Wednesday, January 9, 2013

Taxol Week 9/12--the end of chemo is nearing!

I'm excited that the end of chemo is within sight!  This week is # 9 out of 12 weekly rounds of Taxol.  And then I am done...with chemo.

The long road ahead...
I remember when I began this journey, I thought, "Wow--6 months of chemotherapy...that seems like a huge chunk of time!"  But, the end is almost near.  Granted, the treatment will be cut short by 6 weeks due to me not receiving two rounds of the AC drug.  But still, it is one chapter of this journey that is thankfully coming to an end.   Now that chemo is ending soon, I have begun to look ahead to the other parts of my journey.  I realize that I still have quite a ways to go!  After this, I wait 3 weeks and then will have my first surgery (left breast mastectomy). Then, after a couple of weeks of healing, I will have 6 weeks of radiation (every day for 6 weeks).  Then, about 6 months from my first surgery, I will have more surgeries (right breast mastectomy, both breast reconstructions, follow up procedures, etc.).  Thinking about the long road ahead can really begin to get you down when you are going through something like this.  I refuse to be down.  So, when the temptation to look ahead enters my mind, I squash it!  This is not a new revelation. This is biblical.   Matthew 6:34 tells us, "Therefore do not be anxious for tomorrow; for tomorrow will care for itself. [Each] day has enough trouble of its own."  Instead of worrying about tomorrow, I pray for today.   Philippians 4:6-7 says, "Don't worry about anything; instead, pray about everything. Tell God what you need, and thank him for all he has done. Then you will experience God’s peace, which exceeds anything we can understand. His peace will guard your hearts and minds as you live in Christ Jesus." (NLT)

Answered prayers of healing:
God continues to heal me and take care of me and my family.  Friends and family continue to bless us.  I am thankful for the warriors who keep fighting the battle along with us using the best weapon available:  prayer.  God hears and answers.  Below is a synopsis what has been going on lately with us.

Feeling like a lab rat
Plastic Surgeon Appointment:
Yesterday was a day full of doctor's appointments for me.  I think it was the first time during this journey that I actually felt like a lab rat or some non-human object lab specimen.  I began my day at 8:30am at the plastic surgeon (Nabil Habash, M.D.) office.  I have never met him, and we need to begin to make plans for upcoming surgeries since chemo is coming to an end soon.  I really liked him and he appears to be one of the best in his area of expertise.   He is fellowship trained in reconstructive microsurgery (DIEP, SIEA, TUG, GAP flaps) and he focuses his entire practice on breast reconstruction.  I had no idea the options for breast reconstruction.  Implants are not recommended for me for many reasons, so I am glad he had some great options.  Of all the options, he is recommending the DIEP flap.  A DIEP flap is a type of breast reconstruction in which blood vessels called deep inferior epigastric perforators (DIEP), and the skin and fat connected to them are removed from the lower abdomen and transferred to the chest to reconstruct a breast after mastectomy without the sacrifice of any of the abdominal muscles.  The blood vessels, or perforators, required to keep the tissue alive lay just beneath or within the abdominal muscle. Therefore, a small incision is made in the abdominal muscle in order to access the vessels.
After the skin, tissues and perforators (collectively known as the "flap") have been dissected, the flap is transplanted and connected to the patient's chest using microsurgery. The plastic surgeon then shapes the flap to create the new breast.  Dr. Habash showed me many before and after pictures and the meeting was very educational.  I had no idea my nipples would also be removed during the mastectomy. Dr. Habash can make new ones that look completely real!
Anyway, as part of the normal protocol, I had to strip down into nothing (except a pair of blue paper panties they provided) and have a little photo shoot in their special photography studio.  Never in my life did I ever think I would be part of a nude photo shoot!  The nurse took about 15 photos, at various angles, zooming in at different body parts.  She said she doesn't include the patient's head in the photo.  Thank goodness, because I don't want anyone to be able to put my face to those photos!  I guess the purpose of these photos is so he can review again later to determine which area of my body he will be removing tissue (skin and fat) to create breasts.  Apparently, creating the breasts from your own tissue is a pretty easy task for larger patients, since there is more tissue to choose from.  But, he may have to do a couple of different procedures for me (like also perform liposuction somewhere to harvest some fat for use in the breast, since I may not have enough on my abdomen).  I am guessing we will have another appointment before my first surgery to discuss the game plan, because I think the plan is still in the works.  
Appointment with the Breast Surgeon:
After this appointment, I went home, picked up Drew and Abbey (Luke was at school) and headed to my breast surgeon's office for an 11am appointment.  This surgeon will perform the actual mastectomy and lymph node removal in February.  I have been looking forward to this appointment for a long time, because she has ultrasound machines in her exam rooms. This means I can see the progress of the cancer reduction.  Of course, I have been able to feel from the outside the positive changes in my left breast and surrounding area.  But, we still wondered what it looked inside.  Drew and I, as well as Dr. H. (my oncologist) have been so excited about the progress.  But, Dr. H. said that surgeons don't get quite as excited as us.  I am glad she gave me that information, because Dr. M (my surgeon) really didn't seem excited at all as she examined me.  Perhaps she wasn't in as good of a mood as normal because we brought our tired and hungry one-year old to the appointment.  I kept what Dr. H. said in the back of my head though.  Still yet, I really wanted her to at least smile at what she saw.  So, I probed her to try to get it out of her.  I said, "I was really hoping you would say, 'The cancer looks so significantly reduced.  Hooray!'"  She smiled and said, "The treatment is definitely working."  I asked what size it was and she said she really couldn't tell from the ultrasound. She really won't know until she removes it surgically, what is remaining: cancer, dead cancer, scar tissue, etc.  At my oncologist appointment this morning, I took a photo of Dr. M's notes from yesterday:  

When I looked at her notes this morning, I wondered, "How could she not smile if she documented these things? This is great news!"  This report states the lymph nodes that she viewed do not appear abnormal.  When I was first diagnosed, we saw many enlarged lymph nodes, which we later determined were full of cancer.  The area is much more mobile, due to the shrinking of the cancer and its pulling away form the skin.  It was very immobile before and massive (14cm wide), causing the nipple to pull towards the mass, at the time of my diagnosis.  There are a variety of hypoechoic densities (which could just be dead cancer or scar tissue, but may be remaining bits of cancer), all less than 4mm in size.  This means the mass has been breaking up, regardless.  Again, we won't know what is remaining until after surgery. All in all--very good news!  I will be having a PET/CT at the end of this month to truly see the progress of treatment.  Drew and I were so focused on the ultrasound, that we still do not even know the details of the upcoming mastectomy--how long the surgery will take, what exactly she will do during the surgery, etc.  Luckily, we have one more pre-operative appointment with her, so we will write down all of our questions for that one!

Back to the Oncology office:
After this appointment, we headed home to eat.  I had yet another appointment scheduled for 4:15pm.  At this time, I had my labs drawn at the oncology office to see what my white blood count looked like.  I assumed my ANC would be low, due to just receiving my weekly dose of Taxol on Friday.  It turns out that I was neutropenic, with an ANC of .9.  But, this is higher than I thought it would be.   Regardless, I received my usual injection of neupogen, along with steroids and benadryl, to boost up my counts to at least 1.5.  My goal was to be able to get treatment on Wednesday or Thursday this week (instead of Friday).   

After this long day, I literally felt like an experimental object.  I had been pinched, prodded at, photographed, had my breasts squeezed, had an ultrasound, as well as had been poked, had blood drawn, received intravenous fluids and medications and an injection!  But, I am thankful God is navigating me through all of this. I really have a feeling of peace--like God has already entered in all of the destinations into the GPS navigator and I have the handheld GPS, following right along: "keep right at the fork."  I don't feel like I need to figure it out, intervene or anything.  I have complete and total peace and am along for the ride.  That is a good feeling from someone who is a bit of a control freak.  

So, here I am on Wednesday, my scheduled chemo day.  Last week, I was scheduled for chemo on Wednesday.  I wasn't able to receive it until Friday due to low wbc.  Today is my normally scheduled chemo appointment and guess what?  My ANC is high enough today.  In fact, at 13.6, it is well-beyond the needed 1.5 to receive chemo.  The neupogen from yesterday took effect.  Praise the Lord!

I am feeling great and I am receiving my 9th dose of Taxol. Only 3 more to go after today.  I want to have a party after all of this!  I am so excited to be around more people and get back into my old routines once I am no longer neutropenic!  

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