A Quick Update from Carrie

Hello everyone!

So, Gail's surgery last Tuesday to remove the nodes went well. All of the Nodes were clear (YAY!!!).

In other news, she developed an infection at the surgical site that has not responded as well as hoped to the oral antibiotics. They put Gail back in the hospital Monday afternoon for IV antibiotics and on Tuesday she had another surgery to clean out the infection.

They have not said what type of infection it is specifically. Perhaps they will pop up with that information at a later date.

Gail will go home from the hospital today.

In other, better than infection news, her Bone and Chest/Abdomenal CT scans were all clear. There was one little spot that showed up on the chest scan, but they are saying that the spot either represents the scarred area from her recent surgeries or it could have something to do with her Thyroid. In any event, they have assured us that it is nothing to worry about (finally, something)!

We have been getting good news lately...hopefully it will continue.

Coming up, Gail has an appointment with her fertility specialist and Medical Oncologist. From these visits she should have an update on the fertility preservation and when the anticipated start time for Chemo will be.

Thanks to everyone for all of their help and support.
Carrie

Pathology "check"

I’ve realize that I’m not very good at the “real-time” updating of this blog. It is hard to explain, but every time I receive news from the doctor it takes a few days to write about it. Immediately after I just don’t want to think or talk about it, the next day I’m in information seeking mode and then the next day I seem to be able to think about what it means for and to me. So with that here is the belated update from the three doctors visits on Wednesday, January 14 (i.e. Surgical follow-up visit including pathology report, Medical Oncology Visit and Fertility Preservation Visit).

• Drains from surgery are out. The drains were a minor inconvenience and not at all as bad as described by some folks on Internet discussion boards, but none the less I am glad they were removed.
  
• Of the 7.5 cm mass in the breast found by MRI, 2 cm was Invasive Ductal Carcinoma (bad cancer) and the remaining was Ductal Carcinoma In Situ (“good“-stay-put-cancer). This was very good news.
  
• Tumor had Estrogen and Progesterone Positive Receptors. This is good news as there are drug therapies that significantly reduce the risk of recurrence with positive receptors.
  
• Tumor is Her2/neu positive (3+). From what I can tell this is good and bad news. Bad news, because tumors with this characteristic are more aggressive. Good news, because there are drug therapies that are very efficacious in shutting down the production of these cancer cells and thus reducing the risk of recurrence.
  
• 3 sentinel nodes were removed during surgery and 2 lymph nodes were identified in the breast tissue during the pathology process. 1 sentinel node and 1 lymph node have cancer in them. This is bad news as it means the cancer is on the move. To put this in perspective, I recall something that I read - no one ever dies of breast cancer in the breast, people die of breast cancer that has moved to other areas of the body (i.e. liver, brain, bones etc). All of this means I have to have another surgery called Ancillary Node Resection.
  
• Surgery is schedule for Tuesday, Jan 20th. Ancillary Node Resection is basically the removal of lymph nodes under my arm. This is also inauguration day, so out with Bush and out with cancer! The two seem synonymous don‘t they? I’m not at all crazy about another surgery and recovery period as I thought I already “checked” surgery off the list. I feel a bit defeated, but I know it is certainly too soon in this process to feel defeated, so I know I have to shake this off. This will be another overnight hospital stay and I‘ve been warned by the surgeon that the recovery for this surgery is often more difficult than the mastectomy recovery. Speaking of the mastectomy and sentinel node recovery, 1 week post surgery, I can say the recovery was not that bad, with the help of pain medication. The incision site is really quite impressive, Mike and I just measured it and it is 10 inches. Not real sure how a plastic surgeon is going to make this “look good” but I’ve been told that they can. Best of all my range of motion in my left arm is about 80%. Unfortunately, I still can’t lift Katie but I‘m still able to get plenty of hugs and kisses. It is amazing how insightful a two year old can be, she is very aware that Mommy has a “boo boo” and is acting completely appropriate.
  
• I am negative for the BRCA gene mutation. This is good news.
  

Next Steps:

• Pathology on Nodes due back Jan 28th during post surgical follow-up.
  
• Chemo to start 3 - 6 weeks after surgery. I met with Dr. Dees (Medical Oncologist) after my meeting with the surgeon to discuss "What's next" given the Pathology results. She has suggested an aggressive adjuvant treatment regimen given my age and other factors. This regimen will not change regardless of the pathology results of the nodes. She used words like "early stage" and "curable" which I found to be very comforting. The treatment regime is about 1 year followed by 5 years of hormone therapy. I’ve also been approached about an international clinical trial, called ALTTO, but I need to consult all of the medical and statistical professionals that I know before I make any decision about the trial.


• Radiation Treatment is still uncertain and will be based on the node pathology.

• Fertility Preservation is a bit up in the air for me for reasons I will write about later. We actually ran out of time on Wednesday and we did not have much time to spend with that doctor.


• Chest and Abdominal CT scan and Bone scan are still needed for what I hope are just baseline negative results. The doctor does not anticipate finding anything (i.e. cancer that has spread to any of these area) but I will still not sleep soundly until all the data are in. These will be done next Friday, Jan 23 and should have results no later than the following Monday, Jan 26.
  
• Heart MUGA , scheduled for Jan 26, is also needed for baseline results as two of the chemo drugs have a slight risk (2%) of causing heart damage.
  

Since the last posting, despite the surgery, recovery and doctors visits, I have managed to keep pretty busy with fun stuff and lots and lots of support.

My parents came up the day before surgery and stayed several days to help out around the house. In addition to Mama and Daddy, Mike, Mike’s Mom Vicki, my brother Roy and cousin Carrie were at the hospital during the surgery and Randy and Karen paid me visit after I was out of recovery Thank also go out to Gina for hooking me up with the finest person to put me to sleep.

Mike's sister Debbie took care of Katie the night of surgery and the day of surgery and also brought a delicious dinner my first night home.

Mike’s Dad and Beverly stopped by for a visit and brought a plate of goodies.

Carrie and my girlfriends organized a "game afternoon" where everyone (Carrie, Devonn, Randy, Lisa, Ella, Armide, Laura and Alyssa) came out to our house with snacks, games, DVDs and magazines and we all hung out, played games and ate my mama's wonderful Thanksgiving dinner (complete with my favorite Oyster dressing...mmmm!). Randy also brought yummy burritos. Lisa came with Chicken Cacciatore which is in the freezer and I can’t wait to eat. Mike’s Mom and Lloyd also stopped by the Chicken Pie in hand which is Mike’s favorite. Thanks you all so much for being so supportive and helping me pass the time.

I received flowers from my brother Roy, his wife Paula and son Charlie, which was such a pleasant surprise.

Monday, Mike and I took in the new Clint Eastwood movie and on Tuesday, Carrie organized people from my office to get together for lunch. Mike and I met up with everyone at TGI-Fridays near the office. Kate, Elisa, Katherine, Marlo, Dexter, Crystal, Latrice, Gaye, Diane and Carrie - Thanks for coming out to lunch on Tuesday it was really great to see everyone. And congratulation to Dexter, whose wife just gave birth to a new baby boy.

Wednesday was the big day at the doctor and Thursday we came down to the beach with Mama and Daddy and will be here until Sunday.

As always, thanks to everyone for all of your love and support and cards and gifts! I hope I am one day able to convey to all of you how much I appreciate all of your help and support how important all of you are to me and Mike and Katie.

Love,
Gail

Surgery - "check"

Carrie here -

Okay so, Gail's surgery yesterday went very well. They injected her with the dye (it shows the doctor which nodes drain first so that they can take those specifically for pathology, as opposed to taking them all, or several, because when that is done there is a very high risk of Lymphedema ) at around 11 am, they took her back for surgery close to 2pm.

They called us back right around 4 to see the surgeon. He was very happy with the surgery overall. The left breast was removed down to the pectoral muscle (none of the muscle had to be taken). I asked whether or not he was able to see the mass (I was hoping for an eyeball quasi-diagnosis) but he informed me that, no, he didn't see it, nor had he wanted to. He wanted to (and did) remove the breast with a good layer of fat all the way around the mass - which is really good.

He said she did great in the surgery and was in recovery. He said we would be able to see her in about an hour and a half.

About 45 minutes later, Mike and Gail's friend Gina (the one that helped Gail get in with this doctor) came out to let us know that she had peeked in on Gail and she was waking up. Gina went ahead and took Mike back to see her. The rest of us commoners had to wait the full allotted time.

About 45 minutes after that, we saw them wheeling Gail by on her gurney and she looked great! She was awake and alert and seemed to be feeling well (considering). It took about 10 minutes to get her settled in her room and then we were able to come and go in her room at will.

Her parents, her brother, Mike's mom, Mike and I were there. Also, her friend Randy and his daughter Karen stopped by.

They brought her some clear food and she slurped back the chicken broth with conviction. Her dad and Mike went in search of more.

She should be going home this morning. I will be going out to their house this afternoon and taking some Cosmic Cantina Burritos.

We will get the result of the Pathology next Wednesday so I imagine the next posting will be next Thursday.

Carrie

The Final Plan so far……
I met with my new surgeon on Monday, the 5th and we discussed the findings of the MRI. Basically he is unable to say with any degree of certainty what makes up the 7.5 cm mass in my left breast (invasive carcinoma = bad; in situ carcinoma = good for cancer; or something else = good, probably fibrosis tissue). This is somewhat reassuring because he did say that with some scans he can tell right away that it is cancer, but to him, my scans do not seem conclusive one way or another.

As he pointed out, the money is on the sentinel node biopsy which we cannot determine until surgery.

I met with my Medical Oncologist (Dr. Dees) today and I love her. She concurred with the surgeon (i.e. no pre op chemo required). So on Thursday, January 8 the surgeon will remove my left breast completely. It is likely an overnight stay at UNC hospital.

I will return to the surgeons office the following Wednesday (January 14) to review the Pathology reports from the surgery. I will also meet with the Medical Oncologist on Wednesday to determine a plan for systemic treatment. All of this could require additional surgery, chemotherapy, and / or radiation therapy. I will also continue the fertility preservation on that day as well.

So, the good news is that I am merely 8 days away from getting a good bit of information about my treatment plan. But the bad news is that I also have 8 days to wait. So with that, any distractions, visitations, get to gathers to pass the time will be greatly appreciated.

Though I may not be posting updates regularly over the next week or so, Carrie will be helping me out and keeping all of you up to date on my progress.

Again, thanks to everyone for all of your love and support.

Gail