Wednesday, November 18, 2009

"So....What Kind of Cancer Are You in Here For?"

CJ, my mom, and I made our second opinion pilgrimage up to Johns Hopkins today. We went to the "Incredibly Long-Named Building for a Rich Guy Who Must Have Died from Cancer and Gave Hopkins the Money for the Building," building, aka The Sidney Kimmel Comprehensive Cancer Care Center. No, really. That's the name. I hope Sidney Kimmel, whoever he was/wherever he is now, had a very good laugh making the name so incredibly long.

Once inside, sitting at Admitting, I had a good look around at the other patients there. I had the strongest impulse to poke the guy in his 20s next to me and ask in a jail cellmate-like way, "Pssst...what kind of cancer are you in here for?" Don't worry. I didn't. He was too busy talking to a patient's advocate about his upcoming surgery. And I really had to use the bathroom.

My second-opinion doctor (that is all she does-second opinions. And also works for the FDA.), Dr. Tanya Prowell  (doesn't that name just sound like it was taken from a James Bond novel?) is around my age and great. And just an FYI-her specialty is younger women with breast cancer. Oh-when you click on her bio, don't be lazy. Scroll down.

Yes, she is recommending chemo. However, she is not recommending the drug regimen that Dr. Wilkinson had recommended. (Older, harsher, more cardiotoxic drugs.)

Here are my options:

1. No chemo BUT five years of hormone therapy, i.e. Tamoxifen for the .4cm of invasive cancer that is estrogen receptor positive/ER+ and Herceptin because the cancer is also HER2 +3, which means it is way overexpressed. I cannot try to get pregnant until after that, if I go with this option.

2. This is the doctor's favorite option. Six cycles (18 weeks) of chemotherapy, using the drugs Taxotere and Carboplatin, while taking Herceptin. I would continue taking Herceptin after the chemo ended, for the rest of the year. (The 52 week year that the chemo takes place in.)

Then, after a short medically needed break (not just for me-but to be able to let the drugs leave my system before starting Tamoxifen. Otherwise, it would be hard for the doctors to differentiate any side effects/problems that are caused by the new drug.) I would take Tamoxifen for 5 years and try to get pregnant.

She is recommened CJ and I see a fertility specialist to bank some embryos before chemo, as an "insurance policy."

3. The comprimise. I do the 6 cycle chemo regimen that she suggested with the herceptin, and then take the herceptin for the rest of the year. I then do two years of Tamoxifen and then try to get pregnant.

I'm only looking at option #3 right now. Option #1, aka Dying Young and Stupid, doesn't appeal to me. Neither does Option #2's heavy fertility regimen on my badly-reacting-to-any-hormones PCOS body and the possibility of chemically frying my ovaries. Plus, the outrageous cost of fertility treatments (although CJ's current medical plan does pay for it) but also finding a specialist that can/wants to deal with my older mom age, PCOS, and the cancer cherry on top.

The PCOS problem is rearing it's ugly, acne-riddne head in all of this; my fertile time during my cycle is getting shorter. Just in the past two years. How do I know? I track it by the Fertility Awareness Method, aka FAM. I have a computer program Ovusoft that does it for me. That is how Elizabeth is here. And how I got pregnant last year. So, putting off childbearing is not OK.

Speaking of Elizabeth, I have to put her to bed. I'll write more tomorrow.

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