Hanging on Mona Pinnington's refrigerator is a calendar that tracks month by month from September to the end of December. In between entries that read "6-7 dance" and above entries that say "field trip" is a single word highlighted in pink every third Thursday: "chemo."
Breast cancer invaded her orderly, planned-out world in July, but she is determined not to let it derail her businesses or her family life, particularly for her daughter, 11-year-old Alexandria. Along the way, she faces an increasing number of choices breast cancer patients now have about surgery and treatments. She is also learning how little she is getting for 20 years of health insurance premiums.
Pinnington, 38, had a choice of getting a lumpectomy and radiation or a mastectomy, having the breast removed. Like an increasing number of younger patients, she is opting for a double mastectomy to try to eliminate the threat of cancer showing up in her other breast. Chemotherapy is required.
"If I'm doing chemo, I am doing it one time," Pinnington said, sitting at her kitchen table with her husband, Cameron. "It's still a possibility it could come back, but I'm just at great risk for it to come back in the other breast."
Her surgeon at University Hospital, Dr. Randy Cooper, agreed. Pinnington asked him what he would tell his own daughter. It is a question he has faced often before.
"If you're my daughter, 35 years old, I'd really want her to have bilateral mastectomy," he said, standing in the operating room where it took little more than an hour to remove both breasts. The chance of a cancer returning in the other breast is about 1-1.5 percent a year, but Cooper said he understands why that risk is unacceptable to many young patients.
"There's no science in it," he said. "That's emotion."
While women have more options than before, it also means facing more agonizing questions, said Pam Anderson, a breast health coordinator for University Breast Health Center.
"The good news is we have a choice," she said. "The bad news is we have a choice."
Pinnington also opted to have immediate reconstruction with plastic surgeon Dr. Billy Lynn, who entered the OR as Cooper was finishing up, leaving him two large pockets on her chest to work with. Carefully, Lynn worked on shaping the pockets, using his hands to check that they were symmetrical, and then stitching in tissue expanders that he will slowly inflate over several months, an injection at a time, before he puts in breast implants months later.
IT IS NOT THE SURGERY or losing her breasts that really bothers Pinnington, though. It's the hair.
"Losing my hair, I don't fear it. I'm dreading it, but I'm not afraid of it," she said.
She has a thyroid condition that once caused her to lose all of her facial hair. and it was not pleasant.
"I've had thinning hair before, and it's been traumatic for me," she said.
To help her cope, her mother, Donna Arnold of Fort Wayne, Ind., her sister Justeen Oess of Atlanta and Alexandria crowd into the back of the Second to Nature Boutique at the University Breast Health Center. There, they are surrounded by dozens of heads wearing wigs. After about an hour of trying them on, none seem quite right.
"It's not a secret I'll be wearing a wig," Pinnington said. "But I want it to be as much like now as possible. Find anything, Justeen?"
"Not yet," Oess said, flipping through a book of wigs.
"Just let me have your hair," Pinnington said, running her fingers through Alexandria's hair. "That's what I want."
Looking through hair swatches, Oess zeroes in on a color called 26H. When she holds the swatch against her hair, it is so close that it seems to disappear.
"We're going to be twins again," Pinnington said.
The hair is not vanity for a woman who eschews makeup when she goes to the grocery store. It is an attempt to hang on to at least the appearance of her former life, which is changing rapidly.
A WEEK BEFORE she was to start chemotherapy, Pinnington stood at the counter of CoCo's Cabana in Martinez, one of three tanning salons she owns in the Augusta area. It is a business she built from scratch, and it runs the way she runs everything -- by list.
"I'm a list person," Pinnington said. "It's just all in binders and they just check it off. I've got my daughter making lists for herself. It's a sense of accomplishment. It keeps you organized."
She started her first shop in 1997 after going to a tanning salon not up to her standards.
"They were just filthy," she said. "It just really grossed me out."
Then she looked up at the light fixture, which has a thin single strand of spider silk cutting across it.
"That cobweb is about to drive me crazy," Pinnington said.
The toughest part of starting chemo for her is not knowing how she will react to it.
"I have to know, how am I going to do? How am I going to do?" she said. "No one can tell me."
A month earlier, Dr. Mark Keaton of Augusta Oncology Associates told her she would be getting a regimen of taxotere, carboplatin and Herceptin because she has the HER2 receptor on her cancer cells, which Herceptin targets.
"These tumors historically used to have a poor prognosis, but actually now they have a better prognosis because the addition of Herceptin prevents a significant number of relapses" with the more targeted approach, he said.
The two chemotherapy drugs will probably cause some nausea, but it can be treated with medication and it is usually not as severe as some other regimens. In about 20 percent of patients, it induces a menopause-like state, Keaton said.
"Your appetite is going to change some," oncology nurse Heather Evans said to Pinnington. "You are going to have some nausea. I don't expect it to be severe. But you, probably for a couple of days after your treatment, are not going to feel that great."
"I'm a really picky eater as it is," Pinnington said.
"It's not how much you eat; it's the quality of the food you eat," Evans said, advising her to eat smaller, more frequent meals. The regimen does cause food to take on a metallic taste. And there is the fatigue.
"You're a mom and you're always on the go, always doing stuff," Evans said. "You're not going to be able to do everything that you are doing right now. So now is the time to say, 'Sure, I could use somebody.' If somebody calls and offers to bring you dinner, that would be great. Thank you so much. Or somebody offers to come over and vacuum or go grocery shopping for you."
"Let 'em," Pinnington said. The first treatment, Evans said, will likely be the worst.
ON Sept. 9 Pinnington was not nervous as she sat in the infusion room at Augusta Oncology Associates with her husband, mother and sister. They talked about everything but what they were waiting on. They teased her about the time she walked into Oess' house and said, "When was the last time you cleaned those ceiling fans?"
Two and a half hours after Pinnington arrived, with still no treatment started, Evans tells her there is a holdup with her insurer, Blue Cross and Blue Shield of Georgia, on the Herceptin.
"I thought it was covered," Pinnington said.
"It should be because you're HER2 positive," Evans said, and the clinic has all the documentation.
"Let me talk to them," she said.
"Trust me, I'll be the next one on the phone," Evans said.
Soon after, Keaton decides to forge ahead and start her treatment without the approval. Soon after the taxotere starts, an old friend, Sherry Scott, walks in with a bag of treats and gives her a hug.
The two women share the same oncologist and surgeons. Scott went through breast cancer two years ago and is coming in for her second-anniversary scan.
"Were you sick and down, in bed for days?" Pinnington asked.
"Only like Monday and Tuesday," Scott said.
"You'll get into a routine where you'll know (what's coming)," Scott promised her and gave Pinnington her cell number.
"If you just need to talk, anytime, day or night," she said.
Finally, about six hours after she entered the clinic, the Herceptin is approved, and she starts on her final drug of the day. Around 5:30 p.m., she can leave.
"It was a long day," Pinnington said.
She has five more treatments to go.