If you have lungs, you can get lung cancer

November is Lung Cancer Awareness Month. Sadly, lung cancer doesn't get nearly as much attention or research funding as the other leading types of cancer, despite killing more people than breast, prostate, and colorectal cancer combined. This post is about why lung cancer awareness is so important.

When I met my wife Cara in 2006, she was not a very athletic person at all. She was already making some effort to change that. Meeting me provided her extra motivation. She knew that our chances for a long-term relationship would be better if she could join me in the outdoor pursuits that I loved. She also found, as she began to exercise more, it was something she very much enjoyed herself. It was in the spring of 2007, when she bought a bicycle, that things really began to change dramatically.

It wasn't easy at first, though. Quoting Cara in a May 6, 2013 post on Facebook:

I just want to give a shout out to any/all of my friends who are embarking on journeys to improve themselves physically (or if they're thinking about it but are afraid): You CAN do it. I remember the first time I rode a bicycle in my adult years - it sucked. My legs ached and my lungs burned. I turned around after less than a mile, and cried when I got home because I thought I could never do it. Well, now you guys know how much I love to ride now. 

Be realistic - know when pain equals actual injury/pain - but don't let sore muscles, sweat, or tiredness deter you. You might get dirty, you will be tired, you might be sore - but the results you will notice (not just aesthetically, don't make it just about that) will be your proof that you are doing the right thing for yourself. Walking, running, bicycling or whatever you want to do, just do it. I'll always be cheering you on.

Cara began to ride more and more, and within a couple of years she had become the athletic person that she was so far away from being for her whole adult life. In 2009 she did her first century (100 mile) bike tour. She was so proud of herself that she got a tattoo to commemorate the occasion. And in 2010 I was very surprised and incredibly proud of her when she averaged 18.2 mph in a 20 km cycling time trial, much faster than I had expected. I could see the fierce determination on her face as she pedaled to the finish line. She said afterwards that she finally knew what it felt like for me in all the races she had seen me run.

Cycling became Cara's biggest passion in life. In addition to riding her bike for fun, in tours, and for commuting, she also became very involved in the local cycling community and made many great friends in this way.

In November of 2012, we moved up the hill to Cleveland Heights, adding a substantial incline to Cara's daily ride home from work:

This climb was a big challenge at first, but the more Cara did it, the easier it became. Partway through 2013, however, that trend would reverse itself.

In the spring, some time in mid to late April as I recall, Cara began to experience wheezing, coughing, and shortness of breath. At first she thought it was allergies, although she had not experienced such symptoms in the past. Our move had put us in a neighborhood with many more trees, and it was allergy season, so it seemed plausible. She tried various allergy remedies, which had marginal effects.

On May 29, she did the "Wheels & Heels" ladies' social bike ride. Here is a beautiful picture of Cara with her bike, bicycle tattoo visible on her leg:

Two days later she finally saw a doctor about the symptoms she had been experiencing for over a month. On that morning, before she ended up going to an urgent care, she posted this on Facebook:

Still wheezing horribly, and now there's a crushing feeling in my chest. Fairly sure it's allergies, but I've tried Zyrtec and now Claritin and they might take the edge off - but I still can't breathe. My urgent care coverage is shit, so now begins the arduous task of finding a PCP that will see me today.

Those sound like pretty serious symptoms to me! At the urgent care, after she was given a breathing treatment and it seemed to help, she was quickly diagnosed with asthma.

Of course, she did not actually have asthma. Slightly less than three months later, she was diagnosed with stage IV lung cancer. I would be remiss not to mention the remarkable fact that a few weeks before this cancer diagnosis, she completed a two day, 150 mile bike tour, and she said that, despite all the breathing problems she had been having throughout the summer, she felt great on that ride, ultimately her final bike tour. Here is a picture of her just before the start of that ride:

The doctor who saw Cara at the urgent care never considered the possibility that such a young, active, healthy person with no smoking history could have lung cancer. Cara also remarked later, after we knew the true cause of her breathing issues, that the doctor had said "If you had a blood clot, you'd be dead" so there was no need to check for blood clots. I don't know whether Cara had any blood clots at that point in time, but she had a lot of them by the time she was diagnosed with cancer, and she certainly wasn't dead.

This is why lung cancer awareness is so important. People, doctors and patients alike, need to know that anyone with lungs can get lung cancer. Cara had been having pretty serious breathing-related symptoms for over a month when she went to the urgent care. Those symptoms could have been caused by various things other than lung cancer, but they also could have been, and in fact were, caused by lung cancer. If someone presents with those symptoms having had them for that much time, the possibility of lung cancer shouldn't be ignored. Better safe than sorry. Who knows how much difference those three months might have made? Obviously, the cancer had grown more by August than it had in May, and the more cancer there is, the harder it is to treat. For anyone reading this who doesn't already know the end to Cara's story, she passed away on April 24 of this year. If she had been correctly diagnosed sooner, would she still be alive today? I'll never know for sure, but I wouldn't be surprised.

During her twenty month battle, Cara benefited tremendously from some new treatments that have emerged due to groundbreaking research in recent years. She got to go on a lot more bike rides in 2014, after a point in late 2013 when was practically on death's door. Those treatments weren't enough to save her. Some patients have had their lives extended much, much longer by new lung cancer treatments, but the diagnosis of stage IV lung cancer remains one with a grim prognosis. And that's another reason lung cancer awareness is so important. Lung cancer research gets 1/15 as much federal research funding per death caused as breast cancer research. One fifteenth. That, to me, is shocking. More research funding would lead to better new treatments and even more importantly to earlier detection.

If you have lungs, you can get lung cancer. And every lung deserves care. These are the messages we need to spread this Lung Cancer Awareness Month and throughout the year.

Incidentally, I recently noticed that, in July 2013, Cara rated the urgent care where she was diagnosed with asthma as three out of five stars on Facebook. I'm not sure what was going through her mind when she left that mediocre rating. I imagine the rating would have been lower had she known the truth.