Just when I was starting to get used to the idea of the May 20th surgery date... Dr. Sara throws me a curveball (not a bad one though)!
On Friday morning, I had an appointment with Dr. Sara, and also a Herceptin treatment. After my usual physical exam (three boob flashes), we talked about my test results. Dr. Sara said he'd just been on the phone with the radiologist who examined my scans, and the radiologist said there was a "more than 80% improvement" in the breast, and he also said that the cancer on the liver is no longer showing up as "active" (which we knew).
Dr. Sara said he was extremely pleased with the results (and so am I!). Then he said that because the chemo is working so well, and because I am tolerating it so well, he has decided that instead of sending me to surgery now, I will have two more rounds of chemo to try to reduce the cancer even more.
This is NOT a setback - again, it's because I've had such a tremendous response to the chemo. In the beginning, Dr. Sara had said that the goal is to go to surgery with NO cancer if possible. And because I had such a large mass, it's not something that can be knocked out in 2-3 treatments, so it's totally normal to go 6 rounds. Plus, relatively speaking my side effects have been pretty manageable - I still have not had to miss any days of work because I don't feel well due to chemo side effects. This all played into Dr. Sara's decision to give me two more rounds of chemo before I have surgery.
So now, I have a little more time to prepare mentally for surgery, which will not take place until late June or early July. And although two more rounds of chemo means more fatigue, dry mouth, and fogginess side effects (which may get worse since chemo is cumulative), and although this means I will have to wait a few more weeks for my hair to start growing in, I am not disappointed in this change of plans. Instead, I am happy that my test results are so good and my side effects have been manageable enough to allow for a more aggressive treatment. I'm all about blasting the cancer with as much ammunition as we can. I want every last possible cell to be killed or removed so that the chances of some of those cells lying dormant and reactivating in a few years is lowered!
After meeting with Dr. Sara, I had my 30-minute Herceptin drip, and then we were on our way to meet the liver surgeon, Dr. Attiyeh, for the first time. I could not have my full chemo regimen that day because I was not scheduled for it, and therefore I hadn't taken the Dexamethasone I must take starting the day before chemo to ward off some of the side effects. So, I had the Herceptin as scheduled on Friday, and was scheduled to get the rest of my chemo (Taxotere and Carboplatin) on Tuesday.
After my Herceptin infusion, my parents and I met with Dr. Attiyeh. First we were called into his office where he mentioned that he'd been familiar with my case for awhile now, since Dr. Sara had contacted him months ago when the liver involvement was first found. He then asked me some questions about how my cancer was discovered and especially how the liver involvement was discovered.
Then, I was placed in an exam room where he did a physical exam, with the nurse present (two more boob flashes, making the day's total tally 5 - must be a record!).
After the exam, I went back to my parents in his office and we discussed the surgery. He said it will definitely be two surgeries. He had discussed it already with Dr. Rosenbaum Smith and decided it would be too much to try to do the mastectomy, reconstruction and liver surgery all in one. So, I will have the breast surgery and reconstruction first, and then about 2-3 weeks later I will have the liver surgery.
He has not yet decided if he will do an "open surgery" (with a regular incision) or if it will be laproscopically, but he is leaning towards an open surgery. He said because it will not require a huge incision, the scarring will not be much improved with a laproscopic technique, and he can see better and probably get better margins with an open surgery. I will end up with a vertical scar about 4 inches long or so most likely, and will have to stay in the hospital for 2-4 days after the surgery. Recovery will be another 3 weeks or so.
Dr. Attiyeh said once I am recovered I will feel no different and will not have to change anything about my lifestyle having lost a chunck of my liver. After all, the liver regenerates itself! And, I am only having one section out of eight removed. He said sometimes he has had to remove 6 out of 8 sections from a patient, and it can still be done.
I like Dr. Attiyeh and feel very confident about him, and it is good to have some answers and a better understanding of the liver surgery now. He also mentioned that he had spoken to Dr. Sara the day before and he agrees with Dr. Sara's decision to give me two more rounds of chemo before surgery. I like hearing about how all the doctors are in close contact with each other about my case - it is a testament to the "comprehensive" approach to care that St. Luke's Roosevelt offers. I have read other accounts of breast cancer patients having to find their own oncologist, breast surgeon, plastic surgeon, etc., and it is nice to not have to worry about that. They are all in one spot, and luckily, I have been very happy with everyone I have met.
On Tuesday, I returned to the hospital to get the rest of my chemo regimen. Since I'd just seen Dr. Sara on Friday, I did not have to have another exam with him (no boob flashes!), though he did come by to visit me during my infusion to see how things were going and ask how my meeting with Dr. Attiyeh was.
Since this was Tuesday, it was not a music therapy day, and it was not Quincy's day to visit either. I did see some art therapy going on around me - the woman next to me was making jewelry - but they didn't come by my chair while I was there, which was fine since I was content to read my Rolling Stone magazine instead.
I've had the usual tiredness post-chemo, but all in all I am doing fine!