"You've got something on your lung, but we'll watch it."
In 2002, Anna Mae Kaelber, 72, started to experience shortness of breath and sleep apnea (a condition in which breathing temporarily stops during sleep). As a result of these symptoms, she began to see a pulmonary specialist in Toms River, New Jersey.
It was during a routine chest x-ray in 2003 that the specialist found a spot on her right lung. A computed tomography (CT) scan confirmed the finding. "My doctor said, 'You have something on your lung, but we'll just watch it,'" Anna Mae recalls.
In August of that same year, she was diagnosed with early-stage breast cancer. She had surgery to remove the tumor and surrounding tissue (a procedure known as a lumpectomy) followed by radiation treatment, which she completed in April 2004.
Concerned about the spot on her lung, Anna Mae's breast oncologist asked her about it at each follow-up appointment, pressing her on how long she was going to watch it before doing something. At her insistence, in September 2004, nearly 12 months after the spot was initially found, her pulmonary doctor finally conducted a positron emission tomography (PET) scan of her lung. After the PET scan, he performed a biopsy.
The biopsy revealed that she had non-small cell lung carcinoma (also known as NSCLC) -- the most common type of lung cancer. Of the three different kinds of NSCLC, hers was an adenocarcinoma, the most common form, originating in the cells that line the tiny air sacs called alveoli, which are at the end of small branches called bronchioles that bring air into the lung. These cancers are rising in incidence worldwide.
"Unfortunately I think we watched it a little too long," she says, "but thank God it hadn't gone too far."
Non-small cell lung cancer is usually associated with a history of smoking. Anna Mae had smoked cigarettes for more than 30 years, but had quit smoking more than 20 years ago, at the age of 50, just before the birth of her first grandchild. She wasn't completely surprised at the diagnosis. "The doctor just looked at me and said, 'I don't have good news.' I said back to him, 'I have cancer, don't I?' And that's basically the way I handled it," she says matter-of-factly. "I didn't get hysterical. I've got cancer, so what am I going to do about it? Crying won't make it go away."
Dr. William Pao: A "Johnny-on-the-Spot"
When she got the diagnosis, Anna Mae decided to see a cancer specialist. That December, after consulting with her insurance company, she made an appointment at Memorial Sloan-Kettering Cancer Center with Dr. William Pao, a medical oncologist who specializes in lung cancer.
A few weeks later, Anna Mae drove one-and-a-half hours from her house on the New Jersey shore to her eldest daughter Laura's house in Bergen County, New Jersey, located just across the Hudson River from Manhattan. Laura went with her mother for that first appointment with Dr. Pao to offer moral support and a second pair of ears.
Lung cancer has a tendency to spread, or metastasize, to other parts of the body. To see if her cancer had spread, Dr. Pao ordered a PET scan of her body and a magnetic resonance imaging (MRI) scan of her brain, which is a common place that lung cancer metastasizes. With the results of her imaging and biopsy in-hand, Dr. Pao told Anna Mae that her cancer appeared to be confined to the right lung, which was good news. The probable course of treatment would be surgery, possibly followed by chemotherapy.
"Dr. Pao really laid all of the cards on the table," says Laura, recalling their meeting. "He was just so kind, so considerate, so good, so understanding," continues Anna Mae. "If you could get all of the beautiful words out of the dictionary, they all apply to Dr. Pao. He's a wonderful man."
Describing her oncologist as a "Johnny-on-the-spot," Anna Mae was impressed that he arranged that same day for her to see Dr. Nabil Rizk, a thoracic surgeon, to start planning her surgery.
"If You Stop to Think about Things Too Much, You Could Go Berserk"
Surgery is the most common treatment for lung cancer when it has not spread beyond the lung. Dr. Rizk recommended a lobectomy, a surgical procedure with which he would remove a lobe of her lung. After listening to what he had to say, Anna Mae scheduled her surgery for February.
"I just had to put my faith in him," she says, recalling that initial meeting with Dr. Rizk. "If you stop to think about things too much, you could go berserk."
The day of the surgery finally came, and Anna Mae's family waited anxiously for an update about how the operation had gone. When Dr. Rizk came out to talk with them, he was very upbeat and reassuring, reporting that everything had gone well and that he had removed the upper lobe of her right lung as well as a portion of the middle lobe. Also, he told them that it looked like the disease was in an early stage of development and confined to the lungs. (This was confirmed a few days later, when the pathology report showed that her cancer was stage 1-B.)
"Dr. Rizk was always very straightforward but very patient," says Anna Mae of her surgeon. "I never felt rushed by him. I always felt that he listened to what you said."
The morning after surgery, the nurses got Anna Mae out of bed and made her walk around the room -- this was to help avoid having any fluid retention in her lungs as they were healing. "And that was torture," she remembers, thinking back to how it felt to get back on her feet after surgery. "I had to walk around the hospital floor two or three times every day. But I pushed myself to do it. If they told me I had to do something, I would do it -- because I knew it was for my own good."
"My mother is a great patient," says Laura. "She will do whatever the doctor tells her."
A few days later, while still in the hospital, Anna Mae developed a tiny leak in her stitches, which was allowing air from her lungs to escape into the rest of her body. As a result, she developed a condition known as crepitus, which is characterized by a crackling or grating sound under the skin and around the lungs. Comparing the sound of crepitus to that of the popular breakfast cereal, this symptom is sometimes called "Rice Krispy face."
The crepitus caused her to become extremely bloated, and she was uncomfortable. "She looked very puffy," remembers Laura. "If you had stuck a pin in her, it looked like she would pop like a balloon!" The crepitus eventually subsided. Because of this complication, all in all, Anna Mae was in the hospital for 17 days, which is longer than the four days most patients stay in the hospital following lung cancer surgery.
"Do Something Crummy & Then Do Something Great"
About two months after surgery, Dr. Pao started Anna Mae on a regimen of chemotherapy to make sure any residual cancer cells were killed. Known as adjuvant therapy, this secondary treatment is given after primary treatment to increase the chances of survival.
Over a period of four months, Anna Mae received four rounds of chemotherapy. For each cycle of chemotherapy, one of her daughters, Laura or Joyce, drove her to Memorial Sloan-Kettering's Rockefeller Outpatient Pavilion at 53rd Street in Manhattan, to receive treatment.
"The chemo got progressively worse each time I went," says Anna Mae, shuddering at the memory. "The first time, I felt better after a week or so. The second one took longer, the third one longer yet. The fourth one, I was ready to die. But I came out of it, and everyday I feel better."
During her surgery and subsequent treatment, Anna Mae's family and friends were a great support to her. Her daughters kept everyone up-to-date with e-mails, and there was a never-ending flood of flowers and cards.
Always looking for the bright side of any situation, Anna Mae and her daughters made a deal that they would do something fun at the end of each treatment. "That's been our attitude," says Laura. "Do something crummy and then do something great." Anna Mae agrees: "It takes the edge off of things. We would go to lunch and catch a show. Or go to Bloomingdale's and hope they have a sale."
In many ways the hardest part of treatment for Anna Mae was losing her hair, which is one of the most common -- but often one of the most emotionally difficult -- side effects of chemotherapy.
Not knowing how she would react to losing her hair, Anna Mae used, at first, a kerchief or turban to hide her balding head. Realizing that she would need something more than that, Laura remembers picking out a turban with bangs for her mother on the 11th floor at the Rockefeller Pavilion.
"Through the efforts of a friend who truly understood the situation my mom was facing, she also got a fabulous wig," remembers Laura. "You would never even know she had a wig on. Every once in a while I'd say, 'Ma, your hair looks good.' And she would look at me and I'd say, 'Oh yeah, I forgot -- it's a wig.' We'd laugh a lot."
It was only after Anna Mae was done with treatment that Dr. Pao told her that many people cannot get through the full course of chemotherapy because of the physical and emotional demands. She admits that she would have second thoughts if she was now told that she needed another round of chemotherapy. "Would I do it?" she wonders out loud. "Probably. But I would have a lot of trepidation."
Moving On After Treatment
Anna Mae's last round of chemotherapy was in June 2005 and her scans showed she was cancer-free. A travel enthusiast, she took a trip to Europe that November with her family, making stops in London, Paris, and Rome. She was able to participate in almost every activity, but she took things at her own pace, stopping to rest if she experienced any fatigue or shortness of breath -- two common side effects of lung cancer treatment. Her travels didn't stop there -- a few months later, Anna Mae was invited on a cruise in the Caribbean by her friend Rose.
One unexpected health problem was discovered in June 2006, when her dermatologist in Toms River found a malignant melanoma on her right arm. Wanting to continue her cancer care at Memorial Sloan-Kettering, she was referred to melanoma specialist Dr. Liang Deng. She has had three operations on her arm and continues to undergo treatment.
"Anna Mae was fortunate to have had her lung cancer caught early," says Dr. Pao of his patient. "She's also benefited from her own tremendous spirit. Despite having now survived three separate cancers, she has an amazing optimistic outlook on life. It's been an honor and a privilege to be able to help her along the way."
Having completed her treatment for lung cancer, Dr. Rizk recommended that Anna Mae join Memorial Sloan-Kettering's Lung Cancer Survivorship Program, which she will begin in fall 2007. Coordinated by a nurse practitioner specialized in caring for cancer survivors, patients enrolled in the program have a physical and psychosocial exam every six months -- monitoring current health, evaluating lingering symptoms of treatment, and talking about any emotional changes associated with reentry into life after cancer.
Life has returned to normal, and Anna Mae now spends most of her time with her large extended family and friends. And she will be a great-grandmother in September 2007.
"That's been my attitude my whole life," she says with a broad smile on her face. "You've got to have a lot of fun and laugh as much as you can."
"My experience at Memorial Sloan-Kettering has been marvelous," she says with clear admiration. "Dr. Rizk and Dr. Pao -- there are not enough words to describe how wonderful they are. I can't say enough about them. They're just two extraordinary men."
Last Updated: May. 16, 2007
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