Update

Lots of doctor appointments this past week. It’s my new reality: days full of insurance calls, scheduling appointments, driving to Pennsylvania for appointments, etc. How do people work full time when they have cancer?? I am getting by with the help of my husband, mother (staying nearly a month), and all the friends who have been bringing meals and inviting our kids on playdates. THANKS! Also, thanks for all the nice cards and emails. I am encouraged! (And apologies to all those who were unable to leave a comment on this blog -- I'll try to figure out the problem.)

I have most of my energy back and have full use of my arm again. The surgeon is pleased with the healing. For those of you specifically praying for how I'll handle the physical results, I'm doing better than I expected, perhaps partly due to the recent practice of starting the reconstruction process at the time of the mastectomy.

I also met with a specialized physical therapist for tips on preventing lymphodema and for exercises to promote recovery. How does one prevent lymphodema? Unfortunately, it will require preventative measure for the rest of my life: avoiding any injury to my right arm (including sunburn and mosquito bites); never having blood draws or blood pressure taken from this arm; wearing a compression sleeve during air travel or at high altitude.

The lymphodema expert is also a cancer survivor who is my age. It was wonderful to talk to someone who has been through this recently and shares many concerns and challenges I face as a relatively young patient. She was full of encouragement and practical advice.

Yesterday I met with my oncologist, Dr. Richard Lee (brilliant doctor, family friend, and has an office 2 miles from our home; what a blessing since all other appointments are about 1 hour away!). We now have more details about the course of chemotherapy:

- I will start on Monday, March 28

- Treatment will be given in 4 infusions, with 3 weeks between them. This adds up to 12 weeks.

- Each infusion will be Cytoxan and Taxotere (as well as a "cocktail" of other required meds, like Benadryl to prevent allergic reaction, and an anti-nausea drug)

What does this mean? 

The pros are: (1) I will be finishing treatment before the kids start summer vacation. Hooray! Our long-awaited trip to Yellowstone National Park in June will hopefully still be permitted. (2) This regimen is much more appealing than the one originally considered: one that included adriamycin (another layer of toxicity, including potential heart damage; would require surgical insertion of a port since it's dangerous to infuse intravenously) and 8 infusions delivered every 2 weeks (16 weeks total). So, after considering the original regimen, I feel as if I'm getting off easy with a shorter, slightly less toxic regimen. Also, the adriamycin-containing regimen takes more than 4 hours to infuse, whereas mine will take only 2 hours: that means I can complete an infusion during my daughter's half-day kindergarten without needing further childcare arrangements.

The cons are all the side effects. The most visible will be hair loss. More later on this, but I can pretty much expect to lose my hair between April 7 and 12. The oncologist also explained to me the week-by-week cycle of some of the other side effects. I will likely experience exhaustion during the first week after each infusion. During the second week, I can expect my blood counts to fall low enough that I will be at high risk of infection. If the levels are severely low, I will be asked to alter my diet (eg, no raw vegetables or fruits) and avoid contact with people, including my own children. Any fever will land me in the hospital with an aggressive course of antibiotics. Please pray that my white blood cell counts remain sufficient! Nausea, a well-known side effect of chemotherapeutic drugs, is so well controlled by modern medicine that it only rarely bothers patients these days.