I am in the BEST hands

Last week, I was waiting to hear from my trio of doctors, the main ones being my surgeon, Dr. Nathalie Johnson, and my oncologist, Dr. Rebecca Orwoll.  The third, my radiation oncologist, is Dr. Lee; she is more involved in implementation than in the planning part (hey, I AM a planner after all).  Anyway, Dr. Johnson and Dr. Orwoll were going to discuss the best post-op treatment for me, along with the sequence:  radiation only?  chemo only?  radiation and then chemo, chemo then radiation?  By Friday afternoon, they had not yet talked, and it was stressing me out a bit--not having cancer, not the surgery, but the simple "not knowing" of what will happen next.  Not very rational, I know, but who says I have to be rational?  I have breast cancer, the best excuse for anything!  

Anyway, get this--Dr. Johnson called me at home this morning.  Yes, a Saturday morning--to let me know that she is still trying to contact Dr. O, that she hasn't forgotten, and just wanted me to know she's working on it.  Is this the best doctor I could ever wish for, or what?  When was the last time you heard of a doctor calling a patient on a Saturday just to reassure her?  She's also given Dr. O's folks her cell number so she can be reached on her day off, Monday.  

I feel so taken care of, and so lucky.  

Meanwhile, I'm getting ready for my trip--I leave Monday for Dubai, where I'll get on my ship and sail away.  SO much to do before then!  I've sent both Dr. J and Dr. O letters saying it's ok to email info to me, that I waive any privacy rights, so I will keep updating this blog as I hear from them.  

I don't have to turn the light on anymore

in the bathroom . . . I've had so many scans, injections of isotopes, beams, rays . . . Wednesday was my day for tests at Good Sam.  First I had a bone density scan, then got my injection for a nuclear bone scan.  For that one, a radioactive material is mixed with some other agents and injected into my bloodstream.  After a few hours, it concentrates in the areas of my bones where there has been recent activity.  If those evil little cancer cells had spread to my bones, this would help detect them.  I was concerned that it might be masked by my arthritis--that the scan wouldn't be able to distinguish between the two types of activity.  The techs reassured me that cancer tends to start in the bones themselves, not the joints, so it shows up as a stripe on a rib, for example.  

There is no question that having breast cancer is not a good thing, but I am fascinated by all the things I'm learning about the technology, about what we've figured out about cancer, and so on.  

Anyway, after they injected me with radioactivity, I had lunch with a friend and went back to be scanned.  I lay on this narrow, slighly curved table, and they moved things around me to scan.  Given that I've been getting no sleep, I snoozed through most of it--the techs told me I snored loudly.  Good thing I'm used to being embarrassed.  After that I got my chest X-Rays and went home for another nap.  

Thursday was my last day in the office, and I wound up there until 2 am trying to finish things up.  At least I didn't have any more radiation.  

Oh, and in case you're wondering . . . that's duck breast a la orange.  

March 23--Meet the Radiation Oncologist

This morning is my "consult" (whatever happened to the word "consultation"?) with Dr. Lee, my radiation oncologist. Another smart, likable woman who explains things well.

She and Dr. Orwoll, my oncologist, haven't talked yet, but Dr. L puts a call in to Dr. O while I'm there. Unfortunately, Dr. O isn't in, but it's good to see that my docs are all eager to communicate with each other. She tells me that the "balloon-in-the-boob" radiation treatment can be done before chemo, which is one of the things Dr. O wants to find out. That's good news, as the balloon method is much more focused both physcially and temporally.

Tomorrow I see my psychiatrist and get a vacinnation for Herpes Zoster, aka Shingles. I guess it's fairly common to get hit with it when fighting cancer, and the cancer itself, and then the treatments, muck around with your immune system. Since my diabetes and arthritis already do that, I think it's a good idea. Weird process though--I have to get a prescription from my internist, and then get the shot at a pharmacy. Go figure. I may also call my surgeon and oncologist to see if they've talked.

Wednesday is a bone density scan, a nuclear bone scan, and an x-ray or two. I will probably take the day off from work rather than running back and forth.

As always, I'll keep you all posted!

March 18--Sleeping through scans

This morning I have a scan scheduled for 8 am. Bleagh. It's called Breast Specific Gamma Imaging, and scans both breasts with a much finer focus than an MRI. They inject a radioactive tracer into my arm--it will settle where there's been recent activity, such as cancer cells partying down. It's sort of like a mammogram, except that the camera is on a movable arm, I sit in a chair, and once they clamp the camera thing onto my breast, I sit very still for 5 minutes. We do several views of each breast. It's mildly but not terribly uncomfortable. Dim room, early morning, sitting still--I fall asleep. The technician keeps waking me up, and I keep nodding off again. Put my tit in a wringer, and I'll still take a nap.

Anyway, got the results this afternoon--nothing seen anywhere except where we already found the cancer. Yay! Increasing evidence that this sucker hasn't spread.

Tomorrow I have no tests or appointments associated with the cancer--yet. I'm waiting to hear from some of the labs as to when I can come visit them. I am slated to get my teeth cleaned, but that's about it. I will, of course, keep you all posted.

March 17--Meet the oncologist

This afternoon I met Dr. Rebecca Orwoll, an oncologist. She is incredible. And, it turns out, she was Vera's oncologist too. She clearly loves what she does, and is really enthusiastic and interested in all of the scientific advancements that have occured over the past bunch of years. She's also working on a degree in music. Is this the doc for me, or what?

As with Dr. Johnson, I love her.

She went through a number of studies with me, finishing up with her recommendations/suggestions, which are rather different from Dr. Johnson's.

Dr. Johnson recommends a lumpectomy followed by radiation twice a day for a week. The radiation is administered through a balloon in my breast that sits where the tumor was, so it's very localized. Dr. Orwell prefers lumpectomy followed by chemotheraphy and then perhaps by radiation. Both, by the way, favor tamoxifen for 5 years--it blocks the hormones that make my tumor happy.

Based on the info Dr. O gives me (if I've got it all right), there have been some recent advances that are absolutely amazing. Basically, they can send my tumor off to this lab that will work on the DNA; they will come back in 10-14 days with very specific recommendations for chemo based on the DNA. However, usually doing radiation before chemo messses things up for the chemo. Doing the balloon in my boob radiation weeks after the surgery may or may not be feasible. Also, Dr. O isn't sure if the radiation done with the boob balloon will, in fact, mess up the chemo.

So what now? Mere mortal doctors would just leave me in this dilemma, or would wait for me to ask them to talk to each other--but not my SuperDocs. Dr. O says that she will call the radiation oncologist to see what studies have been done on the sequencing of the boob-ballon radiation and chemo, and see if we can do the radiation first, then the chemo. She also says she will call Dr. J and work through the ideas with her.

I feel like I am in the care of the smartest people on the planet, and that they really care about me. I feel incredibly lucky, too. I expect to hear from my docs in the next few days, but in the meantime I also feel very unsettled--I know the surgery is scheduled for April 28, but have no idea what we're planning after that. I'm trying to channel my inner Doris Day (what will be will be) but it's tough. I'm also feeling bad about inflicting such uncertaintly on my colleagues who are awesomely supportive, but still have their deadlines, too.

Dr. J had ordered more tests, and Dr. O does too, including a bone scan and such.

I go out to dinner with some good girlfriends, and we drink a lot of wine and get very, very loud. I love it.

March 16--Meet the Surgeon

I have an appointment to see the best surgeon for breast cancer, Dr. Nathalie Johnson. It's at her Good Samaritan office at 7:45 AM. Even though I am not a morning girl at all, I don't care--I'm on my way over there. I get there to discover they erred--she's at her St. Vincent's office! I jump in a taxi, and get there in about 15 minutes.

And yes, of course I baked her some cookies: Chewy Chocolate Chip and Oatmeal-Raisin with fresh grated nutmeg. She says she's never met a cookie she didn't like.

Dr. Johnson examines both of my breasts, listens to my heart and lungs, and reads the pages and pages of history she had me fill out. She explains her recommendations very clearly and with a minimum of jargon--she's good at this explaining stuff.

I love her.

She confirms what my gynecologist (Dr. Michelle Sang) told me on Friday--that the results from the pathology studies of the biopsy are all good. It's small (aka Stage I) and the estrogen and progesterone receptors are both +3, also a very good thing. My C-ERB (aka Her-2-Neu) is negative and the proliferation level is low. (I'm putting some of this technical stuff up here for my friends who understand what it is, but I'm not going to try to explain it.)

She recommends lumpectomy, which means she goes in and scoops out the tumor and a little of the normal tissue around it. I won't need reconstructive surgery or anything. She'll also biopsy some of my lymph nodes to see if the cancer has spread. She's confident it hasn't, but wants to check--I agree! They'll keep me overnight in the hospital and then I go home.

Radiation is the standard post-lumpectomy treatment. She thinks I'm a good candidate for a new kind of radiation therapy. The standard is to get what's kinda like an x-ray 5 days a week for 6-7 weeks, beginning about a month after surgery. The main side effects are fatigue, which grows over the treatment period, the risks from the radiation damaging heathy cells., a sense like sunburn, and sometime swelling.

A newer approach involves putting a balloon where the lump was removed (kind of like putting an arena where you tore out the slum housing?). The balloon is filled with saline and attached to a thin tube. Twice a day, radioactivity is added to the water through the tube, and then sucked out. This happens twice a days for 5 days, and then they remove the balloon. It's done on an outpatient basis, so I can hang out with the cat in between boob waterings. Dr. J tells me I'll be off work for 2 weeks with this approach. With standard therapy I'd go back to work sooner, but be tired for a longer period of time.

This newer option, of course, appeals to me more than the standard approach, but I want to see what the oncologist says tomorrow. How "experimental" is the new approach? Also, Dr. Siegal thinks that there are some really strong negatives for radiation at all, and that I should consider chemo. I'll see what Dr. Orwoll has to say.

Dr. Johnson also wants me to have a special scan called a Breast Specific Gamma Imaging (BSGI) of both breasts. This is better (and less hassle) than an MRI at catching any other little bits and bobs of cancer cells. I'm scheduled for 8 am Wednesday (why is all this cancer stuff so damned early in the morning?). She also wants me to get some blood tests, including a Vitamin D level. I'll do that Wednesday, too.

Then we get to the Big Question. I'm scheduled to leave on my cruise from Dubai to Istanbul, finishing with 5 days in Istanbul, on March 30. We don't have two weeks--do I have to (gasp, sob) cancel my vacation? She tells me to go on my cruise--the cancer is so non-agressive that there will be no damage by waiting until I get back at the end of April. Yay!

I'm now scheduled for my surgery on Tuesday, April 28. I had thought about April 27, and was so glad she doesn't operate on Mondays, because this means I can still go to Taste of the Nation on the 27th!

So my next steps: Tuesday I see the oncologist and my psychiatrist. Wednesday I get the BSGI scan and some blood work. Sometime this week I'll have a consult with a radiation oncologist at Good Sam (Dr. Lee?). Then I'll make my decisions about what post-surgical treatment I want, and put it all aside while I get ready for a Dirty Martini show on the 21st, while I desperately try to finish all the work I need to get done before I leave, and get ready to leave March 30. Whew!

More tomorrow after I see the oncologist.

Background--What happened before March 16

On Wednesday, March 4 I had my routine annual mammogram at the Good Samaritan Breast Health Center. They called me that afternoon to come back for more examination. On Friday, March 6 they took more mammogram images of my left breast, then did an ultrasound, then a biopsy.

During the biopsy, I'm lying on my side while a nurse, an ultrasound technician, and a doctor all work over my breast. Of course, to distract myself I start telling jokes. I suspect this is unusual behavior when, by the following Monday everyone at the Breast Health Center seems to know me and that I'm "the one that was telling all those jokes during your biopsy."

Monday, March 9 I learned I had breast cancer. The good news: We caught it VERY early, it's VERY small, it's not aggresive, and it's a very common type so they know lots about it.

The best surgeon for breast cancer is Dr. Nathalie Johnson, but she is extremely busy; I didn't want to go to her if I would mostly be seeing her associates, Physican's Assistant, etc. My amazing psychiatrist, Dr. Francine Siegal, pulled some strings and got me in to see Dr. Johnson one week after my diagnosis--and it's Dr. J I'll be seeing throughout, if that's who I decide to go with. Dr. Siegal also finagled me into an appointment with the best oncologist, Dr. Becky Orwoll. My appointment with Dr. J is Monday, March 16, and I see Dr. Orwoll on Tuesday, March 17.

While I wait to see the docs, I do a lot of online research, read a bunch of stuff the Good Samaritan Breast Health Center gives me, and talk to several people who have had breast cancer. I also send an email to my friends and colleages urging them to get mammograms and, if they have women in their lives they care about, encourage them to get mammed.

All week the responses to my email come in. I have never gotten so many hugs in my life! They really do help. I also get lots of emails wishing me well, offering help, and quite a few saying "I've been putting off that mammogram, but I'll call right now to schedule." I feel surrounded by wonderful, supportive friends.

On Sunday, March 15, I talk to my cousin Sharon who had breast cancer about 10 years ago. Turns out I have exactly what she had--and she's fine now. To my surprise, I learn that my three aunts all died of breast cancer! I never knew this! These aunts are my father's three sisters, and my cousin Sharon is the daughter of one of those sisters. I guess we just don't talk about what people died from. . . .I knew my Aunt Florence died from cancer, but I never even thought to ask what kind, and I don't know that anyone ever mentioned it to me.

All week, I surprise myself with how upbeat I am. I really do feel very confident that this won't be a big deal--I'm taking it seriously, but it just seems like such an easier thing to deal with than my knee problems, where we had dying bone, and didn't know the cause. Plus I had to do a lot of physical therapy for that, and I don't think I'll have to do PT for breast cancer! I'm amazed at how much humor I can find in breast cancer.