This is part 2. Go back for part 1.

Tomorrow is Cathy's last chemo treatment!  We are really happy about that!  Tonight I told the family that I don't want any more chemo, but I'm really enjoying the Sunday-before-chemo family meals.  This has been a long and difficult three months.  We are ready to close this chapter and move on to the next phase.  Chemo has been like a slow burn.  I anticipate that the next chapter will be much shorter, but far more furious.  We are so grateful for all the people who have supported us in so many ways in the past three months.  We are thankful to our families and neighbors who have dropped everything to help at a moment's notice, to friends who have baby-sat, to friends who have organized help, to people who have cooked for us, who have cleaned for us, who have driven us or our children someplace, who have sent cards, who have walked for us, who bought Willow House products or donated, who tied a pink ribbon on a tree, pole, fence, or body part, who have said a kind word, done a kind deed, or prayed for us.  We are so blessed and so thankful.

At tomorrow's appointment we will put the survivorship plan in place and begin to schedule surgeries and other diagnostics.  The survivorship plan will be a protocol of procedures that will further eliminate cancer from Cathy's body and monitor its absence. We aren't sure all that it will entail, but I know we will have a raft of questions tomorrow.  After tomorrow's appointment and a few phone calls we will have a better idea of when the sentinel node biopsy and mastectomy will be and what the next few months will look like.  We feel like we have a good team put together.  References, research, appointments, and good ole gut feelings have led us to four doctors who will help Cathy continue to fight and recover.

Tomorrow will also include questions about Cathy's peripheral neuropathy, which faded a bit two cycles ago, but has come back stronger.  She is having tingling in her feet, considerable pain in her hands, peeling skin in both places, and a twitchy left eye.  Your prayers for help with these symptoms and for guiding the doctor's wisdom in dealing with them would be greatly appreciated.

Thank you for reading through two long posts.  The thoughts and words have been building up.  Getting them into the computer has been another issue.

I've had a post rolling around in my head since Thursday afternoon.  Clara developed a fever Thursday night.  I took care of her all day Friday, trying to spare Cathy from the germs.  Saturday she looked a lot better and enjoyed going to the second half of Jonah's double header (I got to experience the full 5 hours myself).  Then she woke up last night all chokey and wheezy.  Lo and behold, we think it's croup.  So, she was a little fussy and low key today for her 1st birthday party with both sets of grandparents and Addie and Michael.  We uninvited Corby, Emily, and Asa because we didn't want to take a chance with Asa and croup.  We're hoping that this passes quickly and we don't have any of the same kinds of croup scares we had with Aaron.  She's sleeping comfortably now and the boys are getting tucked in so I can steal a few minutes to write.

Cathy felt very comfortable with the plastic surgeon, Dr. Butterfield, at Thursday's appointment.  She is very personable, knowledgeable, intelligent, and it is easy to see that she is an artist.  The information we gathered at the appointment left us with plans A and B, contingent upon the need for radiation, of course with subplans for each plan.  Dr. Butterfield preferred (as did we) to be optimistic and work through plan A, which is what we do if no radiation is needed.  

Plan A.1 is to have reconstruction at the same time as the mastectomy with expander implants.  The expanders would be filled periodically over the course of 4-6 months to grow the muscle and skin, then they would be replaced by permanent implants.  Permanent implants generally last 10-20 years, but can last much longer, before they will need to be replaced or maintained.  The upsides of this surgery are that there is only one surgery site and one recovery site.  The downsides are that there is a greater possibility of infection and healing issues than the other options and that there is more scarring.

Plan A.2 is to have reconstruction at the same time as the mastectomy using latissimus dorsi flaps and small implants.  The LD flaps are flaps of muscle and skin that are cut and pulled from just under the scapulas on Cathy's back and brought around to the front to create new breasts.  The upsides of this surgery are that there is less possibility of infection and healing issues because there is a blood supply brought around with the flaps.  Also, there is less scarring.  The downsides are that there will be two surgery sites and Cathy would experience some numbness in her back at the point where the flaps were taken in addition to some permanent muscular weakness in her upper back.

Plan A.3 is to wait 4-6 months after the mastectomy and choose either of the above reconstruction types.  The upsides of this are that infection and healing issues are nil because Cathy's immune system will have returned to near normal.  The downsides are that it is a longer time, more surgeries, and more scarring.

At this point Cathy is inclined to go with Plan A.2.  Plan A.2 presents a reconstruction that tends to be more successful in terms of healing and healthy, as well as a more aesthetically pleasing result.  She is concerned about having two surgery sites and about the numbness, but feels that the lower rate of infection or healing issues far outweighs the other consideration.  She is concerned about infection and healing issues with plan A.1 and doesn't want to wait for more surgeries with plan A.3, knowing that she has an oophorectomy coming up sometime in the future.

Plan B, and all subplans within plan B begin with a right mastectomy, radiation, and then a left mastectomy and either plan .1 or .2.  We're hoping that we don't even really need to think about plan B.

This has been a long post and I have more to write.  Join me in about 30 minutes for part 2.

During the last few days I've been thinking about how I've made a lot less blog posts in September than in June, July, and August.  I've never been a journal keeper, so I suppose that I should be pleased that I've managed to write anything even once monthly during four consecutive months.  Part of my slow postings is due to less information to share than at the beginning of this crazy adventure - that's about to change.  Another part is that the emotions of the situation have stabilized a bit.  That's not to say that I'm still not sad, scared, angry, etc.  It's just that I've had some time to adjust to all of those feelings and I'm a little more used to them now.  I suspect that they will continue to resurface from time to time.  Since school started there is just less time to think and write, and less energy to do either.  I'm doing less, Cathy is doing less, and the boys are doing less in terms of activities than we've done in many years.  Still, the routine of school, homework, music lessons, swimming, baseball, and the like takes more time and energy than in the summer.  My mind is pretty well occupied with all of that with little room for anything else.  And then there is Clara.  It's easy to think through an entire evening's plans, get it all worked out, and then remember that I need to feed a baby and make sure she's sleeping.  It's a joy every time, but I forget sometimes that there is one more person to care for than in the previous 9 years of my life!

Tomorrow we meet with the plastic surgeon for the first time.  I think we have our questions all lined up, but I'm sure it will be a steep learning curve anyway.

I'm overdue on posting again, but here we are.  On Thursday, we had an appointment with another radiation oncologist.  This doctor is in Blue Ash and does treatments at her office and at Bethesda North, both of which are much nearer to us than Christ Hospital.  She gave us hope, however fleeting it might be, that we won't need her services.  She seemed to think that there might be a good chance that no lymph nodes will contain cancer.  Hopefully, this will be conclusively shown after the sentinel node biopsy, meaning that Cathy can forego radiation altogether.  

This doctor shared the same view as the head of research at the American Cancer Institute that if no lymph nodes are involved then the benefits of radiation do not outweigh the risks.  She did believe, though, that if even one lymph node shows cancer, that radiation would be a worthwhile treatment.  She told us that when even one lymph node is involved that research shows that radiation improves outcomes by 5-10% at the minimum.  This is greater than the 1% chance of a secondary cancer developing as a result of the radiation.  These are numbers we can understand and it's the second time in less than a week that we heard the same thing from sources in whom we feel confident.

Ah, Tuesday!  Predictably, Cathy is feeling noticeably better.  She has done really well this cycle, eating more than previous cycles and having more energy.  Neuropathy is a bit worse than last time and more in her hands, but still not enough for her to take the medicine that Dr. Drosick prescribed.  Cathy was home alone with Clara the last two days and able to care for her with the wonderful mothering love that Cathy expects of herself.  

We will be at an appointment with another radiation oncologist on Thursday.  This doctor was referred to us by Dr. Drosick and is closer to home than the doctors at Christ.  Cathy also had long conversation with the head researcher and chief of oncology at the National Cancer Institute.  She explained the specifics of her case as best she could and they shared with her their recommendations based on their vast knowledge of the current research as it pertains to her particular situation.  They qualified their statements, as they should have, with the understanding that they haven't seen her films or read her reports, but spoke from the point of view of what the research shows.  They seemed to think that radiation would be a good idea if even one lymph node is involved.  If it is conclusive that no lymph nodes are affected they think the risks of radiation could be greater than the benefits.

It will be interesting to see the opinions of other radiation oncologists as we near the surgery time.  In no way do I look forward to what lies ahead for Cathy, but I will be glad to have some additional concrete lab reports and more steps along the path to healing for her.

This round of chemo has, again, been a bit of good news/bad news.  Thankfully, the good things seem to be more numerous than the bad.  Due to Cathy's will power, or the reduced dosage, or some other factor, her energy and appetite have been much better this week.  She was awake for a few hours today, showered and dressed, and ate more than I've ever seen on a Thursday.  She told me she was "just pushing through," but I think it's a little more than that.  The last four rounds I don't think she could have pushed through with all her might.  This round is a little different.

The peripheral neuropathy is still present, but mild.  It hasn't gotten worse, which I count as a blessing.  It doesn't keep her awake and I can usually get it off her mind with a foot rub at bedtime.  Cathy stopped taking her Compazine, an anti-nausea drug, one day earlier than last time (which was one day earlier than the time before).  She thinks the anti-nausea meds make her foggy, so she doesn't want to take them if she doesn't have to.  She keeps them at the ready, though!

Cathy now weighs less than she did on the day we were married.  She looks thin, but not to an unhealthy degree.  She's really only fluctuated 10-15 pounds in the last 15 years, so we aren't really concerned, yet.  I think she's lost some muscle mass.  We're working on increased protein to build muscle and she's walking/doing yoga when she feels up to it.  I think when she feels better on a regular basis some of this will come back.

The big thing this time around seems to be that her thermostat is becoming more and more out of whack.  She goes from sweats to chilly pretty quickly, with most of the time spent in sweats.  This is great for me, especially at night because I'm always the one kicking the covers off, but I wish she could be more comfortable.

Cathy is so tough, so determined, so sweet, so loving.  I hate that she has to do this.

It's been a whole week since I last posted.  Sorry for the delay!  That delay means we had a good week last week - we were too busy for the internet!  We had a guest staying with us who was working with the marching band, I went to band rehearsal Thursday, and we all went to the tailgate and game Friday.  We went to the Miami football game on Saturday, followed by Jonah's baseball game and the marching band competition at Kings.  Cathy wants to do what she can do while she feels like doing it.  She was feeling good, so we did it all!  

Jayne went to chemo with Cathy yesterday.  They said it was extremely crowded, but they got through in a little less time than usual.  Cathy was an inspiration to a frightened triple negative patient who was about to receive her first treatment.  We're hoping that they'll meet again today at the Neulasta shot so Cathy can get her contact information.

Cathy's time with Dr. Drosick led to some good reassurance and a minor adjustment.  Last week the radiation oncologist at Christ said that she could feel Cathy's tumor.  Since that time Cathy has been more aware of it and thought that it might be a little larger, but far less dense than when chemo started.  We were both a little nervous about that.  Dr. Drosick said that he thought both sides felt the same and that she has had a great chemo response.  That's reassuring.  He thought that Cathy might be more aware since that appointment and that since she lost weight that she might be feeling the pressure of her ribs on the breast tissue.  Her weight loss also led to a reduction in dosage for the chemo meds this time - not much, but a slight reduction.  

We're going to enjoy today because Cathy will be tired tomorrow.  We're are all so grateful for the love, care, and prayers from so many people.

Christ Hospital is a tough drive.  The traffic, combined with the hills, curves, and many lane changes in the Mt. Auburn area, is very stressful for Cathy.  The driving made a hard day even harder.  Today we met with a radiation oncologist who we liked very much, but her location at Christ might eliminate her from being part of the treatment.  I think Cathy can handle a trip or two to Christ for surgery or other sparsely timed events, but the regimen of radiation will be too stressful.  Unfortunately, I think Cathy has been the victim of one or two too many traffic accidents that weren't her fault.

The appointment itself was also tough.  While the doctor was extremely knowledgable, had a nice personality, and good bedside manner, the information was difficult to digest.  The doctor felt with 85% certainty that Cathy would need to have radiation.  She also felt that radiation would be a good course of action regardless of the lymph node biopsy outcome.  Because of the triple negative cancer type, the high rate of proliferation, and Cathy's young age, the doctor felt that radiation would give her the best chance of not having a recurrence.  The downside is that having the BRCA1 gene mutation makes Cathy's cell reparation process flawed, increasing her chances for some other kind of cancer that is the result of all the radiation exposure.  I think the percentage is somewhere in the neighborhood of 1-2% as opposed to <1% for BRCA-, but I'm not sure my percentages are accurate (it was a lot of information to process, I know I missed some).

Developing another type of cancer seems to be a common thread in the possible side effects of cancer treatment.  I guess when you're using nasty methods to treat a nasty disease you have to face some other nasty outcomes.  I remember that my nuclear medicine doctor warned me of a 1% chance of leukemia as a side effect of radioactive iodine therapy.  That's was a risk I was willing to take to treat 100% certain thyroid cancer.

We have lots of research to read and we need to get some further opinions before we decide on this one - before Cathy decides on this one.  I feel pretty certain, though, that Cathy won't want to go to Christ five days a week for five weeks, as would be the treatment protocol.  It's obvious, though, that the treatment options and protocols for radiation present a lot more variables than with surgery or chemo.  This makes the decisions much more difficult.

On the brighter side of things, Cathy made an appointment with a plastic surgeon.  The initial contact has been favorable and Cathy is excited (at least as excited as you get when you are lining up for surgery).  The peripheral neuropathy has diminished over the last few days, as well.  Thank you for the flood of prayers.  Hopefully, it will stay mild after this next chemo cycle.

Cathy is tough, but not superhuman.  We're praying for clarity, confidence, and comfort.