Next Step: Treatment Plan

(Summer 2020)

Dr. Walker's sense of humour is so understated that it wasn't clear to me when he made the full skeleton image of my bone scan do a little dance that he was doing it on purpose. That was his flourish, which I found very funny, as he told me that the bone scan was free of cancer (which I already knew). He did smile, ever so slightly, when I suggested that this situation was one in which a diagnosis of osteoarthritis was welcome.

After reviewing all my test results, and doing another exam, he laid out two options for me at our appointment on Tuesday afternoon:

Option 1:

Surgery first—a lumpectomy that sounds like it would remove a fair bit of tissue. He explained that if the margins weren't clear after surgery, he would have to do another surgery. Or if more than two lymph nodes were positive, then he would also have to do more surgery. Then there may also be chemotherapy too.

Option 2:

Five to six months of chemotherapy to shrink or even possibly eliminate the tumours, then reassessment to see if surgery is necessary. The downside of chemo, of course, is that it is systemic, affecting the whole body. But the possibility of eliminating the tumours, without surgery, is pretty enticing. And if the tumours shrink considerably and surgery is still necessary, then removal of smaller tumours would preserve more tissue, and presumably, there is less likelihood of complications. Doing chemotherapy with the tumour still present means that it is easier to see how the cancer responds to the chemotherapy.

I really appreciate that Dr. Walker laid out the options clearly. I felt that the decision was mine to make without pressure. He also explained that if I changed my mind, I would just have to call. The nurse reassured me that even though I won't be back for an appointment for 6 months, I could always call and ask for assistance if I needed help navigating anything.

So, I've been referred to medical oncology for assessment. No word yet when that appointment will be.

We are also still awaiting the genetic test results, which should be available in late October or early November. If I'm in the queue for chemo and the test results are negative, then I'll just carry on. If they are positive, I'll stop and consider mastectomy.

I had a CT scan at KGH this morning, which was easy peasy and quick. (It was a routine test in this situation, not for a specific reason.) On the my way back to the parked car, I recognized a colleague, on their way to the Cancer Clinic. We spoke briefly on the sidewalk, and we each expressed our astonishment at how remote and unimportant work

seems to us now, after years of it being so central in our lives. It is another cancer cliché that work is so unimportant in the bigger scheme of things. But it is hard to explain how true that is right now.

On this warm fall day, I packed my swim suit, towel and water shoes, expecting I could have a dip near the hospital after the test. The water was silky smooth and calm, and the sky was so many shades of blue, grey, silver, and white. It was magical. Then, on the return swim, I realized that the curve of the embankment had hidden a rough shelter, made of cardboard, plastic, and wood, tucked under some tree roots and the overhang of the bank. Clothes and a sleeping bag lay close by, totally invisible from the pathway above. An incredible waterside view, but what a damp and uncomfortable place to sleep! More evidence of the housing crisis that needs urgent attention.

In the meantime, I continue to feel that I am receiving such good care, in all aspects of that word. If we could only spread that kind of care, and caring, across all health and social policy arenas. Like milkweed seeds, carried on the breeze.