Cassie Duncan is a warm and friendly young woman. A woman who is quick to smile and who immediately puts you at ease when you enter her home. While talking with her, you feel you are in the presence of a friend. Until recently, Cassie worked full-time as a Probation and Parole officer in Dunklin County. She is a mother to three children, the wife of Gerry Duncan (his parents own Duncan Sheet Metal), a daughter, and a friend. She is also a 38 year old woman who has been diagnosed as having Stage Four cancer which began in both breasts.
"I am that odd case, as they keep saying. Not that I'm a rare case, I'm an odd case because I don't fit the traditional breast cancer patient. I don't have breast cancer in my family. I have cancer but no breast cancer. I shouldn't be having a mammogram for two more years. I'm only 38," she said.
Cassie's journey began on Sept. 6 of this year. This was the day that she went to Poplar Bluff, Mo., to have her very first mammogram after noticing that one of her breasts was sitting different and the nipple had gone in and down. She could also feel a lump underneath on the inside of her arm on one side.
Upon examination of her breasts, the radiologist noted that there was fibrocystic disease but then she felt the lump.
"In my mind, I'm still putting it off. I'm thinking oh, it's hormonal. It's a milk duct. It's going to go away. Of course, it wasn't so I start looking and trying to find pictures on the Internet of actual breasts with cancer and I started reading about if you raise your hand and it dimples and gathers. Well, this one did that."
An ultrasound was also done that day. When the results were received, tumors were discovered in both breasts.
She remembers, looking back now, that she had also been experiencing other symptoms of the disease for a number of months before going to the doctor for an exam.
"Yes, for at least six months back, six months or more, I can start tracing signs of some awkward tiredness I had. You know, of course, you get aches and pains. I have three kids," she said, adding, "You know you can look at it all and I was tired. I had aches and pains, things like that but to go in and say, oh, this would have alerted me to go, 'oh, I need to go to the doctor. Now in the last four to five months, probably the last four months, my tiredness has really got to me as far as me trying to exercise. I had been unusually tired. I was just not resting. I was tired. I just wanted to shut my eyes a lot. What would the doctor have said? Well, you need to slow down."
She noted that the past four months, trying to exercise as well as doing other things was really hard, adding that she couldn't even get in a mile walk. Duncan remembers telling her husband that she couldn't believe that she was so out of shape physically.
"I would be so exhausted. I felt like I had just ran a marathon [with] my heart racing. I work for the state. I go to court and I get up to the third floor of the courthouse. I've lost weight over the last three years so getting up those steps was nothing. But in the last few months when I would get up to that third floor again, I would sometimes feel like I was just going to pass out and I thought, 'boy, I am so tired.' So, things like that now, but you know, you blow it off and I was just like, 'I'm just really bad out of shape, what is going on?'"
Duncan, of course, thought these symptoms just added up to her being out of shape. Other symptoms soon came along as the cancer began its progression. The past two months, she said that she had been experiencing a lot of indigestion, noting that she doesn't ever get indigestion. Co-workers can remember her coming into work complaining of nausea. When the diagnosis was made, they wondered if this was a sign of breast cancer.
Cassie realizes now and was told by her doctor that it wasn't a sign of breast cancer but a sign of the progression of the cancer into other areas of her body. She has been told that the cancer has spread beyond both breasts. It is now in her ovaries, the abdominal lining of her stomach as well as her bone marrow.
"How long we've had it, they can't tell me, he said [the doctor]."
At this point her husband Gerry said, "The doctor said several months."
Cassie then added, "He said it's been months. It's been an onset. You know, that makes sense. I didn't have that stuff. If I had gone to a doctor, what would he have done? He would have given me Nexium." She noted that the symptoms that she was experiencing wouldn't have pointed to something such as this. As mentioned before, she had gone to her gynecologist in April for her well woman exam and her gynecologist felt nothing out of the ordinary and he has been her physician for 13 years.
She added that now she can look back and piece together all the symptoms and finally realize that, "Yes, that's what this was."
When the diagnosis was finally made, Cassie remembers telling her husband, "Gerry, at least I'm not as lazy as I thought I was," she said, adding, "I didn't really have a lot of energy. I pushed myself but I just didn't have the energy to do things."
Part of that tiredness and her racing heart can now be attributed in part to a low platelet count. The original plan was to begin chemotherapy with a port installed. But when Cassie had her bloodwork done, her platelets were very low.
"When they did the biopsy and the first blood work came back in, they called me within two hours after we left and [said] 'We can't get your port put in. Your platelets are 16.' And within a week, they dropped to 12," she said.
Continuing, she noted, "A year ago I had bloodwork and my platelets were 267." She added that doctors want the platelets to be in a range of 148 or above.
At this point, she contacted the nurse practitioner to ask if there were something she could be doing to improve her platelet count and whether she was going to be able to start her chemotherapy treatments. She was told that usually chemo is what causes platelets to drop but at that time she wasn't having the treatment. The nurse practitioner told her the cancer was the cause but she assured her that she would be able to start chemo treatments but perhaps do it in a different way. At this time, she also told her it was in her bone marrow. She noted that she was happy that the nurse practitioner was able to share this with her over the telephone since they usually don't.
"My grade, we found it out when they first did the biopsy. There are three grades and mine was a two which means it was semi-aggressive. So, we knew it immediately," she said. She added that more results were received last week.
In talking with the nurse practitioner, she learned that a hormone test that had been done had returned positive. According to Cassie, the nurse practitioner told her that this is a good thing because it means that doctors are open to some different drugs to treat her cancer.
Cassie noted that her treatment plan is to have chemotherapy but it will last a little longer than first expected.
"They have to do it slow because of my platelets. Of course, they can't put a port in. They're having to do it by IV. They're going to do it slow. Mainly, the reason is my platelets. They're wanting my body to start seeing how it responds," she said.
Her first chemotherapy treatment was on Friday, Sept. 28. On Thursday, the day before that first treatment, she underwent a cat scan and a test on her heart to see if it was functioning well enough to start on chemo. The results from those tests were available the next day. Thursday was also the day she was supposed to have her port put in and also the day doctors saw a fluid buildup in her stomach area. Cassie remembers being bloated and her clothes not fitting properly, all within a two week time span.
"It was making it hard to breathe. I would lean back most of the time. It was hard to sit straight and still, I'd rather lean back," she said.
When asked what her chemo schedule would be, she said, "We do it for two weeks, off a week, and do it for two weeks. We were going to do it once every three weeks but now we're doing it every two then off one. So, I've already started my first one and it went well." The second treatment was scheduled for Friday, Oct. 5. One friend of Cassie's told her to think of her chemo as a Pac Man and when they give it to her, "it's eating all that stuff away." Three drugs are being used, Herceptin, Taxol, and one of the newer ones. Perjeta.
Since beginning chemo, both Cassie and her husband, Gerry, both agreed that the fluid buildup from her stomach has gone down some.
"I can tell a small difference. I do think it has gone down some. And they said that's just the fluid coming off the tumors. He said what that fluid was doing was pushing on all my organs so they're all pushed in together. He said, I could drain you now but I'm going to be honest. I don't see the purpose because it's going to come right back. If it gets worse and worse, we'll relieve some discomfort. He said he'd like to see how my body's going to respond."
She added that the doctors could do some transfusions for her platelet count but are avoiding that because they do not want to introduce any extra antibodies that are foreign to her body.
For treatment, Cassie and Gerry will be traveling to St. Louis, Mo., to the Siteman Cancer Center which is associated with Barnes-Jewish Hospital. She noted that she will receive all her treatments there, chemo and any surgeries that follow. Cassie notes that surgeons plan on doing a double mastectomy and she also wants to have her ovaries removed but surgeries won't be done until she is medically treated and her platelet count is under control. After the chemo and the surgeries, radiation will be given. When it is time for this, she notes that this will probably be done a little closer to home.
"We may do radiation closer because that's going to be for six weeks every day for 15 minutes," she said. She added that her doctors would coordinate that with a facility here.
Since her diagnosis, both Cassie and her husband, Gerry, have maintained a positive attitude and are now concentrating on her getting better. They are both pleased with the doctors that are treating her.
" I feel really happy with where we're at, at this point with our doctors," she said, adding that the situation has been overwhelming. Both of the Duncans agree that the doctors and staff at the Siteman Center have been nothing but positive and supportive. They are not giving a timeline but are, instead, concentrating on getting her better.
When asked if anything positive could come out of this situation, what would she like for it to be, she said, "What I think they ought to do better of is educate and starting like with my daughter's age, in junior high. Educating them more about breast exams, even getting more hands on stuff to feel the difference. The difference of what a cyst is and what they mean by attached [and] moveable because it's just different for everybody." She notes how many women don't know the difference. She does think that guidelines could possibly be changed, letting the woman choose if she should have a mammogram. Not that she was ever told she couldn't have a mammogram but was told she didn't fit the guidelines of it. She added that she had heard that they were trying to up the age. According to Cassie, instead, the age needs to be lowered.
Continuing, she added, that there should be more education on how a lump actually feels, the difference between a lump and a cyst.
"I do think they ought to educate more. I want my daughter to know especially if I come back [and] I happen to be a genetic carrier," she said.
She added that she has been tested to see if she is a carrier but the results won't be available for four to six weeks.
Continuing, she said her oncologist told her if she is a carrier, this would help explain some about her case.
In spite of the diagnosis, she has received, Cassie remains in good spirits and a positive frame of mind. She does admit to having her moments when her thoughts get away from her, but she tries to remain focused on the now and today.
"I do have a good feeling. Of course, you do, you get scared sometimes. I'm not going to sit here and say I don't get scared," she said, adding that sometimes she does have negative thoughts.
Continuing, she says, "I have more positive thoughts than negative."
She next talked of the generosity of the people in Kennett, of how people have reached out to her family. She noted that people are continuously bringing food, and are giving donations, both of time and money. People are messaging her on Facebook with nothing but encouraging thoughts and positive feedback. People at the First United Methodist Church where they are members, upon finding out about her diagnosis, wore pink to all of the church services one Sunday.
"You don't sometimes realize the impact, I guess, that you've had on someone. I read some of this. (She's talking about Facebook). It gives me more strength. Some of the things I've had people say to me, read to me and reach out to me has given me more strength. It's what's going to keep me going. You know, you gripe about small towns but this town has been amazing from the young to the old."
Not only people in Kennett have responded to Cassie but people in other areas of the country as well. One friend is having a Mary Kay Fundraiser for her and is donating 50 percent of the proceeds to the family.
"I couldn't be more blessed and I plan on beating it. I don't have any doubt that it's going to get worse. The main thing, of course, I worry about is my kids. You know, like I said at church to our Sunday School class, that I hope parents also and people who are in contact with kids educate kids more about cancer," she said.
It is no doubt that this diagnosis has impacted the Duncan Family but it has also impacted the community, their friends, and Cassie's co-workers, as well. Three of Cassie's co-workers and friends shared their thoughts.
* "Cassie is a very compassionate person. She loves people...she loves her family, she loves her friends and she loves her clients. There is no doubt that since her diagnosis that her primary concern (even over her own health) has been her children and her husband. She has vowed from the first day of meeting with her doctor that their lives were going to go on day to day without missing a beat, even while she is battling cancer. She has done everything in her power to see to it that her three children haven't missed anything and that their daily routines have continued without much interruption at all. She has the most upbeat, positive attitude I have ever seen, while facing this kind of adversity and says regularly and with the greatest conviction that she is going to beat this. Some of the first words we heard her say after her diagnosis were "I've got three babies! I've got to fight!"
* "Cassie is a dedicated friend and co-worker. She serves on a regional board for Probation and Parole and people all over the state know her and her strong, dedicated work ethic. Our local Probation and Parole office has received calls of concern from people that know her from working with her on the board and they have offered support and assistance to Cassie and her family. They all know Cassie as a giving, hard-working, compassionate person and want to help her in any way possible. Around the local office, she is the person that always notices if someone is going through a hard time, or having a bad day. She is always "slipping" a card or note on someone's desk offering support, a word of encouragement, and her friendship." Her positive attitude, her unwavering friendship and her continuous support to all of us are invaluable. Even as Cassie was going to her first doctor's appointments and waiting on her diagnosis, she was the "rock" of the office and asking her co-workers if everything was allright and if she could do anything to help. Little did we know at the time that she was going to be facing the most difficult challenge of her life!"
* "Since Cassie's diagnosis, many of her clients have contacted the office wanting to know about her situation. Many of her clients are devastated to hear about her situation and feel personally touched by her illness. They have offered many words and gestures of support to Cassie in the last couple of weeks. A client recently told her that she has always referred to her as her "other mother." She went on to say that she loved Cassie and appreciated that she always stood by her even when she knew she hadn't done right and didn't really deserve it. Cassie has continued to work as much as possible over the last few weeks and plans to do so in the future. She feels a deep connection to her clients and although she may not be seeing them on a regular basis for a while, she is coming in and checking on their progress and trying to personally handle any situation that needs her special attention. She is truly a dedicated officer. Her clients concern for her over the last few weeks has shown that her love for her job and her dedication to her clients has made a difference in many of their lives."
Earlier in our talk Cassie noted how she plans on winning this fight, saying, "I plan on it. I have three kids, 12, 8 and 6. I plan on being here for them and watching them grow."
A woman with many friends, and the determination to fight!