Wednesday - Chemo doctor #2 (electric bugaloo) and the Plastic Surgeon
We started off Wednesday with an appointment with a medical oncologist at Hopkins. Astute readers will remember that the surgeon at Hershey wanted me to have surgery first and then chemo, while my team at Hershey advocated for chemo first and then surgery. Both cited data that the survival rates are the same regardless of order, and I was already pretty sure that I wanted to do chemo first to take care of any of those micrometastases as quickly as possible. However, I also wanted to talk to a medical oncologist at Hopkins to see if a) the surgeon was recommending surgery because he was a surgeon, b) if there were any drawbacks to doing chemo first and c) if Hopkins recommended a different course of chemo.

I'll start off by saying that I loved the medical oncologist at Hopkins (I also love the one at Hershey). She was incredibly thorough. She told me that it was entirely reasonable to have chemo first, and in my case, she would recommend it as well. She looked at the regimen that my clinical trial involves and said that was very reasonable and aggressive. She said that if she was in my place, she would also choose to do the clinical trial. She also said that there is absolutely no benefit to choosing Hopkins over Hershey for chemo, especially since I'll be part of the clinical trial and my treatment will be highly standardized. She did mention that it might be worth going to Hopkins for surgery, and that people frequently choose to get their chemo at one hospital and their surgery at another. I think I will go for another surgical consult at Hopkins (I didn't much like the surgeon I met there last week) before deciding what to do.

She also told me that I have "the cancer of a post-menopausal woman," which caused me to have to hug it out with her (I've realized that I have this annoying habit of saying, "Let's hug it out" any time I need a hug from my doctor). So, one thing I've been reluctant to mention is that, contrary to what you'd think, having breast cancer young is actually really bad. The prognosis for most young women with breast cancer is much worse than it is for post-menopausal women. Part of the reason is that, like in my case, the cancer is caught much later than it tends to be in older women, because young women don't undergo breast cancer screening. Another part of the reason is that young women tend to get a more aggressive form of the disease that is unresponsive to hormonal treatments. Apparently, I don't have this type of cancer at all. Instead, I have a cancer that is much more treatable. So, this is fantastic news.

She told me that if my bone scan and CT scan didn't come back clean (I hadn't gotten the results at this point), that metastasized breast cancer is more like having a chronic condition like diabetes or kidney disease than a terminal illness. This was, and continues to be, a huge comfort.

Finally, she mentioned that she'd mail me a copy of her dictation notes. I pointed out that the dictation notes at Hershey called me "lovely" and "very pleasant," and that I fully expected her to up the ante. She promised that she would, so I'll report back once I get the notes. Ideally, I'd like to start a compliment war between my various doctors.

The plastic surgery consult was pretty much a waste of time. Apparently, I can't have implants because I'll need radiation. (I'll need radiation, despite having a mastectomy, because there is lymph node involvement.) I did learn that I don't have enough fat on my stomach to do a breast reconstruction, so I'd have to use butt fat. I think that's flattering, but I'm not sure. Also, the nurse that spoke with me had had a fascinating amount of work done. As many of you know, I'm a big fan of playing "guess what work the celeb has had done," so the opportunity to play in real life was a treat. I'm almost positive she'd had cheek implants and forehead botox, despite looking younger than me (although maybe she only looked younger than me because of the botox). She may have also had cheek botox and/or collagen, because she couldn't move her lips properly. Her lips were full, but they didn't have that weird underlip feature that is typical of fresh collagen. She looked so overdone that she was starting to fall into the uncanney valley. The doctor, on the other hand, looked like she hadn't had a haircut in 15 years. An interesting pair to be sure!

Next up, we soldier on to Thursday and Friday.