Eyelashes and mastectomies...

Today is my final chemo infusion, and it's a good thing too. Do you have any idea how difficult it is to apply mascara to a single eyelash??? I caught myself doing that the other day as I was getting  ready for work. It was pretty pathetic. It was all I could do to keep myself from just grabbing my tweezers and yanking it out so I could just be done with it. I've never worn a lot of makeup, but I always liked mascara. Well, now I'm getting used to having naked eyes. Maybe I could make this work for me. I'll just get a bunch of tie-dyed scarves and do the hippie/granola thing. Why not? I've already done shepherd, biker, Aunt Jemima....

I met with my surgeon this week. Actually, she is the first of three surgeons that together will take me apart and put me back together again. I should probably mention that from here on in my little blog, things are going to start to get a little personal, so if you are one of my nephews, home teachers, male coworkers, or any other man that I see regularly and you think you might have trouble looking me in the eye the next time you see me, you may just want to have wife or girfriend read the blog and give you the highlights.

Anyway, met with surgeon #1. I love her. My appointment was at 2:30. Neil and I left shortly before 6:00, and very little of that time was actually spent waiting, unlike many doctors' offices I've been in. We spent four hours discussing next steps and options with the surgeon, her medical assistant and nurse. I love the nurse too, by the way. She was the first nurse that I talked to after diagnosis. She's the "Rock and Roll" nurse. (See first post.)

So the surgery is scheduled for March 18th. They think I may have to still have radiation after surgery, but that is still up in the air. It depends on a few different things. One, if there is cancer in the lymph nodes, they will push for radiation. They won't know that until they do a biopsy of one of my lymph nodes during surgery. Two, typically if the pre-chemo tumor was 5 cm or more, they push for radiation. Mine was 4.5 cm, so I'm kind of on the fence. Three, patient's preference. Of course I make the final decision of whether or not I do radiation. I'm hoping to avoid it, but am not going to decide anything until after they do the node biopsy. If there is cancer there, I'll do radiation. If there isn't, I may just decline.

As to surgery options, I will definitely be having at least a single mastectomy, possibly a bi-lateral mastectomy. Often women will choose have a bi-lateral done in order to decrease the chances of another occurance of breast cancer. Not the first cancer coming back, but a new occurance in the other breast. I asked what the chances were of that happening. They said about 2 percent, unless you were genetically predisposed. If that is the case, the odds go up to around 80 percent. I haven't done genetic testing yet. I have a cousin and two aunts, all on my mother's side that have had breast cancer, so the odds don't look too good for me. I'm hoping to have the genetic testing done in the next week or so to help me make a decision. Either way, it will be great to know because if I test positive, my sisters and daughter have a 50/50 chance of being positive too. So this would give them a heads up so they will know to be more agressive in their cancer screenings.

The surgery options have changed quite a bit in the last several years. There are several different kinds of surgery, but basically the two ends of the spectrum are your basic mastectomy where they remove the entire breast. Tissue, skin, everything. There is nothing left but a big 4 inch scar that runs horizontally across your chest. The other side of the spectrum is a total skin sparing mastectomy and I think this is fairly new in the last several years. It is used when the patient plans on doing reconstruction. In this surgery they make about a three inch incision on the breast running from about the armpit to the nipple. Then they separate the breast tissue from the skin layer, pull out the breast tissue, insert a skin expander that is filled with saline to expand the muscle tissue until you are finished with all your treatments and are ready for final reconstruction. I'm probably going with the latter. It will involve at least two separate surgeries, the mastectomy/skin expander surgery and then the reconstruction about 7 months later.

I'm thrilled with my surgeon up at Huntsman. She gave me a book she and the other surgeon that will also be working on me produced for all their patients considering mastectomies. It's amazing. It is rather large with big, color pictures on each page. Basically what they did is take one of their patients and followed her through mastectomy and reconstruction. It gives the patient a very detailed description of exactly what is going to happen. It's amazing. Disgusting, but amazing.

So now, it's really just up to me to decide exactly what I'm going to do. I had another mammogram yesterday. They wanted to get a good look at exactly how effective the chemo has been in reducing the size of the tumor. Before chemo, the tumor was about 4.5 cm in diameter. I hung around after the mammogram so I could talk to the doctor that was going to be looking at my films. When he came in he said that he couldn't see anything. There was nothing there. When I had one of my biopsies, back when I was first diagnosed, they inserted a tiny metal clip into the center of the tumor. It was a marker for its exact location so they could find it easily during imaging. He said he could see the marker but there was nothing around it.

So.... though a mammogram isn't going to show individual cancer cells that may be left, this is still definitely good. It means that if the chemo drugs were able to reduce a tumor of 4.5 cm down to nothing in 6 weeks of treatment, theres a pretty good chance that it has killed of any little random cancer cells that may have been hiding in other parts of my body. However, the doctors keep telling me that a treatment plan is established at the time of diagnosis and they have found that it is best to stick to that treatment plan regardless of what chemo does to the tumor size, so I'm not sure that this changes anything as far as surgery goes. We'll see. I have an MRI tomorrow. It shows even more detail so I'm interested to see if there is anything to see in that one. After that, my surgeon will take those test results, along with my treatment history to a panel of surgeons, medical oncologists, radiation oncologists, etc. to discuss and come up with a recommendation. Then I decide what I want to do.

So that's the latest. Done with chemo today. Only one week left of Taxol issues and then I'll try to rid my body of all the toxic waste and get healthy enough for surgery. I've always looked at this as being a three-phased treatment. First, chemo; second, mastectomy; third, reconstruction. I'm a third of the way done. It's a relief to be done with chemo, but somehow, I don't think that the next two steps are going to be any more pleasant. But that's okay, because in about 6 weeks, I just might start getting my eyelashes back!!!