I’ve returned to work on May 3. It was a bit tiring, mostly from having to get up early again in the morning. I was so used to sleeping in and taking naps during my days off. :-) I’m able to drive myself with not much problem. Yesterday, I also returned to my first step aerobics class since surgery. It was therapeutic to be able to resume my normal exercise.
During these two weeks, Siang and I also struggled with some hard decisions, trying to determine whether we should proceed with chemotherapy or not. Both oncologists we met recommended it. The tricky thing is my prognosis is sort of in the gray area. My lymph node status is negative, tumor margin is clear. I had a mastectomy hence no need for radiation. According to statistics, there’s a 67% chance that I’m already cured.
However, due to the tumor size, my age and the tumor growth rate, both doctors categorized me as high-risk. There is a chance that there’re microscopic cancerous activities going on in the rest of my body that cannot be detected via any medical screening. Also, because my projected life span is much longer than the average breast cancer patient, there’s a higher probability for the cancer to reoccur in the future.
We know for certain that hormone therapy would be beneficial because my tumor is ER/PR receptor positive. Hormone therapy would increase my cure rate from 67% to about 77%. The docs believe that adding chemo on top of hormone therapy would increase the % to about 83%. However, most of the statistics currently available are not that relevant to patients in my age group. The long-term side effects of all the drugs known today might be incomplete b/c most of the patients who took the drugs do not live beyond 25 years after chemo.
It was hard trying to weigh the benefits and risks. Is it worth all the side effects? Would I be cured of breast cancer but left with low quality of life because of all these other potential problems that come with these potent drugs? e.g. leukemia, endometrial cancer, heart damage, infertility, early menopause, the list goes on… But what if there is really microscopic stuff going on and I miss out on the chance to clean everything up?
My geeky husband was trying to calculate probability. I almost wanted to dig out the Excel decision tree model I learned in school to help me decide. :-) But life is never that simple and clear-cut. The only thing we can lean on is for God to guide us through.
We met with the oncologist at the Seattle Cancer Care Alliance again this past Thursday. After a few clarifying questions, we felt a bit more comfortable about going forth with chemotherapy. For now we’ve decided to go with the following treatment:
For those of you who are in the medical field --
Chemotherapy (3 months, start on May 21):
12 weeks of dose dense AC + Neupogen
Adriamycin – administered weekly intravenously
Cytoxane – daily orally
Neupogen – injection I give myself everyday except on chemo days
Hormone Therapy (2.5 -5 years):
2.5 years of Zoladex (monthly injection, start 2 weeks prior to chemo)
2 years of Aromatase inhibitor (start after chemo is completed)
maybe 3 more years of Tamoxifen (depending on whether we want to have kids or not)
I have already received my first shot of Zoladex. This is a shot into the fatty tissues in the belly. Its function is to temporarily shut down the ovarian functions and minimize the amount of ER/PR production. Unfortunately I stumbled across a picture of the Zoladex needle a week ago. It is no ordinary needle. When I saw the nurse, the first thing she warned me was this was a very thick needle, but she said I did not have to look at it. She had to find some good fat in my belly for the shot. I’m thankful that I have plenty of good fat in that region for her to choose from. An ab with 6 packs would not do me any good in this case. The nurse gave me a shot of numbing medicine first before poking me with the Zoladex needle. I closed my eyes the whole time. Now there’s a big bruise on my belly. It wasn’t too bad, I think I can take that… but as I imagine I have to do this once a month for 2.5 years…. that’s 30 shots in total. Wait, plus the numbing medicine, that’s 60 shots. Wait, plus the daily Neupogen shot I have to give myself when chemo starts, that’s another 72 shots, a total of 132 shots into my belly. Nice… Hopefully the Neupogen shots would not give me bruises, otherwise, my belly would be very colorful… … I might as well try to create some sort of tattoo for fun.
Prayer Requests:
(1) God will strengthen my body in preparation for chemo. I’ve lost 7 lbs after surgery, I was told to gain some weight before chemo starts, but not too much. :-)
(2) Before I receive my first dose of chemo, I’ll be having another outpatient surgery to implant a catheter under my skin for ease of drug administration and blood draw. Please pray that the surgery will be smooth and successful.
(3) Continue to pray that I’ll regain my arm/shoulder range of motion and restore my strength. I’ll have my first meeting with a physical therapist this Tuesday.
(4) Pray for peace for Siang and all my loved ones.
(5) I’ll be drawn closer and closer to God and experience His grace on a deeper level.
'Three times I pleaded with the Lord to take it away from me. But the Lord said to me, "My grace is sufficient for you, for My power is made perfect in weakness." Therefore, I will boast all the more gladly about my weaknesses, so that Christ's power may rest on me. That is why, for Christ's sake, I delight in weaknesses, in insults, in hardships, in persecutions, in difficulties. For when I am weak, then I am strong.' (2 Corinthians 12:8-10)