Sarah Howell SLAMMIN' FOR SARAH

First post: 3/20/2017 Latest post: 9/16/2017
Welcome to my Slammin' for Sarah, CaringBridge website. My family will be using this to keep family and friends updated in one place. We appreciate your support and words of hope and encouragement. Thank you for visiting and for your prayers!

Much ❤️ Love!! -Sarah 💞❤️


Slammin' for Sarah ----------

My reason for the journey:


In January of 2017 I felt a knot in my right breast and it did not seem normal! It actually did not feel right! I decided to go to the Doctor in February for an annual mammogram (which I had skipped the previous year)! Ladies, please get your annual mammogram! When I arrived as scheduled, they asked if there were any abnormalities. I explained my self exam and my concern. They explained that I could not have the mammogram until I went to my primary care physician or OBGYN for consultation. I am not quite certain if this is normal practice, but sadly, this delayed my next opportunity for a few weeks.


I had a business trip to San Francisco the next week and upon returning decided to make another appointment for the general mammogram which I can do annually and upon making that appointment did not mention any abnormality. Goal was to proceed as normal! They did just that!


On February 28, 2017, and after my mammogram exam, the technician had issues seeing all required and as I feared saw something abnormal, in the same place which I had felt. Frightened and scared were a couple emotions, to put it lightly. At this point, she knew we needed to proceed with an ultrasound. My OBGYN was consulted and fortunately, and Immediately ordered, that same day, an ultrasound. Since I do have annual OBGYN check ups my Doctor felt certain this cancer was fast growing! I went directly, (alone and scared), to get the ultrasound completed. Had my sweet man knew the circumstances which would unveil in a single day, no question, he would have been stuck to me like glue. The Doctor was very honest that things did not appear good and that I needed to get in to have a biopsy completed asap. I took a bit, and with composure, I went to the car, called Mark, said a prayer, and then drove home!


On March 2nd Mark (my sweet husband) and I went to have my first biopsy. The results shared by the Doctor were obvious and he shared that the size, shape, and appearance left little room for doubt. Reality was staring us down when we were looking at a sure sign of a malignant tumor in my right breast!



At this time we decided to keep this to ourselves and await consultation with our physicians and begin our new normal.


March 13th was our middle daughters 16th Birthday! We wanted this to be special and wait until after her special day to drop this news onto our three precious girls!


On this day, March 16th, three days after my middle daughters 16th birthday, we realized the very beginning of our new normal.


March 16th We met with my Surgical Oncologist for the first time! Dr. Ashley Hendrix was such a phenomenal physician and person! She had a wealth of knowledge! And fortunately for all of us, explained things so well! We knew she was our person! She was the one to see this through! I absolutely adored her and will always! We also had the pleasure to meet my Nurse Navigator, Lindsey Coleman (AKA Angel)!


On the 16th we proceeded with the gene testing to determine if my cancer stemmed from genes which could potentially affect our three girls and my relatives who are still living! You see, my Grandma also had Breast Cancer at age 50.


On the 16th we discussed in depth, the hard results as of March 3rd that had came back. At that time, we reviewed with our Doctor the additional studies from the right breast mass biopsy.


The Results: Invasive Mammary Carcinoma with associated calcifications and high grade ductal Carcinoma in SITU and COMEDO types: largest focus of invasion 0.6 CM. Nottingham Score: 7/9 (T=3, N=3, M=1).


A couple months later and probably the best news on my journey was that the cancer I carry with me is not genetic!


Our complete diagnosis was as follows:

"HER2+ and Estrogen Positive Breast cancer cells with higher than normal level of HER2, called HER2-positive. These fast growth tumors and the protein which causes this cancer are fed by Estrogen. These invasive cancers tend to grow and spread faster than other breast cancers. It’s important to know your “HER2 status” because HER2-positive cancers are much more likely to benefit from treatment with drugs that target the HER2 protein.. "


"As researchers have learned more about changes in cancer cells that cause them to grow out of control, they’ve developed new types of drugs that target some of these cell changes. These targeted drugs are designed to block the growth and spread of cancer cells. These drugs work differently from chemotherapy drugs, which attack all cells that are growing quickly (including cancer cells)."


"Targeted drugs sometimes work even when chemo drugs do not. Some targeted drugs can help other types of treatment work better. Targeted drugs also tend to have different side effects than chemo."


"For about 1 in 5 women with breast cancer, the cancer cells have too much of a growth-promoting protein known as HER2/neu (or just HER2) on their surface. These cancers, known as HER2-positive breast cancers, tend to grow and spread more aggressively. A number of drugs have been developed that target this protein."


"Trastuzumab (Herceptin): This is a monoclonal antibody, which is a man-made version of a very specific immune system protein. It is often given along with chemo, but it might also be used alone (especially if chemo alone has already been tried). Trastuzumab can be used to treat both early- and late-stage breast cancer. When started before or after surgery to treat early breast cancer, this drug is usually given for a total of a year. For advanced breast cancer, treatment is often given for as long as the drug is helpful. This drug is given into a vein (IV).


Pertuzumab (Perjeta): This monoclonal antibody can be given with trastuzumab and chemo, either before surgery to treat early-stage breast cancer, or to treat advanced breast cancer. This drug is given into a vein (IV).


Ado-trastuzumab emtansine (Kadcyla, also known as TDM-1): This is a monoclonal antibody attached to a chemotherapy drug. It is used by itself to treat advanced breast cancer in women who have already been treated with trastuzumab and chemo. This drug is also given in a vein (IV). In my case TDM1 was attached to the Herceptin for the initial 6 three week cycles prior to my double mastectomy."


In sum, Basically this meant we had some choices and one involved a Sarah Cannon research study, a targeted trial study specifically for my diagnosis. This was a targeted drug therapy treatment utilizing the TDM-1 drug prior to surgery to destroy the cancer or rather shrink the tumor/mass.


On March 27th we met with our chosen Medical Oncologist, Dr. Denise Yardley. We determined the course of the Sarah Cannon research trial study and that we were a potential match to be accepted into the study. We were encouraged by the less likelihood of major side effects, a less toxic form of chemotherapy called TDM-1 Kadcyla, the constant monitoring of my vitals by the research team, as well as the bonus of keeping my hair!! I would be on drug therapy of TDM-1 Kadcyla which is attached to the normal targeted drug therapy, Herceptin, to go straight to the tumor and destroy, along with an added drug cocktail of Perjeta.


My planned course of treatment would be as follows:


The TDM-1 Kadcyla/Herceptin combo and Perjeta treatment would be via my port for six cycles every three weeks. After that time, surgery would take place. After surgery and healing, I would continue on the Herceptin alone and Perjeta for four cycles every three weeks. After this, I would continue on the Perjeta for another 7 cycles every three weeks! This treatment would continue until Spring of 2018. We had a long road ahead!


It seemed as though it was taking forever to get to the next step and then all Of a sudden it all was really moving along so fast! I suppose this is the typical progression in such diagnosis. We decided to remain positive, good vibes only!


On April 6th I was accepted into the clinical trial study for HER2+ and Estrogen+ patients. On this day we had my first Echo and full body bone scan. My bone scan was clear and that was a blessing! On April 11th I had my follow up with medical oncologist, Dr. Yardley to discuss results. On April 13th I had my CT scan, and initial baseline breast MRI. On April 14th I had my biopsy with trial titanium clips for the clinical trial study to note the site of tumor through the process. On April 17th I had my port surgery and on the 19th was my initial treatment cycle which consisted of normal labs, exam, trial study nurse visit, and chemo treatment. We were at Tennessee Oncology all day!


We had received the results from the breast MRI and it was determined another biopsy of my lymph nodes was required as the cancer had spread. This was not the news we had hoped for but remained confident that God would take care and with that faith our team of Doctors knew the best course of treatment!


On April 21st we had the biopsy appointment. We had concern of three lymph nodes in concern, at that time.


Treatment #2 was on May 10th and at this time I was still working. This was a hard treatment for me and I had to build back up my iron deficiency so was sent in for iron infusions to increase my levels to remain on course for the trial study required levels! The worst symptoms at this time was bloody nose, dry nostrils, dry mouth, cold sores. All of these seemed minimal to what horror stories I had heard about! I remained positive and tried hard to be content and not complain. I attempted to stay as active as possible and continued to run and play tennis as I could in the progression of my treatments.


On May 30th I had a follow up Echocardiogram and on the 31st had treatment #3 and my iron levels had stabilized! Typically I am at the TN oncology office for a few hours so the duration had improved.


At this time I began the process for all my company offered which was 11 weeks short term disability. Treatment #4 on June 21st and follow up with surgical oncologist, Dr. Hendrix on June 29th.


On June 29th we decided upon our reconstructive surgeon, Dr. Jacob Unger at Maxwell Aesthetics's in Nashville. He and Dr. Hendrix seemed to be a great team. Treatment #5 was on July 12th. On July 18th I met with Dr. Unger for my initial appointment. We discussed surgery and options.


On August 1st my Mom and I went to Pretty In Pink at Centennial to get my post surgery undergarments! I am quite certain that aside from my initial mammogram and ultrasound and one treatment which my Mother also went along, this is the only other appointment thus far which my sweet husband did not accompany me! He allowed my Mom to handle this one! I am very blessed to have both my husband and my Mom!! I have a large support system which has allowed me to remain positive! I am very blessed.


My final Chemo treatment #6 was on August 2nd! This was an emotional day but still a very long road ahead. August 9th I had an Echo to follow up on my heart and make sure I am well and heart healthy! Then in for my pre-op breast MRI to compare to baseline MRI. The very next day on the 10th I had a follow up with Dr. Hendrix, my surgeon. The news was amazing and no residual cancer remained!


Surgery was the next step! I had a window of time that under the restraint of the study I could have the surgery so the tumor and my tissue could be sent in to be evaluated to help other women with my type of cancer!


Mid August prior to our oldest girl heading on her journey to college, we had our Priest do The Anointing of the Sick at Church. Mark, My parents, and our children were present and this was very special as Surgery would be soon. I needed all the blessings I could get and wanted all three girls all to be with their father and I! By God's grace, the timing seemed to work out.


At the end of August, we had the honor and opportunity to both take our oldest daughter to begin her new path in college! This was a very emotional time but almost was the break we needed and I believe, God allowing me to be a part of this process! This was a true blessing.


"I can do all things through Christ who strengthens me" Philippians 4:13 !!


My sister in law Susan was super sweet to set up a meal Train through the next several weeks so my family could eat real food while I concentrated on healing my body! I am so very thankful for having the support to enable my family to have this gift and support to ease my worry and to also nourish me in this process! I resisted this help but it was such a blessing and a need! I thank God for all of those angels who took part in taking care of us during this time!!


My pre-op appointments with both Dr. Hendrix and Dr. Unger were on September 7th and the Surgery was set for September 11th. We decided although this date was not a day we wanted we would make it my survival day, and now it is! All went very well with my double mastectomy on 9-11 by Dr. Hendrix and removal of my cancers, including 24 lymph nodes on my right underarm! All went well with the placement of my expanders under my muscle so my skin can begin to stretch for reconstruction by Dr. Unger! Also on this day, was the day according to my short term disability, that I was to return to work. Fortunately, work goes on without me. I am uncertain about my return to work, at this time! I am thankful for a very patient employer that will hopefully need my services when I am ready to come back! At this time, I am encouraged to stay focused on healing and very thankful I am not in a position to have to get back to work!


September 17th was special 23rd wedding anniversary for Mark and I! Still healing but very thankful for this special day!


On September 19th was my post-op drain removal #1 and #4! A relief to have only two drains left! Getting stronger! On September 21st was my post-op with Dr. Hendrix and went well. Made more appointments with Radiation Doctor and physical therapist! I will be able to be closer to home for these appointments. This is good my to make life much easier! I must find small blessings in all I can in this process! No residual cancer and a 60% chance of no reoccurrence! That's huge!


At this time we had to determine course of radiation treatment and issues of swelling around my right arm, lymphedema. On September 22, my drains #2 and #3 were removed, as planned, so I am healing well!


October 2nd was my first schedule saline fill. 60cc in each expander. I will be set for weekly fills. October 4th was treatment#7 without Chemo! The treatment was long as I had been out of office post surgery to heal. We were there for several hours arriving at 8am and got home by 4:30pm. Very similar to my initial treatment on April 19th! This was only a drip of Herceptin/Perjeta. We did determine that I would begin tamoxifen, hormone blocking medication for five years after my drug infusion therapy is completed in Spring. On October 9th I received my second 80cc fill.


On October 10th my initial visit with Dr, Osborne went very well. My radiation will not occur until after I am to the size pre-op on reconstruction. My reconstruction will not occur until 6 months after healing from radiation. The duration of my radiation is set for 5 week daily cycles taking 30 minutes. The radiation is also targeted to my right breast and under arm region. October 16 was my third fill and I received 80cc fill. I have a couple more visits to be the size I would like but have to make sure the left does not interfere with the beam for radiation so it is likely they will not fill my left as full as my right expander. The purpose here is to stretch my skin to enable radiation to occur and my skin to be stretched to allow for reconstruction.


Meanwhile, I began physical therapy with Jana on October 19th. I was fitted for a lymphedema sleeve and educated more on how we can get my range of motion back in both arms but more work is required on targeted side since 24 lymph nodes were removed. I have some scar tissue on my right arm and it has to be worked through and my arms have to rest behind my head comfortably in order to begin the targeted radiation. I have many goals and working hard to get to this place is key to moving forward in this process!


October 20th was my husbands 50th Surprise Birthday bash! It was a success and am so thankful for all who helped to make this possible! I am truly blessed to have this man by my side!!!


October 23rd was my second physical therapy appointment with Jana. She has been awesome and is getting my arm movement possible to begin the next step of radiation. After my fills are complete and my arms are able to relax behind my head, radiation can begin. It is a process with which I pray for patience and God's healing hand to get by!


October 25th is Treatment #8 and went a lot faster than last time around. I also had my fourth fill with Dr. Unger. I am encouraged by making it through this process. I received 60cc on this day.


October 26th 12:15 was my 3rd physical therapy.


October 31st 10am at Pretty in Pink I was fitted for my lymphedema sleeves.


November 1st was set for fill #5 at Dr. Unger's after which the nurse asked that I come I the next day, November 2nd to see Dr. Unger. He explained that I am to the proper level. I did not have a fifth fill.


I continue with my physical therapy sessions three times weekly and they are making me stronger and we believe breaking through the scar tissue which will enable me to utilize my right arm again to the fullest extent! I am determined to get where I need to be for radiation and after. On November 8th I was given the clear from PT to make my appointment to get started on radiation. I am scheduled for this on November 20th.


Resource: www.cancer.org (American Cancer Society)


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