Medical Oncologist

I'm pretty sure that I have had more medical appointments since finding the lump (November 24th) than I had in my lifetime prior to November 24th, with the exceptions of my pregnancies.  Basically, I've been pretty healthy and not had to see a lot of doctors.  Most of my health has been managed by a Family Practice Doctor (and I love having one doctor for the whole family, as opposed to each seeing specialists).  Well, I now have a HUGE medical team, including:

Dr. Hall--my primary care (family practice) physician

Dr. Janik--OB/Gyn (though since genetic tests were negative, likely won't see her)

Dr. Lal--General surgeon (did mastectomy)

Dr. Sterkin--plastic surgeon (reconstruction)

Dr. Shah--medical oncologist (chemo, hormone therapy)

Dr. Schulz--radiation oncologist (radiation)

Ms. Stoddart--genetic counselor

Deb & Laura--nurse navigators

plus the radiologists and techs...

I can say, without exception, that every single member of my team has been fantastic!  If you find yourself with a breast cancer diagnosis and it's convenient to go to Columbia-St. Mary's (either downtown or Ozaukee Co.--most if not all of these doctors practice both places), consider this team.

So today was the first official appointment with Dr. Shah, though I had previously met with her.  Now she had the full surgical pathology and my plan of treatment.  

The last "step" before starting chemo, and since the cancer was in my lymph nodes, is to determine that it has not metastasized outside of the breast/lymph.  Therefore I will have a CT scan and bone scan as soon as I am healed enough to raise my arms above my head for the scan.  In addition to that, I need to have a MUGA heart scan, because some of the chemotherapies I will be on are known to damage the heart and they need a baseline.  So I will get those done, along with additional blood work and tests to determine if my ITP (low platelets) is actually ITP and not another cause of low platelets, and have an appointment to begin my first chemotherapy the morning of Wednesday, February 11th.  If any of the scans show metastasis, the whole plan of treatment will change, but I'm choosing to believe that I will start chemo that day.  My friend Katie and I were joking about actually wanting the doctor to give you the go-ahead to be able to start chemo, because who would WANT that?  But the alternative is that things are not good, and you're not healthy enough to start on a given day.  Therefore I'm hoping that I'm able to start February 11th.

My routine (referred to as "ACT") will include:

Adriamycin and Cytoxan every 2 weeks, 4 times (those will likely be Wednesday mornings, starting 2/11; I will then have to go in the following day for a Neulasta shot to boost my blood counts)

then

Taxol and Herceptin every 1 week, 12 times (also likely Wednesday mornings)

then

Herceptin alone every 3 weeks for an additional 12 or 13 times (to make up a full year)

Each chemo day will start with a blood test, to make sure my blood counts are high enough that I can tolerate the chemo.  I will then meet with Dr. Shah, and if all goes well, will then get the chemo.  The first rounds (i.e.: before doing Herceptin alone) I will be given IV anti-nausea meds before the chemo, then each chemo separately.  So essentially half a day every other Wednesday, then every Wednesday, then every third Wednesday for over a year.  The expectation is that I'll feel fine on Wednesdays and Thursdays, and then Friday will likely start feeling the side effects, but have the weekend to recover.

Side effects are, of course, individual, but they highlighted:

*hair loss, beginning on about week 3

*nausea/vomiting

*low blood counts, which may increase chance of infection, chance of bleeding, exacerbate my anemia, and may require a blood transfusion

*neuropathy

*general achiness and fever-like feelings following infusions

*heart damage and failure

*bone marrow disorder (myelodysplastic syndrome or leukemia)

Dr. Shah also shared statistics on what effect each of the prescribed treatments are expected to do in terms of cancer-free survival, given the specifics of my particular cancer (its stage, grade, size) and my health otherwise.  With no treatment beyond the surgery I have already done plus radiation, you'd expect 16% of women are alive and cancer-free in 10 years.  By adding chemo and the hormonal therapy (Tamoxifen), 63% are alive and cancer-free in 10 years.  That's a pretty good odds increase to put up with some puking, hair loss, and exhaustion.  (Keep in mind that survival with cancer can be for many, many years beyond that, so survival alone is much higher)

She also examined me and said that my healing from the surgery is going very well.  I am still super sensitive near the spots where the drains were pulled, and my right arm (where the lymph nodes were taken) is sore and sometimes very sensitive to the touch.  But I can tell that every day it's easier to move and less uncomfortable.  Today I was extra tired, after having a few days where I was more energetic.  It might have had something to do with the cloudy day, though.  I won't say I'm excited about chemotherapy, but it is the next stop, and I'm excited to get past the surgery stop and on to the next stage.  And the only way to get to the other side is to go through all the stops along the way.  So I say, "bring it!"