Two Steps Forward, and a kitchen sink

Sunday was a killer.....and my internet was down (still is). By Monday evening I thought I was going to hurl. I had a great blog - all about constipation. Yes - it was a good one...I even referred to scripture - I needed some spiritual guidance. I opened the bible...and the first thing I read was, "This too, shall pass." (Thanks, God - what a sense of humor HE has!!)

I know that if I ever write a book about my experience, I will devote an entire chapter to constipation. If you know my family, you are really getting a kick out of that one. However, yesterday was a follow-up visit to my surgical oncologist and the first visit to my medical oncologist - and I want to share what we found out....

I think I have admitted several times that I have been a bit "cocky" about this cancer. Well, yesterday was no different - and I don't mean cocky in a bad way... I would characterize it more as being confident. We had an appointment with the medical oncologist at 11:00am and a follow-up appt with the surgical oncologist at 11:15am. Since they make the appointments, I inferred that at the first appt the doctor was going to look at me and tell me that I didn't need any treatment. So, David and I walked into Dr. Michel's office - and I mentioned to him that I was supposed to meet with Dr. Margenthaler in 15 minutes....so he walked out of his office and I heard him say to his nurse, "please call Dr. Margenthaler's office and let her know that Mrs. McCartney will be an hour late for that appt." YIKES - what does he mean I will be an hour late? How long could it possibly take him to tell me I don't need any chemo.....

I LOVE DR. MICHEL!!!!!! I think I could pass the entrance exam to get into medical school after talking to him - and I don't say this to lighten the importance of what someone must know to get into med school, but to compliment Dr. Michel on his delivery and compassion. He is the benchmark. He met with David and I for 1.5 hours...and I think if we had wanted to stay longer and ask more questions - he would have stayed......I will try to relay to you as eloquently as Dr. Michel did for David and I what we have to consider.

First of all, when deciding whether or not a patient can benefit from chemotherapy, doctor's look at three criteria. They are as follows:

1. Size of the tumor = if the tumor >1.0cm, then the patient WILL benefit from chemo
2. Lymph Nodes = if the lymph nodes are + for cancer cells, then the patient will benefit
3. Triple negative = if the patient tested negative for progestorone, estrogen and Her2, then the patient will benefit from chemo

Unfortunately for me, I got 2 out of the 3. However, the 1 that I did get - is reallllllyyyyy good!!! My lymph nodes were negative. But since I have what they refer to as "triple negative disease", hormone therapy is not an option for me - only chemotherapy.

Now, my first question was - they got all of the cancer. Dr. Margenthaler even referred to me as "cancer free." I was blessed - I had STAGE I cancer. It is curable - we found it at the best time possible....the area around the tumor was clean. No sign in the lymph nodes - all of this is good. But you know how those doctors are - always doing research and this guy really knew his stuff. I felt so at ease and comfortable with him. He indicated that without any follow-up treatment, there is a 30% chance my cancer would recur within the next two years - and it would most likely be metastatic and not curable at that point (while that sounds a little like doom and gloom....it is JUST a statistic. Listen - there is no doubt where I would fall, but I am thinking maybe I should listen to this guy). With treatment, the chances of recurrence are reduced by 1/3.

We know that since I was triple negative - which means my cancer would NOT respond to any type of hormone therapy (you may have heard of Tamoxifen - it is a very common cancer drug used for hormone therapy, or Herceptin, another hormone drug.. I could take these drugs all day long and they simply would not do anything for my cancer) the only option for me is chemotherapy. The doctor explained the standard treatment which he would recommend for me. It is pretty aggressive since I am considered high risk (the triple-negative thing again). Also - I qualify for a clinical trial. A drug was just approved last month by the FDA. There are 5000 people who will take part in the study - 30 of which come from Washington University.....one of which is ME!!!!

So, Dr. Margenthaler approved me to start chemo anytime. Her only request is that it does not start until 3 weeks after surgery - which would be next Wednesday. I plan to call Dr. Michel this morning and tell him I have chosen to do the clinical trial. My chemo treatment plan will last a minimum of 4 months - 6 months if the shots are 3 weeks apart, 4 months if they are 2 weeks apart. Dr. Michel thought I could handle every 2 weeks.

Now the questions really started coming. I heard the word "Steroid" come out of his mouth - and I have to admit, for a split second I thought to myself - I said, "self, steroids means you gain weight and get fat - okay let's just take our chances with the cancer." Then I came out of that fog and realized....hey - all this means is that I will be fat AND bald.....Now I will know how fat, bald men feel all the time. (yikes - I didn't just say that......I don't want to hurt anyone's feelings. So, if you are fat and bald, I apologize.)

Folks - I could write a book just on yesterday's visits alone. It was a very long day - and my head was so full I didn't sleep well last night. I am actually a little anxious to get this whole thing started. The doctor referred to the trial as "throwing the kitchen sink" at the cancer. I am all for that!!! And why is this even necessary in the first place? Well, we know the lymph nodes tested negative - which is fantastic!!! However, that is only one way cancer cells escape. The other way is via the blood system - and there is simply no way to test if any got out that way. That is why there is need for follow-up treatment.

Speaking of information - I recently found out that my niece is a carrier of the BRCA gene - which means that Robin (my sister and her mom) is, as well (Robin hasn't been tested yet - but since her daughter is a carrier, she is, as well.) What does all this mean? Well, for Nelsie - she must get annual breast exams beginning immediately!!! She is aware and thank GOD there are screening tools for breast cancer. For Robin - she will need to take a few steps, as well. First of all, she should have her ovaries removed - it will virtually eliminate her chance of getting ovarian cancer and it will actually reduce her chances of getting breast cancer. If you are reading this and you have breast cancer in your family - it is something for you to consider. Talk to your doctor to see if they think you should do the testing - and then, of course, you would need to know what you would do with the information.

As you can imagine, the breast reconstruction is secondary to the chemotherapy. The dr. will be able to fill the tissue expanders during chemo, but there will be no surgery to put the implants in until after the chemop is complete. We will also have my ovaries removed at that time. Since I have breast cancer AND test positive for the BRCA gene, there is a 40-80% chance I will get ovarian cancer - and it is not curable. There are no screens available to detect ovarian cancer and Dr. Michel indicated that women who get ovarian cancer typically do not walk away from it. SO, being the frugal one I am, I decided we will get the ovaries and the implants done at the same time - you know, to take advantage of the anesthesia. That stuff is EXPENSIVE...and I can save some money by combining the two surgeries! Anything to save a buck, right?!

Sorry for the long blog.....but thank you for your prayers. Hey - maybe the next time you see me I won't have any hair......just think of the time I will save getting ready in the morning - yeah!

God Bless you!!