Thursday, February 12, 2009

My Chemo Consultation

February 10, 2009

I had my first visit with my Medical Oncologist today. She will be handling my chemotherapy sessions and hormone therapies after my radiation. She is very nice. Everyone in the office seems GREAT!! My mom and I got to the appointment and met Nickie and Chris there. Lola (the nurse) brought me back to the exam room. I left my entourage in the waiting room until after my exam was done. Dr. K came in and examined my breast, arm and the lymph nodes in my neck. Then she want over my history, personal and medical, and asked me a few questions. She asked about having more kids. I was explaining to her that Dr. A said it wasn't a good idea after treatment and my husband and I discussed it and we don't want to chance having to go through this again, so we decided we wouldn't have anymore.

"How do you feel about that?" She asked.
"I'm okay with it, I am thankful for the girls I have." While I am telling her this I realize that I had been crying throughout the entire "kids" conversation.
"I can see that you may not be completely okay with this." She said touching my arm.
"I am getting okay with it." I said through sobs.
"The reason I ask , is most women your age do still want to have kids, or just don't like the idea of someone telling them that they can't. 80 % of women in their 30s do regain their periods. Also, many women freeze their eggs, you don't have to use them, but then when the treatment is finished (and we don't recommend getting pregnant right away, to wait for a few years) you can go to a fertility specialist to help. I can recommend a wonderful fertility specialist. You can have a conversation with him if you wold like. Know that this is an option, whether you want to take it is up to you and your husband. I won't talk about it in the room with your family, this is a personal decision between you and him."

Just then I felt a lifting of grief. I felt like whether or not we meet with the fertility specialist, whether or not we decide to freeze my eggs, WE will be able to make those decisions. WE will decide, a doctor will not decide this for me.

After this wonderful revelation and a few more questions from Dr. K, I got dressed and met Dr. K, and my family in her office. She had a nice big office and a round table to speak to us at. I loved that. Normally, we are crunched in on the other side of a desk, all trying to fit and look comfortable. So this was very nice. Dr. K gave me a packet that described my cancer and what type it is. It is same stuff that we have gone over at every appointment, but here it is again:

I have Invasive Ductal Carcinoma
Stage 3c (meaning more than 10 lymph nodes were infected)
Grade 2 (meaning invasive, medium growing)
My largest mass was 2.5 cm (the Alien), my smallest was 7mm (Bob)
The margins (area around the masses) were negative for cancer (really good news)
The Lymphatic system was invaded
Estrogen and Progesterone receptor positive (by 90% +), which is very good because they know how to kill it.
HER-2 receptor was 1+ (which is negative) but 3% of +1's are actually positive, so they shipped out my specimen again for a more detailed test (called a FISH test). Dr. K is pretty optimistic that it is not HER-2 positive, so we are going to treat it that way
17 lymph nodes had cancer

What I didn't know was that since my cancer has a medium growth activity, it has probably been growing for 2-5 years. Isn't that scary? So while I was pregnant with both my daughters this cancer was inside me.

Okay, down to treatment...
Since my age (young) and health is good (okay relatively good, hahaha) I will have a more aggressive aproach to the cancer. I will be on the 3rd Generation Regimen (also called Dose Dense).

I will be given a combination of two IV drugs for the first 8 weeks. The drugs are Adriamycin and Cytoxan (also known as AC). I will receive them every 2 weeks (so 4 sessions). Each session (when I get the drugs) it will take approximately 3 hours per dose. I know that you all are wondering about the side effects (I was) so here we go...
  • Hair loss (2 weeks after 1st dose)
  • Nausea / vomiting (1st 3 days after each dose)
  • Lowering of blood counts (I will be given an injection the day after treatment of Neulasta that will bring my white cells back up quicker (but causes bone pain, because it makes your bone marrow work on overdrive).
  • Fatigue
  • "Chemo-Brain" (cognitive changes, I think similar to pregnancy-brain)
  • Less than 1% incidence of Leukemia
  • 20% of women to not regain their periods and get sent into Menopause
  • weakening of heart muscle (I am having a MUGA scan to make sure my heart can take it)

Side note: I couldn't figure out what she was saying. I thought it was a Muggle scan, like in Harry Potter... Ooops!

After the 4 sessions (8 weeks), I will be started on a new IV drug called Taxo. Like the AC, I will get one dose every other week for 4 weeks (8 weeks as well). This drug will take 4-5 hours per dose. There is a different side effects for this drug.

  • Total hair loss (eyebrows and eyelashes)
  • Fatigue
  • There can be an allergic reaction during the time of infusion (with each dose). It is kind of an anaphylactic shock reaction, which I am reassured that the nurses will be watching me like a hawk to remedy any reaction that I may have.
  • Numbness and tingling in my fingers and toes (which might not go away after treatment if I don't bring attention to them with my doctor).
  • Muscle aches and pains
  • Nail changes

That is 16 weeks total. Three weeks after chemo I will start radiation (see radiation post). After radiation I will be put on Tamoxifin for at least 5 years if not more (due to my young age).

Whew!! If that was not enough I am eligible for become part of a double blind trial. (Where both the doctor and the patient do not know if you are taking the drug or a placebo). She went over the trial (I will go itno detail in a different post) and gave me some info to read and to decide whether or not I wanted to join the study.

After all the explanations, Dr. K asked if I wanted a port put in. Due to the IV drugs, it is really bad on the veins to have the IV inserted at every session (not to mention painful), so she suggested that if I have crappy veins, I should consider having a port put in. I asked to see it, so she brought me to the "Chemo Suite". This room was a large room with probably 6-7 recliners. There were a few ladies (older women with no hair) receiving their treatments. I was introduced to Jennifer who will be my Oncology Nurse. She was very nice and showed me a book that showed what the "Power Port" looks like, but put another page over top of it and it showed me what it would look and feel like over the skin. It is A LOT bigger than I thought it would be. it is probably a 1/2 inch square and 1/4 inch deep. It will be put in under my skin around the area of my right collarbone. They will need to puncture the skin every time that they give me the drugs, but I will have a prescription for some numbing creme that I am to "goop" on before every visit. Being that every Tech has complained about my veins since finding out I have cancer, I opted for the port.

Okay, the timing...

I will be going in on Monday at 11:30am for my MUGA scan (this is the one to check my heart muscle before chemo treatments). This should not hurt (other than the IV).

On February 26, I need to be at the hospital at 7:30 in the morning and they will put in my port. There will be local anesthesia and maybe IV sedation (if I have anything to do about it, there WILL be IV sedation). After I am released from the hospital I will be driven to Dr. K's office and start my first chemo session. They will even leave the needle in at the hospital so they can use it for my treatment (how convenient).

I think that is about it. I will go over the clinical trial in another post (after I read more about it), and what my decision is.

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