Uzma Educates About Stage 4 Breast Cancer: Video

[This video was a stand-alone Facebook post of Uzma’s in 2017 on October 13th, Metastatic Breast Cancer Day. Read this to understand my approach to turning some of Uzma’s Facebook posts into blog posts. Below the video, I have included Uzma’s message, for which I took a transcript of the video and edited and formatted it for ease of reading and clarity. Watch the video and share Uzma’s message about metastatic breast cancer.]

Hi! My name is Uzma, for those who don’t know me. I am making this video to talk about metastatic breast cancer day, which is today, October 13th. And the reason I am choosing to make this video is to spread more awareness about metastatic breast cancer.
First of all, let me explain what metastatic breast cancer is. When people are diagnosed with breast cancer, the name means having cancer in the breast. Sometimes breast cancer goes into the lymph nodes in the armpit called the axillary lymph nodes. Based on that, cancer is given a stage.

Metastatic breast cancer is when cancer has left the breast and the lymph nodes in the armpit and has spread to other organs in the body. Breast cancer, as a disease, tends to spread to the liver, lungs, bones, or brain. Those are the typical four places where breast cancer cells tend to go.

The other name for metastatic breast cancer is secondary breast cancer or stage 4 breast cancer. With metastatic disease, the treatment goals change. The oncologists stop trying to cure cancer. Now they just want to keep it under control and manageable.

Once somebody has been diagnosed with metastatic breast cancer, they tend to stay in treatment. The only exceptions are people who have done incredibly well on treatments for 5, maybe 10 years. Then their doctors may decide that they are in remission, stop treatment, and continue ongoing monitoring.

Since there is no cure for stage 4 breast cancer, most people stay in treatment as long as they are alive. Treatment can involve oral chemotherapy pills, targeted therapies, or chemotherapy infusions. So in some way, shape, or form, the person is consistently in treatment.

The other thing is because doctors know that cancer is present, there are ongoing scans. A person goes through scans every three months. Scans may include CT scans, bone scans, PET scans, or some combination of these. The oncologists really want to see is the cancer is growing — the term they use is “progression.” Or whether it is getting smaller — they call it “regression.” Based on whether there is progression or regression, the doctors determine whether the person’s treatment is working.

The typical course of metastatic breast cancer is that whatever treatment is started will stop working at some point. It could be nine years, it could be one year, or it could be nine months. Then the patient gets transitioned to the second line of treatment.

Cancer mutates. Because it is part of the pathology of the cancer cell to change and mutate, it is tough for one treatment to work for a really long time. Now, there are metastatic breast cancer survivors who have lived 15, 17, even 20 years. There’s actually a study going on in UW-Madison where they are trying to study these super-responders to see precisely what is different about them that stay alive for so long.

The median survivor for metastatic breast cancer is three years. That is half of the patients are dead by 36 months. But there is significant variation in survival based on where the metastatic lesion is and how the disease is responding to a particular treatment. People who have just bone metastases tend to survive much longer than people who have soft-tissue metastases. By soft-tissue, I mean lung, liver, or brain.

Essentially, metastatic breast cancer is an incurable, terminal disease. And there are ways to slow down the progression. But on a day-to-day basis, knowing that you live with cancer in your body is very hard. It is a daily exercise in patience and gratitude in taking care of yourself, in reframing how you think about life. Because living with a diagnosis you know is eventually going to kill you is not a very pleasant thing.

Also, people who have metastatic breast cancer cope with fatigue. They deal with multiple side-effects. As you can see, I have got a little hair growing. It is because I am on a particular medication that doesn’t cause hair loss. But my scans may show progression, and then I will get transitioned back to chemotherapy. And I may not have hair again. So having hair or not having hair has nothing to do with whether a person is doing better or not. It just means that they are on a particular kind of treatment that allows a person to have hair.

For example, when I was on Ibrance for nine months, I had my hair. I didn’t lose any hair because Ibrance or palbociclib is a very targeted treatment, and it doesn’t cause hair loss. Then I ended up with IV infusion chemotherapy with Taxotere. That causes hair loss. So I had lost my hair again. Now I am on Xeloda, which is oral chemotherapy. And I get to keep my hair or at least grow them a little bit.

The reason I am talking about this is that people who don’t have cancer really don’t want to hear about terrible cancers. And people who have had breast cancer don’t want to think about becoming metastatic because it is terrifying. The return of cancer is emotionally stressful, scary, and devasting, especially to a young person.

Nevertheless, all of us must come together to advocate for more research funding for metastatic breast cancer. When there is a cure for metastatic breast cancer, it will no longer be scary. It is not the fault of the cancer patient if her cancer returns or spreads to multiple organs. It can happen to anybody, irrespective of the initial stage. Patients do everything their oncologists tell them to do, and still their cancer returns. It is the nature of cancer to mutate and recur.

The most famous celebrity example is that of Olivia Newton-John, whose cancer recurred after 20 years. Some cancers are very slow-growing and may recur after many, many years. Or some cancers respond to treatment completely and never come back.

Today, on Metastatic Breast Cancer Day, it is important for us to learn about metastatic breast cancer so that we can join together and push for research into cures for stage 4 cancer, or at least into treatments that can stop the progression of metastatic cancer.

I have friends whose cancers are not responding to treatment, and they are now transitioning to palliative care in hospice. It is tough because, in terms of statistics, we lose 40,000 women every year to metastatic breast cancer. That is, 113 women lost every day to breast cancer. That’s a significant number. As a community, we need to do better.

I appreciate you listening to me and learning a few things about breast cancer.

Thank you so much.


How are you doing now?

How are you doing now?

” How are you doing now?” is a question, I get asked with a fair amount of consistency. The sentence feels jagged and the “now” a bit piercing. Don’t get me wrong, I am thankful that I have well wishers who are interested in my well being but it’s a question that provokes a certain melancholic grief. It reminds me of “then” when things were particularly rough and excruciating .A treatment storm that grabbed me and swirled me around with dizzying intensity and then abruptly let go of me. My head is still spinning and my feet are still unsteady but I am out of the storm. No longer safe from the anxiety of another one that may creep up on me some day but the initial storm has passed.
The now, this. This the life after cancer.
I am quickly approaching the anniversary of the end of all major treatment towards the end of this month. I am still trying to figure out , how I am doing now?
It’s hard to not compare myself to where I was, about 2 years ago. I am considered “fresh” or “new” among the survivors who are many years out. Some are living life with Stage 4 cancer, some are quietly happy for the passage of time without major storms, some have seen more than one turmoil. We all however, live in fear. A fear that is an inevitable part of living after treatment, now.
The fear that haunts every time there is an ache or pain. It is ,but of course cancer, is what your mind says. Every back pain is cancer in the spine, never mind the pulling and lifting the day before. Every dizzying spells is metastatic disease of the brain and every bout of indigestion may the omen of cancer in the liver. Even though I am a physician, I am not immune to this post-cancer neuroticism.

At the heart of all of this, we cancer survivors, live with loss of control over our bodies. We have been subjugated by our bodies, rebellious and rogue. We despise that.
We , then, turn to things that will help us tamper that fear. Food usually becomes a bit of a preoccupation. It gives us a sense of control.” I can choose what I eat”, I can’t rid myself of the fear but I can eat the “anti-cancer diet”. Suck it up cancer! I am in charge.
There are anti inflammatory cancer diets and sugar free diets. All efforts directed towards that chance that the cancer won’t come back. In my heart I know that it’s just hopeful indulgence. Although dietary factors certainly affect the incidence of cancer but if 16 cycles of hard core chemo drugs failed to rid me of the cancer, my kale smoothie is unlikely to turn my fate.
But I do it any ways. I try to eat the 6 servings of fruits and vegetables every day. I regularly take my Tamoxifen. In entire last year there were 6 doses I somehow missed. For the rates of medication compliance in literature, its pretty darn good.
I go to yoga and walk regularly. I have lost all the extra pounds that had befriended me during the steroid fest with chemo. I try to minimize stress and sleep at least 7 hours every night. It’s all healthy but will it prevent a recurrence, I don’t know. No one can answer this question and that’s why I keep doing it, my hopeful indulgence.
Taking supplements get tricky. I worry about supplements interfering with the absorption and action of Tamoxifen I take. Eastern medicine, alternative things, acupuncture, all sounds like wonderful ways to deal with the fear head on.
When treatment ends, even though there is a great relief, there is a parallel anxiety of nothing is now being done to fight with the cancer anymore. You are on your own. To pick up and clean up after the torrid storm.
My physical energy is slowly improving. Yes post treatment progress is slow, painfully slow. Every day is a challenge to stay energetic. I work two days a week and feel quite exhausted by the evening on my work days. I hurt overall sometimes, just a low grade achi-ness. I sometimes get overcome by saddening emotions and I feel like saying ” I don’t want to live like this”, “I don’t want this monkey on my back” “I don’t want this shadow behind me every minute of every day”.
Sometimes, I wish I could be in denial. I wish I could pretend it’s all over and close the window and slam the door shut. I wish I could be sure that I have indeed survived. But with cancer, you dont have such emotional luxuries. It’s there. You live it every day. the reality of cancer.
So how am I doing now? I am managing. I appear to do be doing everything I used to just on a constricted scale. The ever present fear, is a hole in one’s emotional reservoir and there are days I feel emotionally depleted. Then, there are days when everything feels beautiful and I am thankful for being alive.
It’s an ever changing emotional landscape in the mind of a cancer survivor.
I am trying to carry on with grace what life has handed to me, one day at a time.
I continue my grieving process. I have lost the privilege of calling myself healthy, I grieve the ability to plan retirement without a little voice saying “let’s hope”, I am no longer confident that I will see my children’s high school graduations or weddings, heck, I fantasize being old and in a nursing home.
I could be “positive” as I am told to be, but these thoughts stay in mind head. The only time they will become dormant is when I am far, far away from the diagnosis date. They will never disappear but may be less audible.
So this is me , now and I think I am doing as best as I can. I am being patient, I am being thankful, I am trying to not take a day , a moment for granted, I stop and smell the roses and the coffee and my daughter’s hair. I am trying.