DOCTOR DAY #2
I met Dr. Smtih today. He is the chemo doctor. I will say I was not wanting to see him. My gut was telling me don’t do chemo treatments, yet my head was dealing with the horrific implications of major surgery as explained yesterday by Dr. West. I was conflicted this morning as I approached my appointment with Dr. Smith. My family asked that I take an open mind into my appointment and listen to the doctor’s explanations regarding the new pre-op protocol. When you are conflicted to the point you find yourself racing between decisions and unable to settle your mind seeking counsel from loved ones who have been in the room with you is a good move.
The doctor offered a pre-op protocol that is based on a new drug called Perjeta. It is a transformative drug that the FDA fast tracked. This drug has very unique and less destructive properties than previous chemo drugs. In many ways thinking of it as not a chemo drug makes sense. It is an antibody that attaches specifically to the HER2 protein receptors on the cell wall of the cancer cells (the tumor) and kills the cancer cells. In this manner the tumor actually shrinks in size. This targeted approach boldly predicts that healthy cells are not killed. Traditional chemo drugs work very differently. These stop ALL CELL reproduction at the DNA replication stage. To this lay person it sounds like chemo essentially kills you , entirely, for several months with the doctors betting that your “good cells” will start replicating after the chemo drugs are gone. Quite the bet, eh chemo!
So I’m excited. I like this new targeted approach.
Oh no – not so fast! The approved protocol requires that Perjeta be infused along with Herceptin, another antibody drug, and Taxotere, a chemo drug. I asked, can’t we just drop the chemo drug and run with the antibody drugs. Nope! The new drug was tested only in conjunction with the chemo drug as a concurrent infusion which compels the FDA to approve it as a multi-drug infusion along with both Taxotere and Herceptin. Also, it is a pre-op protocol which means waiting for surgery for 30-days after just about 4 months of drug infusion therapy with all the side effects of chemo. There is a silver lining, I would be getting only one chemo drug, not the drug cocktail of old. And, I’m not losing sight of the fact that smaller tumors means the drug is proven up front to be killing the cancer and the surgery option moves to an outpatient procedure with significantly less risk for post-surgery infections and painful reconstruction procedures.
I copied this from Dr. Smith’s bio for those who find these helpful. He is … “a medical oncologist for Breastlink of Orange. Dr. Smith graduated from the Creighton University School of Medicine in Omaha, Nebraska and completed his internship, residency and fellowship at Emory University School of Medicine.
Dr. Wade Smith is a specialist in the treatment of breast cancer as well as benign and malignant blood disorders. He is board-certified in medical oncology and hematology. He received his medical license from the state of California in 2006 and was previously practicing with Breastlink of Rancho Mirage. With a passion for teaching, he had previously served as subspecialty coordinator for the internal medicine residency program at Eisenhower Medical Center.
Dr. Wade Smith has an active interest in the future of cancer treatment. He has been an investigator on several studies, in addition to his publication credits in Critical Reviews in Hematology and Oncology and Seminars in Oncology. Dr. Smith is a member of the American Society of Oncology, American Society of Hematology and the American College of Physicians.
At Breastlink, Dr. Wade Smith plays a prominent role in the oversight of numerous clinical trials that incorporate the latest targeted therapies for patients with both localized and advanced breast cancer.
‘I entered the field of cancer medicine to serve as an advocate for patients most in need of cutting-edge therapies as well as compassionate, supportive care. A sharp focus must be maintained on all of the patient’s needs, including the emotional and spiritual. Superb cancer care requires an integrative team approach – combining all talents and insights into a singular purpose. And having had a close family member go through surgery, chemotherapy and hormone therapy for her breast cancer, I further realized what true benefits could be gained by receiving care within a breast-dedicated center. The most important and central member of the team is the patient herself. Also, encouraging optimal nutrition and lifestyle modifications can help bring about the best possible outcome.’ – Dr. Wade Smith.”
Dr. Smith is his bio come to life. He reacted very well to my lifestyle and dietary changes we started this last summer. More on that in future posts. The doctor’s bedside demeanor is calm. He is a shy man who ably communicates hope and calm. I left his office the better for having listened with an open mind. I have decisions to make. I have preconceived notions I need to examine in light of what I heard today. There are more tests scheduled now – all to be done this week – and then one last visit with Dr. Smith on Friday to go over all of the normal drug disclosures or as he put it to go to school on my final decisions regarding pre or post surgery treatment which is his domain in this multidisciplinary team.
Decisions … decisions … decisions.