Consultation with Surgeon #1

B. and my mom went with me today to my consultation with Surgeon #1. She spent over 1 1/2 hours with me, and I have five pages of notes to show for it.

I received so much information today (about the pathology report, surgery options, radiation, lymph node testing, reconstruction, recurrence statistics, etc.) that it was dizzying.

Here on the blog I'll just hit the highlights that relate to where I am currently in the process.

First some good news

• I'm at most at a stage 2, but probably am at a stage 1. Both are early stages of cancer.

• My estrogen and progesterone receptors are very high, both over 90%, which is good news. I don't know why it's good, but it is. The surgeon tells me it increases the likelihood that I won't need chemo.

• I have sensitivity to the drug Herceptin, which apparently is something to cheer about. This is a drug that a medical oncologist may recommend for me down the line. It does something very useful that I forget (and I'm not looking it up online). It's given through an IV but is well tolerated. You take it for a year or something inconvenient like that.

Here are the basics about my very short-term plan:

1. See Surgeon #2 tomorrow (who is "in-network" as far as my health insurance is concerned).
2. Schedule biopsies (see "MRI" below).
3. Schedule appointment for genetic counseling (see below).

MRI Results

The MRI I got yesterday showed a couple of areas that need to be checked out. They are "probably nothing", but they need to be checked.

One area is on the left (non-cancerous) breast. So I'll definitely need a needle biopsy for that. (Ultrasound-guided if possible, MRI-guided if not).

The other area is on the right, different from the area of the current cancer (which is central, close to the chest wall, and about 3 cm in size). If I were certain now that I'm electing to have a mastectomy, there would be no need to biopsy this new area. But because lumpectomy is still in the running, I'll need to have a biopsy on this new area.

If there's cancer on the right in this new place that the MRI detected, then I'll need to have a mastectomy because it's not near the current cancer. At least I think that's the reason. :-)

Genetic Counseling

I'm going to make an appointment to see a genetic counselor and then possibly will elect to have the blood test that checks for the BRCA-1 and BRCA-2 genetic mutations.

Results of this blood test may affect my decision whether to opt for a lumpectomy or a mastectomy. It takes 10-14 days to get results.

Surgery, Radiation, Chemo

Before making a decision about which surgery to get (lumpectomy + radiation vs. mastectomy) I'll need more information about my situation and will talk to more people, such as a radiation oncologist and a plastic surgeon.

My surgery decision is independent of whether I'll need chemo. There's nothing I can control about whether I will need chemo, and it's still an unknown.

How I'm Doing

This is a lot to take in. I am very light on clients this week, which is good. It's important for me to take time each day to relax, and I have some guided imagery sessions on my iPod (stress relief, healing, optimism, etc.) that are very helpful to give my mind a break and to just relax.

I'm also trying to keep up with exercise and do something that feels good every day (see a friend, watching some silly TV show, read a book, drink some wine).  I suspect I'll be advised to give up alcohol (for good maybe?) but until then, I'm still going to enjoy it.

Sometimes I am just really upset about this whole thing. And other times I'm staying steady and taking care of business. I'm learning how to live with so much uncertainty about what's coming next. As many of you know, I'm a big planner in almost every aspect of my life, so this day-by-day thing is a major challenge.

But it's also pretty incredible to more and more frequently see myself able to let go of worries about the future and just focus on what's in front of me. I'm more capable of it than I previously thought.

But we're all so much more capable than we suspect, aren't we?

Someone I know who has had more than her fair share of challenges in life said to me once years ago, "It's amazing what you can do when you have to." And I bet we all can look back on difficult times we've gone through and agree.