Glad that’s done!

Susan came out of surgery around 5:30. Earl was called in soon after and when we saw him next he had big smile. The news is good and surely Susan will explain it all herself sometime tomorrow or the day after.

For the time being we can all be relieved she’s doing well and now has this day behind her.

Morning report

It was startling to see Susan show up on the phone’s caller id this morning. She’s feeling really good, has gone for a cruise around the ward hallways, and is not feeling any pain (unfortunately that is not going to last). She slept through the night and hasn’t taken any pain killers yet. Earl spent the night at her side and was trying to get her to slow down on her walk. I have a feeling he’ll be doing that a lot over the coming weeks.

The important thing is she sounds completely like her regular self and is optimistic about what’s to come.

(And for myself: thanks for the kind comments.)

I Left My Breast in Santa Clara

Hi again everyone.  Sorry about the tacky title.  You can blame it on Earl’s sense of humor and Tony Bennett.

We returned from the hospital around 1pm today. I’ll post more details tomorrow, but for the time being, here’s a synopsis.

1)  I feel surprisingly good.  Since the anesthesia wore off, I haven’t needed any pain medications.  I keep waiting for any discomfort to start, but I feel no more uncomfortable than when my friend Sachi took Truc and me to a Body Pump class at the Y a couple of weeks ago.  The doctor who checked me out this morning said this is not unheard of, and wrote up a prescription for Vicodin just in case conditions change.

2)  Dr. Bitar was very happy with the operation.  She said the preliminary report on the 3-4 lymph nodes that she removed (which can easily change for the worse with the final path report later, but we’ll be happy with the prelims for now) showed no cancer.  Furthermore, she said there didn’t appear to be any tumor attachment to the muscle wall.  She did go ahead and remove a half-dollar sized piece of muscle to create a clear margin, but again this was definitely less than she had anticipated having to remove.  Do note that the need for chemo and/or radiation will depend on the final pathology results on both the breast tissue and the lymph nodes, which we should have within the next couple of weeks.

3)  After having come home to bathe and wash my hair, I’m feeling much more human.  We’re going to go take a walk around the block in a little bit, and then it’ll be time for some more R&R.

Surgery Day – Part I

Yesterday’s walk around the block turned into a walk around the neighborhood.  Note however that it was a very slow walk around the neighborhood, immediately followed by dinner and a 3 hour nap.

On Monday, Kaiser called around 8.30am to ask whether we could show up early since they’d had last-minute cancellations. They wanted to move the surgery up by a couple of hours.  We hurried to shower, throw together a few last minute things, and make the half-hour drive to the hospital while humming the Rocky theme song.

I checked in at 9.20am and left Earl at the waiting room.  He would be called back to my pre-op room after I’d changed and met with a nurse.  I climbed into my hospital (tastefully striped, acceptable thread-count) gown, arranged my hair attractively in a fashionable blue poof mesh cap, and waited.  And waited.  And waited.  Earl had still not been shown back to my pre-op room, so with nothing else to do, I fell asleep.

Sometime before 11am, Earl was finally allowed to join me.  We noted the revised surgery time had come and gone, and I tried to ignore the increasingly frantic messages from my empty stomach.  I had finished my last meal at 7.30pm the night before, and my body knew breakfast should have already been delivered.  A sign next on a door next to me that said “Caritas Room” taunted my hopeful (vegetarian, no less!) brain into thinking it advertised Carnitas.

Just before noon, a rep from radiology came by to administer my radioactive tracer (to locate the sentinel lymph nodes).  Extracting her tools from a narrow white lead box, she injected a 4cc mixture of Technetium (periodic table #43) and a local anesthetic into (a very sensitive part of) my breast twice with an extremely fine needle.  I had dreaded this procedure after having read some painful sounding stories on the web, but in truth I barely noticed the injections.  I breathed a sigh of relief.

Closer to 1pm, we sighted my surgeon, Dr. Bitar.  She happily related stories about her newly UCLA-graduated daughter and said-daughter’s plans to move to NY for a shot at musical theater and assured us that she was exactly how we wanted my surgeon to be:  fully rested after an enjoyable vacation.  Using a felt-tip pen, she marked my right breast with the letter ‘C’ twice to ensure during surgery they would be removing the correct side and to remind herself to perform the sentinel node biopsy.  And she told us why we had been waiting for so long:  after calling us into the hospital early, Kaiser received an emergency perforated appendix case, which took precedence over my elective surgery.

Dr. Bitar left to prepare herself for surgery, and I sent Earl out to the waiting room to see if our relatives wanted to come in to chat briefly before I left for the OR.  First he brought in my Aunt Helen, who kindly asked after my condition, wished me good luck, and said she would see me again afterwards.  Next, Earl brought in my brother Dale, but not without difficulty.  An authoritarian clipboard-wielding blue-smocked volunteer apparently took it upon herself at this point to grudgingly mete out visitations.  She curtly admonished the two for attempting to enter without her permission, and announced that she had to first go see whether I was ready for visitors.  Not knowing what had transpired in the waiting room, I watched the volunteer briefly hesitate in front of my room before heading down the hall to another.  After that, she went back to Earl to inform him that his loved one had just arrived at post-op!  Earl notified her that surely she was mistaken, and she huffily finally allowed them to come visit me.  Hurumpff.

After commiserating about the surly volunteer and discussing the day’s events, Dale returned to the waiting room to dispatch an update to this blog, and Earl and I continued our wait.  We held hands and hummed the Rocky theme song, I read my Kindle, and I tried to sleep.  I had been raring to go for hours but couldn’t leave the starting gate.  My cohorts in neighboring stalls had long ago departed for their operations, and after 2pm the remaining staff finally started to gather around my room.  Dr. Bitar returned in scrubs, as did my anesthesiologist who asked me brief questions about my history with general anesthesia.

Right around 2.45pm, I Earl and I exchanged one last kiss, and he returned to the waiting area while I was rolled down a hallway, through some doors, and into the OR.  Just before I left the pre-op area, I felt something knock my iv, and I glanced quickly over to my anesthesiologist who apologized (for what, I had no idea).  Midway down the hall to the OR, I felt my left arm and then my left leg start to go numb.  I checked with the anesthesiologist and he confirmed that he had been apologizing for starting the local anesthetic.  By the time I entered the OR seconds later, I was woozy and marveled at the vast assortment of bright lights overhead, my last conscious thought.

Surgery Day – Part II

Seconds later (ok, hours later), I awoke with Earl by my side.  He was smiling broadly, saying the surgery had gone well.  My thoughts were still fuzzy and I had difficulty focusing on objects around my bed.  Dr. Bitar had come by to appraise us of her review of the operation.  Everything had proceeded better than expected, and she was very pleased.

My throat was sore from the intubation (for oxygen and general anesthetic), my nose itched, and with my right arm I could feel the padded dressing covering my wound site.  Gazing downwards at my hospital gown, it was difficult to detect any difference in my chest contour.  It just goes to show, when you start out small, you have less to miss.

Soon another physician came by to greet us, and although he looked familiar to me through my drug induced haze, I knew he wasn’t one of my practitioners.  It turns out he was the husband of my PNS friend Teresa, thoughtfully coming to come check on me and to say hello while coincidentally tending to his own patient.  I think I responded coherently, but Earl reports that for the next couple of hours the lingering anesthetic made me goofily but charmingly effusive to any and all (e.g., “Ohhhhhhhhhhhh.   Thaaaaank you ssooooooo muuuuch for eeeeeeeverythiiiiiiiiiiing.”).  At the very least, this experience gave me the hope that if I ever do overindulge, I will be a happy drunk.

My short-term memory at this point was comically impaired. I would ask Earl about Dr. Bitar’s comments one minute, only to repeat 3 minutes later, ad nauseum.  He complied for a while until I’m sure I just became irritating and then would simply point to his smiling mouth and say that everything went well.  Interestingly enough, while I couldn’t form long-term memories of complex thoughts, my hippocampus functioned well enough to record simple numbers.  While one of the nurses was arranging my transfer to a regular hospital room, Earl tested to see whether I could retain the number 3699 (I still can).  And once the nurse had settled on a room number, I was able to remember 2355 as well.

I was wheeled down to my new residence sometime after 6pm and had just settled in when my first visitors arrived.  My father’s siblings and their spouses briefly stopped by to see that I was doing ok.  Dale and his partner Tom also popped in one last time before heading off to dinner.  Food was no longer paramount in my mind though.  I merely wanted to sleep.

Surgery Day – Part III

Around 7.30pm, a nurse came into the room to check my vital signs and examine my Jackson Pratt (JP) drain.  Much more of a blessing than a hindrance, the JP drain is a soft perforated rubber tube which snakes around The Area Formerly Known As My Right Breast (TAFKAMRB) just under the skin, exits my body through an incision under my armpit, and terminates after about 2 feet of nonperforated exterior tubing in a squeezable bulb.  It functions somewhat like the French drain surrounding the basement walls of our house.  Continuous compression of the bulb creates a suction which pulls liquid through the drain perforations from TAFKAMRB, down through the tube, and into the bulb where it’s stored and then emptied periodically.  The desired result is a reduction in swelling, risk of infection, and discomfort.  My drain will be in place until its output falls below 30ml/day, maybe in another week or two.

Once she’d finished with my drain and blood pressure check, the nurse helped me make my way over to use the bathroom.  I was lightheaded, a bit unsteady on my feet, a touch nauseated, and, when finished, anxious to return to my hospital bed.  The nurse then plugged my iv machine back into the electrical outlet and revelcroed my calves into cuffs attached to the Prophylactic Deep Vein Thrombosis (DVT) machine, which alternated between inflating the left and right cuff to prevent blood clots from forming in my legs.  One might hope that it could also simulate a lower leg massage, but perhaps that can be designed into a later model.

Next, having happily graduated from ice chips, I downed some water and child-sized boxes of juice.  And although my ravenous appetite from the afternoon had not yet returned, I ordered a dinner tray before falling asleep yet again.

Around 9.30pm, I attempted to consume a few bites from my dinner tray, but didn’t find the soggy vegetables or peculiar quiche imposter to be terribly appetizing.  Plus, every time I stood up to make the trek to the bathroom, I experienced gentle but increasing waves of nausea.  Finally, at 1.30am the next morning, the nausea peaked, I returned my few bites of dinner to sender, and felt much better.

The true turning point arrived at 5am.  After having slept through most of the previous 14 hours, I awoke alert and realized that my brain fog had cleared, I had no pain, no more dizziness, no more nausea, and I was famished.

BTW, in case you’re interested, the total copayment for my breast surgeon, anesthesiologist, attending OR personnel, all medication, overzealous waiting room volunteer, use of OR and private hospital room with private bath, pathology work, soggy vegetables, and cheerful 24 hour attention came to a whopping $200.

Magical Recovery Tour

Five days have now passed since my surgery and I feel great.  Not normal, mind you, but considerably better than expected.

I still have no pain and therefore haven’t required any medication, not even Tylenol.  My sleep needs have waned, from 4 naps on Tuesday down to 1 nap today.  For the mental and health benefits, I have been conscientiously walking, a longer jaunt every morning and a short stroll in the evening.  My morning walk has increased by roughly a mile each day while slowly gaining in speed.  My outing this morning was the closest to normal yet with five brisk miles through Stanford campus.

In between my morning and evening exercise, I spend the rest of my time lounging on my favorite chair in my study.  It’s the epicenter for the remainder of my day’s activities:  eating, napping, using the computer, reading my Kindle, and watching movies.

Hair washing has become a high point to my recovery days.  Every evening after I take my makeshift bath (I can’t get the incision sites wet yet), I head downstairs to the kitchen, where my salon slaves (Earl and our 4 year old) await.  I dip my head into our island sink, and they shower my hair with the pull-out faucet, massage in shampoo and conditioner, and rinse.  Aside from the tension attendant whenever a preschooler wields control of an indoor water dispenser, our new daily ritual has been an unexpected and relaxing luxury.

As expected, by contrast, Earl has been spoiling me 24/7.  He is now in charge of all of the laundry, dishes, tidying up, and care for our little guy (the older two children are still visiting relatives in TX).  He makes and serves me my food, tucks me in when I fall asleep, set up a new laptop so that I don’t have to sit at my desk, in short, everything.   With all of the above and carrying the weight of my health crisis on his shoulders, he has found it close to impossible to do any real (i.e., paying) work.  I feel guilty but enormously grateful that he is now responsible for everything in our lives including continuing to make me feel beautiful and loved.

There’s nothing you can do that can’t be done …

No one you can save that can’t be saved.

Nothing you can do but you can learn how to be you in time — It’s easy.

All you need is love, all you need is love.

Boy Scout Buddies

I am posting a couple of photos my old friend Adam sent to me from his boy scout trip last week in west Texas.  Adam and I go way back … we shared very similar class schedules, band commitments, and friends throughout high school in Plano, TX.  And then we both continued on to study electrical engineering at UT Austin, even living in the same dorm (along with 3000 other students) for the first couple of years of college.  Earl and Adam were housemates at UT briefly as well.

While on his boy scout trip, Adam hiked with our BBW group in spirit and here are the pictures to commemorate.  See his comment in yesterday’s Magical Recovery Tour post for more details.   Thanks for sharing the gorgeous pictures, Adam!

Surgical Pathology Results: T1a, N0, Mx, Stage 1a

Earl brought me into Kaiser today for my post-op visit with a physician’s assistant in the surgery department.  The incision sites are healing very well and I might be able to have my JP drain removed by the end of this week.  Just 48 hours after its removal, I would be able to take my first real shower in almost 2 weeks!

The physician’s assistant shared my pathology report with us.  While it could have been better (i.e., if the final diagnosis had been all DCIS), it is much rosier than what I had braced myself for with the multitude of scenarios played out in my head over the past few weeks.  Earl and I are delighted and immensely relieved.

Here are the highlights from the report:

1)   Of the total of 8 (4 more than I knew about!) lymph nodes removed, none showed any signs of cancer.

2)   No angiolymphatic (blood vessel or lymph vessel) invasion.

3)   Invasive Ductal Carcinoma with microscopic focus, grade 3.  Total size of my single invasive tumor was just 0.3cm x 0.2cm, or about half the size of a pea.  Staging is based on the invasive component, not on the DCIS.  And, yes, it’s invasive, but this is a pretty small tumor.

4)   Extensive 5.5cm DCIS (this was as expected, landing right in the middle between the mammogram estimate of 5.0cm and MRI measurement of 6.1cm).  Don’t forget, the DCIS is noninvasive.

5)   All margins clear of invasive and in situ carcinoma.  However, at the skin, there were two areas with very thin DCIS margins measuring 1mm and 2mm.

6)   No carcinoma found in muscle.  There was a 2.0cm clear margin from the lesion to the cut edge of the excised muscle.  Whoohoo!

I think am now diagnosed with Invasive Ductal Carcinoma Stage 1a.  I am still waiting on test results regarding the invasive tumor’s hormone receptor status.

I have a feeling I’m not done yet though.  I will meet with my oncologist on Tuesday next week to discuss the appropriateness of chemotherapy.  Before that meeting, she will be conferring with my radiation oncologist about whether I also need to consider radiation therapy to address the thin margins at the skin if they cannot be resolved with more surgery.

I’ll try to explain in tomorrow’s post a bit more about these results.  For now, I think I’ll just go get a decent night’s rest, satisfied with the fact that we did manage to catch my cancer at a very early stage.  To all you women out there:  please get your mammograms done!

Receptor Results: ER/PR-, HER2+

I received a call from my breast surgeon this afternoon.  She said that she’s not too concerned about the close DCIS margin near the skin and it can be removed when I have reconstruction surgery.

The big news today is that my invasive tumor is Estrogen Receptor (ER) negative, Progesterone Receptor (PR) negative, and Human Epidermal growth factor Receptor 2 (HER2) positive.  Because of the ER/PR- status, for me, neither Tamoxifen nor Femara would be effective in knocking out residual or preventing further growth.  Herceptin, however, now becomes an option because I am HER2+.  It is typically used in combination with chemotherapy, something I’m sure I will be discussing with my oncologist on Tuesday.

There doesn’t appear to be a lot of medical literature out there specific to my case where the tumor is <5mm because oftentimes tumors this small were not treated further after mastectomy with clear margins and cancer free nodes.  However, I have placed a link in the sidebar describing one study showing very promising results from Herceptin treatment for patients like me.  HER2 means my cancer is especially aggressive so I have a feeling that we’re going to want to attack any remaining rogue cells aggressively with adjuvant (Herceptin/chemo) treatment.  Every treatment comes with potentially significant side effects, and therefore it’s not necessarily a no-brainer.

I’ve temporarily cut down on my walking and am wearing an arm sling to help reduce the motion of my right arm while exercising.  This is because back on Monday the physician’s assistant said that I’ll be able to remove the JP drain sooner if I reduce the amount of arm swing during walking.  A well meaning neighbor saw me in a sling tonight and assumed that I’d broken my arm, remarking that our current hot spell is a bad time to be sporting a cast.  It was too complicated to explain the true motivation for the sling, so I simply smiled and concurred.  At any rate, I’ll gladly reduce my exercise a bit over the next few days if it means I can bathe for real sooner, because, after all, a hot spell is a bad time to be skipping showers.