A Journey Toward A Cancer Cure Begins With A 300 Mile Ride

GREENBRAE, CA — Nicole Nada will start her breast cancer treatment at Marin General Hospital's Marin Cancer Institute (MCI) on May 21st, but not before the 41-year-old mother of two makes a grueling seven-day, 304-mile bicycle journey from her home in Arcata to Greenbrae. Along the way she's determined to raise awareness and money for Marin General Hospital's comprehensive integrative healing program, the Center for Integrative Health and Wellness, and for the Humboldt Community Breast Health Project.

Nicole can't think of better way to arrive in style for her first chemotherapy session than the long bicycle ride through California's North Coast region. "My cancer is not going to define me," she says. "I won't lose sight of who I am and I want to show up for my treatment feeling some sense of control."

When she leaves Arcata, she and her husband Garrett will post a note on the door of their popular organic ice cream shop, (Arcata Scoop, modeled after Fairfax Scoop in Marin) announcing she has cancer and that they will be closed for the trip. "The more people that know, the better," she says.

At first, she thought her situation was unique but she has since found others who have similar stories. Young, healthy and fit all her life, she had been vigilant about breast health because her mother had breast cancer. Yet as she was breastfeeding her two-year-old one day, she found a hardened region in her breast. Certain something was wrong, she sat down and immediately wrote a letter to her two-year-old and five-year-old telling them about finding the lump. "It was December 27th-I guess I knew from the beginning that it was cancer," she says.

But her doctors weren't as sure. Nicole's primary care doctor told her she did not see anything concerning. "I said, 'Really? Because this is different,'" Nicole recounts.

Despite her doctor's recommendation not to worry, Nicole asked for an ultrasound referral. She waited three weeks for the test and another week for the results, a nerve-wracking period since she had seen the technician measuring a large mass on the screen during the scan. Nonetheless, the follow-up letter said she was fine. Reading closely a copy of the report, however, she noticed the careful wording: "Benign findings. Recommend careful management based on follow up physical exam findings after lactation."

Nicole went back to her doctor and asked for a referral to a highly respected specialist. Faced with another potential long wait for an appointment, Nicole begged to be notified of any cancellations and got lucky. It was obvious the specialist didn't expect to find anything. She told Nicole, "If I get a patient with cancer I will have to bump you." But when Nicole took her shirt off, the surgeon could see the raised area on her breast and immediately performed a fine needle aspiration that revealed abnormal cells, confirmed by a biopsy performed two days later. It appeared to be 10 cm. in size when it was removed, it turned out to be 14 cm.-more than 5 inches in size.

Looking back, Nicole has pieced together a pattern suggesting the disease has been lurking there for some time. A couple of times when she had been breastfeeding, there had been sudden, inexplicable incidents of pain and illness she attributed to mastitis. They came on suddenly and she was violently sick, yet the next morning she would be fine. Now, she thinks they may have been symptomatic of her aggressive and highly invasive cancer, a type that starts in the breast tissue, not in the ductal tissue as most breast cancer does, and doesn't present an easily-noticed hard lump. The fact that she was breastfeeding-which often causes irregularities in the breast and the type of cancer (pleomorphic lobular carcinoma which isn't easily recognized on ultrasounds and mammograms) had worked against her finding it sooner.

Her doctors jumped into action with a plan for using chemotherapy to shrink the tumor, followed by a breast-conserving lumpectomy. Something didn't feel right; Nicole wanted a second opinion. She called Dr. David Gullion at the Marin Cancer Institute. Twenty years earlier, Nicole had been employed as his daughter's nanny. He had treated her mother for breast cancer, and her grandfather for metastatic cancer.

She faxed him everything. Dr. Gullion discussed her situation at the next tumor board, a session at which different medical specialists meet to review and discuss the condition and treatment options of patients. "He called me back and said, 'Even if we shrank your tumor to half its size, it wouldn't be a candidate for a lumpectomy. You need a mastectomy.'" She and her husband drove down to meet Dr. Gullion at Marin Cancer Institute. The minute they walked in, she felt she had found the right place.

"I've known Nicole for 20 years," Dr. Gullion says. "We've kept in touch all these years. When she came in, I could see that she not only liked our doctors, but immediately embraced the way our program is able to provide integrative oncology (through The Center for Integrative Health and Wellness) to support patients and caregivers through acupuncture, therapeutic massage, Jin Shin Jyutsu, guided imagery, diet and nutrition, expressive arts and meditation."

"I completely trusted the doctors. They had already started taking care of me the second I walked in the door," says Nicole. "And, their East-Meets-West integrative healing approach was perfect for me."

Dr. Gullion introduced her to Dr. Leah Kelly, a breast surgeon. "She didn't act like she was my 'second opinion surgeon'," says Nicole. "She just laid out the plan for my mastectomy and treatment." Dr. Kelly, Dr. Gullion and their colleagues made such an impression that Nicole and her husband changed their plans almost immediately. Even though it was hundreds of miles away and she would have to move to Marin for part of the summer, she wanted treatment at MCI. Nicole's sister, a San Anselmo school teacher, mobilized her whole community and offered Nicole and her family a place to stay while she had treatment.

"All of a sudden everyone was on the same page," Nicole says. Even her doctors in Arcata had changed their tune about the lumpectomy, but now Nicole couldn't imagine having anybody but Dr. Kelly perform the mastectomy. "There was no going back," she says. The surgery took place almost immediately.

Helping hands materialized almost magically. "People were coming out of the woodwork, signing up to drive me on the dates I needed to be down in Marin for appointments," Nicole marvels. "These are old friends I haven't spent any time with for years. It feels like a gift to get to know them again."

Before starting the chemotherapy, she and her husband decided the family should have a vacation together-and Nicole had a brainstorm. They would take a week and instead of driving to Greenbrae from Arcata, she would make the trip by bicycle. Not only would she have a chance to do something she loves, but she immediately saw how it could be used for fundraising and to inspire others. She began lining up sponsors. The money will help fund scholarships for patient and caregivers to access to the programs at the Center for Integrative Health and Medicine, and to support the Humboldt Community Breast Health Project.

"Nicole is inspirational to all of us," says Dr. Gullion. "It's amazing that she can manage all of this: the blog, the bike ride, getting ready for treatment. She even enrolled in one of our clinical research trials-it may help her but it also will further the science of treating breast cancer. We feel it is a privilege for each of us to care for her and know her."

With her customary energy, Nicole has managed to juggle taking care of her family while meticulously planning her bicycle trip and plans for treatment. She is planning to post video highlights each day of her trip on her blog at www.kickingmycancer.com..

Although she hopes to complete the road trip without a hitch, she has agreed to quit if she develops Lymphedema, a fluid buildup in tissue that causes swelling. She's deliberately avoided asking others to ride with her, because she wants to take it easy each day. Her family will serve as her road crew. But on the Sunday before she starts treatment, four of the doctors from Marin Cancer Center will join her for the 50.8 mile trip from Sonoma Coast State Beach to her sister's house in San Anselmo.

On Monday, May 21, she will ride the four miles alone on the bicycle path from San Anselmo to MCI in Greenbrae. It will be the start of another type of journey. She's optimistic about its outcome.

"I can tell that my doctors take each patient and treat them as unique," says Nicole. "They don't take a blanket approach to what they do. As a mother of two kids, they're the world to me-I want the best possible chance of beating this. I can tell that they're the best."