My Surgeon

January 22, 2009

Oh my goodness it was a LONG day!

My husband, Chris and I woke up this morning, and went through our normal routine. Walked the dog, got the kids off to Daycare, but instead of going to work, we were going to see the breast surgeon. We got there at about 8:40am. My Mother-in-Law met us there.

Side note: My husband and I had discussed having his Mom there. She had seen an episode of The Doctors on breast cancer and they said when you speak to the surgeon, you should bring an advocate with you (someone that was NOT your husband, husbands never really listen, and tend to tune out). After discussing it, my husband and I agreed that if we brought anyone with us, it needed to be his Mom. I knew that she would definitely asked the questions I would be afraid to ask. Meaning there might be some questions that I don't want to ask in fear that I would piss off the Dr. and then she would take it out on my poor ta-tas. (I know that this is probably a stupid thought, but that is what I was afraid of). When I asked her, she said that she would be honored to be my advocate on this.

So manned with our questions and notebooks in hand (okay my Mother-in-Law and I had notebooks) and the three of us went back about 9:15 to meet the surgeon. She said hello, she was in her mid-fifties (I am guessing) and went over my history with me. Once again, like many doctors before her, surprised that I came upon this lump myself. Then she looked over all my mammogram, ultrasound, MRI and pathology reports stopping to highlight items she thought important as she read (wasn't she suppose to "review" my chart before she met with me? Wasn't that one of the reasons that I didn't get to keep my Friday appointment?). Then she asked me to come with her and she took me to an exam room and did an exam on my breast. She looked surprised that both the Alien and Bob were so close together. "Well," she said, I can get that with one lumpectomy. That is great news, we don't have to do a mastectomy." I felt my options go out the window....

I got back dressed and met my family in Dr. A's office. When she returned (from what I assumed would be reviewing my films) She laid out our plan of action....

She wants to do a lumpectomy. She believes that she can get to both of them at the same time. She would take both of them and an extra 1/2 inch border around the two and check it for clean edges (meaning no cancer along all the edges). This incision will probably take off some skin as well since the Alien is very superficial (close to the skin). A guide wire will have to be inserted prior to the surgery into Bob so she can find him, but since the Alien is palpable, she will just cut him out. Then after she finishes with the two of them, she is going to make a small incision under my left arm and remove 1 or 2 of my sentinel nodes (these are the lymph nodes that get rid of the waste in my breast). While I am still asleep, they will freeze them and check them for cancer. If they have no cancer, she will close up. If there is cancer in these nodes, they are going to take 10 - 15 more up in my armpit. If there is cancer then I will get chemotherapy and then radiation. If there is not any cancer in the sentinel lobes than I will receive radiation only. Radiation would start two weeks after the surgery and I would have it 5 days a week for 6 weeks.

How they find the sentinel nodes is pretty interesting. About 2-3 hours before the surgery they will inject me with radioactive isotopes and then with a sophisticated Geiger counter they will find which lymph nodes have the most radioactivity (meaning get the most waste) and it will be the ones they cut out. Huh.. Who would have thought?

Then came time to ask my questions... My questions are in light pink.

"What about my right breast and the Lobular Neoplasia?"
"Why would I cut that out? It is not cancer."
"But, I thought..." (Dr. A cut me off here)
"It is not cancer, it is a marker for cancer, it is a marker only and we don't have to worry about worrying if you get cancer, you already have cancer"

Side note: Dr. A is an excellent, detailed surgeon. One of the best in her fields, but not that great of a bed-side manner. I guess she is good enough, she can afford to be a bit cold.

"What about birth control? Currently I am using the Mirena, a progesterone only IUD for contraception."
"That needs to come out. You have hormone receptive cancer. It feeds on progesterone and estrogen so you cannot use any form on hormones for birth control."

"Okay, that leads me to my next question, Will I be able to have a healthy pregnancy when this is over?"
"You CANNOT have any more kids."
"What?" This is where I think I started to lose control of my breathing...
"You really should not have anymore children. You have hormone receptive cancer. You will probably end up taking a hormone blocker. If you increase the hormones in your body, if feeds the cancer." I think she back-tracked a little bit, cause she saw the shock on my face.
"But no more at all?" My husband and I had decided in November before this all started that at the end of this year we would start trying for one more. When we found this cancer, we decided when this was over and done, that we would celebrate by having one more little one to complete our family. This would fill our table which holds six. Now I was being told that I would not be able to have anymore children?? This was too much. I felt the tears welling up.
"I will tell you what, if after 2 -3 years on the hormone blocker and your tests are clear, then we will discuss taking you off the medicine so you can get pregnant. But you will be watched like a hawk. You really need to decide if you want to have another baby and put yourself at jeopardy or enjoy the two healthy girls you have now."
"How long I am suppose to take the hormone blocker?" I asked.
"For 5 years." Was my answer.

"What are the side effects of the hormone blocker?" This questions came from my husband who up until this point had not uttered a sound.
"Full beard growth." I said half-hearted laughing.
"No," said Dr. A, "You might have menopausal symptoms and it might stop your period all together."
"Oh." My husband said, that was the last thing he said in her office.
"Great," I thought, "No more babies, a deformed boob, and menopause at 35. Does this GET any better?" I am hoping you can read these words dripping in sarcasm.

"How long will I need off of work?" I asked. I know that this is stupid, but because of the new year I had NO time available and I am in the minus at work because of our Disney vacation.
"I do surgeries on Tuesday and Wednesday. You will be able to go back to work on Monday of the next week."
"Really?" I asked dumbfounded.
"Yes, with a lumpectomy the healing time is much shorter. With a Mastectomy, the healing time is much longer, you don't need radiation, but then you have the reconstruction as well."

"What is the difference between a lumpectomy and a mastectomy?" I wanted to open back up my option (shouldn't I at least get a pair of new perky titties out of this?)
"There is no difference in the survivor rate. If we do a lumpectomy you will have a 5-7% chance of the cancer recurring, if you get a mastectomy, it is the same. The only difference at this time would be healing time, reconstruction and with a mastectomy there is no radiation."
"What are the side effects of the radiation?"
"You will have what feels like sunburn just at the location, and you might feel fatigued. We should do the lumpectomy, and then IF the cancer returns in 5 years or so, then we can look into a mastectomy."

"Any more questions?"
I believe my Mother-in-Law asked a few, but I was tuned out... So much information was thrown at me at one time, sure I got a cute little brochure with explanations, I saw pictures of other women's breast in the radiation machine, and after shots of the scars, but this was so much, so fast. I wanted to just cry... I think it really hit me, all jokes a side. I have cancer. Then came the kicker...

"Okay, I know that it has taken you forever to get in here and I know that you want to get this thing taken out. I do my surgeries on Tuesdays and Wednesdays, lets see if I'm free next week."
"HUH?" I thought it, but I don't think any words came out....
"Next week?"
"Yes, follow me and we will have Anne set it up for us."
I followed my family numbly into the other room and sat in front of Anne's desk. She flipped through a scheduling book, and scheduled my surgery....

Wednesday, January 28, 2009
I need to arrive at 9:30am.
The isotopes and wire will be inserted at 10:30am.
Surgery starts at 12:20pm.

I got a pretty little binder and was sent on my way. If I have any questions to call Anne...

I spent the rest of the day in a haze. I had to go to a clinic for my Pre-op physical. There was no way that my primary doctor could fit me in by Monday at noon (that was only 3 days). Oh my gosh!! 3 DAYS!!! Then I went by my midwife's office and had my yearly visit and we got to sit and go through my binder, my pamphlets and she helped me get it straight in my head. During my breast exam (third of the day), she explained to me what my breast would probably look like (deformed) and reassured me that my family loves me for me and not the shape of my breasts. She also explained that when this is all over, I could always get reconstruction done. Then she removed my Mirena (note to those who have it, it is so much easier to take it out, than put it in). Finally my Dr. appointments were over and I could go back to work and finish my work day (that ended up being only 2hrs long) and figured out how I was going to make up my time while I was off.