We Have a Plan!

Today was a busy day.

First we met with the genetic counselor, Kayla, to discuss my family history and see what tests we needed to order.  (A full panel will be done, though only a positive result on the BRCA 1 or 2 gene would impact treatment.)  Results will come back in 2 weeks or so.

Next up, we met the nurse practitioner filling in for Dr. Saleem's normal NP.  (Dr. Saleem is the Medical Oncologist, or MedOnc.)  Haihong was... brusque.  She wasn't unkind, but she was very clinical and seemed to have forgotten that she was going over a chemo plan with someone who was new to cancer.  One thing that was important to me was that I be allowed to use a nail strengthener and dark/black polish on my fingernails in an attempt to have them not split/lift off of my fingers.  Women who've experienced the same chemo I'll be doing have used that treatment successfully, and I thought it was worth a shot.  Haihong was dismissive, saying that it wouldn't work, and she wanted to be able to see my fingernails in case there was any sort of infection.  She also seemed to dismiss my concern as me wanting my nails to stay pretty and polished, as if that would be my primary concern.  I also brought up the possibility of using cold packs/gloves to try to prevent neuropathy, and she dismissively said there was no evidence that it would help, though she didn't forbid me from trying.  I'm hoping we will meet and deal with the normal NP on my subsequent visits.  

Dr Saleem, on the other hand, was great.  She was kind, understanding, supportive, and talked to me instead of at me.  When I asked her about the polish, she immediately responded that the nail strengthener and polish could possibly help, and would at least keep my nails stronger, and then brought up the use of cold packs/gloves before I did.  She took her time with us, making sure we were comfortable with everything she had to tell us, and giving us time to ask all of our questions without interruption.

We met with Dr Miggins, the SurgOnc, before leaving, and went over the surgery options in light of the MRI results from Monday.  We also discussed next steps so that I'd have a clear understanding of what to expect.

So here's the plan:  

I'll be getting a port placed (outpatient surgery) sometime in the next few days, and will also have an echocardiogram (like a heart ultrasound) done to get a baseline on my heart since the chemo can be hard on it.  Methodist SL will be contacting me to have that scheduled.  It's likely that this will all happen Friday or Monday.

Chemo will start next week on Thursday.  I'll have 12 weeks of Taxol (Paclitaxel), once a week, to start with.  Following that, it'll be 12 weeks of AC (Adriamycin and Cyclophosphamide), 1 treatment every 3 weeks for a total of 4 treatments of AC.  That means 6 months of chemo.  If my blood counts aren't where they need to be on any given week, treatment may have to be delayed.  I'll have to be careful to stay healthy, which means everyone around me needs to stay healthy.  Lots of hand washing!  I was also given free rein to eat whatever I liked that I could tolerate.  Dr Saleem said the most important thing was to keep my energy and calories up.  I'll have prescriptions for anti-nausea medication to take around the clock if necessary, and will be given steroids and Benadryl with the chemo.

After chemo, I'll have surgery - a mastectomy on the right side, along with removal of all the lymph nodes in my right arm.  More on surgery as we get closer.

After I heal from surgery, I'll have radiation (likely to be 4 weeks, every day M-F), though I haven't yet met with the radiation oncologist.) 

About 9 months after radiation, I'll have reconstructive surgery - possibly the first of several, depending on how things go.

And that is what we know right now.  Things are starting to move along!