The Second Opinion
Well, I guess the effects of chemo brain were demonstrated this morning. I arrived promptly at the Women's Imaging Center for my 9:00 a.m. ultrasound, only to find out that I was a day early. Oops. They were going to squeeze me in anyway (one of the perks of being a regular), but then they realized that my previous ultrasound films were at MCV for my second opinion appointment, and so there would be no basis of comparison for today's films versus the original films. We agreed that I would bring the films home with me this afternoon and return in the morning for my actual appointment. It worked out fine because if I hadn't shown up unexpectedly this morning, I wouldn't have known to bring the films back with me. The universe moves in mysterious ways.
Bo and I dropped the kids off at two different friends' houses this afternoon to disperse the energy output of three boys to a manageable level for our friends. We may need to call on them again! Then we headed for Richmond, about 45 minutes away. The Medical College of Virginia is a research hospital and as such, it was far more impersonal and much more institutional than my own doctors' offices. Everyone was very professional and very kind and compassionate, but I kind of felt like I was waiting for my number to be called at the deli counter. I shared this observation with Bo later, and he said that he had the same feeling. I didn't see it, but he said one of the rooms in which we waited had a sign, "Patient, please take a number."
Dr. B, the surgeon, said that since Dr. P had called him about me so he was already familiar with my case before my information was presented at the the "tumor conference" earlier this morning. Many doctors use a tumor conference to bring the various disciplines together (surgeon, oncologist, pathologist, radiologist, and the radiation doctor) to review and discuss their patients and determine the best treatment options. My surgeon, Dr. H, also engages in this practice.
Dr. B actually conducted one of the leading studies on neo-adjuvent chemo (chemo before surgery), and he confirmed that there is no data to suggest that neo-adjuvent chemo versus chemo following surgery has an effect on survival rates. Because the chemo can frequently shrink the tumor, it is often used by women with inoperable tumors or women interested in breast conservation. I have always known I was deploying the big guns (mastectomy), and so breast conservation has never been an issue for me. I'll trade my breasts for my life any day without a second thought about it! He also said that neo-adjuvent chemo also 1) allows the doctors to gauge the effectiveness of the chemo (although I need to ask my oncologist the significance of this data point), 2) helps facilitate the surgery if the tumor does, in fact, shrink, and 3) may promote early menopause and thus, cut off the estrogen supply. He said since the tumor does now seem to be responding to the chemo, it makes sense to continue the Taxotere.
Dr. B measured the tumor and thought it was about 2 cm by 2 cm. This is not a very precise method, but nonetheless, encouraging. When I had my first appointment with Dr. H back in May, the measurement was about 4 cm by 3.5 cm. Some of that was undoubtably bruising and inflammation from the biopsy, but even so, it is smaller!!! He asked me if it felt softer (it does) and indicated that softening is usually the first sign of response.
He then asked me what I intended to do about the other breast. That's easy. I am having a bilateral mastectomy. Take 'em both, and I'll start from scratch. This time around I can pick the size, and maybe I'll even let Bo have some input... Actually, Bo said he'll support whatever decision I make about having one or both removed and about whether or not I choose to have reconstruction. He has always been more of a derrierre man anyway.
Seriously, after learning that my genetic test results were inconclusive and that I did have some type of mystery mutation, I knew a double mastectomy was the best course of action for me. Bo is also of the opinion that I should have both removed - he doesn't want to go through this again anymore than I do. Dr. B said he had just seen a study that found women without the known genetic markers but with a family history such as mine had a 40% chance of getting breast cancer in the second breast. So there you have it. He just confirmed my decision. If I opt for reconstruction, he recommended I postpone reconstruction until after radiation because 50% of implants are damaged by radiation and end up being replaced or that I go for the reconstruction that doesn't involve implants. I will deal with all that stuff when the time comes.
A medical oncologist also dropped in and spent a few minutes with me. He said that he and Dr. B had discussed my case at length earlier that day and that he felt that continuing on the Taxotere was appropriate, especially since I was tolerating chemo very well. Well, yes, I am tolerating it well, except for the salsa effect. He was actually a little surprised that I was having any issues with my mouth on Taxotere as it is much more common with the other chemo drugs. He suggested that I suck on ice chips during the next treatment, and that will help minimize the effects of the chemo on my mouth. (A former colleague at the Department of Social Services who had breast cancer several years ago had recommended this tip to me, so I will definitely try it. Until then, I am eating only mild salsa. Green Mountain Gringo is particular yummy!)
It was reassuring to hear from two other cancer specialists that my course of treatment is appropriate and consistent with current knowledge (with the caveat that treatment is not an exact science). It was confirmation that nothing has been missed, and I am good hands with Dr. P and Dr. H.
Bo and I dropped the kids off at two different friends' houses this afternoon to disperse the energy output of three boys to a manageable level for our friends. We may need to call on them again! Then we headed for Richmond, about 45 minutes away. The Medical College of Virginia is a research hospital and as such, it was far more impersonal and much more institutional than my own doctors' offices. Everyone was very professional and very kind and compassionate, but I kind of felt like I was waiting for my number to be called at the deli counter. I shared this observation with Bo later, and he said that he had the same feeling. I didn't see it, but he said one of the rooms in which we waited had a sign, "Patient, please take a number."
Dr. B, the surgeon, said that since Dr. P had called him about me so he was already familiar with my case before my information was presented at the the "tumor conference" earlier this morning. Many doctors use a tumor conference to bring the various disciplines together (surgeon, oncologist, pathologist, radiologist, and the radiation doctor) to review and discuss their patients and determine the best treatment options. My surgeon, Dr. H, also engages in this practice.
Dr. B actually conducted one of the leading studies on neo-adjuvent chemo (chemo before surgery), and he confirmed that there is no data to suggest that neo-adjuvent chemo versus chemo following surgery has an effect on survival rates. Because the chemo can frequently shrink the tumor, it is often used by women with inoperable tumors or women interested in breast conservation. I have always known I was deploying the big guns (mastectomy), and so breast conservation has never been an issue for me. I'll trade my breasts for my life any day without a second thought about it! He also said that neo-adjuvent chemo also 1) allows the doctors to gauge the effectiveness of the chemo (although I need to ask my oncologist the significance of this data point), 2) helps facilitate the surgery if the tumor does, in fact, shrink, and 3) may promote early menopause and thus, cut off the estrogen supply. He said since the tumor does now seem to be responding to the chemo, it makes sense to continue the Taxotere.
Dr. B measured the tumor and thought it was about 2 cm by 2 cm. This is not a very precise method, but nonetheless, encouraging. When I had my first appointment with Dr. H back in May, the measurement was about 4 cm by 3.5 cm. Some of that was undoubtably bruising and inflammation from the biopsy, but even so, it is smaller!!! He asked me if it felt softer (it does) and indicated that softening is usually the first sign of response.
He then asked me what I intended to do about the other breast. That's easy. I am having a bilateral mastectomy. Take 'em both, and I'll start from scratch. This time around I can pick the size, and maybe I'll even let Bo have some input... Actually, Bo said he'll support whatever decision I make about having one or both removed and about whether or not I choose to have reconstruction. He has always been more of a derrierre man anyway.
Seriously, after learning that my genetic test results were inconclusive and that I did have some type of mystery mutation, I knew a double mastectomy was the best course of action for me. Bo is also of the opinion that I should have both removed - he doesn't want to go through this again anymore than I do. Dr. B said he had just seen a study that found women without the known genetic markers but with a family history such as mine had a 40% chance of getting breast cancer in the second breast. So there you have it. He just confirmed my decision. If I opt for reconstruction, he recommended I postpone reconstruction until after radiation because 50% of implants are damaged by radiation and end up being replaced or that I go for the reconstruction that doesn't involve implants. I will deal with all that stuff when the time comes.
A medical oncologist also dropped in and spent a few minutes with me. He said that he and Dr. B had discussed my case at length earlier that day and that he felt that continuing on the Taxotere was appropriate, especially since I was tolerating chemo very well. Well, yes, I am tolerating it well, except for the salsa effect. He was actually a little surprised that I was having any issues with my mouth on Taxotere as it is much more common with the other chemo drugs. He suggested that I suck on ice chips during the next treatment, and that will help minimize the effects of the chemo on my mouth. (A former colleague at the Department of Social Services who had breast cancer several years ago had recommended this tip to me, so I will definitely try it. Until then, I am eating only mild salsa. Green Mountain Gringo is particular yummy!)
It was reassuring to hear from two other cancer specialists that my course of treatment is appropriate and consistent with current knowledge (with the caveat that treatment is not an exact science). It was confirmation that nothing has been missed, and I am good hands with Dr. P and Dr. H.
posted by Mary @ 8:10 PM
1 Comments:
At 8:36 PM,
Anonymous said…
HI MB,
When I herd of your ordeal, I was simply amazed. As you know from our conversation a fews years ago in Norcross, my mom had the double mysectomy and I know first hand of the challenges involved. However, knowing you and your strength of character, you will be victorious.
You are indeed in my thoughts and prayers!
Gregory.
Post a Comment
<< Home