Location: Charlotte, NC
Sandra Goldman does not want to be called a survivor. She prefers the term conqueror. Facing cancer for the third time, and enduring more diagnostics, consultations, needle pricks, infusions, radiation and surgeries than imaginable, Sandra gets to be in charge of the terminology. And she is, indeed, a conquerer.
As was true for me too, there have been many strokes of good luck within her bad luck. Sandra first learned she had breast cancer when she went to get a routine mammogram in October 2010, three months earlier than scheduled. “I don’t know why I went in early,” she says. “I did not feel any lumps or anything suspicious.” The early mammogram led to early detection of what was then Stage 2 breast cancer. “It looked like an explosion of planets,” Sandra says. “I knew that was not good.”
Sandra had a single mastectomy of her right breast, where the cancer was located. Her oncologist thought it was unlikely the cancer would show up in the other breast and she also heeded her father’s mantra from her childhood in Lichtenstein telling her not to fix something that isn’t broken. She underwent additional reconstructive surgery and had an implant inserted followed by four rounds of chemo. She was also placed on Tamoxifen, an estrogen blocking hormone therapy pill for five years.
Sandra resumed to her busy and fulfilling life as a loving wife and mother of four and the director of the Hebrew Cemetery in Charlotte. At her five year anniversary, her oncologist decided to keep her on Tamoxifen for another five years. Everything looked good and he told her he only needed to see hear on a yearly basis. With the cancer disruption solidly behind her, Sandra decided to get her health back on track. She hired a personal trainer with the goal of reclaiming her body and getting back into shape.
Getting fit benefitted Sandra in more ways than one because it allowed her to be in tune with her body. At her next diagnostic mammography appointment, she told the radiologist about a small pressure on her right upper chest, where she’d had the mastectomy. She was told it was unlikely anything was amiss since she did not really have tissue left in the area that was bothering her. The radiologist heeded Sandra’s concerns and checked the area out. To the rediologist’s surprise, the image “looked funky,” says Sandra, but she surmised it was most likely scar tissue. She did a biopsy just to be on the safe side, and called a few days later. “She told me, ‘You nailed it,’” Sandra says. She had a tumor in the pectoral muscle on her right side, something that only happens in five percent of cases.
“I told my kids I am a unicorn,” Sandra says. With her first diagnosis, Sandra was operated on to remove the tumor and then received chemotherapy. With the second cancer, the order was reversed. Sandra first endured sixteen rounds of aggressive chemo followed by a PET scan that showed no trace of any tumor. “Everybody was very excited that the chemo had worked,” Sandra says. But Sandra decided to again trust her gut. She told her surgeon to go further than the margins in her surgery to remove some of the pectoral muscle and some more lymph nodes. “Just in case,” Sandra says she told him, “because I don’t want to have to do this again.” It turned out to be a good call. The scan was wrong and had failed to detect additional cancer. The tumor they had prompted the second diagnosis had actually grown and the surgery also revealed a second microcell in one of the lymph nodes.
“Now I went into the textbooks of medicine,” Sandra says, noting that scans are only about 70 percent accurate. She and her husband, Yaron, decided to “get some other eyes on this.” They went to Duke University for a second opinion where a different chemo protocol than the one suggested at the Levine Cancer Institute (LCI) in Charlotte, where Sandra was being treated. “It is very difficult as a patient to decide what to do when you get conflicting opinions,” Sandra says. First the scan and the surgeon had conflicted, and now she was faced with different treatment options. Duke thought she should start with a certain chemotherapy while LCI wanted to start with a different kind followed by 30 rounds of radiation. So Sandra decided to seek more expertise, this time from further away. She reached out to Israel, where she and Yaron had met and fallen in love, and where she had many connections thanks to serving as the President of the local Hadassah chapter. That consultation led to more research (where Sandra tapped into the skills she developed in her former career as a journalist) that yielded an oncologist at Hadassa Hospital in israel. That world-renowned oncologist agreed with LCI’s approach so that is what Sandra agreed to do. After the chemo regimen, Sandra continued to probe options and experts. She found another oncologist who specialized in the estrogen-positive cancer Sandra was battling at Dana Farber Cancer Institute in Boston. She learned Dr. Eric Winer was not taking on any new patients but she sent him an email describing her case and he immediately responded and told her he would squeeze her in before leaving on a scheduled vacation. After examining her and studying her scans and her history, Dr. Winer agreed with LCI’s approach. He told Sandra that she was not sick enough to be his patient, but that his door would always be open to her if she needed his help again moving forward.
Feeling secure in her treatment protocol, Sandra returned to Charlotte for the thirty rounds of radiation. Since her cancer is estrogen-fed, she was also put on a different medication to block the estrogen. That medication not only caused terrible bone pain but led to suicidal ideations. Sandra remembers seeing a wall when she was driving around Charlotte one day and thinking it would be so nice to just drive straight into the wall. “I knew that was not me,” Sandra says. She immediately called her doctor and was taken off the medication.
With everything once more behind her, Sandra and her medical team thought she was good to go. She opted not to have reconstructive surgery (her implant had been removed with her second cancer diagnosis) and to instead embrace being a unicorn. She went in for checkups at three months, then every six months, then every year. All was quiet on the cancer front.
Then this past June, a routine PET scan lit up again. It showed spots on her live and on he vertebrae. Her oncologist shared the scan and the results of a glucose test with his colleagues, who agreed that it was most likely a false positive. They decided to wait a few months and
repeat the scan to see if it was something to worry about. Some patients would find the interim months agonizing, but not Sandra. “I have the ability to put it in the back of my head and lock it up,” Sandra says. “So I locked it away.”
This past October, Sandra had another scan. The original light ups were gone. There was nothing there. But instead spots lit up on the pectoral muscle and also on the deltoid muscle on her right side. This time her oncologist was very concerned. He did an immediate biopsy of her pectoral muscle. The cancer was back. It was exactly the same cancer, Stage 2 estrogen positive. It is unclear whether this cancer is a recurrence or a new cancer, but it is more a question of semantics at this point. Sandra’s team ended up deciding to consider it metastatic because it had jumped over to the deltoid muscle as well.
Sandra again reached out to Dr. Winer at Dana Farber and was able to put him in touch with her LCI oncologist. Together they agreed that the treatment protocol should be regular estrogen-blocker shots coupled with oral chemotherapy. “It is three weeks on, one week off,” Sandra says. “Which I will keep doing until it stops working.” She is tolerating the chemo fairly well, especially because she has a basis of comparison. “The oral chemo is much better than the IV chemo,” Sandra says. She has developed a metallic taste in her mouth (that comes with the silver lining of losing some of the weight she gained in the last few years because she has had no appetite) and feels fatigued. But she has also developed a certain equanimity about her cancer. “When it came back the first time,” Sandra says, “I realized that you are never really done.” She knew her life would never return to her pre-cancer normal. As any cancer survivor knows, there are always side effects. Some are the gifts that cancer keeps giving, while others are the permanent reminders of all of the aggressive treatment your body endured. After her second cancer diagnosis, Sandra learned to think of it as a chronic disease. “I am at peace with it,” Sandra says. “I have come to terms with becoming a lifer.”
Sandra says she can be calm as long as there is a plan in place. “I am a practical person but I am also very spiritual,” she says. And during times of stress, like when she is undergoing scans that are in very confined spaces and can last an hour, she is able to conjure up images that are soothing and allow her to escape whatever distressing situation she is in. With her first two cancers, she would envision butterflies in fields of green pastures. “I would follow the butterflies and feel calm,” Sandra says. This time the butterflies have been replaced by eagles. “I realized that butterflies aren’t strong enough.” An eagle appeared during her last scan when she was unable to conjure the butterflies, and when she researched eagles later she learned that they stand for strength, fight and victory. “That works for me,” Sandra says.
Anyone who knows Sandra or has followed her journey on social media agrees that she has landed on a good mascot. If anyone embodies the strength and tenacity of the eagles that are now her chosen symbolism for this part of her cancer journey, it is Sandra.