On Monday morning, I got another unexpected call from Dr. Sara's office telling me he wanted to see me that day. I kept it together on the phone, but inside I was freaking out, because again, I didn't have a previously scheduled appointment. I knew it could only be about one thing - the liver biopsy results. Then, my Mom called his office to see if it was something they should drive up from central Jersey to go to with me, and the office said "probably yes." Eeks.
At 3pm, we went to the hospital, a little nervous about what we were about to find out.
I will cut to the chase here: the liver biopsy came back positive for cancer. This means that my cancer is now stage 4 (previously it was stage 3). The doctor said that stage 4 used to mean "incurable" - in which case they would have given me chemo to hold it, but it couldn't be cured.
Obviously this was not the news we were hoping for, but please note he said used to (see how I bolded AND italicized it for emphasis?). Nowadays, they have so many advances that stage 4 does not necessarily mean incurable anymore. He even said that the testing was so advanced that this small spot on my liver may not have even been caught a few years ago, so it is good that we caught it now.
So, how does this change my treatment? Not by a whole lot actually. I will still get my full chemo regimen every three weeks as originally scheduled, but I will now be getting Herceptin every week, at least to start. The hope is that the chemo will completely clear up the spot on my liver, as well as shrink or hopefully get rid of the tumor in my breast completely. Then, I will eventually need surgery on my liver. The good news is that because the spot is so small (only 10 millimeters) and because of where it's located - in a pretty accessible spot close to the skin - the surgery should not be a major big deal, and will likely only require a small incision. Also, the liver is the only organ in the body that regenerates itself, so when they cut a piece out, it will grow back on its own. He actually called up my CT scan on his computer and showed us the spot on my liver so we could see it. It's kind of weird to see your internal organs on a computer screen, but it was interesting nonetheless!
The cancer in my liver is the same as the cancer in my breast. Most likely the cancer cells found a blood vessel to attach to and that is how it traveled to my liver. But because the cancer is the same, that means that it will react the same way to the chemo. Sometimes, they find a totally different cancer elsewhere in the body, not related to the first diagnosis, but luckily this is not the case with me. Also, sometimes they do scans and find the cancer in many places - multiple lesions on the liver, in the bones, in the brain, etc. So although my cancer is stage 4, in my mind it's a very early stage 4, and it could still be much worse!
Dr. Sara also told me that he presented my case that very morning at their weekly "tumor board" meeting, which includes 20-25 doctors from not only Roosevelt, but St. Lukes, Beth Israel, and other places that are part of Continuum - the hospital conglomeration they belong to. This includes medical oncologists like him, surgeons, radiation oncologists - the whole works. All of the doctors at the tumor board agreed that my course of treatment was the right one, so Dr. Sara said it's like I already had 25 second opinions!
One of the first things Dr. Sara told me when we first met was that he was always going to be completely honest with me - he would never sugarcoat things. He said he believes that it's insulting to the patient when doctors do this. He believes that my situation is beatable. And he reminded me on Monday that he promised he would always be straight with me, so if he thinks I have a chance to beat this, he really believes it, and so I do too.
Everything now depends on how the cancer responds to the chemo. Luckily, I am young and healthy, and so hopefully I will respond well and we will start to see that liver spot clear up and the tumor shrink. Dr. Sara said that we should start to have an idea of how the chemo is working after the second chemo treatment. He said I will probably know even before he does because hopefully I will be able to see and feel the change in my breast as the tumor shinks.
Monday night and Tuesday morning were pretty rough emotionally as my family and I dealt with this news. I tried to just relax and process it in my mind, but at first it was very difficult to get past the "stage 4" and "used to mean incurable" parts and focus on all of the things working in my favor. But, less than 24 hours later, my attitude started to turn around and I became focused on the next task at hand - starting chemo.
On Monday, as I got a little teary in Dr. Sara's office after hearing the liver biopsy results, he said that it was good and normal to cry. He also said it was normal to be a little scared of chemo. I told him right there that I was not scared of chemo, and if I could walk down the hall and give them my arm I would gladly take the chemo right then and there!
Luckily, I didn't have to wait long for chemo to start. Because of the impending snow, last night my parents and I stayed in a hotel just a block from the hospital, so that we could be sure to get to the hospital on time.
We showed up at 9:30 this morning. In the hotel room before we left, I prepared by putting on a necklace a friend gave me that says "Don't Give Up" and I also used some holy water a family friend gave me that came from one of the holy places overseas (probably Our Lady of Lourdes). Every little bit helps!
After having my vitals taken (blood pressure and temperature), Dr. Sara did a physical exam, along with Debra, the nurse practitioner, and Dr. Dy, a fellow we met on Monday who is now part of my team. That's three boob flashes to add to the count, and this time they even took a picture! Now I know what it feels like to be a Playboy Bunny I guess!
After the physical exam, we waited for a short time in another waiting room and then they brought me into the infusion suite. I sat in a nice recliner, with a footrest and everything, and my parents had chairs so they could sit next to me the whole time. First, the took some blood and inserted my IV (that's one needle stick to add to the count), and started giving me saline through the IV.
Then, they gave me my "pre meds" - Tylenol, Benadryl and an anti-nausea drug. The Benadryl gave me restless leg syndrome - which has happened to me in the past when I've taken it. But luckily it didn't last too long and this was the only time all day that I was a little uncomfortable.
After my pre-meds, they started with the chemo drugs - Herceptin first. This was on a 90-minute drip, but the nurse said that next time it will be only 60 minutes, and the third time it will go to 30 minutes. After the Herceptin, they started the next drug, Taxotere. This is a drug that can cause a reaction the first two times it's given, so the nurse told me to call her immediately if I felt any tightening in my chest or throat, or lower back spasms. There's even an emergency button on the chair to press if there was any "funny business" as she called it!
Earlier in the day, Dr. Sara had introduced me to Bernardo, a fellow in the hospital's music therapy department, which is a very interesting program that does research on the positive effects of music on patients undergoing treatment for cancer and other diseases. As the Taxotere was starting, Bernardo came back with his guitar and a few other instruments. He gave my Mom an "ocean drum" and asked her to play it. She was skeptical at first about her musical abilities but she just had to tip the drum left and right, and the movement of the beads inside mimiced the sound of ocean waves. She did great!
Bernardo started playing a very relaxing song on his guitar and I closed my eyes and really relaxed. He had said that this was a good time to do the music therapy, because if I did have a reaction to the Taxotere, I would probably notice it more readily. If I wasn't relaxed, I would probably have been very agitated waiting to feel the tightening in my chest (which luckily never came). After the first song my Dad had returned from getting a newspaper outside, and Bernardo gave him an instrument called a "gato box" - a wooden box that is played with a mallet. My Dad was even more self conscious of his musical talents than my Mom, and told Bernardo that he can't even clap his hands in time! But he played the "gato box" anyway and did great. The music therapy was a very nice interlude and kept me very relaxed during the Taxotere drip.
The Taxotere took quite a while, because they very gradually introduced it into my system in 10-minute increments. Even though I didn't have a reaction today, that doesn't mean that I won't have a reaction next time, because it can happen in the first two sessions. After the Taxotere, I had a one-hour drip of the last drug, Carboplatin.
I was finally done around 4pm, and it was time to head home. I was tired from the long day and the Benadryl and took a nap when I got home. But otherwise, I am now feeling perfectly fine and normal.
I am just glad that the chemo has started and hopefully it's starting it's beatdown on those nasty cancer cells right now!