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Here are some thoughts and observations while we await a call from the Oncologist’s office letting us know that a treatment plan has been formulated.

Was our decision to proceed with the bi-lateral mastectomy the correct option to take? Well, let’s list the options:

  1. Stop at the lumpectomy (the second one in less than a year), take Tamoxifen for five years, have a breast MRI in six months, then six months later have a mammogram. The cycle of MRI and mammogram procedures would last five years, or until a cancerous tumor appeared.
    • Diane tried the Tamoxifen and did not tolerate it very well. Then add the apprehension and cost of undergoing a breast MRI or mammogram every six months and it seemed intolerable to us. Plus there was the real possibility that more lumpectomies would need to be performed.
  2. Have the bi-lateral mastectomy and the reconstructive surgery, which should reduce the risk of breast cancer forming in the future.
    • The pathology report from the second lumpectomy showed that there was a real risk of cancer appearing in the near future. We had more than eight years where we did not have the apprehension and worry leading up to the results of the imaging procedures every six months.

Here are some advantages to our situation as it is today:

  • Diane has already gone through the pain and discomfort as a result of the bi-lateral mastectomy and the following breast reconstruction.
  • A lumpectomy will be sufficient to remove the cancerous mass.
  • The existing work done for the breast reconstruction should not be affected.
  • The formation of cancer may have been delayed because we elected to have the bi-lateral mastectomy done pro-actively.
  • The pathology report from the second lumpectomy showed that there was a high risk of two different aggressive cancers forming in either breast and the initial findings so far show the cancer to be a less aggressive type of cancer.
  • In the past nine years there have been advancements in the treatment of cancer i.e. adjustments have been made in the order of the procedures that will need to be done, the drugs used for the chemotherapy and nausea are improved, and there is hope that hair loss can be lessened through the use of cold cap therapy.

The only disadvantage I see is that Diane is eight years older now, which was one of the factors in our decision to proceed with the bi-lateral mastectomy.

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Diane’s breast surgeon’s office just called and she is scheduled for a breast MRI early Friday morning. Apparently the Oncologist and the surgeon decided that they want more information before deciding on a treatment plan. This may have something to do with the lymph nodes above the breast that showed some abnormalities on the images from the ultrasound and CT/PET Scan. This is not a surprise to me since the Oncologist told us that there were contradictions in the test results and he wanted to consult with others before laying out an initial treatment plan.

Diane is very special to so many people for countless reasons. I am not going to attempt to list them here. Those of you that know her personally have had the pleasure of experiencing some of her many special qualities.

The fact that she has been diagnosed with cancer after undergoing a bi-lateral mastectomy in an effort to try to avoid breast cancer from forming, is a rarity. We are now aware of additional reasons that make her special after our visit with the Oncologist. He informed us that the treatments he prescribes are unique to the individual, but they usually follow certain norms. Diane’s case seems to be a first for him and he is an experienced doctor that appears to be in his upper sixties.

I had done some research about treatment options before our appointment and the oncologist seems to be in the know about current treatment protocols, including the new options for the scheduling of surgery, chemotherapy, radiation, and estrogen blockers. It is a common practice now that chemotherapy is administered before surgery and in some cases chemotherapy is not prescribed at all, just radiation, then estrogen blockers afterwards.

The oncologist discussed the results of the ultrasound, the biopsies, and the CT/Pet Scan with us. As a whole the findings are a bit unusual in that the results create some very important questions. I won’t go into specific details except that there are two important issues under consideration.

The first is whether chemotherapy should be administered at all, and if so, when. There is some question whether chemotherapy will be effective in shrinking the mass. The combined findings of the pathology report and the estrogen testing somehow include contradictions about whether chemotherapy will be effective. Why expose the body to the rigors of chemotherapy if it will not be effective in shrinking the mass? There is a genetic test that can be done that may show whether chemotherapy will be effective, but as with any testing, it is not 100% accurate. This test would be performed on the biopsied tissue and would delay the beginning of treatment by two weeks.

The second revolves around the results of the ultrasound and CT/Pet Scan that show abnormalities in the shape of the two lymph nodes that are above the breast but do not definitively show that the nodes are cancerous. Is this enough of a reason to tip the scales in favor of recommending that chemotherapy be administered?

The Oncologist will be consulting with other doctors within his circle of peers and then he will be discussing the situation with Diane’s breast doctor/surgeon. Once he has formulated a treatment plan he will call to discuss his recommendations with us and then we will decide on how to proceed. We want to make sure that we consider the benefits and risks involved and make sure we have done all that we can so that Diane may live a long and hopefully healthy life afterwards.

We were told on Monday, the 11th of June, 2018 that Diane has breast cancer.

Diane was at the city pool putting lotion on and she noticed a lump at the top of her breast. The lump was about the size of a quarter. We decided that it should be checked out by her gynecologist. The doctor examined her and scheduled an ultrasound at the imaging center. Upon completion of the procedure, the radiologist reviewed the images and recommended a biopsy be performed. Several days later needle biopsies on the mass and a lymph node under her arm were performed. The pathology report showed that there were cancerous cells in the mass but not in the lymph node.

There are more lymph nodes above the area where the mass is, but they are not available to do a needle biopsy on because of the anatomy that surrounds them. It would be too dangerous to attempt a biopsy on them, there is some concern about these lymph nodes due to the irregular shapes that appeared on the ultrasound images.

As you may know, we elected to have Diane undergo a bi-lateral mastectomy in order to avoid such a diagnosis from occurring. The odds were in our favor, but not 100%. After a mastectomy there can be trace amounts of breast cells/tissue that does not get removed. That was enough for a cancerous mass to form therefore creating this serious health issue we were hoping to avoid, the type of cancer is a lobular carcinoma. This is the second most common form of cancer behind ductile carcinoma. The cancer is at a stage 2, so it was found early enough to make a difference.

Diane’s surgeries always makes me nervous, hopefully this is the last in a long series of procedures. The surgeon told me he trimmed the stratus and added a few suture points to tighten the pockets. He said all looks real good now, Diane should be pleased with her decision.

Diane was taken to surgery around 8am and I saw the surgeon shortly after 10am. The recovery time will be much shorter than the previous procedures since no muscle work was involved. There are no surgical drains to mess with either.

More later.

Diane is having surgery to take out some scar tissue that the surgeon thinks has formed on the bottom corner of one of the pockets of the internal “bra” that holds the implants in place.  The surgeon used irradiated muscle stratus to form them, the patient’s body grows tissue within and around the foreign muscle that eventually becomes part of the body.

A ribbon of scar tissue has formed and is causing irritation and pain on her ribs.  During the day her undergarments put pressure there and at night she has trouble sleeping on that side.  Massaging the area on the other side helped to keep scar tissue from forming but on this side it did not help as much.

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We are approaching three months since Diane had the expanders removed and the permanent implants put in place.  Diane is doing well, there is some muscle pain yet and those crazy twinges from the nerves firing off as they recover.  The amount of pillows Diane needs to support her while sleeping is gradually diminishing.  She can sleep on her side for short periods too, but she still gets sore when she does.

Diane has been walking, getting back in shape.  She had gained weight because of the reduced physical activity and the need to eat every time she took medicine.  The city has added some nice paved walking/running paths in the greenbelt (floodway) in the past couple of years which makes the activity much nicer than utilizing the city streets and sidewalks in the past.  The greenbelt is just half a block away so it is convenient too.

Diane’s mom is getting married in the middle of November so we will be seeing a lot of family and friends for the first time since all this began a year and a half ago.  Diane should be doing just fine by then and will be able to thoroughly enjoy the time with her mom.

Sunday I removed the pain ball tubing.  It was inserted between the breasts and then had extremely sticky clear tape covering it to help keep it in place.  Approximately four inches of the tubing had to be pulled out, Diane said it felt weird as I pulled it out.  The ball was in a fanny pack that Diane had to lug around or find a place to set if she was sitting or lying down.  Diane was thankful to have one less accessory to carry around and get in the way.

Wednesday we visited the surgeon’s office and the nurse removed the rest of the external plumbing, the surgical drains.  They serve an important purpose but they are a pain in the “you know what”.  Diane commented on the amount of fluids that we emptied out of the drain reservoirs over the week since the surgery.  It would be a lot of fluid for the body to absorb and get rid of on its own.

The tubing was inserted lower on her sides this time, last time they were inserted at her arm pits.  The lower location was a little less irritating than at the arm pits but the tape still caused plenty of irritation and itching.

The nurse that removed the drains was real nice, she assists the surgeon when he performs procedures in his office.  We have had a wonderful team taking care of the princess, they have been professional, extremely skilled, and will patiently answer all questions put to them.  We are pleased with the final result so far barring any last minute complications.

What a long day we had yesterday.  I was up at 5:15am so I could be at the job-site by 7am to go over everyone’s duties for the day.  I went back home after a couple hours, ate a nice breakfast, then we headed to the hospital to check-in.  The check-in process went quickly, they are beginning to know us there, plus a lot of the info could be transferred over from our last visit.

Then off to the out-patient surgical center where we saw more familiar faces.  More questions to answer while another technician checked blood pressure, oxygen levels, pulse, etc.  The IV was administered, this is always an adventure due to Diane’s small, tough, rolling veins.  Then the waiting began.

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It is 9:30PM and Diane had ice chips, crackers, Jello and water.  She was given pain meds, plus Valium for muscle spasms.  Now she is resting while antibiotics are fed to her through the IV.  We are still scheduled to go home tonight.  What time that will be we don’t know yet.  It could be a longer night than we were expecting.  Whenever you miss out on the outpatient dept checkout procedures, the process seems to drag on forever.

The power just went out for a couple seconds, the lights went out and there was silence.  It has been raining but it has not been storming here.  Maybe there are some storms in the area that affected the power.  Very strange.

Breast Cancer Awareness

Breast Cancer Awareness

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