Another day, another chemo: Round No. 3

For today's chemo, we got assigned to the overflow room in the basement -- a big space with six recliners spaced around the walls, a small table with magazines in the middle, and no cell phone reception. It wasn't well set up for support people; Ben perched uncomfortably on a little stool next to me, but it was loverly having a nice long date with him. He and I are losing our twin look because one of us is getting male pattern baldness and has a weird comb-over look going on -- and it's not the male.

The session went fine; not much to report, except that I am now three-quarters done with the hardest part of chemo, Adriamycin and Cytoxan. Here's my patient's-eye view of the HazMat-approved administration of Adriamycin:



The big news is that yesterday, after weeks of pleading, pulling strings and making dozens of phone calls to have my many test results faxed, I met with one of the leading breast cancer doctors in the Bay Area for a second opinion on my treatment. (She had exchanged e-mails with me before I started chemo, concurring on my initial treatment plan of dose-dense AC.)

Dr. Hope is clearly brilliant and has decades of experience. She was also warm and thoughtful; she'd spent considerable time reading through my five-inch thick medical file and she spent almost an hour talking to me.

So much for the good news.

Dr. Hope was definitive that my cancer is Stage III and very aggressive.

She based that on both the number of nodes involved and also on the way it had managed to break down tissue barriers and spread into surrounding flesh once it was in the nodes.

She had several suggestions for making my treatment even more aggressive:

>Once I finish four rounds of AC chemo, I was slated to get four sessions of Taxol every other week. She recommends 12 weekly sessions of Taxol instead (at lower dosages, although the total amount will be higher). Several studies have shown this improves survival rates, and the lower dosages reduce side effects. Taxol's primary side effect is neuropathy, tingling and numbness in fingers and toes that sometimes does not entirely go away, so I'm definitely gung-ho about reducing that. But this will add another month to my chemo regime.

>When breast cancer metastasizes, it most commonly goes to the bones. A class of drugs called Bisphosphonates, which are used to treat osteoporosis, may help prevent bone metastasis. So that would be another addition to my regime. This may mean keeping my not-so-beloved port in for two more years.

>Auntie Flo has been continuing to show up on schedule every month despite all that poison flowing through my veins, which usually induces the old biddy to pack her bags and hit the road. Dr. Hope wryly said it looks like my body really, really doesn't want to enter menopause. She really, really wants me to stop menstruating stat, and so she wants me on monthly injections of Zolodex to accomplish that. That's so I can get started sooner on aromatase inhibitors, a powerful class of hormone-blocking drugs that only work on post-menopausal women.

>She feels my greatest risk for metastatic recurrance will last for 10 to 15 years and thus so should my treatments. Most patients get five years on the aromatase inhibitors; so now I'm looking at double or triple that. I've read that many breast cancer patients are noncompliant about taking them (it's a daily pill) because they hate the side effects, but I'm not going to go into that now. She also pointed out that five years from now there will be lots of new research results and so there may be other treatment/prevention options that we'd explore.

Today when I met with my own oncologist, Dr. D, she concurred with everything recommended by Dr. Hope, who is clearly a goddess in the field. Dr. D herself is no slouch in the brilliance department and also has been quite kind to me and generous in spending lots of time going over everything I bring up.

There is no question in my mind that I'm going to do exactly what Dr. Hope suggested. If she said I needed to hang upside down for an hour a day, learn kick-boxing or move to Utah, I would just do it. (Those all actually might be slightly more pleasant options than what she did suggest, with the possible exception of Utah.) The stakes are too high.

Perhaps you've noticed: not such a funny post today. I could barely muster the one joke about Auntie Flo (a quaint term I never have used previously).

As soon as I got home last night, I hit the Internet and it wasn't for election results. In the same way my tongue compulsively keeps probing a sore spot in my mouth, I feel compelled to look up survival rates every time I get told I'm at a different stage. But after I looked it up and had a few minutes of mild freak-out, I decided to drop that line of thinking.

Here are some words of wisdom from a cancer mentor who dealt with this a few years ago and has been a wonderful source of support and strength:

But may I say something about all these statistics? They can drive you crazy, but remember: those statistics aren't YOU. It's kind of numbers game, but these numbers are pretty general. I had a 20-25 percent chance of recurrence but I tried not to get too worked up about it because those numbers weren't necessarily me. You're in good shape, you have good health care, you eat well, you're otherwise healthy etc. It sounds trite, but ultimately the only statistic that really matters is 0 and 100.

So I lied before when I said Dr. Hope's being nice and smart was the end of the good news.

Actually, I recognize that I am lucky that so much research has been devoted to breast cancer so that there are more treatment options all the time. And I have a lengthy list of things to be grateful for: Mark, Ben and my fabulous friends -- and thank you for all the incredibly loving and supportive blog comments while I'm at it! -- really good medical care, good insurance, manageable side-effects from treatment, supportive employers. And I fully recognize that lots of cancer patients -- certainly anyone with Stage IV -- would trade places with me in a heartbeat.

I'm not excited to spend the next 15 years with a sword of Damocles hanging over my head; I'm not happy about subjecting my body to still more toxic treatments and their potential side effects. But I'm not going to focus on that. My attention is on doing everything possible in the here and now to combat this.