When You've Gone as Far as You Can Go, You're Halfway There

The Dutchman told me today that I'm his second patient ever to undergo three lumpectomies;  less sweater meat and I would have had a mastectomy on round two.  I'm suspicious that he's simply warm for my form, but I'll give him the benefit of the clinical doubt.

Today's consult is brought to you by the letter E and the number 4.  E is for equivocal.  I might be finished surgery, or I might be back for a fourth round.  Not "shit" exactly, but certainly "crap".  The latest pathology report showed that the third excision uncovered more DCIS:  two focal areas a centimetre apart in the tissue adjacent to the last surgery site.  But in the section between that location and my chest wall, there were only normal cells.  So, the question is whether to move me along to radiation, or perform a lopatitoffame.

With the information I have -- an MRI that shows no further invasive cancer, a clean section behind the latest DCIS discovery, still only stage one cancer, and the knowledge that a regular screening mammogram is a solid early warning device -- and without professional advice to the contrary, I'll roll the dice and keep my rack a while longer.  But The Dutchman's by-the-book (just one of the many things I love about him), so it's back to the Tumor Board we go.  If his peers don't feel strongly that there are benefits to the mastectomy option, then I'm done with the knife;  if they do, the decision is ultimately mine to make.  Either way, I'll hear from the man after their May 13 meeting.

In the meantime, with The Dutchman's approval, I've confirmed my next appointment with The Burn.  On May 7, I'll undergo a CT scan and meet with her and the radiation team to map out my plan.  If I need to detour for another surgery before we get started on treatment, so be it.  But if not, I'll be more than ready to bust out the sun cream.  I'm sure I saw SPF 400 at Shoppers...

(G)Rad School

Booby school was three months ago, and now that I'm about to graduate from surgery to treatment, I feel as though I'm beginning my advanced degree in all things cancer.

It turns out ionizing -- or high energy -- radiation can be delivered alone or in combination with surgery or chemotherapy, and internal or external to the body.  I'll take the surgical/external combo platter, hold the chemo, please.  With a side of Tamoxifen (and a Diet Coke, natch).

Radiation damages a cell's chromosomes, preventing division and growth -- which is great for cancer cells, but not so sexy for normal ones.  So, the idea is to focus on the tumor, or tumor bed, if the tumor's been removed (...the tumors were nestled all snug in their beds...), and steer clear of the surrounding tissue.  The total dose is divided into fractions -- small daily doses -- in order to allow the healthy cells to recover and repair themselves during the course of treatment.  (My geeky heart was happy to learn that a unit of radiation is a "Gray", named for Louis Harold Gray, who invented the field of radiobiology.  100 units are a centiGray.  But I digress.)

Before my radiation plan can be finalized, I'll undergo a CT scan, which will allow the radiation team to see 'slices' of my body in the treatment area -- including my internal organs, as well as the boob in question.  The plan design is more complex than simply the number of treatments and the dates and duration over which they'll occur.  The radiation oncologist, therapist, nurse and physicist powwow about the number of beams they'll use, and the angles at which they'll direct them at my breast, in order to hit what they want to without also targetting my lungs, heart and spinal cord.  Only once they've sorted out the details will my 30 dates be confirmed.

The day I have my scan, I'll also be tattooed, so the technicians can position the beams in the same place each time I'm on the table.  Apparently, the tats are freckle-sized dots, applied by someone in a white coat.  So, the leather-clad, ponytailed biker inking in the kanji for "lopsided" turns out to be a pigment of my imagination.

Go For The Burn

So, I'm three for three on the cancer docs.  I met The Burn for the first time today, and we really clicked.  She's my radiation oncologist -- the chick in charge of my remaining treatment, once The Dutchman finally breaks it off with me.  Nothing we talked about, this morning, will firm up until The Dutchman says so, but I expect that my date with him on April 29 will be our last.  Assuming that's true, here's what else I can expect.

Thanx to the hefty hogans, I'm in for 30 radiation treatments.  That's 25 for the booby, and 5 for the scar.  (If I had a reduced rack, it would have been only 20.  Quel dommage.)  Radiation technicians apparently work bankers' hours, 'cause it'll be five consecutive days, with weekends off for good behaviour.  My rusty math says that's six weeks in treatment.

Once I'm officially done with surgery, I can start on the daily 20mg of Tamoxifen, as The Burn doesn't mind if I take it during treatment.  Bring on the hot flashes and the weight gain:  pseudo-menopause at its finest, unless I'm one of the lucky ones who doesn't experience those side effects.  Seriously, this is me:  what are the chances?

And only after The Dutchman signs me off can I schedule the beginning of 'rads' (listen to me, all down with the medical jargon).  But The Burn says between six and eight weeks post-surgery I need to be under the beams.  And I'm the girl who does what she's told -- at least by her doctors.  That's how I ended up here, remember?  The first appointment will be for a CT scan, and to design my treatment plan.  After that, we go live.

Looks like I'm guaranteed a sunburn, this summer.

Easy Peasy Lemon Squeezy

Surgery was so easy, the third time around, I could hardly stand it.  With no wires to install, no tracers to inject, and a surgery time of 3PM, the BFF and I weren't even required at the hospital 'til 1PM.  After that, it was check in, loll about in my room, try to ignore my rumbling stomach, and wait for the gurney that would take me downstairs.

I shared a room, this time, with a woman who was in for her first round of chemo after having surgery to remove a tumor in her neck, and part of her tongue.  Further evidence that I've gotten off lightly.

After autographing my right shoulder, as usual, The Dutchman told me Sunday's MRI revealed no surprises, so the surgery we discussed was the surgery I would have.  I'd been secretly concerned the MRI would somehow be a game-changer and I'd come out of OR with the bosom of a 9-year-old.  As it was, he spent about twice as long with me as expected -- surely he knew this would be his last chance to see me naked! -- but reported later to the BFF that everything went very well, and I'm going to be fine.

Was there ever any doubt?

Redemption

Elgar would be spinning like a top in his coffin, but "Land of Hope & Glory" was playing in my head as I strode, triumphant, from the MRI suite at Princess Margaret Hospital, this afternoon.  My regal pale blue cotton robes floated around me, and the booties-that-look-like-hair-nets softened my imperial step on the cold linoleum, but the effect was as magnificent as circumstances would allow.

2mg of Ativan, the BFF, and a delightful technician I'll name "Darling" got me smoothly through the IV installation, then into -- and 25 minutes later out of -- the trauma tube.  What a relief to have it behind me.  But what a kick to finally achieve what had felt so difficult on previous attempts.  And how proud I am to have been able to do, at last, what The Dutchman requires of me.  I do so want to be the pefect patient.

I hope I'll be able to learn the results, before I head into OR on Tuesday.  I'm quietly concerned that the images will show further areas of concern, and the course of my surgery may change.  But I'll burn that bridge when I cross it.  'Til then, I'm happy to have tucked another success into my medical folio.  Now where's that pink champagne?

He Just Can't Wait to See Me Again

'Yes' is my favourite word, and I got to say it again today.  The Dutchman's assistant let me know that there'd been a cancellation on the 13th, so she could move my surgery up two weeks.  I was rescheduling meetings before she could confirm the timing!

The BFF's on board, my agenda for next week has been cleared, and I'm ready to go.  All that's left is figure out what to do with the Sharpie on Tuesday morning.

Watch this space.

Gimme a "T"!

Mortification.  I forgot to shave!  I realized that two minutes before The Pusher walked into the exam room, this morning.  It's not like I didn't shower, or apply deodorant.  I just couldn't present him with the ne plus ultra of feminine underarms.  And on first meeting, too.  I was certain he'd be revolted.  Honestly, the stuff that goes through my head!

But, I got over it.  And, of course, The Pusher never said a word.

But he sure spouted a lot of numbers.  1.2 cm was the size of the largest site of invasive cancer The Dutchman removed (in the first surgery).  That makes me a T1C:  a tumor greater than 1 cm in diameter, but less than 2 cm.  My cancer is grade 1 -- so it can print the alphabet and knows its numbers up to 100.  There are four grades;  four is the nastiest, so I have a decidedly un-nasty kind (I believe "low grade" is the correct terminology).  I have a strong estrogen receptor positive expression, but only a 20% progesterone positive expression.  I showed no lymphovascular invasion (hence, the decision not to take further nodes in the next surgery).  And I'm HER-2 negative (the HER-2 protein is not causing my cancer):  woo hoo!

So, with a relatively small, low-grade tumor that's estrogen receptor positive in a HER-2 negative patient, the prescribed treatment is -- wait for it -- Tamoxifen.  And no chemo.  Officially.  It's The Pusher who would order that.  But he didn't.  Ahhhhhhhhhhhhhh.

It turns out only post-menopausal babes qualify for aromatase inhibitors;  so it's Tamoxifen for sure, and for five years.  Side effects?  Increased risk of uterine cancer and blood clots in the legs, leading to pulmonary embolism.  But the ones most likely to affect more women:  hot flashes and weight gain.  Why is it weight loss is never a side effect?!

Though I left with a 'scrip, it's actually the radiation oncologist who'll determine when I begin to take it.  Apparently, some of them prefer the patient to wait 'til radiation's concluded before they begin the drug therapy.  I'll get that news a week from Friday, when I meet with The Burn.

But one way or the other, I'm gonna be one hot mess in a matter of weeks.

The Brave One

The chairs in today's writing workshop all had labels on them.  We were asked to sit in the chair with the label that best represented us:  Seeker, Wild Card, Ms. Gloomy, etc.  Third to arrive, with two options claimed, I chose The Brave One.  Our last exercise for the day was to write about why we chose the chair we sat in.

* * * *

I only know how to have cancer one way.  That's because it's happening to me for the first time.

A screening mammogram in August resulted in a call-back in September and now -- seven months, three mammograms, four ultrasounds, three biopsies, two MRIs and two surgeries later -- I'm four weeks from my last surgery and ten from the start of radiation.

But it's my friends who think I'm the brave one.  I yam what I yam, as Popeye said.  This cancer business has been an inconvenience, and an occasional downer, but not -- at least for me -- a life-changing experience.

If I'm brave, it isn't breast cancer that made me that way.

As a kid, I moved halfway 'round the world with my family.  At 27, I quit my job and went back to school.  At 34, I divorced my abusive husband.  At 43, I made the biggest mistake of my professional life.

So, cancer?  Cancer's just the current canvas on which I paint the bravery I already have.