And Here's the Wind-up ...

I met with my surgeon today.  Colleen App - she's fabulous. 

I donned a floral cape (SO not a gown) and pretended to be an organic super-hero as she did an in-office ultrasound, comparing my various images with her own taken today, and clarified our plan for surgery.  What, when, where, how, expected outcome for the bosom. 

                        *slightly reddened cheeks*

I'm having surgery next week Friday, January 29th. 

What kind of surgery?  Good question.

That depends on the outcome of my two MRI-guided biopsies on Monday.  Beyond my tumor - located at 11 o'clock in my left breast - my breast MRI identified two other questionable areas, one in the lower outside quadrant of my left breast ... and one in the lower outside quadrant of my right.

You can imagine the concern, right?  One area of one breast vs the whole breast vs oh-crap-it's-in-BOTH-breasts.  The biopsies I'll have on Monday will answer that question.

So, come next Friday, early in the morning, I'll be headed into surgery.

If the biopsies are negative, I'll be getting a lumpectomy of my left breast with the surgical removal of several sentinel lymph nodes (to double check that they are clear for cancer).  It will take about 4 hours.

If the biopsies are positive for cancer, then Friday, I will be having surgery specifically to check my lymph nodes.  Are the sentinel lymph nodes - those nodes to first encounter fucked up breast cancer cells - clear?  If so, yay.  If not, if there is evidence of cancer in my sentinel lymph nodes, then they'll take all of them.  Then, a week or two later, I'll have a mastectomy, single or double depending on what's needed.

Oh, and there's a drain.  DRAIN.  Once they start taking lymph nodes, they'll need to insert a tube into ... well ... my underarm so that fluid that would normally drain out the lymph system can drain out the tube into, I swear to God, a clear grenade that I then empty as needed.  This continues over 5-7 days while, I guess, the area heals from the surgery.  It helps to prevent infection.

                           Yada yada yada.

I heard ... GRENADE filled with fluid from my body that I have to empty. And depending on whether cancer is found in my lymph nodes, I get to have this drain for 5-7 days or more AND learn all about what I would need to do to avoid .... conditions I hope to never need to explain to you without the benefit of wine.

But wait! There's more! Dr. App explained to me what she would do during a lumpectomy to make my left breast whole again.  She explained where the incisions would be made and how, once the tumor is removed, she would lift the breast, make it round and whole, and sit the nipple oh-so-perfectly on top.  A round breast with the nipple perfectly placed.

I'm 45 years old people.  What do you think my first thought was?

[Let me get this straight.  BEST case scenario is my left breast is cleansed of the cancer and basically reconstructed into round perfection then I undergo chemotherapy and radiation and, all that while, I have a perky left breast and my normal 45-year-old droopy ass right?  So, I'm short, bald from chemo, with a perky left breast and droopy right.  Gotcha.  Proceed.]

Would I forever has mismatched tits?

[Because that's the important question when fighting cancer but ... whatever.]

The answer, surprisingly, is no.  No, I will not.  Because the law, believe it or not, guarantees me a matching set.  At some point after all my treatment is done - after the chemo and after the radiation - a plastic surgeon will lift my right breast so that it matches the left!  How AWESOME is that!?

Random, unexpected, and awesome.

So, that's it.  Surgery on Friday  - one way or another.  Hope with me, if you will, that my biopsies are negative.  I'd really love to have my lumpectomy Friday and move on to the next step.

[I'm a bit skittish these days about hoping - it seems whatever I hope ends up a bit skewed.]

________

I had one last happy hour with some coworkers tonight.  Well, last for a few weeks anyway.  Obviously, next week, I'll be hopped up on painkillers post surgery.  The week after, who knows.  It was nice to sit and talk and listen to the odd cases.  To get a "cheers" to the surgery. 

In the midst, my little brother called me - not a usual thing - to apparently tell me about some depositions in a current case.  I took this to be code for ... "I want to call her, I'm not sure what to say about her boobs, so I'll talk work to really say I love her" ... see how I interpret?  It was sweet. 

Honestly, the most frightening part of today was going through the drive thru at Taco Bell tonight - which I do not typically do - and getting to the window with my exact change ready only to have the worker say my food was FREE because of the wait.

        Huh.  Taco Bell.  Free?

               What fucked up hell is THIS?

I'm not ready to die, dammit, it's just fucking breast cancer!!

________

And ... here's the pitch! 

A Plan. Of sorts.

I find myself wondering what to share here.  Do I share all?  Do I stay a bit vague on the details and only cover the main events?  Surgery, etc.?  There are benefits to both but, in the end, if someone stumbles upon this blog who is just beginning to fight breast cancer, I guess I'd rather them have my whole experience instead of a diluted version. 

So, here we are then.

After my initial diagnosis of breast cancer last week, I was referred to the Breast Cancer Multispecialty Team (MST) for treatment.  Frankly, I knew going into the appointments that my cancer is aggressive.  The pathology report for my biopsies finally posted early this morning and, so, I read it before going to the MST session.  If you're going through this right now, you'll have to decide for yourself whether or not you want to read reports before meeting with your doctors.  You know better than anyone else whether you'll benefit from it or be harmed. 

Don't listen to anyone else; make your own decision.

For me, if there is a chance it will be bad news, I'd like to read it, digest it, and perhaps get sick from it in private than sitting in front of another human being.  But that's me.

So I knew that my cancer is aggressive.  I joke that since I excel at so many things (Ha!), I should have expected my cancer to excel as well.  Now, I know my joking is a coping mechanism.  And I'll continue to joke for as long as possible.  Forgive me if it offends you.  But I really don't give a damn.

Because my cancer is aggressive, I'm on a priority list for surgery.  So my surgery will likely be within the next 2-3 weeks.  The grading of my cancer is a 3 on a scale of 1 to 3 with 1 being slightly abnormal and 3 being  ... really fucked up.  The pathology also tests whether the cancer is responsive to estrogen or progesterone.  If it is positive for that, then there are medications that have proven effective for helping fight against any reoccurrence.  Mine is negative for both.  Mine is also negative for a protein called HER2.  So my cancer is a triple negative invasive ductal carcinoma. 

Alas - this apparently is quite different than being a triple crown winner.  But, in a way, it is just another tool for the doctors to use to determine the best treatment. 

Which brings me to the plan:

This week, I'll be getting a chest x-ray, which is a fairly standard pre-operative test.  I'll also see my regular primary care doctor for pre-operative approval. 

Next week, I'll be getting at least two more biopsies.  I mentioned my pathology report above.  I also got the results of the lovely hang-loose breast MRI.  Along with measuring my tumor - it is anywhere between 11 and 15 mm depending on the test you read: the MRI has it at 13 mm - the MRI showed a questionable area immediately above my tumor that may be DCIS - ductal carcinoma in situs - basically, cells that would be invasive cancer IF they broke out of the duct.  It is sometimes called Stage 0 cancer.  The MRI also showed two small questionable areas on the bottom outside of both breasts. 

So, next Monday, I will be getting each of those two small areas biopsied.  If they come back negative for cancer - remember that MRIs can show things that look like cancer but are not - then I will be receiving a lumpectomy of my left breast, i.e., the surgeon will remove the tumor and a few lymph nodes (to double check those).  Before that surgery, the doctor wants a biopsy of that area above my tumor in order to determine exactly how much tissue needs to be removed.

If, however, those first two biopsies next week come back positive for cancer, I will be having a double mastectomy, the removal of both of my breasts.  Again, this would be due to the aggressiveness of my cancer so please, if you're just beginning to deal with your own, remember that everyone is different and many things go into the decision of how best to treat breast cancer.  All I can really say about this possibility is this: 

        If I'm to lose the ones I have, I expect the new ones to be SPECTACULAR. 

The actual surgery will likely be sometime during the first two weeks of February.  Up to two weeks of recovery is expected for a lumpectomy - and it would be outpatient surgery.  I'm not sure right now about the mastectomy recovery - I'll cross that bridge if it comes.

Roughly four weeks after the surgery, I'll be starting chemotherapy.  I'll have a port installed so that the drugs can be put directly into a larger artery and I'll receive it every other week.  The good news is that my oncologist strongly urges women getting this chemo to continue to work.  She does not expect me to have nausea or other issues that would impede me from doing so.  The bad news, or at least odd and surreal news, is that I WILL be bald.  Early on in the chemotherapy, my hair will fall out over a day or two - it happens quickly apparently - and I will then struggle not to call myself Gollum. 

Seriously.  Short, bald creature with large eyes.  Just call me Sméagol. 

Yep.

 My chemotherapy will last four to five months. 

And about two weeks after the last dose, I'll likely begin up to six weeks of radiation.  The radiation would take place at daily 15 minute appointments.  It is meant to make sure no stray cells of cancer remain and greatly lessens the chance of reoccurrence.

Regardless of what type of surgery I receive, the end result after chemotherapy and radiation will be this: 

My chance of reoccurrence will be between 4-6%.  When you consider that the chance of any woman in the U.S. developing breast cancer in her life is 12%, those odds sound pretty good. 

So, that's the plan.  I might be forgetting some specifics but, hey, it's been quite a day. 

Do me a favor if you've read this far.  Trust that I am strong.  Trust that I'll be fine.

I really am quite a bitch when I need to be.   

Make me laugh if you can.  It really is the best medicine.  Cause, hey, I'll be a hot mess of bald and boob jokes for most of 2016. 

In short, trust that I've got this.