An MRI can be Fashionable

The MRI biopsy was done at Good Sam. After checking in, I met Dr. Alfredo Nino, the radiologist who would perform the biopsy. He was something of a shock. Instead of the pleasant, short, plump, Hispanic looking man that I had envisioned, he turned out to be one of the handsomest men I have ever seen in my life. He is tall with golden hair and light blue eyes.

I look adorable in my MRI gown.

Dr. Nino explained that they would try to isolate the same spots seen previously seen on the MRI to biopsy and take a sample from the most promising section. If they couldn't see them then they would not do a biopsy and we would recheck in six months. That seemed like a good scenario to me.









My girls kept me company!


The MRI is done with me laying face down on the MRI table, breasts hanging through a hole. Each breast is squeezed by paddles just like the ones for mammograms except these have gridlines on them and open areas for the biopsy catheters to go through. One MRI is done to see if they can find the spots they saw previously ( they could see them both) and where the spots are in relation to the grid. This took two tries and then they brought me out of the MRI tunnel and cleaned the skin and numbed the area. After a few minutes, Dr. Nino placed the catheters in each breast using the grids to find the correct area. A quick trip back into the MRI machine was done to make sure the catheters were in the right spot and then the tissue samples were taken and titanium clips placed to make it possible for the surgeon or a future radiologist to find the exact area at a later time.

After the procedure a mammogram is done, ice applied. There is a lot of bruising and more discomfort after this biopsy because the MRI identifies areas that are needing more blood supply so there is more blood in the areas they sampled than the last biopsy.

Results sometime Monday!

Six Word Stories

Corey found an article in the AARP magazine ( yes, we are card carrying members now) that said that someone once challenged Ernest Hemingway to write a story in six words.
He came back with the following story: For Sale, Baby Shoes, Never Worn.

Wow - to pack all the possibilities in just six words! AARP is publishing six word stories based on themes and we are attempting to write some. The first theme was enduring love and friendship.

My attempt: We still fit together like spoons.

Theme #2: Holiday Traditions.

My attempt: In Iraq, no trees to trim.

I would love to see your six word stories!

Pathology Update

The pathology is back on the original slides. The cells were Estrogen Receptor Positive, Progesterone Receptor Positive and Her-2/neu Negative.

Estrogen and Progesterone positive cancers can be treated with medicines that lower the estrogen in your body, as well as medicine that blocks estrogen from getting into the hormone receptors of the your body’s cells. This means that my cancer should stop growing or be prevented with hormone suppression treatment, such as tamoxifen. I have not talked to the oncologist yet but my surgeon thinks I will need that medication for at least five years.


The HER2 is a gene that sends control signals to your cells, telling them to grow, divide, and make repairs. A healthy breast cell has 2 copies of the HER2 gene. Some kinds of breast cancer get started when a breast cell has more than 2 copies of that gene, and those copies start over-producing the HER2 protein. As a result, the affected cells grow and divide much too quickly. This is not a factor in my case as the Her2 cells are normal.

Today another biopsy will be done on both sides under MRI at 1pm. I should have results by Monday will let us know if I need a mastectomy.

Ups and downs for May 26th

My next procedure is Thursday at noon - an MRI guided biopsy of both breasts. I have a doctor's appointment tomorrow and one on Thursday morning. Some of the tests are in but I have to wait to get results until someone calls me. ( I'll know instantly if it is good or bad news... the doctor's always call me themselves with bad news.)

I had a great weekend with Corey, my girls and my family.

My cousin Wendy, who is just six months younger than I, is recovering from her double mastectomy and had her first chemo treatment. Her hair is gone but my cousin Tracy reports that her spirit is bright.

A favorite patient died on Sunday, I went to see her on Saturday and am glad that I did. She was very sweet and so brave throughout her illness that I know she will live on as an inspiration to me and to those knew her.

On the flip side I had an article published with a group of colleagues from the CF community.
You can find it at:
http://respiratory-care-manager.advanceweb.com/Article/Airway-Clearance-Revisited-2.aspx

That inspires me to get back to work as soon as I can.

Imagining the Sphere

A comment from my friend Kathryn Sabadosa brought to mind this favorite poem of mine. Thanks Kathryn!

Happiness is like a crystal,

fair and exquisite and clear ,

broken in a million pieces,

shattered, scattered far and near.

Now and then along life's pathway.

Lo! some shining fragments fall,

but there are so many pieces,

no one ever finds them all.



Yet the wise as on they journey

treasure every fragment clear,

fit them as they may together,

learning to be thankful,

though their share of it is small,

for it has so many pieces,

no one ever finds them all.



Poem by Priscilla Leonard AKA Emily Bissell.

I have always loved this poem thinking it a great accomplishment to find the little bits of happiness in each day. This is my goal for this weekend...to look around for all the things that I might have missed.

TRIVIA: Emily Bissell was not only a poet but has another claim to fame. She made a name for herself at a young age as the founder of Wilmington's (DE) first public kindergarten and for her efforts to introduce child labor laws in the state of Deleware. She also introduced the Christmas Seal Campaign to the U.S. in 1907 as a way to raise money to help people with TB.

"Cancer is not just about one person."

Wise words from my friend Shirley.

On the Sunday before the surgery, Corey and I had a cookout with my family and good friends Michelle and Shirley in the backyard. Our backyard has been the site of many happy times! Sunday was no different.

Shirley, Michelle, my daughter Ali, and I were sitting in the family room by the french doors when Ali looked at Michelle and they both teared up soon to followed by Shirley and myself. Shirley, who qualifies as an expert in this area, observed, "That's the thing about cancer, it doesn't just affect one person."

Cancer means that nothing in your life will ever be the same. When you hear the diagnosis - you know that in some way your vision of the future has shifted and nothing will ever look as it did or as it might have. You may walk the same path and see the same things that you saw yesterday but they just do not look the same. You drive the same places, pay the same bills, read the same magazines and except for the endless procedures and therapies, you are living in the same city and state as you did yesterday, but you know that nothing will ever be quite the same again.

For a while the road not taken has been mostly my choice. To paraphrase Robert Frost, I could peer down one path or another as far as I could see and choose the one that looked most fair. For now, I fear the path will be chosen for me, and "knowing how way leads on to way", I doubt I will be back to this great spot again.

Read Robert Frost's Complete Poem:
http://www.wsu.edu:8080/~wldciv/world_civ_reader/world_civ_reader_2/frost_road.html

Change in Plans

Sadly, the MRI showed much more extensive cancer than orginally thought. I am being scheduled for an extensive MRI guided biopsy of both breasts at the Breast Center at Good Sam probably with Dr. Nino ( spelling?).

I doubt that will be until next week due to the holiday. This undoubtedly makes the surgery much more extensive... sigh.

Peace.

Check Back for Exciting Updates!

No news about times for tomorrow. The radiologist needs to study the MRI. They then call me back in to place a guide wire to help the surgeon get to the right spots. The placement of that might be today or tomorrow and the surgery tomorrow sometime depending on when they can place the guidewire.

Just a quick note. There is a chance that I will need a second surgery next week. A second surgery is dependant upon the pathology reports from tomorrow. Most surgeons have about 40% chance of needing to go back in, Dr. O'Neill runs about 20%. Let's hope that for once I can follow the crowd!

I will post updates on this later this afternoon.

Right Now, I am in Pretty Good Shape

I once heard Len Doak say, "You have to be in pretty good shape to be sick." He was so right.

Not only do you have to feel pretty good in order to keep up with everything; you need a lot of time as well. Medicine is an art delivered on time schedule.

When I called the disability administrator this Monday, the intake nurse asked why I needed any time off before my surgery which is not until Thursday morning. I explained that I had spent the morning with one surgeon before rushing off for a second opinion, and then I had an MRI scheduled for 3 but needed to check- in at 2 and in addition, I had yet to have labs, pick up old records, have an EKG, have a guidewire placed before the surgery, make appointments for the oncologist and radiation oncologist, and pick up prescriptions. Oh, and I might spend some time getting used to the fact that I have cancer. "My office is not going to like me just coming in for lunch!", I told her. " She responded that they usually did not approve time off before a surgery.

Not all of the time is productive of course, there is time spent commuting to and from the various testing sites, consultations, treatments and pharmacies. Waiting room time is enormous. Coordination between the various points is... uncoordinated.

Even when you know what you want or need, someone thinks that he or she knows better. And when you are a patient, too few people listen to you.

Everyone in the waiting room wants to talk to you (or to me at least). I never mention that I am a nurse because no matter what is wrong with them, the stranger next to me will invariably say, " Oh, if you are a nurse you will then you will be interested in this." They then proceed to launch into a long drawn out story about their hemmorhoids (which I not only have no interest in but can't even spell), constipation or some other aspect of their disease process.

There is a slight advantage in having cancer though. If you need a bit of peace and quiet, you can just say rather bluntly, " I have cancer." It makes most people so uncomfortable that they let you get back to your murder mystery!

Our First Team Member - Dr. Jennifer O'Neill

Corey and I chose our first team member. This is a key person because they essentially follow me for the rest of my life although hopefully she will retire first! Dr. O'Neill is a hugger (which I am not) but I liked her anyway.

There were five spots of cancer. The cancer appears to be "in situ" which means that none of the cancer cells have leaked from those spots into the surrounding tissue. That will be confirmed in several ways. Yesterday, I had an MRI which measures the blood flow to the cells. The idea is that rapidly growing cells need more oxygen so there should be more blood flow to any spots of cancer that are active. The second way to confirm that the cancer has not spread is through pathology tests. This is actual samples of the tissue that are looked at under a microscope and abnormal cells are identified.

The first pathology report did not reveal any cancer cells in the surrounding tissue that they took from my breast during the biopsy. This makes the cancer "Stage 1" which means the cancer has not spread anywhere else.

Stage 1 is a good thing but the cancer is "high grade" which means that the cancer cells are rapidly growing. I think they can tell this by the amount of mitochondria in the cancer cells that they tested. I wish now I had paid more attention in biology class.

There is no survival advantage in having a mastectomy versus having the cancer cells and an extra 2 centimeters all around the cancer areas removed so we decided on the second option. We then headed to the Good Sam Breast Center for an MRI and hopefully will hear about that later today.

Corey headed to California this morning and will be back tomorrow night. We will then interview radiologists and oncologists and make plans for the next step in treatment.

Are you some place you can talk?

Oh,dear. The instant knowledge that those words impart.
Dr. Vanesian called me after 3 days of waiting. With those words I knew that good news was not to follow. The cells that had been removed the Thursday before, all five spots were cancer, officially, ductal cell carcinoma. He went through what might follow, a surgical consult, an MRI, surgery, radiation and chemo. No lump, no bump, no pain. The cells in right breast had been picked up at my annual mammogram and that news has sent me on a journey.
I called my husband and asked him to call my girls, Courtney & Ali. I called my sister who came to pick me up from work and helped me make appointments. And I deeply appreciated the comfort and strength from my friends and co-workers. No need to call them – they were just there.
The many, many calls I have received have been welcome but to be honest, I just get tired of talking about it, thinking about it, explaining it. This blog was the ingenious idea of my friend Kathy Promberger to keep people in the loop when they want to be and to keep me from obsessing.
Next comes my husband Corey returning home tonight from California. That will be a huge relief. On Monday we go to the surgeon and the plan will clearer after that.

Fortune Like the Moon

O Fortuna!
Velut Luna
Statu variablis
Semper Crescis
aut Decresis.

(From a poem I read in Latin Class in High School)

Oh, Fortune!
Like the moon, changing.
Forever waxing and waning.