Monthly Archives: December 2017

It’s Just Hair

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When I found out I was going to have to get chemo, I knew hair loss was going to happen. I told myself it was not a big deal. Hair would grow back. I can wear a wig, hat, turban, scarf, etc. I never even had great hair to begin with. It’s wavy, frizzy, and dry. I really shouldn’t be too attached to it. It’s just hair!

Then suddenly on Tuesday after I washed my hair, for the first time I saw my hair starting to fall out. In large quantities. Not quite chunks, but very heavy shedding. It was all over the bathroom floor and shower. Then I tried to comb my hair and even more fell out. I wasn’t ready to see this. I thought it wouldn’t happen this soon and it would take a few more weeks before it started falling out.

I cried to Roberto about it. He comforted me and we went over reasons there are more important things to focus on than hair:

  • Roberto didn’t fall in love with me because of my hair and loves me no matter what my hair is like or what I look like.
  • My family loves me unconditionally, regardless of my hair.
  • My friends are not friends with me because of my hair.
  • My hair does not change the ultimate end goal of my cancer treatment, to be cancer free.
  • If anything, my hair falling out means that the chemotheraphy is working.
  • My hair loss has no impact to the baby’s health and development which is far more important.
  • The hair loss is temporary. It will grow back.

Logically, I know these are all very good reasons why I shouldn’t be afraid of losing my hair and focus my energy on something else. But I had one recurring thought that seemed to override all the positive thoughts above.

I realized I was afraid of what I was going to look like without hair.

It’s scary to me simply because it is unknown and a bridge I have never crossed. After talking to other wonderful sources of support and also reading more online, it’s incrementally easier to cut my hair short now than to deal with long clumps of hair falling out later. I called my hairdresser and even though she was fully booked up this week, she graciously was able to squeeze me in after her shift was over because she realized my urgency.

Over the next 30 hours before my hair appointment, I went through a roller coaster of emotions and thoughts. Sad because this was all happening way too fast. Scared because I didn’t know what I would look like and I may not like it. Worried that Camila would not recognize me. Roberto told me he thought I had a cute shaped head and that I would look great no matter what. Maggie and Sherrie picked out some hats for me to choose from for them to order. Slowly, an unwilling acceptance started to set in as more hair shed.

Maggie and Roberto came along with me to my hair appointment. It was nice having them there to put my mind at ease. Jenni, my hairdresser, talked through ideas with me. I went in thinking I needed to shave it all off and that a short interim haircut was pointless because I’d eventually go bald. The idea of shaving it off was probably what made me nervous all along. Jenni convinced me that we could just do a short, feminine haircut to transition to short hair. Then when I was ready or needed it, we could later shave it. This sounded much more reasonable and less nerve wracking.

Jenni started cutting my hair, erring on the “longer” side of a short haircut. She asked me if I wanted to cut more off. I tried to find the balance between having a styled short haircut, but not something too long that would eventually still leave clumps of hair everywhere.

We evetually got to the final length. I’m happy with it. I know that I will eventually go bald, but this is a way to ease into seeing myself with less hair and also avoid seeing clumps of hair when it eventually all falls out.

The unknown is no longer unknown and not scary anymore. Camila recognized me right away! Roberto likes it too. I’ll enjoy this new look until I go bald.

Thank you to Jenni at Emmanuel Salon in Sugar Land who kindly comped my haircut ❤️

Chemo Treatment #1 – DONE!

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I have 6 chemo treatments total and I’m proud to say that the first treatment is completed and went very well! I already feel a significant improvement in my symptoms. Normally, the chemo treatment I’m prescribed (R-CHOP) is done outpatient and in a day, but due to my pregnancy, my doctor wanted my first two treatments to be inpatient and administered slowly so they could better monitor me and limit any adverse side effects.

Prior being admitted for my first treatment, both Roberto and I felt incredibly pumped to start. I was tired of feeling like crap all the time and ready to start feeling better! My doctors had said that even after the first treatment, I’d start to notice a difference. I didn’t care if chemo was going to possibly have bad side effects, I was weirdly excited about feeling better.

Before every treatment, I meet with my high risk obstetrician and she checks the baby through ultrasound to make sure everything is going well. She signs off that the baby and I are ready to go through chemo. The R-CHOP chemo regimen has been used on pregnant patients in the past and the outcomes have been positive.

Chemo – Day 1

I was pretty ignorant about cancer before my diagnosis. Admittedly, I didn’t even know chemotherapy was administered through IV. I have a tremendous amount of respect for anyone in the medical field and especially the staff at MD Anderson who openly educated me over the last few weeks. I’ve learned a lot!

I was admitted for treatment on December 4th, less than a week after my diagnosis because I needed to start immediately. Aside from when I had Camila, this was my first time staying in a hospital. And for anyone who has stayed in a hospital, you know that a lot of it is waiting. By no means am I saying the hospital is inefficient, but there’s lots of checks and due diligence required before they can start giving you drugs. Because I have so much downtime, I’ve been able to continue working during my treatment

Roberto and Maggie (my best friend, who is conveniently also a clinical pharmacist at MD Anderson) stayed with me throughout my chemo treatment. I really couldn’t have been in better hands! Having them there really made me feel more at ease.

My chemo treatment, called R-CHOP, was started in the evening around dinner time. They gave me the CHOP portion of it. The C, H, and O were administered over IV and took about 3 hours total. The P was prednisone, a steroid pill that I take daily for 5 days. They gave it to me at night, so I was super hyper that evening. Roberto said he had never seen me so chatty at night in a long time, because lately I’ve been so exhausted.

We were done with the CHOP portion by bedtime and immediately that evening I already noticed my symptoms subsiding. I was coughing much less and way less itchy. Maggie said that this is probably from the immediate effects of the prednisone, but this was really exciting to see I was already feeling better! I didn’t fall asleep until 2am because of the prednisone side effects.

Chemo – Day 2

The next day, I was going to be administered the R portion (rituximab), which is the largest dose of chemo and most likely to have side effects. The doctor wanted to administer it very slowly to minimize my side effects… so slow that it was going to take over 13 hours to do it. We started around 11am and it completely finished at almost 2am! The only adverse side effect I had was a brief period of feeling lightheaded and low blood pressure at the very beginning. It’s very possible it was caused by the Benadryl they gave me though, to help with the possible itchy skin side effect. Overall, it wasn’t too bad as I expected it to be. I was still able to get up and walk around with my IV while it was being administered.

I was fortunate to have several people come visit me at the hospital that day to keep me entertained during the long infusion. My cousins Brian and Julie, aunt Thu, and friends Alice and Jeff came by to keep me company.

My symptoms continued to improve that evening. It was really motivating to see such immediate results. Also, I started to finally have more of an appetite and eat like a pregnant woman. The hospital food at MD Anderson is actually pretty decent and the portions are huge! I was laughing with the nurses because the fried shrimp platter contains 8 pieces of shrimp, each the size of a baby’s fist. What other restaurant serves that much shrimp and that big?!

Day 3 – Ready to Go Home

By the third day, I was ready to be discharged because we were done with treatment and I had no adverse reactions that required additional monitoring. However, I needed a blood transfusion to increase my hemoglobin count before going home. This is a pretty simple procedure with minimal risk. (Side note: thanks to anyone who has ever donated blood in the past!) Being pregnant, doctors wanted me to have sufficient hemoglobin so enough oxygen could be carried in my blood to the baby. I had to get two blood transfusions that day which took over 7 hours to do. I was finally discharged at 9:30pm that night and it felt so good to be home!

A New Routine

As soon as I got home, I realized my home life was not going to be the same. I had to focus on my health. That meant making sure I didn’t get sick because my weakened immune system may not be strong enough to fight it. Inconveniently, Camila had a cold this week so I had to stay away from her.

There are a lot of things I have to avoid doing now to prevent getting sick or infections. This includes not going to crowded, public places, working from home, washing my hands constantly (they are so dry now), wearing a face mask, not doing certain household chores, avoiding raw fruits/veggies, and the hardest of them all, relying on others to care for my child. Since Camila goes to daycare, it’s potentially exposing me to a whole lot of germs. And it’s cold and flu season. For now, Roberto and my parents are the one helping take care of her (as well as many other things around the house) while I sit wearing a face mask. I know she’s in good hands with them, but it’s hard to sit back and not be mom. (More on this topic in a future post.)

All these things are temporary though. Eventually, my life will be back to normal and I realize this is a temporary sacrifice for my overall health.

Until the Next Chemo Treatment

I have three weeks between chemo treatments. I’m still working during this time (willingly and happily, as I enjoy my job and my employer has been very understanding). I’m able to work from home. It helps me feel safer since I’m less likely to get sick, and I also feel productive and engaged everyday.

My priorities each day are to get lots of rest and sleep, drink lots of water, and exercise/walk. So far, I’ve been feeling great. My energy levels have been pretty good. The doctor is happy with my progress. To reduce daily stress, we’ve outsourced some of our household chores. Several gracious friends and family members have provided food for us and that has taken the relief off from cooking.  I’ve even succumbed to using the <gasp> dishwasher daily!

My symptoms have dramatically improved just after one treatment. I went in with a terrible cough caused by the mass in my chest. The mass was so large that I couldn’t even lay in a reclined position without coughing uncontrollably and feeling like I was suffocating. The cough is nearly gone now! I can finally lay in reclined positions comfortably (my back is so happy). I no longer get winded from walking up a flight of stairs! My fractured rib is nearly completely healed. I still have itchy skin and unfortunately this keeps me up at night at times, but I’m optimistic it’ll improve with the next treatment.

All the Support

I want to thank everyone for the outpouring of support. Whether this is praying for me, texting to see how I’m doing, sending food, helping with Camila, or just sending positive vibes, please know all of this is helping me!

I know a lot of people feel sad when they hear my situation, but please don’t feel this way. Instead, find comfort and hope knowing that my treatment is going well and I feel so much better.

Notable Progress From This Round

  • Coughing is almost completely gone!
  • No longer winded from walking up a flight up stairs. I even went on a 30 minute walk and started doing light resistance training at home.
  • Huge appetite increase – finally eating like a pregnant woman and having cravings!
  • Increased lung capacity – spirometer (breathing tool) readings have gone up 500 mL since I left the hospital.
  • Improved energy level – I have more energy now than before. There are some days I am fatigued, but it is completely manageable.
  • As of the publish date of this post, I still have my hair and have not yet noticed any hair loss. I’m crossing my fingers those prenatal vitamins pull through, but I know it’s a long shot.
  • I had an MRI after the first chemo treatment to check if the cancer ever spread to my pelvic and abdominal and it did not! So this means I do not have stage 3 or 4 lymphoma, likely stage 1 or 2.
  • Most importantly, baby is healthy and growing at the right pace. As of the date of this post, I’m 25 weeks pregnant.

Next chemo treatment is December 27th. I’m ready! I’ll be 1/3 done by the end of 2017!

How It All Started

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It all started as a little cough. It wasn’t too bad so I didn’t think too much of it and procrastinated seeing the doctor about it. More than 2 months later, the small “tickle of the throat” cough turned into a stronger, spastic cough. I was 14 weeks pregnant at this point and the cough was now disruptive to my everyday comfort. I also noticed I started having some shortness of breath, fatigue, and itchy skin but figured it was due to the pregnancy. I did find the shortness of breath unusual since I was still regularly working out and teaching fitness classes.

Disclaimer: if you don’t want a TL;DR version, you can stop here and know it all started with a cough. If you want the full version, keep reading!

Over the course of the next 6 weeks, doctors tried to treat my cough as asthma, allergies and a sinus infection, with the limitations of medications available to a pregnant person. Nothing improved. Every doctor I visited listened to my lungs through their stethoscope and said my lungs sounded clear. I had been through inhalers, tons of different allergy medications, and three rounds of antibiotics. My cough continues to be powerful, riveting my whole body to the point where I fractured a rib. I tried to be patient with each of the different treatments we tried, eagerly hoping one of them was “the one” to solve my cough. I also started getting winded just walking up a flight of stairs. This was unusual for someone who regularly worked out, I thought.

Nothing worked. My symptoms got worse and my body was in pain from constantly coughing.

When Benefits Outweigh the Risks

Finally, one of my doctors said we were at the point that we needed a chest X-ray if we wanted to find out more. I hesitated. X-ray? Pregnant women aren’t supposed to get X-rays, I thought. It’s just not safe! I consulted with my obstetrician and he said at 20 weeks pregnant, it was okay as long as they shielded my abdominal region. I moved forward with getting my X-ray.

Within an hour, I got a call from my doctor with results. He said there was some sort of large mass around my left chest. It could possibly be pneumonia or a tumor, but he couldn’t confirm from the X-ray, but there was definitely something abnormal. Both of these possible results sounded awful. He told me to come in the next morning ASAP to further discuss with my regular PCP (the doctor that got the results was my PCP’s backup since she was out that day). I remember hoping it would be pneumonia because I thought that would be much more treatable than a tumor.

My doctor explained that she needed a CT scan to be able to tell what the large mass in the X-ray is. CT scans have incrementally more radiation than an X-ray. Is this safe for the baby? As a mom, we constantly have the mental battle between sacrificing ourselves for the sake of our child. My doctor consulted with my obstetrician and he said that a CT scan would be okay as long as they took extra precautions such as shielding my abdominal region and minimizing contrast used. He also explained to me that based on my X-ray results, we were at a point where we needed to weigh the risk vs. benefit of what I potentially had. In order for the baby to be healthy, I needed to be healthy.

The C Word

My CT scan was scheduled the following morning. Within two hours of doing my CT scan, my doctor had the results and called me. I remember being at work and having to find a quiet place to sit down to talk to her. She explained it was a 14cm mass sitting on top of my left lung, pressing against some of my vital airways and blood vessels. This was why I was coughing and having shortness of breath. She wanted me to meet an oncologist with MD Anderson ASAP because a biopsy of the mass was needed to determine if it was cancerous. Cancer. That word alone is scary.

Thanks to my doctor’s quick action and sense of urgency, I was able to see an oncologist at MD Anderson in the next three hours. Due to my pregnancy, my situation was prioritized.

My world was spinning at this point. In less than 48 hours, I went from thinking I had a sinus infection to possibly having cancer. We met with the general oncologist at the MD Anderson Sugar Land location. She explained that the “ideal” situation would be that the mass could be lymphoma, which is very treatable with chemotherapy, even during pregnancy. If the mass was actually benign, surgery would actually be more complicated to remove it due to its close proximity to my heart and other major blood vessels.

I wasn’t sure what to think of those possibilities presented to me. Both sounded awful. The next necessary steps were for me to get a biopsy of the mass to confirm if it was cancerous. The oncologist and radiologist had to evaluate how to do this biopsy. There are noninvasive, efficient ways to do a biopsy, but they involve radiation. These weren’t an option for me due to my pregnancy. The radiologist said he could instead do a biopsy using an ultrasound and find a place to extract the mass tissue. This is usually done under general anesthesia, but because of my pregnancy I opted to do it under local anesthesia to reduce more drug exposure to the baby. I remember feeling extremely nervous about the biopsy. Was it going to hurt? Could I tolerate the pain?

The biopsy was done a few days later, the week of Thanksgiving. They used lidocaine to numb my chest area and got to work on the biopsy. It was painful, even with the lidocaine. Due to the mass, I have a hard time laying flat without coughing compulsively. This, coupled with the biopsy pain and discomfort, was hard. It was finally over and I felt a sense of relief. One obstacle down, but there were many more to come.

And We Wait

I tried to enjoy Thanksgiving as much as I could. It was hard to lie to well-meaning relatives asking me if I was okay and why I was still coughing so much. I told them it was allergies to try not to worry them.

While I waited for the biopsy results, there was a lot of praying and reflection. Deep down, my intuition told me that I thought I had cancer. Roberto and I prayed it could be something else that was treatable. But for some reason I had the lingering thought that it was cancer.

An Answer and a Plan

A week after the biopsy, at 22 weeks pregnant, I got a call from my oncologist on the results. She confirmed it was lymphoma. Specifically, I had a non-Hodgkin Lymphoma called primary mediastinal large B-cell lymphoma. She explained to me that getting chemotherapy treatment pretty soon was necessary due to the size of the mass. She didn’t know the stage of the cancer, as this requires additional tests like a PET scan and bone marrow biopsy. Due to my high risk situation with my pregnancy, she wanted me to be seen soon by a lymphoma specialist at the MD Anderson main campus for a consultation.

I was at work and in shock. I didn’t know what to do. I called my mom and told her the sad news. My mom was devastated. She told me she wished it was her instead of me having to go through this. I remember my dad calling me shortly after to tell me that my mom had told him the news. He told me he had no words, except that he was here for me. I held back my tears. Roberto and I left work early to absorb the news privately.

I am eternally grateful for all of my medical team who treated my situation with such urgency. It is thanks to them that I received immediate, customized medical care. There are many people who cannot even get admitted to be seen at MD Anderson, the #1 cancer treatment center in the country, and I had an appointment within hours. I was able to see the lymphoma specialist the next day. This day happened to be our fourth wedding anniversary.

My obstetrician called me and said he learned the news from my general oncologist. He recommended I look into maternal fetal medicine specialist who was experienced with high risk pregnancies. But because my case was so rare, he didn’t know any that were experienced with cancer patients.

We met with the lymphoma oncologist who I later learned treated the most pregnant lymphoma patients in the practice. I felt I was in the right hands. She immediately got down to business and explained to us what chemotherapy treatment I needed and that I needed to start it the following week. I was blown away. In 5 days, I needed to start chemotherapy?! She explained the mass was so large and pressing against major airways and blood vessels that we couldn’t afford to wait.

The chemotherapy treatment recommended for me is R-CHOP, which is safer for pregnancy than other chemo treatments that are used for my same diagnosis. I would have six chemo treatments, once every 3 weeks. This amounted to about 18 weeks of chemo, which ironically was the same amount of weeks left in my pregnancy.

The lymphoma oncologist also recommended a maternal fetal medicine specialist that was experienced with cancer patients. They would work together to ensure each chemo treatment is going well for me and baby. After later meeting with the maternal fetal medicine specialist, she explained that our goal was to have four chemo treatments, wait three weeks, deliver at about 35-36 weeks pregnant, and then finish my last two chemo treatments.

Being the planner I am, I felt relieved we had a plan now to start my treatment. Seeing the chemo and pregnancy plan in small increments made it feel achievable and less intimidating.

What’s Ahead

So that’s my story of how it all started. The road ahead is scary and full of unknowns. But what I do know is I choose to be strong because being anything else at this time is not a choice for me and my baby.

My First Life Challenge

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For a team building event at work, we were asked to tell our autobiography. Everyone around me told fascinating life stories about the hardships they endured, challenges they faced, and how that got them to where they are today. When it was my turn, I realized in my short 30-something year life I had a pretty calm life. I didn’t have any hardships. I had never endured any tragedies. I lived a very fortunate, blessed life, surrounded by loving friends and family. My childhood was full of great memories. I have a loving husband and healthy, smart daughter. I went to a top university and now have a career I love. I have hobbies I’m passionate about and get to enjoy regularly. By no means is my life perfect, but it is certainly blessed.

Now at 33 years old, I face my first big life challenge. At 22 weeks pregnant with my second child, I’ve been diagnosed with lymphoma.

The road ahead to fight cancer and adapt to a family of four is scary. But I know I can do it with my amazing support system by my side and the care of a top team of doctors. This is my fight and I’m ready to conquer it.

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