Complex Care

Blue Cross called the other day. Now, generally, the insurance company doesn't call unless they are trying to get out of covering a bill, and since I still have quite a few bills in the insurance pipeline, this is what I expected to hear.


The reason they called was actually far less ominous, and far more unexpected. They were calling to ask me if I'd like to enroll (at no additional charge) in their Complex Care Program. This program, for people with varied and complicated medical issues, provides additional support and information to help patients make care choices and get background on different therapies, drug side effects, etc. On the surface, this sounds like a great program, and after talking with the administrator and then the RN assigned to work with me, I think it is a very helpful service, but the whole idea that I popped up in Blue Cross' database as someone with complicated medical issues is just a bit disheartening.

I've never considered myself a sick person before! I considered what happened to me to be an aberration, Randomness! It also hadn't occurred to me that my insurance carrier would tag me with all those sick people who have diabetes and heart disease and, oh yeah, cancer.

So, in the interest of information gathering and seeking out answers wherever I can, I signed up. I now have a case nurse (R.N.), Debra, who will call me every 6 weeks or so and if I need, I can call her anytime I have a question. She can also call in a pharmacist to help with any drug interaction or side effect questions. Debra is scheduled to call me just before my 3-month follow-up next month to go over what I should expect the oncologist to do and to answer my pre-scan freak out questions before I see him.

So, despite not being thrilled with the label of "sick person", I'm going to give this a chance. There are SO many things to hate the insurance company for, maybe this can be something they can do to help in real, tangible ways. I'll let you know after I talk with Debra next month!

More Randomness

Last week my husband came home with a box for me. The wife of one of his colleagues sent it. Inside, was a quilt, made of patches of what I can only call "breast cancer design". The whole quilt is covered in pink ribbons on various pink backgrounds. My first response was "What is this woman thinking!?" I understand that many women get into the pink ribbon thing after they are diagnosed. But, after hearing about all those "brave breast cancer survivors" this October, while I was still wearing drains and dealing with healing from the mutilation where my breasts used to be, I have not yet become a big fan of the pink ribbon.

Friday night, at my husband's company Christmas party, I met the woman who sent the quilt. And I ate crow.

First, she is 35. She was diagnosed with breast cancer at 32 (what is going on when a 32-year-old gets breast cancer?!!). Margo is a very cool, working mom, who sees power in the pink ribbon because she feels like her life was spared. Here is her story:

Margo never wanted children. But, after she had her son, she loved him with all her heart. And she developed an Adenoma (non-cancerous tumor) while breast feeding. Because of the Adenoma, her doctor had her get a mammogram. Immediately after her mammogram, the radiologist did a sonogram and ultrasound, on the opposite side of the Adenoma. There, they found a large area of DCIS (Ductal Carcinoma in Situ) that was just about ready to burst and become full-blown invasive cancer. So, with her infant son at home, Margo underwent a lumpectomy and 10 weeks of radiation.

In her own, very matter-of-fact manner, Margo explained that she is grateful for her son. Without him, she would never have breast fed and never developed the Adenoma, which led her doctor to discover the DCIS just before it became life-threatening. She now sees her surgical oncologist every 6 months and has mammograms, years before she ever would have without the cancer.

Like me, Margo has no breast cancer in her family, no pre-existing condition or activity that would say "breast cancer at 32". Randomness is all that makes sense for her as well. And every time I look at the quilt, it is her strength that I'll think about.

Depression and Cancer

After my mastectomy, my surgeon was very forthright with me about the incidence of depression among her mastectomy patients. She said I would likely become depressed and she stressed that I should get help if I needed.

So far, I have been very fortunate in that I don't think I've experienced the level of depression she talked about. Anger, yes and generally being ticked off about the whole cancer-thing, yes. But depression, at least that I recognize as such, no.

However, I'm learning more and more about the emotional toll that cancer takes on the individual. I've become a regular reader of Kris Carr's blog, http://crazysexycancer.blogspot.com/. Yesterday, she had a guest blogger, Terri Cole, who is a therapist and cancer survivor.

Terri gave a very clear, thoughtful discussion about cancer and what it does to our spirits and talked very openly about what we can do, every day, to keep depression at bay. One of the items she talked about was the inner messages we give ourselves every day that can either build us up or tear us down. Women in particular send ourselves negative messages about our bodies, our personalities, and our spirits. Things like "I'm so fat", "No one could possibly like me", "I have nothing of value to offer" do such damage to our own psyches and impact the ways in which we interact with our families, friends and colleagues. Keeping those messages positive, "I am strong", "I have a giving spirit", "I am a loving friend", can impact our outlook in a real way each day. Even if we don't feel these things all the time, even if we don't totally believe them all the time, they can help us to see ourselves more clearly, and perhaps more the way our friends and family see us.

Yesterday, I had a long talk with a very old friend. We've been friends since the 6th grade, so she knows me better than most. We talked about how I am doing living post-surgery and within the land of cancer drugs. She sounded so surprised when I told her I have not yet gotten prosthetics that I wasn't sure what to make of her reaction. I tried to explain why I haven't yet been fitted, but even I didn't like my reply. Being the wonderful friend that she is, she told me that if I never get prosthetics, I am very brave, if I choose to wear them, I am equally brave, and if I have the surgery, I am also brave. It is a good friend who accepts and supports all of your decisions!

I still had to think about why I haven't made that call. For awhile my ribs were too sore. They are no longer sore, so that really isn't a good excuse anymore. Does it have to do with depression issues? Am I depressed to the point of not being able to move forward? Am I afraid of what getting prosthetics means?

And what does it mean? Am I giving in to society's expectation that all women have breasts, or am I acknowledging that I am damaged, not whole without breasts? or is it really what I told her, that I just don't want them and I don't think anyone even notices.

I want to believe that I am ok with how I look now. In reality, I'm probably not, but I want to be. And I really want to be ok with what happened to me before I make the next step. Maybe it has nothing to do with depression, but it does feel easier to think about these things if I give myself a positive message that a friend shared with me, "I am brave", even when I don't totally believe it.

Is there a right way?

I had two conversations this week that made me worry about how I've dealt with the cancer. One was with a dear friend, the other was with my mother. Both love me and want the best for me. They are both concerned that I haven't really made any changes in my life after the cancer and surgery. I haven't really done this cancer thing right.

So, following on their concerns, I did some research. According to the sites and articles I looked at, after cancer, one is supposed to do one or more of the following:

• Change your diet
• Change your exercise routine
• Cut back on work
• Cut back on social obligations ("Learn to say no")
• Start taking yoga or pilates or meditation classes
• Take a vacation
• Take up a new or long-desired hobby or avocation

That was discouraging. I haven't done any of those things. I work a lot, I kept the same diet I've had for the past 20 years, I exercise as many days a week that I can given my husband's and children's schedules, and I try very hard to keep up our social obligations.

I work because I have to, I take care of my husband and children because I love them, and I try to keep up with our social obligations because I want our family to be active, engaged members of our community. Cancer has to fit into that life. Right now, at this point in our lives, I don't have the time, money, or opportunity to change my life because of cancer.

I suppose if I knew why I got cancer in the first place, I'd be able to change that thing. But, since I've never smoked, I don't drink heavily, I've been a vegan for the past two decades, and I've exercised regularly for years, I don't know what to change to keep from getting cancer again. So, maybe I'm not doing the post-cancer thing right. But then again, no one gave me a guide on how to deal with having cancer, so I'm not sure that there really is one "right" way to live post-cancer. At least not right now.

The holiday outfit

I tend to lump shopping for the Holiday Outfit in the same category as shopping for a new swimsuit. Both are items I don't wear a lot, they tend to fit tighter than my regular clothes, there is always a certain expectation (primarily mine) that I am supposed to look nice in the garment, and both have a lot to do with cleavage.

While I have become a fan of retail therapy, I usually stick to easy things like shoes and boots. Because of my height, I can't buy pants without special ordering them anytime, and tops and dresses are not my favorites lately. Last weekend I gave or put away all the dresses and blouses in my closet because not one of them fits me anymore.

The company my husband works for does a very elegant holiday party each year. They tend to book very fancy hotels and put the couples up for the night. This year they are sending us to the Inn at Spanish Bay. Sweaters and jeans are not going to cut it here.

Yesterday I decided that I could either hide at home and miss what is always a fabulous party, or suck it up and find something that will work. Frankly, I don't know who had a harder time, me or the salesgirls. When they found me looking around, they would ask what I needed, and I'd explain, "I need a holiday dress that requires no cleavage at all, no darts, no seams, no bustline detail, nothing." Then they'd bring me a dress with an empire waist and detailing at the bust. One young woman said she had just the thing and brought be a dress with built-in wires at the bust. As she brought it to me she explained that it was a great dress for small-chested women. I felt terrible as I saw her face fall when I explained that no bust sometimes means mastectomy, not small.

After several frustrating and unnerving hours of looking, I came home with two dresses that I'm willing to try on again. My husband will have to decide, or I'm wearing a sweater and jeans anyway.

What not to say

The American Cancer Society, along with a number of other cancer-related web sites, have pages dedicated to helping friends and family know what to say to their loved one who has been diagnosed. Among the most helpful advice is to offer specific help, and to not put more pressure on the individual. I am very fortunate that most of the people I know either read these sites or knew instinctively what to do and say. Friends I hadn't seen in a long time brought a meal or sent a card with well wishes. Those closest to me were and are nothing less than completely supportive and loving.

However, despite all of that kindness, the words of one individual, who thought they were being funny or something, keep coming back to me. This person called me a few days before my surgery with some questions they felt were appropriate. These included:

- Do you intend to make it through the sugery?
- Have you made arrangements in case you don't make it?
- Has your husband said goodbye to your breasts?
- Have you taken pictures of your breasts so you'll remember what they looked like?

Two months after my surgery I am struggling with chronic nausea and exhaustion from the Tamoxifen, anger and frustration about my mutiliated body, and difficulty figuring out what I am supposed to do with one person's utter lack of sensitivity.

Up until now, I kept this to myself because I didn't think it was worthy of repetition, but it hurt and I didn't know what to do. I've taken steps to protect myself and my children from this person, as they clearly do not understand boundaries or what is appropriate, but it still bothered me. Then yesterday, as I cleaned out my closet to get rid of all the clothes I can no longer wear, I realized that I still have power. I can take action to remove the things that no longer work for me, like my old clothes, and just maybe, I can get rid of a hurt by writing down.

Because really, as I read the words on the screen now, they are not a reflection on me, they are just the words of an ignorant person who really should have visited the American Cancer Society web site.

Side Effects of Tamoxifen

The most well-known side effects of Tamoxifen are the menopause-related ones. These include hot flashes, weight gain, night sweats, changes in periods, etc. When my oncologists recommended this treatment, these are the ones they talked about.

According to a couple of the Tamoxifen-related web sites (and there are a lot!), additional side effects are nausea, headaches, depression, hair thinning, dizziness, tiredness, visual problems, voice changes, blood clots, and rarely, tumor flare.

The nausea and tiredeness are the first of the side effects I've noticed. Though, I can't be certain the exhaustion is the Tamoxifen alone, or if it is that coupled with too much work and not enough sleep. I'm guessing the latter two are most to blame for this one.

But the nausea is not fun. I've tried taking the Tamoxifen with food and I'm careful to take it at the same time every day, and I'm eating as healthy as I can, even though nothing tastes very good or appeals in any way. One of the web sites said this side effect only lasts a few weeks, so hopefully it will stop soon. I don't want to take any other meds to deal with this while I take the Tamoxifen. I have too many pills in my life right now as it is.

Looking on the bright side, as long as the nausea continues, I probably won't have to worry about the weight gain :-)

A new schtick

Yesterday we celebrated my youngest daughter's "gotcha day" with a little party and some of the families who traveled to China with us those 5 years ago. Can it be that long?!

Each year we try to get together to just catch up and to marvel at how beautiful and amazing each of our daughters has gotten. This year we met at "Pump it Up", and indoor bounce house place, and then went to dinner at a local Chinese restaurant.

Over the years, things have changed with each of the families; job changes, moves, divorce, new chidren, all the things that families go through over the span of a child's life. This year I attended with just my two girls. My husband is on a business trip and couldn't make it.

I didn't think too much about it being a social occasion until I got there and suddenly felt very vulnerable. I'd purposely skipped a friend's birthday party the previous night because I knew I was not up to being in a social setting yet. When I talked with her about my hesitation, she'd been very understanding and I knew I made the right decision. However, In my focus on my daughter's special day, I forgot that this was also a social event. And, without my husband there, I was expected to be "on" and chatty.

The simple, "How has your year been?" is a loaded question for me and I am so tired lately that I can't seem to readily manage to come up with a pat, "Great! the girls have been.... and how has yours been?" with any conviction. And really, while I know I don't need to go into details, even a bit of the truth is tough to just throw out there without it landing like a grenade. Cancer? BAM! End of conversation.

One of the families knew what has been going on because I had to explain my hesitation this year to commit to going to the party at all. She was very sweet and said that I look great, that she couldn't tell that I'm sick. Snaps to me for good makeup and hair at least! Beyond that exchange, though, I found myself extremely edgy about how I look and what to say to people who I don't see that often.

In my last post I said that I don't think people really notice the change to my body because they are busy with ther own lives. I still believe that is true, but the problem is that, even though I can think that and then not worry about it when I'm going to work or church or with friends or family, I feel the difference when I'm in a social setting. I know I look different, and I know I feel different, and I don't yet have a set response, a good schtick, for the "How are things going?" question that always comes up in those settings.

I thought last night about how my parents had to handle these kinds of things when my dad broke his neck, though in their case, the wheelchar was the first clue into how their year had been. And then when my dad died, I remember the tension we felt all the years my siblings and I had to come up with responses about why no one ever met our dad.

I also thought about my mother-in-law, who dealt with breast cancer 35+ years ago, and especially about my sister-in-law, who has spent this past year coming to terms with the death of her partner last year. Almost everyone faces challenges in their lives that don't help when trying to come up with a tidy, socially acceptable reply to the question "How have you been?" at a party.

So instead of the standard, "I'm fine, how have you been?" schtick that everyone expects, perhaps a response that is a bit closer to the truth would be better. Something like, "This year has been pretty darn awful, but I am here and I'm not broken. Buy me a cocktail?" would be more honest, without feeling like a grenade has landed.

Concaveness

I suddenly realized today that I don't have any doctor appointments this week or next week, and possibly not even the next. In fact, my next real cancer-doctor appointment isn't until January.

My next step will be to get fitted for prostheses and bras. For the moment I am pretty ambivalent about this. I have had to quickly get used to the concaveness of my figure, and with the weather getting cooler, sweaters help bulk me up a bit. To me, wearing a prosthesis is simply a way to appear "normal" under clothes. Perhaps for many women, this is important, and I'm sure that in years past, having one's figure altered this dramatically would have been awkward at work and in social circles. However, from what I've observed the past month or so, people really don't notice. Everyone is so busy and so tied up in their own lives and worries, I don't think anyone even notices.

That is not to say I don't notice. Because I do. Breasts are everywhere in our culture. And every time I see a Victoria's Secret or worse, a Playtex ad, I hunch a little more.

In truth, I am very hesitant about getting the prosthetics because I really don't want to go there by myself. This is not something the husband should see, my best friend is hundreds of miles away, and this is not something a casual friend would relish as a "fun" outing. i just keep imagining the conversation, "Hey, how about lunch and a couple of hours at the cancer store?"

I know many people would just say, "Get implants and get it over with." But it is not that simple. The process for implants is 3 surgeries over several months, including the creation and tattooing of a nipple and aureole. And, despite what people think implants look like, reconstruction when there is no breast tissue at all is not the same. If you doubt this, please read Dr. Susan Love's "The Breast Book." She is very clear about what reconstruction can and cannot do. And what it cannot do is look like a natural breast. I will never look the same as I did back in July.

And right now, the thought of prosthetics and implants only makes that reality more stark than being concave.

Tamoxifen and Scar Tissue

This week has been odd. Tuesday I heard from my 2nd oncologist. The OncoType DX results give me the same percentages for recurrence that I had before. So, he gave me prescription for Tamoxifen to take 20mg a day and an appt. to see him again at the end of January for a checkup and blood work. So for now, no chemo.

If you've never seen a Tamoxifen prescription, it is pretty hilarious, in a weird way. The side effects are hot flashes, nausea, hair thinning, and headaches. Basically, you get menopause while still getting periods (Menopause twice, my poor husband!). There is also increased risk for ovarian and endometrial cancer. These I knew from the doctors. What they didn't tell me is I have to be careful to wash my hands thoroughly after touching the pills, and I have to be sure it does not come into contact with anyone who is pregnant or might be pregnant. And then, there are the drug interactions. The one I found really odd was St. John's Wort. It doesn't say why. My husband asked if it listed any of the common antidepressants, but it doesn't. Which is probably a good thing, since I suspect many women on Tamoxifen are also on some kind of antidepressant for at least part of the 5 years.

My fear of not doing enough is still there. But, the oncologist assures me that I've done everything I can. The aggressive surgery was the biggest piece. By removing everything now, I've eliminated the tissue where the most likely recurrence would happen. I also saved myself from the long-term consequences of radiation and chemo. I will need to watch the Tamoxifen for the first few months for side effects; for me the biggest risk is the hormone fluctuations. I could never take birth control pills because the hormones caused terrible PMS and mood swings. The oncologist said I may get the same problem from the Tamoxifen. She didn't say what happens if the Tamoxifen isn't tolerated, but that is going too far down a road, I think.

The scar tissue thing is the other piece I've been dealing with this week. Apparently I have some scar tissue forming around one of the few nerves I have left near the scars on my left side. This has been causing a lot of pain and spasms that last much of the day. The only way to stop it is to work harder at my stretches to break up the scar tissue. She didn't say how I'm supposed to fit more exercise time into every day though. Still working on that.

Trying to put it on a shelf

Last week I met a couple of women who recently completed their cancer treatment, and they said that one of the hardest things to adjust to was the expectation by their family, their friends, and even themselves, that they could just pick themselves up and take on all of their responsibilities. Treatment is over, so put the cancer on a shelf and move on. What they are finding, though, is that even after treatment is over, there are lingering side effects, exhaustion in particular, that sometimes interfere with them doing what is expected.

I sort of feel that way now. The mastectomy was 4 weeks ago today. I am back at work and taking care of the girls and the house and my husband, and just waiting for the test results. Life moves on while I wait, so I have to put the cancer aside. For me, this is a better way of dealing with the unknown than sitting around trying to predict the results.

However, I learned last night that, even with my "put it on the shelf" approach, there are consequences. Surgery sites get very sore and exhaustion sets in if we are not paying proper attention. So, while my approach alows me to not dwell on the cancer, I'm also not always listening to my body (here is where my family and friends are saying "DUH!").

So, today, I am slowing down (a little), doing my 30 minutes of weight-bearing exercise, stretching, drinking my Kombucha and backing off a bit. I'm learning, albeit slowly and reluctantly, that when I try to put the cancer on a shelf too early, it can fall off and land with a big thud, right on my chest!

Tests and Insurance

I've mentioned already that my surgeon and oncologist both recommended the Oncotype DX test to determine what help chemo would offer in my cancer treatment. Last week the oncologist submitted the paperwork to Genomic Health, the company that does the test. He mentioned that we are fortunate here because the closest testing facility is only about 40 miles away.

Yesterday, I received a call from a Patient Advocate at Genomic Health. She told me that Genomic does not have a contract with my insurance company, Blue Cross of California. I found this to be shocking because I knew about the Genomic facility here and because my husband's company had provided me with a printout of the Blue Cross of California policy statement on the Oncotype DX test. I explained this to the Advocate, and read to her the policy outline, including the section where Blue Cross sets out 10 criteria for coverage. She just told me to keep the policy, because we might need it later.

Because there is no contract with my insurance carrier, Genomics will submit the bills to Blue Cross, but the advocate warned that they may pay nothing. The test costs $3,500. Now, Genomics does have a program to help families pay for the test. If you meet income levels, which allow for deductions for mortgage, car payments, education and medical expenses, you will pay only $50 for the test. We don't meet the criteria. After a short talk with my husband, we decided to do the test anyway. It is too important to us.

The cost is huge for us, but that wasn't what really bothered me. My husband I both work, and we don't have a lot of debt, so we are lucky. We will figure it out.

What really bothered me is the insurance company not covering the test. Here's the thing. If the test shows I don't need chemo, which the insurance does cover, they save thousands and thousands of dollars. If it shows I do need chemo, then the expense means that the chemo is a necessary treatment and will reduce the risk that I'll have a recurrence which would cost more down the road. If my husband I decided we could not take the financial hit of the test on top of all of the other surgery, pathology and hospital co-pays and deductibles we have to pay this year, then I may likely have decided that not doing chemo was too high a risk, and the insurance would have covered the chemo treatments.

Again, I know I am lucky. There are so many people facing devastating health bills because they have no insurance or are under-insured. They don't have the option of making the choices I am making. I don't want to let this go. There are tests and treatments that are being developed to target cancer treatments in more effective ways than the traditional cut, burn and radiate methods. Companies like Genomics are doing a wonderful service by helping families who can't afford to choose a test in spite of their insurance company and I hope other companies are doing the same. As for Blue Cross of California, I'll be getting ready to fight them if I have to.

Finding Support

Last evening I attended my first Breast Cancer Support Group. I was not enthusiastic about going, and I'm not certain yet how I feel about it, but I do see the value of this type of interaction.

There are support groups for all sorts of conditions, circumstances and places in which people find themselves. When my first child was born, I joined Las Madres, which is really a support group for new parents. Through that group, I met amazing women and made wonderful, lifelong friends; friends who are supporting me today as I deal with cancer.

In this case, the support group is very specifically focused on this one type of cancer. The group dealt with where everyone is in their course of treatment, and more importantly, provided a safe and caring atmosphere in which to express fears, hopes and challenges that dealing with breast cancer brings to life.

I learned last night that talking about breast cancer is very different when you are talking to women who also have breast cancer. Friends, family and colleagues are wonderful sources of support, but there seems to be a different quality and depth to a conversation among a group who all have the same cancer. There is a level of vulnerability, and of humor, that gives texture and body to the words and emotions that goes far beyond sympathy or even empathy; it is a knowing.

I'm not sure if I'm quite ready to share in this way on a regular basis. But it is helpful to know that the option is there.

Percentages

I'm discovering that dealing with cancer long-term is all about percentages. Once the initial tumor or tumors are removed, it becomes a game of statistics, i.e. What is the chance that the cancer will come back to the original location or appear somewhere else in the body?

In my case, by opting for the double mastectomy, I've pretty well eliminated the risk of the cancer coming back in the same location. Now, I have to decide what my comfort level is with the risk that the cancer will show up someplace else. That risk factor changes depending on what adjuvent treatment I choose.

I met with the new oncologist yesterday. After talking with him and looking at the basic risk factors: tumor size, tumor grade, hormone receptor status and node status, my husband and I agreed with him that more data would be helpful. Basically, using those 4 factors, if I go with Tamoxifen alone, my risk of recurrence is 10%. If I go with Tamoxifen and chemo, my risk of recurrence is 5%. In the world of cancer, these are supposed to be very good odds. The oncologist said I am a pretty straightforward case, but he thinks having more data would be helpful. So, we are doing the Oncotype DX test. This test looks not at the 4 factors, but at 21 genes in the tumor to assess recurrence risk and it seems to be the best predictor test for my particular type of cancer. So, in 10 days, we'll have more data to help us decide what to do next.

Dealing with cancer in this way is odd at best, and more disconcerting than I'd like. I do understand that my risk of having the cancer come back is pretty low, but the thing I can't seem to shake is that my risk of ever getting breast cancer in the first place was even lower. And yet, here I am.

It's very stark

My surgeon is a wonderful, caring woman. She has been very forthright with me about my cancer and the treatment options. When I decided to fore go the bi-yearly mammograms and certain biopsies of my left breast to do the double-mastectomy, she called me to her office to be sure I was certain about my decision and to talk about what it would look like.

Yesterday, after she pulled the last drain (ouch!), she spoke to me again about the realities of the double. She said, "It's not pretty, and with you, because you are so tall and lean, it is very very stark". She also told me that she always worries when she does a double, because she knows the reality is so harsh. She said she tries to make it as clean as she can, but it is not pretty, it can't be pretty. But, if I decide on reconstruction later, they'll be able to do a clean job and make it pretty again. That will take 3 surgeries.

Today was my first shower without having drains around my neck to block my view of the scars. When I got dressed today, it took several outfits and far longer than usual to finally decide on something I could live with. This afternoon, I caught a glimpse of my profile. It was very very flat. So, being the adult, well-adjusted woman that I am, I went to bed for a few hours to watch "Sex and the City". My husband, the only one besides my surgeon and I who will really see, gave me some time and then came in to tell me that I am still beautiful and to ask me if I'm afraid people will notice, or if it is just too different.

I guess, for now, it is too stark.

Not quite there

Surgeons don't tell their patients that drains will hurt and pinch and be generally a discomfort and nuisance. I know this because my surgeon told me exactly this just before she pulled out 3 of my 4 drains today. They also don't tell patients that when drains are inserted up the chest wall, removing them in one motion HURTS!

The reason they don't tell patients these things is because, when they do, patients call every day following surgery asking to have the drains removed, which the surgeon can't do until they are no longer collecting fluid. She told me this as I held my painful chest after she pulled them out. Good to know, now.

I hope to go back and have the last drain removed on Friday. This is a lower drain, so only a few inches of tube have to be pulled. So, not quite done with this step.

My pathology came back. The left side was clear, which was expected, and the right side had some cancer cells and a fibroadenoma (non-cancerous tumor), but clean margins, also good.

We talked today about next steps. I am scheduled to see the oncologist again on the 15th. But, before I do that, my surgeon has suggested another oncologist for a second opinion and further testing of my tissue with an OncoTypeDX test. This particular test has good prognostic results for recurrence with women who are node-negative but estrogen-positive, as I am, and should give us a more clear picture of what happens if I do Tamoxifen alone or chemo plus Tamoxifen. My surgeon feels that I'm on the edge because of my tumor size, so more tests would be better. I agree. It seems that the work in the next step is to find the right combination that minimizes the side effects and short-term discomfort with the best long-term prognosis to not have a recurrence.

I guess I was hoping that the mastectomy would be my discomfort, and that the rest would be easier. It seems I not quite there yet, either.

Post-surgery

I am a visual thinker. I like to be able to visualize how a web site will visually appear to the user before I begin coding, how a document will be presented as I write it, how the finished cake will look before I begin baking. Even the big-life events I try to visualize before they happen, the birth of my first daughter, meeting my second daughter for the first time, moving to a new house. The mastectomy scared me largely because I couldn't visualize what I'd look like, how my life would look, after...

Five days after the surgery, I'm still not sure how I'll look. Right now, I have four tubes coming out of my ribcage, these lead to four bulbs that collect fluid from the surgical sites. I also have two long, C-shaped scars across my chest and under my arms, a little longer on the right where the surgeon did the sentinel node biopsy. When I get dressed, I wear big shirts and sweaters over my ace bandage and the special T-shirts that hold the drain bulbs around my middle. Frankly, I look pregnant!

My day to day life right now is much much slower than I'm used to. My mom, husband and friends are taking care of my girls and the household chores, work is going on without me or holding until I get back. I'm spending way more time in bed than I have in years, I take walks every day to try and keep the back pain and leg cramps under control, I'm trying to read and watch movies, but really, my attention span is just awful right now, so I'm doing a whole lot of nothing. I blame the Vicodin for that.

I feel like I'm on hold. Wednesday I get the drains removed. Once those are gone I can begin working on stretching my arms and building up my strength again (right now I can't lift my arms above my head or lift anything at all). When I get my arms working, I can drive again and hopefully go back to work soon. As I try to get those things under control, we'll also deal with the rest of the cancer issues. The pathology report will tell us how extensive the cancer was and whether the mastectomy tissue had a clean margin. Thankfully, we already know that the lymph node was clear. After the pathology comes back, I'll meet with my oncologist to talk about the follow up (adjuvent) treatment options. Eight weeks after surgery, I'll go get fitted for prosthetics and learn how to dress with fake breasts.

Then, at some point after all of that, I'll begin my life again, post-breast cancer and with a "new normal" that I still can't quite visualize.

Surgery Tomorrow

I'm pretty proud of the fact that I've made it this far with no Valium or other anti-anxiety drugs. Well, except for the evening Margarita, but does that count?

My plan to focus on work and kids' activities and house chores has also gone pretty well. And today my mom even got me to sit still long enough for a manicure and pedicure. I'm hoping that bright red, pretty toes will make up for at least a little bit of the crapiness I'll be feeling tomorrow and in the coming days.

So, I was doing OK until tonight when the anesthesiologist called. If you haven't had surgery before, the anesthesiologist gets his schedule at the end of the day and then calls the next day's patients to check on allergies, potential problems with any of the drugs they generally use, etc. His call suddenly stripped away all of the tasks and things I've been using to avoid dealing with losing my breasts tomorrow and made it all too real. I called my husband and told him to come home because I'd just lost it.

I pulled myself together in a little while and thought long and hard about how I want to deal with all of it, the cancer, the loss of my breasts, the fear of what comes next, and then I remembered my prayer; God, Please give me the strength to do what I have to in order to live a full and active life with my family, and the grace to do all of it in a way that honors the life I've built with my husband and my relationships with my family, my friends, and my God.

I'm afraid, though, that the hard part is still to come.

What to do while waiting

My surgery is in 5 days. Friends have been asking me the past couple of days how I'm doing, am I ready, and is there anything I need.

I'm managing, mostly I'm just working, trying to get things in order before I have to be out for more than a week, getting ready for the Bible study we host on Saturday, stocking the kitchen, writing tons of notes for my husband and my mom about the girls' schedule, lunch box foods, homework and upcoming tests, and mostly trying not to think about what will happen in 5 days.

And, in perfect honesty, I'm also trying to wear every good bra I own and every cleavage-requiring top I have because I won't get to wear the bras again and the tops won't fit the same ever again. Fake breasts, whether prosthetics or implants, don't sit the same as real breasts. (Warning, boob discussion comes next) Most women who nurse end up smaller and saggier than before. I didn't. Yes, the boobs are less perky than when I was in my 20s, but they are fuller and I have actual cleavage. Nursing for 3 1/2 years didn't flatten me out, it gave me boobs I didn't have before. Like most women, my boobs aren't foremost in my mind, especially since I stopped nursing. But, the thought of not having any breasts at all because of a cancer I can't even feel, and even more so, the thought of having an implant that is not me and has no feeling at all, saddens me in ways I never thought possible. I need to not think about that.

So, for the next 5 days, I'll work, take care of my girls, spend time with my husband, prepare for the Bible study, write notes for my mom, and try my best not to think too much about what I have to do next Wednesday.

The Peg Leg Store

I started calling it the peg leg store to help alleviate my boss' distress at having me mention prosthetic breasts in the office. Have I mentioned I work for a church? Fair warning, this post is all about the peg legs.

This week my friend, Kathryn, agreed to go with me to pick out the t-shirts I'll need after my mastectomy. They have little pouches that hold the drains I'll have after surgery and they are supposed to be very very soft and easy to put on and take off while recovering.

The ladies who run the shop are so very nice. They set me up in a very sweet dressing room to try on the shirts and then took care of all of the insurance (insurance covers 2 of the t-shirts, since they cost more than $50 each, I'm very grateful!). Once the shirts were fitted, they showed me the prosthetics that they have for younger women. These are lighter and perkier than their standard prosthetics, with lotion on the skin-side to help even out any rib or scar lumps. They were also glad to show me the bras so I could see that they were not all staid, old designs. Now, I have to admit they were nice, not the type of bra I'm used to wearing, but I suppose none of this is what I'm used to anyway.

I still think Victoria's Secret should come out with a line of prosthetic bras since it seems that there are quite a few women my age and younger with breast cancer. We all won't want to immediately go with implants, so I think the market is there.

At any rate, I won't need to worry about the prosthetics for 8 weeks or so. They won't fit me for these until I'm completely healed. Until then, t-shirts and what they call "softies", which I plan to skip for now. They look more like little doll pillows than breasts and are stuffed with regular pillow stuffing. actually, they are closer to the "stuffing the bra with socks" method! They are so far off the mark that I would prefer flat to sock stuffing.

Crazy Sexy Cancer Abounds

The DH is out of town, so no one is home to talk to after the girls are tucked in.

I've started reading Kris Carr's book, "Crazy Sexy Cancer Tips". I love that it is written by a woman who, despite a rare and incurable cancer, decided to use all of her talents and resources to tell the world that cancer abounds among young, active women. She wrote a wonderful paragraph about how, when someone says "cancer" you either picture a child or an elderly person, never a twenty, thirty or forty-something man or woman with a job, friends, kids, and a mortgage! Yet, despite the stereotype, there are thousands and thousands of young and middle-age adults living with one form of cancer or another. The point of her book, and of the documentary that will be on TLC, is that cancer is unmistakably redefining, but that there are ways to take your life back and make the most of it after cancer.

Today, while waiting for my youngest at gymnastics, I was reading this book and talking to my oldest about the pictures (which, by the way, are very cool) and about the women in the pictures and how they all have cancer, like mommy does. A few minutes later, the mom sitting next to me apologized for listening in, then asked me if I have cancer. When I replied that I do, she smiled and said she does, too. Hers is colon cancer. She'll be getting her 12th round of chemo next week to get ready for her 4th surgery. No family history, no risk factors, just colon cancer. Her matter of fact manner just made my heart ache. Today, she was watching her son at gymnastics.

We talked for a few minutes about the apparent rampent-ness of cancer among people our age (I have a whole theory I'm working out about the Baby Boomers and Millennials trying to squeeze out Generation X, but that can wait). Then we talked a bit about the book. She's going to check it out. I hope to see her again at gymnastics, to check on her and to see how her cancer posse is coming.

Here is the URL for the documentary and the book. Check it out: http://www.crazysexycancer.com

Meeting the Oncologist and Prepping for Surgery

Last Friday I had my initial appointment with my oncologist. She came highly recommended from two friends who also see her and from my surgeon.

The hardest part came when I was sitting with my husband, waiting, and suddenly realized that I was at "the cancer doctor". It struck me that the surgeon's office didn't bother me too much because almost everyone has surgery of some kind in their life. And the radiologist is the same guy that every woman sees every year for her mammogram, sick or not. But the oncologist is someone else. Only people with cancer see the oncologist. I know it probably sounds strange after the diagnosis and all that, but it just hit me very hard that I have CANCER.

The appointment itself went fine. She said the only unusual aspect to my situation is that there are three different types of breast cancer that were found: DCIS, Invasive Ductal Carcinoma, and Tubular Carcinoma. All are treatable and the prognosis for all is quite good. She showed me the database they use to determine treatment options (it is called Adjuvant) and what the mortality rate and recurrence rates are for the various options based on my diagnosis.

Because I'm doing the double mastectomy, I've eliminated the need for radiation of the left side, so we only looked at chemo and Tamoxifen. Depending on what is found in the pathology after the mastectomy, I'll either do chemo then 5 years of Tamoxifen, or just the 5 years of Tamoxifen. The decision will be based on the extent of cancer that they find in the breast tissue and if there is any lymph node involvement. I won't see her again until October 15, because she wants me pretty well healed before we do anything else.

Today I spent much of my morning at the hospital getting registered and having my blood work and chest x-rays done. This was all very straightforward. The questions the pre-op nurse asks are pretty funny, though. "Have you ever experienced weight-loss that you did not intend?" Well, not until I was diagnosed with cancer and got too stressed out to eat! and "Have you ever experienced anxiety or depression that interfered with your life or required medication?" Not until recently!

In all fairness, the nurse was very nice and she knew what my answers would be to these questions. I asked her if she gets those answers a lot. She smiled and said she's been a nurse for a very long time.

Call from the Surgeon

A call from the surgeon's office asking me to come in the same day understandably makes me nervous. The first time this happened, I was told I had cancer, but it was very early stage "baby breast cancer". The second time this happened, I learned that it was not really "baby brast cancer" but invasive ductal carcinoma, at Stage 1c. So yesterday, the call gave me pause.

It actually turned out OK. Nothing has changed in my pathology or diagnosis, but she wanted to talk about the double mastectomy, what it would mean surgically, and to review my receptor tests again to see if I'd be a candidate for a Herceptin port (a little plug thing that is inserted just below the collar bone to receive the Herceptin drug. It is supposed to help especially with smaller arms and veins). she's now ordered what is called a FISH test that reviews the Her2Neu (gene) receptors again to getter a more detailed report. this will give a much better determination of whether I am a candidate for Herceptin and the port.

She also wanted to talk to me about how things will look after surgery. She said it will be dramatic and stark. I am pretty thin and tall and removing all the breast tissue will leave a long blank field. After talking with her, I expect to look like a big swizzle stick. She also mentioned depression. She said most mastectomy patients experience depression after the bandages come off, because the body and body image change are so radically altered. Maybe this is why so many women opt for reconstruction right away?

We talked about my decision to wait on reconstruction until I am done with treatment. She agreed with my reasoning. Quite simply, I am not up to interviewing plastic surgeons right now while I am still dealing with the cancer issues. I want to be able to interview a lot of them. Plastic surgery was never something I considered for any reason, except maybe in a weak "I hate my thighs" moment. If I am going to do plastic surgery, I want to be fully committed to what I'm doing. Right now, I'm just not.

The next step, barring any more calls from the surgeon, is to meet my oncologist on Friday to talk about the follow-up options. Then, next week Monday I do the pre-registration and bloodwork at the hospital and Tuesday I am going to the local prosthetics shop. I want to see what the prosthetics look like, check out wigs and buy this t-shirt for post-surgery that is supposed to be super soft and has a pocket for the drains that I'll have for the first week post-op. I promised my friend, Kathryn, that if she goes with me, I'll take her to radiation that day. We are certainly redefining the ladies day out!

I Don't Have Time for This

Like many new cancer patients, I've been reading a lot about cancer, about my options, and about others who have dealt with this already. What none of the things I've read seems to talk about, is how much time cancer seems to require of one's life!

My mastectomy is in two weeks (double, plus sentinel node biopsy). Between now and then I have to finish as many projects as possible for work, set up help for my girls, set up a group and calendar for those who are so lovely and want to help, and get my house ready, maps together and directions set up for my mom and my husband so they can run the house while I am stuck in bed. On top of that, I need to go to doctor's appointments, visit the prosthetic shop to see what my options will be after the surgery, get to the hospital to register and do the blood work and I should continue trying to read as much as I can so I'm prepared for the doctor's appointments.

Oh, and I have to deal with the waves of panic and frustration that seem to come out of no where.

Like most moms, working or not, I have enough trouble trying to finish the myriad things I deal with every day. This cancer thing is just not helpful to maintaining my delicate balance of work, school, soccer, gymnastics, home, church and husband (sometimes, unfortunately, in that order).

Really, cancer is a time sucker.

God is in control...

For anyone who doesn't know, I am a christian. I keep it purposely lowercase because the world I live in seems to have far more shades of grey that the one the right-wing conservative Christians live in.

About 2 months ago, I left my job as Assistant Dean of the Library at a small college about 30 miles from my home to become the Director of Operations for my local church. Through all of the doctor appointments and biopsies and thoughts of more surgery and chemo, I am reminded daily that changing jobs when I did has become an unexpected blessing. Long commutes and late-night and weekend hours would have made going through all of this much harder. Looking ahead, chemo would have been impossible with my old job. But now, I know I'll have the support and flexibility needed to both fulfill my obligations at work and do what is necessary to beat the cancer.

And yet, I still am not sure why this is happening. People I know at work, at my girls' school, and other friends of faith have all said they are praying for me. I find enormous comfort in those prayers. What I am unsure of is how I should pray. I know what, selfishly, I want to pray for, the cure; the cure for myself, for Kathryn, for everyone dealing with cancer of any kind. But, I know that cure is not what I should pray for.

I should pray for strength, for wisdom, for the ability to build up others through this, and I do, sometimes. But, what I also want is to not have to do any of this at all; surgery, chemo, exhaustion, losing my breasts and maybe my hair, starting menopause too early, I just don't want to do any of it. Then again, neither does anyone who has to deal with these things.

Thought I might have an answer at the end of the day. Guess I need to continue working on those prayers.

Deciding on the Double

My radiologist's office called today to let me know that my biopsy came back clean, but the nurse was quick to add that I would need to come back in 6 months and that any changes at that time would be biopsied as well. Both my radiologist and my surgeon told me the same thing last week.

Last Friday, I met with a woman who decided to do a double mastectomy after having chemo. Today, I received an email from a woman who opted for the double mastectomy even though her cancer was DCIS and she would not require radiation, chemo or any follow-up drug therapies; but her mother had breast cancer. In both cases, the women explained that it was the only way they would feel sure that the cancer was gone and that it eliminated the fear each time a mammogram was done that the cancer would appear in the saved breast. Both also made the point that after reconstruction, if only one side is done, you are left with one droopy, regular breast and one permanently perky breast. Point taken.

In my case, the cancer is already invasive and since there were no clean margins in my biopsy, they don't really know yet how much cancer is left on my right side. My surgeon and radiologist wanted a biopsy of the left side because there is a good deal of microcalcification present. After getting the "every six months" talk from three people, I get it. If I kept my left breast, I'd just be waiting for the cancer to come back.

So, tomorrow I'll call my surgeon and tell her it will be a double.

BTW, today is my wedding anniversary. We'll celebrate next year for sure.

Does it hurt?

Last evening, my brother-in-law asked me if I have any symptoms from the cancer. A completely legitimate question, but I had to reply that, except soreness from the two biopsies this month, there are no symptoms. In fact, I really won't have any physical symptoms of cancer until treatment begins. I've spoken to other women with breast cancer about this and they have had the same experience. It is the cure where the discomfort begins. A friend who has been spending her summer with chemo and radiation simply said to me, "Welcome to the sorority, the initiation is a bitch".

On Friday morning, I spent time interviewing a woman who is a year ahead of me in this process. I asked her how she dealt with telling her children, then 7 and 9, about her illness. She said initially she explained it much the same I way I already have to my girls, that mommy has a boo-boo in her breast and that the doctors are going to make mommy better by taking off the boo-boo and then making sure all the bad stuff is out of my body. It was during the chemo that she said the explanation started to falter. She'd summon up all her energy to tell her children that she was going to the doctor to get more of the good medicine to make her better, then she'd come home and get more weak and more tired, and bald and sick. Her oldest thought she should check to be sure the doctor knew what he was doing. She gave me the titles of two books that I'm going to find to try to help the girls through this, "The Year My Mother was Bald", by Ann Speltz and "Mom and the Polka-dot Boo Boo", by Eileen Sutherland.

I'll be meeting with my oncologist soon (just as an aside, before July, I barely ever saw a doctor, now I have a radiologist, surgeon and an oncologist?!). My hope is first, that she'll be able to help me deal definitively with the chemo question. And, if I do have to have it, then when would be most effective, before or after surgery. And second, I'd like to be able to come to some decision about reconstruction (add plastic surgeon to the list).

The Stereotactic Core Biopsy - Reality is setting in

I learned on Tuesday that I needed a biopsy of my left breast to check out an area that my surgeon and radiologist felt warranted extra attention given my diagnosis on the right side. So this morning, I took my girls to school then headed to the radiologist's office for another biopsy.

UCSF explains the Sterotactic Core Biopsy as, "Stereotactic core biopsy was developed as an alternative to surgical biopsy. It is a less invasive way to obtain the tissue samples needed for diagnosis. This procedure requires less recovery time than does a surgical biopsy, and there is no significant scarring to the breast. Your physician, the radiologist and you may consider this type of biopsy when there is an abnormality found on a mammogram that cannot be felt."

Here is how it works in reality - you lay on a table with a hole cut out for your breast (btw, the tables are not really made for women taller than 5'8"!). While you lay there, the breast is mushed into a mammogram machine under the table while the radiologist looks at real-time views to locate the "area of interest". Once it is located and he's marked up the breast with magic marker, they make a small incision and insert a needle that is attached to a vacuum that sucks out cells from the area. Then, the cells are sent off to be X-rayed and the patient (me) gets mushed some more to stop the bleeding (try making small talk with a woman holding your boob for 15 minutes!). After all that, you go get a mammogram of the breast they just biopsied (seriously unfun). Now, this is certainly nothing like the surgical biopsy I had a few weeks ago, but really not a cake walk, either.

Afterwards, I was given directions to go home and lie down for 2 hours then rest at home the remainder of the day. So of course, I went home, decided I felt just fine, packed my bra with an ice pack and went to work. Seriously bad idea. The numbing medication wears off a couple of hours after the procedure and things get quite painful. And, if one has not been resting, you feel really bad, too. Next time, LISTEN to the resting advice.

After the procedure, my radiologist came to talk with me. He works closely with my surgeon and knows my diagnosis. I'd already told him that, if the biopsy showed anything at all, the left side would have to go with the right side. So I suppose he wanted me to have all of the information. He explained that with this type of biopsy, the collection is only a small portion of the cells. If I keep the left breast, her wants me back in 6 months and then every six months for a couple of years. And, if anything changes, a full biopsy will have to be done. Great.

With all of the advances in breast cancer treatment, it seems that the only real way to be sure it doesn't advance or come back is to have the breasts removed. I understand that mastectomies today are not as radical as in the past in terms of lymph node removal, but removing the breasts is just that. I do get that reconstruction is an option, but not immediately, at least not in my case.

Tomorrow I'm meeting with a friend of a friend who has gone through this already and decided to do a double. Reality is setting in that I probably shouldn't try to keep either breast.

Telling friends and family

I'm at the point in my diagnosis that I really have to start telling my friends and family what is going on. While there are a few people who know already, it is the friends I see less frequently and the family to whom I am reluctant to tell this kind of news that I really need to address now.

I sent an email last night to the women of the mothers group I joined more than 8 years ago when my oldest was born (can it be that long ago?). We have remained in contact and pretty close over the years, even with different schools and moves and all the changes families go through over the years. These are women I admire and care for. It was unbelievably difficult to tell them that I have cancer. Another mom and a dear friend in our group was diagnosed earlier this year with breast cancer and I know, at least for me, the news was devastating. To see a friend in pain is so hard. I don't want to increase their distress but I don't want to hide what is happening either.

I ran into one of the moms a few weeks ago at the grocery store and, in that moment, I realized that I had to find a way to tell them the news and to give them the opportunity to help out if they wished. The middle of Safeway is just not the place to break this kind of news.

It is that last piece that I still need to get and accept. I will need help. I'm not very good at accepting help; never have been. My husband, and now my boss (have I mentioned that my boss is a Pastor?) feel it is impotant that I accept that I will need help through this, both with the day to day activities (soccer, school, gymnastics, groceries, etc.) and with the emotional and mental toll (therapy, really?). So, while I think about the whole "professional listener" thing, I am taking steps to ask for help with the stuff I can quantify. The Yahoo Group and calendar should be set up soon. A friend is helping me get this together and will help me add friends and family to the group to let people help me.

If I haven't said it enough, I am very grateful for the help my friends and family have offered, and I do humbly accept. I'm not as clear about the depth of my thanks in person. Thank you all for the help you have offered and the help you will provide in the coming months.

Statistics and Breast Cancer

According to the Northern California Cancer Center (http://cancer.stanford.edu/features/research_news/nccc-report.html), rates for breast cancer in all races/ethnicities have declined since 2000, and more dramatically since 2003. Among white women in Santa Clara County, the rates are 154 per 100,000 women.

I recently learned that I'm one of the 154.
With no family history of breast cancer, no personal history of smoking, a lean body type, successful nursing of my first child for more than 3 years, and a vegan diet for more than 20 years, I never expected to fit into that statistic. According to the American Cancer Society, my risk factors are that a) I'm female and b) I gave birth to my first after age 30.

Yet, with all of that, I now find myself with T1c cancer, meaning I'm Stage 1, but the cancer is invasive and the largest of the tumors is over 1cm. At the end of September I'll be having a mastectomy and sentinal node biopsy.

I suppose I should back up. I've been having mammograms every year for the past 5 years, ever since one doctor felt a little lump in my left breast. It turned out that the left breast was fine, but the right breast had a small bit of microcalcification. So, every year after that, I had a mammogram and the radiologists would check the 2002 films to confirm no changes. There never were any, until this June.

Following my annual mammogram, I was called back for more views, ultrasound and 3D ultrasound of both breasts. During that visit, the radiologist looked at everything and said he'd like to look at it a bit more closely and would send a report to my gynecologist. A week later my gynecologist 's nurse called me to say that the radiologist called their office and left a message, which he apparently never does, so it would be a good idea to meet with a surgeon to see if a biopsy was needed. When I met with the surgeon 2 weeks later, it wasn't a question of "if" but "what kind" of biopsy would be done.

On August 7th, my 41st birthday, I had an excisional biopsy of my right breast. At the end, I asked the surgeon how it looked and she replied, "mostly ok". With that noncommital response, I decided to just try not to think about it for the next 7 days until the results came back. The surgeon's office called 2 days after sugery asking me to come in the next day with my husband. So much for the "mostly".

The initial pathology was optimistic. Very early stage 1; 3 very small tumors, all DCIS (Ductal Carcinoma in Situ). It could be resolved with either breast conservation surgery and radiation, or mastectomy with no further treatment. The surgeon assured me it was 100% curable and to just spend the next few days thinking about which surgical option would work best for me. She expected the final pathology to come back the next week.

The final pathology came back almost 3 weeks later, and things have changed a bit. There were no clean margins in the biopsy, meaning the whole 2x2x1 inch tissue sample was cancerous. The cancer is not only DCIS, but also IDC (invasive ductal carcinoma) and the largest of the 3 tumors measures 1.1cm. This all means that mastectomy is the only surgical option, and I will be having a biopsy of the left breast on August 30 to see if it will be a double or single. It also means a sentinal node biopsy during the mastectomy. Following the mastectomy, I'll meet with an oncologist to go over the remaining treatment options which, at this point, appear to be: Chemo, Tamoxifen, and potentially some other hormone blockers (adjuvent therapies).

So there we are. Random breast cancer.