6 or 8 Rounds of Chemo - Finally Decided

Aug 11, 2014

Last week we met up with my Kinda Handsome Surgeon, Dr Austen. It was just more of a touch base because my oncologist, Dr Stewart, didn't sign off on a definitive plan. The ultrasound is scheduled for a week after my next (6th) round of chemo and it will give us an idea where we are at treatment-wise. Dr Austen kinda felt that there may still be canser present on the ultrasound just cause of the density of the mass the chemo had to get through. This is probably a good thing that he mentioned it cause till now I had been assuming they won't find anything - and had they still found a bit (of canser), I would have probably been in tears if it had caught me off guard. Now at least I'm prepared either way. 

But he repeated that whether it was going to end up 6, 7 or 8 rounds it would be no issue from a scheduling perspective for surgery. I filled him in on what Dr Stewart had said at the last appointment. Dr Austen is heading out on holidays in the next week but said once I had met with Dr Stewart after the ultrasound and we decided on treatment, to let his assistant know (or my nurse navigator Edith) and they would get in touch with him. How amazing is that?

So my mom and I  walked into my pre-chemo Monday appt to get my blood work done (and fill out paperwork!) and discuss what Dr Stewart thought my treatment should be.

My nurse said my counts were good and was happy to hear the 1st round of docetaxel went so well. And she laughed when I told her about Big Valley. "We don't hear of alot of chemo patients going to Big Valley, so good for you!".

She seemed genuinely happy for me. I mentioned to her how thankful I was for Dr Stewart waiting for me that day when I had to come up to Tom Baker unexpectedly. I also told her I was eager to find out what he thought I should do treatment wise. So she went and got him.

He came in smiling. I told him again how grateful I was that he waited that day. I also told him we had met with Dr Austen just to touch base. Dr Stewart said we could meet in 2 weeks when Dr Austen was back to get a plan together after the ultrasound. 

Here I asked him "So what do you think we should do treatment wise? Is the ultrasound the deciding factor? Cause if you say 8, I will do 8. If you say 6, I'll do 6. I don't ever want to do this again and with it being triple negative, I'd like to know what you think".

I think this took him aback for half a second.

He then explained his position:

"Ultrasound is a good way to see where we're at. But it can't show cells. Only masses and lumps. Pathology is the best for that, which we won't get till after surgery. So if we do 6 cause ultrasound shows clean (ie no detectable canser on ultrasound) and after surgery pathology still shows canser cells, we would potentially have to do 2 more rounds of chemo then. Research says doing more for sake of doing more does not show benefit, but with only an ultrasound, we won't know if we are doing more to kill cells, or just extra. "

So I asked if we should just do 8 then? He said it was up to me. I said, no, I want to know what you recommend.

He went on to explain that because we were dealing with a canser we're concerned about (ie triple negative and assume cause it was so aggressive)  and I'm tolerating the treatment well, he'd recommend...(and here he actually physically leaned back in his chair lol) 8 rounds. 

Me: "Ok! I'd rather go through all the hell now then break it up. I don't think I could handle more chemo after surgery (emotionally)"

I think this took him by surprise.

I asked what happens if after 8 they should still find canser cells after surgery? Could we do more chemo then? He said no, 8 rounds is kinda the max but that radiation would take care of any localised cells that might be left. Cause chemo should have taken care of any potential break off cells that might have travelled elsewhere.

We are still going to get the ultrasound done so we have an idea where we're at. 

But I'm good with the decision to do 8 treatments from the way he explained it ( I'm sure there is way more to it than the layman's terms he explained to me). And I trust Dr Stewart. If there's still canser detectable on ultrasound this becomes a moot point anyways.

So 2 more rounds after tomorrow's. My last official dose should be Sept 23, assuming no delays. That puts surgery mid/late Oct. Friday we meet with the Radiation Oncologist to have an initial consult. Hopefully we'll get an idea how long after surgery I would start just so we have an idea what life will be like the next few months. 

I can finally see the light at the end of the chemo tunnel. It feels good.