October 24, 2006: Post-Surgical Update

Family & Friends,

I have to apologize for the late update - things have been a bit crazy in the last week around the house, and I've started going back to work on the days that I don't have doctor's appts. I have been very bad at replying to emails, so you'll have to forgive me if I haven't personally replied to you yet.

We finally got some good news from the Tumor Board last week. It looks like they are not recommending that I go in for a second surgery right now, and that the positive lymph nodes will be treated through chemo & localized radiation (of the chest & axilla).

Right now, the plan is that I will start chemo around Nov 27th and will do a regimen called CAF for 18 wks (every 3 wks x 6). Once that has has concluded (approx March), they will give me a break. There is some discussion about whether or not I will have Taxol for an additional 12 wks after the CAF, and that remains undecided at this point. Once the chemo has concluded, I will have 8 wks of daily radiation (during weekdays only), and will start another drug called Herceptin every 3 wks through my VAP (port in my chest) for another full year. Herceptin is considered the biggest break-through in cancer research and because my tumors are Her-2 positive, I can have the medication...it reduces recurrence levels by over 50%! My tumors are also Estrogen/Progesterone receptor positive, so I will likely take Tamoxifen for 5 yrs once the chemo has concluded to prevent recurrence. From what I understand so far, the Herceptin and Tamoxifen don't have the std chemo reactions, so I'll be able to go back to normal life after the chemo/radiation are over.

On a side note from the Tumor Board mtg - the Pathologist let Jeff & I go in to look at all of my slides under the microscope and spent over an hr explaining what they look for, how the cells looked different, and how they identify the different hormone & Her-2 receptors. It was fascinating!! I really feel confident about my doctors and believe that they are doing everything they possibly can to give us the best medical attn available. My Oncologist has been speaking with specialists from Stanford (she just moved out to the East Bay from the Breast Center at Stanford) as well as Cooper Univ in NJ. The Tumor Board was also a conglomerate of many Oncologists, Pathologists, Surgeons, etc who are part of the John Muir Medical Center system...having all of those heads together on my case is amazing to say the least.

Over the next 5 wks, I will be undergoing genetic counseling to find out if I carry the genes for breast/ovarian cancer (BRCA1/BRCA2)...if I do, then I will likely have a preventative left mastectomy and have my ovaries removed since there is a large correlation between genetic breast cancer & ovarian cancer, and monitoring the ovaries for cancer is not down to a science yet. The removal of the ovaries will put me into menopause (if the chemo doesn't already do it), so there will be concerns about my bone density and a much higher risk of osteoporosis in the future. I am also going in for a baseline echo-cardiogram, and will be continuing these every 3 months to ensure there aren't any dangerous changes in my heart...heart problems are one of the side effects of the meds I will have to take, so the docs will be following me closely.

I saw my surgeon yesterday, and she says the scar is healing wonderfully and that I have great mobility in my right arm (not at it's full potential, but better than her normal post-menopausal patients....I attribute that to picking up Maryn, who is almost 19 lbs now!!). I'm feeling good overall - a bit tired still, and I find that I really hit an exhaustion period in the afternoons, especially with Maryn waking 1-5x/night (lovely teething & colds in our house). My mom came in this past Sat, and has been a huge help around the house and with Maryn. Jeff seems to be doing well, and is accompanying me to all the appts to ensure we get the same info out of the discussions. He has been incredible through all of this!

Thank you so much for all of your support!!

With love,
Leanne