At long last, we have a treatment plan.
On Monday, Christian and I met with my Oncologist, Dr. G, at the Cancer Center. It was such an incredibly nerve-wracking few days leading up to the appointment. I was terrified of more bad news, more uncertainty, more tests. I didn’t know what to expect, but I was reaching the end of my rope. I needed to stop waiting and move forward. As you could expect, that made me a real peach to be around all weekend.
Our appointment, originally scheduled for 4:15 pm, didn’t happen until close to 5. We had several other auxiliary consultations that afternoon with the dietician and chaplain, the whole time waiting, dreading, nervous for what was to come. By the end of the day, Christian and I were so emotionally exhausted that we curled up on one of the couches in the waiting room and dozed for a little bit. I’m sure we were quite the picture, with our heads on each other’s shoulders, holding hands, finding a rare moment of quiet and calm in the midst of this storm.
K, Dr. G’s nurse practitioner, came in first to meet with us and got right to the point: the biopsy results showed that the cancer had spread to my bones, so my diagnosis of metastatic breast cancer has now been confirmed. She was very matter-of-fact, but also stressed to us that she was tremendously optimistic about my prognosis. I rolled out my laundry list of questions and we addressed them one by one. We talked about treatment plans, lifestyle changes, personal care needs, and maintaining my expectations and projections for these medications and possible future protocols.
While we currently don’t know much about my particular cancer, and it is, unfortunately, very advanced, the things we do know are all fairly positive. Stage 4 breast cancer encompasses a lot of different situations: people with numerous recurrences, hormone receptor statuses, ages, genetic risk factors, and locations of metastases, to name a few. If you google “life expectancy for stage 4 breast cancer”, the information you’re going to get is remarkably grim: around 20% of women life past five years with a metastatic diagnosis. Our doctors have been very clear that these statistics are both outdated and inaccurate. I have the most common type of breast cancer, invasive ductal carcinoma, and the most common type of hormone receptor: estrogen receptor positive. This means that there are a lot of different types of drug therapies available to me. Additionally, new treatments for breast cancer are being developed all the time. A drug that I will be starting in January is less than two years old! That means that it was not available for use outside of clinical trials when Felix was born! This fact boggles my mind. K elaborated that she thinks there may even be a cure for metastatic breast cancer – which is currently treatable but incurable – developed in my lifetime. Not just a treatment, but a cure. At one point, I asked her point-blank about my life expectancy. She refused to give a number, only repeating “we just don’t know at this point.” When I pressed her, she reiterated what she had said previously: there are many treatments available and new ones are being developed with incredible speed and regularity. “Many, many years” was all that she would offer, until, and unless, we learn more that shows otherwise. Further on my side: the cancer has only spread to my bones, not my liver, lungs, brain, or any vital organ. While this causes me a bit of bone pain, it is not impeding any major bodily functions. All told, I’m young, otherwise healthy, and am at one of the best cancer facilities in the world. There is no reason not to be optimistic.
After this conversation, I started to feel much more at ease. There were no more big surprises waiting for us today, no grim reapers looming in the shadows. We were finally starting treatment. Unlike the previous protocol that had been discussed when my cancer was thought to be stage 2, chemotherapy and surgery are currently not options. Instead, I will receive two shots a month: the first shot, Lupron, will force my ovaries to cease functioning. This will cut off significant estrogen production for my body and force me into immediate menopause. The second, Xgeva, will help my bone strength and eventually reduce my bone pain. In addition to these two shots, I will take an aromatase inhibitor, Letrozole, every morning. I also received some more targeted pain medications to address my bone pain. In January, when I return to the Cancer Center for my monthly shots, I will also start Ibrance (Palbocyclib), an entirely new class of drug that is designed to inhibit cellular proliferation in metastatic breast cancer cells. This drug has had impressive results in clinical trials, and my doctors are very optimistic about this combination. However, they have also stressed that if this protocol doesn’t work, there are others to try as well. In addition, the side effects of these medications are not anticipated to be nearly as debilitating as those from surgery or chemo. As the appointment went on, it felt like K and Dr. G were handing back to me small pieces of my life, pieces that had been lost in the devastation of this diagnosis. I slowly felt tension and anxiety and fear I had been carrying ease up a tiny bit as I gathered the tools I would use to gradually rebuild.
We concluded the appointment on a positive note, and I went downstairs to do blood work, while Christian hustled to the pharmacy to pick up my medications before they closed. It was just after 6 pm by this point. Once they finished the blood draw I returned to the exam room to receive my first injections. This was really and truly happening. I was finally beginning treatment. It felt surreal. The first shot went into my arm without any issue. The second needle was one of the largest I had ever seen. This was the shot that would immediately shut down my ovaries. Once I received the shot, I would never be able to have any more children. I mentioned this to the nurse, and we shared a sad smile. I took a moment, and felt a small sob choke in my throat. But for our trying to expand our family, I would probably not have made my appointment with Dr. F when I did. Instead of welcoming a new baby next year, we will be managing our new normal as a family living with cancer. But instead of mourning things that didn’t go according to our plan, we now have an entirely new blank slate. We have an opportunity to explore life as a family of three. We can move forward knowing that, by making this choice, we are making it so that we can have each other for as long as possible. And I am ok with that. The nurse administered the shot, and with that, I was in treatment.