I am in appointment season; ending one treatment phase (chemo), entering the next (surgery), and planning for the last (radiation).
Since my final chemo on March 8th, I have had one follow up with the Nurse Practitioner (just a check-in to see how I was doing).
John and I met with the breast surgeon on Friday for my pre-op appointment, which included another ultrasound of the right breast, where the tumor was, and of the lymph nodes under that arm (which now show no cancer activity as well!). Dr. V. says that he expects that my post-surgery pathology report (this will provide the most accurate information about my cancer status since my biopsies and scans last fall) to show either near-complete (98-99%) or complete (100%) pathological response. YAAAAAASSSSSSSS
Additionally, he stated that this means that my prognosis is at 90% of never having a recurrence. This, my friends, is the gold here, and I will admit to feeling skeptical, a little afraid to believe that could be true for someone with TNBC. Don't get me wrong, I am extremely happy to hear this, but I am also going to ask my medical oncologist for her opinion. One thing I have come to learn is that different doctors have different takes on how they discuss cancer, for example if they use the word, "cure," or whatever. I tend to view my medical oncologist as more of a "cautiously optimistic" type, and my breast surgeon is definitely more... emotive.
Dr. V. also discussed his thoughts on how many lymph nodes he will take (something he won't know for sure until we are in surgery). He wants to be sure to take what is needed, but not to take too much. He thinks maybe 3-4, but to be certain he will first inject me with dye and radiation (sentinel lymph node biopsy) that will highlight any active cancer. I am hoping for this low number, because the more you take out, the higher the likely is for developing lymphedema (swelling and/or cording in the arms where lymph nodes were removed). I do not want lymphedema. The nurse navigator, M., also met with us to book my first physical therapy appointment and EKG that will need to happen prior to surgery.
In the meantime, Dr. V. wants me to practice calming exercises such as meditation, breathing exercises, and chest-openers to help with my posture.
Next we attended a breast surgery pre-op class, where John was congratulated for attending and for taking notes (he should get tons of credit for being a great partner! And this also weirds him out a little). We learned about:
Pre-Surgery Prep
Since my final chemo on March 8th, I have had one follow up with the Nurse Practitioner (just a check-in to see how I was doing).
John and I met with the breast surgeon on Friday for my pre-op appointment, which included another ultrasound of the right breast, where the tumor was, and of the lymph nodes under that arm (which now show no cancer activity as well!). Dr. V. says that he expects that my post-surgery pathology report (this will provide the most accurate information about my cancer status since my biopsies and scans last fall) to show either near-complete (98-99%) or complete (100%) pathological response. YAAAAAASSSSSSSS
Additionally, he stated that this means that my prognosis is at 90% of never having a recurrence. This, my friends, is the gold here, and I will admit to feeling skeptical, a little afraid to believe that could be true for someone with TNBC. Don't get me wrong, I am extremely happy to hear this, but I am also going to ask my medical oncologist for her opinion. One thing I have come to learn is that different doctors have different takes on how they discuss cancer, for example if they use the word, "cure," or whatever. I tend to view my medical oncologist as more of a "cautiously optimistic" type, and my breast surgeon is definitely more... emotive.
Dr. V. also discussed his thoughts on how many lymph nodes he will take (something he won't know for sure until we are in surgery). He wants to be sure to take what is needed, but not to take too much. He thinks maybe 3-4, but to be certain he will first inject me with dye and radiation (sentinel lymph node biopsy) that will highlight any active cancer. I am hoping for this low number, because the more you take out, the higher the likely is for developing lymphedema (swelling and/or cording in the arms where lymph nodes were removed). I do not want lymphedema. The nurse navigator, M., also met with us to book my first physical therapy appointment and EKG that will need to happen prior to surgery.
In the meantime, Dr. V. wants me to practice calming exercises such as meditation, breathing exercises, and chest-openers to help with my posture.
Next we attended a breast surgery pre-op class, where John was congratulated for attending and for taking notes (he should get tons of credit for being a great partner! And this also weirds him out a little). We learned about:
Pre-Surgery Prep
- Move oft-used items on high shelves to low shelves (I will have limited range of motion for a bit, aka T-Rex arms);
- House cleaning;
- Meal prep ("This is not the time to say no to people who offer to bring you meals");
- Remove tripping hazards;
- Stock up on additional pillows for propping up in bed (I will need to sleep only on my back for a bit);
- Purchase mastectomy bras (I didn't know what these were, either. Basically a super-soft front-zip sports bra with lots of ways to adjust to accommodate swelling and bandages-- OR you can go the high fashion route with AnaOno or Stella McCartney);
- Dr. V. suggested that since I am going to attempt to avoid opioids for pain management, I should take cold showers for the 5 days leading up to surgery (ugh).
What Happens in Surgery
- The breast surgeon will perform surgery first, and then the plastic surgeon will take over for reconstruction;
- Will last 3-4 hours (and I will have to stay overnight one night);
- The goal is to remove all of the identifiable breast tissue;
- I am having what is termed a "total or simple" mastectomy;
- Not sure yet if I will have direct-to-implant or expanders (will know more at plastic surgeon pre-op appointment on 3/29).
Post-Surgery
- Bland foods are ideal for the first few days (le sigh);
- Hydrate, hydrate, hydrate!;
- I will have at least 2 drain bulbs (look like clear plastic grenade attached to tubing that will be the means for draining extra fluid from the mastectomy site and yes this sounds gross but we deal, do we not?!), and they gave me a drain belt, which is a definite fashion statement;
- Must empty drains and record amounts;
- No heavy lifting for 4-6 weeks;
- Must do daily PT exercises;
- Take it easy but stay active;
- Complementary pain management (distraction, relaxation, progressive muscle relaxation);
- Drains removed when fluid output becomes consistently minimal;
- We should receive the pathology results within a week;
- Follow up with breast surgeon at 6 months.
After Treatment
- Reducing risk of recurrence:
- Maintain healthy weight (includes limiting animal-based products);
- Limit alcohol intake;
- Adopt a physically active lifestyle;
- Smoking cessation.
NEXT UP:
- Radiation oncologist consult;
- Medical oncologist post-chemo/pre-surgery check-in;
- Plastic surgery pre-op;
- 30-Day post-chemo labs and appointment with Nurse Practitioner;
- Pre-surgery phone call with a nurse;
- Physical Therapy initial appointment;
- EKG.
My mom will be coming out for the surgery and to help me out for a few days afterward. Thanks, Mom!
So now you know what I am up to (aside from list-making). Very lucky to have contract/work-from-home flexibility during this time, and for the flexibility John has had with his schedule so he can attend some of these appointments with me. It is true that having someone with you to help absorb all of the information is a wise and good thing.
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