Chemo...

Yesterday was a LOOONG day of appointments. The 1st one having nothing to do with cancer was our Wellness Exam for our health insurance, this one beginning at 9:00 am. Next, Dr. Stalnecker (Plastic Surgeon) at 10:10 am, Dr. Nate (Breast Surgeon) at 11:30 am and lastly Dr. Bhatia (Medical Oncologist) at 1:30 pm. So, we began at 9:00 and were out of the doctor's offices at 3:45, it was almost like a full day of work.

I'll start at the beginning with Dr. Stalnecker. We went into his office and low and behold there was another KY FAN waiting in the waiting room! You see, I get excited about that because we don't see so many of those here in the Hoosier state but there are definitely more than you would think. However, this KY fan we found out was not from IN but from Nashville, TN. He was a father who was waiting with his daughter who obviously had breast cancer. I know this because she had clearly been through chemo and was now waiting in the Plastic Surgeon's office. She was young, like me and said she had just moved here 1 year ago. We didn't talk about our cancer, only about KY basketball because as everyone knows, that is what we live for as Wildcat fans! After our conversation about our new KY players and how we felt about their performance from the previous night which I am sure all of the women behind the desk loved because I am sure they are all IU (who Ryan states barely got past beating the girl's school when they played the other night LOL), Purdue or Notre Dame fans, I was called back. I couldn't wait for this appointment because I knew I was getting at least 2 of my 3 drains that I have left taken out. So, I handed my drainage tracking sheet over to the nurse and hopped up on that chair ready to get my drains out. The nurse started to set up and said, I don't want to be the bearer of bad news but I wouldn't be surprised if the dr. doesn't take all 3 out. I told her that was ok because I figured the axillary (one in the armpit) drain would not come out because I know it's still draining quite a bit so she just got stuff ready for 2 of them to come out. Dr. Stalnecker came in, looked at my drainage tracking and said, "So close but I think they need another week." I told him, yeah I figured that one would stay in another week and he said, "No, I mean all 3." All 3, really, ALL 3?!?! I mean, who doesn't want to keep their drains in as long as possible? Oh, well, I guess I'd rather have the drains than have an infection! I may not have gotten any drains out but I did get more saline/saltwater injections in my expanders so they are getting there :) My next appointment is Monday so we will probably pump them up a little more.

After a little break and some much needed Starbucks since we had to fast for our wellness exam, we saw Dr. Nate. When we got to his office, we saw the KY fans again! I realized at that time she had not had her surgery yet. We did things in an opposite manner. She, chemo then surgery, me, surgery then chemo. Anyway, I was called back and Dr. Nate came in and talked about my pathology report again. Since this was my follow up surgery appointment, we talked about surgery again, went over the report and then I asked some questions. He of course said my tumor was about 2.8cm x 2.5cm x 2.0cm which he removed. He then said I had that micro met in my lymph node of which he took 19 out and the cancer had gone outside of the lymph node a little bit which is why they are talking about radiation. I then spoke to him about the numbness, tingling, sensitivity and burning pain on my right side from from my shoulder blade to my elbow. I asked him if this was normal, will this go away and will I get feeling back? He told me to give it a year and by the end of the year, however it feels then is probably how it will be permanently. Well, if that is all I have to deal with then I'm fine with that. It's definitely better than cancer! He also said that I may have to do a little physical therapy because it is still difficult to lift my arm above my shoulder and he said that is normal as well with the number of lymph nodes he took out.  He did his exam and said everything looked good and he would not need to see me back for 6 months or unless I need a port for chemo put in because he would be the one to do that. So, good news there!

Last, we saw Dr. Bhatia. When we got to the cancer center, there were so many cars in the parking lot there wasn't a parking spot, Ryan had to park on the side of the building. I told Ryan that it is really sad that there is not a parking spot in the Cancer Center parking lot because that means there are a lot of people there for treatment. When I went in to register, there was hardly a seat to sit and wait. After about 20 min, I was called back. Dr. Bhatia talked about my final pathology report as well and then wanted to talk about chemo. He explained that nothing about my cancer has been clear cut meaning there has been no clear cut yes or no answer to anything other than the diagnosis and the fact that I had to have the mastectomy because we could not preserve my right breast. Other than that everything has kind of been in between. I know that doesn't make sense and honestly I didn't know that was possible because I thought the whole treatment process what clear cut. Well, I was wrong. He said that he feels that at this point because of my clear margins from surgery he could say I AM CURED!!! However, he did not have enough evidence to prove that I am or am not cured. He said that if I choose to take the IU approach which says, I'm under the age of 35, I've had surgery and there are clear margins therefore no chemo he would be ok with that but he would order the Oncotype 21 test which is a gene test that is used in stage 1 and stage 2, node negative, estrogen receptive positive invasive breast cancer which will basically provide a prediction of the 10 year risk of recurrence to help guide treatment decision making. However, he said that since everything else has been in the middle, these results probably would be too and I would still need to make a decision but it really depended on how aggressive I am willing to be. He then said that we could take the MD Anderson approach which says, I am under the age of 35, I may have had surgery and have clear margins but there is still a risk of the cancer recurring and we can't prove that there are no other cells in my body so there is no choice but to do chemo. Well, MD Anderson is the best cancer center in the country for a reason and of course I want to be as aggressive as possible so I will be taking chemo along with the hormone suppressing pill for 5 years called Tamoxifen. When I told my dr this he told me that he would have supported me either way but he feels I made the best decision regarding my future survival. He also gave me some statistics to back my decision up. Basically, a women at my age in my position, if I had chosen...

No Additional Therapy: 65 out of 100 women are alive in 10 years
                                   34 out of 100 women die because of cancer
                                     1 out of 100 women die of other causes
Hormonal Therapy (Tamoxifen): 74 out of 100 women are alive in 10 years
                                                25 out of 100 women die because of cancer
                                                  1 out of 100 women die of other causes
Chemotherapy Only: 82 out of 100 women are alive in 10 years
                               17 out of 100 women die because of cancer
                                 1 out of 100 women die of other causes
Combined Therapy (MY CHOICE): 87 out of 100 women are alive in 10 years
                                                        12 out of 100 women die because of cancer
                                                          1 out of 100 women die of other causes

I feel like the numbers speak for themselves. Since making my decision, a plan has been put in place. My first chemo treatment will be Dec. 6 and it will be an infusion over about 2 hours of Taxol & Cytoxan (TC). This is one of the most common treatments given to women with stage 1 to stage 2 breast cancer with minimal node involvement. The Taxol slows or stops cell division and keeps enzymes from making the proteins cells need in order to grow. The Cytoxan stops cancer cells from replicating so between the two they work together to destroy cancer. I will receive 4 to 6 cycles which will occur every 3 weeks so it will be over 12 to 18 weeks of treatment. They do treatment every 3 weeks now because they have learned the your blood count is the lowest after about 4 days from your infusion and if they are too low they have to hold the chemo. So waiting gives your cells time to replenish. The side effects can be allergic reaction, nausea/vomiting and hair loss. Nausea/vomiting is not as prevalent and they used to be because of the anit-nausea medications that are available now. Hair loss will definitely happen approximately 2 weeks from my 1st treatment. Once my hair begins to come out, I will shave my head. I have already ordered a wig which looks just like my hair and I have begun finding cute head scarves and warm winter hats! Also, Sharlee seems to think that I won't need a port because my veins look good enough to withstand the number of treatments I will be receiving but we won't know until my first treatment and since my lymph nodes were taken out of the right, we only have my left arm to work with.

As far as radiation is concerned, this is something that happens after chemo is completed. I will meet with the Radiation Oncologist on Dec 2 and he will make that decision then but Sharlee seems to think that I will not need radiation but we will let the dr make that decision. Also, on Dec 2 I will have a teaching session regarding chemo so I know what to expect and they will show me around the cancer center where treatment will occur.

I know this was a lot of info but I also received A LOT of info yesterday! I am glad we have a plan in place as far as the second part of treatment and I.AM.READY!!