THE GOOD, THE BAD, & THE UGLY

I went to the "goldenhands" of oncologists yesterday. Honestly, I was dreading the appointment because pretty much all appointment of late have resulted in those "WHAA?!!" realizations, and although I've wrapped my mind around the fact that I will definitely be getting chemo, and have even joked about being sick and bald, I hadn't really thought about what exactly that would entail for me over the next six months, other than it couldn't be that much worse than being pregnant, right? (minus the bald thing). In any event, another firehose education with some mixed results.
The Not So Good: Remember that "now I'm cancer free" concept? Again, I was smoking something, according to the "Sedlacek Metastictic Index/SMI" (Sedlacek is the doctor) that uses tumor characteristics to quantify the risk of 10 year metastasis with local therapy alone... (Metastisis means the cancer spreads to the bones/lungs/liver. At this point, they can't do much about it when it gets to that.)
2% risk for each 1mm up to 100mm --> 20%
1.5% risk for each 1mm of tumor from 10 to 35mm --> 30% (Note that I had thought my tumor was around 2cm (20mm), turns out it was more like 3cm, but I still need to clarify this with the surgeon-- how could all of the scans been so far off?)
8% for each lymph node in 1-3LN+ patients --> 8% (remember that negative/positive node thing, turns out I count as positive in at least 1, darn)
adverse pronostic factors:
ER negative (check)
PR negative (check)
HER2/nue positive (I'm negative-- yippee! but double edged sword, they actually have this new miracle drug that treats this really well)
High Ki-67 and/or %S-phase (e.g., aggressive tumor) (check)
Multiple total risk by 2.5X for 3 adverse prognostic factors. 58% x 2.5 = >100%
...if the cumulative risk of metastasis at 10 years is greater that 100% than take 58% of the 10 year risk to determine 5 year risk = 84%
Well, shit.
(Note that I almost NEVER swear, to the point that my mom even offered me money to say the "S Word" at one point, but if there was ever an appropriate time...)
Bottom line: I REALLY REALLY need chemotherapy. According to the doctors index, there is certainly that lurking cell somewhere within me. The good news is that chemo works well and with it will reduce the chance of metastasis by 75% (this is the number he threw out). My immediate translation of that probably-not-so-scientific analysis is that I have a 1 in 4 chance of getting terminal cancer in the next 10 years. There, I said it. Worse fears confirmed.
I repeat-- Well, shit.
As an engineer, my inclination is to latch onto these numbers as something concrete and real. I want to do more research to determine with more confidence (note that although this is a straightforward formula, I have not seen risk quantified like this in any of the other books I've read, which puts it more into the "rule of thumb" rather than "absolute fact" world.) That 75% reduction due to chemo he threw out there plagues me... Where did that come from? Is he overestimating because he's biased? How is success (still don't like "survival rate" terminology) affected by age, health, and a billion other factors? (Not the least of which-- (maybe the most?) is attitude and support network?)
Ultimately though, IT JUST DOESN'T MATTER.
It doesn't matter if it's 99% or 1%. It does me (and everyone else around me) no good to dwell on negative possibilities. All that matters is what I can do. And I will do everything I possibly can-- I will get the most aggressive chemo they can offer me (but that's nothing new, and that's where the good news comes in, see below.) I will amp up the healthy lifestyle-- eat right, and exercise (this step alone will likely benefit my entire family in the long run more than if this never would've happened) and whatever else comes up. I know this all sounds trite, and I can't deny that I'm having a hard time right now... heck, I still can't pick up my kids for goodness sake... but I will get there.
I guess it comes down to the question of would you change anything in your life if you knew you were going to die in the next 10 years?
My initial reactions is-- not really.
Now, how cool is that?!
The Good: Dr. SMI laid out several different chemotherapy paths that are appropriate for someone in my situation. From my appointment with the other oncologist, I "knew" I would need 8 rounds of chemo, likely one dose every 3 weeks (3x8 = 24 weeks = 6 months). What we learned from Dr. SMI is that there is a new "dose dense" method where the 8 rounds are given every 2 weeks. (16 weeks) There is an alternative where a different group of chemicals is given every 3 weeks, but for 6 rounds (18 weeks). More importantly, he said the anti-nausea drugs are such that only 50% of patients get sick, and if I am in the sick half, the first go-round will be the worst as they can change doses so that it gets better every time. Most importantly, I will get this drug called "Neulasta" that will increase my white blood counts enough that I won't have to worry so much about infection-- e.g., we don't have to chose between taking the kids out of daycare and banning them from being around me. He said that I would be sick for only a day or two after each treatment-- That for four months, compared to being miserable sick, and worse, in danger of infection, for 6 months is fantastic! (again, it's all so relative).
The Ugly: I'm definitely going to lose my hair. Probably by mid-March I will be bald. Something that I'd never really thought about before alexander was born was head shape. I have been surprised at how many (and there have been a lot) people have complimented alexander on this quality, as in "my, what a beautifully shaped head he has!" (I did not know this was a cosmetic feature of interest, but hey). I have always maintained that this feature comes from ME, since in every other sense xander is a mini-jim. Now I get to prove it :)

p.s. If you're reading this PLEASE post a comment/send me an email etc. I wasn't kidding about that feedback thing. I need you guys.