2B or not 2B?

Frank and I saw Dr. Kuan today, to go over the pathology report and to discuss chemotherapy. What a long appointment.

First, the details. The CT scan showed the breast lump and the rather large lymph node in my armpit, but that's it. So, yay, we get a zero on the M(etastisis) for the TNM staging for breast cancer. We told Dr. Kuan that Dr. Broderick had said I was staged at 3A (67% survival rate) and she looked confused. She said, no, a T(umor)2 and N(odes)1 meant a 2B. She looked through the pathology report and we talked about lymph nodes that are "matted," which can move a stage 2B to a 3A, but she said the pathology report showed no indication of this, so we're going to take that 2B with no further argument, thank you very much. All in all, given the TNM "score" combined with the fact that the tumor was "high grade" (i.e. aggressive), gives me a 75% survival rate. (But as my oncologist friend, Carla, reminds us, "these statistics refer to large numbers of people, not to individuals.")

After clarifying those details, Dr. Kuan let me know that the cancer center is doing a clinical test on Taxol infusions. If I sign up for the test, my chemotherapy would consist of 4 bi-weekly infusions of Doxorubicin (Adriamycin) and cyclophosphamide [abbreviated AC], and then either 12 weekly infusions or 6 bi-weekly infusions of paclitaxel (Taxol). The benefit of taking part in a clinical trial, of course, is that you have even more doctors watching your condition. So, despite the fact that weekly infusions would be a drag from the perspective of getting on with life, we are considering it.

We got to meet the nurse for Dr. Kuan's practice, Lisa Mune, who showed us how the "port" works for the chemo infusions. You can go here for an image of where the port goes. This port, which is surgically inserted under the skin, enables the nurses to give me my chemo meds and to draw blood without having to find a vein every other week. We're hoping that Dr. Broderick can put in the port when he's doing the recision to get more of the margins (still no word on when that will occur, yet).

But, if you look at the image, you'll note that meds go right into the vena cava, which leads right to the heart. So, to make sure my heart can handle all this (the Adriamycin, the "A" part of the AC, is hard on the heart) I'm having a heart scan (MUGA) on Thursday morning.

Whew. What a day.

On a positive note--I went camping this past weekend with the moms and daughters in Maggie's girl scout troop. There were four girls and four moms in Marin and it was lovely. I came home on Sunday utterly exhausted. But I'm figuring I won't be doing much of that kind of thing for at least the next six to nine months, and I wanted the Maggie time.

Houston, we have a "stage"

My surgeon removed the drain today--yay! I had no idea how much it was irritating me. No, I mean, I know it was bugging me, but I didn't realize how much of the discomfort in my armpit was due to the little plastic tube up there. Now it's out and I feel better already. :-)

Bad(ish) news--the margins on the tumor were a bit close, so he wants to go back in and remove more of the edge around the existing "cavity" (where the tumor was). (The tumor was about 2.5 cm.) Since there definitely won't be lymph node involvement this time, it actually *will* be same day surgery. But, of course, we have to go through the approval process (again) first. So, everyone be thinking positive thoughts along the lines of "surgery next week, surgery next week, surgery next week".

And of the 18 lymph nodes they removed, 3 of them were positive.

This makes me T2 and N1 in the cancer staging. We're assuming (hopinghopinghoping) that the M (metastisis) is a 0. Hopefully the CT scan taken last week confirms this. I'll know more, I'm sure, when I meet with the oncologist on Monday.

The surgeon says they're staging this as a 3A. Not fantastic, but not end of the world, by any means. And, we're lucky enough to live in a nice metropolitan area, with access to extremely fine care.

Meanwhile, we continue to be touched by the genuine help and good thoughts we're continuously receiving. We can't thank folks enough. Please just know how much we do appreciate your thoughts and words.

Surgery? Check.

To everyone who has been sending the positive energy and kind thoughts and words (and flowers and chocolates and tea and housecleaning and, the list just goes on and on....) thank you. We have felt your love most sincerely and we most sincerely appreciate it.

I got discharged a bit late today--it seems that my surgeon was assigned another case today and I'm thinking he assumed someone else from his office would see to my discharge, but, no such luck. So, after figuring I'd get to leave the lovely Summit hospital around 11 this morning, I actually got to walk out the doors around 4:30 p.m.

And sleep last night? Sheesh. You need sleep to heal, but heaven knows that the hospital is not the place to get sleep. Between being awakened to have my blood pressure checked every 4 hours, and my IV bag going empty and beeping at 3 a.m. and, well, oy vey, I got about 5 hours sleep last night. I'm sooooooo looking forward to sleeping in my own bed tonight.

For the very brave of heart, there is clinical pre-op info down below, but don't feel compelled to read this. I only put it here for the gluttons for punishment (like myself).

I'll be checking in with my oncologist on Tuesday and the surgeon on Friday. The surgeon will need to put in a port for the chemo, but I'm sure that happens a bit closer to chemo, which will likely start in about 4 weeks (after we take Em off to Santa Barbara).

So, there won't really be much news until next week, and so we'll have a bit of a lull in these updates. Thank you again, so very very much, to everyone.

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Here be the icky clinicial stuff........

So, we arrived at the Breast Health Center at the Summit "campus" and first up were the "wires". Guided by ultrasound, the very nice doctor (Dr. Kanter is an opera fan, so he and I had a very nice discussion and he heartily recommends I take in the Seattle Opera's ring cycle), inserted wires on either side of the so-called mass, to guide the surgeon. The wire insertion was preceded by local anesthetic, so it didn't hurt. But he had to wiggle the needle inside the breast to see it on the ultrasound, and I was a teensy bit concerned that the lidocaine would wear off before I got the general anesthesia for surgery. (It didn't <whew>)

Then off for a mammogram that showed the wires.

I had to get in a wheelchair and then in an ambulance to be taken the whole 4 blocks to the hospital. Arrived there around 9:30, got checked in to Same Day Surgery, and then wheeled down to Nuclear Medicine. Probably the worst part. They need to shoot isotopes into the breast to "highlight" the sentinel lymph node(s). Which means a needle under the nipple. This, too, was preceded by local anesthetic. But still? Something I'd prefer to avoid in the future.

Loaded with wires and isotopes, I was wheeled back to Same Day Surgery, where I met the kindly anesthesiologist, who checked to make sure I had no allergies, blah, blah, blah. I got wheeled over to surgery, they put something dopey into the IV and then put the mask over my face. I remember thinking, "oh, the mask is over my face" and then I woke up in recovery.

I felt fine until the nurse told me I would not be returning to Same Day Surgery, but would be spending the night because I knew that meant they found something in the lymph nodes. Damn, damn, and double damn.

I'm not experiencing much pain and I've been good about moving the left arm. I have a drain from the surgical wound, and will need to empty it for about 4 days. But all in all, this is not all that bad. Certainly easier than chemo will be. More on that after we get the pathology report and have my doctor's appointments next week.

From Frank

Hi all friends and family and assorted loved ones. Karen is in the hospital tonight, so she asked me to post everyone about her status.

She is in good spirits and quite chipper after a rough day of surgery.

She has been pretty clinical and detailed, so in that vein, I'll do my best: After pre-op poking her with wires and injecting her with various unnatural substances starting at 7:45 a.m., she went into surgery at 12:00 noon, and was out a little before 3:00. They took out the tumor, and will be studying it for the next few days to gain confidence that they got all of it. They also took out her "sentinel lymph node" and tested it for cancer. It tested positive, so they had to go in and take out all her lymph nodes on that side. They will be testing them over the next several days to determine if they are cancerous. The prognosis will be influenced by the number of lymph nodes affected. Frankly, the oncologist has made it pretty clear that an aggressive treatment of chemotherapy is in Karen's future.

She's extremely brave and in good spirits. I have extended all of our love to her, and I know she appreciates the extraordinary kindness that has been shown, including notes, calls, flowers, dinners, cleaning, and checking in on the girls. Really amazing, and I know she feels very much loved. As she should.

The Waiting Game

Well, now we're just waiting. And rather than have people fret and wonder what the heck is going on, I'll just give you the situation, as we currently know it.

We got the pathology report last Thursday just before meeting with the surgeon. Technically, all we know so far is that I have "invasive DCIS (ductal carcinoma in situ)". It appears that there is lymphatic and/or vascular invasion. But they can't know anything for certain until I have a lumpectomy. Which will happen as soon as we can get approved. Which will happen in five to ten business days. Argh! Insurance: blessing or curse?

Anyway. We're probably looking at surgery next week, sometime.

The surgeon is on the young side (Frank might prefer it if he wasn't so handsome. Me? I'm wondering if he's too old for Emily....) But very capable and Frank and I both felt assured and confident in his abilities.

During surgery, they'll check out the lymph nodes. If they look bad, they'll remove them at the same time as the lump. Afterward, they'll test the margins of what they've removed, to ensure they got everything.

But meanwhile? We just wait.

I'll email again when we've got a date for surgery.

(Also, please feel free to forward this to whomever you like. If I've missed anyone, my sincerest apologies.)