May 21, 2013: A Journey of Faith Update #3

I naively expected that I would have increased energy since I completed the first round of chemo over two weeks ago, and I always had more energy in week two of the cycle than I did in week one. But I've learned, much to my dismay, that that is not the case. I haven't updated this blog in weeks because of the extreme exhaustion that has become a part of my every waking moment.

May 2:  Chemo #4

I met with the oncologist before the last chemo session and brought a whole list of questions with me for him to answer. Yes, I will need radiation and another round of chemo after the surgery. Yes, the tumor has shrunk from golf-ball size to the point where he can barely feel it. (Yay!) And I'm clear to have the surgery any time after May 16, which is two weeks after this chemo session.

The fourth chemo session went much as the first three, with one exception:  the thing I feared most when I found out I'd have to have chemo finally happened. I threw up. Fortunately it was only once and not as bad as I've heard, but it was most unpleasant. 

I'd discovered early on that brushing my teeth seemed to invoke the dry heaves and I'd fought them for the week or so after each chemo treatment. But there's nothing worse than throwing up because you brushed your teeth, and then wishing you could brush your teeth to get the taste out of your mouth – but knowing that if you did, you'd likely throw up again! What a conundrum. Fortunately, the dry heave problem resolved itself five or six days after each chemo treatment; but the bummer is that the chemo leaves a strange taste in your mouth and makes everything taste funny, so you WANT to brush your teeth more often. You just can't unless you want to risk the dry heaves and/or throwing up.

May 15:  Meeting With The Surgeon

Mike went with me to meet with the surgeon, and we waited for over an hour for my 4:30 appointment. Normally that would really irritate me; but knowing that this good man spends as much time with each patient as that patient needs tempered my irritation. As it was, he spent over an hour with us patiently answering every question and explaining the tiniest details of the upcoming surgery until we completely understood and were comfortable with how the events would unfold.

The surgery could have been scheduled as early as today (May 21), but I requested that it be scheduled for next week so that we could take advantage of the upcoming four-day holiday weekend to grab some R and R at Daytona before settling in for the surgery and its aftermath. And so the surgery has been scheduled for Tuesday, May 27th. The surgeon recommended, and we agreed, that he perform a lumpectomy rather than a mastectomy.

I have an 8:15 appointment at the radiologist's office that morning for the insertion of a needle guide. I'm somewhat anxious about this 90-minute procedure since it took the same radiologist's office six injections to numb me for the biopsy and I'm not a big fan of pain. Since the tumor has shrunk so much, the needle guide will locate the center of the tumor for the surgeon so that all he has to do is follow the guide in and remove the tumor and surrounding (presumably healthy) tissue.

After the guide is inserted, the radiologist will bandage me and send me off to the hospital for my 10:00 check-in, pre-op appointment. In addition to removing the tumor and surrounding tissue, the surgeon will also remove the sentinel (first) lymph node under my arm to ensure that the cancer has not spread to it. In order to find that lymph node, part of the in-hospital pre-op procedures will be to inject a radioactive dye into the area surrounding my nipple. That dye will circulate to the lymph node and act as a guide so the surgeon can remove it. He explained that this is an uncomfortable procedure that burns a lot, so I should request a sedative before it is done. Good to know. Again – not a big fan of pain.

The surgery itself is scheduled for noon. I asked about the incision site and the surgeon explained that that would be decided by the radiologist's office when they locate the tumor for him. (That will be done using the marker that was left in my breast from the biopsy procedure.) He said that I should request the radiologist to insert the needle at the site of the puckered skin if possible so he can remove that skin at the same time. The marker will be removed during the surgery, as it was inserted into the center of the tumor. The surgery is being done on an out-patient basis, which means that I can leave the hospital as soon as I feel up to it or I can choose to spend the night there and leave in the morning. In any event, our insurance will only cover up to 23 hours of hospitalization for this procedure.

There could be an obvious size difference in my breasts after the surgery, depending on how the tissue looks when he actually gets in there. He has to remove enough tissue so that the lab can safely say he got all the cancerous cells. Recovery time will be one to two weeks, depending on how much pain I'm in; but I'm clear to go back to work as soon as I feel up to it. He has placed no restrictions on my return to work.

I asked why, if the tumor has shrunk, the dimpled/puckered skin is still visible and he gave me a wonderful explanation. It's too bad I can't remember what it was right now (I was too busy holding my stuff inside a paper gown to make any notes), but I do remember that it does not mean that the cancer is where the puckered skin is.

As it turns out, I'm not a candidate for the mammosite radiation because of the size of the original tumor and the fact that the biopsy showed lymphovascular invasion. So I will have to have the external, six-week version of radiation. I'm still unclear as to whether the radiation will follow the surgery or the chemo will; the oncologist said chemo then radiation, but the surgeon said radiation and then chemo. I guess we'll sort it out after the surgery.

Pre-Op Appointment

Tomorrow morning I have a 90-minute pre-op appointment at the hospital's out patient facility. They'll be taking x-rays of my lungs and doing an EKG to make sure I can handle the general anesthesia okay. I'm a little concerned about the general anesthesia too, since that's another first for me; but I have faith that all will be well.