The Chemo Decision

So after a dreadful experience with oncologist number 1, we decided to seek not only a 2nd but also a 3rd opinion.  This week gave us an opportunity to meet back to back with the new oncologists.

Tuesday we met with oncologist #2.  I IMMEDIATELY felt comfortable with this doctor.  He walked in and said, while I've read your chart, I want to hear about things in your words.  I asked him where should I start, and he said the beginning.  He was very much about spending this appointment talking about options, questions and concerns we might have.  He explained to us WHY chemo was necessary, which made sense as soon as he took the time to do so.  Evidently when a breast cancer tumor forms it circulates cells through your body through either the lymphatic system as well as the blood.  We know that it wasn't traveling in my lymphatic system since my lymph nodes were negative.  However until the tumor was removed, we have no way of knowing what any of those cells were doing in my blood.  There is no way to tell if some cells broke out and attached themselves somewhere else in my body.  The chemotherapy will hopefully eliminate any of these cells from developing into tumors.  He made a suggestion of a new chemotherapy regiment (TC) that is less toxic than previously used (AC).  He suggested just 4 rounds lasting 3 months, and felt confident that I would tolerate it well and should be able to continue to work through the chemo treatment.  He then said we would follow up with the 5 years of tamoxofin, but said we could talk more about hormone therapy later.  We made appointments to see the nurse practitioner and then scheduled the first round of chemo.  While I've been afraid of having to go through chemo, I felt more comfortable with it after this appointment.  We decided to go ahead and keep the appointment scheduled for Wednesday.

Wednesday we met with oncologist #3.  We were first introduced to the doctor's fellow.  He spent time explaining the desired regiment for chemo which is what oncologist #1 suggested.  They want 4 rounds of AC every 3 weeks followed by taxol every week for 12 weeks.  Total time in therapy would be 24 weeks (6 months).  This would be followed by the 5 years of tamoxofin.  In our conversations with the fellow I expressed concern for the length of time in treatment and we expressed our concerns with fertility.  He left to discuss the case with the doctor who then came in to talk to us.  She said another option with the chemo would be to do dose density therapy, where I would have my treatments every 2 weeks, but I would need to receive an injection of Neulasta, which is a growth factor injection.  It would help boost my bone marrow back up after the chemo attacked the cells.  As far as addressing the fertility issue, she suggested injecting me with Zolodex which would put my ovaries to sleep in a sense, but should provide a barrier around my ovaries during the chemotherapy.  After chemo she said I would have to take the Tamoxofin for 2 years (effective time) at which time they would allow me to stop taking the Tamoxofin and give us a 6-9 month window to get pregnant before I would need to finish the remaining 3 years of Tamoxofin.  Because of the toxicity of the AC treatment, my best option is to have a port put in to allow for easy access for the nurses administering the chemo drugs.  Thankfully it's an outpatient surgery but one that will still require a good 4-5 hours at the hospital for monitoring.

After many tears and a lot of time spent in thought and talking things over with Brian I've made a decision as to which treatment I'm going to undergo.  Which the thought of taking the easy way out and having a much milder and shorter time with TC I am going to go with oncologist #3 and go for the more aggressive treatment.  I only have 1 shot to get this right, and we both think that the aggressive chemo will give me the best chances of not having to deal with this again.  Plus I like that oncologist gave me an option for having a child rather than just barking "freeze your eggs" when expressing my dire to have children.  I know I have a very rough battle ahead of me, but I know with the support of my family and friends that I will be able to someday put all this behind me.