It's B-Day . . .

It's 12:30 and I'm due at Good Sam at 11 am.  I'm a little nervous.  Wish me luck.  A lot of it.  Will write again when I've been de-lumpified.  

It's been a while . . .

. . . because I've been traveling while trying to find out what's going on at the same time.  Now I'm back, and have a better idea of the plan.  Here's the latest:  My lumpectomy is on Tuesday, the 28th.  I head over to Good Sam at 11 am, where they'll put me in the Short Stay Unit, make me put on silly hospital clothes, run a bunch of tests and do some things to prep me for the surgeon.  The two biggies are an injection and a guide wire.  First, they will give me an injection that's a mix of a blue dye and a radioactive material.  The radioactive material and dye will go into my lymph system so they can find what are called the sentinel nodes--more about that later.  Second, they'll insert a guide wire into the side of my breast.  This won't be too bad, as they can get me numb pretty easily.  When they did the biopsy, they left a speck of metal where they were taking samples; that makes it easy to find the area again if the biopsy is positive.  So, using ultrasound to find the speck, they will insert a wire right to speck.  The wire will guide the surgeon so she doesn't have to dig around.  

At about 3 PM they'll take me to the operating room, knock me out, and Dr. Johnson will do the lumpectomy.  While I'm on the table, she will do three things.  First, she'll take out the tumor itself.  Second, she'll perform a sentinel node biopsy.  According to WebMD, "Sentinel node biopsy is a . . . way of pinpointing the first few lymph nodes into which a tumor drains (called the "sentinel" node). This helps doctors remove only those nodes of the lymphatic system most likely to contain cancer cells. The sentinel nodes are the first place that cancer is likely to spread.  In breast cancer, the sentinel node is usually . . .under the arm. . .  If the sentinel node is positive there may be other positive lymph nodes upstream. If it is negative, it is highly likely that all of the upstream nodes are negative."

The dye and radioactive material injected earlier go into the lymph system along the same route that the cancer cells would go (if they've spread), and highlight the sentinel nodes.  Dr. J  will be able to just remove the one or two sentinels and send them to the lab--while I'm still on the table--to see if she needs to take more nodes or not.  Given the kind of cancer I have, and how new it is, it is highly unlikely that it's spread.  

Third, after Dr. J is done taking things out, she'll put a balloon in where the tumor was, with a tube leading to the outside.  Then they'll patch me up, move me to Recovery where they'll monitor me as I come out of the anesthetic, and listen to me beg for ice chips.  At that point I will have been without any water for 9 or 10 hours.  Once I'm stable, they'll move me to the oncology unit on the 6th floor where I'll spend the night.  

Wednesday morning they'll do a scan of my left boob to make sure the balloon is positioned right for the radiation treatment, and then they'll send me home.  

I have Thursday off ;-).  

Friday at 7 am I take some meds for anxiety and pain, and at 8 am I go to the radiation oncology area at Good Sam.  This is a little ookey--and the reason for the anxiety and pain meds.  Dr. Lee, my radiation oncologist, will take out the balloon Dr. Johnson put in my breast and insert another one.  The one Dr. J put in was just a placeholder; the one Dr. L will insert is designed for the radiation treatments.  It's a balloon (that will be filled with saline) and an inner tube that's like a straw with one end sealed.  The inner tube is dry and is where they insert a wire with radioactive "seeds."  Then I'll have my first radiation treatment: a machine inserts the wire with the seeds and, 20 minutes later, takes it out.  I go home, and at 2 PM go back for another treatment.  Then I get the weekend off.  Most people don't have any side effects from this type of radiation because it is so localized and the treatment time is so brief.  It is a good idea for me to make sure I get plenty of rest and good food during the treatment--but that would be a good idea for the recovery from the surgery too, so . . . 

Monday (we're now at May 4) I go for radiation treatments at 8 AM and 2 PM, and do the same Tuesday, Wednesday, and Thursday.  At the second appointment Thursday, they take the balloon out and I'm done with radiation.  

While all of this has been going on, my tumor has been shipped of to a lab that analyzes the DNA and advises my oncologist, Dr. Orwoll, what my chemotherapy should be--which drugs, how often, how much.  We should get the results from the lab at about the same time that the radiation therapy finishes up.  No idea what the chemo will be, or what the side effects will be--but I'll keep you posted!

Final bit of news on the medical front:  Dr. Orwoll ran a truckload of tests on me, and one of them was a Vitamin D level.  Turns out my level is about one-quarter of what it should be!  Vitamin D deficiency may be related to a host of conditions, from MS to diabetes, cancer to thinning hair.  One of the clear links is osteoporosis: you need D to process calcium, and if your D is low . . .so next time you see your doc, ask for a Vitamin D level.  

 

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.