On Saint Patrick’s Day 2010, I received the phone call from my wife confirming that she did, indeed, have breast cancer. For a full week, awaiting results of the biopsy, I had been able to successfully keep my thoughts positive and optimistic, but the final results shattered them like the fragile film that they were. Some say that when tragedy strikes, your world comes to a standstill. But when I received the news, everything before my eyes went into hyperdrive and I understood what it meant for life to flash before ones eyes. Or, rather, the reverse effect. Instead of seeing a review of my past life, I saw a future without Stacie. Are we wired to project the worst possible scenario?

On the same day that Stac broke the news to me and our families, she received a call from my brother-in-law Dr. Ralph Wynn, who sought her permission to review her results. Ralph had been a Godsend a few years earlier, steadying-through-educating a fearful family when my sister Malia was diagnosed with stage 4 breast cancer. In Stacie’s case he immediately facilitated the creation of a world class UT Southwestern team to treat my wife through all phases of treatment and recovery. The love we have for him aside, we are forever indebted to Ralph.

Following are a couple of compositions sent to family and friends informing them, in the first letter, of what was to come and, in the second, how it went. Also included are some of the heartfelt responses we received.

26 March 2010 / The News

To those among you – Stacie’s ‘Ohana – who are hearing of this for the first time, we send you this message to share some news with you. It’s been a week in coming, but rather than drop an alarming & uninformed announcement on everyone, we wanted to wait until we had some answers, in the hope that we could provide a positive and educated message to our loved ones.

It may sound strange to hear the words “breast cancer” and “fortunate” uttered in the same breath, but in this particular situation we do consider ourselves extremely fortunate. One week ago today Stacie received the results of a biopsy and confirmation that she has breast cancer. There are numerous reasons we consider ourselves fortunate: (1) the tumor was detected at an early stage, (2) it is not a very aggressive form, (3) the procedure that Stacie has chosen is not accompanied by radiation, (4) both families have breast cancer survivors and are familiar with what lies ahead, (5) we have great confidence in the medical professionals and the speed with which the process has proceeded.

Stacie’s cancer is Invasive Ductal Carcinoma, the most common form of breast cancer. It is in its early stages, the tumor estimated to be between 1.2 – 2.0 cm. The cancer is both inside and outside the ducts but appears to be contained within the breast. It is estrogen and progesterone-receptive, meaning it is not of the aggressive variety.

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TMI

For those (guys?) who may be a bit on the squeamish side, suffice is to say that the prognosis is very good. Stacie will go through a surgical procedure, maybe some chemo, and reconstruction. All should turn out well. You can skip the details laid out below.
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Chronology

Monday 3/8 – Annual mammogram – “a suspicious mass;” 2009 imagery obtained and significant change noted.

Friday 3/12 – 2nd mammogram & ultrasound

Monday 3/15 – Needle biopsy

Wednesday 3/17 – Received biopsy results and confirmation of breast cancer

Monday 3/22 – Consultations with surgeon, radiologist, geneticist, patient coordinator & plastic surgeon.

Wednesday 4/14 – Surgery

Genetics

Cancers which appear early in family members are more likely to be genetic, and conversely late-appearing cancers are likely to be lifestyle or environmentally linked. That which has appeared in both sides of Stacie’s family came later in life, and while her mother and sister are both survivors, it appears that there is probably no genetic link between Stacie’s and Susan’s cancer and her mother’s cancer. Tests results in two weeks will clear that up. Either way, the info will be of use to other family members.

Surgery

Surgery is scheduled for Wednesday, April 14. Due to the apparent proximity of the tumor to the surface and the nipple, a lumpectomy is not an option as the minimum amount of tissue surrounding the tumor is not available. The remaining options are removal of the entire breast or the removal of both breasts. With the first of these options, the rate of recurrence is 30% within the next 2 to 3 years. Use of the medication Tamoxifen reduces the rate to 15%. Removal of both breasts drops the odds to 1%. Rather than face the possibility of going through this again, Stacie has chosen the last option. On the day of surgery they will first remove the sentinel lymph nodes to see whether the cancer has spread that far. If so, all lymph nodes under her arms will be removed. As stated above, there is no radiation treatment associated with a double mastectomy. Drains (two per breast) will remain in place for 2 to 3 weeks.

Chemotherapy

In most cases, tumors larger than 1cm call for some level of chemotherapy. Stacie’s surgeon considers this a grey area and will make the determination upon removal of the tumor.

Reconstruction

The options for reconstruction are (1) to insert tissue expanders once the mastectomy is complete. Beginning three weeks after surgery the expanders will gradually be inflated over a period 6 to 8 weeks until the desired size is attained. Once the skin has had time to settle at that level, the expanders are replaced with implants, (2) combination of tissue expander, implants and patient tissue, (3) exclusive use of patient tissue, taken mainly from the abdomen. Chances of infection in option 3 are the lowest of all three options. This form of reconstruction takes place upon completion of the mastectomy and requires an additional 8 to 9 hours. The decision on which option to go with was made moot upon examination by the plastic surgeon. However, the story behind that is amusing and was by far the highlight of Stacie’s long day of consultations and tests. With one quick glance at her tummy, the young, rich, handsome surgeon with the soap opera star name – Michel Saint-Cyr – informed Stacie that there wasn’t enough tissue there to build even one A-cup breast. Option One it is. She is still beaming =) The bastard probably even drives a James Bond Aston Martin =) Sorry, got sidetracked . . . one to three months after insertion of implants, the nipples will be reconstructed, and shortly thereafter, the areolae will be tattooed on.

The Pros

We were very impressed and feel completely confident with the physicians who will be working with Stacie. They come highly recommended and the seamlessness from one specialty to another was very impressive.

Dr Ralph Wynn, MD, head of Mammography, UT Southwestern (to his fancy professional titles, Ralph has recently added that of “Grampa” – congratulations!)

Dr Roshni Rao, MD, Assistant Professor Surgical Oncology

Kathy Pratt, RN, Patient Coordinator

Dr Michel Saint-Cyr, MD, Assistant Professor Plastic Surgery

Last, but not least, The Patient with the A-cup Tummy

You are all familiar with the wise-cracking, can-do, ever-optimistic, can’t-sit-still, don’t-tempt-me woman named Stacie. So you should have no trouble believing when I tell you that she is mentally and emotionally in great shape and ready to get the show on the road. While the final outcome appears very good, we know there will be many tough times in the next few months, some ugly ones too. But there will also be unique opportunities to grow as individuals, as a couple, as family and as friends. We are fortunate to have each of you in our lives. We cherish who each of you are to us and appreciate all you have ever offered of yourselves.

Our love to each and every one of you. Stay tuned.
Aloha,
Stacie & Steve Mahelona

Kind Responses

Thanks for sharing this. It’s really inspiring and I’m glad to hear that they are both so positive throughout such a huge life-changing “event.” I’m sure with such strength mentally, emotionally and physically, that this can only to help the recovery process be much more productive – Karen

Thanks for sending Kanani. I really appreciate it. Please let them know that many people they don’t even know, are thinking about them. Love you, Janell

Wow chile…just wow.  Cannot believe this, but his letter, his attitude and hers, are amazing and beautiful.  Thinking of them with all my heart!!! xoxo  Big, Big Love to all!! – Cindy

My girlfriend at work (who is Jonathan Hayes from KLUV’s wife) has her expanders in right now and has “chemo light” every Friday until October.  About a couple of years ago, she was also diagnosed with lung cancer and did very well, only to find out last year that she has breast cancer.  She has such a good attitude and she is doing great.  I know so many women who are getting breast cancer.  I faithfully have my mammogram’s yearly and have been so lucky.  My prayers go out to Steve and his wife.  Please forward this to him.  Thank you – Jan

Hey, so very sorry to hear about Stacie…it is a good thing that it was caught early on and the cancer is not the aggressive type.  Steve and Stacie are well educated in this matter and that is great.   With their knowledge, great support system and most of all their positive attitudes, they have the best chances in the world to overcome this!  Please send them my love.   Love you, Jen

I am praying for every step you take guys!  I love you both and thank God you know you have already won this battle! Please let me know if I can do ANYTHING! – Deanna 

I have to say, as troubled as I am about the news, that is the best cancer news I have heard in a long time. I will pass the word on to Denise and we will keep Stacey and the whole ohana in my prayers. I well remember the shock and dismay when my own physician called me one day. I had to ask him, “Are you looking for a golfer to fill out a foursome? “No? OK, how about someone to fill out your doubles team?” He wanted to inform me that the biopsy taken from my abdomen was melanoma. Obviously, the whole thing worked out all right since, after three successively deeper tissue removals, the melanoma was determined to have remained isolated and no further treatment was required. It caught Denise and me by surprise and caused quite a few sleepless nights. We will miss y’all in April but we look forward to seeing y’all a bit later in the season. This strengthens my resolve to get us involved in the Race for the Cure. I’ll need to e-mail Kehaulani and get further details about how we can support the event – Mike

I thanked God last night that Stacie’s cancer was caught early and she is going to be with us for a long time.  I know how difficult this can be and the emotional rollercoaster your about to take.  One thing I’ve learned going through this process is rely on your family and friends and be possitive.  It upset me that you have to go through this and my heart is with both of you.  I care deeply for both of you and IF you need me for ANYTHING I’m there.  From the bottom of my heart…I’m there for you. I Love You Guys!!! Kim

Aloha Pumehana (warmest love) and support during the months ahead. We are available whenever and whatever you need us for. Me Kealoha Pau’ole (Never ending love), Mom n Dad

I’m very sorry. If there is anything I can do, don’t hesitate to call upon me. Cheers – Daniel

Our prayers go out to both of you, our ohana. If you need anything just ask and we will do our best to help in any way – Dani

Thank you Steve. And there is Caringbridge if you want to get on that to eventually keep everyone posted. It is easier than emailing everyone.  She can kind of journal on it too as a therapy tool and get comments and feedback. I know she has that “can do” attitude. I told her ” how are you talking about this and not crying” and her answer was “wtf”. I laughed so hard. She is a trooper!  We are so grateful for you. I don’t know how Stacie and I are so blessed with Chris and you!  We are some blessed girls! Love you both! Michele

Dear Steve, I read your e-mails. We thank you for sharing it with us…Firstly, Terry & I are SO sorry that this is happening to our princess Stacie.  This is very sad…Please let Stacie know that our thoughts and prayers are with her.  No matter what, we love her very much! I will write again – next week – when  I get back from Tempe Dragon Boat Festival.  In the meantime, please please keep us posted. Take care! Love you both! Terry & Mas

I very much appreciate you including me in the distribution of this message.  It will be my joy to add you both to my prayer list regarding these developments.  Your message lightenend my heart because of your mental attitude and most excellent perspective. I also commend you on sharing the depth of information you did because it allows your ohana to be better informed and experience less apprehension for Stacie. Stephen, I can reassign the Lauren Bartlett story to someone else if that eases your schedule during these important next few months. Prayers of thanksgiving and peace for you – Danno

Thank you so much.  The more I am around you, the more I like having you as a brother-in-law. I am shocked that Stacie had her mammogram 5 years to the day that they found my cancer.  What are the odds?  Maybe Stacie and I should go in together and buy some lottery tickets. Jim and I were coming in on the 13th to Dallas but if you and Stacie could spend an extra day with us, could we come up on the 12th and hang out before the surgery.  We are staying at the Holiday inn close to the hospital. Love you guys, Susan

I’m so sorry to hear. Please give stacie a hug for me. It really sounds like you guys are doing well with the news and how to attack it! I know that doesn’t make things any less scary. I’m here if you need me. My thoughts and prayers are with you guys. Please keep me updated on her progress. Is there anything I can do? Love you guys – Marie

I was already proud to have you as my uncle and Ohana, Steve, and always knew you were Stacie’s angel… from day one, I saw your halo. 🙂 If there is anything you need, anything Stacie needs, or anything you as a couple, need… I’ll be there. Katie

Wow….never before have I read such an informative, uplifting, hopeful and loving account of the journey ahead.  You two are so lucky to have each other!!!  And we are so lucky to have both of you!!!!  Sending you all the love I can muster……love you both so much….can’t wait to see you and hug you both!!!  Love, Nani

Hey Brother, thanks for including me on this important and difficult message.  My heart and my thoughts go out to you and Stacie, and I will keep her in my prayers for the next several months as you guys journey down this path.  It really sucks when bad things happen to really outstanding people like Stacie (and you), but, reading the tone of your email and hearing the optimism in your message, I’m quite certain that you both will come out ok, perhaps even stronger, as you alluded to. PLEASE let me know if there is anything I can do to help during these crazy times ahead.  Whatever you or Stacie may need, do not hesitate to ask, yell, email or whatever – I want to be available to you all.  Even if you just need to vent, or have a drink, or share some laughs, I’ll make myself available to you guys. I’m sorry to hear the news, truly I am, but I know you guys can overcome this obstacle.  Tell Stacie to stay strong and positive; we need her to get better soon so we can go and share some more wine!!! Take care, God bless, and please keep me posted…Rob

Our prayers are with you and Stacie. Love you guys! Tavis

Surgery / Wednesday, 14 April, 6:30am

She kissed and hugged her Mom, sisters Catherine, Cyndi & Susan, niece Randi and brother-in-law Jim, and the door closed behind us. Over the next two hours we met all of the pros who would perform their magic this day, heard in detail everything she would undergo over the next few hours, signed consent forms and looked into each other’s eyes, lost in our own thoughts and assuring each other that we were both okay. She was utterly calm, but I could see the apprehension and fatigue in her pretty blue eyes.

At 8:30 they started a Happy Cocktail in her IV and within five seconds she had departed that cold, clinical space, probably bound for a cozy seat in a canoe on some warm ocean.

By 9:30 we received the first update, the one we had been waiting on pins and needles for. The initial look at the removed sentinel lymph nodes – two from each arm – showed that they appear clear of cancer cells. This first look is 100% accurate in about 85% of cases, and further dissections and tests will remove any doubt, one way or the other. It seems that every time we turned around we were confronted with numbers and percentages related to accuracy and risk, and eventually we just accepted that things simply are or are not, and that they will happen or they won’t. Anyway, this news removed the weight of the world from our shoulders, and there were murmurs of thanks and a few teary eyes.

Over the next few hours we received regular updates letting us know that things were proceeding well. Shortly before noon, they herded us into a room for a consultation with her surgeon, Dr. Roshni Rao. She told us that the surgery went perfectly, that her vitals were very stable and that her plastic surgeon, Dr. Saint-Cyr, was at this moment inserting the tissue expanders. The sentinel lymph nodes, tissue and tumor (still embedded in the breast tissue) were sent to Pathology to conduct further tests to check more thoroughly for signs of cancer. Based on the results of these tests, Oncology will make the call on whether chemo will be necessary.

About 1:30pm we trooped back in to talk to Dr. Saint-Cyr, who let us know that his portion also went as expected, and explained his estimated timeline for removing drains and beginning actual expansion of the tissue. By the end of the first week, the first two drains may be removed, and a week later, perhaps, the final two. Depending on the decision from Oncology, tissue expansion could begin as early as the third week after surgery. Expansion will continue for 6 to 8 weeks, with a two month settling period prior to removal of expanders and insertion of implants.

Shortly after 3pm her name disappeared off the status board in the surgical waiting room, and they advised us that she was on her way to room 726. As anxious as were to see her, we took our time gathering up our stuff and heading upstairs, figuring it’d still be a while before she arrived in the room. In typical Stacie manner, she was there waiting for us when we walked through the door.

She has since told me that we all made this thing so much easier for her. But personally speaking, it was she who made it easier on all of us. She had less fear and more resolve and belief going into this than any of us, and when we saw the vibrant, glowing woman who greeted us with a smile, we were amazed, relieved, thankful and joyful to the point of tears. What she showed us in that smile brought forth a depth of comfort and belief that cannot be gained from any medical expert’s assurances.

The next two days of her hospital stay were somewhat of a blur, with everyone’s exhaustion and release of tension. What was crystal clear was Stacie’s marvelous attitude and determination to deal with the here and now, to improve quickly and steadily, and thereby earn a quick trip home. On the first night she was sitting up unaided, ordering a meal from Zale-Lipshy’s room service menu, and snoozing through the constant visits from nurses and techs. First thing the next morning she set out for a walk down the hallway, pausing each time she passed the large picture window to watch the planes rise from Dallas Love Field in the pre-sunrise glow. Throughout her stay she laughed and lightened the hearts of her visitors, smiled reading her messages, remarked at the beauty of the flowers around her, and maintained a comic dialogue with her doctors, nurses and techs. She told her resident that she expected to be released by 3pm Friday, and he arrived out of breath minutes before the hour to get the release paperwork rolling.

Discharge / Friday, 16 April, a few minutes past 3pm.

As we pulled out from under the porte-cochere at Zale-Lipshy University Hospital, her first words were, “We did it.” We – meaning she and all of you – and all those who sent prayers and expressions of love, encouragement and support.

From our hearts, mahalo nui.

Love,

S&S

(Stac and her Doc at NYC Race for the Cure)