Decisions about Chemotherapy and Radiotherapy

This entry is part 19 in the series Victory in the Valley

Start at the beginning of the story

Now read on . . .

When my youngest, David, came home, he came straight to the point, with the impulsiveness of youth.

“He’s a Christian. You like him. Dad thinks he’s the right guy. This is the right man!”

His elder brother Stephen responded gently. “Mum it’s your decision. We only want what is best for you. But he sounds good to me.”

Why am I not convinced? I was still uneasy. His practice is so small – why? I like the man. Lord, he’s one of your children; and yet …?”

Eventually after much agonizing, I concluded that I would probably not be happy with any other Oncologist either. I was launching into a totally unknown area. I didn’t know enough about the subject to make an informed decision. My husband was sure. I decided to be guided by my family, and nervously agreed to return to Dr. Meiring the next day.

Drive to Johannesburg

The following morning, we made the one-hour trip through heavy city traffic, to the smart new private hospital in the center of Johannesburg. As we walked into Dr. Meiring’s other consulting rooms on the third floor of the impressive new hospital, I felt much more at ease. In some strange way, this felt more like a “proper doctor.” Little did I know that within two months he would close these rooms, and move exclusively to working from home.

“I have spoken to three colleagues,” he eventually said, having spent the past half hour talking “Church” with my husband. Why do I resent this? I wanted to get on with the matter at hand. After all—I was the patient. The sooner he dealt with me, the sooner we could get out of this room. 

He meticulously wrote out for me, in a beautiful script, the three options of chemotherapy that the other oncologists had suggested. As I was to learn, no two oncologists ever seem to see things quite the same way. Dr. Meiring presented me with three possible chemotherapy regimes. Well really, it was four. He took some things from each suggestion, altered one of the drugs completely, and then doubled the recommended period of chemotherapy.

“This is not the traditional treatment.” I can see that! “But I believe it is the best possible treatment for you.” He explained that he believed I needed an entire year’s chemotherapy, divided into two full courses of six months each.

More than I wanted to know

The one course of chemotherapy comprised of the drugs Carboplatin and Navelbine, both drugs not normally given for primary breast cancer. The second  would be made up of CMF – a combination of Cycloblastin, Methotrexate. and 5 Fluorouracil.  He elected to give me Methotrexate in place of the more usual because of my history of Rheumatic Fever, as he said it could aggravate my heart damage.

When I indignantly told him my heart was just fine, he retorted, “No it’s not. You take medication for arrhythmia. There is something there. The medical profession just hasn’t found it. But I don’t want us to find it during chemotherapy.”

I couldn’t think of a suitable answer so wisely kept quiet.

“The Carboplatin regime will definitely cause your hair to fall out,” he continued cheerfully. “But not to worry—it will grow back better than ever. Sometimes it even comes back another color.” 

The choice I didn’t want

All my life I had complained about my deep auburn hair. I had never appreciated being a ‘red-head’. Suddenly I liked my hair very much, and I really didn’t want to lose it.

“The CMF might not take your hair out,” he continued, “but it will make you very nauseous. We will obviously give you something to counteract this, but you could still have some unpleasant effects to cope with.”

He leaned back in his chair. “First we need to get the radiotherapy behind us, then we will decide which formula we will use first. You can think about this.”

Whoopee! What a choice. Do you want to lose your hair first, then get sick? Or would you prefer to get sick first—then lose your hair? It didn’t seem like much of an option to me.

Tamoxifen

In addition to the radiotherapy and chemotherapy he also prescribed Tamoxifen tablets daily. Initially he said this would be for twenty years. Later he changed it to “at least five.”

Tamoxifen is an anti-estrogen, which is normally prescribed to people whose tumor have a positive estrogen receptor. In other words, starve the cancer cells of estrogen and they will die.

Goliath however had been estrogen and progesterone negative, meaning that removing estrogen would not have any effect on it. However this was the one thing which all the consulted Oncologists agreed upon. I should take Tamoxifen, as a prophylactic measure, to discourage the growth of an estrogen positive tumor in the other breast.

I found it unnerving, to say the least, to read in the tablet’s insert that under no circumstances should this be used in the case of an estrogen negative tumor. Many times during my treatment I queried this with the ever-patient Dr. Meiring. Each time, he would reach for his big blue Oncology text book and make me read for myself what the latest research said.

Next on the agenda was radiotherapy which absolutely terrified me. As a student nurse I had cared for patients with horrific burns from this practice. Even though Dr. Meiring assured me this should not happen in my case, I remained unconvinced. Meantime, I faced an impossible decision. Really, which chemotherapy regime did I want first? Did I want to lose my hair first? Or did I want to get sick? How about I didn’t have it at all?

Have you ever faced an Impossible Choice?

Which of the two would you choose to have first?

Please leave a comment, and if you leave a live URL in your comment, I’ll get back to you.

NOTE:
These events occurred between 17 and 20 years ago. I have tried to recreate events and locations as accurately as possible, but in order to maintain their anonymity, in some instances I have changed the names and identifying characteristics of individuals and places.

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20 comments on “Decisions about Chemotherapy and Radiotherapy

  1. These are impossible choices, Shirley. I guess I’d simply trust God, not put a lot more thought than that into it. Of course, my health issues are chronic, not life-threatening, so I may have an entirely different opinion were I in your shoes.

  2. I have never read a detailed post by a cancer survivor before, and this is so informative as well as overwhelming. I can’t imagine what you must have gone through when the doctor gave you options that sounded just as bad. Kudos to all the cancer survivors and to you. Thank you for sharing your story.

  3. My aunt is presently going through chemo and my Uncle sends regular updates of how hard it is for her. I can’t begin to imagine what you and your family went through, Shirley. As I told you before, you’re an inspiration!

  4. Yes i faced some challenges while taking important decisions in life but nothing comparable to what you had to take. Taking a right decision during tough times is not easy. Hugs to you.

  5. I can imagine it was quite devastating. I too used to moan and groan about my curly unruly hair till one day I was so emotionally devastated that I experienced severe hair fall. Now my once thick and unruly hair is thin and wispy and I long for my old head of hair.

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