Surgery scoop...and a new development...7/30 post

Okay so here goes:
On Wednesday, I went to Dr. Dreisbach's office to check my status on blood. My red counts were low again, so they gave me a procrit shot to help with that. I generally have to be tested weekly on this. After that appointment, I went to see probably the best local surgeon for breast who everyone I know highly recommended and she was great (Dr. Ihde). I had some time in between appointments and opened up my package of mammograms that I had received back from City of Hope on Monday. I had wanted to put them in order before my visit to Dr. Ihde.
Inside, I found a report generated by the doctor who reviewed my mammograms at COH and it stated that they felt there were two more areas of suspicion that were microcalcifications (literally areas of calcium in a milk duct, of which I have a malignant area of this currently in the right breast adjacent to the tumor). There was one new area of suspicion in each breast. Okay...this was new information and came as quite a surprise because I thought that I had been looked at quite thoroughly. So...given that bit of revelatory information, it really kind of rocked my world before the doctor appointment with Dr. Ihde, and actually it was probably a God thing that I found that report when I did because it then became part of the conversation of surgery in that appointment. In sum, there are a few ways of looking at the possibilities:
First, if these new suspicious areas are benign, then I could possibly still have a lumpectomy on the right side and as well as the axillary dissection. However, I would still have to have about six weeks of radiation to that breast and there would be a significant dent-not due to the tumor but due to the fact that they would have to excise a wide area to remove the calcifications that currently exist next to the tumor. Relative to my breast size that means that In the long run, however, I would still have to have mammograms and ultrasounds likely every six months-and if I have a propensity to generate these kinds of calicifications, which are difficult to discern in my dense breast tissue, I'm not sure that it's really worth the level of concern that would persist in that case. I think I would just want to have peace of mind that the tissue was removed, i.e. double mastectomy. It's a pretty major surgery though and that's a bit daunting, and of course I'd want to do immediate reconstruction, but I don't know if I' a candidate for that since I have a lymph node involved....I need to see someone who lives eats breathes and sleeps breast to find out more specifics. Immediate reconstruction is a much longer and can be tricky surgery so it's not really done often as I understand it. It is more common to wait for a few reasons: time for tissue to heal, doctors have to coordinate with eachother, but most importantly if there are four or more lymph nodes that they find were involved after they do the axillary dissection, they I would have to have radiation in addition to the double mastectomy, and you really can't radiate successfully with an implant in place. You also have to wait for the tissue to heal so that you can do the reconstructive surgery later.
Secondly, if the new suspicious area in the right breast is malignant then there is little doubt that I have to have a mastectomy on the right. In my mind, I would elect to remove both in this case because I would want to be balanced.
Thirdly, if the calcifications in the left breast are positive, I'm not sure that lumpectomy on both sides is really a good choice. I would probably still elect a double mastectomy in this case. Though that is a big surgery-yikes. I just think it would be so nice to wake up from surgery and at least have something in place of what they're going to take. I mean, I didn't think they were that important to me until now. That being said, I want to the have the information that I need to make the best decision, and I can totally see that God is guiding me in the process of seeing different doctors to work it out. He's showing me what to do by showing me what not to do, or what direction not to go in at the moment.
That Wednesday proved to be a major shift in my thinking because I was hoping for a lumpectomy with radiation, especially since the chemo has shrunk the tumor and positive lymph node to about half of their original sizes. Dr. Ihde confirmed that each are about 1 cm at present rather than the 2 cm they were at the beginning of chemo. Hey, maybe since I'm only halfway through chemo, at that rate, they will be almost gone or hopefully all gone and just a bunch of necrosis (dead cells) at the end!!
The bummer is that, if they are virtually eliminated, I still have the issue of the DCIS (cancerous calcifications) which are unaffected by chemo. Chemo doesn't work on that kind of cancer. So, I was kind of reeling from reading that report on the way to Dr. Ihde's office wondering what the impact would be and what my next steps should be.
So, what are my next steps?

A. I have to go for a special 360 degree ultrasound called a U2 next week that will closely look at both breasts
B. I will have to have a biopsy of each of these two new sites
C. Several folks incluing my uncle have been assisting me to get in to see a surgeon at USC Norris/Lee Breast center. One of these surgeons happens to be like the godfather of breast surgery, Dr. Mel Silverstein, who has been doin this for a long time. Dr. Ihde, who is the local surgeon I saw this week recommended him as well. So, I’ll make an appointment on Monday to get into USC for a surgical consultation if I can (prayerfully....)


Speaking of surgery.....
I had surgery Friday to put in a port to make the infusions easier. It is an implant that they put in below my left collar bone and feels somewhat like a thick bobbin beneath my skin. It has a connection directly to my vein so that blood draws can be taken and drugs can be infused without the needles hurting me so much every time. Since I'll have to have infusions (the herceptin mainly which is a non chemo drug but one that fights the cancer) for a year it just seemed like the right thing to do. I was really tired of getting my hands and arms beat up every week for whatever was needed and it was pretty uncomfortable.
Anyway, they put me out and a couple of hours later or so on Friday it was in, and it hurt. I was pretty uncomfortable after I woke up and into that evening. So, they gave me some vicodin which I’ve only taken 1/2 s of when I’ve needed to. I was kind of out of it that day. Saturday I still had pain but it's less today. I have a much better range of motion, so I an tell it's getting better. Lou Sexson from school took me and picked me up and then brought me home and really took good care of me while I basically slept in the afternoon. She’s also going to be my contact person for the next week since Glynis and her kids will be in Georgia. Oh, I also found out in a roundabout way that I have to take 1 mg of coumadin every day while I have the port so that it reduces the risk of clotting. Nice. They didn't tell me that, and in fact, the nurses didn't say anything about taking the coumadin at all. It wasn't until I saw Rick Jervis this weekend that I even knew what it was...oy vey. I'm so glad I saw Rick becuase I called the surgeon that night to inquire about it and he said yes indeed I was supposed to take it. I'll add it to the list...

Speaking of Glynis, she had to come and pick me up on Saturday with my keyboard for church because I wasn't supposed to life anything over 10 lbs until I got clearance from the doctor. I also had to have her carry it in and put it on the stage, then have someone else set it up and tear it down and put it in my car for me. I probably shoudn't have done this, but I thought I could get it out of the car with my right side and I figured that if it didn't hurt, I was in good shape. Well, I managed to get itout of the car and into the house, though I'm not sure that was totally wise. Oh well.

So, thanks to Glynis I could get to church in time for rehearsals on Saturday and then I was able to drive myself on Sunday. I had a great time singing playing and serving with everyone. It was truly great. I loved what Dan spoke on this weekend, too. It was challenging.

I have chemo tomorrow and Joy is going to go with me. My sister got sick and I told her that I didn't want her to be around if she had some kind of viral infection, so she'll come for the next round on 8/21. I'm not sure what the effects will be from this other type of chemo drug. We'll see...I'll keep you "posted." Ha ha....I love puns

Any input you have for me about the decision to "double" or not to "double" you are welcome to email me at: jbloch@dc.rr.com
or just post a comment.

Blessings,
Julie