Post-Op Update

I had my lumpectomy two weeks ago today, and went back to my surgeon this afternoon for a follow-up.  She reported that the grade, which was initially thought to be a 1 was upped to a 2, and the stage, which we expected to be a 2, was lowered to a 1. It may not sound great, but since the stage is more critical than the grade, this is actually a good thing!

On the other hand, although they successfully removed the entire tumor, and the lymph nodes and margins were clear, the pathology report indicates that the cancer cells were positive for estrogen and progesterone receptors. This was not totally unexpected.  Unfortunately, the pathology results were also positive for the HER2 receptor. If the HER2 had been negative, I could likely have gotten by with just having radiation and 5 years of taking hormone blockers.  The HER2 receptor has to be treated more aggressively, so I may have to have chemotherapy.

I have to admit that this news took me a bit by surprise.  I was growing more resigned to the idea of radiation - but was hoping to avoid chemo. I was feeling pretty optimistic about it, given my grade and stage. I may be able to do a modified chemo, without the usual side effects, but time, and the oncologists, will tell. 

The Ups and Downs of Voice Mail Messages

I cannot begin to count the number of times that I have left someone a phone message and apologized at the end of it for either rambling or for not being very clear – or both. Invariably my messages are longer than I would like them to be, in part because I usually dial the phone having given minimal thought to not reaching the intended party.  I don’t think ahead about how to distill what I want to express into a twitter length summary if I should get voice mail or an answering machine.  I envy those who are able to leave a message that is brief and to the point.   

Now, imagine being a cancer surgeon’s assistant and having to leave some longed for information on a patient’s voice mail. You don’t know anything about the patient’s household and whether the whole household has access to the message, so you try to walk a fine line between being informative without being too revealing. I suspect there are protocols in place if the news is not good. In that case, I imagine you leave a message asking the patient to call the doctor’s office at their earliest convenience.  But if the news is good, you may try to convey that, at least in a concise fashion.

A good while after receiving a voice mail message on Tuesday, indicating that my lymph nodes were free of cancer, it dawned on me that there was something else in the message from my doctor’s assistant that I didn’t quite catch.  I listened to the message several times and, although I thought the additional little snippet might mean something really good, I wasn’t quite sure.  The statement was quick:  “Everything was removed in surgery and your lymph nodes were negative.”  What was everything?  I had had a lump removed and two lymph nodes.  That was everything as far as I knew.  Yet, I wasn’t sure if the message was confirming that or saying something more. 

On Wednesday, I left a message for the assistant, asking for further clarification. I spoke directly with the assistant on Thursday morning.  She was most apologetic about not having been clearer.  She has only been in her job for a month, and I gather that a lot of this is new ground for her.  I don’t envy her having to make these sorts of calls in the first place.  I wouldn’t want to be the one to do it, especially if it involved delivering the bad news.  But in my case, it was indeed more good news.  Not only were the lymph nodes clear, the tumor margins were also clear, meaning they had successfully removed all of the cancer.  So they really did “get everything”!  I just could have used an additional word or two to help me catch that the first go round.

The lesson learned on my end:  I realize that I need to listen to important messages several times, whether concise or rambling, to be sure I catch even the subtlest hint of something that merits my attention.  As for my surgeon’s assistant, I suspect that time, and too many opportunities for practice will make her a pro before long.

Yes, apparently!

Well, tomorrow is my birthday and I got the greatest gift imagineable today.  Test results are in and my lymph nodes are clear!  The cancer has not spread beyond the site of the tumor.  Now here's a question to ponder: since the tumor is gone, and there is no sign of it having spread, can I now say that I am now cancerless?  To paraphrase Ms. O'Hara, I'll think about that one tomorrow.  In any event, the answer to yesterday's question of whether no news could be good news is an absolute YES -- at least in this specific instance.  Yipee!!!  

Is No News Good News?

It’s been a week since my surgery and I am healing.  I’m less sore than I was, and I don’t look quite so battered and bruised.  I’ve gone from black and blue to purple and yellow, so that’s progress!  I must admit I am growing weary of sleeping on my back, but suspect I can manage it a little while longer.    

In other news ... I don't have much news to speak of.  I haven’t yet had results from the sentinel node biopsy, and am still awaiting word on whether the tumor was hormone sensitive – all keys to what additional treatments will be recommended for me. I should have those results in the next day or two.  I have a post-op visit scheduled with my surgeon for next Monday, so I trust I will know a good deal more by the time that’s over.  I did go back to work today and made it a full five hours, which I guess is news of a sort.  Stay tuned, and I hope to be back with more news in the next day or so.

I Am Not Alone

I am not the only cancer patient in this household.  Maya, my canine companion of over 14 years, was diagnosed with nose cancer this spring.  Her cancer is incurable, but she won’t be defeated by it quite yet. That’s good for me, because I want her by my side as I recuperate from surgery, even though I can’t expect her to hold on through whatever the rest of my treatment is.

Although she’s a mix – part lab and part cattle dog – she’s a rare breed.  Not only is nasal cancer uncommon in dogs – it makes up only 1% of the cancers found in dogs – it is predominantly found in large breeds and males.  Maya is 35 pounds and, as her name would suggest, a female.  So how did she manage to develop a cancer found mostly in large, male dogs?

Well, we used to joke that taking her for a walk was really a matter of going on a sniff.  It was a slow, and sometimes painful process as she tried to stop and smell everything along the route. All along the way she marked everything as well, lifting her leg to leave a trace of herself for other dogs to sniff.  She never was very ladylike! Dogs can inhale things that may then get lodged in their nasal passages and ultimately irritate them enough that some of the nose cells start to go haywire and become malignant.  As a very sniffy dog, she would seem likely to have inhaled more than her fair share of irritating foreign matter.  Whether that's the actual cause of her cancer is unknown.

She’s had her ups and downs through this disease.  When she was diagnosed we didn’t expect to have her this long, but she has had some relatively asymptomatic times, including a whole month just prior to my own cancer diagnosis in August.  Now things are not so easy for her, and therefore for us. She gets very restless at night and has trouble breathing through her nose.  She can make some alarming wheezing, gurgling, snoring, drowning sounds.  On the other hand, she still is vastly more interested in food than anything else.  She still chases the Frisbee a bit, greets guests with gusto and can be the bossiest little cattle dog mix on Earth when she wants something from us.  She certainly makes her wishes known. 

I will miss her more than I can say, and although I hope she’ll stick around a little bit longer, I fear her time is drawing near.  She has been the best of companions with the greatest personality of any dog I’ve ever known.  Despite the sadness I feel seeing her fade, I am so grateful to have found her and to have had her in my life.  I’m especially glad that she has been with me this past week, providing me with comfort and company as I recover.  My eternal gratitude, Miss Maya.  

The Simple Pleasures of Life

Ahhh!  Now that feels better.  I have taken a shower and washed my hair for the first time since surgery on Monday.  Sponge baths, although better than no baths, just don’t prove as satisfying as a good hot shower.  I feel like a new woman, although I look shockingly like a battered one.  Then there was the treat I received last night of M&M’s.  So simple, and so satisfying – a true comfort candy!   I came upon this quote, attributed to Charles Dickens:  "There is nothing better than a friend, unless it is a friend with chocolate."  I couldn’t agree more!  Thank heavens it was only a small bag or I might have been awake all night with sugar dreams.  As it was, I had my first night’s sleep without painkillers and I truly appreciated the absence of bizarre, exhausting dreams.

There are actually some pleasures I discovered at the hospital as well.  I wish we could adopt some of them for home use.  What a wonderful thing it is to be wrapped in a warmed blanket. They are so cozy, and I like being all tucked into one, almost like a mummy.  No claustrophobia here.  In addition, I was introduced to a new kind of hospital gown, the “Bair Paws” warming gown.  It has two layers, with a flannel-like lining.  There are ports in the gown into which you can connect the warming unit – a device that is reminiscent of the old home-style bonnet hair dryers with hoses!  The hose from the unit connects to the gown through the port and fills the gown with warm air.  It was a wonderful comfort in the cool air of the pre-op area, and I would welcome it during the winter when the house is a little cooler than I’d like.

So for the moment, the secrets to immersing oneself in the simple pleasures of life are:  1. Good friends and family, 2. Good friends with chocolate, and 3. Warmth, whether from good friends, or warm blankets and gowns!  I couldn’t ask for anything more these days!

Oh so tender...

Day 3 of recovery.  What a relief it was to remove the huge dressing they had put over the two incision sites.  They used a heavy duty tape to hold the elaborate dressing in place, which also caused some heavy duty itching.  It was the kind of itching that had the potential to drive me slightly insane.  Phew... a deep sigh of relief now that it's off.  Now I just have to wait for the tenderness to subside.

In other related developments, I have been having wild, vivid dreams thanks to the the pain medication.  Such convoluted scenarios that could be translated into full length motion pictures, if the stories actually made any sense.  I felt as though I were in the midst of a very long Russian novel, populated with all sorts of complicated characters and, despite my best efforts, I was unable to extract myself from the scenes.  

My plans for the day are very unambitious.  Relaxing, resting, dozing, eating a little bit, then more resting, relaxing and dozing.  All stops on the road to recovery!   

I'm so blue...

Shades of Avatar!  Literally.  All went well, but I'm a bit sore and a pitiful ashen color from the blue dye they injected to identify the sentinel node.  Otherwise, everything went fine and I'm happy to be back at home.  I'm on the bed with Sam, about to have a bite, a percocet, and then a nap, but I wanted to let everyone know that things are okay.  Until later!

'Twas the night before...

Here I am, having just come home from a performance of "You Can't Take It With You", finishing up some work, about to have a snack -- it's before midnight, after all -- and thinking how wonderful everyone has been to me these past few weeks.  I meant to contact more of you directly this weekend, but I got caught up in deadlines and time has just gotten away from me.  So to those of you who should have heard from me directly and didn't, my apologies.  I will catch up with you soon.  Thanks to everyone for all their good wishes -- I feel as though I have been showered with kindness and love, and it's an awfully sweet feeling.  Thank you all.  Until tomorrow!

Save the date!

It's true what they say. Waiting is the hardest part -- at least so far. Although I received my MRI results on Friday and today is only Wednesday (and Monday was a holiday), it has felt like an eternity since then as I have waited to hear about a date for surgery. The wait is now over.  I am scheduled for surgery on Monday, the 13th.  Now, suddenly that feels as though it is coming too quickly!  I have lots to do over the next four days.  I have a work deadline to meet, a newsletter to create, a friend who needs a hand on Saturday, as well as finally contacting my insurance company to see what I'm up against with them, and learning what I can about the upcoming procedure.  I also have to go to the hospital tomorrow for what they call pre-anesthesia testing.  Two hours of blood work, medical history (how many times do I have to dole out my medical history at the same hospital, which is fully equipped with the latest in technology?) instructions and who knows what else.  So I had better get back to work and wrap some of these things up before Monday.  

Thanks for all the support, the offers of help (which I'm sure I will take you up on eventually), your kind thoughts and good wishes.  I will keep you posted or will have my emissary (aka Lydia) do so.

The Big C

I was diagnosed with breast cancer 10 days ago, which is just 10 days after my doctor found a breast lump during my annual exam on August 20th. This all seems to have happened at warp speed. She sent me to the Breast Health Center at the premier hospital here in St. Louis on the 24th. I was there for four hours and had a diagnostic mammogram, ultrasound, and, ultimately, a core needle biopsy. The fact that they kept using the word 'suspicious' clued me in that I might not hear the usual results of a benign condition that I've gotten in all previous 'scares'. In fact, I received my diagnosis on the 26th: invasive ductal carcinoma. It sounds pretty scary, doesn't it? However, it doesn't mean that we have a case of the invasion of the body snatchers.

I met with a surgeon on the 30th. She ordered an MRI for the 2nd, and I got those results last Friday. The MRI results confirmed what we thought we knew about the tumor from my ultrasound. They also indicated that there are no other cancerous growths in either breast. All pretty amazingly quick.

At this point things are looking pretty good -- if you discount the one big negative -- the fact that I have cancer in the first place! It seems we caught it fairly early and the cells are low grade. For those who are uninitiated in the realm of grade, my cancer is grade 1 out of 3. That means that the cancer is slow growing and the cells look very much like regular milk duct lining cells. However, they were found outside the duct where the cells originated, and now exist in the fatty part of the breast where there shouldn't be any duct cells. Hence the word invasive. The low grade also indicates that the cancer is not aggressive at this point.

What does this all mean to me? With any luck, I will have a lumpectomy within the next couple of weeks. Then it's likely that I will undergo radiation therapy. Whether or not I have to undergo chemotherapy will be determined by a closer examination of the tumor and the sentinel lymph node. If the cancer has: a) not spread to the closest, or sentinel lymph node, and b) has been found to be fed by estrogen and c) is indeed stage 1 or 2, then the pathologists are able to look at 16 specific genes within the tissue that will help determine whether I am at a greater or lesser risk of developing another tumor. If I'm at low risk, no chemo. If, I'm at high risk, chemo. Needless to say, I'm hoping for the low risk option.

I'm coping remarkably well -- at least at the moment! It's not totally unexpected given the fact that my mother had breast cancer when she was younger than I am now. She had a radical mastectomy and lived another 37 years! Ellen, my first cousin on my father's side, had it 12 years ago and is now doing fine.  My paternal grandmother developed it in her late 70's. She died from it the day before she would have turned 79.

Now of course, it's Labor Day weekend. So I have to wait until Tuesday before I will be able to connect with the doctor's office and schedule the surgery. It's not that I'm so keen to have surgery, but waiting for things to happen is more challenging than moving forward. However, my mantra has been "one step at a time", and that has been working for me so far.  Tune in again for future updates.