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Posts Tagged ‘recurrence’

The Lord giveth and the Lord hath taken away…[Job 1:21]

In the world of cancer, it seems things can change so rapidly it’ll make your head spin. Tuesday’s wonderful news that I’m cancer-free provided almost 24 hours of pure happiness and gratitude. I spent that afternoon phoning my dear friends and family to tell them the good news and to share their relief, which was almost as huge as mine. And, of course, I followed my doctor’s orders by celebrating that evening with one glass of champagne – that quickly went to my head!

But, unfortunately, the pure joy was interrupted the next morning when the phone rang and it was Dr. Fekrazad. He sounded sheepish as he told me he hadn’t slept the night before for thinking about my case. He’d phoned some colleagues in other countries (Germany and France, I think) to get their take on my situation. He said that, after further consideration, he’d like me to come back in to talk to him – could I be there at noon?

Somehow, I held it together pretty well even though I knew what the meeting would bring. Tim drove me over to the Cancer Center, where we bypassed the exam rooms I normally see Dr. Fekrazad in, and instead were taken directly to his office. He proceeded to tell me that, while it’s still great news that I responded so well to treatment and surgery (“no cancer remaining”), after more research and discussion, he now felt I might benefit from another course of chemotherapy. He said there really is no right answer, but his European colleagues felt more chemotherapy would be added insurance against experiencing a relapse. Apparently, the statistics he’d relied on the day before were “not complete” and at least one other doctor he spoke to was emphatic about ordering more chemo in my case.

Nonetheless, he wanted the final decision to be up to me.  He laid out three options:

1. Do nothing – other than continued monitoring every three months as originally planned;

2. Full therapy – Xeloda (oral chemo) taken two weeks on and one week off, plus Oxalyplatin (chemo infusion) once every three weeks, both for a total of six months; or

3. Xeloda only (with no chemo infusions) – taken two weeks on and one week off for six months.

Dr. Fekrazad had told me when I first met him that he also treated his own mother for colon cancer (she was Stage 4 when it was discovered) and she’s been cancer-free for nearly 3 years now. He reminded me at this meeting that he put her on Xeloda for 9 months after her original treatment and surgery. He admitted that he wasn’t sure whether he’d been treating her or himself when he had her keep taking it. But he ended by saying, “If you were my sister, I’d want you to do more treatment.”

So, I’m reeling a bit from this revised information. I haven’t decided yet what I will do. A part of me intuitively believes that my chances of a recurrence won’t be any different with more chemotherapy. I’ve already begun adopting many of the recommendations of the cancer nutritionist I’m working with (whose plan for me is based entirely on scientific research that indicates a specific benefit for people who’ve had colon cancer). I also feel strongly that my attitude and lifestyle choices will help prevent a relapse as much as any treatment I might do.

But the “rational, conscientious” side of me is whispering: why not at least take the Xeloda and see how it goes? I won’t be having concurrent radiation therapy as I did before, and nearly every one of my healthcare folks has said that’s probably what made me so sick. Dr. Fekrazad has also said if after some weeks or months I’m not tolerating it well we could simply stop the treatment. So what would it hurt to try it?

A portion of my dilemma is merely emotional: I was totally prepared on Tuesday to hear Dr. Fekrazad say he’d like me to do more chemo. If he had said it that day, I’m pretty sure I would have simply replied, “Okay, when do we start?” But having gotten on the rollercoaster of thinking I didn’t need more treatment, plus telling the whole world my fabulous news, it became much harder to swallow this new setback. I even delayed writing about it here (or talking about it with those closest to me) because I really didn’t know what to say and, truthfully, I just don’t want to deal with it right now! I’m still very much in the midst of trying to adjust to life with a colostomy (I’ve had no choice but to get very intimate with “my shit” these days). It’s also early in my recovery period from major surgery, so I’m still managing pain both in my abdomen and my butt. With all that I’m coping with at the moment, I’m just not in the best frame of mind to make a big decision about further treatment. I’d actually like nothing more than to pull the covers over my head and pretend none of this is happening right now – and live in the illusion (at least for a short while) that I’m going to wake up and have my “pre-cancer” life back, complete with yoga, wine, travel, work, gardening, creativity and the energy to do all of it.

But, that’s not the path I’ve been given to travel yet. I trust I’ll be guided to make a decision that’s right for me. I know that the same great Spirit that’s held me up throughout this entire journey isn’t likely to forsake me now. A few more tears may need to be shed before I can find my way, but I know I will.

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I just got home from my office visit with Dr. Fekrazad. He was all smiles as he waltzed into the exam room with a copy of my pathology report from the surgery. His P.A. Cynthia was right behind him with a big grin, too. Silly me, I thought they were just happy to see me doing so well only 12 days after major surgery. It actually took me quite a while before I understood why they were so gleeful.  But the phenomenal news eventually landed on me: There’s no evidence of cancer and no need for more chemotherapy!

Perhaps I’m just dense at various times, but as he was discussing the details of the pathology report with me, I was just certain he was about to drop the bomb that I needed another round of chemo. I had even shed some tears this morning right before heading out the door for the appointment because I was so wrapped up in anticipation of hearing those words. So, when he had me follow him out of the exam room and into his office so we could all look at some statistics on his computer, I became really confused!

He pulled up a screen and plugged in some figures pertaining to me (age, sex, depth of cancer invasion [T2], lymph node involvement [N0], histologic grade [gr. 3], etc.) and two graphs appeared indicating the percentage of patients with my exact circumstances who relapse within five years. One graph was for patients who had no additional chemotherapy and the other was for patients who had additional chemotherapy. The figures for both graphs were identical! The bottom line was: there is a 10% chance of recurrence over the next five years whether or not I have more chemotherapy. Another screen showed a 7% chance of mortality (death) within five years, again whether or not I do more chemo. Sobering info, yes, but I finally understood: the pathology report was saying my prognosis is as good as it can possibly be. I have about the same chance of dying from a recurrence of cancer during the next five years as I do of dying from any other cause! I sat there staring at the computer screen in stunned silence. Then, Dr. Fekrazad hugged me and said, “Go celebrate! Have some champagne tonight! I’ll see you again in 3 months!”

As I prepared to leave the cancer center, I stopped and hugged everyone I saw! Each nurse, each healthcare worker, each doctor I saw who had helped get me to this day got a big hug and a tearful smile. I am so grateful for the exceptional care I’ve received over the past six months. And I know in my heart that every one of you has also contributed to my healing – through your positive thoughts and prayers, visits, food preparation, hand-holding, and every other form of love you offered. So, here’s a virtual big hug and tearful smile for each of you! Thank you! Thank you!

Time to Celebrate!

I’m going to take Dr. Fekrazad’s final orders very seriously and crack open that bottle of champagne this evening. I’ll be lifting a glass to my health and then to all of you for your love and support. Join me in spirit or in reality if you will.

Wonderful news aside, we’re not done yet! I have follow-up visits with Dr. Brown and I’ll be getting an ultrasound to see if the blood clots in my right arm are gone. When I get that all clear, they’ll finally remove the port-a-cath from my chest. Plus, I’m still adjusting to the colostomy experience and will have more to say about that very soon. So, stay tuned for further blog posts over the coming weeks…you see, you can’t get rid of me that easily!

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