Nov. 4, 2021

Day 77: Did the Tumor Shrink?

Day 77: Did the Tumor Shrink?

After 11 long weeks of chemotherapy we’re at the clinic to see Dr. Ali, the oncologist. Kristen is hopeful because she can see her tumor and it appears on the surface like it’s getting smaller. But the only true measure of whether the tumor has grown is the MRI, and Dr. Ali delivers the news

After 11 long weeks of chemotherapy we’re at the clinic to see Dr. Ali, the oncologist. Kristen is hopeful because she can see her tumor and it appears on the surface like it’s getting smaller. But the only true measure of whether the tumor has grown is the MRI, and Dr. Ali delivers the news.

Kristen can’t shake the question of why shrinking the tumor even matters if it’s going to be removed with surgery in a few weeks. She forces herself into a different mindset about treatment.

In this episode, we go with Kristen to the actual appointment and hear her conversations with the doctors.


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Meet Kristen’s doctors: surgical oncologist Dr. Louis Rivera, hematologist and oncologist Dr. Sonia Ali, plastic surgeon Dr. Salvatore Pacella, and radiation oncologists Dr. Anuradha Koka and Dr. Kenneth T. Shimizu.

About Breast Cancer Stories

Breast Cancer Stories follows Kristen Vengler, a 56 year old single empty nester in San Diego, from her diagnosis of hormone positive breast cancer through chemotherapy, mastectomy & breast reconstruction, radiation, and whatever happens after that.

In 2020, Kristen moved from Austin to San Diego to be near family and start her life over after a life-shattering workplace trauma. A few months later she had that terrifying moment in the shower we all hope we never have.

From her breast cancer diagnosis, through chemotherapy, breast reconstruction, and radiation, we experience each new milestone as it happens. This podcast is about what happens when you have breast cancer, told in real time.

Support the show by sharing online, writing a review, or donating at .

Host and Executive Producer: Eva Sheie
Co-Host: Kristen Vengler
Editor and Audio Engineer: Daniel Croeser
Theme Music: Them Highs and Lows, Bird of Figment
Production Assistant: Mary Ellen Clarkson
Cover Art Designer: Shawn Hiatt

Breast Cancer Stories is a production of The Axis.



Eva Sheie (00:07): Kristen's chemotherapy's been going on for a while now. And she's just had an MRI. Today we're at her oncology appointment to find out if that tumor is growing or shrinking. So she and I talked on Zoom while she was waiting to be called back for that appointment. And after our update, you'll hear the actual recording of her appointment with Dr. Ali and the tumor progress update. This is a story about what happens when you have breast cancer told in real time.

Kristen (00:51): I'm not in your way, am I? I'm good?

Speaker 3 (00:52): No you're not in the way.

Kristen (00:53): You're good? Okay. Okay. Great.

Speaker 3 (00:54): I'm just going to leave this here.

Kristen (00:55): Totally.

Speaker 3 (00:56): Thank you.

Kristen (00:56): Yeah.

Eva Sheie (01:00): It actually looks like you're in cozy booth at a restaurant where you're about to have... I imagine that you're about to have eggs and hash browns where you're sitting.

Kristen (01:09): That would be so good right now.

Eva Sheie (01:10): Wouldn't it?

Kristen (01:13): I'd love that. Yeah, I'm sitting in a little corner over by the internal medicine department. And they have one of this little sweet area.

Eva Sheie (01:24): Okay. So talk to me about today. What are you doing over there?

Kristen (01:30): Today, I get my port thing done. If you can see the party that's going on right here.

Eva Sheie (01:36): It looks like you have a big round bandage over the part of your shoulder that is just above your armpit. With the port on it.

Kristen (01:47): It's over my port. Can you see this tube thing right here? No, hang on.

Eva Sheie (01:53): Yeah. It looks like the edge of an IV.

Kristen (01:56): Yeah, that's what it is. And so it's in my port, my chest. But today I see the doctor. And so on the days that I see the doctor, it takes a little bit longer. So I go over and they access my port. So I put lidocaine on before I get here, to numb the port area, because the needle's pretty big that they put in and then I cover it with saran wrap and tape an hour before. And so I get here and they take that off and they clean it and then they access the port and then they flush it to be sure that it's clean and there's no blockages. And then they make sure there's a good blood return and they take my labs. And then I wait here for about an hour so the labs have time to process. And then I go in and see my doctor.

Eva Sheie (02:38): Does it feel all chilly when they flush the port?

Kristen (02:41): Yes. And it tastes like what you would think it acetone taste like. Nail polish remover.

Eva Sheie (02:48): Yeah.

Kristen (02:48): And I've never tasted it, but you get a taste in your mouth. It's really weird because they flush it with saline. So you think it would be a salty taste. Right? But it's not. Whatever happens in your body, it tastes like what you think nail polish remover would taste like.

Eva Sheie (03:03): Well that sounds very unpleasant.

Kristen (03:06): It's super great. So what they do is they put the IV in, they flush it also, and then they put the different medicines in and stuff like that. So the port stuff is done over in the hematology area. They have to have a certain specialization to do that. So it's totally different from an IV draw in your arm.

Eva Sheie (03:28): Yeah.

Kristen (03:29): So the whole reason that they do a port is so that they don't break your veins in your arm because they're accessing it so much. They're putting poison in there for hours at a time. That's really rough on your veins. I don't know if you can see right here. Looks like a vein. Can you see that?

Eva Sheie (03:45): Yeah.

Kristen (03:46): So what that is, is it's a tube that they put in that goes from the port up to my carotid artery and then it goes down into my chest and down into my heart and into my veins.

Eva Sheie (03:58): Wow.

Kristen (03:58): Isn't that crazy?

Eva Sheie (03:59): Yeah.

Kristen (04:00): Yeah, I'll have to send you the graphic of it. So I see the doctor with this chemo. It's Taxol. And I see the doctor with this chemo every three weeks because it's not as harsh as the AC chemo that we were doing the first eight weeks. So I'll see her today after getting the ultrasound and the MRI that I had last week. So I think I texted you and said that the tumor had shrunk a little bit, right? Like 0.2 centimeters. And that was from ultrasound. And then when I went to the MRI, I got the information and it shrunk on one side 0.2 centimeters. Everywhere else it's the same size, but it hasn't grown in three months. It hasn't shrunk a lot.

Kristen (04:48): I know that my oncologist was a little bit disappointed that the tumor you can see on the outside hadn't shrunk. And I think I sent you an audio tape. I think I still have it bur what she said... And I was like, "Okay, great." She's like, "Well we're trying a new medicine so maybe that one will work better." And I'm thinking so the last eight weeks of hell were for nothing? And so I hope I'm making sense with this because I've had a hard time understanding why it's important to them that it shrinks.

Eva Sheie (05:19): Mm-hmm (affirmative).

Kristen (05:21): Because in my brain they're just going to take it off in June.

Eva Sheie (05:24): Right.

Kristen (05:24): So if they take off two centimeters or one centimeter, they're still taking it all off. And what she's explained to me is that the goal is to cure the cancer. It's not just to save my life. And with curing the cancer, is having the chemo go in and kill all those micro cells that could be lurking. That are small enough that you can't see them in a scan. Does that make sense?

Eva Sheie (05:51): It does. Have you asked how often are they actually switching medications? It seems like it's-

Kristen (06:00): Just the once.

Eva Sheie (06:01): Is that typical that they have to try different stuff?

Kristen (06:05): So I think it's typical depending on your diagnosis and on your stage. Because a lot of people are confused as to why they're doing chemo before they're doing surgery. Because a lot of times they just do surgery. Because I've been sitting here with this tumor in my body that I've known about for four months and I want it out. But I think depending on the type of... Oh, just all the different things that are going on with your cancer, that they have different protocols. And so this protocol was using two different medications, not necessarily changing because one wasn't working but doing two different types-

Eva Sheie (06:48): Mm-hmm (affirmative).

Kristen (06:49): ... of chemo protocols. Right? And so, hang on one sec. There's a lot going on right now.

Kristen (07:00): Okay. So we're back. What I do love about my oncologist is she's extremely straightforward. She'll just say it. And so she was just like, "Well, so we're starting a new medication. So maybe this one will be more aggressive," is kind of what she said. And so to me, all I can think of is, we're doing all of this to kill the micro cells. I can't be worried about whether it's shrinking or not. If it shrinks, that means to me that the medication is killing the micro cells. That's what I envision. That it's working, even if it's not growing, even if the tumor isn't growing. At least the medication is working to kill anything that might be sitting out there getting ready to form something else. So I'll see my doctor and then I'll talk to her about the MRI.

Kristen (07:51): Uh oh, hang on. I think they're calling me.

Eva Sheie (07:55): Okay.

Kristen (07:56): Sorry. I hear it from around the area over there. Okay. Sorry. Got to run.

Kristen (08:03): So we're waiting for Dr. Ali. And let's see, what was my blood pressure? 106/65 which is high for me. I'm usually probably 100 on the top one. But apparently she has a fellow [inaudible 00:08:20].

Dr. Beck (08:22): Hello.

Kristen (08:23): How are you?

Dr. Beck (08:24): Hi. I'm good. Dr. Beck.

Kristen (08:25): Nice to meet you.

Dr. Beck (08:25): I think I've seen you... Have I seen you before?

Kristen (08:27): I don't think so but you have great hair. I'm super envious these days.

Dr. Beck (08:31): Well, I spent years and years chopping it all off and donating it. So hopefully someone got something.

Kristen (08:40): Sure. Nice to meet you.

Dr. Beck (08:40): But I work with... Nice to meet you. I work with Dr. Ali, I'm one of her fellows. I think you've seen a fellows before, so.

Kristen (08:44): I haven't, but that's great. I think its awesome.

Dr. Beck (08:46): Well, she is training us and I want to do breast cancer. So I know you're here for cycle four of your Taxol. How has it been compared to the AC?

Kristen (08:56): I haven't felt as nauseous.

Dr. Beck (08:57): Very good.

Kristen (08:58): Which is good. My sleep has been horrible. And so I don't know why. I don't know if it's different.

Dr. Beck (09:05): Are you on steroids?

Kristen (09:06): Mm-hmm (affirmative). Well, I'm not... They're giving the steroids with the chemo.

Dr. Beck (09:09): Yeah.

Kristen (09:09): But I'm not taking it days 2, 3, 4, like I was which is-

Dr. Beck (09:13): [crosstalk 00:09:13] Very strange that you wouldn't have. Okay.

Kristen (09:15): I know it's weird. Like I've noticed that I can go to sleep, but I'm up easily at three and wide awake. I've been taking melatonin. And so that's been helping a little, but then it will be...Like tomorrow, it'll take me probably until about two in the morning to go to sleep. It's really weird. And I've noticed some anxiety of chest pains.

Dr. Beck (09:45): Okay.

Kristen (09:45): Which is weird. I don't know what's going on with that. And nothing's changed in my life.

Dr. Beck (09:49): When it's time to sleep?

Kristen (09:50): Just even when I'm in there on the chemo, which is weird because I'm not nervous about it or anything,

Dr. Beck (09:58): But you think it's basically anxiety?

Kristen (10:00): I can feel... Yeah, I used to have anxiety attacks and stuff and I haven't had those in forever.

Dr. Beck (10:04): Are you still taking your medication for anxiety?

Kristen (10:06): Mm-hmm (affirmative).

Dr. Beck (10:06): Okay.

Kristen (10:06): Yeah. I'm taking the-

Dr. Beck (10:07): The Wellbutrin-

Kristen (10:07): ... The Wellbutrin and the... Is it Cymbalta?

Dr. Beck (10:12): Cymbalta. Okay.

Kristen (10:13): Yeah.

Dr. Beck (10:14): Do you have Ativan as needed? If you want, you can take one before treatment.

Kristen (10:17): I don't. Uh-uh (negative).

Dr. Beck (10:19): So, that's an option.

Kristen (10:20): Okay.

Dr. Beck (10:20): It can help.

Kristen (10:23): Okay.

Dr. Beck (10:24): If it's just with treatment. I don't know if you want to be taking that. Do you drive yourself to treatment?

Kristen (10:26): No, I have somebody who brings me and picks me up. But what it does is it kind of starts an anxiety thing that keeps going and I have to really-

Dr. Beck (10:32): It's hard to get away. Right. Yeah, we can definitely have you. I'll talk about Ativan. And then you said nausea is better. So are you eating okay? Are you-

Kristen (10:42): I put on, I think 20 pounds, which is a lot to me. She's happy that I'm not losing weight.

Dr. Beck (10:48): I know. And then any nail changes or numbness and tingling? No? You can grab everything? You're not dropping anything?

Kristen (10:54): Yeah. So far I have the ice things so that they stay nice and cold.

Dr. Beck (10:56): All right. I know I'm allowed to tell you, your labs is really good today.

Kristen (11:02): Oh good.

Dr. Beck (11:04): So, very, very mild anemia, but it's over 11. So very good. Your platelets are good. White blood cell count is good. So I don't have a lot to tell you.

Kristen (11:13): That's awesome.

Dr. Beck (11:13): Just keep staying hydrated. As far as anything else, if there's anything you think of when I bring her back in, we can talk about it.

Kristen (11:21): We did an MRI and an ultrasound.

Dr. Beck (11:24): And someone called you and told you.

Kristen (11:26): Well, I got the ultrasound immediately.

Dr. Beck (11:30): Yeah it shrunk. Can you feel anything?

Kristen (11:30): Can I feel it different?

Dr. Beck (11:30): Yeah.

Kristen (11:30): Mm-mm (negative).

Dr. Beck (11:30): Okay.

Kristen (11:33): I mean, not really.

Dr. Beck (11:34): But you can feel the area?

Kristen (11:36): Uh-huh (affirmative).

Dr. Beck (11:36): Okay.

Kristen (11:36): Yeah, you can see it and feel it. It would probably be really good for me to see because-

Dr. Beck (11:39): Yeah, I'd love to. Would you mind hopping up?

Kristen (11:44): No. I'm always like, I get to see my cancer. I mean, who gets to do that.

Dr. Beck (11:48): Well, then you can follow it. You make sure everything we're doing is working.

Kristen (11:53): Yeah. [crosstalk 00:11:53]

Dr. Beck (11:53): All right, we can unzip. I know it's not the warmest [crosstalk 00:11:57] .

Kristen (11:57): That's okay. I'll take this off. I just don't want to mess with the port part. Okay.

Dr. Beck (12:06): Okay. So let's see. To me, it looks different when I look at it like this.

Kristen (12:08): Would it be okay if I laid back?

Dr. Beck (12:09): Totally.

Kristen (12:10): Because you used to be able to see an indentation down there.

Dr. Beck (12:14): And you can't anymore.

Kristen (12:15): No.

Dr. Beck (12:16): So that's good. So not only... Well, we have the best way we have imaging, but we also have this here.

Kristen (12:24): I think it started at two centimeters but I don't know what it's at on the surface. But it's interesting because you wouldn't... I mean, I expected when, if it's cancer or to be like this big thing you can definitely see a difference with. And it's not. I mean, if you compare the two.

Dr. Beck (12:38): It's just the bit under the nipple, correct?

Kristen (12:40): Mm-hmm (affirmative).

Dr. Beck (12:41): Yeah.

Kristen (12:41): Because if you compare the two, I mean.

Dr. Beck (12:44): Yeah. Okay.

Kristen (12:46): That's the only way that I know.

Dr. Beck (12:49): Well, yeah, because sometimes nipple areas can be firm. The areola-

Kristen (12:51): Completely.

Dr. Beck (12:51): ... It really can be.

Kristen (12:54): Yeah. The only way I knew, that I found it is that this was a little flatter.

Dr. Beck (12:58): I'm going to have you lay here. Better for you. That usually is the case. But-

Kristen (13:02): That's what I've heard.

Dr. Beck (13:02): ... Everyone's different though. So, glad that it wasn't you. All right, you can sit up.

Kristen (13:07): More fatigued obviously, because it's chemo day.

Dr. Beck (13:09): It's chemo day.

Kristen (13:09): Yeah.

Dr. Beck (13:09): Did you get outside this weekend? You can go ahead and put that jacket on.

Kristen (13:14): I did.

Dr. Beck (13:14): Yeah.

Kristen (13:14): Yeah, in fact-

Dr. Beck (13:16): It's a beautiful weekend, right?

Kristen (13:17): So pretty. In fact, last weekend. Check out what I did in my head. I had this headband on.

Dr. Beck (13:22): Yeah.

Kristen (13:23): And look.

Dr. Beck (13:24): Oh my God. How cute. Yeah you got a little sun in the back of your shoulder.

Kristen (13:29): That was yesterday.

Dr. Beck (13:31): Yesterday? It looks like a little tan.

Kristen (13:33): Isn't that funny? I didn't notice it until I was walking outside and my neighbors like, "Hey, nice yamaka." I'm like "What?" And he is like,-

Dr. Beck (13:39): Your hair is starting to-

Kristen (13:40): Yeah, it is. I usually shave it but because of this, it was peeling a little bit. I didn't want to aggravate it.

Dr. Beck (13:48): Oh yeah, I see it peeling a little bit. Okay. Well, you're not used to it.

Kristen (13:52): Yeah. I mean-

Dr. Beck (13:54): Who thinks of it except people like my dad who are balding and things like that.

Kristen (13:59): Right.

Dr. Beck (13:59): Did you ever feel anything in your armpits?

Kristen (14:01): No. Mm-mm (negative).

Dr. Beck (14:05): Okay. So I'm going to grab her. She's already gone over everything. So this will be cycle four. So you have it for 12 cycles and then you're going to have surgery. So is Dr. Rivera your surgeon?

Kristen (14:16): Mm-hmm (affirmative).

Dr. Beck (14:16): Yeah that's correct. So maybe, I was wondering... I didn't see you have an appointment with him, but this will all be done in May.

Kristen (14:21): End of May. Yeah.

Dr. Beck (14:23): So maybe-

Kristen (14:24): When I talked to him in January, I think it was right after I started chemo. He said that we would connect again in April.

Dr. Beck (14:32): Oh, okay perfect. Well, we're getting there. So just make sure, because you don't have an appointment. I just don't want you to-

Kristen (14:38): Yeah.

Dr. Beck (14:39): ... miss the date. And that's it otherwise.

Kristen (14:41): Okay.

Dr. Beck (14:41): All right. I'll be right back. Be comfortable. Sit right on-

Kristen (14:44): She's going to want to see this too.

Dr. Beck (14:45): Probably. If you can drape that over you.

Kristen (14:47): Sure.

Dr. Beck (14:47): But yeah, she'll want to see it.

Kristen (14:48): Okay.

Dr. Beck (14:50): But I'm happy with that image.

Kristen (14:52): Good.

Dr. Beck (14:52): Keep shrinking.

Kristen (14:53): Me too.

Dr. Beck (14:53): Okay, be right back.

Kristen (14:53): My God, that girl had the best hair. She's so cute. So it must have shrunk more than what it looked like in the report to me. So it's good. It's good news. So I guess after today I'm halfway through the number of chemo's. So more than halfway through the time that I will have gone through eight of 16 chemo's. Girl, I gained 20 pounds, in two and a half months. Holy shit. It took me so long to lose that. Damn. Wow. My wrinkles aren't showing as much in my face then probably. We'll go with that.

Dr. Ali (15:43): Hey there.

Kristen (15:51): Hey. Like my look.

Dr. Ali (15:52): I like it.

Dr. Beck (15:53): Well, I told her. I told you that you told her to see it too.

Dr. Ali (15:58): So Taxol's going okay?

Kristen (15:59): Yeah. I was telling her that I don't sleep as well.

Dr. Ali (16:05): Yeah.

Kristen (16:06): Is that normal? Like, is it?

Dr. Ali (16:08): You do get some steroid pre medication when you get your infusion.

Kristen (16:11): Right.

Dr. Ali (16:11): So you're unlikely to sleep well tonight. Possibly tomorrow.

Kristen (16:15): That's what it, yeah.

Dr. Ali (16:16): So that's why.

Kristen (16:17): Okay. And it gives me a little bit of anxiety. Like-

Dr. Ali (16:20): It's the steroids.

Kristen (16:21): Okay. Steroids. Okay.

Dr. Ali (16:22): Yeah.

Kristen (16:22): All right. Good.

Dr. Ali (16:24): No neuropathy?

Kristen (16:26): No, not so far. The first week it was kind of like an ache.

Dr. Ali (16:29): Yeah.

Kristen (16:30): And if I really sit here and go like this, it aches a little bit, but it didn't before. It's like a 0.5 out of 10. It's not...

Dr. Ali (16:38): All right.

Kristen (16:39): Yeah, so I got my chest full of mittens and booties and-

Dr. Ali (16:43): Very good.

Kristen (16:44): Yeah.

Dr. Ali (16:45): Blood work showed slight increase in your liver function tests, but that happens on Taxol. We're just going to watch it.

Kristen (16:50): Okay.

Dr. Ali (16:51): Just make sure you're not taking Tylenol, drinking alcohol, drinking green tea.

Kristen (16:56): No green tea? Okay. I have drank green tea. I won't drink green tea.

Dr. Ali (16:58): No more green tea. We have noticed... I thought it was crazy, but actually we've noticed that green tea can affect liver function. Hop over there, let me take a look. Your MRI looked a little better. Still measuring about the same on exam.

Kristen (17:20): Okay.

Dr. Ali (17:20): All right, you're good. Carry on. And I will see you in three weeks.

Kristen (17:23): Okay.

Dr. Ali (17:23): You can call me if you need, okay?

Kristen (17:23): I will. Thank you. I'm glad to know that's normal because I was like, "What is going on? Am I like freaking out about the chemo or."

Dr. Ali (17:32): It's the steroids. Especially if it's just happening the day of and the day after.

Kristen (17:36): Mm-hmm (affirmative).

Dr. Ali (17:37): That's what's going on.

Kristen (17:38): Okay.

Dr. Ali (17:38): All right.

Kristen (17:38): Great.

Dr. Ali (17:39): Bye.

Kristen (17:40): Thank you. Nice to meet you.

Dr. Beck (17:40): Nice to meet you as well.

Speaker 3 (17:40): Okay. And you can head this way.

Kristen (17:47): And that was that.

Eva Sheie (17:54): Thanks for listening to Breast Cancer Stories. There's a link in the show notes with all of the resources mentioned on this episode and more info about how you can donate. If you're facing a breast cancer diagnosis and you want to tell your story on the podcast, send an email to I'm Eva Sheie your host and executive producer. Production support for the show comes from Mary Ellen Clarkson and our engineer is Daniel Croeser. Breast Cancer Stories is a production of The Axis.