Lain's Log


March 22/11

The first consult is now in the past. Everything went well.

Princess Margaret Hospital is amazing. We arrived a little early for the 1:30 p.m. appointment, for paperwork or whatever. Sam took my picture as we were about to enter the clinic for the first time, so I could put it on the blog.

Wore a zip-up hoodie so I wouldn't have to take anything off over my head. Brought with me the films, (mammogram and ultrasound), the pathology report (just in case they didn't have it), newspaper, magazine, my new medical notebook, pen, list of medications, etc. Was given a medical report to fill out. Before I could even finish it, got called into an examination room, right at 1:30.

Had to undress - just the top, and put on a gown.

A VERY handsome young doctor (McCready's "fellow") came in and met Sam and me. Right away, he said he knew how anxiety-ridden I must be, (which I was, despite the 5 mg. Diazepam). He basically told me I have DCIS, (Ductal carcinoma in situ), but that it's been caught early and I can go the route of a mastectomy OR, do a lumpectomy combined with radiation. He said studies conducted over 35 years, show that women in an early stage (such as mine), will get the same results from a lumpectomy plus radiation as they will with a total mastectomy. "Survival outcomes are the same," he said.

He asked if I'd given any thought to what I wanted to do! Had to laugh. I told him, "That's ALL I've thought about." He wanted to know my opinion. I told him, "I want to live." (thank you Emmy winning writer Bruce Kirshbaum for giving me this line - which is the TRUTH!) I explained, if there's a way to do that without a mastectomy, then naturally, I want to save some of the breast. He explained that many women just say, "Take it all."

This young guy examined my breast and could feel the lump. (later, Sam wanted to know what he was doing - even though Sam was sitting right there, watching). I told him he was feeling me up.

After a long discussion, about all kinds of horrible things that nobody wants to talk about, he left. Sam and I were alone, just staring at the wall. Sam turned to me and said, "Well, THAT was intense."

Thank God, Sam decided to take notes. I'm usually great at doing that, but, just couldn't do it for myself! Luckily, since he takes notes every day for a living, he's an expert.

Next, Dr. McCready came in. I recognized him right away from his pictures during all my online research. A nurse accompanied him. McCready pretty much said the same. He told me this is NOT a race against time and that it will likely take about four weeks (after testing) before I get surgery. At one point, he said to us, "There is NO reason to think it's not early enough. You'll be fine." (Sam was THRILLED to hear him say this).

He is a very nice, soft spoken man, explains things clearly, precisely and kindly. Looks you right in the eye and tells you what he thinks you need to do.

A few things came out that I EXPECTED and a few I DIDN'T expect.
I had thought he would tell me I needed more testing, which would include another (larger) biopsy, but the only test he is calling for is another ultrasound and possibly an MRI. However, what I WASN'T so thrilled about is that they will need to remove some sentinel lymph nodes for testing.
(the doc called it a sentinel lymph node biopsy).

He explained, that for the surgery, they will need to do what is known as a "wire-guided lumpectomy". It apparently involves jamming a wire into your boob. Just fantastic.

In order to do this, I will have to come in the day before, have dye injected into the areola - (you better believe I'll be talking about proper use of Lidocaine again!) - and then have the wire put in. Then, the next day, I have the surgery and go home later that night! (or possibly a day later).

What they apparently will do, is to remove the entire 2.5 cm. fibroadenoma (which contains the cancer). They will take a little more than they might need to, hopefully to be sure to get clean margins. They will also remove the lymph nodes at the same time (all while I'm under a general).

Then, I have to wait TWO WEEKS before I get the test results back to see if they got it all and to find out if the cancer has spread to the lymph nodes. The drag is, if they DIDN'T get it all, then they have to do a second surgery and do a full mastectomy. I asked how often this happens. He told me, in about 5 percent of the cases. And if it HAS spread to the lymph nodes, I have to go back and have THEM removed.

It's really a tough decision(s) to make and I'll be doing a lot of reading and research for the next while. They gave me TONS of stuff to read.

After McCready left, two nurses came in. I had to sign a consent form, allowing the surgery and agreeing to allow them to use any tissue they remove in their teaching and training. I said yes to this. (why not, right?)

Then, they asked me to go the lab for an ECG and blood work. They took me immediately for the ECG (which was over in about two minutes) and then, immediately for the CBC (complete blood count), which took about one minute.

They also want me to go back to my GP to have her sign some paperwork and to have a full physical. I was SO mad, because apparently, my last full physical was March 23rd, 2010, so, according to OHIP, I can't have the next one till exactly a year later. Can't do it Wednesday, since we're FINALLY meeting with the lawyer, re: Mum's house/property. May be able to get in for the physical on Thursday.

The doc told me to expect to hear from his secretary very soon with a surgery date. He's hoping it might be April, but no guarantees.

Two weeks after the surgery, assuming they got clean margins, etc., they will then, "map out a treatment plan," which may not include chemo, but will definitely involve radiation (lots of burning).

I was also able to discuss my pain issues with the nurses, but it was ridiculous. One nurse told me, "Many women find lumpectomy surgery
isn't that painful and they just need some Tylenol 3s!" (I laughed).

I told her about "the pain woman" - (Hollye Jacobs, who writes a blog called Brookside Buzz for The Huffington Post. She didn't get the meds she requested after surgery and suffered horribly for many days). Yes, I realize she had a double mastectomy, but I mean come ON! There's a time for heavy meds like Dilaudid and Morphine, and I'm thinkin' breast cancer surgery is one of those times! Call me crazy.

Seriously...I've had Tylenol 3s for DENTAL pain (or hangnails), and they barely made a dent! Good grief. You can bet the pain management team will be next on my list. I need to talk to these folks.

I've also been warned that removal of lymph nodes causes all kinds of delightful "side effects" like arm swelling and leaking. You also often have to get a drain placed under the arm to remove fluids. Sounds like a real barrel of laughs.

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