Monday, May 31, 2010

Day 6 - Memorial Day

We spent today like most everyone else. We cooked out and hung out by the pool. It was really nice to have a normal day. Today was the most normal our days have been since we got the news. I hope more days like today are in our near future as we journey down this path. Mike is trying to prepare me for treatment - eating better (although we don't eat that badly now) and exercising more to make sure I'm in a better physical condition going in to this so I come out of it in a better condition.

I spent a lot of time today thinking about chemo and the hair thing. I guess I didn't put together that losing my hair includes losing eyebrows and eyelashes as well. Potentially, anyway. But I have to come to terms with the worst case scenario of any possible outcome- so I think about it - make my peace with it. At least until it actually happens. It's the only way I'm going to be able to arrive at a decision. If I don't make my peace with it ahead of time, I most likely won't make a descision for treatment. And we can't have that.

Mike said he'd shave his head and eyebrows with me. I told him not to. There has to be one nice thing to look at in the house when I'm all sickly.

Sunday, May 30, 2010

"I Am Woman"

"I am woman, hear me roar
In numbers too big to ignore
And I know too much to go back an' pretend
'cause I've heard it all before
And I've been down there on the floor
No one's ever gonna keep me down again
CHORUS
Oh yes I am wise
But it's wisdom born of pain
Yes, I've paid the price
But look how much I gained
If I have to, I can do anything
I am strong (strong)
I am invincible (invincible)
I am woman
You can bend but never break me
'cause it only serves to make me
More determined to achieve my final goal
And I come back even stronger
Not a novice any longer
'cause you've deepened the conviction in my soul
CHORUS
I am woman watch me grow
See me standing toe to toe
As I spread my lovin' arms across the land
But I'm still an embryo
With a long long way to go
Until I make my brother understand
Oh yes I am wise
But it's wisdom born of pain
Yes, I've paid the price
But look how much I gained
If I have to I can face anything
I am strong (strong)
I am invincible (invincible)
I am woman
Oh, I am woman
I am invincible
I am strong
FADE
I am woman
I am invincible
I am strong
I am woman"

I am woman. 

Day 5

I've decided that IF I have to do chemo, and IF I choose to do the shorter term chemo, the type that may cause me to lose my hair -- that I'm going to cut it off - as short as possible -- to save it and have it made into a wig ahead of time.

I've donated my hair once before in 2006, to Locks of Love. I wonder if it's possible to find out where my hair went - to whom it was given. It would be neat to meet that person.

Saturday, May 29, 2010

Day 4 - Pick Your Poison

So it's day 4 of this 5 year journey. Everything is still so new and surreal. It doesn't make sense that this is what I'm really suppose to be going through. I'm waiting for the morning that I wake up and I've dreamt it all. We spent the day today at the dog park with Tomo, at the pool with the Bailey clan and grocery shopping for the weekend. At the back of all of our minds I'm sure - Mike, my mom and I couldn't stop thinking about it. I'm a cancer patient. I'm going through what you watch on TLC or NatGeo. You don't ever expect to be going through it. This is one time I would much rather spectate, than participate.

So where are we now? We met with the first surgeon yesterday, Dr. Kercher. (Pros) She was incredibly nice, had a warm and caring bedside manner. I liked her, and trusted what she had to say. She definitely made me feel like she knew what she was talking about. The only issue is - (Cons) if I decide to pick her, she's 20 miles away, in either direction from work or home, in Littleton and the rest of the "team" that I would need to see on a regular basis would be scattered throughout Littleton and and the Tech Center area. Too far to be convenient, especially if I would need be there everyday. Tuesday is looking more and more encouraging -- meetings with the entire, potential, team that would be working on me ... everyone in one place, at one of the best cancer centers in the state, so I'm told. It was good to meet with Dr. Kercher first however. Get the tough news ahead of time -- have my huge meltdown (as I did when we got home during and after I talked to my sister) -- it gives me time to prepare for the next meeting -- time to focus my questions -- time to be quasi-decided on the path I'm going to take for treatment.

So treatment - where does it start. Dr. Kercher said my tumor was "good" -- meaning, it's not big, bad and nasty and out to kill me. This is good. It has a moderate growth rate, replicating itself every 120 days or so roughly. So I have some time to think through all my options without it being a danger to my health. This is good. So here's what she confirmed for us, based on my pathology reports:

1) The tumor is ductal. This makes for a tumor that grows into a nice little ball, instead of spidering throughout my breast tissue which is more difficult to detect early. Ductal breast cancer is accounts for roughly 75 - 80% of all breast cancer, so it's very common, doctors see it a lot, and there's a lot of historical data because of that.

2) Size -- we don't know for sure but the ultrasound is showing roughly 2.7 centimeters.

3) Grade - it's a 2, on a scale of 1 to 3. Grade = aggressive nature of the tumor based on a combination of various factors.

4) The tumor is Estrogen and Progesterone positive - meaning the tumor has receptors on it for estrogen and progesterone and these hormones are potentially feeding the tumor. Since these are present in birth control pills, I've stopped taking my pills. No need to feed the monster.

5) Ki-67. This is a "tumor marker test". High levels of Ki-67 indicate an aggressive tumor and a poor prognosis. A high score on this test means that the tumor cells are rapidly dividing and growing. The score for this test is between 1 and 100. My score is 16. This is good. It's not an angry monster. Dr. Kercher told us that most women my age who are diagnosed with breast cancer have scores of 98 and 99 on this test. So to have a 16 is a good sign.

6) Now, Stage. "What stage of cancer are you in?" This is the question. Stages are from 0 to 5. Right now, as my tests show, I have a Stage 2 cancer. This is based solely on the size of the tumor. Stage 2 is "tumor is larger than 2 cm or has spread to the lymph nodes under the arm." So, because of the size of mine, and because there are no signs that it's in my lymph nodes, I'm considered Stage "2A" ... meaning no lypmh nodes. All this could change however once they get in and take out a "sentinel node" (meaning taking out the node that catches the flow from the tumor) and dissect it under a microscope to ensure that not even 1 cancerous cell is present. If even 1 cell is present, then it has spread to my lymph system.

So here's the million dollar question - the answer to this question will determine my treatment. How do I want it taken out? I have 3 options for removal: lumpectomy, mastectomy, or double mastectomy.

Lumpectomy is just removal of the tumor and surrounding tissue. This would require radiation therapy and most likely chemotherapy as well.

Mastectomy will remove all the milk ducts and breast tissue, sparing the muscle and skin. This won't require radiation (I believe) because there won't be any breast tissue left on the right side, but it most likely will require chemo. Additionally, the chance of recurrence in the left breast is roughly 1% per year. Being that I'm 29 right now, I have a lot more years left to live. So, if I do one, why not just do both.

Double mastectomy will remove all the milk ducts and breast tissue in both breasts, sparing the muscle and skin. This won't require radiation, but most likely I will still need chemo. But both breasts are now, non-functioning.

In both mastectomy scenarios, tissue expanders may be needed before I could be fully reconstructed if I don't have enough skin to cover the implant. So I would be looking at a couple months before I'm fully recovered just from the surgery. Add treatment to that, and it's half a year before I'm maybe back to "normal" excluding dealing with side effects i.e. hair loss or infertility.

Do you see where this is going?

I most likely will need chemo - regardless of the option I choose above. Why? Dr. Kercher said I need to differentiate the treatment processes. Chemo isn't for my breasts, for the most part anyhow. It's primarily for cleaning my bloodstream. If just one of those cancerous cells broke off and entered my blood stream, I run the risk of it settling elsewhere in my body somewhere down the line in life - potentially settling in my liver, lungs, or bones. So -- the only way I'm going to avoid chemo, as I understand it right now, is if I choose to.

So really I have to pick my poison. Nice tumor or angry tumor, I still have to go through similar treatment processes. So what about kids? We don't have them yet, and I really, really want them. The "deal" was we would start trying one year after we married. But if I choose not to do the chemo that makes you lose your hair, and I choose the pill Tamoxifen, which is just a different form of chemo, it blocks hormones and I would be infertile while I'm taking the pill. Seems like the better option on the surface, only the pill has to be taken for 5 years. That's a long time to be infertile and to wait to have kids. But, if I did the chemo that makes me lose my hair, I would need to be careful of the drugs to ensure that they don't harm my ovaries. And most likely I would lose my hair, but this type of chemo could only be for a few months, instead of years.

It all just feels like bleak and bleak. Not an easy way around any of it. Unless, they let me choose my surgery and postpone chemo until after we've had kids and then I pick up chemo when the kids are toddlers and I'm fully healed from the surgeries. Don't know if this is a feasible option at the moment, but I'm going to ask.

So ... one boob or two?

Friday, May 28, 2010

Good News

Got a call from the nurse about the MRI results! "No further imaging
needed"

Hooray!!

__________________
(Sent from my iPhone)

Day 3 - Put them where?!

MRI is done and over. Nothing like laying face down on a table with your chest sticking through perfectly cut out holes on an MRI table
and being slid in feet first into the machine to make this "cancer" thing real. Even with ear plugs the noise of the machine was loud. It sounded like really bad techno music. It was missing the base line and the beat was nervously fast. The picture taking, as the tech called it, took about 45 minutes. 45 minutes face down in a noisy tube - thank goodness for yoga breathing. "This picture will take 20 seconds" she said to me over the speaker system. So I had to sit still for 20 seconds. All I could do was "blink and breathe" while the machine was taking its picture. Then it was a mixture of 2 minute pictures, 20 second pictures and 5 minute pictures. Finally she said "This is the last picture, it will take 7 minutes." "Ok" I thought, I can sit still for that long. Then, true to Melissa form, 2 minutes into that last picture, I had to pee.

I managed to make it through successfully. The IV wasn't so fun, but there isn't a needle that I like anyway. But the tech Linda was really nice and did everything she could to make me comfortable and it worked. I didn't have as much anxiety today as I did during the biopsy, so that was really good. Not that the biopsy nurses weren't nice and did what they could, it was more just that I knew I would be stuck with multiple needles. Mike said I need to conquer that anxiety. I guess he's right considering I'm going to have a lot more tests.

Here's a picture from this morning. Mike was giving me heck about my pink high heels, but hey - if I have to do something, might as well look good doing it. :)
Going into MRI room



IV Time

Late Night Arrival

The Calvary is in town, all 4'11" of her.

Mom's here. =)

__________________
(Sent from my iPhone)

Thursday, May 27, 2010

Day 2 - First Blue Morning

I woke up a little blue today. Definitely not as chipper as yesterday. I had an early morning call with an RN at the Cancer Resource Services group with my insurance. She checked the doctors and hospitals I was looking at to make sure they were in network and sent me some good information and various lists of questions to ask during my consults and treatment. She asked if I was experiencing any depression. No, no depression I don't think. I mean, I think it's going to be a roller coaster of emotions right now. And today looks like it's panning out to be one of those days where I'm teetering between tears and smiles. I did break down a little after I got out of the shower. Mike just hugged me. He's so good. I got a good one. I said, "I told you this was coming" and he said he's sure it's not the first. Getting into work made me feel better. It took my mind of things, it forced me to focus on something else when I couldn't do it willingly, like yesterday. I'm arranging to get my films and reports sent from the Women's Center to the Hospital where I'm having my consult on Tuesday. I got a call from the Women's Center also to confirm my MRI tomorrow morning. And my sister just called to check on me. I kinda broke down on the ride in when I was talking to her too. She's a good one too.

Wednesday, May 26, 2010

Day 1 Wrap Up

It's been a whirlwind 36 hours. There's a lot to consider. Everything we've found on the internet applies to women who have 30 years on me. Where do I fit in? Where do WE fit in? My poor husband. He got a defective model.

I mean, I don't feel sick. It's hard to hear your sick, when you feel fine. It's hard to grasp the severity of "cancer" -- when you feel fine. Do I really have cancer? I don't feel like I do. What does it feel like anyhow? All I know is that I have to get a series of appointments done. That's it. That's as far as I can take it. I haven't talked with the surgeons or oncologists yet - so I don't know much more than my results and what the internet tells me that means.

Mike keeps telling me he's surprised at how well I'm taking all of this. I guess I don't really have any other way to take it. I'm not going to die, so anything other than that - is good. There really isn't any other way to look at it. I didn't have a choice in this, so all I can really do it just deal with it as it comes.

So, the next steps are to get a bi-lateral MRI and then have my consults with the surgeons, radiation people, plastic surgeons, etc. and then to pick a team and a course of treatment. Sounds easy enough ...

Diagnosis

I called the Women's Center later that afternoon - when my head was on more straight. Mike was home with me. He had left work shortly after I got there and dropped the news. With both of us home, and another pair of ears - I asked Sue to tell me the results again. She said what I have is "Infiltrating Ductal Carcinoma." The tumor has a grade of 2 right now. On a scale of 1 to 3, 3 is the most aggressive for a tumor. Evidently I'm right in the middle. It's about 1.5" in size overall. And you can see it.

When we were on our honeymoon - Mike so nicely pushed me into the "Macarena" line on the snorkel cruise we were on. We were on our way back to the marina in Cabo San Lucas when the guys on the yacht began their "show." Mike was snapping pictures as I was thoroughly embarrassed, but I went with it and had fun. As we looked back through the pictures he took, we noticed the lump that we knew was there. This was the first time that it was captured on film.

If you look close, I put a red rectangle over the lump. I found it for the first time in December 2009. I thought it would go away on its own. I've had one other mass that turned out to be fluid filled, and after 3 months, it had disappeared on its own. No such luck with this one. After this picture, I knew I needed to go to the doctor and get it checked out. At my appointment, my doctor initally thought that it was going to just be a cyst like the previous one. He said "We'll treat you like you're not 29 and get the proper tests ordered." From there it was downhill, an ultrasound that turned into a mammogram, that turned into "You need to go in for a biopsy" to "you have breast cancer."

The News

So it's been 32 hours since I got the news. It went like this -- Doctor: "Melissa - this is your doctor -- I pulled your lab results. The results show that the mass is cancerous and you need to get to a surgeon." Me: "What?! (SOB SOB SOB SOB SOB SOB SOB) ... " with a few sniffles thrown in there for good measure. He said more - but it was just so much information ... and I was so emotional. I wrote down "high-grade" and "intraductal carcinoma" and the names of two surgeons that he referred me to. One who he has personal experience with because as it turns out my doctor just went through this with his wife ...

Wife. We just got married less than two months ago. Is this happening? Breast Cancer? B-R-E-A-S-T C-A-N-C-E-R. Really? Now? But I'm only 29. Is this really my path? I have a hard time grasping that. Cancer? Me? Now?