Can't Stop Smiling!!

We officially have all the test results back and I can't stop smiling!!  All the positive thoughts and prayers are working.

The BRC (genetic testing) and HER2 (cancer growing accelerant) are negative.  Given this news, we are feeling pretty good about having just a single mastectomy with tissue expander, lymph node biopsy and reconstruction to follow.  As long as the lymph node biopsy and margins surrounding the cancer are 'clear', I may be able to avoid chemotherapy. 

I will be participating in clinical trial for the Tamoxifen drug.  This is the medication that will treat and remaining microscopic cancer left over from the surgery.  It requires that I take it for 5 years and may cause early menopause, nausea and vomiting.  The trial will be taking the medication a week before surgery and then 2 weeks afterwards.  They are trying to determine two things:  Will taking the drug for 7 days shrink the size of the tumor?  And, if so, will the knowledge that the drug is this effective motivate me to continue taking it for the full 5 years despite the potential side effects?  If Chemo is necessary, I'll stop taking it as you don't take it in tandem with any other treatments but as a follow up. 

Surgery is on Friday, October 12th.  It will require a day or two in-patient hospital stay and some serious recovery time.  Alan will update the next posting and let you know how everything went and the results of the biopsy. 

In preparation for the surgery and battle to come, Alan and I are heading out of town this weekend to San Diego.  Gathering some sunshine and relaxing.  He is only able to stay for the weekend due to his work schedule but Brittany is going to 'swap him out' and play with me for a few extra days.  Looking forward to storing away a little extra sunshine!!   

We want to thank all of our friends and family for the overwhelmingly wonderful support.  We've definitely felt like we have been 'lifted along' throughout this experience. To my family - thank you for your strength.  It is not hard to see where mine came from.  Love you all!

My JetBlue family has been amazing.  Special thanks to Frankie for her incredible, incredible support.  It is extremely rare to consider your boss among your best friends.  Justin and Jill - your willingness to be our sounding board and 'helpdesk' for our many questions (both physical and emotional) has been invaluable.  Traci and Danny - for your love and positive messages...as well as for picking up the slack for me at work as needed the past couple of weeks (along with Justin)...thank you!!  To those who've given us hugs and kind words...you are wonderful.  It truly has been an amazing experience.  There are so many who have reached out and offered their love.  You've made all the difference. 

Truly - we are so incredibly lucky to have each of you in our lives. 

Patience, The Results and a Partial Plan

In case there has ever been any doubt, patience is not amongst the virtues I possess. 


It has been a long week waiting for the biopsy results and the phone call that would give us our game plan for treatment.  When the pathology report was not back late Friday afternoon, I was sure we'd be waiting through the weekend for the results.  However, the truly awesome Dr. Neumayer, called late last night and we discussed the report with us over the phone.  I think she gets my type 'A' personality.  

As expected, the 3.4 centimeter mass detected in the MRI is invasive cancer.  To our surprise, it was Invasive Ductal Carcinoma with Lobular tendencies.  What?  In all our reading, we've not come across this particular diagnosis and based on the previous pathology report, we thought it was Invasive Lobular Carcinoma.  Dr. Neumayer thinks its fascinating.  In the end, it doesn't matter what it is called as the beginning of the treatment plan is the same.  

The pathology report still showed a strong hormone receptor result which is great news.  The hormone treatment (Tamoxifen) for 5 years will produce great results.  Dr. N offered us a clinical trial which was designed to track if women, who take the treatment before surgery and see a positive impact on tumor size, stick with the full 5 years of treatment. We agreed and will start that at least 7 days before surgery. 

Another change from the last pathology report to this one was the HER2 result.  It is now 'borderline' and will be sent for some extended testing.  This is the 'accelerant' which, when positive, causes cancer to grow like gas on a fire.  If that comes back positive, chemotherapy will be necessary. 

So - the beginnings of a plan!  We are scheduled for surgery on October 12th.  They'll verify that Dr. Agerwal (plastic surgeon) is available but that is our date right now.  Given a variety of factors from the test results, mastectomy of the left breast is a definite.  We are going to do a mammogram of the right breast to ensure it is not necessary to remove that one as well but, for the moment, that doesn't appear to be the case.  The results of the BRAC test will also help us with that decision.  At the time of surgery, they will test the Sentinel Lymph Node.  If they find any cancerous cells, chemotherapy after surgery will be necessary. 

So to recap - what gets me chemo?  If the HER2 comes back positive from the extended testing or if the Sentinel Lymph Node has any cancerous cells when it is tested during  surgery.  We are pleasantly surprised that it isn't already a given and are accepting all positive energy, healing thoughts and prayers on this one!! 

Probably the best piece of news for me was when Dr. N reassured us that the breast lift was truly a miraculous intervention and not an unfortunate complication.  She said that it was highly unlikely that even this year's mammogram alone would have indicated that this lump was cancer and that it would have likely grown for a least another year before it was caught.  It was the fact that Dr. Saltz (my sweet plastic surgeon) happened to remove those two small pieces (each millimeters in size) that may have saved my life in the long run or at least spared us a more challenging fight.

Many thanks to all our wonderful family and friends who've been by our side on this crazy roller coaster of a journey.  We've appreciated the hugs and hand holding...and most especially the patience (a virtue we appreciate that others possess) as we've been a bit 'hyperfocused' on gearing up for the battle to come.  We love you all. 

One Step Closer

Three appointments in one day equals one tired lady and a three hour nap.

We arrived at the Huntsman Cancer Institute at 0800 and started the day with an ultrasound to determine if we could do the biopsy today.  The results looked clear and thus they could do the biopsy today but with another appointment at 0900, we had to wait until afterwards to allow enough time for the procedure.

At 0900 we met with Dr. Agerwal's (plastic surgeon) assistant for the first hour and another 30 minutes with Dr. Agerwal.  We discussed the process for reconstruction with mastectomy.  He was very informative and describe that the phased approach to the process in great detail.  While it varies depending upon the treatment plan we ultimately land on - we can expect that they will put the tissue expanders in behind the chest muscle at the time of the mastectomy.  This will result in a one to two day stay in the hospital.  For approximately three months, they will continue to expand and stretch the muscle wall to the appropriate size and when we are through treatment, another surgery would take place to insert the implants.  As long as it does not have any additional complications (meaning Radiation therapy), we can expect an outpatient experience.  With Radiation, it will require some muscle relocation (likely from the back) and thus another one to two day hospital stay.  The bad news, because of my breast lift, I will likely not be able to save my nipples during the process.  The good news, we can do some reconstruction (including tattooing) which will give the appearance of nipples. 

After this appointment, we were finally able to do the biopsy.  I was a little nervous about the procedure but they did a great job numbing the area and made sure I knew what was happening during each step.  I did feel some discomfort at one point but they were quick to reapply the numbing agent and things proceeded with no more pain.  It was fascinating to watch the process on the ultrasound.  They took four tissue samples and then inserted a titanium 'clip'.  This clip is to ensure we always know where the tumor was should the medications (Chemo) shrink it significantly. 

At the end of the procedure, I asked the doctor (Matthew Morgan) what his opinion was on the likelihood that this mass was cancerous based on his experience.  He stated that I should prepare myself for the likelihood that it is cancerous because it looks 'suspicious'.  I asked what made it look suspicious and he pointed out the uneven or jagged circumference of the mass.  So, we are preparing to hear that this is a cancerous mass within the next 3-4 days.  But - so much better to be prepared than surprised!!  So - I was grateful for his honesty. 

Our final appointment was with the genetic counselors.  We reviewed my family's medical history.  (Let me tell you, that was no easy feat to compile!!)  Together, we determined that a BRAC1/BRAC2 genetic test would be beneficial in helping us make the decision as to whether or not  a single or double mastectomy was the best direction to go.  It will also let me know what the risk is to my beautiful daughters, sister and mother for this same cancer and possibly ovarian/uterine cancers for all of us.  We also decided to donate additional blood samples, and tissue samples from my biopsy, for research.  Anything to help with finding the cure!!  My hope is that by doing additional genetic testing, I can offer peace of mind to my loved ones in the future or ensure they are carefully watching for these cancers. 

Tired and sore, I will confess to a three hour nap after these appointments.  It was heavenly and a bit decadent. 

We are now waiting again for the final results of the biopsy and to hear Dr. Neumayer's recommendation for treatment.  I'm ready to move from 'discovery phase' and on to the 'execution phase' of this project.  All my work friends will recognize this tendency.  :) 

We'll update again with the results and treatment plan (hopefully) in the next blog.  We are overwhelmed by the love and support from all of you.  It means so much to us.  xoxo 

The Beginning

The diagnosis of breast cancer came as a complete surprise. 

For my 45th birthday, I took a week and a half off work and gave myself the gift of a breast lift.  It was something I was looking forward to and my visit to the plastic surgeon was meant to be nothing but a routine follow up.  The only thought on my mind was getting  the drains out and getting back to work. 

Alan was busy with work so Brittany (our 23 year old daughter) drove me to the appointment and was patiently waiting for me in the reception area.  When Dr. Saltz arrived he had two of his nurses with him.  They quickly checked out my drains and incisions.  He sat down and reminded me that they had sent all excess tissue from the surgery to pathology  .  He told me the news wasn't good as the report came back that I have Breast Cancer in my left breast. Dr. Saltz was teary eyed and his nurses were crying.  They had Brittany come back and I can only imagine her surprise at everyone's obvious distress but she was a rock.  A bit like her Mama. 

The next day, we had the presense of mind to ask for the pathology report.  This is how we discovered it was Invasive Lobular Carcinoma.  Only about 15% of all Breast Cancer are of this type (most are Ductal) and it can be very hard to detect as it appears as strings of cancer cells not necessarily as lumps/tumors.  This explains why my mammograms over the years have not detected it.  Also - the good news was we were HER2 negative (which is a bit of an accelerant in regards to cancer growth) and Estrogen/Progesterone positive (which means hormone therapy is an effective means of treating).  The cancer was less than .5 Centimeters.

We felt extremely lucky to have found this hard to detect form of breast cancer so early!! 

Armed with this information, we met with Dr. Leigh Neumayer at the Huntsman Cancer Institute.  She is obviously brilliant as well as highly recommended by the Komen Society.  Let's just say she can talk very fast and it was a good thing we came prepared, having done our homework on the topic.  Her recommendation was to have an MRI at Daybreak as a mammogram might be too difficult with my recent surgery still healing.  The treatment options as they currently stood were 5 years of hormone treatment (pill form) and due to the size it didn't appear that Chemotherapy would be necessary.  It was even possible to make a choice between Lumpectomy with Radiation or a Mastectomy. 

While we waited for the MRI appointment, we met with the Radiologist also at Daybreak.  It was a nice facility and Dr. Gaffney was reassuring that the long term side effects of radiation were not a big concern.  For the first time, we considered Lumpectomy with Radiation as a real option. 

The MRI day came and being excessively claustrophobic, I was given Valium so the experience was pleasant despite some issues with the MRI machine.  We really viewed this process as more of a formality but, to our surprise, that turned out not to be the case.  The results came in on Friday and we were surprised to hear that there was a 3 Centimeter mass detected.  Dr. Neumayer explained that it was possible that the surgery only 'clipped' a piece of the bigger cancer off.  This changed everything. Should this turn out to be cancer, Chemotherapy is now back on the table due to the size of the 'mass'.  The doctors would need to decide on whether or not chemo would come before or after the surgery. 

An ultrasound and possible biopsy is scheduled for tomorrow morning (Tuesday, Sept 17th).  Should the ultrasound not work...they will schedule an MRI guided biopsy later this week.  We also meet with the plastic surgeon (Agerwal) and Genetic Counselors tomorrow. 

We are so appreciative of the love and support of friends and family.  We will continue to keep everyone posted on this blog as we learn more about the diagnosis and treatment plan that is determined.  We feel lucky, blessed and loved.