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.

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