“Hi, this is Dr. Rugo.”
“Hi,” I say, with a cheery eagerness more appropriate to a social call. But I AM thrilled to hear her voice. I want to know my fate. But that’s not what I say, instead, I say, “How are you? How was your weekend?”
I think I take my oncologist a little bit off guard. “Actually, I had a cold all weekend,” she says. “But I’m beginning to feel better.”
“What a drag,” I say. “I’m sorry you had to be sick on a holiday weekend.” What the heck am I doing? Do I want to know what chemo regimen I’m going to have, or not? Maybe I’m not as eager to know my fate as I think I am. Dr. Rugo doesn’t strike me as super chit-chatty, so I get back to what I know is the point of the call.
“So…what did everyone in clinic say?”
“Well, I presented your case to two groups. And the range of responses I got was amazing. Some people advised a fairly light regimen. Others suggested doing the full court treatment: Taxol [the drug that burns your veins], Adriamycin [one of the toughest drugs, I gather] and all the rest.”
“I guess people just have a knee-jerk reaction,” I suggest.
“Well, not exactly, “she replies. “It’s not even a gut reaction. It’s more that people tend to put things in boxes. You had a very high recurrence score, so some people tend do the same thing in that situation. But the tumor was also very small. And size does count in this case. We don’t want do treatment that’s overkill. But we also don’t want to be wrong.”
“I appreciate that,” I say.
“So here’s what I think we’re going to do…”
Dr. Rugo starts talking quickly, just as she did during my first meeting with her. This is the fate she outlines for me:
• Six full cycles of chemo, every three weeks. This will include: Taxotere (an alkylating agent that messes with the DNA or RNA of rapidly-growing cells and keeps them from dividing. Cells that can’t divide, die.); another alklyating agent that has platinum in it, Carboplatin; and a monoclonal antibody that targets Her-2 receptors, and zaps cells that have a lot of them. All of these drugs will be delivered intravenously, and the Herceptin dosing will go on longer than the others, for a year. Ugh.
• They’re going to re-run the second Her-2 test that they did on my tumor cells, just to make sure. This test, FISH for “Fluorescent in situ hybridization,” uses fluorescent probes that only bind to genetic sequences that can be specified. In my case, that means the gene that codes for “human epidermal growth factor 2,” a gene that aggressive breast cancers like to express willy-nilly. But Dr. Rugo says the result will likely be indeterminate just like the last time. I get the sense that she thinks my Her-2 status is close enough to positive to merit the Herceptin.
• They’ll do an echocardiogram to make sure my heart is OK. Herceptin has a “rare side effect” of interfering with the heart’s ability to pump. My all-time favorite line from the Herceptin section of ice skater and cancer survivor Scott Hamilton’s excellent “ChemoCare” website is: “Herceptin may be discontinued if symptoms of heart failure appear.” Sometimes, cancer can be deadpan funny.
• I’ll have to do a “Chemo-Teach” appointment where I guess they’ll tell me about getting a soft toothbrush and gargling with baking soda to combat mouth sores, and carrying hand sanitizer to avoid infection when my white blood cell counts are down, getting PAP smear to avoid false abnormal results after chemo, having dental work done because of infection risk during chemo and all sorts of other secret chemo knowledge.
• Brain scans and cognitive testing for the fuzzy brain clinical trial in which I’ve agreed to participate.
“Do you think we ought to do a body scan?” Dr. Rugo asks. “Just to be sure?”
I’m pretty sure she means a PET scan, a incredibly sensitive and outlandishly expensive test. (More on this later in a Cancer Geek-Out post). I say, by all means. I’ve been reading a little too much about “micro-metastases,” the process by which cancer cells sail off into the bloodstream and lymph system and try to plant their flags and claim other territory for the cancer kingdom.
“So when do you think we’ll start?” I ask.
Dr. Rugo suggests the week of October 25. We agree on Thursday, October 28. It’s going to be a busy couple of weeks, and then I strike out for unknown territory.