Well, yeah. Probably.

Whooping cough outbreak spreads to multiple collar counties

Pertussis?

Well, hmm. Months of a hacking cough, now bad enough to be painful and debilitating, not to mention sleep-depriving. The oncologist chimed in unhelpfully last week with, "Well, you're almost done with chemo. It'll go away." (Note to those lucky enough not to have cancer: If ever you're stricken with this, don't take issues and side effects to your oncologist. He doesn't care about your aches and pains, no matter how bad they are. He cares about your blood work and whether of not you need a transfusion this week. Go to your gp. Trust me on this.)

..which I did, finally, after remembering that the toddler was hacking two weeks ago and put on an albuterol inhaler. She recovered quickly, of course. Me, not so much.

"Well," she said," we don't know that you DON'T have pertussis," and promptly prescribed antibiotics and cough syrup w codeine.

Local gp: 1

Uncle Trog, who recommended guifenesin, which really helped: 1

Oncologist: 0

Interesting article on pertussis (whooping cough) in adults is here.

Taxol 3

Another allergic reaction led to a marathon session yesterday.

On a happy note, the bone pain has not returned.

Just two more weeks until we say au revoir to chemo. Couldn't come soon enough.

On the way back

Vaccuumed the whole downstairs AND cleaned the bathroom.... without taking any breaks!  Yay!

Sigh.

MY LEGS HURT, GOD DAMNIT!!!!

After days of aches and pains, and berating myself for being a lazy yoga practitioner and not stretching enough in general, it occurred to me: Bone pain is an expected side effect of taxol.

Will call Monday seeking pharmaceutical relief.

And will start yoga and qi gong twice a day from here out.

Taxol 2

Hemo now over 9. Yay!

Second taxol went well, though it lasted about 4 hours. Extra meds beforehand, no allergic reaction during. Can I start counting days now?

Won't need the nanny past the first week of Jan., but she may be here til this is all over... mid-March.

Whew.

Hemo now 8.3, so I think we'll skip the transfusion this weekend.

On the way back

Hair stopped falling out last week, in case I didn't mention it. Even if I don't get it back til spring, this makes me Incredibly Happy.

Transfusion

Well, THAT was fun. Hemo was 6.9, is now 8.3, and normal is 14. So, it doesn't look as though taxol will be such a walk in the park after all. Plus, my fingers are swollen, hurt when I bend them, and are extremely sensitive to heat... which the oncologist who did rounds today said he'd seen before with taxol. I can't imagine what I'll do with all the time I'd have otherwise spent knitting. Plus, my tongue is starting to have 'issues.'

The good news is that I think the anemia will be able to be managed -- or at least monitored -- locally by my GP. The bad news is that the anemia (a.k.a., exhaustion) looks like it's going to take some serious wind out of me over the next few months.  Waiting to hear what the oncologist has to say on Monday about all this.

Taxol - a mixed bag

Had an allergic reaction to this one about 10 minutes in, which wasn't fun. But they shot me up with benadryl and hydrocortisone and I slept through the rest of it. I'm "extremely" anemic (didn't ask for the number), which accounts for recent dizziness, shortness of breath, and exhaustion.... but they think my numbers will go up from here, so they're not scheduling a transfusion. Yet. Need to recheck blood counts on Tuesday.

On the bright side, this is supposed to be a much kinder, gentler drug than the two I've been on.

My helpful and dear friend visiting from California this week is being calm and useful. I'm so grateful!

Is it just me?

... or does the entire Whole Foods store in River Forest smell like a cross between a Rush Street alley garbage bin after midnight and an abbatoir?  Oh, riiiiight...... it's just me.

I swore I wouldn't whine like this. Blood counts are low at this point in the cycle, which doesn't help anything. Cumulative effects of cytoxan and adriamycin have finally rolled me into a ball of misery. I am grateful that it took this long, and that the end of these miserable drugs is near.

Treatment only gets ... er, less miserable from here on out.

Ugh.

Let's see now... Dizziness, shortness of breath, exhaustion, hot flashes, nausea. What fun. Could be anemia, could be dehydration, could be low blood count. Could be premature old age, I suppose. But I doubt it.

Taxol had better be as symptom-free as advertised.. aside from the numb fingers and toes. Frankly, that sounds like heaven to me about now.

Halfway there

...to the end of chemo, that is.

My uncle gently reminded me, in the context of annoying side effects, to consider the larger picture. And he was right. This misery will pass soon, hopefully forever. The hair, as the toddler reminds me constantly, will grow back. The cancer, ideally, will not.  Thanks, Trog.

In other news, I greatly anticipate picking up a prescription for artificial tears. One tricky thing about chemo is that one tends to diagnose annoying but ultimately harmless maladies as "something else"... rather than checking with oncology to see whether they can be fixed. Pays to be a hypochondriac in this situation.

Happy Friday

Yes, I do still have my eyebrows.

Am finally befriending various pharmaceuticals to deal with unpleasant side effects. Better living through chemicals!

Oncologist's nurse threw cold water all over the NYT piece that's been giving me agita since I read it. She says that the greatest chance for recurrence occurs within the first two years. After that -- and especially after the 5-yr milestone -- it goes down. I can barely describe how happy this makes me.

So. let's do this again. I'm stage 2b.
Chance of recurrence out of the gate: 25%
Treatment cuts that in half: 12%
Thus, the 5-yr survival chance: 88%
After 5 years: 88% OR HIGHER

Not 50%, you crazy bitch. You owe me -- and all the other freaked out cancer patients out there -- an apology.

and

Thankyou to my sister in Seattle for both shaving her head in solidarity (we actually look like sisters now!) and for signing me up for the Exotic Fruit Of The Month Club! First shipment was pomegranates, blood oranges and sapotes. MM-mmm good.

Thankyou to my other sister for sitting through my chemo sessions with me. First I thought it was silly, but now I find it comforting.

Thankyou to Butch for taking doggie on long walks with his doggies.

Thankyou to Eric and Laura S for being smiley and comforting and good friends in my hour of need.

Three down, five to go.

Cytoxan was a bit nauseating today, but I'm ok now.

Turns out what I'd thought was overly severe seasonal allergies, due to a weakened immune system (all-day itchy eyes and drippy nose) is just the chemo, which means it'll be gone after the next treatment, yay.

When the toddler turned two and suddenly had loads of energy that was preventing me from accomplishing any productive evening activity, my friends said, among other things, "Put away Julia (Child), get out the peanut butter." And they were right. But we can't live on peanut butter.

Happily, I've realized the answer to both the aforementioned dilemma and treatment exhaustion: the crock pot! Hurrah for slow-cooking! 15 minutes of prep in the morning, and you're done. Experiment #1, chicken with tomatoes and olives, wasn't great.. the chicken was dried out and flavorless... but I think I took too long in browning it, and cooked it instead. Next stop: root veggies.

Thankyou, Nana and Poppy, for taking the toddler overnight on treatment day.

The Table

Glad to see I'm not the only one slightly obsessed with recurrence.

Lookie here in the New York Times.

In other news, the trouble in my mouth turned out to be thrush... now medicated and much better.

Worry about what you can control

Or, slightly more helpfully, don't worry about what you can't control. My friend Eric keeps reminding me of this oldie-but-goodie.

So I shall try. I can control making sure all the financial and social ducks are in a row for the toddler, in case The Thing comes. So this week I am reviewing all of that with the financial and legal folk, plus retirement (i.e., health care) funding, and how to protect her inheritance from being consumed by The Thing, if it comes.

Oh, and let's be clear on "mouth sores" for a moment: They're not canker sores. It (not "they") is a state in which all the soft tissue in your mouth aches, and eating the slightest bit of crunchy thing will tear up your cheek and gums... like you've been chewing glass.

I anxiously await the arrival of a box of perfect fruit, sent by my sister. And then another one next month. And then another, and another, and another!!  Mad love, yo!!

The mind game

When I'm through with treatment, I won't be a "survivor." I won't join a support group or wear pink ribbons or raise money for breast cancer research. This thing will not infringe on my identity or time any more than is necessary.

But I do need to figure out how to live with the hovering black cloud of metastasis. My chances are 15% (from what I can figure). But they feel more like 85%. The answer is probably to figure out the chances of other horrible things... speeding busses, etc. If they're over 15%, I can forget about cancer, I guess. Until then, I feel like the walking dead, waiting for the next set of symptoms to start. Regardless of my tendency toward depression and downright moping, that state does the toddler no good. I don't want her to show up in therapy someday talking about her mopey, walking-dead mom who sat on the couch for 10 years waiting to die.

In other news, the hair has started to go, right on schedule. Am especially excited about losing my eyebrows.

Nanny!

Found a lively Polish nanny to start on Monday and continue through Christmas, perhaps til the end of radiation if I need it. The toddler took to her immediately and enthusiastically, which she does not do with everyone.

I was hoping for a Russian, in the bilingual department, but Polish is ok too.

What a relief!

Round Two

Two down, six to go. After-school babysitting provided by a young neighbor was helpful, if not strictly necessary. Other than that, hot flashes and arrhythmia. Whoo hoo.

Thank you

I've had several reports, lately, that I've been added to people's prayer lists. Some of these people have never met me. I've also had a report today from the catering service, which informed me that I've a healthy balance in place, ready to be used whenever I can't stomach the idea of cooking a meal for the toddler. Or myself, I suppose.

I am grateful for every thumbs-up, every postcard with good wishes, every offer to do "whatever you need," every sounding board that doesn't flinch at my rage and misplaced blame and mis-spent energy in trying to wrestle with this situation. And every child who likes my mohawk. And there are several, I'll have you know. I'm a huge hit with kids, with this thing. Go know.

"Breaking Bad"

Been re-watching this series on Netflix. (For those who've not seen it, the series is about a straight-laced high school chemistry teacher who, when diagnosed with stage 3 lung cancer, decides that the best way to try and provide for his pregnant wife and disabled teenager with what little time he has left is to use his chem knowledge to cook methamphetamine.)

Cancer plays an interesting role in the show. It's not the melody or the harmony, not even a dramatic horn solo. It's the drone note. The low and persistent hum. And yet it is the premise of the show. And it's a brilliant premise, really ... exploring the limits of what reasonable people are capable of when facing terminal illness, when nothing matters to them anymore except trying to ensure the health, safety, and happiness of the children they're going to leave behind.

I don't believe I'll go shopping for beakers and chemicals any time soon. But I can relate to the desperation of it.

Buy lots of life insurance while you're still healthy, people. I know -- it feels like throwing money away. Just do it.

Mouth sores

Several. On top of that gross omnipresent taste in my mouth. I've read it tastes like metal, but mine doesn't. It just makes me want to brush my teeth every five minutes.

Must. Start. Daily. Exercise. Again.

The gloom is taking over a bit, not helped by overcast skies, indigestion, and a sick toddler. Daily sweat and adrenaline are the only way out of this hole. (Or dopamine.. whatever.)

On the bright side, I interviewed a nice Russian nanny last night.

Tired

This about sums it up for me today.

Wow.

Not only is my chatty chemo nurse a musician, but she's a knitter! The time just flew.

Turns out that they drip about 45 minutes worth of anti-nauseau juice into you before Administering the Bad Drugs.

I feel absolutely, completely fine. Tomorrow, I get a shot of a ridiculously expensive anti-nausea drug (neulasta). And my choice of three different anti-nausea drugs to take at will.

If I'm going to feel pukey here it's apparently going to take some effort.

Exhaustion will be another question entirely. No meds for that.

Proceeding as planned

My surgeon has recommended alternative oncologists for me, at my request, and has clarified the critical point.

Chemo will cut my risk of developing metastatic disease in half.

Such a simple fact. And it makes all the difference.

Saturday

It's easy to forget the day of the week when you're on vacation. When my oncologist's assistant informed me this morning, via her answering machine, that she's out of town as well til Tuesday, I happily rang up my surgeon to grill her on why exactly, numerically, I ought to get chemo. "Can it wait til Monday, or would you like to speak to the doctor on call?" said the desk. Oh... riiiiight. Saturday.

So, sports fans, hang onto your hats for a couple more days til we all find out whether I shaved my head in vain.

Why am I doing this?

“You have a 25% chance of recurrence.” – my oncologist

In light of the facts I posted yesterday, I've no idea why chemo and radiation are worth the bother.

In other words, the salient number here is 30%. By what percentage will C&R reduce it?

Happy little fact of the day

In developed countries, nearly 30 % of women with early stage breast cancer will eventually develop metastatic breast cancer. [1] Median survival after diagnosis is three years. There has been no statistically significant improvement in the past twenty years. [2]

[1] (O’Shaughnessy J. Extending Survival With Chemotherapy in Metastatic Breast Cancer The Oncologist.2005;10 (suppl 3): 20-9) 

[2] (American Society of Clinical Oncology [ASCO] Report - 2008)

Wintertime daycare germs, keeping the toddler home

Upon hearing of my worries that the toddler would infect me all winter as she did last winter -- a repeat of which I will not be able to afford, with a low white blodd cell count -- my aunt ran the facts past her MD, who came up with the right solution... one so simple I'm embarrassed I didn't think of it: Keep the kid out of daycare til the end of chemo.

I have zero in-town days to find a full-time nanny, since I'm now on vacation and will start chemo the first day back.

On the bright side, I'm now not worried about getting sick.

Thanks, Mary!

Vitamins and supplements, alive alive-o!

No, they can't cure anything, once cancer is bullying your body. But yes, they can boost the mojo of your immune system, which is compromised by chemo, and they can bolster the health of your bones, which is critical for me, since b.c. spreads most commonly to liver, lungs, and bone.

Consensus among medical groups seems to be that making sure you are maxed out (though not above that, which can compromise the effectiveness of chemo) on vitamins A, C and D, plus calcium is a very good idea. All have been tested w b.c. patients, and have made a difference.

Also, CoQ-10 and flaxseed oil have been tested w b.c. and are recommended. The onco docs have ok'd my use of both. CoQ-10 does 3 things: boosts immune system, protects the heart from the probable damage that adriamycin will incur, and acts as an antioxidant. Flaxseed has been proven to  reduce the growth ofr cancer cells.

Am investigating dietary recommendations, but haven't found much beyond the above. My feeling is that getting these nutrients from food as opposed to pills is a good idea... but it remains to be seen whether I can deisng a diet regimen that will actually give me enough of it w/o needing supplements.

Meanwhile, have added Co-Q10, flax, a multivitamin and a calcium supplement (how ridiculous is it that even the multivitamins meant for women over 50 include HALF the daily recommended amount of calcium? Look it up.).

Second opinion

The lovely oncology people at University of Chicago Medical Center are of precisely the same opinion as those at NWM about the chemo cocktail. I am very relieved, and will set up to begin upon return from imminent vacation.

Nutritionist

General guidelines from the nutritionist at the oncology center. Interesting thought about fruit. Seems sound advice even for the healthy.

1. Limit red meat -- including pork. (Huh? -- Yes, according to the American Cancer Society, pork is red meat.)

2. Tip the balance of what you eat towards the plant-based. More fruit. More veg.

3. Beware food contamination, since chemo supresses the immune system. Wash fruits that have a rind, since when you cut them, you drag the knife right through. Limit sushi  (waaaah!).

4. Beware multivitamins that contain more than 100% of the daily recommended amount of anything. Superdoses of anything, even herbs, can interfere with chemo.

5. Lots of advice on dealing with nausea, which I see no reason to detail.

Mammogram policy shake-up, 2009

Fascinating. I mean, the sort of "fascinating" that makes one sick to one's stomach.

---

Nov. 16, 2009 -- U.S. Preventive Services Task Force issues revised breast cancer screening guidelines.


Dept of Health and Human Services says women younger than age 50 do not need routine mammography screening and that women ages 50 to 74 should get a mammogram every two years.


Sticking with existing guidelines
Leading organizations say they plan to continue following existing breast cancer screening recommendations rather than implementing the U.S. Preventive Services Task Force's new guidelines.

American College of Radiology: Annual screening mammogram for women 40 and older.

American Cancer Society: Annual screening mammogram and clinical breast exam for women 40 and older.

American College of Obstetricians and Gynecologists: Annual or biennial screening mammogram for women 40 to 49. Annual screening mammogram for women 50 and older.

National Cancer Institute: Annual or biennial screening mammogram for women 40 and older.

The American Medical Association did not issue a statement on the guidelines, but it has existing policy calling for annual mammograms starting at age 40."

---

Mammograms

Tomorrow I see my GP for the first time since diagnosis. Since her recommendation to skip the annual mammogram for the past couple of years is what allowed the cancer to blossom, I believe I'll ask her to show me, in writing, the AMA policy to which she referred at the time -- that annual mammograms are now only recommended for women past 50 (which I am not).

Regardless of her answer, I need a new GP.

Love the one you're with

Kiss your baby today. If you don't have a baby, kiss someone who makes you happy. We are only on this earth for a short while. Don't be stingy.

"And in the end, the love you take is equal to the love you make."

Clinical trials

Ahem. Back to the matter at hand.

A friend has suggested that since I have the most common form of a most common ailment (meaning that the common drug regimens have been well-tested and used), and that my chances of survival are so high, that I not take a risk by participating in a clinical trial for chemo.

I must admit that I had been thinking on the opposite tack: that if I could find a trial that used common drugs, but perhaps in smaller doses, then perhaps I would sign up. Arguably (said the layman), this would mean less toxins for my body, but also that fewer cancer cells would die. Would I rather die of the damage caused by toxins, or from a cancer recurrence?   *sigh*

Or, as he also pointed out.... there's always the speeding bus that would make the question moot.

My only other thought on the subject is that a dear friend passed away due to a clinical trial for hormone replacement drugs in which she was participating.

More thought needed on this subject.

My new theme song

Thanks, chemo!

Listen up.

Actually, this one is much screamier... but I prefer The Cramps' version.

Second opinion

Now set up.... for August 29.

Bleach

How many of you can say that your mother bleached your hair? None? Thought so. Tomorrow she goes for the pink.

The back

My lovely neighbor Leigh shaved the back of my head, since I chickened out halfway through. Have acquired two hues of Manic Panic and some super-strength Aquanet. Now the fun begins!

Mohawk

Yes, I've chosen the fun route to hair loss. Curious people can email me for a picture. There will not be one here.

No more surgery needed

.. by the way.

Chemo drugs, clinical trials, and free housecleaning

Recommended regimen = ACT. adriamycin, cytoxan, taxol. More here. It's one of the more common ones.

Have my work cut out for me, looking for applicable clinical trials for chemo. But there is this site, which is a gigantic help. I found 41 that apply.

And I learned of Cleaning For A Reason, which can provide 4 free housecleanings for ladies with cancer - one per month. Yay.

Chemo consult, hair situation, A Word Of Advice

Chemo dude had nothing new to say, and felt okay with minimizing the effects of chemo, to boot."I've had patients compete in triathlons during chemo." And screw you, you smug defensive bastard. The drugs he recommends are A C T -- details tomorrow since I can't remember right now. I will get a 2nd and perhaps 3rd opinion on the cocktail.

Hair situation -  I think I'm going to wait until it starts to fall out (because who knows? says my denial engine, it may not fall out at all!)  ... and get a mohawk. It will avoid the soul-crushing clumps-on-the-pillow situation and also give me the satisfaction, finally, of going full-on punk. I can't wait.

Advice: My brain goes into gridlock when I talk to doctors, mostly. The fear overwhelms me, the internal chatter starts up, I get home and have no idea what they said.  My cheeky self tried an experiment --- the tape recorder -- and lo -- the surgeon, radiation dude  and chemo dude all agreed to be recorded. This should prevent the hysteria I experienced last week, when I forgot what the surgeon had apparently already explained once. A hearty HUZZAH! to MDs who are willing to be recorded. And if yours won't, good people, find yourself new doctors.

Swelling update

Hospital says that the swelling is not lymphedema, since that usually happens in the arm. And the numbness, etc. I have is mostly near the other bits that were affected by the surgery .. but not my arm.  It can take a year to go away, and I apparently probably worsened it by picking up the toddler with both arms, but I'm relieved.

Swelling

Well, let's hope this is the beginning and the end of edema, and a side effect of surgery. Amazingly, fluid buildup hurts far more than surgical incisions. Go know.

Help with dinner

My lovely friend Laura set up a gift account for me and the child with a local service that delivers home-cooked meals with very little notice. Anyone interested in footing the bill for a meal can call up and do so (they don't offer the service online, apparently).

Using the service is not only a brilliant suggestion for me, but it also allows people who would like to help to do so .... without needing to deal with my crankiness in person. Kudos to her for making The Thoughtful Gesture Of The Day. I image I'll get know these folks pretty well over the next four months.

BONUS PRIZE -- They offer gluten-free, dairy-free, and veggie options. And not even simultaneously. Whoo-hoo!

The Perfect Dinner / 708.660.8731

Radiation consult / Baby thought

So, what did we learn from radiation dude? Nothing new, really. Changes caused by radiation to both the texture and tissue of the overall breast may be permanent. I hadn't thought about it, and I don't particularly want to think about it now. One sort of cool thing: In order to make sure that they pinpoint the therapy, they make a big 3-d foam mold of your bod from the waist up, and you lie in it at each visit. Smart.

Baby thought: The baby needs a solid solution that takes into account mama's sick days and nana's sick days. Especially during the holidays, I will not be able to deal with frequent one-off emergency planning. She likes the daycare, so perhaps she can put up with it 5 days/wk. It's quite near the hospital where I'll get both C and R.

Went 'public' with this thing on facebook yesterday, and my lovelies both near and far have  been incredible. Love to you all. I am grateful.

The biggest loser

... is the toddler, whose mama loses patience with her even when she is not nauseous and exhausted. She won't understand what is going on (right now we talk about "mommy's owie"), so I need to make sure there's something in place that will relieve her of my presence during the worst of this.

Metastasis

What a horrible word. I am just now absorbing the fact that since the moment the DCIS became invasive -- and who knows when that was? -- there were probably cancer cells floating throughout my body. I feel so... riddled with it. I feel as if I should be able to stand still and be very quiet and be able to tell  - be able to feel where else it is. Is it in my brain, looking for a dusty corner to hide in? Is it in my heart? Or my little toe? If cancer had any pity, it would cause a great deal of localized pain, so one would know when and where it was present. But I suppose we know that it has none.

Today's wisdom from the surgeon is as follows.

The general schedule of the next year for me will be:

Sep - Dec   8 treatments of chemo, given every 2 weeks (hair-free portion of this time: Nov through New Years, during which time I shall wear hand-knit hats made by self, not a wig)

Jan     rest

Feb-March   8 weeks of radiation

Next 3 years    Mammogram every 6 months to detect possible recurrence

Next 5 years    Hormone therapy, probably tamoxifen for a year, then perhaps another drug. Tamoxifen prevents the estrogen in your body from attaching to cancer cells, preventing new growth.

Possibility of surgery to remove more lymph nodes:
Slim but possible. More news of that next week after she consults with her team of oncologists, radiologists, surgeons, etc. The complication here is that the metastasis was in a NON-sentinel node, which is unusual. My assumption is that more surgery will increase the likelihood and severity of lymphedema in my left arm, so I'll skip it, thank you very bloody much.

On the additional cancer found in the margins:
It was non-invasive (DCIS), which is the precursor to invasive. Such findings are common -- the two types co-exist. Reason not to worry: Radiation takes care of this and other presumably present but undetected diseased tissue. "If we could remove every last cancer cell with surgery, there would be no need for radiation."

Also, it was found only in one margin, not in the other three. She is not concerned about it.


Stage two:
Because of the lymph node involvement and the size of the thing (it wound up 2.6 cm as opposed to the 2.0 that showed on the mammogram), it is now stage 2, which means a lower survival rate. Does the difference between 2.0 and 2.6 mean it was fast-growing? No - it's the difference between imaging and pathology.

Menopause:
Considering my age, the chemo will bring on menopause. 'Nuff said.

Green light at the end of this misery:
Nope. Full-body scans are seen as more anxiety-provoking than helpful.

Tomorrow, a visit to the radiation oncologist.

Surgeon

OK, I've now spoken to the surgeon. Seems things are more complex than I'd realized regarding how cancer spreads.

Having cancer in one node is not as bad as having it in a lot of them. But it also means there is a higher chance that it has spread.

"Higher than what?" you ask. Higher than the 1 in 4 chance that any invasive cancer will have cells break off it and go floating around your body looking for a new place to try and kill you regardless of lymph node involvement.

I meet with her tomorrow, but she says it's "interesting" that the cancer was not in the sentinel node, where it usually is found, if anywhere. She may go back in and take out more nodes, but is not sure yet.

But chemo sounds like a definite to me now. Hoorah.

I'm NOT leaving the baby.

DO YOU HEAR ME, NORTHWESTERN MEMORIAL HOSPITAL?

YEAH, I'M TALKING TO YOU, YOU TORTUROUS MOTHERFUCKERS.

Surgery results

I got the results of the surgery from a secretary who was unable to answer any questions.

They removed 4 lymph nodes. One is cancerous.

The margins around the tumor, which turned out to be 2.6cm, are mostly cancer-free but there is evidence of a different non-invasive cancer there.

Chemo is highly likely, and will be done before the radiation.

Within the week, I will meet with the surgeon, the radiation doc and the chemo doc and have more information about the prognosis and treatment.


I must say, I find it appalling that not only did the surgeon not call me though a call was promised (I finally broke down and called her assistant), but to be given such results by a person who lacks the ability to answer the simplest question, namely HAS THE FUCKING THING SPREAD TO THE REST OF MY BODY? is unforgivable. Absolutely unforgivable. And we're not dealing with Yipahoopee State Medical Center, either. This is a well-respected hospital. Though not respected by me anymore.

We're not talking about a broken toe, here. I am speechless at the heartless and clinical way these results were handled.

The surgery

You've been asking, so here's the story.

The surgery had two parts:

1. Tumor removal (including removal of margin of "clean" cells surrounding it). The whole thing is biopsied, to make sure that there are no cancerous cells near the edge, within the supposed cancer-free margin. If there is cancer there, they go back in and try to get the rest of it.

2. Sentinel lymph node biopsy. If the cancer has spread, it will have done so via the sentinel (first) lymph node. So if it is cancer-free, they can assume that the rest of the body is also. If not, I'll almost certainly get chemo, which involves the whole body. The danger of messing with the lymph nodes is the risk of lymphedema (fluid buildup), which is Extremely Unpleasant. The diagnostic mammogram did not show swelling of the lymph nodes, which is a good sign.

So, what we'll know on Tuesday is a) whether the entire tumor is gone, and b) whether the cancer has spread.  It's up to the oncologists to decide whether radiation will be sufficient.

My uncle, who's had more cancer treatment than is right and proper in one life, has suggested I put off the chemo if it's recommended even if the cancer has not spread, and I will probably take that advice. If cancer has spread, it will be slow-growing, and holding off chemo for 6 months or indefinitely won't hurt.

So much for the easy part

Surgery went well, though delayed. And I had a nice surprise --- twilight sedation as opposed to general anesthesia! I was very relieved.

Baby backs from Fat Willy's nicely rounded off a day of no food or water. I'm trying to get through the next few days without the hydrocodone, though the need for it is finally coming on.

Unexpected side effect: Peed a lovely peacock blue this morning. Yikes.


I suppose this is true of all MD appointments, but... if you ever need surgery, be the first slot in the AM. Less likely to be delayed.

Results expected Tuesday. Next two weeks will also bring decisions on radiation (when) and chemo (whether... surgeon says "likely," due to my age).

Grateful

Friends from both long ago and far away are checking in on the cough and my general mood. I feel so loved! Friends and family make life worth living.

Good excuse

... to review my medical power of attorney and other "affairs."

Surgery postponed

Still coughing. Postponed surgery one week.

Lungs

The child's bronchialytis seems to be reaching out, first to one of her caretakers, and now to me, with a cough and chest congestion. If this keeps up, I don't see how I can go under general anesthesia next week.

Mucinex.

X marks the spot

I wonder if it's possible to tattoo scar tissue.

I don't have any tattoos, but somehow marking the spot seems like it might be appropriate.

Okay then.

The bad news: 

The tumor is grade 3, which means that on a scale of 1 (best) to 3 (worst), it does not play well with others and is more likely to metastasize.

It also means, in combination with my age and other factors, that there may be a need for chemo even if the cancer has not spread. Since I liken chemo to drinking Drano for a few weeks, I am Not Happy about this. Won't know til after surgery whether it is necessary. It would be a drip, not a pill.

The good news:

There is probably little possibility that my daughter will have an elevated risk of breast cancer, since my family has no history of it (and thus, no gene mutation is suspected). This issue will be addressed at a later date, via genetics. First things first.

My fear about radiation close to my heart was somewhat lessened upon hearing the news that the current practice is to shoot the radiation parallel to the body, as opposed to directly into it.

It's stage 1, as I expected.

No MRI or additional pre-surgery testing will be necessary.

Because of the tumor location and size (and the size of other things, ahem), disfigurement is not expected. I'll believe it when I see it, but I'll give them the benefit of the doubt.

The hormone situation is good on all levels, which is apparently important.

It sounds as if I'll be able to get the 5-6 weeks of radiation within a couple of miles of home and work full time through it, with few side effects.

It also sounds as if I will not be given zombie-level pain meds for the days following surgery, as I was after my C-section. This is good news indeed, since I don't like being a zombie. Or the crazy all-night itching those meds brought me last time.

The other news:

The MDs say that the dozens of different drugs I shot up during my 12 months of IVF treatment probably accelerated the cancer, which they assume has been there for 1 or 2 years (my daughter is 2-1/2). I fully expect that in 20 years, it will be announced that some or all of those drugs cause cancer. Oh well. (Note: I brought up the possible connection, not the MDs.)

Although I was hoping for a surgery date of, oh.... say... tomorrow afternoon, I am pleased that it's scheduled for July 21.

The surgeon has hard, cold, clinical eyes. I suppose this is one wants in a scientist / professor.

Getting ready

Reading up on nutritional and exercise recommendations from Susan G Komen, Mayo Clinic, American Cancer Society. This thing is a good excuse to get the daily 30-min regimen back in gear. Also a good excuse to start regulating water intake again. After radiation, apparently I'll also get to use the enormous daily protein recommendation (70g/day) as a justification to eat more sushi.

Blink

24 hours ago, I was diagnosed with invasive breast cancer -- invasive ductal carcinoma -- via a core needle biopsy of a lump I found and a diagnostic mammogram. It is by far the most common type of breast cancer. 180,000 Americans are diagnosed with IDC each year. The survival rate for white American women between 45 and 50 is around 90%, for cases caught early.

My gut knew it was cancer before I got the call, though I've never had it before and am generally healthy. My gut is also preparing for a fight, partly because it is generally hostile to invasive forces and partly because every member of my father's family has had cancer of some sort... though not this particular sort. I hope this blog will document my utter unwillingness to let it take hold, spread, and kill me.

The lump is 2cm -- on the small side, from what I understand. The MD says it seems localized, meaning it probably has not spread to my lymph nodes and thus other organs.

I see the surgeon on Friday morning, thanks to the phone calls made on my behalf this morning by my primary MD. I am expecting her to advise a lumpectomy, which apparently usually comes with 5-7 weeks of radiation. The surgery and disfigurement don't scare me. The radiation does, especially since it's on my left side. I am expecting to be able to go on vacation in September as planned. I've already cancelled my July vacation.

Bottom line: I am a middle-aged single mother of a toddler .... via IVF and a donor I do not know. So there is no possibility that the father can take over in my absence. I frankly wouldn't consider it such an earth-shattering tragedy if this thing were to take me out. But I refuse to leave the baby alone. Period.