A Marathon of Appointments

A marathon of appointments before treatment starts. 

It has been a busy week of doctor appointments and tests.  We started with a conference call early Sunday morning with Dr. Neumayer to answer our questions about the pathology report.  During that call she clarified that the lymph node invasion was actually a macrometasis and not a micrometasis but just barely.  Together we determined that some of our questions and my case should go before the Huntsman Cancer Board for review. 

They met on Thursday and discussed my case. 

• They changed my stage from 3A to 2B.  My largest tumor was 1mm smaller than 5 cm and thus the change.  They also reviewed whether or not I needed to have more lymph nodes removed and thankfully they determined this was unnecessary. 
• They were divided on whether or not I should remove the right breast with the discovery of the 'surprise' tumor in my left breast.  That will a decision for Alan and I to make together but will only take place after chemo/radiation are complete.  I'm leaning toward removing the other breast but am not anxious to repeat that surgery in the near term. 
• Probably one of the biggest items we wanted reviewed was the use of a drug called Adrimyacin in my chemo 'cocktail'.  It has some potentially bad side effects including heart damage which is particularly concerning to us.  Unanimously - they all recommended that this drug in the TAC cocktail was the way to go given the large size of my tumor, close margins and Grade 3 cells.  To that end - I had a baseline Echo of my heart this week so we can monitor any impact of the drugs. 

We also met with the oncologist they assigned to my case, Dr. Hung Khong.  He is very competent but our communication styles appear to be very different.  So we've requested to meet with another oncologist as we know this will be one of the most important doctor/patient relationships we'll have during my battle.  We are meeting with Dr. Patricia Legant out at the UofU Daybreak facility this coming week.  The location is much closer to our home and it would be nice to not have to travel as far for treatment.  Cross your fingers that we like this doctor!!  It was hard to decide to change as we are anxious to start treatment and this will likely delay things. 

Yesterday, I had same day surgery to insert a port on the right side of my upper chest.  It was an experience to say the least.  I was sedated but not put under completely.  I remember the surgery in great detail including the fact that a young doctor who looked an incredible amount like Doogie Howser stitched me up.  The port will allow them to administer chemo and draw blood without having to insert an IV or stick me with a needle.  I'm sore from the experience but they assure me I'll be grateful as the treatment gets going. 

I was also able to have one of the two drains removed from my mastectomy surgery yesterday.  It is now much easier to hide the remaining drain under clothing and less challenging while I'm sleeping so I'm SO HAPPY to have one gone.  It will likely be another week before the other is removed and it has to be out before I can start chemotherapy.

Also this week - I have a PT/CT scan of my body to ensure we don't have any other cancers to worry.  Dr. Neumayer stated that the odds are only about 5% that this is the case so I'm hopefully to move quickly through that checkpoint. 

I'm also meeting with my dentist to ensure my teeth are ready for the damage the chemo will inflict on them.  He's making fluoride trays to protect them.  Last but not least, I hope to go wig shopping with friends to prepare for the loss of hair.  My sweet hairdresser has agreed to shave my head while her shop is closed shortly after my first treatment.  Alan plans to shave his head at the same time as a symbol of his support.  Such a cutie.  I love that man. 

I've had lots of questions from everyone asking how I'm doing.  Honestly - 90% of the time I'm doing really well.  Optimistic and ready for the battle.  I do have my bad days when I wish this was either over or just a bad dream.  I get angry.  I get emotional and weepy from time to time but I think overall I'm staying positive. 

Many thanks again for all the love and support. The notes, cards, flowers, phone calls and text messages have been wonderful.  We love you all. 

Pathology Report and the Silver Lining

The silver lining - the breast lift saved my life. 

I had the mastectomy of my left breast last Friday, October 12th.  Alan did a great job relaying that experience in his post.  It was a little frightening but we knew I was receiving the very best of care and was in the best possible hands.  We ended up spending two nights in the hospital to ensure we had the correct medication to manage the pain.  It was a lovely room and the staff very accommodating but I was grateful to get back home and sleep in my own bed.  Recovery has been slow but sure.  Lots of resting and taking it easy.   My awesome husband and sweet kids have been playing nursemaids and doting on their Mama.

Today, Dr. Neumayer called with the results of the pathology report.  We had been hoping that we'd be able to get by with a single mastectomy and hormone therapy but it appears it will be a tougher, longer battle after all.  They found three masses in the left breast.  Two of the three masses ended up being cancerous with the largest one measuring more than 5 centimeters and the second just over 1 centimeter.  Also - after further testing, they did find a microscopic invasion of one of my lymph nodes.  All that said - I'll be undergoing both chemotherapy and radiation to be followed by breast reconstruction and hormone therapy for Stage 3a breast cancer.  Not the news we were hoping to hear but the silver lining called out by the doctor - the breast lift most definitely saved my life!!  I ever so grateful for that life changing decision.  

So - next week we'll meet with the oncologist  to discuss the treatment plan.  In true 'Nannette' fashion - I want to get it started as soon as possible - so we can get it over with as soon as possible. They'll be charts and spreadsheets to manage the biggest project of my life...maybe even a Gant Chart.   I'll keep you all posted.

Thank you for all the kind emails, voice mails and text messages.  They've truly lifted my spirits.  Having everyone in my JetBlue family dress up in their 'Say No, No to Breast Cancer' T-shirts on my last day in the office as well as on the day of surgery was touching.  I truly feel like I have an army fighting this cancer alongside me. 



My JetBlue Army



It has been a bit of a roller coaster ride

It has been a bit of a roller coaster ride; but, our hopes are high. 

Yesterday was surgery day.  We started out the day with feelings of hope and apprehension.  Upon arriving at the hospital at 10:15 AM, we began with the typical check in, pre-op IV, blood draws, and etc.  By 2:00 PM Nannette was ready for surgery with pain meds in her system, an epidural type block (paravertebral block), a low level radioactive dye injected into her left breast to detect any lymph node invasion (investigated during surgery); and, discussions with the anesthesiologist about her uvula and pain control, and both surgeons about the procedures (single left mastectomy & preliminary breast reconstruction/expander placement). 

Within an hour, the great news that there has been no lymph node invasion!!!  What a relief!  We had been under the impression that this meant no chemotherapy would be necessary, with the exception of Tamoxifen (an oral, and less invasive form of chemo); however, when Dr. Neumayer completed her part of the surgery, we found out that until the pathologist can check the actual size of the tumor, and the "margins"/how far into the breast tissue the cancer has spread, we won't know whether chemo and/or radiation will be necessary.  Those findings won't be available for another week!  So, we are waiting again.  We also found out that there is no way to save the nipple; because, this surgery was so close to the breast lift, and the nipple hasn’t had the time to recover. 

After Dr. Neumayer completed the removal of the breast tissue; taking extra tissue to insure all of the margins were clear, Dr. Agarwal took over to place the expander behind the pectoral muscle, and start the preliminary breast reconstruction.  After 4 hours of surgery, they were done, and were pleased with the results.  By 8:00 PM we were into the VIP suite (how did we get so fortunate?), and settling in for the night.  A long, but successful day, at one of the best cancer centers around.  They have taken good care of our girl. 

 This morning has been a flurry of activity; with visits for nurses, residents/interns, and doctors.  Nannette is recovering well.  She has had the paraverteral block removed, the IV’s & monitors removed, and we are working on managing the pain.  If we are able to get the pain managed we can leave the hospital this evening.

We look forward to the pathology report; and whether chemo and/or radiation will be needed.  If chemo is required, they will start as soon as the surgical drains have been removed (2 – 3 weeks).  They will also start the expansion process; where they inject a saline solution into the expander, a little bit at a time until the pectoral muscle has been stretched enough to insert the permanent implant.  If radiation is also required, they will wait until the chemo is complete, and the expander has reached the desired volume; the implant would not be inserted until the radiation is done, and a portion of the latissimuss muscle is brought up to the breast area to bring a new blood source to the radiated area.  If radiation is all that is required, they will have to complete the expansion before the radiation can begin.    

We are very hopeful for good news, and appreciate all of the support, thought, and prayers.