Making Plans for Poisons!

Those of you who know me well will hear the joy as I type the following: We have a plan!!!!

Granted, the need for a plan and most of the reality of carrying out the plan both suck, but we have a plan and that means so very much to me and makes me happy. :)

Today was oncology day. I got to have my first cancer-free, boob-free visit with Dr. Obenchain, who I was reminded yet again is an amazingly supportive and caring woman in addition to being a really good doctor.

Dave and Laura (husband and great friend/cancer sister, respectively) joined me for this visit to hear the recommendations for my ongoing treatment. Dr. Obenchain went over the same test results we'd heard from Dr. O'Neill a couple of days ago and focused on the fact that now that I am now cancer-free (Yay! Never gets old, does it?) there are things we need to do to increase my chances of staying that way.

She confirmed that I had three tumors in the left breast, with the largest being only 1.1cm - all in all, quite a good outcome for breast cancer if you have to have it. (Which I sincerely hope you never do, of course.) Adding in the negative lymph nodes and the tumors being hormone-positive, I have quite a few reasonable treatment options ahead of me.

Luckily, one of Dr. Obenchain's roles is to provide information on the odds, the pros and cons, of all of the treatment options. This means numbers and statistics for me! Again, yay! (LOL - Ever the dork, right? Finding joy in the numbers regarding my cancer odds...)

Using the computer modeling and all the relevant info about my tumors, their aggressiveness, size, lymph nodes, hormone tests, genetic tests, and the kitchen sink, Dr. Obenchain let us know that if I did absolutely nothing else to treat my cancer, I should have a 75% chance of remaining cancer-free for the rest of my life.

She told us this news and said it was good news. But of course, what I heard her say despite her actual words was, "You have a 1 in 4 chance of getting cancer again."

She immediately stopped and laughed at the fact that Dave and I had completely different facial reactions and responses to hearing those odds. He heard the 75% and I heard the other 25%. So of course, I said 25% was not good enough for my two little people at home, so I absolutely will be doing more to reduce those odds.

Because my tumors are hormone-positive, which is apparently rather rare in young pre-menopausal women, this allows us a treatment option that is quite good. Depending on how we choose to attack the natural hormones in my body that serve as food and fuel for my cancer, we will either block the receptors of any cancer cells that may not yet be detected or may have been missed, or we will make my body stop producing the hormones altogether. Either way, I will experience menopause; it's just a matter of whether or not it's permanent, with which I would be fine. My two amazing kiddos are all I plan to have anyway.

The particularly good news from this conversation is that even if we decide to go the route of permanent menopause, there may be ways to do it without another actual surgery to remove my ovaries. We may just be able to chemically turn them off - which of course kind of makes me think of just making them shrivel like raisins in my body, but that's kind of an icky visual, so try not to think about it. (Easy, huh?)

And we will make more detailed determinations on the hormone therapy once we get through the chemo part, but the statistical modeling suggests that doing just the hormone treatment alone would reduce my risk of future cancers from 25% to 16%. Definitely an improvement, but still not a number that makes me too incredibly happy.

So we discussed chemotherapy options. Dr. Obenchain was very honest and informative about the short term effects and possible long term effects of putting poison in my body. Most of the short term ones are fairly well known, even though they do not necessarily happen to everyone with the same severity or at all: hair loss, short term memory loss, nausea, weakened immune system, possible mouth sores, dry skin, lots and lots of fun things. The long term effects are much less likely to occur, but quite a bit more serious: approximately a 3% chance of heart failure and a less than 1% chance of actually causing another cancer such as leukemia by the treatment itself (which did actually happen to my grandfather after his colon cancer treatment).

With my young age and good health, however, Dr. Obenchain said she believed that my own actual risks are lower than these statistics because these include cancer patients of all ages and those receiving much longer and stronger forms of chemotherapy.

Adding chemo to the hormone therapy should reduce my risk of future cancers to only 10%, which is actually not too much higher than the risk for any average person on the street who has never had cancer. Please think about that for a moment and make sure you are wearing sunscreen and getting your recommended health checks. Breast cancer is 1 in 8 for women while prostate cancer is 1 in 5 for men. Seriously people, pay attention to your body and catch any cooties early and before they catch you!

We discussed many more details about which chemo drugs she would recommend based on my pathology and it turns out she would not be using drugs that require a chemo port. Yay again! One less procedure, one less scar, one less place on my body to be sore and prone to infection!

She told us to consider our options and let her know which route we were most comfortable with, but I told her quite honestly that I want my future risk number to be as low as possible as soon as possible, so I am fine with the short term effects and long term risks, especially if it means "long term" will have a much greater meaning to my life.

So I'm all in for chemo. She told me to pick a day between Sept 9-17 to get started (about a month after the surgery to allow for more healing) and I'm ready to get this show on the road. I will have only 4 chemo treatments (the minimum) at three weeks apart to allow my body to recover and my immune system to rebuild a bit between treatments. I came home tonight, pulled the calendar off the wall and figured out that if I start on Sept 9 or 10, I will be done by mid-November. I will probably still be recovering from the cumulative effects of the chemo exhaustion around Thanksgiving, but I should be back on my feet in time for Greta's birthday at the end of November and Fin's birthday two weeks later.

Yes, I will be bald in their 3 and 5 yr b-day pictures, but I will be there and will be in the photos from many, many more of their birthdays as well. And because we can finish breast reconstruction 3-4 weeks after chemo is done, there's a chance I'll even have my new boobs in time for Christmas! (Though I will have to consider NOT being in recovery from another surgery over the holiday, too...)

We will likely start the hormone therapy with the new year and my plan is to be completely DONE with cancer and treatment before my 36th birthday in May.

When I laid all this out to Dr. Obenchain, she just looked at Laura and they both cracked up about what I planner I am and how I was ready to get the show on the road.

So - that's the plan: start chemo in about 2 weeks, have the usual ups and downs for about 3.5 months with that fun, be a bit recovered for the kids' birthdays and the holidays, then kick off the new year with more insurance toward keeping cancer out of my life for good. And really, what better New Years Resolution can you think of than "Keep Cancer AWAY"?

The next several months will not be easy and they will not be fun, but I am not scared of what's ahead of me. Every time my gorgeous Greta giggles or my sweet Finny gives me a gentle hug and says, "Love you mama" I know I would endure anything to be around them as long as I possibly can. There's no way any nausea, baldness or exhaustion will keep me from doing whatever it takes to make myself as healthy as possible for as long as possible.

Interestingly, when I have told a few friends and family members about my plan - with all the joy I have mentioned having about simply having a PLAN in place - I have been met with responses of, "Are you okay with that?" or "Wow- you really have to do chemo?" or "How are you doing with that decision?" And it surprises me every time. Because I know this plan is a hard one, I know I will have some really sucktastic days in the next several months - but I also know that I am surrounded by family members and friends who are forever checking in on me, asking how they can help and offering me love and support from all over the world. Add that to my babies and I can do anything.

Which reminds me of something I don't think I mentioned when I updated after surgery a few weeks ago. When I was wheeled into the operating room, I was greeted by the anesthesiologist and Dr. O'Neill. The anesthesiologist (Dr. Rahman, I think, but I really only chatted with her briefly - she was very friendly) asked if I wanted to sing along with some Adam Lambert that was playing. Then the nurse asked if I could move myself from the wheeled bed onto the operating table. I confidently said, "Sure - I can do anything." I moved over, they told me to put my left arm out on the side table and that's the last thing I remember until I was waking up and taking a peek under the sheet covering me to see what I looked like with no boobs. These are honestly the last and first thoughts I have around the surgery blankness and I love that the last thing I remember saying when I actually had cancer was "I can do anything."

Hells yeah.

So that's obviously still my approach and I hope I will remember it on the days ahead that will be tougher than the ones I've had so far. Recovering from surgery has not been a blast - after a long day yesterday, I was so sore and in so much pain that I tossed and turned (as much as one can when you can't really roll over at all - I basically just kicked at blankets and pillows and yelled about cancer being stupid) until after 2 in the morning. But even with today being my most painful and exhausted day of the last two weeks, I know the road ahead will take me through even more of this crap. Unfortunately, this is just the start of this journey.

I really thank those of you who are by my side now, who know how sucky this will eventually be and who will be there to help me through the worst of it. I can't imagine my life without you and I know I am loved and blessed to have such incredible support through this journey and all the hard things and happy things in my life. Thank you.

<3
-B-