Dr. Amy Shaw called Monday to confirm the cancer was in both the breast and the liver. It was such a shock to learn about the breast with all the testing we have done since last April. Repeated mammograms and ultrasounds, a biopsy, and then everything that has happened in the last month. But again, I can't be crying over spilled milk, just gotta move forward. And in all reality, with the knowledge of the liver having 10 lesions, one fairly large, it seemed very plausible. And since I wasn't waking from this nightmare, I went with it.
Both Dr. Dhar and the St Jude tech assure me an MRI of the brain is safe as long as it is done at the 1.5 Tesla level, whatever that means. Don't think I'm getting a new car out of the deal -- DAMN! It is an MRI of the chest and body area that is not safe with my ICD (Implanted Cardioverter Defibrillator).
Now you have the back story!
... On to the plan for the future...
FIRST, let me say, THEY ARE ON THIS!
This morning, bright and early at 8:00 am, Mark, Alura & I met with Dr. Ian Anderson at Annadel Medical Group offices on Round Bank Circle in Santa Rosa. Annadel is part of St Joseph's Health Care in Santa Rosa (Memorial Hospital), and Annadel includes the offices where Drs. Elboim and Shaw practice, along with host of other physicians, specialists, and services. This is where I go 90% of the time for my tests, scans, appointments, etc.
Arriving at the office, especially for Mark, brought on a lot of anxiety and anger. Mark was not a happy camper and it took quite a while before he could sensibly discuss things with Dr. Anderson, but he did finally come around.
Dr. Anderson spent a good 2 hours, and more with us. There was so much information, medications, and medical procedures being discussed, that it was hard to keep up. But Alura and I had a list to cover, and Alura and Mark took notes. So this is what we all learned.
Between the PET Scan and biopsies we know...
- This is Stage IV breast cancer metastasized to the liver.
- There are 12 tumors in my liver (rather than 10), the largest 4.1 cm. Surgery is not an option, and other treatments that target a specific area are out as well.
- There is a slightly inflamed lymph node near the liver.
- The liver cancer is highly Estrogen Receptive (ER), which means the cancer is feeding off of Estrogen.
- The cancer in my left breast (surprise, SURPRISE), is mildly ER. And there is an inflamed node under my right arm, but we cannot feel it there, so perhaps that is a good sign.
- The better information is that there is no cancer in my bones and lungs, two other common places that breast cancer shows up in. And the fact nothing shows on the PET scan in the colon area is also good.
- A baseline Echo this Friday so we keep tabs on my heart.
- I will be getting calls right away to set up all of the following:
The side notes to the bullets above, go something like this...
- At Dr. Anderson's recommendation, a consult at UCSF to review all the previous findings and see if there is anything else out there available other than what Dr. Anderson has in mind. Or the Doctors at UCSF may agree that this is a great plan and say -- GO WITH IT. Either way, we expect that everything can be carried out at Dr. Anderson's offices, for the most part. This is great as we had planned to ask about a 2nd opinion.
- A brain MRI at UCSF to rule out cancer metastasized to the brain, although all previous tests show that is unlikely -- Whew!
- Labs to check for cancer tumor markers, just as precaution. These will continue as my treatment progresses.
- An appointment to get another Port -- Woohoo -- I miss my old one. So I will have dual gadgets in my chest; an ICD, AND a port.
- There is something called FoundationOne that Dr. Anderson is looking into as well. FoundationOne is "a fully informative genomic profile that helps physicians make treatment decisions for patients with cancer by identifying the molecular growth drivers of their cancers and helping oncologists match them with relevant targeted therapeutic options. Check out the very cool videos at the link." This is very exciting, in my mind.
- Chemo, unless UCSF changes this plan. Normally Dr. Anderson would start with hormone therapy due to the ER. But since I have been on Letrozole, an Estrogen suppressing drug, for nearly five years to prevent the recurrence of the cancer of 2011, chemo is a better first approach.
- Hormone Therapy following chemo, once the liver responds to the chemo and we knock the cancer back to where it is less life threatening.
- Possibly Immune Therapy, but that would be later on when they have something more tried and true for breast cancer.
- Chemo will be two drugs together (Either Gemcitabin, Carboplatin, or Taxol); one infusion each week for two weeks in a row and the third week there is no infusion. After two cycles (6 weeks) I'll have a Pet Scan and labs for tumor markers. Chemo will cause hair loss. So I imagine it will be like last time with nail loss too -- such fun. It is safe for my heart. YIPPEE!
- They are jumping on the chemo with guns loaded and both barrels drawn (Is that how you say it). It is urgent we take action now and I should be getting some treatment within 7-10 days.
- Hormone Therapy will include one or the other, or both, (way too much info to absorb it all today) of the drugs Faslodex (a shot to either cheek; and I'm not talking face, once or twice a month for a couple of months, I think), and/or Ibrance (a pill).
- If chemo is tolerated well, it could last up to 3-4 months. If chemo works miracles, we may switch to Hormone Therapy sooner. If I don't tolerate Chemo, or it isn't doing it's job, we'll switch to another drug.
- These treatments will tax my immune system so we will be watching all this closely.
- Mastectomy not warranted at this time. Perhaps the chemo will help the fat necrosis and allow my skin to heal. Right now there is some drainage and bleeding that may continue until I get some treatment. A mastectomy would postpone the chemo, and we don't want that. And it may not be very successful since the mass is so large and my skin is not healing well due to lack of healthy blood supply, or some such thing. So post chemo, or hormone therapy, once the liver is "under control" and if mastectomy still warranted and the time is right... you get the drill.
- Did I already say that PET Scans and labs for cancer markers will be happening all along the way. They are standard, now that I am Stage IV. They are not advised for regular old, run of the mill, breast cancer. Not trying to make light of breast cancer here. Instead, I am screaming that why are they not standard????
- Clinical Trials -- most likely my heart failure will disqualify me for any clinical trials. But Dr. Anderson can still prescribe the same treatments under his care. So he will talk to the experts at UCSF on this topic.
- Would Mastectomy back in 2011 have changed the current state of events -- NO.
- They will also consider antibiotics during chemo since my breast is constantly on the verge of infection and chemo will encourage such with a depressed immune system.
It was a long, exhausting day. And same for the few days leading up to this. But I'm feeling confident about my Doctors and the approach set forth so far. Let's hope the optimism continues!
So there you have it.
Now on to the fun part of the day following this appointment --
|Brunch with Mark & Alura at a new place, Lida's Cafe. We'll be back.|
|A friend I found outside Lida's.|
AND a Cardiomyopathy warrior!!!
• I AM STRONG • I AM HEALTHY • I AM LOVED •