Reilly Starr

Reilly Starr was diagnosed with MBC in January of 2019. In addition to more than 20 years of public relations and communications for major corporations and law firms, she also founded her own businesses that focused on empowering women and children.

 

Full Transcript

Discovery of Metastatic Disease

 

Reilly Starr:

In the middle of 2018, I had my first child. And it was a very easy pregnancy for me. However, following my pregnancy, I really started to go downhill and feel a lot of pain throughout my body. It was uncomfortable to sleep. I was, at night, moving from the couch to my bed, back to the couch and using pillows to prop myself in ways to feel comfortable. And yet I really found no comfort. I would say as a college athlete, I’ve gone through many injuries, and many surgeries and the pain that I experienced was pretty unbearable. 

I tried to communicate this to my pediatrician who just sort of, you know, tried to comfort me by saying, this is what it’s like to be a mom for the first time. Which I tried to, you know, respect and understand and do my best to just try to dull the feelings and the pain that I was going through. But it was really, at the end, I knew in my gut, there was something not quite right. 

And so after really pleading with my pediatrician, I was able to get my first mammogram and when I had that mammogram, I was in a lot of pain. It was really hard for me to even turn over, to let the nurse get a better image, or just, you know, even try to communicate what I was going through. It was just so immensely painful. 

And sure enough, we found seven tumors in my breasts. And if anyone is watching this that’s gone through this process, you know that that’s a lot. And it was really an emergency situation that I was in to start the process of diagnosis. 

The scans started, we scanned my breasts and then we realized that there was more to that. So I was obviously beyond the early stage. And it went from my spine. We started to notice that there were tumors and it went up to my neck. And that’s when, you know, it was pretty clear I was Stage IV and I was 39 years old at the time.

Coping with a New Diagnosis

Reilly Starr:

Following almost a year of my first line of treatment, I was diligently getting scans done and x-rays and making sure that I was as much ahead of my cancer spread as possible. And, as you can imagine, when you’re stage IV de novo, you’re going through a lot of pain. It’s a lot of new pains. Occasionally it’s hard to decipher what is really an issue and what is a side effect and how to present just so many new, you know, feelings and experiences and moments that you don’t feel are normal, but should you report these, you know, problems? Are they problems? 

Really, how do you manage such a new – it’s not even a diagnosis at this point – it’s a new phenomenon. It’s like you’re experiencing something that you’ve never gone through before in your life. And being someone that had, you know, a history of athletics and endless injuries that were typically within, you know, just pointing to where the pain was, or saying enough keywords that a doctor could easily remedy the situation. 

But when it came to my newfound life of cancer, I quickly realized it’s extremely difficult to describe sometimes. Because sometimes the pain doesn’t happen every day. Sometimes a pain could happen just once and it was severe. And sometimes you just forget because the pains all start to mesh together. So when it comes to having a conversation with your doctor and really trying to create an accurate picture of what you’re experiencing, it’s extremely intimidating and it’s challenging and it’s trivial. 

And so, you know, making sure that you’re conveying an accurate picture of what is happening to you is something that should be simple. And it’s so far from being simple that you find that you’re in a guessing game and you need, you know, someone to lead you. And so it’s great to talk to people, but when you’re in the midst of it, and you’re in the trenches of trying to figure out something quickly, it’s a very intimidating and oftentimes depressing experience. 

When I was trying to decipher exactly what I was going through, it was very overwhelming and I, you know, could barely describe it to my family or my closest friends, because I couldn’t even understand what was going on. And quite frankly, it was so new to me. I didn’t know cancer. I didn’t have friends with cancer. I didn’t have, you know, many family members with cancer, or enough to just find guidance. So, you know, I tried my best and I think that I guessed enough in the right way that I was lucky to tackle new issues presented during my first year that I was able to find solutions to the problems.

And I think that you really have to stay on top of conversations with your team, at the hospital that you’ve committed to. If you need additional help, you need to make sure that you are reaching out and advocating for yourself. And that’s a huge step in the process – is learning how and when to advocate for yourself and to really capture that, you know, this is a problem and it needs a solution and being direct about that and having the type of support that can propel you in the right direction.

Diagnosis of Brain Metastasis 

Reilly Starr:

When I was initially diagnosed, most of my cancer was in my liver, and it spread to my spine. And so that was quite an undertaking in terms of treatment, and it wasn’t just chemo, it was radiation. So, of course, there was a lot of imaging to go through and to keep on top of. 

What I didn’t expect, and I don’t think my team expected either, was that when we looked at the scan of my spine, we saw that there was a lot of need for radiation and controlling the cancer and the pain that was happening. But as we went up my spine, we started to see that my neck had some indication that there was activity happening. And I don’t think anyone on my team, and I love my team, I have full faith in my team, I respect them. I really don’t think anyone expected for there to be as much activity happening in my brain as there was. 

In fact, I will never forget sitting in the waiting room with my mom, who is my number one fan, and she couldn’t even wrap her mind around how many lesions I had in my brain. And it was just – I remember it was a moment of reality, having to convey to my biggest fan, just how much treatment I would need, how much help I needed, to eradicate what was going on in my brain. 

And I think at that point in time, I had such a rough first year, like most of us do. Just trying to mentally process what we’re going through. Physically learn how to manage our, you know, aches, and our pains, and our questions, and, you know, how do we communicate all of this to friends and family, to the doctor? It’s a real intimidating and daunting experience in our first year and throughout the entire experience of what breast cancer brings to us.

But I would say, when you’re learning the ropes, at first, it can be something that comes with error and questions and doubt. And I think it’s important to not only convey everything you’re experiencing, because at the end of the day, you don’t know if one thing can actually be a very strong indicator.

So don’t hesitate to communicate and to share your aches and pains and fears. And you know, if you felt something a week ago, but you don’t feel it today, you need to talk about what happened a week ago. Because these are signs that will lead to potential problems and you need to try to identify these problems as soon as you can.

Making Treatment Decisions

Reilly Starr:

When I first learned that the cancer had spread to my brain, I was just knocked off my feet. I was overwhelmed. It was something I didn’t expect so quickly following my initial diagnosis. So it was a real moment of needing to educate myself and create as many options for myself. While I had so much vested and trust in my lead oncologist, I felt like this was the time that I needed to start to branch out and ask others. Because, after all, it’s my brain and my brain is the most important thing that I have.

And so I did talk to other oncologists and, you know, made sure that I was seeking out the best advice that I could possibly gain in this mission to make a determination as to next steps for myself. I can’t stress enough that it’s important not to be led into a decision without you being fully knowledgeable and able to feel confident in what’s being recommended to you. Because, you know, you need to understand what’s happening with your body and ask questions. And if you need to develop a team outside of your local team, make that happen for yourself because you’re fighting for your life and you’re fighting for all those that love you, so you need to really take the time to understand the problem and seek out as many solutions and then decide what the best solution is for you. 

In my case, you know, I could have tried other drugs, and I did, and it didn’t work, unfortunately. So I did, finally, reluctantly, give into whole brain radiation. But actually we first focused on a part of my brain, on the cerebellum, because that’s where the most activity was. And unfortunately, you know, my radiation oncologist didn’t think it was good enough. We needed to do more and we did. But it was, you know – it was a combination of me understanding the steps we were taking and my radiation oncologist enabling me to make those steps and in a comfortable way, and not rushing into something second guessing it, regretting it. 

It really needs to be a solid decision, not only for you, but for your team and your family. So, you know, you all feel confident that you did the right thing because it’s your brain. And you want to feel that you’re doing the best for yourself, and that, you know, it’s not a mistake that you regret down the road. Because we have precious time that we need to protect and we need to make sure that we’re doing the best for ourselves and loving ourselves by doing as much educating and talking with, you know, the experts as possible.

Making of the Mask

Reilly Starr:

When you commit to whole-brain radiation, there are steps that you have to take ahead of time to prepare for the actual procedure. And in hindsight, it got easier with each time that I had to radiate. But you should mentally prepare yourself for, not only the fitting of a mask, that will not only be placed on the front of your face, but will be also on the back of your head.

And I would say that initially the heat that you’re going to feel from the mask taking shape to your face is going to be a little startling, but it’s never to a point that you are going to feel in danger. You’re just going to probably feel a little alarmed by the amount of heat that you’re experiencing while in a mask.

But I would say that that part is not as bad as when they clip you in and that’s to make sure that you’re not moving because it’s your brain. And you do want to make sure that you can save as much as your brain as possible from being incorrectly radiated because you do want to make sure that you’re pinpointing all of the lesions accurately. So by having your face, not only in the mask, but also pinned in a way that you can’t move is going to be the best for you ultimately. But it may be uncomfortable. If you find that you are claustrophobic or you’re going to have trouble with it, you can tell your doctor ahead of time. They can medicate you. I did not choose that just because I wanted to make sure that I was fully aware of what was going on. 

It was a painless procedure. And the other thing to keep in mind is it took about a minute, which was great. It doesn’t take much time at all. It’s just the prep and being in a mask can be uncomfortable, mentally more than physically, because it’s over very quickly. And for me, I talk a lot if I’m nervous and I just made sure to talk to the nurses and, you know, they understand that this is nothing that, you know, you can scoff at. So they’re there for you and just talk to them. If you need to start over, start over. If you need to take a second, drink some water. Take care of yourself. They are there for you and you need to feel as comfortable as possible in this procedure.

Once you’re on the bed and you have your mask on, you can expect to be able to see above you what’s going to be doing the radiation. And the machine is going to whirl around, not only your entire face, but it’ll take probably four, sometimes five, different x-rays. So you need to be prepared for seeing an instrument kind of whirling around your face. And you’re not going to feel anything. It’s not heated, it’s not uncomfortable. It’s just taking pictures. And usually the staff will have stepped out at this point. So if you have any issues, you definitely will be able to click an alarm and they’ll come in immediately.

And I think, you know, what you always just need to keep in mind is that it’s going to be a quick procedure. And each time you have to go in – so usually it’s 10 times, occasionally if you have just a minimal amount of lesions, it could be half that amount of time. So ask ahead of time what to expect and that’ll help you prepare for the procedure. 

So once you’re done with the procedure and they’ve captured the different angles that they need, the staff understands that you’re, you know, in a stressful situation, it’s uncomfortable – they will come in immediately. If you think that you are particularly, you know, stressed out, express that to them. Say, you know, I would kind of joke around and say, you know, clap my hands like I was a coach and say, let’s go team. We’re going to go fast. And they kind of find that, you know, it kind of breaks the ice a bit, but it also keeps them on their toes. Like I’m a person that is uncomfortable right now. I need this team to come right back into the room and take the mask off. Because they’re there for you and they understand, and they will try to make you feel as comfortable as possible.

Experience Post Radiation

Reilly Starr:

Personally, my whole brain radiation experience was over the course of 10 treatments. And those 10 treatments happened over a weekend. So I had a break which I felt I just wanted to speed through it all. But the weekend does happen. The staff does have, you know, some time to enjoy on their own. So as much as you may want to go through all 10 days, you’re gonna have to take a slight break. 

But following those 10 days, you’re probably gonna feel a little nervous about what to expect, when do the side effects start to, you know, come into play. And I personally felt the effects about a week later. I just had severe fatigue and so I slept a lot. And what’s interesting is that the sleep that we have known our entire lives, tends to help us and revive us and refresh us. But when you’re recovering from whole-brain radiation, you actually just continue to feel tired. And, you know, it’s perfectly normal to have that fatigue for about a month or so following the procedure. And that’s normal. Everyone’s different. That was my experience. And I think that a lot of people feel the effects for about a month afterwards. And then he started to normalize a bit. 

However, you may experience a cognitive decline. And, you know, identifying that decline is kind of by happenstance. So it’s not like immediately you can’t remember, you know, your old neighborhood and the dogs or your teachers from, you know, your history of school. It’s more like short-term memory and you can’t remember if your husband just reminded you to take out the trash. That will completely slip your mind occasionally, and you just need to, in my opinion, train those that are close to you about your tendency to forget more and your short-term memory has been impacted. And that if you forget something, just kindly remind me. I don’t mean to frustrate you, but I am recovering from whole-brain radiation. 

And you don’t even need to go into that. Just say, I just need a little reminder every now and then. And it’s better to do that ahead of time than frustrating yourself, frustrating those around you. And again, it’s just a matter of educating people, you know? It’s unfortunate that you and I have had to go through whole brain radiation, but we come out on the other side with a brain that is able to function better and hopefully for a long time. And it just is a matter of recovery. 

And hopefully you do fully recover. And there’s – you’ll be taking medication to help with that recovery. And the interesting thing is that what they may prescribe to you, it should be very effective. So it’s just always taking each day by day and making sure that, you know, you have the support that you need.

Whole Brain Radiation Results

Reilly Starr:

Following my whole brain radiation procedure, I was able to figure out and anticipate any type of forgetfulness I was having. Or just helping to train my family and friends on, you know, needing little reminders here and there. But what was most important was the followup with my radiation oncologist and figuring out my response to the procedure. And thankfully, I responded very well. 

The 60-plus lesions were showing shrinkage, not all of them. But there was confidence that I was on the road to the right recovery. And so I was elated. It was such a daunting step in my cancer treatment. And yet it became one of the easier things to recover from.

So, you know, you just have to be patient with yourself and everyone else needs to be patient with you. Because our brain is the most important thing and even though following the treatment, you’re trying to make sure that you’re taking care of yourself in the best way possible, give yourself a chance to just relax. Because there are long term effects that you can experience. So just be easy on yourself and, you know, just be in touch with your memory, your response time, your needs. Creating a system for those around you to keep on top of your daily needs. And if you’re forgetful about something, it’s great to have someone there to help you and make sure that they understand what you need.

 

 

Lynda Weatherby

Lynda Weatherby is an MBC patient whose advocacy work includes co-founding the Northwest Metastatic Breast Cancer Conference as well as the MBC Patient Advisory Group to Komen HQ. Lynda was first diagnosed with “Stage 0” DCIS in 2001; after a bilateral mastectomy she was told she had a 2-3% risk of recurrence, but in 2013 her cancer roared back with metastasis to her bones, brain, and a life-threatening tumor to a major facial nerve. Lynda is doing well today after two Gamma Knife SRS treatments and ongoing hormonal therapies. She remains deeply grateful for life-saving interventions and care from her team at Seattle Cancer Care Alliance.

Full Transcript

  1. Symptoms & Diagnosis of Brain Metastasis 

 

Lynda Weatherby: 

I was having bone pain that I did not associate with a potential recurrence of breast cancer. I just did not have it in my head. And I was 12 years out from an early stage diagnosis when my symptoms really started coming on – that were symptoms of metastatic disease. I had, in a very condensed series of days, I received the word that I had bone metastasis. And that weekend, while I was waiting to go in on Monday to get my PET scan to understand the bone metastasis – that weekend, I had a terrible pain on my face. An excruciating pain on my face that dropped me to my knees and took me out. And my husband took me to the emergency room. 

And the emergency room – we alerted them about the bone metastasis that I had just found out about two days before. And they thought that the pain on my face was something entirely different, which was terribly overwhelming and did not even consider cancer. So they basically sent me home with the best painkillers they could manage for trigeminal pain. 

And it was two days later when I got in for my brain MRI. So my oncologist suspected right away. When I told her that I had facial pain, she suspected right away and sent me for the brain MRI. I, of course, had no idea that I might potentially have metastasis to my brain. But I learned real fast.

Learning of Brain Metastasis 

Lynda Weatherby: 

When I found out that I had had a spread to my brain, I just was really unable to process it. It was not in the realm of possibility in my mind. I had had an early stage cancer 12 years earlier. There was just no thought ever that it could come back because I was told I had a 2 to 3% chance of recurrence.

I had extensive bone mets on my recurrence, but then also tiny, tiny spots to the cerebellum and a tumor on the trigeminal facial nerve, which just didn’t – it just didn’t add up. And I spent a few days just in complete shock. My doctor recommended that I take Ativan to kind of get through those first days and the days of the first PET scan, the first MRI. And that was extremely helpful. I mean, I totally needed it.

Care Following Brain Met Diagnosis 

Lynda Weatherby: 

Once I found out I had the brain mets and kind of the shock factor wore off, I was referred immediately to a local doctor in Seattle at the University of Washington for a consultation and for consideration of Gamma Knife surgery, because my spots were very, very tiny. They were on the order of a couple of millimeters in several different places, maybe up to five places.

And once I met with this doctor at the University of Washington, I really did feel confident with her. And I love her to this day. I mean, she saved my life and I went ahead with Gamma Knife with her on the recommendation of my primary oncologist. And she also treated the tumor that was on my facial nerve.

I haven’t met anyone else who’s had a tumor on their facial nerve, but it does happen. And it was in an inoperable spot. So it had to be radiation. So she treated the cerebellum and the facial tumor, facial nerve tumor, and that was at diagnosis. And we have been monitoring with her. I’m eight and a half years out from that treatment. We’re still monitoring with her every three months. 

I did have a second Gamma Knife in 2018. So that was five years after the first. And it wasn’t really for progression. It was more for things that had been on watch that they had gotten some new technology, and they could visualize them better. And she said these things, I think, indeed, are tiny micro mets. Instead of keeping them on watch, let’s go get them. 

So we did that in 2018. I think altogether now I’ve had about 12 spots treated with Gamma Knife, including the facial tumor and one skull met. But things have been quiet since 2018. We just keep monitoring. And my doctor says, you know, there’s always an end of the tail of the curve and that’s kind of where I’m living. And I hope it stays that way, obviously. But I feel really, really lucky for the care that I got.

Gamma Knife Treatment

Lynda Weatherby: 

So on treatment day for Gamma Knife, I went in, in the morning and I believe that our facility schedules up to three patients in a day for Gamma Knife. I was really fortunate that one of my treatment days, the other two patients couldn’t do it, or they chose not to have it. And I was the only patient in for treatment that day, which was really a gift because my doctor was just focused on me all day long. 

I believe I started the day with an MRI to get a, you know, up-to-the minute current MRI compared to the last one that I would have had, which would have been not too far before this treatment day, maybe a couple of weeks. My doctor, treatment doctor, radiation oncologist sits with a physicist to plan out the actual treatment. You know, very, very precise down to every site they’re going to treat. 

Then, for Gamma Knife, they place the helmet on the head, and that’s specific to Gamma Knife. And that was not done by my radiation oncologist. There was another doctor in the practice who was expert at placing these helmets, just super fast. So I believe I had three different relaxants in order to get the helmet placed. I’m pretty sure that was standard. It wasn’t unique to me. They give you an IV with some kind of real relaxing medicine. I took an Ativan and they numb the actual spots where they screw in, bolt in, to the forehead, down to the skull. So the bolt or screw goes down to your bone, through your skin, and then two at the base of the skull.

And this guy did it so fast. It was honestly less than a minute that he was just zip, zip, zip, zip, and I was done. You stay in the helmet while the doctor and the physicist are finalizing, finalizing everything. And then I entered the treatment room. And the machine looks, to the best of my recollection, the machine looks like a doughnut machine. You know, we’re all familiar with scanners. And you lie on a table and you go back into the scanner and then the helmet bolts into the machine so that there is no chance of movement.

And treatment, I don’t remember treatment taking that long. Now it depends on how many sites they’re treating and there’s a maximum that they will do with Gamma Knife. But I probably had, I think I had three sites the first time, and then I had quite a few more the second time – up to nine. Sorry, four sites the first and then maybe eight on the second. I think I’ve had 12 altogether. One being a facial nerve tumor and another being a skull tumor that we found on the day of treatment. And my doctor said, do you want me to treat it now with Gamma Knife? I could have waited and had regular radiation to it, but I said, no, absolutely treat it now. 

So I think I’m up to a total of 12 sites. And it was less than an hour, definitely. And then they keep you for observation for just a little bit and take the helmet off when they’ve decided that you’re not reacting to anything and you go home.

Recovery From Radiation

Lynda Weatherby: 

So when I got home, I did come home with meds, that was basically prednisone, to control swelling in the brain after treatment like that. And I think that’s pretty standard. For me, the oddity about me was this tumor that I had on a facial nerve was really, really rough. And I had a very tough time getting off prednisone and feeling okay. So that was complicated, but that’s really unusual. For everything that was treated in my brain, I feel like that recovery just went really smoothly. I did have an awful lot of fatigue afterwards. 

The first time I had Gamma Knife, I was also undergoing regular radiation at the same time for spots on my vertebrae. I was in the middle of a three week radiation plan and we took one day off and did the Gamma Knife. But the combination of those two together was, I mean, I was in bed. I was not up on my feet. So that was kind of a lot. It was definitely doable, but just something to plan for if, you know, for anyone who’s in that same situation.

The second time I had Gamma Knife, it was five years later. I was not undergoing any other treatment other than systemic aromatase inhibitors for my bone mets. And the fatigue was far less. Definitely a few days. I mean, you know, you just give yourself some space to kind of lay down and do Netflix. But, nothing like the first time when I had both radiations going on at the same time.

Lynda’s Advice

Lynda Weatherby: 

What I’ve learned as a patient is that there’s a great podcast now for MBC patients through SHARE. And they always say, no one should go through MBC alone. And that is absolutely the truth. I mean, when I was first diagnosed, I knew of a couple of people, but I didn’t really know any MBC patients and the best thing I have ever done is go out in search of other patients, kind of going through the same thing that I’ve experienced and different stories too. Cause there’s lots of different types of metastatic breast cancer. 

But try to connect with others. And in brain mets, especially because, you know, not everybody gets brain mets, it’s kind of a subset. It can be so helpful just to hear other patient’s stories and how they’ve had good luck and, you know, great providers. You can get the names of people to go see and, you know, other institutions to go to, if you’re not satisfied with where you are.

One way to do that is to go to the mbcbrainmets.org website. This is a new website being built largely by advocates who have been through this and are just converging all kinds of resources and information about how to get current treatment and standard of care treatment in brain mets for breast cancer. But definitely try and find other people – connect over Facebook, you know, connect – I’m sure the website can also provide a list of resources and maybe a list of other ways to connect to other patients too.