The Oncologist and Treatment Plan

I met the oncologist yesterday; Dr. YB. He is wonderful. When he went over everything, he drew pictures and diagrams and dumbed everything down so I could understand the whats, hows, and whys of everything, which was refreshing because, while I know my diagnosis, I don’t really know what any of that means. So it was cool to get a visual on that.

Here’s the nitty gritty details:

Invasive Ductal Carcinoma
Estrogen positive (99%)
Progesterone positive (5%)
HER2/NEU positive (3+)

Don’t ask me to reiterate what all the doctor said…I have the visual in my head and can see and understand it, but I can’t translate it as well as he did. Haha. That information up there is how they determine the treatment, which is chemo and hormone therapy.

So scan and lab results…JP is measuring at 2.8 x 2.2 x 2.2 centimeters, which puts me at Stage IIA. There is also a suspicious node in my underarm on the right side, measuring approximately 1.1 x 0.9 x 0.8. When I have my port placed, they’re going to check that out, but it’s not going to change much in terms of the treatment if it ends up being concerning. The CT scan and the bone scan both came back clean – so hooray for that. Actually, they say “unremarkable,” which is kind of insulting, but whatever. According to my mom that’s what you want to hear…I still think of myself as pretty remarkable, though.

Now for the treatment. Chemo, obviously. And hormone blockers. And immune boosters. Quite the cocktail I’ll be receiving.

So I’m getting a port, that’ll happy on September 18th. It would probably be happening sooner, but because of Hurricane Irma shutting everything down, scheduling is all out of whack as procedures scheduled on the days offices have decided to close will need to be rescheduled and all that fun stuff. I’ll be under general anesthesia for the placement, it’ll take about an hour. It’s ultrasound guided, and this will be done by Dr. JB. While she’s in there, she’s going to ultrasound the node, and biopsy it if necessary. Again, it won’t change much in terms of the treatment plan as we’re already pretty much going balls to the wall.

I also have to have an echo cardiogram prior to starting chemo so they can get a baseline reading of my heart. Then I’ll have to go every so often to get other readings since some of the chemo drugs can cause interference with the pumping action of the heart, so they’ll monitor that closely. Also, I’ll be having ultrasounds with Dr. JB every 6-7 weeks so we can watch JP shrink!

I’ll be on 3 week cycles for chemo, a total of 6 cycles. So that’s 18 weeks total. All-in-all, the chemo/hormone stuff will last a year, but it’s chemo for the first 18 weeks, then they’ll do surgery to remove whatever is left (which may be nothing), then about 34 weeks of hormones to finish off the year. After all that is finished, I’ll still be looking at about 5 more years of some kind of preventative/maintenance therapy, but it won’t be as frequent. I’ll deal with that in a year.

So there’s herceptin, taxotere, carboplatin, and pertuzumab. I’ve linked to info pages on those drugs because, yeah…I’m not a pharmacist. That’s all administered the first day of the cycle. The very first day I get a “loading dose,” so it’s a little bit more, a little bit longer, but after that my first day of each cycle will be about 6 hours total. Lots of time for me to read, write, nap, or take up knitting. I go back the second day for pegfilgrastim, which will boost my immune system, since the first four drugs will weaken good cells, as well as the bad.

I also have a wad of prescriptions to fill. Pills for nausea (one I must take the tree days after chemo and one I take as needed), an antibiotic (to have on hand in case I have a fever and it’s the middle of the night – I won’t have to wait for it to get called in or the pharmacy to fill it), and a cream that contains lidocaine (which I’ll put over the area of the port to numb the skin about 30 minutes before I go in for chemo so the needle going in won’t hurt.

So as far as physical limitations, eating, working, etc…

I made a big deal of the potential nausea. Dr. YB was like, seriously, that’ll be the least of my worries because of all the anti-nausea meds I’ll have. He said he’d be concerned about the weakened immune system and heart stuff, and I was like…dude, I like to eat. My mom, the doctor, and the medical assistant laughed, but I was totally serious. I like to eat, I don’t want to be nauseated and not able to eat. He said I should be fine. He also said he has chemo patients who do the bridge run (which, if you’re not from the Charleston area, is a very popular 10k race). So physical activity shouldn’t be a problem, though I will have some days where I may feel like dirt and not want to do anything, and that will likely remain pretty routine with my chemo cycles. So that’s good, I like for things to be routine, even if they’re a crappy routine.

So the first day I go in for chemo will be a longer day due to the loading dose, but in general when I have day 1 of each cycle, we’re looking at about 6 hours. So where does my mind go? Yeah…I asked K, the medical assistant, a little bit about that day and she told me I could bring whatever I wanted with me (blanket, tablet, books, but not my dog – I asked). I asked how long I’d be there, she said about 6 hours. I asked if I could eat. Her and my mom laughed. Again, I was totally serious. She said I could bring food and drinks with me, run out and get something, send someone to get something, etc. So I’m all set, as long as I have access to food.

Don’t get me wrong, I know my love for food may dissipate as the treatment goes on, and I will have good days and bad days. I won’t always be Suzy Sunshine, but I’m going to embrace all the good feelings when I can. And when those good feelings include an appetite, I’m going to be ALL OVER IT.

So don’t rain on my parade, or piss in my Cheerios.

The Diagnosis

On Monday, August 28^th, I was diagnosed with breast cancer.

Cancer.

It’s probably the dirtiest word in the English language—at least one of them—right up there with the F word. Such an ugly, stupid little word. A word that can mean so many different things to so many different people.

In all fairness, I got lucky with my cancer. It’s curable. It’s not terminal. It’s not a brain tumor. It’s not inoperable. I’m not going to lose a limb. This entire experience is just going to be a blip on the radar one day.

Doesn’t make it suck any less, though.

When I received the diagnosis, I immediately decided I needed to document this experience. Writing for me has always been relaxing, and I assume/hope this will be no different. It will be an outlet for me; a way to communicate everything I’m going through so I can share it with my family and friends, and maybe even look back on it one day when I need to remind myself that I’m a survivor. Maybe it’ll even inspire someone else, give them comfort in their own journey; maybe it won’t.

Funny, when I decided I wanted to write about it, I wished I’d started when I first found the lump. But really, who wants to assume the worst when they find a lump? I sure didn’t. I’ll backtrack at some point and go back to finding the lump and the procedures that led me to the diagnosis, but for now I’m going to move forward.

So the diagnosis…invasive ductal carcinoma. Yuck. Double yuck. When I received the initial diagnosis, we were still waiting for the rest of the biopsy results which would indicate whether the cancer was protein or hormone sensitive, or something like that. I was kind of in a fog during that part of the conversation, and my notes from the phone call looked like pure chicken scratch. I think I even threw them away while cleaning by accident (I swear, it’s like I’m nesting). So the rest of the biopsy results determine whether I will need to undergo chemo or have some kind of hormone therapy.

Chemo. Blech. Seriously, my biggest concern at that point (not even kidding) was that if I had to go through chemo, I might vomit…after the chemo. I’ve heard/read/seen on TV where people get sick from chemo. I hate throwing up. Absolutely despise it. I can probably count on one hand the times I’ve vomited in my life (aside from early childhood as I don’t remember much from back then because, yeah, it’s was more than 30 years ago).

Here’s another thing that floors me. I’m 35 years old. I think I was in denial that my lump, let’s call it Jean-Paul (French accent and all, just because – and JP for short), was anything because I’m only 35. I either naively thought that breast cancer happened to women older than me, and the occasional male, or I didn’t think about it much at all. Interesting how I accepted its possibility in men more than in women in their 30s. I was so wrong. My doctor had diagnosed 3 other women in their 30s the day I went in for my biopsy.

Cancer sucks.

By now you probably have an idea that my stream of consciousness, which I’m pouring all over this post, is sort of all over the place. It’s hard to focus on one particular thing when there is SO MUCH running through your brain. That’s how I feel – utterly overwhelmed. I’m overwhelmed, but I’m positive. Optimistic even.

My cancer is curable.

Not everyone is that lucky.

So back to the diagnosis. I got a call back from my doctor a few days later with the rest of the biopsy results (after playing phone tag because she called while I was in class, and like a good little student, my phone was tucked away in my backpack on silent). All my finger-crossing that it wasn’t the kind of cancer that required chemo was for naught. It is indeed a protein-based cancer that will need to be treated with chemo. Boo. I just hope the anti-nausea meds work, but I’m not holding my breath. If I lose my hair, I’m probably not going to like it, but I hate feeling nauseous more than I love my hair. How’s that for priorities?

I’ve got HER-2/NEU. My doctor asked me if I’d done any research on the internet. I said no, which is still sort of surprising to me. I’m the kind of person that wants information and facts. I want to know everything about everything so I can make well-informed decisions. Oddly enough, I didn’t research this. Why, you ask? Well, because I loathe Dr. Google. A cramp in a pinky toe can turn into an aneurysm in about 3 seconds flat with the right web search. So I didn’t want to do that. Granted, when I first found JP (the lump…stay with me here), I did a little searching to see what I might be dealing with. But that was it. I looked at the list of potentials, and made a plan. I didn’t agonize over what each and every possibility was and what it meant because it could have been anything and I didn’t want to drive myself insane and end up with an anxiety disorder on top of whatever the heck JP was. I’ll include more about that in a later “flashback” post, though.

So HER-2/NEU, chemo, and an appointment with my specialist and an oncologist on September 8^th. I’m having some imaging done this week (MRI, bone scan, CAT scan) – to determine size and see if there is cancer anywhere else, which I’ll talk more about later.

That’s where I’m at right now.

This post may not have made any sense whatsoever, but, like I mentioned before, my stream of consciousness is sort of all over the place. Had I started these posts immediately, they’d probably be a little better organized.

**Shrugs** Oh well.