A (Tentative) Treatment Plan

Let's start with some good news.  I heard from my surgeon yesterday and they have me scheduled to have a port inserted on Friday early AM.  That's great because hopefully we can get that procedure done before any more COVID delays.  However, we've been told a port is particularly important for the chemo I'll be receiving, so it seems to qualify as essential.
Now onto the not-as-good-news.  We also spoke to my medical oncologist yesterday.  He had performed a  MammaPrint test that evaluates potential recurrence  based on 70 DNA factors.  It essentially helps double-check to see if chemo is the right choice for a particular patient's situation.  It helps rank risk and treat appropriately without over-treating. 
We don't have a copy of those results yet (he's going to give us one) but the test did confirm that I am high risk because my breast cancer has basal like cells (among other factors). In short, it's aggressive (which we knew) and thus requires aggressive treatment--early.  A hard-and-fast chemo treatment puts me in the best place long term with my particular strain of cancer.
We had been mostly prepared for this.  After doing quite a bit of digging Ben had a hunch that my cancer perhaps acts more like triple negative, because the ER+ percentage was fairly low.  My surgeon felt that way as well when I saw her last week, and today the medical oncologist confirmed that he suspects that to be the case and will be treating it that way.  That's actually a good thing, even though it requires a more aggressive treatment of neoadjuvent (before surgery) chemo.  I'd hate to NOT get that treatment right away when it's most likely to be effective.  

Research has shown that when triple-negative breast cancer is treated with chemotherapy before surgery — what doctors call neoadjuvant chemotherapy — and there is a pathologic complete response, disease-free survival and overall survival are better.

One way for doctors to judge the effectiveness of neoadjuvant treatment is to look at the tissue removed during surgery to see if any active cancer cells are present. If no active cancer cells are present, doctors call it a “pathologic complete response” or pCR.

Disease-free survival is how long a person lives without the cancer recurring. Overall survival is how long a person lives whether or not the cancer recurs.

So, the plan is that I'll start chemo next Thursday, April 16th, approximately a week after my port is put in.  I'll be on a dose-dense regimen of chemo nicknamed the "red devil", which includes Adriamyacin and Cytoxan for 2 months (4 sessions, 2 weeks apart).  In short, it's the strongest, nastiest form of chemo.  And frankly I'm glad I'm starting with the worst, not having to work up to it!
When that is completed, I'll have surgery #1 to perform a double-mastectomy and expander reconstruction.  Recovery will be about 4-6 weeks for that, and our best guess is that will be in June or July.
Then I'll start a second round of a different type of chemo (Taxol) that will last 3 months (12 sessions, one each week).  During that time I'll also be working on adding volume to those reconstruction expanders.
When that's all over, I'll have surgery #2 for the final silicone implants to be exchanged for the saline expanders to complete my reconstruction.  
The estimated timeline for all of this will be in the October 2020 to December 2020 range before most of the intense stuff subsides and my hair starts to grow back---assuming all goes as planned and on schedule -- which everyone knows is a wish in the wind.
While this is certainly a more difficult form of breast cancer and a longer timeline than any of us wish for, there are some silver linings. 
First, I'm starting soon and we're excited (or thankful at least) about that. 
Second, triple negative breast cancer often responds well to this type of chemo, especially when it's early stage, which is the case with mine.  So we feel that while it's an aggressive treatment plan, it seems it's the right one. 

Third, in our current quarantine world, everyone I know is already practicing how to keep from getting each other sick, which will be particularly important for me as I go through both rounds of chemo.  The kids being "homeschooled" for the next 9 weeks may actually turn out to be a major blessing to avoid bringing home all kinds of illnesses.
So things are underway, which is an answered prayer.  I'm anxious about it all, for sure, but doing my best to prepare myself, the house, my work, and all the other things to really be able to concentrate on my treatment.
Our family and friends have been incredible.  And even though there are so many weird ways that we can't accept normal help right now, people are finding meaningful ways to help us every day already.  
Including these wild socks from Toni & Wendy, which absolutely qualify as "essential".

6 comments so far:

Jennie said:

Love & prayers for you and Ben, Ayla & Paxton. Thanks for the blog report. It lets me know how you are doing and how to pray specifically for you at each particular time. ❣️

Kati said:

Praying without ceasing my friend! Love you

Melissa Howard said:

Been thinking & praying for you and your family! My 10 year old told me “mommy I prayed for your friend at the gym last night before bed!” :) so you have another prayer warrior rooting for you too! Xoxo

Brandi Davis said:

On my knees for you daily sweet friend

Fran said:

I love you! I'm praying for you and your family!

Susan said:

Praying for you!

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