Monday, January 15, 2018

GUEST POST BY GISELE - Feeling Nervous

I'm kind of scared about all that's going to happen this week. My Mom is going to have so many doctors appointments, plus chemo! She has to have a port surgery, which is a surgery where they stick a port in her chest that stays there until the end of cancer! So every time I look right where the port was inserted I'll see a bump right there, and know that that bump is really a port stuck in her for a year! My Mom said that all the scars she'll be having will be proof that she did something very brave. In addition to that, my Mom is going to get chemo! She is going to go bald! Actually, I'm interested in how that will turn out. But mostly weirded out.



Wednesday, January 10, 2018

We Have a Plan!

Today was a busy day.

First we met with the genetic counselor, Kayla, to discuss my family history and see what tests we needed to order.  (A full panel will be done, though only a positive result on the BRCA 1 or 2 gene would impact treatment.)  Results will come back in 2 weeks or so.

Next up, we met the nurse practitioner filling in for Dr. Saleem's normal NP.  (Dr. Saleem is the Medical Oncologist, or MedOnc.)  Haihong was... brusque.  She wasn't unkind, but she was very clinical and seemed to have forgotten that she was going over a chemo plan with someone who was new to cancer.  One thing that was important to me was that I be allowed to use a nail strengthener and dark/black polish on my fingernails in an attempt to have them not split/lift off of my fingers.  Women who've experienced the same chemo I'll be doing have used that treatment successfully, and I thought it was worth a shot.  Haihong was dismissive, saying that it wouldn't work, and she wanted to be able to see my fingernails in case there was any sort of infection.  She also seemed to dismiss my concern as me wanting my nails to stay pretty and polished, as if that would be my primary concern.  I also brought up the possibility of using cold packs/gloves to try to prevent neuropathy, and she dismissively said there was no evidence that it would help, though she didn't forbid me from trying.  I'm hoping we will meet and deal with the normal NP on my subsequent visits.  

Dr Saleem, on the other hand, was great.  She was kind, understanding, supportive, and talked to me instead of at me.  When I asked her about the polish, she immediately responded that the nail strengthener and polish could possibly help, and would at least keep my nails stronger, and then brought up the use of cold packs/gloves before I did.  She took her time with us, making sure we were comfortable with everything she had to tell us, and giving us time to ask all of our questions without interruption.

We met with Dr Miggins, the SurgOnc, before leaving, and went over the surgery options in light of the MRI results from Monday.  We also discussed next steps so that I'd have a clear understanding of what to expect.

So here's the plan:  

I'll be getting a port placed (outpatient surgery) sometime in the next few days, and will also have an echocardiogram (like a heart ultrasound) done to get a baseline on my heart since the chemo can be hard on it.  Methodist SL will be contacting me to have that scheduled.  It's likely that this will all happen Friday or Monday.

Chemo will start next week on Thursday.  I'll have 12 weeks of Taxol (Paclitaxel), once a week, to start with.  Following that, it'll be 12 weeks of AC (Adriamycin and Cyclophosphamide), 1 treatment every 3 weeks for a total of 4 treatments of AC.  That means 6 months of chemo.  If my blood counts aren't where they need to be on any given week, treatment may have to be delayed.  I'll have to be careful to stay healthy, which means everyone around me needs to stay healthy.  Lots of hand washing!  I was also given free rein to eat whatever I liked that I could tolerate.  Dr Saleem said the most important thing was to keep my energy and calories up.  I'll have prescriptions for anti-nausea medication to take around the clock if necessary, and will be given steroids and Benadryl with the chemo.

After chemo, I'll have surgery - a mastectomy on the right side, along with removal of all the lymph nodes in my right arm.  More on surgery as we get closer.

After I heal from surgery, I'll have radiation (likely to be 4 weeks, every day M-F), though I haven't yet met with the radiation oncologist.) 

About 9 months after radiation, I'll have reconstructive surgery - possibly the first of several, depending on how things go.

And that is what we know right now.  Things are starting to move along!

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Monday, January 8, 2018

Monday Scans... and Some Results

Today I had a nodal ultrasound and a breast MRI.  

It was an early wakeup for someone who hasn't been sleeping well, so I was moving slowly this morning.  So slowly that I ran out of time and wasn't able to make my cold brew latte and had to go without coffee.  Not a good start.

The nodal basin ultrasound was easy-peasy, though I had to explain to a few different people that yes, I had already had the regular ultrasound, and no, I didn't need that done again, yes, I just needed the other areas checked.

The tech and the doctor both were reassuring - nothing new was showing up on the ultrasound.  They saw the funky axilla lymph nodes that we already knew about, but nothing new.  The doctor cautioned, though, that the MRI could pick up on something that the ultrasound may not.

At least I had some good news to share - nothing new on the ultrasound!

I had gone through a brain MRI before (Maybe twice? It's been a while), but never a breast MRI.  I was given a couple of hospital gowns first for modesty (goodbye to the comfy Breast Center robe!) and then walked over to a small room to have an IV placed since the MRI was both with and without contrast.  The IV tech was very nice and told me to look away as he did his job since I'm not a fan of needles.  Good thing, too, because the next few minutes were a flurry of pain, three repetitions of, "You're a good bleeder!" and the grabbing of a towel to clean up my arm when the small wipes proved ineffective.  Once the bleeding was under control, he took me to the MRI room, where the MRI tech used another towel to wipe the remaining blood drips from my arm before positioning me on the table. 

For a breast MRI, you lay facedown on the MRI table.  Your breasts are... arranged through two cutouts in the table, and your face is squashed into a padded hole similar to that on a massage table, though much less comfortable.  Your arms are stretched out above you, Superman-style, but pulled as straight as they can be without coming out of their sockets.  They are then squished inward, crunching your shoulders, as you are moved into the machine.  A lightly padded board runs along the bottom of your ribs, and another is between your breasts, making each breath tortuous.  

And then you're told to hold still and breathe lightly for the next hour and forty minutes.

When I was pulled out of the machine at the end, I couldn't move until my shoulders had been massaged and blood was flowing properly again.

But worse than the MRI itself was the call from the doctor a few hours later to go over the results.

The original tumor was 3.6cm, as seen on mammogram and ultrasound.  The MRI says that it is 4.3cm.  It's located at about 9:00 as you're looking at my right breast.  The MRI shows a second tumor located at 8:00, but deeper.  It's 2.2cm.  And there's a third, about 5cm away from the first one.  It's also located around 8:00 and near the nipple, and is 1.1cm.  The doctor is suggesting an MRI-guided biopsy to my surgeon so that we can have a better idea of the surgery options.

Additionally, the MRI noted 4 axilla lymph nodes as abnormal, with the one biopsied as the largest.

And?  A lymph node on the right side of my sternum showed up on the MRI, which usually happens only if it's involved.  It's too dangerous an area to biopsy, so the node will be noted on the doctor's report because that area will need to be included in radiation treatment when it happens.


Two more scans tomorrow.  Both to see if the cancer has spread beyond the lymph nodes.  Pray, please.

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