Starting Chemo

Dr. Ramirez,

I received a call from MD Anderson asking me to authorize the release of information to Dr. Kirby Smith. Please forward a copy of all of my records to his office. I would appreciate it if you could include the Vanderbilt records as well so he can have a full picture of my case.

I so appreciate you working with him so that I can be treated here in Memphis. Blood work was drawn on Wednesday, and my chemo starts on Monday. It is very relieving not to travel for chemo and to be able to be home with my kids.

I am still confused about how we will follow my case after chemo. I understand you will do pelvic exams and CA 125s every 3 months, I just have a hard time understanding since the 125 was normal throughout this process. I do understand that the CT Scan shows things over 1cm and so it is less reliable for early detection…but I am not having a recurrence, so maybe this is all moot anyway….I still believe this is early stage, and there is so little microscopic evidence that the chemo will get rid of any possibility…that’s my story and I’m sticking to it! :)

Above all, I know God holds me in the palm of his hand….and I pray sincerely for you, your wisdom, knowledge and insight, and I know he is blessing your heart, your life and your practice….

Chemo starts tomorrow….we are on the same team; let’s win this thing…


P.S., Here's a great song..... Love they way they WIN in the end!

More Encouragemenet

Go get 'em tiger!

I will have the office send the records

Dr. Ramirez

The "Getting Me Ready For Chemo" Letter

Dear Dr. Ramirez,

I have checked and I am scheduled for chemo at 10 am on Tuesday. I am scheduled to meet with you to discuss chemo right before that….. Here are the things I wish I could hear in that meeting; I know you have said some of them already, I just wish I could hear them again:

  • I can’t believe you left the hospital 12 hours after surgery and went out to lunch!
  • This is amazing…you have such a strong, healthy body!
  • You were out passing a football (note: I really NEED to TELL you that I don’t “toss” a football!) 4 days after surgery!!! That is awesome!
  • Keep up that spirit!
  • 4 Wheeling?? 10 days out?? Go for it…enjoy life!
  • I am proud of you!
  • You can do this, keep going and don’t look back!
  • Cross the finish line with gusto…this is not a repetitive loop!

….if you want to, you could read me what Dr. Cliby, the lead researcher on the study you sent me, told me after he read my records….I tracked him down to ask him how I looked when compared to the people in the study…he said I was in better shape than they were as they had more LN involvement….here is the rest of what he said….

  • I am in a good class for prognosis because it was primarily limited to the ovaries
  • It does have the capacity to leave the ovaries, as evidenced by the node
  • The node had only microscopic involvement which was good
  • Chemo is to get rid of any remaining microscopic cells but the fact that there is no identifiable residual disease is strongly in my favor
  • My situation is ‘very promising as there was a very small amount of spread’
  • I had a remarkable recovery from surgery and that he thinks I will have a remarkable experience with chemo
  • The number of lymph nodes taken from the pelvis were small but it didn’t matter as the point was to see if they had cancer and they didn’t
  • 57% in my class have no recurrence at all, and my biggest point in my favor here is there is no peritoneal disease
  • The 5 yr survival rate is 75%
  • Treatment is the same no matter which stage—Get Treated!
  • Dr. Ramirez is a very good doctor
  • I have every reason to be optimistic about a non recurrence

It occurs to me that you may be wanting to, in a nutshell, tell me that chemo can kill me….
I guess I should tell you bigger things have tried! Basically, as I think about the information concerning negative effects chemo might have, I have 3 questions:

  1. Do I have a choice about chemo if I want to get over this, never have it come back and move on with my life?” if answer to A is no, go to B
  2. Do you feel you have a legal or moral obligation to verbally relay all the bad things that could happen to me with me in the room? If the answer to B is yes, go to C
  3. Would you mind terribly if I wore my headphones? >>>>>>>>> I mean just during this part of the discussion… I don’t want to miss a minute of the part above…. :)

Here is how I see it:

  • If I have numbness or tingling in my hands or feet, throw up a lot, feel so tired I can’t function, can’t use my bladder or colon, or have strange, weird, or otherwise disconcerting things happen to my body, I’ll tell you
  • If I need to be rocked, held, told I am beautiful no matter what, assured I go out and play, be reminded of my strong will, have my faith in God’s power renewed or need to hear the loud voice of someone cheering me on, I’ll tell my boyfriend
  • If I am scared of the future, worried about my babies, feel lost, or like I can’t tell where this road is going, need to have my spirit renewed, need to be reminded of the many miracles already performed in my life, or need reassurance that a force much more powerful than I can imagine is guarding me, I’ll tell God

Between the three of you, I am sure you can work it all out while I am in the gym….


Positive Encouragement

Outstanding.....that's the attitude....I'm proud of you

Patient Staging Perspective

Just thought this was interesting….so I think I’ll take Stage II-N

“Taken together, these data demonstrate the necessity for
stratifying patients within current FIGO Stage IIIC disease
when comparing outcomes, or the addition of further subgroup
within Stages I and II disease (possibly I-N or II-N in cases with
positive lymph nodes).”

I really do appreciate the article, and it does seem like there is a place for early stage to have some microscopic lymph node involvement….maybe there will be some things that come out of all of this that can help others….I know you know this is hard for me, but I truly believe that I am going to do well, get over this and move on with my healthy life….and I want to make a difference along the way…

Here is how I figure my shot:

Overall Stage IIN survival rate 70%
Really strong constitution 10%
Lots of love and prayers 20%
Faith in my God 100%

So the way my math works, I have a bit of life and love I can afford to share……


Post Surgery - Chemo Next


I am so glad to hear that you are doing well.....even tossing a football...that is awesome!!......Attached please find the article that I was describing to your boyfriend.

Do you want to come in for your first cycle of chemotherapy this Tuesday since you are feeling so good?.....please let me know so that I can arrange.......otherwise next Tuesday would be fine too

Keep up that spirit!

Pedro T. Ramirez, MD
Associate Professor
Director of Minimally Invasive Surgical Research & Education
Department of Gynecologic Oncology

Digging for Info

Dr. Ramirez,

I would like to know more about the study that you discussed which showed a much better prognosis for patients with my type of disease presentation. Could you please send me a link to the study or tell me where and when it was conducted? Also, I am not sure what my next steps are in terms of timing, so if you could let me know when I should be in Houston, I would appreciate it.

Again, I appreciate all you are doing. Your surgical skills are amazing as evidenced by the fact I was out passing a football yesterday….uh, maybe I shouldn't mention that part….actually, I rested quietly, just exactly like you were expecting….…. :)


Thoughts before surgery

This was written to a close friend the hour before going under anesthesia for my hysterectomy and staging for ovarian cancer.

Poised on the edge of the ragged cliff,
That juts so dominantly against the arch of the sky,
Water so far below it looks like a mirage.
I wonder if it will be there when my hands reach to slice its surface.

Muscles fall in perfect form; old memories from long ago
Steady the strength in my legs.
I feel their power, ready for the demand that lies moments ahead
I know how they will burst forth to define the strength of my plunge.

My back straightens with the tension so needed to guide my core,
My heart leaps at the depth before me;
But, again, old memories remind me of the power
That lies ever present beyond my vision.

I know my God is true, He has never failed.
He knows the exact point of entry,
Where my body and the water become one;
And my being yields before my master, unafraid.

As I surge forward, slicing air first, I hear hoofs;
I know their sound; I know their wild beat like my own.
And I hear the stallion find the rhythm of my fall.
He runs in perfect time as gravity forces me to the water below.

I steady at the hand of the God above me,
And the wild nature of one who knows my ways.
And then I am there; the shock of water
So cold upon my fingers first; then I am under.

My body enters with ease, and my heart is at peace.
I see the underworld of obscure shades I know so well,
And the force of my plunge drives me deep.
My world is forever changed as I become a creature of the sea.

Then I find a new rhythm in my fight; and I reposition for the surface;
Forcing my lungs to hold, my arms to reach high,
The strength within me rages for the air I need,
For the place where new life unfolds.

Sunlight bursts through in my mind as I picture its rays
And I swim hard, upward, pulling against the water like a mountain climber against the rock.
I know the hoofs stopped when I went down so deep; and they wait, now,
To see my face break through, throwing bubbles of life to the sky.