Renewal / A Day in the Life Post-Mastectomy

I sat here, ready to write about endings as this year came to a close. Life as I've known it no longer exists.  I was ready to write about confronting mortality, about the stark realization that I am not invincible. I have cried many tears since my mastectomy for the loss of my health, my breasts, my sense of normalcy. I am no longer physically independent. I feel weak in the areas I used to feel strong. There has been so much loss and sadness in the past month (42 days, really). It would be easy to sit here and write a melancholy contemplation of all that is wrong in my world. And while that might function as a window into a small aspect of my world as 2013 comes to a close, it hardly reflects my daily reality.

Most mornings, I wake up before the sun. I'm usually in pain, but Doug and I have been smart enough to leave a pain pill and a muscle relaxer on the night stand, along with an already opened bottle of water. I don't have enough strength in my arms and hands to twist off the caps from the medicine and water bottles, so leaving them out and at the ready has helped to ensure I can get to my meds and get relief quickly (and Doug gets to sleep). Don't worry. Charlotte knows the dangers of touching pills that aren't hers.

I check on Charlotte and Clover every morning. This usually ends in wanting to take a picture because my two girls (human and canine) sleep and snuggle in some of the most hilarious positions I've ever seen. Most days I resist the urge to capture the image, kissing their noses and covering them with blankets instead. I head downstairs for coffee and to enjoy the morning sun breaking from its slumber, casting a cool light on the marshy area that sits just beyond my sunroom. Though this isn't our forever home and it's still in a bit of disarray from the move, I really love it here. It's cozy. Something about that sunroom makes me feel peaceful, calm. Not a common feeling in my life. I imagine sitting there, writing and drinking coffee and the literariness of that imagined scene makes me really happy. One day, that will happen. I will sit there, drinking coffee in the morning light and write something that will change the world.

This morning was the first I was able to take something close to an actual shower. I've been washing daily from the sink and giggling in my mind because I used to pretend to be Laura Engels from Little House on the Prairie when I was young and bathing in the sink reminds me of those hours of play. Ok, maybe I don't giggle so much as wince in pain most days, but each day was better and today was great. I showered! Doug helped wash my hair and Saran Wrapped me to help keep my final drain (Yes! I'm down to one!) from getting too wet. I think he's beginning to understand my love/hate relationship with my hair. I think he's developing one of his own with it, having had to brush and wash my hair on several occasions. It's thick, curly, unruly. A beast. I'm thinking of hacking it off to make the days simpler, but it will likely fall out someday soon anyway and I'm torn about it. Might as well enjoy it while I can. I really do love it more than I hate it. Plus, I think I've hacked off quite enough lately [insert dark laughter - that was a joke =)]. 

Update: I did it. I've met a wonderful woman at Great Clips in Leland. Vanessa is kind, great with hair, & has made me feel great each time I've visited, even when only for a shampoo & style. She was so blown away by how much hair we cut off in the first attack, she recommended I photograph it for the blog. I should've taken a 2nd shot of the hair that fell when she actually shaped the rest of my cut. Nearly as big as this first pile. See for yourself: 

I shaved my legs today and I'm pretty sure my armpits actually got clean. The removal of my lymph nodes has really taken a toll on my left arm/armpit. I can hardly lift my arm from the side of my body and simply touching the skin in my armpit and on my arm is incredibly painful. I'm not exaggerating here. That pain is worse than the bruised ribs I endured from the deck collapse. We've attempted, daily, to clean that area, but it usually ends in tears. The right side hurts too, but I have more mobility there and can actually, on occasion, stretch that arm out to reach for things when I need them. This failed, of course, the other day when I was reaching for a coffee cup in my cabinet. I could not reach far enough, though I tried to stand on my tippy toes and reach out as slowly and far as I could muster. No mug=no coffee. It was a start to a bad day. But, we are learning lessons. Now, much like the meds, we leave a mug on the counter each night so I can have coffee in the morning.

Doug has to help me get dressed most days and each day starts and ends with him milking my drains and measuring the output of lymph fluid. He doesn't complain. We are newlyweds, mind you. We should be in the hot and heavy stages of passion. I suppose, though, that our passion just looks different right now.

Most afternoons are filled with happiness. Friends come and go. Delicious meals are dropped off. Charlotte's been able to play with a friend (or a few) nearly everyday. My parents and Doug's mom and brother have spent so much of their time caring for us;  helping clean the house, keeping things running smoothly, looking after Charlotte's needs and mine. Our fridge and cabinets are full of food, nutritious and treats. Lots and lots of treats. I'm so grateful for all the help and the distractions and really overwhelmed by everyone's generosity of time, spirit, gifts and meals.

I'm exhausted by 8 or 9pm. I've been going to bed before Charlotte most days. The (very low dose) Ambien has helped me sleep, though I seem to wake up instantly when it wears off (around 3am).

Most days are mostly the same, though something simple happens every day that reminds me I am healing. I am getting better; a simple task that most of us take for granted I can do today that I couldn't the day before. Shower, reach a mug, chop a small onion, scramble an egg, shave my legs. Such joy in the simplest of tasks. Though each day seems to start with pain, I am reminded of these simple joys when I reach for the pain meds I've learned to leave within reach, when I hear from friends and family calling or dropping in to check on me. When I look in their eyes or hear in their voices their desire to take this away from me, to shoulder this pain, to rid me of cancer.

As we put 2013 to bed, there are a few things I know. I know tomorrow I will wake up in pain, but it will be less than I felt today. I know relationships will be challenged in the coming year, and likely grow stronger. I know I will have some of my worst days in 2014, but I'm hopeful to have some of my best. I know I will look, sound and feel different. I know there will be fear and uncertainty, but I also know there will be strength and joy and a level of closeness I've never known.

Cancer is a curse, but it's also a blessing. I will know renewal unlike ever before. I hope each of you reading this post will find blessings in the coming year. So many of my close friends are fighting battles they don't deserve, that could destroy their very spirit, but they are strong and they are fighting.  I hope and pray for a positive outcome for each of them, for whole hearts, stability, pregnant bellies, honest love, for everything they hope and pray for. And for each of you, battles unknown, may 2014 be the year that brings you the peace, love and joy you yearn for.

I'm going to sip some bubbly with my family and crawl into bed well before the ball drops tonight. I hope to fall asleep tonight to the same image as last night. Doug holding my hand. Charlotte snuggled between us, wiggling her hand between ours, the three of us bound together, holding on to one another.

Post-Mastectomy News

Hi friends. I'm still recovering, managing pain and trying to wrap my head around this cancer diagnosis. Even now, after my breasts have been removed, I'm still waiting to wake up from this nightmare.

I'll be honest, I've had more sadness and fear than confidence and strength in the past week. I'm working on turning that around, but for now, some sad days and lots of tears, frustration, anger.

I was excited to have 2 of the 4 drains removed just days after my surgery. The drains are super annoying and anytime the move against or pull away from my skin, they hurt. There was some immediate relief from the removal of the first two drains, but the others are still troublesome. At least things are moving in the right direction and I am healing. I'm hoping the remaining 2 drains will come out on Monday morning.  I was told the removal of the drains wasn't painful. I don't know who told that lie!  Ouch!  It happens quickly, but made me cry out loud, which I hardly did giving birth to my daughter.

I got to cruise around Costco in a motorized cart. I'm simply too tired and weak to push a cart around the store (probably should've been at home, but really needed to stock up on fresh/organic produce for juicing). The carts are a nice perk, y'all.

We met with the oncologist on Christmas Eve. The news was mixed. The good news, that the remaining 7 lymph nodes weren't involved, was overshadowed by the surprising news that the tumor was 5.5cm. 1.5cm larger than they initially thought. This means my final grade/stage determinations are Grade 2 (speed of reproduction is 44out of 100), Stage 3a (based on size and minor lymph node involvement).  My Oncatype Dx Score was 29, which placed me on the high side of intermediate risk for recurrence (31 is high). I was advised that based on my Oncatype score, I have approximately a 20% chance of recurrence. Recurrence of breast cancer is not likely to have a good outcome, so our task now is to figure out and do whatever is needed to minimize that recurrence risk. That means chemo, and the nasty one at that.  Unless something changes in the next week or so, I'll be starting an 18 week cycle of TAC chemotherapy. I have to have a MUGAScan before starting to test the function of my heart because the "A" in TAC can cause heart failure and deadly secondary leukemia.
TAC chemo should reduce my recurrence percentage to 9-10%. I'm having a small surgery to place the power-port on the 10th. They'll use the port to give me the chemo infusions.

Dr. Weinberg and Dr. Kotz are going to bring my case to the tumor board once again for some final recommendation on radiation (and TAC vs TC, but several oncologists in his practice have already agreed with the TAC recommendation). I have an appointment to meet with a radiation oncologist. If it is truly necessary (will significantly reduce recurrence chances), radiation will happen after chemo (everyday for a month). Dr. Kays wants radiation to wait 8 weeks after chemo so he has a chance to finish my reconstruction and I can heal before they radiate my skin (which can cause the reconstruction to fail due to issues with healing). Dr. Kotz also mentioned he's presenting my case at a conference (wish I could attend, I love conferences!).

So, that's the news. Sorry if it isn't clear or well-written. I'm so exhausted from not sleeping well, over-doing it on a regular basis (because I am stubborn and can't stand laying around in bed all day), emotional exhaustion and the foggy feeling I get from Oxy.

Hoping all had a merry Christmas!
 

There's No Place Like Home

I came home from the hospital Thursday (12/19) around dinner time. I was feeling great at the hospital; energetic and a good range of motion in my arms.  I hadn't been using the pain pump much, maybe half as much as allowed, and did well on the oral pain meds. I'd taken a few walks, gone to the bathroom several times and was really ready to go home to my own bed.

Shockingly, I overdid it trying to move around the house on Friday. I do need to get up and move a few times a day to help prevent blood clots in my legs (I had pressure sleeves around my legs and shots of Heperin in my stomach to help with that in the hospital), but I should really stay in bed otherwise and that is hard for me. I want to be up, moving and doing, By Friday night I was really sore, and my drains had increased output, a clear message that I need to park it in bed.

The drains aren't quite as bad as I'd imagined. They are uncomfortable and gross to look at, but not as awkward or painful as I'd thought they'd be. Doug does a great job of milking them and draining them, keeping track of the output for the doctor. The running joke around here is I'm a suicide bomber. The drains look like grenades and I usually button only the few buttons above them so the shirts don't feel too tight.

 

 

Dr. Kays had to cut additional skin because that Spy Elite system showed poor blood flow to the wound site on my right side. Because of this (and my history of smoking) he did not add any saline into the extenders. My chest is now square, hard across the top. I feel a lot of constant pressure across my chest with some shooting pains, particularly when I try to sit up on my own. I also have a strange numb sensation across my entire chest and into my upper arms. If you've ever had Novacaine injections in your cheeks or lips, and touched that area while it was numb, you know the strange sensation I am talking about.

 

It was a bit of a struggle to see the incisions and lack of breasts the first time the nurse came in to change my dressing. I shed a few tears. My body shape is out of balance. At one point, I called to Doug frantically because I thought my belly was bloated, filling up with fluid. It looked so much larger than the rest of me, larger than what I remember it looking like. It's just out of balance. I'm used to having breasts to balance the size on top with the size of my hips, abdomen and butt.

 

 

I'm not sleeping well because of the pain meds. I drift off for 10-20 minutes at a time and usually wake up from a muscle spasm or from the ever-so-slight vibration from the drain suction. I've had a stretch or two of an hour's sleep, but not much more than that.

 

 

My BRCA results came in earlier this week. I'm positive for BRCA2, like my other family members. I'll be consulting with my ob/gyn sometime soon to discuss  Oophorectomy or Hysterectomy. BRCA2 positive indicates a much higher rate of breast and ovarian cancer. Ovarian cancer is much harder to find and treat. I'd rather not take any chances.

 

My Onkatype results also came back. That's the test that looks at the genomics of the cancer and the results indicate likely recurrence rates, among other things.  My results came back at a 29 (intermediate). Dr. Kotz said the highest he's seen is a 39, though the scale goes to 100. A score of 29 on the Onkatype means this cancer has a 19-20% chance of recurrence (and recurrence is not easily/likely curable). Chemotherapy is now a definite. I'll meet Dr. Kotz on Tuesday morning to discuss. From previous discussions, it sounds like chemo will start within the next 3 weeks. 

 

Dr. Weinberg took the remaining lymph nodes on my left side and a sampling from my right side. The nodes and the breast tissue have been sent to pathology. I should have a lot more information by Tuesday.  I also have an apt Monday with Dr.Kays. I'm really hoping he'll take out a drain or two by then.  I have to rest in order to heal. With that in mind, I'll leave you. My comfy bed awaits and maybe some reading for pleasure. I've spent so much time reading student papers, textbooks, journals, etc that reading simply for the pleasure of it hasn't happened in more than a year. I get bored sitting in bed. If you're local, please come visit. Distractions are welcome =)

Surgery is done.

I'll make this quick because I 'm typing from my phone. 

Surgery went really well. I felt really good right after, with the exception of sore throat & dry mouth. I felt like I could conquer anything at that point. 

As those pain meds wore off, I started feeling more pain, but I have a pain pump and that's helping. I don't sleep well on pain meds, so I'm just trying to catch quick 20 minute naps whenever my eyes decide to shut. Apparent I've been falling asleep for a minute or two mid-conversation. 

My skin is itchy, have some pain despite pain meds & muscle relaxer & I'm incredibly thirsty. Otherwise all is well. Just trying to be still, relax & heal. 

Thanks for your prayers, warm thoughts, messages & help. I'm so blessed to be surrounded by such amazing people !

Counting Blessings

At this point, I'm hopeful that most of the surprises are behind me. There are still some unknowns, but I know the choices that will need to be made (chemo, radiation, oophorectomy, etc.) and the information we are waiting on to inform those choices. I'm resigned to the fact that over the next year I will repeatedly undergo surgeries, major and minor, and I'm feeling more prepared. This next year will be unpleasant, but I know I will survive it, one day looking back with a sense of pride and humor. In the meantime, there is no doubting the blessings bestowed upon me in my time of need.

Sure, I'm frightened, worried, angry and unsure. I'm also lucky, blessed, and strangely full of joy. I look around and see SO MANY others looking back, feeling many of the same emotions and wanting nothing more than to help relieve some of the stress and worry in my life. I am grateful that my days are bookended and filled with the love and support of my husband and daughter, my parents and siblings, my mother and brother in law, my fun/"complicated" extended family, old friends and new, colleagues, mentors, students, medical professionals and acquaintances, all of which have shown and continue to show overwhelming support and compassion. I've always known that I was surrounded by amazing people. Every day I wake up and feel relief in knowing that any need, tangible or otherwise, will be met because I am blessed to be surrounded by people with a boundless desire to help. To all of you, please know that I am thankful and humbled by your compassion. You are all making a difference with your words and actions.

It's been a busy week so far, but there is good news to share. The CT Scan and Bone Scan came back clear. This cancer may be feisty but it hasn't yet spread beyond the lymph nodes (that we can tell). I did ask Dr. Kotz (my oncologist) about having a 2nd reading of the results. After having one radiologist say that the micro-calcifications and tiny mass were likely benign and to follow-up in 6 months, only to have Dr. Weinberg confirm, less than a week later, that I did indeed have a golf ball sized malignant tumor in my breast, I'm a bit weary of having only one radiologist/doctor interpret imaging results. Still, clear scans = happy news.

Pre-op is done, armpits are waxed and hair appointment has been made. I know that must sound really vain, but it's more about making the post surgery days easier and maintaining some personal sense of dignity during the days when I'll need the most help doing even the simplest tasks.

I visited with Dr. Kays (plastic surgeon) and his staff on Monday, mostly so they could take my "before" pictures and answer any other questions I had. We talked a lot about the drains. Kerry, the most helpful and well informed surgical assistant ever, mentioned a process called "Milking the Drains" which I haven't heard of yet. I said "So, you mean to tell me that I'm going to have surgery to remove my breasts, and then you're going to milk me!" We all had a laugh at that. Milking the drains is a lot like curling ribbon. Whomever is helping to empty my drains will need to hold the drain at a point close to my skin and pull down the length of the drain with the back of a butter knife. This helps to clear the drains and keep the wick-like part inside of me from clogging. It sounds scary, brought tears to my eyes, in fact, but we'll get it figured out. All of my doctor's are impressed with our knowledge of everything involved. Doug is particularly well researched and well prepared. And it's really nice to have doctor's talk to us without that ever-so-common condescending tone. My doctors and their staff have been wonderful every step of the way. I've never encountered so many hugs and warm smiles.

Dr. Kotz and the tumor board discussed my case on Wednesday morning. He said they all leaned toward chemo for treatment, but participating in the national study is still worth considering. We're going to wait for the Onkatype results before any decisions are made. Dr. Weinberg wants to discuss my case with a radiation oncologist. They were hopeful the radiation oncologist would be at the meeting, but s/he wasn't available. So, radiation is still under consideration.

There is still a lot to do before surgery. I have so many papers to grade and final grades to submit. Boxes need unpacking. The house needs cleaning. The laundry never ends. Clover needs grooming. I'd like to set up play dates for Charlotte so her days aren't consumed by grown-ups and caring for mommy. It will all get done, I know.

Surgery is next. I'm supposed to arrive at the NHRMC Surgical Pavilion at 10am on Wednesday,  12/18. The surgery will start around 12/12:30. The bilateral mastectomy takes about an hour and a half. The reconstruction will last approximately 2 hours. I take my time waking from anesthesia, so that's another hour and a half. I should be admitted and heading up to a room at the hospital by 5 or 6. I'll be staying overnight, maybe two. I'll definitely be home by the afternoon of the 20th. I'll see Dr. Kays on the 23rd for his post-op and Dr. Kotz on the 24th. I'm looking forward to that one. By the 24th, we'll know my Onkatype score, we'll know exactly the size/shape of the tumor and we'll know a final number for the lymph node involvement (Dr. Weinberg is removing the rest of the lymph nodes from my left side and a few from the right side for pathology to examine). By Christmas, I should have a treatment plan in place for chemo.

The next 5 days are sure to fly by. If there is anything new to mention, I promise I'll post it. Otherwise, friends, I'll post again as soon after surgery as I can.  Thank you all, again, for your kindness, generosity and love. "See you" on the flip-side. 

Eleven Days

Surgery is officially scheduled for 12/18. That means I have 11 days to prepare and there's a lot to do.

It's the holidays, and I don't want to disrupt the joy of the season. Doug and I bought a lovely tree yesterday and we're planning to have a decorating party tonight (thanks, mom!). I'd love to think I will be able to do some holiday shopping and baking before the surgery, but that doesn't seem likely. I'm barely managing to keep up with the laundry.

Charlotte's 5th birthday is quickly approaching. She's been looking forward to her roller skating party since May. Really, since May! She invites total strangers and literally wants everyone she has ever known to come. Her invite list (of her friends only) is about 35 kids long. I'm bummed, to say the least, that I won't be able to skate with her. I used to be quite the skating Diva (right, dad?!) Maybe I can rent a wheelchair and roll around, bopping to the music instead. Do they make leg warmers for grown-ups? I was hoping, at one time, to go all "Pinterest" on y'all and create a my-little-pony birthday wonderland from scratch. Instead, Papa John's will deliver some pizza and I ordered an awesome cake from For Heaven's Cake (two-tier, stripes and polka dots, hand-painted, fondant-covered rice crispie pony on top). Hopefully I'll remember to buy my-little-pony themed plates & napkins and some parting gifts for the mass of kids that come to party. At this point, I know, even if I screw it up and forget all of it, she'll still be surrounded by her friends and family, still get to skate for a couple of hours, and still eat a gorgeous & tasty cake. Ok - the "surrounded by friends and family" part assumes I don't forget to send invitations.

There's work to finish. I took on too many classes this semester (9 in total - that will NEVER happen again). I was great about keeping way ahead on the prep work. Since most of the classes I teach are online, I can get a lot of that done ahead of time and spend most of my work days grading and responding to students. The overload started to become noticeable around mid-semester. I had a hard time keeping up with grading. I was backed up by about  3 weeks on grading and then BOOM! Lump. Doctor. Radiology. Scary Phone Call. Doctor. Biopsy. Cancer. Doctor. Doctor. Doctor. Doctor. Surgery. Doctor. Doctor. Doctor (shall I keep going?!). It's been impossible to focus on responding to student's papers. I was talking with my lifelong friend Meghan early on about not wanting the cancer to take over my life. She said "You have cancer. Cancer doesn't have you." And I was all "YEAH!!!" But then reality kicked in. You get cancer and your life becomes a blur of doctor's appointments and phone calls. You're lucky if you can find the time to hold hands with your new and most wonderful husband or read books to your super-bright daughter. Forget about unpacking, arranging and cleaning your new home that somehow (by the grace of that new and most wonderful husband and our families) got moved into in the midst of all this cancer crap. Anyway, back to my point. Those who know me know that I LOVE my work. I LOVE my students. I can't accept letting them down. I have a lot left to do in the next 11 days. It will get done, somewhere between spending time loving my family and...

Doctor's Appointments.  Need I really say more? I have at least 5 appointments between Monday and Wednesday of next week. In that time, I will pose topless for photos (for the plastic surgeon - get your minds out of the gutter), have a CT scan of my chest and abdomen and a whole-body bone scan (which "aren't likely" to show cancer in other areas of my body, right?!), get poked and prodded some more for pre-op, and meet with my oncologist again for more discussion about the chemo/radiation plan (if any).

I also need to pack a hospital bag. I've done some research on what other patients recommend. It's a long list which has made me woefully aware that I don't keep some very basic items around (like button-up or zip-front shirts, slippers, large safety pins, etc, etc, etc). Most recommend having your hair done and armpits waxed prior to surgery (thanks to Keri for that tip!). Many women report having difficulty shaving (due to range of motion issues) for up to 6 weeks. Since I already have persistent pain in my left arm from the node biopsy, I think it's safe to assume that shaving issues are a possibility for me.

It's all very overwhelming, and that's with the incredible support team I have. How do women do this without help? It feels like a nuclear bomb has exploded in the center of my life and the cancer cloud is releasing little droplets of cancer crap all around. And I never know what emotion will pop up next. Sad. Scared. Angry. Defiant. Determined. So many more. I know a year or so from now, this will be just another story I can tell about my past (like the deck collapse, the camel spider in Iraq, the recent near-death canoeing incident), but friends, between now and then, it's like emotional nuclear fallout. An example: I had a great afternoon yesterday. Charlotte and I had a play date with our awesome new friends. We met at Halyburton, played on the playground and went for a 1.5 mile walk on the trail and then an ice cream treat. The weather was great, in the 70's. The girls had fun. I got some baby love. Great afternoon. On the way home, I got a speeding ticket. I thought I was in a 35mph speed zone, but apparently it was a 25. I was doing 39. I started crying as soon as the trooper took my license and registration back to his car. I put my sunglasses on to hide the tears because I felt like an ass. I kindly thanked him for the ticket and as he walked away I started sobbing so hard I couldn't catch my breath. There were some random moans. I stayed pulled over on the side of the road for a good 10 minutes, crying. Charlotte was in the car. Not really the reaction I want to model for her. There are better days, but moments like these really catch me off guard.

That's it for now, friends. I'll be sure to update next week after the various appts. In the meantime, have a great weekend. Oh - do me a favor. Stop the craziness of your life for one hour this weekend and just enjoy someone or something you love. And then tell me about it (in comments or on Facebook).

Chances are...

I'm tired of hearing that "there's only a small chance" or "less than a 10% chance" because, so far, I've been in that small affected group.

Don't get me wrong, I still feel really confident and have a positive outlook as to the outcomes of this obstacle. I'm just getting tired of the surprises and bad news.

A few days ago, I felt triumphant. The sentinel node biopsy had indicated that my lymph nodes were clear. Dr. Weinberg had mentioned that she'd sent the 3 nodes they removed to pathology, mostly as a precaution. The nodes looked clear and there was "less than a 10% chance" that pathology would show a different result. She called yesterday to report that I'm part of that 10%.

Here's the best explanation I can give: There is a threshold. When a node has a certain number of malignant cells (meeting that threshold), the cancer has officially metastasized (meaning that it's trying to move out of the breast and elsewhere in my body). The first of my sentinel nodes met that criteria, having "clusters of malignant cells" throughout the node, according to the pathology report. The two nodes behind that node have malignant cells, but not enough in each to be considered malignant nodes. It only takes one malignant node to disrupt the plan and change the overall condition of the cancer. At this point, I'm considered Grade 2, Stage 2B (but this could move to stage 3 depending on results of upcoming tests). Chemo is now likely and radiation is back on the table, too.

Dr. Kotz spent nearly 2 hours with me (and my family members) today, explaining in detail all of the choices, issues and considerations we now face. He and his staff were great!

The highlights of that discussion include:

1. I'm scheduled for a CT Scan (with oral and IV Contrast) of my chest and abdomen and a Bone Scan of my entire body this Tuesday. But no worries.... the "chances are slim" they'll find cancer anywhere else in my body [insert sarcastic voice here].
2. Dr. Kotz participates in a monthly breast cancer board, where local physicians get together to review cases and discuss additional options. He'll be presenting my case to the board on Wednesday morning. I'll meet with him later that afternoon to narrow down treatment choices and we'll go over what the board discussed/recommended at that time.
3. I'm going to have an Oncotype test done on my cancer cells. This is a genomic test that will reveal the genetic disposition of the cancer. The results are measured as low/medium/high and let us know, genetically speaking, how likely the cancer is to recur and how likely it is to spread. A very low result may mean I won't need chemo. A medium result would indicate the need for TC Chemo. A high result indicates the need for TAC chemo. TC chemo is a two compound chemotherapy, 4 treatments over a 12 week period. TAC is harsher, 3 compound chemotherapy, 6 treatments over an 18 week period. Both are given intravenously. For women in their 30's, chemo is highly likely to land me in the hot-flash, night sweats, mood swing world of menopause. Oh the joys.
4. Radiation is a possibility. Generally, if a patient opts for a lumpectomy, radiation is a given. With a mastectomy, it's not. If more than 4 nodes are malignant, radiation is also a given. When 1-3 nodes are malignant, the need for radiation is somewhat of an unknown. There isn't a lot of research to support that it increases survivability with so few nodes impacted. On the other hand, radiation works better than chemotherapy on areas with known clusters of cancer cells. This recommendation is one that will be discussed at the board mentioned earlier. No answers as to radiation yet.
5. I'm going to have the BRCA test done. If this comes back with a positive result, I will also likely have an oophorectomy. This is the removal of the ovaries and sometimes includes the removal of the fallopian tubes. A BRCA1 or BRCA2 positive result significantly increases my ovarian cancer risk. The results take about a month. If I'd had the test done when it was first suggested, I might have saved myself an extra surgery, because they could've done the mastectomy and oophorectomy at the same time. I guess, for now, we'll leave that category as pending...
6. Doug and I need to discuss our future in terms of babies. If we want to have a child together, we need to see a fertility specialist in the next few days and start working on harvesting any eggs I currently have (can't use estrogen to produce more because my cancer thinks estrogen is candy, or chips, or whatever it's snack preference is...).

I meet with Dr. Weinberg again in the morning for the post-op on my sentinel node biopsy. She has me tentatively scheduled for the bilateral mastectomy on 12/18. I suppose she'll be checking on my incision site and talking more about BRCA and scheduling. Who wants to plan the "Eject the Breasts" party? Here's the theme song for the party: http://www.youtube.com/watch?v=HkhfL0pnMPQ  warning: it's the explicit version!

Oh, my friend Beth told me about a great book called The China Study. I'll be ordering that in the next few days to read up on evidence-based practices involving nutrition and cancer. If any of you happen to know of other really great resources, books, etc., please let me know.