Thirty-five-year-old Ava and her fiancé, Adam, had just moved to Orlando, when she noticed a small lump in her left breast. It seemed to come and go though, and knowing she had fibrous breasts, she didn't think much more of it. Four months later, however, it wasn't going away, and in fact, seemed to be growing quickly.
Ava decided to head back to St. Louis to have the lump checked out. If there was a problem, she wanted to be close to the rest of her family. Ava's sister, an ER physician, referred her to the Missouri Baptist Cancer Center.
News no one wants
Ava was referred to Paul Yazdi, MD, a breast surgeon in the Breast HealthCare Center at Missouri Baptist. With no genetic markers or history of breast cancer and being under age 40, Ava had only a five percent chance the lump would turn out to be cancer.
"Dr. Yazdi said it was probably just a floating fibroid; but we needed to get a mammogram and ultrasound to make sure," Ava recalled.
The mammogram and ultrasound led to a biopsy. The next day, a Friday, the news came. Ava's tests showed she had a seven-millimeter tumor with cancer cells detected throughout the left breast and in her lymph nodes.
Preparing for battle
As a healthy, active couple who enjoy traveling, sharing good food, going for walks, and challenging each other at tennis, Ava and Adam had long-term plans together that meant beating breast cancer.
Nothing short of comprehensive treatment strategy is acceptable when battling cancer. To help Ava understand the battle plan for her treatment, she met with the nurse navigator and with Dr. Yazdi the following Monday.
"My nurse navigator, Lynn, was great," Ava said. The nurse navigator's role is to guide patients like Ava through the process.
"She explained everything about my cancer.," Ava said. "What stage it was, what that meant, and whether it was curable."
Step one: Chemotherapy
"Dr. Yazdi explained that besides the tumor, I had these pieces of cancer, like chocolate chips, splattered throughout my left breast and in my lymph nodes," Ava said. To slow the spread of her cancer, Ava needed to have five months of chemotherapy before surgery. "The chemo treatment worked well, but it was exhausting," Ava said.
Step two: Surgery
"Because the cancer was spread out, removing the whole breast was the only way to go," Ava said. "A single mastectomy and lymph node dissection was recommended medically. Removing the second breast doesn't improve survival rate, but I decided from the beginning that I wanted a double mastectomy. I didn't want to have to do this again."
Step three: Outpatient therapy
Removing 14 lymph nodes made Ava highly susceptible to a condition known as lymphedema. Lymphedema is swelling that occurs when the fluids in the lymph system are not flowing properly.
"When the occupational therapist called to schedule a therapy appointment a week after my surgery, I thought 'Why? I can't move," Ava said.
At her first visit Ava's occupational therapist, Helen Demse, OTR/L, CLT, conducted a lymphedema index test known as L-dex, to assess how much fluid was building up in Ava's lymph system.
"Whenever possible, we like to see patients before surgery to measure their lymphatic fluid and compare it after surgery to determine the possibility of the patient developing lymphedema," Helen said.
"When you have as many lymph nodes removed as Ava had, fluid can back up in the arm and cause swelling. The fluid needs to circulate through the body to remove toxins."
Ava said the treatment helped immediately. "Helen did a lymph drainage massage on my arm. By the time I left the first session, I could straighten my arm again."
To help improve weakness, stiffness and range of motion issues that resulted from her treatment, Ava also worked with a physical therapist.
"We challenge patients to get back to their former life and not feel limited by their diagnosis," said Jennifer Ibe, PT, DPT. "Ava used to play tennis, so we set a goal for her to be able to swing a racquet pain free. Now she is back playing tennis with her fiancé."
Since her diagnosis, Ava's goal was clear. She wanted to be cured and return to her quality of life as it was before diagnosis. She has worked hard both in her therapy sessions and at home to regain her ability to move without pain and get back to her normal life as soon as possible. Today, Ava is cancer-free.
"Everything I was asked to do I did," Ava said. "I've received excellent care. I really love my outpatient therapy, and Dr. Lyss is the most amazing person when it comes to cancer. His whole demeanor is comforting. He's a fantastic oncologist."
"The most important determinant of whether a patient will survive breast cancer is whether she complies with all of the components of her treatment," Dr. Lyss said. "Whether it's chemotherapy, targeted therapy, radiation, surgery or hormonal therapy, compliance with treatment is a life-and-death matter."
Ava says she's fiercely independent, but her cancer taught her it's okay to accept help when you need it. For her, that help came from Adam, who helped her keep up with the game plan. "There's just so much information that they throw at you, even someone with a clear mind has a hard time remembering it all," Ava said. "And sometimes you don't know what you don't know. Adam went with me to every appointment, and that has been invaluable."
"You have to be patient with yourself, your body and the process. If we can get through this, anyone can," Ava said. "This last year has brought us closer together. We want to get married. We just love being together."