The Oncologist

The next day I met my oncologist, Dr. Naqvi.  {Knock-Wee}  I really like her.

Stephen had to work, but his brother, Jordan, was in town, and I asked him to go.  It was nice having someone with the same medical knowledge as Stephen to help me remember everything!  {I was, however, pretty upset about my appointment getting moved up 2 hours because that meant I couldn't go to my friend's birthday lunch OR Iron Chef, 2 activities I'd been looking forward to/had coordinated child care for all week!  But, my life is worth more than a few cancelled lunch dates, right?}

I had my picture taken, height/weight recorded, and BP checked.  For the second day in a row, a nurse commented on how low my blood pressure was.  At Dr. Pollack's, it was a bit higher, but the nurse said, "Wow! Even after just hearing a cancer diagnosis, your blood pressure is great."  And at Dr. Naqvi's office, there was almost shock in the nurse's voice at seeing 106/64 on the monitor.  "Wow! Your blood pressure in LOW!"  

We met with Dr. Naqvi in a room with couches.  She came in to discuss the biology of my cancer, the stage, and the treatment.  I felt the information was very thorough and that I was in good hands.  First, the biology:  My tumor is "invasive ductal."  There is a grade given, based on the rate at which it grows, which can be seen as the cells divide under a microscope.  Since my pathology results weren't even supposed to be in AT THE EARLIEST that very day, there was still not an official result to go off, but Dr. Naqvi estimated my grade is somewhere between 2 or 3, 3 being the worst.  The next part of the biology of a tumor is the results for the receptors--ER{Estrogen} and PR {Progesterone} and Her2.  These results name the types of substances that are feeding the tumor, causing it to grow.  Again, my results weren't in on this part, but she explain that the best case scenario is for +,+,-.  If the estrogen and progesterone are both positive, it's easy to treat by simply blocking those hormones.  If Her2 is positive, there is a special drug to combat that.  The worst case is all three receptors coming back negative, as they don't know what is causing the tumor to grow and cannot stop its source.  {So, we are all praying for any results but triple negative!}

Next, a cancer is given a "Stage."  At this point, Dr. Naqvi could not nail down an exact stage, but from the results she had, she guessed that my diagnosis is Stage 2.  This means that my tumor is large, is into the lymph nodes, but I don't have tumors in the rest of my body.  {A CT scan and bone scan next week with help confirm this.}  I will also have genetic testing {BRCA} done.  Because of my age and the lack of family history of breast cancer, there might be a genetic mutation in me that could be a contributing to the tumor.  If this test comes back positive, there is basically 100% chance that I will develop cancer again in the future, so a double mastectomy would be done, along with an oophorectomy {removal of the ovaries.} If the test comes back positive, I'm also encouraged to have my siblings and children have this test done to be aware of their possible risks.   

Dr. Naqvi then explained the chemotherapy with me.   My chemo will last a total of 6 months.  Chemo is designed to kill any cells in the body that are dividing rapidly.  Chemo cannot--at this point--differentiate between "good cells" and "evil cells."  It kills them all in order to kill the cancerous ones.  It's split into 2 main "cocktails."  First, is FEC, which would be every 3 weeks, 4 times.  This, to me, is the "typical" chemo that I think of.  There are side effects of nausea/vomiting, fatigue, immune suspension, hair loss, mucositis, constipation, and gray nails.  However, for each side effect, Dr. Naqvi explained that there are wonderful treatments and developments to help.  She told me that if I follow my drug prescriptions religiously I "will most likely not ever vomit, but may just be a little queasy."  They give Ritalin to help with the fatigue, "and you're going to need all the help you can get with those 3 boys!"  For the immune system, they will give me a growth factor for white blood cells.  This is to stimulate my bones to mass-produce white blood cells in defense of the chemo.  Even though chemo will kill off most of my supply, I'll be left with enough to keep me healthy.  The hair loss--there's really nothing to do about that.  "You will lose your hair.  You will lose it in 3 weeks, and it will be dramatic.  Once you lose that initial clump at around 2 weeks, most of my patients cut their hair very short or simply shave it off because it can be painful at the follicles."  She told me that I would get a prescription for a wig and that I should get one ASAP, especially for my boys.  "They are too young to understand, and you want to look normal to them and not scare them."  Again, I cried at this point of knowing I'd lose my hair.  {Silly, I know, to tear up over such a funny thing.  But, I FINALLY like my hair, have a great hair dresser, get compliments whenever I get it done.  And, now it's going to be gone.  However, just think of all the money I'll save this year in cuts and colors!}  And for the mucositis, she just told me to keep my mouth and throat cold, so I get to eat a lot of popsicles and ice!      
The second half of the chemo cocktail is Paclitaxel.  This will be given once a week for 12 weeks.  There is a shorter list of side effects of this half of treatment: neuropathy and nail changes.
 The only switch up in this treatment occurs if the results for Her2 come back positive.  There is a specific drug {Herceptin} they add to the chemo, but it can only be given with the Paclitaxel, as it can cause cardiomyopathy when combined with FEC.  If this were the result of that last set of tests, I'd just switch the order of the "cocktails," and then go back to the Herceptin, as it has to be given for a total of one year.  
Dr. Naqvi then did a physical exam.  The measured the tumor to be around 4.5-5cm.  She also seemed pleased that my lymph nodes did not seem to be enlarged.  "Thank God" was a welcome phrase at this point in the day.  The bad part about the size is that at 5cm, that is pretty much the border line of an almost certain mastectomy.  At that point and larger lumpectomy and radiation are not quite enough.
At that point, the schedules began to be made.  I am set up for my CT scan and bone scan on Wednesday.  I'll have a follow up appointment with Dr. Naqvi on Thursday.  Her office said that Dr. Pollack said she could put my port in on Friday, but that is not a confirmed appointment.  After that procedure, Dr. Naqvi likes to give around 3 days for the area around the port to heal and start chemo.  So, I should be starting my first round of chemo sometime before the end of January. 
Even though this is quite a bit to take in, It's nice to see all of the advancements in medicine.  Dr. Naqvi told me that 90% of her patients work full time and don't have to miss work for chemo.  To me that means that this will be tough, but I can make it.  It's not going to be without challenges, and I'll have to rely on help from others, but I'm going to be able to take it one day at a time.
 After that huge load of information and a few deep breaths, we were off to enjoy the healing effects of Mexican food and Dr. Pepper!