Dr. David DeBiose, Radiation Oncologist

Daniel's cell phone alarm went off at 0700--he sets his phone when he makes appointments, then forgets about them, and it wasn't written on the calendar. When he got up and looked, it was an eye appointment for a check on his pre-glaucoma condition, at 0800. So he got out early. He called about 10:00, saying he was just leaving, and that the Dr did some further testing after dilating his eyes. Dr said everything was stable, no changes from the previous check 6 months ago, but wants to do a visual field test, and that's scheduled for sometime mid-January.

I was up, dressed, and fed, and worked on yesterday's entry. Daniel came in, fussing that he couldn't see because of the dilation, and finally closed his eyes and rested.

We left to go over to Ingham Greenlawn where the Radiology Center is. Dan let me out at the door to go in and drop off the request for medical records. I did that, and went back out to the car and we drove around the building to park. Inside, the nice lady Vicky had me sign in, and she asked for my insurance card and the forms I had filled out, and handed me a clipboard with even more forms to sign. She copied the card and handed it back, I went to sit near a window in the sun and fill out the new pile of paperwork. I took that stuff back to Vicky, who thanked me and said she'd tell the RN that we were here, then returned to wait to be called.

And wait. We finally got called back about 2:15. Melissa is an RN who is also certified in radiation as well as chemotherapy. She led us back to an exam room (typical exam room--small, exam table, exam light with a flexible "gooseneck", two chairs, rolling stool, counter with sink, etc.) Melissa told me to leave my coat and purse in the room, and Dan stay there too, while she and I go to where the scales are kept. 142 lb. We go back into the room, she reviews the history stuff I've filled out, and after we've chatted a bit, she checks my blood pressure. 128/66, pulse 88, temp 98.0. Melissa also measured the circumference of my arms. She measured 10 cm from the outer elbow down the forearm and up the upper arm, one arm at a time. The left arm was: Upper-30 cm, Lower-23 1/2 cm. Right arm, Upper-27 1/2 cm, Lower-23 cm. She starts talking about the status of my tumor--receptors positive, etc, and that I've got all the "good" things going for me. She likes Dr Amy Bolmer, and we discussed the treatment options given us. Melissa, being very familiar with the drugs, told us that if there was another tumor of some type in the future, I would not be able to have the Adriamycin again. So her thoughts were to go with just the cytoxin and taxotere; that way the Adriamycin would be out there available if we needed to use it. And it's so harsh. I liked her thinking. She also said that one of the drugs, I think it was the Cytoxin, causes neuropathy (numbness). Permanent. In the hands and feet. What?? I ask her if it resolves over time, she says not usually. She couldn't predict how my body would respond, but that it almost always causes some residual numbness, at least in the fingers and toes. I asked about fingernails and toenails. She nodded her head--the nails lift up off the bed. Eww. They do recover, but it takes a while, like almost a year. And we are doing this on purpose?? Well, I've always had pretty hands, and I've liked them. If they change, I guess I'll be ok with that, at least I'll be alive to remember what they were like. And we have the beautiful hand pictures of our wedding rings, and of Mom's and my hands. Yep, I'm ok with that. The numbness, though, ......not so much.

We had a good discussion: she answered our questions about some things that Amy had said yesterday, and expounded on a lot of things too. She seems to know her stuff. She told us about the radiation treatments--how it's not invasive (no iv's or anything), and the statastics of radiation vs. no radiation. Much better to have radiation. We picked her brain for other concerns and questions, and we were done. She asked me to change into the patient gown, shook our hands again, and left the room.

Dr. DeBiose came in after a few minutes. He was maybe 50-ish, maybe 5'8" tall. Very pleasant, he shook my hand, and I introduced him to Daniel, they shook hands. He launched into a few questions about how we were doing, and what the treatment plan is. He asked me to sit up on the exam table. I told him chemo starts January 9. He told us that the Ingham Radiology Center is unique in that it is affiliated with McLaren Health Systems, Michigan State University, and University of Michigan. He mentioned that Foote Health System has a University of Michigan affiliated radiology program, and he offered if I preferred to go to Jackson for my treatments. I asked if I could have treatments in both places--no, the machines are too sensitive, and if we tried to change the adjustments from one to the other, there is no way to make it precise enough. So, I chose to stay in Lansing.

He said radiation usually starts a couple weeks after the chemo is completed, and mine will be daily, 5 days a week, for 6 weeks. He went on to talk about the risks, what happens, and what to expect. He was summoned at that point by a knock on the door, and excused himself. He came back in after just a few minutes. He started talking again about the process, and asked to examine my breast. He poked and felt, he was focused on the pouch above the axillary wound and talked about lymphedema. Right now this collection of fluid is what I have, but that may change at any time in the future. He said that with all of the factors of my cancer, he will not radiate the armpit. (Yea!!) It will be just the whole of the breast tissue, and he indicated an area larger than the breast that we see. Also, he said he will not include any other lymph, like in the sub-clavicular area (below the collarbone). He feels that there is no need to bother that lymph system any more than what it is. He also looked at the breast, the incision on the breast, the areola, etc. He thought it was healing well, and said when the seroma and hematoma have gone my breast may be a bit mis-shapen. He also said that radiation makes the breast tissue more firm, like fibrous, like it's scar tissue inside. And it will stay, if you will, "perky", where the right one will sag with the passing of time. Hm. Interesting.

And we ask why then don't we do radiation on both breasts? Because each breast is it's own entity, and each breast cancer tumor is its own. Like, the cancer won't migrate to the other breast. So we only treat the affected one. Oh.

He is done telling us all the required stuff, and we've asked all of our questions. He said the office will check with Amy's office to see how I'm doing, and in a couple of months maybe we'll get a CT scan of the breast. If I'm not up to it, we can wait until after the chemo is done and do it then. Then we start the radiation about 2 weeks after the chemo is done, daily for 6 weeks. Wow.

No more questions, he shakes our hands again and shows us out. Dan and I walk back to the car, saying how much we liked both of those professionals. It was 4 o'clock, we had been in there almost 2 hours. I called the nursing home and asked the staff to feed Elaine, as I was hungry myself, and wanted to spend time with Daniel.

We stopped at Flap Jack Shack, ate, got home. Dan put the ace wraps on for me, and I headed to Jackson. Mom was just being brought from the feeder room, and I told her how the visit went. She made the noises she makes when trying to talk, and I talked back to her like I knew what she was saying. I got her washed up and ready for bed, tucked in, and came home. I got home about 9, Daniel was already in bed asleep.

He woke up and held me. That was really nice. He reassured me that we'll get through this, that this time next year we would be almost back to "normal".

Is there a normal...???

Friday is a workday, Saturday is haircut and party in the evening in Flint, and Sunday is our Family Christmas is Concord. I asked Mom if she was looking forward to going to the Christmas party, she nodded her head yes.

Thanks for reading, for supporting us, for praying for us. For the phone calls, emails, and especially the hugs. Your positive energies are easing this difficult road. Love you all. Kathy & Dan

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.