Tuesday, July 23, 2013

What (I Think) You Want to Know -- Part Two


2. Is your cancer in remission?

Although I often hear the word remission in the regular world, I have never once heard any of my doctors or nurses use it. To be honest, I'm not exactly sure why that is and since I still refuse to research anything about cancer, I don't have any great clinical explanation. What I do know, however, is what my oncologist, the Chief Medical Officer at the Dana-Farber Cancer Institute (Dr. Bunnell), has told me (after I told him not to tell me anything bad). And Dr. Bunnell has explained to me that the "overwhelming odds" are that chemotherapy and, more importantly, Herceptin, will cure my cancer. We're not putting the cancer to sleep and waiting for it to awaken one day; we're defeating it. For good.

The first time that Dr. Bunnell ever mentioned my cancer coming back, I told him that I wouldn't have breasts anymore. So how could that happen? He explained that the cancer could come back elsewhere in my body; on my chest wall or in my brain, for example. It would still be breast cancer, he explained, but it would have metastasized. Well, crap. Was I the only fool who had assumed that cutting my boobs off meant no more chance at breast cancer recurrence? Lesson learned, I guess.

So we arrive back at that HER2+ test result. My tumor tested positive for a protein known as HER2; a protein that, if left to its own vices, will lock on to healthy cells in the breast or anywhere else, and turn healthy cells into cancerous ones. In 2005 (so says Brian who researched it), a miracle drug called Herceptin came onto the market. Herceptin changed everything for women with HER2+ breast cancers.

Herceptin includes (or is?) an antibody that is literally attracted to the HER2 protein. Once the two meet up, Herceptin prevents the protein from locking on to healthy cells. It stops cancer. For the luckiest 99% of women with tumors similar to my grade 2 tumor, Herceptin has been shown to cure breast cancer (at least, in one study that Dr. Bunnell has cited several times).

3. When will you be all done with treatment?

I will have completed my one year of Herceptin infusions at the end of October. I'll take my daily dose of Tamoxifen until January 2023.

4. How much do you worry about dying?

Now, I can go several hours without worrying about it. I used to not be able to go a single minute, so I’ve made great progress. My worry and fear come in all different forms, from light and manageable (the common kind) to overwhelming and necessitating a good cry or, on a really bad (and thankfully, very rare) night, an Ativan.

The hardest part of the worry now is that my guard is down; my armor is under the bed, as a great friend explained to me. I’m back in the real world and there, death-by-cancer is all around. I won’t lie; it’s really hard to hear that someone died of breast cancer. When that happens, I still feel a few minutes of suffocating fear. Then, with a pit in my stomach, I carry on, and gradually that terrible feeling goes away.

Since I often have my own mortality on my mind, sometimes I kind of feel like a ghost of myself. For instance, when I get home at night and I hear Brian giving the kids a bath, I smile, but I also tear up inside. Every night, when Annabel asks, You guys going’ any-weera? my heart aches a bit and I pray to God that I’m not. It’s really hard to imagine being absent for all of that, or better yet, it’s too easy to imagine it, and I really don’t want to.

5. Do you have any regrets about your treatment or surgery? 

No. Not one. I was blessed with easy access to one of the best cancer institutes in the world (if not the best). I have the utmost faith in my core medical team. And while I have hit bumps in the road like anyone going through serious medical treatment, there’s nothing that I could have done to avoid those things.

If I had to stretch my answer into something I don’t care all that much about, I'd admit that the whole adding-the-nipples process is totally inconvenient. Sometimes I think it would be nice to look a bit less robotic in the chest area and the big scars can be reminders of times I don't want to remember. But at this stage, I wouldn't take time off of work or away from vacation so that my plastic surgeon can create new nipples for me. (Out of Office auto-reply: Thank you for your message. I will reply as soon as I have nipples. Nah, that just doesn’t work.) So if my nipple-less figure ever really starts to bother me, I know I can just call Dr. Chun and make an appointment to explore my options. For me, that’s enough of a solution for right now.

On a more serious note, I have the right kind of regret for the fact that I did not harvest my eggs prior to beginning my treatment. If I knew what I know now (that my cancer hadn’t spread and that the Taxoxifen was going to be a 10 year course), I may have done so, but life doesn’t have a rewind button. In the end, I have faith that if Brian and I want to have a third child, we will have one. He or she won’t have our genes, but I’ve come to realize that genes are a small detail to the concept of family.

6. Can you have any more biological kids? If not, why not?

Like any woman, I’m not entirely sure, but I think that it would be physically possible, yes. While the treatment I have received sends some women into early menopause, it hasn’t done that to me (at least, not yet). But it’s not as easy as that.

Dr. Bunnell believes that I should stay on Tamoxifen for 10 years and he said that I should absolutely not get pregnant while taking the drug; something about how they don’t know how it would effect the fetus, I think. Since I started Tamoxifen when I was almost 33, that means I’ll be 43 when I complete it (with faith). If I have not gone through early menopause by then, there’s a chance I could have a baby. But while 43 is not “too old” for some women, I think it’s probably too old for me.

Had I harvested my eggs, we could have tried to find a surrogate mother to carry embryo(s) that the fertility clinic could have made with Brian’s little swimmers. But we didn’t do that because, just days after being diagnosed, the process of injecting me with hormones and extracting my eggs was not a top priority. Especially when I had just been told my cancer was hormone-receptive and they did not yet know how far it had spread.

A few appointments ago, I was given a clip board of information asking me if I’d like to take part in a clinical trial at Dana-Farber. If I enrolled, I would stop taking the Tamoxifen after 18 or 36 months, try to get pregnant, then go back on the Tamoxifen once I had a baby. I do not judge women who choose to take part in that study and if I didn’t have my own children already, I may very well have considered it. But for me right now, it doesn't feel like the right thing to do. Adopting, on the other hand, very much does. And if it's a girl, I've already picked out her name.

To be continued...

7. What were some of the most (and least) helpful things that people did for you this past year?

8. What have you told your kids about your cancer?

9. Have you done anything to prepare for your own death?

10. Did cancer change you? If so, how?

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