Three Thumbs Up

Emu Tree

Today, I had my first follow-up appointment with my oncologist, Dr. David Heyer, so he could check the progress of the tumor.

Before examining me, he asked if I thought there was any progress in the tumor shrinkage and I replied "Yes, I am pretty sure there is a big difference." I hopped on the table and he began feeling the left breast.

Dr Heyer: "Hmm... wow... OMG... big difference... wow..."
Jennifer: "There is a difference, right?"
Dr Heyer: "Yes, significant difference, Jennifer"
He continued feeling all around, at all angles, and shaking his head in disbelief.
Jennifer: "Can you show me where the actual location of the tumor is because I'm not so sure."

He placed his hand on my hand and pressed deeply on the far right side of my left breast directly against the sternum.

Jennifer: "You know, I will be honest, I don't know if I would have ever felt this lump during my monthly exam."
Dr Heyer: "You wouldn't have."

I contemplated this for a few seconds and took a deep breath. This could have been so much worse if I did not give birth to Camilla, if I didn't breast feed... my baby truly saved my life in more ways than one.

One of my best friends, Amy, went to the appointment with me. She is in the medical field and started to ask specific questions.

Amy: "Do you expect this type of progress based on a second treatment?"
Dr Heyer: "Absolutely not. This much progress is remarkable."

I also had several questions to ask:

1. What if the lung nodules continue to grow during chemo and we aren't aware they are growing? Dr. Heyer said there is a 0% chance this would happen, even though he said he should never say 0%. His hopes are that the nodules are killed off by chemo due to their small size. If for some reason the nodules were resistant (which is slim) they would remain the same and not grow.  
2. How do you think the cancer reached the lung nodules? I had my own opinions after looking over my medical records. My radiologist, pathologist and breast surgeon confirmed my lymph nodes appeared to be contained. My idea was that the lymph nodes appeared due to local metastasis, which is when a tumor was aggressive enough to force through cell walls. Dr. Heyer said he thinks the tumor literally sidetracked and got into the lung lymph node, which created the nodules. He doesn't believe it spread via the systemic lymph nodes (it's the highway of the body which is a very good thing). However, there are lymph nodes that go directly to an organ and the tumor penetrated the lung lymph node.
3. Chemo - He considered minimizing the number of chemo treatments left and schedule surgery sooner; however, after a couple minutes of deliberation he decided we will stick to our original plan. He wants to see me again after two more sessions and will only do a PETscan after my last treatment to "restage" me. We will then discuss surgery and radiation.
4. AC vs. Taxotere/Carboplatin - I asked why he ultimately switch from AC to the current chemo plan. He explained he does not like to give the drug Adriamycin to young women due to the risk of heart issues post treatment. He said, "I compared you to a 68-year-old woman with cancer. Why would I want to give a 35-year-old woman a treatment risking heart problems for the rest of her life?" Point taken.
5. Turkey Tail Mushrooms - OK. I am obsessed with this new study about the benefit of turkey tail mushrooms. I initially asked him, "So, what are your thoughts on turkey tail... and he looked bewildered. Amy then interjected, "It's a mushroom." He said, he is not opposed to things like this if I want to try them, but that I am not to try them during chemo because it could be toxic when mixed together. He explained all chemo drugs are a derivative of a plant or tree and the specific chemo I am on comes from the bark of an emu tree, so if I want to go eat some bark ... (what a funny guy, he is). I asked where I could get an emu tree because I WILL eat bark, if necessary ;) I really don't think this surprised him one bit. Anyhow, he said that I can take the turkey tail mushroom supplement if I choose, but after chemo. I promised.
6. Side Effects - I have yet to have any significant side effects from chemo. He was quite happy to hear this and joked he made the girls out front (his nursing staff) promise not to make me sick or they would need to answer to him (again, he is such a funny man).
7. Tumor Marking - Tumor marking is done by blood work and used to manage cancer patients. I asked his thoughts on tumor marking. He said he doesn't prefer tumor marking because it is not completely accurate and causes a lot of unnecessary anxiety. He prefers to scan which I will have done every three months.

Overall, Dr Heyer said if he had three thumbs he would give me three thumbs up! The news he gave me today was better than he would have ever dreamed of giving. Before he left, I asked if I could give him a big hug and he said of course - he left grinning ear-to-ear and finally said the words I needed to hear, "I think everything is going to be OK."