Meeting with the Surgeons; And More!

So I had appointments with three surgeons. Some of the stuff I read said you should meet with a few surgeons, to find one you were comfortable with. So I met with 3. One that my GP recommended & works with, one a co-worker recommended from her bout with breast cancer a few years ago, and one from Georgetown U. Hospital. I would have gone to see more, but one was on vacation the week I was looking for surgeons, and the other didn't take my insurance, which made that decision easy. On Tuesday, 10/14, I went to see the first surgeon, who was as cute as my GP had warned. Tee hee! Hello, doctor! I went to see two others on Thursday, 10/15. The one at Georgetown in the morning, and the other in the afternoon. I ultimately decided to go with Dr. Costanza Cocilovo at Georgetown, who is great. I liked all three doctors, and I wasn't worried about any of their credentials, so it was nice to have a choice. Georgetown is halfway between me & my parents, plus it's pretty close to work, which will be a lot easier for follow-ups, etc., especially if they're in the middle of the workday. Also, Georgetown has a whole cancer center (the Lombardi center, named for the famous football coach, who went there during his bout with cancer), and within the cancer center is a center specifically for breast cancer (the Ourisman Center, which I believe is the same Ourisman family who owns a bunch of car dealerships in the DC area). It's also nice to have almost everyone under the same roof (more on that in a sec). During that initial appointment, we discussed treatment options. She said I would definitely need chemo, so goodbye hair - and I had just started growing it out. Sigh! She also mentioned the possibility of egg harvesting, as chemo can push you into early menopause, which you may or may not come out of. She referred me to Dr. Eric Widra with Shady Grove Fertility (who is supposed to be on the cutting edge of freezing things), so he's the one guy who's not under Georgetown's purview, since GUH is a Catholic hospital, and the Church still frowns on those sort of 'playing God' kind of things. Hey, at least they're consistent.

So in between these visits to surgeons, Wednesday 10/15 specifically, I had a breast MRI, which was interesting. They put an IV in, and take some pictures without a dye, and some with. You lie face down on a board with a face support, like on a massage table, and two holes, for the subjects in question. Then they take a picture for 3 minutes, then a picture for 1 minute, then a picture for 2 minutes. Then they turn on the dye, and repeat the process. All the while the MRI machine is making these loud buzzing & humming noises, in different tones. Sort of musical, if your mind tends towards those kind of things. That loud clubbing, type of music - you can feel the vibrations going all through your body, because it's very loud (they give you earplugs).

Next appointment was on Thursday, 10/23 with Dr. Minetta Liu, oncologist. She's also great. Very warm, (hooray for bedside manners!) and knowledgeable, and has no problem taking extra time to explain things, and make sure you understand all your options. In fact, we ('we' is generally my mom & I) didn't see her until a good couple of hours after my appointment time . . . but what's a couple of hours for a doctor you like? And what would I be doing anyway, working? She was upfront about the fact that she's always running behind, so I guess that's all you can ask for - forthrightness! In fact, when we got out of there, everything was shut down, and everyone was gone. It was kind of spooky, like being in your office on a Saturday. Dr. Liu suggested neoadjuvent chemo, which is chemo before surgery. The benefit of this would be a) seeing if the chemo is actually working in shrinking the tumor, so they can adjust what kind of chemo or dosage or whatever, and b) shrinking the tumor, so the lumpectomy will not have to be as invasive, and I have a better chance of coming out of surgery with evenly-sized boobs. The downside is that I'll still have the tumor inside of me, which some people have a problem with, still having the cancer sitting there inside you where you can feel it. I hadn't really thought of it that way until she brought it up. Thanks, Dr. Liu! One more thing to panic about! No, I'm not panicking about it. I like the idea of seeing the chemo shrinking it, so we know it's working, an option that's not available if you go ahead with surgery first. In some (relatively rare) cases, the tumor will shrink so much, they'll have hardly anything to excise. Here's hoping!

So that afternoon, and Friday (10/24) morning, I joined a study for genetic counseling. We don't have a family history of breast cancer, but we also have a very small pool of women. We also have a strong history of cancer, in general. Three out of four of my grandparents died from one cancer or another, and my dad had prostate, which he has thankfully beaten. So, given that genetic mutations in the BRCA-1 & BRCA-2 genes are rare, and only account for 5-10% of breast cancer cases, chances were that I didn't have a mutation. So why get the testing? Well, having cancer doesn't imply that you'll have the gene, but having the gene strongly implies you'll have cancer again. Maybe in the other breast. My results have come back negative (phew!), but if they had come back positive, I would have seriously considered a prophylactic double mastectomy and possible oopherectomy (not sure on that spelling - it's removal of the ovaries, as the mutation also affects ovarian cancer rates). So, I am relieved to have one thing I don't have to worry too much about!

Monday, October 27 through Monday, November 3, Mom & I went out west, first to San Diego to visit some cousins, then down to Cabo San Lucas for another cousin's wedding. It was fantastic, and I forgot I had cancer for awhile! Be careful of the water, though. I had a (very mild) case of Montezuma's Revenge. It went away when I did like the pilgrims & drank beer instead of water. Hey, it was Corona, so it wasn't far off from water. Also: all-inclusive resorts are the way to go. We didn't have a mini-bar - we had a mini-fridge with sodas (aka mixers) & a bar with full-sized bottles of tequila, rum, vodka, and whiskey. So after a lovely wedding, with lovely people, and releasing of some baby sea turtles (SO CUTE!!!), we flew home. Keanu Reeves was on our plane going back to LA! He was just as gorgeous as ever. And we were thisclose to making eye contact. It's true! I think, much like me, he was trying to get away from his troubles for awhile. We have so much in common! Call me, Keanu! Luckily for him, his troubles are over, since he was cleared in that paparazzo case. If only we were all so lucky!

So, the following Wednesday (11/5), I went to meet with Dr. Widra about egg harvesting. He had some blood drawn (last time for my left arm!) and did an ultrasound of my ovaries. I'll spare you the details of how he did that, but no, they don't just put the ultrasound on your belly. Yeah, they do it that way. I had 10 developing on the right and 6 on the left. Come on, leftie, catch up! So everything points to a good possibility of having a good-sized litter, which is really what you want when you're harvesting. And, bonus, it looks like insurance is going to cover it. Which is nice, because I really have no money right now.

Thursday, 11/6, I went in for a sentinel node biopsy and possible axillary dissection with Dr. Cocilovo. I couldn't eat, or even drink water, after midnight. I went in at 10, and was given a Valium, to take the edge off the day, just like a 70s housewife. I went up to take some pictures of my nodes, with the help of some radioactive dye they had to inject just under the skin. Let me tell you, that was probably the most painful part of the day. It's like those TB tests, if you've ever had one. I haven't had one for twenty years, so I forgot how much it hurt. And they had to do three! Right around my nipple! That is a sensitive area, people. So we went down, and around 1pm (starving!), they came by to put in the IV & take me into surgery. I've never walked into a surgical suite before. For both my appendectomy and my bladder surgery, I was wheeled in, so that was different. And wow, there's a lot of equipment in there. Which, I guess, should be comforting. This ain't no M*A*S*H-style field surgery. Afterwards, I went over to my parents house with a prescription for Percoset. So now, I can't have blood drawn or have my blood pressure taken from that arm. Ever! This is one of the problems of having no lymph nodes. You have to be extra cautious about possible infections. They say you should even shave your underarm - use electric clippers instead, which, guys, tell me I'm right when I say that won't be as smooth. I'm thinking I need that laser-hair removal. I can't not shave my pits. You all will thank me in the summer.

Next Friday, 11/14, I went in for my follow-up appointment with Dr. Cocilovo. I noted that it was actually hurting more on Thursday and that day than it had earlier in the week. She said "Yep, you've got some fluid build-up", and drained almost 3 of those big 6-inch long & 1.5-inch wide syringes full from under my arm. Immediate relief! And results of the biopsy: 2 out of 3 sentinel nodes were positive and 2 out of 13 of the rest of the axillary. So 4 out of 16 total. Ideally it would have been 0 out of 3 sentinel, then they wouldn't have had to take out the rest, but them's the breaks. It sounds like 4 out of 16 isn't too bad, in the grand scheme of things.

Yesterday morning, I went in for what I thought would be my final haircut until P.C. (Post Chemo). I went shorter so it'll be less traumatic when it falls out. My hairdresser (Dusan from Vidal Sassoon! Love you!) then told me about how he needs hair models in a couple of weeks, and would I like to be one? Oh, and bring a friend. So I will be having one more haircut - and it'll be pretty funky. They'll do color correction and a new cut. I think he's going to give me the same cut, but edgier. Stay tuned for pictures from that. Later this afternoon, I will dying my hair a crazy shade of red. I never did this stuff in college (I had so much & so long hair - it would have taken 3+ boxes and if I didn't like I was screwed - it was down to my waist so it would have taken forever to grow out), so I think it's about time.

So that brings us up to now, I think, pretty much. I have an appointment tomorrow morning to drain more fluid, and I think I need it. It's getting uncomfortable again, and it's kind of firm. A lot firmer than my other underarm. The over/under on number of syringes-full she gets out this time is 2. Any takers?

Coming up this week: I make an appointment for the go-ahead for egg harvesting. Apparently I'll be a raving lunatic for a couple of weeks while I'm on the hormones. I will warn you here when I start, so you can avoid me. I also will be making an appointment with my oncologist. She should know now what kind of chemo I'll be needing and how long I'll need to have it for, so stay tuned for updates.