April 17, 2008 - Oncology Opinions

I sent an email yesterday to friends and family that know about my diagnosis. I received many sweet responses, and I wanted to reply to all of them, but with testing and work and baseball and ..... etc..... Well, I feel overwhelmed right now....I realized I had better start a blog to capture my thoughts and keep people informed that have an interest in knowing about my journey.

I had seen a doctor in Fountain Valley last week for my first oncology opinion, and I adored him and his office staff, and I really thought I would do further treatment with him. I read the book, THE BREAST CANCER SURVIVAL GUIDE, and I got lots of info from it. I felt confident that, by reading this book, I understood my pathology report before I even saw him. The book taught me that I'd need chemo, which made the doctor's news easier to take. He set me up for a teaching to learn about chemo. I was to get the chemotherapy combination "TC" for 6 treatments, one every 2 to 3 weeks. I scheduled the teaching class for the day after I was to see the next doctor.

My husband and I figured we'd probably get the same info from the 2nd doctor, but that didn't happen. Dr. VanderMolen (at Hoag) asked what had transpired medically since my 3/18 surgery. I had nothing to say, except for the follow-up with my surgeon. He asked about testing to check for further spread (via CT Scan, bone scan, etc.). He went over things in detail, and we felt more confident with his plan. We will go with Dr. VanderMolen, even though the chemo regimen is a bit more intense. The regimen scheduled now is AC for 4 cycles, one every two weeks, and Taxol (T) for 4 cycles, one every two weeks.

Both doctors seemed really good at what they do, but something scared me about the fact that the first doctor didn't order any tests (CT scan, bone scan, etc.). The new doctor wants to understand the total body situation.

Here's the email I sent after my 2nd oncology opinion:

Hello. You've received this email because you already know about my breast cancer diagnosis. If you're uncomfortable receiving this type of info, please let me know, and I won't send anything further. I look at these types of things with an "it is what it is" attitude, so I will deal with the diagnosis and treatment and try to understand it as much as possible.

I had my 2nd oncology opinion today. The first doctor had recommended 6 chemo treatments, followed by radiation. Chemo treats systemic spread and radiation treats local microscopic cancer cells around the area of the surgery. I think everyone needs a second opinion, so I scheduled one at Hoag. It was a little rough talking with a doctor that "doesn't do 2nd opinions", but once we got past that little argument, Clayton and I learned a LOT from Dr. VanderMolen.

I thought I understood my pathology report pretty well until he explained it in detail. It was kind of fascinating. (I know. I'm strange.) He went through the good and bad.... * No lymph node involvement (good). * Both hormone receptors (progesterone and estrogen) were negative, so they cannot treat me with hormone therapy (not good). * Tumor size was 1.8 cm (not good). Under 1 cm considered good. Still at Stage I, though. * Proliferation rate was extremely high (not good and most worrisome factor). The first doc told me these cells divide about every 40 days. * Her-2 Neu, a gene, was low (good). With that, Dr. VanderMolen wants to do chemo and radiation after a series of tests (CT Scan, Bone Scan, and Echocardiogram), which are all scheduled for Thursday. The first doctor scheduled no tests. When breast cancer spreads, it spreads to the liver, the lungs, and the bones, so he is using the CT and Bone scans to check for macroscopic cells that might be present. The echocardiogram will test my heart to make sure it's strong enough for the chemo treatments. He informed me that chemo should start as soon as 1 month after surgery, so I should start chemo on Monday. He also said the treatment the other doctor had recommended was not appropriate for my particular situation, and he thought I had a pretty good chance of relapse in 2 to 3 years if I was to choose that option. Instead of 6 chemo treatments, I'll now do 8 treatments over four months. And yes - I will temporarily lose my hair - a small price to pay for a longer life. I always wondered what I'd look like with short, spiky hair, and now I get to find out (with an excuse)!

So - now I've joined the ranks of the 1 in 9 women with breast cancer. I hear it's not a fun experience, but it's HIGHLY treatable, and I will get through this just like other women do. I thank God for the thousands and thousands of women who went before me to test the treatments that are available today. Please have all the women you know do self exams. I had my mammogram in October, and I found the aggressive lump on my own in January. I didn't do regular checks because with all the lumpy stuff already present, I didn't think I'd notice anything different. It was a freak thing that I found it. I'm not shy about talking about it, and I don't mind who knows, but I am a bit self conscious about wearing no make-up, so I can imagine I won't want to show up too many places with no hair. I won't miss one of my son's baseball games for anything, though! They are in first place (7-1). Woo hoo! Thanks for letting me share.

Update at end of season: The team took 2nd place overall and got some cool trophies. :-)