Tuesday, March 31, 2009

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.

Monday, March 30, 2009

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.

Thursday, March 26, 2009

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.

Wednesday, March 25, 2009

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.

Tuesday, March 24, 2009

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.

Monday, March 23, 2009

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.

Thursday, March 19, 2009

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.

Saturday, March 14, 2009

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.

Thursday, March 12, 2009

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.

Monday, March 09, 2009

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."

Friday, March 06, 2009

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)

Tuesday, March 03, 2009

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.

Monday, March 02, 2009

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.

Sunday, March 01, 2009

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.