You're Funny... You're Hired!

Reconstruction Consult #2

After last week's reconstruction consult, I was thinking I would change the pace and get a consult from a male doctor. I thought surely a male doctor would try harder to preserve the size of my natural breasts.  I mean, doesn't it stand to reason that a male who willfully went into the business of breast augmentation and reconstruction is a "boob man"?  I thought so too.

So Wednesday January 23rd I went to the head and neck unit at ECMC to meet one of the male plastic surgeons that Dr. Lindfield recommended.  I was very leary about going to ECMC. I am not proud to admit my ignorance. It has the word 'County' in it, so I always assumed it was for people who couldn't afford to pay or had no health insurance.  It has the word 'County' in it, so I assumed it was dirty, run down, and poorly run.  When I first arrived for my appointment, my fears appeared to be confirmed. I checked in and had to use the ladies room. The only bathroom on that floor was a single seater and a woman lugging a wheeled cart full of clothes got in right before me and did not come out the entire time I was waiting in the waiting area. At that point, even if she did come out, I am not sure I would go in. The nurse who accompanied me to the room stopped at a scale in the hallway to get my weight (yay-my favorite part! Yes, that is sarcasm).  What made it so much better is that instead of standing next to me and writing my weight down, she kept walking to see if the exam room at the end of the hallway was available, and instead yelled down the hall for my weight. PRIDE = GONE.  Oh well, at least I can disappear into this exam room before anyone knows who just yelled their unusually high weight down the hall.

I waited in the exam room for quite a while for the doctor. This time I was alone because I was beginning to feel bad about all the work that my entertainment entourage was missing.  I am lucky enough to work for an awesome employer that has been more than flexible with me, but hubby and Dad's girlfriend are not so lucky. Hubby works for corporate america and Dad's girlfriend has other committments to take care of every day. At this point in the process, I felt that I was relatively certain what needed to be done and that I could make my own decisions.  Judging by my experience at ECMC thus far, I was going to be scheduling a 3rd consult with someone else anyway, so it was good that they didn't miss any work to sit in this boring, locked down exam room with me for 2 hours. By the way, I really still had to go to the bathroom....

Finally about an hour and a half after my appointment time the doctor came in. My first impression was "Hey, did you go to Timon? Didn't I use to drink with you in high school?"  I immediately felt at ease with this doctor and was excited to hear what he had to say.

Example of breast reconstruction with implants

This doctor communicated in a way I am used to - with a white board.  He came in with 3 different colored Expo markers and immediately went to work explaining the process of breast reconstruction with implants.  He explained that the whole process will take about 9 or 10 months, not counting nipple reconstruction if I want it (that still cracks me up.... ). He explained to me that if at any time during that 9 to 10 months if I develop capsular contracture, he will have to remove the expander, let it heal and shrink, and start over again.  If it is only a month or so in, this is no big deal, but if it is 10 months in, this could be a huge deal. I would only have 1 boob!  The doctor also noted that at this point, I had lost 15 pounds since January 7th.  If I continued to lose a lot of weight, I would need to have surgery again. I had thought that if I got implants now, they would always be the same size and the same perkiness. This doctor told me that this is not true... if I were to lose a lot of weight, the breast skin will sag just like natural breast tissue, but the implant will remain firm causing what he called "rock in a sock" syndrome. Yuck! At that point, he showed me an expander, a silicone implant, and a saline implant. When the time came, I could choose between silicone or saline. Silicone was much more realistic. It was soft and firm, like gel. The problems with silicone is that if there were to burst, it would not be apparent for many weeks or months because they leak slowly.  The government claims that the silicone is safe if it were to burst, but I still don't buy it.  The government says Twinkies are safe. Saline implants look like water balloons.  Natural breasts bounce. Saline breasts ripple. Enough said.

Then the doctor went to the whiteboard and explained the process of autologous reconstruction using the DIEP flap procedure. This was a colorful masterpiece on the white board. Unlike the TRAM flap that Dr Lindfield told us about (read that post), the DIEP flap doesn't take any abdominal muscle, allowing the recovery time to be much faster.  Unlike using implants, all the new breast tissue would be my own, so I would never need to worry about rupture, capsular contracture, or 'rock in a sock' syndrome because it is all my own tissue. If I lose weight, they would get smaller (oh darn), if I gain weight, they would get bigger. And it would age like a natural breast. Nothing more awkward than a grandma with silicone DD's. Once the DIEP flap procedure is completed, all I need to do is heal on my own and then come back for nipple reconstruction.  There is no annual maintenance.  However the initial healing is hard.  Not only does the chest need to heal, but the stomach needs to heal as well.  Where the implant hospital stay is a day, the DIEP hospital stay is 5 days.  The doctor also says that it may be longer before I return to work than it would be with implants. I have a computer job so I am pretty confident that I can work from home pretty shortly after getting out of the hospital. The DIEP flap procedure also carries risk of infection, like the implant reconstruction, but if there is any infection it can be treated with antibiotics, not another surgery. Then finally, with the DIEP flap, the breast size is only limited by how much stomach tissue I have to spare. Hence, I know that I will be just fine!

The whole time the doctor was doing his whiteboard diagrams he was making fun analogies and he was wearing a really cool tie. I asked him if he could show me some pictures of his past work. He said he had tons of pictures but he couldn't show me because he never asked any of his patients for permission to show them. (So at least I know this doctor has more integrity than my past boyfriends).  I told him that I willingly volunteer to be a model.... as long as he does a good job. ("And that's how she got into the internet porn industry....") 

After speaking with this doctor, I was leaning much more towards an autologous reconstruction using the DIEP flap procedure rather reconstruction with implants. I asked the doctor how soon I could get scheduled for the DIEP procedure, but he gave me the red light right there. He had noticed that I came to this appointment alone and didn't want me scheduling anything without talking to my husband and family.  Obviously I need the mastectomy and we all decided that I want reconstruction, so I was upset that he wouldn't let me make my own decisions.  He said I had come in wanting one procedure and within 1 hour did a 180 and now wanted to schedule a different procedure and I didn't consult with anyone. I could see his point, but I still didn't like being forced to delay.  The doctor told me to come back with my entertainment entourage and he would go through the entire dog and pony, including white board diagrams, with them so that everyone is on the same page. I, of course, was mad that I had to wait a whole week before I could even try to schedule. What could I do. No hurry, it's just cancer.

Not Sure Why, but No Thanks.... (A Funny Post)

Reconstruction Consult #1

On Wednesday January 16th I met with my first reconstructive surgeon, also called a plastic surgeon, to discuss my options for breast reconstruction with implants.  I was expecting it to be a discussion about how big or small I wanted my new breasts to be and whether I wanted silicon or saline implants.  I also expected to come in, shake hands, and schedule for later that week. I knew she had an opening and I knew what I wanted. Easy appointment, right? The consultation appointment went nothing like I expected.

Once again at 9am I showed up for my doctor appointment with my entertainment entourage. Unfortunately for me, we had literally no wait time in which to be mischievous. I swear after the 2 hours we spent trashing Dr. Dougherty's office, he called ahead to everyone... they locked down all their office 'accessories' such as cotton balls and tongue depressors, and wouldn't leave us alone in the patient room for more than 5 minutes. I guess I should have been happy for the short wait time, but I wasn't. Perhaps I was not in the right frame of mind when the doctor came in to talk to me... I hadn't laughed enough yet that day.

At this point, I had known that I had cancer for 9 days and had already seen an iridologist, a breast surgeon, and an oncologist. I was very certain of my predicament and that the outlook was great.  With my new diet and the herbal supplements I was on, I was already down 10 lbs since January 8th, had brand new boobs on the way and I was convinced I was going to end up on the other side of this cancer thing better than when I started.   So I felt somewhat condescended upon when the Doctor came in and began a pep talk about how I am going to be fine and that her and I were going to get to be really close over the next few years. Point #1 - I know I am going to be fine, but thanks for reiterating it.  I am smiling and laughing, do I look like I need to be spoken to like a scared child? I can't really hold that against her, I am sure people with cancer come in with all sorts of feelings and how is she supposed to know where I am in the mental process of accepting cancer.  Point 2 - YEARS??? I was hoping to put this entire ordeal behind me in 3-6 months. 

This was when the doctor reviewed with me again what Dr. Lindfield had told me earlier in the week.  Luckily, Dad's girlfriend took impeccable notes during every visit because I had forgotten or not really heard everything Dr Lindfield told me during my visit with her. This doctor reiterated how the breast reconstruction was going to work. First, the mastectomy and most of the breast skin is removed.  Then deflated expanders are inserted under the pectoral muscle and I am sewn up. After surgery, every 2-3 weeks, I would come back to her and she would use a syringe to pump some more saline into the expander. When she and I were comfortable with the size, she would allow the skin and muscle to adapt for 2-3 months, and then operate again to remove the expanders and install saline or silicone implants. The Doctor told me that I didn't have to decide on saline or silicone until they were ready to install the permanent implants, so she didn't even have one to show me.

OK, so what went wrong? Two things this doctor told me made me second guess my decision to get the full mastectomy with implant reconstruction with her. First, she told me she could not get my breast size as big as it is now. I don't consider myself very big chested. I wear a DD, but I am also a very big girl.  She said she could get me maybe to a C. If I had to balance my 'quite curvy' butt with only a C cup size in front, I would fall backwards all the time! God gave me DD's so I have equilibrium and can stand upright! This was just not going to work for me. 

Secondly, the doctor breached the sacred oath. You know how you never tell a man that his package is small or smaller than he thinks? The same goes for women and their breast size.  Once the doctor examined me, she told me that I have been wearing the wrong bra size for years and my breast size is only a C.  Hmmm. I have been measured multiple times at multiple stores... they must have all been wrong?  Hi, have a nice day... not hired.

Needless to say, I did not book my mastectomy for that Friday and I told the Doctor I would discuss my options and call back.  Later that night, I got an appointment for a second opinion with one of the other doctors that Doctor Lindfield recommended. I just couldn't accept that I would end up with implants that were smaller than my natural breasts. Where is the justice in that? I needed to set out to see if I could get a different answer from someone else.

On a side note, even though I was insulted, I can take the criticism, so that weekend I took my Kohl's cash and bought a new bra....a size C.  If I lose another 15-20 lbs I may be able to wear it in public.  Otherwise I am overflowing in the front and on the sides. I stand by the DD measurement I had last time at Cacique, thank you very much. FOR SALE - OLGA DEMI CUP BRA, 38C, Never worn. 

Another Little Bump In the Road- Why Not?

The PET Scan

I mentioned a few posts ago that Dr Docherty ordered a PET scan to see if there was any visible cancers anywhere else in my body. Along with that, I also had to have an MRI of my breasts done to see the tumors with more detail. 

Example PET Scan Image

A PET Scan (Positron Emission Tomography) is a radiation-based Xray of sorts that is taken of your entire body.  The images shown on a PET scan are similar to what the TSA sees when they scan your carry on bags at the airport (I came to this analogy on my own).  To receive the PET scan that I got, it was necessary fast for 12 hours and then receive an injection of a nuclear fluid.  The nurse at the radiologist's office told me that I was to have extremely light activity for the 24 hours prior to the scan. She said any prolonged activity would show up on the PET scan and may be misinterpreted as a tumor.  I will accept someone telling me to take it easy any day! But this test got better... When I got to the office the day of the test, the nurse gave me my injection, and then put me up in a recliner with soft, spa-like music in the background, turned down the lights, and covered me in a heated sheet where I had to lie still and relax for an hour. I really enjoyed this test, it was pretty awesome. Until she told me I had to put my phone away and couldn't text.  Apparently the repetitive motions of my thumbs would show up on the scan not only on my thumbs but on my forearms.  This shocked me... I still wonder if this was true or if the nurse was just annoyed at my frantic texting and Facebooking at 9am on a Tuesday morning.

Once I was sufficiently relaxed I got to go in for my test. The PET scan involved lying on a table while the table glided in and out of a donut shaped recepticle. This took about 15 minutes and then I was good to go home!

PS. That's not me... just a stock photo of a PET scan

Oh but wait... As I was putting my coat on to leave, I noticed a huge lump in the back of my throat that wasn't there when I had gotten there. It felt like I had swallowed a Cheerio and it was stuck in the back of my throat.  I walked back into the exam room and asked if that was a normal side effect of the test. The nurse not only said it was not normal, she rushed me back to my recliner and ran and got a doctor. Then the doctor came in with an epi-pen longer than my forearm.  This one moment was the scariest moment I had experienced during this entire breast cancer ordeal.  Whoa... hold on there, what are you doing with that???? Apparently the doctor thought that the lump in my throat was going to continue to swell until I could no longer breathe. Luckily this didn't happen.  The lump in my throat never got any bigger, it just got more annoying. They made me take a Benadryl and sit in the recliner for another 45 minutes to make sure the reaction didn't continue or get worse. I sat there and tried to swallow whole ice cubes and I drank about 5 cups of water trying to dislodge this lump in my throat. No use. It was going to stay and hang with me for the next day or 2.  If this was the worst thing I had to endure, I was cool with that.

The best part of all is that later that week, Dr. Dougherty called to tell me the PET scan was all clean. No other cancers for me to worry about. I was really beginning to love Dr. Dougherty. He always had good news for me.

The MRI

The MRI that I was scheduled to take was very interesting. This MRI was specifically looking at my breasts.  Getting a breast MRI is quite interesting. The machine looks like a donut shaped recepticle, just like the PET scan machine. But because they specifically wanted to see my breasts, I had to change position to allow for optimal imaging. For this MRI, I had to lie on the table on my stomach and there were 2 cut outs in the table... one for each breast to hang through. You are probably visualizing this and I have to tell you, it really was that funny looking.

Besides the funny positioning, this test went off without a hitch and I was soon back at work going about business as usual. 

I was not so lucky with my MRI results. I received a call from Windsong Radiology that the MRI results were not good. The doctor had found a 4th mass in my left breast.  All they knew from this test is that there is a 4th mass. They would not know if it was benign or malignant until they did the biopsy.  Since the mass was not visible on the mammogram or ultrasound that I did previously, they would have to do the biopsy while being MRI'd. They call it MRI-Assisted biopsy. This entailed me getting back on the MRI table with the boob holes and having a surgeon underneath  the table biopsying me.  As if the initial MRI with my boobs hanging through the table wasn't awkward enough, I had no idea how this was going to work. 

I called Dr Lindfield with these results and discussed options. We determined that since I was doing a full mastectomy anyway, I could forego the biopsy. Dr Lindfield would biopsy the mass in whole once all the breast tissue is removed.  I feel very confident in this decision.  I feel pretty strongly that this mass was indeed another cancerous tumor and that it is the same strain of cancer, Invasive Ductal Carcinoma, that I have in the other 3 tumors.  However, since it was so small that it didn't show up on mammography or ultrasound, I am certain it is too early to have spread to any other tissues or lymph nodes. Dr. Lindfield can verify that for sure at the time of my mammogram.

Funny, finding out I had a 4th mass, probably a 4th cancerous tumor, really didn't phase me much. Why not? When you have 3, why not 4?  I always liked even numbers better anyway. It's like kids, once you have a few, what's a few more? Actually, no, it's not like kids at all. Once you have a few of them, STOP while you are ahead...

Methods of Surgically Removing Breast Cancer



The Cure - Phase 2 - The Surgery

Dr. Dougherty told me the main weapon I have to rid myself of cancer is to remove the cancerous tumors. This means either a lumpectomy or mastectomy. Dr Dougherty, even though he told me my cancer was HER2 negative and not growing very quickly, was able to call WNY Breast Health and get Dr Vivian Lindfield to move my appointment from Thursday January 24th up to Monday January 14th.

Once again, I showed up for my 9am appointment with Dr Lindfield with my entertainment entourage. Sadly though, Dr Lindfield's staff did not leave out any cotton balls for us to play with... Dr. Dougherty must have called ahead and given her the heads up. In fact all the drawers were locked. Busted. And Bored....

Dr Lindfield came in and explained in further detail the pros and cons of a lumpectomy versus a mastectomy. She did not try to sway me towards either procedure, but laid out what I can expect either way.

Removing the Cancer

Example of a Breast post-Lumpectomy

The option of a lumpectomy was the least invasive, however she wanted me to understand that they will take more tissue than just the lumps.  My tumors ranged in size from 10mm to 18mm. When they remove the lumps, they need to take the cancerous tumor, the tissue immediately surrounding the cancerous tumors, and if there are multiple tumors on one breast, which there are, they will need to remove the tissue between the 2 tumors.  After a lumpectomy it is almost certain that I would need radiation therapy. Radiation would affect both healthy and cancerous cells in the areas where the lumps were removed. If any cancer cells were left behind, radiation will kill them. Radiation will not affect healthy cells in the long term. Lumpectomies very often will disfigure the breast. In extreme cases, plastic surgery may be available to return the breast to a normal shape and consistency.

A mastectomy is another option I had to consider.   Up to this point, I thought a mastectomy was a radical decision, only to be used in the most aggressive of breast cancers. I learned from Dr. Lindfield that it is actually fairly common.  No longer are the days when mastectomy meant living with craters in your chest. If I chose a mastectomy, the option to reconstruct both breasts at the same time was available. Even with a mastectomy, there is still a chance that I will need radiation, but the need for radiation is radically lessened when the entire breast is removed. If I chose a mastectomy (I would need a double mastectomy since I had tumors on both breasts) I have a choice of 2 reconstruction options... or I could choose not to reconstruct. Since I consider my boobs two of my best assets, 'no reconstruction' is not even an option I considered so I can't provide much insight into this option.

These are the facts about the mastectomy and lumpectomy that I considered, but there are others that you should consider if you need to choose a mastectomy or a lumpectomy for breast cancer removal. Take the link to see other considerations.

Rebuilding New Breasts



Example of Breast with Implant Reconstruction

One method of reconstruction is with the use of implants. When I arrived at Dr. Lindfield's office, I thought that to reconstruct using implants they would simply scoop out my breast tissue from the skin pocket, like an avocado, and then fill it in with a silicone implant.  Oh boy was I wrong on this one. The first step is to remove the breast tissue, nipple, and most of the breast skin. Before sewing the skin shut, a temporary breast expander is placed under the pectoral muscle. The temporary expander is a flexible saline implant which is mostly deflated with a magnetized penetrable rubber seal towards the top.  Over the next few weeks as you heal, the expander starts to slowly stretch your pectoral muscle and breast skin.  Every 2-3 weeks, you return to the plastic surgeon and using a magnet to locate the rubber seal he will inject more saline into your expanders.  Again, you wait a few weeks for the skin and muscle to stretch and return for another injection into your expander. This continues until you and the doctor have decided that you are happy with the size of your breasts.  Once optimal size is reached, you wait 2-3 months for the skin and muscle to relax to this size. When the plastic surgeon is confident that your body has adjusted, you go in for surgery again to remove the expanders and replace them with permanent implants. Then you have to choose either saline or silicone implants. 

Something else I learned... you may notice that the picture I chose to show an example of post implant reconstruction boobs has no nipples... When performing a mastectomy, the nipple and areola are removed because they are attached to the mammary glands and ducts. When the ductal system is removed, the nipple will die. So when the breasts are reconstructed, they are done so without any nipples.  After most of the healing has occurred, nipples can also be constructed using skin or cartilage from elsewhere on the body for the nipple itself, and the areola is actually tattooed on. Now you have some information that I'll bet you never knew that you didn't know!

The other option for post-mastectomy reconstruction is autologous reconstruction.  Autologous reconstruction allows you to create breasts using your own tissue rather than synthetic implants. The two most popular methods of autologous reconstruction are the TRAM flap method and the DIEP flap method. TRAM involves severing a diamond shaped piece of skin, fat, and muscle tissue from the lower stomach and weaving it through the chest cavity. The surgeon will then use the stomach tissue to create 2 new breasts complete with fatty tissue from the tummy. After the tissue is transplanted to the breast, the stomach is stretched and sewn shut. The result is basically a tummy tuck. The DIEP flap is similar to the TRAM with the exception that the skin is completely removed and microscopically reattached to the blood supply in he chest.  Also, the DIEP flap does not remove any muscle, only skin and fatty tissue. This allows for a faster recovery time. Again, with the anologous reconstruction, nipple construction is EXTRA! (Want fries with that?? Why YES I DO! duh) 


Example DIEP Reconstruction Before and After

 Pros and Cons of Reconstruction Methods

Both implants and autologous reconstruction have their pros and cons. With implants, you come to the hospital with boobs and you leave without them. You will have an expander in, but to start it won't be very big. So to someone like me with a DD cup, that would be quite shocking and could totally mess with your psyche.  Also, you will have to go back to the plastic surgeon every 2-3 weeks for the first 6 months or so. Then when your expanders have reached full size and you wait 2-3 months for your muscles to settle, you need to go in for surgery again to have the expanders removed and the permanent implants put in.The whole process can take a year or more, depending on how large you want your new boobs. On top of that, you will need to return to your surgeon every year or so for a check up to make sure your implants are in place and not ruptured.  Believe it or not, if you choose silicone implants, it may not be apparent if you rupture. That was pretty scary to me.  There is also the risk of infection around the implant. If that happens at any point in the expansion process, the expander must be surgically removed, you must heal, and then you must be operated on again and started over with a new expander.  The scars are usually straight lines across the breast that can, for the most part, be covered later by a nipple add-on (I still think its hysterical that those are an optional add-on). On the bright side, the mastectomy and all subsequent surgeries are same day procedures, so there will be no long term hospital stay.  Also, within a day or so of each surgery you should be able to resume a pretty normal life, except to stay away from heavy lifting, lifting over your head, and chest presses (and other no brainer activities).

An anologous reconstruction brings a whole different set of circumstances. You come for your mastectomy with boobs and you leave with boobs. The reconstruction is immediate. There will likely be follow up visits to your plastic surgeon to reposition the breasts to be more even, to add nipples and arreola, and to treat any infections. There is also about a 5% risk that the skin from your stomach will not "take" to the transplant and die. If that happens the doctor can try to operate again and try once again to connect the blood vessels from the chest to the blood vessels from the stomach, but if it still doesn't take,  you need to be sewn up, heal, and begin reconstruction with implants. There is also the risk for infection at the breast or at the stomach suture site. If an infection occurs, it is easily treatable with antibiotics. The scarring from an analogous reconstruction is much more significant than with implants.  Not only will your breast be scarred in a straight across or diamond shaped patter, you will have a scar across your stomach from hip to hip at the site of the flap removal.  You need to be ok with scars if you choose this type of reconstruction.  And finally, because autologous reconstruction occurs at 2 sites on your body (chest and stomach) there is a longer recovery period.  When you choose this type of reconstruction, you can expect to be in the hospital 4-5 days and to be at home on light duty for 3-6 weeks. 

 What's Next

After Dr. Lindfield presented me with these 2 options for reconstruction she told me that she works with and recommends three plastic surgeons.  She sent me first to a female plastic surgeon who specializes in implant reconstruction. At this point this was the way I was heading. However, if I wanted to consider the autologous reconstruction, she could recommend 2 male doctors in the area that also do implants but are also known for analogous reconstruction.

Then she asked if I was leaning one way or another. I told her with 3 tumors on both breasts and having so much of my life ahead of me still, I was definitely leaning towards a bilateral mastectomy (bilateral means both boobs for those of us who only speak English) with reconstruction.  While she left the office to get me contact information for the plastic surgeons she recommended, my entertainment entourage asked me if I was going to get implants.  They had just assumed that's what I would do. I have to admit, the idea of age-proof perky boobs was intriquing, but I was more intrigued by autologous reconstuction. Not only would I get the tummy tuck that I have always dreamed of since 2003 but the lower overall maintenance appealed to me too. I can't maintain the oil in my car, how the heck will I maintain implants over the next 40-50 years?  Plus, I am a proven clutz. I mean, how many times now have I broken or sprained my ankle?  Every single time I fall or walk into a wall, I am going to be paranoid that I busted an implant.  This has a habit of happening a lot. 

Then my entourage asked if I was really considering autologous reconstruction. I said "Yeah!" Then they both said "Why?" and of course I said "Why not?". It has everthing going for it.  Or so I thought. Then my entourage pointed out what happens when stomach scars go bad. I hadn't thought of this. And the down time may just be too much. I would miss a month of work, Dr. Lindfield said, and would not be able to sit up and do much for weeks. Not only would I go crazy, but when I finally did come to, I am sure I would be disgusted with the house.

I had decided then that I would get the double mastectomy with implant reconstruction.  Funny how making my decision reminded me sort of like picking something for dinner off a menu where there are lots of good choices. So Dr. Lindfield made an appointment for me to see the implant specialist that Wednesday to get on her surgery schedule.

Finally More Information on Breast Cancer

The Oncologist

On Thursday January 10th I had my first official cancer-related doctors appointment. My relationship to Alice Mammoser apparently has more perks than just free iridology readings. Alice has some great contacts in the medical community and was able to get me in to see one of the top oncologists in the WNY area with only 3 days notice. 

I was really anticipating my 2:00 appointment with  Dr. David Dougherty. I was excited that finally someone with some medical background could tell me what my radiology results meant. Yes, I knew I had Invasive Ductal Carcinoma and that it was "architecturally well differentiated" and "intermediate nuclear grade", but what did these things really mean? It was hard to figure out just by Googling the terms.

The first thing I learned about oncologists is that they are very busy. My 2:00 appointment ended up with me being called into the office at 2:45 and finally being seen closer to 4:15.  What could I say? It is nearly impossible to get any priority or special favors from an oncologist, after all, ALL his patients are dying! I didn't mind the wait so much because I had an entertainment entourage with me. My husband and my Dad's girlfriend had accompanied me to Dr. Dougherty's and they didn't fail to entertain. Who knew you could have so much fun stuffed in an exam room? We spent the last hour and half wetting the cotton balls that were in a dish on the countertop and flicking them and trying to stick them to the items on the walls.  When Dr. Dougherty finally came in we shamefully hid the wet cotton balls we were holding under our thighs so he didn't know what we were doing, but I think he figured it out when he bent down to pick up all the wet cotton balls on the floor between the door and his chair. Busted.

My visit to Dr. Dougherty's office resulted in the best news I had gotten in a long time... He said I was boring.  This is a wonderful thing for an oncologist to say. Dougherty told me that the IDC that I have is a run of the mill cancer and very common in 60 and 70 year old women. He said it was treatable all day long and with removal of the tumors, I have a 92% survival rate to look forward to. Being told that my cancer is boring was about the biggest relief we all could have gotten. What did intrique him is that I have 60 year old cancer but I am only 37 and have no genetic history of cancer in my family.  I always thought that cancer can happen to anyone and it comes out of nowhere but apparently that isn't so very often. Yes, it can happen... it happened to me, but more often there are predictors such as a history of certain cancers in the family or a genetic mutation of the BRCA and BRCA2 gene.  Dr. Dougherty ordered a genetic test on me to see if I had that genetic mutation because that would at least explain why I contracted this cancer so young. A BRCA mutation would also be a huge predictor for future similiar cancers such as ovarian cancer.

Dougherty continued to explain to me that "architecturally well differentiated" refers to the shape and spread of the cancerous tumors. The more differentiated the tumors are, the easier it is to remove the tumor whole and get out all the cancer cells. The less differentiated the tumor, the more it has spread into nearby tissues and the harder it is to get it out whole without other cancer destroying methods such as radiation and chemotherapy. 

Doctor Dougherty also told me that my cancer was Estrogen positive and HER2 negative. I learned that this meant that my tumors were actually being fed by Estrogen, so if I were to cut off my Estrogen supply, my tumors would die. Sounds like an easy solution, right? Unfortunately, a lot of who I am would die too and I would likely start what is called induced menopause. If other treatments don't work, we may end up resorting to that.  HER2 is a gene present in the chromosomes of the cancer cells that determine how fast the cells are reproducing. If the cancer sells show too many copies of the HER2 gene, it will grow very aggressively. These cancers are called HER2 Positive. My cancer is HER2 negative, meaning the cancer cells are growing and spreading at the same rate as my healthy cells and not overly aggressive.

Removing Breast Tumors - Surgery Options

Dr. Dougherty explained to me that the first step to curing my cancer is to have the 3 lumps removed.  I will need to have surgery for this. There are 2 types of surgery available to me: a lumpectomy and a mastectomy. 

A lumpectomy is a process where the surgeon would remove each of the lumps and the tissue immediately surrounding the lumps. A lumpectomy would leave most of my breast in tact and would likely need to be followed by radiation therapy in the exact locations where the lumps were removed. A mastectomy is where the entire breast, or in my case both breasts, are removed.  When a mastectomy is performed, breast reconstruction is performed at the same time or shortly after, so no longer are mastectomy patients flat chested.  Where a lumpectomy with radiation sounds less invasive, it leaves behind a lot of breast tissue. When there is breast tissue, there is a chance for a recurrence of breast cancer. Mastectomy, although more radical in nature, would result in the total loss of all breast tissue thereby reducing my chances of a recurrence (in my mind), and will in many cases not require radiation therapy.  Dr. Dougherty insisted that a lumpectomy with radiation is just as effective as a total bilateral mastectomy, but I was really not convinced.

Given that my tumors are well defined and not growing very fast, Dr. Dougherty was relatively certain that with a lumpectomy and radiation or with a mastectomy I will be rid of my cancer for good with little to no chemotherapy.  He felt that keeping to Alice's diet and herbal supplement regime would only help my predicament, so I decided to give it a go. Before I left, I was scheduled for a PET scan and the BRCA genetic test. The PET scan was to see if this cancer was growing anywhere else in my body.  And so I left his office with my entertainment entourage with a smile on my face (After I picked up the rest of the wet cotton balls off the floor, countertops, and walls).

Next step - arrange for surgery. 

Ridding Yourself of Breast Cancer

In my last post I told you about the process of being diagnosed with breast cancer. Now I want to tell you how I am going to get rid of it.

The Cure - Phase 1 - The Iridologist

The day after my diagnosis I went to town on Google and WebMD looking up the term "Well differentiated" and "intermediate nuclear grade".  None of these words sound terribly daunting or gloomy so I had a pretty good feeling that it was still early and not dire.  Through family connections, I was able to get an appointment with a well respected oncologist for Thursday January 10th, so I had a few days to kill before I got definitive answers.  Being the impatient person that I am, that STILL wasn't fast enough for me so Tuesday January 8th, I set out to see what I could do NOW to start ridding my body of cancer.

I am extremely lucky to have a world renowned iridologist in my family. My paternal grandmother is none other than the famous Alice Mammoser who is accredited with curing cancer and other terminal ailments naturally in such books as Wise Secrets of Aloha: Learn and Live the Sacred Art of Lomilomi by Harry Uhane and The Power of Flow: Practical Ways to Transform Your Life with Meaningful Coincidence by Charlene Belitz. In an effort to make this flow better, I will refer to her as Alice as opposed to "Grandma Ma" which is what we call her. Alice travels the world to visit her clients and right them when they have wronged their bodies through diet, herbal supplements and cleansers, and other alternative medicine suggestions.

I am not a full believer in iridology, in fact, many studies have found that it holds no merit. What I do believe in, because I have seen it with my own eyes, is that people with terminal cancer who declined traditional oncologigical treatment are still living fully 2 to 3 years later because of what Alice has prescribed for them to do.  I have basically no information except that I have breast cancer in both breasts at the ripe old age of 37. I feel that I eat healthy, yet I am severely over weight so obviously there is room for change. I don't smoke, I do drink occasionally, and I have been known to indulge in french fries and Lindt truffles maybe more often than I should. What do I have to lose by seeing what Alice has to say? I would say the several hundred dollars an hour that she charges (and people pay) to see her, but being her favorite grand daughter I get in for free and get to skip to the front of the line! (sticking my tongue out).

So Tuesday afternoon Alice saw me, shortly after my "last meal" at the local chinese buffet (I will explain later). She told me that I have been poisoning my body. The stuff I have been consuming is dangerous at best but in my predicament, it was a superfood to feed cancer. She told me I consume too much sugar. I don't indulge in sweets generally, except for the Lindt truffles I get as gifts at Christmas time, so I was not sure what she means.  Apparently everything that I have been eating has sugar in it.  Don't believe me?  Read labels of everything in your kitchen cupboards and try to not consume anything with sugar in it for one day. Remember, other names for sugar are lactose, fructose, glucose, sucralose, basically anything that ends in -ose.  She said I can't have soda any more. I told her I could because I drink diet and it has no sugar in it. She knocked me upside my head like only your grandmother can do and said "If it is sweet and it has no sugar, it is even worse. It has aspartame or, even worse, saccarin which not only feed cancer, some studies show they actually cause cancer".  In addition to sugar, she told me caffeine and gluten also feed cancer. I had to cut them from my diet immediately.  I think the only thing that rivals trying to find food that doesn't include sugar is finding food that doesn't include gluten.  So, if you are keeping score here, Alice told me to eliminate from my diet: sugar, wheat, pasta, rice, coffee, soda, iced tea, any caffeinated teas, all fruit, any dairy products, coffee creamer, cheese, any canned or prepackaged foods that use sugar as a preservative. Then she went further to list some things that weren't apparent with this list of no-no's such as saltm,vinegar, beef and pork and any non-organic game.  Why? Any meat that is not organic is likely injected with hormone before slaughter.  Breast cancer is known to often begin and be fed by estrogen and progesterone in the body. The last thing a breast cancer survivor needs is foreign hormones. 

So what can I eat? I spent about 3 days trying to figure that out.  I can have organic chicken, turkey, or lamb. I can have fish (yuck). I can have most green vegetables except green bell peppers (don't ask, I don't understand either).  I cannot have iceberg lettuce...again I don't know why.  I can have lentils, beans, goat cheese (again... no idea why I CAN have this but I'll take it!). I can have almonds, pine nuts, and sunflowers but not peanuts or cashews. I can have blueberries, raspberries, and blackberries but that is the only fruit I can have. I can have brown rice, but not white. I can have quinoa and quinoa pasta.  Many of the things she told me I can have I had never heard of before so I had to learn what they were before I could cook them. As depressing as this sounds, I need to lose weight anyway so this can only be good.

It gets more interesting.  The diet will help eliminate toxins and stop the growth of the cancer.  Apparently I also need something to clean my blood and make my cells spew all the junk that I have been filling them with for the past 37 years. Enter herbal supplements. I can take some vitamin D and echinacea just like anyone, but nothing would have prepared me for what I was about to be handed. Alice went to work listing all the supplements I needed to go buy and start taking ASAP.  I am not talking 5 or 6 vitamins, I mean more like 30 to 35 vitamins, 3 times a day.  If I had to purchase these supplements myself at a store, I would have to invest about $350 in supplements for the first 2 weeks. Thankfully once again, Grandma Ma came to the rescue and gave me for free whatever she had on hand.  Then my Dad and his girl friend picked up the tab on the rest. Thank goodness too because over the next few weeks I was about to get co-pay shell shock.

So, one hour with Alice and life as I knew it was over. I couldn't have my morning coffee. No chicken fingers, no cheese, no fast food, no pasta and worst of all, NO WINE!  That is why I was so glad that I enjoyed my last lunch out with Chacha Tina at the Chinese buffet. Now I wish I had eaten more. I am not thrilled. I am actually kind of depressed, but as anyone will tell you, if you keep doing what you have always done, you will keep getting what you have always gotten. So far what I have always done got me fat and gave me cancer. I suppose I am due for a change and change is never easy.

Using her iridology, Alice told me that my cancer is well contained in my breasts and has only reached a few of my lymph nodes.  As I mentioned before, I am not a firm believer in iridology, but I was happy to get some information... ANY information. I was finally able to sleep that night.

A Detour on the Journey

The Discovery

Christmas Eve 2012 after dinner, which was really awesome and I didn't have to host it, we came home to tuck the kids in bed and prepare for Christmas morning (wink, wink). After changing into my pj's I put my hand over my heart as my way of relaxing myself. Much to my surprise I feel a lump on the left hand side of my chest, where you would put our hand for the pledge of allegiance. Because I am naturally a hypochondriac, I ask hubby to verify that he felt it too, which he did.  "Better get that checked out" he says.  And check it out I will at my next Ob/Gyn annual which was already scheduled for mid January.

New Years Eve 2012 I wake up and go about my business going to work. Not until I get to work and see the first live person of the day do I realize that I can't get any sound to come out of my mouth. Not total laryngitis but definitely labored speech. Damn. I just had my annual cold 3 weeks ago, what the heck is this? Normally I would call my doctor but the truth is that I don't have one.  I have a foot doctor (2 of them actually), a girlie doctor, an orthopedic doctor, a headache doctor, and a mental doctor.  However, if I have a general cold or need a flu shot, I don't have a Primary Care Physician (PCP).  Did I mention I was a hypochondriac? Or at least I was at one point in my life.... I have found that I have been too busy to be that way for some time now. What I did learn from my years of hypochondriasis is that if you are visiting one of those specialty doctors for a specialty problem but you have a cold or the flu, they will treat you.  So, I happen to have this lump I found a week ago that strangely didn't go away, so I call up my girlie doctor to see me right away.  Sure enough, the get me in under the false pretenses of this worrysome lump and tell me it is a viral infection (my cold) and just needs to go away on its own. However this worrisome lump is quite worrisome. I needed a new mammogram.

 

The Mammogram

January 3rd I went into Windsong Radiology for my second ever mammogram. They are not so bad after all, and at this point I am just going through the motions because I am certain that this lump is a fatty deposit or a result of my monthly hormonal changes. This time was different. It was bad. Very bad. It was extremely painful like putting the most sensitive part of your body into a vice voluntarily. Men can compare it to having their scrotum squeezed like a pimple about to pop.  Women... well, they probably have experienced it. My first mammogram wasn't this painful.  I had no idea what had changed this time around, perhaps where I was in my cycle? 

The Ultrasound

To be safe, my Ob/Gyn also ordered an ultrasound of the lump on my left breast. Happy that the mammogram was over, it was nothing for me to lay on the bed with my arm over my head while the girl massaged me with warm ultrasound jelly. I almost fell asleep because I was so relaxed and happy to be out of the mammography machine.  When the radiologist was done, she told me she was just going to make sure the doctor was happy with the images she got and then I could go back to work. To my surprise she came back and said she had to look at the right side too. For the first time I had a twinge of anxiety about this. "Wait... what?" This time I was not falling asleep. I was on high alert craning my neck to see what the radiologist saw on the screen. I kept seeing a black hole.  I am not in the least bit medically trained.  But most of the tissue looks white, the black hole I am thinking is the cyst but it looks black... hollow... liquid filled.  This is good! When the radiologist was done the second time, again she went to show the pictures to the doctor and I went to work on my iPhone checking WebMD for breast ultrasounds and tumors on mammograms. I found that 10% of all mammograms show tumors or cysts and of those 10%, only 10% of those are malignant. That means for every 100 mammograms, 1 is cancer. Those are pretty good odds. When the radiologist came back in again, she said the doctor wanted more close ups of the right hand side with a different camera. That didn't take too long so soon I was dressed and ready to go home.

Wait, hold up there... not so fast.  The doctor wanted to see me. This is when I was brought into a small viewing room with monstrous 'better than 1080p' monitors lined the wall and the doctor was looking at all the images that were currently being taken throughout the mammography wing. She showed me my mammograms which showed little kidney bean shaped white spots that were concerning her on both breasts. "They are not symmetrical or smooth" she said. "Plus, since we cannot find your baseline mammogram from 2 years ago, we have nothing to compare it to so we have to be over cautious" she added.  Well this I understood. Breast cancer seems to be running rampant these days, I certainly understood and appreciated her over cautiousness. The next steps, she said, was a biopsy of each of the 3 kidney bean shaped masses.

The Biopsy

The waiting for the biopsy was the hardest part. They got me dressed appropriately, showed me a video explaining what was going to happen, and then they lead me to the biopsy room. There I sat and waited for over an hour for the doctor to come in.  Thank God for my iPhone I was able to do emails, chat on Facebook, and play poker which helped pass the time. Thank goodness I didn't bring anyone with me who would have been in the waiting room all this time... the 1 hour mammogram and ultrasound had now taken almost 3 1/2 hours! Also thank goodness I have an understanding boss who was able to deal with the fact that I went out on lunch and never came back for the rest of the day.

Finally three radiologists and the doctor came in to do the biopsy.  A breast biopsy is not as intense as it sounds.  I basically laid on the table like I did for the ultrasound. When the radiologist found my masses with the ultrasound, the doctor inserted them with a needle. This needle had a local anesthetic which quickly numbed the area. Then another needle inserted into the mass took a small chunk of the tumor as it exited for testing. Then a third needly inserted into the mass deposited a small titanium clip into the mass so that when I had future mammograms, the radiologist would know that those masses had been tested already.  I now officially have bionic boobs. They did this to 3 masses and deposited 3 titanium clips. It really wasn't that painful. I was chatting and laughing with the 3 radiologists who were holding me still (I guess they thought I would try to run away?) and we were comparing the texting habits of our pre-teens.  All fun and games. I was completely relaxed and completely sure that I was perfectly fine and all this was just a precautionary measure.  Figures... for years I think something is wrong with me and there isn't. Then I think there is nothing wrong with me and there is. I finally left the office 5 hours after my appointment time. I missed the entire afternoon at work and my lunch date with my husband.  Planning on a big lunch, I skipped breakfast and come 5:00 I was very sorry for that decision.  My stomach was louder than the musak that was playing overhead. I was out of there and so glad to meet up with hubby and kids for a dinner out since I hadn't taken out anything for dinner and was completely famished.

That first needle that delivered the pain killer was my messiah. Once that pain killer wore off, the next 3 days were tortuous. I couldn't lift my purse let alone anything substantial. I couldn't raise my arms over my head to get anything off the fridge or off a high shelf.  My right breast was so bruised it turned purple, nipple and all, over more than half of it.  I usually hate ice on my skin, even when its necessary, but ice packs were so very welcome for the next few days.  I will go to great lengths to avoid ever having a breast biopsy again.

The Cancer

The next few days went on as usual.  Even though I was still convinced that there was nothing wrong with me, something had changed. I called my girlfriend of many years and said that we need to go out. I stopped trying to impress everyone with how strong I can be and started asking people to carry things for me. I let my kids cuddle with me on the chair even though they were partially sitting on the arm of the chair, which will eventually break the chair. I went to a family party and played with the little kids. I wore a new sweater that I got for Christmas that was a little too short and tight but I liked the way it felt, even though it made me look fat. I downloaded and started reading a book that I knew nothing about. I prayed before bed.  All the while I was convinced that this is just a drill, but I wanted to see things differently from now on.

That Monday, 3 days after the biopsy, I received a call from my Ob/Gyn asking if the radiologist had told me anything about the biopsy and I said they hadn't, I was hoping she was calling to give me results.  She said she was and unfortunately all three masses that they had biopsied showed positive for IDC - invasive ductal carcinoma - a common form of breast cancer. She told me it was well differentiated and intermediate nuclear grade. I was on my way into our weekly meeting at work so I told her I would have to call her back for more information and I went to our meeting. That was a mistake. Do you remember watching the Charlie Brown specials and when the teacher would talk, it would sound like "Wah mwah mwah mwah mwah?".  That's what my boss was saying. For 20 minutes I had no idea what was going on before I realized that if I continued to stand there I may be asked a question and I had no idea what was going on, so I slipped out and returned to my desk.  Then I called my doctor back and asked her what "intermediate nuclear grade" and "well differentiated" meant. She told me she was not sure, but the breast surgeon would tell me. I could get in to see her on January 24th, 17 days later. Yeah. OK, that was not happening. If I had to wait 17 days for more information I would be in a straight jacket. I had to get answers pronto.

Coping

So what would you do if your doctor just called you and told you that you had cancer? Yep, me too. If I called you or said anything stupid to you on Monday January 7th I apologize. I was very drunk.

Then on Tuesday, January 8th, I woke up and got to work on getting better!