Hematology/Oncology

"HemOnc" is the chemotherapy physician.  Dr. Claire Dees immediately struck me as a very compassionate physician.  She explained to me that the results of the sentinel node surgery would determine which of two different chemo regimens I might receive.  If there was no lymph involvement, I would have 4 treatments over 12 weeks. If there was lymph involvement, I would have two separate courses of chemo with 4 treatments each, 2 weeks apart, for a total of 16 weeks.

I told Dr. Dees that I was pretty sure Dr. Ollila was expecting lymph involvement in one node because he palpated it several times and asked me whether I felt anything.  She said there was still a chance that it might not be. In general it's more helpful for me to prepare for the worse option, so that's what I decided to try to do.

Crown Detour

I developed a pain in my lower left molar that felt like another time when I had a cracked tooth.  I called my dentist and begged him to fit me in for an appointment, which he did the next day.  He told me that I would have to get a crown.  I explained that I really needed to get this done ASAP because I would not be able to have any dental work done while undergoing chemotherapy.  He was very caring and understanding and got me an appointment for the crown fitting for the next day, then put a rush order on the crown.  He did expert work, as always.  If you need a dentist and you live near Carrboro, I can highly recommend Dr. Stephen Randall.

Surgical Oncology

As soon as I met my surgeon, Dr. David Ollila, I connected well with him. We're the same age and he spoke to me like a peer.  He explained that the MRI showed a spot on the right side that they needed to investigate further, so I would have an ultrasound on that side, and if they couldn't see it well enough to perform and ultrasound biopsy, I would have to have an MRI biopsy.

He scheduled an outpatient surgery for November 5 for removal of several sentinel lymph nodes.  The results of the MRI biopsy would determine whether this would be done only on the left or also on the right.

He told me that the cancerous cells on the left were in two main sections connected by a small thread, and overall they form in a web, rather than a lump.  This is why it's hard to detect on imaging.  He explained that it would not be possible to do a lumpectomy.  I told him that I had already figured that out based on the diffuse areas that were biopsied, and that I had already decided I was probably going to have the same surgery Angelina Jolie had.  He seemed extremely relieved that I was the one bringing this up and said, "We're going to get you through the next 34 years of your projected lifespan."  He explained that I would first have "neo-adjuvant" (before surgery) chemotherapy, and the regimen would be based on the results of my sentinel node biopsy.  He told me that I would meet with a plastic surgeon prior to the surgery to discuss reconstruction options.  He said that it's not determined yet whether it will be necessary for me to have radiation.  This may depend on how much the chemotherapy is able to shrink the margins of the tumor.  It can also affect reconstruction options, so I'm hopeful it won't be necessary.

My surgeon is the head of the Breast Center at the top cancer research hospital in the Southeast, so I am quite confident I am getting the best care possible, and that is a great feeling.

Radiation Oncology

I met first with Radiation Oncology, which was a bit out of order, because although they told me exactly what was going to happen after my surgery (a specific number of radiation treatments over a specific duration), when I met with my surgeon he said I may not need radiation.  So this is definitely not on my radar until after surgery, when that determination will be made.

MRI

The MRI was originally scheduled for an outpatient clinic.  When I arrived they told me it had been rescheduled for 6:30 pm in the main hospital, but nobody had informed me of the change.  Thankfully, I knew where I needed to go and I had my "stress relief" tea with me!

This was my first MRI and I handled it fine.  I had brought ear plugs for the noise and I was very relaxed.  I'm not claustrophobic so it really didn't bother me.  I just pretended I was on Space Mountain.

1st Acupuncture session

I originally scheduled an acupuncture session for October 3.  My original goal was to find out why I had been feeling so much fatigue.  I had to cancel the October 3 session because of the biopsy appointment.  When I called to tell Andrew this, he said, "Don't worry, whatever the results are, we'll get you through this."  It was very comforting.

When I finally saw him on October 10,  I knew my results and I was going to get an MRI that evening. Andrew spent two hours with me and by the end I was extremely relaxed.  I slept very well that night.

D-Day (Diagnosis)

My nurse navigator called me to tell me...It is breast cancer, it's very slow growing, which is what you want...It's receptive to estrogen and progesterone, which is what you want because that is compatible with the treatments we already have available. She told me they wanted to do an MRI just to sure they hadn't missed anything on mammogram/ultrasound.  She also scheduled me to see surgical oncology, radiation oncology and hematology/oncology a week after the MRI.

Biopsy

The same physician who conducted my ultrasound also performed my biopsy.  I was relieved because my first impression of her was that she was the smartest person I had ever met, and that she would get to the bottom of it.  When I told her that my gynecologist had given me a supplement to help clear up my breast tissue (thinking it was fibrous tissue), she openly sneered.  She asked me if I had early onset of menstruation (yes), how old I was at my first pregnancy (over 30), and how much I drink (maybe 1 drink per month?).  I later learned these are all risk factors for my (eventual) diagnosis.

The doctor took 7 biopsy sites from my left breast, and a small titanium clip had to be inserted in each site.  She let a resident try one of them and there was some "kickback" from the procedure.  After that I asked for a cool washcloth for my forehead but otherwise was okay.  She told me she was going to put a rush on the labs and that I might have results by early the following week.  I did not expect that I would have to have *another* mammogram afterward to make sure all the clips were in place.  The nurse asked me if anyone was waiting for me and I said no, nobody told me I would need anyone to drive me.  She said, "You seem like someone who would want to do this alone," and I agreed that it would have stressed me out more if someone had been waiting for me.  In any case, I took the bus to the park and ride and drove myself home with no difficulty.

The biopsies caused multiple bruises to emerge over the next few days. 

Mammogram and Ultrasound

After completing the mammogram and ultrasound, the radiologist asked me if I could come back that afternoon for a biopsy.  This was the first I realized something was likely wrong.  I had to teach that afternoon so I said I could come the next day.  It took the scheduler a long time to get me fitted in and she had to involve her supervisor.  Their persistence told me the doctor had expressed some urgency in scheduling my biopsy.