new plan?

Here it is Saturday, and I have been working on this post since Tuesday.  Quite a long time because I am so……confused?….no, that’s not the right word.   Conflicted?  No, that’s not it either.  I want to be able to make an intelligent decision based upon facts and I am stuck in “emotion”.  I know what my heart wants to do, but I am so concerned about making the correct decision, because well……it all comes back to desperately wanting to see my kids graduate from High School.  It is so easy for others to cheerily reply…..”oh, you will!”…….and I think that might be true, but I don’t know that.  These are the “tear-jerker” thoughts I have at a moments notice.

Wow, how interesting it was to go to U of M on Tuesday and listen to a whole new version of a viable “treatment plan” for my unique cancer case.  I don’t mean to make my personal pack of terrorist cells sound like they are something special or anything.  (Well, they are kind of special to me, even though I intend to kill them).  At University of Michigan, the Breast Care Center is quite a big place.  Lots of breast cancer walks out of the elevator doors there.  I felt like a sick chick suddenly opening the doors to the Cancer Land of OZ.

My experience at the Breast Care Center began with a review of my history, a brief physical examination, and Dr. H (a “resident”, I think) brought up a website called “adjuvantonline” which has statistical data to help an Oncologist discuss the “rate of recurrance” of cancer, or the “mortality rate” with your personal information plugged into the program.  Then they enter data of different types of therapies and get a bar graph that demonstrates the risks/benefits of each therapy for you.  I know some are skeptical of this site, but if a major medical/research facility uses it, it’s good enough for me.

OK, the whole motivation to go to U of M was to get a “port” placed in my arm for delivery of chemotherapy meds.  Imagine my surprise when Oncologist/Internist Dr. Schott said, “No…you don’t need a port.”  I was stunned.  What I had taken as acceptable reality in Toledo was kind of “old school” at U of M.   Dr. S  recommends four treatments of chemo three weeks apart.  Only four treatments?  Yea, only four treatments.  Not enough to have the inconvenience of surgically inserting a subcutaneous port.  The ports make it easier for the nurses to administer the meds but also have risks of their own, as well.  She assured me that the nurses at U of M are  very good at what they do, and they will be able to find a vein sufficient enough for chemo meds, and no, they won’t “collapse” my veins and yes, it will be all right, they do this all the time with women my age and older. 

The most significant difference between Toledo and U of M?  In Toledo, I have Stage II Carcinoma, at U of M, I have Stage I carcinoma.(**see note at end of post)  Wow.  Big difference.  I could give more examples of differrences between the two places like, recommended behaviors, suggestions for short term planning, etc. …but the staging of the tumor?  Well, that really muddies the water.  I have been evaluating  my records from Toledo to try to figure out what grading scale was used, U of M indicates the Scarff/Bloom/Richardson grading scale.  I have read and researched, and I honestly don’t know which place is correct.

Of course the “stage” of your cancer is vitally important when determining the adjuvant therapy (nice way of saying chemo-poison and other drugs) most appropriate.  Here there is a significant difference in “suggested method of treatment” (I word it that way, because the Oncologists I have met have been very careful to provide a choice, and not be too pushy about which of  the two is better.)  In Toledo, my Onco-man has suggested a TAC regimen. This means: Taxol, Adriamycin and Cytoxan for six treatments, three weeks apart…about 18 weeks of chemotherapy, followed by “hormone” therapy, to block estrogen and progesterone I still naturally produce (my cancer “feeds” on estrogen and progesterone.)  At U of M, the suggestion has been to infuse Taxotere and Cytoxin in four treatments every three weeks….about 12 weeks of chemo, followed by “endocrine” therapy (same as hormone therapy, but a “more accurate” term).  Notice U of M leaves out the Adrimycin.  Funny thing about Adrimycin…it has a nasty side effect of “potential heart damage”.  When Dr. S explained a potential chemo mix that included Adrimycin, it only decreases the rate of recurrence within five years by 2%.  What would you pick?  Take the drug with the potential of damaging your heart muscle, or, a 2% better chance of no recurrence of cancer in the next 5 years?   I have ten more years before Charlie graduates from High School.  Sigh……….

Of course, that intellectual dilemma takes me back to the question of “Stage”.  If truly a stage II cancer, perhaps a more aggressive approach will get me to the goal.  Maybe I’ll be lucky and not have the “side effect” of heart damage.  Then I think about the No 1 killer of women……of course, heart disease.

**Revision (6/15/09)  I need to add an updaste to this post.  From my first visit to U of M, I discovered that I misunderstood some information that was presented to me.  The Pathologists at U of M did indeed list my cancer as a Stage 2 cancer.  (I misunderstood information about the “grade” and “stage” of the cancer.)  Once I had made a second call to the nurse practioner who assists my oncologist, she patiently explained all relevant information to me not once, but twice.  This small experience goes to show you that even when you think you have fully understood everything, took notes, etc. there can still be misunderstandings.  It is SO IMPORTANT to ask questions, and don’t settle for an answer you do not understand!  It is your life and you deserve to be fully and completely informed!

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