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November 01, 2010

In a groove

of good spirits.  For whatever reason, and I am not questioning my good karma on this matter, my ability to be a bit more even-keeled has extended into today and no end appears to be in sight.  Not only did I not spend the entire day worrying about next week (or the weeks after) but I was actually able to get a few things accomplished.

I'd like to believe that something magically clicked and my enthusiasm for life will not again ebb, but I am not going to go that far.  I do think that finally really revisiting the oncologist appointment with Peter might have much to do with it.  As much as I expected last Wednesday afternoon to be a complete wash, I was actually pleasantly (yes, a happy word) surprised by the visit.

Now I am not necessarily 100% on board with everything that she desires for my treatment plan. However, as it stands now, there is only one semi-definite item on her list for me:  hormone therapy, in the form of Tamoxifen.  As far as I am concerned, this needs to be discussed a bit more.  I was not expecting to hear anything about it in the appointment, so had not adequately researched it prior to our meeting.  Now that I have....well, many questions will have to be answered and topics discussed before I will choose to go ahead with it (yes, choice, a wonderful thing!).  It doesn't mean I won't, but I am not jumping head-long into anything.  However, we have plenty of time for a review, so yet another item  I can put on the back burner for now.

Perhaps I should start at the beginning....after lunch following the visit to the plastic surgeon, we drove to the hospital arriving at the hospital well ahead of our visit.  We arrived very promptly at the wrong office, and then spent 15 minutes trying to find the oncologist's office.  One problem:  it was located next to the cancer treatment area and no one could tell us exactly where it was.  No signs pointing us in the right direction, and we finally stumbled upon it by sheer dumb luck (why are hospital ground levels like mazes?).   The receptionist was kind (why do they have to be so nice?), but inundated me with a stack of paperwork.  My medical history (just one more time...), the usual consents and basic contact information.  

A few minutes later we were interuppted to begin the appointment.  It wasn't until this point that I realized that the office was within the treatment center.  The nurse took us back and let me know she needed to get my weight.  We turned the corner and landed smack in the middle of a room half-filled with patients in the middle of chemotherapy treatments.  I was stunned and it hit me full-force why we were there.  Yes, it was only a consultation, but that could easily be me in a few months.  

Suddenly weak-kneed, I stood on the scale.  She noted my weight and I realized quickly the (only) bonus:  I am dropping weight faster than I have in years.  It's not the cancer, but the accompanying stress.  I was fully clothed with chunky-heeled boots on and still weighed two pounds fewer than I noted on the form (and I thought that was a low estimate).  The nurse then took my temperature and blood pressure and exited in time for the doctor to arrive and ask that we continue the meeting in her office.  

I was not sure what to expect at all, but she was just, well, normal.  Not overly stressed, not in my face about treatments or my "lack of options," just concerned and wanting to get as complete a picture as possible of my history.  Peter began and then she began peppering me with questions.  She admitted it wasn't to stress me, but to really try and figure out what was going on.  In fact, she was still catching up on my case and had not realized that I was not going to have neo-ajduvant chemotherapy prior to surgery (yes, we, too, were surprised when she mentioned it).  There were a few minutes of confusion and she finally realized another exam was needed to give her the full picture.  

The exam gave her a better idea, but the primary problem is that no one knows the full extent of what is going on inside me.  There are numerous calcifications surrounding the tumor and the lump that I felt may or may not be entirely cancerous.  It is, sadly, a mystery of sorts that will only be solved when the entire area is excavated (if you will)  and studied next week.  While it is thought that (unlike the original estimate) the invasive portion is only .2 cm, no one knows for sure...hence the need for surgery.

The exam, a thorough review of the path report and finally confirmation that I am Her2-negative (this is a good thing).  In case you are taking notes, I am also ER and PR positive.  This is the situation that the oncologist was hoping to find, as it means more treatment options and that the breast cancer may not be as aggressive as it could be.  Yes, this is GREAT...well, so I have been told.  It doesn't negate the fact that I have still have cancer and am facing up to...egads...months to years of treatments, it simply means that the response to the treatments might be much better than if I happened to be ER/PR negative and/or Her2-positive. 

After the spiel on Tamoxifen and the mention of "shutting down my ovaries," I fell into a daze of sorts.  I am guessing that between the stunned look and a few tears, that she seemed to think we could discuss the subject more later.  She then began to touch on chemotherapy.  I didn't lose it (amazing, as I am not pro on the idea at all), but at least in this area, there is more room for contemplation.  She utilizes a method of testing called Oncotype DX test in order to assess whether chemo is truly needed.   Clearly, I am hoping to be on the low end of the spectrum, but we will discuss thoroughly and weigh the options no matter what score I receive.

Given my family history of clotting issues, she was motivated to order a rather thorough work-up to ensure that if hormonal therapy would be used, it would not be problematic for me.  The visit ended on a high note of only 9 tubes of blood being drawn, though the wait was far more painful.  It was a good 20 minutes before the nurse could figure out how to "code" the test, take the blood and then not screw up the tube labeling.  

Ideally, I would never choose to spend the afternoon at the oncologist's office.  However, she was so refreshingly human that it was not nearly as painful as I expected.  I can't say I was working on all gears, as I was so incredibly nervous about what she might suggest.   It wasn't until I started reviewing the information that I realized I had digested worst case scenarios that she had not mentioned.  By Saturday, I was up to reviewing the day with Peter and he realized that I was putting more stress on myself by somehow confusing one of the issues on chemotherapy.  He insisted he was correct, and thoughtfully verified with the doctor today.  Oh, and he didn't call her, SHE called us.  She just wanted to relay the results of the blood work (all clear) and check on me.  Thoughtful, eh?  

I really don't want to have an oncologist.  However, I think if one must be had, her demeanor, concern and willingness to help in a thoughtful manner has convinced me that she is the right one for me.  Not something I ever thought I would say or write, but I'm liking the calm and just going to focus on the positive...(I know I've said that before and promptly fallen off the wagon, but I think I'll cut myself a little slack given the circumstances).  Oh, and another reason I may be happier...a day off from appointments tomorrow AND a trip into DC with the girls.  Distraction City, baby!



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Hope you and the girls have a great day in the city! Yay for being in good spirits. :) Thinking of you!

Your oncologist (as much as you didn't want to have one) seems to have the right approach to your situation and is helping bring some much needed sanity into your world. Sounds like you the level of trust in her that's very needed in those situations. That's a very good thing!

Have a wonderful time with the girls downtown!

Hey lady, my hubby deployed today so I've been MIA. We always go into hermit mode before he goes :-) I just got caught up on your posts. I can't believe how similar our stories are! My mother has had deep vein thrombosis and many issues with clotting. I was really worried about Tamox for that and many other reasons. Just want you to know that I've been on it for three years and the side effects have been minimal to NIL! I do get hot flashes but the most annoying thing about Tamox for me is remembering to take it everyday. It's nice to have one more weapon. My DX score was 24, right in the middle, of course. It's hard because you want to make the right choice but there are so many unknowns. It feels a little like you could be damned if you do or don't do certain treatments but you could be fine too, if you do or don't do certain treatments. If that makes sense. Knowledge is power true but you need to trust yourself as well. You'll make the best choice for you.

It's hard walking into cancer centers to meet with the onc docs. I always feel like I don't belong as everyone is so much older than me! I'm glad to hear you're having some good days. Best of luck! ~Laura

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