Treatment Plan #2

Lots of information today & made one of the many decisions.

We made it to Rochester by 9, I was asleep not long after. First appointment was at 8 with the Mayo oncologist, a lovely Irish woman! We joked that I will definitely need to go there after treatment (uh, duh).

The oncologist confirmed the TCHP cocktail was a great option. She went over several other different ways to go about this and how they differ. She’s waiting to see what the skin biopsy says, which may make me a good candidate to get chemo with one less drug (a clinical trial). She also went over possible treatments after surgery that involve hormone suppressers. What treatment I would get if there is residual cancer after chemo. It’s at least 5-10 years of drugs. And then there’s the risk of recurrence, which is possible. And because it’s Mayo, there are a ton of clinical trial options.

If I’m recalling correctly, there’s a 40% chance the chemo gets rid of the cancer. If not, a lot of good options are available.

The surgeons came in next – there was a resident who was really nice (from Mexico!). He went over potential surgical options. His “boss” came in after, explaining that we’ll do the surgery a few weeks after the end of chemo. (She gave me a timeline and, of course, I went right out my brain.) She said that if I wanted to try for a lumpectomy, I would need the calcium deposits to be biopsied BEFORE chemotherapy. I turned that down – both surgeons have noted that it’s more likely I’ll need a mastectomy. I’m tired of the biopsies, let’s just get on with it.

Also, my nipple cannot be saved.

What’s cool about having surgery at Mayo is that during the surgery, there’s a radiologist on hand who biopsies tissue on the spot. This will help them take everything out that they need to. The node will be removed/biopsied to see if the cancer got murdered by the chemo. 😉

I told them that I’ll likely opt for no reconstruction, I’d rather not deal with any of that. Both the surgeon and the radiologist I spoke with agreed that was a good option for me. I might even opt for a double – just to make them even. And JUST to be sure it’s fucking GONE. The genetics test might swing that way anyway, but that’s how I’m feeling at the moment.

BOOBS, BE GONE!

In between doctor visits, I had nurses from a couple clinical trials pay me a visit. I opted into one – “the breast registry.” Basically, it’s a wide study of bloodwork and then excess tissue from surgery. Having my boobs go to future cures seems cool – let’s do that. So they snuck in some bloodwork before my last appointment.

The other clinical trial, I turned down…but it’s a damn good study. It tracks the impact of chemo drugs on your heart. They put you in one of three groups that integrate a heart drug to see if it has an impact on heart function. It requires that I head to Mayo 9 times in 2 years to get echos, and that I would need to come back for an echo before starting chemo (the one I took up here doesn’t count). That one really sounds interesting but I’m tired of tests, and I just want to get moving.

After all that, I met with two doctors from radiation oncology – one being the resident. She was pretty awesome – showed me my PET scan. She and the other radiation oncologist had conferred earlier in the day about my scans and noticed a little spot light up by my sternum. There are lymph nodes behind the sternum – but those you can’t biopsy or remove, so they’ll concentrate a bit on that area in radiation.

Now, radiation is a bit down the road. They also gave me a timeline that I forgot, but it’s something like 6 weeks after surgery, I meet with the radiation oncologists again to finalize that treatment.

Radiation is every weekday for 5 weeks, targeted on my chest wall and armpits. They use protons that are less likely to impact other internal organs. She went over the side effects, which include cancer. Yeah, like a different kind of cancer. But it’s skin cancer, so benefits outweigh the risks…I think. Radiation also increases the chance I get lymphedema – +10%. There are options for me if that happens…I hope not. But, you know, luck and all that.

They’ve already scheduled my next trip to Mayo where I’ll see the plastic surgeon and the surgical oncologist to finalize the surgery part. That’s in November.

Got a message from my local oncologist – someone will call me tomorrow about scheduling chemotherapy.

I’ll also get my COVID booster and flu shot tomorrow.

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All in all, I feel good about the treatment plan. Mayo is thorough. The doctors are fantastic. And they’re diverse! As much as I hate waiting around and being alone, I’m so glad I ended up there.