Vivian Bucay is a dermatologist in San Antonio and a melanoma survivor whose disease progressed from stage 3 to stage 4 in a matter of months. Here, she shares her story.
As told to Elizabeth Siegel, Allure
Vivan Bucay photographed by Marie Langmore
The possibility of cancer wasn't on my radar. Ironic, I know, since I'm a dermatologist. But when I was 45, I had some dryness in my belly button. I wear dark clothing, and one day, when I took my shirt off, I saw a white residue. I didn't see a lesion of any kind, so I thought it was eczema or psoriasis, which can happen in that area. But it didn't go away, and I didn't know what it was, so a few weeks later I thought, I guess I'd better biopsy it. I did a biopsy on a Friday, and the following Wednesday, I got a call from the pathologist. He said, "I'm afraid it's a melanoma, and it's probably metastatic." I said, "Can you wait a second? Let me go pull the chart." And he's like, "No, I'm talking about you." I had this really hot sensation in my body, like blood was just draining from me. The first thing I did was pick up the phone and call my husband. The second thing I did was call the surgical oncologist to whom I refer everybody. I was in his office that same afternoon by 2 p.m., making a plan. There's not a whole lot of time to think. You have to just do.
I was shocked but grateful I'd biopsied it. My husband--he's a cardiologist--jokes that he would have totally ignored his belly button. He would have just kept putting baby powder on. But as a dermatologist, I did what I always do when there's something strange. My case is proof that melanomas don't have to be dark moles, and they can happen anywhere. I certainly think my history of sunburns as a teenager contributed--I laid out in the sun every chance I could, starting in my early teens. I quit doing that around the age of 21, when I knew I wanted to be a dermatologist.
I had a wide excision and a sentinel node biopsy and found out that the melanoma had spread to my right groin. I opted for a really long surgery called a radical groin dissection, during which all of the lymph nodes in the area are removed. I think there were 27 or 28 lymph nodes I eventually had removed, so now I have some permanent tendency for swelling in my right leg. I was good about wearing a nasty, giant support stocking for the first five years, but now I'm like, OK, I can't wear those day and night.
I had to take six weeks off after the surgery--my doctors didn't want me to work--but then I went right back to seeing patients. I also started Interferon treatments, which boost the immune system and theoretically help slow cancerous growth. In all the years doctors have been prescribing Interferon, they haven't found that it actually increases survival rates, but I was a stage-three patient, and that was the only adjunctive therapy available at the time. It made me feel like I was taking charge and taking control.
Months later, I also entered a clinical trial for an immune-treatment drug called Ipilimumab, which has since been approved. (Being a doctor is a double-edged sword, because you know just how bad it can be, but you also have really quick access to things.) Routine body scans were part of the protocol, and after one of these, the radiologist called me immediately to say, "Are you feeling OK? Are you having any breathing problems?" And I'm like, "No, why? I'm perfectly fine." And she said, "No, it looks like both of your lungs are just flooded with melanoma." I didn't completely believe her. Everyone gets rashes with these drugs. I thought I had the equivalent of a rash but inside my lungs. They told me I'd need to have a lung biopsy to continue in the trial and prove that it was not melanoma. So two days after my younger daughter's bat mitzvah, I had the biopsy, and it was positive for melanoma.
Everything had started in May, and now, by the following January, I'd progressed to stage 4 melanoma and been dropped from the trial. I had gone from having a 50/50 chance of living for five years to a dismal prognosis: My chances of long-term survival were down to 3 percent, but I decided not to pay attention to the statistics. I made an appointment at the National Cancer Institute to see Dr. Steven Rosenberg, who is the world's authority on melanoma. I wanted to join another trial, but the National Cancer Institute told me I couldn't until I'd exhausted every other avenue of fighting the cancer. First, I had to do Interleukin-2, a form of chemotherapy that's so toxic you have to stay in the hospital to take the medication. I'd spend a week in the ICU getting the drug, then check out and go to work. It's a last resort, because it really drops your blood pressure and it makes all of your blood vessels leak. Your kidneys can shut down. Your lungs can flood. I would get rashes. I would literally gain 15 pounds overnight. But it felt like a small price to pay.
Interleukin-2 has just a 6 percent success rate, and not everybody can tolerate it. There are 14 doses, and if you can't hold a dose--you get to sick too keep going--you can't make it up. I was determined to hold all 14 doses, particularly after my first-round scan in April showed that I was responding. That summer, I had a long wait to find out whether it had worked. On August 1, 2007, I had my follow-up scans and the news was really good: My lungs were clear, and there was no cancer. I'm just one of the really lucky ones.
For me, it was very motivating to have three young girls to take care of. If my daughters ever did get a sense of my being sick or if they were worried, my line to them was always, "Nope! I'm tough. And I will dance at your weddings." Hopefully, one of these days one of them will get married, so I can actually fulfill that promise. Good lord, I'm not getting any younger here. When I first got the news, my husband was so panic-stricken and nervous and emotional. I said, "The one thing I can't afford to do is be worried about you all being worried about me. So let me just handle this. I'm going to be fine." I mean, you do and say stuff that sounds so corny.
Now I'm down to getting checkups once a year. And I do try to think about what I'm eating. You know, I've read so much about diet, and acid environments are favorable for the growth of cancer cells. So I eat more alkaline foods, like green vegetables, and I add lemon to water (lemon is an acid outside the body but once it's metabolized, it's alkaline). More than anything else, I want to say to anybody who gets a bad diagnosis, don't be afraid to let others help you. It's good to have a sense of community. I'm in touch with people from around the country who have reached out to me. My mother is a cancer survivor, as well--I had her example. She doesn't give up on things. I don't think there is anything wrong with being afraid, but hope is one of those things that nobody has the right to take away from you. When doctors say, "No, there is nothing we can do for this" or "Get your affairs in order," that's just not true. It ain't over until it's over.
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