Friday, March 30, 2012

The calm before the storm

Happy Friday!

Today, I had the pleasure of having back-to-back scans; three CT scans (chest, abdomen and pelvis) and a bone scan. In preparation, I got to have a super fun breakfast of berry smoothie-flavored barium. Oh, and for what it's worth, "berry smoothie-flavored" is a flat out lie. It's more like milky chalk with a dash of berry flavor and just a hint of... what was that flavor? Oh, yes. Cayenne pepper. Yummmmmy. Once I got to the hospital, I headed to the nuclear medicine/cardiac pulmonary unit to get my IV started and yet another contrast. That contrast was for the bone scan and it needed approximately three hours to work its way through my system. While I waited, I headed down to Imaging to drink grody fake berry smoothie-flavored barium drink #2 and get my CT scans.

The CT scan machine looks kinda like a big donut. I laid on my back (no need for boobie holes!) and was told that it would only take about five minutes or so. The nurse explained that once me gave me the contrast (yes, this takes me up to four), it would "feel very warm and just like you've peed in your pants - but you haven't." Oh, yay! With that, they started the machine. The nurse announced that she was giving me the contrast and within about 3.2 seconds, a lovely warm feeling turned into "wow... it DOES feel like I peed! How 'bout that?!?" Yep, I snickered to myself. I'm such a child. Minutes later, I was done. The nurse took my IV out and I was on my way...

I had about an hour and a half before the bone scan was done "cooking", so Matt and I went to grab breakfast. The real kind. About hallway through the meal, I realized that with my big ol' bandage wrapped around my arm and the ID bracelet still on my wrist, I probably looked like an escapee. "Don't worry, folks... She's a dork and not harmless at all..."

The bone scan was likely the most uneventful thing I've had done thus far. Prior to going in, the nurse told me to please empty my bladder because otherwise, it looks like a big blob on the scan. A pee blob. Pretty. I was starting to sense a theme here. Since the contrast was ready, I didn't need another IV. I was told that it would take about 20 minutes. The nurse simultaneously moved me into the machine and moved the top of the scanner down. I felt oddly like a semi about to barrel under an overpass that was lower than expected. I'm sure I must have grimaced because he said "don't worry, you still have about three of four inches clearance". Whew!

A bit later, I awakened to another nurse telling me that she was going to look at my pictures to see if I needed more and then I was done. I had actually fallen asleep! It was so nice and cool and quiet... How could I not? I looked over to see four orange images on the computer screen. "Is that me?", I asked. She smiled and said, "It sure is!" Waaaaay cool. (By the way... No pee blob. Woot!)

Shortly after Matt and I got home, Dr. Hubbard called to let me know that he had my CT results. In his exact words, "They came back squeaky clean!" This was the best news that I had heard since I began this journey. I did not one, but TWO happy dances!

Thursday, March 29, 2012

Insurance companies are silly

I really don't have anything to report out today but do want to share this silly nugget...

My nurse navigator (like a nurse that's an admin/liaison/point person) told me today that wigs are referred to as "cranial prosthetics". Um. That's right up there with being vertically challenged and the like. I had to laugh. She also told me that my doctor will give me a prescription for one. Wow. I can hear it now... "Yes, I have a prescription that covers this rasta hat and dreads plus the pink 'Crazy Britney' bob. Why do you ask?"

Clearly, I'm easily amused. Just roll with it. You can snicker. It's okay.

Wednesday, March 28, 2012

And the winner is...

Yesterday afternoon, I met with a surgeon from MD Anderson, which is rated as the top cancer hospital in the country. Her name is Dr. Rourke. (You read that like Tattoo from Fantasy Island, didn't you.) I'd say that she's around my age and full of piss and vinegar and no nonsense. I liked her immediately. Not only did she echo the same findings as Dr. Hubbard had, she also drew me pictures. Anyone that knows me knows that I love pictures. She made lists and charts and drew boobies and examples of the types of surgery. She explained in further depth what type of treatment I could expect. Her opinion was:
1: Chemo
2: Surgery (To remove breast(s) and put in expanders)
3: Radiation
4: Final reconstructive surgery

In her words, "tissue, implants and radiation do not play well in the sandbox". I had wanted to have chemo first, so this plan wasn't a concern. She did mention that if surgery is done first, there can be issues with lymphedema if all of the lymph nodes are removed. She said, "I'd clean you out - lymph nodes and all." Chemo, then, would be "garden variety" and wouldn't be catered to my specific situation - only because there wouldn't be anything left inside of me to monitor in terms of progress. She also indicated that having chemo first gives patients something tangible to measure in terms of success. They can see and feel that the tumor has reduced. Medically, though, doing chemo before surgery or vice versa doesn't increase a person's chance for survival - it's simply preference.

Both she and Dr. Hubbard mentioned that many women use their own tissue. Well, smack my ass and call me happy! I have a stockpile that is ready for the harvesting! Have at it! She wasn't sure that I had enough gut fat for a full set. This, of course, was on the heels of her telling me that I was "thin". I said, "Did you just call ME thin?" She laughed and said, "If I can feel your ribs, it counts and you're thin." REALLY?!? Have you SEEN me??

She recommended that I meet with the one of the oncologists there. I had an appointment with Dr. Nelson today. He looks like a cross between my brother-in-law, Rob, and my distant cousin, Leon. He was very nice and also shared the same opinions as both Dr. Hubbard and Dr. Rourke had. He explained a bit more in detail what the types of chemo would look like and what the timeframe would be.

Chemo - Round 1:
Once a week for 12 weeks

Chemo - Round 2:
Once every 3 weeks for 12 weeks

Total time = 6 months

Dr. Rourke had also mentioned that it would be approximately a month to recover from the initial surgery plus 6 weeks for radiation. After THAT - I'll have reconstruction, which should take another month or so. For those keeping score, this puts me into the beginning of 2013. It's just crazy to think about and hard to fully absorb but I'm ready to get going...

I asked Dr. Nelson today how long it would be before I could start chemo. He said that I could start as early as next week. I have my bone/CT scans this Friday, so we scheduled an ECG to make sure that my ticker is ticking nicely and surgery to have the medi-port installed. In a nutshell, this will keep my veins from blowing throughout treatment and will make the whole chemo process a little more efficient. Yay for efficiency.

My chemo will start next Thursday. I will start to lose my hair 1-3 weeks after my first treatment. This means that I will be Kojak-esque the day after that first clump falls. I ain't playin'. It's coming off. Who knows? I may totally rock the bald look! Who loves ya' baby, indeed!

So, after all of my meetings with various doctors, I've decided that I am going to stick with MD Anderson for the full range of treatment - including surgery. It just makes sense. It'll suck to tell Dr. Hubbard "thanks, but no thanks" but the sum is bigger than the parts here. I think it's the best approach for me.

And the hits just keep on coming...

Once we returned from Alabama, I met with my nurse practitioner, Joan, who gave me the full report. She scheduled an appointment with the surgeon that their office recommended and I met with him later that afternoon. Dr. Hubbard is a man in his mid to late 60s. He's been in the industry for a very long time. He reminded me of a southern version of my grandfather. He explained things slowly and in layman's terms and sprinkled in a good dose of dry humor. I liked him immediately. He gave me an exam then went over treatment options and recommended an oncologist to see as well. He ordered an MRI, bone and CT scans for me to give a full picture of the cancer in my whole body - not just my breast. While there, we also discussed BRCA genetic testing to see if I carried the gene. He explained that if I did - I'd likely have to have my ovaries removed as well since the cancers are closely related. My girls and my sister, Jenny, would also be impacted by this news as their risks for both types of cancers would exponentially increase. Lovely.

Later that week, I had the MRI. The best part? It was like a massage table and I was face-down except it had boobie holes. Boobie holes!!! How awesome is that? I've had other MRIs but this one was almost comfortable! It took about 25 minutes and I was on my way.

Dr. Hubbard called early Monday evening to give me the results from the MRI. He said that he had consulted with the radiologist and they were both concerned about what they had seen. The tumor was actually 6cm and there were a couple of satellites off of it that were approximately 4cm. Total cancerous area was 10cm. This was over 3 times the size that they had originally believed via the mammogram and ultrasounds. He told me that because of the size of the main tumor alone, a lumpectomy was no longer an option and that I'd have to have a mastectomy. Even though I was leaning towards this decision anyway, it's a completely different beast to told that it's NOT, in fact, an option. I was in shock and the fact that each visit seemed to yield more serious results, was very concerning. It was official. My boob had some major funk and I wasn't feeling it.

Telling the Girls

Given the fact that I got this craptastic news in the car and we were well into Louisiana at that point, I clearly had to tell the girls right then and there, which was absolutely not how I envisioned it. While I didn't say any of the trigger words ("cancer", "breast", "positive"), Hannah could hear the concern in my voice and had started to cry in the backseat. Maddie, on the other hand, was oblivious and sound asleep.

I kept my composure for the bulk of the call, but finally my emotions won and my voice broke at the end. Once I hung up, the sobs came. We opted to pull into a gas station to share the news. We woke Maddie up and I through teary eyes and a shaky voice, I told them the news that I had just been given. Matt was silent as his eyes filled up with tears. Hannah put her face into her hands and sobbed. Maddie pulled her blanket up around her face and did the same. It was the single most difficult thing I've ever had to tell my children.

Hannah didn't talk for the next 24 hours. I'm sure she was in shock. Maddie was quiet, but handling it pretty well, all things considered. Once I pulled them aside and explained that I wasn't in any pain and that this wasn't a death certificate that had been handed to me, they were relieved. I also showed them the site of the biopsies and assured them that it wasn't a big deal. I asked if they wanted to feel the lump itself and I got immediate, "um, no thanks!" responses from both. I expected it, but hey - I thought I'd ask if that would help them!

Maddie told me that if she pretended like it wasn't happening, that maybe it would just go away. She hasn't asked many questions but she's been very supportive and loving (as she normally is - but the amped version). Hannah desperately wants to support the cause and contribute in some way. She wanted to walk in the Avon Walk in Houston in mid-April, but participants have to be 16 the day of the walk. Unfortunately, she won't be 16 until July. She'd like to participate in the Komen run in October. This will give her plenty of time to train and fundraise, etc. It'll also give me an opportunity to potentially walk with her.

I'm glad that the girls are a little older, but it breaks my heart that they have to be burdened with this - both now and as they get older since it could heavily impact them genetically.

Cancer just sucks. Period.

Monday, March 26, 2012

In the beginning...

My name is Nancy. I'm a healthy 41-year old woman with no family history and yet... I was recently diagnosed with breast cancer. Specifically, Stage 2 Invasive Ductal Carcinoma.

Because I can be a slacker and a procrastinator, I chose to do my self-exam the morning of my annual exam. With super soapy hands, I did my little circular motion slowly across my right breast and came across a big ol' lump that clearly didn't belong there. It felt to be approximately cherry tomato-sized from my perspective. I immediately went to the other side and... nope, nothing. I can be prone to lumpiness when I've had excessive amounts of caffeine, but this was very different.

While at my exam, I told my nurse practitioner about the lump and she believed it was bigger; closer to golf ball-sized, in fact. She ordered a diagnostic mammogram and an ultrasound for me to check things out. I hoped it was only a cyst or a fibroid. About a week later, I had my appointment. My husband, Matt, came with me for the ultrasound portion if the show. The lump appeared as a ginormous black void on the screen. I gulped....

After the initial ultrasound, the radiologist reviewed the results along with the results from the mammogram. He came in and performed another ultrasound. I got a bad vibe from him immediately. I knew... just knew that it wasn't good. He told us that the lump was not a cyst and that it was a tumor. He also indicated that he saw a lymph node just above my collarbone that appeared to be enlarged as well. He said that a biopsy was necessary. I feared the worst.

A few days later, I went in for the biopsies. The lymph node that they originally saw was located behind a vessel and not easy to get to so they opted to biopsy another. They did that via FNA, or Fine Needle Aspiration. The biopsy in the tumor was done via core biopsy, which was basically just a larger gauge needle. Both of which were several inches long and looked not unlike little guns. Swell. After a few shots of lidocaine, the radiologist was ready to roll.

I'll admit, I was all kinds of curious, so I watched. It was pretty darn cool and looked very similar to the images of an egg being fertilized in vitro. On the scale of pain, waxing is 20 times worse. Now you know. I got a teeny bandage and was done. I was told that I could expect results in 3-5 business days. This was a Monday morning. We were leaving for Alabama that Wednesday to see my mom and sister. I had a feeling that I'd get a call while we were trapped in the car with my girls and I'd have to break the news that way...

Wednesday at 2pm, we were driving through Louisiana and my doctor's office called. I gasped as I saw their number and showed Matt. On the other end was my nurse practitioner, who is such a sweet woman. She told me that she had my results and wanted to know if I wanted to come into the office. (Red flag alert!) I told her that we were driving and wouldn't return until the following Sunday. She asked if I wanted to call when I got to Alabama. I said, "You can tell me here. It's okay." She responded with "Do you have someone with you?" I laughed and said, "You know I'm reading between all these lines, right??" She relented and said, "I have good news and bad news. The good news is that your lymph node is clear." She paused. I felt my stomach drop. "The bad news is that you do have some cancer in your right breast." All I could think was, "I fucking knew it."