Day 18, Cycle 7: Pivot to surgery

Last infusion: finished!
Last infusion: finished!

Having received my last chemotherapy session, I’m now being allowed to rest and recover for the next phase. Although I will still receive Herceptin intravenously every three weeks until late March 2017, I’m done with the strong, destructive components (Carboplatin and Taxotere) that kill cells.

I’ve been marvelling at how precisely the dosages are calculated to take the patient exactly to the point where they can tolerate that last infusion but not one more. You really feel like you could not get up anymore if you had another round.

My skin still shows the last two rounds’ worth of skin burn despite the careful flushing of the IV between medications and after. At Day 13 they looked like this (they’re a bit better now):

Chemo burns
Left: the most recent, inside the right forearm; centre, the sixth infusion,  back and wrist of right hand; right: an example of the butterfly needle used.
The Oncatogy team
The Oncatogy team

I have felt very tired since the infusion and have not recovered my appetite, but my taste buds are gradually returning to normal. (Thank the Flying Spaghetti Monster!) I have spent most of my time receiving felinotherapy with the Oncatogy Department.

When I’m awake I’ve been researching the surgical options, namely conservative breast surgery (a.k.a. lumpectomy) and mastectomy. Most resources say that out comes at 10 and 15 years are similar in terms of survival and recurrence, so choice should really be based on how important it is for the patient to keep her breast and/or to have symmetrical breasts.

While that’s correct as far as it goes, the phrasing always makes me feel frivolous: “Of course, if you really must keep your breasts…” Well, duh. Yeah, I’d like that very much but I don’t want to die early for it either. A little help, here? I tend to decide based on risk factors and quantifiable outcomes when I can.

Finally, some of the recent articles I found were more helpful (links below). Based on them it seems that conservative breast surgery is easier on the patient with fewer complications and possibly slightly better outcomes overall, though with a slightly higher (by four percent) risk of recurrence. The primary differences lie in the need for general anaesthesia for mastectomy (and an overnight stay at the hospital) versus local anaesthesia and sedation for conservative breast surgery (an outpatient procedure), as well as the number of lymph nodes removed (the fewer, the least risk of lymphedema.)

After all my reading, I felt more inclined towards conservative breast surgery unless the genetic test results indicated a predisposition to breast cancer (BRCA1 or BRCA2 mutations.)

But I was tremulous when I met again with the surgeon on Wednesday. She comes across as very focused, rigorous, factual. In our first meeting back in March she had presented the options but like most modern doctors, refused to give advice one way or another. This time I started by telling her what homework I had done and what my current inclination was, and she suddenly had this big smile. “I’m really glad to hear you say that!” she exclaimed.

We went in detail over the compared procedures and follow-up steps, and the various complication risks. Then we tentatively scheduled the conservative breast surgery procedure for September 21, as well as a bunch of the pre-op checks. If my genetic test results come back positive for breast cancer markers, then we’ll reschedule for a mastectomy.

I have to add that Dr. Chen seems to be very popular with the staff. Several people in other departments waxed eloquent about her. This does not happen for just any doctor; it feels out of the ordinary. The anaesthetist’s medical assistant was telling us that she insisted, when her own sister had breast cancer four years ago, that the surgery be performed by Dr. Chen. This too was a conservative breast surgery. (The sister is doing well, apparently.)

And after conservative breast surgery, I’ll be looking at one or two more weeks of recovery, followed by five to seven weeks of radiation therapy, five days a week. That should take us just about to the holidays…