On Remembering and Carrying On | September 11

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I wanted to go for a run downtown yesterday. Really, I wanted to park near the Pentagon and run across the Memorial Bridge onto the mall. But, figuring that security around the Pentagon would be crazy, I decided that wouldn’t be the best plan. My second choice was to park in Rosslyn and do a similar route coming back through Georgetown and the Key Bridge. But since I couldn’t find anyone who could spend the morning with me, and frankly, I had other things I should be doing, too, I settled and headed out on my normal neighborhood loop.

I’m sure there has been a cloudy September 11 since 2001. Yet I feel like every year, I look up to a bright blue, cloudless sky and think how amazing it is that every year, the sky looks just the same. In 2001, I headed into the lab super early every morning, so by the time the first plane hit the World Trade Center, I was finished with my morning’s work in the tissue culture room and came out to see the image on my labmate’s computer screen.  After a brief chat, we carried on with our work, but gathered back around the computer as word filtered down the halls that the second tower had been hit. I fielded the call of a friend who was supposed to be relaxing after defending her thesis the day before but was instead frantically looking for the work number of a friend who worked in the World Trade Center.  Finally, I remember running across the hall to stand next to the desk that would eventually be mine to look out the window into that crystal blue sky, watching smoke rise from the Pentagon before we were eventually sent home.

Somehow, every year on September 11, I feel compelled to run. Because I can. This year I wanted to go downtown, run past the same skyline I saw looking out that window. I wanted to run across the Key Bridge, remembering the fully armed National Guard troops who welcomed me across for weeks as our city struggled to return to normal. I was a little disappointed to “just” be running my normal loop. Yet as I ran the lovely wooded trail along the interstate, I could see the flags placed on the overpasses every year by the Arlington County Fire Department in memory of that day.  I saw the cherry blossom-themed sign pointing towards downtown.  Crossing over the interstate as I headed home, I could hear the hum of traffic and the rumble as a metro train passed under me.  The sky and the flag, so beautiful. The traffic, so blissfully normal. The day will not be forgotten, yet we have carried on.

And as for that run downtown, there’s always next year. (At which point my St. Louis Cardinals-loving eight year old would tell me I sound like a Cubs fan!)

Gettin’ My Groove Back | Running After Cancer

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I managed to run all through chemo. I didn’t go as fast, or as far, or nearly as frequently as when I was in top shape, but I had cancer. So I was winning. Then surgeries started creeping in, and I LOVE my plastic surgeon, but he’s a stickler about limiting activity after surgery. The six week ban on anything that causes you to bounce or break into a sweat probably isn’t necessary, but he wants to ensure the best outcome possible. When it comes to plastic surgery, I’m all for a good outcome, so I obliged.

We all know that breaking a habit is far easier than starting a new one, so at the end of each six-week doctor imposed hiatus, it took a while to get back into the groove of a regular morning run. And then as soon as I’d gotten back in the swing of things, I’d need another surgery. Training interrupted by surgery has kind of been my go-to excuse for the last two years. But just this week I realized that my most recent surgery was in June of last year. That means I’m almost a year surgery-free! Which is awesome. But also, that fact makes my go-to, perfectly respectable excuse completely pathetic. There’s no reason I should be sleeping in far more days than I’m getting out for a run.

Enter the plan to get back my groove. It is a multi-pronged approach:

  • Run with a friend: Accountability helps. And so does companionship. Last week I made Emma Clare run with me before Turner’s baseball game. I have a neighborhood friend who I run with before the kids head to school– our plan is twice a week. (When life doesn’t get in the way.) And then Sally and I have decided to resurrect our chemo runs, meeting in Old Town once a week or after a shopping outing, and have even added a third friend to that mix.
  • Make a goal: I’m completely out if I don’t set myself a goal. But with a (reasonable) goal, I’m a fierce competitor. So I’ve got a couple of friends in on it, and we’re doing a minimum of three runs a week and reporting back. I kind of wanted a mileage goal for myself, too. I decided on a May marathon– not that I’m going to run a marathon at the end of May (ha!) but that I’ll run a total of 26.2 miles in the month of May.  I’m off to a pretty strong start, though, so I am thinking I might need to up that goal…
  • Power through: This is the hardest. The weather yesterday morning was perfect for a run, the trails were packed, and the trees were lovely. And my run was abysmal. I’m not fast, so it doesn’t bother me to get passed. But yesterday, I got passed by a guy running in a cotton tee and dockers. (Hard to tell myself that he passed me because he puts in a lot of miles when he’s running in a pair of chinos.) Also, I got passed by a woman at least twenty years my senior, who, based on the fact that both knees were taped and she had a terrible gait, was running in a significant amount of pain. Hard to keep going after grandma limps by. The one lucky break? One of the top candidates for neighborhood gazelle joined the path quite a bit ahead of me, so she can keep saying with conviction that she’s sure I’m not that much slower than her. Nevertheless, I finished the run and was determined today would be a better day.  I had actually set up two running dates. First one got cancelled last minute because my partner’s dog hid one of her shoes. She never did find it! Second one cancelled due to that partner’s stomach bug. (Apparently, it’s not a great thing to be my running partner!) Thankfully, though, I powered through and went out solo. The music was great (thanks, Spotify!) and I spent some time thinking through a phone call I have later today.

So after a few false starts, I managed to make it a respectable week. What about you– how do you get your groove back and restart a cast off habit?

On Being Med-Free | Tamoxifen and Long Term Breast Cancer Treatment

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Forgive the old picture, but I don’t have any current pics of my meds.  Because I don’t have any meds.  Which is sort of a blessing and a curse.  It’s great that I don’t have to remember to fill a prescription and remember to take a daily pill.  It’s really great that I don’t have to deal with side effects.  What’s not so great, you may be wondering? I’m not actively doing anything to help prevent a recurrence.  If you know someone who’s had breast cancer and finished her treatment, odds are good that she’s taking a pill every day for the next five or ten years, and so it’s an obvious question to wonder why I’m not.

And this is where we go back to the science.  Remember when I explained about how my breast cancer is called triple negative? (Yep, if you look at that post, I used the same picture! Sorry!) Pathologists look at three main receptors when classifying breast tumors: ER, PR, and HER2.  Since my tumor didn’t have any of the three, I am considered “triple negative.” Tumors that express ER or PR are considered hormone responsive, and they make up 60-70% of newly diagnosed breast cancer cases.  These tumors use estrogen to grow, which means that shutting down their ability to use estrogen can shut down tumor growth.  No tumor growth means your tumor won’t kill you.  Obviously, hormone-targeted therapies have made a significant impact in the management of hormone responsive tumors.  There are several ways to manage hormone responsive tumors long term.  Tamoxifen is the most commonly known, and it acts as an anti-estrogen in the breast and effectively shuts down estrogen signalling.  Other drugs (raloxifene, toremifene, and fulvestrant) work in a similar manner.  Aromatase inhibitors halt the production of estrogen (letrozole, anastrazole, and exemestane) and can also be used to starve the tumor of estrogen.  (Fun fact– a woman’s body uses testosterone to make estrogen using an enzyme called an aromatase, so aromatase inhibitors prevent that conversion).  In premenopausal women, ovarian ablation (with drugs like gosserelin or leuprolide) can be used in conjunction with aromatase inhibitors, and have recently been shown to be very effective.  These treatment regimens are long term– five years used to be the standard, now some studies indicate ten years is even better– and are not always tolerated well.  Like any treatment, some women don’t have many side effects, but for some women, the treatment causes significant quality of life issues leading them to choose to stop treatment.  (This is certainly not a decision to be made without talking to your doctor! I’m just saying that it happens, good or bad…) Most women deal with some side effects that fall into the undesirable category, but are considered a reasonable trade off for the reduction in risk of recurrence.

All of that is to say that at least 60-70% of women treated for breast cancer benefit from long term hormonal treatment.  But for those of us without hormone responsive tumors, there is no reason to take the meds.  Our tumors don’t use the estrogen, so blocking it won’t help us.  And herein lies the blessing and the curse.  I don’t have to take daily meds and deal with the side effects, which is awesome.  But I’m also left in the position where there is no medication that I can take that will reduce my risk of recurrence, and that’s a little less awesome.  I’m just going to count on the fact that the chemo did its job and keep running, running, running.  (I do wish it would warm up, though.  It’s a little cold and icy to enjoy running right now!) I can’t take tamoxifen to help me, but exercise has been shown to reduce recurrence risk.  And so I will run.  As one triple-negative friend put it: “Running is my tamoxifen.”

For a more complete discussion on hormonal therapy for breast cancer, check out what this fact sheet from NCI (National Cancer Institute).  It’s complete and not overly technical.

My Ambivalence of Normalcy | “Normal” After Breast Cancer

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After I was diagnosed with breast cancer, I can remember that maintaining normalcy, especially for my family, was one of my main concerns.  I didn’t want to hide the fact that I had breast cancer, and I knew that things would be different for everyone.  But, for the most part, I wanted things to feel normal for them. I wanted to help with homework, drive to gymnastics, play games, and do Girls on the Run.  But I wanted things to be normal for me, too. Not to pretend that there was no cancer, but to give me some sense of control.  I wanted to be stronger than the cancer, I wanted to be my normal self in spite of the breast cancer. That’s how this blog got its name– I was determined to keep things normal by going for a run and always putting on some lipstick, even if chemo was my next stop.  It did take a lot of energy to be nothing more than normal, but it was energy that I wanted to expend.

But now I have a love/hate relationship with the word normal.  Exactly six weeks after my mastectomy, I went out on my first run post-surgery.  That  night, I was standing in the kitchen, and I remember Clay congratulating me on my first run, and he asked, “So is everything back to normal now?” I bristled. Was I supposed to be the same as before? Was he just hoping that he was off dishwasher-unloading duty?  Of course, I know his question had more to do with the relief that I was healthy and cancer free– free of treatments and their restrictions and side effects– than the dishwasher.

But back to normal? No.  Of course, physically, I don’t have any more restrictions.  I can reach what I want, lift what I want.  I don’t take any medications. (More on that in a future post, if you’re curious.)  But seatbelts still irritate me. My hair is growing out and driving. me. crazy. I have scars and tattoos. I have worries that no elementary school mom should have.  So maybe  a new normal, then? Lots of people love that phrase. I am not one of them, for the record.  I guess technically I have a new set of things that are part of my “normal” everyday life.  But to embrace the phrase new normal seems to acknowledge the fact that there’s no going back to the old normal, there’s no going back to that girl.  The girl with long hair who blamed headaches on PMS. The girl who went for a run because she wanted to lose ten pounds and be healthier, not because she feels like she’s inviting a cancer recurrence with her couch potato ways. The girl who bemoaned having to wear her cute little balconette push-up bra.  She’s gone, and sometimes it makes me sad.

Of course, there are a lot of good things about the word normal.  In fact, when I enter the auspices of Virginia Hospital Center, I crave the word.  My MRI? The PET scan? Normal.  Blissfully normal.  All my genes? Plain old vanilla normal. At support group? It is so reassuring to hear that what I’m feeling is completely normal. Normal is good.  Normal is just, well, so normal.

And so I find myself walking a very fine line.  Between loving and hating the word normal. But I continually strive spend more time considering the good, plain old vanilla type normal than mourning the old normal that is gone.

Lessons Learned at North Parking | Breast Cancer Awareness at the Pentagon

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Early morning PT, that’s the Pentagon behind the group to the left.

When I got a call the last week in August from my friend, Karen, she had just started as Nurse Educator with the Fit to Win program at the Pentagon health clinic, and she had just over a month to help put together a breast cancer awareness event.  It has been a work in progress for most of the month, but I consider myself an easy going person, so I’m fine to go with the flow if the details change.  (foreshadowing alert!) The whole day was a great experience, but I’m waiting on pictures from Natalie, the day’s official photographer, so we’ll start the recaps with the early morning fitness routine, since I managed to grab a quick photo of that.

The general premise of the day had always been perfect for me.  I would join the clinic staff for their monthly RUN, head inside the Pentagon Athletic Center to shower and put on some LIPSTICK, and then give a couple of talks about breast cancer and CHEMO.  Run, lipstick, chemo.  Like the day was made for me.

After agreeing enthusiastically, I got a little nervous.  I was intimidated to run with all those military types– I run, but I’m not fast. Karen reassured me, it’s just a three mile run to the Lincoln Memorial and back, and the first half they run all together at a 12 minute pace. I can do that.  I was ready.

Imagine my surprise (shock, horror?) when the gentleman in charge of the o-dark thirty festivities, whose arms and legs resembled tree trunks, announced that we would not be running. Instead we would do something “fun.” Twenty minutes of army PT followed by fun relays. Gulp. I was a good sport, managed not to totally humiliate myself, and was, quite frankly, thankful for having had a mastectomy, which gave me an easy out from all the push ups.  Man, they do a LOT of push ups.  I decided to do sit ups instead to show that I was a “team player,” but did opt out of the bear crawl relay with a few others recovering from recent surgeries.  It was fun, and I even learned a few things:

  • They do a LOT of push ups.
  • Sit ups on an asphalt parking lot hurt.  If you position your spine along the parking space stripe, it’s not quite as uncomfortable.
  • Running short distance relays where you turn and go back (suicide style, at least that’s what we called it in middle school) works out a totally different group of muscles than “normal” running or body pump classes.
  • Doing upwards of 200 sit ups on an asphalt parking lot (even on the stripes) will leave you with bruises along your spine. You may wonder if you should blog this, not wanting any of the push uppers to make fun of you later. Secretly, though, you may consider your bruised spine a badge of honor.
  • Did I mention they do a LOT of push ups?
  • Being a VIP has its privileges– when they picked teams for the relays, I got picked first!
  • Most sets consist of ten of each exercise, and as they count off, after nine comes not ten, but one-zero.
  • Sometimes they do more than “one-zero,” in which case everyone (except the random civilian) knows to stop because of the tone of Mr. Tree Trunk’s voice. Said random civilian gets an extra workout by doing two extra jumping jacks before stopping like everyone else.

Intimidating as it seemed, I know that they were taking it easy on me. (I was a lot more sore from the body pump class full of ladies that I took earlier in the week!)  But they didn’t act like they were taking it easy on me, they let me feel like I was totally hanging with them, and they had great team spirit– lots of cheering on those relays for everyone. They made me feel completely welcome and it was a pleasure spending the day with them. And stay tuned, there are more stories to tell!

Early Morning Reflections

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You know when you’re at a shopping mall and you’re looking for the directory and all you can find is those signs with the ever-changing ads? I guess after the kids thought Daddy worked at a mall the first time we visited him there, it shouldn’t surprise me that the Pentagon has those same signs.  But this week, my face will float by that screen for ten seconds at a time!  So cool.

Yesterday I got to meet a lot of people at the clinic, and had a nice time speaking to the nurses after a yummy lunch.  I even got to chat with one woman nearing the end of her reconstruction process, and as always, it was like we were old friends, bonding over our common experiences.

As I sit waiting to form up for this morning’s run, I am in awe of the fact that I get to do this! I’m sure some people are used to this type of thing, but the idea of being a “VIP” with my face plastering the walls of such a high profile building kind of makes me giggle. I definitely feel like this is another instance of God getting everything ready before I knew what was even going on.

But that’s probably enough reflection for now. I’m starting to see people show up, I should probably stretch so I don’t injure myself somewhere between the Pentagon and the Lincoln Memorial. At least running with the Pentagon clinic staff, I know I’ll be in good hands even if I do!

Eighteen Months Post-Chemo | The Pixie Grow Out Saga Continues

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Ah, what a difference a little hair and make up make!  Thought I’d give another update in the great pixie grow out saga. Not because I need to see more of my face on the screen, but because I keep looking for pictures of other people’s!  It’s hard to get an idea of what to expect when you’re waiting for hair to grow back from nothing.  So for those keeping track, my last chemo was February 1, 2013.  That makes this just over 18 months of growth, though I have been getting regular haircuts to keep it under control, the most recent was last week.  On the left, you can see how long those front pieces are getting.  I think they should tuck behind my ears by Christmas.  But on the right, you can see that I’m a hot mess when I go running now– my sweaty band keeps my hair out of my face, but now it’s getting too long to do the cute little thing where it all stands up behind the headband.  Clay just got his hair cut this week, and my hair is now officially longer than his.  Somehow, I think he’s a little happier about that than I am! But I’ve promised to keep at it, and Dragan says I should “play around with it,” so stay tuned for more ridiculous hairstyles!