Cloud with a silver lining

The last few days I have been feeling really good. This always happens about a week or so after my chemotherapy session. In the first 7-10 days I just want to sleep so I don't feel the pain. When I am awake I feel really ill, specifically nauseous, and that I’m like a zombie walking around. Gentle swimming helps me a lot because it wakes me up and I usually start swimming slowly 2 or 3 days I have my Chemo. Then I need about 5 or 6 more days to start feeling stronger and this is when I suddenly wake up and feel great so I take full advantage of it. I go swimming full force, running, Yoga, dancing you name it!! I never skip a day of exercise when I feel good. 

Some of the significant things that happened over the past month or so:

I decided to shave my head because my hair was falling a lot. This process was very hard for me. I am not used to seeing myself bald at all. Also my eyebrows are thinning out and my eye lashes are not so full right now (Thank God for makeup!!!) I have cried so many times because of this and of course wonder why is this happening to me. It feels like a bad dream, it is so surreal. After my second chemotherapy I was feeling really ill... then I looked at myself in the mirror and felt so helpless…I wondered how did I end up like this if all I have done is take care of my health. I wonder what did I do wrong, why is this happening to me. I honestly didn’t feel like writing in the past month because I’ve always wanted to be as positive as possible on this journey and in this blog and I just have not felt that way.  

That same week I went through genetic testing to learn if I have a genetic mutation or not. Because of Angelina Jolie’s experience this test has become extremely popular and now has a long waiting list. Genetic testing can be used to determine if someone has a change in their genes (mutation) that make them more likely to develop certain diseases such as cancer. Tests that measure likelihood for a disease are called “predictive genetic tests.” BRCA1 and BRCA2 are the most common genes involved in hereditary breast and ovarian cancers. Testing can be performed on either a blood or cheek swab sample to tell if a person has one of these BRCA mutations. This test does not detect whether a person has cancer or not; it indicates whether a person carries a change in one of these genes which can increase cancer risk. I tested positive, which means I carry the gene and it has developed. It also means that my chances of getting cancer back are higher. This news were devastating for me in the beginning. Due to this result my treatment will include two surgeries: a mastectomy with reconstruction and a Prophylactic oophorectomy which is the removal of my ovaries. Having this surgery will give me a higher probability of the cancer not coming back. I keep praying to God that this experience never comes back and I know it won’t. It is the hardest thing I have ever lived through. At the same time it is making me stronger and making me see how life is precious and how we need to live every moment and really be present because PRESENCE is all we have.

My third chemotherapy session was also very hard but somehow easier because now I have become stronger and know what to expect. I know I will feel terrible for a week or so but then I know that I will feel really good. I learned to accept myself bald. When I feel like it, I put makeup and nice earrings and my head covers and I feel like I look pretty, I actually like it. I have learned so much from this experience that I no longer see my outside looks only but also what I have learned and somehow I have become more secure within myself and who I am today. I feel more free and no longer see my physical looks only but also the beauty of my inside and how this experience has transformed me. Now, I look in the mirror and I see myself again. I know my hair, eyebrows and lashes will grow again. What matters is the spirit and how I can learn to live through this experience as a blessing in disguise. Or as my husband says a cloud with a silver lining. You also recognize that how you look is of such little importance relative to the opportunity to be alive and in good health and being close to those whom you love. That material possessions are completely insignificant. I still have a lot to learn but I feel like I am living life at another level now. I feel this every day and I actually love it. I have my last chemo at the end of this month and four weeks later the surgeries will start and hopefully this will place me in a position to return to my husband and boys and get back to my normal life.

If you are reading this and you have been diagnosed, there is no doubt that it will indeed be a very painful process, but know that there is light at the end of the tunnel even on those days when you don’t want to stand up from bed. Know that there is light even when you are at your worst and that even on those darkest nights there will God willing, always be another beautiful day to give you the opportunity to feel better. You must never lose faith. Keep your spirits up and offer your pain to those who are suffering more than you. I often think of one close friend and colleague of my husband’s whose journey has been so much longer and more difficult than mine yet she embraces life with such an amazing spirit and outlook. It helps to trust that God will always hold your hand and guide you through this process. There are so many that have so much less than us, that don’t even have access to a phone or computer to read this blog. I think about the situation in Syria, Iraq, Palestine, and Yemen, the victims and refugees from war and conflict around the world, and the people in developing countries that are not able to afford or access quality medical care. I thank God for everything we have and how fortunate we are to be able to treat my condition at a great facility with great doctors and a great support network. I can’t take this for granted and I don’t. There is more that I can give to help others and I hope this blog will at least help someone going through a similar experience to mine.

I am dedicating this blog to my beautiful mom. My mother has been on this journey with me from the beginning, she left her life in Mexico even though her parents are very old and need her. She is the central part of my family in Mexico, yet she left her husband and my brothers and sister to come help me with my youngest son and to support me with anything I need. She does not only help me, she does it with a big smile in her face, enjoying every moment with Oliver, and always concerned about my eating, sleeping, exercise, shopping, looks, she is always there and always with a BIG SMILE. Thank you mommy, I do not know what would I do without you, I love you so much and admire your attitude and positive view on life. I am blessed to have you on this journey with me.

Difficult Times

Got back from my trip which was AMAZING really one of the best trips I have done with my husband in a long time. We really enjoyed every single minute. I was ready for my appointment on the next day.. sad that my trip had ended but glad I had the opportunity to do it and decompress before starting chemotherapy. 

The first step was to confirm the treatment plan with my Doctor. There were 2 different chemotherapy options and I ended up choosing a “regimen” of Taxotere (Generic Name Docetaxel) and Cytoxan (Generic Name Cyclophosphamide), which was to be taken 4 times in 3 week intervals. But what is chemotherapy and how does it work? Chemotherapy is a process where disease is treated through the use of chemical substances, particularly cancer by cytotoxic and other drugs. These drugs are often given to the patient through IV / infusion over the course of few hours. 

Just to give you a brief description of the medicines and how they work. Taxotere comes from a class of chemotherapy drugs called plant alkaloids and is made from the bark of the Pacific Yew tree. Cytoxan is classified as an alkylating agent and believe it or not is a derivative of mustard gas! Both generally work by damaging the DNA or RNA that tells the cell how to divide. If the cells are unable to divide, they die. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells, and will kill all cells that are rapidly dividing. This is the main reason why chemotherapy comes with some serious side effects, physical and cosmetic, like mouth sores or hair loss.

Before my treatment I had to take steroid medications…and oh boy let me tell you these were the worst!! I became so hyper, moody and hungry!! I went running non stop 25 minutes with my headphones, then I walked another 30 minutes at a fast pace…and I was still not able to calm myself down. I did not sleep well the night before, I think it was a combination of the steroids and anticipation about my treatment. Doctor Parker also prescribed me medicine for anxiety but I didn’t take it every 4 hours as she had instructed and I only took it before I slept.  

The next morning at about 7am before going to my Chemo I went down to the beach and did a relaxing meditation, I prayed, cried, and when I came back I took the kitchen scissors and told my husband to cut my hair. He looked at me and said are you sure..and I said, absolutely. Please cut it off. I cut it off right under my ears. I feel like I need to take control of some of the effects before they take  control over me. After that I went and got ready for this next step in my journey.

We got to the infusion center at Moores Cancer Center and the first thing they did was withdraw blood to check the metabolic panel. This will be a routine before every treatment and I have gotten very used to having my arms checked to see if i have “good veins”. I had to wait for an hour for the results and to be honest I was pretty calm. I spoke to a few of my relatives and friends and I was ok. One of my friends gave me a ready pack for my chemo session which was a beautiful tote bag with a blanket, a diary, a cup for hot drinks, cup for cold drinks and of course a set of beautiful shades of lip gloss…every girl needs to feel pretty at all times right??

Well the time came, I went to my reclinable chair which was pretty comfortable, they gave me a pillow for my back, I had my cozy blanket thank God as it was cold in there. All I could see were smiley faces the nurses at this center have the best attitude and have a lot of compassion for all the patients. One thing I noticed was that the patients that day were older ..50+ or 60+..Most of them had lost their hair, some of them still had some hair, some of them it looked that it was growing back. Strangely everyone looked happy. The Chemo itself was not a big deal that day, I did not feel anything at all..it was like having saline water entering my body. I was able to eat a salad while having the chemo. I finished my treatment and I went home and did some cleaning and my usual walk. 

Now the difficult part starts here. After the treatment they gave me a shot (Neulasta) and it is used to stimulate the growth of healthy white blood cells in the bone marrow, once chemotherapy is given. White blood cells help the body to fight infection. This is not a chemotherapy drug and it is given 24 hours post treatment. The first two days after both procedures I felt ok, just a bit tired and confused. I thought wow I can do this. After a couple of days though, Oh my Gosh…I felt so achy. Imagine, feeling like you are getting a really bad flu every day and that your body aches and you feel constant body pain. This is what I felt. Then it got worse in my lower back I started to have lower back pain exactly the same as back labor pain but with no breaks. It was terrible, so bad I was crying because of the pain and then I got a fever at which point we followed the hospital’s instructions and called the emergency department.

When you have Chemotherapy treatment your immune system and your bodies ability to fight infection drop dramatically. They warn you about fever because in this state it can be life threatening. I was instructed to call the hospital if I got a fever of 100.3 F or more. My fever was 101 F so when I arrived to the emergency room they took me in immediately. They started an IV with antibiotics because of fear of infection and checked my blood cell counts. My husband slept on the floor next to me that night because they did not have extra beds in the emergency room. I learned later that my white blood cells, which are those that fight infection, had dropped extremely low and that I was classified as “neutroponic” which meant that I had to be isolated from almost anyone and that myself and anyone treating me had to wear a mask to prevent risk of infection.

After the second night in the hospital my white blood cells count increased and I immediately felt better. I went down to the hospital lounge and got some tea and went for a relaxing walk to stretch my legs. I was ok to leave that day fortunately :) and after this event I have been feeling better everyday. I focus on exercising and eating healthy every day, the only thing I dislike is that I still have to take pain medicine because I still feel body aches everyday which can get uncomfortable if I do not take the medication.  

Other symptoms: I am constantly thirsty and need to have ice water all the time. What is funny about this is that I used to love room temperature water and now with the chemo warm water tastes terrible. Also I constantly have a metal taste in my mouth. Other symptoms include dryness in several parts of my body, my hair is beginning to look dull and its falling more than normal :( this is very upsetting but at the same time I knew it would happen so I am prepared. I cannot eat spicy food and I used to eat it all the time. What happens with chemo as well is that it kills all the bacteria and enzymes in your body so spicy food can be very harsh. I used to love coffee and black tea and now I cannot drink either….my taste buds just can’t handle the taste. I am lucky I did not have much nausea and I did not throw up at all thank God.   

Overall I am very lucky, even though its been hard at times, I always focus in the positive aspects of my journey. I am extremely grateful for all the support of my family and friends specially my beautiful mom and amazing husband.

I want to dedicate this blog to the love of my life Matt Ayoub. Bear, I love you so much, I am so lucky to have you as my husband. I always knew you were an amazing man but you have showed me real love in this journey and I am grateful to God for sending me such an amazing incredible, smart, handsome, compassionate, humble, hard working, great dad, the list is endless I love you with all my heart for ever. I would not be able to do this without you my love.

Lastly but not least please remember to check yourself!! Mammograms alone are not enough and no one knows your body better than you. When I did my mammogram my tumor did not show and when I asked the doctors here in the states they told me that sometimes its hard to see it in a mammogram. Be safe and stay healthy and fit to prevent any zombie attacks :))

Decisions about my treatment

In the second appointment I had to give them my actual tumor which my husband brought with him from Dubai. They told me I needed to have the Oncotype DX test performed after which they would have a better understanding of a suitable treatment for me. The test would take two long weeks.

Oncotyping helps doctors understand the risk of recurrence and how a particular cancer will respond to different forms of treatment. After two weeks my Oncotype DX test came back with a lower risk of recurrence. Because it came back lower risk, I became a candidate for a clinical trial for women with 1-3 positive lymph nodes and a tumor <2cm. My results indicated that I was a candidate to have hormone treatment and radiation only to help researchers understand if this is a suitable alternative to chemotherapy in similar patients. However, the initial research is very new and does not have enough data for women my age.

That same day I had an appointment with the nurse practitioner (Kim) to review what to expect about chemotherapy. She mentioned hair loss, sickness, nausea, aches and many other risks and side effects of the treatment. She said some people feel all side effects, some people feel a few, and some others feel nothing. She gave me a packet of articles for me to review. 

Doctor Parker came into the room after Kim left. Dr. Parker was comfortable for me to decide what was best for me given all the information she gave me but mainly because of my younger age and my plan to live many many more years, her ultimate recommendation again was for me to start with chemotherapy. She said that her opinion was to have chemo, radiation and hormone therapy. She also said, that she was ok if I decided not to do Chemo and just do the hormone therapy and radiation and that might be ok. She said the only thing I want you to think about is that if in 10 years down the line anything was to come back, I don't want you to feel like you did not do everything in your power to treat yourself the first time when you are young and strong.

So right at that moment when I looked into her eyes, my husband’s and my dad’s eyes I knew I would have to do the Chemo. It is pretty overwhelming to know that you have to put all these medicines in your body. Specially because I have been an individual that rarely takes any medicines and been so healthy my whole life. It actually sucks big time!!! :( but I think I have to see these medicines in a friendly way and be thankful for all the advances in medicine. Be thankful that I was able to meet one of the best doctors in California, thankful about my wonderful insurance and lastly about my not so bad condition. I know I sound positive and optimistic…this is who I am, however it does not mean that I am not suffering as well. I have very emotional moments and sometimes I feel like I don't cry enough because I feel awkward crying around people so I always cry by myself. The other day I was going through an emotional moment and my husband walked in the room. He saw me and just held my hand and cuddled me. It felt nice but at the same time I felt like I had stop because he was there. I need to learn to cry any time I feel like it, even if I am in front of the whole world…I think it is healthier this way.

So this is where I am at right now…It has not been easy but I know I will defeat this beast no matter what and I will try my best to stay healthy and exercise as much as I can. Exercise by the way has been proven by research to be a significant variable in the success of treatment, reduction of side-effects, and overall survival rates of cancer patients. 

I will make the best of this experience….I am not going to let it defeat me, I still have a lot of life ahead of me and a wonderful husband whom I love with all my heart. My beautiful boys who make my days more amazing even during tough times and my amazing family and great friends who have been angels on earth.

Before i start my treatment next week, my husband Matt and I decided to take a short trip alone to Los Cabos Mexico where we are staying in an amazing hotel called the One and Only Palmilla. It is absolutely beautiful here and the people are so kind. My husband asked me when was the last time we spent a few days alone together and i honestly could not remember. We have amazing views from our room and we are living our love to the fullest while preparing ourselves for the journey ahead. 

Establishing Base Camp and First Appointment

One of the most important questions we were faced with was where I should go for treatment. This was a really difficult decision given the need to balance life, family, and work, as well as trying to create as little disruption as possible for my children and husband. While Abu Dhabi has made amazing progress in its health care systems, we decided to find a comprehensive cancer center in the States where I could have access to the latest treatment possible.

This comes with its own set of challenges. Which center? Which doctors? Where to live? How to move around? How to manage the insurance?

As soon as i received my lymph node results, my husband and I decided I should leave as soon as possible so I ended up leaving 10 days before my planned date. I am used to traveling with my three kids and this time I got to travel alone, leaving the pleasure of traveling with 3 kids to my husband who would follow in the next 2 weeks. Strangely the flight felt longer than usual so to use the time wisely I started writing my story.

After arriving to San Diego, where Matt and I married and lived for more than ten years, I immediately felt the beautiful weather, the crisp air and the beautiful sunshine. One of my good friends picked me up from the airport and I stayed at my aunt's house which was very comfortable.

My goal for the next ten days was to be as productive as possible and to start curing myself. I arrived on a Thursday and the next day was my first doctor's appointment. I decided to go to the beach and watch my first sunset where I did a guided healing meditation for 12 minutes. I sat on a high cliff right infront of the ocean. The sunset was beautiful, it was so perfect. Picture the perfect waves and perfect ocean sound, birds flying around and fresh air. Also there were a lot of surfers that day it was absolutely beautiful. When I started doing the meditation I envisioned all the cells of my body traveling throughout and i pictured them white. Then I added a few tiny red cells floating around. During the meditation I made the white cells surround the red cells and make peace with them and eventually the red cells disappeared and became white as well. I try to do this everyday, it helps me a lot. Now that I am not jet lagged, I also do long fast walks for about an hour followed by strengthening exercises. Then I sit infront of the ocean and do a meditation or pray the Rosary. I am lucky enough to have my family supporting me with taking care of my kids when I do my exercise. My husband has been amazing, so supportive, as I am writing he is looking for yoga classes for me to attend in the area we live now. I just keep counting my blessings and I am thankful for all the support, for the amazing weather and for the fact that right now I feel very good physically.

My first appointment was that Friday at 12:30 pm, I woke up went for a short walk got ready and went to my appointment. I was going through a mix of emotions. One one hand I was feeling exited to finally meet the famous doctor everyone was recommending me and on the other hand I was feeling scared and thinking ok..here we go, this is it...

Doctor Parker showed up, she was the most professional, decent, straight to the point person I have ever meet. She sat down and reviewed my information carefully. We were there waiting for her to speak...after a while, she said ok..we are going to perform a few tests before starting your treatment but this is what you will need if I take care of your case...She showed me a paper with a map of my treatment. She said because you are very young you need to have Chemotherapy, radiation and hormone therapy. She said a patient my age with a positive node could be at risk of having reacurrence of cancer later in life. She wanted to do everything in her power to make sure my cancer does not come back. She also said, even if we do all these we dont know if the cancer can come back, hopefully not. My doctor is very experienced, I trust her 100% and she is  the type of doctor who likes to feel like she did everything she could to cure me. She does not like to leave any strings hanging.

I left this appointment with so much information in my head and I was really overwhelmed.

Finding out I had breast cancer

It started after I breastfed my youngest son Oliver, whom I breastfed for 1 year and 2 months. About three months later, I felt a lump on my left breast. I took action right away and went to a well known doctor in Abu Dhabi. She examined me and was not worried because she said I had just finished breastfeeding. To double check she sent me for an Ultrasound to the Cure. The ultrasound came back clear. Then I did a mammogram later that year and the results came back clear. They told me to check back again after 6 months. I did as they said, I went for a second ultrasound after six months and then they sent me for a biopsy at Al Noor Hospital. The Doctor who received the report of the biopsy said everything looked fine. He said to remove the cyst at my convenience. I did not feel very confident with that doctor so I went back to the first doctor. She saw the report and did not like it at all..she said: this report does not say anything at all and she decided to send me to Dubai to a wonderful doctor named Paul Sayad, who did my surgery at City Hospital in Dubai. 

After one week I came back to see him. I came to see him with a smile in my face because I was planning to go shopping for presents for my family this summer. I sat down in his office and I asked: So, do you have my results?……I will never forget the serious look on his face. He said yes, I do and they are not good. First I thought, yeah right. He must be joking but then I said why?! He said it was a tumor with cancer. I started to cry and saw my 3 children and my husband in my mind and I told him: I cannot be sick, I have 3 children and a wonderful husband. I kept crying, sobbing. It was not a fun experience since I was alone. I did not expect to hear these news. I cried the whole day and did not want to eat or speak to anyone. Dr. Sayad told me that he would help me. He told me you need to stay positive but in that moment I was just to shocked and thought he was telling me this only to keep me calm. I went to my car and balled for another 30 minutes then called my husband whom immediately showed up to talk to the doctor. My husband was completely shocked as well. I mean how could I possibly have cancer. I don’t have breast cancer history in my family, I eat healthy 90% of the time, I don't smoke, I rarely drink alcohol, I am a fitness instructor and I have a very happy personal life. That following weekend was very emotional. I woke up in the morning and went to my lounge with a cup of tea. It was 6 am, shortly after my husband showed up. He told me with tears in his eyes that he would look for the best treatment for me. He told me we will fight together and get rid of it. We agreed not to tell the kids at this point. 

I decided to change my doctor because the trips to Dubai were overwhelming and very tiring, I was very lucky to have Cleveland Clinic in Abu Dhabi which opened shortly after my first surgery. I had the pleasure to meet Dr. Yasir Akmal a general surgeon that had just arrived from California whose specialty was breast surgeries for breast cancer. He was very savvy on my situation. He recommended an MRI followed  by a lumpectomy I did my MRI and Thank God the other breast looked clear then I had my surgery in which the doctor removed three lymph nodes and additional tissue from my left breast. He gave me so much confidence before he did the operation. He introduced me to everyone in the Operating room before they put me to sleep. I held his hand and thanked him and I told him: I trust you Doctor do what you have to do. He answered: your life is part of my life now and you are going to be just fine. One thing I learned here is that you have to like and trust your doctor and you need to let them know. Dr. Yasir was always very honest with me and that gave me a lot of confidence towards him. 

After my surgery I got my results 4 days later. I had to wait for the weekend to pass and oh boy! that weekend was loooong. I been learning that when you get a diagnosis like this there is always waiting time and this can be very frustrating but at the same time, I learned that I need to enjoy every moment and yes it was frustrating not knowing but I had to enjoy life anyway. I am lucky that I do not have any symptoms. I do not feel sick at all!! on the contrary I have tons of energy and I am dying to teach my classes. I also have my family that needs to see me smile and enjoy life with them, especially if I do not feel ill.

Got my results. Fortunately from the three lymph nodes he took out, only one came back positive. What does this mean: Well, it means that the cancer has gone to one of the lymph nodes and this is not so good but it is good that it only went to one. This lymph nodes carry the blood cells to the rest of the body, some bad cells might be in my body now because of this. We don't know for sure. This meant that most likely I will need Chemotherapy and yes this sucks! I am not going to lie. Chemotherapy scares me. I am a woman and of course it scares me to loose my hair, It scares me to be sick all the time, it scares me to loose my energy which has been high all my life. I don't know what is going to happen but at this point I just want to get rid of the cancer ( I call it my mutation). I felt really sad when they told me that. I have felt sad through this process many times but always knowing in the bottom of my heart that I will be fine. I always picture myself healthy because this is how I feel. Even if I get stressed, angry or sad. The next day, I wake up and I see it as another opportunity to live positive. This day we decided to tell my two older kids. I told them that they had found a small tumor and that the tumor had cancer. I told them that it was early detection and that I was going to be fine. I also said that many people hear the word cancer and get really scared but explained that there are several types of cancer and that mine was very curable. I had to tell them because they are older 10 and 9 and they get it. I mean they saw me having two surgeries, saw me crying a couple of times and always wondered what was going on. I did not want to create any type of anxiety for them and after researching enough we came to the conclusion that the best thing for them is to know the truth and to feel included in this process.

 After the surgery the next step is to have CT scans of the essential organs and bones. Did my scans and thank God again all these scans came back clear with nothing!!!.  See, how lucky I am! yes I have breast cancer but I am going to be fine. Yes, it will be hard at times but you know what I have so many people supporting me. My family and my amazing friends. Even strangers have been great. I realize how lucky I am every day and I also discovered that in this world there is more good people than bad. We are in a good place and I have a mission to educate women and spread the love that I have been given. I created this blog for you to take care of yourself, for you yes YOU to check your self every month. No one knows your body better than you do! even if you do ultrasounds and mammograms always check your self. It was me who saved my life. It was my personal examination who saved me. The best time to check your breast is after your menstrual period not before.

Insurance: Thankfully I have an amazing insurance that covers everything but since it is an insurance from Abu Dhabi we had to call them ahead of time and informed them about my plans for my treatment. It took some time to figure out everything but everything worked out well at the end.

I just arrived to California and will go to a Cancer Center called Moores at the University of California San Diego. I am seeing a team of Oncologists here to find out which stage is my cancer. I am ready to fight like a beast and am planning many long walks on the beach and lots of meditation.

Last thing I want to mention today. Some of my friends tell me: how come this happened to you?, you are one of the healthiest persons I know, I guess it does not matter if you are healthy or not. My answer to the above question was: It matters if you are HEALTHY and FIT!! This is what the doctors keep telling me you have a very strong body, it shows in all your tests. Also I believe that this is why my scans came back clean and this is why it will be easier for me to fight cancer. 

Like my father told me: All these things you been doing all your life to stay healthy are like a savings account for your body. Savings account for rainy days like this. 

I also have a dear friend that likes to work out a lot and is super healthy with his food. He said: "People ask me all the time, why are you so healthy and why do you like to exercise so much?". His answer is: "I am preparing for the zombie attack". If It ever hits me, I will be ready for it and my body will be strong to combat the Zombies.

So my advice is: stay HEALTHY and FIT, no matter what!!! Be ready for any Zombie attack and keep saving for rainy days.