Oncology

Dr. Donegan is my oncologist. Words I never thought I'd say together: my oncologist. But here we are. And if we have to be here, and if I have to say those words, I sure am glad that "Dr. Donegan is" comes first. He is fantastic.

Kevin's mom came again to the appointment with us. I left work early, and she met me at the house so we could ride together. Kevin met us there, having come directly from work in the opposite direction. Kevin got there early enough to get his allergy shot before meeting us for my appointment, so he wasn't there when we arrived. A volunteer in the waiting area directed me to the check in area, where the woman checking me in asked all about the baby and said not one word about cancer or being sorry or any of the things that I've heard over and over since this ordeal began. I commented to Debbie as we walked to the waiting area that I don't think I'd ever have realized it had it not happened, but I was so struck and grateful that to her, for a couple of minutes, I was just a pregnant woman to chat with for a few minutes, even while she checked me in to see an oncologist.

We were called back in only a couple of minutes, and after checking my vitals, the nurse told me to go ahead and eat the rest of my lunch (I hadn't had time since I left work early) and that the doctor would be in soon. She also promised to send Kevin back as soon as he arrived.

Kevin came in, I finished my banana, and Dr. D came in and invited us back to his office. He, like my OB and surgeon, started off by promising to take good care of me and the baby. He had already done his research into treating breast cancer in pregnant women, and he assured me that the chemotherapy would not affect the baby. As an easily observed example, although pregnant women undergoing chemo wind up going bald, their babies are still born with hair. I told him that both Kevin and I were bald as babies, and so were our siblings. Laughing, he said that he couldn't help that, and that we couldn't blame him for it.

After talking for a bit, he said he'd like to do a quick physical exam, and he led Kevin and me back to the exam room we'd been in before. After I changed into a gown, he came back in, felt the lump, checked for anything else in my breasts and lymph nodes, and then left so I could get dressed again and meet him back in his office.

As we talked, he wrote out a to do list for me:

• get an echocardiogram (chemo can be hard on the heart, so they want to check the function first)
• blood work
• get a Portacath installed (so I won't have to have a new IV for each chemo, since chemo is rough on veins and since the chemo I'll be having can be quite toxic if it leaves the veins)
•  attend a Teach Session (orientation to the infusion center and what to expect on chemo days); 
• genetic testing (important but not an immediate need; it can wait until a little further down the line)
• chemotherapy: done in two "chapters"
• Chapter 1: A-C (Adriamycin and Cytoxan) every two weeks for four treatments. I'll have to receive (or give myself) a shot of Neulasta 24 hours after each treatment to stimulate my bone marrow and help my blood counts recover, since I'll be receiving treatments closer together, a "dose-dense" schedule that TNBC is particularly responsive to. I'll start this as soon as possible, hopefully by late next week.
• Chapter 2: Taxol, administered weekly for 12 weeks or biweekly for 8 weeks. I'll start this after the baby is born; that'll give me a few weeks after finishing A-C to recover before the baby comes, and then I'll have a couple weeks before starting.

• Stay hopeful. This was the last thing he wrote on my to do list. I appreciated it. 

 He printed several articles for me about pregnancy and cancer, particularly on the safety of chemo during the second and third trimesters. He told me I could show them to anyone who tried to give me any hassle about harming the baby. Multiple studies have shown no adverse affects to the baby.
He answered nearly all of the questions on my typed list before I had an opportunity to ask them; the ones he didn't answer were primarily logistical.

At one point, he noticed and complimented my Claddagh ring. I thanked him and explained it was my engagement ring, and didn't Kevin do a good job? I told him I'd noticed his wedding band was a Claddagh as well, and pointed out Kevin's ring, which is engraved with a Claddagh and Celtic knot design. He then told us the story of when he proposed to his wife, also with a Claddagh. I won't share it here, since after telling us, he laughed and remarked that he'd never shared the story with a patient before.

I saved my scariest question for the end of the appointment. I asked my prognosis. He pulled up a website on his computer that will calculate it based on a number of factors. After walking us through and entering each of the factors, he pulled up the results. My chance of recurrence in 10 years is under 20%. He reiterated how well TNBC responds to chemotherapy, acknowledged that a quick look online will make it seem very scary, as there's a lot of publicity about the times it does not respond, and said that we've caught it early and are going to treat it aggressively. As scared as I had been to ask, I felt very reassured and confident that we were going to kick this cancer. Because we have to. I've got a kid kicking around in my belly, and there's nothing I want more than to raise him or her with Kevin.

All told, we spent a good two hours with Dr. D, and just as with Dr. S on Monday, I never felt like we were being rushed or that any questions or concerns we had were an imposition.