WAIT! Another Change of Plans.

As I said yesterday, I'm learning there's no such thing as a plan set in stone. I didn't expect another reminder quite so soon. I went to my appointment with the radiation oncologist today, Dr. Dilworth, as my medical oncologist told me to. Long story short: somewhere in the game of telephone the information got miscommunicated and I'm doing radiation first. He was at tumor board, that was always the plan and that's what's next. I still have to do chemo again, unfortunately, but first, radiation. 

When his resident, who came in to question me first, reported back to him that I was starting chemo next week, Dr. D got both my surgeon and oncologist on the phone before talking to me. He assured me that everyone's on the same page, apologized profusely on behalf of "the team" for any miscommunication and explained why this is the best plan. It was a more confusing couple of hours than frustrating. And, the more I thought about it, I realized there were many positives to doing it this way. More on that later. 

He said, especially considering how extensive the cancer was when they got in there, it makes sense to attack the area directly with radiation first since that's where we know there was cancer and therefore a likelihood of stray cancer cells if any, especially because the cancer remained so near the skin even if I had clear margins during surgery. The cancer was all the way to the skin at one point and was visible and red this summer. It's great that the chemo was effective enough to get it away from the skin, but there could have been stray cells left behind (is essentially what I took away from his more scientific explanation). Then later we'll do the additional chemo which can perhaps catch any cells that may be lurking in other parts of my body. Daniel's question when I returned home was, "But if we did the chemo first wouldn't it also attack the cells in the breast area if there are any there?" Good question and I wish I would have thought to ask it. It doesn't sound like that would have changed the course of action anyway, but is worth asking. My guess is, smaller target and lots of scientific study about radiation and its effectiveness were behind the decision. 

Although it kind of felt like "Who is steering this ship?!?!" at first today, by the end the new plan made sense to me and I'll saddle up. SO, all that time we had for my incision to heal? We don't have it. He got my plastic surgeon on the phone (who was in the middle of surgery so I pictured him on speaker phone or with some resident holding the phone up to his ear like in the movies) so we could figure it all out while I was sitting there. They chatted in the hall and he said I have to have that surgery to remove this scab and fix the incision. Some people just get a little bit of radiation. I'm not one of those people. He said I'm getting the whole arsenal so I need it to be healed so my skin is in the best possible condition before we start -- and we need to start ASAP. 

As soon as Dr. Sherbert was out of surgery, his office called and we set it up. So, I'm having surgery next Thursday at an outpatient facility in West Bloomfield. The procedure is relatively quick (about an hour), but they said I can expect to be there all day and can expect to be on my butt for another week after. JUST as I was returning to life and becoming physically able to do most everyday tasks short of lifting...back in bed.

This also means no more expanding. I am what I am. In fact, in order to get the skin to close after they cut out the scab (sorry to the squeamish folks), he may have to deflate me a little (not sure what word to use there...) to get the skin to close. Using this cream for the last couple of weeks helped since the area has definitely shrunk and I'll keep using it up until surgery I guess, so the scab is as small as possible. Is this too much information? I can't tell anymore. 

Anyhow, within a couple of days of surgery, I'll go in for "staging" for radiation, where I will lay there and they will measure or take pictures and do math and science (I don't know) so they can plan exactly where to target their science beams for radiation (I really should learn some of this terminology). My body can't change after that at all because it would screw up the staging, thus, no more expanding. And after this intense of radiation the scar tissue will be so tight under the surface that my skin won't stretch, so that's why they can't do it after. 

SO, surgery Thursday, two weeks to recuperate, then daily radiation for six weeks. Depending on when we are able to do the staging I'll start by the end of the month and be done by early March. He said it's going to be intense, my skin will "change color" (he wouldn't/didn't use the word burn), peel and be painful. I'll likely be tired. 

So when do I start chemo after that? He said there's no set protocol as it's not necessarily common to do more chemo after radiation. He's sure my oncologist will want to get started ASAP but he's going to recommend waiting at least two weeks. That will allow my skin to start to turn the corner before chemo, as it gets worse after radiation is done before it gets better. Then, the chemo will make my skin worse again. He said my job through it all is to keep the area clean and dry, no perfume, lotions, oils, etc. unless they give them to me. 

If everything goes according to the new plan (plan, ha) then it sounds like I'll start chemo late March and hopefully be finished late May or so. Kind of a bummer that my hair will be even longer only to (likely) lose it again. Oh, well. I suppose that's the least of my worries. 

I'm still doing the PET scan Monday so as long as that is clear as we think/hope, there should be no more changes to the plan at this point. 

The bad parts: still have to do chemo, what a doozy of a day mentally and not happy about having to have surgery, total plan change with expansion, etc. 

The good parts, and there are many: I'm feeling better all the time, but I don't feel strong. What a crazy seven months it's been. I get this 8-9 weeks to get my stomach feeling better again, maybe gain a little weight back, get in fighting shape for chemo. And when I DO have chemo it will no longer be "cold and flu season." Obviously I have to be careful whenever, but that does ease my mind a bit. Also, my implant surgery has to be 6 months after radiation is finished. It doesn't matter that chemo will be in that six months, so we're looking at late 2017 for that again! Again, no plans, blah blah blah. But hopes. And there are other things that will likely trickle into 2018, but hopefully most of the big stuff can be done this year. Why does that matter? It doesn't really. It just makes me feel better. 

Thanks for everyone who reached out. It was a busy day of appointments and phone calls and whatnot so I haven't had a chance to reply, but thank you! Tomorrow I have no appointments. I'll try to finish putting away Christmas and will be getting a pedicure that my girlfriends bought me months ago. Then we're shipping James off to spend Saturday night with Aunt Sarah and Gigi so we can go on a date. Not a bad end of the week.