From routine checkup to diagnosis (part 2.1)

    

14 May: This day is my last session with the psychologist before my operation on the 22^nd. A lot of realizations and self-awareness. My take home from the session is that your childhood really plays a consequential role in your adulthood. Don’t get me wrong, I had a wonderful childhood. My papsie and mama did everything to provide a safe and happy environment for us. We were loved and cared for the best way they knew how. But also I grew up in a generation when talking back to your elders, (even when you just to want to explain your side of the story), was already considered disrespectful; or when we cry because we were hurt from a fall or had a fight with a playmate, we were just told to zip it. And apparently, subconsciously, if I am confronted with the negative emotions, that I handle it with this learned behavior from childhood – just zip it in. Consequently, those big emotions were not given place and time to be processed. In time, these repressed and suppressed emotions will just have to find its place out. As for me, it manifests with panic attacks at night.. and unpacking these buried emotions that I have suppressed from grieving the loss of my sister and grieving for the state of my present health condition need time..

  walking the dog everyday to prep me physically for the operation

  reaching more than my target step count goal per day =)

16 May: Got a call from surgery to tell me that the planned operation on May 22 will be postponed due to the healthcare strike on that day. There would not be enough personnel for the surgery that day so they moved it on May 28. I will be admitted on May 27 for preoperative scan and other preop labs and the next morning is the operation. How do I feel about these changes? If I am being honest, it is already mentally exhausting to wait this long only to receive a call that I have to wait another more week. It’s mentally draining. I am having panic attacks at night. I would wake up in the middle of the night with rapid heart rate, like I can literally hear the fast ‘lubdub’ sound of my heart beating  and then I cannot go back to sleep anymore. There are nights when I only have 2 hours of sleep and I am just wide awake staring at the ceiling wishing that sleep will finally visit me..  During the day, I will keep myself busy with anything to do in the house and then I will find myself all of a sudden with crying fits. I feel like sometimes my emotions are all over the place, uncontrollable, out of nowhere sneaking out of me without any warning. And then they are telling me I still have another week of waiting before the operation.. another week of this emotional mess?

I am totally overridden with mental anxiety, stress, fear, resentment, anger, also denial – I just sometimes do not want to accept the fact that I have cancer, who does? which I think is completely normal; especially being a mom.. I just want to spare my child with hardships that comes along with this diagnosis.. we (as mothers) typically tend to put ourselves way at the bottom of the barrel.. our priority ALL THE TIME is our children and family – it is just what we are hardwired to do. We tried to do everything to make everyone happy, thriving, and doing well while we also juggle with our own careers and work-related responsibilities.. we wear so many hats that we sometimes forget to take care of ourselves. I think more than anything, this sickness is going to teach me about letting other people help me.. and letting me take care of me because I have not done that in a long time..

they can feel my state of mind and so they kept me company

to be continued...

Part 2 From routine checkup to diagnosis

I let myself cried that day after receiving the dreaded news. The part that broke my heart into pieces was when Kassandra asked “Mom, are you going to die?” This was the moment when I held my child tight and assured her that mommy will fight to live. Kassandra does not know about cancer until she heard about my sister Clarice… and the only concept that she has of it is linked with death because of what happened to her aunt. So it was devastating, as a mother, to hear about her fear that I could die. It is at that moment of vulnerability that I told myself, I have to be strong for her. I have to compose myself and not show her that I am terrified inside. You know when you are going through so much emotions deep inside but you have to push and buried it away so your child will not see you in that state of weakness? – that is what I did. The next day, I went back to work. I have to make all administrative work in order and make all my backlogs of prescription and PT notes up to date among other things. I also already filed for leave for the week after because I am scheduled for a genetic screening and appointment with the breast clinic nurse.

 

April 14 was the first time I had a meeting with Marie, the breast clinic nurse. A very empathic, soft-spoken lady. She must have done this a million times already because she was so calm and reassuring in answering all the questions I threw on her. She then again explained to me that because my cancer is at stage 0 — abnormal cells were found in the lining of the breast milk duct but has not YET spread into the surrounding breast tissue — I don’t need radiation or chemotherapy after the surgery, which actually a good news. I then asked “why so drastic the treatment when the cancer cells has not even invaded the surrounding tissue?” She then went on explaining that although it is non-invasive now, if not treated, might evolve into the invasive type. And according to the biopsy report, what I have is a high grade type DCIS with possible micro-invasion and with an extensive zone of 5.5 cm in MRI. And the best treatment for it is to remove the left breast totally. At that point, I just cannot control my emotions anymore and cried my heart out. . An overwhelming feeling of helplessness just came over me. I must have looked so torn and lost that I heard her already on the other line arranging for a psychological appointment for me. That day, I also needed to have my blood extracted for the genetic screening so I was ushered to the laboratory as well.

                                                       Info brochures handed to me to read

 

April 16 was my first appointment with the psychologist, Hanan. My session with her was supposedly just for an hour but it went on for almost 2 hours because half of the time I was just bawling and weeping. It was clear in that session that I was still grieving for the loss of my sister, and grieving now for the uncertainty of my situation. It was during that session that the emotion of so much grief just came out of the surface.

April 18 – Patrick accompanied me with my appointment with the plastic surgeon. The first thing I noticed when we went in his office was all the certificates and achievements hanging on his wall. I don’t know if it is supposed to assure me that he is one of the best surgeons in the country because it was more intimidating to me. He has this aura of “I have done this for so many times and I know what I’m doing” kind of vibe.  Very professional and a matter-of-factly kind of way in explaining to me the different breast reconstruction procedures and the pros and cons of each. You know that very smart and meticulous kind of doctor like Dr. Cristina Yang (of Grey’s anatomy). I also did my research before coming to this meeting, so hearing the explanation of the expert only strengthen my decision on choosing the DIEP flap surgery.  

 A very long hallway going to plastic surgery department

 

April 23 – Another psychotherapy session and this time the emotion that came out was deep-seated guilt, hopelessness and despair. It was a roller coaster of emotions! I find this session so emotionally exhausting because I didn’t know I have those emotions buried inside me. Guilt that I was not able to come home to say my last goodbye to my sister. Guilt that I was not physically present to support her emotionally when she was going through so much pain and suffering. It was a session of dark emotions – I was angry and blaming myself for everything that’s happening to me. This is the side of me I didn’t know existed and I barely recognized myself during that session.

 My once a week session since my diagnosis 

April 24 – Another meeting with the onco team to discuss changes in the treatment plan. Due to the family history of an aggressive cancer I was advised to wait for the result of the genetic testing. They have to rule out genetic factor as it can affect the course of treatment. If genetic screening turns out to be positive then a double mastectomy is highly advisable. And because I chose autologous breast reconstruction, waiting for the result of the genetic test is the most logical thing to do if in case double mastectomy should be performed. The tentative date of surgery of May 5 was then postponed for further advice. My mind was at that moment in panic mode. How long should we wait? What if the cancer cells spread? I was then reassured that they already ordered to expedite the genetic screening so results will be in 2 to 4 weeks. I went home not feeling reassured at all…

April 29 – Got a call from the breast clinic nurse for an appointment with the surgeon as the genetic test result was received and it was in my favor.. I have an appointment on May 5 to finalize the schedule for surgery.

April 30 – Maybe because of the good result of the genetic test, I felt so relieved like a big chunk of burden on my shoulders was pulled out. The session with my psychologist that day was a little bit lighter. Coming home, I felt more hopeful..

May 5 – At the multidisciplinary onco consult, the surgery is scheduled on May 22. I will be admitted on May 21 for preop preparations. I was also scheduled for a CT scan of the abdomen on May 7. This is needed for the DIEP flap surgery.

To be continued…

From routine checkup to diagnosis (Part 1)

 

I am sitting here in front of my laptop contemplating – thinking what I should write first. These past months have been very difficult for me, emotionally and mentally.. so many things have been in my head and it’s overwhelming – my mind is in chaos.. and when things are not in order, there is a tendency to shut down and I don’t want that to happen. So here I am trying to collect my thoughts and doing my very best to make sense of what has happened, what’s happening and what’s going to happen next..

WHAT HAS HAPPENED

To put things in perspective, maybe it’s better to start from the beginning of this year – January. The start of the year 2025 has not been good for the family. This was the month when my younger sister Clarice died. This has been devastating for us all to say the least.. She was diagnosed with breast cancer 2 years prior. She had undergone mastectomy, chemo and radiation. She was recovering well…in fact she even returned to work early last year (2024). Then her cancer came back with a vengeance! And this time it metastasized to her lungs and liver… she was still fighting until the very end for her children but her fragile body was not able to take it anymore – then she finally succumbed.. it was heartbreaking for all of us..

  Videocall with the family was the only thing I could do because I couldn’t go home…

WHAT’S HAPPENING

February 26, I had my appointment with my gynecologist. It was just a routine checkup.. and since I am also turning 50 this year and transitioning to menopause, I told myself, this is also the right time to ask prescription for  my pre-menopausal symptoms of mood swings and night sweats.. I mentioned to my doctor what happened to my sister and how aggressive her cancer was. There are no other family history of cancer for both my mother and father side. I remember the look of concern I saw on her face and she said she will also order a mammogram as part of the routine check. The next day I went for the mammo screening.

March 4, I got a call from my gynecologist. I was at work and was not able to answer her call in the morning so I returned her call by noon during my lunchbreak. I was told that I have to go back for another mammo and an echo because they have seen something suspicious in the left breast. I was then scheduled on March 6. If you have not had a mammo screening before, then I tell you this – it was really painful for me. They said it’s not that bad, but for me it was. Your breast would be in between two plates and compressed for what seems like eternity.. and then they are telling me to go back and do it all over again?!

March 10 my gynecologist called and informed me that the same lesion was seen but it is not conclusive. So I was advised for an MRI scan and the earliest that they can book me is on March 22. At this time, I am already developing some form of anxiety. I have difficulty sleeping and if I finally was able to sleep, I would wake up in the middle of the night with raising heart rates. Going to work has been my solace as it diverts my mind into thinking all sorts of bad things plus it keeps me busy. I don’t want to entertain any bad thoughts and I don’t want to worry for nothing so going to work has been a good diversion.

  I don’t know why but going inside the MRI room was so terrifying for me..

March 25 another call from my gynecologist telling me she has just received the MRI report and that the lesion seen on my left breast was approximately 5.5 cm x 4.4 cm x 2.2 cm… and because it was BIRADS 4 on the report, biopsy was then recommended. I was then scheduled for a stereotactic breast biopsy on March 31. It has then dawned on me that this might be really serious. Now I have to go for biopsy! So many questions and so much emotions gushing through me.. I was trying not to be overcome by fear. It was a struggle, but I have to maintain control and stay strong.

The day of the biopsy, I was actually feeling perky and positive. I am conditioning my mind that everything will be fine. The procedure itself was something else. If I give mammogram a pain scale of 6/10, I will give biopsy a pain scale of 10/10. It was excruciatingly painful! Like in the mammo where the breast is compressed in between plates, the biopsy I had was the same -  my left breast was pressed in between plates while a long needle was inserted inside to suck a portion of breast tissue while I am not allowed to move even a fraction of a movement. I was just lying there crying and biting my tongue to keep me from moving, but deep inside I was screaming from pain. The nurse said a local anesthesia was administered but I felt every single thing! It’s a good thing Patrick was with me to drive me home because moving my left arm was just impossible without pain.

    Another day at the hospital…

April 3 while at work, I was already feeling more anxious. I was already expecting a call from the day before but they have not called me yet.  That afternoon, I was in front of the computer when I felt my heart skipped a beat or I’m having  tachycardia, I don't know anymore... I felt that there was something so I asked our head nurse in the room if I can get my phone to check if I had a call. And there it was - 3 missed calls. It was my gynecologist. I called her back and the first thing she said was “I’m afraid I don’t have a good news for you…” and everything just went blurred. I was on the phone hearing about the next appointment with a multidisciplinary team and that further questions will be discussed and answered during that meeting, but I don’t actually understand anymore what else she said in that phone conversation. I just remember crying after that phone call and my head nurse even volunteered to drive me home if needed. I remembered sitting there for awhile crying my heart out and after that I composed myself to be able to drive home. I did not even finish my duty that time. All I just wanted was to go home and be comforted by Patrick and Kassandra.

April 8 was our wedding anniversary. Patrick and I are 14 years married. But instead of celebrating that day or having an anniversary date, we were inside a conference room with doctors and nurse. The diagnosis – DCIS. I have ductal carcinoma in situ. Ductal carcinoma in situ (DCIS) is a type of early-stage cancer where cancer cells form in the lining of the milk ducts in the breasts. The doctors were very comforting in telling me that it’s a good thing it was detected early and prognosis for DCIS are very good. They further explained that because my DCIS is grade 3 or high grade and it’s quite big (5.5 cm), the most appropriate treatment with high rate of success is mastectomy of the left breast. And if I consent, a constructive surgery can also be done on the same day. They gave me a tentative date of operation which is May 5. Days leading to the surgery, I still have to do some blood works, genetic screening, appointments with plastic surgeon, appointments with psychologist and meetings with breast clinic nurse to arrange other administrative work. I walked out of that meeting with so much questions than ever and a feeling of overwhelm cascading over my body. How could this be happening to me? How to break the news to my mother who just lost her daughter in breast cancer just a few months back? I don’t know how to deal with these heavy emotions when I am still grieving for a loss of a sister from breast cancer, and then 2 months after losing her, I was also diagnosed with breast cancer. How can life be so unfair?

  Medical oncology waiting room

To be continued...