10/3/19: Medical Oncologist Appointment

My medical oncologist is so warm, she gave me two hugs! One at the start of the appointment, and one at the end.

Mostly we were touching base before I start chemo tomorrow. The biggest update she gave me was that she spoke with the genetics specialist about the VUS in my BRCA2 gene, and she does not recommend getting my ovaries removed to prevent ovarian cancer. There just isn't enough known about the VUS, and it's not enough to justify ovary removal. I was relieved because in the limited research I've done so far, it sounds like a pre-menopausal oophorectomy carries a lot of unknown long-term risks.

She confirmed I will start Lupron with chemotherapy tomorrow. It'll be a monthly injection in the butt. We talked about how Lupron will cause a chemically-induced menopause, so expected side effects are basically the typical symptoms of menopause. I asked if that includes osteoporosis. The short answer is yes; but given my current health, she said she wouldn't expect me to be at high risk for early onset osteoporosis. Chemotherapy itself can actually increase a patient's risk for osteoporosis, so she said she typically orders a bone density scan about 2 years after chemo. She also talked about ways to promote bone health, like doing weight-bearing exercises.

At last week's meeting with the oncology nurse, I got the impression that my risk for nausea was relatively low. But my medical oncologist seemed surprised that the nurse hadn't prescribed this other anti-nausea medication called ondansetron hydrochloride (name brand Zofran), so she gave me that prescription today. Googling it now, it sounds like a preventative medication that is usually taken in advance, but both the doctor and the oncology nurse who sat in on the appointment today (not the same nurse I met with before) said I could take it as needed.

I now have three anti-nausea prescriptions, so I asked how do I know which one to take when? The nurse said the Zofran should be my first option for severe nausea (even though it might cause constipation), and I could use the other one (prochlorperazine maleate) for mild nausea. They didn't mention when to choose the third one, which is primarily for sedation anyway. The nurse also said I could alternate them every 6-8 hours, and that the chemo nurse might give me a kind of calendar or schedule as a guide for when to take which medication.

She reiterated a desire for me to connect with the social worker. The oncology nurse said she'd see if the social worker can stop by during my infusion tomorrow.