Medical Oncologist appointment

Yesterday, after the expansion appointment, we headed to the hospital to meet with the to talk about next steps.   I was really dreading this appointment as I am still in the surgery recovery stage and not looking forward to the chemo phase and its related side effects.  

The oncologist opens the appointment by saying something like, "If we can avoid chemotherapy for you, that is my goal."   At that point, I said, "Thank you very much" and tried to walk out the door.    Unfortunately, in my post-expansion pain, I definitely could not outrun her (or even Emily) so we all laughed and started talking about chemo.

First up, they will run the Oncotype DX test on my removed tissue. This test predicts the likelihood of recurrence in the next 10 years.   It comes up with a score and a percentage.   If the percentage is 10% or less (give or take a few percentage points), chemo would not be necessary as hormone therapy (tamoxifen) will do enough to lower my recurrence chances to a livable percentage (6%-ish).   We are PRAYING for a low score on this test.    Unfortunately, the oncologist does not think I will be so lucky - she thinks I will fall more in the mid-range of scores.  (According to her, she is pretty good at guessing where people will fall with only a few exceptions.)  In this case, she would recommend chemo for some and not others.    Given my age and the fact that I had 2 tumors (and therefore some really messed up DNA in my right breast), she would recommend chemo for me.

Then our conversation turned to the type of chemo.   Previously, she recommended a pretty aggressive regimen - cytoxan, taxotere and adriamycin - given together for 6 cycles, every 3 weeks.   When we got the great pathology results from the surgery, I was all prepared to go in and fight her to tone down the chemo regimen.  I am all about being aggressive and making sure this NEVER comes back but I don't want to needlessly kill myself with chemo for no reason.   Luckily, I did not have to fight her at all.

The chemo regimen she is proposing is cytoxan and taxotere for 4 cycles, every three weeks.   Common side effects are hair loss (a certainty in 3-6 weeks), nausea and vomiting (manageable with drugs) and fatigue (which I just need to trudge through).    She is very supportive of my staying out of work for the duration of my treatment so I can focus on feeling my best.  (I am lucky to work for a company where this is possible.)   She would want to get started it the next 2 weeks - so the week of 4/4 or 4/11.    Even with starting the week of 4/11, I think I will have JUST enough time to swap out my expanders for implants and heal before our Disney trip at the end of the summer.  That would be OUTSTANDING!     While I am obviously not happy about having chemo, this is the best scenario from a regimen perspective so I left the appointment much more positive than I thought I would.

Given that there will likely only be 4 cycles, I am leaning towards not getting a port.    The oncologist looked at my veins and I guess I am really dehydrated so I need to plump myself with water if I want to avoid the port.  She told me the chemo nurses would not be happy if I walked in for a treatment with my veins!   So, now I need to drink a TON of water for the next 2 weeks and WOW her at my next appointment!

The Oncotype DX test takes 10 days if she rushes it, which she has, so hopefully we'll know next week.   We (and the oncologist) are a little annoyed the slides were not sent for the test right after the surgery since we would have the results by now, but oh well...  it gives me more time to recover from surgery before starting chemo.

The oncologist also agreed with the breast surgeon that there is no need for me to see a radiation oncologist so radiation is OFFICIALLY off the table.  Woohoo!!!!