The Treatment Plan and COVID

This is going to be more or less a "just the facts post."

The two weeks following diagnosis were filled with appointments for additional testing and follow-up  including 1) a lymph node biopsy on my left side to see if the cancer has moved out of the left breast into the lymph nodes; 2) a biopsy of the right breast to check some suspicious masses; 3) consultation with the reconstructive plastic surgeon who will work in tandem with my surgeon who will perform the mastectomy; and 4) a follow-up with my surgeon to discuss treatment plan and test results. With a lot of self-advocacy, we were able to have all these appointments completed within a very short time. I also had genetic testing done, and the results showed that I'm positive for a BRCA2 mutation. This means that my ovaries and Fallopian tubes will have to come out before I'm 40.

In short, we found out that the cancer had moved to my lymph node on the left side, which changed the treatment plan and also meant that my cancer was now considered Stage II A, rather than stage I.  (Cancer is stage 0-IV). The right breast biopsy came back completely benign. Thank god. Regardless, I’m planning to have the right breast removed because of my BRCA2 positive status.

Even before I got the BRCA2 results, I had decided to go with a bilateral mastectomy.  Especially when my surgeon basically told me that my current breast size is smaller than the smallest implant, so regardless, procedures would have to be done to my right breast to make it symmetrical with the left. My sister and I could not stop laughing at this. That was the clincher for me- if both breasts had to undergo surgery, I want a fully matching set and a nice upgrade.  I obviously have nowhere to go but up!! (Insert boob/melon emojis, whatever you like, because I can’t figure out how to and I’m too tired.)

Here’s the current treatment plan, which may be altered based on the status of the pandemic.

Phase I:
Chemotherapy for 4 months to kill the cancer cells that are in the lymph and my breast and any that may have migrated elsewhere within my body. I will receive a total of 8 chemotherapy treatments, every other Monday. The first four treatments were of of Adriamyacin and Cyclophosphamide and the second four treatments consist of Taxol. I am scheduled to have my last treatment on May 18th! (I can't believe that's just 2 treatments away). ( I will do separate posts on chemo, losing my hair and all that fun stuff).

Before my first chemo treatment, I had to have a port implanted into my chest under my collar bone.

Here I am port installation day, smiling naively.  I came out of anesthesia talking about the book Brave New World, and the concept of soma vacations.  For anyone who hasn’t read it, I highly recommend it.  As an aside, I wish soma vacations were real. 

I was surprised by how much pain I was in the second day after my port installation.  It felt like my skin was going to rip open. Luckily the pain got better within another day or two.

Here’s a picture of what a port is.  It allows the chemo drugs to be delivered through the port, which has a flexible tube that runs directly into a large vein. The port can also be used to administer IV fluids and take blood.

Here I am about a 4-5 days post-port installation on the morning of my first chemo session. To mentally prepare, I did a light workout.  You can see how swollen and bruised the area was still.










When I first started chemo in early February, my sister BB and or B would accompany me.   In the middle of March, due to COVID, Sloan changed its policies so that only patients are allowed in the facilities with very rare exceptions.  To be honest, I don't mind going alone as I'm a person who tends to appreciate and need a decent amount of alone time. And come on, as any parent knows- hours to watch non-cartoon or Disney shows in peace?!! I’ll take it, even if it is to get poison pumped into my body.  

Phase 2:
Bilateral Mastectomy Surgery with insertion of tissue expanders, around June 25th (timing TBD depending on what is going on with the COVID pandemic).  Tissue expanders are essentially empty temporary implants.

I had planned to have a “Tootaloo Titties” party before my mastectomy in June, but given the current situation, I think that we will just have to have a “Hello Hooters” party at the end of 2020 or early 2021 to welcome my new boobs when things aren’t so crazy. Picture it: boob cakes, boob straws, the fabulously booby works :) Because cancer sucks and you need to take and make joy where you can.

Phase 3:
Radiation Therapy that will likely start about a month after the mastectomy surgery and last 6 weeks.  Radiation therapy will be daily Monday-Friday. (This may also be delayed based on COVID because the doctors want me to have as few visits to the hospitals as absolutely necessary).

My mastectomy surgery and radiation therapy could be postponed, in which case I'll be put on hormone therapy (see below) in the meantime to keep the cancer from growing.

Phase 4:
Second part of reconstruction surgery (there are several sub parts to this and in total it’ll be a 6-9 month process to finish) and removal of ovaries and Fallopian tubes.

As you begin the reconstruction phase, you go in for "fills" of the tissue expanders where a nurse will find a port in the expander, and inject saline. I don't think this "fun" part will start until after radiation is complete. Then when I decide on a size that feels comfortable for me and my skin can accommodate,  I have a second surgery to replace the expanders with the permanent implants. Because I tested positive for a BRCA2 mutation, I will also be having my ovaries and Fallopian tubes removed. At my appointment with my oncologist today, she recommended having this done sooner and later, and recommended talking with my surgeons about having it done on the day of the implant insertion surgery.

Phase 5: 
Because my tumor is hormone receptor positive (mostly to estrogen and slightly to progesterone),  I’ll also be on hormone therapy.  In simple terms, being hormone receptor positive means that estrogen/progesterone acts as fuel for the cancer to grow.  Hormone therapy suppresses estrogen and essentially turns the “on” switch to “off” in the cancer.  If there are any errant cells that have migrated out of the breast into other areas of the body that weren't killed by the chemo, the hormone therapy hopefully will suppress those from growing as well.  I will be on hormone therapy for 10 years. The longer you can tolerate it the better.  But essentially, with the removal of my ovaries and the hormone therapy, I'll be prematurely kicked into menopause in my late 30s.  I've heard that comes with it's own shit ton of side effects.  But whatever needs to be done to keep me around for a long time, I'll do it.

All in, this is going to take up the next year (obviously not counting the hormone therapy).  Luckily my work offers generous short term and long term disability benefits, and I’m relieved not to have to think about working during all of these treatments.  I honestly can’t imagine it, especially now with the kids home.

I’m trying to take it one phase at a time, and I am so excited to be 2 treatments away from finishing chemo!!