Christine's Story
by Christine Druther

Brain Talk, Volume 6, Number 2

At the age of 41, Christine found her own breast cancer. "I had always done breast self-exams," Christine, now 52, states. "Then I found something different in my left breast." She went to the doctor and "he didn't feel anything," she recalls. Christine went for a mammogram anyway. The lump was visible in the mammogram.
 
She went to see Dr. Richard Michaelson, an oncologist at St. Barnabas Hospital in Livingston, New Jersey. "He was my mom's oncologist," she states. "My mom was the first in the family to have breast cancer," Christine says. "Her breast cancer was found in 1978. She had a mastectomy." Her mother's cancer recurred and she died in 1989, at 67 years of age. Christine found her own breast cancer 10 months later.
 
"Dr. Michaelson said I should see a surgeon and have a biopsy," she recalls. "The surgeon recommended that I have a lumpectomy, since the tumor was small enough." She had the lumpectomy in 1990. "Dr. Michaelson said that since my mom had breast cancer, I was at high risk. He recommended that I have chemotherapy and radiation treatments," she says.
Christine had radiation treatments and six months of chemotherapy. "My children were four and six at the time," she relates. She and her husband, Joe, have two daughters, Danielle and Debra.

"After the radiation and chemotherapy, I went for check-ups to Dr. Michaelson for five years," she recalls. "Then the doctors told me to continue yearly mammograms. I also continued my self breast exams." "I knew I needed to be conscientious about following myself throughout the years," she says. "Nine years later we were selling our house and moving to California," she says. "My husband's company had downsized, so we took the opportunity to move to California. My brother in San Diego had been after us for years to move to California."

"I was checking my lymph nodes for lumps," she recalls, "and found enlarged nodes under my left collar bone in May of 1999. I went to an internist who didn't feel anything. But I was insistent. I kept telling him, 'I feel it and need to have a biopsy.'"

Christine went to a breast cancer surgeon who tested her blood for tumor markers, which were slightly elevated. The surgeon also took a biopsy of the lumps in her neck.

 "It turned out it was the same cancer," Christine states. "I had stage IV breast cancer-I had gone from stage I to IV! And this was just a few weeks before selling our house and moving to California." Christine went for CT and MRI scans."They compared the scans to the ones I had taken nine years ago, and determined that the cancer was not in my liver or bones," she says. "No other organs were involved."

Prior to the diagnosis of stage IV breast cancer, she had an attack of vertigo. "So I had an MRI and it showed a brain tumor on my right side," she says. "The breast cancer had metastasized."

"While still in New Jersey, I went online and looked for breast cancer associations," she states. "I was also looking for a doctor in San Diego. I met a woman online, Connie, who said that a doctor had put her on the Herceptin trial, and that she had been doing very well for over six years." Herceptin is a monoclonal antibody that attaches to a growth factor receptor on breast cancer cells, preventing growth factor molecules from attaching.

"I also called an association called 'YME.' It turned out that the lady who answered the phone lived in my new development, just three doors away!" Christine recalls. "After the neck biopsy report was sent to my physician in New Jersey, he said we should see whether Herceptin would work for me," she says. "The test came back strongly positive. He sent this information to my new oncologist in California." "So I got on the plane with my youngest daughter and we went to California," Christine says. "We stayed with my brother for a while."

Once in California, "Dr. Shiftan said that we needed to treat my brain tumor first," she recalls. Dr. Shiftan is a medical oncologist at Sharp Memorial Hospital in San Diego. "He sent me to a neurosurgeon, Dr. Justin Renaudin, and a radiation oncologist. Just before Gamma Knife radiosurgery, I had an MRI with double contrast. The MRI showed that I had two and maybe three brain tumors!" Christine and her doctors had thought there was only one brain tumor.

"On August 16th, 1999," she reports, "I had Gamma Knife radiosurgery on all the brain tumors with Dr. Renaudin at the San Diego Gamma Knife Center in La Jolla. I was only in the hospital from 7 am to 1 pm. It was not as traumatic as I thought it would be. I had follow-ups one month later, then every two months after that."

"Right after Gamma Knife I started chemo," Christine states. She was treated with Adriamycin and Cytoxan. "I couldn't breathe. My left lung filled with a liter of fluid, and I felt like I had to cough all the time. After the third cycle, I was feeling increasingly worse, and I was still scheduled for a fourth. I drove down to my medical oncologist's office and told him, this isn't working. If you don't switch to the next line of treatment you're going to lose me."

"On September 12th, 1999, I had Herceptin for the first time," she recalls. "There were no side effects like the chemo. I didn't even feel slightly nauseous. Three days later all the fluid was miraculously gone from my lung and the nodes on my neck were gone. It was incredible."

"I am taking weekly treatments of Herceptin, and will take it until the docs decide to do something else," she says. Christine also had some Taxol treatments. "My brain tumors were shrinking," Christine recalls. "But then in March of 2000, my six- month follow-up MRI showed that I had five new tiny mets to the brain in various locations."

However, Christine still maintained a good attitude. She says, "I thought, 'Let's get on with the program! I have little tolerance for this anymore!' I wanted to focus on getting well."

"My radiation oncologist said I should have whole brain radiation," she recalls. "So I was treated with two Gray per day for 20 days, with weekends off. The treatments only took a few minutes, but they were completely exhausting after two weeks. When I could, I continued my regular activities. It took me a few months to recover."

"In July of 2000, the other mets were gone, but the original brain tumor that had been shrinking grew to 2 cm," she recalls. "My radiation oncologist called me and told me that the tumor was growing and it looked like there was some malignancy. He said I should go see about removing this tumor and come back in a month."

"I was aghast at his recommendation!" Christine says. "I thought, 'I'm not going to do this. I should seek another radiation oncologist.' I transferred my records to Dr.David Hodgens, a radiation oncologist at the San Diego Gamma Knife Center in La Jolla. He wanted to look at every brain scan I've ever had."

"Dr. Hodgens and another neurosurgeon, Dr. Alksne, decided that I should not have a craniotomy, but that the tumor should be followed closely with frequent MRIs," she recalls. "Dr. Hodgens was not totally convinced that the tumor was malignant." The tumor was in the right occipital lobe. "The tumor grew a little more - but this time in millimeters, not in centimeters," she says.

"Dr. Hodgens sent me for an MRI/MRS four or five times," she recalls. "He was looking at the choline ratio." Performed together, MRI and MRS (magnetic resonance spectroscopy) produce an image of the brain that shows both morphology and tissue metabolism. Certain metabolites are present in greater or lesser quantities in tumors, compared to normal brain tissue. Choline is a cell-member marker that is found in increased quantities in malignant tumors.

"Dr. Hodgens decided that the tumor was growing because of necrosis," Christine reports.
 "I also developed edema from the radiation in the brain," she says. "In October of 2000, Dr. Hodgens put me on a very low dose of Decadron [a steroid] to treat my brain edema. I had been wobbling and had a loss of left peripheral vision due to the edema in my brain. But the very low dose of steroid was enough to make me gain 20 pounds."

"Right now I have some minor longterm side effects from the whole brain radiation," Christine reports. "I had some minor short-term memory lapses, which have since improved." She also has retinopathy in both eyes."I'm not blind, though; I can still drive," she says. Retinopathy is usually found about 14 months after the last month of whole brain radiation, Christine reports. "It happened in my case right on schedule. Others may not even develop this type of retinopathy," she says. "I don't see black spots, but I need more light to read. I had some small laser treatment on my left retina, which seems to have improved my vision. Since then, the right eye has been also treated. I look forward to getting over this milestone as well."

In addition, "My toes are becoming less numb and my extremities feel warmer," she reports. "Taxol was responsible for my numb toes."

Christine, a health educator and nutritionist, wants "to get the word out about the importance of breast exams and not waiting for your doctor to tell you when you have a problem, but know yourself," she says. "It's a disease that can be controlled if caught early on. An informed patient is the best survivor."

"Part of my weekly routine is checking for any lymph node recurrence," Christine says. Her lymph nodes are currently clear, and "all my tumor markers are normal," she reports. "I read a lot of medical literature about breast cancer," she says, "and I keep in touch with the breast cancer sites online. I like to cook, and shop for healthy food. I like to develop new recipes." Christine also likes to go for long walks, listen to motivational music, and travel.

Her daughters, Danielle and Debra, are now 15 and 17 years old, respectively. "Danielle is an actress, and she likes to sing," Christine says proudly. "Debra will start college at UC Irvine this year. She wants to be an electrical engineer."

Christine has recently begun taking the herbal supplement Ginko Biloba. "This is in an effort to enhance the blood circulation and keep out the so-called 'cobwebs' - the neurological effects of whole brain radiation," she says. "After only a week I felt more energized with no side effects."

Christine had an MRI/MRS in late August, and she reports that "it went well after an hour and forty-five minutes of bongos, jackhammers, and tapping noises gracefully vibrating about my head. It's the one trip you could even learn to miss; after all, this ride is not at Disney."

"The preliminary report was good," she says. "I understand that I will have the next follow-up in six months! So that means I'm doing great." Dr. George Wesbey, Christine's radiologist, "says I'm doing so phenomenally well that he considers me a very special case and I will not need to continue taking spectroscopies," she reports. "Dr. Wesbey says everything in my brain is almost completely metabolically normal. He said he's never seen anything like it." She also reports that "the initial tumor, with the help of spectroscopy, has been determined to be a diminishing dead tissue."

"I think the Herceptin helped clear up the blood going to my brain," she states. "Dr. Wesbey is also wondering if the Herceptin seeped through into the brain after radiation."

"It's been two years and three months since the diagnosis (and eleven years since the original breast cancer) and I'm completely well," Christine says. "Every day of my life is a celebration. Don't ever take life for granted because it's such a precious gift."

"Mom had me promise that I'd live to be 75 and beyond," she recalls. It looks like Christine is well on her way to keeping that promise. "I am grateful to all the professionals whose knowledge and care guided me through this illness," she says. "I really felt help was on the way. Well, it has arrived. Eventually I will be going for scans annually, as long as I do well, which I plan on. Overconfident, you say? No, just feeling too good to be anything but well."