Plastic Surgeon Pre-op Visit

Prior to this visit, I had worked extremely hard coordinating between the hospital, the breast surgeon and my insurance company to gain authorization for removal of BOTH breasts.  By the time I arrived at this 2nd visit to the plastic surgeon, I had received an authorization number, otherwise, I would have had to pay in advance what the insurance would not have covered.  

It was a stressful time. During the visit, the doctor had taken "before" pictures and some measurements, I'm sure it was for the surgical bra.  She also gave me a binder of post-op home care (those guidelines will be in another post) and prescriptions which included:

Emend - anti-nausea pill to be taken 90 min. prior to surgery
Kflex - an antibiotic
Percocet - pain killer
Premethazine - anti-nausea cream
Restoril - for sleep if needed. The next time I see my plastic surgeon will be after I awake from surgery.

Chantix Worked!

I quit smoking five months ago by switching to vaping, even before I knew I had cancer.  I really  loved vaping and hated that my husband still smoked conventional cigarettes.  I hated to be around him.

For five months, I was cigarette-free and thought I would be for the rest of my life, but noticed some side-effects, most of which was a general feeling of being not well.  I cannot be more specific than this because I do not recall the exact symptoms, but, I knew it was from vaping, so, back to cigarettes I went, reluctantly.

My addiction to cigarettes was hungrily awaiting any excuse to jump back into my life and the feeling that I was a failure, for not being able to stick with the vaping, just fed this addiction even more.

I went back to cigarettes until I learned that I had cancer and had no choice but to quit if I wanted reconstructive breast surgery.

I started the cheap version of nicotine lozenges and was making headway until my plastic surgeon said that she would not do the plastic surgery if I was still using nicotine. That's when Chantix entered my life and I finally, finally, finally quit smoking!

Chantix - Day Five

Day Five:

Had 1/2 cigarette while on the phone with the insurance company. This is good, typically, being this stressed, I would have had probably FIVE!  This is working!!

Chantix - Day Four

Day Four:

Went really well, I think throughout the whole day, I only had 1/2 cigarette.  This was the day that I started one pill in the morning and one in the evening.  I am so, so, so happy that this is working!!

Chantix - Day Three

Day Three:

I just realized, one month from today, I will be in surgery.

Anyway, back to Chantix - still going well.  I love how my mind is not pre-occupied with the addiction! So far, it's been one pill a day, for these 1st three days.  Tomorrow, the dosage increases, one pill in the morning and one in the evening.  Heck, I cannot imagine what that is going to feel like!  I don't think I could smoke with the dosage increasing.  I think that if I don't want to smoke, I'm not going to smoke.

Chantix - Day Two

Day Two:

Read some research on how Chantix really works, here's my layman interpretation - it blocks the receptors in the brain which nicotine and addiction feed.  So, when I smoke a cigarette, there is no pleasure. Actually, what I am finding is that it's almost like forgetting that I ever was a smoker!  It's like it's blocking the triggers that would cause me to smoke. 

I'm starting to feel like I felt years and years ago before I ever picked up my 1st cigarette... the mental-state of not being addicted. BUT - what I read is that it's important to still smoke during the 1st week of treatment, I'm thinking that by doing so will train the brain that it really is not pleasurable to smoke.  I am feeling more positive about this than any other quit-method I ever tried before!!

Chantix - Day One

Day One:

Started Chantix, had it in my mind that I will cut-down on my cigarettes right from the start.  I honestly didn't have to make an effort to start cutting down.  The drug nearly immediately began doing 'something' and I wasn't smoking when I might normally smoke.

Chantix - A New Hope

Went to our family doctor for a prescription of Chantix, the quit smoking drug. This is my commitment!  I need to quit smoking at least three weeks before my surgery date.  I cannot have nicotine in my system.  Plus, my lungs need to start recovering from all the damage I've done to them.

My Lucky Stars

Yesterday's visit to the Breast Surgeon was tiring.  The drive seems to take forever. Dr. Talbert was wonderful!  She was, of course, very professional, attentive and spent time to answer my questions.  When she examined me, her touch was so gentle, I "felt" that I was in good hands.

She reviewed all of my options, legally, she has to tell me all of the options available to me, beginning with the option of lumpectomy because my cancer is so small.  Right from the start, however, I told her that my choice was to have the bi-lateral mastectomy (double-mastectomy) because of my strong family history of breast cancer.  Her following comments were unsettling.

She explained that because Medicaid had refused to remove the accompanying non-cancerous breast of breast cancer patients one year ago, all of the health insurance companies followed suit.  PHOOEY!!!

"Even with my family's strong history, they wouldn't allow for the removal of the other breast?"

"No."

"But, I WANT it removed!  I don't want to have to come back when I'm older and it would be more difficult to heal," I told her.

She said that that would be ok, but, I would have to pay for the "professional fee" of the removal of the non-cancerous breast.  I told her that that is what we have to do for my mental and emotional well-being.

We then talked about reconstruction.  The doctor who had been recommended to me is no longer affiliated with the hospital where my Oncologist and Breast Surgeon are affiliated.  Dr. Talbert recommended another Plastic Surgeon and left the room to see when they might be able to co-ordinate the surgery. Upon returning moments later, she gave me the date of August 13th for the surgery.  Something about that date rang a bell, but, I couldn't remember exactly why.  It wasn't Triskaidekaphobia.

The nurse came to give me paperwork for pre-op labs and as Harry and I walked to the lab, I remembered the significance of August 13th.  That was the day, in 1996, when I was rear-ended in Tucson and my car was totaled and I suffered three herniated disks.  In my books, that was a LUCKY  DAY!!  Because I could have so easily been paralyzed, or even dead!  Yeppir, August 13th is a day when Angels were looking out for me.

Suddenly, my cell phone rang.  It was the plastic surgeon's office phoning to confirm appointment dates.  I explained that I was in a hallway and would have to call her back to confirm the dates of July 15 for the initial consultation and July 22 for the pre-operative office visit.

At the Lab, I was given an EKG, blood was drawn and a chest X-ray was done.  I loved that the hospital was so very organized and all three of these tests were completed in less than an hour!

This morning, I phoned the plastic surgeon's office to cement those appointments.  Tina, the scheduler told me that I was lucky to be able to get in so soon to see this doctor, "I've NEVER seen anyone be able to get in this quickly.  We're booking all the way in to September!"  I told her that throughout this whole ordeal, I have been lucky, as the Oncologist said, "Your lucky stars are aligned in a strong way for you!"

Here's to my "lucky stars!"

Lightening The Load

Today, I'm backing up computer files - my hard drive is dying.  I wanted to sort through a pile of old CDs that have programs on them, programs that I'll never use and I will throw them out.  That's the only type of hoarding I'm guilty of, hoarding computer programs. So, by next weekend, my goal is to have the computer room clutter-free, polished, dusted and carpet scrubbed.

By the end of next week, I'll have a better idea of when surgery will take place, but, there should be one more doctor's visit - to the plastic surgeon.

Great Blogs Are Great Because...

Daily Post: Great or Greatest?

What makes a blog great? What makes you follow a blog or “Like” a post? Photographers, artists, poets: show us GREATNESS.

The blogs I follow are fresh in their daily material. The author's personality is reflected within the stories or anecdotes and I am attracted to the expressive style in which they record their thoughts. I do not have to agree with every post, but in reading the blogs I follow, I am opened to new ideas and viewpoints.

Typically, I click "like" after reading someone's post because more often than not, I do enjoy the article plus, it makes me happy when someone clicks "like" on my post. It is rare that I will pass up clicking "like" and only happens if I stumble upon a spam blog or one which is written for the purpose of spreading hatred.

Coordinate Immediate Reconstruction

Not accomplishing anything today, so, so exhausted, from yesterday's trip to the Oncologist (long day) and the dog waking me up after only 3 hours of sleep yesterday and today, at 5:00 a.m.  That's ok, there was nothing critical to do today other than make a Doctor's appointment for Harry to have his ingrown toenails treated July 9th.

I also phoned the Breast Surgeon and Reconstructive Surgeon's office to inquire about coordinating immediate reconstruction.  The Breast Surgeon will send my information on to the Reconstructive Surgeon and he will contact me for an appointment prior to surgery. This is good news!

 

Coordinating Surgeons

Phoned Talbert and Sawan's office to inquire about their coordinating for the immediate reconstruction (tissue expanders) during the mastectomy.  Talbert's office will contact Sawan's office, forward my case information and Sawan's office will contact me to set up an appointment.

Breast Surgeon consultation is July 8th, typically, surgery is 1-2 weeks later, might be a little longer if scheduling conflicts with the Plastic Surgeon.  I think we are looking at the end of July for surgery, sincerely doubt that it would be sooner, but will update after meeting with the Breast Surgeon.

Stay Busy

Updated Things To Do for Upcoming Week:

1. Go grocery shopping
2. Cook - 3 more meals for when the boys come & after they leave so I don't have to cook
3. Freeze the food I cook  for when I'm laid-up
4. Clean off my desk - I'm more than 1/2 way finished
5. Update finance files - I'm more than 3/4 way finished
6. Shred papers
7. Copy the CD imaging from the Breast Center to take with me to the Breast Surgeon.
8. Finish Washing Guest Bedding & Dust the room 
1. Wash the window & blinds
2. Vacuum & Power Clean Guest Room Carpeting
3. Set up Air Purifier in Guest Room
9. Clean Toilets & Showers
10. Vacuum, Dust, Clean the other rooms' carpets
11. Give thanks! :)

Thankful

Went to the Oncologist, what a long day.  Everything was good though, she answered every question I had and made me feel that I could call her with any questions or concerns I might have, and I felt she was very sincere.  I'm noticing that the professional health people working in Cancer Care Centers are truly caring.  

Forgot to mention that she told me that I am so LUCKY, all the stars are lined up in my favor with the type of cancer that I have and that it will be treatable with pills and no chemo nor radiation.

Thank you GOD!!

Oncologist Visit

Things went extremely well.  I love the doctor!  She had familiarized herself with my situation, and was extremely well-organized with the information she shared.  The best news is that I will NOT have to go through chemo nor radiation, based upon the current test results!Her EXACT words were, "You have lucky stars aligned in your favor!"

Questions that she answered were:

Q:     Will she order an MRI for me prior to seeing the Breast Surgeon?
A:    No, since I want a mastectomy, there is no need for an MRI.

Q:    Who determines the order for a double mastectomy?  Will my extreme family history help in achieving this?
A:    This will depend upon the surgeon and my insurance company.
The family history will play a significant role in the decision.

Q:    What "STAGE" is my breast cancer?
A:     The "stage" will not be determined until after the surgery when all tissue will be examined/tested.
*** The Oncologist did say that my cancer was very, very, very small, a "smidgen".

Q:    Will there be a BRCA test ordered?
A:     She did take saliva for the BRCA genetic testing, but I told her it will probably come back negative since everyone in my family who has had breast cancer was negative.  I then asked her why my family would be so susceptible to cancer but negative for the BRCA gene.  She simply explained that there has to be another gene that my family carries, that science has not yet discovered.  Makes sense to me.

Q:    Estrogen Blockers - I expressed my concern with the side-effect of stroke from estrogen-blockers because of family members who had strokes.
A:    Oncologist said that she would be leaning toward either Femara Oral, or Arimidex Oral, both of which have lesser side-effects and note associated with strokes.

Lots to do Thurday, but I am exhausted.  It was a very long day, the drive and since we arrived early, we had to wait a little more than an hour - waiting is so tiresome!  All in all, it was a terrific day!

**Note:  These are the two different choices of post-op drug therapy, I need to investigate their side-effect further, at least they don't mention "stroke":

Femara Oral:   http://www.webmd.com/drugs/drug-4363-Femara+Oral.aspx?drugid=4363&drugname=Femara+Oral

Arimidex Oral:  http://www.webmd.com/drugs/drug-4511-Arimidex+Oral.aspx?drugid=4511&drugname=Arimidex+Oral&source=1

Questions For Oncologist

QUESTIONS  FOR  ONCOLOGIST:

Will she order an MRI for me prior to seeing the Breast Surgeon?  This will expedite this process.

1. Who determines the order for a double mastectomy?  
2. Will my extreme family history help in achieving this?
3. Breast Cancer in Maternal family
1. Mom
2. Aunt
3. Jenna - Niece
4. Linda - Cousin
5. Annette - Cousin
4. Breast Cancer in Paternal family
1. Agnes - Aunt ** died from the breast cancer
2. Sally - Cousin
3. Diana - Cousin ** died from the breast cancer
4. Ginger's daughter - Cousin
5. What "STAGE" is my breast cancer?
6. Will there be a BRC test ordered?
7. Estrogen Blockers - concerned with side-effect of stroke - persons in family who had strokes:Maternal Grandmother - recovered (non-smoker)
8. Maternal Uncle Frank - recovered (non-smoker)
9. Maternal Aunt Jenny - died from stroke (non-smoker)
10. Does she have any information on the benefits of an Alkaline Diet?
11. These are all of the questions I have so far, there are still a few more hours prior to my appointment, I may come up with more.

Breast Cancer Pathology Report

PATHOLOGY REPORT

Estrogen Receptor	95% favorable
KI67 MIB-1	2% Borderline
DNA INDEX	1.00 Diploid
HER-2 NEU (FISH)	NOT  AMPLIFIED

ESTROGEN RECEPTOR 95% FAVORABLE - PROGESTERONE  RECEPTOR  80% FAVORABLE. 
The hormone receptor status of your tumor helps guide your treatment plan. If your tumor is ER+ and/or PR+, treatments that prevent the cancer cells from getting the hormones they need to grow (such as tamoxifen or aromatase inhibitors) may stop tumor growth. Tumors that are ER- and PR- are not treated with hormone therapies.

KI67 MIB-1    2% BORDERLINE 
The proliferation rate represents the percentage of cancer cells that are actively dividing. In general, the higher the proliferation rate, the more aggressive the tumor tends to be. The Ki-67 test is a common way to measure proliferation rate. MIB1 is the antibody most often used to label the Ki-67 antigen. You may see these terms on your pathology report. A higher value shows a higher proliferation rate.

DNA  INDEX     1.00 DIPLOID DNA Index of 1.0 means that the cells are diploid and are similar to normal breast cells in their DNA content.  A DNA content that is aneuploid has an abnormal DNA content……… About 70% of breast cancers will be aneuploid and 30% will be diploid.  The 5 year disease free survival for women with diploid tumors is 88% and for women with aneuploid tumors is 68%. The 5 year disease free survival for patients with a diploid tumor and a low SPF is 90% ………

HER-2 NEU (FISH)     1.2 (NOT  AMPLIFIED) HER2/neu (human epidermal growth factor receptor 2), also called ErbB2, is a protein that appears on the surface of some breast cancer cells. It is an important part of the cellular pathway for growth and survival.

• HER2/neu-positive (HER2+)tumors have many HER2/neu genes inside the cancer cells (also called HER2/neu over-expression) and a large amount of HER2/neu protein on the surface of the cancer cells
• HER2/neu-negative (HER2-) tumors have few HER2/neu genes inside the cancer cells and little or no HER2/neu protein on the surface of the cancer cells

About 15 to 20 percent of breast cancers are HER2+ [29-30 ]. These breast cancers tend to be more aggressive than other tumors. HER2/neu status helps guide your treatment plan. HER2+ cancers can benefit from trastuzumab (Herceptin) therapy, which directly targets the HER2/neu receptor. This type of therapy is not used to treat HER2- cancers. Both the  American Society for Clinical Oncology  and the National Comprehensive Cancer Network  recommend HER2/neu testing for all tumors. HER2/neu status can be determined in two ways:

1. Immunohistochemistry (IHC) testing which detects the amount of HER2/neu protein on the surface of the cancer cells
2. Fluorescence in situ hybridization (FISH) testing which detects the number of HER2/neu genes in the cancer cells

Most often, IHC is the first test and if the score is +2 (or borderline), the tumor is sent for FISH testing to confirm the status.

RESULTS  OF  AN   IHC  TEST
Score is 0 or +1	Tumor is HER2-
Score is +2	Results are unclear and should be confirmed by FISH
Score is +3	Tumor is HER2+
RESULTS  OF  A  FISH  TEST
Positive (amplified)	The tumor is HER2+
Negative (non-amplified)	The tumor is HER2-

Prognostic Series of Biopsy Report

Spoke w/ Ashley (in the Lab Dept. at the hospital) this morning, explained that Valerie (another Lab Dept. employee)  had told me to call this morning to see if my prognostic series portion of the Biopsy report was available for pick-up. No, it was supposed to have arrived overnight or early this morning, she told me to check back after lunch.

Meanwhile, today's things to do:

• Double-check all documents and imaging CDs to take to the Oncologist tomorrow
• Wash guest bedroom curtains
• Finish checkbook, filing and shredding
• Spray showers/tubs
• Clean toilets
• Definitely take a nap today, I stayed up way too late last night for the hockey game and couldn't sleep afterward!  Go Hawks!

On another note, I ordered an air purifier for the guest bedroom for Ry, I'm so worried about his allergies out here.  The purifier will arrive tomorrow.

 

 

Sunday - Rest Day

My list of things to do yesterday was not completed, but I did cross off a few of the tasks:

1. Go grocery shopping
2. Cook - roast beef, beef stew, spaghetti, stuffed peppers
3. Freeze the food I cook today for when I'm laid-up
4. Clean off my desk
5. Update finance files
6. Shred papers
7. Copy the CD imaging from the Breast Center to take with me to the Oncologist.
8. Relax, take a nap, watch a funny movie - Slapshot
9. CANCEL  STORM  SHELTER  INSTALLATION!!!!!!!!!
10. Give thanks! :)

Updated list of things to do this coming week:

1. Clean out Kitty Litter
2. Call for Pathology Results
3. Clean off my desk
4. Update finance files
5. Shred papers
6. Copy the CD imaging from the Breast Center to take with me to the Oncologist (6/23)
7. Visit Oncologist - Wednesday, June 26, 2013
8. Always give thanks!
9. Clean guest bedroom carpet
10. Wash guest bedroom curtains
11. Wash guest bedroom bedding & pillows
12. DUST guest bedroom
13. Spray for insects!

Laughter and Loving Sons

Joe, my eldest son phoned to check in on me; we talked for a really long time, nearly busting a gut laughing so hard!!  He informed me that he will be driving with Ryan, my second eldest son,  to visit when I go in for surgery!  

That ought to be a good time, even though I'll be drugged up on pain pills.  It will be so wonderful to see my 40+ year-old babies!!!!

Planning Ahead

Woke up at 5 a.m. today, laid in bed for another hour, listening to the birdies chirping outside and Opie running around the bedroom like a lunatic, chasing imaginary dragons!  When my thoughts of what I need to do today roused my brain to full consciousness, I got out of bed, had a sponge bath, dyed my hair with non-permanent hair dye, fed the dogs and gave them their insulin shots and had breakfast.   Now, I'm ready for the day.

Things to do today: (not in any particular order)

1. Go grocery shopping
2. Cook - roast beef, beef stew, spaghetti
3. Freeze the food I cook today for when I'm laid-up
4. Clean off my desk
5. Update finance files
6. Shred papers
7. Copy the CD imaging from the Breast Center to take with me to the Oncologist.
8. Relax, take a nap, watch a funny movie - Slapshot
9. CANCEL  STORM  SHELTER  INSTALLATION!!!!!!!!!
10. Give thanks! :)

::::::::UPDATE::::::::

Vayda has not been eating her food in the mornings. Her left back paw pad is terribly raw, she's been chewing on it, this happens every year and we thought it was from allergies. We just noticed a HUGE lump in her right side by her shoulder.  Damn!

Two Down and Waiting

I don't remember what I had to do this morning, but I did reach the Surgeon's office and pressured to make an appointment.  The next available opening was at 1:30 p.m. July 8, 2013.  Crap!  That seems like a lifetime away and what if this cancer is an aggressive type?  I accepted the appointment and figured that after I get the pathology report and see the Oncologist  next Wednesday, she'll let me know if I can or cannot afford to wait.  I need to be smart about that which I choose to worry.

Waiting is going to be a big part of this journey.  Ugh!

Sleepless With My Fears

© Google Search

I’ve been upbeat about this whole episode in my life, honestly, my attitude is that I have already won, I just need to inform the enemy that he’s already dead. So… it’s like clean-up.  But, I’m really, really tired because my brain just won’t shut off when it’s bed time.

To this point, there was so much to think about, finding good doctors, forcing my doctor to refer me to these doctors that are not part of his hospital system, researching my health insurance plan to be sure that these doctors are within my insurance network.  Obtaining imaging CDs and reports, only to find that the Breast Center had duplicated one of the CDs and I’m missing one report dating back to 2009.  I don’t think I’m going to bother with that one because it had been declared normal and healthy.

© Google Search

I think I’ll sleep very well tonight, knowing that I’ve got 2 appointments confirmed.  I know those could change if the pathology report comes back really bad and I need to get in to see the Surgeon sooner than 2 weeks from now.   At that, I don’t know how much of a wait there will be after I get in to see her!

Meanwhile, tomorrow, my husband is taking me grocery shopping,  something we have NEVER done together! I am making a menu and grocery list for meals that I am going to cook in advance and freeze so that no one has to worry about making dinners.

Confirmation and Planning

No appointments, nothing scheduled other than searching local hospitals and surgeons and their reputations.  That's an overwhelming task, but, I had no other choice, I was determined to NOT use the "house" surgeon.  By 8:30 a.m., my husband phoned to tell me that he had a "lead."  A fellow with whom he works, knows a woman, a close friend of his wife's, who had breast cancer last year.  Kevin offered to get all of the doctors' names and phone numbers for me.  He further explained that Nicole, the breast cancer survivor, was a very credible, upstanding, intelligent, successful woman and did her own in-depth research before choosing her doctors.  My husband took the information and called me to explain that she will be expecting my call.

When I tried phoning, her line was busy.  A few minutes later, she called me.  Cassie told me as much as she knew about Nicole's journey adding that she had asked Nicole if it would be alright for me to phone her if I had any more questions.  Of course, Nicole said she would gladly answer any questions I might have.  And Cassie gave me the names of Nicole's Breast Surgeon, Oncologist and Plastic Surgeon.

I tried phoning Nicole, but there was no answer, I left a voice message and returned to my computer to research the names of the doctors which Cassie had given to me.  WOW!  I was impressed!

***

9:00 a.m., I phoned our family doctor's office to see if they could refer me to doctors who are not a part of their hospital system.  The scheduler told me that they don't like to do that.  She asked why I didn't like the surgeon that they had and I said that I wasn't impressed with her credentials.  Nothing was accomplished with this phone call.

9:15 a.m., my family doctor phoned me, with a shaky voice, he told me that he had bad news.  I stopped him mid-sentence and said that I knew and asked for particulars about the cancer.  He explained that they did not yet have the pathology report but the biopsy doctor phoned my doctor, telling him that I need to see a Surgeon and Oncologist.  He was going to transfer me to his scheduler, when I stopped him again, telling him that I didn't want the doctor at Saints, I wanted different doctors.  He was fine with that and told the scheduling girl to do what I wanted.  WHEW!

2:00 or 3:00 p.m., the Oncology doctor's office phoned to schedule an appointment for next Wednesday, June 26th.  Whew!  One down, one to go.

3:30 p.m. I took it upon my self to phone the breast surgeon's office to expedite my appointment scheduling.  The girl who answered was 'new' and couldn't help me but promised that the nurse would phone me back that day.  Never happened.

Ready, Set, Worry

The Stereotactic biopsy was performed.  If anyone wants to know or see exactly how the procedure is performed, YouTube has an excellent video of it here: 

 http://www.youtube.com/watch?v=69cNo1h5pzc

After the procedure, the attending doctor told me that he is certain this is cancer.  He said that my primary care doctor would receive the reports by Monday, June 24th and that my family doctor should call me with the results to schedule a lumpectomy.  He stressed that if I didn't hear from my family doctor early Monday morning, I would need to phone them for the results.  His attitude was very, very emphatic!

I was also given after-care instructions to apply an ice pack to the area for 15 min. on and 15 min. off throughout the rest of the day and not to lift anything other than the television remote control!  "Just sit and watch t.v.!"  So, I did kind of...
I thought that I might be able to expedite things, so I phoned my family doctor's office to speak with the scheduling nurse.  My intention was to ask her if she could start the scheduling already.  I know, I know, that's impossible without the biopsy and pathology report, but, I tried anyway.  Of course, what I was asking was impossible, so I asked the nurse if she could give me the names of the Breast Surgeons that are part of their hospital network.  She gave me the name of one.  This whole hospital system only had ONE breast surgeon!  I wrote down the name and began my research.

I did not like the fact that there was only one breast surgeon and no other choice/option. The breast surgeon did not have outstanding credentials nor experience.  I was adamant that I would research and find the best doctors, but how could I do that with my limited local-people-networking???  That's when I really started to worry.