Rebekah Ruby feared she had cancer the moment she felt the lump hidden under what appeared to be a fading bruise on her breast. But she had no idea a hidden heart defect also was threatening her survival. Or that the challenging year to come would ultimately result in a new career path.
"I go big or I go home," Ruby said, smiling. "That's just how I do it."
Breast cancer is the leading cancer for women of all races in the United States.
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You can learn more about your risks for breast cancer by using the breast cancer self assessment tool at http://www.cancer.gov/bcrisktool/
The 24-year-old Ashland coed had just hopped out of the shower after a weekend hiking expedition in Yosemite last summer. At first, Ruby tried to convince herself she was too fit and too young to be facing the big "C." But a Google search only increased her fears. Breast cancer is possible at any age.
"I think everything kind of stopped for a minute," Ruby said.
Ruby called her doctor. Follow-up tests proved her initial hunch was right on July 12, 2011. Doctors first took images, then biopsies, of the malignant tumor.
"This is really happening," Ruby remembers telling her sister. "I have cancer. This is the real deal."
Dr. Nancy O'Neal, a breast surgeon with Oregon Surgical Specialists, was part of the team of oncologists and surgeons who advised Ruby that her best chance for survival would be a double mastectomy followed by chemotherapy.
"I certainly felt compassion for her," O'Neal said. "I felt that at 23 she should be worried about college classes and her boyfriend, and not that she had breast cancer."
But O'Neal also said Ruby was lucky that she and her doctors didn't let her age deter them from pursuing the possibility that she had cancer.
"Her cancer was pretty aggressive," O'Neal said.
Ruby initially was against having mastectomies. The thought of not being able to breast-feed the children she hoped to have someday was almost too painful to consider for the former nanny.
"I didn't want them to take my chest," Ruby said.
Ruby also considered not doing chemotherapy because of sterility fears. But a day with her sister, watching her 2-month-old nephew tackle a newborn milestone, helped put her priorities in perspective, she said.
"He was just learning how to lift his head up on his own," Ruby said. "I realized if this doesn't get taken care of, I might not be able to see him walk and talk."
Galvanized into action, Ruby went to a fertility clinic in Portland and had her eggs frozen. She underwent the mastectomies and began the process of reconstructive surgeries on Aug. 10, 2011. Ruby also had a port put in her chest for the yearlong chemotherapy courses that began Sept. 20, 2011, she said.
Figuring her waist-length brunette hair was going to fall out, Ruby cut it off in stages. First to her shoulders. Then, when the big clumps came out, she ultimately buzzed her head.
Ruby said the hair loss felt like another assault on her femininity. But, once again, her family helped her gain perspective.
"My family was so supportive. They make me laugh. And I'm still alive," Ruby said.
Because Ruby tested positive for an aggressive form of breast cancer that responds well to new a medication that targets tumor receptor cells, part of her treatment included a year's course of Herceptin, said O'Neal.
But Herceptin can sometimes affect heart function, so doctors began to monitor Ruby's heart with regular echocardiograms, she said.
That's when Ruby discovered she had a congenital heart defect. But it wasn't a problem caused by the new medication. She was born with holes between her atrium and ventricle chambers of her heart, Ruby said.
"My doctor said, 'Well, looks like open-heart surgery for you," she said, shaking her head.
"If I hadn't gotten cancer, and had to have chemo, and had to have my heart checked, it might have been too late by the time they found this. One of the holes was really big," Ruby said.
Asante cardiothoracic surgeon Dr. Charles Carmeci was able to avoid "cracking" Ruby's chest for the surgery. Instead, Carmeci went in through one of her breast implant surgery sites on June 15, 2012, Ruby said.
An active young woman who loved exercise, Ruby had worked out at least an hour every day before getting cancer. Eager to get back in the gym and out on the hiking trails, Ruby enrolled in the hospital's 12-week cardiac rehabilitation program.
"I met a lot of very awesome old people," Ruby said, adding the average age of her workout partners, who were mostly male, was about 65.
She graduated from the cardiac program last week and signed up for a maintenance program. Ruby also started school last week. Her next challenge is to follow a lifelong dream to be a health professional.
"I always thought I'd become a nurse," Ruby said.
After facing cancer, Ruby planned to specialize in oncology nursing. Now she is determined to be "a Melanie," Ruby said.
"A nurse advocate. A patient navigator," she said, looking at registered nurse Melanie Dines.
Dines has been Ruby's breast health/oncology navigator. Navigators help a patient through education and communication, while providing compassionate support throughout their journey, Dines said.
A cancer diagnosis is overwhelming at any age, Ruby said. Trying to make sense of medical terminology and treatment options while struggling to deal with the fact that your life has been forever changed is mind-bending and soul-shaking.
"I wish that nobody had to experience what that was like," Ruby said. "It was so painful."
But the support of Dines, Ruby's family, her doctors and nurses and her faith have carried her through this past year.
"Cancer patients are amazing," Ruby said. "I know that they are fighting for their life. I want to be able to support them through that."
Ruby's goal is to get the training necessary so that she, like Dines, can provide that level of support to other women who are fighting cancer. She's already started promoting breast health among her peers, she said.
"I tell my friends they're going to get breast exams, or I'm going to come do it for them," Ruby said.
Ruby still sometimes wonders what some future man of her dreams might make of her cancer battle scars. Dines and O'Neal understand Ruby's true beauty is reflected in her strength, her stamina and her survival.
"She's really a remarkable person," O'Neal said. "She's just tough and she's going to do well."
Running her hands through her short curly locks, Ruby gazes down at the pink ribbon breast cancer survivor tattoo inked on her left forearm. And she smiles.
"This is who I am and these scars have made me who I am," Ruby said. "I'm alive, so these scars are OK."
Reach reporter Sanne Specht at 541-776-4497 or email firstname.lastname@example.org.