The Next Step(s)

I went to my appointment Thursday and my numbers were great -- well, my white blood count anyway. Over 4. My hemoglobin is still only 9.6 (again, it's supposed to be 12), but it's slowly climbing (up from 9.4 on Monday) so she's just going to leave me be and is confident it will come up sufficiently on its own. It probably seems crazy, but that number being over 4 does make a huge difference while on germ watch. I'm significantly less afraid of my kid's runny nose or touching a shopping cart or door handle, while still careful. And you would be surprised how many people cough RIGHT AT YOU when you are out in the world. I never paid much attention until the last year. 

So, what's next? A few things. For starters -- remember how I was saying I needed 4 more Herceptin infusions and probably 10 more Perjata infusions, all 3 weeks apart lasting months and months? Well, it turns out they released the initial findings of the study my oncologist was waiting on and you not only CAN take them together, you're SUPPOSED to take them together. Had she known that, I would have been taking the two of them together all those months I was just taking the Herceptin. So, for now, I'll be taking the two of them four more times, starting June 29. She's waiting on the rest of the study's findings but there's a good chance that will be it. (If not, I will need 6 more Perjatas after that.). So, there's a very real chance that I can be done with infusions in about 12 weeks. BY THE END OF AUGUST. Not getting my hopes up, but... getting my hopes up.  

On Friday I'll have my heart checked. Both because the chemo I was just on is particularly hard on your heart, so they want to check it and compare it to my where it was before. Also because Herceptin is also tough on the heart so they'll have a new baseline to check against after I'm done with my infusions. 

One big question I had was, "So when can I get this port out?" The port has been sooooo helpful and convenient during the last year. Very few IVs or blood draws out of my arm. Just one quick poke into the port that I barely feel and they can administer any IVs and draw blood whenever they want without me feeling a thing. My blood transfusion even went through my port. I'm not sure how or why anyone goes through chemo, etc. without one to be honest. However, I can't wait to get it out. It hurts when you bump it (seems like that wouldn't happen too often but throw a monkey toddler into the mix...) and is really annoying when it rubs against the seatbelt. Even when you're getting dressed or in the shower you bump it and, while not excruciating, it's annoying. I have an ugly, fuzzy seatbelt cover that helps in the seatbelt department, but it still puts pressure on it and bothers me. I'll always have a scar on my chest from it, of course, but I've always felt like once the port is out I will feel like treatment is over. I know people who have kept it in indefinitely. One person for ongoing bloodwork. Another because the chance of her cancer coming back is relatively high. But I don't care. If it comes back, I'll put another one in. I want this sucker out. It's exciting to think that could be in a few months. 

Other than that it's time to contend with controlling the estrogen in my body, since my cancer is fed by it. The thought being, if there are any pesky cancer cells in my body that somehow survived two different regimens of chemo and radiation, estrogen causes it to grow. So, on the 29th, I'll start two things. I'll start getting monthly shots of Zoladex, which essentially shuts down my ovaries. This will continue indefinitely or until I have my ovaries removed. Since pregnancy involves loads of estrogen, they've told me not to have anymore kids, which I've had a tough time coming to terms with throughout the last year. It's getting easier. Maybe, in addition to just not wanting to have an additional surgery right now, that's why I'm hesitant to immediately go the route of having my ovaries removed. I suppose I'll get there eventually, just not right now. 

I'll also start taking the drug Arimidex. A similar drug you may have heard of (and I have mentioned before) is Tamoxifen. It's similar to Tamoxifen, but better for cancers with my set of characteristics. It is a daily pill I will take for years (10 I think?). She explained to me exactly what it does and it made perfect sense, but I'm not sure I can relay it properly. Essentially it doesn't allow the cancer cells to receive the estrogen and then grow (I think). And you have to do the two together for the Arimidex to work. 

So these two things will put me into a chemically-induced menopause. I've talked to several women who are in the midst of it and, quite frankly, it sounds awful. I mean, natural menopause doesn't sound like a picnic either. :) Chemo put me into menopause also -- I've been having horrible hot flashes on and off for a year. But from what I understand, this is worse. I'm not sure whether Googling the side effects was a good idea or not. 

And what do we do going forward? After I'm all done with my Herceptin and Perjata infusions I start returning to life as (new) normal. I go to my oncologist every three months for blood work, with the hope being nothing abnormal is present. She said when breast cancer spreads it shows up in one four places: liver, bones, lungs and brain. If it appears in my liver or bones, the blood work will indicate that. If it's in my lungs or brain, we wouldn't know until I have symptoms. In theory, you could get CT scans all the time to makes sure it's not in those places, but then you could get cancer from all the scans. So, they don't do that. (This also makes me cringe thinking about all the CT scans I've had in the last year...)

She said I do those three-month checks for the first two years. After that, maybe less often? I'm not sure. So, that's where we're at. This week I have a check-up with my radiation oncologist -- I think just to see if I've continued to heal well. I'll also meet with my plastic surgeon to set a firm date for reconstruction -- which I think is actually going to be closer to mid-September. It just has to be six months after radiation ended, which was March 16. 

It's Sunday morning and we're waiting for Daniel to wake up so we can do whatever he wants today, followed by our annual sushi dinner. James has allowed me to sit here and finish typing for about as long as she can stand, so I better go wrangle this turkey. I realize you probably won't read this until you wake up to an e-mail Monday morning, so I hope everyone had a nice Father's Day!