A hard decision

For the majority of the last week, I was fairly certain I was going to choose to put off the follow-up treatment as long as possible. As we get more information and talk to all of my physicians again, it's becoming clear that I will need to do the treatment sooner rather than later. "Sooner" meaning pretty much immediately.

The surgeon still says "Personally, if it were me, I would wait until signs of regrowth" because it was a "radical" surgery where most of the tumor was removed. However, he has also talked to all the specialty doctors and "the majority" of them recommend the adjunctive therapy (chemo/radiation). The chemotherapy oncologist is adamant that early treatment will postpone the time before regrowth, saying that it's better to treat it when there are less cells. However there is no definitive data on that theory. Grade 2s don't respond to therapy the way that grade 4s do, but there is little to no research on grade 3s, since they make up very few of the overall number of brain tumor cases. He also says Dr. O is "just" the surgeon and doesn't know everything about the post-surgery treatment. How's that for ego?

So my case was taken to the tumor board on Monday and what the surgeon called "the tumor convention" this week where he consulted with all the specialties. Since it is a grey area of borderline grades 2 and 3, it's considered a unique case. They do know that there are some anaplastic cells that are considered malignant and can grow quickly. The chemotherapy and radiation therapy work well on those fast dividing cells, which are the most aggressive to begin with. The benign cells are less worrisome but they are hoping the treatment will get rid of as much of both types as possible. With the fact that I'm young and fairly healthy to begin with, they expect very little, if any, long term effects from treatment. The worst part will be the immediate effects.

What we've learned about this so far:
The overall group name for this tumor is Glial Tumor because it occurs in the Glial cells of the brain.
Grade 3 is technically called "anaplastic astrocytoma" and considered malignant.
Astrocytomas are the most common central nervous system tumor.
Grade 3 astrocytoma is "rare" compared to other grades/types and only accounts for 2% of all brain tumors.
Positive MGMT methylation indicates how well chemotherapy will work (mine was positive).
My surgery was considered a "gross total resection", the best possible outcome.

I basically am coming to terms with that fact that I have brain cancer. It's scary, but it's also one of those things people just have to deal with. There's no other way but to do what we can and hope for the best. Modern medicine is amazing. My surgery proved that. The treatments are improving every year. People with this disease are living longer. The emotional journey will be hard. It will be difficult to go through these intense therapies without proof that it's working, but we'll make it through.

I'm currently trying to keep my physical health improving. I jogged 2/3rds of a mile outside this week and it wasn't totally awful. It's an improvement, even over the ones where I walk 2 miles per session. The last time I ran, I had a debilitating tumor-induced migraine for over 24 hours so I was nervous this time, but I feel really well. I am still going to keep up with my exercise routine.

On a different but not completely unrelated note, I'm going to start crocheting again. I bought some soft chunky yarn to start with. I remember the beanie hat not being too difficult so I'll start with that, maybe embellish with a little strap over the forehead or a shell pattern rim. I haven't actually started yet because I need to re-familiarize myself with how to do it, more youtube videos and some practice. It will be a good fine motor skill exercise for me.

In the meantime, we're continuing on as normal here at home. As I spend more time studying for my certification test, it's becoming *very* apparent that I haven't taken a formal math class in over 12 years. Oh what's that, past self? You say you don't want to take another calculus course in undergrad because it's too hard? Yeah well, bazinga, present self! I have a feeling I have more schooling and prep courses in my future. I am also thinking this October will not be the test that I take to get my certification. Maybe in April next year, depending on how the six 4 week chemo treatments go. 

The kids are still doing well. Our nanny has been an awesome constant source of normalcy for them. They are looking forward to seeing Grandma, Grandpa, Aunt Lauren, and cousins this week. I'm looking forward to some newborn cuddles now that I'm officially allowed to carry his weight around (the little moose!). I'm still planning to walk Grace and Liam to school on their first day the last week of August. I'm excited to give them the bikes and backpacks for their 5th birthday next week.