The Next Stage of Treatment

The treatment plan has been made. I met with the oncologist last Wednesday, Oct. 12. Dr. S. is a young woman, but I was impressed with her intelligence, presentation, and the way she treated me. She is recommending chemotherapy for these reasons. One, the size of my tumor. It was 2.2 cm in diameter or about 7/8 of an inch. That's not the largest tumor I've heard of, but big enough that she feels chemotherapy would be best. The second factor is the type of cancer cells seen under the microscope. They are labeled Stage III. That classification refers to how differentiated the cells are from the normal breast tissue cells. Stage III cells are highly different than the normal breast cells. These type of cells are thought to be more aggressive, but they are also more susceptible to the effects of chemotherapy. Third, is my age - 52 years. Ideally, I could expect many more years to live and chemotherapy will help to make that a reality. Without any further treatment, my chance of living 10 more years would be approx. 78%. The chance of a recurrence of breast cancer would be 44%. With chemotherapy treatment, longevity for at least 10 years would go up to closer to 90% and the chance of recurrence would go down to about 20%. That's what I want. A greater chance at long life without recurrence of cancer. In addition, the radiation treatment that will follow the chemotherapy should add to those percentages.

Although it seems that surgery was as successful as it could be in "getting it all", as some people like to phrase it, there is no guarantee that some microscopic cancer cells hadn't broken free and traveled to other locations in my breast or body. Breast cancer cells particularly like to migrate to the lungs, liver, bones and brain. I do not want to have any breast cancer setting up for business in these locations SO I will take the chemotherapy treatment and let it go throughout my whole body attacking any cancer cell that might have broken loose. The problem is that chemotherapy is a systemic treatment - it will attack or poison any fast-growing cell in my entire system. It will not just limit itself to the fast growing cancer cells. This is why there are side effects to chemotherapy. It will affect cells in my bone marrow that make blood cells, the cells that make hair and nails, the cells lining my entire gastrointestinal tract, and others. So, my ability to fight infection will be impaired because I will not have as many white blood cells, I might get tired because of fewer red blood cells, I might lose hair and nails, I might have nausea, vomiting, mouth sores or other gastrointestinal problems. It is impossible to predict what will happen to me because every person's body reacts differently. I do know that the doctor and nurses will have many drugs and other things to help me with these side effects.

Today I am getting a little preview of what may be. I caught a nasty cold (from Craig) and it has really taken a hold of me. The symptoms are the normal stuffy, runny nose, drainage down my throat, sore throat, ear ache, coughing, difficulty sleeping, and headache. A cold like this during chemotherapy will be a very serious illness so I am going to have to be very, very vigilant about exposure to germs and sickness.

The plan is for me to begin this treatment on Thursday, October 28. The next day, I will get my first injection of Nuelasta. This is a drug made of a growth stimulating factor, which we produce in our bodies normally. This medicine is a booster, to help the bone marrow begin forming the blood cells, particularly the white blood cells. I will receive it after every treatment in order to help me produce the white blood cells my immune system needs. If my blood cell count has not come back up to an acceptable level before the next scheduled treatment, then they will postpone treatment until it does come back up. There will be 8 treatment in all, spaced out every other week. So, it should take at least 16 weeks to do this. Hopefully, I'll be able to stay on schedule and finish up by the middle of February.

Honestly, I feel overwhelmed right now. That could be an effect of the cold I am fighting, however. I am planning to cut my long hair and donate it to Locks of Love, an organization that makes wigs for children who are taking chemotherapy. It think it will be less disturbing to have short hair fall out, than to have my long hair fall out. When my short hair does begin to thin or fall out, I may just go ahead and shave my head. That will be one small thing I can control. There is precious little I can control in this situation. Wigs, hats, scarves, earrings, etc. are all things I am considering. But, at some point, someone may just have to accept a bald headed me.

Of course, my attitude is something. I am trying to stay positive, but I am finding it difficult. I am learning that my resources are more shallow than I originally imagined. The support of my friends and family is critical. I am needing to lean on others for hope and encouragement. A breast cancer survivor that I know told me in the very beginning, "You will find out who your true friends are." I do believe that is true. It helps me alot to read the scriptures and pray. I am learning that these two activities are as vital to me as water and air. But, I have many, many blessings. Good health care, good insurance, a good employer, friends and family who love me, and my sweet kitty cats. Where would I be without all these?

Healing and Building Strength

I don't know why I haven't made an entry for almost 2 weeks. Perhaps the business of healing and then getting back to work took all my energy and thought.

Healing is going well. The incisions are not painful, although sometimes irritating. Finally I can take off my bra without getting an ache. When I saw the doctor 3 days ago, Wedsnesday, she drained 3 vials of fluid from my healing breast. She said the accumulation of fluid is called a seroma. The fluid is mostly made up of serum (I think) the clear fluid that is in the blood. There was some blood also in this fluid. After this was removed, the bulge where the tissue was removed was smaller and the site was not as sore. This is the fluid that collects in out of drains that some women have after surgery. I did not have drains. The plastic "tape" over the incisions is starting to peel off my skin, but I am too chicken to pull it off. I will just wait for it to become more detached and for the skin to heal more. When I first looked at the incisions, they caused me a little lurch of fear, but now I am becoming accustomed to the site of these two red lines on my body. I know that in time they will just be barely noticeable white lines. It's just going to take awhile.

Dr. A. carefully reviewed the surgical pathology report with me. The results that she gave me on the day of surgery are confirmed. The margins of tissue surrounding the tumor were clear of cancer cells and so were the 4 lymph nodes that were removed. The report describes the size of the removed tissues. The tumor was 2.2 cm, putting just over the boundary between Stage 1 and Stage 2. Dr. A. explained that this 4 stage system is old and not very useful because Stage 2 can define anything from a smaller tumor (like mine) to a 5 cm tumor and anything from no lymph node involvement to very many lynph nodes involved. They are working on a better classification system. Doesn't matter much to me now. She said she would call my case an early stage 2.

Still, she did prepare me for a strong chemotherapy recommendation from the medical oncologist whom I will be seeing on October 12. The size, the characteristics, and my age all are factors in making chemotherapy a good option. Surgery seems to have done all that it could. Now addition therapies will be helpful to give me the best chance for a long, breast cancer free life.

I was surprised, really, at how well and easily the surgery part of treatment went. Pain was only mild to moderate and I got back to normal in a week. I still do not feel that I am "sick." I feel extremely grateful for this outcome. I am trying not to be pessimistic, but I do wonder if the chemo and radiation that are to come in the future will actually be the more difficult phases of treatment.

Chemotherapy is poison. I heard someone describe it as being taken to the edge of death, killing every rapidly dividing cell in the body, before pulling back and considering that the cancer cells have eliminated. Even then, there is alway a chance that it will return. Sometimes that does happen. Going into surgery I knew that I could do that. I've had surgery before. Chemotherapy will something else. I've never been poisoned. I wonder if I can go through the experience well.

Yesterday, at work, I sudenly felt intense nausea and vomited. Then I got aches and fatigue. I have no explanation for the event. Felt fine up until the moment it happened. Just a little dizzy and then nausea. Will that be like chemotherapy? I think that I have, in my "mature years" become more susceptible to nausea. I dread that feeling. Never having had morning sickness, it is not a frequent experience for me. A couple of times a year, but very discomforting.

I need to keep building up my spiritual strength and faith. I may need to call more on my inner reserves in the next phase of treatment.

So, no it seems like I am in intermission. Act I is over and Act II is about to begin.