Yes...but....

I came to a realization about this disease this week that for some reason had eluded me up to that point. Prior to this week I had an assumption that there would be a day, a moment, an event that would occur. At that point, my Cancer journey would be deemed OVER. Cancer Free? Check. Done. Next please!

After meeting with all of my doctors at one point or another this week, I know now, IT WILL NEVER BE OVER.

I have Triple Positive Stage 3 Breast Cancer.
Triple Positive means that any thing KNOWN to feed breast cancer cells, feeds mine. HER-2, Estrogen and Progesterone all feed the Cancer for me. This is not the case for all women but it is for me.
Since I am a woman, Estrogen and Progesterone are a constant for me. Unless suppressed or somehow disabled.
HER-2 is another constant for me and must be suppressed or disabled. It's also been the most difficult for me to wrap my head around. Below is one of the more understandable explanations I've found. (http://www.breastcancer.org/symptoms/diagnosis/her2)

The HER2 gene makes HER2 proteins. HER2 proteins are receptors on breast cells. Normally, HER2 receptors help control how a healthy breast cell grows, divides, and repairs itself. But in about 25% of breast cancers, the HER2 gene doesn't work correctly and makes too many copies of itself (known as HER2gene amplification). All these extra HER2 genes tell breast cells to make too many HER2 receptors (HER2 protein overexpression). This makes breast cells grow and divide in an uncontrolled way.Breast cancers with HER2 gene amplification or HER2 protein overexpression are called HER2-positive in the pathology report. HER2-positive breast cancers tend to grow faster and are more likely to spread and come back compared to HER2-negative breast cancers. But there are medicines specifically for HER2-positive breast cancers.

This week, after my surgeons and oncology team met to discuss my status and the unexpected presence of cancer cells found in my lymph nodes, I have learned that I am probably CANCER FREE meaning that there are likely no live cancer cells in my body after my surgery. This is GREAT, right?

YES.....but......
            the discovery of the cells in my lymph nodes does seem to worry the doctors a bit about any cells that could be running loose in my system waiting to find a place to hang out and grow.
The part of the fight that will go on forever for me is the fight against the forces inside me which shall NATURALLY will Cancer cells to develop and grow AGAIN and/or expedite the growth of those already there. Recurrence is what we are fighting now. And yet still, there are those who will not likely ever get to the point of "just" fighting recurrence but will be about the business of fighting present and actively growing disease for the whole of their lives. So in truth, we are extremely BLESSED. I know that someday, there will be a level of normalcy that returns. That new normal will take some getting used to but I'm up for the task. And really....for those of you who really know me...I never really fit into the description of normal to begin with....  ;-)

NEXT
The mastectomy is done. I have scars that are "interesting" but that I know ultimately will be addressed during reconstruction and/or fade with time. The scars don't bother me.
What's been recommended by my doctors at this point bothers me. 

Dr. Khan is unsure at this point of his recommendation. At the meeting of the Cancer minds, the consensus was a course of additional chemo called Adriamycin/Cytoxan with Tamoxifen.

Adriamycin carries the nickname The Red Devil or Red Death (does that sound fun or what??).


The list of side effects is long and most are those I have experienced in response to my TCHP regimen. However, Adriamycin lowers white blood cell counts sometimes to an extreme putting the patient at risk for Leukemia and also puts sometimes extreme strain on the heart muscle which can ultimately lead to heart failure. Cytoxan also suppresses white cell production and carries similar side effects to those I have already experienced. Tamoxifen does the work to neutralize my hormones so they aren't a factor in cell growth. A female with an absence of progesterone/estrogen will be in and experience all symptoms associated with menopause. The bonus is that any medication or diet that attempts to control those symptoms does so by mimicking the effect of the hormones within the body. I can't use these methods. Awesome.

When I met with Dr. Khan, I could see him truly agonizing over this decision. Can you imagine the weight that someone like him carries? His decisions could serve me well and extend my life, or expedite my demise. What a horrible position to be in!! There were moments when we were together and I was asking questions that I felt such compassion for him. I wished this away for HIM. I wanted my situation to be more black and white; for there to a stack of studies to prove that THIS was the standard of care and give him some confidence that he would be doing the right thing to either prescribe this course of treatment or to support the decision not to.
But I am special; my case unique. My young age is a huge factor in decisions at this point. If I didn't have SO many potential years left, they wouldn't be AS worried about it recurring over the course of those years. Dr. Khan, if you ever read this, I have never been an easy one to figure out. You're not the first and won't be the last of those who have tried.... but I do apologize. :-)

As our discussion concluded I could tell he was less sure of his position. He asked me to give him some time and to allow him to consult 3 of his nationally known medical oncologist buddies, provide them my information and see what they say. Based on his and their feedback, we will make a decision from there. I, of course, consented. Five heads are better than 2, right?

RADIATION

Sooooo...back in the day...I wrote that I planned to opt out of radiation if it was indicated in my situation. Now that I know it HAS been by a group of renowned experts in the field, I'm gonna have to waffle a bit. I have an appt to meet with Dr. Michelle Mitchell (KUMED) next week. Her job will be to convince me that radiation will substantially reduce my risk of recurrence and therefore potentially extend my life. If she can do this, to opt out of this treatment because it's the easy way out, would be one of the more selfish decisions I would ever make and would certainly not be in line with my doing whatever it takes to stay around for my boys. I don't want to do it. But I will.

Radiation will likely negatively impact reconstruction. It will put me at greater risk for infection post surgery. It will forever change the makeup of the skin, blood vessels, muscle and nerves being irradiated making reconstruction an even greater adventure than it stands to be without radiation. 

I was truly crushed the day I learned that both chemo and radiation were being considered in this next phase. But today, because His mercy is new every morning, I have renewed hope. Jesus has seen me through every moment leading up to this one and He is faithful to do the same regardless of the path ahead of me.

I have several appointments in the upcoming days and weeks and am hoping to have some idea of a treatment plan soon. I remain hopeful and know that God is still SO good!

Click on the link for my latest theme song, feel free to make it your own, for we all have battles we are fighting.

https://www.youtube.com/watch?v=rOVgZGzJ1kk

Until next time.....