The "Sandra"

Karen and her friend, Sandy, picked up Karen's new wig on Saturday and it looks great! Truth is, you probably wouldn't know it's a wig unless you were really looking carefully, and even then I'm not sure.

In the end, it was the "Sandra" style with the brown and cinnamon color blend that won out over "Miranda" and "Emma", though it's quite possible those styles could sit on her head some day too.

For those who have followed Karen through her many hairstyles over the years, you've certainly seen this one before. I think this hairstyle is a throw-back to the summer of 2007 -- Karen's "bob" phase.

For the next few weeks it will sit perched atop a faceless styrofoam head on the dresser. Waiting.

My Sister's Keeper

Last night, Karen and I went to see "My Sister's Keeper," the story about Kate, a young girl with leukemia ,whose sister was conceived to help save Kate's life.

OK, maybe going to see this movie wasn't such a good idea. Not that it was my idea, anyway. Let's just say that it's not the kind of movie you want to see if you've just been diagnosed with cancer and are about to begin chemotherapy. Within the first couple scenes, and in others later, we watched as Kate got violently sick and threw up blood. There was no hiding from the realities of having cancer and the effects of treatment. The young girl's bald head and lack of eyebrows were an all too vivid reminder of what was to come for Karen. It was a difficult movie to watch, but we stuck it out 'til the end. Yet, it definitely added to the anxiety and fears Karen is experiencing.

It was a good movie with great performances by Abigail Breslin and Sofia Vassilieva. But I'm not sure it will win audiences given its difficult subject and graphic scenes of a young girl battling cancer.

Roller Coasters

I hate roller coasters. In fact, I hate most amusement rides, but I hate roller coasters in particular. My stomach and roller coasters don't mix well.

Yes, I know that roller coasters are an over-used metaphor for the ups and downs of a person's life. But I can't help but use that metaphor right about now. In these days leading up to the start of Karen's chemo treatment, it's as if our "cancer journey" is making the slow climb up the tracks to the crest of the first drop down the steepest hill. For Karen, that steep hill is her upcoming chemo treatment. The ride to the top is long and slow -- how better to build the anticipation and anxiety. As we climb, we can see the top, but we can't see what lies over the crest of the hill, which adds to the anxiety and uncertainty. But when we reach the top...away we go! In an instant, we're speeding down the hill. Whoosh! Your stomach muscles tighten (OK, mine do) and you brace yourself (OK, I do) as you fly along the tracks. From there you careen around sharp turns and up and down more hills. We can expect a similiar experience in the days ahead. And what about those who are also on board who have their arms raised high in the air? I think they must be the cancer surviors who have been through this before and who raise their arms as if to say "I've beat cancer" and it will be alright! Or perhaps they are all of our friends who have raised their arms high in the air as a sign of their support. Just as I know that I get off a real roller coaster in one piece -- shaken and dazed a bit -- I know that we will get off this roller coaster in one piece. Shaken and dazed, but in one piece.

Prêt-à-Porter (Ready to Wear)

I took a short break from blogging. Not because I was tired of blogging, but because there wasn't much new with Karen's treatment. Up until this week, we have been in a sort of a holding pattern as we wait until chemotherapy begins on July 9th. But we have started to use this time to prepare in a few ways:

• On Monday, Karen had a port implanted in her chest. This will make it oh so easier to infuse her with her chemo cocktail every two weeks. No need to try and find a good vein or poke her with a needle every time she has a treatment. Instead, the port will allow the oncology nurses a direct line right into her chest and right to her jugular vein. The Cytoxan and Adriamycin will get coursing through her blood stream in no time! The procedure to install the port -- though a short one -- still took the better part of a day between prep, procedure and recovery. And her recovery left her in more pain than she had expected. Karen doesn't have any fat on her chest. So without any "padding", the port and line is anything but comfortable.
  
  
• We also did some wig shopping together on Saturday. I've driven by the Wigwam (cute name, huh?) literally hundreds of times in the past 10 years. Never did I think I might find myself inside actually shopping for a wig with my wife. But here I was -- assessing whether the "Emma" or the "Sandra" was the right look for Karen. Or maybe the "Miranda" would be better...more hip and youthful, perhaps. And color? Would brown with cinnamon highlights be flattering or should we stick with blond highlights? The platinum blond wig on the mannequin was an interesting look. I'm sure that would turn some heads. Imagine the fun you can have in a wig salon! Though we settled on one (which one will remain a secret, of course, until it's unveiled), I'm thinking we may pick at least one other...or maybe several more so Karen can have a different look every day. In the end, we had a little fun with our adventure and Karen took one step closer to confronting one of the most difficult side effects of chemotherapy.

Shock and Awe

Karen's planned chemotherapy regimen may best be described as "shock and awe." I'm not sure any chemo protocol is light fare, but the treatment course prescribed as part of the clinical trial she'll participate in shortly is designed to pound the hell out of any cancer that may be left in Karen's body.

Today we got a chemotherapy tutorial -- a 2+ hour introduction to all-things-chemo. We left more educated and anxious to get this phase of treatment underway. We also left with a sense of dread (or I did) now that we are weeks away from Day 1 of a 22 week -- yes, 22 weeks -- course of treatment. That's 154 days, but who's counting?

The chemotherapy protocol involves three standard chemo drugs (Adriamycin, Cytoxan and Taxol, referred to as AC/T) and a fourth drug (Bevacizumab, aka Avastin) introduced as part of the clinical trial. The purpose of the clinical study is to determine if adding Avastin to standard chemotherapy reduces the risk of the cancer coming back, compared to using standard chemotherapy alone. The study specifically targets patients "who have breast cancer that has been surgically removed but has features that have a significant risk of recurrence". Karen fits this profile because she has "triple negative cancer" which is more aggressive and has a higher rate of recurrence.

The chemo protocol is what they call "dose dense" -- the intervals between each chemo treatment are shorter than with a standard protocol. So, instead of three weeks between each treatment, Karen will get chemo infusions every two weeks. Since the treatments are closer together, the theory is that the cancer has less of a chance to grow. But the higher frequency in treatments make these protocols tougher to endure. (Fortunately, Karen received an "I AM STRONG" T-shirt and bracelet from the American Cancer Society courtesy of a thoughtful client, so I think she's ready to go!).

In an earlier posting I shared some of the common, possible and rare side effects from the drugs. They're all ugly, so I won't bother re-hashing them again. Before we left our appointment today, we were armed with at least 5 or 6 anti-nausea prescriptions. I think you get the point. We also got other tips and instructions on what to look for and what to do when any of the other nasty or serious side effects occur.

In short, the 22 weeks of treatment break down like this:

• AC plus Avastin (or a placebo) every 2 weeks for 8 weeks. First treatment: 7/9
• 2 week break
• Taxol (T) plus Avastin every week for 12 weeks.

And on the 7th day, we rest.

The toughest part of the treatment will be the AC -- the first 8 weeks -- in part because the drugs have a cumulative effect. Our goal: make it to Labor Day! Depending on which "arm" of the trial she is on, she may continue the Avastin drug for another 10 weeks after the Taxol. There's a 20% chance she will receive the placebo instead of Avastin (she won't know that until near the end of the trial).

So...this is probably way more than you wanted to know (not that you asked). Chemo is fascinating, isn't it? If you logged on for more stories about Karen's attempt to squeeze into a new pair a jeans (see "Do I look fat in these jeans?" below), I'm sorry to disappoint you. But since this "journey" would not be nearly as fun without showcasing more of "My Life with Karen" (as opposed to "My Wife with Cancer"), please be sure to return on a day when we're not consumed with this annoyance called cancer.

You're so vain...You probably think this blog is about you. Don't you? Don't you? (Carly Simon)

For those of you who tune in to the blog to keep current on Karen's medical reports, as opposed to my deep thoughts and weekly reflections on our journey, hold on -- there is news! Actually, good news...the kind we like.

Dr. Tchou called today to say that she got "clean margins" during last week's surgery (it's about time!). Pathology reports indicate that she got all of the cancer cells from the breast tissue and there was no cancer in the chest wall. So for now, anyway, we bid good-bye and thanks to Dr. Tchou and will start to get to know Dr. Kaplan-Tweed who will guide Karen through her chemotherapy. This Thursday, we go to "Chemo School" (I'm not kidding, that's what they call it) where we'll learn more than we ever wanted to know about chemotherapy (look for the posting titled, "Shock and Awe", due later this week).

Karen also started physical therapy this week to help stretch and rehabilitate her arm which has developed a painful condition called "cording" (a muscle pulled tight like a violin string) -- a side effect of removing some of her lymph nodes. The physical therapy will also help prevent lymphedema -- a much more serious side effect of surgery that causes the arm to swell.

Karen returned to work last week just two days after surgery and is working a full schedule again. This is good in some ways, but tiring and stressful too since she still is recovering from her surgeries and trying to fit in other medical appointments.

Although I may stray to other topics, some about Karen and some that aren't -- I will always be sure to keep you abreast (I really do like how that word works in this context) of Karen's recovery and treatment. For now, it's a bit like the calm before the storm...though I'm not sure you'd share that same view if you spent a week with us.

(my thanks to Karen for her sense of humor...I think)

"Do I look fat in these jeans?"

"Do I look fat in these jeans?", Karen asked as she stood in front of the mirror.

I roll my eyes, sigh (I sigh a lot) and mutter an exasperated "No" and keep walking. (Note: there's only one right answer to this question).

There was a time long ago -- OK, last week -- when this was Karen's most pressing vanity concern. Mind you, she has no reason -- none -- to have angst about whether the Seven for All Mankind jeans somehow add pounds to her thighs. They don't. But she is Karen. Is there a bit of vanity involved here? Sure. Is it a bad thing? No.

Karen will wince at these words on the screen. But she's like many women who worry about whether their jeans make them look thin or fat, the gray in their hair and the glow of their skin. There's nothing wrong with it. Hell, we all -- yes, most of you too -- spend billons of dollars to look good. Karen takes tremendous pride in her appearance. She works on it. And it shows. I appreciate the effort she puts into looking good...in fact, I demand it.

(What? You're waiting for the "wink, wink"?).

It is true. Karen did ask me about her jeans recently. But the question gave me pause and struck me quite differently than the 238 times she's asked me the question before. My thoughts this time -- though not spoken at the time -- were that soon, too soon I feared, her concern over whether her jeans made her look fat would give way to a range of raw emotions she has never shared before. As the chemotherapy begins to take its toll on her body, it will throw her beauty regimen into a tailspin. This sounds harsh, because it is harsh. But she -- and I -- will learn how to deal with it and we will get through it. They'll be tears -- lots of them, and hopefully the ability to laugh. And the fit of those jeans? This I know: we'll look back at that six months from now and have a good laugh.

There's a certain irony between the beauty of a woman and the repulsiveness of cancer. It's hard to understand how the two co-exist. And though chemo may (will) take Karen's hair and her skin may become pale, she won't lose two of her most magnificent attributes: her Julia Roberts' smile or her beautiful brown eyes.

Because I know that the physical transition imposed by chemotherapy will be one of Karen's greatest challenges, I explored the Internet for information on how chemotherapy patients cope with the changes to their appearance. One of the programs I came across is "Look Good...Feel Better." It's a great program aimed at helping cancer survivors cope with an important aspect of their quality of life during cancer treatment -- their appearance. The program -- staffed by volunteers -- has helped thousands of women look and feel beautiful. It has given women confidence, boosted their self-esteem and helped them find hope and courage when they need it the most. Whether Karen participates in this program or something like it, I know that once she gets over the initial shock of the changes, she'll discover how to be...well, how to be Karen.

More than the program itself, I was attracted to the "Look Good...Feel Good" ad campaign. I included one of the ads at the top of this posting. But I was also inspired by the ad....inspired to dig through some old photographs of Karen to give her a role in the campaign too. I think the photo speaks for itself!

Drive-thru Surgery

I'm not sure why people keep demanding that health care needs to become more efficient. If Karen's surgery on Wednesday was any indication, Penn has got the efficiency thing figured out. This was as close as it comes to drive-thru surgery. Karen was swiftly whisked through the process: prep at 6:15 am...surgery at 7:30 am, out to recovery at 8:30 am and headed home to Harrisburg by 10:30 am (the early hour left no time for the beauty mask that preceded the last surgery) In fact, the four-hour round trip from Harrisburg was as long as the hospital visit itself. But we're not complaining, the care was still first-rate. From Artis the funny and irreverent receptionist who greeted us when we arrived to Karen's surgeon, Dr. Tchou. Though quick and efficient, we were happy to get back home.

Though Karen wouldn't want me to characterize the "re-excision" as uneventful....thankfully, it was (no scary side effects like her last visit). But having someone chip away at your breast tissue and chest muscle (just enough so that Dr. Tchou can prove that the cancer has not spread to the chest wall), is no fun. A re-excision is a procedure to re-open the lumpectomy incision to remove more breast tissue. If you've been reading this blog, you might know that the first surgery failed to get "clean margins" around the cancer. In other words, there were some cancer cells left behind (they're hard to find). So, Dr. Tchou went back for more. We now wait until next week to get the pathology report to confirm that the breast tissue -- and the chest wall -- are free of cancer. That doesn't necessarily mean that Karen is "cancer free". Oh, if only surgery could do the job. People ask why, if the surgery removes the cancer, why Karen needs chemotherapy. If just one cancer cell travelled outside her breast tissue and made its way to some other place in Karen's body, it could quickly divide and grow. So, chemo is like insurance...just in case there's still some cancer lurking elsewhere.

Kick Cancer's Ass

Karen's sister-in-law, Jen Huart, is participating in the Breast Cancer 3-Day walk in honor of Karen and other family and friends who have battled cancer. The event, held in various cities across the country on different dates, is a 60-mile walk over the course of three days with proceeds benefiting the Susan G. Komen for the Cure. This is Jen's second time participating in this event, which requires significant personal commitment, determination and endurance to complete. Thanks, Jen!

If you'd like to support Jen in her walk and help kick cancer's ass, you can visit Jen's personal page on the 3-Day website.