My appreciation for the chemo nurses began the first day I went in for chemo teaching and for them to take a look at my infected groshong. That seems like so long ago right now, but it was only July. My sister, Joyce, came with me and we sat down with Anita for a crash course on chemo and managing the side effects.

Anita was so confident and knowledgeable about everything. We went over tons of information and while I was a bit overwhelmed with everything, I was also confident that I was prepared for what was to come. After the consultation we went over to the chemo area and she took a look at the groshong. As she gently cleaned it and discussed different maintenance regimens with me, I became more comfortable with everything. Somehow, she made chemo, a catheter coming out of my chest, and everything else I was feeling seem normal. When she was done, she hugged me. It was the most human thing any of the health care professionals had done through this whole experience.

As treatment has progressed, I have the majority of my interactions with the nurses. There are four that work at the facility and they are all wonderful. They have the ability to ease the fear by providing information about the drugs used, how to manage the side effects, and knowing just when it should be referred to the doctor. They are professional, yet still so very personal and human. In a very professional way, it is as if they know just how to “kiss it and make it better.”

I know that my treatment has gone well and that I have had very few complications, yet I have still had to call the nurses at least once between each treatment. As busy as they are, I never seem to feel as though I am pestering them. In fact, they make it seem that I am the most important person at the moment. How does anyone deal with the range of emotions and complications that they see every day? The grace that surrounds these women is powerful. But then again, the grace that surrounds each one of us is amazingly powerful.

At some point I may have to close my door and work topless (remember now, I’m talking about my hat!). The hot flashes are frequent and, well, hot. I might appreciate them if I lived in a cold climate, but they just add way too much warmth to the already warm Southern California climate. Although I think I could the thermostat down to 60 and still feel them!

One side effect that has gotten worse with each treatment is the dryness of my eyes. By the fifth day after treatment it is very noticeable and even painful. You know those comical hats that look like a hard hat with two can holders and a straw that comes down to your mouth (as seen on TV – they aren’t part of my hat wardrobe I swear). I thought about rigging up something similar that would hold eyes drops with a dropper that goes directly to my eye. But even that didn’t seem like it would be enough.

My oncologist recommended I see an ophthalmologist to be sure there was no permanent damage being done to my eyes. Luckily, I found out that my eyes are very healthy, but they are indeed very dry. The doctor assured me that this is very normal with chemo as the drugs prohibit you from producing enough natural tears. She inserted temporary plugs into my tear ducts in an effort to hold the moisture in my eyes longer. The eyes will still drain, just not as quickly. I must agree. The moisture drops I use seem to stay in and sooth my eyes and I already feel better.

The aches and pains are subsiding as well and I am slowly turning that corner. It is amazing how differently my body reacted to the two different treatments. While it wasn’t pleasant, I will say that I know I can get through the next three. It is easier to deal with anything if you aren’t nauseous. Thanks for all the encouragement, support, and happy thoughts. Even through everything, I do know that I am truly blessed.

Even been to a bar and you just couldn't decide which cocktail to order? If I had to choose between the previous chemo cocktail and the new one, I'm not sure which one I'd choose. On the one hand, I have not had the nausea this time around at all. This is always a good thing. I have, on the other hand, had tremendous discomfort with bone and joint aches. Usually by Sunday evening, I feel as though I have turned the corner and start feeling better. I'm still waiting for this to happen. I may need an extra day to recover from this round. Ouch.

At least if it is killing the good cells it must also be getting the bad guys. And I also know there is an end in sight for me. So today I am offering up my discomfort for all those people with chronic pain in the hope they will get some relief. But if anyone wants to offer up some happy thoughts, I won't turn them down. :)

The Rolling Stones sing, "Time is on my side," but it sure didn't feel like it. Holy Cow! Talk about a waiting game! Chemo Thursday was one long day. Please join me while I recap.

Let's just say they were a running a little behind with the doctor's appointment. It was more than an hour before I was called in which is highly unusual for them. I typically barely have a chance to finish the e-tablet questionnaire on symptoms and side-effects before getting called in. I eventually had my exam and went over the lab results. My hemoglobin count dropped another .4 so this weekend I get to start the Aranesp injections. Aranesp is very similar to the highly advertised Procrit except it works longer so the injections are less frequent. It stimulates the bone marrow to produce more red blood cells. This helps the chemotherapy-induced anemia and also boosts the energy levels a bit. Other than this issue, I believe her exact words were, "You are sailing right through this!"

Chemotherapy-induced anemia occurs in 7 out of 10 patients. The chemo drugs can't distinguish between the good cells and the bad cells and unfortunately, take out some of the good ones. Anemia can be very danergous. Without the proper levels of red blood cells, the heart works harder to get enough of the oxygen-carrying cells through the body. Without the proper oxygen, your organs don't work properly. While I am grateful that there is a treatment for this, I was a little surprised to hear this news since I started a mild iron supplement and had felt so great for the last 8 days. Once again, this is a pharmacy benefit under my insurance so I get to self-administer the shots every two weeks.

Next I was off to chemo for the Taxol. Prior to starting the Taxol, I was given two Tylenol and a Tagamet pill. This was followed by a 50 mg Benadryl injection into my groshong. People can have allergic reactions to the Taxol, so they provide the Benadryl as a precaution. Lucky me! The injection hit me so quickly and made me light-headed, queasy, agitated, and gave me leg twitches and spasms. But next came the Taxol. It was set for a 4-hour drip to make sure I could handle it. My favorite chemo nurse came by every so often to check my vitals and make sure my blood pressure was not dropping as can often occur. It stayed pretty steady so she increased the rate a couple of times. Her exact words were, "You are sailing right through this!"

At first I was chilled so she brought me a warm blanket and then my sister Joyce, my coffee angel and nurse extraordinaire, came by with a soy latte and a penza bar from Starbucks (could the day have gotten any better?). This perked me up a bit and I was feeling a little better. I was at a comfortable temperature and feeling okay. A little while later I enjoyed my very first full blown hot flash. Hot flashes are an expected side-effect of treatment. It is actually surpsing that I haven't had them sooner.

Let me just say that if men experienced hot flashes, had their makeup float off with their perspiration, and had their hair go flat and stick to their heads, they might be a little more sympathetic to menopausal women. But I digress. . . . I dragged my IV stand to the restroom and splashed some cool water on my pulse points and relaxed a bit. That seemed to calm me down so I returned to the chemo lounge. An even better diversion was when the nicest gentleman came to sit next to me. Talking to him helped pass the time.

His name was Jimmy and this is his third round of treatment for lymphoma. He was first diagnosed and treated in 1997. He has been in remission twice since then, but is back for round three. You wouldn't know it to look at him. He seems like a healthy athletic man. In fact I thought he was my age, but it turns out he is twenty years older. We had a lovely time talking about treatment, our families, and our faith. He committed his life to Jesus Christ in 1974 and has been a devout Christian since then. For someone going through everything he has battled, he had a great attitude and just a peace about him. It gave me strength to be in his presence.

Like this entire journey of ups and downs, even though the seven hour marathon at the oncology office was taking a toll on me, in the end I was blessed. All I can say now is . . .

FIVE DOWN AND JUST THREE TO GO!!!

I had the opportunity to meet with the plastic surgeon who will complete the reconstruction portion of my surgery in December. He was a very knowledgeable man and we sat and talked for quite some time before jointly reaching conclusions on how to proceed. He did a great job of answering all my questions, but I was disappointed to hear how long this process takes and all the steps involved before I am completely finished with everything. I think I may need to sort through all the information in my head and do a a little research before I post everything on this site.

In the meantime, tomorrow I begin the Taxol series of chemotherapy. I'm on the downhill side now with this being treatment five. I continue to feel confident about my treatment, the team of doctors (and their staff) who are working with me, and the wonderful chemo nurses who are such a tremendous support (look for a future post on chemo nurses!). I feel so lucky because physically I have felt so good this entire week and I continue to be amazed at the wonderful support network I have. Everything has been significant: the daily hugs, the cards, the laughter, the calls, the emails, the blog comments, and most importantly, the willingness to listen. As Bruce Springsteen sings, "Still at the end of every hard earned day people find some reason to believe." If I have ever had the slightest of doubt, I just have to look around me to find that reason to believe.

"One must always wear a hat when lunching with people whom one does not know well. One appears to one's best advantage. " --Coco Chanel

My chemo-induced hair loss has given me a new appreciation for hats. As I was sitting in church yesterday, I realized I was the only person wearing a hat. Let's face it, we have become a topless society. No one wears hats any longer. Sure you see the occasional ball cap, but a hat isn't the crowning accessory any longer. Hats traditionally have been worn to protect against the elements, but evolved to represent much more. In early Roman times, hats may have marked a person's rank. As fashion evolved, hats became a symbol of social class. So what has happened? Why do I often feel like the lone hat wearer in a sea of topless people?

Put aside your notions that hats are reserved for bad hair days, beach trips, and sports activities. I present to you my list of Top Ten Benefits of Wearing a Hat. Maybe you too will join me as a hat fashionista after reading the list.

Top Ten Benefits of Wearing a Hat

10. Hats are very couture! Lucy never left home without one on.

9. A hat can be a great accessory to help you get someone's attention. It works even better, if you hold the hat in your hand and wave it in the general direction of the person whose attention you want.

8. A hat can distinguish you as part of a team.

7. A hat can protect your head from those pesky pigeons when sightseeing at European landmarks and town squares (trust me on this one, no really, trust me).

6. A hat can be a fine place to display your Olympic pin collection.

5. A hat can double as a glove at a baseball game to help you catch foul balls and home runs.

4. Hats identify your occupation: fireman, cowboy, showgirl, etc.

3. Hats allow you to display a personal message such as, "I'd rather be _________" (fill in the blank).

2. At a horse race, the hats help you to spot the jockeys.

1. Hats make it so much easier to identify the "good guys" from the "bad guys."

It is amazing how different I feel when the veil of fatigue lifts. For each treatment it has happened at roughly the same time frame, around the eighth day following chemo. This particular cycle was rather dramatic with low lows following treatment and high highs as I started to feel better. The great part of this is that I don't realize how badly I feel until I start to feel better. When I feel how good, good is, I then realize how bad I felt. Wow, I hope you understand what I am trying to say! Bottom line is that I feel really good this weekend and for this I am so grateful.

Today I was out with my sister and we stopped for lunch. While we were waiting for a table, I noticed two women waiting nearby. Both women were a bit older than us and seemed happy to be out as if this were a special day or special treat. As I looked closer I noticed that one woman was wearing a hat that was covering her bald head. As I looked closer I noticed her eyebrows were expertly drawn in. She looked beautiful in her coordinating pink outfit. All the signs were there: hat, loss of hair and eyebrows, wearing pink. Perhaps I am generalizing, but it seemed that she too may be going through her own journey with breast cancer. I smiled knowingly in her direction and then my instinct was to run as far from her as possible.

The reaction shocked me. I was ashamed of myself. It was like that first day at the oncologist's office when I couldn't look at anyone and couldn't wait to leave. I wanted to run then because I didn't want to be "one of them." Could it be happening again? Now? It seems as though I shout from the rooftops that I have breast cancer to make people aware of this terrible beast. Why now when I see a "sister" did I want to hide?

I've given it so much thought and my conclusion is that today I felt so "normal." I was out with my sis doing some shopping in Pasadena and stopping for lunch. We haven't done that in months and it is one of our favorite things to do together. Seeing her made me realize how much my life has changed and that old view of normal may not be reality again for quite some time if ever. We may indeed do our Pasadena thing, but I will never be that same person again. The strange thing is that I am okay with that.

Nobody should get cancer to find a deeper meaning in life or develop her spirituality and connection with others. Prayer, meditation, soul searching, reading, hiking in the Himalayas with a Sadhu . . . I could list a million ways to seek out a deeper meaning in life and dealing with cancer would not be one of them. Maybe it's just a way to find something positive in this journey or maybe my mom was always right -- I never do things the easy way! As much as the negative side effects have impacted me physically, the positive side effects have made their impact as well. I will keep that beautiful woman in my prayers that her journey be swift and her recovery be long and joyous. She has become one more friend for the journey.

Today indeed was a good day.

Each and every day I become more aware of what living with and surviving breast cancer means. Strangely enough, this lesson is not coming from my personal experience. I’m learning it through the people I meet and those whose stories I hear. With 200,000 women in the U.S. diagnosed with breast cancer each year, there is a wealth of heroic stories out there. I read about a young woman who was diagnosed with breast cancer at age 23, tumor and with positive lymph nodes. She fought and won. She now has 3 beautiful daughters. Then I read about the young woman who was diagnosed at age 32 while nine months pregnant. She also had positive nodes. She had a c-section, mastectomy, and lymph node dissection all at the same time. She just finished chemotherapy. I just know she will continue to fight this beast with courage and tremendous faith and live to see her grandchildren grow up.

Of course there is a show off in every crowd. There is a woman who was a model and a marathon runner who was diagnosed with breast cancer around age 30. She ran her 4th marathon in the middle of her chemo treatments (really, that’s just sick!). She is doing great now as a survivor. Still running marathons and working as a motivational speaker. She and all the other countless surviviors are amazing. I carry them all with me on my journey.

I guess I just don’t allow myself to look at the big picture for myself right now. I have to focus on the things that come up each and every day and win the small battles. This includes dealing with the side effects, dealing with my insurance plan, finding the energy I need just do “normal” things. Although the definition for “normal” sure escapes me these days. When I hear the courageous stories of the women who have fought this battle, I am so inspired though somehow I don’t relate to them personally. On so many levels this journey is more than real and on some levels it feels like it isn’t happening to me at all. I just take it one day at a time. I am sure that one day I will look back in amazement at everything I have been through. For now, as long as I wake each day and try in some small way to make the world a better place, nothing else really matters.

So many thoughts have been swirling through my head. The side effects of the last treatment have sidelined my reflections and left me focusing on trying to shake the nausea, aches, and general fatigue. Today I awoke feeling pretty good as far as the nausea, but the post-chemo fatigue has really set in. I know this will improve each day and by the weekend I'll be better. When I awoke with no nausea, I knew this would be a good day and I haven't been disappointed.

First, a new Starbucks opened in town. Since I was out of soy milk at home and couldn't enjoy my homemade version, I thought I would stop in the new store and grab one before work. Many of you understand my coffee enjoyment (notice I didn't say addiction or obsession?). Those of you who are local also know how difficult it is to get a coffee at my local Starbucks in the morning before work unless you plan on an extra 35 minutes. The place is so busy and it is a drive through making it difficult to maneuver around the parking lot a bit. The new Starbucks is roomy, not a drive through, and few people know it has already opened. I drove up, parked in front, walked in, ordered my coffee, and was back in my car in four minutes. Is that a way to start the day or what? It was a sign.

I have been in need of some inspiration. Even though I have reached the half-way point in treatment, it still means I have just as much to go through as I already have done. I don't doubt I can do it. I have not been discouraged; I have just needed energy. Ask and you shall receive. I asked for inspiration, and it came to me.

"If one can surrender and trust their journey, one can handle the most challenging situations. Knowing that there is a reason for everything we encounter gives our lives meaning. We find the strength to conquer even what seems unconquerable." --Maryam Nassirbegli

Enjoy this day. And most of all, remember to laugh and share your smile with others.

Thanks for all the kind wishes, positive thoughts, and prayers. The AC went out with a bang, making this perhaps the most difficult treatment so far. On a positive note, I am feeling better this morning and I know that as each day passes this week, I will continue to feel better. Thanks again for everything. I know that there are times I woouldn't have the strength to move forward without the amazing support I continue to receive. I continue to ask myself, "How did I get so lucky?"

I still haven't gotten used to the day after chemo. I feel fine for the most part and feel like I should be doing something, but I know if I do, it will wear me out and intensify the side effects. And then there is the dreaded Neulasta shot coming up in just a few moments. Rather than whining about the little things, I should be focusing on the many things for which I am grateful.

At my doctor's appointment yesterday, I found out my blood levels are still strong. My red blood cells went from 11.8 to 11.6 -- just a slight dip. As a reference, at 11.0 they would start supplemental medication to assist in keeping these levels high. At 9.0 they start transfusions. So I am still in good shape. She recommended I consider adding a daily dose of iron if I could tolerate it. This would help keep my levels up without adding additional medications. I think her direct quote was, "Frankly, Jeannette, I'm quite impressed. You are doing excellent." She also concurred that the cellulitis was looking fine, but still encouraged me to just keep an eye on it.

I also mentioned that I have started having some burning and tingling in my feet. This is likely a sign of chemo-induced neuropathy. This isn't as common a side effect of the AC cocktail; however, it is much more likely to experience this side effect on the Taxol which I start next. To prevent this from getting any worse, the doctor suggested I start glutamine supplements. Glutamine is an amino acid which helps the body restore itself. This will help manage the damage caused by the chemotherapy to the good cells. For the specific symptoms I reported, it will help protect the nerve endings and also balance the GI tract a bit which may help with any problems I have been experiencing in that area (bonus benefit!).

Once again, it isn't so much a complication as an annoyance and it is a side effect that can be managed. I continue to be grateful that treatment has evolved so far. The miracles of modern medicine are amazing. The blessings of generous God are even more amazing.

Today I will have my fourth chemo treatment and the last of the AC series. The "A" in AC, is often referred to as the red devil because of its harsh side effects and the bright red color. Please say a prayer or think happy thoughts for a peaceful weekend. I will officially be at the halfway point! Have a great day!

When I went in for my lab work this morning, the nurses wanted to take a look at my cellulitis -- all four of them. We went into a side room and they agreed there was some inflammation there. They were relieved that I would be seeing my original surgeon directly following this appointment. I think it would have been interesting to keep an "examination meter" running from the beginning of this process. I'm glad everyone is so thorough, but I 've had more medical breast exams in the last few months, even the last week, than I have in my lifetime!

It was good to sit and talk with my original surgeon. When I met with the doctor at Loma Linda last Friday, Dr. G., he gave me three surgical options and stated that there was no medical reason to discount any of them. I would have to choose based on my personal concerns and the outcomes I desired. My first surgeon, Dr. S., had been very opinionated about the best choice in my situation. In fact, my medical oncologist, Dr. B., concurred with his recommendations 100 percent. So now I meet this new surgeon and he says it's my choice and any of the options are reasonable. I was beginning to doubt my original plan.

In my appointment today, Dr. S. took the time to catch up on what has been happening with me. He also examined my cellulitis and said it didn't seem to be anything to worry about at this point. His conjecture was that there could have been a remaining bacteria from the previous infection that normally would have been taken care of by my body naturally, but flared up given my compromised immune system from the chemo. We also discussed my current confusion regarding further treatment. After going over the results from my most recent tests, including the BRCA analysis, he stands by his initial recommendation. I appreciate his expertise and I appreciate his concern. As a surgeon, even a surgical oncologist, his job is to take care of the procedures (take out the trash, so to speak). He doesn't need to stay abreast of what's going on with me or even provide recommendations for procedures he won't be doing. He is a caring man who has provided excellent guidance throughout this journey. So today I am thankful. He managed to take my "annoyed" face and give me back my smile. What more do I need today?

Only I could have an infection and have it not get worse until I start taking antibiotics. My mild infection called cellulitis had been exactly the same for about a week until Dr. G diagnosed it and prescribed antibiotics. Since that time it has progressively worsened. Today I head back to my original surgeon to have him evaluate it. It is not uncommon to have cellulitis flare up on the site where you have recently had surgery. I keep telling myself this is not a complication just one more little annoyance.

It will be great to talk to my original surgeon and see if his recommendations for my treatment will be the same now that all my markers and test results are in. I haven't seen him in nearly two months after seeing him so frequently at the beginning of this process. I truly do respect his opinion. Everything he recommended was clearly backed up when I did my own research. I knew if I dug down deep enough I would find the positive side of this situation (but for the record -- it is still annoying).

Now that I have had three treatments it is a little easier to see patterns and cycles. One thing I noticed after this last treatment was a mood swing falling around the same time as my last mood swing. I have noticed that usually around the fourth or fifth day after treatment, I tend to have a two to three day period where I am particularly moody. I wouldn't say I'm depressed, just irritable or annoyed and maybe even a little weepy at times. I wasn't sure if this was just an emotional release of this whole process or if there was an actual relationship to the medications. After doing some research it seems I am not alone.

The magazine, Redbook, has been featuring a series titled "Me against Breast Cancer." It is a multi-installment piece written by a journalist as she goes through breast cancer treatment. I have read both the first and second installments and her story is very similar to mine. In the second installment she mentions the mood swings and their timing after treatment. In my research I have also found sources that make this link as well. There are so many contributing factors noted including, medication side-effects, changes in sleep patterns, changes in diet, changes in hormonal levels, and the overall emotional considerations of dealing with breast cancer. While it is nice to know all of this is explainable, it certainly doesn't make it any easier for those who interact with me on a regular basis.

In searching for a safety belt for all my chemosabes feeling the g-forces of my emotional roller coaster, I have added a mood indicator to the right column. Remember, it is only placed there for your own safety. Relax. We have a good ten days before the next ride.

It is a beautiful thing to hear someone pronounce my last name as it was meant to be said. I do not expect people on a daily basis to pronounce my name with melodic Italian notes; however, when it comes naturally off the tongue of a native speaker, it is music to my ears. When I met my surgeon, Dr. G, a man whose accent does little to hide his Italian heritage, his pronunciation of my name brought a smile to my face. His charm and confidence also helped put me at ease and feel comfortable as we discussed plans for the final chapter of my treatment.

I had been waiting eagerly for the consultation at Loma Linda University Medical Center, the facility for my final surgery. I have been anxious to know what procedures would be done and whether or not I would be able to stick with my personal plan of getting everything completed before Christmas. Loma Linda was also a "foreign" place to me with doctors I had never met and I wanted to be sure I would feel comfortable there as well. It's reputation is stellar and the work that is completed there is amazing. I never once doubted the facility or it's medical team, I just wanted to be sure it was a good fit for me -- somewhere I would be comfortable having such a major procedure done.

After meeting the Breast Health Center's coordinator, having an affirming and uplifting discussion with the counseling intern, a thorough exam and medical history evaluation with the nurse practitioner, and finally a consultation with the doctor, I have every confidence in this team. Their approach to addressing the needs of the whole person, not just addressing the cancer, inspires hope and aids in healing body, mind, and spirit.

And now I know how the story ends. The first week of December, my surgery is scheduled. Once I meet with the plastic surgeon, I will have the final details regarding procedure and recovery time. As long as my chemo schedule stays on course (which relies on me rebounding at the same rate after each treatment with no further complications), I should complete all treatments by November 4th, have a month to recuperate and get my levels back up, surgery in December, and by New Year's Day I'll be somewhere fabulous.

In the meantime, the doctor also noticed that I have a case of cellulitis in my right breast ( a slight skin infection), so I have another round of antibiotics to complete. While I noticed a very faint redness and warmth in the skin last Friday, I wasn't alarmed because it didn't get any worse, I had no fever, and the darn thing just hasn't been the same since my first surgery and subsequent hematoma. With my challenged immune system due to the chemo, getting infections, and other complications is relatively normal. And maybe having an infection explains why I've been dragging a bit more this week. At least I know I am on the road to recovery and even had a peek at the last page of the story.

Remember the episode of Friends when Phoebe was pregnant as the surrogate mother for her brother’s triplets? Phoebe, the staunch vegetarian, became a ravenous carnivore during pregnancy. In this episode of my life, once again life imitates art. Shortly after my second treatment I was craving turkey. I tried to avoid it. I even tried to wish it away. During my chemo teaching they kept telling to listen to my body. This has not always been the best advice for me so I kept trying to ignore the craving.

Finally I began to think that perhaps I wasn’t getting enough protein. My taste buds had been screwed up since the first treatment and fish wasn’t very appealing to me. Perhaps the protein was indeed a little low. The craving kept coming back. I gave in. A carnivore emerged, reared its ugly head and ate a turkey sandwich. And it was good. I thought the craving would be satisfied, but eventually I had another, and then later another still. And they were all good.

In the episode of Friends, Phoebe, struggling with her animal rights conscience, strikes a deal with Joey where he will not eat meat for the duration of her pregnancy. Her justification is that it would cancel out her carnivorous ways and no additional animals would be sacrificed.

One question remains. Who volunteers to give up turkey sandwiches for the duration of my chemo?