July 15, 2014: Tears, Phone Calls, and Meeting the Oncologist

Monthly Prenatal Appointment

I happened to have another prenatal appointment this morning.  But about an hour before, I got the phone call from Dr. A's office to confirm the results of the biopsy: cancer. And just like that we were living a new reality.

Jeremy and I sat around until it was time to see my OB.  She was running about 45 minutes behind, so again we waited (I have a feeling we're going to get really good at waiting).  As soon as she walked in, I started to cry and she gave me a good, long hug.  I didn't even have to say anything because she had received the results before she even came in the room.  We listened to the baby's heartbeat (still going strong!) and discussed the risks of having various diagnostic tests that I'd probably be getting later this week, such as a mammogram, x-rays, and MRI.  She also said that if I ended up having a mastectomy (and it was already sounding like this would be the case), I was at an "optimal" time in my pregnancy to undergo surgery, if there is such a thing.  She also referred me to a perinatologist who specializes in maternal/fetal medicine.  I left the appointment unsure of how much involvement Dr. T. would have in my prenatal care from this point on. So much for being a textbook pregnancy.

Phone Calls

That afternoon, Jeremy and I headed to meet my oncologist, Dr. M.  At this point, I was supposed to see several clients in the afternoon, and I hadn't even called to cancel yet.  I couldn't bring myself to make a phone call without getting emotional, but it was getting to the point where I had no choice.  I hadn't even announced my pregnancy to any of the families I work with, so that was an additional bit of information I'd have to include.  

I called my first parent, and through my tears I vomited a string of words, "Sorry-I-have-to-cancel-today-but-I-just-found-out-I-have-breast-cancer-and-am-on-my-way-to-the-doctor-oh-and-I'm-also-four-months-pregnant!"  It just so happens that this parent, a sweet Greek woman, is a breast cancer survivor.  She didn't quite understand what I had said at first, so I had to repeat myself.  She then exclaimed, "Oh, honey!!!  Honey!  I am so sorry!  You will be ok!  One day this will just be a story you tell!"   Her words really stuck with me and I find myself repeating that when i'm having a rough day.  

I found myself dropping the bomb of bad news over and over for the next week.  When I throw in the part about my sister being diagnosed the week before, that's just the icing on the shit cake.  But wait, there's more!  Her husband is about to have open heart surgery!  This is a Nicholas Sparks type of storyline; such a shame it's not made up.  A part of me wished I worked in a regular office where I could just tell the story to everyone all at once and be done with it.  Thankfully, I asked my boss to contact a few parents on my behalf, which was really helpful. 

Meeting the Oncologist

Ok, so we arrive at Dr. M's office and I catch a glimpse of a patient who is clearly undergoing chemo.  No hair, wearing a bandana and a face mask, and looking generally tired and miserable.  So of course, I start visualizing myself in the near future: bald, pregnant, and tired, with one boob.  It was a Debbie Downer moment.

I am called into the exam room and have vitals taken by a nurse, along with another woman who we later realized was a student nurse.  The student nurse was kind of a big gruff lady, and after they left the room, Jeremy joked, "Glad you weren't her first victim for a blood draw!" I'll get back to that in a minute... 

My first impression of Dr. M. is that while he lacks the nurturing, motherly personality of my other doctors, I appreciate the fact that he (fingers crossed) knows what he's doing and will get down to business.  We discussed the use of chemo during pregnancy and he handed us some journal articles about treatment outcomes.  Because being diagnosed with cancer during pregnancy is uncommon, (and because it's ethically frowned upon to do research on pregnant women), the current research essentially consists of case studies lumped together and analyzed over time.  The good news is that chemo can be used during the 2nd and 3rd trimester, with no known detrimental effects to the fetus.  It is not recommended during the 1st trimester, however.  

Dr. M. explained that the plan would be to first remove the tumor (via mastectomy), wait about a month for me to recover, and then begin rounds of chemo.  At the time of this appointment, he didn't yet have my full pathology report, which would have given him specific information about which medications I'd likely need.  He did a physical exam, and stated that he could feel some enlarged lymph nodes under my armpit. 

He ordered an ultrasound of my liver, to determine whether the cancer had spread (metastisized).  From my "official" Google research, I learned that if breast cancer is going to spread, it typically goes to the lymph nodes first, and then sometimes the liver, lungs, brain, or bones.  At this point, most people would be sent for an MRI, but this turned into a source of debate among my doctors, as it's not recommended during pregnancy.  I learned that at the end of the week, my case would be presented to a review committee (called the "tumor board") where other physicians essentially give their opinion.  At first this freaked me out...like, awesome, they have no idea what to do with me so they're going to go ask their doctor friends. But after thinking about it, I realized that this is actually a great thing, because more physicians will be able to give their expert advice. Multiple second opinions for free! I'll get to the results of that later.

Like Dr. A., I learned that Dr. M. has also never worked with a pregnant patient.   But, he said that the treatment plan and outcome for a pregnant woman is actually very similar to a non-pregnant person of similar age, type of cancer, and stage.  One difference, however, involves the type of medication used.  For example, I won't be given any "newer" chemo drugs.  It's safer to use the drugs that have been around the longest and therefore researched the most.  Also, if I tested positive for a certain protein called HER-2, there's a specific medication that I'd need that wouldn't be safe for baby. But, at the time of this appointment, we didn't yet know whether I tested positive for this.  I did know, however, know that my sister is HER-2+.  She actually texted me with this info while I was waiting in the exam room, so I was able to relay this info to the doctor.  He said it doesn't necessarily mean that I'd be positive as well.  

During this appointment, Dr. M. ordered some labwork, and his nurses were able to do it right away.  And guess who got to draw my blood?  She begins by examining my arm and happily proclaiming, "Boy, she's got nice juicy veins!"  For reals??!  I casually mention that she should be careful what she says, because Jeremy, who was also in the room, has a reputation for passing out when he gets bloodwork done (like the firetruck and ambulance had to come and everything.  He loves when I tell people about this).  So I figure she'd be a little quieter, but son-of-a-biscuit, she proceeds to say it again!  This time louder and with more glee!  Then, she drops a tube on the floor and when it's time to unwrap the band around my upper arm, she tries to yank it with one hand while holding the vial with the other.   This was enough excitement for one day, and I couldn't wait to go home and crawl under the covers.