I have thought to sit down to write so many times in the last month.  I actually intended to write a follow up from my last entry while Doug and I were at the beach with Christian and Mary's family.  But, since I procrastinated, there is more to write about, and I guess that is a good thing.

At that same visit with Dr. Lee, (August 29th) where she laid it all out on the table, she talked about my treatment plan.  The standard treatment for any of these epithelial cancers consists of two chemotherapy agents: Carboplatin and Taxol.  These two agents are given every three weeks, times six.  She also told me that I was a candidate for the Intraperitoneal (IP) delivery of the chemo agents. (that's where they infuse the drugs directly into my abdomen through a port in my belly)

I interrupted Dr. Lee and asked her if we had already talked about my previous experience with Taxol.  She said, "No, but please tell me now."  I told her that Taxol was the chemo agent that was used in my second set of chemo during my breast cancer treatments, and that I had some pretty intense side effects. I explained how after just one treatment I had experienced the worst bone and joint pain ever in my life.  And, that after the second treatment, I could no longer walk on my own without holding on to someone, or a wall.  (Taxol attacks bone marrow cells)  Additionally, I had terrible neuropathy in my hands and feet.  My oncologist stopped the treatment.  I was supposed to have four total, but he was so concerned about permanent damage that he stopped that treatment.

She first said that given this information, we would not consider the IP delivery.  And, she said that she was inclined not to use Taxol at all.  If I could only make it through two treatments before, how would I make it through all six.  Dr. Lee said there is a "sister" drug called Taxotere, that has the same active ingredient, but it is a different formula that has less severe contraindications for damage to the bone marrow.  However, it did have it's own unique side effects.  I felt somewhat relieved to know that I would not have to endure the wrath of Taxol again.

I also told her about how plans were made months ago to go to the beach with Christian and Mary and their family the second week of September.  She said that I could wait to start treatments until I got back.  That was nice.  So, the plan was to see her in one week for blood work and final instructions.

On September 3rd, I saw Dr. Lee and she did a final post operative exam.  Then, she told me about a newly released study out of Japan that published their results just last week.  It wasn't a very large study, only about 630 women with Stage II to Stage IV ovarian cancer participated.  But, the results were still significant.  She told me that when she saw the notification, she thought of me.  Half the women were treated with the standard care of Carboplatin and Taxol every three weeks for six weeks.  The other half were treated with a "dose dense" taxol regime.  What that means is that in the three week cycle, on day 1, the patient is given the standard dose of Carboplatin, but a smaller dose of the Taxol.  Then one week later, day 8 they have another smaller dose of Taxol and then one week later, day 15 another smaller dose of Taxol is administered.  This cycle continues over 18 weeks, with no breaks.  You have a chemo treatment every week.

In the standard treatment, the dose of Taxol in 180 mg.  With the dose dense treatment, you get 80 mg each week.  This means that over the 3 week cycle, you are actually getting MORE Taxol (240 mg) but spread out.  The dose of Carboplatin is exactly the same as the standard treatment.