Scheduled

On Friday, January 12 I will be having a bilateral mastectomy. At least one lymph node will be removed. When I get to St Joe's, they'll do an ultrasound and insert a wire marker into the affected lymph node. Then I'll get "a very painful shot of radioactive fluid just outside my right areola" that will travel to the lymphatic system. During surgery Dr Kommareddi will use a Geiger counter to see where the fluid traveled. If the known affected lymph node is first in the chain it may be the only one removed, but if there are other lymph nodes between that one at the breast they may be removed as well. After Dr Kommareddi has completed the mastectomy (1.5 hrs), Dr Rao will step in to begin the reconstruction process (4.5 hrs). He will put spacers beneath the pectoralis muscle on each side to begin the skin stretching process. He'll work on stretching the right side as much as he can before radiation. Radiation thickens the skin and causes scar tissue to build up in that area. Post radiation stretching may be exactly the same, it may not stretch at all, or do something in between. There's no way to tell until it's time. So I'll go in twice a week to have fluid added to the spacer until radiation starts. If I remember correctly, Dr Rao said he'll only be adding fluid to the right side at first, keeping the left side flat so it's not in the way during radiation (the beam comes in at an angle to the center of my chest so as to avoid internal organs). So my sexiness factor will be off the charts! Radiation will start about a month after the mastectomy and will be every day for 6 weeks. There will be a "grace period" of about a month after radiation before the reconstruction process will resume. I'm waiting to hear back from the doctor about whether or not the hysterectomy can be scheduled during that Grace period. If not, I'll get another Zoladex shot to keep my ovaries hibernating. Estrogen is feeding the cancer, so we want to keep those bad boys turned off. I think that's all for now - I'm so so so very grateful to have Christmas back! Ho Ho Ho! Oh yeah - many people ask about Todd and how he's handling this. He's fine as long as you don't discuss details of any of the surgeries. After hearing the doctor describe some different reconstruction options he told me that he doesn't understand why I even want to do that, that a flat chest wall is fine with him! The kids are fine. I worry that I'm giving them the wrong understanding of cancer. They talk about it casually and it freaks out adults. They don't know the weight that the word Cancer holds to most people. I am also grateful that they don't need to learn just how serious it really can be. Not yet.

Making a plan

After meeting with the breast surgeon, oncologist, radiation doctor, gynecologist, and reconstruction doctor, I have a plan. Not a schedule yet, but a plan nonetheless. I will have a bilateral mastectomy with spacers put in for reconstruction during surgery. They'll stretch the skin on the right side back to boob size (as much as they can) before radiation, which will start 3-4 weeks later. They plan to radiate the lymph nodes in my right armpit area, upper chest and central chest. The only known affected lymph node is in my armpit, but there are other enlarged lymph nodes in those areas. I'll go in every day for 6 weeks for radiation. This is why we've decided to go with immediate versus delayed reconstruction. Radiation changes the elasticity of the skin and builds scar tissue. So to get the most natural looking and symmetrical ended-result, they'll stretch the skin in those first few weeks before radiation begins. I just got an ovarian suppression shot in my belly so my body will quit producing estrogen, which is feeding the cancer. Once the shot shuts them down I'll switch from Tamoxifen to a different, better drug for post-menopausal women. After surgery and radiation I'll have a hysterectomy with ovaries removed. So that's my news - just waiting to hear about scheduling the first surgery.

Diagnosed

During my routine annual exam, my OBGYN NP felt a lump in my right breast. She sent me for a mammogram (haven't had one yet, as they pushed the starting age back to 40) to take a look. There, they asked if I had time for an ultrasound (uhh, yes please), then she called for a doctor to come in (I've had enough ultrasounds that I know it's not normal for a doctor to come in), and he asked if I had time to have some biopsies done. One on the original lump and one on an auxiliary lymph node (again: yes please). I got news a few days later that the lump and lymph node were positive for breast cancer. I met with the breast surgeon who gave us the low down on the results. Estrogen Receptor - positive Progesterone Receptor - positive HER2 - negative (There's other stuff, but this was the important information) This particular combination fits into this special category of cancers - back to this later. Because it had already spread to the lymph node, she recommended we see the oncologist first before any surgeries, planning to fight systemically, then remove the tumor and lymph node. The oncologist started me on hormone therapy medication that day. The estrogen that my body produces is feeding the cancer, so he wanted to curb that right away. Because of other non-related issues, I already have a hysterectomy scheduled for January - now they'll plan to remove the estrogen producing ovaries as well. He had many more tests and scans he wanted to see before we made treatment decisions. So I've been X-RAYed, CAT scanned, MRIed, biopsied, genetic tested (waiting on results) and still have more scans scheduled. (Side note: all of these appointments are full of people telling me "you're so young" - it's lovely 😊) The one test that I'd been waiting for was the oncotype test. This is where my particular combination of positives and negatives plays in my favor. Cancers that are hormone receptor positive and HER2 negative can potentially be fought with hormone therapy alone. Using material from my original biopsy, they were able to test that particular cancer to see what the "benefit of chemo" is (in addition to hormone therapy). A score under 18 is "low benefit" a score of above 30 is "high benefit". My score came back at 20 - on the low side of the gray "decision area". I am being aggressive with body part removal (planning a double mastectomy & full hysterectomy) and studies show a very similar level of recurrence with or without chemo - so we're not planning on doing chemotherapy at this time (blue hair is here to stay!). My next steps are to meet with the radiologist and breast surgeon again. I am fine and I will be fine. The doctor told me that I was more likely to get hit by a satellite falling from the sky than for this cancer to kill me. So every time I see a shooting star, I jump a little. I feel fine, but I have Stage 2 Invasive Ductal Carcinoma. Yeehaw!