Surgery report

Sherrie had her reconstruction surgery yesterday. We arrived at the hospital about 11:00, and by 12:30, she went into the OR. We saw the surgeon before the procedure, which was a good thing because, in spite of our efforts to the contrary, she wasn't aware she was supposed to remove Sherrie's port-a-cath. The surgeon also drew lines all over Sherrie to help her during the surgery.

The surgery went a little faster than the nurse indicated; I saw the doctor no more than 90 minutes after it started, perhaps a bit sooner. The surgeon said everything went well. It must not have been too invasive, as she said that Sherrie could ski in three weeks!

After about an hour, they moved Sherrie to recovery, and I got to see her. She was very groggy, sore, and nauseous. The nausea lasted a couple of hours, slowly getting worse, until Sherrie threw up all the liquid in her stomach. After that, she started to feel better fairly quickly. We got her dressed and out the door and drove through a snowstorm to get home.

Sherrie slept in the La-Z-Boy last night. She slept okay, but wasn't that comfortable, and got into bed early this morning and slept a little more. The doctor gave her a prescription for pain-killers, but they make her sick so she's just taking Tylenol. She's sore, but seems to be doing well.

Early indications are that recovering from this surgery won't be near as bad as the mastectomy was.

Surgery on Tuesday

Sherrie's reconstruction surgery is scheduled for sometime in the afternoon on Tuesday. We won't have an exact time until Monday afternoon or evening.

Follow me on Twitter (drmdwebb) for updates during surgery.

Update

Sherrie had another visit with the plastic surgeon a few days ago. Her reconstruction surgery is scheduled for 29 December! She's excited about it because (a) it will happen before the end of the year, and since we're maxed out on our insurance, we won't have to pay anything, and (b) she'll get to have her mainline port removed during the surgery.

Sherrie's hair is growing, albeit too slowly for her expectations. It's not long enough that she feels comfortable going out in public without her wig, but hopefully soon it will grow out.

Slowly but surely, things are getting back to "normal."

The long and short of it

A few readers have been gently, and perhaps not so gently, chiding me for not updating this blog recently. They say, "you've got to update the blog; Nathan still has the flu and has to get better!"

Of course, Nathan got over the flu long ago, and the rest of us managed to avoid it up until now. We have all been healthy and hope the flu stays away! Her sinus infection went away quickly, and she's been strong and vibrant ever since.

Sherrie went back to her job at school three weeks ago. Although the flu and other illnesses are prevalent in our community, she's managed to avoid becoming ill. I suppose her tendency toward Adrian Monk-ish-ness helps.

Sherrie had a blood count this past Monday, and her counts all looked pretty much normal. The white count was a bit low, but nothing to be worried about. As far as her blood is concerned at least, chemo is a distant memory.

Sherrie's hair has started to grow out, but only just a tad. For weeks, I've been teasing her that she looked like Casper the Friendly Ghost, and now I'm teasing her that she looks like a GI Joe doll with a painted-on buzzjob. Not very flattering I know, but I have to call it as I see it :-D

Seriously though, her hair is growing quickly. It's quite blond so it doesn't show up like it would if it were dark, but she definitely has a five o'clock shadow.

Sherrie has been back to the plastic surgeon for more preparation for reconstruction. We're hoping that the remaining surgery can be performed before the end of the year.

After the last appointment with the oncologist, she started taking Tamoxiphen. She has to take it twice a day for five years. We hope the side effects aren't too pronounced.

It's good to have the challenge of chemo behind us. We hope to keep it in the rear-view mirror. Every indication we have now suggests we will.

Post-Neupogen update

Our son has the H1N1 flu, as diagnosed and tested by our family doctor last night. The doctor gave the whole family a prescription for Tamiflu, which should help our son feel better sooner, and keep the rest of us from getting it.

Sherrie has a sinus infection. The doctor gave her antibiotics. The antibiotics often don't help her sinus infections, but maybe this time will be different.

Sherrie's white count on Sunday at the end of a week of Neupogen shots was only 4.5 or so. That's normal, but it's not very high after a week of shots. We are going to get another CBC on Wednesday of this week. I expect it will be low, and she'll have to go on more Neupogen shots, but we shall see.

Sherrie is looking forward to getting back to school. She was planning to go back this Monday, but based on the prevalence of the flu and her probable low white count, she's likely going to wait a week. No sense rushing it and catching something from the germ cesspool in school.

Goodbye to chemotherapy

Sherrie received her last chemotherapy today!! The day started dreadfully when the nurse told us her white count was only 1.6 (it needs to be 2.5). Sherrie was very disappointed, and began to feel the gloom of having to take several more Neupogen shots and be delayed further. She asked the nurse to beg the doctor to let her have it anyway since it was her *last* one, and he said yes! Neither of us could believe it, as he has been a stickler for the blood count in the past. He made sure that she start on Neupogen (six shots) tomorrow.

The administration of the 5FU was straightforward, except that Sherrie started feeling quite nauseous as soon as the nurse started to hook her up. As happened last week, the nurse kept the drugs hidden "under wraps," (even though the 5FU and the others are clean), and after just a few minutes she was done.

I literally had to run to catch Sherrie as she bolted from the clinic. She likes the nurses and the doctor, but wanted to get out of there as soon as possible. We had a good chuckle over that on the way home.

We go again in about three weeks to see the oncologist, and around the same time to see the plastic surgeon again.

We are grateful to be able to receive such wonderful medical care from caring and competent people. It's a great blessing.

Chemo report

Cycle number six has finally begun. We saw the oncologist again today, and had the usual interview and exam. All appeared well, and he gave her the go-ahead on chemo, based on last Friday's white count of around 3.5.

Sherrie did quite well during the administration of the chemo. She didn't have any trouble with nausea (real or conjured in the mind). The nurse kept her busy talking about stuff so that she wouldn't focus on the drugs. The nurse also covered the syringes so Sherrie wouldn't see the "red poison."

After the treatment, she felt pretty well, and even went into a store with me on the way home. She also ate a small amount of dinner. She's sleeping in her laz-y-boy chair right now,  so I'm not sure how she'll feel when she wakes up.

She was very excited on the way home to be able to say, "I'm done with all the nasties!"

The doctor mentioned during the exam that he'll see her four weeks after the "easy chemo" next Monday. At that appointment, we'll start talking about hormone treatment (Tamoxiphen). The doctor also cleared her to get a flu shot 2-3 weeks after next Monday's treatment.

CBC

Sherrie finished her week of shots Sunday night. She had a CBC of nearly 60--which is way high. The nurser at the hospital was so concerned (and apparently unfamiliar with Neupogen) that she called Sherrie's oncologist. Sherrie talked to him while we were at the hospital. He told her to stop the Neupogen (she had already had the last shot) and asked her to call the office Tuesday to schedule another blood test for later in the week. We don't want the count to plummet to nothing by next Monday. If it gets too low, they'll probably give her a couple more shots over the weekend.

Cycle number five complete

Sherrie completed cycle number five on Monday. Her blood count was quite high (47.3), and so it was a go.

As soon as the nurse started to infuse her with the preparatory items, Sherrie turned white and asked for a barf bag. Lucky for us and the nurse, there was one right at hand, which was a good thing, because within seconds she lost her lunch (and probably breakfast too). She threw up twice, in rather copious amounts.

The funny but not-so-funny thing is that (a) she didn't have any chemo drugs in her yet, and (b) the 5-FU they were going to give her has never made her sick. It was all mental; she associates the time she does get ill with the place, the nurse, and the process.

I can relate. When I was around 12 years old, I got sick once after eating apple crisp. Every time I even thought about eating apple crisp, I would get physically ill. I didn't eat apple crisp for probably 10 or 15 years because of it. A friend of mine at work had a similar issue with Ding Dongs; he couldn't eat them for many years.

The brain is a very powerful force.

In two weeks, and we start cycle number six. I sincerely hope she can get through it without getting too "mental."

Not today

Sherrie was rejected for chemo again today. Her blood count was 27 on Friday (not 17 as I reported) and was 1.7 today. She has to have another round of 5-6 Neupogen shots this week and we'll try again next Monday.

Over the hump

Sherrie made it over the hump around Thursday night or Friday. She's been much better since then. Her white count was high enough on Friday (17 I think) that she should be able to receive the second part of this round of chemo on Monday.

Sherrie was feeling so well that she went mountain biking with me on Saturday. We went up Logan canyon and road up the dirt road that follows Beaver Creek up into Idaho. We rode a little over four miles up the road, stopping to rest a couple of times in the shade. We then had a nice coasting ride back down to where we had parked the truck. We saw what appeared to be active beaver dams and lodges along the way. It was beautiful and we had a fun time together.

The end is in sight. If all goes well tomorrow, we can start to say, "only one more round of chemo!"

A bad few days

Sherrie has had a bad few days since her treatment. She has vomited a few to several times each day, and has trouble sleeping at night. She's getting very bored laying around, but doesn't feel well enough to do anything else. This "nasty" treatment has been harder on her than any of the others. She's in good spirits considering what she's going through, but it's hard on her.

Chemo cycle number five begins

Sherrie began chemo cycle number five today. We met briefly with the oncologist, who looked over her lab reports and gave her an exam. He said her white count was less than ideal, but that she could still go ahead (yeah!). He scheduled her to begin receiving Neupogen shots tomorrow, and a lab for Friday. If her count is okay, she'll get the second part of this treatment a week from today (Monday).

The chemo infusion went according to routine, except that as the nurse began, Sherrie said, "I think I'm going to throw up." The nurse went looking for a barf bag, and I watched Sherrie turn white, close her eyes, put her hand to her mouth, and will it to stay down, which it did. After an interminably long time, the nurse finally found a bag and brought it to Sherrie. She had a dry heave or two, and then was okay for the rest of the treatment. Whether it was the large cup of red Sobe we bought on the way to doctor, or the nurse in her blue smock, something set her off.

So we now have a few days of some vomit and bad nausea, and then the worst of cycle five will be over.

From 40 to 2.6 in a week?

Sherrie had a lab today, preparatory for chemo on Monday. Her white count last Monday was 40, but today it was 2.6. Is that a record for a rapid white cell count drop?

So, we are a bit worried that chemo may not go on Monday. We think that last time, they just took the lab results from a few days prior and went with it. We are hopeful (?) that they don't do another test and find a count that is too low. Or, maybe we should hope that they do a test and find it is too low and give her more shots so it's not dangerous? 

CBC update

Sherrie just finished a week of Neupogen shots, and her CBC today was over 40. That is very high; can it be too high? We hope that it stays up high enough over the next week that she can start chemo on schedule next Monday.

Chemo was successful

Sherrie's chemo on Monday was successful, in that her blood count was high enough (22!) and she had the treatment. This one was the "easy" one, so it's been relatively low impact. She's felt pretty well all week, though she's a bit more tired than normal.

She started on Neupogen shots on Tuesday, and will have them through Monday (tomorrow). I think she's going to have a CBC tomorrow as well, so we'll likely know if her count is good or not.

Sherrie is scheduled for another round of chemo on the 17th. She's supposed to have a lab on the 14th to see if her count is high enough; hopefully it will be.

Try again early next week

Sherrie heard from the doctor today: they want her to take more Neupogen shots over the weekend and have a CBC on Monday for a possible chemo attempt on Tuesday.

She feels quite discouraged because the Neupogen doesn't seem to be working very well. She is worried that each of the final two rounds will have a similar story, and extend her even longer.

We'll obviously be consulting with the doctor on this next time we see him.

CBC still too low

Sherrie had a CBC this afternoon and got some discouraging news: the total count was 1.2. That's too low for chemo. The results were faxed to the doctor, and we'll wait to hear from them what they want to do next.

Needless to say, Sherrie is discouraged. It's frustrating for her to want to be done, but to be held hostage by her body's inability to keep up.

No joy today

Sherrie was denied chemo again today. Her blood count was too low (1.3 total white count), and her infection fighters were especially low (0.4). So, she's going to get Neupogen shots for the next three days, and then try again with a CBC on Wednesday for Friday chemo.

She took it in stride, though she's disappointed. She really was hoping to be all done by the time school starts, but that doesn't look likely right now.

As the doctor said, it's much safer not to do chemo with such a low count, even if it pushes the schedule back.

Report on latest chemo round

Sherrie began another round of chemo (number four!) on Monday of this week. Like clockwork, she threw up around 9:00 that night. She seemed to get a bit behind on the nausea on Tuesday and Wednesday (maybe because her scrip for Compazine ran out?), and had a rough couple of days.

She went on her morning walk this morning (Thursday), and seems to be feeling better. Hopefully she'll bounce back quickly.

The oncologist ordered Neupogen to start Tuesday the day after chemo. Maybe it will work well enough that she can get part two of this round next Monday.

Chemo cycle number four

Chemo cycle number four starts today. Sherrie had a CBC on Friday, and her white count was only 3.4 or so. That's not very high, but I think it will be high enough to start (hopefully; unless it has gone down more since then).

Sherrie has lost almost all of her eyelashes and eyebrows. I'm sure that whatever is hanging on will be gone within the next cycle. I know it's kind of a big deal to her, but I think she looks great, and she needn't worry about losing them.

Chemo report

Sherrie's blood count was high enough yesterday (10.0), so she had the 5-FU chemo yesterday. It went quickly and well, with no surprises or issues. She felt a little queasy later last night, but seems to be feeling okay today.

She was going to take herself to the doctor today (non-cancer related visit), but her eyes were tired and she had trouble driving, so I took her instead.

She's on Neupogen shots again for the next six days, and she'll have a CBC next week to make sure her white count is high enough.

Sherrie is now officially halfway through chemo; three more cycles to go!

Another setback today

Sherrie had another setback today. Her CBC showed a total white count of 1.8, and the "infection fighting" white cells at 0.5. The former has to be over 2.5, and the latter over 1.0, or they won't do the treatment. So, no chemo today.

The plan is to have a batch of Neupogen shots over the next several days, and then try again next Monday.

Sherrie was quite disappointed. As she said, she's a person who likes to keep to schedule, and having these hiccups is hard to swallow. But by this evening, she was feeling better. She knows it's best to be safe; getting an infection would be far worse. So she's being patient and strong.

End-of-week update

Sherrie is starting to feel better. She had a rough few days since Monday. She managed to keep food down after Monday night, but she's been quite nauseous and tired since then. Last night she started to feel better, and she seems more chipper, so we're hopeful things will be looking up. If we can keep her from getting "anticipatory nausea" on Monday, she should be able to have a good couple of weeks.

She starts Neupogen shots on Tuesday, and this time she'll get six of them. We will make sure we find out what her white count is when she is done, and if it's not high, we'll contact the doctor and see how to proceed.

The last vestiges of her "normal" hair have fallen out, and she's left with very fine, hard-to-see white hairs. She still has her eyelashes and her eyebrows, and she's hopeful she'll keep them a while longer (forever?).

This week while she was ill, she made a lovely crocheted hat out of bamboo yarn--it's soft and comfortable.

Chemo report

Sherrie's white count was quite high today (around 18!), so she received the chemo. The bone soreness which came with the Neupogen shots the time before last didn't occur this time. (The doctor says that when the shots are working well, the bone marrow expands and makes the bones ache.) Nevertheless, the shots must have worked, because her white count was high.

We've tried everything in the book to keep her from getting sick, but she still got sick and vomited tonight around 8:00 or so. I feel so badly for her; she's not feeling well at all. It will likely be a day or two before she can hold anything down, if past experience is any predictor.

Although she has another appointment next week for the second treatment in this cycle, it won't likely be bad at all, and so tonight she feels like she's halfway done. She's doing awesome!

Chemo today

Sherrie is scheduled for another attempt at chemo today. She had Neupogen shots on Thursday, Friday, and Saturday. Her hips ached a little, so hopefully that means the shots were working and building up the white cell count.

I'll tweet something later after we find out if she's able to receive the chemo today.

Disappointing setback

Sherrie wasn't able to receive her chemotherapy injections today. Her white blood cell count was too low, particularly the infection-fighting component (count was 700, anything under 1000 is considered bad).

As a result, Sherrie is going to have three days of Neupogen shots, and then another attempt at chemo will be made on Monday, depending on whether the white cells come back up.

Apparently, the fact that her count was so low "slipped through the cracks" as the doctor said. The white count was 3.5 after the last series of shots. The doctor said that if he had known that, he would have ordered more shots until the count came up.

So Sherrie's schedule has slipped several days. From now on, chemo will be on Mondays, assuming no more slippage.

Sherrie was a bit disappointed, as she had psyched herself up for chemo today, a bad weekend, and feeling better early next week. Now, we'll have to wait.

It's probably for the best, as getting sick with a low count would likely set her back much more than a few days, besides being a bit dangerous.

Cycle number three starts tomorrow

Sherrie starts chemo cycle number three tomorrow. She's had a great attitude the last several days, but started feeling a little nervous today. I think she's done marvelously at keeping a positive outlook through the whole ordeal. I can only imagine the feeling of dread that must come about now, but it doesn't show at all. She's a great example and my hero.

She had a CBC (blood count) today, but no word on her white cell count. I suppose the doctor will tell us tomorrow. After the last chemo injection two weeks ago, she started on Neupogen the next day. After five days of shots, her white count was only 3.6 or so. I think that the Neupogen and the chemo were having a battle for white cells. She didn't get sick, so the Neupogen must have won, though we wished the count had been a little higher after those five days of shots.

Nonetheless, she's made it through two complete cycles without getting sick (at least, nothing other than nausea and throwing up :-)

Her hair is essentially all gone. A lot of little nubs on the top of her head held on for quite some time, but they're pretty much all gone now. She rubbed many of them away in the last couple of days. Her head is sore in the spots where the hair is still falling out. She has a nicely shaped head, and I think she looks good bald, but nobody else will really get to see her that way; too bad.

We're hopeful that a combination of anti-nausea meds, ginger, and a positive outlook will keep the stomach problems away this time. After this cycle, she'll be halfway done!

Sherrie's "chemo 2" day

Sherrie had "chemo 2" yesterday (they gave her only 5-FU). She was getting quite nervous in the days leading up to it, even though she didn't really have a bad reaction the first time. The nurses explained this as "anticipatory nausea," and it's apparently quite real for many people. The nurses told us that they've met some of their patients months or years after chemo and the patients will have the dry heaves or even throw up when they see the nurses! So Sherrie has this association problem to deal with each time we go.

She felt better after the treatment, though she did feel a little nauseous last night. She hasn't been without nausea since the "chemo 1" treatment (all three drugs) last week. Hopefully she'll get feeling noticeably better today.

Sherrie had a CBC yesterday and her white count was already down to 2.5. The nurses said they wouldn't do the treatment if it fell below 2.0. Since she's starting a five-day course of Neupogen today, they went ahead with the treatment yesterday.

She also has some sores on her head, so the doctor gave her a prescription for an antibiotic given her low blood count.

Sherrie's weekend

Sherrie had a reasonable weekend, but she hasn't started feeling noticeably better yet as of tonight (Sunday). She's still feeling a bit tired, nauseous, and not quite up to snuff. Hopefully a good night sleep and she'll be much better tomorrow.

What goes down must come up?

Sherrie threw up last night a couple of times. She seems to be feeling better this time than last, but one can't be sure. She held down a banana this morning and just tried some rice. She seems a bit weak, which is only natural considering what she's been through.

We're hopeful the ginger and anti-nausea meds will help her to feel better this time than last.

Chemo 1 report

Today's chemo session was unspectacular, at least so far. The only thing of any import that happened is that the oncologist told us he would order Neupogen for Sherrie to begin the day after her chemo session next Thursday. He said that since she had demonstrated falling to a low white count during the first cycle, we should just assume it will happen again, and try to prevent it with a five-day course of Neupogen. Sounds eminently logical.

The chemo induction was relatively quick and relatively incident-free. Sherrie didn't feel much like eating her ice toward the end, but she came home and ate a nice dinner (provided by a loving friend and neighbor--thanks!).

So now the waiting game begins. Hopefully the combination of the ginger and the two anti-nausea drugs will make the beginning of this cycle easier than the last.

Chemo 1 today

Sherrie has a "chemo 1" appointment this afternoon. We hope that she is well enough to do the chemo; her fever came back yesterday a little bit (around 99F), but it was gone this morning. So we'll see what the doctor says.

Sherrie's been taking ginger the last few days, which hopefully will help wit the nausea (see http://www.cnn.com/2009/HEALTH/05/15/ginger.chemo.nausea/ ). She's not too excited about the beginning of the new cycle, but she has to get through it to get to the other side.

She's growing accustomed to wearing scarves and her wig. I think she looks awesome in both.

Look for an update later today.

White fever?

Sherrie didn't feel super-well the last few days. She had a near-continous headache since receiving the Neupogen injections. The last of these was given on Monday, but the headache persisted beyond that.

Sherrie had a CBC on Monday and her reported white count was 17.0! Normal is anything above 6.5 or so, and her white count had gotten as low as 1.7 late last week. The Neupogen must be doing its job.

Of moderate concern to us is that she had a slight fever (around 99.5F) beginning Tuesday around noon. We watched it rather closely throughout the day and evening, but it never got higher. By Wednesday afternoon, the fever and headache were gone, and she was feeling better. It seems rather odd that she would have a fever when her white count was so high. This will be a question for the doctor on Thursday.

We're hoping that she'll be feeling 100 percent for the beginning of the next round of chemo this Thursday afternoon.

General, the ranks are thinning ...

Sherrie had a blood test today, and within 30 minutes the oncologist's nurse called and informed her that her white count has fallen alarmingly low. We had to go this afternoon to their office to receive a shot of Neupogen. Neupogen is an amino acid which promotes the growth of white cells in the marrow-producing bones. There's an interesting website at http://www.neupogen.com/pi.html which describes it nicely. It's definitely a high-tech drug; it's produced by recombinant DNA techniques in E. coli bacteria.

Sherrie has to have a shot of Neupogen each of the next five days. Since one of those days is a Sunday (and the office isn't open), she gets a larger size dose on Saturday. Her white count was down to 1.7 (in whatever units they measure white count). Normal is above 6.5 or so. Last week, just before the chemo 2 injection on Thursday, her white count was 4.5. They want to get her white count up to 10.0 by the beginning of the next chemo cycle on Thursday of next week.

Apparently this isn't a rare thing for chemo patients. The oncologist told us that about 60 percent of patients have to have Neupogen (or equivalent) injections during chemotherapy.

The funny thing is Sherrie feels great, with no apparent ill effects. It's kind of scary that one's white count can be so low, and yet feel fine.

She may have sore bones (back, sternum, and hips) as a side effect of this drug.

Hair today, gone today

This morning was a traumatic one for Sherrie. Her hair started coming out in small bunches last night. She could run her hand through her hair and pull out little clumps. This morning, the clumps were a little bigger, though it didn't look as though her hair was thinning yet. She struggled with the reality of the situation ("maybe it won't all fall out, but will just thin a little"), and in the end, she asked me to shave her head. So, we had a head shaving party this morning, and after a few minutes with the hair trimmer, it was all on the floor. It was an emotional experience, in spite of the mental preparations of the past few weeks.

Other than that, Sherrie has been feeling quite well. She's not really experiencing much (if any) nausea, and she seems to have sufficient energy each day. Her white count is surely low right now, and we have illness (colds) in the home, so those of us who are ill are keeping our distance as much as possible. She's beginning to dread the beginning of chemo cycle number two next Thursday.

I'm very proud of Sherrie for her great attitude and indomitable spirit. She's being put through the wringer, but she weathers the storms with strength, dignity, hope, and a positive outlook. She's a great example to me.

"Chemo 2" report

Sherrie had her "Chemo 2" today. We got a bit of a late start because we had to wait for the CBC blood work report to come from the hospital. After that, it went relatively quickly.

Sherrie had several questions about side effects and what it means to "overdo it." On the latter, she had been told not to "overdo it" when exercising, but didn't really know what they meant by that. Basically, they meant don't work so hard that she gets really tired or is really sore the next day. I joked that I always feel like that after exercise ;-)

On the issue of side effects, we found out that the nervous jitters are caused by the steroids used to enhance the effect of the chemo drugs. We're grateful that our doctor uses a smaller dose of the steroid than some others (according to the nurse). The nurse told us that most patients don't have that kind of reaction at the lower dosage Sherrie is getting.

The nurse also told us that Sherrie's brain will become accustomed to the nausea associated with the chemo, and even though the drug today shouldn't cause the bad nausea of last week, she might still experience it. The nurse told us a story of one patient who saw one of the nurses in the mall some three years after treatment and had the dry heaves! Evidently, the brain learns to be nauseous, even though the drugs are long gone, and the brain exhibited a learned response on the sight of the nurse.

Sherrie's in good spirits right now. She had a milkshake on the way home from the doctor, and a good lunch, so if she gets ill, she should be able to last a while ;-) Last week, she didn't start throwing up until around 9:00 the evening of the treatment, so we won't know for sure until tonight or tomorrow what kind of reaction she'll have.

They did tell her not to let the nausea illness to get ahead of her, as it's difficult to recover once you start throwing up. On the way home, we wondered what we could have done differently last week. Not much, if anything.

"Chemo 2" tomorrow

We've taken to labeling the first "chemo day" of the cycle as "Chemo 1" and the second chemo day, a week later, as "Chemo 2." So tomorrow is Chemo 2 day. Sherrie will receive one injection of 5-FU (we think). Hopefully the reaction won't be as bad as it was last week (she didn't start feeling well until late Sunday or Monday). Sherrie's nervous about tomorrow, "but not nearly as nervous as I will be in two weeks!" (for the next Chemo 1 day).

A better day on Sunday

Sherrie had a better day on Sunday. She felt well much of the day, and ate reasonably well. She still has some antsy, nervous feelings, and has remarked on the irony of being tired,worn out, and jittery all at the same time.

It's Monday morning; the queasiness hasn't gone away, and she's still quite tired. She's wondering what she's going to do with all the time now that she's not going to school anymore.

Not a good day ...

Sherrie didn't have the best day today. She was quite tired and feeling queasy all day. She hasn't eaten much at all the last couple of days, and is feeling weak from that as well. She was quite tired, and suspects that the anti-nausea meds are zapping some of her strength. She will probably try not taking the meds tomorrow and see if that helps.

Although she hasn't vomited since Friday, nothing sounds good to eat, and when she does eat, she doesn't eat much. We're hopeful that things improve in the next day or two.

On a related but sad note, we've learned this week that Sherrie's sister-in-law Laura, who lives a few blocks away, also has breast cancer. We hope the best for her and her family.

The worst is over ... ?

The worst appears to be over. Sherrie is feeling much better and has kept down her brunch (egg and toast). She seems in good spirits. If the bad nausea only happens for ~12 hours each time, it won't be that hard to stomach ;-)

Nausea ad nauseam

Sherrie was ill all night and didn't get much sleep. She ate part of a banana this morning, but tells me now that she's feeling some rumblings.

I've called the doctor's office twice, and I'm still waiting for them to call me back to confirm they've called in the prescription.

Hopefully it only lasts a couple of days and she can start feeling better.

Nausea update

Well, Sherrie felt okay for a while, but slowly started feeling worse through the evening, and has just thrown up most of the day's intake. She feels better now, and we're hopeful that she'll be able to keep down her meds and eat enough to keep her strength up.

The nausea is supposed to last 2-3 days. We'll call in the morning and get the second anti-nausea prescription.

She was surprised that the vestiges of lunch were still there ;-)

Report: first chemo session

Sherrie had her first chemotherapy session today. It's been about 90 minutes since the last drug finished dripping, and she's feeling no ill effects yet. The IV-administered anti-nausea drug is about to wear off, and she's taken her first anti-nausea pill, so we'll see how things go.

We first spoke with the doctor for a while. He reviewed the same information we received earlier about the treatment and the drugs. He re-emphasized the importance of treating a fever as a medical emergency. If she gets a fever, we are to go to the hospital right away and not wait around to see if it turns into anything nasty. He talked about the side effects of the chemo drugs. He then gave her a medical exam, reviewed the blood work results, and pronounced her ready to go.

We had quite a bit of excitement when we started to receive the IV. Another patient there, an older gentleman who is quite heavy, had a sudden urge to go to the bathroom. Evidently, he'd had a reaction to some drugs earlier, and was quite sleepy and drugged up due to the counter-reaction drugs they gave him. He had a lot of trouble getting to the bathroom and had fallen (without getting hurt) and was having trouble getting up. At one point, they had *five* people, including the oncologist, in the restroom trying to help him. In the end, it took 45 minutes to get him situated, so Sherrie's treatment was delayed that long. It wasn't a big deal to us; we each had something to read and we waited patiently.

The nurse talked to Sherrie for quite a while while she administered the drugs: about the treatment, what to expect in terms of side effects, how to manage side effects, etc. I had expected the drugs to be administered by IV drip, but two of the three drugs were "pushed" in the IV in a relatively short time (about five minutes). Evidently, the have done studies to determine how best to administer the chemo drugs. It depends on the drug and the type of cancer. For example, they pushed 5-Flourouracil in a quick burst, but other patients have to have the same drug pumped into them over a 48-hour period (with a take-home pump). So, for Sherrie, "5-FU" as it's called, and Epirubicin, are pushed in just a few minutes, but the last drug, Cyclophosphamide, was dripped over about 45 minutes or so.

Sherrie felt no real effects during the session, however, when the nurse started Cyclophosphamide, she said that a sinus headache is a common side effect, and a few minutes later Sherrie thought she felt a headache coming on. The nurse gave her some Tylenol and that seemed to help.

One thing we learned is that to prevent mouth sores common to Epirubicin, Sherrie should suck on ice while it's being administered. The drug affects the digestive track, starting in the mouth, and sucking on ice will reduce blood flow to the mouth and lessen the effects. Given that Sherrie has braces and has been prone to mouth sores since she got the braces, we thought it would be good to have a cupful of ice, so I ran to McDonald's before the treatment began. It turns out a large cup of ice is just the right amount to last through the treatment.

The nurse recommended taking the anti-nausea drug every six hours for three days, whether or not she's nauseous. Once the vomiting begins, it's tough to stop it because one can't keep anything (i.e., the pill) down. If the pill she's taking doesn't help, we're to call and get a prescription for a second pill to take in addition to the first. We should know more later tonight as the IV drug wears off.

We might expect Sherrie to feel worst after the first week of the cycle, not so bad the second week (when just 5FU is administered), and best the third week. Her white count will be lowest 7-10 days into treatment, so she'll have to be most careful then. We are all to wash our hands frequently, and Sherrie should avoid large crowds and anybody with an infection.

Chemo this week

Sherrie's infection has abated and is basically gone. We saw the doctor again this week and she inflated Sherrie's expander a little more. The pressure pushed out a bunch of yellowish "serum" or pus. The doctor also subscribed more antibiotics, and they seem to have gotten rid of the vestiges of the infection, as the redness and swelling (at least from the infection!) are gone.

We have a great deal of uncertainty this week with the beginning of chemotherapy. We don't have any idea what to expect. We've heard about the side effects and things that happen, but they are always couched in terms of "everybody reacts differently." So we are anxious and a bit pensive and nervous. We really have no idea what will become of this summer and how well Sherrie will feel. She hopes to be able to do normal things like work in the garden, help care for her mother, and have fun outings with our family. Time will tell.

We'll post an update after the first treatment on Thursday of this week.

Quick update

We don't have much new to report. Sherrie has been fighting a minor infection the last several days. She was given an antibiotic by the plastic surgeon late last week after a checkup. She wasn't feeling too well on Saturday, but felt better on Sunday and seems to be okay today, though the redness and swelling isn't completely gone. We go see the surgeon again on Friday of this week.

Last night, Sherrie slept in her bed for the first time since the surgery! She can only lie on the "non-operated" side, but she was happy to be out of the Lazy Boy (even though she likes it a lot).

We are anxiously awaiting the chemo to start on 7 May, and hoping she's strong and well (i.e., the infection is gone) by then.

"Port-a-cath" procedure

Sherrie had a "port-a-cath" installed this morning in an out-patient procedure at the hospital. The "port-a-cath" is a catheter inserted in a major vein near the heart, buried under the skin. It allows clinicians to administer IVs and take blood easily, safely, and relatively pain-free. It's a lot better than having an IV on a regular basis during the chemo cycles.

The procedure took less than an hour. Sherrie had a less powerful form of anethesia; the surgeon said, "it gives you amnesia." She remembers nothing between going into the operating room and waking up in the recovery room. She had none of the ill effects of general anesthesia, except that she was sleepy for about 90 minutes after the procedure.

She's sore now and resting (sleeping) in her easy chair. She has a bandage over the affected area, and can take it off in a day or two. On Friday, we go see the surgeon to have him check it out to be sure all is well (the same day she gets the rest of her stitches out).

At one point during recovery, we were small-talking about nothing much in particular, and Sherrie remarked, "It sure is sleepy in here."

MUGA scan report

Sherrie had the MUGA scan this afternoon. From my perspective, it went fine, but Sherrie had to hold her arms over her head while they were taking pictures, which made her sore. (She was lying down on the detector table.)

Briefly: a MUGA scan is a "multi-gated analysis" (or something similar) in which the blood is infused with Technetium-99m (a gamma source). The detector is prompted by an EKG to count photons (gamma rays) at various parts of the heart's cycle (eight times per cycle). The system integrates the counts for about 5-10 minutes per scan. The system makes the scans from three different angles, constructing a 3D model of the beating heart. From the data, the system can measure the heart's efficiency. A healthy heart is about 60 percent efficient, meaning that it "moves" about 60 percent of the blood in the ventricles per heartbeat.

The technician was nice to us and talked to us about the procedure and the pictures in real-time. As soon as he started taking the pictures, we noticed a black spot right on top of Sherrie's heart. It showed up in the scans from all three angles. At first, the technician thought that Sherrie must have had some metal on her body or inside her. He later decided that it was coming from the expander which was placed inside Sherrie's chest. At the end, we looked at the detailed pictures and could see a perfect ring about 1/4 inch in diameter, lying in her skin above the heart. We're still not sure what it is. Presumably there is no metal on the expander, but I'm not really sure. Perhaps it is some other material which absorbs the gamma-rays.

Sherrie's heart efficiency was about 68 percent, which is better than the expected "threshold" of 60 percent. Assuming nothing untoward comes up in the more detailed analysis, we believe she should be good to go for chemo.

The technician showed us "moving pictures" of the heart's beating cycle. It was really cool.

Progress update

Sherrie got her drain and half of the stitches removed this morning; the other half of the stitches will come out in one week.

Sherrie was excited to get the drain out in the hope that some of the soreness would go away. Removing the drain hurt quite a bit, and she was quite sore immediately afterward. We hope that quickly goes away and she starts feeling better soon.

This afternoon, we have the appointment for the MUGA scan. In two weeks, she goes back to the plastic surgeon and may have a little fluid put into the expander before the chemo begins.

Getting the drain out today was big.

A couple more notes re: oncology appointment

For the interested student, the three drugs that will be administered to Sherrie are 5-Flourouracil, Epirubicin, and Cyclophosphamide. Yes, the known,common side effects are many and undesirable.

Another side effect I forgot to mention in the previous post is fatigue. She can expect to feel 80-90 percent during much of the time she is on chemo, but that will go up and down with the administration of the drugs.

First oncology appointment

We had our first appointment with the oncologist today. In summary, I would say the appointment was sobering but hopeful, punctuated by a few light moments, mostly dealing with hair loss.

The most sobering point was that the "micrometastatic tumor" in the lymph node was bigger than we had been told. It's still not clear in my mind exactly what happened in the surgery, as the oncologist told us that the surgeon took out and tested three lymph nodes. I wonder now if he was confused with the three stains the surgeon recounted (?), or maybe the surgeon didn't clearly inform us that in fact three lymph nodes had been removed. In any case, one of the three tests (nodes?) had cancer cells in it. The oncologist told us that the cancer cells were in a mass about 2mm in size. Not big, but definitely bigger than "one or two cells" as the surgeon initially said (or implied).

Another sobering point came when the oncologist told us that in some cases, the cancer will return in either the other breast or in another part of the body, and if that happens, they can't cure it--only fight it and prolong life. Without chemotherapy, for Sherrie's circumstances, the odds are one in three that the cancer will return somewhere at some time.

The good news is that if Sherrie has chemo, the odds of a recurrence are cut in half (to one in six). So, chemo is definitely indicated for us.

Another piece of good news is that tumors which are estrogen-positive like Sherrie's respond better to the chemo than the ones that aren't estrogen-positive.

Sherrie needs to heal before beginning chemotherapy. The oncologist said we should begin four to five weeks after the surgery, so we are scheduled for our first treatment on the 7th of May.

The course of treatment will be six cycles, separated three weeks apart. In the first week of the cycle, she will receive three drugs via IV. The next week, she will receive one of the drugs again, and the third week is a "rest" week. Concurrent with the administration of these drugs will be frequent blood tests to measure counts, particularly white cell counts. We had been expecting the chemo to last six months, so the fact that it will be over around the first of September (assuming no problems) is good news.

Prior to beginning the course of treatment, the oncologist wants Sherrie to do a nuclear medicine imaging test of the heart. Evidently, the chemo drugs can be hard on a heart that isn't healthy, so he wants to be sure her heart is strong.

Sherrie will have a semi-permanent catheter installed in her upper chest near/under the collarbone. This provides an easy and safe way to draw blood and to administer the IV drugs. The surgeon will install this catheter in an out-patient procedure sometime soon, and it will be removed after the course of treatment.

She can expect to feel quite nauseous for one to two days after each treatment. The oncologist will give as many anti-nausea medicines as are required ("we just keep adding them") until she is able to deal with the nausea.

A serious concern for patients on chemotherapy is infection. Sherrie could literally go from feeling fine to being in a life-threatening situation within the course of a couple of hours. A fever of over 100.5 is a medical emergency, necessitating a trip to the emergency room. If her blood count is low, she'll be in the hospital on IV antibiotics for a few days. School in May might not be recommended--too many germ carriers!

Sherrie will lose her hair, within days of the first treatment. It won't really start growing back in earnest until several weeks after the last treatment. Summer is probably not a bad time to lose one's hair and wear a hat.

Through all of this ordeal, I've been grateful for Medicine and its ability to help people. Modern medical care saved Sherrie (and Jared) when Jared was born, and it's saving her life again. For that I am profoundly grateful.

Pathology report

We visited with Sherrie's surgeon today and got the pathology report, which was good news and bad news. First, the good news: the margin was clear around the tumor (which was 2 cm in size). The bad news: the more detailed look at the lymph node showed  a couple of cancer cells with one of the two stains they use to look at the node. They look at the lymph node initially during the surgery with a quick-look stain, and then after the surgery with two more detailed examinations. One of these was clear of cancer cells, but the other showed "literally one or two" cancer cells. The surgeon called this "micro-metastasis."

It's not the best of news, but it's not the worst either (lots of cancer cells in many nodes would be more grim). The bottom line is that chemo is now a sure thing. We have our first appointment with the oncologist this Friday, which is most likely an initial consult and scheduling. The actual chemo itself won't start until about a month after surgery (three weeks from now), after Sherrie has had more time to heal. We expect the chemo to last about six months.

The surgeon said that we should wait until the drain is producing less than 30 cc per day "for a couple of days" before having it removed.

Sherrie was secretly hoping not to have to do chemo, but has a good attitude about it. Who knows, maybe she'll tolerate it well.

Dr appt tomorrow

We have our first follow-up with the surgeon tomorrow at 4:30 PM (the "normal" surgeon, not the plastic surgeon). We've no idea what he's going to say, but we're hopeful that Sherrie can have her drain removed!

People have been so kind and thoughtful in so many ways. We are very grateful to all.

Home from the hospital

We are home from the hospital, after a day which began poorly but is ending quite nicely.

Sherrie didn't do well during the night or most of the day today. The effects of the anaesthesia hit her pretty hard. She couldn't keep food down until late this afternoon, and had a headache much of the day.

At noon they removed the IV drug (a heavy-duty narcotic). The drug helped her make it through the night, but affected her poorly, making her dizzy and probably contributing to the nausea. When they removed the narcotics, they gave her an anti-nausea drug and started her on Ibuprofen. About an hour later, she was able to keep down some soup and a banana. She then fell asleep for about four hours!

When she woke up, the headache was still present, but the nausea was gone. After about an hour or so, we decided to go home. We got the discharge instructions and were out the door.

Sherrie perked up on the ride home, and was downright chipper after some more soup and a couple of Oreos. Right now, she's sleeping in her chair while the TV serenades her. I expect her to wake up soon and want more to eat.

The next step will be to remove the drain in her chest, but that can't happen until we collect less than 30cc of fluid in a day, and the doctor's available to take it out. In about two weeks, we'll go back to the plastic surgeon to get the stitches out, and we'll have our first appointment with the oncologist.

A rough couple of days, but days full of blessings from a loving Heavenly Father. Many people have taken care of us in a variety of ways today. We are humbly grateful.

Surgery day recap

If you've followed the "tweets" today, you have a pretty good idea of how things went. In a word (or a couple): it went swimmingly. The big news of the day was that the sentinel node was negative. The doctors both said that the surgery went quite well. The only potential issue is that there wasn't a lot space available for the expander (or skin to cover it), so the sutures are tight right now. Hopefully the skin will adapt over time and the reconstruction can proceed (whenever the next stage begins) as planned.

I am pleased and content with the care Sherrie is receiving at the hospital. People were kind to us and thoughtful about our tender state. It is a great and wonderful blessing to be able to receive such excellent medical care.

I left Sherrie at the hospital around 8:00 PM tonight, in a semi-conscious state between sleep and full cogency (if I can use that word). To my astonishment, she called around 9:00, sounding quite alert, to check to see if I had arrived safely and how things were going at home. She reported that she had thrown up her post-operation apple juice/ice water cocktail, but the nurses weren't overly concerned and had given her some more anti-nausea meds. As you might expect, she was concerned about her family and wanted to know how each was doing. She had yet to stand up, but that was coming soon, as she needed to respond to the call of nature ;-)

She will come home tomorrow, assuming that she shows no signs of trouble and has moved smoothly from IV pain killer to pain pills. I presume that sometime late in the morning they will discharge her, but we shall see.

Thanks so much to the many people who followed our progress today and provided words of love and encouragement. We are so grateful to have family and friends who love and support us such as you do.

And special thanks to the many people who have supported us with acts of faith, including fasting and prayer, on our behalf. We are humbled and grateful to receive such tender mercies.

Follow us on twitter during the surgery on Wednesday

You may keep up-to-date during surgery day in near-real-time, should you so choose, by following us on twitter at http://twitter.com/drmdwebb

The night before surgery

Sherrie and I had a wonderful day skiing/boarding at Beaver Mountain. It snowed about a foot the last couple of days, and the conditions were great. Spring has definitely sprung, and the conditions generally aren't so good this time of year, but the fresh snow was reminiscent of winter: soft and fun. We spent a lot of energy today and are tired tonight, but content and happy.

We went to the hospital tonight for the pre-op appointment. They registered us, talked to us about what to expect tomorrow (and when to come), took some of Sherrie's blood and made her pee in a cup (to be sure she's not pregnant).

We need to be at the hospital at 10:00 AM, to prepare for the sentinel node injection at 11:30. The surgery is scheduled for 1:00 PM, but may shift around a bit (hopefully not a lot!).

We still do not know what to expect for the hospital stay after the surgery. The nurse tonight asked us, "How long did he say you'd be here? Three or four days?" Eek! When I spoke to the doctor's nurse yesterday, she said that Sherrie might leave the same day, or maybe the next day. I think that since the surgery is going to be rather late in the day (at least 1:00 or later), she'll most likely stay overnight tomorrow night. But we shall see.

We have experienced a wonderful outpouring of love, concern, and help from our many friends, acquaintances, and family. It's a great blessing to have such special people in our lives. We are grateful to a loving Heavenly Father for placing so many angels in our circle of influence. We are blessed.

Surgery on for Wednesday!

The surgery will be on Wednesday. The time won't be given to us until Tuesday night, but the nurse said that the sentinel node injection will be at 8:00 AM Wednesday morning. The surgery has to be at least 90 minutes after that. We'll probably have to be at the hospital by 6:30 AM Wednesday morning. We may know the surgery time  when we go for the pre-op appointment on Tuesday night.

The nurse said that Sherrie may be able to go home later that day, or for sure sometime the next morning, depending on how she does.

Plastic surgeon appointment report

We met with the plastic surgeon today. Overall, it was a positive appointment, we accomplished a lot, and the doctor answered many of our questions. The big question (when is the surgery?) wasn't answered definitively, but we're pretty confident it will be on Wednesday the 25th. We just don't know the time yet.

The biggest surprise was finding out that the complete reconstruction won't happen until *after* any chemotherapy or radiation is completed. This makes sense to us after the doctor explained some of the reasons. For example, if Sherrie's on chemo, her white count will be down, and it wouldn't be as safe to inject the expander or perform the implant surgery. If she has radiation, the skin and breast tissue will change, and so reconstruction would be premature.

The doctor explained Sherrie's options, which basically are an expander/implant, or removing skin/fat/muscle from another part of her body (the stomach area) to reconstruct the breast. The latter isn't really an option for Sherrie because she's had previous abdominal surgery (the C-section when Jared was born), and she doesn't have enough abdominal material to complete the reconstruction (i.e., not enough fat). So the expander/implant is the only viable option. This is a good thing, because the recovery time for expander/implant surgery is quicker.

After any chemo/radiation, the doctor will slowly (over the period of a few weeks) fill the expander with saline until the skin stretches enough to accept the implant. Notably, the expander has to be about 50 percent bigger than the implant so that things will work out okay. The surgery to place the implant is fairly simple, and occurs on an outpatient basis.

Sherrie also has to decide between a silicone and saline implant. Before you get too excited about silicone, you need to realize that (a) the most recent and largest studies of the effects of silicone implants show no statistically significant difference between the long-term health of a control group and women who have had silicone implants, and (b) the new silicone implants do not leak like the old ones did. As the doctor explained, they are like a "giant gummy bear." So if the covering breaks, the silicone stays in place and doesn't migrate to other body tissue like the old silicone implants did. Saline implants are harder and show "ripples" under the skin; silicone implants are softer. Sherrie doesn't have to choose which until the time comes to place the implant. Also, if you are wondering, silicone implants are approved for breast cancer patients.

The doctor pointed out that after the surgery, Sherrie will actually be *concave* in the breast region. Apparently, many women say they don't want an implant after the surgery, but after they see the "hole" in their chest, they change their mind.

We liked the doctor; she seems very knowledgeable, competent, and "no-nonsense" as Sherrie said. She will be performing the surgery on her day off, which is a nice thing to do.

When we get a surgery time for Wednesday, I'll post it here.

Appointment today; tweeting

Today we have an appointment with the plastic surgeon. We *hope* this means we'll have a firm date for the surgery by the end of the day.

I'm not such a fan-boy of my own life that I think there are thousands of people out there who have to know what I'm doing all the time. For this reason, I've never been a big fan of Twitter (http://twitter.com). Then again, I'm not Paris Hilton or of her ilk.

However, I think there can certainly be a use for a service like Twitter for some people/businesses who need to be connected in real-time.

I have a Twitter account (http://twitter.com/drmdwebb), which I set up mostly out of curiosity. Now the punchline: during Sherrie's surgery next week (hopefully next week), I'm going to update my Twitter account ("tweet") regularly. So, anybody who is interested in hearing about what's going on in real-time can follow me and get updates. I will of course update this blog later.

If you are interested in hearing about things in real-time on surgery day, set up a Twitter account (if you don't have one) then "follow drmdwebb" as they say in Twitter Land.

It seems the height of arrogance and self-aggrandizement to tweet, but as I said above, it may have its legitimate uses, and surgery day could be one.

Oh, and Paris Hilton has 12,495 followers as of this posting ;-)

UPDATE: I've added a Twitter gadget on the right; you can follow me from there.

Surgery schedule--sort of

Sherrie's surgery is scheduled; sort of. The surgeon tried to schedule the plastic surgeon for this Monday, but it didn't work out. So, we go see the plastic surgeon on Thursday the 19th, We think that the surgery will happen on Wednesday the 25th, but that is supposition based on our conversations with the doctor's nurse. We won't know for sure until after the 19th.

We are grateful for the plastic surgeon's willingness to help Sherrie. Apparently, she is very popular, and "normal" appointments with her are now being scheduled for June. Also, her schedule is so tight that she works in "special" cases like these on her days off.

With respect to the timing of the surgery, Sherrie is a little disappointed and at the same time relieved. It means waiting another 10 or so days for the surgery, but it also means she'll be able to go to school next week and prepare her reading groups for her absence. It also means we have a few more days to prepare for the surgery and the downtime afterward.

We'll post more updates here as we get more information.

Biopsy results

It's a cliche, but we have good news and bad news. First, the bad news: the tumor on Sherrie's left side is cancerous. It is a "ductile carcinoma," meaning it first formed in the ducts of the breast. According to the doctor, about 95% of breast cancers form in this fashion (a few percent form in the lobes, and a few rare cancers in other ways).

The good news is that the cyst on the right side is benign.

We were quite pleased with our doctor and the time he took with us. We had to wait about 90 minutes for our appointment (the doctor was held up in surgery earlier in the day), which is quite symbolic of our life right now, and a bit frustrating. But after we saw the doctor, he took his time to explain simply and in great detail all of the decisions we have to make and our options. He's probably had the same conversation a hundred million times, but we were grateful for his patience in explaining things to us.

The doctor told us that there are four things to do: (1) get rid of the cancer, (2) determine if the lymph nodes are positive for cancer, (3) remove the possibility of any other sites in the breast having cancer, and (4) commence hormone therapy. The latter (hormone therapy) is required because Sherrie's cancer is hormone receptive positive (HR+; about 1/3 of breast cancers are HR+), meaning that estrogen and progesterone help the cancer to grow. There are hormone therapy drugs (e.g., Tamoxifen) which are quite effective at managing this, however. Initially I thought this was a good thing, but now I'm thinking it would be better if it weren't HR+, as it means taking hormone therapy drugs for a long time after surgery (five years or so, according to what the doctor said). The good news is that drugs like Tamoxifen help a lot in preventing a recurrence of the cancer.

On removing the cancer, Sherrie has two options: lumpectomy with radiation treatment, or mastectomy with reconstruction. Sherrie has decided to have a mastectomy. Given the size of the tumor and other considerations, she feels like this is the best option. The doctor said that the long-term prognosis is the same for both approaches, and it comes down to which option makes the patient most comfortable. There are pluses and minuses to each approach, as you can imagine.

During the surgery, the doctor will remove a sentinel lymph node and it will be examined by a pathologist in real time. If it is cancerous, several more lymph nodes will be taken out in an "ancillary dissection." If it is not cancerous, no dissection will be performed.

Item (3) above is accomplished by a complete mastectomy or by radiation after a lumpectomy.

Any decision on chemotherapy will happen after the surgery and the tests done on the lymph nodes, in consultation with an oncologist (a few weeks after surgery).

The timing of the surgery is uncertain at this time. It's possible it may occur as soon as this coming Monday (the 16th). This would happen if Sherrie is able to see the plastic surgeon on Friday (tomorrow). If not, the surgery will likely happen on the 23rd or shortly thereafter.

I asked the doctor if we could be sure that the cancer originated in the breast and didn't migrate there from somewhere else, and he responded affirmatively.

The doctor gave us some good advice on a couple of issues. Many people will have great ideas on where we should go to receive the best care. The simple fact of the matter is that this type of breast cancer is very common and excellent treatment options are available right here in our community. There is nothing unique or exceptional about her cancer, so specialized treatment from elite clinics is not indicated. Additionally, some people will have great ideas on alternative treatment options which are better than anything standard medicine is doing. The plain truth is that if anybody anywhere makes a (proven) breakthrough, doctors everywhere will know immediately and begin to implement the breakthrough as soon as possible, so we shouldn't put much stock in these reports. Finally, some people will tell us horror stories about somebody they knew who had a terrible time with cancer and died. The doctor explained that everybody is unique and responds differently, so no matter how similar such episodes may be to Sherrie's cancer, her outcome is unique to her.

The notion that the surgery could occur as soon as Monday was a bit shocking, and made it all very real. In spite of how much we've thought about the issues and talked about it, until today it was fairly abstract. It is now much more concrete and real.

We are very hopeful and upbeat. Many people have much more dangerous cancers (and other diseases). Sherrie's outlook for a complete and full recovery is very promising. We are grateful to our family and friends for their love and support, and we know that our Heavenly Father and his beloved Son will see us through this trial.

Sherrie's biopsy

Sherrie and I just returned from the biopsy. Overall, it wasn't the most pleasant experience for Sherrie, but she's feeling fine now, though starting to get sore. She'll likely be sore for a couple of days.

First, the technician performed an ultrasound (both sides) to see the suspicious masses, and then she went and spoke with the radiologist to plan how to perform the biopsies. The basic procedure for both was to give Sherrie a shot to deaden the area (both on the surface and deep inside), then insert the biopsy needle/gun, take a few samples (they said five on each side, but ended up taking only three on each side), insert a metal marker to mark the spot where the biopsy occurred, apply pressure to stop the bleeding, clean up, and apply a bandage.

It sounds simple, and for the most part it was. though one of the needle pokes hurt Sherrie quit a bit. Also, she bled a fair amount on the second (right) side, but the doctor and his assistant weren't overly concerned about that. The whole procedure took about an hour.

I was in the room with Sherrie and watched the procedure unfold on the ultrasound screen. I could see the doctor positioning the needle near the mass and then when he shot the "gun", another part of the needle would shoot through a couple of centimeters (my guess). The shots occurred in pairs, and then the doctor would pull out the needle and put the tissue sample in a bottle of some kind of liquid.

At one point during the second biopsy on the right side (with the smaller mass), he asked if any of the samples were "sinkers." Sherrie asked about this, and he said that a "sinker" is more likely to be a "good sample," meaning more dense tissue. I took this to be a codeword for "malignant" tissue, but that's just my supposition. The fact that they got a "sinker" on the right side as well as the left may be some indication that the mass on the right side is cancerous as well, but that's pure speculation on my part.

After the biopsy procedure, Sherrie had another mammogram to document the location of the markers where the biopsy tissue was taken.

She has to take it easy for a couple of days ("no tennis, vacuuming or weightlifting"), and they said ice would be "her best friend" for the next day or so. She is to expect some bruising where the needle shot through her tissue.

Our appointment to get the results and speak with the surgeon is scheduled for Thursday, but may change to Friday depending on how fast they get it done.

Sherrie is in good spirits. She's been making rather humorous observations of late. For a few days now, she's been lamenting the fact that she's never bought pink breast cancer awareness items. After the biopsy, she asked if I had seen the metal marker they put inside. I said, no, and she remarked that it was shaped like the ubiquitous ribbon for AIDS awareness, breast cancer awareness, POWs, etc. She said something to the effect of, "I guess if you don't buy the stuff, they eventually stick it in you anyway."

A couple of links on breast cancer

Here are a couple of links on breast cancer which I found informative and useful.

Staging and Survival Rates of Breast Cancer

Breast Cancer (Carcinoma of the Breast)

One more note from the visit with the surgeon

During our visit with the surgeon today, he made some comment about the fact that the tumor has probably been there for three or four years. Sherrie asked him why it wouldn't have shown up in previous mammograms. He then talked about the geometric growth rate of cancerous cells--they double about every three months or so (according to him). This means that the tumor would grow about an order of magnitude in size every year (my calculations; not his: double every three months = 2^4 increase in size per year, or 16x per year). So, the tumor was probably about 16x smaller a year ago, or one or two millimeters in diameter, which may be why it was missed. Perhaps it was even smaller.

First visit with the surgeon

Sherrie and I had our first visit with the surgeon today. The most surprising aspect of the visit was his unwillingness to diagnose the lesions as definitively cancerous. The strongest word he used was "concerning." When we stated the the radiologist was "high 90s percent confident," it was cancerous, he said that he wouldn't ever say anything conclusively until after the biopsy because he had been surprised too many times. On the other hand, for most of the interview he was talking as if it were cancer, and Sherrie and I are under no delusion that it's not.

Another surprising aspect was his apparent concern over the lesion in the right breast. It was "concerning," but not quite as concerning as the much larger one in the left. He stated that there are five characteristics of benign cysts, and that since the lesion in the right breast didn't have all five characteristics, he wasn't willing to say it isn't cancerous.

We are scheduled for the biopsy (both sides) next Monday, March 9th, with a follow-up visit with the surgeon on Thursday the 12th. We will get the biopsy results at the appointment on the 12th. The doctor's assistant worked hard to get us an appointment as soon as possible. The first option would have meant waiting probably a week to 10 days longer to get the biopsy results, and she called back and begged for an earlier appointment. We are grateful for her!

We spoke about the different surgery options, and whether or not chemo may be indicated. That former will depend largely on Sherrie's desires (lumpectomy vs. mastectomy), and the latter will depend on the results of the biopsy and surgery. in some cases, chemo will decrease the odds of recurrence, but in other cases, it may not have much of an impact. This decision will be made with an oncologist after the surgery.

That's about it. This will be a long journey, and we can't see the path clearly, but we are happy that we've taken the first step.

Visit with the surgeon on Tuesday, 3 March

I've just called to verify Sherrie's appointment with the surgeon on 3 March. The receptionist said this appointment is the initial consult. The doctor will determine if a biopsy is indicated, and which kind of biopsy to perform. The biopsy will occur "usually within a week" after the initial consult.

We hope to be able to ask some questions, but we may not have much more information after Tuesday's appointment.

Sherrie's initial diagnosis

Sherrie had a clear mammogram in December of 2007, roughly one year ago. Last week, she had another annual appointment with her nurse practitioner, and a mammogram in conjunction with that appointment. The hospital and the NP called on Tuesday to say that the mammogram gave them cause for concern, and that she needed another mammogram and ultrasound exam.

We went to the hospital on Wednesday morning for the exams. I sat in with Sherrie for the ultrasound and the tumor/mass was clear even to an uninitiated person like me. The technician measured the tumor in various directions, and also performed what I believe are Doppler measurements to look for blood flow in the affected region. The tumor is shaped sort of like a chocolate M&M: flat and round. In its largest extent, it is about 1 inch in diameter. The tumor's edges were not well defined, but sort of disappeared gradually into the surrounding areas.

Of possible concern is that the mammogram also showed, and the ultrasound confirmed, the presence of another small mass in the other breast. This mass was much more well defined and much smaller.

After the exams, we met with the radiologist. He expressed to us that he wished he knew us better, because he doesn't like to give bad news to people he doesn't know. He then stated that he was "high 90s percent confident" that the tumor was malignant. His official report calls it "invasive adenocarcinoma."

I asked the radiologist about the mass in the right breast and whether he felt that indicated that the cancer had spread. He stated that the two are probably not related, and that the mass in the right breast is probably not cancerous, but should be biopsied just to be sure. We were grateful that the radiologist consented to talk with us. At this point in time, the uncertainty associated with all of this is the most difficult thing to bear.

Our next appointment is Tuesday with the surgeon. we do not know if that is only an exam, or if the biopsy will be performed then or scheduled for later.

Next appointment

Sherrie's next appointment is Tuesday March 3rd with the surgeon.

Sherrie has breast cancer

Come back to this post occasionally for updates on her status.