How Much is Too Much?

Last Thursday I had my first appointment with an oncologist. I went in thinking I would get a treatment plan, and I had decided to spend the weekend researching the drugs and making a plan of my own for managing the effects my treatment would have on my daily life: how to prevent getting sick while my immune system is compromised from chemo, figuring out how to keep up with the housework if I'm too tired to do it myself, finding what I would wear when my hair falls out, looking for support resources for Walker if this whole thing gets overwhelming for him, dealing with my job....

I didn't get a treatment plan.

Dr N, the oncologist, first went over my treatment options. There are three choices on the buffet: radiation, chemotherapy, and hormone therapy. In my case, there will be a combo meal of at least two, radiation and hormones, but I'm still in the holding tank on the chemo. A test has been developed that looks at 21 factors of a tumor to determine the risk of cancer recurrence. The tissue excised during my quadrectomy is used for this test. The results take one to three weeks to come back. The lower I score, the less likely it is that chemotherapy is warranted.

Some women take the chemo regardless. They want to use every available weapon in their fight and no doubt, chemo is a powerful weapon. Some women absolutely refuse chemo, taking their chances with just the other therapies. And for many, that works out fine.

For me, well, some days I feel like my brain is a puddle of mush, incapable of making a decision. I don't know if it's stress, or fear, or information overload. Right now, without the information from the 21 point test, Dr N rates my risk of recurrence at 30%. Radiation lowers it to about 20%. Hormone therapy will lower it further, as much as down to 10% but more likely somewhere in the 12% range. Now, there is never a 0% chance of recurrence, unless you're dead. Chemo would knock a few more points off that risk rating, but it's pretty hard on your body. Some side effects can be permanent. So I ask myself, how much risk is too much? Is going through chemo worth a 5% drop in risk? What about a 3% drop? Every woman in America has nearly a 13% risk of developing breast cancer in their lifetime. Radiation and hormones put me right about at that same spot. Do I really need to go through chemo?

I'm trying not to form any opinions or make a decision until the test results come back. It's hard, though. For a person like me, who needs an action plan, sitting around waiting is the worst part of this whole thing. I just want to get on with it.

Click here to read a more clinical explanation of the test and treatment options.

Baby Steps

On the day of my official breast cancer diagnosis, Dr C presented me with a book. I call it my "How to Not End Up Dead from Cancer" manual but that really isn't what it's about. The book presents information and resources for each stage: everything from how to tell your loved ones to treatment options to what to pack for the hospital to dealing with the after effects is detailed in that book. At first, I focused on the surgical options and the chapter on radiation therapy and pretty much ignored the rest. Last weekend, I stopped avoiding and read.

The section on chemotherapy was hard to get through. For one thing, I haven't fully come to terms with it. I feel fantastic ~ it's hard to make myself believe that I need this treatment that will make me sicker than I have ever been in order to get better. How do I get better than fantastic? Mostly, I think I'm just plain scared of the whole thing. I imagine that's normal but it sure doesn't feel good. I had to read a page or two, do something else for awhile, read another page or two, do something else, yada yada yada. I did get through the whole chapter eventually.

One of the things the book advises is a dental checkup, to make sure you don't need any work done during treatment. Chemo wipes out a lot of your natural immune system. Dental work can release all kinds of bacteria into your bloodstream that your body won't have the resources to fight off. So they suggest you go in for a dental check right away and take care of any necessary issues before you start chemo. I figured I could do that now, while I'm still on medical leave.

Well, I called the dentist today but the receptionist I spoke with didn't seem to know anything about having a checkup before chemo. She's been there for years ~ am I really the first client who asked for a pre-chemo checkup? She did make an appointment for me, so I guess I'll see what the dentist has to say when I get there.

Since I was on a roll, I also called my favorite hair salon and made an appointment to get my hair cut. I spoke directly with my stylist. When she heard that I was most likely going to have chemo she told me she's help me come up with a plan to transition to short hair over the next couple weeks. She was very sweet about the whole thing ~ she didn't make me feel silly for not wanting to lose my hair. She also told me that the salon has a private wig studio in their lower level. I've gone there for years and never knew that.

I'm glad I finally read the book. I always feel better when I know what I'm up against. I'm glad I found some things that I can do, now, instead of just sitting here waiting.

Ten Day Update

It's been ten days since my surgery. The incision is healing really well. There's no drainage. I can wear a normal bra. I can pull a t-shirt on over my head. I still have quite a bit of discomfort in my pit from the nerve trauma that occurred when my lymph nodes were removed, but no swelling that I can see. This morning, I woke for the first time since surgery with no swelling in my hand and no pain in my arm.

The girls....well, kudos to Dr C. The healthy breast is a little more round than the healing breast, but when I'm dressed I can't see a difference in them. When I'm not dressed the healing breast has a bit of a flatter side, toward my armpit. I don't know if there's some swelling under the skin yet, but right now, I don't feel like I'll need any enhancement to balance things out. I considered posting photos, in case anyone else going through this would benefit from seeing actual documentation. The books I have feature lovely line drawings that don't really help outside of the technical aspect. But breast cancer is part of my life, not my whole life. This blog is my outlet for several of my interests. So I decided against photos.

I'm having a hard time getting used to the idea of chemo. I know that in the grand scheme of things, chemo is just a blip on the radar. What my dad would have called a speed bump on the road of life. Still, it's hard.

I don't like the idea of looking sick. I don't like not knowing what to expect, how my body will react. I want to know if I will be able to go to work, if I'll get puking sick, if I'll be able to have some semblance of normalcy. Everyone handles chemo differently. I just don't know. Not having a plan takes me completely out of my comfort zone.

And honestly, I worked hard to get myself back to a healthy body weight. I'm not quite there yet, but I've made great progress. I'm not happy about seeing that go down the drain. Chemo for breast cancer often causes weight gain. I get that chemo is necessary, I get that a few extra pounds shouldn't matter; still, it does. If that makes me vain and silly, then I am vain and silly.

And of course, there's the hair. Chemo lasts three months, but it will take years to grow my hair back. If I do grow it back. It's been long-ish most of my life. Maybe I won't want it long after this. I wonder how I'll feel six months from now when I run into someone I haven't seen in a while and they comment about me cutting my hair. Will I tell them I had chemo, or just say, "Oh, do you like it?" My eye brows and lashes will likely fall out as well. There are no wigs for brows and lashes.

Diva will be here this weekend. I want to talk to her, to get the inevitable conversation over with. I want to explain that even though I'm going to be sick for a while, in the end I'll be stronger and healthier than ever. She's the kind of kid that takes everything in stride, yet I wonder if all this will freak her out. Diva is the world to me. I can't help but wonder how my cancer will affect our relationship.