I never intended to embark on this journey, however, I found myself thrust into this uncertain path in April 2001. Once begun, there was no turning back. A routine mammogram showed some micro calcifications. Since my breast tissue was very dense, an ultrasound was performed for a better view. There it was a 2.5 cm tumor in my left breast. At first I was stunned. I was the healthiest person I knew. I didn't drink or smoke; I ate a healthy diet, exercised regularly and breastfed four children. All this was supposed to reduce my risk of getting breast cancer! I forgot about genes. Both sides of my family had a strong history of varied cancers and two first cousins had premenopausal breast cancer.
As a nurse I was medically more prepared for what lay ahead than most, but I suffered role reversal. I was now the patient and reluctant to give up "being in charge.” I was relieved that my oncologists at MD Anderson Cancer Center in Houston considered me an integral member of my healthcare team. They listened to my concerns and welcomed my input. My diagnosis was Stage 2a Hormone-receptor-positive, Her 2 positive Invasive ductal carcinoma. The plan was to begin with chemotherapy (Taxol, followed by FAC) to shrink the tumor, and then perform a lumpectomy with sentinel node biopsy. Six weeks of whole breast radiation would follow, and then I would start Tamoxifen for 2 1/2 years, then switch to Aromasin for 2 1/2 yrs. Herceptin had not yet been approved for early stage Her2 positive cancer so I would not take that drug.
The course was set. God was in charge, but I had to cooperate and I did the best I could. I got through it all with prayer, the constant love and support of my husband, my family and my friends. I still maintained control over some things, like my hair. I was going to decide when it went! I had my hairdresser shave it off before it started falling out. I even had some fun without my hair. I would show up for lunch with friends, sporting a platinum blonde wig and just enjoy their reaction! Humor makes people relax and can really erase awkwardness in situations where people just don't know what to say.
My active treatment was completed in March 2002 and I was back to the business of life –only that life would never be the same. I now felt driven to advocate for breast cancer awareness and to make a difference for those following in my footsteps. I did not return to nursing, but instead got involved in the breast health community. I volunteered on the Susan G. Komen For The Cure's Education Board and advocated in the community for breast health awareness. I also started volunteering as a "Pink Ribbon Volunteer " in MD Anderson's Nellie B. Connally Breast Center as well as volunteering in MD Anderson's Regional Care Center in Sugar Land, Texas where I live.
I learned of a clinical trial in 2006 for the drug Tykerb, an oral medication. It was hoped that this drug could prevent recurrences in Her2 positive patients who had not taken Herceptin—that would be me. I enrolled and took the drug for a year, after which I would have a follow-up visit once a year for 10 years. I thought this was added insurance against recurrence.
Life was pretty good. My children graduated school, my daughters got married and had babies and I could travel with my husband to exotic places. Then in 2010, almost 10 years post-diagnosis, I developed an abscess at the site of the lumpectomy. Two rounds of antibiotics finally cleared it up, although residual effect could still be seen on ultrasound. My breast oncologist decided I should be followed with an ultrasound every six months until all of the residual effect was gone. So it went until November 2012 when the ultrasound showed an "area of concern" in another part of the breast. An MRI-guided biopsy was done. This time I was scared. I had been there, done that and now knew too much to believe it was nothing. In the nearly 12 years since my diagnosis I had seen many patients with recurrences and made and lost too many friends to breast cancer. My oncologist called—the biopsy was positive. How could this happen to me again after this much time? The very same week I received a letter from the Tykerb study researcher, stating that my follow-up was being discontinued as midterm analysis showed no significant benefit against recurrence. How ironic was that!
The pathology showed hormone-negative, Her2 positive, Invasive ductal carcinoma. This time the hormone receptors were negative, but I was still Her2 positive. The first time I had no lymph node involvement. This time a PET scan showed no positive lymph nodes on the affected left side, but two positive right pectoral nodes and two positive right axillary nodes. Yet, there was no cancer in the right breast. How could that be? My oncologists were convinced it had to be in the right breast, but nothing ever showed up on scans.
I had started down this uncertain path in 2001, but now I was on the warpath! This new cancer was considered locally advanced and required more than a plan; it required a "war strategy!” Once again, God would lead me through it and my husband, family and friends would once again support me. This war plan started with chemotherapy –Taxotere. I now had Herceptin in my arsenal as well as the newly approved Her2 targeted drug, Perjeta. Being in chemotherapy first gave me time to research my surgical strategy. I requested Dr. Anthony Lucci for his excellence, passion, caring and groundbreaking research in the field of micro metastasis. I completed chemotherapy in April 2013 and had skin-sparing bilateral mastectomy surgery in May 2013. Expanders were inserted during surgery and would be exchanged for implants at a later date.
Pathology and a post-op PET scan showed I had a pathological complete response to treatment—no cancer seen anywhere! Since I responded so well, all agreed I should continue on the Herceptin/Perjeta combo every three weeks, indefinitely. Am I thrilled about getting an infusion every three weeks? No, but if it keeps me NED (no evidence of disease), I will do it. Five weeks of supra clavicular radiation followed surgery. My radiation oncologist timed my treatments to end just in time for me to travel to London with my husband. I learned that my radiation oncologist would also be in London performing with his church choir at St. Paul's Cathedral while I was there. I managed to be at St. Paul's for the performance and it was wonderful. Was he ever surprised to see me! I mention this because we are still living life in the midst of all this turmoil!
I waited until January 2014 to have a Left Latissimus Dorsi Flap transplant. This was done to replace the previously radiated skin and tissue from my first treatment. I did well with the surgery and waited until July 2014 to do the expander/implant exchange. I am very pleased with the cosmetic results and continue to be a "work in progress.” Nipple reconstruction is planned for April 2015 and a tattoo will follow in October 2015. I hope that will conclude the physical "Reconstruction of Rosemary.” The emotional reconstruction is never over for those of us who have experienced breast cancer. We are continually adapting to life changes. One cannot go through all this without some "collateral damage.” I am no exception. I developed mild lymphedema in my left arm post-radiation. Fourteen nodes were removed from my left axilla and all were negative. Seventeen were removed from my right axilla and all were negative as well. I also have "chemo brain,” but have developed good coping skills.
I used to think breast cancer was the worst thing that could happen to me. I was wrong. Our son, the joy of my life, took his life on the day of my mastectomy surgery. I know breast cancer and I know how to fight it. Heartache is entirely different. I struggle with it every day and will for the rest of my life. Yet, I continue to be hopeful and embrace the life I have been blessed with. I choose to focus not on the sadness, but rather concentrate on what I can do to help others. The following quote from William Faulkner's The Sound and the Fury has long been a favorite of mine and expresses my sentiments of faith and hope: "I believe that man will not merely endure, but he will prevail. He is immortal, not because he alone among creatures has an inexhaustible voice, but because he has a soul, a spirit capable of compassion and sacrifice and endurance." There are many things we cannot control, but we can choose what our attitude will be and how we will react to any given situation. Given the choice, I choose a positive attitude and hope!