Opinions #10

On Sunday April 13th , I drove to Sacramento (just over the hill) with Jennifer to stay the night for my appointment Monday morning with Helen Chew, MD Breast Cancer Specialist at UC Davis (aka The Specialist). Mom couldn’t go with me because Shauna was having knee surgery. Jennifer and I made a fun night of it with dinner at Chicago Fire (I looked for those hot fireman like on the TV show but they weren’t there!) We did manage to find this little gem on our way. Jen said she’d push if I needed a break from walking. I gently explaine,  I’ve been couped up in my house for almost 4 weeks girl! It’s beautiful outside and we’re walking even if I still have a partially collapsed lung!

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We met with The Specialist and I’m really glad my oncologist, Suresh Reddy, MD,  aka The Blood Guy asked me to meet with her. She spent an hour and 45 minutes with us. Completed a thorough physical exam and was very prepared given the short time to prepare. I too was ready. I had this thought that I could probably show her I was peri-menopausal, maybe even closer to menopause than we think. Couldn’t I simply take an AI (Aromatase Inhibitor) and skip the whole ovary suppression shot altogether?

So with the help of my sister, I quickly got my data together to present my case. I had a little trouble with finding a fax machine that works at UC Davis (apparently there are ghost machines all over the medical campus, no one knows if they work or not!). I had labs of my hormones, the several ultrasound images and reports showing my ovaries have shrunk significantly, my Ob/Gyn’s office notes stating I was in menopause, and the schedule of my menstrual cycles that have happened in the last 2 years. The Specialist was patient and listened with compassion, shook her and raised her eyebrows from time to time while I was presenting my idea. In the end, she very kindly looked at me and plainly said I was not postmenopausal or even close to menopause but she was impressed and wished some of her residents could put this much effort into things. Ha Ha Ha!

We talked about a lot of stuff but by the end of the appointment she agreed with The Blood Guy that first line treatment would be Endocrine Therapy (ovary removal or suppression). I explained I wasn’t ready for that and she completely understood. She helped me understand that it is not a wrong decision. I have lots of options and we just need to find the right treatment for me. She was crystal clear when she stated that at some point I will have to move to Endocrine Therapy but it doesn’t look like I’ll have to that anytime soon.

There are no clinical trials right now that I qualify for. So, we discussed several agents for chemotherapy treatments. We focused initially on single agent treatment (1 chemo drug). We talked about how the taxanes family didn’t work for me and she was concerned about cross-resistance. This is something The Blood Guy is also concerned about. There is no compelling evidence that combination regimens are superior to sequential single agents. We talked about combination therapy (more than 1 agent). We talked about future therapies in research.

I left the appointment feeling better but still no decision as to what chemo agent I should start. We have to keep in mind how we will move forward with 2nd line and 3rd line treatments when the time happens. Remember, this is not about a cure anymore it is about my quality of life and preventing spread of the disease. Balance is the key and finding my special cocktail will take some time and patience as there is no end date.