Post Surgical Followup Appointment-Finally, some Good News!

So, yesterday morning I was incredibly nervous about my followup appointment with my Surgical Oncologist. I also had to find something appropriate to wear "out and about" that hid my damn drain lines and bulbs that are hanging out of my chest. I basically had to imagine that I was wearing two side arms...like an overzealous detective...but it worked...and it made me laugh! I wore a tank top with a gauzy flowy, oversized jacket thingy that hid my side arms...(the lines/bulbs/and my chest.)

I opted to drive over to Tampa for the appointment, and it was my first time to drive since the surgery on 9/16/09. My dad was actually the one who offered to let me drive...and for those of you who have been in a vehicle with my dad behind the wheel, Tory on Percoset is a better driver than dad in his best possible shape (sorry Dad, love you!) Anyway, driving was a bit  (okay, very) tiring and it made me sore. Made it over to the appointment just a few minutes late. I also drove us home...stopping at Starbucks on the way (gasp!) We also had to stop in at the drugstore, as I had split some of the incision points (yeoch...not too badly tho)...and I needed gauze, tape, antibiotic ointment, and Vitamin E Oil (thanks, Mel for the suggestion on the Vit E--works like a charm!) Yeah, I was incredibly tired after all of this, and I had one hell of a nap to "celebrate." Funny how you just crash out after a sort of "anxiety release." <--insert lots of jokes about men falling asleep after sex.

During the appointment, Doctor Cox, my Surgical Oncologist, was his usual cheerful self, and we read through the older-style Tampa General Hospital Pathology Report (the Moffitt and UCH reports were made using some newer software and were much easier to read and decipher) during the visit. I had my usual list of questions that we went through...

Left Breast: completely removed; additionally, all cancer was completely removed with good, clear margins; ample margin between cancer and chest wall; ample margin between cancer and skin surface; the final measurement of the cancer is about 4 cm...although it was so abnormally shaped...and much of the actual cancer was happening on a microscopic level, it had not formed into an actual "mass" per se. The rest of my left breast was full of fybrocystic breast disease--nothing too abnormal.

Doc said that I heal "very well" and he had no suggestions for me to follow/no specific change in anything. I asked him this as he had just performed the left breast lumpectomy just 2 weeks prior...and he would have been able to see how well/not I was healing from it.

Right Breast: completely removed. No cancerous cells found in breast tissue or the sentinel lymph nodes that were removed; however, there were numerous indications of some early pre-cancerous activity. The right breast was also full of fybrocystic breast disease (again, this is not too abnormal, lots of folks have that--surprised I felt no pain from it!) Essentially, I would probably have developed breast cancer in the right breast sometime in the near future. I feel very strongly that I made the correct decision in having the double mastectomy. Hell, it is a shock to look at the results...but at least I am here and able to look in the mirror at this odd breastless-being I have become ;-)

As you know, I have two drains hanging out of my chest. Unfortunately, the drains could not be removed during the appointment, as I am still draining more than the "less than 30 ml" requirement for removal. You could tell the doc really wanted to help me out by taking them out, but I really did not expect them to come out so soon. Besides, I find that they are a really handy-dandy place to keep the gun powder for my musket.

I received the Pathology report from Moffitt as well...they did some further testing and did the staging unlike the first surgical pathology report...pT2, pN1a, pMX with venous/lymphatic invasion present, extensive.

I asked the doc if the Moffitt report provided him with additional information he felt would be useful to him...as I could request the Tampa General Pathology slides be sent over there too. Dr. Cox did not feel like the additional information (other than what had been provided) would be beneficial at this point. If the Medical or Radiation Oncologist want the info, I will have the second review done by Moffitt.

Also, the Stage is at II instead of IIIa...this makes me feel a hell of a lot better. Cancer staging says a LOT about ultimate prognosis (okay, chances of death within 5 years), so the lower the number the better, statistically speaking. Now, I can say that I have always been an outlier on, well, everything, so I will just have to continue using that to my advantage. And right now, I see no advantageousness in my own death ;-)

Dr. Cox indicated that he would assist me in any way I needed to ensure my care was properly coordinated. He asked that I call him with any problems or issues I may be having.
I told him that I felt like he a lot of faith in his recommendations of the Medical/Radiation Oncologists...so I asked him what exactly made him recommend them. He indicated that he knew both of the docs and that the three of them speak regularly, throughout the week, and that they were all "friends." I told him that I would go with them as long as the three of them coordinated my treatment and worked with ME as a team. There are too many other options out there for me to feel uncomfortable with a doctor or the way a group of people work together for me to put something so serious as my own cancer treatment in the hands of people I cannot stand to work with!

Honestly, this is too emotional of a disease...and I have to be the head-honcho in control of my care. Some folks might not want that...hell, I have to have it...that's just who I am.


Next steps:
I need to call the Medical Oncologist to set up an appointment (this was done today, and my appointment is 9/30/09 at 9:15 AM).
The Medical Oncologist will coordinate the PET/Bone Scan, the Genetic Testing, and will begin to work with me on chemotherapy plans. It is possible that by Wednesday, I will know exactly when chemo will start. I should know most of the medications they plan to use...so I can research them prior to starting. I do know that they will be hitting me pretty "hard" with chemo...as I am young, I had an aggressive "grade" of cancer, and the fact that the cancer was HER2+ (also aggressive). I fully expect they will be recommending "Double Density" chemo....along with Herceptin. This would mean I receive the traditional chemo in heavier doses, every other week for just over 3 months. Additionally, Herceptin would be given weekly for about a year.
Since they will find NO OTHER cancer dammit on the PET/Bone Scan (positive thoughts!), this should be the worst part of the treatment...and it will be over...then Radiation will begin for about 6 weeks.

I also need to call back the Radiation Oncologist to determine if I need to see them now or sometime after chemo starts.

Reconstruction: I can begin this journey once chemo and radiation are completed--about 6 months out. I have tons of folks giving me recommendations on reconstructive plastic surgeons...Dr. Cox has some recommendations as well. I will just (mentally) have to look at this later, as I am kind of stuck with the indentions I have now...that is what I will call them instead of "former breasts..." how's about "the indentions formerly known as breasts?" I have had the pleasure of looking at tons of photos online of reconstructive surgery before and after pics. I should warn you...if you choose to look at these for shits and giggles, they are NOT for the faint of heart. Wow.

Returning to work: I should be able to start back to work on Monday...slowly, with some work from home (remote computer access rocks!)...up to 4 hours a day, 2 hours at a time. Limited driving at this point. I will slowly get back up to a normal work schedule over a few weeks. This is good...I am ready to go back (slowly...I am still way too tired throughout the day to go full on!)

Alrighty then...I think that is all for now...

With love and affection, and from the boobless one in West-Central Florida,
Tory