addition to the history of Osteopenia, I began an aromatase inhibitor in September (2009) which stops the production of estrogen in post-menopausal women. Aromatase inhibitors work by blocking the enzyme aromatase which turns another enzyme, androgen, into small amounts of estrogen in the body. Aromatase inhibitors can cause bone loss (osteoporosis).

Cancer patients with symptoms of bone pain sometimes have bone scans to look for cancer that may have gone to the bone; e.g. breast cancer; prostate cancer; etc. A bone scan is different than a bone density scan. A bone density scan, or DEXA, uses a low amount of radiation (less than a chest X-ray) to measure your bone mineral (BMD) and predict the chance of fracture. The test takes about 20 minutes and the results are returned within a week. The DEXA scan results will come in the form of two scores:

* T-score: The T-score is the difference between my bone density and the bone density of young, healthy women. A score above -1 is considered normal. A score between -1 and -2.5 is classified as Osteopenia and a score below -2.5 is classified as osteoporosis. The score is used to estimate my risk of breaking a bone.
~ Results of scan in 7/2008: My T-score range was in the level for Osteopenia in my back and hip however it was in the osteoporosis level in my wrist. Oops – remember the wrist fracture while on a cruise to celebrate the end of chemotherapy in June 2009?

What have I been doing to help strengthen my bones?

* I walk two miles a day on a treadmill and lift weights (I started passive resistance training for my wrists late last summer).

* Zometa: In the past I took Boniva (ibandronate sodium) monthly for a couple of years. Boniva is the medication advertised on TV showing Sally Fields playing with her grandchildren. I didn’t like Boniva because I didn’t like having to get up early to take the pill and then waiting to eat breakfast. Plus it was monthly and I sometimes forgot to take it. Lastly, my insurance didn’t allow me to buy more than one month supply so I had to make monthly trips to the pharmacy and I had a co-payment each time.

I switched to Reclast (zoledronic acid). Reclast is given once annually as an infusion. I had the nurses at our office give it to me (nothing like experienced chemotherapy infusion nurses administering non-chemo medications painlessly). Now, as a breast cancer survivor, I’m taking Zometa (zoledronic acid). Reclast and Zometa are the same, both are zoledronic acid however the difference is that Reclast is FDA approved for the treatment of osteoporosis and Zometa for prevention and treatment of bone loss in cancer patients. Reclast is given once a year at a slightly higher level than Zometa and the latter can be given on a monthly basis or once every six months. I get Zometa every six months.

* Vitamin D

* Good nutrition (lots of vegetables and fruits).

~ I’m still trying to get my weight back to what it was before surgery in February 2009. You may recall that I gained nearly 10 pounds. I still have about 3 or 4 to lose.

* Multivitamin

I’ll update you once the results of my tests are in.

Thoughts and prayers are with you.

Love,
Veronica

December 19, 2009

Dear Family and Friends,

I’m relaxing in Minnesota as I await the annual Blaha Christmas Party at Janet and John’s home in Minnetonka. Life is pretty much back to normal for me thus no time for blogging. I’m not entirely back to the level of exercise intensity I was at prior to my diagnosis however I am able to stay involved in family activities until 10 or 11pm and wake easily at 5:30am. It feels good to be ‘normal’ again.

At the office, we just completed an eight-session group program for people who are struggling with Stage IV cancer. I’ve participated in many groups with cancer patients. Most often it is with newly diagnosed cancer patients however this time I wanted to structure a program with people that have lost all naivety about their cancer diagnosis, treatment and survivorship. I may write more about this program later but for today, I want to share some of the comments made by the participants.

THEME: Am I going to survive this cancer?

• One women with breast cancer that has spread to the brain, bone and the liver shared a story about how she hesitates to go to her dentist because her internal dialog questions “why bother getting my teeth fixed when it’s likely I won’t be here long enough for anyone to see them?”

• Another woman with colon cancer that has spread shared how when she was really sick she found herself coming to the conclusion that it was okay to die. Once she started to feel better however, she says she got greedy – and wanted more time.

THEME: Can we talk about funerals here?

• How do I get a coffin for my wake when I’m planning on being cremated?

THEME: Talking with adult children about advanced cancer

• It’s okay for children (even adult children) to believe that you’re going to survive cancer, even when you think you’re not.

This group was a phenomenal experience for me and truly a privilege to be a part of with these unique women. I’ll write more on this later.

Merry Christmas.

Love,

Veronica