Saturday, November 1, 2014

Plowing Through to a Better Self

November 1, 2014

Dear The Mums,

Today was Shabbat Lech L’cha, your favorite parashah.  I’m sure Cantor Dubinsky didn’t know that when, during the hakafah at minyan, she asked me to recite the Torah blessings, but it seemed like an appropriate coincidence, so I nodded my agreement. 

It seemed appropriate, too, that following minyan and Torah study, I'd arranged to meet Lil’ Zigs at a (highly recommended) wig store near Columbus Circle, setting us off on a journey to ChemoLand, a place we do not know.

I think I need to back up, though, and fill you in.  In mid-August, just a few days before her birthday, her annual sonogram (which, in addition to a mammogram, she's been having since you died, even though she pays out-of-pocket because her insurance doesn't cover the cost) picked up something that, although it didn't show up on the mammogram turned out to be breast cancer.  Needless to say, she was blindsided, and I was stunned by the absolute irony of the diagnosis, given that I’m the one with the BRCA mutation.  In fact, to ensure that this was truly “sporadic” breast cancer and not the result of a hereditary mutation, we met with a genetic counselor, and LZ had genetic testing beyond the Multisite 3 BRACAnalysis we'd both had in 2010, which tests for only the three Ashkenazi founder mutations.  (When my results turned up positive for the BRCA2 Ashkenazi founder mutation, and LZ was negative, no further testing was done.)  Thankfully, her more recent comprehensive BRCA analysis and BART test both came back negative.  A cruel roll of the dice, gave her this cancer, and lumped her together (no pun intended) with the 12% of women across the board that randomly get breast cancer within their lifetimes, although some might suggest that she was at increased risk given her family history.

In early September, she met with the same surgeon who did my mastectomy and we learned that the tumor was small (1.6 cm) and that it was estrogen receptor and progestin receptor positive, as well as positive for the HER2 protein.  This last characteristic made it more aggressive than other types of breast cancer.  By the end of that appointment, there was a lumpectomy on the calendar for September 25 – which was Rosh Hashanah this year – the first date that worked for both the surgeon and Lil’ Zigs, given the crazy travel schedule she maintains for her wildly successful business.

Two weeks after the lumpectomy, we met with the surgeon again and learned that the tumor was totally contained, that the tissue surrounding it was clear of cancer, and that the lymph nodes were not involved.  The upcoming chemo is insurance against any microscopic spread in light of the tumor's HER2+ profile.  The first session is scheduled for a week from today and the A-C-T regimen looks like this: 
  • Adriamycin and Cytoxan once every other week for four cycles (eight weeks)
  • Taxol once a week for 12 weeks
  • Herceptin and Perjeta – which are antibody therapies and have no side effects – every third week during the 12 weeks of Taxol, and continuing every third week for a year.  These two drugs are specifically used as insurance against the return of HER2+ tumors and are especially effective when used in combination with chemotherapy.
She's got appointments scheduled in January with a plastic surgeon and a radiation oncologist so that she can figure out next steps -- mastectomy or radiation.  That decision is hers to make, but in the the meantime, she's got plenty of time to ponder the pros and cons of each.

As I’m sure you can imagine, Lil’ Zigs wants no part of anything pink, no support groups, no coddling, and no fussing over her.  She's planning to plow through all "this nonsense" as she says, so she can get on with the rest of her life. 

Nonetheless, she has cut back on her travel significantly beginning in mid-November, but in the meantime, she’s front-loaded a ton of business into this coming week (and the week following her first chemo session) and will be on 10 flights and in six cities during the next seven days.  Only when she returns from all that travel will we begin our journey to a place we do not know.

But, like Abraham, we are blessed on this journey. You are with us each day -- in our hearts and in our minds -- as we travel into ChemoLand.  We’re lucky, too, to have an abundance of friends – some we know and others we have not yet met – who already are sharing their time, their talents, and their expertise, so that Lil’ Zigs and I can go forth from all “this nonsense” to our new and better selves.

Miss you…love you,
~ Boo!