Oh boy, another month of waiting!
This time I don't mind. I've got April to plan for taking time off work, getting some logistics for the kids in place, for B. and I to maybe go somewhere for a weekend, and just to enjoy normal life.
I'll be in the hospital for one night, then home sometime Tuesday, May 1, assuming there are no complications.
Yesterday I brought B. along for the pre-surgery appointment. I had the opportunity to talk to the surgeon, Dr. C., more specifically about what she's going to do and what I can expect.
Surgery
Dr. C. thinks there's a good chance she can get clear margins, even with the tumor proximity to the chest wall factor. So radiation later is a possibility, but definitely not a foregone conclusion.
As is standard, she'll do a sentinel node biopsy to check on the status of the lymph nodes. Before the surgery I'll get an isotope injected and then during surgery they inject some kind of blue dye and based on what Dr. C. sees in the lymph node area, she'll remove the lymph nodes she needs to. Her guess is that she won't have to take many. I didn't ask why she thinks that - I just went with it.
I believe I'll get a call later that week with some information about the pathology report and then will go into that in further detail with Dr. C. on May 7, when I have a follow-up appointment with her. At that time she'll have at least an overview of what I might expect in terms of additional treatment.
After Surgery
Then I'll see either a radiation or medical oncologist to talk about the plan. (We'll see how long the wait is for that appointment!) I was surprised to learn that I may have some choices to make. I assumed I would be told what to do and would have no options. But Dr. C told me that oncology could present a few options with different pros and cons and that I'd get to pick. Interesting.
What seems to be expected is that I'll go on Tamoxifen (technically oral chemo) for five years. This is a standard drug that pre-menopausal (used to be all women) breast cancer patients go on to suppress estrogen (and maybe some other stuff) and reduce the odds of recurrence or a 2nd cancer. I'm sure I'll learn all about this later.
I also expect to hear about the drug Herceptin, which I mentioned several posts ago, because there is a factor about this cancer that indicates it's receptive to this drug. This factor also indicates that the cancer is on the aggressive side. But for now I'm really trying not to leap too far ahead. (Have I mentioned this is not my strong suit?!)
How I'm Doing
I'm both happy to have a surgery date and dreading it. I'm happy because the sooner I can do this, the sooner I can get through the rest of it and adjust to being a breast cancer survivor instead of be a breast cancer patient.
But I'm dreading it because the surgery marks the beginning of physical changes that I'm just so sad to have to go through. What will I feel like? How will I be changed? What will be my new "normal"? These are all mysteries I wish I didn't have to explore.
Of course at the heart of all this is determination to become cancer-free and be well. But since this cancer doesn't cause symptoms I can feel, it feels surreal to be fighting an invisible intruder. After all, if I hadn't had a mammogram in January, I'd just be living my life as if nothing much were going on.
So while I'm grateful that I don't feel bad physically now, facing the breast cancer surgery and treatment process feels like the beginning of pain rather than the beginning of relief, even though I know it will relieve the cancer.
Expectations for May
Dr. C. said that she wants me exercising (there are special ones to help gain full movement of my arm and shoulder) right away. I'm supposed to stay active and I might be able to resume driving after only a week or so.
Of course I'm not supposed to lift more than ten pounds for six weeks, and there are some other guidelines to follow.
The nurse yesterday said that it can take a month for the general anesthetic to clear your system and that a very common side effect is mood swings. This would be on top of the emotional challenges of this surgery and of facing more treatment.
OK, May is officially Be Kind To Myself Month.
And if you've got any funny stories to tell or distractions to offer - save some for May for me!
March 30, 2012
March 19, 2012
Consultation with the Plastic Surgeon
Um, maybe you don't want to read this while you're eating.
The plastic surgeon I met today, Dr. Y., lives about a mile away from me and frequents the same coffee place I go to on occasion. Considering he took photos of me wearing lovely blue paper underwear today I'm going to switch coffee places for a while!
Today's meeting led to one firm decision, and that is to delay reconstruction (if I choose to do it at all) until after cancer treatment is done, rather than start it immediately during the breast surgery.
This is because there's a chance I'll need radiation due to the proximity of one of the tumors to my chest wall. If the breast surgeon can't get clear margins as a result, then radiation comes into play.
And as I mentioned before, radiation will pretty well eliminate one of the reconstruction options open to me (the implant, which follows a 3-6 month period of tissue expansion. That sounds fun, huh?)
But we won't know about the need for radiation until the surgery. So it makes no sense to plan to start reconstruction immediately.
Dr. Y. presented an overview of the reconstruction options. All of them have their pros and cons. All of them have potential complications and the potential not to look very good. None of them would look just like my real breast or any real breast.
I'd be a good candidate for a TRAM flap, which is when they use - let's just say material - from the abdomen to reconstruct the breast. It's not a tummy tuck but it does tighten things there (although it also can look not so great).
There's also a latissimus dorsi flap, when they use material from the back to cover and support a breast implant.
And there's the breast implant that is inserted after breast tissue has been expanded, that doesn't require disturbing any other muscle or tissue in the body (again, not an option if radiation is necessary).
I can decide to do reconstruction as soon as 6-12 months following radiation (if I have to go through that), 1 month following the completion of chemo (if I have to go through that) or years from now.
I'm relieved to have the reconstruction decision and process off the table for now. Even if I were a good candidate for immediate reconstruction, I'm not sure I'd be up to committing to it. And since an implant can look better if done immediately, I might have felt pressure to go ahead and do it, to get the best-looking result possible.
Now I know that I'll have some period of time to adjust to wearing a prosthetic and can put all my medical-related focus on getting through cancer treatment, rather than also dealing with the reconstruction process. I can have time to really process my adjustment to my changed body and, without the distraction of cancer, decide at any time in the future whether I want to pursue reconstruction. This feels right to me.
Next step: I have a pre-op appointment with the breast surgeon on March 29 (she's out of the office this week). I'm not sure what all goes on during this appointment, but scheduling the surgery should be on the agenda. I'm ready to just get this going already.
The plastic surgeon I met today, Dr. Y., lives about a mile away from me and frequents the same coffee place I go to on occasion. Considering he took photos of me wearing lovely blue paper underwear today I'm going to switch coffee places for a while!
Today's meeting led to one firm decision, and that is to delay reconstruction (if I choose to do it at all) until after cancer treatment is done, rather than start it immediately during the breast surgery.
This is because there's a chance I'll need radiation due to the proximity of one of the tumors to my chest wall. If the breast surgeon can't get clear margins as a result, then radiation comes into play.
And as I mentioned before, radiation will pretty well eliminate one of the reconstruction options open to me (the implant, which follows a 3-6 month period of tissue expansion. That sounds fun, huh?)
But we won't know about the need for radiation until the surgery. So it makes no sense to plan to start reconstruction immediately.
Dr. Y. presented an overview of the reconstruction options. All of them have their pros and cons. All of them have potential complications and the potential not to look very good. None of them would look just like my real breast or any real breast.
I'd be a good candidate for a TRAM flap, which is when they use - let's just say material - from the abdomen to reconstruct the breast. It's not a tummy tuck but it does tighten things there (although it also can look not so great).
There's also a latissimus dorsi flap, when they use material from the back to cover and support a breast implant.
And there's the breast implant that is inserted after breast tissue has been expanded, that doesn't require disturbing any other muscle or tissue in the body (again, not an option if radiation is necessary).
I can decide to do reconstruction as soon as 6-12 months following radiation (if I have to go through that), 1 month following the completion of chemo (if I have to go through that) or years from now.
I'm relieved to have the reconstruction decision and process off the table for now. Even if I were a good candidate for immediate reconstruction, I'm not sure I'd be up to committing to it. And since an implant can look better if done immediately, I might have felt pressure to go ahead and do it, to get the best-looking result possible.
Now I know that I'll have some period of time to adjust to wearing a prosthetic and can put all my medical-related focus on getting through cancer treatment, rather than also dealing with the reconstruction process. I can have time to really process my adjustment to my changed body and, without the distraction of cancer, decide at any time in the future whether I want to pursue reconstruction. This feels right to me.
Next step: I have a pre-op appointment with the breast surgeon on March 29 (she's out of the office this week). I'm not sure what all goes on during this appointment, but scheduling the surgery should be on the agenda. I'm ready to just get this going already.
March 18, 2012
A Week of Research
I've been spending a lot of time thinking about and researching reconstruction. I've talked to some friends of friends who are done with BC about their decisions and it's been really helpful.
I also know a physical therapist who specializes in working with women after breast surgery and I asked her a bunch of questions about how the healing works with the different kinds of surgery.
The plastic surgeon's office sent me a bunch of resources to look at about how to decide about reconstruction, details about the options, and video testimonials from all kinds of women who chose different options for different reasons. I meet with the plastic surgeon tomorrow for a consultation and am bringing my posse, Mom and B.
My particular options will be related to what kind of treatment I'm going to need (especially important to reconstruction is whether I'll need to have radiation, which I have no idea about at this time). I hope to learn some useful info tomorrow.
Since I've been immersed in this stuff for a while, I'm no longer completely grossed out by the discussions about what the different surgeries entail. But I'm aware that I could tread way into "TMI" territory here with you, so I'll give you some warning if things are going to get a little graphic.
It just would be way easier if this were all about my wrist or some other non-personal body part. I thought about this when I started the blog, whether I was really going to commit to revealing a whole lot about something that I don't reveal at all under normal circumstances.
But whatever. Whenever it becomes a little much for you, just stop reading!
And if a group of friends and acquaintances all know what kind of surgery and cancer treatment I've had, that's still OK with me.
I have a very full week this week so I may not get a post up about the surgeon's visit until later in the week.
And thank you thank you for your continued support and well wishes! They still mean so much.
I also know a physical therapist who specializes in working with women after breast surgery and I asked her a bunch of questions about how the healing works with the different kinds of surgery.
The plastic surgeon's office sent me a bunch of resources to look at about how to decide about reconstruction, details about the options, and video testimonials from all kinds of women who chose different options for different reasons. I meet with the plastic surgeon tomorrow for a consultation and am bringing my posse, Mom and B.
My particular options will be related to what kind of treatment I'm going to need (especially important to reconstruction is whether I'll need to have radiation, which I have no idea about at this time). I hope to learn some useful info tomorrow.
Since I've been immersed in this stuff for a while, I'm no longer completely grossed out by the discussions about what the different surgeries entail. But I'm aware that I could tread way into "TMI" territory here with you, so I'll give you some warning if things are going to get a little graphic.
It just would be way easier if this were all about my wrist or some other non-personal body part. I thought about this when I started the blog, whether I was really going to commit to revealing a whole lot about something that I don't reveal at all under normal circumstances.
But whatever. Whenever it becomes a little much for you, just stop reading!
And if a group of friends and acquaintances all know what kind of surgery and cancer treatment I've had, that's still OK with me.
I have a very full week this week so I may not get a post up about the surgeon's visit until later in the week.
And thank you thank you for your continued support and well wishes! They still mean so much.
March 12, 2012
My Trip to the Fake Boob Store
Attention male readers: this post is just a lot of girl talk about breast prostheses and bras. Just so you know!
It occurred to me last week that I'd like to investigate what I can about what it's like to live with one breast before I make a decision about whether or not to reconstruct.
I decided to go on a field trip to my local fake boob store and just start asking questions. Here in my city there's a specialty store and there's Nordstrom. So I went to the specialty store, which has been family owned for over 30 years.
I was pleasantly surprised and heartened by what I found out. Prosthetics have come a long way, and they're continually being improved. (The main complaints are that they're too heavy and too hot).
Their goal at this store is to keep you in your favorite clothes, swimwear and bras. They have a seamstress who alters clothes and swimsuits to make it easier to do the prosthetic thing. And many of the bras with pockets in them for prostheses look like the ones I buy now (at least the basic-colored ones).
There are prostheses that stick to your body, that are good in the pool, that are extra light, that make dinner for you - OK, maybe they don't actually do chores.
Of course I don't know how I'd really feel about using these products, but it seems like I'd have a decent chance of wearing the clothes I'm used to and just living my life. Once again in this process I feel grateful to be a small-breasted woman (smaller prosthesis = greater comfort).
Obviously I'm thinking about life both in clothes and out of clothes as I think about reconstruction. But the trip to the fake boob store was a good start.
It occurred to me last week that I'd like to investigate what I can about what it's like to live with one breast before I make a decision about whether or not to reconstruct.
I decided to go on a field trip to my local fake boob store and just start asking questions. Here in my city there's a specialty store and there's Nordstrom. So I went to the specialty store, which has been family owned for over 30 years.
I was pleasantly surprised and heartened by what I found out. Prosthetics have come a long way, and they're continually being improved. (The main complaints are that they're too heavy and too hot).
Their goal at this store is to keep you in your favorite clothes, swimwear and bras. They have a seamstress who alters clothes and swimsuits to make it easier to do the prosthetic thing. And many of the bras with pockets in them for prostheses look like the ones I buy now (at least the basic-colored ones).
There are prostheses that stick to your body, that are good in the pool, that are extra light, that make dinner for you - OK, maybe they don't actually do chores.
Of course I don't know how I'd really feel about using these products, but it seems like I'd have a decent chance of wearing the clothes I'm used to and just living my life. Once again in this process I feel grateful to be a small-breasted woman (smaller prosthesis = greater comfort).
Obviously I'm thinking about life both in clothes and out of clothes as I think about reconstruction. But the trip to the fake boob store was a good start.
BRCA Tests Are Negative!
Hey, good news - I don't have the BRCA1 or BRCA2 gene mutation!
This means that M. and C. don't, either. What a relief. At this point the recommendation is for them to begin cancer screening at age 34, ten years younger than my age at diagnosis.
And it also means that my ovaries can stay. Yay.
I had a brief conversation with my surgeon on Friday. The second bit of cancer on the right side is small, about 5 mm in size, and is "probably" the same cancer, just in a different place.
This means that M. and C. don't, either. What a relief. At this point the recommendation is for them to begin cancer screening at age 34, ten years younger than my age at diagnosis.
And it also means that my ovaries can stay. Yay.
I had a brief conversation with my surgeon on Friday. The second bit of cancer on the right side is small, about 5 mm in size, and is "probably" the same cancer, just in a different place.
March 5, 2012
Some Celebrating, Some Sadness
Waiting for the phone call with biopsy results is a pretty agonizing experience, and I'm glad it's over.
The Good News
There's no evidence of cancer in the left breast! This is a big relief. I need to go back in six months for an ultrasound and MRI to see if there are any changes.
Also, there's no need for an MRI-guided biopsy on either side.
The Bad News
There is more infiltrating ductal carcinoma in the right breast, so I don't have the option of lumpectomy and radiation - it will need to be mastectomy.
This is all the new information I have at this point. I have a phone consultation with Dr. C, the breast surgeon, on Friday. I assume she'll have some information for me about what the pathology reports say.
And like I've said, when I get results from the BRCA tests (by March 16 hopefully) and meet with the plastic surgeon (March 19), I'll have key information I need to make additional decisions.
So today I'm focusing on the fact that I have one less thing to worry about than I did yesterday. I can work with that.
The Good News
There's no evidence of cancer in the left breast! This is a big relief. I need to go back in six months for an ultrasound and MRI to see if there are any changes.
Also, there's no need for an MRI-guided biopsy on either side.
The Bad News
There is more infiltrating ductal carcinoma in the right breast, so I don't have the option of lumpectomy and radiation - it will need to be mastectomy.
This is all the new information I have at this point. I have a phone consultation with Dr. C, the breast surgeon, on Friday. I assume she'll have some information for me about what the pathology reports say.
And like I've said, when I get results from the BRCA tests (by March 16 hopefully) and meet with the plastic surgeon (March 19), I'll have key information I need to make additional decisions.
So today I'm focusing on the fact that I have one less thing to worry about than I did yesterday. I can work with that.
Subscribe to:
Posts (Atom)