The C Word

APPOINTMENT WITH RECONSTRUCTIVE SURGEON

Dr. Lim referred me to Dr. Aldona Spiegel, a reconstructive surgeon specializing in mastectomy reconstruction and who works closely with Dr. Lim. She discussed the options for reconstruction but seemed to firmly move in the direction of immediate implants as opposed to tissue expanders. She explained that her office would act as the “lead” in defining surgical scheduling, process and recovery. The timeframe would be roughly seven hours of surgery from mastectomy to reconstruction happening consecutively. She will want to see me one more time before the surgery and has requested a stress test with my cardiologist, clearance from him as well as the rheumatologist or GP, and, finally, a full clearance workup by the anesthesia/pre-op department. She is my favorite doctor so far. She is reassuring, positive and has a tremendous reputation in the breast cancer community. Although, Dr. Lim is a very close second. My cardiologist called her “famous” because of her reputation in the medical community. So far, I feel I’m in good hands. But, I will not say that I am truly okay with any of this, really. In another thought, I am still completely in shock how I went from trouble-shooting Lupus to breast cancer. I still find myself saying, “Wait, what?” Moving along.

ONCOLOGIST APPOINTMENT

I went to see Dr. Tejal Patel, an oncologist recommended by Dr. Lim. Dr. Rubin had suggested getting me in to see her prior to surgery because of Lupus issues and treatment considerations. Dr. Patel further explained the findings so far, surgery options and potential treatments. Oftentimes, an anti estrogen is given as part of the post-surgical treatment, but, in my case, this may have to be reconsidered, adjusted, etc. due to that medication’s blood-thickening side effects. She will also do a complete genetic workup to determine BRCA genes and other cancer genes. A lot of emphasis was given to the number of cancer-afflicted family members, three of whom died from the disease (grandfather, uncle and aunt). So far, no direct family members have been diagnosed with cancer. She also explained that only about 5-10% of breast cancer patients have a positive BRCA gene. If it’s positive, this means I am pretty certain to develop the cancer again in the future. It also means that both Mom and Anna are positive.

RESULTS (4/10/18)

BRCA IS NEGATIVE! This doesn’t affect my current situation, but it alleviates certain probabilities with regard to cancer for me and my daughter and mom.

RHEUMATOLOGIST – LUPUS COMPLICATIONS

Went to Dr. Richard Rubin, rheumatologist, to discuss Lupus complications, as it relates to the cancer. The current high levels of cardiolipin antibodies (IGM) (a Lupus issue) will affect my ability to utilize certain cancer-treating drugs beyond the surgery. Also, removing me from the blood thinners (which I take for AFib as well) will be necessary for the surgery, but it will also be necessary for me to get back on them ASAP beyond the surgery to assist with both conditions in preventing stroke. Dr. Rubin also discussed other complications (schleroderma) and did blood work to rule this out. He will communicate with the cancer surgeon and oncologist with recommendations.

RESULTS

No schleroderma! Cardiolipin antibodies still extremely high.

CARDIOLOGIST – AFIB COMPLICATIONS

Went to my cardiologist, Dr. Omar Awar, to have a ZioPatch heart monitoring device put on for the next two weeks. This will allow the doctors to determine how often my heart is going into AFib.

RESULTS (4/12/18)

No AFib during the two weeks, only premature beats. I am feeling good about this!

BREAST MRI

Dr. Lim sent me for a breast MRI. I’ve had lots of MRI’s and don’t have claustrophobic issues with the exam. However, I had an issue this time. I felt normal, with the exception of a severe lack of sleep, and moved through the steps with the tech. She had already inserted the IV for contrast. Again, I had to lay on my stomach with my breasts positioned through holes beneath me. My arms were above my head and my back was slightly arched. In positioning the bed into the machine, I felt the room spin and my vision hollow out. I started shaking and turned white. I felt myself being taken off the bed and smelling salts beneath my nose. I was quickly taken next door to the urgent care where people seemed to scramble faster than my brain could keep up. My blood pressure had dropped and I couldn’t seem to find my “footing” for a bit. They ran a lot of tests and, in the end, decided it was important, considering my illnesses, to transport me to Methodist Hospital for 24-hour observation. More scans and blood work. In the end, we don’t know what happened.

APPOINTMENT WITH BREAST CANCER SURGEON

We went to see Dr. Sherry Lim, a breast cancer surgeon who trained at MD Anderson and is highly regarded in her field. She explained, in complete detail, what we were looking at. At the 10:00 position, I have a DCIS (ductal carcinoma in situ) mass that is small and can be treated easily. It is the most common form of breast cancer and there is a high recovery rate. At the 6:00 position, there is another mass that came back inconclusive beyond the biopsy. She said she discussed it with the other doctors and believes this mass is highly suspicious and potentially not the more favored cancer, DCIS. She said she would not know until it came out but that, in her experience, this particular mass was worrisome. We discussed the options: lumpectomy of both masses, followed by radiation; single mastectomy and reconstruction; or, double mastectomy and reconstruction. Mastectomy would not rule out the need for radiation and/or chemotherapy; however, it would lower the chances for having to have it. At some point, I needed to cry. I was fading out in the same way I did with Dr. Hilgers and I needed a moment to compose myself. She was lovely about it all. In the end, she explained that there were pro’s and con’s to each decision, but that the final choice would have to be mine. She did seem to steer me away from the lumpectomy, which I appreciated. The meeting lasted about an hour or so. That weird feeling I continue to have, that feeling of wanting to run, was born in this meeting with Dr. Lim.

RESULTS

Dr. Stephen Hilgers (gynecologist) called me on my cell phone this afternoon. I was in the car after dropping my daughter, Anna, at work and was just pulling up to my garage. The landscaper, Francisco Mendoza, was there and I was meeting him to go over some things about the irrigation system. I asked Dr. Hilgers to wait a moment so I could get him off my speaker phone in the car. I also asked Francisco to give me a moment that I needed to take an important call. Dr. Hilgers, who is a kind, classy and polite man, a doctor who is more on the calm side than the alarmist side, began an explanation that slowly sent little shocks into my extremities and made me dizzy. He used medical terminology assuming I was following along. I suddenly became aware of the sun and the wood grain on the step beneath me. I was hearing his voice through a tunnel, a filter that allowed me to stay upright. At some point, there was a pause. I thought it might be a good time to make sure I was following the conversation, to get to the point, to hear the words. I asked, rather bluntly, “Dr. Hilgers, so I have breast cancer, is that correct?” He simply answered, “Yes.” I felt my eyes fill up and my jaw slightly hang. I thought of all the times I felt grateful for the doctors’ attention, the times I felt annoyed if I didn’t get it, and how, now, I couldn’t hang up that phone fast enough. He explained that he would be referring me to a surgeon, Dr. Sherry Lim, that she is one of the very best. I thanked him and finally got off that phone.

Francisco, noticing I had hung up, slowly approached to explain the irrigation. We have been working with him for four years now. I began sobbing. He offered to wait with me until Ken got home. It just felt surreal. Here was Francisco, dirt on his shirt, standing there in the sun, thinking about irrigation, and here I was, in this medical fog, wondering how in the hell I went from trouble-shooting Lupus at the onset of this whole thing, to breast cancer. Our worlds could not have been more different, yet there we were. I stood up, wiped my face and we walked around front. I told him to please explain it all to Ken. We hugged and he left.

I called Ken to tell him it was positive. He packed up his stuff and came home. He worked from home the remainder of that week and, together, we began our plan to fight this.

BIOPSIES

Went in for two biopsies: stereotactic at 10:00 position on left breast and ultrasound-guided at 6:00 position on same breast. Stereotactic was first requiring me to lay down on my stomach with my left breast positioned in a hole beneath me. Paddles similar to mammogram paddles were used to position the breast and view the mass. The doctor worked beneath the table. I was told to stay still and a local anesthetic was given. I heard a whirring sound during the biopsy and felt pressure and some discomfort, then an “air gun” type of sound when they inserted a marker into the tumor. The procedure was about ten minutes I think. I was helped off the table and brought to another room. This time I laid on my back with my left arm above my head. The ultrasound wand was used to locate the mass. Again, I was told to lay still and a local anesthetic was given. This time, the machine was more of a popping sound during the biopsy, then the “air gun” sound again for the second marker. Biopsies complete.

I was bandaged, given instructions and told the results would be in between Tuesday and Friday of the following week.

I was proud of myself. I had been worried about the procedures and thought my “shakey” nature regarding anything medical would prevail and I would have to be coddled. The opposite became the case. I was quiet, still, no tears and the staff complimented me on being such a good patient. I hadn’t heard that a lot in my life, so this turned out to be a good day. I felt good about myself.

ADDITIONAL IMAGING

Returned to Houston Methodist Breast Care Center for additional imaging. Had one round of images taken and sent to waiting room. Called back for a second round of images and returned to waiting room. Called back for a third round of images using another machine and returned to waiting room. The tech came in after the third round of mammogram imaging and said they will need ultrasound. I was brought to another area and proceeded with an ultrasound. The tech did her part and then left the room, asking me to stay in the position. She returned with the radiologist who continued the exam. I felt anxiety setting in. The radiologist began her explanation, that there are two suspicious masses that will need to be biopsied. I stared at the wall and began to cry. I straightened myself, got dressed, and went into a consult room to speak with a nurse. The procedure was explained along with directions for getting clearance from my other doctors to stop taking full strength aspirin. I have AFib and Lupus complications (high positive IGM cardiolipin antibodies which thickens the blood). The two conditions (individually, and especially, combined) put me at risk for stroke.

ROUTINE MAMMOGRAM

Saw gynecologist for a cyst on my left ovary. This day was a follow up appointment to discuss findings beyond abdominal CT scan w/contrast, pelvic ultrasound, MRI and blood work to rule out ovarian cancer. Per Dr. Stephen Hilgers at Methodist in Houston, all clear for ovarian cancer. Suggested I go for routine mammogram in same building and to just walk in without an appointment. It had been three-four years since last mammogram.

CALL BACK

Tech called me on cell phone twenty minutes after leaving saying I need to come back, they need more images. I asked why (thinking they made a mistake in getting the images) and was told they see something suspicious. I asked if I should worry and she told me it was too early for that.

Then the nurse from Dr. Hilgers’ office called and said not to worry but that I needed to get back ASAP and she would help me set up an appointment for the following day. I told her I didn’t want to, that I needed time to digest what they were telling me. We agreed to wait for Wednesday.