Knockin' on chemo's door

My oncologist was on vacation for a few weeks so for my regular 9 week appointment I saw a stand-in.  He had a unique bedside manner for a physician as he was not very good at eye contact. But he was very thorough.
I was phoned the day before my appointment and told that my appointment was being bumped a half-hour later. The reason for the delay was that the stand-in oncologist was presenting my case to the tumour group.
The initial decision by the group was that it was time for a change in my treatment. The reason behind the decision was my PET scan results from August.
My results were actually quite encouraging.....other than the lesion at the base of my skull. There were a few little spots on my right lung and in my right axilla that are likely scar tissue from the radiation I had in April. The spot on my 5th rib where I also had radiation was showing signs of healing. The original metastases I had at initial diagnosis are also not really showing on the PET. The most interesting thing was the specific mention of my liver, and to quote "liver looks normal". !!!!!!!
That means that the combination of Herceptin and anti-estrogen treatment has done a great job of getting the original ER+ metastases under control.
The next decision was that radiation is no longer an available option for the lesion at the base of my skull as I have received the maximum amount of radiation I can get to that area. That lead to the decision that it was now time to move back to chemotherapy.
The skull lesion has been growing even with regular Herceptin and there is concern that without a treatment change the lesion could get out of control and spread elsewhere.
I have actually been thinking about chemo for a few weeks so when the oncologist brought it up I was not surprised. It has been over a month and a half since I had the radiation and while the motion in my face is better there really has not been great improvement in the other symptoms. I am at the point where I am willing to change treatment in the hopes that the symptoms improve.
Once we had agreed on chemo the next step was deciding which chemo as there are currently two main options. The first option, and the one recommended by the group, is the more aggressive option. Hmmmm.....that will probably be my choice then as I have always gone for the most aggressive option first. This option is also the current first line of treatment for newly diagnosed stage IV patients. It was not available when I was first diagnosed and the group felt that just because I had bad timing (my words not theirs) I shouldn't miss out on the opportunity to receive this treatment. As I had already received some treatment it was necessary for my oncologist to request permission for me to now get this treatment, but.....the first person to suggest I get the treatment is actually the doctor that gives initial approval so I suspect the request would get approved pretty quickly.
The second option is less aggressive and more easily tolerated. But, if I went with the second option I would also be shutting the door on a few treatment options down the road. The second option is something called TDM-1 that was approved for use not long after I was originally diagnosed. It is a Herceptin molecule attached to a chemo molecule so when the Herceptin attaches to the Her-2 the chemo can more directly attack the cancer cells. By choosing this treatment though I would officially be going off Herceptin even though it is a part of the new drug and once I am off Herceptin there is no going back. That may in part be a funding issue but whatever the reason I don't want to lose the option to use a drug that is still working.
Option #1 that I am going with is a 3 drug combo of Docetaxol, Herceptin, and Pertuzumab. Pertuzumab is another monoclonal antibody that specifically targets Her-2.
Docetaxol is similar to Paclitaxol that I was on the first time I did chemo.  The most common side effects are hair loss (boo......I just hope that when my hair grows back next time it doesn't decide my chemo hair is my real hair and so it grows back like my old hair. That would suck.), nerve pain in my hands and feet for a few days after treatment, possible nerve damage to my hands and feet, fluid retention (yay, to go with the fluid I'm already retaining), mouth sores, and low neutrophil count.
Once the decision to go with chemo had been made Ian asked me what are the rules were for while I was on chemo. Ummmmmm......lots of hand washing and always carry Kleenex. I couldn't remember anything else. I think I need to read my old posts and see what else I did.
I remember something about always using a straw and drink lots of soda water to help prevent mouth sores. Stay off public transit because of all the germs. Always carry Kleenex. I know. I obsess about Kleenex. I can't help it, losing one's nose hairs is really annoying.
After my oncologist returned from vacation I talked to her to get a few more details about my treatment plan. Her ideal plan for me is 8 rounds of chemo and then staying on the Herceptin and Pertuzumab. If I don't tolerate the treatment well she is okay with only doing 6 rounds but she really wants 8. I will do my best!
Friday I spent the day getting organised as chemo starts on Monday morning. I picked up and filled the prescriptions I will need, including more steroids. The dose is high enough I should be bouncing off the walls for a few days. I also have a couple anti nausea pills. One I take immediately pre chemo the other is only as needed. Hopefully it won't be needed.
I also stocked up on hand sanitiser and Kleenex. I still have my collection of hats and tuques so I am set there.
So now I have one day left before chemo starts. I am ready to get it going as I really hope the chemo does its thing and shrinks the skull lesion. I am ready for my hearing, balance, and taste buds to return to normal.
I will see you all on the other side after treatment #1 is done.