Friday, February 28, 2014

A few good results!

Oh man, I am so exhausted from my errands!

At the end of my day, Dr. Oncologist tacked on a brief appointment with her.  She said she couldn't go without seeing me.  It was great to touch base with her, in person, for the first time since receiving the preliminary pathological results last night.

The bonus was that she had the results of some of my scans:  there does not appear to be any cancer in my bones (huzzah!) and my brain is also "unremarkable" (I beg to differ, but huzzah for no cancer!).  There are more data to come, regarding whether cancer cells are in my blood and whether cancer cells have taken up shop in my internal organs.  A blood test and a PET scan, respectively, will provide those data.  I gave the blood sample today, and the PET scan will be on Monday at 8 am.

Intriguingly, she has not yet concluded that the cancer is inflammatory breast cancer (IBC; what I had before), either new or recurrent.  Clearly we need to wait for the breast biopsy results to make any conclusions, but I had already been assuming that it is IBC.  That is because the current lump feels EXACTLY like the beginning of my previous bout with IBC.  I am very interested in the notion that it could be something different, perhaps even a "normal" cancer that is not as bad as IBC.

I am trying not to get my hopes up for a different cancer, but it is hard because it feels so good to end the day with hope.  Also, I don't even know what I'm hoping for.  Mastectomy before chemo instead of after?  Different chemo that turns my hair curly instead of straight?  Once daily radiation for 5 weeks instead of twice daily for 3?  I lack information to make clear hopes, but I know that I don't want IBC, and I don't know of the worse things that I should be hoping against.  

In summary, the cancer is not in my bones.  It's not in my brains.  And I will use my healthy-brain mind powers to quarantine the cancer until Western medicine has caught up to me.    


The mountain was shaken.  Here comes the avalanche.

I'm on my way to the clinic here in town for a blood draw, bone scan, brain MRI, and heart echo.  All today, starting as soon as I put my shoes on.  PET scan on Monday at 8am.  The purpose of these tests is to discover whether or not the cancer has spread to other locations in my body.  I will get the results of these scans on Monday afternoon.

No updates on the breast pathology yet.

Haven't told the kids yet.  We're billing it as a fun family day at home, and mommy has a couple of errands to run.


Thursday, February 27, 2014

Cancer, details unknown

New hardest thing I've ever had to do:  have a normal evening with my darling daughters after Dr. Surgical Oncologist calls with a preliminary diagnosis.

6:04 pm  Normal life
6:05 pm  Cancer life
6:10 pm  Pretend it's still 6:04

The only result she has so far is of the lymph node aspiration, and that was indicative of cancer.  It strongly suggests that the lump they biopsied will be cancer.  The lump biopsy results will likely be delayed until next week now that we know it is cancer, because they will run extra tests (is it estrogen-receptor positive, for example) to determine all of the markers.

Dr. Surgical Oncologist said the first thing I will have to do is meet with one of her colleagues, a medical oncologist, to discuss the risks of repeated chemotherapy treatments.

Because we will once again start with chemotherapy.

Dr. Surgical Oncologist offered to call Dr. Oncologist tomorrow and discuss my case.  I said please and thank you.

I apologize that you are reading this here, because you deserve a phone call, but I lacked the strength.  I broke the news to my daddy, then my mommy, and tried to call my other mommy (in law), and then took the easy way out on this here blog.  It's too hard.

Tuesday, February 25, 2014

No fear

Today I went the distance to get a second opinion from Dr. Surgical Oncologist regarding my lumpish thing that's going on.  To recap, Dr. Radiologist in my town said not to worry, it's just a mildly inflamed lymph node, but Dr. Oncologist wasn't satisfied that evaluation and suggested I give my rockstar Dr. Surgical Oncologist a chance to check it out.

The clinic was unusually quiet today.  I barely had my coat off when I was called back into a room.  I handed over the disks of my recent scans, then I played on my new smart phone while waiting for the doctor.  She came in and rather quickly made the same evaluation as Dr. Oncologist and me:  there is definitely something new and unusual going on in there.  She said that she'd like to have another ultrasound, perhaps one where they did not focus exclusively on the lymph nodes.  Fortunately they could fit me in later in the day.  Pending the ultrasounds results, she presented three plans:  A)  perhaps the radiologists would like to use the ultrasound to guide a biopsy, B) if not, she would like me to come back to her clinic where she would perform a biopsy, and C) perhaps we'll just perform a lumpectomy on a later date, regardless of A or B.

I said that all sounded fabulous because of things:  1) biopsies are the best ways to get answers, even when they are inconclusive; and 2) I love her anti-wait-and-see strategy.  I've already waited, and I've already seen.  Given my previous bout with IBC, further waiting does seem to be nonsensical.

I had just over two hours to wait until my ultrasound appointment.  I decided to visit the hospital library.  On my way there I walked through an atrium that was resonating with some delicious music.  It was coming from somewhere below me, but mirrors and windows prevented me from seeing the source.  I changed course to better enjoy the music and was delighted to find a string quartet playing Beethoven.  They were brilliant.  It was unclear how often they performed in the hospital, but it's possible that it was a rare bit of marketing because at the end of their performance they invited everyone to attend their recital on Friday.  It was a lovely interlude in my day.

The ultrasound technician was friendly, talented, and quick.  Within minutes she had the pictures she wanted and was out the door to consult with Dr. Radiologist.  The technician returned to my side with both Dr. Radiologist and Dr. Department Head Radiologist, who all took turns exploring the live images.  They concluded that in addition to the lymph nodes identified by the previous scans, I had an additionally enlarged lymph node in my arm pit.  Only slightly enlarged, but noticeable.  Regarding the lumpish firmness that started me on this path, they determined that it is irregular and a shade darker than the neighboring tissue (by ultrasound), but that is all.  There is nothing really to see or say about it.

Just after 3pm they agreed that a biopsy would be a good thing to do, and yes they would go ahead and do it then and there.  They decided to perform a needle aspiration of the largest lymph node (armpit) and to perform a needle biopsy of the firmness.  I said yes to all of it.  Everyone left the room.  Then the parade began.

The technician came back and started prepping things for minor surgery.

Dr. Radiologist reentered and asked if I'd be part of a research study.

Dr. Research Study arrived and invited me to participate in a research study on whether or not the DNA and RNA of breast cancer are the same as in adjacent armpit lymph nodes.  Even if my results are benign/negative, I would be part of the normal (control) group of participants.  Naturally, I agreed to be a part of the study.

Dr. Department Head Radiologist entered and exited numerous times, apparently waiting to witness one particular aspect of the procedures.

Three pathologists arrived and set up a microscope just outside the room to analyze certain samples instantly.  This does not mean that I have results for you; this means that they needed to ensure that they had enough of my cells to perform their tests.  Here's how it worked:  Dr. Radiologist numbed up the area, then used the ultrasound wand to guide where she inserted the needle.  Once satisfied with the location, she sucked up a tiny amount of cells from the fluid part of my lymph node.  Then she sent the needle-full of my lymph node cells out to the pathologists.  She did this repeatedly until they said that they had a sufficient amount of my cells.  It took 5 needle samples.

Then Dr. Radiologist took a bonus sample of lymph node (the size of pencil lead is what they told me, but that's a touch ambiguous) and gave it to Dr. Research Study.

The pathologists left, then Dr. Department Head Radiologist came in and stayed for the lump biopsy.  Dr. Radiologist once again used the ultrasound wand to tell her where to stick her instruments.  Using a noisy little needle-punch contraption she took out 5 samples, all approved and indeed coached by Dr. Department Head.  Then she took one bonus sample for Dr. Research Study.  At some point during this phase of sampling, Dr. Surgical Oncologist stopped by to see how things looked.

I have nothing to fear as long as these women are on my team.

The penultimate task was to insert a little token into the lump.  They placed a sterile titanium clip to mark the area that they biopsied (this should tell you how difficult it is to visualize this lumpish thing--they had to permanently mark it with a metal shard).

Then the final step was a mammogram, to be sure that the clip is in there, and in the right place.  But putting a freshly biopsied breast in a mammogram compression is likely going to be bad for bleeding, you might say.  Ah, they have thought of that!  Before the mammogram they bandaged me up and used compression for 15 minutes to inhibit the bleeding.  They achieved this with a sandbag.  Yep.  Just like the ones my mom puts in the back of her pick-up truck in the icy winter months.  I laid there on the table with an enormous towel-wrapped sandbag over my chest for a quarter of an hour.  The sandbag was unexpected and completely disarming, and it was a relief to laugh out loud after the seriousness of the previous hour.

The lidocaine prevented me from having too much discomfort during the mammogram.  It was quick and no problem.  The clip is pretty cute in there.

We'll have the results on Thursday or Friday.  They said that Friday is more likely, and that if I haven't heard by 2pm then I should give them a call.  

I want to thank everyone for their support today (and always).  It was so awesome to use modern technology to receive all of your well-wishes all day long.  

I'm hoping for the best, but I'm not fearing the results.  I've got this, no matter what it is.  I've fought the good fight once and I can do it again.  No worries, everyone.  No worries.        

Thursday, February 13, 2014

This is how it works when you used to have cancer

It's all relative.  All of it.  I jammed my toe on the bedpost tonight, which for a second was the worst pain of the day but then subsided faster than the rest of my bodily discomforts.  But if you tell someone that jamming your toe is more painful than, say, having contrast dye injected into your bloodstream while laying face-down on a hard plastic plank, they are not likely to believe you.  People also have trouble believing that you are going to report to your job for a few hours between your breast MRI and ultrasound appointments.  Might seem ridiculous to the layperson, but hey, when you've had cancer this is just the way it goes.

Let me explain.

For the past week or so I have noticed a tingling firmness in my right breast.  It's more lump-like than the inflammatory breast cancer ever was, but it's not distinctly lumpy like a pea or other round object.  My quarterly appointment with Dr. Oncologist is scheduled for tomorrow morning, so I thought I'd be proactive and report this new development to her via electronic correspondence (MyChart is awesome for those of us with health issues!).  I figured she could either wait to check out my lump on Friday, or order some exploratory tests prior to our meeting.  No harm either way.  In true Dr. O fashion, she took my words at face-value and ordered some tests.

This by itself was refreshing, because I sometimes wonder how well I walk the line between being a hypochondriac and too complacent.  As a cancer survivor who is still in the high-risk-of-recurrence zone, I worry that I could be overly sensitive to every little bodily change.  I don't want to turn into the girl-who-cried-wolf when it comes to a potential recurrence.  On the other hand, I want to be diligent and not miss something if it does pop up.  No one knows my body better than I do, so if something truly alarming happens I want to sound the alarm.  Instantly.

At any rate, Tuesday evening, I sounded the alarm.  Dr. O had a sample of my blood before noon on Wednesday, and she had me scheduled for a mammogram and breast MRI scan on Thursday morning.  At the mammogram appointment the radiologist briefly viewed my pictures and requested an ultrasound of the breast, too.  That appointment was made for Thursday afternoon.

You see, it all sounds awful when it's typed up like this, but I promise you it was no big deal.  These are just the things you have to do when you've had cancer before.  I wasn't even stressed about it.  I'm still not stressed about it.  I'm a bit sore and stiff from spending 3 hours being smashed (mammo) or contorted (MRI) or both (ultrasound).  But mentally I'm bringing my A game because I'm not sick.  I'm WELL.  And if a lump disagrees with this assessment of myself, then we'll cut it out.  And if the lump decides to go viral before we get it cut out, then we'll kill it with chemicals.  And after the lump and its cancerous offspring are out we'll irradiate the premises to make sure it's gone for good.

See?  I'm a professional.  This is no big deal.

Also, I got a preview of the results.  Wanna hear?  Dr. Radiologist thinks that 1-2 lymph nodes are the culprit(s).  The one that I can feel is a tiny bit enlarged.  A neighboring lymph node is both a tiny bit enlarged and has slightly increased metabolic activity.  However, he reminded me that lymph nodes commonly get enlarged when they are busy fighting an infection.  I don't feel sick, but I have been exposed to illnesses so perhaps my lymph nodes are busy.  His recommendation is to have another breast ultrasound in 2 months.  I'm not holding my breath on that because I think it's entirely possible that Dr. O will want a biopsy tomorrow, but that's okay.  Biopsies are the best way to learn what's going on!

I'll end with the good omen that was Dr. Radiologist.  It was the same radiologist who performed my spine biopsy, and he is the best radiologist in town.  I told him that I was thrilled that he was on my case (the way my clinic works, it's a lottery which of the 8 or so radiologists assess your pictures).  After describing the cause of my lump(s) to me, he launched into the usual doctor spiel about how we don't really want to do a biopsy unless it was absolutely necessary...I cut him off and said that I am perfectly willing to call up Dr. Surgeon and have a biopsy right that second.  I am not afraid of using biopsies to get answers; in fact, biopsies have been the only way I have gotten most answers.  Dr. Radiologist replied with, oh, well, then I'll talk with Dr. Firstname Surgeon about it.  In fact, he was going to see him tonight and converse casually about my case.

Brilliant!  One point for having a team of talented medical professionals working together to work for me, and two points for living in a small town.  

Everything's fine.  Time to watch some Olympics!