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Amanda’s Extraovarian Primary Peritoneal Carcinoma Story

Amanda’s Extraovarian Primary Peritoneal Carcinoma Story

Amanda, a resident of Seattle, Washington, shares her harrowing journey with cancer, which began with her family’s history of the disease. In 1999, her mother’s diagnosis of endometrial uterine cancer marked the start of a series of cancer battles within her family. Despite initial success in treatment, subsequent diagnoses among family members, including her older brother’s colon cancer, prompted concern. Initially hesitant to undergo testing, Amanda eventually faced her own health scare, experiencing symptoms like fatigue and changes in bowel habits.

In 2017, Amanda received a shocking diagnosis of metastatic cancer of an unknown primary source. Despite challenges in pinpointing the primary tumor, Amanda underwent surgery and radiation treatment. However, her journey took a new turn in 2022 when she experienced pelvic pressure and underwent surgery for what was ultimately diagnosed as extraovarian primary peritoneal carcinoma (EOPPC)

Facing uncertainty, Amanda opted for chemotherapy and immunotherapy, navigating side effects and advocating for her preferred treatment options. Today, Amanda is in remission and emphasizes the importance of self-advocacy, finding a supportive medical team, and cherishing life’s moments amidst the challenges of cancer treatment.

Amanda shares her cancer symptoms and treatments
  • Name: Amanda W. 
  • 1st Diagnosis (DX):
    • Metastatic cancer of an unknown primary source
  • 2nd Diagnosis (DX):
    • Extraovarian Primary Peritoneal Carcinoma (EOPPC)
  • Symptoms:
    • Swollen lymph node in groin
    • Pressure and pain in pelvis
  • Treatment:
    • Surgery
    • Radiation
    • Immunotherapy
      • Keytruda
    • Chemotherapy
      • Carboplatin, taxol, and paxil

Always listen to yourself and push for the things that you feel in your heart you want.

Amanda W.

This interview has been edited for clarity. This is not medical advice. Please consult with your healthcare provider for treatment decisions.


Symptoms

Tell us about yourself

My name is Amanda and I live in Seattle, Washington. My cancer journey has been very long. I’m going to have to take you all the way back to 1999, because it didn’t really begin with me. It began with my mom, and in 1999, I was 19 years old, and a freshman in college. 

She was diagnosed with stage 2 colon cancer.

I received a phone call from my mom one day and she said, “Mandy, I have cancer.” My heart sank, because back then, cancer still felt like an ultimate death sentence. She was diagnosed with endometrial uterine cancer. She had radiation, was fine, and we went about our merry way thinking that was a one and done thing. 

Three years later, my older brother was 26 at the time, and started getting really sick. He was a captain in the Army and was supposed to be in the pinnacle of health and fitness. He lost 30 pounds overnight and started going through a slew of tests. The last one was a colonoscopy on September 2nd. I remember the day clearly. He was diagnosed with stage 2 colon cancer.

We were floored because he was 26. Back then, we thought colon cancer was an old person’s cancer. My mom went to her oncologist and started talking to him about it and he put two and two together. I have a younger brother and an older brother. He said, “You need to get your other two children checked out.” My mom said, “Honey, we need to get you and Nick,” my younger brother,  “colonoscopies.” I said, “No, there’s no way I’m going to go get a colonoscopy.” I put it off. I was 22 at the time when she approached me about this, so I put it off for two years, to the point where I started noticing newer symptoms. 

What were your initial symptoms?

It was about September of 2004. I had just gone back to school, so I was finishing my college degree. I chopped them up to working full time and going back to school. It was massive fatigue. I wanted to sleep all the time when I came home from school or work. My bowel habits changed. I had this really chalky complexion. It felt like I was not absorbing all the nutrients that my body was taking in. 

My gut started to say, okay, I think I need to go in and get this colonoscopy. That led me to make an appointment. It was two days after Christmas in December of 2004. I went in for my colonoscopy. When I came to, I remember my doctor talking to the nurse and saying, “You need to go get her mom and bring her back to my office.” I was like, oh my gosh, how can this be happening? I knew something was wrong. 

I didn’t have full blown cancer yet, but I had a very large colon polyp that was weeks away from turning into cancer. There was no way to absolutely tell, but it was within weeks to a few months. I had to have part of my colon in my rectum removed. That’s a whole story in and of itself, because I almost died from that surgery. 

Receiving genetic testing 

It was because of that we realized we needed to be tested for any kind of genetic abnormality, which led my mom to get tested. Back then, there were insurance laws that led my brother and I to not want to get tested, because if it came back as anything, we could potentially not get health insurance. 

My mom was tested and she came back positive for what is called Lynch syndrome, and the rest of the journey unfolds from there. It wasn’t until 2017 that I was genetically tested and tested positive for Lynch syndrome. There are a lot of things that happened before that. One being, after my experience with the colon polyp, a year later my mom was diagnosed with colon cancer. A year after that, my maternal grandfather was diagnosed with colon cancer, and then my cousin was diagnosed with stomach cancer, and unfortunately passed away within 9 months. I did develop a skin cancer, squamous cell.

All of this happened within an 8 or 10 year period. Then we had a little bit of a gap in time. 

Amanda on Mt Whitney

I was genetically tested and tested positive for Lynch syndrome.

»MORE: Genetic Testing For Cancer

Years later, new symptoms arose

In 2017, I developed a lump in my lymph node in my left groin. It popped out overnight. It was small but concerning. I was coming off of a season of doing triathlons and races. I climbed Mount Whitney, which is the tallest mountain in the lower 48. I was at the epitome of health at that point. My first thought wasn’t, this is potentially cancer. It was, I have some kind of infection. I did go to the doctor and said, “This is really concerning.” 

At the time, I had bacterial vaginosis as well. They chalked it up to that. I said, “Well, this is my family’s history. I would be much more comfortable if we could schedule a biopsy.” They said, “We don’t think you need that,” but my gut was like, I want a biopsy. Something was screaming inside of me to get a biopsy, but they put me on antibiotics and it went away. 

Six months later, the lump came back with a vengeance and I lost a lot of weight. I went into the same clinic, but saw a different doctor, and I said, “I want to get this biopsied. This is very concerning.” I did have bacterial vaginosis again, but I knew enough about my body to know that something was wrong. She said, “I agree with you.” She was an awesome doctor. I never felt like I had to push for anything with her. If I said I wanted something, she said, “No problem, we’ll do it.” 

First Diagnosis

What did biopsy results show?

I went and got this biopsied on St. Patrick’s Day. I was working at a restaurant at the time, and I was heading out the door to go to work when I got a phone call from her. She said, “I got your test results back, and it is cancer.” The blood drained from me. My immediate thought was, it must be lymphoma. Then I just started spiraling. 

Amanda's metastatic cancer diagnosis at Moore's cancer center

My final diagnosis was metastatic cancer of an unknown primary, which is very rare.

She continued, “The actual diagnosis is called metastatic cancer of an unknown primary source.” She gave me the cell type and it was the squamous cell. Then I had to undergo a bunch of other testing to figure out where this was coming from because they ruled out lymphoma. They started ruling out everything. 

Then she got me into an oncologist at Moores Cancer Institute down in San Diego, because that’s where I was living at the time. They did know there was a secondary tumor, but they could not find a primary tumor. My final diagnosis was metastatic cancer of an unknown primary, which is very rare. That was 2017, and from there, I had surgery to remove it.

How did you process your cancer diagnosis?

I didn’t process that very well. I went into shock and was extremely numb. My whole family lived in Seattle at the time, and I lived in San Diego, so I was alone. People started coming down to help me go to appointments but it was really, really scary. 

After talking to the oncologist, there were two main cancers that he thought it could be. One was vulvar cancer and the other was anal cancer. Not that any cancer is glamorous by any means, but these were two cancers where I was like, how am I going to get through this? I knew I could get through other sorts of cancers, but these two specific cancers, because there’s so much stigma attached to them, it all was devastating. Then I was like, you know what? I’m just going to take it one step at a time. I need to collect information. 

Describe your experience with your medical care team

From the time of diagnosis to the point of being in surgery was about a month. I was diagnosed on March 17th and then I was in surgery on April 17th. I had colonoscopies, CT scans, PET scans, and a bunch of other procedures to rule out everything. I saw 5 different oncologists. Ultimately, I settled with a gynecological oncologist, who I adore to this day. 

Amanda is a woodworker
She was happy with her medical team during her cancer journey

We believed it was more than likely some kind of gynecological cancer that was the primary source. I have been incredibly lucky with having an amazing support team. I know that people have horror stories. I feel like I’ve been in the medical world for so long that I have a pretty good gauge around who I can and cannot work with. That’s not to say that everybody I’ve worked with has had the best bedside manner, but my core team has always been phenomenal. 

I didn’t get a second opinion because it was such a weird diagnosis and because my whole diagnosis process involved 5 different oncologists, I felt like I was thoroughly being taken care of. There were so many different eyes on my pathology report that I felt well cared for. My oncologist had an incredible reputation, so I felt really lucky. I do highly recommend people get a second opinion if they feel like something in their gut is telling them something’s off. 

What was your treatment plant?

The treatment plan was up in the air because this is a rare cancer. Ultimately, there were talks of me doing chemotherapy and radiation, but we settled on surgery and radiation. I was pretty adamant that I did not want to do chemotherapy. I had a very strong opinion about not doing it, primarily because there was no primary tumor and they got all of the cancer out. 

I did settle on radiation. I felt like radiation was the lesser of both evils, but after going through radiation, my opinion about it completely changed. I don’t think that there’s a lesser of either one. They’re both horrible and they both come with horrible side effects. At the same time, they save so many lives. It was a hard decision to make because I’m very holistic. When I laid out all of the pieces, it was a no brainer. I did 6 weeks of radiation, 5 days a week, and then surgery. 

Amanda Testing

Second Diagnosis

Second cancer symptoms

That brings me to my latest cancer diagnosis. That was in 2017, and a year after I finished radiation, my mom was diagnosed with colon cancer again. Then 6 months later, she was diagnosed with bladder cancer. She’s had 4 cancers 4 times. Then we had a bit of a gap, and in that time, my bonus dad passed away from liver cancer. Then, in August of 2022, I started feeling fullness in my pelvis. 

I was really busy at the time. I’m an artist, and I flip furniture for a living, so I was fully engrossed in that. Then I moved into the spot I’m currently in. I had all this stuff going on, plus the grief of losing my stepdad, but I had this dull new pressure in my pelvis. I was keeping tabs on that. It was around my birthday, September 6th, that it started feeling stronger and stronger.

It started to feel like I was being pushed open from the inside of my pelvis. I called my oncologist that I started seeing for maintenance and follow up and said, “I feel like I need to come in and see you. Something feels off.” I went in, saw him, he gave me a physical exam, and he said he did feel something in there. He got me orders for a CT scan. 

Receiving surgery to determine the problem

In mid-October, I got a CT scan and there was a grapefruit-sized mass in my pelvis. A good portion of it was cystic, but there was a small portion at the very base that was solid. I just knew it was cancer. It went from sort of painful to excruciatingly painful within 2 weeks. I had a trip to Disneyland with my family in October and it was horribly uncomfortable. 

Amanda experienced pelvis discomfort signaling something was wrong

I lost a lot of weight. Right before I went on that trip, I had to go to the ER because I hadn’t had any bowel movements for 5 days. The mass was wrapping around my colon. He got me scheduled for surgery,  and at that point I just wanted it out, so I didn’t care. It was like being ripped apart from the inside out and it was growing really fast. 

I went in on November 17th and I didn’t know they were going in laparoscopically. There were all these different things that could have potentially happened in this surgery. I went in very blind, not knowing what I was going to wake up to. My doctor, who’s my surgeon and oncologist said, “We’re going to go in laparoscopically but I don’t know what we’re going to find when we get in there. We may have to cut you open. I don’t know if anything is affecting your colon, so there’s a small chance that you could wake up and you could have an ileostomy or colostomy bag.”

“We’re going to go in laparoscopically but I don’t know what we’re going to find when we get in there.”

Amanda’s surgeon

It was really nerve wracking going into this surgery. My previous colon polyp was right down there too, so I had to have part of my rectum and my colon removed when I was 24. I’m like, this is either colon cancer or endometrial cancer. When I woke up, the first thing I did was reach my hand down to my belly. I felt the tape, but I didn’t feel any bags. I had to have a temporary ileostomy bag when I was 24 because I developed peritonitis from that surgery, and that’s why I almost died. That’s a whole other story, but I knew what to expect. I was like, thank God I don’t have that because I didn’t want to have to go through that again.

What was your second cancer diagnosis?
Amanda post surgery

My official diagnosis came back as extra ovarian primary peritoneal carcinoma.

I was kind of in and out, but I do remember every time a nurse came in, I asked, “Is it cancer? What cancer is it?” She said, “Your doctor will be in and talk to you in the morning.” He came in around 6 or 7 a.m. and confirmed that most of it was cystic, but there was a small portion down in the base that was cancerous. 

It was the same cell type as before, the squamous cell. I had to wait for pathology reports to come back to confirm all of this, but he did mention in that initial meeting that the next course of treatment would most likely be a mix of chemotherapy and radiation. That was in the back of my mind. 

Three weeks later, my brother went with me to get the pathology report back. Initially, I was diagnosed with endometrial carcinoma. Later, after they sent it off to another specialist, my official diagnosis came back as extra ovarian primary peritoneal carcinoma. I think of it as ovarian cancer and peritoneal cancer. 

What was your next course of treatment? 

When I went to see my oncologist, my biggest concern was, I had really long, beautiful curly hair. I was like, I really don’t want to lose my hair. I know a lot of people are not going to understand this, but I feel very strongly about not wanting to do chemotherapy. He said, “I could put you on one where, most likely, you won’t lose your hair.” I said, okay, I’ll do that. 

»MORE: Hair Loss and Regrowth After Chemotherapy  

We were originally going to see if we could go the radiation route. It turns out, I couldn’t do radiation because too much of my previous area that was radiated before would be covered, and it was too dangerous. I had to go the chemotherapy route. 

My brother and I went back to him in early January of 2023. He presented all of the options for me. One of the options was that I could do a mix of carboplatin and I think doxil and I wouldn’t lose my hair. Then he presented a mix of carboplatin, taxol, and paxil with Keytruda immunotherapy

There were so many studies coming out showing incredible things were happening with this immunotherapy, but I would lose my hair. He said, “There are studies showing that Keytruda is bringing the recurrence rate down to next to nothing.” It was a no-brainer for me, especially having Lynch syndrome and knowing that I had such a high chance of recurrence rates and a laundry list of cancers that I can get. Two weeks later, I was at my first chemo appointment. 

Side Effects

Was this second cancer diagnosis connected to your first diagnosis?
Her second diagnosis was not connected to her first diagnosis

I don’t think this was connected to my first diagnosis when I was 24, but he does think this is the primary tumor to the diagnosis in 2017. My other oncologist was very clear that it’s not an if, it’s a when. The original tumor will pop out at some point. It was a relief when it finally did, because I’ve been walking on eggshells. 

July of 2020, I had a scare. I had a pelvic ultrasound done, which was part of my regular screening. The tech was acting really weird and asked me weird questions. I was like, just come out and say you found something. It turned out to be nothing, but that was the last straw, because since I was 24 years old, I’ve been told that I need to have a hysterectomy. I wanted to have kids, and so I didn’t. I said by my 40th birthday, I’ll make the decision. 

This was the final straw. I called my oncologist and said, “I don’t want to wait anymore. I’m tired of having scares. I want the hysterectomy.” I had a total hysterectomy in July of 2020 to prevent this from happening. Ironically, I was still diagnosed with extra ovarian primary peritoneal cancer. 

Did you have any side effects from chemotherapy?

With chemotherapy, I had no idea what to expect. You can read and read but everybody’s bodies are so different. I went into that first chemotherapy  session extremely nervous. I was trying to preserve my hair, so I did cold capping but it didn’t work. 

The nurses would give insight into what to expect over the course of the following days. They said, “You probably won’t sleep or you’ll be up at 3 a.m. painting your bathroom.” I slept fine that night, but the next day, I had so much energy. I thought, if this is what it’s like, I’m fine. This is great. I can do this. Then I went to lunch with my family. We were walking down that beach and all of a sudden my legs felt like tree trunks. I said, “Mom, I have to go home. I feel like I can’t walk anymore.” 

I went home and laid on the couch and proceeded to fall into the most excruciating pain I’ve ever felt in my life. It was like all my bones were crushing. I had a splitting headache. I did call my doctor, because after three days of feeling this way, I said, if this is how I’m going to feel, I’m not doing this anymore. I cannot do five more of these. 

Did anything help with the chemo side effects?

I’m very active on social media. I was putting it out there in my stories, and people kept writing back to me and they’re like, “Are you on Claritin?” I said, “Nobody told me to be on Claritin,” and I did start taking that. It was a night and day difference. Check with your doctor first, but Claritin was the missing piece for me. I had bone pain but it was not as excruciating. 

The first chemotherapy is very shocking, but then you start to develop your rhythm. After 5 days, I started feeling better and better. Week two, I felt pretty good. Week three, I felt great. You find your groove.

Asking for help during cancer treatment

Everybody wants to help but you have to tell people exactly what you need, and you can’t be afraid of telling people what you need.

Amanda with Friends

I had so many people asking what I needed, and it was wonderful, but also very hard for me to respond to everybody. I thought, we do wedding registries and birth registries. I’m putting together a friggin cancer registry, because why not? I don’t have kids, I’m not married, but if people want to help, I’m going to lay out exactly what I need. I put together a document, I put it on my website, and I shared it on all my socials. Direct links to an Amazon wish list and my Venmo were on there.

I had a friend who started a meal train for me. I put my dietary restrictions and everything I needed. Everybody wants to help but you have to tell people exactly what you need, and you can’t be afraid of telling people what you need. Some other things I really loved were heating pads. I got inundated with pajama sets, socks, and slippers, which was really nice. 

A lot of people lose their sense of taste and I still had mine for the most part. I wanted fruit all the time and popsicles. I ate so much watermelon. I did Liquid I.V.s and hydration stuff. I invested in new water bottles. I used to hate ice cold water, and now I live for it. A lot of things change physically in your body. I wanted ice cold things all the time.

Immunotherapy

Do you have any side effects from Keytruda?

I get pretty bad rashes on my face that look like acne. I get it all over my face and my chest. Every immunotherapy is different. I always say it’s like Russian roulette because I never know what I’m going to get afterwards. Over the summer, my whole body, head to toe was covered in this horrible rash after one session. That never happened again. 

It’s much easier than chemotherapy. I’m growing my hair back now and there’s not those kinds of side effects. One of the ways that it really affects me is fatigue and my breathing. It can affect your lungs. I have to take a lot more deep, longer breaths. I get winded faster. 

I’m currently seeing a neurologist because there’s some things going on neurologically right now. He doesn’t know that it’s necessarily from Keytruda, but we’re crossing all our t’s and dotting our i’s right now. I will say that it’s chemo brain. 

One of the major side effects is it affects your thyroid. I already had Hashimoto’s so it is really affecting my thyroid, which could be contributing to a lot of fatigue. We’re constantly having to adjust my thyroid medication which is a bummer because there’s so many side effects that come with low thyroid that are hard. It’s also a wonderful alternative for people and it’s helping. It’s giving so many people additional years when they normally wouldn’t have them.

»MORE: Keytruda Side Effects 

Describe the process of receiving Keytruda

You go in and it’s a 4-hour day because I have to get labs. I meet with my doctor, and then the actual treatment itself is only 30 minutes. It’s way different than chemotherapy, which was like a full day at the hospital. 

Amanda uses a port to receive medication

I get it every 3 weeks and. I have a port here. I named her Natalie Portman. I do pretty much everything from my port. Occasionally, if I’m just doing a blood draw, I’ll do it from my arm. If you’re on the fence about whether or not to get a port, it’s not the prettiest thing, but it is such a life saver. The poke here is so much better than the poke in your arms. I have rolling veins and I have a hard time getting access through my veins, so this has been a lifesaver.

They go through my port and it’s pretty easy. You’re usually in the chair for about an hour, because sometimes the pharmacy takes a while to get you the medication. I drive myself and I get them in the mornings, and then I come home. 

It gives me a bit of a stomach ache. I want to stay inside and be close to the bathroom. Other times, I’ll go out to my workshop and work. I don’t make a lot of plans with people after treatment. Every session is a little bit different. I just gauge it off of how I feel. 

How did you get the generic version of Keytruda?

I have therapy every 3 weeks, so I have one more year of Keytruda. The social worker in the hospital ended up going straight to the company, and they gave me the treatment. It’s income based. I wasn’t working very much and I’m still not working a tremendous amount. 

People don’t understand that there are so many tools you can access through your hospital social worker. People think I can’t get this, so I’m just out of luck. Talk to your social worker at your hospital. There’s usually always something that can be done, or at least they can try to do something. My social worker went directly to the company that makes [Keytruda], and I get it now. 

Reflections 

Reaching cancer remission

I am in full remission now. I was supposed to do 6 rounds of Keytruda, the generic version, with my chemotherapy, but my insurance kept denying it. I only did 2 rounds of it with chemotherapy. I’m doing 2 additional years of immunotherapy now, as much as my body can tolerate. I had my first scan right after I finished my 6 rounds of chemotherapy and everything looked great.

I had a couple scans because I thought I was feeling similar pressure, but it’s post-surgical changes and not abnormalities. All my organs settle differently now. If I am not having regular bowel movements, it’ll start to feel like pressure in there. I have to be really on top of my digestive track. Everything has been really good so far. I seem to be tolerating immunotherapy pretty well. 

»MORE: Learn More About Cancer Remission

Do you have any advice for someone on a journey with cancer?

Always listen to yourself and push for the things that you feel in your heart you want. 

Make sure that your team really listens to you because they’re your team for the long haul. Just because you are going through cancer doesn’t mean that once you go through treatment and if you go into remission, then it’s done. You’re with them for the long haul. You want to be very comfortable with them. 

Amanda encourages people on a cancer journey to advocate for themselves

Always listen to yourself and push for the things that you feel in your heart you want.

My team knows that I like to do a mix of holistic and Western medicine. I’m grateful for both. One of my oncologists said the most amazing things to me. He said, “There’s great things about Western medicine and there’s great things about holistic medicine. They work symbiotically together.” I loved that he said that because I felt heard. Find somebody that makes you feel heard and try to live your life. It’s the scariest thing you’ll probably ever go through, but you have to keep finding life in the little moments throughout your day.

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Categories
Chemotherapy Colon Colorectal FOLFOX (folinic acid, fluorouracil, oxaliplatin) Patient Stories Treatments

Kyle’s Stage 4 Colorectal Cancer Story

Kyle’s Stage 4 Colorectal Cancer Story

Kyle, 45-years-old from Miami, found himself facing stage 4 colon cancer amidst the joy of preparing for adoption with his husband. Despite initial concerns while on vacation about unusual symptoms, Kyle’s diagnosis came as a surprise. After a colonoscopy revealed a mass in his sigmoid colon, further tests showed cancer had spread to his liver. Despite the emotional toll on his family, Kyle remains resilient, viewing cancer as a battle they’re fighting together.

Kyle’s treatment journey started with aggressive FOLFOX chemotherapy. Despite its challenges, he remains determined, sharing his experiences openly to encourage others to prioritize preventive screenings. From managing side effects like heightened senses to navigating chemo crashes, Kyle offers insight into the reality of living with stage 4 colon cancer.

Kyle encourages other cancer patients to be your own advocate. From proactive screening to asking tough questions, he emphasizes the importance of taking control of one’s medical journey. Kyle’s openness about his experience underscores the critical need for early detection and support. As he continues his fight, Kyle reminds others that they’re not alone in their journey against cancer.

Kyle shares his colon cancer symptoms and treatment
  • Name: Kyle R.M.
  • Age at DX: 44
  • Diagnosis (DX):
    • Colon cancer
  • Staging:
    • 4
  • Symptoms:
    • Blood in stool
    • Constipation
  • Treatment:
    • Chemotherapy
      • FOLFOX

You’ve got to find that inner strength and advocate for yourself.

Kyle R.M.

This interview has been edited for clarity. This is not medical advice. Please consult with your healthcare provider for treatment decisions.


Symptoms

Tell us about yourself

My name is Kyle. I just turned 45 in February. I live in Miami, Florida, and that is my hobby and my interest. Everything in the city keeps you busy all the time. 

I’ve been married for six years, and my husband and I are currently in the middle of an adoption, so that’s very exciting. We’re finalizing soon and couldn’t be more happy that cancer hasn’t postponed the adoption. We’re becoming parents and moving next week in the middle of my chemos, because we have to have a bigger home to bring the child in. 

That exciting time of becoming parents and having that new chapter start in our life happened to be right in the middle of my diagnosis. How we are navigating through that is what’s taken the forefront.

What were your first symptoms? 
Kyle began experiencing unusual symptoms
Kyle traveling

I knew something was wrong. My husband and I went to Europe for a month. Before we went to Europe, he had some major gastro issues. We went down the Dr. Google rabbit hole and we were accepting the fact that he may have colon cancer. He ended up getting an endoscopy and a colonoscopy, and he turned out perfect, thank goodness. It just happened to be a flare up. 

I knew something was wrong.

Then we spent a beautiful month in Europe with friends, and traveled all around to multiple countries. When we came back, I was honest with him and said, “While we were gone, I had major constipation and blood in my stool. It’s getting to the point where the blood is becoming more than the stool, and it’s making me very nervous.” 

Getting scans & tests

My husband had to go back for a follow up on his colonoscopy to make sure his stomach was doing okay. While he was there, I said, “See if they can squeeze me in.” He called me back and said, “Believe it or not, they have a cancellation. Can you come on December 27th?” Two days after Christmas. I work in retail, so that’s a very busy time for us. 

I took the day off, I went and got the colonoscopy, and after the colonoscopy was over, I was freezing cold. The doctor said, “Can you join me in this room?” I texted my husband and said, “When you came out of your anesthetics, did they ask you to quickly join them in a room?” He said no, and I immediately knew.

His bedside manners were okay. He leaned up against the wall and said, “During your colonoscopy, we found a mast in your sigmoid colon.” I said, “What does that mean?” He said, “Colon cancer.” I went out and I told my husband, “They found something.” He asked me, “How do you feel?” I was like, “We’re going to get through this, it’s fine.” 

Diagnosis

He ran the tests and it was colon cancer.

NJRJ Music Awards
Receiving a cancer diagnosis

We came home that night and I got very proactive. I started reaching out to friends in the medical industry, and asking for advice from them. A friend, who is a doctor, was able to get me in touch with another doctor. Again, this is all during the holiday. He said, “Let me see the imaging.” I sent a picture of that. He said, “When I get back from my vacation, you’ll be my first patient.” 

Kyle received a stage 4 metastatic colon cancer diagnosis

Luckily, I got in there and I saw that doctor immediately. He ran the tests and it was colon cancer. We had all the other tests start happening. I saw an oncologist at that point, and started getting scans. Unfortunately, when they did a CT scan, it lit up in my liver. At that point, we had to stop what we had started and immediately focus on what’s going on with my liver. When the surgeon called and said, “It’s in your liver. It’s out of my wheelhouse now,” my heart sank into my chest. I was like, I’ve got to deliver this news to my husband and my family.

The news wasn’t taken by my family very well, and there was a lot of crying that night. I stayed strong, but it was emotional. It’s not just me that has cancer, it’s the whole family, is how I look at it. For friends and family, anyone around me in my circle, we’re all doing it together. It was a tough night. It was bad news because there were 4 different significant spots in my liver. I had more testing done and my CT scan. The good news is, after my CT scan, it was not in my lymph nodes. It’s nowhere else, just in my colon and liver. 

Describe your experience with getting a colonoscopy

A colonoscopy, people think, it’s super expensive, it’s invasive, it’s a surgery. The one thing with the colonoscopy is everybody dreads that they have to drink this horrible drink, and it’s going to make them have bowel movements. 

Kyle describes his colonoscopy experience

You have to prepare yourself. I went on YouTube and watched this one woman say, “This is how I prep for my colonoscopy.” The message was: water. She said, “Be super hydrated 2 days before you start the cleanse and then your cleanse won’t be so bad.” My cleanse wasn’t bad at all. I’ve heard horror stories, but my cleanse wasn’t bad because I followed what she said. I was drinking around a gallon a day and regular tea also.

You have to fast for 20 or 24 hours. It’s not that bad. Everybody can do it. It’s for your health, it’s for your family, and so you can be around for many, many years to come. The colonoscopy part, it’s nothing. You go in, get in a bed, you have a nurse come and check your vitals, and then the doctor comes over to the bed and introduces himself, and then you get walked back into a room and they put a mask over your face. They say to count backwards. I counted backwards and I was out. I woke up and it seemed like it took no time. 

When I woke up, there wasn’t any funny business, I wasn’t saying weird things and I didn’t feel any pain. I didn’t feel very bloated. I got bad news, but from the time that I left the bed with the doctor to when I actually found out that they found a mass was 15 minutes. I think it was probably a 15 or 20 minute recovery in the bed. Then I went into the office and he told me what happened, and I was coherent.

»MORE: What It’s Really Like To Get A Colonoscopy

Treatment

What cancer treatment are you on?

We started on a very aggressive chemo immediately. February 19th was my first chemo, FOLFOX. I did that for 48 hours each time. 

Chemo was an eye opening experience. I tell people when they ask me what the symptoms feel like, they feel like the worst adult hangover and the flu for 4 to 5 days. I can drink water, which is great, but I can’t eat. I’ve learned that eating during chemo makes me even more sick, so I choose to fast those 3 days. On the fourth day, I resumed eating. That’s what I’ve found works for me. 

What are your side effects from chemo?

Some of the side effects that I’m getting are weird. I call it a superpower. I can smell and break down scents like you wouldn’t believe. I can tell you if somebody brings me peanut butter on bread, I can smell the peanut butter, the grains, the wheat, to the point where it’s nauseating. The only thing that helps is pure peppermint oil. We’ve learned that if we spray it underneath our kitchen table onto the rug, it goes throughout the house and it soothes everything. 

It makes me feel selfish for having this issue, because no one can cook in my house. I can smell what’s cooking in the neighbor’s house. When I go outside and take my first walks with my dogs, I can smell the ground, the grass, and how the sun heats up the concrete. 

»MORE: Cancer Treatment Side Effects

I get hiccups for about 3 days. They did prescribe me a muscle relaxer. It works great because it also makes me fall asleep. A double win for me. The more you can sleep the better when you’re going through chemo. 

Kyle Stage 4 colorectal cancer traveling with his husband

The other day I was eating an acai bowl and part of it was still frozen. When I swallowed it, it felt like it got stuck in my throat. It felt like I had a thousand needles in my throat, and my tongue immediately swelled up to the point where we were concerned. It went down in about five minutes. It was a very interesting feeling. 

Describe your experience with having a chemo CRASH

Another one of the side effects is that I get a chemo CRASH or a toxic crash. When I get my chemo, I get one for an hour and 20 minutes, then 2 different chemos for 2 hours and 20 minutes. Then, when they go to do the fourth chemo, it’s a pump that I take home in between the second and the third chemo. The fourth is when my body starts to react, my temperature goes up, and my blood pressure goes through the roof. They have to call in a doctor.

It happened twice. They have to call in the main doctor that’s overseeing the chemo ward for the day. Then they have to lay me flat, calm me down, switch me out, and put on an IV of liquids. They wait about 20 minutes and I snap back, I sit up out of the bed, and I’m like, okay, I guess I’m ready to go home. It’s a very interesting feeling. 

Kyle in the hospital with stage 4 colorectal cancer

Every year since I turned 40, I’m now 45, I did the at-home screening…I did that for 4 years before I had my colonoscopy. All my levels were fine.

This attending doctor gave me some advice. He said, “What has happened is that we’ve loaded your body full of one toxin and a lot of volume, and your heart is trying to figure out what to do with all this volume. I’m going to say that this is going to be consistent with you. Every time you go from this much volume down to a smaller amount of volume, it’s just your body adjusting. Next time, we’re going to lay you flat, we’re going to be prepared for it, and we’ll be good to go.” 

Words of Advice

Where are you at in your treatment plan currently?

I have 2 chemos down. I have 3 to go next week. I’m meeting with the oncologist, so I’m sure we’re going to start doing some more scans and possibly biopsies again to see where we’re at. I’ll have more of a handle on it then, but as of now, the chemo is where we’re at.

The importance of getting preventative screening

Every year since I turned 40, I’m now 45, I did the at-home screening because I did speak to my general practice doctor and let her know that my grandmother passed away from colon cancer. She said, “Let’s be proactive and do the screenings.” The screenings didn’t catch it.

How I did the at-home test is that my doctor prescribed it. It was a kit and it had swabs in it. I had instructions on how to retrieve a sample. You would stick the entire thing in, you’d break the swab, you’d break the top off, and then you’d put it back in a biohazard envelope. You put it in the mail and then they give the results back to the doctor. I did that for 4 years before I had my colonoscopy. All my levels were fine. 

Kyle battling stage 4 colorectal cancer

My doctor said to me that he is seeing cancer like the flu. If that’s any indication that we have a problem in the United States with cancer.

Since I’ve got the colonoscopy and the diagnosis, I’ve been so open about it. On my personal Instagram and Facebook page, I post every time I have chemo. I do videos when I’m able to feel better and tell people my progress. The amount of people that comment, “Because of you, I got a colonoscopy.” Or, “Because of you, I got a mammogram.” That’s magic to me. Prevention is key. My doctor said to me that he is seeing cancer like the flu. If that’s any indication that we have a problem in the United States with cancer. More people need to hear the messages and get screened. What’s two days of your life to be able to have a life, to go get screened? It’s worth it.

The week that I got diagnosed, two of my friends also got diagnosed with cancer. We meet up and I have colon cancer. They both have breast cancer, but two different types of breast cancer. We’re all going through our journeys. We go and we hug each other and say, “Get through the week and we’ll see you next week.” It’s crazy to think, within a circle of friends, I got diagnosed, then my friends got diagnosed within one week, and we’re all young. 

Do you have any advice for cancer patients?
Kyle with his socks that say "Dear Cancer, you picked the wrong guy!"

Be your own advocate. Do not be shy. You are going through cancer and chemo. If you’re not going through chemo, you’re going through radiation or some sort of treatment. You’ve got to ask questions, and don’t wait. I have asked every question possible. I don’t think that there’s any way to get through this unless you’re your own advocate. 

You’ve got to find that inner strength and advocate for yourself when it comes to insurance and finding out your medical path. Do your homework. Don’t wait for the doctor to call. 

»MORE: How To Be A Cancer Patient Advocate 

More Colorectal Cancer Stories

 

Shannon M., Colon Cancer, Stage 1




Cancer Details:
Found the cancer as a result of her Lynch Syndrome
1st Symptoms: Routine colonoscopy found polyp
Treatment: Partial colectomy

Hugo T., Colon Cancer, Stage 1



Cancer Details: Diagnosed 2 weeks after 5 years remission from testicular cancer
1st Symptoms: Inflamed bowel
Treatment: Subtotal colectomy, immunotherapy

Rachel B., Sigmoid Colon Cancer, Stage 1



Cancer Details: The sigmoid colon (or pelvic colon) is the part of the large intestine that is closest to the rectum
1st Symptoms: Stomach discomfort, nausea, bloating, blood in stool
Treatment: Colectomy

Chris T., Colon Cancer, Stage 2



Cancer Details: Discovered Lynch Syndrome after genetic testing
1st Symptoms: Found the cancer as a result of family history, early colonoscopy
Treatment: Partial colectomy

Shannon C., Colon Cancer, Stage 2A



Cancer Details: Diagnosed at 29, tested positive for Lynch Syndrome
1st Symptoms: Severe pains after eating
Treatment: Partial colectomy
Barbara smiling

Barbara M., Colon Cancer, Stage 3



Cancer Details: Family history wasn’t flagged, should have had colonoscopy earlier
1st Symptoms: Stomach discomfort, difficult to process food
Treatment: Colectomy, Chemo (FOLFOX, CAPOX)

Shelley B., Colon Cancer, Stage 3B



Cancer Details: Had no usual first symptoms, found as a result of routine colonoscopy and endoscopy
1st Symptoms: None
Treatment:Partial colectomy, chemotherapy (FOLFOX)
Lindsay

Lindsay D., Colon Cancer, Stage 4



Cancer Details: Diagnosed at 32, cancer spread to ovary and lung
1st Symptoms: Lump in pelvic area, funny-smelling food, weight loss
Treatment: Chemotherapy, colectomy (surgery)
Lee

Lee J., Colon Cancer, Stage 4, Recurrence



Cancer Details: Recurrence then remission
1st Symptoms: Discovered stage 4 cancer from unrelated CT scan
Treatment: Neoadjuvant chemo (FOLFOX), hemicolectomy (partial colon surgery), adjuvant chemo (FOLFOX), chemo post-recurrence (FOLFIRI), liver surgery

JJ S., Colorectal Cancer, Stage 4



Age at Diagnosis: 27l



1st Symptoms: Abdominal pain, blood in stool



Treatment: Surgery to remove tumor, chemotherapy, clinical trial of Keytruda (pembrolizumab)
Haley P. feature profile

Haley P., Colon Cancer, Stage 3C



Symptoms: Constipation, fatigue, shortness of breath
Treatment: Surgery, chemotherapy
Amanda G. feature profile

Amanda G., Colon Cancer, Stage 2A



Symptoms: Gurgly stomach, blood in stool, chronic constipation
Treatment: Surgery (hemicolectomy), chemotherapy (CAPOX), Zarxio
Jason Randall describes his colon cancer journey
Jason R., Colorectal Cancer, Stage 4 Diagnosis: Colorectal Cancer Symptoms: Abdominal pain, constipation, belly button discharge Treatment: Liver surgery, chemotherapy, radiation
Angelica A., Bowel Cancer, Stage 3

Symptoms: Fatigue, anemia, irregular bowel movements, loss of appetite, heavy periods Treatment: Laparoscopy, chemotherapy, partial hysterectomy
Danielle shares her stage 4 metastatic colon cancer
Danielle A., Colorectal Cancer, Metastatic Stage 3 Diagnosis: Stage 3 Colorectal Cancer Symptoms: Abdominal pain, constipationTreatment: Surgery, Chemo
Keith shares his stage 4 colorectal cancer story
Keith H., Colorectal Cancer, Stage 4 Diagnosis: Stage 4 Colorectal Cancer Symptoms: Abdominal painTreatment: Surgery, Chemo
Sherrie shares her stage 4 metastatic breast cancer story
Sherri O., Metastatic Breast Cancer & Colon Cancer Diagnosis: Colon & Metastatic Breast Cancer Symptoms: Shortness of breath, lump under armpit, not feeling herself Treatment: Chemotherapy, Transfusions
Dania M.

Dania M., Colon Cancer, Stage 4, with Liver and Peritoneal Carcinomatosis



Symptoms: Constipation, diarrhea, terrible bloating, swollen belly, as if pregnant
Treatment: Surgery, immunotherapy (KEYTRUDA)
Stephanie K.

Stephanie K., Colon Cancer, Stage 3



Symptoms: Very bad cramps, bloating, indigestion, burping
Treatment: Surgery, chemotherapy (CAPOX)
Jason A. feature profile

Jason A., Colon Cancer, Stage 3B



Symptoms: Abdominal pressure, fatigue, small amounts of blood in stool
Treatment: Surgery (colon resection), chemotherapy (FOLFOX: folinic acid, fluorouracil, and oxaliplatin)
Kelly shares her cancer story
Kelly B. Diagnosis: Stage 3 Colon CancerSymptoms: Blood in stool, cramping, bloating Treatment: Chemo, surgery
Courtney shares her colorectal cancer story
Courtney H. Diagnosis: Stage 1 Colorectal CancerSymptoms: Blood in stool, fatigue Treatment: Chemo, oxaliplatin, capecitabine, surgery
Zykeisha shares her stage 4 colon cancer story
Zykeisha L. Diagnosis: Stage 4 Colon CancerSymptoms: Anemia, stool changes, blood in urine, back painTreatment: Chemo, Avastin, FOLFOX, FOLFIRI, surgery, Neupogen shots
Kyle R.M. Diagnosis: Stage 4 Colon Cancer Symptoms: Constipation, blood in stoolTreatment: Chemo, FOLFOX
Categories
ABVD Chemotherapy Hodgkin Lymphoma Patient Stories Treatments

Alexandra’s Stage 4 Hodgkin’s Lymphoma Story

Alexandra’s Stage 4 Hodgkin’s Lymphoma Story

Alexandra, a stage 4 Hodgkin’s lymphoma survivor, shares her journey of diagnosis, treatment, and reflection. Initially experiencing symptoms such as weight loss, night sweats, and hair thinning, she attributed them to stress from a breakup. It wasn’t until swollen lymph nodes appeared that she sought medical attention. Biopsies confirmed Hodgkin’s lymphoma.

Facing an abrupt transition from teaching to undergoing chemotherapy, Alexandra navigated the challenges of treatment. From the shock of discovering her cancer had progressed to stage 4, to managing side effects like nausea and hair loss, her journey was marked by hurdles. Yet, through perseverance and support, she found ways to cope, embracing activities like painting and caring for a puppy to uplift her spirits.

Reflecting on her experience, Alexandra emphasizes the importance of being an advocate for oneself in the medical journey. Despite regrets about fertility preservation options not being fully explored before treatment, she finds solace in newfound perspectives and maturity gained from her battle with cancer. With a message of hope and resilience, she encourages others to lean on their support networks and find sources of joy to navigate their own cancer journeys.

Alexandra shares her cancer symptoms and treatment
  • Name: Alexandra G.
  • Diagnosis (DX):
    • Hodgkin’s lymphoma
  • Staging:
    • 4
  • Symptoms:
    • Hair thinning
    • Night sweats
    • Weight loss
    • Swollen lymph nodes
  • Treatment:
    • Chemotherapy
      • ABVD
        • 6 rounds, 12 sessions
Alexandra shares her cancer timeline

What I went through at such a young age is a blessing because I have been given so much insight into the world around me, and it’s changed my perspective.

Alexandra G.

This interview has been edited for clarity. This is not medical advice. Please consult with your healthcare provider for treatment decisions.


Symptoms

Tell us about yourself

My name is Alexandra and I’m a stage 4 Hodgkin’s lymphoma survivor. I was diagnosed back in September 2020, and during that time I was a full-time teacher. I stopped teaching and began painting. Now I’m a full-time artist.

Alexandra with her artwork
What were your first symptoms?

I went through a breakup. I was with this person for about 5 years, and that was in November of 2019. I was super stressed, as most people are during a breakup. Around the same time, I started to lose weight and experience night sweats. My hair was thinning out quite a bit. My hairdresser asked, “Are you healthy? There’s something different about your hair texture.” 

I noticed all these little symptoms, but I thought they had to do with the breakup. I thought, I’m just stressed. That was in November. In July, I noticed I had swollen lymph nodes on my shoulder. I have a lipoma here, which is just a fatty tissue deposit, which I had gotten tested a year ago. It’s non-cancerous. But my swollen lymph node was right beside it. I was like, that’s weird. Why is this one hard and this one soft? I couldn’t quite figure out what was going on. Then another swollen lymph node happened around here [on the neck] and then one at the back within 3 days. 

Alexandra noticed swollen lymph nodes on her shoulder
Did you visit the doctor for your symptoms?

I had gone to my doctor within 3 days of getting the swollen lymph nodes. Right away they began testing. I had an ultrasound and it came back abnormal. They said the shape of the lymph nodes was off, so they wanted to do a more in-depth ultrasound. I went back for another ultrasound and did bloodwork. Nothing in my bloodwork appeared, which is strange for a blood cancer. You would think something would show up, but it never appeared until the day before I started chemo. 

Now I get bloodwork every 6 months to make sure I’m still in remission. That’s how we determine it. It drives me insane because I’m like, my bloodwork didn’t show cancer for months. 

I got an MRI and then biopsies that they had to do to diagnose Hodgkin’s lymphoma. They did a needle one and it came back inconclusive. Then they cut, which I have a scar from, and they took a tissue sample. That’s how they were able to diagnose it. I have a little bit of a different mindset about it. 

I had an ultrasound and it came back abnormal. They said the shape of the lymph nodes was off.

Diagnosis

Describe your biopsy experience

They freeze the area, but you’re awake during it. I’m chatting away to the doctor, and he was lovely. They said it could take up to 2 weeks to get the results back. He got back to me right away. Then they gave me the option – would I like to do the needle one again to avoid scarring, or do I want to just get cut and get a tissue sample? I was like, just cut. Let’s just get this show on the road. I got two biopsies within 2 or 3 weeks, but that was what gave me the definitive answer.

Receiving a stage 4 Hodgkin’s lymphoma diagnosis

I had just landed my dream teaching job right before COVID. I wanted to teach at my elementary school and I got a job there full-time. Then, on Friday afternoon, I was at school. I was on my way to my classroom when I checked my phone and saw it was my doctor ringing. He always called on Friday afternoons. 

Alexandra received a stage 4 cancer diagnosis

Within a week and a half, they told me it was stage 4.

I answered it and he said, “Alexandra, good news and bad news. The good news is I’ve got an answer for you and it’s a good type of cancer. The bad news is you do have Hodgkin’s lymphoma. You gotta pack up. You’re not teaching anymore because you’re going to start chemo in 2 weeks.” I headed home and told my mom. 

»MORE: Reacting to a Cancer Diagnosis

Treatment

Preparing for chemotherapy

The lead-up to chemo was doing all this testing to make sure my body was strong enough for chemo and also to see how far the cancer had progressed. I had to undergo testing of my lungs and my heart. I did the PET scan to see how far cancer had traveled. Within a week and a half, they told me it was stage 4, so that was surprising. I was thinking I was stage 1 or 2 because I could feel the lymph nodes here, but I couldn’t feel them anywhere else. I had cancer in my neck, my lungs, and around my spleen, that’s what made it stage 4 Hodgkin’s lymphoma. 

When I went in, it was a Thursday, and my doctor said, “You’re starting treatment tomorrow at 8 a.m. Be here at this time.” It was like, oh, wow. I wasn’t expecting it to happen that fast. In a way, it’s good because it didn’t allow my brain to think about it. 

Did you have side effects on chemo? 

I did ABVD. I didn’t have radiation or surgery, just 6 rounds of chemo, and 12 treatments. The first chemo that I went to, I was like, this is a walk in the park. I’ve got this. I guess your body’s not used to chemo yet, so it was fine. As time went on, each chemo got progressively worse. I dealt with a lot of nausea.

Around the second chemo, I woke up and I was like, oh, I don’t feel well. But it’s all in my head. I’m gonna push through, have a shower, and get ready for my day. I ended up passing out in the shower because my blood pressure was so low and I was trying to push my body to be mind over matter type of scenario, which I shouldn’t have done. I learned pretty quickly, that this is pretty serious. 

By chemo 4, I was experiencing a lot of shortness of breath from one of the chemo drugs I was on. I was hospitalized at that point.

Alexandra began ABVD chemotherapy
Did anything help with the chemo side effects?

They did lower my dosage of that chemodrug. My main thing was nausea. I experienced a lot of nausea, and I felt like the medication I was taking masked the nausea but then they would cause other side effects. At one point, I counted 12 different medications I was on because they kept masking the symptoms. I didn’t love that. 

I never have been a napper, but during chemo when I was dealing with the nausea and mentally drained from it, sleeping was the best cure. I did have home hydration, so staying hydrated helped. I felt like drinking water was making me more nauseous, but the IV through my PICC line for hydration helped. 

As time went on, each chemo got progressively worse.

»MORE: Cancer Treatment Side Effects

Also, food would make a big difference. You get this weird metallic taste in your mouth and certain foods weren’t sitting well. It took me a few chemos to realize if I don’t eat a lot during these 4 or 5 days, so be it. I would eat a ton the week after when I was feeling good. I did a lot of binge eating, but that’s what worked for me. It was just listening to my body.

I had gotten a puppy at the time so I was taking the dog for walks and going for hikes. I monopolized my time off of chemo to be active outside. That helped with my mental health, too.

Remission

Did you lose your hair from chemo?
Alexandra chopped her hair and dyed it pink

During my first chemo, I had a girlfriend who cut hair. I had long blonde hair and she cut it short and dyed it hot pink because I knew I was going to lose my hair. A cute little pink bob, which I loved. Around chemo 5, I started to lose chunks of hair and shaved my head. I did have a shaved head from chemo 6 to 12 at the end. 

I was always someone who loved to play and do my hair. I loved updos and curling it. I was extremely upset to lose my hair, not just for my physical appearance, but also because it was a hobby and creative outlet for me. That was one of the worst parts, and I feel so shallow saying that, but it was.

The good thing is, that hair does grow back. I did buy a nice wig that looked pretty much like my bio hair. That was my safety net. I did wear that a lot. Looking back, I wish I embraced the baldness, but that was what gave me comfort. I wore that wig a lot. 

Was chemotherapy effective?

Right after treatment, I went for my one PET scan and they’re like, “Okay, it looks good. You’re on your own. See you later.” My mind was blown. I was moving out [of my parents’ house] that next week, I just finished chemo, and I had a new home. 3 months after that, I went for a scan. Now it’s been every 6 months for 5 years, and then I’ll be cleared.

»MORE: Learn More About Cancer Remission

Reflections

Did you preserve fertility

That was one of the first questions I asked my doctor was about fertility because that was so important to me. He said not to worry. Lots of patients on this type of chemo will go on to have children later in life. He gave me examples of clients. My doctor was pretty dismissive of the conversation. 

Alexandra discusses fertility preservation

When you’re diagnosed with stage 4 Hodgkin’s lymphoma and your doctor tells you, “You’re going to be fine. Let’s go into chemo,” I went ahead and started chemo. Looking back, I wish I had pushed to get my eggs frozen at that stage. Here in Canada, if you get your eggs frozen, it will be covered. 

When I finished treatment, then I decided, now I wanted to see what my options were. I went through fertility testing on my own after treatment. I only got about halfway through the testing because it started to get super expensive. To get your eggs removed and frozen on your own is pretty risky on if it will actually work and also it’s super expensive. That’s when I found out that if I had done it before treatment, it would have been covered. I was really upset that information wasn’t given to me beforehand. 

The importance of being a patient advocate

You do have to do your research. When your doctor is telling you information, it’s all new. You don’t have time to process it. You need to make sure that you go home and research so you feel brave enough to go with your questions and push for correct answers. I do think it’s wise to Google and to ask other people in the medical field and get second advice, because it’s only going to give you knowledge, and knowledge is power. 

Do you have any advice for others on their cancer journey?

What I went through at such a young age is a blessing because I have been given so much insight into the world around me, and it’s changed my perspective.

Alexandra shares her advice with other cancer patients

Find those people around you who truly care about you and are there for you during that time. I do find that what I went through at such a young age is a blessing because I have been given so much insight into the world around me, and it’s changed my perspective. There are a lot of silver linings with it. I think I’ve matured way faster than a lot of people my age have, and I’m thankful for that. 

Find something that’s gonna get you up in the morning and get you excited to still be alive. For me, it was art and getting a puppy. The doctor said, don’t get a dog. But the dog got me outside, got me walking, and made me laugh. Being around people who care about you I think is the key to getting through that time and knowing that there is an end. It is going to get better. I’ve gotten through it and I’m proud of myself for getting through it. 

More Hodgkin’s Lymphoma Stories


Lia S., Nodular Sclerosis, Stage 4A



Cancer details: Most common and most treatable form of Hodgkin's lymphoma
1st Symptoms:
Extreme lower back pain
Treatment:
ABVD chemotherapy
...

CC W., Hodgkin's, Stage 4



Cancer details: Diagnosed at 29, misdiagnosed as mono
1st Symptoms: Achiness, extreme fatigue, reactive rash on chest and neck. Later: chills, night sweats
Treatment: ABVD chemotherapy (6 cycles)
...
Categories
Brachytherapy Cervical Cancer Chemotherapy Hormone Therapies Patient Stories Radiation Therapy Treatments

Cara’s Stage 2C Cervical Cancer Story

Cara’s Stage 2C Cervical Cancer Story

Cara, a 34-year-old primary school teacher from Inverness, Scotland, shares her journey with stage 2C cervical cancer. Despite experiencing symptoms like lower abdominal and back pain, along with bloating, she initially attributed them to irritable bowel syndrome (IBS). Due to a lack of awareness about cervical cancer symptoms, Cara’s diagnosis was delayed. She highlights the importance of recognizing potential signs early on.

Following a routine pap smear, abnormalities prompted further investigation, leading to a diagnosis of cervical cancer. Despite initial uncertainty, subsequent tests revealed the cancer’s extent, classified as stage 2C due to its spread beyond the cervix. Cara underwent cancer treatment, including chemotherapy, radiotherapy, and brachytherapy, alongside fertility preservation measures due to the impact on her reproductive health.

Cara emphasizes the need for increased awareness and education about cervical cancer symptoms, especially among younger women. By sharing her experience, Cara hopes to encourage others to prioritize their health, seek medical attention for concerning symptoms, and advocate for more comprehensive gynecological education.

  • Name: Cara R. 
  • Diagnosis (DX):
    • Cervical Cancer
  • Staging:
    • 2C
  • Symptoms:
    • Lower back pain
    • Abdominal pain
    • Excessive bloating
  • Treatment:
    • Chemotherapy
      • 6 rounds
    • Radiation
      • 25 sessions
    • Brachytherapy
      • 3 days
    • Hormone replacement therapy
Cara shares her cervical cancer timeline
Cara shares her cancer timeline

We need to be empowered by our knowledge and by our actions. Hopefully, bigger change will come government-wide and in education in schools, youth clubs, and anywhere else that we go.

Cara R.

This interview has been edited for clarity. This is not medical advice. Please consult with your healthcare provider for treatment decisions.


Symptoms

Tell us about yourself

My name is Cara. I’m currently 34 and I’m a primary school teacher. I live in Inverness, in the Highlands of Scotland. In my free time, I like to go running, go to the gym, and socialize. I like to spend my spare time with family and just really love being around people. 

What were your first symptoms?

It all started, I would say, in November or December of 2022. I was getting lots of lower abdominal pain, lower back pain, and excessive bloating. I had gone back and forth to the GP and they suggested that I had irritable bowel syndrome. They said that that’s something that could be triggered by stress. At the time, life was a little stressful and work was stressful, so it made sense. I didn’t question it. 

Unfortunately, I didn’t know the symptoms of cervical cancer. That’s one of my regrets. I just had no awareness. I didn’t question the GP and I certainly didn’t challenge it. I just tried to reduce certain foods out of my diet that could be triggering. I did so much research about what that meant for my gut health. I went down the line of, I have IBS, how can I manage this? 

The symptoms were getting progressively worse to the point that I was taking time off work, and I had a hot water bottle strapped to me. I spent an obscene amount of time in the bath just because it took the pressure and the pain away. Eventually, I had to take painkillers. Not strong painkillers, just paracetamols. I was unable to go on any car journey that was longer than 15 or 20 minutes because of the discomfort. It went from being a little sore to more severe and more frequent. It was almost every day. 

At this point, I genuinely did not make the link. I should have. If I knew the symptoms and I was more aware, then I would have.

Receiving a routine pap smear left doctors wondering

It just so happened that I was due for my smear test in January of 2023. At that appointment, when the nurse did the scraping of my cervix, she said, “Oh, there was a little bit of a bleed there.” She asked me lots of questions and said, “I’m just a one-man band. It’s just myself that works here. For my peace of mind, I would like you to have a second opinion. I would like to book you back in for a GP that specializes in female health.” I said, “Yeah, no problem at all.” 

About a month later, I went back to the GP and it was with this lady who was fantastic and she has a special interest in female health. She said, “I think I can see a little bit of a discoloring at the neck of your cervix. At the moment, I’m not overly concerned, but I think it would be a good idea to get you referred to the colposcopy clinic in the hospital. Have you had your smear results back yet?” I said, “No, funny you should say that. I did phone to chase them but there was a bit of a delay.” 

The symptoms were getting progressively worse to the point that I was taking time off work.

I think usually in the UK it’s about a 6 to 8-week wait. Unfortunately, it was closer to about 16 weeks at the time. I’m not sure if that was because it was just a backlog or the time of year, but there was a delay. She decided to get the ball rolling anyway and have me referred to the hospital. 

Did you suspect you had cancer at this time?

We started to think, okay, this could be more. At this point, I genuinely did not make the link. I should have. If I knew the symptoms and I was more aware, then I would have made the link. But I thought I had two parallel things going on here: an abnormal smear and IBS. Two completely different things. 

We went to the colposcopy clinic. She had a little look at the health of my cervix and said, “I can see the discoloring that we’re talking about. I think they might just be high-risk cells. Fairly common. What we do is remove these cells, and depending on how severe they are, there are slightly different ways of doing that.” I was a bit nervous, naturally. It just so happened that afternoon when I got home, my smear results had come back to say, “There are high-risk cells being detected and we need to get them removed,” but I was already in the process. 

Diagnosis

Receiving tests & scans to reach a diagnosis

I’m petrified of needles and anything related to the hospital. Until this point, I had only ever been to the doctor for eczema and just the usual things. Nothing serious. I opted to be put to sleep for the procedure. They give you lots of information about how it will be carried out, and the thought of them burning cells from the cervix, awake, didn’t fill me with joy. It filled me with stress. 

I think if more women knew about their gyno health, if we knew symptoms for different gyno issues that happen, and we know the places to go for help, I think that would make all the difference to women.

It’s quite an undignified thing, sitting in the gyno chair. I’ve always been so private. I’m not one to flaunt my body or anything. To have someone there between your legs, it’s tricky. I understand I needed to do it, but I opted to be put to sleep, and I just thought, if I go to sleep, then I don’t know what they’re doing. They see this every day. I don’t need to be worried about anything other than just going in and getting it done. She could see I was very nervous at the appointment. 

Due to my naivety at the time, I said, “I’ve been with my partner for 10, nearly 11 years. Is this a sexually transmitted disease? Should I be tested for other things?” I was hysterical because I didn’t know what HPV was and it was my first time learning about it. It was my first experience of having an abnormal smear or having to do anything about it. It was all foreign land for me. 

»MORE: Reacting to a Cancer Diagnosis

To be honest, that in itself needs to change, because going to a colposcopy clinic and going to a gyno clinic is normal to a certain extent. This place is meant to make you better. They have such a specialized service, that actually, I think if more women knew about their gyno health, if we knew symptoms for different gyno issues that happen, and we know the places to go for help, I think that would make all the difference to women.

Overcoming the stigma of gynecological health

In this country, it’s embarrassing to talk about. There’s a stigma related to talking about your gyno health. People tend not to do it without a beetroot-red face and get embarrassed and want to skip the subject. I get it. I was that person. I probably didn’t go for my smear as quickly as I should have because I was so embarrassed. I was so ashamed of my body. 

A drawing of an eye

Looking back now in hindsight, that’s ridiculous. But that’s just truly how I felt. I think lots more can be done in schools and youth clubs and at home with your friends. If we talk about these things, it just normalizes them. Women have vaginas, that is what we’re built with. We have a cervix. These words are not swear words. We shouldn’t be embarrassed to say the word, because if we’re embarrassed to say the word, we’re going to be embarrassed to seek help when something down there goes wrong, whether it be discharge or something that changes. 

I think we will empower ourselves if we talk about these things openly. Burn down all of the stigmas, because it’s so important that we look after our female health. The same goes for men, but we’re talking about cervical cancer. A lot needs to change. I don’t know if it’s the same in [America], but over here, a lot needs to change.

What were the initial results from your cell-removal procedure?

I was put to sleep for my procedure. I was then awoken from the procedure. I got myself dressed and had some water and something to eat. You have to tick those boxes before you’re allowed to leave the hospital. I thought I didn’t even feel sore down there or tender. The consultant came in. The lady that spoke to me before the appointment. She came in before to say hello and, “I’m going to be carrying out the procedure today. This is what we’re going to do. Do you have questions?” The same lady, came back in after the procedure and said, “Can we go somewhere more private?” I burst into tears. 

We were in a shared ward. I think there were maybe 6 other ladies there. I thought this wasn’t good if she wanted a private chat. She said, “We could do it here if you’d prefer, but I think it would be better for it to be private.” Luckily, my mum and my auntie had walked through the door to take me home. I messaged them and said, “It’s done.” Little did I know, it wasn’t done. 

The three of us, me, my mum, and my Auntie Shirley, went into her little room and she knelt in front of me and put her hand on my knee. I thought, oh, this is terrible. She said, “I’ve gone in to remove the cells. Unfortunately, I wasn’t able to do that today. I think we’ve gone beyond cell removal.” I asked, “What does that mean? Do I have cancer? Am I going to die? Am I going to lose all my hair?” 

I don’t remember what she said after that. Everything just went silent. My brain was rushing so I wasn’t able to process what else was happening in the room. I do remember her saying, “Cara, I’m so sorry, but I can’t answer those questions right now because we don’t know what we’re dealing with. What I have been able to do is take biopsies. We’re going to send them away to the labs and they will give us those answers. I’ll just leave you for a moment with your family.” 

How did you process your cancer diagnosis?

Due to naivety, I thought cancer meant I was going to die and there might not be anything they can do for me.

I didn’t know how serious it was, if I had a diagnosis or not, how unwell I was, and unfortunately, the consultant wasn’t able to answer my questions. I completely understand why she wasn’t expecting that situation either. 

That day we left the hospital, and naturally, my brain went to the worst place. I thought I was probably going to get quite a serious diagnosis here. Due to naivety, I thought cancer meant I was going to die and there might not be anything they can do for me. I suppose my experience of cancer is in much older people, and usually, the result is that they do pass on. I suppose I’m very lucky that I don’t know lots of people who have experienced a cancer diagnosis. 

Now I know there are lots of cancers and treatments, and there is so much hope and success with those treatments that the result isn’t always dying. I wish I knew that at the time. I think I was just looking for a bit of reassurance, but I also understand she can’t give me reassurance in case what she was saying wasn’t right. I lived in a bit of a haze for a few days. 

Staging

When did you receive an official cancer diagnosis?
Cancer was detected in Cara's labs

The labs are back and cancer has been detected.

The gyno team at the hospital contacted me and said, “I would like you to come in. I specialize in gyno cancer.” He was able to answer all my questions and said, “Right now, we don’t have your diagnosis because of the biopsies that were taken, there’s not enough tissue there. I’m going to do the same procedure again. But this is what I do. This is what I specialize in. I want you to come in tomorrow morning and we’re going to squeeze you in as an emergency case.” 

He took the biopsies. At that point, he was able to answer all the questions. What happens if this happens? What happens if it is cancer? He gave me lots of different scenarios and what would happen in each of those. I was like, okay, this might not be the end. After he took the biopsies, he also referred me for an MRI. He said, “Let’s just get this ball rolling.” 

I think about a week later he phoned and it was the day of my MRI. In the morning I went in for my MRI and in the afternoon he phoned and said, “Cara, I just wanted to let you know the labs are back and cancer has been detected. At this time, we’re not able to give you your staging until we get all your scans.” 

What staging were you?

There was also a question mark around my lymph nodes from the MRI. They were slightly swollen, [doctors] were curious as to whether they were swollen because they were trying to fight what was going on down there, or was there cancer involved in the lymph nodes. I was then sent for further scans. Thankfully, the lymph nodes were not infected. They were just inflamed. 

Scans revealed a stage 2C diagnosis
Lymph nodes were unaffected

The cancer was contained to the neck of my cervix, which they called a large tumor. I believe it was somewhere between 3 and 4 cm. It had gone slightly into the surrounding tissues so that it impacted the neck of my womb as well as my cervix. That made me stage 2C. I think I would have been stage 3 if the lymph nodes were involved, but thankfully they weren’t. 

Fertility Preservation

Did you discuss fertility preservation?

We started to talk about fertility. He asked, “Are you a parent?” I said, “No, at the moment I’m not.” He said, “I really need you to think about if you want to be a parent.” I said, “Absolutely.” 

Although children were not in my or my partner’s imminent plan, they were definitely always the plan for the future. I think you always just assume that you’re going to have babies and have a family. Me and my partner had been together a long time. 

He referred me to a fertility clinic in Aberdeen about 100 miles away from my hometown. That process started. 

Doctors discussed fertility preservation
Describe the fertility preservation process

The next stage was fertility preservation. I got my diagnosis and we had the chat on Wednesday or Thursday of one week. The gyno doctor had referred me to the fertility clinic. I think I started treatment that following Monday. It was so quick. I had an injection every day for 5 days. On day 5, that went up to 2 injections. Then at the end of the second week, I believe there was a third injection. 

The first injection was to harvest my eggs and to get my ovaries nice and juicy. I’m not going to use all the technical language because I don’t remember it, but this was the way it was explained to me. The second injection on the second week was to stop my ovaries from releasing the eggs like a period. That third and final injection – I think they called it a trigger injection. Exactly 36 hours after that injection was administered, that’s when they took the eggs out

I was very, very lucky that on my 34th birthday, I was in the procedure for egg retrieval. They managed to successfully take out 14 eggs that they had frozen. Through freezing and thawing, they’ll not all survive, but 14 is a lovely number and I’m really happy with it. It was our only opportunity. It was now or never. 

Pregnancy success rate post-cervical cancer 

It was explained to me right at the start that any treatment to your pelvis is really going to impact your fertility in the future, and it’s probably unlikely you will successfully carry a baby to term because of the impact on your cervix. Apparently, from treatment, it shortens your cervix. Even if I was to fall pregnant, unfortunately, I’d be very likely to miscarry because of the weight of the pregnancy on the cervix, it wouldn’t be strong enough to hold. It was explained right from the get-go and we were very lucky to have that opportunity.

»MORE: Fertility After Cancer Diagnosis

I know other women, I’ve heard their stories and fertility just wasn’t something that was discussed with them and they missed the opportunity. It wasn’t offered to them and it was straight into cancer treatment. I got my egg retrieval on the 5th of June, which was my birthday, and then we had a few more scans to do. That was when I met with my oncologist for the very first time. 

Cancer Treatment

Beginning cancer treatment

[My oncologist] is the person that pulls all the strings and he makes all the decisions about my treatment and everything else. He took me and my partner in to discuss what it was going to look like and how it was going to be done. He answered all our questions. 

It was decided that I would have 6 chemotherapies. I started them on the 6th of July. Every Thursday for 6 weeks I had chemotherapy on a Thursday, and running alongside that Monday to Friday, I’d go in for radiotherapy each day for 25 sessions. On a Thursday morning, for example, I would go into my radiotherapy. When you’re on the bed doing the actual radiotherapy, it doesn’t take very long and you’re on the bed for about 10 minutes. It’s high doses of radiation targeted at your pelvis or to the tumor area. 

»MORE: Chemotherapy FAQs & Patient Stories

On a Thursday, I had just enough time for a wee cup of tea and then I was straight into chemo. I was there most days till about 4 or 5. It was a really long, exhausting day on a Thursday. Every other day was just radiotherapy. I had to drink a certain amount of water and then wait for my bladder to fill, and then I would go on to the bed and they would do the treatment from there. It’s so surreal thinking about it. It doesn’t feel like I did it, but I did. 

Describe your experience with brachytherapy

That was for 6 weeks, then I had a week off, and then I came back down to Aberdeen and did what’s called brachytherapy. That’s direct treatment to the cervix. An applicator is inserted into the vagina and connects to your cervix. Targeted radio pellets run up through this machine. I did that over 3 days. It’s a proper procedure to get the apparatus inserted, and it stays there for 3 days. 

You lie flat on this bed and try not to move. You don’t want it to be moving inside of you because it’s programmed so perfectly that the radioactive pellets hit just at the right spot at the right time. It’s incredible equipment and an incredible way of doing things. Apparently, it’s one of the oldest methods of radioactive treatment, and they still use it today. 

I’m not going to lie, that was quite horrific. I think it’s the invasiveness of it. Your dignity is all gone as you’re being wheeled around a hospital with a catheter hanging out, and this apparatus inside you. It wasn’t pleasant, but that was a really important part of the treatment. I think the consultant said, “This treatment is going to give you another 50% of the amount of radiation you’ve already had.” I had a certain amount over 5 weeks, the 25 sessions. “This is going to give you 50% of that again targeted over 3 separate sessions.” 

Overcoming mental barriers to receive treatment 

Again, my mind was blown. I’d never heard of brachytherapy before in my life. I did consider declining that part of the treatment. When I read about it, I thought, I just don’t know if I can do this. I struggled to get a smear test, never mind having this procedure done. It just felt so invasive and undignified. I was mortified thinking about it. 

I decided that it was really important that I did it, and I had to do everything I possibly could to make sure that my outcomes were positive, and that I was going to hopefully live a long and happy life. I just had to get over myself at that point and decide. This could be life or death. Cara, get a grip. Just go in, get it done, and hopefully, you never have to do anything like that again. 

Did you have any side effects from cancer treatment? 

The chemo definitely made me tired, super tired. I was very lucky though. I know that lots of chemo makes you lose your hair. I was very fortunate that that wasn’t the case for me. I wasn’t overly telling everybody [about my diagnosis], so not everybody knew. I told the people who needed to know – my best friends, family, and work colleagues. Beyond that, I wasn’t shouting it from the rooftops. I felt like if I lost my hair, everyone would then know. Sometimes that’s not a conversation you’re ready to have, but you’re almost forced to because people can physically see you’re not okay. 

Everybody warns you about how brutal it’s going to be, but it’s just a case of showing up and taking each session as it comes.

I know chemo makes people vomit a lot and physically sick. Again, I was very lucky that that wasn’t the case for me. My symptoms were nosebleeds, lots of shivering, headaches, and fatigue like you wouldn’t believe. When the chemo goes in, it goes in through your hand through a cannula. It’s so cold, that you can feel it travel up your arm. It’s the weirdest sensation. 

The nurses, I have a whole different level of respect for what they do on the daily. They were so happy and chirpy, and they just lifted me up and didn’t stop. My chemo, for some reason, took quite a long time to go into my body, whereas lots of other people were in and out. I saw most of the people come and go throughout the day. I was probably there for one of the longest. I’m not sure why that was. Different chemos, different cancers, different treatments, I suppose. 

Everyone was so lovely. Considering it’s a cancer treatment, you would expect it to be quite a sad place, but it wasn’t. They were all so lovely and really supportive. It was a surreal experience. 

Cara describes her side effects from cancer treatments

Hormone Replacement Therapy

What would you tell someone going through cancer treatment?

You’re going to get through it. I was going to get through it. I was so scared because it can be really brutal. Everybody warns you about how brutal it’s going to be, but it’s just a case of showing up and taking each session as it comes. Everybody is going to be different and everybody’s body is going to react differently. I think I just put so much pressure on myself, I was so petrified of losing my hair and of the side effects. 

I wish I was more accepting of, what will be will be. If I lose my hair, I lose my hair. I wish I didn’t spend so much time dwelling on those things. Some of those things didn’t even happen, so it just feels like such a waste of energy. It’s not a scary place. I mean, it is scary, but the ladies that treat you truly make a difference. They’ll look after you and they’re going to make sure you’re alright. There’s no need to be any more scared than you already are of your diagnosis.

Experiencing premature ovarian insufficiency

After brachytherapy, I knew I was going to have to physically recover. I was very sore and on lots of medication. My head was quite hazy for a few days until I got home and slept. After that, it was very quickly that menopause started to hit me. I thought it was treatment. I was getting really hot flushes and my body was getting really sweaty. I could almost feel a heat rise through my body. It would rise up my back and feel quite prickly.

At first, I didn’t make the link. One day I was with my mum and she was drinking her tea. I could hear her gulp and it irritated me beyond words, which is completely irrational. Poor mum, just having her cup of tea, but it made me angry, which is so silly. I knew at that point, something was not right. I would never have noticed that before. Never mind, let it bother me. There were a few other things besides the agitation like a really low mood. When I say low, I’m talking way lower than at any time during treatment. I just could not see the silver lining. 

Throughout treatment, I always found 3 things I was grateful for in a day. It was something I learned from a coach years ago, and I’ve done it intermittently. I thought it was really important that I look for things that I’m grateful for through this time, and it made a difference to my mindset. Life is good, and I am very lucky. It gave me that positive something just to get me through. On some of these really low days, I couldn’t find a thing. I was so low and the headaches and my skin were so itchy, it was crawling, oh my goodness. Some of the side effects were just horrendous.

It was very quickly that menopause started to hit me.

I went to my GP, I contacted the hospital and they said, “Speak to your GP. This sounds a little bit like menopause, which is likely with the treatment that you’ve had.” I went to the doctor and true enough, it was premature ovarian insufficiency. My ovaries were now no longer producing eggs the way that they would have or should have as a result of treatment. They were so damaged. 

Receiving hormone replacement therapy

Over time, my ovary’s ability to produce estrogen will fluctuate and slowly decline to when it just won’t [produce] anymore. Because my GP was amazing and really knew her stuff, she walked me through all the options and said, “I think that hormone replacement therapy is a good idea for you. The way I look at it is that your body is no longer producing, so your body is losing its estrogen production. All we’re doing is topping up that bucket. We’re just giving you what your body would have been making itself. We’re replacing what your body’s losing.” 

She sent me away to have a think about it. I did a bit of my own research. When I realized what estrogen does for your body in terms of your cardiovascular health, your brain health, your eyes, and your female organs, I was blown away. I thought, whoa, I cannot allow my estrogen levels to just deplete and not replace them. That’s going to set me up in a world of being scared of having a heart attack. And what about my bone health? 

Cara describes hormone replacement therapy
Cara experienced premature ovarian insufficiency

Basically, my womb is aging much quicker than it ever would have. I think in the UK, they say an average age would be about 50 to 51 [to have menopause], and at the time I was only 33. We’re talking almost two decades earlier. It petrified me to think that my body wouldn’t have estrogen. My consultant said I was okay to have hormone replacement, so I went for it. 

I have to say, it’s made a huge difference to my mood and to all the other side effects. It is definitely still a daily struggle in terms of the symptoms that just come from nowhere. Some days I feel like a little kangaroo and I’m ready to take on the world, and other days I just can’t. My energy levels are really low. Lots of fatigue, and headaches, my eyesight is a little duller than it was before, and I have aches and pains. The list really does go on. It has such an impact on your body. 

Reflections 

A need for more education on women’s health

I was lucky that my GP was fantastic. I know not everybody has the same experience. Lots of GPs are not educated and they don’t have to keep up with hormones, or they don’t have to keep up with the newest studies and trends in terms of knowledge around female health, hormones, or menopause. It’s only if you have a keen interest that you then take it upon yourself to learn more. 

There’s definitely a gap there in education too in terms of GPs. I know that they have a huge curriculum to get through, and I don’t think the hormone and the menopause stuff takes up very much of that time. Maybe a few hours, a few modules. I don’t know the exact specifics, but I do know that it’s not enough to support 50% of our population at all ages. It’s going to impact all women. 

Cara emphasizes the need for greater education on gynecological health

Also, there’s a real thing of [people assuming] you’re too young. No, we’re not too young. Women go through premature ovarian insufficiency (POI) way earlier like in their early 20s, late 20s, their 30s. Menopause isn’t just for a woman in her late 40s, or early 50s. It’s really not. I think the sooner we raise awareness about it the sooner the government takes it more seriously and realizes that our GPs really need to be educated to a much higher level to support these women…

Some women are going back and forth to their GP for 10 years and still not getting a diagnosis, which means that for 10 years, the estrogen in their body is depleting, sometimes progesterone and testosterone too, but 10 years? That’s really putting them at risk. Not to mention the daily struggle and suffering because they think they’re bananas. They think they’ve lost their minds because that’s what they’re being told. But no, you’re just experiencing early menopause or perimenopause. We’ve got a lot of work to do. 

»MORE: What Does Cancer Feel Like?

What do your current scans show?

I was scanned on the 18th of December, just at the start of the new year. I had a call from the consultant to say that the scan was good and not so good. The tumor is now mostly gone, and lots of the surrounding tissues that were showing as cancerous are now showing as scar tissue, which is what they would expect. However, there is still this cluster of cells that are visible. 

At the moment, they’re just going to monitor me because unfortunately, the scan is not completely clear. What they’re going to do from December to April is they’re going to leave me and I’m going to be scanned on the 23rd of April. I suppose I’m just praying that the scan is completely clear and hopefully, I can just move on. That’s all I’m praying for.

What would you tell someone on their cancer journey?

If you’ve had a diagnosis, you’ve absolutely got this. I’ve had lots of people say, “I don’t know how you’ve done it.” You do it because you have to. You don’t have a choice. I can promise you that you are going to absolutely surprise yourself with your resilience and your strength. I mean, that won’t be every day. There will be days where there are lots of tears and you lose hope, but you can do it and you will do it 100%. 

If you don’t have a diagnosis but you’re supporting someone who does, just be there. Sometimes a cuddle is enough. Sometimes listening is enough. Sometimes a hand of reassurance or that little cup of tea is absolutely enough. Make sure you’re checking in on that friend even if they go silent. Treatment is so all-consuming. That little text message of a love heart or that text message that says, “I’m thinking of you today. You’ve got this. Love you.” Those very messages and check-ins make a world of difference. I think for everybody when you’re healthy and well, we all need to do better.

If you’ve had a diagnosis, you’ve absolutely got this.

We need to educate ourselves on female health. We need to educate our daughters, our sisters, our aunties, and our nieces, and we need to talk about it. There is no shame in having a vagina, or a cervix, or going for these health appointments. They’re so important. We go to the dentist for our teeth. We just need to go to the doctor or the GP for our smears. It’s so important. 

Please keep on top of all your health issues. Any changes? Report them. Get to know your symptoms. There are 5 gyno cancers and there are symptoms linked to each. If you know them, you know what you’re looking for and you can detect a change. It was silly that I didn’t know so it took longer. Don’t get me wrong, those symptoms can be other things, but if you go to a GP, they can really look into it for you. We need to be empowered by our knowledge and by our actions. Hopefully, bigger change will come government-wide and in education in schools, youth clubs, and anywhere else that we go. 

More Cervical Cancer Stories

Categories
Avastin (bevacizumab) Chemotherapy Colon Colorectal FOLFIRI (folinic acid, fluorouracil, irinotecan) FOLFOX (folinic acid, fluorouracil, oxaliplatin) Medical Gaslighting Surgery

Zykeisha’s Stage 4 Colon Cancer Story

Zykeisha’s Stage 4 Colon Cancer Story

Zykeisha, a 37-year-old mother and fire rescue dispatcher, faced a difficult battle with stage 4 colon cancer. Her journey was marked by initial misdiagnoses and persistent symptoms like anemia and unexplained back pain which arose around the time of her pregnancy. Despite enduring grueling treatments including 12 rounds of chemotherapy, liver surgery, and a subsequent cancer relapse, Zykeisha’s faith and resilience moved her forward. She became a beacon of hope, advocating for herself with determination to overcome each setback.

Through her journey, Zykeisha emphasizes the importance of self-advocacy, urging fellow cancer patients to ask questions, explore treatment options, and prioritize their mental and emotional well-being. With her infectious smile and steadfast faith guiding her, Zykeisha’s story serves as a testament to the power of resilience and inner strength in the face of adversity.

Zykeisha shares her stage 4 colon cancer story
  • Name: Zykeisha L. 
  • Diagnosis (DX):
    • Colon Cancer
  • Staging:
    • Stage 4
  • Symptoms:
    • Anemia
    • Stool changes
    • Blood in urine
    • Sharp back pain
  • Treatment:
    • Surgery
    • Chemotherapy
      • Avastin
      • FOLFOX
      • FOLFIRI
    • Neupogen shots
Zykeisha shares her stage 4 colon cancer timeline

Whatever gives you peace while going through something like this, find that and protect that.

Zykeisha L.

This interview has been edited for clarity. This is not medical advice. Please consult with your healthcare provider for treatment decisions.


Pregnancy & Symptoms

Tell us about yourself
Zykeisha is a fire rescue dispatcher

My name is Zykeisha. I am 37 years old. I am a mother of two beautiful, active boys. They are seven years apart. One is 13 years old and 7 years old. I am a fire rescue dispatcher by occupation. Hobbies: I love traveling. I love reading. I’d rather read a good book than watch a movie. I love to laugh, like anybody. I’m always smiling, that’s how I’ve always been. No matter what, I’m going to smile when I find a reason. 

What were your initial symptoms?

I started experiencing symptoms in, I want to say, 2014 or 2013. I did not know initially that they were symptoms. I started having issues with anemia, so I had applied for insurance that they were telling people to go get – the cancer insurance. The insurance company actually dropped me, but kept my then husband and my youngest son. I received a letter in the mail that said I was dropped, and I was like, he has more health conditions than me. How was I dropped? I did not know that anemia is one of the things that insurance companies look for as a sign of cancer.

We had to do a physical for my job and I did my physical. The physician called my mom and said, “Your daughter needs to go to the hospital. Her hemoglobin is super low. She could pass out.” I didn’t think much about it. I went later on that night because I had a migraine. 

I did not know that anemia is one of the things that insurance companies look for as a sign of cancer.

Zykeisha was dropped from cancer insurance due to anemia
She went to see the doctor for her new symptoms

The doctor actually did a very uncomfortable stool test right then and there in the room. Beyond uncomfortable. They were checking me to see why my hemoglobin was super low. It was not because of a cycle. It was not because of anything. Nothing else was said or done about that. I was given a blood transfusion and nothing else. I was told to go on bed rest for two weeks after the blood transfusion. 

More health problems arose during pregnancy
Zykeisha received iron infusions for her low hemoglobin count

When I got pregnant with my youngest son, I did the regular tests that they have you do at 6 months, such as the glucose test. They called me and said, “Your hemoglobin is really low, you need to see a hematologist. I said, “Okay.” I called and said, “My hemoglobin is at a 6 and I’m 6 months pregnant. They said, “You’re not coming here, honey. You want to go to the hospital.” 

I went, I was admitted, and they said, “Something is taking your blood, but we don’t know what it is and we can’t do extensive tests to find out.” They gave me the rundown on what was happening with the baby and so forth. They said, “We’re going to give you iron infusions.” Every time they gave me iron infusions, my hemoglobin kept dropping back again. They were like, something is going on. 

Describe your delivery and postpartum

Before you have any major surgery, your hemoglobin has to be a certain number. Mine dropped right before my due date. Prior to then they were trying to take him early and I said, “Nope, his birthday is this date and that’s what it is.” When it came down to the actual day, I said, “Well, what are y’all going to do? Y’all can’t leave him in there, you have to take him.” 

They gave me all these antibiotics. They were really concerned about doing major surgery with your hemoglobin being low. I delivered the baby and nothing else was said about the hemoglobin being lost. Nothing. 

When I came home, I started noticing excruciating back pain. I was like, something is wrong with my back. I went to my primary doctor who had me do x-rays. She said, “Well, nothing’s wrong with your back. It may be the epidural.” Then my stomach was acting really weird. My stool had changed. When I would eat, I felt like I had diarrhea, but it wasn’t diarrhea. The doctor said, “You have irritable bowel syndrome” and gave me some pills for that. I didn’t know then about questioning the doctor more. 

Then one day at work, I went to urinate. I was not on my cycle or anything. I turned around and it looked like a massacre was all over the toilet, there was blood everywhere. I took a picture of it and cleaned it up. I was at work and it was in the afternoon. 

Zykeisha had a C-section despite low hemoglobin levels

Diagnosis

Symptoms worsened

I went to my doctor and I said, “This is what happened when I was at work, and it was the only time that this particular thing happened.” She said, maybe it’s hemorrhoids. It was always a, “Maybe it’s this, maybe it’s that” kind of thing. Mind you, for a whole year, I’m going to the doctor for the back pain and my stomach with my babies in tow because I’m like, something is not right. I thought, well, maybe it’s me. You start thinking, is it in my head? Am I really having this? Are these symptoms really that weird? 

It wasn’t until one morning that I was getting ready for work. I nursed my son as usual. Afterward, I had this really sharp pain under my right breast and I was like, that’s weird. I continued getting ready, and this is at 4:00 in the morning. I dropped him off as usual and went to work. I had to work a 16 hour shift that day. 

I was sitting there with my co-worker and I said, “I’m having this sharp pain.” It was getting sharper, deeper, and really fast. We were sitting there and going, “Maybe it’s your appendix, maybe it’s this, maybe it’s that, maybe it’s gas.” It was a variation of maybes. I said, “I’m going to go to urgent care on my lunch break and let them see what it is.” 

Zykeisha began to feel like her symptoms weren't as bad as she believed

You start thinking, is it in my head? Am I really having this? Are these symptoms really that weird?

I went and the urgent care physician said they do not have the equipment there to do any testing. I need to go to the emergency room because maybe I pulled a muscle or it’s gallstones. At that point, I was like, I’m not going to the emergency room for a pulled muscle. What if that’s just what it is? I have to work a 16 hour shift. I’m just going to go back to work. My supervisor told me, “Do not come back here without going to the emergency room first to see what is going on.” I was like, “But what if it’s a pulled muscle?” She said, “If it’s a pulled muscle, then at least it’s a pulled muscle and you know.”

Taking a trip to the E.R.

You don’t think that it’s anything huge. On my way to the E.R., I prayed. I said, “God, I’ve been praying that they don’t find anything. But today, God, I’m asking you, let them find out what it is because something is not right.” Everything just lined up. They took me in right away. I didn’t have to wait. 

They started giving me morphine because I couldn’t lay down at this point. I could not lay flat. The pain was so bad. I described it as a throbbing toothache in my stomach. They asked, “What does it feel like?” I said, “A throbbing toothache in my stomach.” 

They did an ultrasound and other tests. A lot of that was a blur. I remember the ultrasound and one of the tests came back. They asked, “Has anything come back about your liver, the tests or different things you’ve taken? Have you been going to the doctor?” I said no. He said, “Hmm. We found a mass on your liver, but don’t worry, it could be benign.” I said, okay. I never paid attention to what happened after that because they told me it was gallstones and that they’re going to remove my gallbladder in the morning. 

I was admitted to the hospital. But I never paid attention to the fact that I was admitted to the oncology floor. It was, someone who was close to me at the time. She said, “Do you know that they admitted you onto the oncology floor?” They had a suspicion and I did not know anything that whole night. 

Zykeisha was admitted to the hospital after masses were discovered on her liver
Unbeknownst to her, she was admitted to the oncology floor
Receiving a cancer diagnosis 

The next morning, right before surgery, the admitting physician walks in and says, “You have tumors and it’s colon cancer.” He just said it. He just walked in and said it. I was like, whoa. No one was with me. It was hard to process something like that because, in my mind, I didn’t think cancer. My thing is, I’ve been going to the doctor for a whole year. They never connected the actual dots. I went to the hematologist for the pregnancy, but no one said anything afterwards. They told me in the hospital that something is going on but we don’t know what it is and we can’t do the testing.

No one said after I delivered that baby, let’s talk about what’s been going on. Let’s talk about you weren’t supposed to have a C-section with your hemoglobin being at that level. No one spoke on it. It was really confusing. These are not like the best doctors or anything, because there are some phenomenal doctors out there. 

I do tell doctors now, “See me how you would want to be seen or how you want your loved ones seen.” Being a dispatcher, I don’t see names. I don’t see who we’re helping, but to all, I always try to go above and beyond. You don’t know when you may need help. 

How did you react to your diagnosis?

I thought it was a death sentence.

Zykeisha thought her diagnosis was a death sentence

No one expected this. The people that knew I was getting ready to have surgery cried. I had people that called me and I cried with them. At one point, I was comforting people like, “It’s going to be okay. It’s going to be okay.” 

All I could think about were my babies. I said, “God, why? Why are you taking me from my babies you just gave me?” That’s all I could think about. I thought it was a death sentence. It’s something that I wouldn’t wish on anyone to receive. Even if it’s expected, it still hurts to hear it. 

At that point, they did a colonoscopy and they said, based on the scans, that it was for sure colon cancer. They could not tell me the stage. I had to go see a specialist afterwards and I did not go right into surgery. 

»MORE: Reacting to a Cancer Diagnosis

Chemotherapy

Meeting with an oncologist

I met the first oncologist I had. I’ve only had two. The first one I had was all facts and evidence. Every question you asked him, he’d say, “Facts and evidence says this and facts and evidence says that.” He got to the point where he was unreachable. 

My insurance, I didn’t know, did not cover me getting treatment at the hospital that I was at. I would have to change [medical care] and that was the best change. God was all in the math for that. The oncologist that I have today [helped me] get in remission. He’s still my doctor. He’s just a phenomenal person and he cares about my life. 

Beginning chemotherapy
Zykeisha began aggressive chemo

He ordered that I start chemotherapy. I had to get 12 rounds of aggressive chemo. Aggressive chemo was something that I was not prepared for. The first oncologist told me, “You’re still going to be able to go to the gym. You’re going to be able to run around after the kids. You’re going to be able to do all these things.” Research showed that people do these things while going through treatment. 

Firstly, we were going to do 6 rounds of chemo and then surgery, but we ended up doing 8. Then I went back in for the last 4 afterwards. With colon cancer treatment, one of the drugs I had was Avastin

Before I did chemo, I had a cruise already booked for my sons and I. It was a birthday cruise for my oldest. I went on that cruise, came back, and started treatment. The same day that I came back, I had to get my port placed that morning, and I said, “This is it.” I found a video the other day that I didn’t know I recorded of my sister taking the bandage off of my port, and I said, “I’m going to keep this in for one year then we’re going to be done with this thing.”

What was your experience on chemotherapy?

Treatment was not what I expected. Nothing could have prepared me for what happened. I was so sick, treatment was hard, and it was depressing. I’m not going to lie, I dealt with depression in a different way. I always show up and smile like nothing is wrong, but this was different. I had to sit in it. 

I couldn’t be around people. This was before COVID. I was wearing masks and gloves before COVID. I’d get stares and my kids had to be careful around me. They had to go to daycare and school but had to watch out. 

Chemo was 46 hours total and I had to get the Neupogen shot after that. I didn’t know what Neupogen was. After a few rounds of my white blood cell count going down, they said, “We’re going to give you this Neupogen shot and it’s going to bring your cell count up.” I’m like, okay, cool. Let’s go.

Oh my God. That shot is traumatizing. I’m traumatized to this day from what it does. The bone pain is not mild. It always started at my neck like a heated rush. Then it felt like something was breaking my bones. It would go down my body, just breaking. It’s paralyzing pain. I felt like I couldn’t move or touch anything, just scream. 

»MORE: Chemotherapy FAQs & Patient Stories

Receiving liver surgery

I switched to the University of Miami where I met my surgeon. Before I started treatment, he said my liver was covered in masses. Only a small portion of it was clear, but the majority of it was covered. I knew that I would have to end up getting surgery. He told me that he considered it because of my age. If I was older, he would not recommend something like this. The liver is a huge surgery. I didn’t know how huge it was because it’s bloody, it’s all the above. 

Zykeisha had 70% of her liver removed

I did about 8 rounds of chemo and then it was time to go into surgery. Two weeks after I did chemo, they withheld the Avastin, but I did the other chemo. FOLFOX at first and then I went to FOLFIRI. I didn’t recover well enough but went straight into this huge surgery.

Before I started treatment, he said my liver was covered in masses. Only a small portion of it was clear.

I didn’t know how to speak up for myself or say, hey, wait a minute. Is what we’re doing a lot? The conversation when you’re dealing with the cancer world is, “We’re trying to save your life so we’re going to do this, this, this and this, and you just gotta deal.” 

I went into surgery. They put me to sleep really fast. I woke up from the surgery and I wasn’t sent to the ICU. I was sent to a regular room to be admitted. They said the surgery went fine. The conversation was to remove 60% of my liver but the surgeon removed 70% of my liver. That was the first time that I was diagnosed. I was diagnosed three times and that was the first. Mind you, this was in the era where colon cancer in a young woman was not the norm. This was in 2017. Now you’re starting to hear more about colon cancer in younger people. 

Relapse 

Was your cancer treatment successful? 

When I went back to my primary [care doctor] where this all started, he was so nervous. They said, “We would have never suspected this in a young, fertile woman.” I immediately became a case people were curious about. Wait a minute, you had stage 4 colon cance? I had it when I was pregnant. 

After that, I was told. “Hooray! You’re in remission.” After the surgery, I had to go back for what they called a clean-up chemo, just to make sure that there was no residual [cancer]. They kept saying, “Hooray, hooray, you are in remission.” I didn’t know how serious colon cancer is. There are other cancers where you can be stage 4 or 3, but they’re curable. Colon cancer is the second deadliest cancer, so it may not have been curable. I did not know that at that time. I was like, why are they so surprised that I made it? 

Colon cancer was not as common in young people when Zykeisha was diagnosed

This was in the era where colon cancer in a young woman was not the norm…Now you’re starting to hear more about colon cancer in younger people.

My oncologist said, “You’re in remission. This is good news. This is celebration time.” So I did what I love. I went on a 3 day cruise to celebrate that I’m still here. After the cruise, I said, “Let me live life a little.” I took my kids to go see snow in Baltimore. I was living life. 

Did you receive follow-up scans?

At the same time, I was having this pain on my right side. When I went to the surgeon and said, I’m in pain, he told me I should not be having pain still. “The surgery was a success,” is what he told me. He went on to say, jokingly, “Maybe it’s because you don’t want to go back to work.” I was really annoyed because I said, “I actually like my job. If I’m having pain, I’m having pain.” 

My mom is like a doctor without the degree. She researches everything. She would go with me to these appointments, so when he said that, she said, “How about we do a scan to find out why there’s still pain?” I said, “Yeah, let’s do a scan. Let’s find out what’s going on.” We did this scan and it sat on his desk for about a month or so, maybe longer. 

Experiencing cancer relapse

When I came back, I started getting all these phone calls. They called me back to back. The nurse said, “Hey, something showed up on the scan that you did back in December.” Now we’re in January. “The surgeon wants you to go see your oncologist.” I went to the appointment. Before I went to the appointment, I went on the the app to see my results to see why they’re calling me. “Nodule in the right lung has grown since August.” I said, what? 

Zykeisha underwent a relapse

Now I’m looking up nodules. I saw that it could be pneumonia, it could be this, it could be that. I believed it could be pneumonia because I had just left the E.R. after that scan. They told me I had pneumonia. The nurse practitioner confirmed it wasn’t pneumonia, it was indeed cancer. Now I was confused because I’d just left the emergency room and they didn’t say anything. They said, “Well, maybe they figured you already knew.”

I thought, this can’t be it. The surgeon did not speak to me. He did not deliver the news. I went to my oncologist. He was very caring, phenomenal, and the first words out of his mouth were, “I hate that you have to start the year off like this.” I went to see my oncologist, let’s just say on a Tuesday, and he already had chemo scheduled for me to start in 3 days or so. 

The nurse practitioner confirmed it wasn’t pneumonia, it was indeed cancer.

They had to do a PET scan to see where all the cancer was at. It was in my lung and it came back in my liver. Mind you, I just had surgery on my liver. Now the concern was, if we cut any more of my liver…There are so many concerns. Then the oncologist said, “Okay, before chemo, we’re going to do the surgery. We’re going to have the lung surgeon go in and remove that nodule.” He said the only way to get cancer out is to get it out, so let’s go there first. 

What was your next course of treatment?
Zykeisha received multiple surgeries

Right before the surgery – this is how you know your doctor is really thinking about you and really concerned – he calls and says, “You know what? I thought about it all night. I looked at your scans all night and I think it’s best to do chemo. Let chemo get as much out of it as it can, and then we’ll do the surgery.” Well, this time I knew what chemo was going to be like. I knew what to expect. I knew the biggest part was the neupogen shots. 

That chemo took away the cancer in my liver so they just had to remove the nodule from my lung. It was then that my oncologist told me my prognosis was a 15% [likelihood] of me making it through that, but it goes down every time you’re diagnosed. That was a very humbling moment because I have small babies. It puts a lot on you. It takes a toll. I did that, went into remission, rung the bell, I had a whole party, and I was good. 

Side Effects

Processing cancer complications

My oncologist told me my prognosis was a 15% [likelihood] of me making it through that.

Zykeisha's doctor did not give her a good prognosis

I went back to work and a friend’s husband had passed away from stage 3 colon cancer. I got to the point that I took a break from cancer completely. It wasn’t a [long break]. I just made up my mind, I’m not going to  scans. I’m not doing anything. I just don’t want more news. I’m done with cancer. She told me, “You’re going to those scans.” She made me go. 

I went to go get the results. This was the same week COVID happened, but this was a few days before the world shut down. I went to the doctor and we were talking like I was good. Then the doctor said, “There’s an area of concern.” I literally broke because it was that week that things happened between my ex-husband and I that I was hurt by and then the cancer. 

I was like, what is going on? I was trying to co-parent and all these things. I broke down. I think that was the biggest shock of my life. I just did not expect it. This time, it was more than just going right back to chemo again. I was diagnosed on Thursday and Tuesday I had to start chemo. He already had it planned out for me before I even got there. He’s such a phenomenal oncologist. I really do thank God for him. I said, “I’m just tired.” At that point, I was tired of life. I just didn’t know what to do. 

Did you have side effects on chemotherapy? 

I went to chemo. I would show up to chemo with my graphic t-shirts, light up shoes on, make up, and head wraps. This time he changed it to full fury. He said, “I don’t want the burns on your hands. I don’t want all these things. I’m gonna do full fury with you this time.” It was that chemo that took out my hair. The bone pain was crazy. Also, chemo brain. 

I had a lot of chemo in a short period of time. It wasn’t spaced out. It was almost 4 years back to back. People didn’t get it. People look at you and say, “There’s nothing wrong with you, you’re good, you’re together,” but there’s so much inside. 

Zykeisha shares her side effects from chemo
Zykeisha was on Avastin
Zykeisha was on FOLFIRI and FOLFOX

Also, my teeth. My teeth are a big thing for me now. I had braces when I first started chemo. I was told by the orthodontist and dentist that I would be fine, and I probably would have been fine that one time, but I had a second and third time. I still went to them and they were like, “Everything is going to be fine.” When they got ready to take the braces off, the enamel from my teeth started coming off with it. Little by little, my teeth just kept decaying and my dentist told me it was going to continue because at this point, the chemo had rotted my teeth. When he showed me an x-ray from me being there just one year before until that time, it looked completely [different]. I had just had all this dental work done. Dental is a big thing of it. 

There’s a lot in the mental and emotional side of it. I can honestly say I went to a deep, dark, place that this can take you to. At one point, I felt like I was trapped and could not get out. 

»MORE: Cancer Treatment Side Effects

Undergoing additional preventative surgeries
Zykeisha and her son

I had a phenomenal surgeon. I love him, he’s so honest. I had 4 major surgeries at one time. One was a full hysterectomy because I was told that in women the cancer tends to hide in their uterus. I spent about 10 days in the hospital. That was the minimum that they required. I don’t have a colostomy bag. They did not remove my entire colon. They removed 34 lymph nodes from my stomach, a lymph node near my left kidney, the full hysterectomy, and my gall bladder. I think that’s it. They would have kept me longer, but mind you, it was during COVID. My heart goes out to people who have to be in there longer. 

My last treatment was April 2021, and I’m just relieved. I started to see remission differently. Remission is a waiting period. They’re waiting for something to happen because they’re big on, after 5 years, I’ll celebrate with you. I had a phenomenal surgeon. He even said, “After 5 years, I’ll celebrate with you.”

Reflections

Zykeisha gives her advice to cancer patients

Whatever gives you peace while going through something like this, find that and protect that.

Do you have any advice for cancer patients?

I would say, be your own advocate for your health. Ask the questions. Do not feel scared to ask questions. Do not feel scared to try things. You have to be at peace with your own decisions at the end of the day. Some people are anti-chemo, some people are for it, and some people grew a garden and that’s how their cancer went away. Whatever it is, you have to make sure that you’re at peace with every part of it. 

»MORE: How To Be A Cancer Patient Advocate 

Don’t just take the first answer that’s given. Go research some more, ask the questions, and research more. One more thing, for me, my faith was a huge part of it. Mental and emotional, the way you go into this is huge. I always smile. I was told by a lot of nurses and doctors that because I smiled through it all, that that’s the reason why I made it. I’m not saying that you have to smile. That’s not my thing. I’m just saying, whatever gives you peace while going through something like this, find that and protect that.

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1st Symptoms: Severe pains after eating
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Barbara M., Colon Cancer, Stage 3



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Lindsay D., Colon Cancer, Stage 4



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Lee J., Colon Cancer, Stage 4, Recurrence



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JJ S., Colorectal Cancer, Stage 4



Age at Diagnosis: 27l



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Angelica A., Bowel Cancer, Stage 3

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Zykeisha L. Diagnosis: Stage 4 Colon CancerSymptoms: Anemia, stool changes, blood in urine, back painTreatment: Chemo, Avastin, FOLFOX, FOLFIRI, surgery, Neupogen shots
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Categories
Chemotherapy Colon Colorectal Eloxatin (oxaliplatin) Patient Stories Treatments Xeloda (capecitabine)

Courtney’s Stage 3A Colorectal Cancer Story

Courtney’s Stage 3A Colorectal Cancer Story

Courtney, a high school English teacher from Spokane, experienced symptoms such as fatigue and blood in her stool that led her to suspect she had colon cancer. Despite initial dismissals from multiple doctors due to her age and lack of family history, Courtney persisted in advocating for herself, ultimately undergoing a series of tests, including colonoscopies and scans, which confirmed her suspicions. Diagnosed with stage 3A colorectal cancer, Courtney underwent surgery to remove the tumor and lymph nodes, followed by chemotherapy as a precautionary measure.

Throughout her treatment journey, Courtney faced various challenges, including side effects from chemotherapy such as hand-foot-and-mouth sores and neuropathy. Despite these obstacles, she pushed forward, continuing to teach full-time and engaging in physical therapy to regain her strength. Three years into remission, Courtney emphasizes the importance of self-advocacy, listening to one’s body, and pushing for answers, especially when faced with medical dismissals or ambiguity. She encourages others to trust their instincts, seek support from loved ones, and persevere in navigating the healthcare system to ensure proper diagnosis and treatment.

Courtney shares her stage 1 colorectal cancer story
  • Name: Courtney H. 
  • Diagnosis (DX):
    • Colon Cancer
  • Staging:
    • 3A
  • Symptoms:
    • Blood in stool
    • Fatigue
  • Treatment:
    • Surgery
    • Chemotherapy
      • Capecitabine
      • Oxaliplatin
Courtney shares her colorectal cancer story timeline

Advocate for yourself, know your body, listen to your body, and keep pushing until you find answers.

Courtney H.

This interview has been edited for clarity. This is not medical advice. Please consult with your healthcare provider for treatment decisions.


Symptoms

Tell us about yourself

My name is Courtney. I am a teacher. I teach high school English – specifically honors 9 English and mythology. I am a big lover of reading. I like to play outdoor volleyball, garden, and explore. I live in Spokane, in the Pacific Northwest. It’s so beautiful. We have four seasons and lots of activities and different things to do. I like to spend time with my niece and nephew. 

Courtney is a teacher
What were your first symptoms?

I took an anatomy and physiology class in college, and one of the only things I remember from that was that the professor said, “Most often when you have internal bleeding of some sort, it is your body’s inability to heal itself, and that usually comes in the form of a tumor.” 

What had happened was I had gotten a teaching job in Othello, where I grew up, and I moved down there. This was August of 2020. I was a very busy new teacher. I was the head cheer coach for a cheer program. I worked a lot of jobs in grad school, and so I just was very used to being on the go all the time and having a busy and packed schedule.

I knew I was sick. I knew I had colon cancer, so I just kept pushing.

When I moved to Othello, I started showing one symptom – I had blood in my stool, and I instantly knew. I knew instantly that I had colon cancer. Moving down to Othello, I had to get all of my records and everything transferred down there, including all my medical stuff. So I wasn’t able to go in and see a doctor until October. My symptoms kept progressing, and I just knew when that started happening. I was trying to find somebody that could help me find the exact diagnosis. The answer. 

Did you have any additional symptoms?

Just blood in the stool and fatigue. My friend’s mom, who’s a nurse, did a blood test on me and she said I was very anemic. What we ended up finding out when they had taken the tumor out is the blood flow was feeding the tumor, and that’s why I was so anemic. 

Colorectal symptoms included fatigue and blood in stool

Colonoscopy

Experiencing medical gaslighting

The first general practitioner doctor I went to, he dismissed all my symptoms and said, “There’s nothing wrong with you. You’re thin, you don’t have a family history. You just need to make some dietary changes.” I was like, “Well, I’m going to keep trying to find answers.” It was in the middle of COVID, so everything was pushed back. Then symptoms kept getting worse. When I came home for Christmas break – home was Spokane – I saw a different doctor and it was the same thing. He spent about an hour with me, ran some tests, dismissed all my symptoms, but I knew I was sick. I knew I had colon cancer, so I just kept pushing. 

The first doctor in Richland, he actually had put in a referral for me to see a GI specialist. I was able to see a GI in January of 2021 and [experienced] the same thing. She dismissed all my symptoms. Finally I said, “Listen, this isn’t about you being right or me being right. This is about figuring out what’s wrong. You’re speculating and I’m speculating.” They were all saying, “We think you have Crohn’s or diverticulitis, diverticulosis, or a bleeding hemorrhoid.” 

Courtney was raised to listen to her body and to advocate for herself

One of the greatest skills that my parents ever taught me was the ability to advocate for myself and to know your body.

I said, “No, I think that I’m sick. What can we do?” She said, “Well, we can give you a colonoscopy. You’re too young and they’re very expensive.” I said, “Well, I’m a teacher. I have great health insurance. We need to do this. I think it’ll give me peace of mind knowing that we have tried everything.” 

Receiving a colonoscopy

Months later, she did a colonoscopy and found the tumor. That was February of 2021. That whole month and a half that I went through 9 different tests. I did 3 colonoscopies, a sigmoidoscopy, 2 CAT scans, a PET scan, and an MRI. There’s another one I did but I can’t remember the name of it. All of those tests brought me to the diagnosis. Now what are we going to do? What’s the plan of action going to be? I got a team together. 

What tests did the first doctors do?
Doctors assumed Courtney was healthy and hesitated to do extensive testing

He did a blood test and some general stuff. He felt my stomach to see if I had any lumps or bumps. Then he went through and looked at family history. Obviously, I don’t have a family history of it. He said, “You’re thin, you’re not pre-diabetic.” I was in Richland, Spokane, and then I went to Kennewick. So three different cities, three different doctors. The doctor in Spokane pretty much did the same thing. They didn’t do anything extensive because you can’t really diagnose it unless you actually get a colonoscopy.

The problem was, neither one of those two doctors could perform that. Then they just dismissed my symptoms. They said, “Well, we’re not going to put in a referral for you to have a colonoscopy because we don’t think, from our experience, that you have it. I really had to beg the GI specialist to give me one. 

We did a blood test with the first doctor and he didn’t see anything abnormal. Then the doctor in Spokane didn’t really see anything abnormal. But my friend’s mom, who’s a nurse, knew what to look out for because I told her what was going on. She did her own test and said, “You are severely anemic. Something’s going on.”

Did your insurance cover the cost of the colonoscopy?

I paid a little bit out of pocket, but it was mostly covered. The problem was, and this is something that I think a lot of people run into when they’re getting tests done, especially a colonoscopy or sigmoidoscopy. My insurance company did not want to pay for the right type of drugs. I didn’t know that. I didn’t hear the confirmation. They actually had to tell my parents, and it took 8 hours for the drugs that they gave me to wear off. So I actually didn’t find out about the tumor until the next day. My parents waited to call because they tried to talk to me after the procedure and I was just bonkers. 

Surgery

The importance of advocating for yourself

They dismissed the symptoms because I didn’t fit the profile, but one of the greatest skills that my parents ever taught me was the ability to advocate for myself and to know your body. I just knew I was sick. I had that feeling in my stomach. Sometimes science can only go so far, and sometimes you have to put it in your own hands and keep pushing for it. It was a unique set of circumstances, because when I did my colonoscopy, COVID cases were very light, so I was able to go in and get a colonoscopy. When I had my surgery, COVID cases were really light, so they didn’t push my surgery back. These were just perfect little windows where things ended up really working out in my favor. 

Formulating a treatment plan

Because I didn’t have the right drugs, she couldn’t finish the colonoscopy. I would have to come back 4 days later and do another one. I came back that Friday. I had [the first one] done on a Monday, came back that Friday, and everything else looked clear. She said, “I’m 98% sure that this is a cancerous tumor. We’re going to send it off to have it biopsied.” 

It took two weeks to get back. The next conversation, I said, “I know a surgeon who saved my dad’s best friend’s life. He had stage 4 rectal cancer and he’s been in remission for 20 years. I want that guy.” She was going to put in a referral for somebody else. I said, “No, I want this guy.” Then everything started to move, all the tests. 

After all of the tests came back – because the original plan was to do some radiation, 6 weeks of chemo, and then do surgery after the MRI, – the radiologist called me and said, “This is miraculous, but your tumor is a lot smaller than we thought, so we’re going to operate. Nothing else is lining up in your body, so we’re just going to go for it and operate.” So they did. 

Describe your surgery

Dr. Holbrook went in and did a lower anterior resection and took out part of my colon, 21 lymph nodes, and my appendix. He said, “I had a stage 4 appendectomy patient who’s 17 years old last week. I just thought I’d take your appendix out.” He spent about 4 hours in surgery. He just retired last year, but he’s one of the best in Spokane. I trusted him.

»MORE: Cancer Surgery Treatments 

Did you have to prepare for your surgery?

The prep work was I had to go onto a liquid diet about 48 hours before. They gave me some things that they wanted me to take prior. After I was in the hospital for about 4 days, I had a series of things that I had to go through to get out of there. I had round the clock bloodwork. They would come in at 2 a.m., they’d come in at 6 a.m.. They were checking fluids and different things like that. 

As far as the procedure, he just went in. He didn’t tell me how much of my colon he took out, but he took out the sigmoid region of the colon. That’s the end. He took that part out and did the lymph node pluck. After that, I was on a liquid diet for about 3 weeks, giving my bowels a break and allowing things to heal. He was able to go in and do it minimally. The incision where he went in was about this big. He was able to go in right underneath my stomach and do it.

Chemotherapy

What stage were you in?

We got a really good prognosis back. I had a stage one tumor. There were just a few little cancer cells that had broken off and gone into one lymph node, so I had a really good prognosis. 

Preserving fertility before starting chemo

I had my 3 week clearance from surgery, and then I actually harvested my eggs, and then I did chemo. It was boom, boom, boom. My body had been through some things. Harvesting your eggs is quite an interesting process. I didn’t know this. When you go through and you do all the things, they monitor you, they take your temperature, they do all the things. 

The day before my procedure, they did a COVID test on me and it came back positive. I didn’t know I was asymptomatic. Seattle Reproductive had to fight with Seattle to advocate to harvest my eggs because it’s a $15,000 procedure. They ended up saying, we’re going to suck it up, risk it, and do her procedure. Then I started chemo right after I was cleared from COVID. 

»MORE: Fertility After Cancer Diagnosis

Beginning chemotherapy

I didn’t have to do chemo because of my prognosis, but my surgeon and team recommended that I do it as an insurance policy. I was prescribed 2 different types. I had an infusion chemo which entered through a port and a pill chemo. I would do one infusion every 3 weeks. Then I was on pill chemo for 2 weeks at a time and I’d get a break at the end of it. 

»MORE: Chemotherapy FAQs & Patient Stories

Chemo Side Effects

Which chemos were you on and did you have side effects?

Capecitabine. The infusion chemo was called oxaliplatin. I had side effects with each. With capecitabine, I had hand-foot-and-mouth, where you get really bad sores everywhere. The other chemo was oxaliplatin. It’s a platinum chemo. It had some really strange side effects. You couldn’t touch anything cold. You couldn’t ingest anything cold. I couldn’t drive in my car with the AC on or it could close my throat. Everything had to be room temperature or hot. 

Courtney discusses her chemo side effects

It was in the middle of the summer, so one of the biggest issues I ran into was I was dehydrated a lot. I was hospitalized 2 different times for dehydration which was scary. I lost a lot of weight. I think I lost about 25 pounds. I tried to eat when I wasn’t hungry. I had to watch what I ate. They tell you you can’t have raw fruits and vegetables while you’re on chemo, which is so weird because you should be eating healthy foods, and they said to eat what I could. 

The first two days after infusion chemo and pill chemo, you’re the sickest, you’re nauseous. It’s really, really hard to get up and move around. With oxaliplatin, like I said, it’s a platinum chemo so it causes neuropathy. You have a lot of tingling going on in your body. It got to the point where my eyes were affected by it. I could taste it in my mouth. It was very all-consuming throughout my body. 

Stopping oxaliplatin

I did my own research about my particular prognosis and I decided to stop oxaliplatin after 4 rounds. That’s the infusion chemo. A lot of patients push past that, and there are some patients that end up disabled from doing that chemo. I did not want to do that. I didn’t want to risk that. It was making me so sick that I could barely eat. 

Did anything help alleviate your chemo symptoms? 

When I was dehydrated, I would go in and get pumped with fluids. That helped. I did take Zofran to help with the nausea. You can’t be in the sun either when you’re on chemo. You have all these things that you can’t do. 

»MORE: Managing Nausea and Vomiting from Chemotherapy

The best thing that helped with the side effects was to get my mind off of it.

I think for me, the best thing that helped with the side effects was to get my mind off of it. I taught full time while I was on it. That was my choice. I didn’t want to lay in bed every day and dwell on it. That’s just my personality so I decided that I was going to work and let that be the thing that would help get my mind off of it. I did oxaliplatin for 3 months and capecitabine for 6 months. 

When I went back to school to teach, I did physical therapy and that helped a lot. It helped me build up strength because I had lost so much muscle mass and lost so much weight and it helped with getting through those days.

Courtney worked through chemo treatments to stay distracted from the side effects

Reflections

How long have you been in remission?

I am almost at the 3 year mark of being in remission. I count it as April. My oncologist counts it as November because that’s when I finished chemo, but I think that the surgeon got everything. 

How often do you get scans and do you experience scanxiety?

I don’t think that it ever really leaves you. I think that it stays with you.

I just hit the 2.5 year mark, so now I go every 6 months. I think that’s one of the hardest parts. I was joking with a friend that I’m a part of an exclusive club now because it doesn’t really ever leave you. With scanxiety, I just do my best to just try and stay positive. It’s always quite exhausting because it’s a 4-day process – blood work, scan, and meet with your doctor. 

My aunt is a phlebotomist, so she’s always encouraging, giving me tips on how to stay positive and hydrate, make sure you’re ready to go. But it is a real thing, and I honestly don’t think that it ever gets any better. I think that you learn how to manage, how to live with it. The farther out that you get, you feel better. But I don’t think that it ever really leaves you. I think that it stays with you. 

What advice do you want to share with cancer patients? 
Courtney encourages everyone to advocate for themselves

Advocate for yourself, know your body, listen to your body, and keep pushing until you find answers.

You need to advocate for yourself and you need to be able to listen to your own body. Science only goes so far. Knowing, understanding, and listening to your body is really important. Because if you’re sitting in front of this doctor that doesn’t know you, you’re just a statistic. They’re trying to see where you fit, and if you don’t fit the category, you don’t fit the profile, of course they’re not going to suspect anything. 

I also think that you have to hold on to your faith and keep pushing through roadblocks and things that are in your way. You just have to keep going until you find the answers that you really desire to have. For me, that was, I’m sick of hanging out in ambiguity. I know I have it. You are speculating, but that’s why we have science. That’s why we have these things. We shouldn’t be profiling people based on their age or the way that they look. We should be listening to the patient and to their concerns. 

Advocate for yourself, know your body, listen to your body, and keep pushing until you find answers. That’s why I’m alive and well today, because I advocated, and I continued to push until I got the answers that I needed. I don’t blame any of them. They’re doctors, they’re human, but I do think that they need to listen to patients better. I think that they need to listen to their patients, listen to the concerns that they have, and really do a better job of putting something in place that is going to help. Help eliminate this ambiguity. For people that may not feel as comfortable to advocate, you just have to remember that you know your body. So even if it’s something that’s totally foreign, talk to somebody about it and try and find those answers that you are desiring to look for.

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Categories
Chemotherapy Colon Colorectal Patient Stories Surgery Treatments

Kelly’s Stage 3 Colon Cancer Story

Kelly’s Stage 3 Colon Cancer Story

Kelly, a small-town entrepreneur from Illinois, received a life-altering diagnosis of stage 3 colon cancer shortly after celebrating her 50th birthday. Despite her active lifestyle of flipping houses, running a tumbling gym, and being an avid runner, Kelly noticed concerning symptoms such as blood in her stool. Despite initial dismissals by her primary doctor, Kelly persisted in seeking answers, ultimately leading to a diagnosis of a sigmoid colon tumor.

Her journey took an unexpected turn during surgery when complications arose, prolonging her hospital stay. Despite setbacks, Kelly’s determination to advocate for herself remained unwavering. She navigated through treatment options, including chemotherapy, with a strong sense of autonomy. Kelly’s decision to undergo chemotherapy was not without doubts, but her resilience and determination prevailed as she faced the challenges of treatment.

Chemo has proven to be a daunting experience, marked by side effects. However, Kelly’s perspective on life underwent a profound shift. Embracing each day with a newfound appreciation and a sense of urgency, she encourages others to live without regrets and prioritize self-care.

Kelly shares her colon cancer symptoms and diagnosis
  • Name: Kelly B. 
  • Diagnosis (DX):
    • Colon Cancer
  • Staging:
    • Stage 3
  • Symptoms:
    • Blood in stool
    • Cramping
    • Bloating
  • Treatment:
    • Surgery
    • Chemotherapy
      • 12 rounds

Cancer or no cancer, you’ve got a life to live.

Kelly B.

This interview has been edited for clarity. This is not medical advice. Please consult with your healthcare provider for treatment decisions.


Symptoms

Tell us about yourself

My name is Kelly. I’m from a small town in Illinois of about 800 people. I was diagnosed with stage 3 colon cancer on November 1st. I wasn’t expecting that from my 50th birthday. 

Kelly owns a tumbling gym

I own two self-employed businesses. I started flipping houses 5 years ago – I’m on [house] number 9. It was a hobby and it turned into an obsession. I absolutely love buying old houses and turning them into something brand new. Picking colors, flooring, and all that stuff. I’m the tear out girl, so I do most of the construction work pulling things out myself, such as drywall, cabinets, you name it, I’ve done it. I can do everything but electrical. 

I also own a tumbling gym with a hundred athletes, and we compete competitively throughout the state of Illinois. We attend nationals once a year. Sometimes we go to West Virginia or to Florida. It depends on where we’re at that year. I have since taken a leave of absence from both jobs due to the diagnosis. 

My hobbies are running. I love to run. I ran the marathon and half marathons. I’ve been running consistently for years. I journal a lot, even prior to the diagnosis. I was just settling into accepting the empty nest thing after my son went off to college 3 years ago, and getting into a groove. I love to travel to Florida. I’ve been back and forth to Florida 6 or 7 times in the last year, and that’s actually when I started seeing signs that something wasn’t right, in June.

What were your initial symptoms? 

My first symptoms were that I had blood in my stool. I was actually in Florida in June, celebrating my 50th birthday with all of my kids, and I chalked it up to something that I ate. Maybe it wasn’t blood. I talked myself out of it thinking it was something that I ate or I was drinking red ice drinks a lot. 

It continually kept happening and it seemed to happen more when I was in Florida, which I thought was strange. I didn’t have anything other than blood in my stool, which I knew wasn’t normal. I thought it could be anything, really. I didn’t think for a second that it was colon cancer. 

I associated cancer with low energy, losing weight, and just not feeling well. I felt really good…Doctors kept telling me I was fine.

»MORE: Colon & Rectal Cancer Symptoms

I came home from my trip, scheduled an appointment with my primary doctor, and saw them at the end of June. They told me that they thought it was hemorrhoids and I shouldn’t be too worried about it. I again saw them because it continually happened probably 2 or 3 times a week.

I wasn’t losing any weight, so I really wasn’t that concerned but I was concerned enough to continue to call my primary doctor. I saw them again in July. I wanted blood work to see where my levels were at. My dad died of a brain tumor at the age of 56, so I went in for cancer screenings once a year, but nothing came up. 

What did blood work show?

I had blood work done. My NPV level was the only thing that was flagged as low. I think it was at a 7 and they were not concerned about that at all. I took that and decided I’ll just keep coming back until somebody gives me some answers. 

Kelly received blood work

I went back 2 times in July and 2 times in August. They finally sent me to a specialist in October – a gastro specialist. He saw me and he said he would schedule me for a colonoscopy, but told me not to be worried. I did, at that point, start to have some cramping in my stomach and maybe a little bit of bloating. Again, I just turned 50 in August, so I thought maybe it was menopause. Maybe I was just getting old. 

Did you suspect you had cancer?

I associated cancer with low energy, losing weight, and just not feeling well. I felt really good, even though I was continually having blood in my stool and a little cramping. Doctors kept telling me I was fine. I finally did go see the specialist and he said it was all good. 

Diagnosis

Receiving a colonoscopy

I’d never gotten the call back to go get a colonoscopy. Here I am 3 months later after being diagnosed with stage 3 colon cancer. That was frustrating because nobody would take me seriously until I went and got another opinion. She scheduled me for CAT scans of everything from the waist up to rule that out, then the waist down. 

They found a large mass in my colon so they set me up for a colonoscopy. I did the colonoscopy prep on my favorite holiday, Halloween, which is awful. The prep didn’t go well for me because I’m a puker. I was not really pooping like I was supposed to. I was throwing up. 

We did the colonoscopy on November 1st, and the doctor came in after I woke up, they took us to a little room, so I figured it was not good news. He said it was 100% cancer.

Kelly describes receiving a colonoscopy
How did you react to your diagnosis? 

I’ve been going to the same doctor for years. It’s not like I didn’t trust them, but I had to trust myself more, and I knew something wasn’t right.

I said, “Okay, let’s go to Applebee’s. I’m hungry.” My daughter was devastated. I thought, okay, we’ll just deal with it however we need to deal with it. That’s it. I wasn’t feeling heard. I knew something was wrong. I didn’t know what was wrong. I’m pretty good at being able to tell what’s going on with my body. I’m very in tune with my body, my feelings, my thoughts. I felt like I was being dismissed. 

They kept telling me over and over again, “It could be hemorrhoids.” I said, “It’s not hemorrhoids. I’ve never had hemorrhoids in my entire life. Even when I gave birth to 3 children who are now adults.” I knew it wasn’t hemorrhoids. I started to get a little bloated towards the end of October, but again, I chalked it up to menopause. I almost talked myself out of my symptoms because nobody would listen to what I had to say, and I’ve been going to the same doctor for years. It’s not like I didn’t trust them, but I had to trust myself more, and I knew something wasn’t right.

Kelly discusses how she reacted to her diagnosis

»MORE: Reacting to a Cancer Diagnosis

He said that the tumor was so large that they could not get the camera through on my colonoscopy, even though they changed the camera to a NICU baby size. The mass was too big. I didn’t really understand that because I’m a tiny girl. If I had such a large mass, how could I have not known that? The mass ended up being 11 inches big. 

Creating a cancer care plan

When he told me I had cancer, I said, “Okay. Let’s go. What do I do now?” He was urgent, and said, “We need to go now. You need to see a surgeon. You need to schedule this and that.” I was clearly not in a hurry because I’d been dealing with this for months, so I was like, let’s just take our time here, people. 

But that’s not how it works when you’re diagnosed with cancer. That was the crazy thing. They said I could have had the tumor for 5 to 8 years. Dr. Kerry was the first one to actually listen to me, listen to my symptoms, and want to rule anything out. She suggested the CAT scans. Of course, I went along with that because I wanted to know what was going on.

After I was told it was 100% cancer and it was time to see the surgeon, they scheduled me in. I went to see him the first week of November. He wasn’t too concerned about getting me in for surgery right away because the tumor was so slow growing that I could have had it for, he said, 5 to 10 years. 

Did you have a family history of colorectal cancer?

They assured me that I didn’t do anything wrong because nobody would get me a colonoscopy. I didn’t have any family history of this. It sounds silly, but my friends and I made a pact to get colonoscopies at some point because my best friend’s husband died of colon cancer. So that makes the story a little bit crazier. 

Surgery

Kelly didn't rush to receive surgery
Not rushing to get surgery

After I saw Dr. Kerry, things moved really quickly. I met with my surgeon, Dr. Modi, who is phenomenal. He’s like a little Doogie Howser and he didn’t push me to go too soon. He gave me a couple of weeks. He told me to go live my life. He knew the tumor was rather large, but he was very confident that he would get it out with the robotic arm hands. Surgery would take about 3 hours, so he gave me 2 weeks to go do whatever I wanted to do. 

I really wanted to travel. My kids wouldn’t let me do anything. They were scared it might rupture. I teach gymnastics too, so I went back to work and did my thing. 

Describe your surgery

I went in for surgery on November 21st, and that’s when things got really real, because the surgery didn’t go the way I expected it to go. I thought for some reason it was like going to the spa. I packed books and things like I was going to recover fast, and it didn’t happen that way.

My tumor was in the sigmoid colon. Surgery was my only option to get the tumor out. There was not going to be any radiation or chemo at that time. They’d remove the tumor and then we would go from there. We didn’t expect the tumor to be 11 inches, and it was in my sigmoid colon. I had also told my surgeon that I did not want the poop bag. I didn’t even know the correct terms for that. There were certain things I was not going to do, and I guess I wasn’t a really great patient, but I advocated for myself.

Complications during surgery

He ended up taking my colon out of my body, setting it on the table, fixing it, and putting it back in.

Kelly had her colon removed and fixed during surgery

We went in for surgery on November 21st. It was supposed to last 3 hours. Apparently it lasted 7, because my prep didn’t go well. When he had me on the table, it was supposed to be laparoscopic, robotic, for incisions to get the tumor out, but he ended up having to open me up because I started to fill up with poop.

He ended up taking my colon out of my body, setting it on the table, fixing it, and putting it back in. The strange thing is, I remember going in at 7:30 in the morning and I had no doubt it was going to go very easy. When I came out of it and I started to wake up, there were so many people in the room and it was dark outside. I knew something wasn’t right and that it didn’t go as well as he had expected it to go. He ended up having to call in a colleague to help him with all of the feces. 

When I woke up, I wasn’t too happy because I had the incision, but I didn’t have the poop bag. I didn’t have to worry about that because there was a certain way I was going to live my life after this, and it wasn’t going to be with that. No disrespect to the people who have [a colostomy bag]. I just knew that it was not going to work for me. I didn’t want that. I wanted choices. If I had to make that choice, it was a no. 

Hospital Stay

How was your hospital stay?

In the hospital, things did not go well. We thought that I had an infection or a leak where the incision was and in my colon. I guess I didn’t. In the hospital, I don’t remember a ton.

He went to have an anastomosis. Putting my colon back together, filling everything around me with water to see if there were any leaks. My surgeon was convinced there were leaks. I was convinced there were no leaks. I just didn’t feel like he gave my body enough time to recover. He wanted me to sign consent to open me back up to see if there were any leaks. I refused to sign the consent form. I knew that my body just needed more time, so he sent me down for CAT scans. 

I will say this, when you are throwing up and you lose control of your bowels…I was puking and throwing up at the same time, it was the most humbling experience for me. I am trying to get on the CAT scan table and crawling over after surgery. It was like doing the army crawl to get on the table to do the CAT scan. That was my lowest moment in the hospital. I really felt like things were not going to go well. I probably did have an infection and that was just the way it was going to go, because I was not going to let them open me back up. I couldn’t do it. I wasn’t strong enough. I had accepted it. 

»MORE: Types of Cancer Treatments

Kelly describes her hospital stay
Kelly had to stay in the hospital due to complications
Kelly had to delay finishing chemo

My kids were devastated, but I also knew that if I was just given a little bit more time, my body would come back a little bit. I have to trust my gut through this entire journey. Everybody’s got a lot of opinions, but I knew I didn’t want to go back under the knife. I wasn’t going to do it. It didn’t matter, life or death. I wasn’t going back under and got the CAT scan results back and there was no leak. 

Leaving the hospital

I took more antibiotics and they took out the NG tube. For a couple of days, I thought they were just getting the infection out, so after my CAT scan came back normal, I said, “Get the NG tube out. I’m done with that.” It was triggering me to vomit a lot. That was the worst feeling in the world for me at that moment. Two days later, the doctor said, “If you can eat and drink a little bit, we’ll let you out of the hospital and you can go home.” That is what I did, miraculously.

I was technically only supposed to be in for 3 days and I ended up being in for 5. I was still on track because they said the most was 7 days. I really think they released me to get me out of there. I was not an easy patient to deal with. I’m stubborn. I kept telling them, “Give me more time, give me more time, and I’ll get out of here on my own accord.” 

The importance of advocating for yourself

I think it’s super important to advocate for yourself. Cancer or not, you are the only person that’s in control of your own feelings and yourself. You know your body. If you know something’s not right, it’s not right. I just cannot stress that enough to people. If you think something’s not right, it’s not right. Keep looking for people until you find a physician that will listen to you. You’ll eventually get there. 

Kelly encourages everyone to advocate for themselves

I was lucky it only took me a few times, but it took me a span of 6 months to know something wasn’t right and then to be diagnosed with stage 3 colon cancer. It was unbelievable. When they diagnose you with cancer, it goes boom. I didn’t want a stage 3 diagnosis. I wanted a stage 2, but one of my lymph nodes out of 32 came back positive for cancer cells. 

I think it’s super important to advocate for yourself. Cancer or not.

»MORE: How To Be A Cancer Patient Advocate 

Just keep pushing. Push for yourself. After I was released from the hospital, I had some time to look for an oncologist. Unfortunately, I live in an area where there’s not a lot. There’s not a lot that specialize in colon cancer. I was determined to find at least 3 different people so I could figure out what the best course of action was for me. I don’t follow everybody else’s rules. I don’t. I do what I want when I want to. I’m extremely independent and stubborn, and it’s not a one size fits all. 

What did doctors recommend next for treatment?

I wasn’t a candidate for radiation. The first oncologist that I saw was actually pretty fantastic. He recommended chemo 6 times over a 3 month period, but he was more nonchalant about it. Do it or don’t do it. It didn’t really matter to him. I wasn’t comfortable with chemo at first and I said I’d get back to him.

I went to my second opinion, which was the University of Iowa Cancer Care Clinic in Iowa City, and I met with an amazing doctor, Naomi Fei, and she sat me down and said, “You need to do chemo,” and also backed it up. My surgeon was really hell bent on me doing chemo as well because I said, “I don’t think I’m going to do it.” He said, “If it were my mother, daughter, sister, or family member, I would want them to do chemo.” My second opinion at Iowa City said that it’s like an insurance policy. It’s preventative care.

Kelly agreed to begin chemo

My surgeon got all the cancer. It had not metastasized to any of my other organs, thank God, for as long as they think that I had it. She recommended 12 rounds of chemo for 6 months. I didn’t want to hear that. I had told my children – like I said, they are adults – that if my scans were clear and it had not metastasized and my bloodwork looked good, I was just going to live my life. They gave me maybe 5 years, and I was okay with that. I just turned 50, I could do another 20, but I just wasn’t comfortable with the chemo. 

Chemotherapy

Did you decide to still do chemo?

I came home from Iowa City. I had a third opinion but I canceled that appointment. I sat by myself for hours and hours. I don’t know how you guys feel about Jesus, but he talked to me. I’d already told my kids, I’m not doing it now. I’m gonna live my life, sell my house, and move to Florida. Then, this is going to sound crazy, but I made friends with my ceiling fan. When you’re down, you spend a lot of time in your bedroom. You spend a lot of time by yourself. 

I had a lot of conversations with myself, took a lot of funny notes in the middle of the night when I couldn’t sleep. I decided, plot twist, that I would do 12 rounds of chemo for 6 months. I just finished up with my second round a couple of weeks ago. I called my kids and I said, “I will do chemo. I will get through as much of it as I can.” 

It still didn’t register with me that I had cancer up until just a few weeks ago. I hadn’t processed it yet. I didn’t feel sorry for myself. I’ve yet to really cry or get upset. I’m not angry. I really feel like I would be doing a disservice if I didn’t take the chance and do the chemo to live a little bit longer, because there’s many people that didn’t get the chance to do the chemo. My best friend’s husband, like I said, died of colon cancer 31 days after diagnosis. I couldn’t imagine at least trying to get more time. Of course, my kids were elated when I agreed to do the chemo. 

Describe your experience with chemo

I’m going to tell you that chemo is not nice. I went in and got my port with my surgeon and I’ve seen him since then. He wants me to keep my port in longer than I expected – a few months after I get done with chemo. 

Kelly talks about the difficulties of chemo

Unfortunately, my third round of chemo was supposed to be last Friday, and we had to cancel because my white blood count was down by 140 points. That might have been the first time that I cried because I just wanted chemo. I just wanted to keep marking off the numbers and be done. I have no control over this, and I’m a woman that has control issues, a little bit of OCD, and a whole lot of ADHD. I’m a planner and I was devastated because my body said, “Not right now.”

Colon cancer chemo is not what people expect. I go in for my chemo and sit in an infusion chair for 4 hours. At first, it was a little terrifying. It’s really just sitting still for 3 or 4 hours. I didn’t like that at all. Being hooked up and watching the poison drain into my body, I didn’t like it. I’ve acclimated and I’ve had 2 treatments. I go in and infuse for 4 hours and then I have to go home with a chemo pump bag for 46 more hours. 

When I tell people that they don’t really get it, I didn’t either. It’s for this certain type of cancer. You go home, you pump for 46 hours, and then you disconnect. We’ve decided to disconnect the needle from the port at home, which is going very well. 

Have you had side effects on chemo?

The side effects of chemo…I might as well be pregnant. I’m very sensitive to smells and things anyway. With the chemo, I probably threw up at least 25 times, but I also don’t like to take my meds. I’m not a pill taker. I’m a self-care, “I’ll just deal with it.” Even if I’m sick, I just want to deal with it and mask it. Chemo had other plans for me. We tried to mask the nauseous feeling as much as we could. 

Kelly describes her chemo side effects

The first treatment didn’t go well. The second treatment, I did do all of my meds, but I still probably vomited about 10 times. My energy level was hard for me to get back to normal. I pump for 3 days and then I have 4 days of feeling miserable. It’s really one week of total hell. I start to get better the next week, but it’s every 2 weeks. By the time I get to the good stuff, I have to go back into the chemo chair. 

Like I said, my third infusion was canceled and I go back in for blood work on Tuesday. Hopefully I’ll be back in the chemo chair on Wednesday. People are like, “You’re the only person that cried because they couldn’t get their chemo,” but I just want to be done with it. There’s a lot more to do.

Reflections

Has cancer changed your outlook on life?
Kelly describes how her outlook has changed with her diagnosis

I’ve always had a different outlook on life. I felt like, prior to the cancer diagnosis, you really don’t know how much time you have left, you don’t know what’s coming. You don’t know what’s in store for you. I lived my life like that prior to cancer, but now my friends call me a little unhinged. I know I can’t just say I see things differently, but I literally see things differently. The colors to me are brighter. I don’t quite understand that. The sky is blue, the grass is greener, the snow is whiter. I just see things differently. 

Happier? I can’t say that I’m happier with the cancer diagnosis, but I really think that God was trying to slow me down a notch, because I’m a workaholic. I own two businesses, gymnastics and flipping houses. I think this was his way of saying there’s more to life than just work. You need to calm down, and I have. I’m definitely unhinged. The hardest part about this cancer diagnosis is people telling me how I’m supposed to feel. That is extremely difficult for me. 

I look at people differently. It’s not that my healthy friends are wasting their life by any means…But I’m not tired. Maybe during my chemo weeks, I’m tired and I take a few naps here and there, but if I’ve got some good time…Like yesterday, I painted the kitchen with my daughter. We just go get things done. There’s no excuses. Cancer or no cancer, you’ve got a life to live. Doesn’t matter how long it is. Go do it, people. Just go do it.

Do you have any advice for someone on their cancer journey?

My best advice would be, no regrets. If you’ve got things to say to people, say them. If you’ve got things to do, do them. Everybody always waits like they do have more time, and we don’t. Cancer or no cancer, like I said, go and live your best life. 

Be selfish. I’m not a selfish person. I’m very empathetic. I do a lot of things for other people. I have my whole life, and now I’m like, if I don’t want to do it, I’m not going to do it. It’s okay to put yourself first, and that’s a lesson that took me a really long time to figure out. Without cancer, I don’t think I would have got that. I think I would have continued to do things for people, but I have to take care of myself. Saying no to doing things is so much easier than it was before. 

Kelly encourages people to live their life to the fullest

Cancer or no cancer, you’ve got life to live.

With that being said, travel, take trips, don’t hesitate, and love people. Love yourself, love your family, and let go of some of the stupid shit that doesn’t matter anymore.

More Colorectal Cancer Stories

Allison

Allison R., Colorectal Cancer, Stage 2C



Age at Diagnosis: 32
1st Symptoms: Extreme fatigue, unexplained weight loss, blood in stool, "blockage" feeling after eating
Treatment: Concurrent adjuvant (oral) chemotherapy + radiation, colectomy, oral chemotherapy
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Michelle C.



Symptoms: Felt like either a UTI or yeast infection
Treatment: Chemotherapy (carboplatin and paclitaxel), surgery (hysterectomy), and radiation
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Kelly S., Colorectal Cancer Diagnosis: Stage 3 Colorectal Cancer Symptoms: Constipation, blood in stool, abnormal-smelling stool, fluctuating appetite, weight lossTreatment: Dostarlimab
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Jason R., Colorectal Cancer, Stage 4



Symptoms: Blood in stool, diarrhea, tenesmus, feeling run down
Treatment: Chemotherapy, radiation, HAI pump
Raquel A. feature profile

Raquel A., Colorectal Cancer, Stage 4



Symptoms: Frequent bowel movements, pin-thin stools, mild red blood in stool
Treatment: Chemotherapy (oxaliplatin, 5-fluorouracil, and irinotecan)
Andrea P. Diagnosis: Stage 3 Colorectal Cancer Symptoms:Frequent blood in stool, lower back pain, rectal painTreatment: Chemo, 5-FU, radiation, surgery
Categories
CLL Patient Events

Shared Treatment Decision Making in CLL

Shared Treatment Decision Making in CLL

How to Be an Empowered CLL Patient

Updated October 9, 2023. Originally broadcast September 20, 2023.

Quality of life and precision are top of mind for chronic lymphocytic leukemia (CLL) patients. Understanding the complexities of available treatments can help you optimize your CLL care and prioritize the questions to ask your doctor.

During this live conversation, panelists Dr. M. Yair Levy, director of hematologic malignancies research at Texas Oncology, and Dr. Catherine Coombs, a hematologist oncologist at UCI Health who specializes in CLL, discussed the latest in CLL care. The discussion was hosted by CLL patients, advocates, and administrators of the CLL Support Facebook group Michele-Nadeem Baker and Jeff Folloder.

This discussion covers the current landscape of CLL treatment and care options, as well as new CLL treatments awaiting FDA approval, factors doctors consider when starting or switching a patient’s treatment, encouragement for CLL patients to advocate for themselves, and each doctor’s outlook on CLL treatment and patient quality of life.

There is hope. Hope to live a normal life, and hope to see your kids and your grandkids grow up. There’s always hope on the horizon, in my opinion.

Dr. Catherine Coombs

Abbvie has helped sponsor this discussion by the Patient Story
BeiGene has helped sponsor this discussion by the Patient Story

Thank you to AbbVie and BeiGene for their support of our patient education program! The Patient Story retains full editorial control over all content.

This interview has been edited for clarity and length. This is not medical advice. Please consult with your healthcare provider for treatment decisions.



Introduction

Michele-Nadeem Baker: I’m Michele-Nadeem Baker. I’m a medical and health journalist, but in addition to that, I am also a patient. I started advocating for other patients on my first day of treatment when I realized that there was so much unknown out there and to demystify things for my fellow patients and help them through their journey.

Jeff Folloder: My name is Jeff Folloder. I am a passionate patient advocate. I am now in year 14 of my little journey with CLL and I am living a great life. That’s why I became a patient advocate because I want to make sure that everyone knows that it is possible to live a great life with CLL. 

First up, I get to introduce Dr. Catherine Coombs. She is a hematologist oncologist with UCI Health and she specializes in chronic lymphocytic leukemia. She also helps lead clinical trials, trying to find better ways to treat CLL. Dr. Coombs, tell me what drew you to specializing in CLL. We don’t hear that a lot.

Dr. Catherine Coombs: It was a long road. I went into medical school knowing I wanted to be a cancer doctor. I didn’t have any doctors in my family, but I do have a lot of family members with cancer. It always inspired me to be on the patient end of the oncologic relationship. That’s always what I thought I would do. 

Now, I didn’t decide on CLL until my residency years. I looked for a research project right away, because that’s the only way to get into a good fellowship program is by doing research. It always was something I wanted to do regardless. I found a wonderful mentor in my time at Duke University as a resident, Mark Llaneza, where I focused on the underlying genetic risk of CLL as my residency project. That drew me to the field right away. 

Then I saw all these other benefits of being a CLL-focused clinician, which is that the patients do really well and they live a long time. I love having that long-term relationship with my patients. I love blood cancers in general, but I would say the acute leukemias, which I had focused on a bit earlier on in my time as a faculty when I was doing a bit of both were hard because there are a lot of patients that we lose and I really admire the docs that do it. But I think for my long-term well-being, I know that it’s just so much more gratifying and less emotionally traumatic to be able to have patients that thrive for so many years and be able to really enjoy those relationships as the added benefit. 

The therapeutics have just continued to improve over the 13 years since I first graduated medical school and started doing research.

Michele:  We need more doctors like you. Dr. Coombs, thank you so much. I’d also like to introduce Dr. Levy, who is a hematologist oncologist at Texas Oncology. He is the director of Hematologic Malignancies Research and specializes in CLL. He’s also helped lead clinical trials in CLL. Dr. Levy, what drew you to CLL?

Dr. Yair Levy:  Before moving to Texas, I actually did mostly chronic lymphocytic leukemia, but I’m a little older than Dr. Coombs. So back when I was doing it, it was still a relatively better outcome for this cancer, but we still lost some folks to chronic lymphocytic leukemia. However, if I reflect on my current experience, I don’t believe that I have lost a patient to chronic lymphocytic leukemia in the past decade. This is not because I have a shortage of patients. I’ve probably accumulated about 150. I’m not saying that the patients don’t die, but they don’t die of CLL. 

So to live a normal life is the goal. Even though we still think of CLL as a treatable but incurable malignancy, for the most part, people are doing relatively well. Not to mention, not only are our treatments better in terms of efficacy, but they’re so much better tolerated.

If I reflect on my current experience, I don’t believe that I have lost a patient to chronic lymphocytic leukemia in the past decade. This is not because I have a shortage of patients. I’ve probably accumulated about 150. I’m not saying that the patients don’t die, but they don’t die of CLL. 

Dr. Yair Levy

Jeff: We have an interesting topic for today’s program, Shared Treatment Decision Making: How To Be An Empowered Patient. This is something that strikes me right in my heart. I am a firm believer that patients who take an active role in their own care tend to have better outcomes, and this is actually borne out of clinical research. 

I took an active role in my own care. I chose not to go in the specific direction that my first doctor wanted to go in, and I wound up at a large research hospital participating in a clinical trial. I’ve been living a great life as a result.

Changes and improvements in CLL treatment

Michele: For me, treatment decision-making also came down to becoming an empowered patient and becoming health literate in CLL. The more I could learn from credible sources, for me, was better. I realized all patients are different and doctors, you can probably relate to this more than anyone but the world has changed quickly and pretty drastically for clinicians, researchers, and those of us who are patients. 

I was diagnosed 11 years ago, not quite as long ago as Jeff, but still a long time ago. My frontline treatment started in 2015 and things were even different back then. I was on a trial that combined ibrutinib, which at the time was not approved yet for frontline treatment. It had been for relapsed and refractory but not frontline treatment. It was combined with FCR, the standard at the time, fludarabine, cyclophosphamide, and rituximab. Things have changed so quickly even since then. In my frontline treatment, I’m now on a different treatment. I had relapsed in between. 

Dr. Coombs, could you tell us how the landscape of treatments for patients has vastly changed over the last couple of years?

BTK Inhibitors
Dr. Catherine Coombs, UCI Health

Dr. Catherine Coombs:  Over the past decade, but even over the past few years, we’re seeing advances. When I first got into the field, yes, it was chemoimmunotherapy for patients fit enough to receive it like FCR and BR. With the introduction of targeted agents, largely chemoimmunotherapy is not widely used. However, we still do see about a third of uptake looking at these large-scale studies across the country. 

I’d say that doctors who are focused on CLL realize that chemoimmunotherapy is not worth the toxicity. Its efficacy is also inferior to these novel drugs that are more efficacious, so more likely to put the CLL at bay, in remission, and delay time until ultimate progression, but also hugely safer. That was first ibrutinib, as you wisely know from your own personal experience and your knowledge over the time of your journey as a patient. But now we have a lot of newer and better drugs. Ibrutinib has been amazing and revolutionary, but it does have some side effects. Fortunately, they’re not so common, but they still can be clinically significant. 

The first category of drugs that have really changed in the past few years is newer generation BTK inhibitors. Ibrutinib was the first in class. It inhibits this critical protein that’s part of CLL cell machinery, BTK, but it’s not totally selective for its target. We now have 2 additional drugs that inhibit BTK – acalabrutinib and the most recent addition, zanubrutinib which was FDA-approved in January.

The advantage of both of these drugs is that they’re more selective for their target, BTK. That, fortunately, has translated to improved safety, where both drugs have been compared head to head with ibrutinib and they demonstrate improved tolerability, specifically lower rates of atrial fibrillation for both drugs. Acalabrutinib also has the advantage of lower rates of hypertension. 

What we don’t know is whether zanubrutinib is better than acalabrutinib or acalabrutinib is better than zanubrutinib, because we don’t have that comparison. But I think they’re both excellent options and both offer advantages over the ibrutinib days when we were dealing with a lot of atrial fibrillation. There’s a lot less in the way of that. 

The other huge class of drugs that I haven’t mentioned is a completely different way of treating CLL, so I’ll mention it briefly. I don’t know if we’re going to get more into the nitty gritty on this, but these BTK inhibitors work wonderfully at controlling CLL, but they’re considered as treat-to-progression regimens, meaning that patients go on and stay on as long as they’re, number one, tolerating it and their CLL is responding favorably.

Some patients don’t like the idea of being on a drug indefinitely, so the other huge therapeutic advance over the past few years that’s been widely available is the drug venetoclax. This is typically combined with another drug called obinutuzumab when used in the frontline setting. Because it can so effectively kill off the CLL to very deep levels, patients are able to completely stop treatment after one year and then eventually relapse, but it can take a long time. That’s one of the other major, major changes in CLL just over these past 5 years or so.

I’d say that doctors who are focused on CLL realize that chemoimmunotherapy is not worth the toxicity. Its efficacy is also inferior to these novel drugs that are more efficacious, so more likely to put the CLL at bay, in remission, and delay time until ultimate progression, but also hugely safer.

Dr. Catherine Coombs

Michele: Dr. Levy, what else would you add?

Dr. Yair Levy: Dr. Coombs, you hit the nail on the head. It’s a dramatic change from chemoimmunotherapy. In the chemoimmunotherapy era, our high unmet need was what we considered high risk which were ones that harbor a 17p deletion, or a mutation in this TP53 tumor suppressor protein, or these cells of origin that are called pre-germinal cells of origin. So a more immature cell that had gone bad, and we’ve known that they have done historically quite poorly with chemoimmunotherapy. 

Dr. M. Yair Levy, Texas Oncology

As Dr. Coombs mentioned, the biggest improvement that we saw was when we actually recognized druggable targets within the B-cell receptor pathway. The first such drugs were actually not Bruton’s tyrosine kinase (BTK) inhibitors, and they are largely relegated to the history of the B-cell receptor pathway now. But these were the PI3K delta inhibitors. Those worked irrespective of cell of origin, and they also worked in the 17p deletion. So again, they did certainly have some tolerability issues and the efficacy was not comparable to those of Bruton’s tyrosine kinase inhibitors, which is one of the big reasons that those have really fallen out of favor.

As Dr. Coombs mentioned, the BCL2 inhibitor venetoclax has also been a game changer. We’ve been utilizing these agents, either alone or in combination with CD20 monoclonal antibodies. Now, the European Medical Association has even approved the combination of a BCL2 and a BTKi. This is something that we’re doing further studies on within the United States as well because we’re seeing that people achieve very impressively high rates of response. More importantly, very deep responses can allow, hopefully, a very long treatment-free interval, and perhaps even in some cases, a functional cure. 

So, in the beginning, we were saying that CLL is largely treatable but incurable, but we put an asterisk on that. Even with chemoimmunotherapy, there was a subset of CLL that may have been cured by chemoimmunotherapy, or at least a functional cure. I think we’re going to see the same thing with these other combinations as well.

Dr. Yair Levy discusses improvements in CLL treatments

We’re seeing that people achieve very impressively high rates of response. More importantly, very deep responses that can allow, hopefully, a very long treatment-free interval, and perhaps even in some cases, a functional cure.

Dr. Yair Levy

How CLL doctors are providing CLL patients with precision care

Jeff: This is exciting stuff. We’re talking about an awful lot of options for patients, but before we can get to those options, we need to figure out how we get to that point. So let’s chat a little bit about the tests that are needed to diagnose and then accurately inform those potential treatments. 

Genetic testing in CLL

A lot of us in the support groups and on social media love tossing around the cute names, the FISH test, the flow test. Not a lot of people truly understand what’s going on with those tests. They don’t understand the concept of chromosomal abnormalities that may be going on with a patient at the time of diagnosis. Dr. Coombs, can you briefly give us a top line as to what these tests are doing and more importantly, what they’re telling you in terms of prognostics?

Dr. Catherine Coombs: Absolutely. Before the advent of all these, let’s call them sophisticated tests, we would stage patients. That’s always what I think cancer patients think of, what stage am I? We do have a staging system called the Rai Staging System that we use in the US. In Europe, they use this Binet Staging System. But the idea is, how much is this really affecting me? Rai stage 0 is when it’s just a high white count to Rai stage 4 when you have low platelets from the CLL. 

I’m taking a step back because there were, for decades, ways of saying this a good or a bad CLL. However, what we’ve learned over the years is that there are some patients with really early-stage disease that would follow very aggressive clinical courses and then some that may have been technically a Rai stage 4 that were totally stable for decades. The goal with all these more sophisticated tests was to better predict, how is this person’s CLL going to behave, which then helps us as clinicians know what to expect. It helps the patient as far as what he or she should expect. 

So taking a step back, we now have a lot of advanced testing that we can send. The good news is that these can be sent on the peripheral blood so it’s not necessary to get a bone marrow biopsy early on. Of course, we do consider these at the time of therapy, but we can send these tests in the blood because the CLL, by its nature, is circulating in the blood. So we can pick up different abnormalities that can tell us, this is a good or a bad CLL or maybe somewhere in the middle to help us, number one, know if we should follow this person more closely. Number two, is this someone that perhaps it’s less likely to cause more trouble than not? 

The categories of tests are looking at the DNA, which is either via a FISH test which uses fluorescent probes to find common abnormalities that are known to be seen in CLL. The most adverse is the 17p deletion. On the other spectrum, the most favorable is an isolated 13a deletion.

However, what we’ve learned is that this is only looking at certain probes. Sometimes you can have other abnormalities that aren’t present as part of the FISH panel. In my own practice, I also send a karyotype test which looks for the same thing, abnormal chromosomes. Instead of using a preselected panel of common abnormalities in CLL, it just looks at all the chromosomes. The chromosomes, just for the patient’s knowledge, are just the big chunks of DNA that live inside every one of our cells. We’re focusing on what these abnormalities are in the cells because there are common patterns. There are good patterns and bad patterns. 

It’s also bad to have a complex karyotype, meaning 3 or more abnormalities in any given cell, so that’s one category. The 17p deletion I mentioned is known to behave more aggressively. It’s still a chronic disease, but those are often the bad actors, especially back in the chemo days when chemo doesn’t work well at all. It does do better with our new drugs, but that is a particular problem because it deletes a copy of this very important gene called TP53.

We used to think the only way of losing that gene was by completely deleting the part of the chromosome where it’s contained. What has been learned over the past 10 to 15 years now in CLL, is that it may not be deleted, but it could be mutated. That’s another test that I think is very wise to send, especially in patients who are going to need treatment because a TP53 mutation is largely the same as a 17p deletion. There are a little bit of nuances there, but these are 2 separate tests. They both give similar information because those 2 abnormalities are treated as one and the same as far as their impact on prognosis.

The next category of testing is looking at the immunoglobulin heavy chain status, so a normal B-cell over its life. CLL is a cancer of B-cells that undergoes a process of somatic hypermutation where it just acquires mutations. It’s actually good to have a mutated, immunoglobulin-heavy chain. The bad finding is for that to be unmutated, which suggests this is a bit more primitive of a cell. And what’s been borne out through a lot of studies is that patients with unmutated are the ones who need therapy quicker and they don’t respond as well to certain therapies. Now, again, the negative predictive impact of some of these abnormalities is somewhat outdated. Sometimes they do just as well with our new treatments, but they definitely don’t do as well with the old treatments. 

The other test I always send is the beta-2 microglobulin (B2M), mainly because that goes into our scoring system for CLL, the CLL International Prognostic Index, but it’s an adverse finding to have that elevated. I think that wraps up the bulk of all the prognostic tests that I send at the time of meeting a new patient and trying to help understand what is our future going to be like.

The goal with all these more sophisticated tests was to better predict, how is this person’s CLL going to behave, which then helps us as clinicians know what to expect. It helps the patient as far as what he or she should expect.

Dr. Catherine Coombs

Jeff: Let me play that back for just a second and put it in terms that are not quite so technical. You have a toolbox, and that toolbox has a lot of really nifty tools in it, where instead of saying you have leukemia or you have chronic lymphocytic leukemia or you have one of these genetic abnormalities, you’re able to hone down to a very precise level of differentiation. That’s where the term personal and precision care comes in. Correct?

Dr. Catherine Coombs: Excellent explanation. Yes.

Michele-Nadeem Baker:  I love this term and how that is happening more and more for patients. Dr. Levy, before planning treatment, what do you like to understand from your patients so that you can learn more about them when it comes to prescribing their treatment?

We need to speak with the patient and find out what is most important to them and explain everything about the treatment, including side effects, logistics, expected outcomes if you choose one route versus another, and the cost of travel. There are a lot of things that go into everything.

Dr. Yair Levy

Dr. Yair Levy:  We’re all different and everybody’s cancer is also different. The reason that we have jobs as oncologists is because, I’m not sure that’s true here, but hopefully we know more about CLL and the treatment options than the patients. It’s our job to explain to them all their various options and then help them arrive at a choice that makes the most sense for them. 

I think Dr. Coombs mentioned that we have a lot of options, but they haven’t necessarily been compared head to head. So we can’t tell you prospectively how treatment A compares to treatment B or treatment C. There are certain guidelines of what’s called preferred therapies and other alternative therapies that are also acceptable. We need to speak with the patient and find out what is most important to them and explain everything about the treatment, including side effects, logistics, expected outcomes if you choose one route versus another, and the cost of travel. There are a lot of things that go into everything. This is our job to get them to ask the right questions and then answer those questions.

The role of patient comorbidities in CLL care

Michele: And what about comorbidities? Is it important for patients to discuss their other health issues with you, such as cardiac issues? There’s a myriad of so many other types.

Dr. Yair Levy: Absolutely. This is what we were saying is, we’re all different, we all have different things that matter, and we are all in a different place in our lives. We take all of that into consideration, there’s no question about it.

The comorbidities are incredibly important, but we certainly advanced past where we were 15 or 20 years ago when we were looking at whether patients are fit enough to take therapy versus not because right now we’re not necessarily looking at fitness for therapy as much as we’re looking at what is the optimal therapy for them.

Many of the therapies that we have, if you take a look at what’s called the Preferred Category 1 recommendations from the NCCN Panel, were all studied in what we would have technically called a non-fit population before. It’s wonderful that we have all these highly effective therapies that we can give to people, even if their fitness is not optimal.

The benefits of watch and wait 

Jeff is a co-admin of the CLL Support Facebook group

Jeff:  We’ve been talking about a whole bunch of novel therapies, stuff that has really impressive outcomes these days. Michele and I will both be able to tell you without hesitation, that the first thing that most patients encounter is not treatment. It’s this thing that we call watch and worry. You guys call it watch and wait. CLL does not always need to be treated right away. Your medical team is going to work with you to decide when it’s best to start treatment. In the meantime, the patient’s worry. Did I sum that up correctly, Michele?

Michele: We sure do, even though we tell everyone not to and to take a breath when they’re first diagnosed. Jeff, you and I both know that we still go through that when we’re back in that time period. It’s just so counterintuitive to not be treated right away when the disease has not progressed where it ends up going when you do get treated. 

Dr. Coombs, what are you looking for when it’s time to treat? You go through years, hopefully, during watch and wait. Worry and wait, as patients call it. But what is it that you’re looking for and is there any benefit to treating it sooner as with some of the other cancers out there?

Dr. Catherine Coombs:  I’m coming straight from my clinic. I’m in a clinic room. I just had this conversation with a patient who is newly diagnosed about watchful waiting, which I totally understand why it’s watchful worrying for many. I always see it as my duty to help them understand why this is our approach. I acknowledge this is not what we do for many other cancers where you hear, find it early, treat it early. I wish our treatments were so good that treating it early would knock it out and you’d never have to worry about it again. In 2023, we haven’t been smart enough to come up with something that will do that for CLL. 

1 in 3 CLL Patients Never Need Treatment

The way that I help put that in context for my patients is this disease can be so indolent that maybe up to 1 in 3 patients never need treatment in their lifetime. So if we treated everyone, inherently we’re over-treating people. I hate giving people things they don’t need because every treatment comes with a cost, whether it’s financial or side effects. That’s my one very strong argument for not over-treating. But also, none of the early treatments that we have tried and done clinical trials on have been shown to make patients live any longer. That is just where we are. 

I definitely could understand the frustration on the part of patients because that leaves you with these worries. I do see those getting better in patients as time goes on. There’s this initial period of uncertainty, but then as you see what your pattern is, that either tells us, maybe we are approaching the time for therapy or nothing’s really changing, I feel fine, and this is something I can accept. 

Now, obviously, we never know which camp a patient is going to fall into in these prognostic tests. They help us have a general sense of, maybe this will be a super slow CLL versus one that progresses more rapidly, but nothing is certain. I do personally have enthusiasm for making this change.

There is an ongoing countrywide clinical trial looking at early intervention for patients with high risk. That is open at my own institution and across many, many institutions in the country. I really hope things will change so we can improve patients with early disease. I don’t think it’s going to be every patient because of this third that never needs treatment. I don’t ever see a reason to just treat everyone, but the trial specifically is focusing on high-risk patients. Maybe there will be some movement there. It’ll probably take about 10 years to find the results of the study because you have to follow patients for a really long time. 

For now, my job is to not over-treat and not make people who are feeling good feel worse. If you’re asymptomatic, then the best I can do is leave you alone, but hopefully calm some of whatever natural anxieties come about with what is a life-changing diagnosis.

This disease can be so indolent that maybe up to 1 in 3 patients never need treatment in their lifetime. So if we treated everyone, inherently we’re over-treating people.

Dr. Catherine Coombs

Michele: We have some questions coming in from our audience. Dr. Levy, here’s one of the questions for those of us with liver enlargement. Should we watch and wait?

Dr. Yair Levy:  I completely understand the anxiety that comes along with this. I’ve been treating indolent lymphomas for a couple of decades now, and I’ve got the same experience. You talk with patients, you tell them they have cancer, and then they’re saying, “You tell me I have cancer, but you’re not going to treat me now. Are you sure you went to medical school?” I had that come up several times. 

Active Surveillance in CLL

By the way, we don’t do watchful waiting anymore. We call it active surveillance. Nobody likes watchful waiting, but if we’re saying we’re actively surveilling you, that sounds certainly a lot better. 

The way that I explain it is, that there are really only two good reasons to treat you for anything. This isn’t just an oncologist, it’s in all of medicine. My wife is a real doctor, she’s an internist. She has the same parameters for treatment. So, number one, if you can make somebody feel better, that’s absolutely a great reason to treat them. Number two, if you can make them live longer. 

What we’ve seen, as Dr. Coombs was saying in chronic lymphocytic leukemia, as well as a variety of other indolent non-Hodgkin’s lymphomas is that early treatment does not confer a benefit in survival. In other words, if we treat you when you’re asymptomatic, you’re not going to live any longer than if we wait to treat you when you are symptomatic. This is important because as we were talking before, our treatments are changing and changing for the better.

The treatments are becoming more effective and better tolerated. And remember, something is only incurable until we’re able to cure it. So there are a lot of good reasons to wait. Dr. Coombs mentioned this as well. If I can’t make you live longer by treating you earlier with our current therapeutics, the question is, can I make you feel better? If you’re asymptomatic, I can’t make you feel better. I can make you feel worse. I can spend a lot of your money, but I’m not helping you. You are the most important part of that equation. 

If somebody has liver enlargement, the question is, are they symptomatic? Are they having pain? Are they having any other symptoms from their liver involvement? If they’re asymptomatic, I would not necessarily treat them just for liver enlargement. The same thing is true with spleen enlargement as well, which is a far more common finding in chronic lymphocytic leukemia.

If we treat you when you’re asymptomatic, you’re not going to live any longer than if we wait to treat you when you are symptomatic.

Dr. Yair Levy

Michele:  I experienced that when I relapsed, but along with other things as well, which led to my going back into treatment. Dr. Levy, thank you. You brought up a lot of great reasons why people are not rushed into treatment which also hints at all the things that you do look at when it is time for treatment, which we’ll continue to talk about as we go through with our program today. Thank you very much.

Considering the duration of treatment for CLL patients

Jeff:  We spoke earlier about a bunch of the newer options that are available. We know that the treatment landscape is changing by the minute. I’m going to tee this up in terms that forum participants and our support group participants, they all had the same questions. 

Yeah, the drugs are great. Am I going to have to take them for the rest of my life, or is there a chance that I can do it for a fixed duration? Dr. Levy, let’s break down what those current treatments are, what baskets they fall into and is this a lifetime activity or could we end it in 6 months? Could we end it in one year? You’ve got a lot of stuff that ends in -ibs, and -tas, and -mabs, and all that. Explain to us what’s going on.

Dr. Yair Levy:  Again, this treatment progression model is a relatively new phenomenon for us in the treatment of malignancies. We used to treat with a fixed duration of therapy when all we had was chemoimmunotherapy. You can understand why. Once we give chemo, we can’t take it back. Certainly, the effects of cytotoxic chemotherapy are not something that you want in a cumulative manner.

Because of the logistics of how cytotoxic chemotherapy works, we could not give that till progression because that would be a very difficult life. Everybody thinks that the worst thing in the world is dying, and no, the worst thing in the world is not dying. The worst thing is a long, crappy life. That’s what we would assure we would do to people if we continued them on chemoimmunotherapy. 

Currently approved CLL therapies

If you take a look at our approved therapies right now, basically it’s two categories. Bruton’s tyrosine kinase inhibition, BCL2 inhibitors, and monoclonal antibodies, can be sprinkled on any of these regimens. In terms of approved fixed durations of therapy, it’s only with the BCL2 inhibitors. The reason for that is that’s the most ideal drug that we have seen in the treatment of chronic lymphocytic leukemia. What I mean by that is it is a killing machine. It kills so well that we had to attenuate the dose because if you kill things too quickly, that can also become a problem.

We’re able to get those very, very deep responses. These deep responses, even if they’re what’s called MRD, which stands for minimal residual disease, really should be measurable residual disease. Even if people achieve a level of disease below where we can measure it, we know that in many cases it still returns. We really need to get that logarithmic killing. We really need to reduce their tumor burden by many zeroes in order to give them that long treatment-free interval. Currently, that’s possibly more likely with a BCL2 inhibitor venetoclax. 

Fixed duration therapy in CLL

As we were alluding to before, we are seeing combinations of Bruton’s tyrosine kinase inhibitors like ibrutinib, acalabrutinib, or zanubrutinib in combination with venetoclax. Again, this was based on these laboratory models in which they actually saw whether or not these cells were primed for death with this combination. They actually saw synergy, meaning that the drugs worked better together than the sum of their parts.

As we mentioned, this is a fixed duration of therapy that’s actually approved in Europe right now, but not here in the United States. In the United States, we certainly can give a fixed duration of therapy with venetoclax and a CD20 monoclonal antibody. I can tell you that anecdotally, I’ve also done that with Bruton’s tyrosine kinase inhibitor and a monoclonal antibody if I can achieve that very deep response.

In terms of approved fixed durations of therapy, it’s only with the BCL2 inhibitors. The reason for that is that’s the most cidal drug that we have seen in the treatment of chronic lymphocytic leukemia.

Dr. Yair Levy
CLL Shared treatment decision-making

Factors in choosing a first-line treatment for CLL

Jeff: Excellent. Lonnie’s got a great question. Since we’re now considering treatments, he wants to know what are the primary factors to consider in choosing a first-line treatment. Dr. Coombs How do doctors and patients make that call? How do you choose which drugs are up on deck first?

Dr. Catherine Coombs discusses factors she considers in recommending a first line treatment to CLL patients

Dr. Catherine Coombs: I think there are disease-related factors and patient-specific factors. We tackle those one at a time. I think there is an important role in knowing what an individual’s CLL risk findings are because those can help inform how likely a treatment is to lead to prolonged remission. Specific to a venetoclax-based approach in the front line, what we do know is that there are shorter remissions in patients with the 17p deletion or TP53 mutation and also shorter remissions for individuals with unmutated IGHV. 

I tend to be an optimist and so my view is that these therapies, venetoclax-based, work way better than chemotherapy ever did for patients with these high-risk features. We can still see lengthy remissions on the order of a little over 4 years for the 17p patients for progression-free survival or around 5 some years for the unmutated IGHV. That is shorter than if you don’t have those markers. 

I do think it helps weigh expectations on what to expect from a time-limited regimen. If you have high-risk markers, if you have all favorable markers, venetoclax also works really well and it just works longer than if you had negative markers. 

Now, Bruton’s tyrosine kinase inhibitors as a class that have really leveled the playing field. If we divvy up patients with the unmutated and the mutated IGHV and the chemo days, the unmutated would relapse years faster than the mutated. There’s not much of a difference, and so those drugs work really for everyone. Now, they’re just so different conceptually and side effect-wise, which is why it is so important to weigh the patient’s comorbidities. 

In addition to these disease-related factors that could help gauge the relative success of any given therapeutic approach, there are patient-specific factors. That’s why it’s so important for me to know, not only the details of the CLL but also the details of your specific comorbidities. Do you have a high degree of cardiac comorbidities where maybe we might be a little bit nervous about the BTK inhibitors, which can have cardiac side effects?

I will say the newer drugs are much better than ibrutinib, but it is something I weigh whether you have significant kidney disease, which might be a little bit risky. When we think of a drug like venetoclax that causes tumor lysis syndrome – none of these are complete no-goes, but they help tip the scale of which one are we favoring a bit more. 

Then, of course, I want to know what other medications you’re taking, because a lot of medications can interact. That’s something we have to make sure of. Often that’s not a big deal, we just switch one out, but we have to know. 

Lastly is social factors. What are your preferences? Are you the type of person who wants to do everything and doesn’t mind a frequent schedule, but wants that payoff of then being done with treatment in a year, where we might lean more towards venetoclax-obinutuzumab? Or are you someone who wants to spend as little time at a doctor’s office as possible and is okay with indefinite treatment where we may lean more towards BTKi? Those are the 3 major categories I think of – disease factors, patient comorbidity, specific factors, and then social and preference.

My view is that these therapies, venetoclax-based, work way better than chemotherapy ever did for patients with these high-risk features.

Dr. Catherine Coombs

The benefits of monoclonal antibodies for some CLL patients

Michele: Dr. Coombs, thank you for talking about the biomarkers that might indicate someone is a high risk, such as 17p or TP53. I am high-risk, but I don’t have either of those. I have the other that you had discussed being unmutated IGHV, and that actually impacted my treatment decision when I relapsed. I just finished. I am on acalabrutinib and was on a blinatumomab until a couple of weeks ago. It was obinutuzumab for 6 months along with the acalabrutinib.

Now, I will be staying on acalabrutinib indefinitely because I am considered high-risk. I had originally stated before that I started on ibrutinib. BTK inhibitors work for me and I just had adverse events initially and that’s why I went off. I had a couple of years of a drug holiday and then my doctor decided that while BTK inhibitors were still working, let’s go for it. I would still have another option with venetoclax. 

Dr. Levy, why does a monoclonal antibody help? What does it add to the one-two punch? I know you talked about the different things that they’re addressing and being a killing machine, but why is it only for some patients? For example, what I’m on, acalabrutinib and obinutuzumab trials have shown that it specifically works the best. One trial was presented at ASH this past year for people like me who were unmutated. So, why only for some patients is it a benefit?

Dr. Yair Levy: Well, that’s a great question. The CD20 monoclonals were our first immunotherapy in the treatment of many B-cell malignancies. When we combined them with some of the targeted therapies, we didn’t necessarily see what we were expecting. In all of the trials with chemoimmunotherapy, adding a CD20 monoclonal improved progression-free survival. But interestingly, when we took a look at some of the studies that had arms that contained both ibrutinib, our first, covalent Bruton’s tyrosine kinase inhibitor in combination with a CD20 monoclonal or without those progression-free survival curves were superimposable. I think we were really surprised by that. 

By the way, I need a button that says “I agree with Dr. Coombs.” Dr. Coombs was actually mentioning the fact that there are differences among these covalent Bruton’s tyrosine kinase inhibitors, and our first one had a less focused kinase profile. In other words, it hit other kinases, not just Bruton’s tyrosine kinase that we were trying to inhibit. One of the other kinases that it inhibited was something called ITK or IL-2-inducible tyrosine kinase. This led to antagonism of the CD20 monoclonal, which is why we got no benefit from the addition of the CD20 monoclonal. 

This is not true for the other covalent BTKi, zanubrutinib and acalabrutinib. However, you’re seeing the combination with acala because that is FDA-approved and zanubrutinib does not have an FDA label in combination with a CD20 monoclonal. Do I have any reason to think that it wouldn’t work as well? I do not. There’s certainly data that supports that as well, that there are differences in terms of PFS for folks receiving the combination of zanubrutinib with a CD20 as well as without. 

Now you can say, so why doesn’t everybody get a CD20 monoclonal? The answer is that there are trade-offs. Everything in life is a risk-benefit ratio. We know that, for example, there is this virus here in Texas, I don’t know if you guys have it too, called COVID. We know that for COVID, the CD20 monoclonal certainly antagonized an immune response to vaccination, as do the BCL2s and Bruton’s tyrosine kinase inhibitors.

Certainly, you are at more risk for adverse events and complications when you add additional drugs, so everything is a trade-off. We’re getting additional efficacy but at a cost. Our job is not to tell patients what to do. Our job is to have a discussion and come up with a solution that works best for them after we have a discussion and they are fully informed.

Now you can say, so why doesn’t everybody get a CD20 monoclonal? The answer is that there are trade-offs. Everything in life is a risk-benefit ratio.

Dr. Yair Levy

What CLL doctors consider before ramping up treatment and dosing

Michele: Thank you. Dr. Coombs, let’s talk about ramping up treatment. When you start treatments such as with venetoclax or even obinutuzumab, you start with smaller amounts and then ramp up to full dosing. Why is that?

Dr. Catherine Coombs:  It’s different based on the drug. Let’s tackle obinutuzumab first. Obinutuzumab is the monoclonal antibody that can be paired with either venetoclax or acalabrutinib. It can also be used by itself less often. It’s a hugely effective drug, and it doesn’t really have that many side effects except for one that’s almost universal, which is these infusion-related reactions. Of course, it has other side effects such as impaired vaccine efficacy infections. It can cause low blood counts, but the one that’s universal is infusion-related reactions. 

Instead of just giving patients their full dose of 400 mg daily, we…slowly introduce it so we’re more slowly killing off the cells in a way that’s friendly to the kidney and friendly to the rest of the body to minimize any potential risks from all this dead cancer cell debris.

Dr. Catherine Coombs

What they’ve learned over the course of developing this drug in clinical trials is that, instead of blasting patients with the full dose on the first day, the reaction seemed to be more manageable if you split the dose. The traditional way of administering obinutuzumab, the full dose is 1000 mg.

Obinutuzumab

Instead of doing that all at once, which would make for a very colorful reaction in the infusion suite that no one nurse nor patient wants to be involved with is giving 100 mg on day one and then the other 900 mg on day two. Then of course you follow along with the rest of the schedule. The reactions, fortunately, are almost always on the first 1 or 2 days and then not long-lasting except for rare exceptions. That’s the reason for ramping up obinutuzumab, to make the reactions more manageable. 

Venetoclax is a different story. As Dr. Levy mentioned, this drug is remarkably effective at annihilating CLL cells. But it’s not a good idea to kill any cancer just too quickly, because when you kill a cancer cell, all this dead cancer cell debris gets released into our bloodstream and our kidneys can’t handle that, even the best kidney in the world.

Instead of killing cancer rapidly by administering the full dose, it’s been learned through very well thought out and designed clinical trials that patients tolerate it better with less chance for dangerous tumor lysis syndrome, which is the term for complications from cancer dying too quickly, is to ramp it up. Instead of just giving patients their full dose of 400 mg daily, we give them a little whiff of venetoclax in week one, 20 mg, a little whiff the next week, 50 mg, and slowly introduce it so we’re more slowly killing off the cells in a way that’s friendly to the kidney and friendly to the rest of the body to minimize any potential risks from all this dead cancer cell debris.

Considering the side effects of CLL treatments

Jeff: Dr. Levy, I love the fact that you used the term risk management because that’s pretty much how I approached my entire journey, with risk management. We know that for most people there are going to be some side effects. There’s going to be some challenges when they start treatment. Can you give us a minute on, are they all going to happen upfront? And how do you manage them?

Dr. Yair Levy discusses the side effects of CLL treatment

Dr. Yair Levy:  That’s a great question. As Dr. Coombs mentioned, for the CD20 monoclonals, most of the reactions occur early and typically improve as you receive more of the drug. This is also true for the oral medications that we have. Most of the side effects, if you look at what’s called adjusted incidence, meaning how likely is it to happen per amount of time, it’s more likely to happen in the beginning. However, as we talked about, some of these therapies are indefinite progression or intolerance. 

If you take a look at the cumulative incidence of events that continue to go up, there are certainly some events that are much more difficult to come back from. One that we worry about in particular is what’s called ventricular tachyarrhythmias, so getting a funny heart rhythm can actually lead to sudden death. It’s tough to come back from sudden death, isn’t it? One person’s done it right. They wrote a book about Him. One Person came back from the dead. A very popular book, but nobody else has done it since so we want to make sure that we give patients the safest possible therapeutics that we can.

Reasons to switch a CLL patient’s inhibitor

Jeff: Sometimes patients are told that they need to switch out their BTK inhibitor. There are a lot of reasons why this could be done. Dr. Coombs, can you tell us what’s going on with this?

Dr. Catherine Coombs:  That is a common question, and that’s something that’s evolved over the years from having one option, just ibrutinib, to now having multiple options. In my own practice, I actually have switched patients for a number of reasons. I would say the reason that I consider switching a patient off of a BTK inhibitor to a different BTK inhibitor is if they’re having some side effect that’s negatively impacting their quality of life. I have switched patients from ibrutinib to acalabrutinib with very good success. I’ve also switched patients from ibrutinib to zanubrutinib, and I’ve even switched patients from acalabrutinib to zanubrutinib. 

There have been studies looking at switching for side effects. About 70% of the time, the patients have improved tolerability on one of the newer drugs. There have been studies looking at switching to both acalabrutinib from ibrutinib and then switching to zanubrutinib from both ibrutinib and acalabrutinib and it seems to be a pretty uniform result where more often than not, the newer drugs are better tolerated than our oldest drug, specifically ibrutinib. I think that’s a very valid reason to switch. 

The education point is, I would not switch in the setting of progression. That just is not a strategy that works more than a month or two and it isn’t really worth it. If you’re progressing on a BTK inhibitor of these FDA-approved ones, again, not speaking to switching from any of the approved ones, ibrutinib, acalabrutinib, or zanubrutinib, that is not recommended. 

Now, I’ve heard of some occasional doctors just switching everyone off of ibrutinib. I’d say I talk to a lot of the community. I think most of us don’t do that because the side effects that occur most of the time are early on. I don’t use ibrutinib for my new starts, but I definitely have patients in my clinic who have been on it for years and they’re doing well. The old expression is if it ain’t broke, don’t fix it. Some people think, well, let’s just switch everyone. I don’t think that’s wrong, but it’s just not something that I’ve done for the reason I mentioned.

Jeff: Thank you for that. Makes complete sense.

I would not switch in the setting of progression. That just is not a strategy that works more than a month or two and it isn’t really worth it.

Dr. Catherine Coombs

New CLL treatments awaiting FDA approval

Michele is the co-admin of the CLL Support Facebook group

Michele: Doctors, there are so many types of treatment and clinical trials. Dr. Coombs, which ones are you most excited about that are getting closer to FDA approval?

Dr. Catherine Coombs: There are two that I’m going to mention. I’m excited about a lot of things, but the ones that I think are the closest to being approved potentially, I have no window into when the FDA actually approves things. One is a drug called pirtobrutinib. This is a drug that inhibits the same target as ibrutinib, acalabrutinib, zanubrutinib, and BTK, but instead of inhibiting it irreversibly, it is a reversible inhibitor. 

Pirtobruitinib CLL Treatment

The reason that that’s important is that when patients develop resistance to ibrutinib, acalabrutinib, and zanubrutinib, the resistance is shared by all of these drugs. So you can’t switch from acalabrutinib to zanubrutinib or ibrutinib to zanubrutinib, etc., if your patient is resistant because they develop most commonly mutations where the drugs bind. Pirtobrutinib binds at a different mechanism. It’s in a different part of the BTK molecule protein and it has shown very excellent efficacy in a very large study. I do think that that may attain FDA approval for CLL in the coming days.

It’s already FDA-approved for mantle cell lymphoma as of January, so there are ways to get it off-label, but I would much rather see it get full FDA approval to help with insurance paying for the drug when it’s needed. It fills a huge unmet need for patients who have progressed on covalent BTKis, especially after patients who have progressed following venetoclax where we don’t really have good options. 

Dr. Catherine Coombs, UCI Health

The other big category that Dr. Levy has alluded to is the combination of a BTKi plus venetoclax. Europe approved the combination of ibrutinib with venetoclax, which did not get approved in the United States. I can’t really speak about the reasons because I’m not involved with those discussions. I do wonder if some of it may be the toxicity of that regimen, which can be somewhat hard to tolerate, especially for older adults.

But what we know is that we have better BTK inhibitors with respect to tolerability. So there are a couple of trials that are looking at the combination of acalabrutinib and venetoclax that I do think hopefully will be positive trials that lead to FDA approval. That’s the other major category that I’m looking forward to. Those would be frontline treatment. You would use that combination as your first treatment. Whereas pirtobrutinib, if it gets approved, would be a relapsed treatment, at least for now. Things obviously change as time goes on.

It fills a huge unmet need for patients who have progressed on covalent BTKis, especially after patients who have progressed following venetoclax where we don’t really have good options.

Dr. Catherine Coombs

Michele: So your top two are pirtobrutinib and the combination of–.

Dr. Catherine Coombs: A BTKi plus venetoclax.

Michele-Nadeem Baker: Dr. Levy?

Dr. Yair Levy:  I agree once again. There are other small molecule inhibitors, again, targeting that B-cell receptor pathway, which has really revolutionized the way that we treat a lot of these B-cell NHLs. In addition, the bispecifics, are certainly working their way into our armamentarium for non-Hodgkin’s lymphomas as well as CAR Ts.

Interestingly, one of the first articles that came out about CAR T was in chronic lymphocytic leukemia, despite the fact that our current constructs, these current autologous derived products are certainly not showing the same level of efficacy in chronic lymphocytic leukemia as they are in diffuse large B-cell lymphoma, for example. Nevertheless, I think that we are going to see some tremendous improvements in terms of the CAR Ts in chronic lymphocytic leukemia as well as the Bispecifics.

CLL doctors’ top takeaways

Jeff: So, Dr. Levy, I’m going to put you on the spot. What is the number one takeaway that patients should be grabbing from this discussion that we’re having today? What’s the top of the list?

Dr. Yair Levy: We’re doing so much better. As I mentioned at the beginning of the conversation, I have not had a patient die of CLL in the past decade. When we take a look at the high unmet need and again, Dr. Coombs was alluding to that. Folks who have progressed on a Bruton’s tyrosine kinase inhibitor and a BCL2 inhibitor are certainly the unmet need. We have a tough time finding those folks.

We’ve had some studies that have been languishing for accrual because it required folks to become double refractory. Again, we have a tough time finding those patients, which is wonderful. I don’t want to find those patients. I’ve put 2 people on in the past 5 years, and one of them was actually not even really refractory. He just wasn’t taking his medication. With CAR T, once I give it to him, he can’t take it, so this was more of me being paternalistic.

We’re doing so much better. As I mentioned at the beginning of the conversation, I have not had a patient die of CCL in the past decade.

Dr. Yair Levy

Jeff: Dr. Coombs, what is the single most important thing that you want patients and their caregivers to take away from this discussion?

Dr. Catherine Coombs: Jeff, we are friends now. It’s going to be hard to narrow down one thing, but I think if I have to say one thing, it’s there is hope. Leukemia is a horrifically scary word to hear for the first time, or maybe even after years of knowing that this is what you have. But all the treatments work extremely well and they work for an extremely long time. There is hope. Hope to live a normal life, and hope to see your kids and your grandkids grow up. There’s always hope on the horizon, in my opinion.

Encouragement for CLL patients to advocate for themselves 

Jeff: What can patients and their caregivers do or ask if their local hematologist-oncologist isn’t quite looking at this new wonderful stuff that’s on the plate right now? What if they’re just going with the old stuff?

Dr. Catherine Coombs encourages CLL patients to advocate for themselves

Dr. Catherine Coombs: That’s such an important question. And, you know, I think it’s tricky. I think it depends on what your personality type is. My personality is that I want to make everyone happy. I never want to offend anyone. I certainly understand the hesitation to question your doctor. But I think in the end, you just have to realize this is your life. If your doctor is not sounding up to date or if you’re just not getting your questions answered, then you deserve more than that. 

I just think it’s so important to advocate for yourself or advocate for your loved ones if things aren’t adding up. I think our community docs are amazing. The ones that I interact with, I have no idea how they keep up with everything they keep up with. To put things into context, there are around 20,000 cases of CLL diagnosed a year.

When you think about the common cancers that have a majority of patients, they’re seeing lung cancer, breast cancer – those are like 200,000 plus cases. CLL ends up just being a much smaller slice of what they’re seeing every day, and it’s just very hard to keep up. I would say most community docs I work with very much welcome the second opinion because I can teach them something and then we now have a relationship where they’ll ask me questions and we can work together. 

So, number one, don’t be worried about offending your doctor. Number two, most doctors aren’t going to be offended. Number three, if they are, well, I don’t know what to say about that, but I don’t get offended. Back when I was at UNC, I had patients go to Duke and the Duke patients would come to me. Sometimes it’s just good to hear things twice. I think if your doctor is offended, that’s a red flag on their own ego. I think all that we should want as your doctors is for you to get the information you need. That is your job to advocate for yourself, and almost all doctors are going to be totally happy with it. We can learn something from each other as we share in your care journey going forward.

There is hope. Hope to live a normal life, and hope to see your kids and your grandkids grow up. There’s always hope on the horizon.

Dr. Catherine Coombs

Jeff: Thank you for that and I love the way you put it. Patients should not be concerned about asking questions. They shouldn’t be concerned about saying, why not? If they’re having trouble getting along with their doctor, like you said, that’s a red flag.

Navigating what symptoms you should share with your doctor 

Michele: We have some more patient questions, so here’s one of them. Sara N. asks, “How do I know when I should contact my doctor between visits? Do they need to know about every infection or just about CLL symptoms?”

Dr. Catherine Coombs: Sara, that’s a great question. I think in the digital age, we certainly can let doctors know about every single detail, but I think it’s good to set up expectations. I try to do this on my first visit or maybe my second visit if we don’t have time to cover it. 

But what things do I always want to know about, and then what goes into the other category? I always educate my patients on red-flag symptoms. Things that for my patients on watch and wait, watch and worry, active surveillance, things that make me think, we need to get you in right away. Unintentional weight loss, drenching night sweats, fevers. I go through the list of the things I always want to know about – a rapidly enlarging lymph node, etcetera. 

Then there may be other symptoms, and the ones I want to know about are the ones that are worrying you. I don’t want you to go to bed freaking out about something that may be nothing. Just send me a message and I’ll tell you, that’s nothing or I need more information. Maybe let’s have you come in. I’d say, it’s never wrong if it’s something worrying you. But of course, we all have to acknowledge it could get to be a lot of messages if it’s every single thing. I think you just learn that over time as you establish with a doctor, but I think it’s good to go through what things should I let you know about right away, and what things can wait. Then obviously there’s some gray zone where it doesn’t hurt to just pass the info along and then you can get back a message and not worry about that.

Michele:  In looking at a patient holistically, so to speak, regarding these little things that we may not think are important, such as all these various infections – I keep getting sinus infections. I’m trying to think of some other types of infections. Maybe you could list those for patients, some of the ones that they might be seeing that you want to know about.

Dr. Catherine Coombs:  We do see an increase in infections in our patients with CLL. I do like to get a general sense of how often patients are getting infections. If they have a primary care doctor who’s very responsive, I’m okay with them treating these infections. I’m also okay taking the lead, whatever works best. 

But when they become really frequent, especially if it ends up with the patient landing in the hospital, I absolutely do want to know about that. There are some strategies we have to lessen the incidence of these infections.

Patients with CLL, a proportion of them, don’t make enough immunoglobulins. If you’re landing in a situation where you’re having a lot of severe infections, meaning pneumonia that you’re in the hospital for, or terrible sinus infections, etc., that may be a reason to consider this intervention called immunoglobulin infusions. 

I definitely like to know about things that I can fix. I’m okay knowing about things I can’t fix too. The ones where it’s like, this would change what we do, those are especially important. The patients may not know that before messaging me, and that’s okay. It’s okay to just message because you don’t know and then I’ll tell you there’s nothing to do or let’s bring you in and talk about X, Y, Z.

I always educate my patients on red-flag symptoms…Unintentional weight loss, drenching night sweats, fevers.

Dr. Catherine Coombs
Panelists discuss navigating what CLL patients should tell their doctor between visits

Jeff: Fantastic. I’m going to make this a little bit personal as far as what I hope people are taking away from this discussion. When I was first diagnosed with CLL, my doctor told me straight up that I was going to die in about 6 years, and that doctor got fired. My next doctor told me, “Don’t worry, we’ve got this. You might die with this, but you’re not going to die from this.” 

Listening to both of you fantastic doctors talk about the landscape of CLL and even use the 4 letter word “cure,” I am convinced that I am going to be able to continue doing everything that I want to do, and I want to do an awful lot of things at some point. If my daughters’ are cooperative, maybe I’ll become a grandfather, but I’m going to continue knocking out half-marathons. I’m going to continue knocking out full marathons. I’m going to drink good wine and good whiskey. I’m going to eat well. I’m going to laugh a lot. I’m going to smile a lot and I’m going to share my story so that patients and their caregivers know that that can be their life, too. Michele, how about you?

Michele: I agree some of my key takeaways are that there are so many things in research and we have the potential of being approved in the somewhat near future, which is yet another option for us. As you had explained, it does work in a different way than the traditional types of BTK inhibitors we now have. I think this is fabulous to have yet another option for patients. 

Also, I love what you said about what you really need to look for in your own doctor and not be worried about offending your doctor. This is so vital for patients. I ask a million questions and I encourage patients to do so so that they can become more empowered for their own care and self-advocate for themselves. 

It’s been so great hearing you and Dr. Levy both talk about patients asking questions and encouraging them so that patients are not afraid of this. This is again, one of the things I had started doing to try to get rid of the mystique around care and treatment with people’s doctors. I continue to do that. 

In addition with Jeff – and we’ll be toasting soon, hopefully in person about this with something more than water, which we’ve been drinking during the program – and that is to live life to its fullest and to live a normal expected life span thanks to doctors like you, Dr. Coombs and Dr. Levy. I thank you so much for joining us, both of you and I thank all of our audience members watching us. 

Dr. Catherine Coombs: And thank you both for all the work you do in patient advocacy. Like 10, 15 years ago when the Internet wasn’t available, I think there’s so much more fear. To be able to bring light in a way that patients can understand is so hugely important. So thanks for what you do as well and for having me.


Abbvie has helped sponsor this discussion by the Patient Story
BeiGene has helped sponsor this discussion by the Patient Story

Special thanks again to AbbVie and BeiGene for their support of our patient education program all about building shared treatment decision-making! The Patient Story retains full editorial control.


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Categories
MPN myelofibrosis Patient Stories

Natalia’s Myelofibrosis Story   

Natalia’s Myelofibrosis Story

Natalia shares her myelofibrosis story, a rare form of blood cancer that leads to scarring in bone marrow, anemia, and fatigue. 

In her story, she discusses her misdiagnosis and the long road she faced before being correctly diagnosed with myelofibrosis.

With a passion for painting, yoga, and Reiki healing, Natalia talks about how she coped with extreme fatigue and other symptoms. She explains why everyone should trust their gut and be a patient advocate, and what she’s doing to live life to the fullest.

Natalia started a Mediterranean diet after being diagnosed with Myelofibrosis

  • Name: Natalia A.
  • Primary Diagnosis:

    • Myelofibrosis
    • Polycythemia Vera (PV) *Misdiagnosis
    • Pericarditis

  • Symptoms:

    • Anemia
    • Fatigue
    • Weakness
    • Shortness of breath

  • Treatment:

    • Phlebotomies
    • Iron pills
    • Blood transfusion



Table Of Contents
  1. First Symptoms and Tests
  2. Cancer Diagnosis
  3. Getting a Biopsy and Treatment
  4. Quality of Life
  5. Incorrect Treatment Advice
  6. Switching Hospitals and Doctors
  7. Changes in Lifestyle and Outlook
  8. Reflections

First Symptoms and Tests

Tell us about yourself

I am a mom of two adults, Gabriel and Ingrid. I’m an artist, so I paint. I’ve been painting since I was in high school – oils, watercolors, acrylics. I am also an executive. I work for an aviation company. I’m the head of administrative operations there, so it’s a big job. The painting kind of releases stress. 

Aside from that, I love getting together with my family because I love to cook. My grandfather was a chef and my mom was a really good cook. She had several restaurants, so I think I’m genetically predisposed to that within my family. I love music. I’m a historian – that was my major in university. 

The business side is the survival side, but I think my creativity has helped me in my executive career a lot. I’m the type of person that, whenever there’s a problem, people come to me to brainstorm. That’s helped me a lot.

What were your initial symptoms and diagnosis?

At the end of 2021, in the fall, my mother had passed away in August and I was going through a divorce. I started feeling shortness of breath. I always thought, “Maybe I’m just really stressed out.” But at one point, it got so bad that I couldn’t sleep lying down. I would have to sleep sitting up. 

I knew it wasn’t an asthma attack because it was different – the pressure felt different in my lungs. 

That’s when I decided to call my cardiologist, Dr. Mechanic. I called her and I said, “I’m having this problem. Can I come in?” 

She did some tests, and then she told me that I was diagnosed with something called pericarditis. That was the first indication that there was something wrong.

Did you ask any questions after receiving your diagnosis?

She gave me a treatment plan for 2 weeks. I was supposed to take 25 100-mg of aspirin – some crazy stuff like that. Before I left her office, I looked at her and said, “What could cause this?” Because you don’t just randomly have something like that. That question saved me. 

I’m still here because she immediately looked at me and said, “Well it could be an autoimmune disease.” So I said, “Who would I go to for that?” And she said, “Well, you could try a rheumatologist.” And that’s exactly what I did. 

What if I just walked away and said, “Okay. I have this and now I have to treat it.” I think you need to go further and say, “What could cause that?”

I knew it wasn’t an asthma attack because it was different – the pressure felt different in my lungs.

It’s just very random. I mean, if they tell you it’s something genetic or caused by a medicine you’re taking or something like that. But for her, there was no other indication of that happening to me. So that kind of saved me. 

I immediately thought, “I am going to go.” I made the appointment and I saw the rheumatologist and she ran about 7 different blood tests on me.

The importance of asking your doctor questions

I respect doctors very much. They have so many patients and such little time. And that’s why I believe that you need to ask the questions – to have your list. 

I never go to a doctor, since then, without a list of questions because it’s easy to forget. They’re rushing and you feel like you’re imposing or you [consider] the waiting room is full of people.

That one question, “I need more information” could save your life.

I never go to a doctor, since then, without a list of questions because it’s easy to forget.

Describe your visit to the ER

I had a very funny day because I had to go in to get my results from hematology. I was living in my daughter’s apartment at the time, on the third-floor walk-up. I walked out, got very dizzy, and fell down the stairs. I had to call her to help me untangle myself. 

At tje doctor’s office, and the first question they asked was, “Have you fallen? Have you been falling? Have you fainted recently?” I told the doctor that I fell down the stairs and she told me to go to the ER. I responded with, “No, I have to go to work and I have meetings.”

She was looking at me weirdly and then she told me ”Your hematocrit was something like 59 and your hemoglobin is 17 so you must not be feeling well.” She said, “I’m not a hematologist so I can’t give you any more details or tell you anything, but you need to see a hematologist immediately.”

I think her words didn’t really make any sense to me because I’ve never had to deal with hemoglobin or anything like that. She was looking at me like I was a ghost, like I wasn’t supposed to be standing. Their expression immediately felt like a cold sensation from my heart to my stomach. 

I said, “Okay, I’ll make an appointment immediately.”

The hematologist suspected everything was fine

I went to a wedding in Columbia. I was with both of my kids. It was a hectic schedule. I started feeling like I couldn’t breathe, I couldn’t go up the stairs. I was thinking, “This is probably the altitude, I’m in the mountains.” Came back, and started getting very, very ill and extremely tired.

That one question, “I need more information” could save your life.

I came back [from Columbia] and I went in for my appointment. They drew blood and then the doctor came in and says, “We’ll have the results by tomorrow but I believe what I’m looking at right now is a mistake.” She was looking at the labs from the rheumatologist and she said, “I think they made a mistake. By tomorrow we’ll have our lab results and it’s probably going to be very different. I don’t think there’s anything wrong with you.”

Cancer Diagnosis

Was this the same doctor you’d made an appointment to see?

I showed up on the 23rd to see a specific doctor, and they told me, “You’re going to see a different doctor.” I said, “Well, that was not what I wanted.” And they said, “Well, that’s what we have available.” 

You’re here and you feel very trapped in the sense that I had already waited for a whole month to see the specific doctor. Then you have a situation where they told you it’s urgent. Are you going to walk away? No. You’re just going to go in and see whoever so you can get some answers. But I knew I was not with the person, that I felt, had the knowledge.

How did you find the doctor you wanted?

I go on the hospital page and look at hematology. [The doctor I chose] was basically just taking care of hematology disorders, blood disorders. I had seen [the doctor I was assigned] because she was part of that group, but her expertise was gynecological hematology and I thought it was something to do with breast cancer. So she had several things, but he was a specialist on blood disorders and that’s why I picked him. 

Then you go to Healthgrades, of course. You see the patient comments to make sure that people are being treated well. For me, that was the person that had great reviews and knew about what I was there to find out about.

COVID delaying information on lab results

I wasn’t worried because she said, “It’s probably a mistake.” I completely trusted her views and went home. Then the next day, which was December 24th, she called and said, “You need to come in and you need to see me next week.” I said, “Well, I have a trip on Monday. I have my ticket.” And she’s said, “You can’t travel, you can’t get on a plane.” That’s when she explained to me, “Your hemoglobin is so high that if you get on a plane right now, you could have a stroke.” 

I immediately had to cancel all of my plans. My kids were devastated. My family had an Airbnb. Everything abandoned. I went in to see her on December 28th – that was her first available appointment. I arrived and the minute that I got to the floor before I left the elevator, I was escorted out by the management because she had done a COVID test on me the week prior and it had come back positive.

My daughter and I were kicked out of the premises. I had no idea. I usually keep the little tests at home. I was testing because I knew I was going into a cancer place. I told her I tested this morning and they said, “No, we did the blood test. You’re positive.” I needed to wait 2 weeks with minimal information. 

“Yes, you have something very serious, but you can’t come near the hospital because you have COVID.” It was probably the worst Christmas of my life because my mother had just passed, my kids went on another trip with their dad because the whole Columbia thing was scrapped, and I was sitting there just not knowing what it was and had to wait until January 12th to see the doctor again.

What did you do following your cancer diagnosis?

The doctor said she thought I had Polycythemia Vera and the way that we can immediately attack it is by doing phlebotomies. She wanted to start doing phlebotomies every 2 weeks. 

That was the first day that I ran from her office to the infusion center and had attempted to have my first phlebotomy. That didn’t work out very well. I had to leave and come back the next day.

Natalia who shares her myelofibrosis story, painted as a way to express her creativity.

That was the “it” day because then you go home and you start looking this up and go into a bit of a panic.

When I realized what was happening to me emotionally, I called one of my best friends, Bernice. Her mom is a pediatrician. I spoke to her and I said, “Hey, I just heard this. I’m very scared.” She called her friend, who was a hematologist in Venezuela and called me back and gave me the lifeline of words. 

She told me, “You’re going to be fine. It’s controllable. I have a friend that has this.” I stopped searching and just said, “Okay, I’m going with what she’s saying.”

You have to look for the most positive energy source, and that was mine.

You have to look for the most positive energy source, and that was mine.

Natalia painting

Were there any additional tests you had to do?

Yeah, especially genetic tests. They look for certain genetic mutations. She couldn’t give me anything definitive until I completed that.

From there on, I start having phlebotomies. I think we started every week. Because there was so much going on, I started getting weak, and very dehydrated. 

I’m scheduled for a biopsy on February 7th, so she starts checking. We’re doing scans of the brain looking for any sign of strokes. She checked my entire body. We did scans of everything – MRIs, etcetera – just to make sure I wasn’t having any blood clots because that’s what the condition causes.

Getting a Biopsy and Treatment

How did your body react to phlebotomies?

On February 7th, I do my biopsy. Biopsy results usually take 2 to 3 weeks to come back. By that time and during that time – January 31st, actually – I had already called in because I was so weak from the phlebotomies that my doctor gave me a letter so I could get some short-term leave. 

From the end of January to the end of February, I’m already on medical leave, trying to control this. At one point I started telling her, “Look, I don’t think I can do these things because I go home for 2 or 3 days, I’m useless. Could you give me some fluids?” 

I started figuring out that the pain I was feeling was probably from being dehydrated. She changed the way we were doing it and she would ask them to do the phlebotomy and then give me 2 hours of fluids afterward.

How did you feel after receiving your biopsy results?

Natalia being treated for Myelofibrosis

Then the results come in. Of course, we have a very different conversation, her and I. She tells me, “This is going to be a lifelong situation where you’re going to be taking blood out. I need you to be at a certain level where you’re kind of anemic. We need to lower your hemoglobin to at least 11 or 12.” And I said, “Okay, let’s do it.” 

To me, it was like I was already there. She wasn’t going to go look for anything else because I felt overwhelmed. That’s why you should do the research before because once you’re in there and you get that diagnosis, your mindset is very different. You’re just in crisis, in shock mode.

It was tough because with it came the knowledge that because you’re making so many red blood cells, your bone marrow is overactive. Your bone marrow starts getting tired and it starts getting fibrosis, which is like scar tissue. 

She tells me at one point, we might get to a level where the opposite happens and you stop making the red blood cells and we go into something like leukemia. This is terrifying news. 

At the same time, she said something kind of weird. She said, “Well, of all the cancers you could get, this is the best one.” [I] didn’t agree with that, because I don’t think there’s anything that you could say to someone that would sound good at that moment. 

It was a knowledge that it was progressive, that there was absolutely no cure for this. I Googled, “Has anyone ever gone into remission?” and found one person in 1984. I kept it in one of my phone’s URLs. I kept it there until this year. I would look at it as if one person could get out of this, so can I.

What were some symptoms that arose with your treatments?

We start a process where they’re taking blood out. My veins are not easy to find, so that was another issue. I had one person that could find them [with] a special light. 

You go home from the phlebotomies. I think it’s 500 cc’s that they take out every time you go. I had to drive myself because my entire family is working at this time. By the time I was getting home, my eyelids were getting heavy. I had to go up 3 floors and then and I could feel all my joints. It’s like a toothache in your bones. 

Natalia in treatment for Myelofibrosis

Progressively, I started having pain in my hip, and then I couldn’t sleep at night because I started having night sweats. I had to purchase this little machine that is like a little air conditioner. Four times during the night I would have to put that on. I had the air conditioner going at home and had to put that on so I could come back to normal. 

I started chewing ice. There’s a condition called pica that is caused by severe anemia, and then you get addicted to ice. I’d be chewing ice all day. Then at night, I would have to pee 7 times a night. My nights were horrible. I stopped exercising. 

Quality of Life

What kept you going?

My life became very small. Then I had a conversation with my dad, and I told him, “I feel like I can’t do anything. I don’t have the strength to move around, to do the things that I normally do.” He said, “You have to move.” That voice stayed with me. Where I live, there was nowhere to walk around. He said, “Even if you go to the parking lot and you go 2, 3 times around the parking lot, you have to move.” 

It’s true because it’s all about your circulation and the blood clot situation. You need to move and [my doctor] had told me that. But until I heard it from my dad, I was feeling like a victim.

I’m just taking in hits and I wasn’t coming out and doing anything about it. That gave me my first fighting punch. I was like, “Okay, let me move” and I started moving.

I would wake up every morning and I would do yoga in my room because I didn’t want to move around too much. I would do meditation, I would do yoga, then I would drive to this little park that I knew about. I would go around a few times. I would go to this organic store every day and buy the ingredients for the meal that I was going to have because that forced me to do something outside of the house. 

I did TikTok videos about my recipes and kept looking for things to keep me going. I started reading a lot about spiritual healing meditation and called one of my really good friends, Marianne, and asked her, “Hey, do you know someone that does Reiki healing?” And she’s like, “I’m a Reiki healer. I went to the best school.” I had no idea!

She goes, “Start coming.” I would go and see her once a week and that just changed the entire process for me.

Natalia started practicing Reiki healing.

No signs of improvement with treatment

I started feeling that we were just taking blood out over and over. I thought at one point I was going to feel better and kept asking her, “I have to go back to work. Am I going to feel better?” And she kept saying, “You need to adjust your lifestyle to the condition.” And I said, “But there has to be something.” 

She suggested hydroxyurea and she said that my insurance had approved it if I wanted to go on it. I said, “No, I don’t. I don’t want to take that. I don’t feel that’s going to add to anything. I’ve studied it, I’ve seen the side effects and I don’t think that I’m at the level where I would be able to handle that. I want to feel better before I go to the next step like that.” 

She was struggling with me. I could tell that she kept looking at my results and scratching her head, “What’s going on?” Because one day it was the platelets and then it was the white blood cells. And then she was getting a handle on it. 

I went to do my phlebotomy on May 10 and the nurse told me, “You are a hemoglobin level of 8.” Anyone who was a nurse or a doctor knows you can’t take more blood from that person. I know that now, I didn’t know that then. She asked me, “Do you think we should take the blood out?” I looked at her and said, “I’m not a doctor. You need to talk to my doctor.” At that point, I didn’t know if she was dealing with platelets or red blood cells. She said, “Okay, we’ll talk to your doctor.” 

I came back on May 19th for another phlebotomy. The answer, when asked “Did you talk to the doctor?” was “It’s still in the treatment plan.” They took blood out that day and then they took out blood again on June 7th. That’s 2 times after my hemoglobin level 8. 

I came back on the 9th because the gentleman that was doing my phlebotomy that day refused to do the IV on me. He said, “I don’t have the right package, I’m not going to do it.” He took my blood out in 11 minutes. It would normally take 30 minutes. He just destroyed me after that, I was so sick. 

My daughter started calling the doctor at night. She told me she was going to call 911. I’m like, no, because I was afraid of going to a hospital. This is a very rare disease and I knew no one would know what to do with me. So on the 9th, I came back. They gave me the fluids. 

Describe working while still battling cancer

By that time, I’m still going to work. I would get to the office. I would call my security guard. Jason would come down and I told him the first day, I said, “I’m so sorry because I know this is not your job scope or anything, but I need a human favor. I can’t carry my laptop anymore.” So he would wait for me. 

I would give him the laptop bag and all the stuff that we carry for work. I would go park, then I would walk and he would wait for me. He was a gentle giant. He would wait for me and walk me to my office. Then it would take me about 15 minutes to recover from walking up. 

I would have this huge thing of ice that I had to eat. The ice had some sort of chemical reaction in the brain that gives you a little bit of oxygen, so it would make me feel better. 

I couldn’t have rice and potatoes for lunch. I would have a carrot and a cucumber because if I had a normal lunch, I would fall asleep on my desk. That’s when I realized, this can’t be it. Like, how is this happening?

Incorrect Treatment Advice

The doctor had made an error

I went to my sister’s house on the weekend of Father’s Day. Saturday, I couldn’t talk. I sat there and I couldn’t talk. I couldn’t move around. 

The next morning, which was Father’s Day, I drove myself to the ER and they told me, “Your hemoglobin is at 6. We need to do a blood transfusion immediately.” And I said no, because my doctor had already told me, you can’t get a blood transfusion because the red blood cells are going to just explode. So I refused it. 

Then I waited maybe 2 more days to see her because she was coming back from vacation. 

When she finally saw my labs, she said to me, “I am so sorry. I miscalculated your numbers and you will need a blood transfusion now.” I was furious.

Painting became a form of therapy for Natalia in dealing with her cancer diagnosis.

I would fall asleep on my desk. That’s when I realized, this can’t be it. Like, how is this happening?

She said, “Once you get the blood transfusion, you’re going to start making blood like crazy and we’re going to be back to the level that you were in January.” Imagine going through this every 2 weeks – phlebotomies and all the pain. How am I going to go back to that? That didn’t make sense to me. 

She said, “We need to go right now. We need to put you in the ER.” I said, “No, I need some time. This is a serious situation. A blood transfusion is something very serious. I need to talk to my family. I need to go home and I need to think about this.”

What was your doctor’s reaction to your refusing a transfusion?

She was not very happy with me saying no because I think she realized the responsibility of me just going home the way that I was. But I went home and I called Bernice’s mom again. She called her friend, the hematologist and we waited until the next day because he’s in Venezuela. And he said, “She’s wrong. You’re not going to start making red blood cells like crazy. Your hemoglobin with the blood transfusion is only going to go up 2 points and that’s it. [For] the rest, you would need iron.” That’s another story. 

So that’s when I called her back, on a Thursday. I spoke to her and I said, “I’m going to go through with the blood transfusion.” She said, “I’m going to have my office call you and schedule it immediately.” They never call me back, to this day, not even to find out if I’m still alive. 

Did you still get a blood transfusion?

I waited until Saturday because my friend Lizzie works at the hospital. She told me, “You need to go into the hospital on a Saturday around 7 to 9 a.m. There won’t be anyone if you’re going through the emergency room.” 

I started researching who had the best hematology group for my condition. I found South Miami Hospital. I found Dr. Kim, who was in charge of blood disorders. I went to her hospital but went through the emergency and then I was assigned to her. 

From there, I got my blood transfusion. I think it was June 24th. My hemoglobin went from 6 to 8 within a few days. Then I was with the new hospital, a new doctor, and went from there.

How did your first doctor explain their miscalculation?

I said, “Well, how do you mean? Your team has been telling me that [my hemoglobin was level] 8 and I shouldn’t be taking blood out. Did they reach out to you?” And she said, “Yeah, but I thought that because you have Polycythemia Vera, you would make so much more blood, so I wasn’t concerned with that. I figured we were following the right pace, so you were making blood at the same speed that was taking out. I don’t think it should have been a problem.” That was the explanation I got.

Switching Hospitals and Doctors

Beginning treatments for anemia

I was with Dr. Kim from June until last month. In February, she started giving me iron pills because now we’re trying to get me out of very aggressive anemia where I have zero iron deposits. 

She starts giving me the pills, she tells me there’s no more phlebotomies for a long time, you can now fly because you have blood! [She] started treating it in a very positive way, but I was still very weak. Without the phlebotomies, I start feeling a little bit stronger. I go back to work. I realized that I couldn’t do a lot of physical activity, but I tried to walk a little, maybe like 20 minutes a day just to help me out. 

Everything was going fine but we kept doing labs and my hemoglobin numbers were not moving and my iron. I think all of last year, we were able to get it up to 9. That’s it. We’ll be stuck at 9 or even a little lower or go up to 9.5, but never more than 10. It was like 9-point-something always. 

When I left on vacation in December, she told me “When you return, we might have to give you iron infusions because I’m not getting anywhere with the pills.”

Developing a papilledema

I come back from vacation, I start working. January 21st, I’m sitting here with my family having dinner, and I start seeing something very strange in my eye. The next morning, I wake up and I see I have a floater, a dark spot. I got very tired. My limbs felt tired. I stayed in bed all Sunday. Monday I call my ophthalmologist. They gave me an appointment for that morning. 

At the time, one of my cousins sent a video in our chat about what it feels like to have a stroke, and in the video, there’s a picture of a person seeing what I was seeing. I panicked.

Dr. Kim and her team would answer phone, email, everything within 2 minutes. I tell her what’s going on. She said, “Don’t go to the ophthalmologist, go to the ER.” I went to the ER and she was already there, she came in immediately. I had MRIs done on my brain. I had something called papilledema, which is an edema of the brain, which affected the eye.

Getting a second biopsy and diagnosis

What happened (it’s probably because of all the anemia) they checked my numbers and my platelets were very high. They were 740. That’s when she realized, “This isn’t right. Her numbers are not responding and I need to do something.” 

She told me “I’m going to have to do another biopsy,” which I was terrified of. She goes, “It just doesn’t make sense to me. I’ve been giving you iron for months and nothing changes, and now I see your platelets are up. This doesn’t make sense.”

February 7th, I go through another biopsy and she calls me 2 weeks later and says, “You have primary myelofibrosis, not Polycythemia Vera. It makes sense because in myelofibrosis sometimes you’re making a lot of red blood cells, and sometimes you’re making zero. Sometimes the problem is the platelets or the white blood cells.”

I had MRIs done on my brain. I had something called papilledema, which is an edema of the brain, which affected the eye.

Not having access to medical records from the previous doctor

Whatever she was reading, because she had the other doctor’s diagnosis and notes, was not what is happening.

The only thing that she’s able to see from my former hospital is what I have in my chart. She’s never able to get my official medical records, even though I sent 2 letters to the hospital and I called the hospital and spoke to, I don’t know how many people. So they never got my records.

They don’t answer anything. [I] kept sending the letters, because at one point, I called and they said, “Send a letter.” I did that during the fall of last year, but nothing happened. 

[My doctor] said, “I don’t have anything to compare, but the notes that are on there. I need to see the actual pathology exam that was done.” She was under the assumption that whatever [my previous] doctor had put on her notes was what was happening.

How did you react to being diagnosed with myelofibrosis?

That was a very difficult week, a very dark week. I was so happy to know that there was a path. Now things made sense to me. 

I was told immediately that I wasn’t going to stay with Dr. Kim anymore because she’s a benign hematologist. I needed to go to another hospital and go to malignancies. That was difficult because I was already very attached to Maria and Dr. Kim because they were awesome. 

I was traumatized. I thought, “I don’t want another doctor. I’m good here.” You met someone you could trust, now I have to find someone.

But they were so sweet. They said, “We’re going to be with you until everything’s done.” The first thing they did is an iron infusion immediately, so I got an iron infusion. They gave me the options that are available in this situation. 

They have an amazing new medicine. I believe it’s Jakafi. They also said, “Miami has an excellent cancer center in Baptiste’s, a brand-new building and it is just truly amazing what they’re doing there.” They told me “You have the option of getting a bone marrow transplant. They have a team there that does it.” That’s also another point that you feel great. “We’re going to refer you to this new doctor at this location.” 

Changes in Lifestyle and Outlook

Finding hope by reading about patient’s experiences with myelofibrosis

Of course, the next morning, and the next 3 days are terrible because I, again, am looking at everything possible about myelofibrosis. It is terrifying until I found [The Patient Story].

I found Mary’s story. I had spent 3 days where I couldn’t move. I would cry 7 times a day. I live by myself, so it’s not a good environment for someone that’s going through this because I’m not hungry because of the anemia. I wasn’t sleeping well. I was just in a very dark place.

I see her story and the first thing she says about fatigue (I was feeling really tired), if you’re fatigued, you need to move. Don’t go take a nap – move.

»MORE: Mary’s Myelofibrosis Story

I see her story and the first thing she says about fatigue (I was feeling really tired), if you’re fatigued, you need to move. Don’t go take a nap – move.

I immediately started thinking, “Yes, I’ve been at home for months with all the stuff that was going in my brain and taking this medicine that they had put me on, then they gave me this very difficult news.” I’m just going into that little world from last year. I immediately thought, “I need to call someone.” I knew that one person that would have the time to wake me up every morning and get me out of the house.

Getting back into an exercise routine

I called a [family friend] and said, “Hey, can you be here every day next week at 9 a.m. and get me out of the house?” I love biking outdoors. Walking is very difficult because it’s hot here in Miami. The heat is not good. But when you’re biking, you’re getting air and it’s just easier for me. He agreed, and for an entire week last week, he would come in and we would walk. 

I mean, [at] first, we walked, but it didn’t work out. So I’m like, “No, biking” and we would bike [for] 12 minutes. I would have to sit down and catch my breath for the return. And then he would help me prep food. We went [with the] Mediterranean diet because the new hospital sent me a Zoom meeting where they told us food is medicine. That week, I was able to bike 4 times.

What’s your outlook on living with myelofibrosis?

You’re here to get your children through difficult situations. You’re not here just to live and breathe. You’re here to affect other people.

I decided my spiritual beliefs are, you have to fight for every inch of life that you can get. Even if it is less than normal and if it is painful sometimes.

Most of the time you are here to inspire, you are here to love. You’re here to get your children through difficult situations. You’re not here just to live and breathe. You’re here to affect other people. All of us affect each other. I mean, [The Patient Story] affected my life in such a positive way. This is what we do. So I said, “Whatever it is I need to do, I’m going to do it.” I stopped reading all the horrible stories that you find on Google. 

[I] got my appointment with the specialist. I saw her on Monday. This week, I’m going to see the transplant specialist on the 8th. [I] got amazing news because they have a resident in that hospital that was able to obliterate or get rid of the graft versus host disease, which is one of the biggest problems after a transplant. I have my sister and my 2 kids as possible donors. I’ve had a crazy amount of people being brave enough to even say “I will do it.” I was like, “Wow, that’s amazing.”

Did biking improve your quality of life?

[Biking] makes a complete difference because your circulation is hindered by how thick your blood is with this condition. Once you start moving, you realize when you come back from it, you have 3 or 4 hours of high energy which you don’t have if you sit around. You don’t get the tingling in your hands or your feet. 

Psychologically, you’re out, you’re getting some fresh sunlight. I think the worst thing you can do is lie down and close your shades because you just really need that vitamin D. 

We human beings need everything around us that’s been created for us. Water, sunlight, other people. That’s the best medicine.

The biggest thing that helps is exercise because it helps with joint pain.

What are some other things that improved your quality of life?

Once I got the infusions, I stopped eating ice. I’m excited. That helps me sleep through the night a lot better. 

If you’re having hot flashes, which you will have with these conditions, they sell these covers for your mattress that are cold and a pillow. The items that I bought helped me so much. You just put it on here. They sell them on Amazon for maybe 20 bucks. If you wake up in the middle of the night, you turn it on and you’re able to cool down enough to go to sleep. 

In case you’re in a situation like I was where the anemia was so terrible and you need to work, having that lunch that I would have, carrots and cucumbers, would get me through the day so that I could come home, have a regular meal and be able to digest it and get sleepy on my couch, not at work. 

I think the ice did help a lot during that time because it helped me breathe better.

Reflections

Have you spoken to your first doctor again?

No, I’m writing her a letter. A lot of people have told me, “Why don’t you do something about it?” I don’t want to do anything with litigation or anything like that, because I need positive energy in my life right now.

Trusting your gut

I believe you have to look at how things make you feel. It is difficult to say to a doctor, “You don’t make me feel right.” It’s not a fact, it’s just feelings. But feelings are very important, especially when you’re going through this.

When people are paying attention to you, pay attention. If they’re making eye contact, pay attention. If they’re looking at their watch and they’re in a hurry, you can fire your doctors. I learned this and it is the best thing to learn. 

If you go to someone and they make you feel inaccurate, they discard your symptoms as not important…

I had gone to a cardiologist, different from Dr. Mechanic that year, and he had told me there was nothing wrong with me. When people are paying attention to you, pay attention. If they’re making eye contact, pay attention. If they’re looking at their watch and they’re in a hurry, you can fire your doctors. I learned this and it is the best thing to learn. 

When she told me, for example, about the drug, I felt in my heart that I would rather go through the symptoms that I was having than take that medicine. I went and I studied it and I went into the blogs and I saw what people were going through and I said, “No, I don’t want this.” I, told her, “If you see that I’m close to dying, then I have to take it. I will. But at this point, do you feel that I’m at that stage?” She said, “Well, it would be great.” 

Remember, they’re advocating for medicine. I’m not saying that’s [always] the case, but sometimes they are because they’re selling something they’re trying out too. Sometimes we’re guinea pigs. They’re trying stuff on you. 

If it makes you feel weird, it doesn’t feel right, walk away. Say no, respectfully. I told her, “I’m sorry. I know you got it approved, but I’m not interested in that right now. I need time to process this, and I don’t feel like I want those side effects.” I think it’s kind of like chemotherapy medicine, so it’s a serious medicine that you can’t just be offering to people. Do your homework, read. 

Also, if you are told to take something and it has to be that way, don’t believe the worst-case scenarios. We’re all different, we all react to things differently. Just focus on how you feel.

How does that energy of that person make you feel, in the case of a doctor, when they offer you things? She told me, “Let’s go for the blood transfusion right now.” I said, “No, I need time” and give yourself that time because there will come a time when you say, “I’m ready.”

Whatever it is, don’t let anyone rush you into anything. It’s your body, it’s your life.

I would have been on that medicine for a year and I would have been on the wrong medicine because right now they’re like, “No, we’re not going to give you that.” So imagine.

We’re all made of energy, so it’s the most important thing [to] be around people who present that energy. There are people that are going to come and look at you and you’re going to tell them what you’re going through. But because you look fine and you have hair, you don’t look like you’re very ill, they’re going to just tell you, “So and so has this disease and they’re fine.” Do not listen to that. You are a unique human being and only you know how you feel.

Communicating your needs to people

The other thing is work. We’re indispensable and we have to be there. That was my first struggle – I need to go back to work. I need to go back to work even though we have remote work. That’s helped me so much – my company gives us 2 days of remote work a week. 

I’ve been able to keep my job because of that opportunity. Talk to the people around you, talk to your boss, talk to your assistants, talk to your co-workers. You don’t have to give them details, you just need to let them know. 

I told my boss, “Hey, there’s certain things that I’m not very good at right now” like events. I was the life of the party. Now I’m not. [I’m] kind of sitting in a corner, but I told him that. He’s an amazing boss. He’s just so understanding. He’s like, “Okay,” because he didn’t know that. So you let them know. 

Also, you can’t expect people to assume and know. You need to let people know if you’re not feeling well, because people are worried about their life. 

Many times, I would not tell my boss or people in my family how I was feeling and I kept treading on. Then you get to a point where you get upset, and it’s not their fault. They’re fine, they’re not in your shoes. You’re the one that needs to communicate, “Hey, today I’m not going to be able to go to that party because I can’t stay up after 9 p.m.” 

My lifestyle has changed completely. You can’t drink alcohol. I can’t do certain activities in the sun, for example, I can’t take sunlight. I changed a little bit of my lifestyle, but I let people know. I let them know I’m a little different now. I’m still me, but we’re going to have to do things a little different. 

What’s your top advice to others?

I got so much support after I started speaking up. If you stay silent, it’s not going to help you. At the beginning, I was like, I’m not going to bother. Then you’re the one that is going home hurt and sad, and they’re not to blame. They don’t know what you’re feeling. So speak up. Let people know. Find a buddy if you need to. My husband’s my buddy. I call him, “Carlos, I know you’re a health nut, so you need to help me now.” 

In this case, for example, you ask for help and sometimes you’re going to get help that is not what you thought you needed or the person. Take what they’re giving you. My friend gave me this mug, it says “Mindset Is Everything.” I read a book called “The Biology Of Belief.”

They focus on the placebo effect and the fact that 30% of people just heal without taking medicine. Focus on that. I mean, how amazing is it that just by believing that you’re taking something your own body will heal?


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Special thanks again to AbbVie for its support of our independent patient education content. The Patient Story retains full editorial control.


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