New Day, New Info, New Plan

SUMMARY: Judy will begin radiation therapy at MD Anderson Monday. She will finish December 14.

EXPANDED COVERAGE:
Yesterday was a whirlwind day in Houston. We thought/hoped we’d come home with a game plan for Judy’s post-operative therapy. Did we ever! The appointments began with us thinking we’d have to miss our “Christmas in China” trip. Judy had hoped to delay radiation until after Christmas. Dr. Buchholz didn’t want to wait—he actually had Judy scheduled for a “simulation” on November 24. (The simulation is a meeting with the radiation team—highly technical—lasting several hours. During this time they simulate a radiation therapy and mark the areas to be radiated.) Radiation would begin soon after the simulation. When the good doctor realized we would be knocked out of the Christmas trip, he left the room and got busy. Upon returning he announced we could get in the required number of sessions (20) in time to make the trip. He also said they’d just had a cancellation for the simulation area and we would do the simulation NOW.

Judy will be receiving the Canadian Fractionation with Boost radiation. (Brace yourself, dear reader, for an extended explanation. Go get a cup of coffee—I’ll wait.) Standard protocol calls for 5 to 7 weeks of radiation. The Canadians, with their free-but-hard-to-get medical service couldn’t get the good ole government to fund 7 weeks of therapy. So the Canadians began to experiment (doesn’t that give you good, fuzzy feelings about the government being in the health care business) with innovative ways to get their cancer patients cured. [Confession: I’m more than a little intimidated about writing all this because Diane Johnston, APN, promised to review my blog to check for inaccuracies. I’M BEING GRADED BY A REAL LIVE MEDICAL EXPERT! HELP ME JESUS!] They finally discovered that by increasing the intensity of the radiation for each session they could diminish the number of sessions. (Standard protocol calls for 200 rads per session for 30 days. Canadian Fractionation calls for 265 rads for 16 days. But the highly intelligent folks at MD Anderson—people like Diane Johnston, APN, realized what the Canadians haven’t yet discovered which is that you actually need 20 sessions, not just 16. Thus, Judy is getting the Canadian Fractionation plus Boost {boost being an extra 4 sessions to give the therapy a boost}.) Their data for 15 years suggests no difference (for patients eligible for the Canadian Fractionation) between the patients who get 20 sessions at the increased intensity over the patients who get 30 doses in smaller proportions. (I told you to get coffee—you need the caffeine to be able to stay awake during the explanation. Wish it would get better—the explanation—but it probably won’t. Go get the second cup—wait, make that an espresso.) They don’t know about 30 years out, so this is still a little experimental in nature.

WARNING: more technical jargon to follow.
We still have a decision to make about chemotherapy. Judy’s medical oncologist, Dr. James Murray, told us about a new test we’ll willingly take. It’s called Oncotype DX and is a unique diagnostic breast cancer test that looks at the activity of 21 different genes (yawn) in a woman’s breast tumor tissue. The test measures the chances of that particular woman’s breast cancer returning and the likelihood of her benefiting from chemotherapy treatment. (Yawn! STOP IT—TAKE ANOTHER SIP OF YOUR ESPRESSO!) It will take about 3 weeks to get the results. If she’s in the high risk group, then we’re looking at strong chemotherapy. If she’s in the low risk group—no chemo. If she’s in the moderate risk—well, we’ll decide then, looking at the markers. We do know she will be taking a hormone therapy pill for the next five years. We’re hoping that’s all she has to do following radiation.

(THE TECHNICAL STUFF KEEPS COMING)
We’re also interested in still another test, a genetic test to see if she has the Brca gene (brca comes from breast cancer). Since Judy’s grandmother and cousin on her father’s side had breast cancer, and an uncle (that’s right, an UNCLE) died of breast cancer just two months ago, we think we need to explore this test further. At some point during her 4 weeks in Houston, she’ll meet with the Genetics Department at MDA to fill out a questionnaire to see if she should take the test. This will have implications for our children and grandchildren.

(BRACE YOURSELF, HERE COMES THE SLIGHTLY DISTURBING NEWS)
One bit of eye-opening news came yesterday. We thought that Judy’s chances of having her cancer recur were very slight following successful surgery. The glitter came off that rose a little. As it turns out, based upon the data they’ve collected, she has a 1 in 4 chance of the cancer recurring within the next 5 years IF WE DO NOTHING MORE THAN SURGERY. Obviously we’re going to do more than surgery. We’re going to do all we can to keep her cancer free.

So my sweet wife is in full panic mode—not really, just running at mach one with her hair on fire—trying to meet work deadlines before she begins the “exile in Houston.” She’s planning to come home on weekends and I’ll go there for Thanksgiving (already got my tickets). We’ll adjust and before we know it, this will just be a memory. (CONGRATULATIONS DEAR READER, YOU MADE IT TO THE END!)