by Riezl Banilao-Catacutan, RN

March 26, 2019 was a frightful day in my life. That morning, I was heading to the hospital to get the result of my confirmatory excision biopsy that was done almost a month earlier. As you could imagine, the time in between was filled with uncertainty, trying to figure out the unknown that is to be revealed. To some extent, I kind of knew what to expect from the biopsy, but I was still hopeful that the odds were in my favor. Unfortunately, I was wrong.

The words in the report were the most painful words I ever read in my whole life: “Invasive Ductal Carcinoma.” Boom! I am a nurse so I know exactly what that meant. I have cancer.

My husband was in the car waiting for me to tell him what was in the biopsy report. With a bland and mellow tone, I told him, “It’s positive. I have cancer.” He did not say or ask anything, instead, he immediately started the car. That hour-long trip was the most quiet and longest drive home that we had in our entire marriage.

Deafening silence welcomed us at home. We were all lost as we tried to face the new reality. I believed at that point I had already convinced my husband and daughter that everything was going to be fine—that I would not die. I found out from my husband that he thought cancer to be synonymous with death.

The results showed that I had Stage II Breast Cancer, Hormone Receptor (ER/PR) Positive. It was also classified as HER2 Positive, an aggressive type of breast cancer; Ki67 – 75% (very high proliferation rate). Unlike the usual types of breast cancer, this type requires extensive and expensive treatment.

I didn’t know what to feel at that moment. But it didn’t take too long for me to accept the truth. The next day, my husband and I started to figure out my treatment plans. During that time, my feelings were more focused on my treatment rather than the impact of knowing I have cancer.

I was also concerned about the impact of this dreaded news to my family, to my aging parents and especially to my only daughter. The depth of her serenity was something that I feared. She’s not tough enough. I had to show them that I was truly okay. Thankfully, my siblings, especially my youngest sister, helped a lot in easing the tension. She would continue to go out of her way to be available even in the wee hours of the morning to be around us in times of emergencies. Since my husband has a hard time withstanding the rigors of hospital environment, my sister has always been accompanying us whenever I needed to be brought to the emergency room.

My journey to recovery has been a long battle. But with continuous support and strong faith, I know this fight will come to an end.

The treatment begins

The first leg of my treatment was Lumpectomy, a surgery to remove the cancerous lump in my breast. A sentinel lymph node biopsy was also done, confirming that the cancer hadn’t spread through my lymphatic system. I underwent surgery in April 2019. 

In May 2019, I started the six cycles of Standard Chemotherapy which were divided into two sessions per cycle. Overall, I underwent 12 sessions which ended in September 2019. Alongside, this treatment, I also had the Targeted Immunotherapy (or anti-HER2), the most expensive part of my treatment, which is given every three weeks for 18 cycles. The last dose was given in June 2020. I am also receiving Hormone Therapy, an estrogen blocker depot injection which is given every three months for three years. I will be shifting to hormone pills from the 4th year to the 10th year of therapy.

In addition, I will be undergoing 20 daily sessions of Radiation Therapy, which will start around the third week of September 2020, a week after the CT Simulation.

The cancer diagnosis and treatment pose extreme hardship not only for me, but also for my family, especially my husband. Unfortunately, I wasn’t able to pursue my new job because of my condition. I lost my source of income, leaving my husband and our daughter to go to work and support our family and my treatment.

At first, we tried to convince ourselves that everything would be okay. With Philippine Health Insurance (Philhealth) coverage on top of the HMO benefit from my daughter’s employment, we encouraged ourselves that we would be able to cover the financial cost of the treatment. Initially, we went to a reputable private hospital and cancer institute. Unfortunately, we could not afford the total cost of treatment with them despite our healthcare coverage.

We decided to pursue the rest of the treatment at a government hospital, where treatment costs are 40% lower than at private hospitals. But even with the markdown, we still had to spend a staggering  PhP3.5 million (roughly 67,000 dollars) for the entire treatment. This amount did not include additional expenses that would cover the costs of unforeseen complications. 

With confidence and faith, we decided to proceed and start the first step, eventhough we were unable to come up with adequate funds. We trusted the Lord would provide us with what we would need along the way. My family tried to bear the burden during the first phase of the treatment. However, our resources quickly ran dry.

We explored and exhausted all our credit lines and maximized our credit cards, as well as my sister’s.  My husband and my daughter took salary loans. We also borrowed money from family and friends.

Apart from my treatment, we also had to deal with other household expenses. Before the pandemic, my husband worked nights as a Grab operator to bring home extra income. He had to spend 5-6 hours every day after work to cover the car amortization and house rental. Unfortunately, we lost that additional income because of the pandemic. 

Asking for help was a humbling experience

My husband and I have been working hard to become financially independent. We made sure that we would meet our needs and set aside some money for savings. But the illness made the financial burden heavier. It was like a storm that washed away everything we had and then drowned us in debt.

With our financial resources depleting, not asking for help was no longer possible. We decided to open ourselves to the kindness of others. 

I spoke to some of my close friends about our struggles in pursuing my treatment. One of them my college classmate, who is a priest assigned to a parish in Florida. He suggested raising funds from our classmates and some friends in his parish. I felt awkward about the idea, but he calmly told me, “Riezl, it’s okay to ask for help. You’re in such an extraordinary circumstance. We are all vulnerable. Like so many others, one unforeseen circumstance can flip our world upside down.” 

That assurance helped me to be open to look for and accept help. I was also inspired to initiate fund-raising activities. For instance, I started selling merchandise online using my Facebook account. With God’s help, I was able to raise roughly 500k pesos. Often, many of the buyers would pay way more than the cost of their merchandise. Others would simply send any amount to throw their support in my cause. Amazingly, on-line sales reached many people who willingly supported me financially. Some of them  were friends who I had not spoken with in decades.

People also would send me notes of encouragement and offer prayers of strength and healing. This humbling experience made me believe in the goodness of the world, the kindness of the human heart, and the generosity of people

Meanwhile, my husband had been extremely patient in asking for assistance from different government agencies and charitable institutions like the Philippine Charity Sweepstakes Office (PCSO), which issued a guarantee letter that covered 10k to 45k pesos (roughly 200 to 900 dollars) of my chemo drugs. It was a big help. 

Faith, as the cornerstone of well-being

Cancer treatment in general comes with side effects and at times, unbearable pain and discomfort. I was always given Aloxi, a medication to minimize the discomforts post-chemo like headache, nausea and vomiting. It was a bit expensive but it helped me a lot. 

In my case, the gastro-intestinal tract was the most severely affected. When I am constipated, it is to the extent of bleeding.  When I don’t have severe constipation, I have frequent bouts of diarrhea. I also had experiences of passing watery stools before getting to the toilet, so I usually wear sanitary pads. I could not digest high fiber foods and green leafy vegetables, so I have had to eat soft and easily digestible food. 

Nausea and vomiting were never a big deal for me. I always had to find ways to feel better. I made myself busy with household chores and my online selling to forget about nausea. I didn’t force myself to eat food (even very healthy) that I felt would trigger nausea and vomiting. Steamed and grilled fish, blanched vegetables, boiled stuff, any simple food usually helped me through. 

Another hardship for cancer patients undergoing chemotherapy is the side effect on the taste buds. At breakfast your food tastes like rust, at lunch the food may taste very salty, then at dinner the food may be very sweet. Even your plain water would be salty and sweet and whatever. But I was never bothered. Whatever the taste is, I have to eat to have energy. I have to eat to help my body recover from the damage caused by chemo drugs. If it’s really hard, I cross my fingers and pray. 

Exhaustion, tiredness, and weakness have been my companions two to three days after chemotherapy. Instead of staying in bed, I would rather move around, clean the house, wash the dishes and cook. Those chores helped me get more tired so I could sleep. Insomnia is also one of the side effects of chemo drugs. The more you force yourself to sleep, the more you would stay awake. That is why it’s always better to keep myself busy and get tired until I can finally fall asleep.

My WBC and RBC counts were also fluctuating, which resulted in countless blood monitoring and injections of Filgrastim and Eposino to normalize them. I would perform the injections myself.

The chance of hair loss is common for cancer patients undergoing chemotherapy. Many patients fear hair loss the most after being diagnosed with cancer because it reminds them of their condition. But, it never bothered me. I was very ready for that.

Although there have been a lot of side effects, the treatment has, so far, been successful. I cannot find the right words to describe the hospital’s Medical Oncology Team’s support and compassion for me and other patients. Aside from top-tier Oncologists (mother and daughter tandem), there are four trained, world-class nurses as well as five Medical Oncology Fellows on duty taking care of 30 to 40 patients a day. All of us, patients, are well-taken care of.

Despite all the odds, I try not to be discouraged. I see my illness as a time of reflection that has led me to consider new goals and priorities. I have learned to value life and people. I also have become more positive in all circumstances. 

As I struggle on the road to recovery, my faith has been my cornerstone to my well-being. I sing praises every time I feel I am falling apart. I always talk to the Lord. I talk to Him in times of discomfort. Since I’m usually alone in the house during the day, I’ve had all the privacy to pour my feelings out loud until I feel better. The Lord has been my refuge in both good and bad moments of my life. He has been my hope and my strength. 

The COVID-19 Pandemic Pose Challenges to cancer patients

Under normal circumstances, life as a cancer patient is already extremely hard. It’s become a lot more difficult due to the COVID-19 pandemic. All of us are forced to comply with the new normal. Most of our daily activities are affected, from mingling with family members and friends to pursuing social activities, from transacting usual businesses to dealing with health concerns and scheduling doctors’ appointments and laboratory work.

The escalating number of cases and the fear of getting infected have nearly paralyzed us all. It is hard to imagine the added hardship and burden that cancer patients like me have to bear as we continue with our treatments. Recently, there have been a lot of delays due to the slowing down of the delivery of needed supplies and medications. In-person appointments with healthcare providers have also been affected. As a result, many cancer patients are unable to continue their treatments.

At the hospital, patients also need topass through strict COVID triage. No companions are  allowed inside the hospital during treatments. We’ve also had to limit our exposure even to family members because being a cancer patient makes us extremely vulnerable to infection.

Another ill-effect of the pandemic, as I’d mentioned earlier, was the loss of extra income that helped cover  our household expenses. 

Finding support from hospital staff and other patients

I am always filled with gratitude for the services that the hospital has provided me. For more than a year now since I began my treatment, my world revolves around my family and the people at the hospital. I found companions on my journey with the hospital staff and other patients. We make each other feel that we are in this struggle together. They gradually became my second family.

I always look forward to seeing other patients and sharing experiences and stories that would help each other in recovering. We have learned many new things from one another. Every moment is emotional, and I cherish every encounter with each one of them. Yet, I also feel tremendous loss when I learn the passing of some who succumbed to the illness.

A future filled with hope

My husband and daughter are the most important people in my life. They are my inspiration, and my primary source of comfort and support.  

I still feel blessed to have a chance to be with my only daughter and watch her grow as she takes off with her career. Although I wish that my daughter could have an easier situation at this stage of her life, I believe that this illness is also a learning curve for her. As my daughter grows up, I would always give her pieces of advice and lessons from my life. I hope that the current circumstance help her to become a more caring, sensible, and faith-filled human being.

My battle would have been impossible to win without the strong arms and love of my husband. Throughout my life, I believed that I was the strongest in the family – that I could manage life all by myself. But this battle made me realize that I could not make life better without a partner and I cannot thank God enough for giving me my husband. He has been God’s greatest gift. I am so lucky. I really am. 

I refuse to be consumed by the hardship of this journey. I cannot afford to break the hearts of these two precious gifts from God. I have to win this battle.

I am optimistic about the future. Lately, I entered the busy world of the blogosphere and joined millions of bloggers by creating my own YouTube channel. It was a casual decision. One day, I thought that since I have a lot free time, I might as well use it to jumpstart a platform to communicate and bring awareness to people about breast cancer. My posts are testimonies of my journey to cancer prevention and treatment.  

My YouTube Channel is also my way of showing my gratitude to the many individuals who have been part of my life. 

I have been receiving various positive feedbacks from viewers and subscribers about my new channel. I realized that I should have done this before. I should have listened to the many friends who have been suggesting that I should create blogs about my journey. But it’s never too late.

I intend to keep cancer out of my life and to continue to move forward. I have every reason to be optimistic.

“Early Detection Saves Lives. It already saved mine. Please allow me to help save yours and others. Let’s spread Breast Cancer Awareness.”