I'll Get Right to the Point!

I've tried to blog before, unsuccessfully.  I have a sister-in-law who is a prolific and entertaining blogger - I'm not so talented.  This attempt is likely to be different, since my reason is more personal and the purpose is my battle to beat breast cancer.  My hope is that tracking my story will not only keep me sane, but perhaps provide some insight to others undergoing the same or a similar struggle.  

So, here goes!

My 50th year seemed off to a fantastic start, new job and all.  I was ready to make this transition and begin in a new direction, little did I know how far off my previous course I'd be thrown!  Pardon the length of this first post, more of a chronicle to catch you up ;-)

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May 5th, 2013 -- woke up in the middle of the night in severe pain across right breast! So bad I cried and woke my hubby.  In the morning I noticed my right nipple had inverted - WHAT???

May 6th, 2013 -- called my gynecologist and scheduled an appt.  he saw me the next day. Both of us felt the lump under my nipple - about the size of a quarter and about 1/4 inch thick.  He sent me for a diagnostic mammogram and ultrasound on May 8th.  Incredibly, both of the tests found NOTHING!!!  Whew!  I was relieved :)

May 10th, 2013 -- got a call from my gynecologist - he wasn't convinced by the test results and recommended I consult with a surgeon for a second opinion - REALLY???

May 14th, 2013 -- received a letter from the imaging center confirming the findings. In fact, this is what it said, "we are happy to inform you that your recent breast imaging study shows NO ABNORMALITIES TO SUGGEST BREAST CANCER.  A report has been sent to your doctor." Yes, in all caps!  I thought all was well.

May 22nd, 2013 -- got another call from my gynecologist. They had checked and noticed I had not scheduled an appointment with the surgeon yet.  I explained how busy we were at school and that I wasn't sure it was necessary given the letter dated May 13.  She scheduled the appointment for me!!  So this is where I get scared!!!

May 30th, 2013 -- saw the surgeon.  He felt the lump too.  Said I needed a surgical biopsy done to check it. Said he was going to go in and take a conical section of the lump to evaluate, and that my breast wouldn't be too terribly a deformed - only I would notice it looking down.  Yikes!!!  Can't believe this is happening :(  Did I mention I've been getting annual mammograms since the age of 35???

June 4th, 2013 -- Hubby accompanied me for the biopsy.  I hate medical procedures, especially those that involve IVs and cutting into my body :(  All seemed to go well.  I wasn't coherent after the surgery, but the doctor told hubby that he took about a 2cm section of the tumor and that it looked pretty "gritty"???  Curious me looked it up:

June 6th, 2013 -- went for the post-op appointment (on our 26th anniversary, and the day we planned to celebrate our amazing son's birthday)...  The doctor walked in the room with a frown on his face.  I'll never forget his words, "I wish the news was more positive, I've only seen this 3 or 4 times in my 30 years of doing this," referring to the fact it had been missed with multiple diagnostic screenings. He handed me the pathology report, having highlighted a few things. I have breast cancer. 

Here are the report highlights (literally, he highlighted the "important" sections for me):

• Infiltrating Ductal Carcinoma
• The largest diameter of invasive carcinoma is 1.5 cm
• With regard to Ductal Carcinoma in Situ (DCIS), yet another cancerous area, there is an "extensive intraductal component" with an estimated size of at least 2.8 cm
• With regard to surgical margins, "Invasive carcinoma is present at the anterior, inferior, and posterior surgical margins."

Here's what he chose NOT to highlight:

• The grade of the infiltrating carcinoma (IBS - invasive breast cancer) is 3 and the Nottingham score is 8 (look up what THAT means: http://pathology.jhu.edu/breast/grade.php ).  Sucks a big one!!!
• Lymph-vascular invasion is present: ( http://m.youtube.com/#/watch?v=rVxVxt4qQU4&desktop_uri=%2Fwatch%3Fv%3DrVxVxt4qQU4 )
• The nuclear grade of the DCIS is also a 3 (most aggressive growth pattern).
• Cancerous involvement at the surgical margins is extensive for the IBS, and areas of lymphatic space are also involved.

Well, this is just NOT good!!!  I would need an MRI to check the rest of my breast area for other potential issues. Shock and horror :(

We ended up going out to dinner anyway - neither of our kids had been told anything was going on.  

June 7th, 2013 -- MRI to check for spread. The poor radiology tech tried so hard to put me at ease, to no avail!  I was really pretty rude, then just cried through the preparations.  The contrast dye stung and made my mouth taste like metal.  45 minutes is a LONG time for me to be still!  We waited nervously for the results... for 5 days!

I told our amazing son today.  He'd called hubby in the morning to see about meeting for lunch.  I was supposed to attend a leadership training seminar in Macon, but decided not to go.  Given my emotional state I think it was a wise decision.  Anyway, hubby was uncomfortable lying to our amazing son about why he couldn't do lunch (my MRI).  So, I drove to see him and share the news in person.  Our most precious daughter was still in Alabama working as a camp counselor and wouldn't be home for another week.

June 12th, 2013 -- met with a reconstructive surgeon to discuss options - YUCK!  While hubby shared he'd back whatever I wanted to do, we both decided, given the level of involvement (2 more hours in surgery and potential complications healing before treatment, plus if radiation is part of the plan it could damage the implant) that I'd pass.  We REALLY hoped this surgeon had seen my MRI results, but no such luck!

June 13, 2013 -- my surgeon called and left a message (b/c I'd called the day before wondering about the results).  The news was the best yet!!!  No indication of cancer in my left breast, nothing distal from the biopsy site, but some activity in the area near it.  We met with him later in the day and he suggested a partial or modified radical mastectomy during which he'd also check my lymph nodes.  They'll inject radioactive isotopes into my areola before the surgery to determine lymph node involvement.  We scheduled the surgery for the next Tuesday.  

Here's what he'll do:

June 14th, 2013 -- after an outing with one of my best friends, I realized I needed to inform the folks at my new place of employment, a wonderful small college in north Georgia.  While I had the job offer, and had accepted in writing, they might still renege.  The dean could not have been more supportive and understanding :)  He said the college family takes care if its own, and not to worry.  I felt a huge weight lifted from my shoulders.

June 15th, 2013 -- precious daughter came home today, SO excited about camp and rambling on with counselor stories.  I LOVE her excitement and enthusiasm about this (her absolute gift is to support children with chronic illnesses), and truly didn't want to dampen her high spirits.  But, I needed to tell her.  It was not fun :(  We were supposed to go to Nashville to celebrate her 21st birthday...

June 18th, 2013 -- so this is the day I lose my right breast!  Not such a loss given it's current diseased state, but...  I cried while the radiologist injected the isotopes - still can't believe this is really happening! They took me to Day Surgery from the Breast Center (where the isotopes were put in), then left me in a pre-surgical room, by myself, for FAR too long!!!  More crying :(

I'd requested an overnight stay, per the pre-op nurse's suggestion.  My surgeon, however, said he'd wait to see how I felt after the procedure to make that call - I thought he was NUTS!  I did, in fact, end up going home that evening :)   Surgical drains and all!  Hubby was a pro at emptying these babies and keeping track of the output: 

This is not me in the picture - I had a little pink belt with 2 pockets - my drains were both on the right side.  Notice the yucky stuff in them in this picture???  Yes, that's what needed to be emptied multiple times each day with a crazy complicated procedure that ensured a suction would be maintained, volume recorded for each drain "grenade."

June 20th, 2013 -- back to the surgeon, again, for a post-op visit.  I was doing well, thanks to my great caregivers :)  I just couldn't look at myself under the dressing though.  Just not ready yet...  I'll be back again in a week, and maybe he'll take out these horrible drains!!!

It's hard to sleep or get comfortable, pain pills take the edge off, but it still SUCKS!

Visits, calls, and cards from good friends helped tons!  Their prayers sustain me :)

June 23rd, 2013 -- got to take a "drip shower" today!  I used a shower chair, held my drains in my lap, and let the water run over me :)  Not quite "heaven" but a big improvement over wet wipes ;-)

I LOOKED today...  Wow!  Just, wow!

June 27th, 2013 -- second post-op visit.  Doing great, and finally got the stinkin' drains removed!  The surgical nurse clipped the sutures - OUCH - then pulled those suckers right out - SUPER OUCH!!!  But, what a relief!!! Freedom!  Except my range of motion with my right arm was still VERY limited.

Post-op pathology report highlights:

• Right axillary sentinel lymph node biopsy - metastatic adenocarcinoma in 2 of 3 lymph nodes
• Tumor size: largest diameter of invasive carcinoma is 3 cm
• No involvement of surgical margins (YAHOO!!!)

Other facts from report:

• Grade of infiltrating carcinoma is still 3 with a Nottingham score of 8 :(:(:(

• 2 of my 3 sentinel nodes were metastatic, but NONE of the 6 he dissected beyond that were :)
• The largest metastatic nodal deposit was .8 cm
• There was evidence of extra nodal disease :(
• My cancer is ER (estrogen receptor) negative :(
• PgR (progesterone receptor) positive ? (This is rare)
• Her2 status is negative +1 (this is a good thing!)

July 2nd, 2013 -- had my first oncology appt.  Since I'd done some research, I wasn't surprised he suggested systemic chemotherapy.  He shared with us the prognostic summary which, on the whole, agreed with my findings.  If we do nothing beyond surgery, there's a 70% chance it will come back, stage IV, within 10 years - Yikes!!!  If we do both chemo and hormonal therapy (the latter being questionable due to my ER negative status, but we'll add it nonetheless), that figure drops to 25%.  If the hormonal therapy is not effective, the figure's about 45% (still better than 70!).

The plan is Adriamycin + Cytoxan (A/C) for 8 weeks (infusion ever other week) followed by Taxol (T) for another 8 weeks (again, every other week).  Chemo will be followed by several years on Tamoxifen. The A is quite powerful, and has heart risks so I'll have an echocardiogram to determine if I'm strong enough to handle it.  I'll see my surgeon again for port placement and attend a chemo education session before starting treatment on July 17th.

Time to KICK SOME CANCER BUTT!!!