Dr. Pham’s Cancer Journey

“Don’t walk behind me, I may not lead. Don’t walk in front of me, I may not follow. Just walk beside me and be my friend.” – Albert Camus

Krystal Pham and her husband

My dear friends and family…I invite you to walk with me, side by side, entering into this journey of somewhat unfamiliar territory.  It may be a surprise to some that I will be the first amongst many generations in my family to have come to face this diagnosis. 

I have seen it, helped diagnosed it and at times followed along with patients with it but I have never been this close to IT.  I will try my best to capture the ‘moments’ so that you may be able to walk beside me, and understand the process to some extent.

Although my mind may be fogged by all that is to come, my heart is strong.  It beats to the rhythm of the love that you have shared with us. Knowing that you are right there next to me, in prayer, in silent cheer, or just looking on, I will surely be able to put one foot in front of the other. My heart is so full. I see clearly God’s love and grace in each and every one of you. My hope is that I will be able to instill some hope and comfort to those that may need it, by persevering, fighting and never giving up on the power of love and prayer. 

“Thousands of candles can be lighted by a single candle, and the life of the candle will not be shortened. Happiness never decreases by being shared.” – Buddha

 

hope breast cancer

Here we go!

Our guardian angel and greatest blessing that brought light to this journey: Dr. Mary Yamashita

If you ever need someone to read your breast imaging, she will be your golden key to precise, accurate answers. You will just need to trust me on this one. My story is too long to write here.

Once my diagnosis was confirmed, the planning began. Informing family, friends and patients were all in this initial stage of planning. And yes, I was afraid. The unknown is very scary to me. I have read all about the chemo meds and understand their side effects but how does that apply to me? Will I tolerate this? Can I still be active and “functional”? Can I get up to make my boys’ lunches and do normal things mommies do and is it okay to do so? Can I still go in to do deliveries and see patients?  Will overdoing affect my treatment results? All these questions were fired at our doctors in the days to come. 

As my diagnosis became known to family and friends, an army appeared. I will let the pictures below explain itself.  To all our Prayer Warriors:  YOU are my rock, my fort, my reason why I will win this battle.  You will not see my footprints in the sand, for during these times of trial I have been lifted and carried.  God is truly good.

Chemo Day 1

Oct 23, 2020:

We all gathered for the morning mass at Sts Simon and Jude Catholic Church.  Here a special blessing and anointing of the sick was given by Father Mike Rizzo to kickstart my treatment.

As family and friends gathered, Fr Mike gave a powerful homily reminding those present to not only be supportive on Day 1 of this journey but Day 30, Day 180, etc. My tears were definitely welling up at this point. Not because I was afraid to be alone but because I knew of the large army sitting right behind me ready to take on this battle  to the ‘nth day with me where we can proclaim cancer-free. My anxiety though, was starting to build…

Chemo infusion ddAC 1 of 4 (1 of 8 total):

Dr. Pham chemo day 1

I overall tolerated both chemo drugs very well.  However, I did experience an adverse reaction to one of the chemo pre-med Emend (horrible heartburn and flushing), but once it was stopped and the IV rate was slowed at restart, all was good to go!

Chemo Day 2:

A day of trial. I woke up to unusual epigastric and right upper quadrant pain…waited around but the pain didn’t go away and the nausea started to kick in very abruptly.  It was like it was angry at me for some reason.  I decided to take a dose of zofran and within half an hour, the pain miraculously subsided and my exhaustion and sleep took over again.

Morning came and overall I felt renewed although just slightly weak.  Feeling the extra energy I went around the house, did dishes, and some laundry. By 10 am I started to feel the quizziness again.  Since this was unchartered territory I decided to trial Zyprexa which was supposed to be one of the chemo pre-med and post-med for nausea.  Needless to say I am quite sensitive to almost any meds. The Zyprexa gave me an out of body experience with slurred speech and knocked me right into a deep sleep, where I could not keep my eyes open for longer than a minute.  Even though my sisters and best friend were all at my house, I was able to peek open my eyes for just a few seconds and fell right back to oblivion…this was definitely a first for me!

Chemo Day 5: 

Pushing the limit!

I woke up to NO nausea or headaches so…I decided to go into the office to see a patient. Lo and behold, we had to send this patient into the hospital for the delivery because the patient was in labor but was supposed to have a repeat c-section! I was still feeling quite well, so went on later that day to perform her repeat c-section and met beautiful baby Olivia for the first time in person. This absolutely made my day! More importantly, I made it home in time to say grace and have dinner with my kiddos:-).  Family has and will always be my top priority but at times it is very challenging.  As in the last sentence of our Hippocratic Oath “…may I long experience the joy of healing those who seek my help” – this my friend is pure joy.  My heart is happy.  No “C” can ever take this from me. 

Dr. Pham and baby Olivia

Chemo Days 13-15:

It seems I have been stuck with writer’s block for quite some time now. I apologize for being stuck in this fog for so long. Reflecting on these two days seem so distant yet so near.  It was exactly the day before my 2nd round of chemo when I started collecting large clumps of hair the size of my palm.  Nothing could have really prepared me for the feelings of helplessness that rushed over me as I tried to frantically pick up my long strands of black hair from my neck, shoulders and all over the ground. Everytime I touched my head, clumps of hair fell effortlessly between my fingers. It almost felt as if part of my identity was fading right before my eyes.  Indeed there was a different image staring back at me in the mirror as I could make out small areas of balding that was not there before.  However, to a passerby, it may not have been so obvious because I was fortunate enough to have been born with a full head of hair.  The amount of hair falling out became unmanageable so the decision to shave all of it off was not difficult on Chemo Day #15.  I knew this day would come, as I have seen it, comforted patient after patient about it and was even gifted a beautiful wig from my sister in law to prepare for it but I was not immune to the overwhelming emotions that it gave me when it finally crept up on me. There is definitely an unspoken, amazing connection between a girl and her hair.  Just knowing that my hair will grow back one day made enduring all the emotion much more doable.

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Chemo cycles 3-4 of ddAC:

Christmas cancer journey
Christmas came early- gift from our SSJ community.

“The light shines in the darkness, and the darkness has not overcome it” John 1:5

The nausea, loss of appetite and fatigue progressively worsened in the last two cycles of ddAC. It became more difficult to walk up a flight of stairs but I endured. I had to. My chemo drugs were slowly wearing down on my body physically but my mind remained clear and it pushed my worn down body to try to and stay as active as possible.

I continued to go in for deliveries of beautiful babies, and saw patients in the office if only to reassure them that I was okay and they too would be okay and somehow, someway, we would make it through this “dark” year. 

I continued to encourage all my patients to stay vigilant in this fight to get through this COVID-19 pandemic, to not share the air and wear their masks at all times.  Reflecting on how my mind stayed clear and strong… I can only say that this is an immersion of love and prayers from our family, friends and community. 

The food deliveries to our home during my chemo infusion days continued from our loving SSJ community. We were filled to the rim from our bellies to our hearts. My vitamins were being provided from the freshest vegetable and fruit juices after hours of juicing from my dear friend Nicole Nguyen who appeared at my door religiously after every chemo session.  For all of this I remain steadfast, and am beyond grateful to be alive and well so that I can watch my boys grow, be silly and do what I love most.

“Cautious Optism”- Chemo cycle #1 of 4 for ddTaxol (5 of 8 total treatments):

I walked into this second half of my chemo treatments with cautious optimism.  A repeat breast MRI, ultrasound and mammograms were done shortly before the start of the second half of our  chemo regimen.  The anxiety was real. If these scans do not show stability or if there is increase growth of the cancer, we would proceed directly with surgery and forego the rest of of our chemo treatments.  Fortunately,, the repeat images showed a small shrinkage of both the cancerous mass and lymph nodes, which translates as a positive response to the initial neoadjuvant chemo (ddAC).  I became hopeful for this second half of my treatment because everyone from the nurses, to pharmacists to physician informed me that “it” would be much more tolerable, especially in terms of the nausea and vomiting. They did however, warn me about possible numbing of my fingers and some bone pain.  Again, I walked in with cautious optimism knowing that there was a higher rate of drug reaction with Taxol, hence the large dose of steroids I had to take before the infusion.   I tried not to think much of these side effects as I was secretly glad that I was going to get my taste and appetite back. 

Unfortunately I was not prepared for what was to come.  The bone pain came unexpectedly, shooting from all different parts of my body, from my knees, to my hip bones and throughout my shoulder blades. The pain came intense, every 15-20 minutes, reminding me of…labor pains! There was no epidural to ease these pains. I succumbed to a trial of ibuprofen, no relief. Then acetaminophen (Tylenol extra strength 500mg) with actually some relief. My liver is very sensitive to Tylenol so I was cautious to take only one dose a day to take off the edge, mainly at night so I could get some sleep. With just a total of three doses over the course of three days, my liver enzymes nearly tripled. So there goes my option for pain control for the next round of Taxol! The agony of enduring this pain and not being able to walk up a flight of stairs without holding on to the guard rails for dear life was none like others that I have experienced before.  So I share with you a pain that is not commonly spoken of but is quite real and for some of us more debilitating than losing our appetite. I have found hot steam showers to help, as well as my electric heat pad. Praying and researching for better remedies to counter these side effects for the next round but until then…we are going to let it ride.

Jan 29, 2021: Chemo Freedom Bell – 4/4 ddTaxol- the final dose (8/8 total!)

cancer last chemo

Again, life has taken the best of me keeping me busy switching from all sorts of hats (Mommy, doctor, wife, patient, housemaid, short chef, etc). So time flies and before you know it I was walking into my “hopefully” last course of chemo infusion.

It’s hard to even explain this surreal feeling, almost like a bad dream that kept coming back or now a good dream that you survived through it all. It seems like a very long tunnel that we have been walking through these last four months and for the first time, the rays of sunshine can be felt as I rang the “Chemo Freedom Bell.”

SSJ community giving their “high fives” as I walk into my last cycle of chemo, many with loving words of comfort and joy (photo below).  As we dropped our kids off to school before my last treatment, there was a beautiful rainbow that appeared in plain view above us to embrace and bringing immediate warmth to our hearts.

Dr. Pham's cancer journey
unnamed
last chemo rainbow
chemo freedom bell

March 9, 2021

The anticipated day for the surgical removal of my breast cancer came and left.  The weekend leading up to this was busy with delivery of another beautiful baby. Adding to this beauty was the St. Simon and Jude Moms Community Zoom gathering with a Rosary session and a special prayer/intention for my speedy recovery and healing from the coming surgery.  The power of prayer is very real.  My greatest anxiety before the surgery was getting my brain tickled with yet another COVID nasal swab and the nuclear injection around my right breast so my surgeon can perform her sentinel lymph node dissection.  The injections were very brief (seconds to be exact) but quite painful like a deep bee sting.  Being on the patient side of the pre-op area was quite the experience for me.  Since I already knew the feeling of being on the “other side” my anxiety level was not so bad, but it was still there along with some fear of the “unknown” while I was being prepared to go into a deep slumber of some sort. Seeing that my life has been so busy, God decided I needed a longer nap so my surgery was a few hours longer than anticipated. I vaguely remember being told it was almost noon before taking this nap and then woke up in the recovery room sometime after 10pm. I ended up having a full radical left axillary dissection in addition to the planned bilateral mastectomies. With God’s grace and a very skilled plastics surgeon at USC, three of my lymphatic channels were reanastomosed. Post anesthesia recovery was quite the experience as I was given appropriate pain meds to relieve the feeling of having been run over by a truck. However, I could not tolerate any of the narcotic pain relievers. It was almost projectile vomiting and a worse feeling than the pain in my chest wall. So I was only able to resort to just acetaminophen and ibuprofen as my main source of pain relievers and some valium to help with the soreness. Once I figured out what my body could tolerate for pain, I was able to go home to the comforts of my bed, warm blankets and kids warm hugs.  

The much anticipated first post-operative visit and review of my final pathology report came with much anxiety. Fortunately all the cancer is out of my breast tissue on both sides with nice negative margins. However, there is still a long battle ahead of us because there were a lot more positive lymph nodes than we anticipated and would like to see.  Fortunately for me, as I have mentioned from the beginning of my journey blog, I have been graced with the strongest army of prayer warriors fighting this battle with me and carrying me through it all. I have kept busy reading about clinical trials, new breast cancer treatment, etc and in my corner, friends and colleagues from Hawaii, to Vegas to Northern CA have offered their expert opinions and helped me to formulate my next strategic move in our aggressive attempt to rid of this monstrosity that has grown in my body. 

I thank everyone for their prayers, love and support as we travel through this journey together. My heart continues to beat to the rhythm of your love and it remains very strong.  I will not lie, there is so much guilt inside of me as I am not able to wear my different hats/roles, especially as a doctor during this whole ordeal.  So to my loving patients…thank you for your understanding, support and patience as I try to beat this battle and come back to doing what I love with an even stronger heart and mindset.

As it is March, here is an Irish Blessing to all:

“May God grant you always…

A sunbeam to warm you,

A moonbeam to charm you,

A sheltering Angel so nothing can harm you.

Laughter to cheer you,

Faithful friends near you,

And whenever you pray,

Heaven to hear you.”

breast cancer journey

Happy Spring- stroll in the park with my baby nephew to get some Vitamin D after surgery.

  Love is all we need. We will prevail!

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