Coincidences? I Think Not.

In July of 2020, I had a non-cancer-related appointment with my cardiologist which resulted in a referral to get my calcium score and imaging of heart done - no alarms going off - just to get a baseline. Results came back, and I rocked my calcium score, but radiology noted an enlarged hilar lymph node and some nodules on one my lungs. Because of my health history, and the chance that the 2007 breast cancer had possibly metastasized to my lungs, I found my way back to MDAnderson and landed in their pulmonology department for a bronchoscopy with biopsy.

Nothing really to write home about after this procedure. What tissue could be biopsied showed no signs of cancer (a relief), but just to be safe, going forward I would be monitored with regular CT scans. Between August of 2020 and August 2021, I had CT scans every three to four months, and each time results indicated stability - hilar lymph node remained the same size and the nodules waxed and waned in size and number.

In June of 2021, Nat and I moved from Houston to Chicago, and at some point shortly after arriving, I decided I should secure a local general practitioner at Northwestern Medicine (NW) due to proximity to where we live, a former Houston neighbor’s daughter happily practices at NM, and as a medical institution, it has a solid reputation. Nothing major to report from this August 6th appointment with my new doctor other than getting a tetanus shot in my left arm. A week later, I headed down to Houston for a recheck CT scan of my lungs. Assuming results would be same old, same old, I wasn’t feeling anxious, so when they did come in a few days later, I was a bit taken aback. Lymph nodes in my left arm pit were enlarged, and a biopsy of those nodes was recommended. Booooo!!!

How could this be? Was there a chance that the tetanus shot I had gotten a week before the CT scan might have caused the lymph nodes to be enlarged? Had cancer really come back? I wasn’t enthusiastic about hopping back on a plane, returning to MDAnderson and finding out - best case - that the lymph nodes were negative for cancer. I also considered - worst case - if the nodes were cancerous, I’d be shuttling back and forth between Chicago and Houston for on-going care. Also not a great scenario. So I decided to look to Northwestern Medicine for the recommended biopsy of the lymph nodes.

My first step in transferring healthcare up north was reaching out to a nurse navigator in the breast oncology department. While waiting to connect with her, I started looking around Northwestern Medicine’s website. Insert Elaine from Jerry Seinfeld yelling her iconic, “Get Out!" because when I pulled up the list of breast oncologists, I couldn’t believe my eyes!

There he was! Sitting there looking back at me! It was a picture of Dr. Cristofanilli, my former oncologist from MDAnderson who treated me back in 2007-08!!! How could this be? Destiny? Fate? Didn’t matter because there he was! I explained to Lynn, the nurse navigator, who he was to me, how I had lost track of him after he’d left MDAnderson in 2008, and how amazing it was that he was right in front of me on my computer screen! Lynn joined in my excitement and quickly secured an appointment for me with Dr. Cristofanilli. Almost 15 years had passed, and for someone who faced stage 3C cancer that many years ago, it’s a noteworthy number of years. It was even more meaningful to be alive and vibrant at that September 13th appointment as I waited for the man who was on the team of practitioners who saved my life back in 2007.

When Dr. Cristofanilli walked in the door of my exam room, he was as I’d remembered - kind, thoughtful, forward-thinking. After a few minutes of pleasantries, he got down to business. His approach to the next steps in figuring out the cause of the enlarged lymph nodes was deliberate and thorough. I am guessing that Dr. Cristofanilli suspected that cancer had recurred given that one of the spots it can show up is in the lymph nodes - and here I was with enlarged lymph nodes. I was scheduled for a PET scan (covering skull to thighs) the next week, and a mammogram, ultrasound and MRI a couple days after that.

The PET scan happened on a Monday, and early morning the Wednesday after, I was waiting to be called back for the first of that day’s appointments. As I was sitting by myself near a window overlooking downtown Chicago, an alert from the patient portal, MyChart, popped up on my phone screen. I knew right away that it was the results from the PET scan, so I logged in to my account and started reading.

Taking in the findings from top to bottom, the results unfolded like this. First paragraph (basically head area) - nothing - OK, fine; second paragraph (chest area) - hilar lymph node still stable and lymph nodes in left arm pit showed no cancerous activity - actually stating they were likely enlarged due to vaccine - OK, great; third paragraph (pelvis area) - nothing noted; fourth paragraph, and here’s when my heart sank… “a hypermetabolic lytic lesion in the left greater trochanter of the femur.” And a little further on, “suspicious for osseous metastasis…” It looked likely that cancer had settled into my upper left thigh bone.

It’s weird what you remember in moments like this. I remember how quiet I was; my breathing was steady. I remember texting Nat and saying that I thought I was in trouble. I talked on the phone. I remember sitting in the windowsill of the waiting area tucked away from where people periodically walked so I could quickly organize my thoughts. I reminded myself that nothing was definitive. I knew that there’d have to be more tests done to confirm - I’ve been down this road before. And on that day, the goal was to figure out what was going on with the lymph nodes. So one thing at a time…

The mammogram with ultrasound took a bit of time because I had more images taken than a normal yearly appointment - but not a big deal as far as appointments are concerned. The same was true for the ultrasound. In fact, I remember a doctor stopping in to see how things were going. She felt sure the lymph nodes in my arm pit were enlarged because of the tetanus shot I’d had before the CT scan. She also commented that now they needed to figure out what was going on in my thigh bone. Later that day I had an MRI - also not a big deal, except for the noise - the machine is loud!!

The lymph node biopsy the following week was a different story. I’m sure that past memories and the PET scan results collided during this procedure because I remember thinking that I couldn’t believe I was going through this again. Granted - it was difficult to get a core needle to a lymph node, and when it was finally reached, despite numbing medicine, the biopsy was sharp and biting. Tears fell from my eyes, and the team around me noticed it. They apologized for discomfort and reassured me that they were almost done, but what they didn’t know was it wasn’t just about the physical pain I was feeling. I was sad for a lot more than that. I was sad because I’d ever gotten cancer in the first place. I was sad because I didn’t want to hurt again, I didn’t want to be medicated again, I didn’t want to be a regular at the hospital again. I didn’t want to be thrust back to doing cancer again.

At the end of all the appointments Dr. Cristofanilli had ordered, the lymph node biopsy, PET scan, ultrasound and mammogram confirmed that there was no cancer in the lymph nodes or chest area - which is good news. But because the PET scan also lit up my upper left thigh bone, I ended up having to have a bone biopsy in November of 2021, and that, along with a liquid biopsy (blood work that showed tumor cells floating around) confirmed that my original 2007 breast cancer had metastasized to the bone. And this was/is not good news.

November 15, 2021 - ready to have bone biopsy of femur done

While I’m less than thrilled that I have metastatic breast cancer, I still marvel at how things unfolded for me from July to November of 2021 from choosing a GP based within Northwestern Medicine, to deciding to cancel my appointment in Houston and have the CT scan in Chicago, to pulling up NM’s breast oncology website and discovering Dr. Cristofanilli. I believe that things happened just as they were intended. Coincidences? I don’t think so.

A final note - as I moved into the next phase of care, there’s one more (little non-coincidence) moment that happened during the initial treatment of my tumor that I’ll save for another post. Cy-Fair friends - this will be a extra special for you!!!

Lisa