What's Next?

So, it's been nearly 3 weeks since my last chemo infusion (and my last post), and the question I get asked most is: "What's next for you?" So... Here's the scoop.

Maintenance Infusions

I'll continue receiving infusions every 3 weeks, for the remainder of a year. But, they'll be much easier to tolerate.

Up to now, I was receiving 4 meds at each infusion: 2 chemo drugs, and 2 smart drugs. I'll continue receiving just the smart drugs for the remainder of a year. 

All cells, or maybe just all breast cells, have a certain receptor on them called HER2 Receptor. This attracts a protein, also called HER2, which tells the call to divide. Normal cells have 2 or so receptors, but HER2++ c cells have a lot of them, so they attract a lot of the protein, and divide much more rapidly. This makes this type of c more aggressive, but doctors are really smart, and they have medications that block these receptors, essentially turning off the division mechanism. So, if the cells can't divide, the c can't continue to grow and spread. Yay!

Plus, since these meds are so smart, they don't have nearly the amount of side effects that chemo meds have, because they're targeting only the c cells, rather than all fast-growing cells. I'm told I can expect some tummy troubles, but nothing like I've been experiencing. Double yay!

Radiation

Another thing coming up is radiation. I've already met the radiation oncologist, and I'm waiting on insurance to approve my treatment so I can get it scheduled, which should happen maybe this coming week.

The first step in that process (well, second, after my initial consult last week), is a planning appointment. This involves using a CT scan to map out my body and the zones they want to target, plus the nearby organs they want to miss. Then about a week later, I will start receiving the radiation. I'll have 6 weeks of 5 sessions per week. 

They target the entire breast area (because a mastectomy cannot remove 100% of the breast tissue), the armpit (because of that one pesky lymph node) plus another small area nearby that "c likes to go to next if it's going somewhere else."

Side effects should be minimal: 

-Redness that looks like a sunburn, but doesn't hurt.

-Potential skin breakdown, since the skin nearest the incision is very thin and new. If this happens, and I think it's rare, I think we just take a couple days off and be more aggressive with what cream I need to use on the area.

-Some fatigue, more toward the end, but nothing like chemo fatigue.

Some questions I've gotten (or had myself) about radiation:

Q: Is radiation necessary? 

A: It's necessary because with lymph+, hormone+, HER2++ c, the standard of care is surgery, chemo, radiation, hormone therapy. It is a proven treatment, not experimental. 

Q: Do they do a scan of some sort first to see exactly what we are radiating, if there's still c there, etc?

A: The areas areas I talked about above are the standard places to radiate in cases like mine, so they don't need to do a "look for more c" type of scan first.

Q: Is radiation dangerous to other organs, like your lungs?

A: That's what the CT scan is for. It allows them to minimize the radiation to other areas. For example, only 2-3% of the lung, right on the edge, will receive any radiation at all. None will hit my heart, esophagus, or any other important stuff in that area.

Q: How does radiation work, and what's the difference between chemo and radiation?

A: Chemo is medicine that I received by infusion. Picture an IV bag, but instead of a regular needle, it goes into the port in my chest, near my collar bone. (If you ever wanna see it, I can show you. It's not gruesome.) 

Radiation, on the other hand, is like... Laser beams, I guess. They aim the machine at the targeted areas and blast it. It does two things, and I can't take credit for this analogy - it's courtesy of the Radiation PA, who was great at explaining things. So, radiation kills any "seeds" that might be trying to take root in that area. It also changes the environment, making it inhospitable to growing anything new. So kind of like the opposite of fertilizing a garden.

Hormone Therapy

This is a pill for 5 years,  suppresses estrogen and progestin, and that's about all I know about that. I think I start it after I finish the smart drugs, so next summer.

Reconstruction Surgeries

About 6 months after radiation, I'll have my first reconstruction surgery. This involves taking a section of abdominal tissue (think: tummy tuck), and using that to construct a new breast. The procedure is called DIEP Flap Reconstruction, if you care to google, but I probably wouldn't do a lot of googling if I were you. Recovery is about 3 months. 

Then, we will talk about phase two surgery, which will be for symmetry (think: boob job, ha). The recovery for that one is much easier, more like 4-6 weeks or so I think.

Ok, that got really long. If you have more questions about what's next, please ask - I don't mind sharing details!

In the meantime, I may not be posting a whole lot because I'M BUSY FEELING LIKE A PERSON AGAIN!!