Author: Vangtime (Page 3 of 5)

I had my pre-op appointment on Wednesday morning. I met with the plastic surgeon, a medical assistant, a surgery nurse, and an anesthesia nurse or PA.

Plastic surgeon: did another exam, then talked about the procedure, risks, benefits, followups. Talked about the prescriptions I’ll be getting. Some other stuff. It will be a temporary implant – a “tissue expander” – which will be replaced after several weeks with a permanent implant, provided everything goes well. he also puts an ‘alloderm sling’ which is a tissue material that helps hold the implant in place. This will eventually dissolve.

Some of the stuff I will have to do after surgery:

• Sleep at a 30 degree incline. I will have to make myself an inclined bed spot. I found a bunch of extra pillows in one of the closets so I can use those. I know we have some extra pillowcases lying around too.
• I will have drains. I got trained on how to measure and empty them. When I produce less than 30 cc’s of fluid for two days in a row, I can go in to have them taken out. I already have an appointment for that but if that happens earlier I can go in earlier.
• I won’t be able to lift over 10 pounds for two weeks. I need to weigh all the things i pick up regularly to make sure I don’t mess that one up. i know for sure that Demi and all the cats weigh more than 10 pounds each.
• My expected medical leave is 3 weeks. That will have me back at work the day after Memorial Day.

I wil also have to do several things before surgery. Some of the interesting ones:

• Call the surgery center the day before to get my exact check-in time. I’m expecting it to be crazy early but we’ll see.
• Get a COVID-19 test. I did that Friday morning and got the results last night: Negative!
• They gave me a list of stuff to bring so I’ll need to pack that. I don’t know how that stuff is going to be managed – do they put it in a room? does The Mighty Sam hang on to it? I am particularly concerned about my glasses. I am not supposed to wear contacts and I am not going to be able to see anything without the glasses.
• Also I’ve got to do a fuckton of showers before I go. Shower the night before, and then wipe myself with these sterile wipes. Then sleep on clean sheets. Then another shower the morning of, and another wipe down.
• Dress in clean loose clothes. Shirt should be a button-down. I realized I don’t have any loose button-down shirts. I tried to find some online but couldn’t find anything that would be delivered in time for surgery so I decided I would just have to wear one of Sam’s shirts.

What to expect on the day of surgery:

• Check in at the surgery center. Pre-op prep will probably take an hour – they have to do a thing where they set me up to figure out where my “sentinel nodes” are, and set up my IV. I will have these removed on both sides, since they are also doing an excision biopsy on the left (even though that biopsy came back negative).
• Surgery itself: The general surgeon goes in first and does the mastectomy, the excision biopsy, and the removal of sentinel nodes. Then the plastic surgeon comes in and puts in the tissue expander and the alloderm sling. Total time: expected to be about 5.5 hours.
• They said they have a reader board out the family waiting area so The Mighty Sam will be able to see where I am in the process. I told him it was like a flight tracker! he shook his head in exasperation because I am so annoying!
• After surgery I’ll have recovery in two stages. They said they would put me into a “support garment” right away. That will be a special bra with a velcro front closure. I’m supposed to keep that on for 48 hours. Recovery is supposed to be a couple of hours.
• It seems possible that they might actually send me home that same day. But they said that would likely be a game time decision, depending on how well I’m doing.

I picked up several prescriptions: Pain meds, anti-nausea meds, antibiotics.

I am a little nervous about the surgery, since I’ve never had surgery before. Everyone seemed to be sure that I would be a good candidate for surgery and recovery, so that’s at least good. And I need it. it’s not like this is optional in any way.

I’ve also prepared a list of chores that The Mighty Sam will need to do while I am not able to. Since I can’t lift anything for a while he’s going to have to take full responsibility for taking the dog out for her bathroom breaks – she needs help up the stairs now and I won’t be able to do that. And i won’t be able to lift baskets of laundry.

But I’m NOT supposed to hang around in bed all day. I’m supposed to start walking around right away.

I’m kind of thinking that I will just queue up a bunch of podcasts for my recovery entertainment. That way I won’t have to worry about being able to read. But I’ll have lots of books available too. Who knows what I’ll feel like doing? This is brand new for me.

I am kind of thinking that having migraines might be helpful in dealing with this: I know what it’s like to have horrible nausea and excruciating pain while lying around doing nothing all day. Except with this, I’ll have anti-nausea meds and pain meds! Medical technology can be amazing.

Friday was a great day because I got everything scheduled. I now have a surgery date: May 5. Cinco de Mayo. Or SEAGULL DE MAYO as one of my dear friends suggested. So henceforth May 5 will be SEAGULL DE MAYO.

I talked to my plastic surgeon at 1:00. We discussed the options for reconstruction. He strongly recommended immediate reconstruction, which I agreed with . There are some risks involved – with this process I would get to keep my skin and nipple, and the implant would go behind my pectoral muscle. But there’s a risk that parts of the skin or nipple will die, especially if I end up needing radiation after all. Which we won’t know until they actually get the tumors out and do all the pathology on them. And that would involve more intervention and procedures than if I just did the mastectomy now and then waited to see if I needed radiation, then got whatever other treatment I would need, and then, finally, got reconstruction. But if I did that, I would lose the chance to keep my skin and nipple. So I figured that was worth the risk. If it goes badly I will lose them anyway.

We also discussed the “excision biopsy” on the left, and whether I will need any reconstruction after that. I said I wasn’t really too worried about it, especially since the left boob is bigger, and the doc said that my assymetry is favorable. I said, Yeah, Favorable Asymmetry is my new band name.

Right after that a scheduler called me and we set up all my appointments – a big pre-op appointment next week, where I’ll meet with both surgeons, the plastic surgeon’s PA, and a nurse. I’ll get examined and measured again, and then I will meet with the nurse who will help me with all the stuff I need to know and do before surgery.

One of those things is setting up a drive-by COVID-19 test, within 72 hours before surgery. So that is kind of nice, that I will actually get tested, but it also means I am not fucking going anywhere except doctor appointments until after the surgery and healing.

Right after that call, the scheduler called me and set up all my appointments – the pre-op, the surgery, ad a bunch of post-op appointments.

I also had a quick call with the medical oncologist. The upshot of that is that we will talk again a couple of weeks post-surgery after he has seen all of the pathology, and we’ll decide treatment from there..

I’l get a clearer idea of what to expect afterward at the pre-op appointment, but Im’ thinking I will be off work until at least May 26 – the day after Memorial Day, or possibly the Monday after that, which is June 1.

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On Thursday I “went” to an online breast cancer support group. Most of the women were much older than me – I’d guess average age was around 65 – and most were at least a couple of years post-treatment. There was one who had been diagnosed last fall and was done with her treatment – I think she was probably early to mid-50s. There were, I think, 9 total, all white except one Black woman. It was nice, although it did kind of feel like joining a circle of church ladies. It’s only once a month so it’s no big deal to attend. I might like to find a more raw group with some more sweary people in it.

Good news! The left side biopsy was NEGATIVE. I got a call from the surgeon today and we discussed the results and the surgery.

Again, we confirmed that mastectomy on the right side is the right way to go, with the plan to keep my skin and nipple. There are risks for that – sometimes parts of the skin doesn’t recover and those parts die and need to be removed. Also – risks include excessive bleeding, infection, and heart and lung injury.

The left side biopsy was negative, but the surgeon suggested (and I agreed) that she will do a – I think she called it “incision biopsy” – at the same time as the other surgery, so they can get that out and really check the whole thing.

Also, before the surgery they inject a substance in the breast that will identify the “sentinel node” – the lymph node that is the first in line for anything that comes from the breast. They take that node out and biopsy it to make sure it is clear. We also decided to do that on the left side as well, because why not be safe?

She said she would order the surgery and a scheduler would contact me to actually schedule it. She also said I would need to talk to the plastic surgeon.

Soon after that the plastic surgeon’s office called me to schedule an appointment for tomorrow. That is scheduled for 1:00, and then I talk to the medical oncologist at 3:00.

I hope that by the end of the day I’ll have all my ducks in a row. And a surgery date!

Just waiting for the results of the MRI-guided biopsy. Waiting sucks.

I’ve sewed a couple of cloth face masks using a sheet. The Mighty Sam bought me a sewing machine. I ordered some additional supplies from Joann Fabrics but they are slow in getting delivered. Once I get some good sharp scissors i think I’ll get a few more out.

Elastic is just about impossible to find but I realized that there’s a strip of elastic around fitted sheets that I can use. It’s not ideal – I tried to get the elastic out of the fabric it’s sewn into, but it seems like the fabric is sewn INTO the elastic so i have to use it with the fabric covering.

The watercolor postcards I ordered arrived, and so did the postcard stamps.

My MRI-guided biopsy was today, and now I’m an old pro at biopsies.

I didn’t really get how the MRI-guided biopsy was going to go. I’ve had a breast MRI and I’ve had an ultrasound-guided biopsy (actually two of them). It seemed like putting them together was kind of incongruous – like bungee jumping on the prairie or taking an airplane to go spelunking. But it turns out you CAN do it. It just takes a lot of steps.

First they place an IV. My last IV was in my inner elbow, but this one was in the top of my hand. So another new experience. This time I knew what placing an IV was like, though, so I wasn’t worried. It does hurt when they put the needle in, but once they get the IV placed and take the needle out it stops hurting.

Then you get into position in the MRI machine. It was the same position as last time – face down, arms overhead. Since this was just a single boob this time, that one was positioned in the MRI table slot and the other one was shielded.

For an MRI-guided biopsy they have to really squash your boob. The squashing was by far the worst part of it. They jam these plates or whatever to stabilize you just so. Then you get the headphones. They asked if I wanted to listen to any music – they could put Spotify on – and I asked for XTC. That was nice, but mostly the MRI is so loud you can’t hear it.

Then I went in for the first scan. There was the initial scan, then they administered the contrast through the IV, which again, feels REALLY WEIRD. But definitely bearable, and it was soon done. After that they did another scan, and then pulled me out.

The next step was for the radiologist to look at the images to determine where to place the biopsy needle. She looked, and then gave me the local anesthetic, and then placed the needle. Then back in the MRI for another scan to see if the needle was placed correctly.

Fortunately it was placed correctly the first time. They told me that sometimes they need to pull you out to make adjustments. But the radiologist nailed it.

Then I was wheeled out again to do the actual biopsy. The tool they used was different: it made a drilling sound and then a ding for each sample. The radiologist took a bunch of them. Then she placed the clip to mark the spot. For my other biopsies the clips were titanium. Because this is was an MRI, this new clip is made of bone!

After that I had one more scan to check that the clip was placed correctly, and it was!

After that they undid all the stuff that was squashing me. That was a huge relief. Then I was able to get up out of the bed. They had me sit up first (with the nurse holding direct pressure on the biopsy needle spot), and then I got to stand, and the nurse put on a dressing.

The last step was to go get a gentle mammogram, again, to confirm the location of the clip. And then I was done.

And now I know the drill: No lifting more than 5 pounds for 24 hours, keep the sports bra on overnight, take Tylenol for pain.

Results should be back by the end of the week, and I have an appointment with my oncologist on Friday. So by THEN I should be able to get my surgery date.

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I mentioned this earlier: the day I got my MRI results I was in kind of a shitty place mentally. My lab results had been promising, and it had been looking like my treatment would be manageable. And then suddenly everything was looking much worse.

So I emailed the person who runs the breast cancer-specific support group, just to introduce myself and ask if she had any online forums or other resources to recommend. She emailed me back right away and told me that her group was meeting via Zoom the following Thursday. She also gave me her phone number and said she was happy to talk with me any time. So I set up a phone call with her on Saturday, just to “meet” and touch base.

That all did make me feel a little better. I called her on Saturday and had a nice conversation with her. I told her about my diagnosis, where I was in the treatment, that it was likely that I would get a full mastectomy on the right side because of the third spot (I didn’t know at that time that it was going to turn to to be benign), and that I would be getting a biopsy on the left side on Monday.

She told me a little about herself: she was diagnosed in 2015, had a full mastectomy on her left side with reconstruction at the same time. She’s a bit older than me – she said she was 69 when she was diagnosed. She recommended a mastectomy bra store – Mary Katherine’s on Aurora. She also told me about the Zoom meeting next Thursday (this Thursday!) and asked if I would be willing to go first. I said sure!

So I need to get ready to prepare a quick intro for myself! She told me that since it’s a free Zoom account it will get cut off after 40 minutes, so I don’t want to waste time.

Already I want to ask people if their diagnostic process took FOREVER like mine seems to be taking. I’m going to guess YES, especially because they still do tests and analysis on everything they collect from the surgery itself.

The next Breast Conference was a week from the first – April 9. I got a call from the oncologist after. He said they found a third suspicious mass in my right breast, in a line with the other two. Total length of all three: 7.5 cm or so. Too big for just a lumpectomy. Also they found a tiny spot in the left breast as well. So. Followup ultrasound-guided biopsy for both of those, which was scheduled for the next day.

There was some good news on that day though – I got a call from the genetic counselor who told me about the breast mutation gene tests coming back negative. Also, since the COVID-19 curve seemed to be flattening, they were starting to schedule surgeries again. So the Breast Conference said that I could get the surgery first and start hormone therapy afterward – the normal progression of things.

This news was the first time after my initial diagnosis that I got mentally a little thrown.

I had tried to go to the general cancer support group phone meeting on Tuesday, but it was scheduled right around the time of one of my project meetings so I could only “attend” the first half-hour. Since I was only going to be on a short time I just listened and didn’t talk. It was really too short to get much out of it – a couple of different people talked about their treatment, and there was a little discussion about toilet paper (there’s not a shortage of toilet paper per se – there’s still tons of commercial grade toilet paper that businesses aren’t buying because everyone is working from home). I thought it might be better to try the breast cancer specific group.

I got the second biopsy procedure on Friday of that week, 4/10. Also at Bellevue. I was an old hand at the drill so I knew exactly what to expect. They were able to successfully biopsy the third spot on the right side, but they couldn’t find the spot on the left side.

I had a phone appointment with the oncologist on Tuesday after the biopsy – 4/14. They still didn’t have results back but he did say we needed to do an MRI-guided biopsy on the left side. So I have that scheduled for this coming Monday, 4/20. He said it was possible that they still wouldn’t be able to find anything, in which case I would just have a follow-up MRI in 6 months.

The next day I got a call on the biopsy results: NEGATIVE. I was so happy. Even so, I thought it would make sense to go ahead and do a mastectomy and reconstruction on that side. I have small breasts, and that one is smaller than the left one anyway, and even if the new spot was negative for cancer I wouldn’t want to take the chance of it going rogue later down the line.

I had another phone appointment with the general surgeon on Thursday morning. She said that my lymph nodes all looked great on the MRI, which is good. She also wants to see the results of the MRI-guided biopsy on the left side before we settle the surgery, but she agreed with me that full mastectomy on the right is the best course of treatment.

So, as far as medical news, I think I’m now up to date. MRI-guided biopsy on Monday, and then I have a phone visit scheduled with the oncologist on Friday. And hopefully by then I’ll know my surgery date.

when we were driving to the full day o’ doctors appointment, we were listening to KEXP. Suddenly the DJ started reading an email request from listener Sam. It was MY Sam. He had requested that they play “Hero” by Foo Fighters in honor of me, since I had just been diagnosed with breast cancer and we were on the way to my medical appointments.

The Mighty Sam said that I was his hero. That was amazingly sweet. I cried.

The DJ followed that up with “Heroes” by David Bowie.

One thing that I forgot to mention from the general surgeon appointment: I had to stop taking my whore pills. I have been taking progesterone-only pills since 2014, because I was having too much uterine bleeding due to a couple of fibroids. But since my cancer has positive progesterone and estrogen receptors, more hormones will make it worse. My last whore pill was on April 1.

I was concerned I would immediately start up the bleeding again but so far it hasn’t happened. I set up a phone appointment with my regular doctor (she had called and left me a message when she saw my diagnosis in my file), and we talked about it. She said that it was possible that since I’m older the issue may have resolved itself. Then there is also the way hormone therapy would induce menopause and that would also work the issue out. It’s been a little over 2 weeks and no bleeding so far. We’ll see if I start having real periods again.

The MRI was definitely weird. I took off all my rings (they said to remove all jewelry) and wore comfortable clothes. Once there, I was instructed to fill out a consent form and then remove all my clothes except underpants and socks. I dressed in hospital pants and gown and little socks with traction strips on the bottoms.

I then walked down the hall to get IV’ed up. I had never had an IV before. The IV needle hurts going in, but then they take the needle out and just leave the little tube, and then it stops hurting. (I had been worried it would be like the time I gave blood and it hurt like hell the whole time, which is why I have never given blood since.) Then they tape it up so it doesn’t move around.

There were two guys – the MRI tech and the IV guy. The IV guy did the IV, then the MRI guy told me how to get into the MRI machine. They gave me ear plugs to put in my ears first. Since it was a breast MRI they had me lay face down. There’s a little open area where your boobs hang down, and they have to position these side plates just right on either side. I stretched my arms straight up and there was a bar for me to put my hands on.

In hindsight, I would have tried to be a little more careful about relaxing my arms when I first got positioned. Because I was kind of gripping the bar and after they got started and it was going for a while, I couldn’t relax them without moving. And in an MRI you are supposed to stay very, very still.

Once I was positioned they put a set of headphones over my ears. I could hear the MRI guy talking through them, so I would still be able to get instructions and info once inside. They also gave me a little button on a wire to hold, which they said I should press if I was in distress or needed help. Then I got put into the machine.

Since I was facing down and my eyes were closed, I couldn’t see anything anyway, so there was no need to feel claustrophobic. I’m really not claustrophobic anyway so I don’t think it would have mattered either way.

It was very loud, so the ear plugs and head phones were good. About halfway through the MRI they started the IV contrast. Now, the sensation of that coming in through the IV was WEIRD – a cold, dripping sensation. After that started the MRI tech said it would be another 10 minutes.

So of course, for my ADHD self it is really hard to gauge time passing. I kept trying to think of things to entertain myself with but I kept getting distracted by how tense my arms were. I tried to do focused relaxation of all my muscles and that helped some.

Then it was done and they took me out, removed the IV, bandaged me up, and I could go get dressed. I was a little concerned about the potential side effects of the contrast thing they use but I ended up not noticing anything at all.

As annoying as it is to have breast cancer, and having to deal with all that entails, it has definitely been interesting experiencing these different medical procedures.

I will be glad when I get caught up on all this – of course I wasn’t in a mental state to start writing all this down when it was happening, and also, I wasn’t ready to put it up on The Intarwebs until everyone who needed to hear about it from me heard it from me.

On the way out to the car, the social worker called, so I didn’t get a whole lot of notes on what happened there. This is, again, April 2, two weeks ago today.

But she asked me a lot of stuff about my financial situation, my work situation, whether I had people to support me and give me rides, and stuff like that.

She also gave me some support information. There’s a general cancer support group that meets on Tuesdays, from 1:30 to 3:00. She gave me the phone number and log-in for that, which has been moved to a virtual meeting due to COVID-19.

There is also a specific breast cancer focused group, which I think I am a little more interested in.

She gave me some information on an online general Cognitive Behavioral Therapy resource, which I said I would sign up for (I did – that’s for another post). She also said KP provides one-on-one counseling if I need that. I told her I might, and that I was still just trying to find my bearings with all this.

When I went in to the surgeon visit I got a couple of folders full of information. One is a pink folder that had information on the support groups, plus the business cards of my medical team. The other was a giant envelope with a bunch of instructions and information on surgery. Since I’ve never had surgery before that was very interesting to have.

After that we got home and I chilled out until after lunch. The surgeons told me that they have what they call a Breast Conference during the noon hour, when everyone on the team gets together and talks about me, and about the best course of treatment given my situation.

Next up was the radiation oncologist. He mentioned that he had just gotten out of the Breast Conference so he knows what’s what with the team.

At that point it seemed like the most likely path would be a lumpectomy followed up by radiation therapy, plus hormone therapy given my good hormone receptor results.

They pretty much always follow up a lumpectomy with radiation therapy, Radiation therapy significantly reduces the chance of a reoccurrence of cancer. If you have a mastectomy they usually don’t do radiation, unless there is lymph node involvement, or it has invaded the chest walls, or it is very large.

If you have radiation it is 5 days a week for 4 to 6 weeks. The radiation itself is targeted just to the breast. Generally there are no side effects at first, but after a while you start getting low energy and fatigue. He said it would still be ok to drive, and encouraged exercise since that might make you feel better.

The other main area of side effects is skin effects – skin irritation, pinkness, and tightness. And there would probably be soreness at the end.

Long term side effects include thicker skin and possible shrinkage of the skin and breast tissue. This is not great news for someone who already has a small rack, but I figured that being alive and not getting a recurrence is worth any cosmetic weirdness.

Since the radiation does affect the very top of your lungs, there can also be some lung injury, but he said this was quite rare. It can also make your bones slightly weaker. He said 5-10% of people are still sore 6 months later.

Radiation generally starts about 4 to 8 weeks following surgery – you need to heal up first. And that also is if you aren’t having chemotherapy.

Each treatment lasts about 30 minutes. Most of that time is taken up in getting you set up just right. You can’t listen to headphones because, you know, radiation. But it’s only like 10-15 minutes of just sitting there, plus, he said, they have music playing. Totally manageable.

He said also that before the radiation therapy starts, he’ll do a Design Radiation Plan, where he does a CT simulation. Then you also get a couple of tiny tattoos on your skin to help them align you just right for each session. Also, he said a radiation oncology nurse would meet with me about skin care recommendations to help protect my skin as much as possible.

So that was a ton of information – he took up the full 45 minutes!

The regular oncologist called next. We talked a little bit about the genetic testing, and then he asked me a bunch of questions about my general health.

We then talked about my Dense Breast Tissue. He recommended a breast MRI so we could get better information about what’s actually in there, and I agreed, so he put in an order for that.

He said the Breast Conference would meet again next Thursday, hopefully with my genetic screening results plus the MRI results.

Because of COVID-19, they aren’t doing any “elective” surgeries right now (I feel really irritated that breast cancer surgery is considered ELECTIVE, what the fuck?). Because of that, he said he wanted to start me on hormone therapy while we’re waiting for surgery. He thought he would go ahead and have me start that after the next Breast Conference.

For hormone therapy, you have to come to the clinic to get some shots. One is Leuprolide, which shuts down overian function, and then something called Anastrozole, which shuts down estrogen adrenal glands. So what it’s doing is suddenly putting you in menopause. Side effects are, basically, the onset of menopause.

It occurred to me that one side effect of this treatment might be no more migraines! Since Dragnhild quit getting them after she hit menopause.

A long term side effect is possible osteoporosis. That would suck, but at least now I’m starting from a good bone density situation so that might not be as bad for me as it would be for other people.

He said that there might be a role for chemotherapy, but that is usually indicated for larger tumors, or when there is lymph node involvement. So we won’t really know for sure until they do the surgery and see what’s what.

He said he would schedule a phone visit with me after the next Breast Conference, and in the meantime I would get the breast MRI.

That was all for the doctors. I next spoke with Lizzie, my Nurse Navigator. We chatted a little about the doctor day and what might be next. She then gave me the number to call to schedule my MRI.

I called them, and it turns out they do MRIs 7 days a week. So mine was scheduled for Sunday morning. They told me: Wear cotton undergarments. No jewelry. And asked a bunch of questions about whether I had implants or medical devices or bullet fragments anywhere. Fortunately I don’t have anything like that.

I was exhausted by the end of the day.

The Mighty Sam drove me to my appointment. It was in the Capitol Hill Kaiser Permanente, and it is called the Multidisciplinary Breast Clinic.

At first The Mighty Sam came in with me, but they ended up saying he had to wait in the waiting area since they are being super restrictive because of COVID-19.

The first meeting was with the general surgeon. She did an exam of my rack. The right one was still sore from the biopsy, but it wasn’t too bad. She was able to feel a hematoma from the biopsy but not the masses themselves. She explained about how the cancer forms, where it is, and how it’s removed. Also the difference between lumpectomy and mastectomy.

She also explained a little about surgery itself – they do a contrast chemical thing where they can see which lymph node would get the first metastasis, and they take that node out as well. Lumpectomy would remove just the mass plus a margin of tissue, but mastectomy removes the entire inside of the breast (later I would talk to the plastic surgeon, who said he thought if that was the option we would still be able to keep my own skin and nipple).

She also said at this point my cancer is a clinical Stage 1, but that is re-assessed after surgery when they can do more extensive pathology on it.

After the surgery she said I would have to wear a sports bra and then do some exercises and walk right away.

The next appointment was with the plastic surgeon and his PA. He was super nice. He explained about all the different procedures. With a lumpectomy he often won’t have to do anything. There’s a procedure where, if there’s a divot or something from a lumpectomy he can inject some of your own fat, but it doesn’t always work well. I said I didn’t really care if I ended up with a divot.

He also explained the options for reconstruction: You can either reconstruct using your own belly tissue, or use implants. Since I don’t have much in the way of belly tissue, I am not a candidate for that option. So it would be an implant. Or implants. He said they can do reconstruction at the same time in a lot of cases, and also said that I am a really good candidate for that because I am, other than the cancer, healthy and fit.

Implant reconstruction works like this: a temporary implant is inserted behind the pectoral muscle. This implant can be filled from the outside. So you get it just like a third full at first, and over the next few weeks he gradually adds more fluid until it’s the full size. Then you go back into surgery and he replaces it with a permanent implant. voila! Reconstructed.

After that he did some measurements and had his PA take a bunch of pictures. “We might not even need these,” he said. But he also said something to the effect that he would be very pleased to do reconstructive surgery for me if I should need it. It was really nice.

After the surgeons I went down to the lab to give a blood sample for the genetic testing. Then we got in the car and it was time to talk to the social worker. I’ll write about that in the next post.

I ended up meeting (by phone) with the genetic counselor on April 1, the day before my Big Day o’ Appointments. It was kind of nice, because I would be able to give a blood sample at the lab if we decided it was a good idea to test.

According to the genetic counselor, about 5-10% of breast cancers are related to genetic mutations, 65% are “sporadic” meaning no one knows why they happened, and the rest are likely familial-related but where they don’t know exactly why.

There are two breast cancer mutations that they can test for: BRCA1 and BRCA2. If you have those genes, you have a 40 to 80% chance of developing breast cancer in your lifetime. If you’re a regular person without the mutation, you have a 12% chance – 1 in 8. And I knew that 1 in 8 statistic already.

The genetic counselor had me tell her about my family tree, up to grandparents, and then down to nephews and nieces, and explain any cancer history.

There is very little cancer history in either side of my family. The short version: out of my immediate family, grandparents, aunts, uncles, cousins, and everyone, there are only three cancers that I know of: Paternal aunt had breast cancer which is now completely cured; paternal grandmother developed colon cancer in her 90s, and one maternal cousin has a different kind of cancer (gall bladder, I think). That’s it. No one else that I know of has had cancer.

Immediate family: Mom, dad, sister, brother, five nieces and nephews. No cancer (except me!).

Dad’s side: Grandparents, one half-uncle, one uncle, two aunts, 6 cousins.

Mom’s side: Two aunts, three uncles, 9 cousins, several cousins-once-removed.

They can do the breast genes, and they can also do a full gynecological panel which tests for all the gynecologic-related cancer mutations.

I decided to do the full panel. Although my family history didn’t look very suspect, I do have one aunt with BC and I am evidently pretty young to be getting it. And also, because getting better information now, even if the news is bad, means I’ll be able to get more thorough treatment now. My uterine fibroids and excessive bleeding were worrisome anyway – I’d want all that stuff removed if it was going to cause me cancer trouble later.

There are three possible results on the screening:

1. Positive: That means you have the mutation and you need to think really hard about what kind of treatment to pursue. Also you probably better tell your relatives so they can make their own decisions about testing.
2. Negative: That means you don’t have the any of the known mutations. This does not mean you don’t have something that science hasn’t identified yet.
3. “variance of uncertain significance” this means there was something weird but they don’t know what it means yet. They would send you additional information down later on if they find out more about that particular gene.

Since I’m writing this so much later than when it actually happened, i can say in this post what my results were: NEGATIVE. Not just on the breast cancer mutations, but on the full gynecological panel. So that’s good. I didn’t know these results when I went into the day-long appointments the next day though.