I'm Wiggin' Out...

Went to see the oncologist, Dr. Melamud, yesterday to review results of the Oncotype DX. http://www.genomichealth.com/oncotype/default.aspx?c1=google&source=searchkw=oncotype_dx I was so confident I did not have to be faced with the decision of whether or not to do chemo. Alas...my score fell into what’s considered to be the “intermediate risk” of recurrence area. This essentially means, based on testing about 15 genes from the sample of my tumor, and with the assumption that I will be taking Tamoxophen for five years, there's a 13% likelihood of cancer recurring anywhere (not just breast, anywhere) in my body over the next ten years.

Based on that information I may or may not choose to do chemo. Do I want to lower my odds 4-5%? I supposedly can by doing one of two chemo treatments for approximately four months. Or can I live with 13%?

This reflects if I were to take Tamoxophen but did NOT do chemo:

86 out of 100 women are alive without recurrence in 10 years
13 OUT OF 100 WOMEN DEVELOP RECURRENCE IN 10 years
1 out of 100 women die of other causes in 10 years

If I were to get chemo, I’d have two treatment options: 1st or 2nd generation, 2nd being the "stronger" of the two which means more side effects (e.g.hair loss) but lower odds of recurrence. (There is a 3rd option that is heavy duty and I ruled that out immediately.)

OPTION 1 (along with Tamoxophen);
CMF-Like (Cytoxan; Methaotreaxate; 5FU):

86 out of 100 women are alive and w/o recurrence in 10 years PLUS:
4 out of 100 women are alive and w/o recurrence b/c of therapy
9 OUT OF 100 WOMEN DEVELOP RECURRENCE IN TEN YEARS
1 out of 100 women die of other cause in 10 years

This would be administered by IV six times, once every three weeks. Side effects include minimal fatigue; it’s generally well tolerated; very little to no hair loss; 2-3 drugs are given to combat nausea/GI upset (Aloxi, Emend and Compazine if needed). One must watch blood count and only if necessary, Neulasta is given if white cell count is low.

OPTION 2 (along with Tamoxophen);
Second Generation Chemo Docetaxel (Taxotere) + Cytoxan:

86 out of 100 women are alive and w/o recurrence in 10 years PLUS:
6 out of 100 women are alive and w/o recurrence b/c of therapy
7 OUT OF 100 WOMEN DEVELOP REUCRRENCE IN TEN YEARS (7 vs the 9 from option 1)
1 out of 100 women die of other cause in 10 years

This would be administered by IV four times, once every three weeks. On the day following chemo, an injection of Neulasta is given to support the blood counts (vs only if necessary for option 1).

There is more fatigue, hair loss (i.e. balding), in some cases neuropathy (tingling of fingers); same 2-3 drugs are given to combat nausea/GI upset which is common as well as rawness of skin in mouth and a metallic taste.

I did not commit to doing either and advised the dr. I would get back to him. He not only understood, but encouraged me to think about it. I did ask him, If I were his daughter, what would he suggest? He said, Option 2. If I proceed, the chemo is done prior to the radiation + starting the Tamoxophen. (One can choose to start radiation half way through chemo but the cosmetic effects of the breast are worse than if one waits).

As for the radiation, met with Dr. Chada, but there’s nothing we can do now until I decide on the chemo. I know for sure though that I will do the radiation. Remember, radiation is to treat the area (e.g. le boob) locally vs the chemo which treats the entire body.

After lunch and slugging a glass of anti-oxidant-rich vino, I visited my friend Dana's office (she practices complementary + alternative med http://www.patientsmedical.com/Dana-Cohen-MD.html ) and she is setting me up on a program called First Line Therapy by Metagenics, a highly respected supplement company. There's a food plan which is basically based on eating foods low on the glycemic index therefore controlling insulin my levels. This happens to work well for me at this time since cancer loves sugar; sugar lowers your white cell count quite a bit (consider this before you unwrap that next Snickers bar). The purpose of the program is really for overall well being and can be tailored to your personal needs. I would eat small meals from specific food groups throughout the day and the diet encourages your body to gain more lean muscle mass vs some diets that cause a loss in muscle mass. I haven't read through it entirely yet, but a good portion plus Dr. D brought me up to speed.

I had blood drawn and a full work up is being one; the results will take a few days.

I also made an appointment with Dr. Ronald Hoffman for next week. (You may've heard his radio shows or read his books). http://www.drhoffman.com/ Dana used to work for him and she will accompany me. He treats a lot of cancer patients going through chemo primarily with vitamin drips. He can give me the formula and they can be administered by the nurse in my office for free. Dana and I both looked into an extremely alternative doc (so as to avoid doing chemo) however, although his regimen works very well, it entails a HUGE lifestyle change (including but not limited to 175+/- supplements/day) to which I know I will never stick. I've ruled him out.

Dana will come with me to Dr. H next week. By then I will have my blood results for him to review. I will have an answer of my choice of chemo by next Friday.

For the record, there are plenty of studies using alternative treatments with or without chemo that are poo pooed by many western dr’s and pharmaceutical companies. They do exist though. This isn't just voo doo stuff I’m talking about. If I can lower my risk with the “kinder, gentler” chemo with the help of the alternative stuff, I’d be a lot more comfortable with that.

I am not ruling out anything but I am on the fence about the 1st vs
2nd generation and what I can use as adjuvant therapy. I must do my due diligence. With all the access to info out there, it would be silly not to.

To do, or not to do... to do, what to do... that is the question........