Consult with the Surgeon

I saw Dr. L, the surgeon, today, and she was fabulous. That is a relief.

There is so much I want to say, so many details I want to capture about all of this, but in the interest of trying to allow myself some rest, I will have to write abridged versions of everything, at least for the next few weeks until I get to the end of the semester and the end of my EMT class. Today was pretty much the longest. day. ever. Major events:

1. I had an appointment with the surgeon at 9:20, with a 9:00 check-in time. The appointment lasted until about 10:30.
2. After meeting with the surgeon, we met with the 'nurse navigator,' whose job is to help us get through all of this. It is truly an amazing resource to have because I'm already overwhelmed by everything, and she basically scheduled all of my future appointments for me.
3. After meeting with Cheri (I better give her an actual name because I have a feeling she is going to be someone I talk about a lot in the next few months), I went to get a chest X-ray and a blood draw while my husband took off to get me something to eat. The surgeon also wanted a chest CT, and I was not allowed to eat for two hours before the CT, for whatever reason. The CT was scheduled for 2:40, so I need to be sure to get something to eat before 12:40.
4. After the chest X-ray and the blood draw, I sat down in the lobby of the medical center and ate a quick lunch and then took off to get to work. At work, I checked in with the colleague who covered my classes for me and then printed off some exams.
5. I dashed off to get my CT, which was at the north branch of the hospital about 20 minutes away.
6. I had a chest CT with contrast dye.
7. I raced back toward town to pick up my son and take him to gymnastics. I got a brief moment of quiet while my son and daughter were in their lessons. (My daughter gets a ride from school with a classmate whose mom owns the gym.)
8. My son had the Mother Of All Meltdowns after his lesson. And I Could. Not. Deal. Major parenting fail. Oh well.
9. I took the kids home, ate an early dinner with the family, then headed back up to work around 6:30 PM to give an exam for an online class I teach. (They have to take the exams in person.)
10. I told the class I was Very Tired, and I wanted to leave right at 9:00, so they needed to finish the exam by 9:00.
11. At 9:00, the one student I was worried about, who always takes fooooooreeeever, turned in her exam, then said she needed to talk to me. One gigantic sob story later, I was ready to leave by 9:30.
12. I came home to a gin and tonic waiting for me in the kitchen, which I am enjoying now.

Very generally speaking, the theme as of right now is cautious optimism. Some highlights:

• The tumor is relatively small. Dr. L said, 'Anything under 1 cm makes me happy,' and it looks like the tumor is just at 1 cm.
• The tumor is 'well differentiated,' which means it is a slow-growing and not aggressive tumor. Supposedly this makes it very likely to be a hormone-driven tumor, probably by estrogen. Also, according to Dr. L, hormone-driven tumors are more common within five years of having a child, due to all the changes in hormones that occur with pregnancy. Given the fact that I have a 3.5-year-old and the tumor is classified as 'well-differentiated,' the odds are that the tumor growth is being driven by estrogen.
• The good thing about this would be that there are fairly effective estrogen blockers.
• Overall, all signs are pointing to the tumor being very treatable.
• The major complicating factor in all of this is my DVT, which will need to be managed during and around surgery. This is also the reason the surgeon wanted a chest X-ray and chest CT - to make sure my lungs are clear, since I've never actually been checked for a pulmonary embolism.
• Unfortunately, if the tumor is an estrogen-driven tumor, the only treatment for pre-menopausal women is tamoxifen, which... can cause blood clots. We'll have to cross that bridge when we get there.
• Right now the recommendation is a lumpectomy, although that could change if it turns out that I have one of the genetic mutations that makes me at high risk for recurrent breast cancer (think Angelina Jolie), in which case the recommendation would change to a prophylactic mastectomy.
• Unfortunately, the genetic testing for specific mutations can take a while, up to a month. Since the chances of having one of these mutations is relatively small, the surgeon was okay tentatively planning to proceed with a lumpectomy ASAP.
• She said that the results of my ultrasound from the imaging place had shown that the lymph nodes around the tumor looked good; however, then she did her own ultrasound and said that she saw a few suspicious spots. So she did a biopsy of one of the spots and also ordered an MRI; the results of these could be potential game-changers. The original thought was that it was unlikely the tumor had spread, but now it is less certain.
• The biopsy she did wasn't nearly as bad as the one I had a week ago, although it was still slightly unpleasant.
• The chest X-ray was uneventful, as was the blood draw.
• The chest CT was unpleasant, but fast. I was nervous when I heard it involved iodine, as I know from the arthrograms that having iodine injected into the hip joint is very painful. However, for this type of imaging, the iodine is injected via IV, which is not painful, but makes you feel extremely hot, and like you are peeing yourself. (I'm not kidding - fortunately the tech warned me about this.) Fortunately the feeling is very short-lived (less than a minute). Overall, it was nothing compared to the other things I've had done to me in the past few months.
• The good news is that my chest CT was clear, which is a relief. I wasn't really worried about PE so much as the idea that the tumor had already metastasized. All in all, it was worth the discomfort for peace of mind.
• I had one of those talky techs who told me after the CT that everything looked fine, then Dr. L called me around 4:30 to confirm that my chest was clear. Unfortunately, this was in the middle of my son's Mother Of All Tantrums at the gymnastics center with approximately 20 judgmental parents staring in horror, so I did not answer my phone when it rang. Her message sounded positive, although she said there was something weird with my 7th rib? And wanted to know if I had ever injured it? Or something? Unfortunately, I accidentally deleted her message before I could listen to it again.
• I have an MRI scheduled for Monday.
• I have an appointment scheduled for next Thursday with a medical oncologist/hematologist. She will take care of the non-surgical portion of my treatment - radiation, chemotherapy, etc. The sort of funny thing is that I mentioned how my dad has been doing crazy intense research on the best doctors, and just this morning he sent me a recommendation that is actually IN TOWN - a recommendation from a senior faculty member, an oncologist, at University Hospital. I briefly glanced at the recommendation and the link (and I do mean BRIEFLY), and the only reason it made an impression on me at all - and this is going to sound horrible - is because a) it was a woman (I've clearly been spending too much time with orthopedists, who are, like, 100% male) and b) she was African (which is really not something you see a lot of where I live; this town is, like, 80% Caucasian, and most of the diversity is due to military influences). The doctor also has a very mind-boggling name. LOL. Seriously, I'm not a hick, but I actually looked at the name and thought, whoa, if I ever went to see her, I'd definitely have to ask ahead of time how you pronounce her name.
• ANYWAY, when Cheri, the nurse navigator, asked me if I had a preference as far as oncologists go, I said that I had just gotten a recommendation, then proceeded in hick fashion to explain that I couldn't remember the name of the doctor but she had a funny name. LOL. Eventually we figured out who I was talking about, and the name really isn't that hard to pronounce once you know which letters are silent. Ha.
• But this is huge, because I actually used one of my dad's recommendations, which should hopefully make him and my mom happy enough to get through at least some of this, and not question whatever therapies she suggests. (She does have extremely impressive academic credentials; hopefully she is as impressive as a practitioner.)
• Supposedly I am also supposed to meet with a genetic counselor at some point? I'm not exactly sure why - that got lost in the chaos of everything. They called me as I was trying to get my son from daycare and told me that they had an appointment available on July 9th. WTF? I was sort of like, um, whatever. After a bit of back and forth, the scheduler told me she would see if I could get in earlier and I was sort of like, whatever. (Not to be a snob, but I TEACH genetics and am not convinced a genetics counselor can tell me anything I can't figure out of my own.) And to make a long story short, this appointment is sort of up in the air at the moment.

On a different and less medical note, a really weird thing happened before I went to my appointment this morning. I was a little early, so I went to the restroom before my appointment. I was aware there was someone else in the restroom, someone with a little kid. I came out and was washing my hands and I saw the woman and the kid looking at me, so I smiled. Then as I was walking out the door, the woman stopped me and declared, 'Waning!' I looked at her, my mind racing, trying to figure out who she was. I'm not good with faces, and I am TERRIBLE with faces out of context. Even if I know someone fairly well, if I run into her/him outside of the normal context in which I'm used to seeing her/him, I often don't know who it is. Fortunately, the woman realized I didn't know who she was and told me, and I immediately knew who she was. (I am good with names and numbers.) (And in fairness to myself, I feel like others are at an advantage when it comes to recognizing me, because I am not Caucasian, and therefore stand out more than your average, well... Caucasian.)

I've mentioned before that in a previous life I was a diver and a diving coach, and so was my husband. The diving world is fairly close and tight-knit, so even if you don't know people, you know a lot about them. This woman is the wife of a coach my husband and I know fairly well. She and her husband have an assload of kids (I'm pretty sure it's at least eight), and last I knew, they were done, which was pretty much biology in action, as this woman is older than I am. I'm not sure of her exact age, but it's definitely mid- to late 40s. As I was standing there trying to figure out the age of the kid she had with her, I guessed he was around four of five and was thinking, 'NO WAY! She had ANOTHER KID?! WTF? However, she then went on to explain that this was her youngest, and he was actually seven, but he had a disease of the esophagus that required him to have a feeding tube, and that they were on their way to therapy. She mentioned something like, 'It has been hard.'

I sort of stood there, contemplating. We were in a fairly large medical complex, so there could be a number of reasons for being there. I could tell she was obviously curious about what *I* was doing there, but at the same time she was very respectful. Finally I was like, 'Well, I just found out I have breast cancer, so I'm on my way to see a surgeon.' After that she was like OMG I am so sorry, and gave me a huge hug, and eventually we went our separate ways.

It was just weird because while I truly feel that what I'm going through right now sucks, I realize it could be worse. At the same time, I've never been one to be overly optimistic. I realize you can always find someone who is worse off than you are, but I don't think that necessarily means your situation doesn't suck. However, even in the heat the of moment, I found some comfort in the fact that I was heading off to an appointment about a probable lumpectomy rather than an appointment for a seven-year-old who looked like a four-year-old. I've been through a lot of things with my kids, and know that dealing with issues with kids sucks. Big time. If I have to have a major issue, I'd rather it be with me than my kids.

I guess the major take away message is that life throws each and every one of us curveballs that we have to deal with, and there is no point in wasting time trying to figure out if this is fair or not, or how it compares to what others are going through. You can always find someone who is worse off than you are to make yourself feel better, and you can always find someone who is better off than you are to make yourself feel horrible. But in the end, it is probably best just to stay within yourself and deal with your own reality.

In conclusion:

I feel as if I've hit the ground running, and for me that's a good thing. One of the things I wasn't sure about when all of this started was what sort of timeline we were looking at. I'm pleasantly surprised by how quickly things are moving along. After dealing with the snail's pace of other specialties, it is hard for me to believe that in one day, I had a biopsy, an X-ray, a blood draw, and a CT. Everything is moving so fast I don't feel like I even have time to breathe, but in the end that's a good thing. As my PCP said, waiting without knowing is the worst, and I've definitely found that to be true.

So here's to thankfulness for moving forward.