Angi Perkowski Karvelis was 34 when a doctor told her to prepare a will.
At 20 years old, her mother died of uterine cancer. The disease was swift: She was diagnosed days before Thanksgiving. By February, she was dead.
Karvelis was laying flat on a chiropractor's table 14 years later when a twinge of pain shot through her breast. Later that evening, a few days before Thanksgiving, Karvelis performed her first self-breast examination. She felt a lump.
"My mind immediately went to cancer," said Karvelis, a mother of two who lives in North Fayette with her husband.
"Panicked. I was terrified, to be honest," she said.
Days later, a battery of tests gave her fears a name: Stage IV breast cancer. The disease had advanced, metastasized through her body, before she knew she was sick.
She spoke to two physicians who advised her to begin making final arrangements. She would likely be dead in six months to a year, they told her.
Now, one month before Thanksgiving, Karvelis will mark the second anniversary of that grim 2010 diagnosis. Still alive. Still fighting the disease.
"In the next couple of months, I want to be in remission," Karvelis said. "I want reconstruction (surgery.) I want to go to work, be normal. I want to feel like a woman."
Finding the Balance
Explaining cancer to your children is easier than it sounds, Karvelis said.
She waited a few weeks after the diagnosis to tell her son, then age 4, and daughter, then 7, that mom was sick. Phone calls to other family members were made in the days after her diagnosis.
"I said 'Mom is going to fight this with every single fiber in her body,' " Karvelis explained. "It wasn't something I jumped right into, but we did sit them down.
"It's individual for everybody, but there are so many resources online and you can pull ideas from everywhere," Karvelis said of the discussion with her children. "Kids can really find a way to adapt."
For Karvelis, the first step toward recovery was "finding a doctor who believed in me." She began seeing Dr. Charles Geyer, a former director of the Allegheny Cancer Center at Allegheny General, who has since relocated to Texas.
She started an intensive, seven-month chemotherapy regimen in addition to radiation.
As young mother of two with a full-time banking job, Karvelis knew a thing or two about multi-tasking. Even cancer would have to fit into her schedule, she said.
"I was a full-time worker and I loved my job," Karvelis said. "I knew chemo would make me sick, so I figured out if I got my chemo at the end of the week, I would be sick and throwing up over the weekend and then be better by Monday morning to take the kids to school and go to work."
Karvelis worked during much of her time in chemotherapy; her husband was laid off during a period of the treatment, leaving her the family's breadwinner.
"You're a mom," she said. "You adapt."
In September 2011, she underwent a double mastectomy, performed at Allegheny General Hospital by surgeon Dr. Donald Keene, and is recovering at home.
She is now treated every few weeeks with "softer" chemo infusions, chiseling away at the existing cancer, under the care of oncologist Dr. Saima Sharif.
"You're a mom," Karvelis said. "You adapt."
Taking Steps Forward
"We're hoping we put the cancer to sleep," Karvelis said.
She is often in pain. Post-mastectomy, the cancer has settled in her spine and sternum. The good news: It does not appear to be spreading.
"I have a bird and a dog, and if I have to spend any more time at home with them ..." she said. "I want to be a woman again. Sometimes I feel so useless sitting around the house."
Throughout her treatment, Karvelis, who previously lived in Buffalo, kept family and friends in the loop via her blog on the site CaringBridge.com. She frequently updated the site with news for her loved ones.
For breast cancer patients, she said the Internet can be a double-edged sword: Providing comfort and advice along with sometimes outdated statistics that can unnerve.
"When I first got diagnosed, I'm a thirst for knowledge," Kervalis said. "When you start Googling around and wondering 'How long am I going to live?' it gets bad. I had to shut the Internet off and walk away."
Her family has been a source of relief through the illness, she said.
The running joke for her kids during chemotherapy treatment was "What time is mom going to puke?" Sometimes her daughter would run fingers through her thinning hair to collect the falling strands.
"To other people it's creepy," she said. "But you develop a sense of humor. It's like, okay, she's 7 and she thinks its funny."
She's now turned her attention to what life will be like after cancer. She'll have reconstructive surgery on her breasts and find a new job, she said.
"You can approach it two different ways," Kervalis said. "Find a way to make cancer treatment work in your life. Or you can shrivel up. I have to get better. I want to see my daughter get married and my son become president."