The Next Step

Well, look at that - I kept my promise.  After my last post came after my longest stretch ever without a post, I am blogging again less than 24 hours later - the shortest time ever between posts.  OK, I know it's all because so much has happened during the last few weeks that I couldn't fit it all into one post, but whatever.  Details, details...

Anyway, as I mentioned in my last post, in the last few weeks while all the radiation stuff has been going on, I've also had two Herceptin treatments.  The first one, back on August 25th, was the first time I'd seen Dr. Sara since my surgeries (he was traveling during my previous treatment and I saw another doctor that day in his absence).

Dr. Sara remarked on how well I'd recovered from surgery and said Dr. Attiyeh had told him he'd almost never seen anyone have to stay in the hospital for only two days after the kind of liver surgery that I had.  I said, "Well, I'm an overachiever, what can I say?"  :)

After the typical exam, where Dr. Sara and Deborah mentioned that my scars looked good - and that usually liver surgery results in a big horizontal scar that looks like a hockey stick, so I was lucky to have my vertical one - we sat down to talk.

Dr. Sara went over my the pathology results from both of my surgeries.  Of course, Dr. Rosenbaum Smith and Dr. Attiyeh had already gone over these with me, so there were no real surprises, but when I'd seen Dr. Rosenbaum Smith she hadn't had the final report yet, so Dr. Sara went over that with my parents and me.

As Dr. RS had said, there was still quite a bit of cancer left in my breast, and I did have positive lymph nodes - 8 out of 11 to be exact.  I didn't really understand the significance of the number of lymph nodes so I asked Dr. Sara if everyone has the same number.  He said no - the number can vary greatly.  Most people have at least 10, and some people have as many as 50.  And just because I only had 11 removed (all that Dr. RS had found) doesn't mean I didn't have more at one time - the cancer could have destroyed some lymph nodes along the way.

The results showed that the chemo I'd had before surgery had had a significant effect on the cancer, but not a complete effect.  Not that we expected that - we knew from my scans that there was still cancer in the breast.

One other significant thing that the pathology report did show was that 35% percent of the remaining cancer was estrogen-receptor positive.  Dr. Sara said he was very pleased to see that because it meant that he would be able to give me Tamoxifen, a drug that is given to breast cancer patients who are hormone-receptor positive for five years following treatment.  I've read that it can reduce the risk of a recurrence by up to 50%.  Now, my original biopsy results did show that I had some estrogen resceptor positive cells, but the percentage was not exactly known - it said "10-30% percent, mostly weak".  Now, we know that the percentage was high enough for the Tamoxifen to hopefully be effective.  Dr. Sara also said that this was good because the estrogen receptor negative cancer tends to be more aggressive, so hopefully that means any cancer that might remain is less aggressive (meaning slower growing).

As for the liver, just as Dr. Attiyeh had said, there was still a very small amount of cancer cells found in the liver, but it was greatly reduced from what my original scans had shown, and the part that was removed had clear margins.

Dr. Sara gave me copies of both pathology reports, and I have to say they are kind of funny and kind of weird to read.  Half of it I don't understand, of course, but there is a section where the "specimen" is described and it says things like "the specimen is received fresh" (ew) and "situated central on the skin surface is an unremarkable nipple" (well, exCUSE me!).  Also, the masses which I presume are the remaining tumors are described as "tan" and the previous biopsy site appeared "bright orange" - who knew?

Anyway, after going through the reports, Dr. Sara said that the results - especially the fact that I had positive lymph nodes - led him to decide that I should get more chemo.  There is still a risk that there could be microscopic cancer cells lurking in my body, just hunkering down until they one day decide to start colonizing.  Dr. Sara said that if these results had appeared post-surgery in a patient who had not had chemo first, they would definitely give that patient chemo.  And since we are being aggressive with my treatment and pulling out all the stops to cure me, not just treat, he recommends that I have more chemo.

This did not come as a shock to me.  During my previous Herceptin treatment, when I'd seen another doctor while Dr. Sara was traveling, I had asked if I would need to go on Tamoxifen. When I asked this the doctor and Deborah had said that that would be up to Dr. Sara - whether he would give me more chemo or put me on Tamoxifen (turns out it will be both).  It was kind of said in passing, but I caught it so I already had in mind that more chemo was a possibility.

Now the next round of chemo will not be the same as the first.  Dr. Sara said that they have to change up the drugs they give me because after a while chemo regimens sort of "run their course" and are not as effective.  It's hard to say for sure, but it's possible that either the chemo I had before had run its course, or that the cancer remaining was resistant to those drugs all along.

So, this time I will be getting a new drug (not new, but new to me) called Navelbine.  Dr. Sara said he chose this drug over some other options (including Adriamycin, which I'd read about and knew as a nasty one - it's called the "red devil" because of its red color and harsh side effects, so I'm glad I won't be having that) because Navelbine is known to have a compound effect when given in conjunction with Herceptin.  As Dr. Sara put it, Navelbine plus Herceptin is more effective together; i.e. 1 + 1 = 3, not 2.

The good news is that Navelbine is not so bad with the side effects.  I will not lose my hair again, I will not have that "icky" feeling I had for a few days after chemo last time, and I will not have the dry mouth nastiness again.  Also, I will not need any pre-meds, like Hydroxizine or the steroid Dexamethasone that I had to take last time, which helped contribute to some of the side effects I felt.

(As a side note, speaking of my hair... it has been coming back at a good pace over the summer.  Here is a picture of me and Claire on Labor Day weekend:

Not bad, huh?  As you can see, I definitely have more hair than her now! I probably never would have asked to have my hair cut this short, but I don't mind it at all.  And it makes it pretty easy to get ready in the morning which is a nice bonus!)

Getting Radiated

Uh oh.  It's been 4 weeks since my last post and I said I wasn't going to that, didn't I?  (Actually 4 weeks minus one day, if you want to get technical about it.)  Oops.  Well, this time I won't promise not to go more than a couple weeks without blogging - I'll just say that I'll TRY not to go too long between posts.  Sound good?  OK, I feel better now that that's out of the way.

Since my last post I've had: two Herceptin treatments, one appointment with a neurosurgeon, two MRIs,  one radiation "plan check", and two actual radiation treatments.  Whew!  That is a lot to catch up on, so let's get started...

When we last left off (I know, it was so long ago you don't remember...), I was waiting to hear from Radiation Oncology about when the radiation to my spine would start.  It turns out that a few things needed to happen before treatment could begin.

First, I had to go see a neurosurgeon, Dr. Cohen.  My radiation oncologist Dr. Evans just wanted me to meet Dr. Cohen and have him evaluate me before starting treatment just in case I ever needed a neurosurgeon (which freaked me out only a little).  The appointment was very easy - I didn't even have to change into a gown (one of the few doctor's appointments I've had recently that didn't involve at least one boob flash).  Dr. Cohen just asked me to do simple stuff like touch my toes, walk on my heels, etc.  He asked if I've had any pain in my back or any numbness or tingling (I haven't).

After this quick exam I went into his office where he told me that from a neurological standpoint I was perfectly healthy.  He said he considered the two spots on my spine "benign" - which doesn't mean that they were not cancer, just that they do not currently pose a threat to my spinal cord.  So that was good to hear.  He said he didn't even feel the need to order an MRI, but that if Dr. Evans did, which he expected (and he turned out to be right about that), he would take a look.  But all in all, it was a very easy appointment and I was in and out of there pretty quickly.

The following week I got a call from Dr. Evans' office that radiation would start on Tuesday, Sept. 7th.  But first, I needed to have an MRI, just as Dr. Cohen predicted.  So on the Friday before Labor Day weekend, I went to the imaging place for the MRI to my spine.  Isn't that how everyone kicks off a holiday weekend - with a medical test?  Oh, it's just me? :)

After waiting AN HOUR (at least they warned me and at least I had a book!) they finally called me.  This MRI was just like the others.  I had to lie still while the magnets clanged above me, though I had earplugs as usual, and then halfway through they gave me an injection of contrast through an IV before I had the second set of "pictures" taken.  Ever since my 6-needle-stick day I've been a little nervous about getting IVs since I know my veins are shot and I only have one arm available.  But luckily the technician got it on the first try.  Whew!