Tammy | Journal | CaringBridge

Journal entry by Tammy Payne

I had an appointment this morning with doctor who will perform lung biopsy. He spent 1 1/2 hours with us going over everything.  There are seven nodules, but only one big enough to biopsy.  He actually said that they are all small enough that hopefully chemo will shrink them into nonexsitence.  :)  He showed us my CT scan.  On that, he showed us all of the potential ways he could go in; he showed us why he chose the area and the way he will go in.  The procedure itself will take about 45 minutes, then about three hours in recovery.  We talked about sedation versus anesthesia.  We decided that sedation is the best way to go.  I'll have a combination of fentanyl (pain) and versed (amnesia).  He said in all of his patients with the combination, about a third fall asleep, a third are in and out, and a third are awake but don't care.  I think any of those options sound good.   The three hour recovery time is not just to come out of sedation, but in case of lung collapse.  Statistics -- only about one in five patients have lung collapse (and even just a small bubble is considered), and only about three out of one hundred end up staying overnight with a chest tube.  He doesn't see that happening here, but of course there's always a chance.  Results will take about two days.  He will also put in a port-a-cath at this time.

He actually said, close to the beginning of the meeting, "You could walk out of here right now, have no treatment at all, and live a nice long life.  I don't recommend it, but...."  First person to tell me that.  Wow....

During my afternoon appointment with Dr. Pohlmann, we went over a few scenarios.  Treatment, of course, hinges on the results of the lung biopsy. 

If the lung biopsy shows that the the cancer is a locally advanced disease (not in the lungs), we'll start with chemo and anti-HER2 therapy to shrink the tumors, followed by surgery (most likely a mastectomy).  There will be six months worth of treatment (with new adjuvant therapy), then a checkup every three weeks.  There will be one year of anti-HER2 therapy, radiation, and endocrine therapy (endocrine therapy will be a tablet that I take every day for at least five years).   We're looking at three different clinical trials for our options.  The clinical trials are tried and true chemo drugs, just in different combinations.

If the lung biopsy shows that the cancer is metastatic (has spread to the lungs), the main goal is to stop the progression.  Surgery may not be required, or it can be done later on in the treatment plan.  So first we stop the progression, then we shrink it, then we make it go away, then we prolong my remission.  If this is the case, we won't be looking at the clinical trials.  We'll use taxol with herceptin and perjeta.  There won't be a time limit for this treatment; we'll monitor along the way.

Treatment will begin about two to three weeks from today.

Dr. Pohlman said that if the nodules in my lungs are cancerous, the staging changes from early Stage 3 to Stage 4 -- which certainly brought my mood way back down from what the lung biopsy doctor had said earlier in the day. 

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