Next steps.

Yeah you can face this. (Just have to make the Big Decision first.)

I was diagnosed with stage 1 bilateral invasive ductal carcinoma — breast cancer — in May 2023.

I was immediately overwhelmed by so much.

One of the hardest appointments early on was with a plastic surgeon, who straightforwardly walked me through my surgery and reconstructive options. I remember sobbing as I held a silicone implant in one hand and a saline one in the other.

I hated both.

I didn’t want either, but also didn’t like the third option of no reconstruction at all.

I had to make a decision that I never wanted to have to make.

In our earliest conversations, my surgical oncologist (in Rosenkranz we trust!) and I debated whether I’d have a lumpectomy or mastectomy. I obsessed over this decision and the risks that went with each.

Ultimately, though, because I tested positive for the BRCA2 gene, the decision was made for me: I’d have a double mastectomy. (And I eventually opted for the silicone implants, over the muscle, with the plan to fill to 350 CCs, but we got to 250 CCs and I decided I was good there.)

As devastated as I was to learn I had the gene, I was also relieved not to have to make that surgical choice.

From that point on, most of my decisions were made for me. My medical team — including my surgical oncologist, plastic surgeon, medical oncologists, all of their respective NPs and support teams, a team at Dana-Farber, two oncologists at Mass General, and various oncologists I happen to be connected with through the internet — made their data-informed recommendations, and I took them.

At the end of every visit, I still ask, “What would you tell me to do if I were your wife / daughter / sister / best friend?”

It was emotional. It was hard. But it was straightforward. It was a plan.

In May 2025, I was diagnosed with stage IV breast cancer that had spread to my bones.

This, I learned quickly, is a whole different beast.

And now, coming up on a year since that diagnosis, I am drowning in Big Decisions, and I hate that for me.

I’ve been on a pretty tough chemotherapy regimen since June (Enhertu + Perjeta). Every three weeks — with a few adjustments along the way — I go to Dartmouth Hitchcock Medical Center in Lebanon, NH. I get my port accessed, I do my labs, I meet with my oncologist, and then I go to the infusion center, where I try very hard not to throw up for the duration of the appointment and, usually, for the next 10 days or so.

If there’s one thing I’ve gotten good at over these past few years, though, it’s dialing in. It’s compartmentalizing. It’s processing all of this just enough to make it make sense and to go through the motions, but not so much that I’m in the acceptance phase. It’s showing up, gritting my teeth, doing the hard thing, and then picking my daughter up from school and making the night fun like everything is normal.

I’ve learned that I can power through pretty much anything at this point.

Two cancer diagnoses, a divorce, and a wicked Crohn’s flare all at once — plus a business to run, a daughter, and a dog? I’m no superhero. I’m just numb.

Right now, we’re talking about next steps in my treatment.

At one of my appointments, my oncologists’s nurse practitioner said that while she would never wish cancer on anyone, if you’re going to get it, breast cancer is a “good” one to get because it’s the most funded. There is so much research being done on breast cancer — though yes, of course, the current administration continues to slash so much of that, but I don’t feel like wading into those waters right now — and the data is constantly being updated. I am so lucky in that regard.

Lucky to have choices.

And paralyzed by those choices.

This is the first time in my nearly three years with breast cancer that I’ve had to make a Big Decision.

Without getting too into the medical weeds (is it a HIPAA violation if I’m sharing my own medical stuff? I say no!), there’s new research suggesting changes in my current protocol that I could benefit from.

There’s also great research that says staying where I am, doing what I’m doing, is a solid option.

I have talked about this obsessively with my team at Dartmouth. I was at Dana-Farber on Wednesday getting a second opinion from the brilliant doctors there. I’ve gone to the depths of Google. I’ve asked my closest circle of friends for their opinions, and I genuinely welcome them.

But ultimately, as everyone keeps reminding me (damn them all!), this is my decision to make. I’m practically begging someone else to make it for me.

So.

I’m going to New York City this weekend.

I’ve been itching for a little trip, a change of scenery.

So I’m going to New York. I’m staying in a new-to-me hotel in a neighborhood I haven’t spent time in since I lived in New York City. I was tempted to stay in my midtown routine, with my usual hotel, my usual restaurants (Sugarfish ILY), and my usual runs in Central Park.

But I need a little change right now. Comfort zone be damned.

I’m finally seeing Oh Mary!

I’ll be at the New Balance shakeout run on Saturday morning (188 Lafayette Street; arrive at 8 AM for an 8:30 AM start time), which is free, and you should totally come and say hi. (We don’t get to hang out much before or after live shows, so this is a great way to actually get to chat a bit, snap some selfies, and log a few miles.)

I’m going to get to see so many of my favorite people.

And then, on Sunday, I will run my first half marathon in two years.

!!!

My longest run in two years.

When I knew I was getting a PET scan at the end of February, visions of No Evidence of Disease danced in my head. I was so, so certain I was going to be declared cancer-free, and I started planning my [13.1-mile] celebration prematurely.

I’m not quite there yet.

And I have a lot on my mind right now. (The weight of my world feels really heavy, and I would really like a massage.)

But my scans gave us enough to celebrate.

Being able to run after 11 rounds of chemo is definitely enough to celebrate.

So celebrate we will (who used a Dave Matthews lyric as their senior quote in the yearbook?!), in New York City this weekend, surrounded by loved ones, eating great food, and running the United Airlines NYC Half Marathon.

And maybe by the end of 13.1 miles, I will have made a decision about my next next steps.

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This week on the Ali on the Run Show:

• No Stupid Questions: Shoes & Sports Bras Edition, with Jinger Gottschall: In the second episode in the new No Stupid Questions series, New Balance Director of Sports Research talks super shoes (you deserve them!), sneaker rotations, and those dang removable pads we’re all taking out of our sports bras.

Watching:

• The current lineup is Love Story, Shrinking, and Summer House. Nothing new, but I sure do love all three.

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SPONSOR SHOUT OUTS

I am so grateful for the wonderful brands and partners I get to work with on the Ali on the Run Show. Supporting them = supporting me!

• Shokz: Click here and use code ALI for $10 off your next purchase.

• Lagoon: Click here to get my favorite pillows (I sleep on the Otter every night), and use code ALI for 15% off.

• New Balance: Click here to shop New Balance’s latest releases for the season.

• Oofos: Click here to check out the new Club+ line. Comfy and supportive = a dream!

• UCAN: Click here to get an Edge Energy Gel sample pack (four gels!) for free (you’ll just pay the $7.95 shipping cost), and use code ALI at checkout for 30% off your entire UCAN order. (The Chocolate Almond Butter bars are forever my fave!)

And so…

Take good care of yourselves. Take good care of each other. Be the good. Spread the love.

(You’ve got this. You’re doing great.)

Love,

Ali