Wednesday, December 30, 2009

The Plan.

I just finished an amazing book entitled “Still Alice.” It chronicles an intellectually gifted 51 year old women’s descent into early onset Alzheimer’s disease. I highly recommend this book; it is poignant and eloquently written and made me very grateful that I have breast cancer. At least if this disease takes my life I will know who I am and recognize those I love until the very end. Never will I lose myself in this disease. My name is Patty and I have cancer, but cancer is not who I am. I will never be my cancer. I will not let it embody my soul or rob my spirit. I may be in the fight for my life, but I still have the ability to enjoy every moment of every day and am fully cognizant of the blessings in my life and the adversary I face. For that, I am grateful.

I had an extremely long day at the cancer center today. I started with a visit to see Dr. Rado where he informed me that I am good a candidate for radiation. He sent me to visit with Dr. Rege (radiation oncologist) to discuss my options for radiation and then back to Dr. Rado to discuss when to start my chemotherapy again.

Dr. Sheila Rege is a brilliant physician. She was my doctor four years ago and I am thrilled to have her on my care team again. She is kind, compassionate and extremely knowledgeable; as evidenced by her continued tenure as a faculty member at UCLA medical school. She reviewed my scans with me identifying the seven lesions currently on my posterior (back) ribs. Perfectly symmetrical on the 9th and 10th ribs on both the right and left sides and then the ladder of three additional lesions on the 6th, 7th and 8th left ribs, which could be considered vertically symmetrical. Very unusual. I am only experiencing pain in the 9th and 10th ribs, and those are three of the original lesions and are currently the biggest and most defined lesions. So these lesions will be our main area of focus. Radiation is used mostly to alleviate pain. In addition to easing the pain, it will kill the cancer in those spots (we hope) which will strengthen the bone, mitigating the chance of a fracture due to the metastases. I will have 10 radiation treatments, hopefully starting next week. They will use electrons to minimize the impact on the peripheral tissue and focus the beam on the bones. There may be some minimal damage to the lower lobes of my lungs, but the risk is worth the potential benefits. They also want to radiate as little bone as possible to reduce the amount of bone marrow which will be lost. I need all the bone marrow I have to keep my blood levels up during the next rounds of chemo.

My physicians discussed with me the path forward, and felt that the best course of action would be to focus on the radiation for a few weeks, giving my body a little more time to strengthen and prepare for the next chemotherapy onslaught. So I will start the chemo to kill the rest of the cancer and bisphosphonates to strengthen my bones once the radiation is complete. We haven’t finalized the number of chemo treatments, but preliminarily we had discussed three rounds (six doses) and then perform another CT. I am not sure if we would do another bone scan at that time, but it would make sense to make sure it has not spread further into my bones.

So that is the plan as of today. Mike and I have discussed it at length and reviewed our concerns and questions with Dr. Rado and feel confident that this is the best course of treatment. I will go tomorrow to have additional imagining done at the cancer center so that the physicist can work with the physician to pinpoint the areas of radiation. Then I get to party for the weekend and ring in 2010 with the people I love!

Happy New Year! Cheers to a happy and healthy new year!