Dr. Amy Bolmer, Medication Oncologist

This morning, it was evident that both Dan and I had "something on our minds"... distracted, short sentences and phrases, minimal conversation. I caught myself several times recognizing the anxiety, and taking a deep breath to slow it down. As we had our coats on to leave, we stood there looking at each other. I held him, he held me, and off we went.

Dan and I were at Dr. Bolmer's office about 2:50. I signed in, and the nice lady asked if I had brought my paperwork with me. Yes, and handed them over. She also wanted my driver's license and insurance card to make copies of. We waited a bit, then were shown to exam room 9. On the way down the hall, we stopped at the scale. Dan held my coat, purse, and envelope with my note paper while Latira, or something (no name badges) asked me to step on the scale. 145 lb. Hm. We went into exam room 9, and she took my blood pressure--110/66, temp 97.1, pulse 88. Good, she says. While the blood pressure cuff is on, she asks if she can take my picture for the chart, reaches into a pouch on the machine's stand, and pulls out a polaroid camera. *Flash* click, there it is. Interesting. I wanted to say something smart, like what are you going to do, take one now then take one later when I'm feeling like *^^$#$%^&*??? She briefly looked through the chart, said something about Dr. coming in, and left.

We were in a typical exam room: cabinet, counter, sink, exam table, and 2 chairs. I thought of my friend (Lucy) who likes to open all the drawers and doors and play with the equipment. I tried to get up but was stuck to my chair. In just a few minutes, Dr came in.

She was maybe late 40's early 50's , shoulder length naturally curly light brown hair, tamed with magnifier glasses on top of her head. She greeted us, and she had a raspy voice like a cold or talking too much today or heavy smokers or screamers might have. Interesting--Dr. Sanchez said this woman had been practicing about 5 years, too, and I expected to see a younger person. Dan reminded me that Sanchez also said Dr. Bolmer had been a nurse before becoming a physician. Oh, I had forgotten that. Anyway, she introduced herself, I stood and shook her hand and introduced Daniel, who also stood and shook her hand. Dr. Amy Bolmer pulled up the rolling stool and sat opposite me, using the exam table for a desk. I had my paper and pen handy, and put it up there, too. She spoke fast--so fast I had to keep focused on what she was saying. I did understand the words, the concepts, etc, but I couldn't drift off and process it to see what I thought about it, so I wrote down key concepts and ideas that I thought would help me and Dan later on.

Amy said the tumor was 1.4 cm, and that the DNA studies on the tumor revealed that it was ER+, PR+, and HER2-NEU negative by FISH. (Estrogen Receptor positive, Progesterone Receptor positive, and the HER stuff--the FISH is the type of study). Grade II, Stage II. Which, she said, is all good. (hm, good) So you'll have chemotherapy and radiation, and follow up hormone therapy for 5 years because you're pre-menopausal. When pre-menopausal women have breast cancer we like to treat it aggressively, which leads us to treatment options. (options??)

We can do Adriamycin and Cytoxin, 4 cycles, then Taxol, 4 cycles, for a total of 16 weeks. She called this a dose dense therapy, and it's pretty harsh on the body. Dan says he remembers her saying that you have treatments every 2 weeks, and she said you feel kind of rough for about 10 days, you might feel better for a few days, then it's time for your next treatment.

The other option is Cytoxin and Taxotere, 3 cycles, for a total of 12 weeks. This combination is less harsh, relatively new (in that the women in the studies are only 3 years out of treatment), but she felt that my factors lend to this option. Also, the treatments are every 3 weeks, and you feel better for about 10 days before the next one.

She said that whichever course we decide, we would start on January 9 and January 10. Radiation treatments will start after the chemotherapy is finished. Oh, that's fast.

She went on to explain that the drugs work by inhibiting cell reproduction, and that hair follicles and bone marrow are cells that reproduce quickly. What that means is that you will lose your hair, and we will follow your blood studies for red blood cells and platelets. Oh. Ok. As she is talking so fast, and I'm trying to keep up with her, she takes her prescription pad out and puts it on the table. And so, she says, I'm going to write you a prescription (pause-writing) for (pause-writing) a cranial (pause-and she looks up at me) hair (pause-writing) prosthesis. She looks up at me, tears the page from the pad, and slides the script over. What!!??? You're writing me a prescription for a WIG!?!?!? You're not kidding --I said that outloud--I realized that I had an expression of incredulous-ness, and I was laughing. Yes, she said, some insurances cover a wig with a prescription. Oh, ok. Do you have a recommendation for a wig shop? Yes, Elegance, in the Frandor shopping center. Ok, when will my hair come out? Usually after the first treatment, in a couple of weeks. Hm--holy doo dah. I'm gonna need a wig. She starts talking again, I need to keep up....

Regardless of which treatment option we choose, she felt there was a GOOD PROGNOSIS. I heard that part ok. And I said, Wait, I'm going to write that right here, in the middle of my paper, where there was a large blank area. She smiled. I think that was about the only time she was quiet and wasn't wiggling all over. I mean that her arms, hands, legs, feet, were always moving. And she called the other patients "the ladies".

We went on to discuss the actual process--IV administration of the chemotherapy one day, the next day back for IV fluids--one or two bags, depending on how you're feeling nausea and vomiting-wise. She said they've found that the second day hydration improves how you tolerate the chemicals. Then you come back in a couple 2 or 3 weeks for your next treatment, whichever course we choose. We talked about other supportive medications, like Zofran, Decadron, Benadryl, Nexium, Neulasta, Procrit--all of which may be used at some point. She did say that with the Adriamycin option they first infuse Zofran, Decadron, and Benadryl, and that with the other option only the Zofran and Decadron, because it's not so harsh. All things to consider.

She also mentioned that because of my status--type and size of tumor, age, pre-menopausal, etc--that genetic studies will be considered. Dan and I asked if they would send a pre-authorization request to BCBS. Those results will impact everyone on my bloodline tree. The genetic studies, hopefully, will be done fairly soon. We will probably hear about that in January.

Dr was done, it had been 1 1/2 hours. She invited Phyllis, one of the nurses, to come in and take us on the tour of the office. There were 10 exam rooms, and 12 IV rooms. Each IV room had a recliner with an iv pole built-in, a wall-mounted tv, 2 side chairs, counter with sink, and a window. She said we were welcome to bring personal music, needlework etc, snacks, 1 or 2 people, etc., whatever we needed to help pass the time and be comfortable. Phyllis looked at my right arm for potential iv sites--she said they looked good. I told her I had poopy veins. She said they use 24 gauge needles and usually remove them each time. But could be left in overnight for hydration the next day, whatever works for you. Ok. And we can place a port at any time. Ok.

We didn't have any other questions, and went to the window to check out and make the appointments for the first treatments, January 9 at 10:00 for whichever chemo course we choose, and January 10 at 10:30 for hydration. The first appointment will be approximately 4 hours. Wow.

I am saturated with all that I have heard. Dan and I leave, we're quiet, and hold hands through the parking lot. We look at each other after we get in the car. Wow, I said. It's real. Yeah, he said. I told him it became real for me when she slid that prescription over for the wig. Yeah, he smiled.

We get home, I chew on some food, and head to Jackson to get Elaine in bed, I also have folding tables and chairs in the van for Jim and Polly to pick up for our family Christmas on Sunday. I do all that, and stop at Meijer on the way home, and find that it' s 11 o'clock when I leave the store. Whoa--I didn't mean to be that late. But I've learned to take the time I need, and evidently I had a hard time staying on track. (you think..???) I got home, chatted with Dan and Breon, had a bite to eat, and tried to write. I was so tired, the keyboard was dyslexic, so I just wrote a brief note to the blog. (this is the alteration of that entry)

Daniel and I have info to chew on, research, and make a decision. Tomorrow, Thursday, we see the radiation oncologist, Dr David DeBiose, at 1:45.

Thank you all for your prayers and energies. Each of you help us maintain. I'll write again.