Sue’s first cycle of chemotherapy is done. It was on Friday 9/21, started at 9:00AM and ended a little after 3:00PM. Yup it’s scheduled to be 6 hours long. Why so long? Here is the series of medications she received:

• Normal saline ran all day. We are told she needs to keep hydrated to keep the toxins flushing.
• Two antiemetic drugs. They are tasked with keeping the nausea and vomiting at bay.
• The first chemotherapy drug was Adriamycin. An IV fluid that is actually red (scary from the start) it turns your urine red (quite quickly) and must be monitored by the IV nurse to make sure it is only going into your vein. It is very caustic and can cause serious tissue damage if it infiltrates your skin. The IV nurse actually sits there monitoring it and occasionally drawing back on the IV to make sure blood returns in the tube which is a positive indication it’s still in the vein.
• The next chemotherapy drug was the cyclophosphamide. No special precautions except to run it slowly in steps to make sure there are no allergic reactions.
• The last chemotherapy drug was Taxotere. This is another one that must be infused slowly (it took about two hours) and can also cause anaphylaxis so it’s started real slow and increased as the cycles progress.
• Finally she had to wait for the liter (1000cc) of fluid that started at 9:00AM to finish

Almost 24 hours later she is doing fine. No vomiting, no appetite either. The biggest complaint right now is that her Diet Coke doesn’t taste the same. Dog tired would be a good estimate on how she is feeling.

The new do for the next few weeks

Today we took a trip into the city to get a second opinion from the professionals at Memorial Sloane Kettering Cancer Center (MSKCC). Living in the NYC Metro area and being prepared with great health insurance gives us the option that would be stupid to pass up. We want to review all our options and explore all alternatives.

Our day was not typical (imagine that). We departed the house at 5:30AM for an 8:00AM check-in time, about 2 hours later and 3 blocks away from MSKCC Sue’s cell phone rings. It’s MSKCC informing us that her doctor is still in Montreal. Her flight from the night before was canceled because of all the bad weather on the east coast, they wanted to reschedule. Sue’s red came out with a too bad we are here and you need to fix the situation. Surprise, Sue got her way.

We ended up seeing quite a few docs today and took care of everything in one visit.

• Medical Oncologist – Reviewed everything with us, no surprises.
• Hematologist – Because of some limited family history of blood clots and Faith’s troubles a review was in order. In general just having cancer increases your risk of blood clots and chemotherapy does also. After review and the fact that Faith had no genetic markers for clotting or bleeding disorders, hemo was also confident that Sue would not have problems nor need any additional precautions.
• EKG – Baseline before chemotherapy, in addition to an electrocardiogram we had done previously.
• Flu Shot – Offered and accepted.
• Baseline blood work that’s standard practice before starting chemotherapy.
• Surgery – MSKCC has some of the best cancer surgeons and reconstructive surgeons in the country. We met to discuss surgical options and establish a relationship to understand what the next steps will be after her pre-surgical (Neoadjuvant) chemotherapy. We are thinking towards during the surgery at MSKCC because of all the expertise in all departments (Surgery, Pathology & Reconstruction) available in one stop.

Overall it was a very nice place. Not your typical NYC hospital experience if you’ve been through that. Still too busy and chaotic at times to be a good place to go to for chemotherapy and radiation on a regular basis. Since the experts agree we are going to do all therapies close to home for Sue’s comfort and convenience.

Friday the 21^st will be her first day of Chemo.

Sue had the PET scan today. The results are very good. It looks like the cancer is only in the breast tissue, no nodes or other organs, bones etc. A very welcome relief.

With the new information the clinical staging stays at IIB.

Our schedule for next week is as follows:

* CORRECTION * Wed 9/19 we have a consultation at Memorial Sloan Kettering Cancer Center in NYC.  We want everything done so far reviewed again to get agreement on diagnosis and plan of care. If all parties agree Chemotherapy will begin on Friday 9/21.

I will keep you updated as new information becomes available, please subscribe to the blog if you want e-mail updates.

After the shock of it all I have some more news and information to report. Some of it is better, some not as good. To date Sue has had a Mammogram, Ultrasound & Biopsy of the tumor and a local lymph node.

The biopsy results are as follows:

• Tumor type: Invasive ductal carcinoma
• Histologic grade: Grade 3
• Tumor Prognostic Profile: Triple Negative; Ki-67: Unfavorable; 75.37%
• Lymph node: NEGATIVE (Negatives are not 100% until the lymph node itself is removed and pathology is completed).

Clinical staging is now: IIB, The original staging was III because of the tumor size of 6cm, since there seems to be no lymph node involvement it’s been revised to IIB.

The other biopsy facts indicate that this is a very aggressive and fast growing cancer and since it is a triple-negative (TNBC) it will only be susceptible to chemotherapy. The other modes of treating breast cancer such as hormone therapy would not be effective.

The recommended course of chemotherapy is three agents Adriamyin, Cytoxan & Taxotere (ACT) along with a bunch of meds for nausea, promotion of white cell production & steroids. A very powerful mix that is infused every three weeks for approximately 6 cycles (18 weeks).

The PET scan is on Thrusday (9/13/12) and will determine if the cancer has become metastatic (spread to other organs or tissues). Our hopes and prayers is that it has not. It will be difficult enough to fight in this one location.

The plan also remains to not perform surgery until after multiple cycles of chemotherapy. Multiple reasons exist. First they want to be able to physically see that the chemo is working on the tumor (the can measure growth and shrinkage) it will put things in a better position for eventual surgery and in TNBC it is the standard of care to have.

More good news to come after the PET scan on Thursday.

By the way I’m doing it again www.faithsmom.com will be Sue’s blog to follow our battle with this breast cancer and for updates along the way. It’s going to be from a husbands & caregivers perspective. As a man we are driven to fix a problem when we see it. Once again I’m in the position where I cannot fix it but must contribute what I can to make it better and hopefully help someone else out there going through the same thing. Since I will be the source of information, as Sue may not feel like discussing this as her treatment progresses, I like this medium to communicate all the facts at once with the largest audience possible.