Quality over Quantity

Yes, we have reached this point.

Ever since I returned from my trip to Portland I haven't felt very well. I have had extreme fatigue and weakness. I have been a bit short of breath, and the best way to describe it is that I can feel my lungs. They don't hurt, I am just aware of them. There is a slight wheeze in my deep breaths. I kept telling myself that it is just the Keytruda starting to work and maybe getting a little pneumonitis from the treatment (that's one of the side effects). I started to realize that something had to be off with my oxygen but when I went in for my second infusion (this round) and they would test me it would be in the normal range.
I finally called to tell them what my thoughts were and how I thought something was wrong. They got me up into the Acute Care Clinic (basically an emergency center at Huntsman) and started to do some tests. Again, sitting my oxygen was in normal range, around 96%. They then did a walking test and it dropped down to the 70's. This caused us to get a emergency CT scan. I already was scheduled for a MRI that day so it was just added to the mix. When the CT was read the doctor came in and said that there was definitely disease progression and that they had made an appointment with my oncologist for the next day and he would go over more. I knew that wasn't good. In my head though I thought that we would maybe hit it with some strong radiation or switch to something. Regardless I came up to the appointment the next day.
My team came in and we were talking about how there was definitely pneumonitis in my lungs and we would add my favorite thing, prednisone, to help take that away. Maybe pausing the Keytruda for a week or so to give it time to calm down. My doctor left the room for a minute and then came back in. Everything was different then. He said that he had sent my scans over to another Melanoma guy to look at and see what he had to see and it was what we all didn't want to admit. It wasn't pneumonitis, it was all disease with a small bit of pneumonitis. The cancer has grown substantially in the month between scans and has involved my lymphatics throughout the lungs and is growing too rapidly for any treatment to keep up. I have run out of treatment options. I am at the end of the line for things and we need to enter into symptom management, and I was given 6-8 weeks left.

6-8 weeks.

The tears started to flow as I realized what I was hearing and that we were to a point of deciding quality or quantity. I wasn't supposed to get here. We've never talked numbers. We always are optimistic. We had an unspoken understanding that we don't talk numbers because I will be the one who defies the odds. Tears were being shed throughout the room. He offered that I could do chemo again, but it would only add 2 or so weeks of life. And I would be sick. I don't want to be sick if I only have a limited time.
So here we are. I don't know what this looks like. I don't know how fast I will slowly fall ill to the side effects of the tumors and cancer taking over. Right now I feel good, look good. Prednisone helps with that. I can feel the tumors in my lungs are there, can feel that there is some progression in my bones and around my liver area. I know it's there. That is what is scary; I can't say that I don't believe the timeline.

Since the news I have been trying to tell people intimately but it is so hard and draining. I feel like the last few days have lasted a lifetime and all are blurring together. This morning seems like a lifetime away and my mind is just going a bit numb. This news that I never wanted to share is now a reality. It has already brought out some tough conversations, ones you have to have in these times. Has also brought forward the need and desire to see those I care about and hug them all at least one more time.

I don't know what this is all supposed to look like - all I know is I want to spend the rest of my time with the people I love, doing the things that make me smile and laugh and making memories. I have been so lucky to have been living out my bucket list for the past 2+ years that there isn't anything I feel I have to do. What I want is to be with the ones I love and care about. I will keep on doing things as I still feel well, and when I start to not feel well we will cross that bridge then.

For now I am right back to my motto along the whole line of this fight, one day at a time. One moment at a time, and truly one second at a time.

One day at a time.

Still no decision

Here we are late Tuesday night and there still isn't an action plan in place for the next step in treatment. Can I say though that I have some amazing nurses? I emailed my PA and asked for her to call me and she did, from her vacation in California. I mean how considerate is that? We talked about what I was thinking of going forward, she talked a bit about their thoughts and then said that she would then talk to the doctor today and get back to me. No call today though, so I know I will hear from them tomorrow.
Here are my thoughts.
Just Radiation: Not a fan. If just radiation, then the dosing will be much larger as there is a larger tumor/cells to treat. It will be a re-do of the side effects I had before and I would anticipate severe burns, troubles in my eating/swallowing/mouth with a possibility of a feeding tube. The larger tumor is right about my thyroid so it would hit that hard. The smaller tumor is right on top of my larynx so my radiologist fears it will permanently affect my voice. I also worry that it isn't enough of an attack on the situation.
Surgery then Radiation: This is what I am leaning towards. I don't know the possible complications involved in doing the surgery on the front of my neck, so I don't have a good opinion on what would happen with surgery. As it looks right now it would be just removing these two tumors, which should be relatively noninvasive. Obviously there is possible nerve damage and scaring, but it should be minimal. If they have to do another lymph node dissection then that's a different story. I haven't heard of any additional disease in the right side of neck so I don't see the reason for removing lymph nodes at this time. Also can you go without that many lymph nodes in one main area? Seems a bit crazy to me. After surgery there would be radiation and I have almost all of the listed above concerns. Also to add to the radiation concerns is I would have to go off of my systematic treatment while doing radiation treatment so that is always nerve wracking.
Injectable Treatments: Not on board. An injectable treatment is where they trigger treatment by injecting into the tumor directly, usually using a virus of some sort. It then trains your body to kill those type of cancer cells and begins acting like a vaccine for the rest of the body/tumors/cells. While this sounds good, it actually is poorly timed for my situation. These two tumors have shown they are molecularly different than my other tumors and they are growing while all the others are shrinking in response to my BRaf inhibitor treatment. So with that, the injectable would only treat this exact type of tumor instead of all of them. That is too risky to let them run wild while only focusing on two tumors.

Can only see one tumor here... but you can see just how odd my neck shape is after all the surgeries and treatments. Plus the radiation marker tattoo that looks like a black mole. Also note my dimple chin, beauty mark and "A" necklace that I've worn for 13+ years. 

I am eager to hear what my team suggests. But until then, and until I start whatever is next, I am feeling pretty good. This sinus infection is still lingering but isn't holding me back thankfully. I am trying to cram in as much as I can now since I am pretty sure I will be knocked down in the coming weeks. My trip to San Diego this weekend couldn't have been better timed and I am excited to just go and have a fun time. I am hoping that they clear me to have some cocktails... champagne brunch anyone?! My mind has been running wild lately (for many different reasons, not really on cancer bs) so I need to reset (again). The day before I go I am actually going to see a medium/spiritual counselor. Mediums, if you aren't familiar with them, speak to those who have passed on. I have been before but I had never had anyone close to me who had passed at that time. Now I have several so it should be interesting. I don't have any unanswered questions or messages for those people who have passed, but I just want to see if they come through. Maybe they have some insight. Maybe its all insane? I look at it as entertainment at the least, and take it all with a grain of salt so we shall see how it goes. I will definitely write about it though.

Also I know I have some new followers on here - so hello and thanks for following my journey through this madness! Hope my long-winded-ness doesn't bore you!

Hopefully I will be writing next about the decision on the next treatment (you know, treatment change #14, or is it #15. Lost count...)

Onward, one day at a time.

Good Ol' Snapchat Filters; guessing this is a baby bear? 

Hung my bird feeders this weekend! Hopefully I get lots and lots of hummingbirds!

A letter to my representatives

As many of us are faced with so many hard trials through life in general, let alone add in a stage IV cancer diagnosis, one thing you shouldn't be faced with is the possibility of losing your health coverage. Right now there are some dangerous bills floating around our government and it is important to share our stories so people know what they are voting on. I sent the following to my representatives in hopes to be heard and stop a dangerous change from happening. We shall see what happens. For now I know that I am covered for 2017. 

"I am a 34 year old Utah native and I have stage IV melanoma and have been fighting for 8 years. I've fought through being declined insurance by four insurance companies for preexisting conditions/high risk when that was legal; then I carried "catastrophic care" insurance until the Affordable Care Act was implemented.
My treatments are ever changing and prices range from $5k to $250k depending on what I have to do to keep fighting. I reached my deductible and out of pocket maximum on January 10th of this year.
With the new American Health Care Act I fear my life will be in jeopardy as I am a preexisting condition, and an expensive one at that. I will reach the maximum lifetime limit quickly and will literally have to choose between life and death possibly, due to a vote you will place that affects millions of lives.
Please put faces to your votes, not dollar signs, and show that you are an understanding and caring human that doesn't wish the worst on people.
My name is Alexis Waters and I choose to fight to live and I want you to fight to allow me that right. I didn't choose this battle but I want the choice of how I fight to be mine, not the governments."

If you don't speak up, you'll never be heard