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