Appointments, Scans and Emotions

Last week was a total roller coaster of emotions :-\

I saw my Dr (medical oncologist) and had to have ANOTHER test (MUGA scan to follow up the Echo), had some surprising news from him about recurrence factors, cried (in public) despite my best attempts NOT to...and was RADIOACTIVE (seriously! the muga injection left me (slightly) radioactive for at least 2 days)  *sigh*

Perhaps I should start at the beginning...

I went to the Dr (medical oncologist) on Tuesday (1/28) and had an interesting appointment.  It appears that my ejection fractions are going down again.  Since restarting Herceptin in November, my EF went from 59% to about 50%.  I'm still within the 'normal' range that they can continue my Herceptin, so it looks like that will happen, at least until my next echo (approx every 6 weeks).  The MO did tell me that the Cardiologist felt confident in the echo results, but that there was a part of the left ventricle that he wanted a better view of, so they ordered the MUGA scan.  

After discussing the additional test, we started to discuss breast cancer recurrence factors and ways to lower and keep the risk factors lower.  He asked again what my plans were for having children.  We discussed removing my ovaries and what that would mean for lowering recurrence and risk factors.  He told me that as a physician he can't tell me NOT to have children, but that he has my personal best interests in mind (meaning keeping ME healthy) and that it is alright to feel 'selfish' in my decision making.  We had an odd discussion about men and what it might mean for my future marriage if I was unable to have children {please don't judge...it was odd and I couldn't comfortably out myself at the moment...even though, I swear we have had that discussion}.

Looking at the pros and cons of removing my ovaries versus leaving them, it appears that removing them may be the best bet.  Not only will it stop my body from producing estrogen (or at least the majority of the estrogen production), it will also allow my medicines to change.  I will no longer require monthly injections of Zoladex (one less chemical to have in my body) and he can change my daily medication from Tamoxifen to another med (often prescribed to post-menopausal patients; those without their ovaries) with less side effects.  He said that the new daily med would not have the high associated risks that Tamoxifen does (blood clots, increased risk of uterine cancer).  He also said that women who have had breast cancer are already at a higher risk of developing ovarian and uterine cancer.  Removing my ovaries would remove the risk of developing ovarian cancer.  He also pointed out that with my cancer being as aggressive and fast developing as it was, and being Stage 3A with lymph involvement (4) at such a young age, I may not be so lucky next time.  He pointed out that even without ovaries, that I would be able to carry a child in utero, but that even that could have risks as I would require hormone therapy to have a safe pregnancy (which in turn would make it unsafe for me).  I told him that my gyno (at my last annual exam) had said she would remove my ovaries at some point, but not yet; he asked if I would like for him to call her to discuss; I said yes, and he is supposed to call her. 

It looks like it may be better for me to have my ovaries removed (possibly even a complete hysterectomy), but I'm not 'accepting' it well.  I hate knowing that if I do what's in my best interest health-wise, that I won't have biological children.  I realize that I need to do what's best for me...but there are moments when I feel so damn defeated...that Cancer has STOLEN the beauty and possibility of Motherhood...that Cancer has scarred me and changed me...that it just isn't FAIR.  I also realize that it entirely possible for us to adopt, foster-to-adopt, or even for my honey to carry the child...but it SUCKS that I won't have a biological child of my own.  It sucks that it just seems that pregnancy is altogether a near impossibility at this stage, due to associated risk factors.

I then went to the chemo area for blood work;  Dr asked when my last blood labs were and I said either late Sept or early Oct;  he ordered a CBC, CMP and CEA.  Of course, I was upset and my mind was reeling after our discussion of ovaries and risk factors/recurrences, etc.  Try as I might, I cried...in public.  My nurse was awesome and grabbed a tissue for me and asked if I was okay.  My honey was awesome too!  I had a text that told me how special I am, how much I'm loved and that I should do whatever would keep me here the longest with her.  I'm so lucky...truly, I am!

I received my results on Friday (1/31), but no discussion about it.  I compared my CBC and CMP numbers to previous draws and they seemed 'normal'.  The CEA was the first test of its kind that I have had (to my knowledge).  The range is 0 - 40.  My number is 14.6 -- not sure what that means exactly, as I have NOTHING to compare it to at the moment.

The Dr asked if I had had my annual mammogram yet.  I said "No, my first ever was when I was diagnosed last year...I'm only 34, remember."  He told me that he'd have his office schedule one for me (and they did) for March.  He also asked if I had had a follow up PET scan yet.  I shook my head (no) and he asked, "Would you like to have one?"  I nodded emphatically and practically shouted, "YES!"  They have to get a pre-auth before they can schedule.  I plan to check on the status when I go back for Herceptin this week.

My MUGA scan was Wednesday (1/29).  The test itself is fine, albeit LONG because they have to wait for approximately 25-30 minutes after the injection of the radioactive material to take the pictures/scans.  I was there for about 2.5 hours.  Not too bad...but I did have a killer headache that day, so when the tech started moving the bed around to reposition me for different pictures/scans, I thought I would barf on him, but I held it together.  HAHA