Kim Nelson was no stranger to breast changes. Since turning 40, she'd experienced problems with cysts and painful glands. Though painful, these problems usually resolved themselves quickly following a trip to the doctor. But when a cyst developed in her left breast in March 2011, and didn't go away within a few days, she followed her doctor's instructions to have it checked out.
"I was just going through the motions," Kim said, noting she had no family history of breast cancer. "I thought it was nothing at the time. Had I not gone through the motions, it might not have been caught until it had spread."
Her doctor left an order for a mammogram and she made her appointment. Because she has dense breast tissue, she wasn't surprised when she was sent for an ultrasound.
"Finally the radiologist came out and said I had a spot that needed to have a biopsy," she said. "To me, he seemed really upset about it, but I was like, 'OK, that's why I'm here, to catch these things.'"
Her regular doctor referred her to the Knoxville Breast Center, which Kim wanted because it would allow her to complete the diagnostic procedures quickly. She was there within a week, and within 24 hours of that appointment, she knew that she had breast cancer in her left breast and would be returning for a biopsy on her right side. The biopsy came back non-cancerous.
From there, everything moved quickly. She met with the surgeon that same day and he discussed the treatment options available with Kim and her husband, Gary. The surgery was scheduled, though the surgeon didn't pressure her to decide that day the route she would take.
After the surgeon explained the options, Kim asked him to sit where she had been sitting and she took his chair. Then she asked him, "What would you do if you were in my position and this was your wife or daughter?"
"His opinion means a lot me, and in my view, he was the only one that was going to give me a clear-cut opinion of what would be the best option," Kim said. "Since I was done having children, I may as well be as aggressive as I could to be around longer."
She also decided to go ahead with reconstructive surgery and met with a plastic surgeon the next day.
"He puts his cancer patients ahead of his cosmetic patients and rearranges his schedule so that whenever you're having your cancer surgery done, he can come in and they can work together," she said.
Women have several years after a mastectomy to decide if reconstructive surgery is wanted and still have it covered by insurance. Those who don't have it right away are fitted for a prosthetic, but Kim said she wanted to have it all done at the same time. Otherwise, it would have added a fourth surgery.
"One lady said she was in her garden and was working in her garden with her prosthesis," Kim said. "Her prosthesis popped out again while she was gardening. It was five years after her surgery and she went inside and called and said she wanted a fake boob.
"I felt the same way. I'm still active and do stuff with the kids," Kim said. She and Gary have a daughter, Sara, attending the University of Florida, and son, Dylan, currently at Cumberland University but still in high school at the time.
Though she found great support from her family, friends and doctors, she struggled with whether she had chosen the best option, and it was hard to get anyone to tell her an opinion on if she was doing the right thing.
"Nobody wanted to say, 'Yes, you should do that,' or 'No, you shouldn't.' Everybody was saying, 'It's your choice,'" she said. "Well, you start to get a little mad about it and you want to say, 'Just tell me something.'"
Then, as she was being prepped for surgery, the nurse took her vitals and told her she was impressed she'd made the decision to treat her cancer aggressively. Seven years before, the nurse had cancer in the same spot. She told Kim she was afraid at first and opted not to have a mastectomy. Her cancer returned twice in those seven years.
"I took that as a sign I was making the right decision for me," Kim said. "It's amazing how many people have been through this."
She had her first surgery on day three of Tennessee Comprehensive Assessment Program testing at Pleasant Hill, where she teaches fifth grade. She told the kids she was sick and was going to be out for a little while getting better. She made sure, though, she was back at school before classes dismissed for the summer. She didn't delve into the details, or tell them that she had cancer, leaving that to the parents if they so chose.
"I'm a hugger, and I explained that when I came back, they wouldn't be able to hug me like they were used to," Kim said. "So we came up with a finger hug and everybody was really careful.
"It was important to me to be back before school was out so they could see I was OK. Kids can worry."
Today, she uses her experience in teaching science, talking about DNA and genetics and how her daughter will have to be proactive in her life because of the family history that now exists.
Over the nine months of her three surgeries, she missed only 20 days of teaching. Sometimes, getting up and getting to school was difficult, but she wanted to be there.
"No one can know what you're going through unless they've done it," she said. "Be however you feel that day, especially if you're still going through treatment."
A double mastectomy is an aggressive treatment, and Kim said it was also a bit of a shock to see herself after the surgery.
"I still feel a little like Mrs. Frankenstein at times," she joked. "That first initial look where you see yourself — You know they are taking it all, and expect to be flat as that table, but it's more than that. They take the muscle, the tissue and everything. There is nothing left when they're done, which is what you want."
Lymph nodes are also removed to be tested and ensure cancer has not spread.
After surgery, Kim said drainage tubes were uncomfortable and she slept in a chair because she had to sleep sitting up. Once those were removed, she felt much better. She did exercises to avoid fluid build up.
Kim said she stood up pretty well during the treatment. Because her breast cancer was hormonal, she did not need chemotherapy after surgery, though she takes medicine to block those hormones. She'll be on tamoxifin for five to 10 years.
During treatment, she said she tried to stay upbeat and positive.
"I don't think I ever got down or depressed until a whole year had gone by," she said. "I'm great in emergencies and I fall apart afterward."
That's when the effects hit her, she said. But it also provided a chance to look back on the past year, with three surgeries in nine months.
"It gave me a chance to look back and go, 'I did pretty good. Maybe it's OK that I don't feel great today,'" she said.
There were so many people that brought food to the family so she wouldn't need to worry about cooking while recuperating from surgery, and others that offered a shoulder to lean on or an ear to listen.
"You find how many people love you, care about you and will be there to take care of you," Kim said.
It also provides some perspective on what's really important in life, she said. Her son was set to begin his senior year of high school in the fall of 2011 and graduated in May 2012 — something she worried she wouldn't see after her diagnosis. She saw him graduate and earlier this year sent him off to college in the fall.
"You realize what's important is the people around you and the time you get to spend with them is huge," she said. "When you think you need to go take care of that task, if it's giving up an opportunity to spend time with somebody, you might want to rethink it."
Those people are the ones that help keep spirits up when times get hard.
"Make sure to surround yourself with people that love you on the good days and care about you and hold you closer on the bad days," she said.
She recommends talking to others who either are or have gone through treatment, and get their honest answers about surgery and recuperating. She said talking with Pauline Sherrer, publisher of the Chronicle and a breast cancer survivor, helped her and let her know what to expect in an unexpected situation.
"No one can make those choices for you. Each person is different and there are lots of different routes," she said, adding that some women with her diagnosis had opted not to have a double mastectomy, choosing a less aggressive option. "For some, that first choice worked out great for them. Others wish they had been more aggressive because they had to go back later.
"Be confident in your choice, and it has to be your choice to be as whole and healthy as possible."
To all women, Kim urges you to get regular check-ups, and if something seems wrong, see your doctor.
"Women know their bodies better than anybody else," she added. "If you're not satisfied with the answer you get about something, go somewhere else and get it checked."