April 16, 2025

April 14 I had an appointment with my PCP. She's awesome. We went over the recent diagnosis, the plan from the oncologist, reviewed my labs and did a once-over on Kira to get a baseline of my current health (pre-chemo). She wants to be able to keep an eye on me from another point of view, which I fully appreciate! Nothing against specialists whatsoever, but they do tend to focus on "their" thing so my PCP may notice something later on that might've been overlooked. I'll see her again in 3 months instead of my normal annual visit. She also told me to reach out to her, any time, day or night, for any reason. She'd be there for me any time. How can you not want to just hug your doctor?? I didn't, but wanted to. 

Once again, Tracey and Chris arrive to help with things around the ranch. Their girls, Hannah and Izzy, came along for the week also. They are my babies too. They may not think they were much help while they were here, but I wish I could express just how much of a relief it was having them here. 

As mentioned previously, Nathan set up appointments with VCU medical staff. When they made the appointments, they made them back to back with the whole medical team handling my case. Thank goodness!! Made for a long, somewhat overwhelming day, but at least there weren't numerous 3 hour trips there and back. 

April 16, Nathan and I embark on our journey to VCU. Remember, this is the NCI visit for their opinion of my case. Off we go for the day, leaving our ranch in the very capable hands of extended family.... not that the farm critters are hard to keep, it's the 7 labs that can be a handful sometimes. 

We arrive at VCU Massey Cancer Center for my scheduled appointments and everyone was so nice and pleasant! Short version, if you or anyone you know ever has a run in with this cancer crap, seek their opinions. 

I have 4 appointments - first is with the PA, Dr. Bragg. She's super friendly and knowledgeable. She was the one that actually told me that the team was reviewing my case the day before so they were all on the same page. I'm used to doctors reviewing files while walking into the exam room at appointment time so this was huge for me. She proceeds to give me the highlights, the cancer diagnosis, explanations, and her opinion. 

Dr. Vachhani, the oncologist, came in shortly after and also gave her opinions of my diagnosis. For her, I had questions. I was given the list of meds that were to make up my cocktail and study drugs that were an option for me. I asked her to explain the various meds, reactions and her opinions of the study drugs. Take into consideration that she can't really give an opinion on the study drugs themselves, only what the study has shown to date. The only other thing she can say about them is whether I'd be a good candidate for the study. No one can actually tell me what I am going to do. This is a weird diagnosis in that the treatment information gets laid out in front of me and I make the choices. It's not like "oh, you have strep. You take this antibiotic now".

Let's talk meds.. there will be 12 weekly treatments of these bad boys: 

Pembrolizaub (Pembro for short, aka Keytruda) - this is the immunotherapy drug. Basically, it stimulates the body's immune system to fight cancer cells. I'm quite proud of my existing immune system and I know treatment is gonna flush it down the toilet, so for this drug, yes please. 

Carboplatin - Chemo drug. Didn't care to know more details. 

Paclitaxel (aka Taxol) - Chemo drug. Didn't care to know more details here either. 

From there, an eval of my situation and a run of these drugs: 

Adriamycin (aka Red Devil) - Chemo drug that kills cancer cells by damaging their genes. 

Cyclophosphamide (aka Cytoxan) - Chemo drug that damages cancer cells 

Basically a bunch of drugs to kill this stupid fungus my body decided to grow.... There is a 65-70% chance these will kill this cancer prior to surgery. 

Now, the study drug option....

Durvalumab - Immunotherapy drug like the Pembro above

Datapotamab Deruxtecan - anti-cancer med that is supposed to kill breast cancer. It combines an antibody with a chemotherapy agent to kill the cancer cells with fewer side effects than traditional chemo.

This was described as this: immunotherapy + a seek and destroy missile. It seeks the cancer out and destroys it. 

This option of fewer drugs and fewer side effects sounds great, right?? I think it might be a great option for some people. The trial HOPES this method will be as good as or better than the standard option above, but there's also the risk that it may NOT be as good as the above.... 

My intruder isn't nice enough for me to take the gamble. Grade 3, triple negative, stage 2-3, 4-5cm, invasive and aggressive aren't terms that scream "do the trial" in my mind..... My gut says no. 

Dr. Quinn comes in and explains radiation therapy. Daily localized radiation treatments for about 5 weeks. DAILY. Ugh. Her recommendation wouldn't normally be this as a requirement, except in my case. Her words were "with as aggressive as yours is, I would definitely highly recommend radiation for you." Awesome (insert sarcasm)

Last one to the party was Dr. Louie. He was very cool. Explained how the surgery would go, the various mastectomy options and kinda how reconstruction gets done. He really couldn't make actual recommendations on surgery at this point. We'll have to see what this chemo treatment does. I'll see him again in July and reassess things. 

Also on deck for meetings was the nurse navigator Pam and the social worker, Freda. Fabulous ladies. Freda was the one that passed along the information that VCU has a hotel they partner with for those who need a place to stay during visits to the facility. They handle the reservations AND payment! Great info!! Let me jump ahead real fast and say that she noticed there was an appointment scheduled for me with the plastic surgeon on 4.25.25 so she called to see if I needed a reservation because she remembered how far away I am. That's incredible in my book! 

This was a very informative, mind boggling, overwhelming, calming and hilarious visit. Yes, hilarious. If you've met Nathan and I...well, you understand. We had all the staff laughing! 

Back to the lake we go!