Visit to USC on 8/28 for surgical consult

Hi,
Well I am really really excited about surgery. Yes-I did say excited. You know why? Because I just see God really all over this. thank you for praying for me because I am seeing Him move.
Okay, so here's the scoop. I didn't go to church on Sunday because I still felt pretty fatigued, and I had to go to the Dr. to get another nulasta shot in the morning. So, after that I rested for a bit and then headed off to my aunt and uncle's house in South Pasadena. I love these people as if they were my parents. In fact, I often refer to them as my second set of parents. My uncle Ray has such wisdom and a great way of seeing things that I often ask his advice. My aunt can often be a great sounding board about everything. She inspires me with her creativity and sense of who she's made to be. So, my uncle bbqd a promised rib eye and we had a nice dinner together catching up and seeing photos from their trip with my young cousins' son ( I think that's called once removed, but anyway) to the Canadian Rockies. It was spectacular.

It's so incredible to share the ups and downs of all of this because we all see God moving and orchestrating. My aunt definitely sees this and even senses the holy spirit. We even sensed his presence at the dinner table that night. Anyway, I share all of this becuase they are really special people that are instrumental influences in my life and I just want everyone to know it.
Okay, now on to the appointment:

So, I arrive Monday after a short drive from where I was and everything is fine and after registering, filling out paperwork, etc. I shared all of my info with the breast fellow that works with Dr. Silverstein, and her name is Dr. Guerra, then I went in and saw Dr. Silvertstein. It was a fun interaction, really. I felt a good rapport. Beyond that, when he stated that he was sorry about the diagnosis at my young age I just responded "I'm not." He responded that it was a curious response so I told him why. I said something like, "I have a relationship with God and I know that He is in control. Plus the reason that I know him is for times like this so that He can show his life and who He is." I just felt such joy in being there and told him when I met him that I was just so excited to be there and that I had been looking forward to our meeting for the past weeks. Then we got down to business.
We discussed, albeit breifly, about the option of breast conservation. He felt that, oncologically speaking, the double mastectomy was a better choice, but that, humanistically speaking, he wanted me to have the option of trying to save my breasts. I told him that I'm going with the oncological way of thinking. I mean, he discussed that it might be possilbe to to save it, but becuase I have dense breast tissue, it makes me hard to follow and more challenging. i.e. I have to have a battery of tests every six months. Plus if I go through lumpectomy and then have something suspicious later, I'll have to have another lumpectomy or mastectomy at that time. That just seemed ridiculous to go through that. So I asked if we could make the assumption that I'm going to have a double mastectomy and talk about that.
This is a cool God moment because at that point he asked me if I had made an appointment with a plastic surgeon for that day and I replied that I hadn't. So, he stepped out of the room to check if Dr. Sherman could see me....and it "just so happened" that Dr. Sherman's schedule was unusually light and he didn't have surgery that day and could see me right after Dr. Silverstein. That was really cool. I just knew it was God arranging the circumstances.
So, Dr. Silverstein used the white board in the exam room (isn't that a cool idea?!) to show me what the surgical procedure is that they he would probably use. They then took a picture of me and made the marks on the picture along with the main points about the surgery and gave me a copy to take to Dr. Sherman in order to discuss the reconstruction portion. He called it a flight plan. I just loved it. It was really cool, too to have him show and tell me what they were going to do and how much area would be involved in the mastectomy process as well as the axillary node dissection.
I was really pleased with the approach that I saw and before I was off to the plastic surgeon we made an appointment for me to come back on 9/18 to discuss the results of my biopsies (that I'm having on 9/8 of the "suspicious" heterogeneous calcifications noted by city of Hope). That will affect surgery since, if the left side is positive then he'll probably do a sentinel node biopsy on that side (they determine the first node that the cancer cells would attack by using a speical dye process and remove it) just removing one node. If the suspicious side on the right is positive it probably wont effect the surgery but at least we know it is more widespread than we initially thought. A side note here for those who are wondering, the chemo works on the invasive cancer cells, not on the ones in the duct that appear as calcifications on a mammogram. Those are dealt with by simply removing them and possibly radiating the area.

Next, I was off to Dr. Sherman's office across the street in the University Hospital. Incedentally, Dr. Sherman just "happens" to be the cheif of Plastic surgery at USC and specializes in a few things, including reconstruction. Yeah, it's a God thing.
So, I see Dr. Sherman and we begin to discuss the type of reconstruction that I might have and I did mention that I didnt want a TRAM flap (take the part of the abdominal or rectus muscle and relocate it) but was interested in expanders or implants. The problem is this: radiation. Radiation can damage the tissue, expanders and implants. So, one idea is to perhaps use some of my latissimus muscle in conjunction with the expander or implant to buffer the ratiation effect. However, we didn't go much further in the discussion of procedure because Dr. Sherman needed to talk to Dr. Silverstein about what the probability is that I'll need or have radiation. Dr. Khanna (radiation oncologist) that I saw locally advised that I would have it regardless and her report showed that she wanted to do it supraclavically (which I think might be a bit much). So, we'll have to see what the result is of the two doctors' discussion, and I'll probably find that out on the 18th when I see Dr. Silverstein again. I'll undergo surgery around the week of November 8th. My last chemo is on 10/2, but as he mentioned that it might be good to give my body a couple of extra weeks to recover before going into surgery, I'm inclined to go with that unless something changes with me physically. This sescond shot of taxotere caused me to have these mouth sores that are painful and annoying-not to mention that you get htem in your sinuses and all the way through your mucous membranes. Fun, huh.
That's okay, I'm still in the ring fighting in the eigth round and I've got more to go, so I'm just slower at rebounding from the punches-but I am fighting-and you are all helping incredibly. Thank you for your prayers!!!!!!

So, I'm excited about having surgery at USC/Norris and having the reconstruction immediately in the same surgery. Now, it's up to God directing the surgeons in their surgical plan, and their hands and minds during that operation. Please pray for Dr. Silverstein and Dr. Sherman that they would be able to come up with the best plan for my situation. Pray that God gives me opportunities to share as I go through this with them. I'm going to look for them.

Bless you,
Julie

Update 8/25

Hi all,
Well when I looked up the side effects of the taxotere chemo on a ew websites they basically said call the doctor if you have a fever or chills or body aches, etc...and that's exactly what was going on. I'm feeling better and my tmep is under 100 at the moment but I went to Dr. Dreisbach's office today and they ran my blood to see what my counts were like. My white counts were low as well as my platelets (that part was a bit surprising to my doctor). So, I got a shot of Nupigen and will need to get one each morning for the next two mornings and then they'll test my blood again on Monday to see where I'm at. I hope that they can use the data from this go around to perhaps give me a nulasta shot (white blood cell booster) the day after chemo which is more long acting and I only have to go once rather than on successive days. Regardless of the blood counts, the doctor also gave me a presciption for levaquin and told me to take it if my temp is over 100. I've been between 99-100 all day, though yeseterday was higher. Further, he said if it goes above 101 that I need to call the on-call doc. Meanwhile, he just wants me to pound lots of liquids, so I'm doing that.
I'm so glad that Amy Haven could take me today to the doctor. She's going to take me the next two days to get shots, too. Sunday I'll be going to LA to see my aunt and uncle the night before going to USC. Speaking of USC, Karen Pendleton came over today and brought all of my medical records that I needed her to collect for me. She even dropped off the doctor's note to the district office today stating that I'll need the whole year off of school to go through the treatment plan for the illness. Later on, Karen went to the drugstore to pick up my prescriptions and also to get me some ice cream becaue it just sounded sooo good. So, guess what I had for dinner tonight? Yes, jamocha almond fudge and chocolate chip..It was good. Also, some peppermint tea really helped the funky taste in my mouth. Plus it soothes my funky stomach. It so great to have such wonderful friends.
One other consideration due to the low white count is that I might not go to church this weekend since I don't want to go seeking an infection. I also might not feel up to it tomorrow either. I had planned on going but Karen brought up the while thing with the low white blood cell count being a problem. It might also delay my arrival in LA on Sunday because I was supposed to go to a concert with my aunt and uncle in the afternoon but that might not be wises either. I might just go later in the day. We'll see. I'll have to call them and discuss it.

That's all for now
:-) Julie

Update 8/23

Well, this round of chemo (#6) has been diferent so far. At the moment, I'm laying down on the couch blogging from here and this is pretty much as good as it gets for today. I ake it back, Lou Sexson and Rich Ruocco came in and woke me up this morning to make me a smoothie and visit for a bit. Rich was sporting his BlochAid shirt and it made me laugh. He looks great in pink. It was fun to see them even though I was a bit out of it, and as soon as they left, I crawled back into bed. In fact, I have been in bed most of the day. I'm thanking God that I'm not nauseus - that is huge. It was too bad that I had to bow out of having a fabulous dinner with the Hydes tonight, but I just wasnt up to it.
It's kind of funny, I mean, maybe the decadron (which is an anti-inflammatory steroid that they infuse before I receive the Taxtere (chemo drug I'm on now) really kept me up on Monday night after the infusionn and I was feeling great on Tuesday. I'm actually surprised that I'm not feeling as great as I did last time. That's the way it goes. I'm glad that God keeps me hagning on to Him and not my own notions about how it should be....He does that with all of us...all day long.
Bless you,
Julie

Update 8/20

Hi everyone,
Sorry that it has been about two weeks since I've updated everyone on the scoop. I had a chance to get out of town for a bit and I was so glad to. Now that I'm back, I can update you all on the latest....
1) I did indeed see Dr. Schulz to have one of my stitches out. He seemed puzzled that I hadn't made a decision about surgery yet, but was supportive about my decision to see Dr. Silverstein (which will happen on the 28th). What's funny is that I've noticed a small stitch that is poking through the skin in a different place, and I'll see him on Tuesday just to make sure it's not a problem. My mobility is better and I can lift weights pretty well now.
2) I met with my Principal and Maureen Thompson from personnel at the school district office. We looked at the options financially for the upcoming year. I will have enough days to take off the first semseter without any problem. However, I will have to ask my colleagues throughout the district to contribute a day if I need to take the second semester off, since I won't have enough days. I think this is really realistic since we have about 50 teachers on staff at our own site and I know that I have some incredible friends in the district that wouldn't mind helping. The kind of silly thing is that I can't request days until I've almost reached that point. So, I'll likely contact Mike Duran (President of DSTA) to assist in the "all call" before Christmas Break. It is indeed looking more like I'm going to have the double mastectomy...
3) I met with Dr. Monica Khanna, a great radiation oncologist who practices at the Curci Cancer Center (Eisesnhower) and the discussion with her was exceedingly helpful. First, she said that no matter what surgery option I elected I would have to undergo radiation. Typically, only lumpectomy candidates undergo radiation following the surgery, and mastectomy patients do not. I asked her why, and she said that due to my age (i.e. younger than most ) I would need radiation either way. That was, to me, more evidence to have a double mastectomy. My next question to her was regarding reconstruction. It had been my understanding that radiation wasn't possible following reconstruction. However, if I do the tissue expander reconstruction, then it is possible for me to do immediate reconstruction at the time of the mastectomy surgery, have the expansion and then undergo radiation following. Some people have the more elabaorate TRAM flap surgery (which I do not want because, while it uses autlogous tissue, i.e. your own, you compromise your muscle power in the abdomen, or bak where they take the muscle from) but the TRAM is not for me. Following the radiation, then I'll need to wait soe time for my tissure to heal and hen I'll have the urgery for the implants and then beyond that if I want to have an areola or a nipple added to it (sorry if this is too much information for you...). Anyway, the discussion with Dr. Khanna really seemed to make the mastectomy with reconsruction a reasonable option and the most agressive as well. The more I think about having some of these "suspicious" areas (one in the left breast and one in the right adjacent to where the current cancer lies), the more I don't want to have to deal with being followed so closely mammography-wise when my breast tissue is difficult to follow in this regard in the first place. I think I will have more peace of mind knowing that I've eleced to remove all of the problematic, or possibly problematic tissue. I mean, why have the less drastic surgery if I'm only going have to have surgery again later on. It just doesn't seem efficient or even prudent to leave myself open to developing a cancer that can't been detected very well.
So....I called Jean today (Jean Carroll, my Principal) and let her know that I was seriously thinking about choosing the double mastectomy route with reconstruction, and that the timeline would basically take me out for the whole school year. I wanted to tell her this so that she could look at hiring a credentialed teacher in my stead rather than just a long term sub. A credentialed teacher would be much better than a sub for kids, parents, other teachers, and I want to do things honorably. In addition, I need to make the best decision health-wise and I want to be agressive. I spoke with my friend Tim Tyler today and asked him what he thought about all of this (he directs the pharmacy at the cancer center in Palm Springs and is extremely knowledgeable) and specifically if he though there was anything more agressive that I could be doing. He said no, that the chemo plan I'm on, plus the decision to do the double with radiation is agressive. That made me feel good. I don't want to go through this again, or have it recur if I can help it abate in any way, then I want to do that.
I'm still going to keep my appointment to see Dr. Silverstein because, although I know in my head that it's a good decision to make, I can't seem to gete my head and my heart to connect on this, and i think that seeing Dr. Silverstein, since he is an expert in this field, will help me embrace it. That is, I think that hearing it from him will be the confirmation that I need to do it. I'm about 70% of the way there, but not all of the way. I think just becuase it's such a major decision that affects the next nine months of school bundled with it that makes it difficult. Somehow just blogging about it helps as well. Anyway, if any of you have any input on this you're welcome to write me.
I let Jean know that I would be calling her on the afternoon of the 28th to give her my decision.

4) Meanwhile...I still have to have those other two areas biopsied and that will happen on Friday, September 8th. Dr Lanskowsky has been on vacation so I won't be able to get in to see her before then. It would have been great to see her before seeing Dr. Silverstein, but oh well, my plnas aren't God's plans...
5) Ultimately, this is an exercise in faith. Faith that this decision is the right one and that God will provide the sick days that I need to make it through the year, faith that this is the best decision health-wise, and just trustin God in general. I know that this is just such an opportunity to trust Him. He regularly gives us these opportunities, and it's very apparent to me that this is definitely one.

Thank you for your prayers and your friendship!
Julie
p.s. Chemo #6 tomorrow at about 2pm. I'm hoping for a good result like I had last time. Just in case, I've cleaned the house today so if I need to be house-bound for a couple of days I should be fine. Glynnis is going to go with me :-)

Bloch bowl-o-rama rollin' down on 9/17

Okay, of course I had to give this a silly punnish title, but despite that, it sounds like fun, doesn't it?

Well, Tammie Sue Price, Skip Osgood and others have been in cohoots (spelling?) to put together a fun fundraising event on my behalf. So these fun loving friends have put this together and it sounds like it's going to be a blast!
I personally love to bowl (probably because I'm not too good at it so I just get to laugh, and maybe jump up and down if I manage to actually get a strike) because it's so fun to do with friends.
Anyway, the fun will be on Sunday September 17th at Fantasy Lanes and you can choose from one of two sessions: 1-3pm or 3-5pm. I'm told that you'll want to arrive about 15-20 minutes before to get your shoes and your lane assignment all figured out. I think it would be a fun thing to do if you had a family (of course, you guys are my family...) and the cost is pretty good: $20 includes three games and shoes. To get tickets (you'll need to do this in advance) or more information you can contact Tammie Sue Price at the following e-mail: tamsueppl@msn.com
Or, you can also contact Skip Osgood at the following e-mail: skiposgood@verizon.net

I'm planning on being there that afternoon and I look forward to seeing everyone and laughing together. If you'd like to purchase a ticket but not attend the event, that is fine. All proceeds will go towards medical-related expenses.

Let the games begin!

p.s. I plan to update my blog with new medical news either tomorrow (Wed) or Thursday.

Julie

Day #2 on chemo is fantastic so far, plus more medical news

Hi everyone,
I was so excited to wake up this morning and feel as if I hadn't even been to chemo yesterday. Joy went with me and we were there most of the afternoon and, frankly, I was pretty nervous. After the last round of chemo that was yukky, combined with the fact that I was to be taking new drugs and be using the port for the first time, I was physically and mentally bracing myself for what worst this way would come. But...au contraire: Wow! This morning I went for a walk and ran breifly (like 5 min), then came back home and had breakfast and read my daily dose of My Utmost for His Highest. Then, Lou came over to see how I was doing. I'm just going to check in with her tomorrow to see if I'll need her help but if things keep going as they are now, then I won't. Some people say that the taxtere drug hits you a couple of days later so we'll see...I was just so glad to have the day-it was a great gift from God and I was thinking how wonderful to look at like time that I hadn't planned on receiving and there it was! So, after praying a little, I headed out to run a few errands, which felt great to do for myself.
On a side note, today I was kind of cracking up to myself as I walked around the mall, because I guess I hadn't noticed until now that people looked at me like "what's up with the scarf on that chick" and it just makes me smile and walk taller for some reason. It's fun to be not just surviving but thriving and for others to see it.

Okay so here's the additional medical scoop:
1) I have to go see Dr. Schulz on Thursday to take the stitches out that he put in place when he put the port in.
2) I made an appointment wth Dr. Mel Silverstein at USC. He is like the Godfather of breast cancer surgery and has been in practice for some time. I'm quite excited about getting his input on the situation.
3) I shall be meeting with the district this week to talk about the financial options and return options for this year. It's all kind of iffy at this point. Ideally, I'd like to just take the first semester off and come back the second. However, it may depend on how involved the surgery will be. So, at present it's difficult to make a definitive decision. I could always go with the idea that I'm taking the first semester off and if we need to get someone permanent for the rest of the year then we could hire a credentialed teacher to take my place. We'll see what information Maureen has for me on this on Thursday. Jean (my Principal) is going to go with me so we can get all of our questions answered together.
4) I have an appointment on Friday with Dr. Monica Khanna who is a radiation oncologist. Basically she's the specialist in radiation and can talk to me about to what extent I may or may not need radiation depending on my current status or surgical options I may choose. The big unknown at present is whether or not I will have more than 4 positive lymph nodes (actually it may be greater than or equal to four) becuase if I do, then even if I have a double mastectomy Ill still have to have radiation, which would completely rule out immediate reconstruction as an option after the mastectomies are performed in the same surgery. Thus, I'm looking forward to her input as well as Dr. Silverstein's. That same day I'm going to have the special U2 ultrasound of both breasts to check them out. In particular I want them to look at the two "suspicious" areas of microcalcifications. Of course, ultimately they'll have to be biopsied regardless unless Dr. Lanskowsky from the breast center at Eisenhower (who is really great ) says that they're really nothing to worry about. I think I'd still want a biopsy nonetheless.

That's the scoop for today...more news as it becomes available
Blessings,
Julie