I am celebrating good news today, and it is actually within the context of cancer. It feels like there has been so much bad news, I was thrilled to get some *good* cancer news today. First, the genetic panel came back at least a week earlier than anticipated. I took the call as I was heading to Piedmont to get my stitches out. I was so relieved to hear that the expanded panel we ordered, that tested for the 6 most common breast cancer genes, returned all negative results. Hallelujah!! This affects several things....first off Caroline, but also if you carry one or more of the genes, depending on which one it is, then your chances for recurrence are in some instances greatly enhanced, and/or your chance for a second new type of cancer are increased or greatly increased. So thankful for this piece of news!
I really liked the PA who took my stitches out. It was no big deal, and she even drained a good bit of fluid from under my arm where the nodes were removed. That instantly took a lot of the pressure off the area under my arm, and I was able to actually hang my arm down by my side normally. Dr. Barber made a point to stop in and check the incisions and ask about Yellowstone. I really like him, too. Tonight the incisions are draining a bit, which is new, but I am assuming it's because the stitches were removed today. Overall, the pain is lessening each day and the range of motion of my arm is much improved.
Chris planned to meet me for lunch so we could get in one car and head to Emory. Somehow I had missed the fact that there's an Uncle Julio's a mere stone's throw from Piedmont. Of course we went there, and I abstained from ordering my favorite things topped off with a swirl. Chris was running a bit behind so I needed to order for both.... I chose veggie quesadillas, which I am sure had a ton of butter and of course all of that cheese, but at least veggies, along with the grilled fish tacos with black beans. We did our usual....eat half each. It was delish.
Just getting to Emory was a big mess. When I was going there before it was Emory Midtown, but this was Emory Winship Cancer, which is all the way downtown (I think....how do I still not know Atlanta any better than I do?!). Traffic nightmare, but somehow we managed to get there on time. We valet parked at the suggestion of the nurse, based on her description of the parking situation. What a depressing place. I mean, it's a cancer center, so what should I expect? But man, talk about a sad bunch of people. I was definitely not feeling any warm fuzzies at any point. It has a whole different vibe going on than Piedmont...big time. I was even given a buzzer like you get when waiting on a table at a restaurant. I guess it is good that they have a system, but if their wait gets to be so much that they need a buzzer, that seems a little crazy. But then, I noticed they take walk ups, so maybe that explains it. Still weird. And what the heck is a cancer walk up patient? Anyway...I digress.
I absolutely loved Dr. Zelnak, though. She was clearly smart, articulate, personable and patient. She went through our two basic treatment options, and explained it a little differently than Dr. Mininberg, so we learned again as we went. While the two different chemo cocktails for Her 2+ are both accepted standards of care, she favored the same one that Dr. Mininberg did, so that felt good. It seems it is the more aggressive of the two options, with slightly better (3%) overall success rate than the other, but the side effects are worse and the potential risks are greater. I don't watch Good Morning America, but I guess I have seen a couple of news articles that mentioned Robyn Roberts, who has apparently had a public battle with Her 2+ cancer, opted for this same course of treatment, but ended up with leukemia, one of the risks. Apparently it's a 2% risk. I think I am getting my numbers right. The other big risk is weakening of the heart muscle. Apparently most of the chemo drugs can weaken the heart, but usually it bounces back when the chemo stops. Apparently if this particular round of chemo (Adriamycin + Cytoxan) damages your heart, it might be irreversible. Again...small chances, but they are still serious.
Herceptin is the drug that specifically blocks the Her 2 protein, so it fights my type of cancer directly. It cannot be given until the first 2 drugs above are finished, after the first 8 weeks. She agreed that the standard is to start the Herceptin when I begin what I am calling "phase 2" which is the weekly chemo of Taxol. The Herceptin needs to be taken for a full year. What was new today was the mention of an even newer drug that targets Her 2, called Perjeta. Just last Fall it was approved by the FDA to be administered to patients like me (Her 2 + with cancer in nodes) in the pre op setting. Dr. Zelnak proposed trying to add that to my "cocktail" so that when I start "phase 2" in addition to Herceptin I could possibly add Perjeta. Perjeta attacks a different part of the protein than Herceptin so if one didn't work, then the other might. She gave all of this with the caveat that it is really expensive, and insurance might very well not approve it, especially since I already had surgery and it it has so far been only approved for PRE op. However, I still need to go back for additional surgery, so she said there is a strong argument that I am both post op and pre op. I like her thinking. There are current clinical trials of Perjeta for the post op setting, but the results have not been released yet. Regardless, it felt like this is an additional tool in the tool belt. We plan to talk to Dr. Mininberg about it soon.
Overall our take away was....loved her, loved her brain and info....it helped us a lot to pick her brain and have confirmation on where we are and where we are going....thankful for Piedmont (its location and its people). The only other stat that she mentioned that really stood out to me was about the rate of recurrence in Her 2+ patients. Again, this is a very aggressive cancer, but with these specific and relatively new drugs, about 85% of patients have NOT had a recurrence at the 5 year mark. And that 85% includes patients with 1 positive node (like me) to patients with 10 positive nodes. I am thankfully on the low side of this so in my mind that makes my personal stats even better than 85%. Apparently, with Her 2+, if it is going to come back, it usually comes back within the first 2-3 years. After that, the chance of recurrence drops way down, even lower than for the hormone positive cancers.
I'll have to write more later about my plan for living "after chemo." It will be difficult to put cancer behind me with the threat of recurrence hanging over my head, and with each day right now being so cancer focused. I know I will find the balance, and I was inspired today by a podcast my friend Jennifer sent me this very morning. It is late and I am tired so I will have to talk about that more later, and it will not be easy, but I really don't feel like I have much of a choice. After chemo, it will be up to me to do everything in my power to prevent cancer coming back, and I need to start developing a game plan now. More to come on this! Tomorrow I think the scariest thing will be the shot of dye first thing, then of course, waiting on the results. Oh...and buying a wig. That is on the agenda tomorrow, too.
Isaiah 41:10
'Do not fear, for I am with you; Do
not anxiously look about you, for I am your God. I will strengthen you,
surely I will help you, Surely I will uphold you with My righteous right
hand.'
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