The Week Ahead - New Normal

Been an uneventful few days around here. You know, other than the boys being gone. We sent them off to Colorado for six days to see their grandmother and it's been kinda quiet around here since. Kim and I did what every parent does when their kids are gone, sleep late. Saturday we drove out to Hood River and Mosier for some hiking and Sunday was time for Kim to connect with a friend also facing cancer. Later in the afternoon we enjoyed a ride. Suffice it to say that Kim will remain focused on exercise as a fundamental element of her therapy. But diet remains our primary focus. Sure, Kim will use chemotherapy as an initial first step but she is putting her full attention to food as medicine. I've had a lot of requests to explain what that means and I'm no dietician but here it is:

No sugar
Foods with low glycemic index
No dairy
No meat
Lots of water
No alcohol
A focus on foods that are proven to reduce inflammation
And a healthy diet of big views.

Now that last line is something I came up with. There's something important and elemental about the outdoors and taking in an expansive natural view. Those places where you stand still and just say "wow" in a soft voice. What better way to kick this off than a trip to the Columbia River Gorge? On Saturday we stood on the Mosier Plateau and looked to the east and west at the Columbia River. We hiked through some rocky sections and beautiful, grassy hills. We stood at the edge of a cliff and let the strong winds buffet us until we laughed; it was nuts up there. Later, in Hood River we went to the beach by the river and enjoyed letting the cool water get that hiking dust off of our legs. We went up to a cafe and took in a big view of Mt Adams. The drive home gave us even more great views. I'd say the weekend diet of big views was a success. Today was a little closer to home and quick spin up to Mt Tabor to see the city of Portland in the late afternoon.

And now it's time for bed and the start of a new week. Not too much to do this week other than some routine doctor's visits and a visit with the naturopath. This is Kim's final "regular" week prior to chemotherapy so we're going to try and enjoy it as best we can. I'll be digging into all the operational details of cancer such as insurance coverage, bills, and all that exciting stuff. I'd rather not get blindsided by something later on so this is a good week to look into all that.

The messages Kim and I are receiving from everyone have been wonderful, thank you for thinking of us. Enjoy this quiet week and we'll get back to action-packed posts a week from now.

-CD

The Mosier Plateau

Swimming Hole

All I did was mention dinner...

Tests / Herman / Wigs

This morning was another day spent at Legacy Hospital in NW Portland and, as far as places to be go, this is a pretty cool part of town. Kim's day began with an echocardiogram at 9:00 AM. With the lights out and lying down, Kim had a pretty easy go of it. The machine showed really cool colors as the sound waves reflected back images of her heart. Hard to believe a heart that big can fit on a display monitor. Following that easy test we traversed the many walkways above the streets between medical buildings though we ended up below ground in the Good Samaritan Breast Center for the BSGI. The Breast Center is a really nice place, peaceful and with coffee and tea. As has been the case with every office so far, such wonderfully empathetic staff.


I noticed that the women in this waiting room, despite their diversity, had one thing in common, strength. Every patient here had an air of fortitude and resilience. I'm betting that years of cancer advocacy have given these women the knowledge to face this disease with real vigor. I was pleased to see this. OK, so I need to correct something here, I've said women a lot in reference to the Breast Center and one of the patients I saw today was a man. Herman is an elderly man, with taut suspenders clipped to his trousers, and the air of man from the country. One percent of breast cancer cases are men and I'd bet there still remains a social stigma about it where he comes from. But Herman, nope, pleasant, courteous, and cheerful. His wife, damn it, she was cute as could be. I hope to see Herman again.

Now, we'd hustled down here because my watch showed we had only a few minutes to spare but after checking in and sitting down I realized I was looking at the minute and second hand not hour and minute hand so we had almost an hour to hang out. Guess what, they bumped up her appointment time. I couldn't go in for this test, (the Breast Specific Gamma Imaging), so I gave Kim a smooch and walked a few blocks back to my old office, said hello to some friends, visited the fine folks at The Athletic, and had some coffee at The Commissary Cafe where Andrew works. Kim exited the test an hour later and was looking for me but I was still yapping away at the cafe. She sent me a note and dropped by to grab a salad for lunch so I got a bonus smooch before we both returned to work for the day.

Kim got home around five o'clock and helped the boys pack for their trip to Denver on Friday. I hustled home as well to meet briefly with Kristen and Kim as Kristen brought by even more resources for Kim to consider. Chief among them today, wigs.

Now Kim has spent some time on the subject of hair loss and possible therapies to offset it. We've both looked into cold caps and any number of ice therapies to be worn during chemotherapy as there is some evidence that it can reduce or prevent hair loss. We talked about it a lot. I mentioned to Kim that I wanted her full attention on the problem and not giving energy away to symptoms. She agreed and then decided that since no one she spoke with during her process had first hand knowledge of these therapies that she'd forego the experiment. We did have some great conversations with friends who have experience with this but Kim made the final call that the distraction would be too much.

I had to leave the meeting early to take Andrew to his oil painting class but Jason was eager to help Kim look through wig samples. (While I was out waiting for Andrew I grabbed some dinner and bumped into two friends. Felt good to get those hugs and to bring home the ones they sent for Kim.) So I'm home now and there's a wig box on the dresser. Jason apparently didn't like the super-blonde style or the dark brunette so Kim's first wig will likely look similar to her hair now. But Kim has told me that she may try some wyld stylez* and that no one in Portland is even going to notice because half this town has colored hair.

Initial results on tests today do not reveal anything further than what we already know so we keep to our plan. Chest port goes in on the 9th, chemotherapy on the 11th.

We are kid free for the next six days. Let's ride some bikes and go to the movies.

We had a good day today so I'll ask that you send some thoughts to Herman tonight.

-CD


*my phrase, not hers

Tests & Oncology

Today was a long day for Kim. Up early for work and then off to Legacy Good Samaritan Medical Center in Northwest Portland. CT scan for chest, abdomen, and pelvis at 10:15AM. This required an iodine injection but the entire process went by relatively quickly. Then some waiting which gave her time to read. We do a lot of reading now. And then we talk about what we've read. Next up, a bone scan in the early afternoon. Another injection, this time tiny amounts of radioactive materials which are taken up in various parts of the body and reveal those area where the body may be attempting to repair itself. The bone scan took 45 minutes and Kim just had to lie still. She spent this entire part of the day on her own and then snuck off for lunch over at The Commissary cafe where Andrew works.

I rolled over on my bike for a 3:00PM meeting with Dr Eric Anderson, her Oncologist. How do we keep getting such great members on our team? Amazing guy and the first thing we noticed was he wears cool socks. He is also recovering from a cycling accident so it's nice to have someone who knows the fun of riding. Dr Anderson, along with a nurse, walked us through the full chemotherapy process. It will be challenging but we begin with good news.

The CT scan and bone scan did not return any results we didn't already know. So Kim will be taking on the same tumors we've known since last week. Chemotherapy will be 8 total treatments every two weeks. The first four weeks, cycles 1-4, are a twin dose of doxorubicin and cyclophosphamide. Cycles 5-8 will be paclitaxel. Kim will have a port placed in her chest allowing doctors to access her veins easily and to do lab work with minimal discomfort. Her port will go in the day before her first treatment.

Her treatment begins Thursday August 11th at 11:15AM, my 48th birthday.

Why we are doing chemotherapy first:
Downstage the tumor for an easier lumpectomy
Prognostic information gathering
No concern for wound healing from a surgery-first procedure
Psychological benefit of reducing the cancer

Side effects are likely to be nausea, fatigue, reduced blood count and possible anemia. She'll have a cocktail of drugs to counter all of this. We are also preparing a super diet to fortify her and keep her active.

Hair loss is almost a certainty with thinning likely to begin by the second cycle and total loss by the fourth cycle. This is the only wavering in Kim's strength and I get it. Any of you older men reading this know the feeling, we tie our youth and vitality to our hair; it's tough to watch it go away. For Kim, and women like her, it has the same effect but with a faster pace. And it's a tell-tale sign for the world about your condition. Kim has read some interesting therapies but also has begun thinking about some fun wigs she can wear. I'd bet we find some cool hats, too.

Kim's oncologist is pretty great. He's told her to remain active, stay in constant communication with him on any thoughts, and to "push herself, sort of". I love this comment and I love that he's expecting Kim to be assertive with her recovery and her day-to-day life. He also encourages complementary therapies such as acupuncture going so far as to recommend his own personal therapist. He also advises drinking lots of water. Lots of it. That's good advice for everyone reading this, too. Do it.

During today's business at the hospital we had Kristen and Jim sending notes, staying in touch, and reminding us to ask good questions. These two are incredible and many thanks to them.

Dr. Anderson left us with a positive prognosis and the confirmation that he'll do whatever it takes to help Kim feel her best. He has a great relationship with Dr Johnson so our team is lining up for a great run.

Word about this blog went out today and we've had over 300 friends begin their journey following Kim through hers. As I type this, Jason is performing card tricks with Kim and there's a lot of laughter. Andrew is making a healing tea he calls Hug In A Mug and the house smells fantastic. Me? I made dinner and it was pretty good if I say so myself.

More tests on Thursday so the next two days get to be normal around here.

Thank you for your well wishes to Kim, she feels them. I get a few of them, too.

-CD

The Beginning

On Friday July 15th, 2016, Kim went to Providence Hospital in Milwaukie, OR for a breast biopsy and ultrasound after a doctor's consultation earlier in the week. True to her nature, she went into work early to get a head start and then returned to work afterwards. She was informed that results would take a few days and that it would be Tuesday, most likely, before she heard anything.

Kim enjoyed the weekend with minimal stress including some bike rides and seeing Ghostbusters. (Spoiler alert - It's awesome!). Monday passed by with an uptick in anxiety but life around the house wasn't all that much different. Tuesday, we both waited to hear something and we'd begun making dinner having given up on hearing anything for the day. The phone rang at 6:30.

Kim retreated to the bedroom and heard the news, the biopsy had returned a positive result for breast cancer. Further tests and evaluation would ensue but there was little urgency from the doctor and incredible fortitude from Kim. I sat with her through the entire conversation holding her hand and just kind of floating. We sat for a moment more and then went out and made dinner together. Kim asked to go for a walk after dinner but we sat the boys down first and told them. It was a simple affair and without emotion from any of us. We all made the pact right then and there that while we couldn't control cancer, we can and would control ourselves. We then walked down to the river for a beautiful sunset. That night and every night since it's been pretty much life as normal around here. Kim is so incredibly brave and strong. She's been silently at work on recovery from the very first moment.

Friday July 22nd was the first day we started to learn things. First things first, Kim has the most incredible doctor. Nathalie Johnson is one of the most respected doctors in the field and is a breast cancer survivor herself. What a gift to have this peace of mind. Even better, Kim's Oncology Navigator is our dear friend Kristin Applegate. She has already gone above and beyond to inform and inspire our family. Kim has an incredible team assembled so we can get straight to work on this.

Prognostic Factors
Luminal A breast cancer
Tumor size is 3.6 cm / Stage II (left side)
Lymph nodes / Sentinel node biopsy - Positive
Estrogen Receptors - 100%
Progesterone Receptors - 100%
MIB (Ki-67) - Intermediate 14%

Next steps

Monday July 25th:
Morning: Lab Work, CT scan chest, abdomen, pelvis.  Whole body bone scan.
Afternoon: Meeting with oncologist

Thursday July 28th:
Echocardiogram
Breast Specific Gamma Imaging

Friday August 19th:
Genetic Testing

Kim will begin a 10-year program of Tamoxifen to address the hormone receptors noted above.

This is a "good" form of breast cancer with very good prognosis rates.

Kim will also begin a chemotherapy cycle beginning very soon. This will include treatments every three weeks for the next six months.

Following the completion of chemotherapy Kim will be evaluated for lumpectomy surgery, Reverse Lymphatic Mapping, to address any remaining cancerous tumors. Following this, if necessary, will be radiation treatment.

In all, Kim has a one-year treatment process starting right now.

Our plan is to put weekly updates here and provide as much as we can in the way of results. Kim will add her thoughts as she has time. Bookmark this page and check in. We'll let you know which day we choose for updates once we get into the cycle.

Some notes:
Kim already lives a healthy lifestyle so she has a good foundation for recovery. We are all committed to maximizing our efforts and putting a massive focus on diet. As I type this Andrew is preparing a recipe from a cancer-fighting cookbook given to us by Kristen. Again, Kristen is amazing. Food will be our most powerful agent of change. Andrew, Jason, and I are up to the challenge and have learned so much over the weekend about the foods that will help Kim, and us, become even healthier. I'd bet we post recipes of our favorites on this blog going forward.

Kim will continue to exercise and work as fitness and mental creativity are integral to her well-being. Kim has not missed a step through all of this. She is our inspiration to carry on and be positive.

Now, about positivity, I offer our friend Jim Brown of Olympia, Washington. I've known Jim for over 20 years. He's a firefighter, paramedic, junior cycling coach, husband, and father. Jim has been tackling lung cancer head on for just over a year now. His experience is well-known and has been invaluable for people just like Kim. He's done the same as Kristen, sending us information to educate and inform ourselves. Further, he's a beacon of positive light and an example of the power of the mind and spirit. Kim and Jim, two of the most brave people you will ever meet. I wrote about Jim and I'd like you to read it. Click here.

Andrew & Jason:
What can I say? Their strength and positivity are no surprise as these are traits they learned from their mother. They didn't miss a step and are front and center in the mission to support Kim.

Family & Friends:
Your support is something Kim and I can feel no matter the distance you may be from us. Please stay in touch. We are so fortunate to have each and every one of you.

About that image at the top of the page. We went on a camping trip earlier this month to eastern Oregon. Kim found us a teepee in a state park on the John Day River near the Painted Hills National Monument. On the drive there we passed through Kimberly, Oregon.

And the title of this blog? Kim is very much enjoying Andrew's love of cooking and is always interested in what he has planned for dinner. (The kid is a great cook, folks. And he runs a tight kitchen with his trusted assistant Jason pitching in. I mean, who has kids reading cook books, watching cooking shows, and talking about proper knife cuts?)

OK, that's a lot to read and thank you for making it this far. More to come. Thank you for your love and support of Kim.

-Chris