Advanced Breast Cancer Survivor

A personal journey

Gabriela “Gaby” Perazzo would tell you that she didn’t start her successful transcription and health care management consulting service (prn Medical Management) in 1993, but that it launched her. She might also tell you that when she was in her early 20s, she sort of “fell in” to co-founding the International Hospital for Children in New Orleans, where she traveled around the world as the international project manager.

While she deflects credit for her impressive accomplishments, she fires up when she’s discussing her thoughts on being diagnosed in 2003, at the age of 42, with stage IV breast cancer with metastases to the bone. It’s only one part of her life—but there is so much more. She lives in Knoxville, Maryland, loves to cook and she gives back to her family and friends as a minister in the Native American church.


I’m Gaby. I don’t think of myself as a “cancer survivor.” I look at having cancer as just one aspect of my life—the same way I have looked at other challenging events I have had to face. From day one of my diagnosis, I felt I needed to have balance and not cloak myself with the mantle of cancer, because one of the things I’ve seen is when you are diagnosed with cancer—cancer can become who you are. Even though you have known friends for 30 years, they now see you through a veil of cancer and treat you like that, which gives the disease more power. I reject this with every fiber of my being and do not even see myself as a patient!

I knew I had to approach cancer as a chronic illness. I could not allow it to become my whole life. As of April 2010, I will have celebrated 7 years of a full, and even hectic, life—after having been diagnosed with stage IV metastatic breast cancer. Fighting cancer is serious business, but to me, the important part is to keep living and laughing. The hilarious stories about even the bad things that happen to us, that’s a part of the celebration of life. I know I cry a heck of a lot less now than before I was diagnosed, because I used to spend too much time being irritated about things that were not that important.

Prior to my diagnosis, I had been having severe and transient pain for a couple of years. The pain was in my bones, in my back and in my lower abdominal area, but no one could locate the source. I even went screaming in pain to the Emergency Department, where they did a CT of my chest, abdomen and pelvis, but they missed it there too.

Finally, one of my doctors ordered a bone scan and I took along my father, who was a surgeon. He knew the radiologist, who invited him back to read the study with him. Forty-five minutes later, my dad came out to me—sobbing. That’s when I knew that something was terribly wrong. I actually called a friend of my Dad’s to meet him at home to make sure he would be okay.

I do very well in crises and emergencies. After I sent my dad home, I called one of my best friends, who is an internist, and asked him to talk to the radiologist. By the time I got home, he called me crying as well. Now I had the two men in my life who were physicians completely losing it!

I found out later that I lit up the bone scan like a Christmas tree. The radiologist found that I had absolute widespread bone cancer. It was in the rib cage, spine, pelvis, hips, everywhere. I also had a ginormous tumor in my spine that had grown to a size where I had three compression fractures below the tumor, and it was starting to invade the spinal canal.

If there was any good news, it was that because I had been in the medical transcription business for so long, I had terrific client specialists who arranged to see me quickly. The next morning, I had an appointment with a surgeon who performed a biopsy. Then I went to an oncologist that I knew was one of the best in our area.

This was Good Friday afternoon, and when my oncologist saw my test results, he went to the radiation therapy department to ask if they would stay open and give me my first radiation treatment. Because the tumor was so close to the spinal canal, my doctor was petrified that if it did break that barrier, I might be paralyzed from the neck down. They stayed open late on that Good Friday, and within two days of diagnosis I had started radiation. Talk about being resurrected!

That next week I had hard-core radiation every day, and was also given hormone therapy treatment (my cancer was hormone-receptor positive), which suppressed the production of estrogen. About 10 days into all of this—it caught up with me. I became severely depressed, partly because I had a hard time sleeping while I had radiation. My company was operating around me, but I went into hide under the covers mode.

My internist friend was calling me every day to check on me. He and I have written seminars together for physicians and we had just completed one on the effects of stress. After a few days, he called and said, “You know what happens to your body physiologically when you’re depressed and under this much stress. You know this isn’t going to support your beating this, so do you want to continue to be depressed? You are a fighter and a doer. If you want to be depressed for a week, give yourself a week, but if you allow it to grab hold of you longer, it will affect your chances of surviving.”

I jumped out of bed. I was still in shock, but I forced myself to move. It was, fake it until you make it, and it worked for me.

When I began meeting regularly with my oncologist, I had one prohibition for him: no quoting statistics or prognostics. I didn’t even want him dictating it—because I did my own transcription! I didn’t ever want to hear about how long I had to live. I believe we have an “unconscious us” that hears information and I wasn’t going to bathe those cells in all that bad information. My oncologist is the greatest—he told me that we would just look at this cancer as a chronic disease. I trusted him implicitly, and I could live with that.

After that first round of radiation, the huge tumor in my back disappeared. Since I already had metastatic disease, I didn’t need to have a mastectomy, which my oncologist explained was routinely done to prevent metastasis. The hormone therapy caused the original mass in my breast and in my lymph nodes to go away as well.

Three years later, the hormone treatment was no longer working effectively, and cancer showed up in my liver. I had my first chemotherapy treatment then, and the tumor in my liver was gone after treatment. Over the years, the cancer has continued to pop up—primarily in different bony areas and the liver. The tumor markers go up and we change the therapy. I’ve had three rounds of chemotherapy so far—for cancer in my lymph nodes and in other places in my bones. The tumors dissipated after chemotherapy.

I also participated in a clinical trial where participants took docetaxel (Taxotere), in conjunction with bevacizumab (Avastin). I was one of the control patients that did not receive the bevacizumab, but when my tumor markers went up, I left the study and my oncologist gave me the added bevacizumab, which made the tumor markers go back down.

Throughout my treatment, my oncologist has regularly monitored my tumor markers, with CEA (carcinoembryonic antigen) levels being particularly telling with me. In 2009, he ordered something new, the CellSearch® test, which I don’t think was very widespread at the time. It measures the amount of circulating tumor cells (CTCs) in my blood. It essentially gives him another indicator of how I am doing. The last time we measured my CTCs, my count was zero. Any count less than 5 for metastatic breast cancer is considered favorable.

This test is particularly beneficial for me because it gives me and my doctor another piece of information that we can use to make decisions together about my care. If I can get more information about how I am doing—I’m all for it!

Through every step of my disease, I have been blessed...I had all the right people, and the entire team I needed, right at my fingertips. I’ve had the best doctors, the best care and the best support system. I also have a foot in each of two worlds the scientific, linear, deductive world where I work and function—and the very spiritual world that I inhabit as well. I have been through many things and have experienced miracles in my own life for which I have no scientific explanation—including me still being here.

As a minister through the Native American church, one of the traditions is the thank you—or the “give back”—for all the blessings I have received. The spiritual part of my life has been my give back or my paying it forward. My life has actually become deeper, more focused, and even more colorful, with a wonderful perspective on what is truly important. If I’ve learned anything, it’s that I have to continue to live with no regrets, and to enjoy life and all that it offers, to the fullest.


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