In the past week Candy developed a lump right underneath her right rib cage which was basically sticking out when she was laying down. She is 7+ and I knew that doggies did develope harmless tumours at that age and she was full of energy obviously feeling like tugboat in our morning jogs, but given our present state of mind we could not just let it be so took her to the vet today.
They aspired the lump and it was a fatty tumour.. yey ! and it is 2+ cm.. Hmmm.. did candy develop a empathy fatty tumor the same size as mine and on the same side ? I could not help but think.
Anywhoo... I think I am thinking a bit too much and this should not be healthy lol..
Thursday, January 31, 2008
First 5k After starting treatment !
On February 10 Track Shack has a 5k walk/run for only women which serves a great cause.
About this Event
The Lady Track Shack is a one-of-a-kind event set in the beautiful and lush surroundings of Mead Garden in Winter Park. For over 30 years, community leaders, mothers and daughters, sisters and friends have been taking part in this event to celebrate women's health and fitness. Be a part of the Lady Track Shack 5k as a runner, walker or supporter along the route. Be part of something amazing.
Beneficiary
Race proceeds go directly to the Florida Hospital Track Shack Cancer Screening Program. The Florida Hospital Lady Track Shack Cancer Screening Program provides mammograms to under-served women in our community.
Emailed my friends who have been by my side all throughout stages 1(surgery), and 2 (chemo) they also will be doing it ... I am totally psyched what a great way to finish stage 2 of treatment and move on the 3rd stage(expander replacement surgery).. the last stge will be radiation.
Oh and the Plastic Surgeon gave permission to go to Jacksonville to watch the Breast Cancer Marathon on the 17th, I really wanted to go and watch, get my t-shirt registration packet even if I can not do it this year.
Decision made for sure
Tuesday had a great time at the 5:45 am cycle class, sometimes the classes just work out ok. Other times I just cannot capture the essence and it does not feel right and in the end we end up dodging along waiting for the class to finish which is a waste of a beautiful morning. Have to find a way to catch the 'mojo' in every class. Music selection is very important. Luckily we had a new microphone this time I hate trying to scream over the music while cycling at the same time that does a trick on ones heart rate for sure.
Someone from work will be getting bilateral mastectomy with reconstruction this Thursday I got her the Fuel Belt to use with the drains (since she will also have 4 and that was a life saver for me for the first 2 weeks) I also rekindled my project of sewing something similar and donating it to cancer centers for bilateral mastectormy/reconstr. patients. Have to find someone who is handy with the sewing machine, or might wait for my mom who will be coming next month. If one takes out the flasks and adds 2 flask holders it makes life a lot easier compared to walking around with 4 dangling drains pinned to ones clothing.
In the afternoon went to the Breast Cancer Support group meeting at the Florida Hospital there were 3 facilitators and 3 bc patients so we certainly got one on one attention, wonder why other bc patients did not come. This meeting is open to public not only for the patients of FL hospital. The topic was Journaling and how it helped people in times of crisis(I guess I could totally relate to that .. see blog ! ) the benefits stated were:
Journaling: Write Brain activity
1) Slows down racing thoughts, you can't write as fast as you can think
2) Provides a history lesson: Shows how your life unfolds
3) Presents reality as documented history : Specific time and date
4) Identifies patterns and trends: day of week, time of day, angry, sad
5) Specific and measurable progess or regression
6) Practice being vulnerable- a safe place, helops build trust within yourself able to be painfully honest
7) Mentally an physically healthy: right and left brain activity
8) Practice area : writing, saying, exploring
9) Portable - take with you, do anywhere
10) Focus and clarity- thoughts become visible words sound differently on paper , development of contemplation.
I was extremely pleased that a tool for dealing with stress was covered, however the other participants expectations were more of an informal support group, probably something like a group therapy session with the counselors. Luckily I have my own bc support group similar to that in my neighborhood. Next months topic is Music should be quite interesting. I had read in the Cure magazine that there were some art therapy sessions although I suck at drawing (as seen that my drawings with my eyes closed were as good as the ones that I made with my eyes open) I loved the idea of just doodling with lots of color. I was told that FL Hospital had that service for inpatients hopefully they might consider it for one of the montly support groups. The main facilitator is the girl which I had done a session of counseling with, she is really well intentioned but she is way too uptight to deal with the bc gals! The guest counselor was much more warm/caring.
That night I was extremely wiped out could not even walk straight looked like a drunk ! I am not sure what drained my energy I think all the decision making process is getting to me. I had to make a decision by Wednesday pre-op visit to my plastic surgeon.
Went to bed at 7:30 after a little binge episode. Had a restless night but was able to stay in bed(not hitting the fridge was a huge accomplisment ) until 7:30 Wednesday morning The chill pillow is working for hot flashes for sure. I do not recall the last time I was in bed for 12 hours not even after my surgery/chemo, hmm wonder whether sleep was an excuse/escape to delay making the surgery decision ?
Did a short jog/walk with Candy and went to the office. My decision had solidified, I am not getting the axillary node dissection as I do not believe that is part of my treatment and only will hinder my life quality.
We went out to our weekly lunch with my local team (it is only 3 of us including our manager)and learned that one of the remote team members had resigned. The team had already been operating on fumes.. and this was certain to make things go out of control. I knew what was coming next so chose to take the first step since I knew it was coming my way anyways and stated that with the help from the group I would take over her issues.(better take credit for volunteering) This might help me focus as it has been one month since I started work but I certainly have not been a poster child for dedicated focused employee ! Maybe for ADD ( except medical research)
That afternoon went to the Plastic Surgeons Dr.P office and his nurse G approached me with a paperwork and when she saw my puzzled face she went 'NOW WHAT ?' When I told her that I was only getting the implant exchange and not the axillary node dissection she first was mad at me for changing my mind all the time however when I explained a little bit about the dilemma I was in she goes ' I am really confused and I do not know how you are dealing with this ' yeah.. well tell me about it.
I was jotting down a couple of statements to explain Dr. P why I was switching decisions but he was perfectly fine with it, and actually seemed to avoid the subject. He took pictures of the expanders and said that he might not be able to fix the buckling of the left side, I said I really did not care and was not that anal about the boobs anyways did not start with picture perfect ones anyways, and now that is the least of my concerns.
He also explained that if I was going to get radiation he would not be able to graft the nipples since operating on radiated skin causes lots of problems. oh well I guess I will go the tattoo route if I have to.
After that went to pick up a bike from someone that I knew from the Masters Swimming team(he had just came back from Kite surfing ??? that sounded soo cool) for my brotherinlaw who was looking for an entry level road bike. It is a cool Red/Yellow Cannondale CAAD3 Saeco I am guessing it is about 8+ years old but could not find anything re: manufacture date on the bottom bracket. Not sure whether it will fit him or whether he'll like it, if not Ferit might keep it. Nowadays I seem to be into 'finding homes for lonely road bikes', kind of like a 'road bike rescue'
Did a short weight lifting circuit at the gym, prepared dinner and went with a couple of friends to Timpano to have a drink. Even though I had a single glass of wine this affected my sleep quality. But at least I did not wake every hour thinking about another search keyword that I might have missed to google on ' sentinel node biopsy auxillary post mastectomy radiation '
Someone from work will be getting bilateral mastectomy with reconstruction this Thursday I got her the Fuel Belt to use with the drains (since she will also have 4 and that was a life saver for me for the first 2 weeks) I also rekindled my project of sewing something similar and donating it to cancer centers for bilateral mastectormy/reconstr. patients. Have to find someone who is handy with the sewing machine, or might wait for my mom who will be coming next month. If one takes out the flasks and adds 2 flask holders it makes life a lot easier compared to walking around with 4 dangling drains pinned to ones clothing.
In the afternoon went to the Breast Cancer Support group meeting at the Florida Hospital there were 3 facilitators and 3 bc patients so we certainly got one on one attention, wonder why other bc patients did not come. This meeting is open to public not only for the patients of FL hospital. The topic was Journaling and how it helped people in times of crisis(I guess I could totally relate to that .. see blog ! ) the benefits stated were:
Journaling: Write Brain activity
1) Slows down racing thoughts, you can't write as fast as you can think
2) Provides a history lesson: Shows how your life unfolds
3) Presents reality as documented history : Specific time and date
4) Identifies patterns and trends: day of week, time of day, angry, sad
5) Specific and measurable progess or regression
6) Practice being vulnerable- a safe place, helops build trust within yourself able to be painfully honest
7) Mentally an physically healthy: right and left brain activity
8) Practice area : writing, saying, exploring
9) Portable - take with you, do anywhere
10) Focus and clarity- thoughts become visible words sound differently on paper , development of contemplation.
I was extremely pleased that a tool for dealing with stress was covered, however the other participants expectations were more of an informal support group, probably something like a group therapy session with the counselors. Luckily I have my own bc support group similar to that in my neighborhood. Next months topic is Music should be quite interesting. I had read in the Cure magazine that there were some art therapy sessions although I suck at drawing (as seen that my drawings with my eyes closed were as good as the ones that I made with my eyes open) I loved the idea of just doodling with lots of color. I was told that FL Hospital had that service for inpatients hopefully they might consider it for one of the montly support groups. The main facilitator is the girl which I had done a session of counseling with, she is really well intentioned but she is way too uptight to deal with the bc gals! The guest counselor was much more warm/caring.
That night I was extremely wiped out could not even walk straight looked like a drunk ! I am not sure what drained my energy I think all the decision making process is getting to me. I had to make a decision by Wednesday pre-op visit to my plastic surgeon.
Went to bed at 7:30 after a little binge episode. Had a restless night but was able to stay in bed(not hitting the fridge was a huge accomplisment ) until 7:30 Wednesday morning The chill pillow is working for hot flashes for sure. I do not recall the last time I was in bed for 12 hours not even after my surgery/chemo, hmm wonder whether sleep was an excuse/escape to delay making the surgery decision ?
Did a short jog/walk with Candy and went to the office. My decision had solidified, I am not getting the axillary node dissection as I do not believe that is part of my treatment and only will hinder my life quality.
We went out to our weekly lunch with my local team (it is only 3 of us including our manager)and learned that one of the remote team members had resigned. The team had already been operating on fumes.. and this was certain to make things go out of control. I knew what was coming next so chose to take the first step since I knew it was coming my way anyways and stated that with the help from the group I would take over her issues.(better take credit for volunteering) This might help me focus as it has been one month since I started work but I certainly have not been a poster child for dedicated focused employee ! Maybe for ADD ( except medical research)
That afternoon went to the Plastic Surgeons Dr.P office and his nurse G approached me with a paperwork and when she saw my puzzled face she went 'NOW WHAT ?' When I told her that I was only getting the implant exchange and not the axillary node dissection she first was mad at me for changing my mind all the time however when I explained a little bit about the dilemma I was in she goes ' I am really confused and I do not know how you are dealing with this ' yeah.. well tell me about it.
I was jotting down a couple of statements to explain Dr. P why I was switching decisions but he was perfectly fine with it, and actually seemed to avoid the subject. He took pictures of the expanders and said that he might not be able to fix the buckling of the left side, I said I really did not care and was not that anal about the boobs anyways did not start with picture perfect ones anyways, and now that is the least of my concerns.
He also explained that if I was going to get radiation he would not be able to graft the nipples since operating on radiated skin causes lots of problems. oh well I guess I will go the tattoo route if I have to.
After that went to pick up a bike from someone that I knew from the Masters Swimming team(he had just came back from Kite surfing ??? that sounded soo cool) for my brotherinlaw who was looking for an entry level road bike. It is a cool Red/Yellow Cannondale CAAD3 Saeco I am guessing it is about 8+ years old but could not find anything re: manufacture date on the bottom bracket. Not sure whether it will fit him or whether he'll like it, if not Ferit might keep it. Nowadays I seem to be into 'finding homes for lonely road bikes', kind of like a 'road bike rescue'
Did a short weight lifting circuit at the gym, prepared dinner and went with a couple of friends to Timpano to have a drink. Even though I had a single glass of wine this affected my sleep quality. But at least I did not wake every hour thinking about another search keyword that I might have missed to google on ' sentinel node biopsy auxillary post mastectomy radiation '
Monday, January 28, 2008
Here I go again, another surgeon - Moffitt not giving pathology result ?
Went to get an opinion of a surgeon who had not asked for AND (Axillary Node Dissection) from someone that had 3/3 Sentinel Nodes test positive to see whether he had any scientific research that I somehow missed to back his decision with hard data.
What he said was basically the same line with the radiation oncologists. He does not see removing of the Level 1 & 2 nodes as a treatment, but more of a staging tool.
He also said that at a conference that he attended there was a heated discussion on this specific subject and no consencus was reached of course.
His main points were:
1 - My lymph node involvement seems to be minor, 10-15 years ago my case might have tested as Node negative, the IHC(Immunohistologic staining) is too accurate and captures even minute amounts now.
.
2 - The c cells are trapped into the lymph nodes ( who were doing their jobs of capturing bad stuff from going into the system) and they do not go anywhere from where they are captured.
.
3 - All Lymph nodes are not removed anyways only Levels 1&2 are removed, what happens to the rest ? ( levels 3&4 )
.
4 - The area will be monitored closely for any enlargement of the lymphs and then the AND will be performed if such a thing occurs.
.
5 - The chemo and rads should take care of any micromets that are in that area.
.
6 - He has only done 1 AND in the last 5 years and that was done at the request of the patient.
I was not confused when I left the doctors office because I really do understand what is going on now. This issue of AND being part of the treatment or not is at a turning point in the medical community. And those who do not want to stick their necks out are erring on the side of convention/caution. If one looks at the evolution of the mastectomy which was a totally debilitating surgery when it first was done- removing chest muscles and everything .. to how it is done today, just removing the breast tissue by ensuring of clear margins.
.
So I do have a surgery date of February 14th but am not sure whether I am going ahead with it.
.
When I got home I decided to give a call to Moffitt c center who still has not returned my pathology slides to ormc. The breast center coordinator stated that they were looking at the unstained slides and were doing the her2/neu test.. WT >????????
I asked whether they were doing FISH she said yes.
Hmm.. this is a bit worrisome my initial pathology said HER-, and if they are suspecting HER+ this will change the treatment going forward. But then why the the surgeon at the Moffitt center say that they agreed with the pathology ? Could it be that they had not reviewed it actually at that time ?
This really sucks !!!
Checking into what the stinky FISH means:
"Testing for the overexpression of the HER2/neu oncogene can be done with immunohistochemistry (IHC) (using a special protein to identify the gene's protein) or with FISH (fluorescent in situ hybridization that measures the genes that direct the production of the protein). FISH is somewhat more reliable than IHC, but IHC is most readily available. If your test showed a 2+ by IHC, that is considered "HER2/neu negative," which means a better outcome than if the test were positive. If you did FISH testing on all 2+ by IHC, about 25% of the samples might actually prove to be positive. In any case, Herceptin (trastuzumab) is only indicated presently for women with metastatic disease that is HER2/neu positive. It is also available on a number of studies for earlier-staged patients."
"Two tests are used to figure out if the cancer is likely to respond to Herceptin. One test measures HER2 receptor protein (IHC), and the other test counts copies of the HER2 gene (FISH):
IHC (ImmunoHistoChemistry)
IHC is the most commonly used test to see if a tumor has too much of the HER2 receptor protein on the surface of the cancer cells.
The IHC test gives a score of 0 to 3+ that indicates the amount of HER2 receptor protein in tumors. If the tumor scores 0 to 1+, it's called "HER2 negative." If it scores 2+ or 3+, it's called "HER2 positive."
Women with IHC positive scores tend to respond favorably to Herceptin. The drug is not considered effective for tumors with IHC scores of 0 or 1+.
It's important to remember that results on the IHC test may vary from lab to lab, and that some labs are more proficient at HER2 testing than others. Discuss with your doctor whether you might want to get a FISH test, especially if you have a 1+ or 2+ result from IHC. That way you can get another measure of whether the tumor might respond well to Herceptin.
The IHC test results are most reliable for fresh or frozen tissue samples. IHC tends to be an unreliable way to test tissue that's preserved in wax or other chemicals. FISH testing is the preferred way to assess preserved tissue samples.
FISH (Fluorescence In Situ Hybridization)
The FISH test looks for the HER2 gene abnormality. This test is the most accurate, but less available, way to find out if a breast tumor is likely to respond to Herceptin. The FISH test shows how many copies of the HER2 gene are in tumor cells. This gene directs cells to make the HER2 protein. The more copies of the gene, the more HER2 receptors the cells have.
With the FISH test, you get a score of either "positive" or "negative" (some hospitals call a negative test "zero"). If the tumor is "FISH positive," it will probably respond well to Herceptin.
"HER-2 is a gene that helps control how cells grow, divide, and repair themselves. About one out of four breast cancers has too many copies of the HER-2 gene. The HER-2 gene directs the production of special proteins, called HER-2 receptors, in cancer cells. Read recent research about treatments for women with early-stage cancers that are HER2-positive.
Cancers with too many copies of the HER-2 gene or too many HER-2 receptors tend to grow fast. They are also associated with an increased risk of spread. But they do respond very well to treatment that works against HER-2. This treatment is called anti-HER-2 antibody therapy.
There are two tests for HER-2:
IHC test (IHC stands for ImmunoHistoChemistry)
The IHC test shows if there is too much HER-2 receptor protein in the cancer cells.
The results of the IHC test can be 0 (negative), 1+ (negative), 2+ (borderline), or 3+ (positive).
FISH test (FISH stands for Fluorescence In Situ Hybridization)
The FISH test shows if there are too many copies of the HER-2 gene in the cancer cells.
The results of the FISH test can be "positive" (extra copies) or "negative" (normal number of copies).
Find out which test for HER-2 you had. This is important. Only cancers that test IHC "3+" or FISH "positive" will respond well to therapy that works against HER-2. An IHC 2+ test result is called borderline. If you have a 2+ result, you can and should ask to have the tissue tested with the FISH test"
My result for the HER2 was .9 according to the pathology report.. wonder why they are doing the FISH ???
At that point since my head started spinning there was no way I could focus on work, the weather was gorgeous(around low 60's) I called P and asked whether she would be willing to slug a 3 miler with me. She graciously agreed and we went out for 45 minutes of jog/walk/talk getting some air helped me recompose.
Immediately after we split my surgeon (Dr. Chambers) called (I had called her) she said that, she received the report from Dr. Sollacio (radiation oncologist) if it was her, she would not get the AND.. since I was getting rads.
She also added that If there is still c sh..t in the lymph nodes after chemo and rads I should really be worrying about the systematic mets since that means that chemo and rads did not work, local recurrence is not worrisome no one got into trouble cause of lymph mets. She also added like everyone else(except the Moffitt guy) that there were any positive lymph nodes left there anyways.
.
My million $ question was that whether the c could possibly spread from the lymphs where they were living (if there is still stuff in the remaining ones), of course no one can answer that.
So far those who say go for node dissection:
1 - My oncologist -- has a HUGE weight
1 - Major cancer center(Moffitt) surgeon(who is kind of a rookie)
Those who say no go for node dissection, but just do rads:
2 - radiation oncologists
3 - surgeons
1 - major cancer center tumor board(MD Anderson).(that includes my surgeon)
So no rads are winning 6 to 2.
.
If I do not do dissection my oncologist said that he was ok with it, however then that means that I can not trust him 100% in my treatment going forward..and I need to find a new oncologist ( he already is my 2nd one !)
.
I know at this point the response from everyone will be 'good grief girl, just let it go'
BUT I CANNOT THATS NOT ME !!!
I am being tested but not sure on what
What he said was basically the same line with the radiation oncologists. He does not see removing of the Level 1 & 2 nodes as a treatment, but more of a staging tool.
He also said that at a conference that he attended there was a heated discussion on this specific subject and no consencus was reached of course.
His main points were:
1 - My lymph node involvement seems to be minor, 10-15 years ago my case might have tested as Node negative, the IHC(Immunohistologic staining) is too accurate and captures even minute amounts now.
.
2 - The c cells are trapped into the lymph nodes ( who were doing their jobs of capturing bad stuff from going into the system) and they do not go anywhere from where they are captured.
.
3 - All Lymph nodes are not removed anyways only Levels 1&2 are removed, what happens to the rest ? ( levels 3&4 )
.
4 - The area will be monitored closely for any enlargement of the lymphs and then the AND will be performed if such a thing occurs.
.
5 - The chemo and rads should take care of any micromets that are in that area.
.
6 - He has only done 1 AND in the last 5 years and that was done at the request of the patient.
I was not confused when I left the doctors office because I really do understand what is going on now. This issue of AND being part of the treatment or not is at a turning point in the medical community. And those who do not want to stick their necks out are erring on the side of convention/caution. If one looks at the evolution of the mastectomy which was a totally debilitating surgery when it first was done- removing chest muscles and everything .. to how it is done today, just removing the breast tissue by ensuring of clear margins.
.
So I do have a surgery date of February 14th but am not sure whether I am going ahead with it.
.
When I got home I decided to give a call to Moffitt c center who still has not returned my pathology slides to ormc. The breast center coordinator stated that they were looking at the unstained slides and were doing the her2/neu test.. WT >????????
I asked whether they were doing FISH she said yes.
Hmm.. this is a bit worrisome my initial pathology said HER-, and if they are suspecting HER+ this will change the treatment going forward. But then why the the surgeon at the Moffitt center say that they agreed with the pathology ? Could it be that they had not reviewed it actually at that time ?
This really sucks !!!
Checking into what the stinky FISH means:
"Testing for the overexpression of the HER2/neu oncogene can be done with immunohistochemistry (IHC) (using a special protein to identify the gene's protein) or with FISH (fluorescent in situ hybridization that measures the genes that direct the production of the protein). FISH is somewhat more reliable than IHC, but IHC is most readily available. If your test showed a 2+ by IHC, that is considered "HER2/neu negative," which means a better outcome than if the test were positive. If you did FISH testing on all 2+ by IHC, about 25% of the samples might actually prove to be positive. In any case, Herceptin (trastuzumab) is only indicated presently for women with metastatic disease that is HER2/neu positive. It is also available on a number of studies for earlier-staged patients."
"Two tests are used to figure out if the cancer is likely to respond to Herceptin. One test measures HER2 receptor protein (IHC), and the other test counts copies of the HER2 gene (FISH):
IHC (ImmunoHistoChemistry)
IHC is the most commonly used test to see if a tumor has too much of the HER2 receptor protein on the surface of the cancer cells.
The IHC test gives a score of 0 to 3+ that indicates the amount of HER2 receptor protein in tumors. If the tumor scores 0 to 1+, it's called "HER2 negative." If it scores 2+ or 3+, it's called "HER2 positive."
Women with IHC positive scores tend to respond favorably to Herceptin. The drug is not considered effective for tumors with IHC scores of 0 or 1+.
It's important to remember that results on the IHC test may vary from lab to lab, and that some labs are more proficient at HER2 testing than others. Discuss with your doctor whether you might want to get a FISH test, especially if you have a 1+ or 2+ result from IHC. That way you can get another measure of whether the tumor might respond well to Herceptin.
The IHC test results are most reliable for fresh or frozen tissue samples. IHC tends to be an unreliable way to test tissue that's preserved in wax or other chemicals. FISH testing is the preferred way to assess preserved tissue samples.
FISH (Fluorescence In Situ Hybridization)
The FISH test looks for the HER2 gene abnormality. This test is the most accurate, but less available, way to find out if a breast tumor is likely to respond to Herceptin. The FISH test shows how many copies of the HER2 gene are in tumor cells. This gene directs cells to make the HER2 protein. The more copies of the gene, the more HER2 receptors the cells have.
With the FISH test, you get a score of either "positive" or "negative" (some hospitals call a negative test "zero"). If the tumor is "FISH positive," it will probably respond well to Herceptin.
"HER-2 is a gene that helps control how cells grow, divide, and repair themselves. About one out of four breast cancers has too many copies of the HER-2 gene. The HER-2 gene directs the production of special proteins, called HER-2 receptors, in cancer cells. Read recent research about treatments for women with early-stage cancers that are HER2-positive.
Cancers with too many copies of the HER-2 gene or too many HER-2 receptors tend to grow fast. They are also associated with an increased risk of spread. But they do respond very well to treatment that works against HER-2. This treatment is called anti-HER-2 antibody therapy.
There are two tests for HER-2:
IHC test (IHC stands for ImmunoHistoChemistry)
The IHC test shows if there is too much HER-2 receptor protein in the cancer cells.
The results of the IHC test can be 0 (negative), 1+ (negative), 2+ (borderline), or 3+ (positive).
FISH test (FISH stands for Fluorescence In Situ Hybridization)
The FISH test shows if there are too many copies of the HER-2 gene in the cancer cells.
The results of the FISH test can be "positive" (extra copies) or "negative" (normal number of copies).
Find out which test for HER-2 you had. This is important. Only cancers that test IHC "3+" or FISH "positive" will respond well to therapy that works against HER-2. An IHC 2+ test result is called borderline. If you have a 2+ result, you can and should ask to have the tissue tested with the FISH test"
My result for the HER2 was .9 according to the pathology report.. wonder why they are doing the FISH ???
At that point since my head started spinning there was no way I could focus on work, the weather was gorgeous(around low 60's) I called P and asked whether she would be willing to slug a 3 miler with me. She graciously agreed and we went out for 45 minutes of jog/walk/talk getting some air helped me recompose.
Immediately after we split my surgeon (Dr. Chambers) called (I had called her) she said that, she received the report from Dr. Sollacio (radiation oncologist) if it was her, she would not get the AND.. since I was getting rads.
She also added that If there is still c sh..t in the lymph nodes after chemo and rads I should really be worrying about the systematic mets since that means that chemo and rads did not work, local recurrence is not worrisome no one got into trouble cause of lymph mets. She also added like everyone else(except the Moffitt guy) that there were any positive lymph nodes left there anyways.
.
My million $ question was that whether the c could possibly spread from the lymphs where they were living (if there is still stuff in the remaining ones), of course no one can answer that.
So far those who say go for node dissection:
1 - My oncologist -- has a HUGE weight
1 - Major cancer center(Moffitt) surgeon(who is kind of a rookie)
Those who say no go for node dissection, but just do rads:
2 - radiation oncologists
3 - surgeons
1 - major cancer center tumor board(MD Anderson).(that includes my surgeon)
So no rads are winning 6 to 2.
.
If I do not do dissection my oncologist said that he was ok with it, however then that means that I can not trust him 100% in my treatment going forward..and I need to find a new oncologist ( he already is my 2nd one !)
.
I know at this point the response from everyone will be 'good grief girl, just let it go'
BUT I CANNOT THATS NOT ME !!!
I am being tested but not sure on what
Sunday, January 27, 2008
Road I course
This week work has started to crank up and my mind which has been pretty much on vacation since August is having a hard time focusing. I am hoping that it will get better quickly.
.
Friday evening from 6-9 PM and Saturday from 8AM-3PM we attended the Road I cycling course given by Florida Bicycle Association with my friend Z. I was delighted to see Several Bobbies (Ellen, Keri,Pauline) ! I love bikes so much that I had a great time. Just being around cyclists and bikes gives me such a warm feeling.
We also had a session where we practiced various bike handling skills (quick stop, obstacle avoiding manueveur, quick turn) on top of the parking garage. Then went on a road test on how to cycle in traffic in Downtown Orlando.
Z getting fitted on her bike by Tina.(she was trying to take off the aerobars despite our objection .. Ohh but they look really cool !lol ...they make the handlebars heavier and actually do impact steering quite a bit.. but still they make the bike look 'hot' which is important for us gals.
I learned a lot from the course, I am curious to find out about my test results (we also had a written test, and an assessment of our riding - Keri was going to assess our group)
.
I need to work on my nutrition, I have slacked off gained weight which in turn is making me lazy,I feel fatigued and do not want to get caught in this vicious circle. It would be nice to have a coach that I could work with, but am not sure whether I can find one in this area.
.
Went out to dinner with Ferit Saturday night, I feel a bit tired and snoozed off early. The weather has been pretty lousy lately not only a bit chilly but rainy too, will not be able to go riding outdoors this weekend.
.
Sunday was basically mope around the house day.
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I think I know what is happening,my body was expecting to be down since this would have been a chemo week.. so in anticipation of getting hit by the toxins, it kind of wanted me to slow down.. at least thats my explanation of the lack of energy state. Wonder if I had a 'anticipated chemo' syndrome ?
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I am off all meds, no sleep aids(not even over the counter), or antidepressants..
LIFE IS GOOD !!
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Friday evening from 6-9 PM and Saturday from 8AM-3PM we attended the Road I cycling course given by Florida Bicycle Association with my friend Z. I was delighted to see Several Bobbies (Ellen, Keri,Pauline) ! I love bikes so much that I had a great time. Just being around cyclists and bikes gives me such a warm feeling.
We also had a session where we practiced various bike handling skills (quick stop, obstacle avoiding manueveur, quick turn) on top of the parking garage. Then went on a road test on how to cycle in traffic in Downtown Orlando.
Z getting fitted on her bike by Tina.(she was trying to take off the aerobars despite our objection .. Ohh but they look really cool !lol ...they make the handlebars heavier and actually do impact steering quite a bit.. but still they make the bike look 'hot' which is important for us gals.
I learned a lot from the course, I am curious to find out about my test results (we also had a written test, and an assessment of our riding - Keri was going to assess our group)
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I need to work on my nutrition, I have slacked off gained weight which in turn is making me lazy,I feel fatigued and do not want to get caught in this vicious circle. It would be nice to have a coach that I could work with, but am not sure whether I can find one in this area.
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Went out to dinner with Ferit Saturday night, I feel a bit tired and snoozed off early. The weather has been pretty lousy lately not only a bit chilly but rainy too, will not be able to go riding outdoors this weekend.
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Sunday was basically mope around the house day.
.
I think I know what is happening,my body was expecting to be down since this would have been a chemo week.. so in anticipation of getting hit by the toxins, it kind of wanted me to slow down.. at least thats my explanation of the lack of energy state. Wonder if I had a 'anticipated chemo' syndrome ?
.
I am off all meds, no sleep aids(not even over the counter), or antidepressants..
LIFE IS GOOD !!
Thursday, January 24, 2008
Wednesday Was it a pink day ?
At the office I went down to say goodbye to my friends who were working in the first group that I had ever been in and we realized that we all were wearing pink, that was really funny.
My daughter seems to have found her way to overcome the shortcome of the school that she is attending, due to it being a new school there are kinks that are affecting her education she is taking an online course in which she seems to be doing a lot better. She is a smart girl but seems to have different reasons for going to school ( socializing) well, which teenager goes to school for the love of learning anyways. Sometimes we as parents do need to let the kids figure out the solutions for themselves.
My daughter seems to have found her way to overcome the shortcome of the school that she is attending, due to it being a new school there are kinks that are affecting her education she is taking an online course in which she seems to be doing a lot better. She is a smart girl but seems to have different reasons for going to school ( socializing) well, which teenager goes to school for the love of learning anyways. Sometimes we as parents do need to let the kids figure out the solutions for themselves.
Tuesday, January 22, 2008
Ok I am getting the surgery - rads ???
After another sleepless night( the chillow did not work somehow) I went and lead the 5:45 am indoor cycling class, although I have to literally scrape myself out of my warm bed once I get there I enjoy it immensely. None of the sleep aids touch my insomnia..the only thing that has helped so far was 3 mg Melatonin but that did not work either last night somehow.
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Went to the office but was not able to get much done due to the 'ongoing final research and marathon surgery scheduler phone calls'. Had lunch with J who is also a bc survivor, we exchanged battle stories.
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After doing a 'deep dive' into the Breast Cancer treatment plans I have decided again to go ahead with the axillary node dissection.
Just as I was comfortable with hitting with all the ammo that I can find ( surgery + rads) another article got published on the Journal Of Clinical Oncology.. go figure..another decision to make nothing comes for free, each option has its own price to pay.
Effect of Breast Cancer Radiotherapy and Cigarette Smoking on Risk of Second Primary Lung Cancer
Conclusion: PMRT(Post Mastectomy Radiation Therapy) after a diagnosis of BC sharply increased the risk of second primary LC(Lung Cancer), especially in the ipsilateral lung, among ever-smokers. Clinicians should consider including smoking history in their discussions with patients about the risks and benefits of PMRT.
Trying to schedule the Plastic Surgeon and Breast Surgeon will not be easy I will be pushing to get it done asap, but they do not have availability.
Did 30 minutes of power yoga, I definitely am so tight, have to work on that before I get the surgery since I will be down for a couple of weeks after that too. Recevied the book on Lymphedema that was suggested will start studying that to be proactive about that subject, dont' want to be caught blind sided.
Z and I are on the track of weight loss, I have finally been able to harness my appetite and am keeping the calories between 1200-1500 the weight has started to drop slowly. I will try to limit the weight loss to 2 pounds/week cause I have to keep my immune system high and increase the White Blood Cell count till the surgery for good recovery.
One of my forum friends gave me the following info:
"In its latest edition, Prevention magazine says a poor diet is a top factor in making us susceptible to illness. It then lists the top five foods that give your body the best immunity: beef, sweet potatoes, mushrooms, tea and yogurt. " interesting I was trying to avoid red meat.. however it also adds the following comment:
"Of the five immunity-boosting foods, beef may be the most surprising, considering health experts recommend limiting our red meat intake. But moderation is still key.
"People should still not be eating a 24-ounce porterhouse on a daily basis," Skolnik said. "A three-ounce portion of beef -- and importantly very lean beef that is low in fat -- is an important source of zinc."
Zinc deficiency can greatly increase your risk of infection. Zinc helps develop white blood cells, the cells that we really need those to fight off foreign bacteria and viruses."
I also learned that lack of Vitamin D lead to Extremely Dense Breast Tissue ( mine was that before it got scooped out.. the mammogram reports were red flags staring from day one I still do not have a clue why no one got alarmed and ordered an MRI !). And that when vitamin D levels were measured for Breast Cancer patients they measured really low. So Vitamin D3 is one supplement that I will be using after my treatment ends.
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Went to the office but was not able to get much done due to the 'ongoing final research and marathon surgery scheduler phone calls'. Had lunch with J who is also a bc survivor, we exchanged battle stories.
.
After doing a 'deep dive' into the Breast Cancer treatment plans I have decided again to go ahead with the axillary node dissection.
Just as I was comfortable with hitting with all the ammo that I can find ( surgery + rads) another article got published on the Journal Of Clinical Oncology.. go figure..another decision to make nothing comes for free, each option has its own price to pay.
Effect of Breast Cancer Radiotherapy and Cigarette Smoking on Risk of Second Primary Lung Cancer
Conclusion: PMRT(Post Mastectomy Radiation Therapy) after a diagnosis of BC sharply increased the risk of second primary LC(Lung Cancer), especially in the ipsilateral lung, among ever-smokers. Clinicians should consider including smoking history in their discussions with patients about the risks and benefits of PMRT.
Trying to schedule the Plastic Surgeon and Breast Surgeon will not be easy I will be pushing to get it done asap, but they do not have availability.
Did 30 minutes of power yoga, I definitely am so tight, have to work on that before I get the surgery since I will be down for a couple of weeks after that too. Recevied the book on Lymphedema that was suggested will start studying that to be proactive about that subject, dont' want to be caught blind sided.
Z and I are on the track of weight loss, I have finally been able to harness my appetite and am keeping the calories between 1200-1500 the weight has started to drop slowly. I will try to limit the weight loss to 2 pounds/week cause I have to keep my immune system high and increase the White Blood Cell count till the surgery for good recovery.
One of my forum friends gave me the following info:
"In its latest edition, Prevention magazine says a poor diet is a top factor in making us susceptible to illness. It then lists the top five foods that give your body the best immunity: beef, sweet potatoes, mushrooms, tea and yogurt. " interesting I was trying to avoid red meat.. however it also adds the following comment:
"Of the five immunity-boosting foods, beef may be the most surprising, considering health experts recommend limiting our red meat intake. But moderation is still key.
"People should still not be eating a 24-ounce porterhouse on a daily basis," Skolnik said. "A three-ounce portion of beef -- and importantly very lean beef that is low in fat -- is an important source of zinc."
Zinc deficiency can greatly increase your risk of infection. Zinc helps develop white blood cells, the cells that we really need those to fight off foreign bacteria and viruses."
I also learned that lack of Vitamin D lead to Extremely Dense Breast Tissue ( mine was that before it got scooped out.. the mammogram reports were red flags staring from day one I still do not have a clue why no one got alarmed and ordered an MRI !). And that when vitamin D levels were measured for Breast Cancer patients they measured really low. So Vitamin D3 is one supplement that I will be using after my treatment ends.
Monday, January 21, 2008
Love having a Monday off.
I do not even recall when was the last time I was able to sleep through the night ! Yey ! I think the chillow helped, although it was toasty warm by the morning, exhausted from catching my hot flash energies I slept like a baby.
The weather forecast was predicting it to be in the 40's with 20 mph winds, so we had scrapped the ride that we had planned with Z.
Went on a walk with Candy, as I was walking I was also asking for a sign to come from somewhere(some cloud formations ? writings on the lake by the 2 swans.. or designs on a dog poop .. don't ask me what I was waiting for ) to help me make up my mind regarding my future treatments.
The weather was so beautiful we ended up changing plans and coming home after walking for 3.5 miles and planned an afternoon ride at the Clermont trail with Z. I was never able to see a sign btw.
The girls were not home and had the house to myself, took an early nap, that recharged me. Although I am recovering really fast I seem to need a lot more down time to bounce back from any activity. Well I guess considering that I am only 10 days out of 4 months of Dose Dense chemo it is still a good performance.
Went to the WaterFront park and biked to Killarney station and back, the wind was brutal and the rolling hills ( did they install these hills now ? I have biked there so many times and really do not recall that trail having that many hills .. ) We managed to get about 16 miles in 1:30 minutes and my quads definitely felt it.
Stopped to have coffee on our way back at N's house, it was about 7:20 by the time I got home.
It was a really nice day overall.
The weather forecast was predicting it to be in the 40's with 20 mph winds, so we had scrapped the ride that we had planned with Z.
Went on a walk with Candy, as I was walking I was also asking for a sign to come from somewhere(some cloud formations ? writings on the lake by the 2 swans.. or designs on a dog poop .. don't ask me what I was waiting for ) to help me make up my mind regarding my future treatments.
The weather was so beautiful we ended up changing plans and coming home after walking for 3.5 miles and planned an afternoon ride at the Clermont trail with Z. I was never able to see a sign btw.
The girls were not home and had the house to myself, took an early nap, that recharged me. Although I am recovering really fast I seem to need a lot more down time to bounce back from any activity. Well I guess considering that I am only 10 days out of 4 months of Dose Dense chemo it is still a good performance.
Went to the WaterFront park and biked to Killarney station and back, the wind was brutal and the rolling hills ( did they install these hills now ? I have biked there so many times and really do not recall that trail having that many hills .. ) We managed to get about 16 miles in 1:30 minutes and my quads definitely felt it.
Stopped to have coffee on our way back at N's house, it was about 7:20 by the time I got home.
It was a really nice day overall.
Saturday, January 19, 2008
Discovery of fat around belly --- long run..
Why do gals who go through menopause gain weight in their tummy's, found an interesting explanation on one of the forum threads:it is the body's response to estrogen deprivation.Bellyfat puts estrogen right near our organs, which are deprived of estrogen They keep trying to get estrogen from the bellyfat.
Hmm that might explain the spare tire that plays the jello-man when I run, my ovaries have been taking some vacation due to chemo blast. However I do have to lose the 20 pounds that I gained before I start tamoxifen I will not use the chemo / drug excuse to balloon up any further.
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We decided with Z to share our fitday journal links and start logging our food and workouts starting Sunday
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Sunday did a 2:24 9 mile walk/jog with Z at the gym alternating between 1:30 min walk/1:30 min jog and 1 min jog 2 min walk. Walks at 3 mph, jogs at 5 mph, with 1%incline.
We gave 2 breaks at hours 1 and 2 for a couple of minutes. The first hour was fun we were chatting along and Ferit also came and ran with us(that is the beauty of the treadmill you can run together with people who leave you in the dust) I am getting slower and slower and can't figure out why(Other than the weight gain)
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I emailed the coordinators of the 2 studies that I am interested in which were closed to get any preliminary results that they might be able to release on studies ACOSOG Z0011 and S9927.
Hmm that might explain the spare tire that plays the jello-man when I run, my ovaries have been taking some vacation due to chemo blast. However I do have to lose the 20 pounds that I gained before I start tamoxifen I will not use the chemo / drug excuse to balloon up any further.
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We decided with Z to share our fitday journal links and start logging our food and workouts starting Sunday
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Sunday did a 2:24 9 mile walk/jog with Z at the gym alternating between 1:30 min walk/1:30 min jog and 1 min jog 2 min walk. Walks at 3 mph, jogs at 5 mph, with 1%incline.
We gave 2 breaks at hours 1 and 2 for a couple of minutes. The first hour was fun we were chatting along and Ferit also came and ran with us(that is the beauty of the treadmill you can run together with people who leave you in the dust) I am getting slower and slower and can't figure out why(Other than the weight gain)
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I emailed the coordinators of the 2 studies that I am interested in which were closed to get any preliminary results that they might be able to release on studies ACOSOG Z0011 and S9927.
What I need is the result of the ACOSOG Z0011 trial ! Which is still going on.
The ACOSOG Z0011 trial is a prospective study that randomizes patients with a positive SLN biopsy to either completion axillary dissection or no further surgery
Preliminary Outcome Analysis in Patients With Breast Cancer and a Positive Sentinel Lymph Node Who Declined Axillary Dissection
The arguments that suggest that it may be appropriate to avoid completion dissection fall into the following categories:
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(1) the incidence of positive nonsentinel nodes is low for micrometastasis,
(2) the adjuvant chemotherapy is likely to destroy any microscopic involvement,
(3) information obtained from completion axillary dissection rarely alters treatment recommendations,
(4) there is no conclusive evidence that immediate dissection is better than observation and delayed dissection if metastatic growth in the axilla is subsequently noted.
Hmm.. an interesting info from this article:
There was a low incidence of positive nonsentinel nodes in patients with micrometastasis (ductal, 0%; lobular, 31%) compared with macrometastasis (ductal, 29%; lobular, 75%). Likewise, Chu et al.12 reported a 7% rate of further disease in the axilla when the SLN had a <2-mm focus of tumor and 55% if a >2-mm focus of tumor was identified. Kamath et al.,13 in evaluating SLN micrometastasis alone, found a 15% risk of residual disease.
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Next, adjuvant chemotherapy may contribute to the locoregional control of axillary metastases. Furukawa et al.14 evaluated the response of lymph node metastasis to various chemotherapeutic agents and found that nodal tumor was chemosensitive. It has also been shown that patients with a primary tumor response to neoadjuvant chemotherapy are less likely to have nodal metastasis at surgery.15,16 Fisher et al.,17 in reviewing data from National Surgical Adjuvant Breast and Bowel Project B-18, found 36% of clinically node-positive patients were pathologically node negative after receiving neoadjuvant chemotherapy. Together, these studies suggest that chemotherapy is likely to ablate residual microscopic axillary metastases.
Also, information obtained from completion axillary dissection may not change the patient’s treatment. Baxter et al.18 have shown that most patients with invasive breast cancer undergo adjuvant systemic therapy regardless of axillary node status, a finding supported by the data of Fisher et al.19 and discussed by Singletary20 in her review of systemic treatment after SLN biopsy. Miltenburg et al.,21 in their meta-analysis of SLN biopsy in breast cancer, question the therapeutic benefit of total level I and II lymph node removal, estimating that 70 of 100 axillas will not contain cancer.
Limited information is available regarding the outcome of patients with positive sentinel node resection and observation after adjuvant therapy. The data presented in this study suggest that SLN biopsy without axillary dissection may be an acceptable alternative to completion axillary dissection. However, longer follow-up and prospective randomized studies are needed to delineate appropriate criteria for patient selection and confirm the safety of this approach. Patients should be encouraged to enroll in ACOSOG Z0011, which randomizes to completion dissection or no further surgery. On the basis of the preliminary results of this study, the latter approach is both ethical and justifiable.
Preliminary Outcome Analysis in Patients With Breast Cancer and a Positive Sentinel Lymph Node Who Declined Axillary Dissection
The arguments that suggest that it may be appropriate to avoid completion dissection fall into the following categories:
.
(1) the incidence of positive nonsentinel nodes is low for micrometastasis,
(2) the adjuvant chemotherapy is likely to destroy any microscopic involvement,
(3) information obtained from completion axillary dissection rarely alters treatment recommendations,
(4) there is no conclusive evidence that immediate dissection is better than observation and delayed dissection if metastatic growth in the axilla is subsequently noted.
Hmm.. an interesting info from this article:
There was a low incidence of positive nonsentinel nodes in patients with micrometastasis (ductal, 0%; lobular, 31%) compared with macrometastasis (ductal, 29%; lobular, 75%). Likewise, Chu et al.12 reported a 7% rate of further disease in the axilla when the SLN had a <2-mm focus of tumor and 55% if a >2-mm focus of tumor was identified. Kamath et al.,13 in evaluating SLN micrometastasis alone, found a 15% risk of residual disease.
.
Next, adjuvant chemotherapy may contribute to the locoregional control of axillary metastases. Furukawa et al.14 evaluated the response of lymph node metastasis to various chemotherapeutic agents and found that nodal tumor was chemosensitive. It has also been shown that patients with a primary tumor response to neoadjuvant chemotherapy are less likely to have nodal metastasis at surgery.15,16 Fisher et al.,17 in reviewing data from National Surgical Adjuvant Breast and Bowel Project B-18, found 36% of clinically node-positive patients were pathologically node negative after receiving neoadjuvant chemotherapy. Together, these studies suggest that chemotherapy is likely to ablate residual microscopic axillary metastases.
Also, information obtained from completion axillary dissection may not change the patient’s treatment. Baxter et al.18 have shown that most patients with invasive breast cancer undergo adjuvant systemic therapy regardless of axillary node status, a finding supported by the data of Fisher et al.19 and discussed by Singletary20 in her review of systemic treatment after SLN biopsy. Miltenburg et al.,21 in their meta-analysis of SLN biopsy in breast cancer, question the therapeutic benefit of total level I and II lymph node removal, estimating that 70 of 100 axillas will not contain cancer.
Limited information is available regarding the outcome of patients with positive sentinel node resection and observation after adjuvant therapy. The data presented in this study suggest that SLN biopsy without axillary dissection may be an acceptable alternative to completion axillary dissection. However, longer follow-up and prospective randomized studies are needed to delineate appropriate criteria for patient selection and confirm the safety of this approach. Patients should be encouraged to enroll in ACOSOG Z0011, which randomizes to completion dissection or no further surgery. On the basis of the preliminary results of this study, the latter approach is both ethical and justifiable.
Friday Saturday
Friday went out to dinner to Jeffrey's to celebrade S and Z's birthdays, then had our Book Club meeting we read 'Eat, Love and Prey' this time. I was hoping for a more heated discussion but somehow we must have spent too much energy at the dinner and the discussion was not as climactic as I would have liked. Maybe my expectations are a bit too high from these get togethers but they are just turning out to be really mellow. Came home around 1:30 am found a defenseless veggie pizza on the table and wolfed it down.. my Chillow came .. yey ! This is supposed to be really good for the hot flashes that I am having at night. ( a cooling pillow)
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Saturday morning went to Gaylor Palms hotel for my mil's 70th birthday. I ate like a PIG ! not sparing donuts, cream cheese.. someone has to stop me. It was a very nice family get together.
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Vegged out the remainnig of the day.
Tomorrow is going to be in the 40's so decided to do our long walk/jog with Z on the dreadmill.
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Saturday morning went to Gaylor Palms hotel for my mil's 70th birthday. I ate like a PIG ! not sparing donuts, cream cheese.. someone has to stop me. It was a very nice family get together.
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Vegged out the remainnig of the day.
Tomorrow is going to be in the 40's so decided to do our long walk/jog with Z on the dreadmill.
Thursday, January 17, 2008
Since I had not gotten a call from the Plastic Surgeon yesterday decided to call in his office and talk to his nurse G. I knew that he would not be in the office seeing patients on Thursday.
I was put on hold and then suddenly transerred to Dr.P .. I was pleasantly surprised he apologized for not calling me yesterday and said that he had a lengthy discussion with Dr. S the radiation oncologist who stook his ground saying that I did not need surgery but radiation. Dr. P said that they were taking my case again to the tumor board at the hospital today and he would join the call and call me on what the final decision was. Oh boy I feel like I have stepped into some kind of power struggle between my oncologist and radiation oncologist. I understand and respect their difference in opinions however they should get together to deliver a treatment plan to me as a Team !!! Bouncing me around is really not acceptable.
I AM ECSTATIC !!! Finally one of the doctors is taking responsibility to coordinate and it is not my oncologist, surgeon or radiation oncologist but my plastic surgeon !!
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At noon since it was raining scrapped the plan for riding outdoors and decided to hit the pool to see whether I could still float(have not been in the pool for about 6 months at least). Was able to get in about 500 yards (took at least 15 minutes with stops every 100 ) I suck.. but it seems workable.
Then went into the steam room for about 10 minutes, felt kind of good, will do the sequence like that from now on.
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At night did a short weights workout for about 30 minutes. And did the elliptical for 20 minutes. I was really tired, still not recovered I guess from the chemo last week.
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I was glued to the phone for the whole day waiting for a call from the PS, he called around 6 PM stating that he attended the call but the radiation oncologist had submitted my case to be addressed in the call 2 weeks from now !!! WHAT ?? They wanted to review my pathology slides ( oooppss. they are at Moffit need to bring back to Orlando ASAP ). He apologized that he could not provide any more insight. Somehow I got the vibes that his involvement in this was not welcomed. I am thinking more and more that I am caught between the fight of 2 major school of thoughts. The surgery principles regarding node management might be in a turning point within a couple of years just like my friend K who is also a surgeon stated.
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I am at the high end of the studies.. my Sentinel Nodes being positive at .2(micro), and >2mm(cutoff for macro), the studies not favoring ALND have tumor size 2cm ( mine is 2.5 cm).
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Axillary Node removal is going to be considered more of a staging tool then part of the treatment for cases where there are no clinical diagnosis of c(that is if they are not palpable or appear in the scans ) in the lymph nodes and the c in the sentinel node biopsy is microscopic(less than 2mm.. I have 1 that is 2mm just at the borderline ) I do believe that chemo and radiation actually will wipe out.. radiation acting like 'bleach' in doing a major cleanup. It might be an overkill to do the ALND.. hmm.. again..
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The direction seems to be going towards expanding the scope of the Sentinel Node Biopsy, by taking not only 1-2 but 4 or more nodes. ( which is my case 6 nodes ).However at this point there are not enough studies ( I only found 2 studies
Axillary Recurrence After Sentinel Node Biopsy
which says in the end :
The introduction of sentinel node biopsy (SNB) into breast cancer care marks a further progression in our understanding of this disease and has permitted a less extensive surgical option for many breast cancer patients.9–13 SNB allows the removal of fewer lymph nodes and has afforded a more targeted evaluation of the sentinel nodes, with decreased morbidity when compared with axillary dissection.6–8,14 The identification of histologically negative sentinel nodes indicates that an axillary dissection is unnecessary.7,9,12,15–17 The role of axillary dissection for patients with microscopic involvement of the sentinel nodes remains in question.
Thus far, 2 preliminary studies with 31 and 46 women with positive sentinel nodes and no further axillary surgery have recently been published. They showed no incidence of axillary recurrence after at least 2 years of follow-up. The extent of nonsentinel nodal involvement has been shown to decrease with smaller primary tumors and decreased axillary tumor burden. Thus, axillary dissection may have more limited utility with early-stage disease.
One hundred fifty-eight (68%) sentinel node–positive patients underwent completion axillary dissection (Table 4). The mean age for this patient population was 57 years, the mean tumor size was 2.4 cm, the mean and median number of sentinel nodes were 1.8 and 1, respectively, the median number of additional nodes harvested during axillary dissection was 12, and the mean follow-up was 28.6 months. Seventy-six (48%) of these patients had additional axillary disease, with an average total number of 3.7 (median, 2) positive nodes. Thus, an average of 1.9 additional positive nodes were yielded through completion axillary dissection. The median size of nodal metastasis for patients undergoing axillary dissection was 7 mm; the mean size was 8.4 mm (Table 5). Of the patients managed with breast-conserving surgery, 85% received radiotherapy. Eighty-one percent received systemic therapy. No sentinel node–positive patient who underwent completion axillary dissection has had an axillary recurrence.
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The remaining 73 (32%) sentinel node–positive patients were managed with observation alone (Table 4). The mean follow-up for this patient population was 27.6 months, with a mean age of 59 years. The mean tumor size for these observed patients was 1.9 cm, the mean number of positive sentinel nodes was 1.2 (median, 1), and the median number of nonsentinel nodes harvested was 0. The median size of nodal metastasis for patients managed with observation alone was 1 mm (median, 2.7 mm; Table 5). Tumor size and pathologic grade distribution for this patient population was reflective of the larger sentinel node–positive patient population (Table 3). In this group, 58 (79%) of the observed sentinel node–positive patients were ER positive, and 15 (21%) were ER negative. Of the patients managed with breast-conserving surgery, 92% underwent radiotherapy. Eighty-five percent received adjuvant systemic therapy. No patient in the sentinel node– positive observation group has had an axillary recurrence (odds ratio, .37; P = .725). Management with axillary dissection or observation had no influence on recurrence in node-positive patients (P = .578).
Background: Sentinel node biopsy (SNB) has evolved as the standard of care in the surgical staging of breast cancer. This technique is accurate for surgical staging of axillary nodal disease. We hypothesized that axillary recurrence after SNB is rare and that SNB may provide regional control in patients with microscopic nodal involvement.
Methods: With institutional review board approval, SNB was performed with peritumoral injection of 99mTc-labeled sulfur colloid. From 1996 to 2003, 1167 patients were entered into a prospective cancer database after surgical therapy; 916 patients consented to long-term follow-up. Fifty-two patients (5.7%) did not map successfully and were excluded, leading to a study population of 864 patients. The median follow-up was 27.4 months (range, 1–98 months).
Results: The median number of sentinel nodes harvested was 2, and 633 (73%) patients had negative sentinel nodes. Thirty (4.7%) of those sentinel node–negative patients underwent completion axillary dissection, whereas 592 (94%) patients were followed up with observation. A total of 231 (27%) had positive sentinel nodes: 158 (68%) of these patients underwent completion axillary dissection, and 73 (32%) were managed with observation alone. Two (.32%) patients who were sentinel node negative had an axillary recurrence; one of these patients had undergone completion axillary dissection. No patient in the observed sentinel node–positive group had an axillary recurrence (odds ratio, .37; P = .725).
Conclusions: On the basis of a median follow-up of 27.4 months, axillary recurrence after SNB is extraordinarily rare regardless of nodal involvement, thus indicating that this technique provides an accurate measure of axillary disease and may impart regional control for patients with node-positive disease.
2nd one:
Is Axillary Dissection Obsolete for the Management of Breast Cancer?
3rd one:
How Much Is Enough? The Continuing Debate on the Axillary Lymph Node Dissection in Breast Cancer
( I do not have clinically positive lymph node disease)
Currently, it is accepted that ALND(axillary node dissection) is indicated when a patient presents with clinically positive axillary lymph node disease. As stated above, there is also agreement that no further ALND is indicated when the SLNB shows no disease. The major point of debate now is what to do with positive SLN in patients with otherwise clinically negative regional disease in early breast cancer. Studies have shown that the SLN is the only positive lymph node in 38% to 67% of cases when completion ALND was followed.7 This reflects dramatically changed presentation over the last decade of breast cancer with decreasing primary tumor size and lymph node positivity in patients with invasive breast cancer.8 Unfortunately, there is no proven method other than ALND that can identify the group with additional axillary nodal disease.
There is no clear indication that ALND provides a survival benefit. In the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-04, ALND did not show survival benefit in patients without clinical evidence of axillary adenopathy. With 25 years of follow-up, no significant survival differences have emerged.9 Proponents of ALND argue that B-04 did not have enough patients in the trial to see a survival benefit. A metaanalysis of six trials evaluating the impact of ALND on breast cancer survival showed an average survival benefit of 5% with ALND (95% CI=1.7-8.0%, probability of survival benefit >99.5%).10 It warrants mention that these patients received no adjuvant therapy and that tumor size was larger in these studies than the tumor size we see now. This exemplifies a common problem in evaluating the issues surrounding breast cancer treatment. The problem is that only a small benefit can be seen many years after the studies are started, and that demonstration of the benefit requires large numbers of patients as in a meta-analysis.11 Thus, the data may no longer be applicable because of improved survival from other new treatment modalities.
4th one:
There is currently a large national clinical trial called Z0011, which is evaluating exactly that question. In this trial some patients are chosen (randomized) to receive a full axillary lymph node dissection if their sentinel lymph node is positive. Some patients are chosen to not undergo any further lymph node dissection, and they are carefully watched. All of these patients will receive chemotherapy. The two groups of patients will be compared to see if there is a benefit to doing the full axillary dissection if the sentinel lymph node is positive. Or, alternatively, they will be compared to see if there is a detriment to not doing a full axillary dissection if the sentinel lymph node is positive. This is still experimental, and should only be done under controlled circumstances after being enrolled in this trial by a participating breast cancer surgeon. Doing a full axillary lymph node dissection if the sentinel lymph node is positive is still considered “the standard of care” with which all patients should be treated. To do otherwise, risks under treating your breast cancer.
5th one:
Preliminary Outcome Analysis in Patients With Breast Cancer and a Positive Sentinel Lymph Node Who Declined Axillary Dissection
Limited information is available regarding the outcome of patients with positive sentinel node resection and observation after adjuvant therapy. The data presented in this study suggest that SLN biopsy without axillary dissection may be an acceptable alternative to completion axillary dissection. However, longer follow-up and prospective randomized studies are needed to delineate appropriate criteria for patient selection and confirm the safety of this approach. Patients should be encouraged to enroll in ACOSOG Z0011, which randomizes to completion dissection or no further surgery. On the basis of the preliminary results of this study, the latter approach is both ethical and justifiable.
6th one:
Axillary Dissection Is Not Required for All Patients With Breast Cancer and Positive Sentinel Nodes
7th one: a smaller trial but interesting results:
Sentinel node biopsy should be supplemented by axillary sampling in patients with small breast cancers
For patients with a positive sentinel node, the finding of additional positive nodes in the axillary sample strongly indicated the likelihood of further positive nodes in the axilla, therefore, justifying an axillary clearance. If the SNB was positive and the ANS(axillary node sampling-getting a few more after SN) negative, the likelihood of further malignant nodes being revealed by an axillary clearance was much lower (1/12, 8%) but with only this limited evidence we still feel that this figure justifies proceeding to ANC.
8th one:
Is Axillary Dissection Obsolete for the Management of Breast Cancer?
9th one:
[P-3] Micrometastases in the sentinel node: take it or leave it? -well I have macrometastases.
10th one:
Clinical practice guidelines for the care and treatment of breast cancer: 16. Locoregional post-mastectomy radiotherapy
I was put on hold and then suddenly transerred to Dr.P .. I was pleasantly surprised he apologized for not calling me yesterday and said that he had a lengthy discussion with Dr. S the radiation oncologist who stook his ground saying that I did not need surgery but radiation. Dr. P said that they were taking my case again to the tumor board at the hospital today and he would join the call and call me on what the final decision was. Oh boy I feel like I have stepped into some kind of power struggle between my oncologist and radiation oncologist. I understand and respect their difference in opinions however they should get together to deliver a treatment plan to me as a Team !!! Bouncing me around is really not acceptable.
I AM ECSTATIC !!! Finally one of the doctors is taking responsibility to coordinate and it is not my oncologist, surgeon or radiation oncologist but my plastic surgeon !!
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At noon since it was raining scrapped the plan for riding outdoors and decided to hit the pool to see whether I could still float(have not been in the pool for about 6 months at least). Was able to get in about 500 yards (took at least 15 minutes with stops every 100 ) I suck.. but it seems workable.
Then went into the steam room for about 10 minutes, felt kind of good, will do the sequence like that from now on.
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At night did a short weights workout for about 30 minutes. And did the elliptical for 20 minutes. I was really tired, still not recovered I guess from the chemo last week.
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I was glued to the phone for the whole day waiting for a call from the PS, he called around 6 PM stating that he attended the call but the radiation oncologist had submitted my case to be addressed in the call 2 weeks from now !!! WHAT ?? They wanted to review my pathology slides ( oooppss. they are at Moffit need to bring back to Orlando ASAP ). He apologized that he could not provide any more insight. Somehow I got the vibes that his involvement in this was not welcomed. I am thinking more and more that I am caught between the fight of 2 major school of thoughts. The surgery principles regarding node management might be in a turning point within a couple of years just like my friend K who is also a surgeon stated.
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I am at the high end of the studies.. my Sentinel Nodes being positive at .2(micro), and >2mm(cutoff for macro), the studies not favoring ALND have tumor size 2cm ( mine is 2.5 cm).
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Axillary Node removal is going to be considered more of a staging tool then part of the treatment for cases where there are no clinical diagnosis of c(that is if they are not palpable or appear in the scans ) in the lymph nodes and the c in the sentinel node biopsy is microscopic(less than 2mm.. I have 1 that is 2mm just at the borderline ) I do believe that chemo and radiation actually will wipe out.. radiation acting like 'bleach' in doing a major cleanup. It might be an overkill to do the ALND.. hmm.. again..
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The direction seems to be going towards expanding the scope of the Sentinel Node Biopsy, by taking not only 1-2 but 4 or more nodes. ( which is my case 6 nodes ).However at this point there are not enough studies ( I only found 2 studies
Axillary Recurrence After Sentinel Node Biopsy
which says in the end :
The introduction of sentinel node biopsy (SNB) into breast cancer care marks a further progression in our understanding of this disease and has permitted a less extensive surgical option for many breast cancer patients.9–13 SNB allows the removal of fewer lymph nodes and has afforded a more targeted evaluation of the sentinel nodes, with decreased morbidity when compared with axillary dissection.6–8,14 The identification of histologically negative sentinel nodes indicates that an axillary dissection is unnecessary.7,9,12,15–17 The role of axillary dissection for patients with microscopic involvement of the sentinel nodes remains in question.
Thus far, 2 preliminary studies with 31 and 46 women with positive sentinel nodes and no further axillary surgery have recently been published. They showed no incidence of axillary recurrence after at least 2 years of follow-up. The extent of nonsentinel nodal involvement has been shown to decrease with smaller primary tumors and decreased axillary tumor burden. Thus, axillary dissection may have more limited utility with early-stage disease.
One hundred fifty-eight (68%) sentinel node–positive patients underwent completion axillary dissection (Table 4). The mean age for this patient population was 57 years, the mean tumor size was 2.4 cm, the mean and median number of sentinel nodes were 1.8 and 1, respectively, the median number of additional nodes harvested during axillary dissection was 12, and the mean follow-up was 28.6 months. Seventy-six (48%) of these patients had additional axillary disease, with an average total number of 3.7 (median, 2) positive nodes. Thus, an average of 1.9 additional positive nodes were yielded through completion axillary dissection. The median size of nodal metastasis for patients undergoing axillary dissection was 7 mm; the mean size was 8.4 mm (Table 5). Of the patients managed with breast-conserving surgery, 85% received radiotherapy. Eighty-one percent received systemic therapy. No sentinel node–positive patient who underwent completion axillary dissection has had an axillary recurrence.
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The remaining 73 (32%) sentinel node–positive patients were managed with observation alone (Table 4). The mean follow-up for this patient population was 27.6 months, with a mean age of 59 years. The mean tumor size for these observed patients was 1.9 cm, the mean number of positive sentinel nodes was 1.2 (median, 1), and the median number of nonsentinel nodes harvested was 0. The median size of nodal metastasis for patients managed with observation alone was 1 mm (median, 2.7 mm; Table 5). Tumor size and pathologic grade distribution for this patient population was reflective of the larger sentinel node–positive patient population (Table 3). In this group, 58 (79%) of the observed sentinel node–positive patients were ER positive, and 15 (21%) were ER negative. Of the patients managed with breast-conserving surgery, 92% underwent radiotherapy. Eighty-five percent received adjuvant systemic therapy. No patient in the sentinel node– positive observation group has had an axillary recurrence (odds ratio, .37; P = .725). Management with axillary dissection or observation had no influence on recurrence in node-positive patients (P = .578).
Background: Sentinel node biopsy (SNB) has evolved as the standard of care in the surgical staging of breast cancer. This technique is accurate for surgical staging of axillary nodal disease. We hypothesized that axillary recurrence after SNB is rare and that SNB may provide regional control in patients with microscopic nodal involvement.
Methods: With institutional review board approval, SNB was performed with peritumoral injection of 99mTc-labeled sulfur colloid. From 1996 to 2003, 1167 patients were entered into a prospective cancer database after surgical therapy; 916 patients consented to long-term follow-up. Fifty-two patients (5.7%) did not map successfully and were excluded, leading to a study population of 864 patients. The median follow-up was 27.4 months (range, 1–98 months).
Results: The median number of sentinel nodes harvested was 2, and 633 (73%) patients had negative sentinel nodes. Thirty (4.7%) of those sentinel node–negative patients underwent completion axillary dissection, whereas 592 (94%) patients were followed up with observation. A total of 231 (27%) had positive sentinel nodes: 158 (68%) of these patients underwent completion axillary dissection, and 73 (32%) were managed with observation alone. Two (.32%) patients who were sentinel node negative had an axillary recurrence; one of these patients had undergone completion axillary dissection. No patient in the observed sentinel node–positive group had an axillary recurrence (odds ratio, .37; P = .725).
Conclusions: On the basis of a median follow-up of 27.4 months, axillary recurrence after SNB is extraordinarily rare regardless of nodal involvement, thus indicating that this technique provides an accurate measure of axillary disease and may impart regional control for patients with node-positive disease.
2nd one:
Is Axillary Dissection Obsolete for the Management of Breast Cancer?
3rd one:
How Much Is Enough? The Continuing Debate on the Axillary Lymph Node Dissection in Breast Cancer
( I do not have clinically positive lymph node disease)
Currently, it is accepted that ALND(axillary node dissection) is indicated when a patient presents with clinically positive axillary lymph node disease. As stated above, there is also agreement that no further ALND is indicated when the SLNB shows no disease. The major point of debate now is what to do with positive SLN in patients with otherwise clinically negative regional disease in early breast cancer. Studies have shown that the SLN is the only positive lymph node in 38% to 67% of cases when completion ALND was followed.7 This reflects dramatically changed presentation over the last decade of breast cancer with decreasing primary tumor size and lymph node positivity in patients with invasive breast cancer.8 Unfortunately, there is no proven method other than ALND that can identify the group with additional axillary nodal disease.
There is no clear indication that ALND provides a survival benefit. In the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-04, ALND did not show survival benefit in patients without clinical evidence of axillary adenopathy. With 25 years of follow-up, no significant survival differences have emerged.9 Proponents of ALND argue that B-04 did not have enough patients in the trial to see a survival benefit. A metaanalysis of six trials evaluating the impact of ALND on breast cancer survival showed an average survival benefit of 5% with ALND (95% CI=1.7-8.0%, probability of survival benefit >99.5%).10 It warrants mention that these patients received no adjuvant therapy and that tumor size was larger in these studies than the tumor size we see now. This exemplifies a common problem in evaluating the issues surrounding breast cancer treatment. The problem is that only a small benefit can be seen many years after the studies are started, and that demonstration of the benefit requires large numbers of patients as in a meta-analysis.11 Thus, the data may no longer be applicable because of improved survival from other new treatment modalities.
4th one:
There is currently a large national clinical trial called Z0011, which is evaluating exactly that question. In this trial some patients are chosen (randomized) to receive a full axillary lymph node dissection if their sentinel lymph node is positive. Some patients are chosen to not undergo any further lymph node dissection, and they are carefully watched. All of these patients will receive chemotherapy. The two groups of patients will be compared to see if there is a benefit to doing the full axillary dissection if the sentinel lymph node is positive. Or, alternatively, they will be compared to see if there is a detriment to not doing a full axillary dissection if the sentinel lymph node is positive. This is still experimental, and should only be done under controlled circumstances after being enrolled in this trial by a participating breast cancer surgeon. Doing a full axillary lymph node dissection if the sentinel lymph node is positive is still considered “the standard of care” with which all patients should be treated. To do otherwise, risks under treating your breast cancer.
5th one:
Preliminary Outcome Analysis in Patients With Breast Cancer and a Positive Sentinel Lymph Node Who Declined Axillary Dissection
Limited information is available regarding the outcome of patients with positive sentinel node resection and observation after adjuvant therapy. The data presented in this study suggest that SLN biopsy without axillary dissection may be an acceptable alternative to completion axillary dissection. However, longer follow-up and prospective randomized studies are needed to delineate appropriate criteria for patient selection and confirm the safety of this approach. Patients should be encouraged to enroll in ACOSOG Z0011, which randomizes to completion dissection or no further surgery. On the basis of the preliminary results of this study, the latter approach is both ethical and justifiable.
6th one:
Axillary Dissection Is Not Required for All Patients With Breast Cancer and Positive Sentinel Nodes
7th one: a smaller trial but interesting results:
Sentinel node biopsy should be supplemented by axillary sampling in patients with small breast cancers
For patients with a positive sentinel node, the finding of additional positive nodes in the axillary sample strongly indicated the likelihood of further positive nodes in the axilla, therefore, justifying an axillary clearance. If the SNB was positive and the ANS(axillary node sampling-getting a few more after SN) negative, the likelihood of further malignant nodes being revealed by an axillary clearance was much lower (1/12, 8%) but with only this limited evidence we still feel that this figure justifies proceeding to ANC.
8th one:
Is Axillary Dissection Obsolete for the Management of Breast Cancer?
9th one:
[P-3] Micrometastases in the sentinel node: take it or leave it? -well I have macrometastases.
10th one:
Clinical practice guidelines for the care and treatment of breast cancer: 16. Locoregional post-mastectomy radiotherapy
Wednesday -- I need to determine my action plan asap
Well it has been almost 1 week since my last chemo and I have to make arrangements for whatever further treatment I will be getting.
Called all 4 doctors and left messages with their nurses saying that I had decided on getting radiation for sure and whether they still wanted me to get surgery to remove the axillary nodes.
Surprisingly when I said that I wanted to talk to my Plastic Surgeon the receptionist must really have felt for me cause he came to the phone. I told him that I had decided on radiation and had some concerns about doing the implant exchange that close to surgery due to possible healing concerns. While we were talking I also mentioned the dilemma I had regarding my further action plan and he said that I should not be dealing with such things the decision should not have been mine to make. He offered to talk to the radiation oncologist about my treatment plan and the surgery (wohooo, finally someone IS talking to the other ) and call me back later during the day.
Wednesday i was not able to get much done at work since I knew that I had to make a decision within the next days. I went online and read too many medical articles to help me make a decision.. some are :
http://www.dcmsonline.org/jax-medicine/1998journals/march98/RadiationTherapy.htm
http://www.cancer.gov/clinicaltrials/results/additional-radiation0205
http://patient.cancerconsultants.com/CancerTreatment_Breast_Cancer.aspx?LinkId=53880
http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Radiation_Helps_Survival_After_Mastectomy_and_Chemotherapy.asp
http://www.breastcancer.org/treatment/radiation/when_appropriate.jsp
http://www.unc.edu/news/archives/oct05/masectomy101005.htm
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VHS-47S52FH-6&_user=10&_coverDate=02%2F28%
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VHS-47S52FH-6&_user=10&_coverDate=02%2F28%2F2003&_rdoc=1&_fmt=summary&_orig=browse&_cdi=6074&_sort=d&_docanchor=&view=c&_ct=1&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=25e759b9dd1a901c2e6da4c4d5610a52
http://www.ro-journal.com/content/2/1/40
http://www.medscape.com/viewarticle/431672
http://xnet.kp.org/permanentejournal/spring07/enough.html
http://www.medhelp.org/forums/BreastCancer/messages/1265.html
http://jco.ascopubs.org/cgi/content/full/17/1/143
http://www.medscape.com/viewarticle/412495
http://www.asco.org/ASCO/Abstracts+&+Virtual+Meeting/Abstracts?&vmview=abst_detail_view&confID=34&abstractID=34038#
http://jco.ascopubs.org/cgi/content/full/17/5/1465
http://jco.ascopubs.org/cgi/content/full/17/5/1465
http://www.asco.org/ASCO/Abstracts+&+Virtual+Meeting/Abstracts?&vmview=abst_detail_view&confID=34&abstractID=34038#
http://www.annalssurgicaloncology.org/cgi/content/abstract/5/2/131
http://www.breastcancerupdate.com/miami-conference/2005/MBCC05_Poster22.pdf
http://books.google.com/books?id=op7lm69RypkC&pg=PA291&lpg=PA291&dq=axillary+node+dissection+versus+radiation+breast+cancer&source=web&ots=-00Gl02sMT&sig=8g2H-CVDdEVlnOmadFMTCLemI98#PPA291,M1 ???? -- from the book :
Breast Cancer: A Guide to Detection and Multidisciplinary Therapy
http://www.bccancer.bc.ca/NR/rdonlyres/16B06932-272E-4467-B4A6-6BD6A8EB4913/19788/NDavisAxillaryStaginginBreastCancer.pdf
http://www.cfpc.ca/cfp/2002/Jun/vol48-jun-cme-1.asp
http://www.cmaj.ca/cgi/content/full/170/8/1263
I am getting pretty frustrated, I had actually left a voice mail to the surgery schedulers of both my Plastic Surgeon and my Surgeon to coordinate a date for my surgery and they had not called yet !
My oncologist called and said in an impatient tone that regardless of getting radiation he wanted me to get the axillary nodes removed. Ok now I have to hear from the others.
Went home, the last Taxol symptoms were going away only there is some neuropathy on my feet which goes away when I wear my running shoes with orthotics. Went on a short run/walk with Candy on the trail. It felt really good to be out with Candy but I really need to do something about her taking off while running she thinks she is a tugboat.
Called all 4 doctors and left messages with their nurses saying that I had decided on getting radiation for sure and whether they still wanted me to get surgery to remove the axillary nodes.
Surprisingly when I said that I wanted to talk to my Plastic Surgeon the receptionist must really have felt for me cause he came to the phone. I told him that I had decided on radiation and had some concerns about doing the implant exchange that close to surgery due to possible healing concerns. While we were talking I also mentioned the dilemma I had regarding my further action plan and he said that I should not be dealing with such things the decision should not have been mine to make. He offered to talk to the radiation oncologist about my treatment plan and the surgery (wohooo, finally someone IS talking to the other ) and call me back later during the day.
Wednesday i was not able to get much done at work since I knew that I had to make a decision within the next days. I went online and read too many medical articles to help me make a decision.. some are :
http://www.dcmsonline.org/jax-medicine/1998journals/march98/RadiationTherapy.htm
http://www.cancer.gov/clinicaltrials/results/additional-radiation0205
http://patient.cancerconsultants.com/CancerTreatment_Breast_Cancer.aspx?LinkId=53880
http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Radiation_Helps_Survival_After_Mastectomy_and_Chemotherapy.asp
http://www.breastcancer.org/treatment/radiation/when_appropriate.jsp
http://www.unc.edu/news/archives/oct05/masectomy101005.htm
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VHS-47S52FH-6&_user=10&_coverDate=02%2F28%
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VHS-47S52FH-6&_user=10&_coverDate=02%2F28%2F2003&_rdoc=1&_fmt=summary&_orig=browse&_cdi=6074&_sort=d&_docanchor=&view=c&_ct=1&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=25e759b9dd1a901c2e6da4c4d5610a52
http://www.ro-journal.com/content/2/1/40
http://www.medscape.com/viewarticle/431672
http://xnet.kp.org/permanentejournal/spring07/enough.html
http://www.medhelp.org/forums/BreastCancer/messages/1265.html
http://jco.ascopubs.org/cgi/content/full/17/1/143
http://www.medscape.com/viewarticle/412495
http://www.asco.org/ASCO/Abstracts+&+Virtual+Meeting/Abstracts?&vmview=abst_detail_view&confID=34&abstractID=34038#
http://jco.ascopubs.org/cgi/content/full/17/5/1465
http://jco.ascopubs.org/cgi/content/full/17/5/1465
http://www.asco.org/ASCO/Abstracts+&+Virtual+Meeting/Abstracts?&vmview=abst_detail_view&confID=34&abstractID=34038#
http://www.annalssurgicaloncology.org/cgi/content/abstract/5/2/131
http://www.breastcancerupdate.com/miami-conference/2005/MBCC05_Poster22.pdf
http://books.google.com/books?id=op7lm69RypkC&pg=PA291&lpg=PA291&dq=axillary+node+dissection+versus+radiation+breast+cancer&source=web&ots=-00Gl02sMT&sig=8g2H-CVDdEVlnOmadFMTCLemI98#PPA291,M1 ???? -- from the book :
Breast Cancer: A Guide to Detection and Multidisciplinary Therapy
http://www.bccancer.bc.ca/NR/rdonlyres/16B06932-272E-4467-B4A6-6BD6A8EB4913/19788/NDavisAxillaryStaginginBreastCancer.pdf
http://www.cfpc.ca/cfp/2002/Jun/vol48-jun-cme-1.asp
http://www.cmaj.ca/cgi/content/full/170/8/1263
I am getting pretty frustrated, I had actually left a voice mail to the surgery schedulers of both my Plastic Surgeon and my Surgeon to coordinate a date for my surgery and they had not called yet !
My oncologist called and said in an impatient tone that regardless of getting radiation he wanted me to get the axillary nodes removed. Ok now I have to hear from the others.
Went home, the last Taxol symptoms were going away only there is some neuropathy on my feet which goes away when I wear my running shoes with orthotics. Went on a short run/walk with Candy on the trail. It felt really good to be out with Candy but I really need to do something about her taking off while running she thinks she is a tugboat.
Additional drawings for conflict resolution
Well since my main conflict at this point is whether to get additional surgery and/or rads I draw 2 pictures one myself getting surgery the other radiation.
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Then I went ahead and drew with my eyes closed (Ferit said that my drawings were so bad that my eyes closed ones were almost the same as the ones that I made with my eyes open ! ), choosing the colors blindly also..
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The radiation one is like being abducted by an alien ship(according to Ferit) both seem ok.. although the stuff taken out is bright colors not yucky stuff hard to tell none are talking to me yet.
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Then I went ahead and drew with my eyes closed (Ferit said that my drawings were so bad that my eyes closed ones were almost the same as the ones that I made with my eyes open ! ), choosing the colors blindly also..
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The radiation one is like being abducted by an alien ship(according to Ferit) both seem ok.. although the stuff taken out is bright colors not yucky stuff hard to tell none are talking to me yet.
Wednesday, January 16, 2008
Can my drawings tell me what to do
In the book I am reading it is suggested that our subconscious self knows everything we need to know( or at least thats how I interpreted) and Bernie Siegel gave a couple of steps that he used with his patients. Well at this point since the medical community cannot give me a firm path but only options I guess it will not hurt to explore alternate inputs to make up my mind. So far I have always made good choices regarding my treatment(they had suggested lumpectomy instead of mastectomy but I went with the mastectomy which was the right move) however at this point I feel like I need some tools to listen to my inner voice that will tell me what is good for me. There is too much distraction for me to hear it.
So here is what I did..
1st step : draw a picture of yourself, treatment , disease and white blood cells eliminating the disease.
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2 - Draw a picture or scene (since nothing was specified went with a picture where I am rowing in a river by the mountains.. )
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So here is what I did..
1st step : draw a picture of yourself, treatment , disease and white blood cells eliminating the disease.
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2 - Draw a picture or scene (since nothing was specified went with a picture where I am rowing in a river by the mountains.. )
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Tuesday - Radiation oncologist visit .. I irritated myself
Went to see the radiation oncologist in the PM. They actually thought that I had came to get mapped ( they do some kind of mapping session as a dry run for radiation) and the doc was not quite happy that I was in the room again with a lot of questions.
- If I need radiation is the size of the implant ok or does it need to be deflated ?
- Does silicone implant withstand radiation in case we do the exchange before radiation?
- How long after the surgeries(axillary node+port removal+implant exchange) can rads start ?
- what should be the timing for the rads after chemo ? How soon, what is the latest ?
- Is it possibility to do longer duration lower dose radiation to prevent implant damage?
- Will your decision change regarding me getting rads if no additional nodes test positive from the axillary node dissection ?
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But before I was able to start the questions the conversation drifted to a totally different state. I could say that he was getting annoyed with me circling the same questions over and over again well I was getting annoyed with myself too! Sometimes I think my body manufactured this disease so I stop trying to be in control of everything giving the message ' Hey ! You always want to be in control, you never go with the flow.. here you go try to be in control of your treatment.. now how do you like that ???'.
He went over the same things that he had told last time, basically that in his opinion I needed radiation even if there were no nodes that were positive, his decision based on the multifocal aspect of the tumor and vascular lymphatic invasion. He certainly did not believe that axillary node dissection was needed or was even helpful. His point was that axillary node dissection is not part of the treatment but was just for staging purposes.There already had been 6 nodes removed so there was no point in going in and removing more. And I had already planned out my treatment so additional information on staging was not going to change anything. He dis'sed the surgeon opinions that I got and went as far as saying that the if any other non-radiation oncologist doctors were giving opinions on whether or not to radiate me they were practicing medical malpractice !! Oh geeshhh.. now what ???
My oncologist is not coming outright saying that I do not need radiation but he is saying that I need the surgery and the next step will be determined after I get the surgery.
The rad onc.. also did not like the idea of my getting the implant exchange at the same time with the axil node dissection, he said that the radiation had to start 3 weeks from the end of chemo and it was not a wise thing to delay the radiation for a plastic surgery.
I got out of the office totally puzzled AGAIN. What he said really made sense but I have to trust my oncologist ( which I do ) since he will be monitoring me from now on... just as I thought that I had reached a decision.
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- If I need radiation is the size of the implant ok or does it need to be deflated ?
- Does silicone implant withstand radiation in case we do the exchange before radiation?
- How long after the surgeries(axillary node+port removal+implant exchange) can rads start ?
- what should be the timing for the rads after chemo ? How soon, what is the latest ?
- Is it possibility to do longer duration lower dose radiation to prevent implant damage?
- Will your decision change regarding me getting rads if no additional nodes test positive from the axillary node dissection ?
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But before I was able to start the questions the conversation drifted to a totally different state. I could say that he was getting annoyed with me circling the same questions over and over again well I was getting annoyed with myself too! Sometimes I think my body manufactured this disease so I stop trying to be in control of everything giving the message ' Hey ! You always want to be in control, you never go with the flow.. here you go try to be in control of your treatment.. now how do you like that ???'.
He went over the same things that he had told last time, basically that in his opinion I needed radiation even if there were no nodes that were positive, his decision based on the multifocal aspect of the tumor and vascular lymphatic invasion. He certainly did not believe that axillary node dissection was needed or was even helpful. His point was that axillary node dissection is not part of the treatment but was just for staging purposes.There already had been 6 nodes removed so there was no point in going in and removing more. And I had already planned out my treatment so additional information on staging was not going to change anything. He dis'sed the surgeon opinions that I got and went as far as saying that the if any other non-radiation oncologist doctors were giving opinions on whether or not to radiate me they were practicing medical malpractice !! Oh geeshhh.. now what ???
My oncologist is not coming outright saying that I do not need radiation but he is saying that I need the surgery and the next step will be determined after I get the surgery.
The rad onc.. also did not like the idea of my getting the implant exchange at the same time with the axil node dissection, he said that the radiation had to start 3 weeks from the end of chemo and it was not a wise thing to delay the radiation for a plastic surgery.
I got out of the office totally puzzled AGAIN. What he said really made sense but I have to trust my oncologist ( which I do ) since he will be monitoring me from now on... just as I thought that I had reached a decision.
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Saturday, January 12, 2008
Saturday through Monday
Saturday morning did a systems check and all cylinders were still firing 110%. Even though I had only slept 2 hours ( from 2 - 4 AM) but this did not worry me I got used to the 1 week no-sleeping phase after each chemo.
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Oh and there is a peach fuzz appearing on my scalp, seems to be totally white, I heard that hair did start growing during Taxol treatment although sluggishly,and tends to come out curly. My psoriasis spots came back (the Cytoxan had treated them once that washed out of the system they are back) and I am losing the clear complexion too, breaking out a bit. Oh well.. it is a good sign that the drugs are getting washed out of my system.
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Did a short walk with Candy, even though I felt good I do not like doing cardio the week following chemo, my body is already busy with all the toxins there is no point into introducing additional stress.
Then headed off to the Kundalini Yoga session. By the time I came back I started feeling weak and went to Blockbuster rented off a couple of movies to keep me busy the coming 2-3 days.
Took the hint from my body to start shutting down, basically just moped around Saturday and Sunday allowing myself to do absolutely nothing.. going on online chat rooms for hours,getting a lot of reading done. After this was my last chemo so decided to take the down time as really down.
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Monday was pretty much the same. This time since I did not get the Neulesta shot the side effects were a lot less and keeping off my feet somehow helped me avoid severe GI problems, I still was not 100% comfortable but it was a lot better than the last times but did not have enough to log onto work and get stuff done.
.
There was a book that my coach had given me last year Peace,Love and Healing.. interestingly I had seen the same book at my counselors office, so decided to read it and could not put it down. It is about the mind-body connection, how to connect with the subconscious and its effects on healing, a pretty old book but the principles clicked with me.
.
Monday night while trying to find a way to go to sleep got pretty creative and realized the peach fuzz that was trying to grow on my scalp aha.. so hair is trying to grow back on Taxol. Decided to take weekly pictures of the hair growth.
January 14- scalp
.
Oh and there is a peach fuzz appearing on my scalp, seems to be totally white, I heard that hair did start growing during Taxol treatment although sluggishly,and tends to come out curly. My psoriasis spots came back (the Cytoxan had treated them once that washed out of the system they are back) and I am losing the clear complexion too, breaking out a bit. Oh well.. it is a good sign that the drugs are getting washed out of my system.
.
Did a short walk with Candy, even though I felt good I do not like doing cardio the week following chemo, my body is already busy with all the toxins there is no point into introducing additional stress.
Then headed off to the Kundalini Yoga session. By the time I came back I started feeling weak and went to Blockbuster rented off a couple of movies to keep me busy the coming 2-3 days.
Took the hint from my body to start shutting down, basically just moped around Saturday and Sunday allowing myself to do absolutely nothing.. going on online chat rooms for hours,getting a lot of reading done. After this was my last chemo so decided to take the down time as really down.
.
Monday was pretty much the same. This time since I did not get the Neulesta shot the side effects were a lot less and keeping off my feet somehow helped me avoid severe GI problems, I still was not 100% comfortable but it was a lot better than the last times but did not have enough to log onto work and get stuff done.
.
There was a book that my coach had given me last year Peace,Love and Healing.. interestingly I had seen the same book at my counselors office, so decided to read it and could not put it down. It is about the mind-body connection, how to connect with the subconscious and its effects on healing, a pretty old book but the principles clicked with me.
.
Monday night while trying to find a way to go to sleep got pretty creative and realized the peach fuzz that was trying to grow on my scalp aha.. so hair is trying to grow back on Taxol. Decided to take weekly pictures of the hair growth.
January 14- scalp
Friday LAST CHEMO !!!!
Armed with a huge cooler with foods ranging from turkey burger sandwiches, chips, grapes, chocolate cherries.. and 24 'Better than Sex Cupcakes' that I made for the oncology nurses for my last chemo we headed to Suite 381 with Z who is again my babysitter for todays chemo. It is her birthday, I felt bad for asking her to come with me but she convinced me that it was ok.
.
By the time she went to Starbucks to bring me my 3.41 tall decaf soy latte I was zoned out with a suspected Benadryl overdose that the nurses might have given me to stop blabbering ;o). And I slept pretty much the whole treatment(only waking up to chomp all the chocolate cherries,2 sandwiches and the chips) , and continued sleeping in the car on our way back and immediately went to bed and took a 3 hour nap when I got home.
.
Then around 8:30pm the Benadryl must have started to wear off cause I started to think that I most probably would be feeling ok that night and the next day but will start crashing Saturday evening and recovering earliest on Wednesday and I wanted to do something to celebrate my last chemo and take advantage of the 'up' that was accentuated even more with the abundant amounts of steroids circulating in my bloodstream. Ferit was at Hooters with a friend I texted him saying that I wanted to go to Blue Martini to listen to some music.
P also came with us we really had a good time the band was nice, the crowd was quite interesting.
Oh and I loved the haircut of one of the bartenders and had to take a picture so I can get my hair that style once it grows out. It was similar to the Posh cut that I got before my hair decided to evacuate my head.
.
By the time she went to Starbucks to bring me my 3.41 tall decaf soy latte I was zoned out with a suspected Benadryl overdose that the nurses might have given me to stop blabbering ;o). And I slept pretty much the whole treatment(only waking up to chomp all the chocolate cherries,2 sandwiches and the chips) , and continued sleeping in the car on our way back and immediately went to bed and took a 3 hour nap when I got home.
.
Then around 8:30pm the Benadryl must have started to wear off cause I started to think that I most probably would be feeling ok that night and the next day but will start crashing Saturday evening and recovering earliest on Wednesday and I wanted to do something to celebrate my last chemo and take advantage of the 'up' that was accentuated even more with the abundant amounts of steroids circulating in my bloodstream. Ferit was at Hooters with a friend I texted him saying that I wanted to go to Blue Martini to listen to some music.
P also came with us we really had a good time the band was nice, the crowd was quite interesting.
Oh and I loved the haircut of one of the bartenders and had to take a picture so I can get my hair that style once it grows out. It was similar to the Posh cut that I got before my hair decided to evacuate my head.
Thursday - Bike ride Last Oncologist visit before surgery
Met with Rosie and Z to go on a short bike ride on my lunch break. They are both just starting out biking but are really strong. I will be having a hard time keeping up with them pretty soon. We did intervals around the neighborhood.
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Went to my last oncologist visit today to see Dr M with Ferit.. he was happy about my decision to get the axillary node dissection, since he was pushing for it from the beginning. . He also wanted me to push to get both surgeries done at the same time and he also said it was ok to remove my port !!! yey !!
He does not think that I will need radiation if everything comes out fine from the surgery.
.
He hugged me and said that he'd see me in 6 weeks, now why do I feel like a kid who is watching his parents drive away after having been dropped off to Summer Camp for the first time ?
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He was my security blanket, felt like seeing him everyother week was keeping the c at bay..
.
My next step would be hormonal therapy since I am ER/PR+, and will be put to Tamoxifen those will be discussed in my next appointment with him.
.
Went to my last oncologist visit today to see Dr M with Ferit.. he was happy about my decision to get the axillary node dissection, since he was pushing for it from the beginning. . He also wanted me to push to get both surgeries done at the same time and he also said it was ok to remove my port !!! yey !!
He does not think that I will need radiation if everything comes out fine from the surgery.
.
He hugged me and said that he'd see me in 6 weeks, now why do I feel like a kid who is watching his parents drive away after having been dropped off to Summer Camp for the first time ?
.
He was my security blanket, felt like seeing him everyother week was keeping the c at bay..
.
My next step would be hormonal therapy since I am ER/PR+, and will be put to Tamoxifen those will be discussed in my next appointment with him.
Crazy Tuesday
I definitely overdid it. Somehow when I returned to work at the office I suddenly thought that I could do everything that I used to do immediately.. so I gave the spinning class at 5:45 in the morning, stopped by another gym to talk to a personal trainer, went to work, went to the tire store ( got 2 nails in 2 different tires yesterday )had lunch with a friend while waiting for the new tires, went back to work, drove 20 miles to pick up a friend to go to a Kundalini Yoga session which was a further 15 miles away. Did 1.5 hour K yoga, then went to the friends house to dinner.. then came home.. but I was literally falling asleep at the red lights .. for the first time in months I was able to get some sleep without even any sleep aids. Wednesday I still was feeling the fatigue.. that was stupid of me.
Going back to work really helped my mood, the people who did not know what I went through just thought I was working from home. They complimented on my new hair color (a redhead !) I guess Iwas pretty good in camouflaging that I did not have any eyelashes and only a couple of strands of eyebrows. I put the others who were 'avoiding eye contact with me' at ease by starting out a conversation from where we left never mentioning anything about my treatments unless they asked.. that seemed to work pretty well.
after having 3 days in the office here is how it went.
There were 3 types of collegues:
1 - Did not have a clue I was sick just thought that I had colored my hair red(I had long brown hair, got a red wig).. who were shocked when I told them..
2 - Some were giving me big hugs.. taking me to lunch, bringing me coffee.. really sweet.
3 - Some that were avoiding looking at my eyes,having a 'fear in their eyes' so I had to be proactive for these.
- for those who I wanted to maintain a friendship I approached them smiling and started up a conversation about the things that we used to talk about before my dx.. that seemed to loosen them up and they started talking about stuff.. and then eventually - although very shyly - approached and asked about my treatments.. I gave them the minimum info as those are the type which really do not know how to handle this. I was able to see the relief in their eyes.. cause they were just clueless on how to interact with me.
-For those that I did not really care I did not bother doing anything.
Sooooo it was not that bad !! Other than the first 10 hour wig wearing day wanted me to rip it off my head !
Going back to work really helped my mood, the people who did not know what I went through just thought I was working from home. They complimented on my new hair color (a redhead !) I guess Iwas pretty good in camouflaging that I did not have any eyelashes and only a couple of strands of eyebrows. I put the others who were 'avoiding eye contact with me' at ease by starting out a conversation from where we left never mentioning anything about my treatments unless they asked.. that seemed to work pretty well.
after having 3 days in the office here is how it went.
There were 3 types of collegues:
1 - Did not have a clue I was sick just thought that I had colored my hair red(I had long brown hair, got a red wig).. who were shocked when I told them..
2 - Some were giving me big hugs.. taking me to lunch, bringing me coffee.. really sweet.
3 - Some that were avoiding looking at my eyes,having a 'fear in their eyes' so I had to be proactive for these.
- for those who I wanted to maintain a friendship I approached them smiling and started up a conversation about the things that we used to talk about before my dx.. that seemed to loosen them up and they started talking about stuff.. and then eventually - although very shyly - approached and asked about my treatments.. I gave them the minimum info as those are the type which really do not know how to handle this. I was able to see the relief in their eyes.. cause they were just clueless on how to interact with me.
-For those that I did not really care I did not bother doing anything.
Sooooo it was not that bad !! Other than the first 10 hour wig wearing day wanted me to rip it off my head !
Tuesday, January 8, 2008
Surgeon meetings on Monday
Got a busy start to the week.
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Had a personal trainer appointment for my second assessment at 7:30 to go over the 24 minute workout sequence. I was not able to do several because I want to baby my chest muscles. Does not make sense to make them stronger while at the same time I actually am tring to expand/stretch them out. But Eddie was ok in giving me alternatives whenever I could not do a machine.
.
Headed off to my first appointment of the week. With Dr. Chambers - my original surgeon. Talked about scheduling the axillary node dissection surgery, when I asked why they ( the previous group she was in) did not do it immediately after my mastectomy she said that they chose to proceed with a less agressive, less conservative approach considering my lifestyle and did not want to jeopardize me getting lymphedema. Well initially I was thinking the same way however later after talking to multiple doctors I really thought that I should get the lymph nodes out and see where I was at, and where I am at now. She will be able to request certain pathologists to review the slides to make sure that nothing is missed and I also will have an option to send the slides to a different facility to get them reviewed.
She does not want to do the axillary node dissection on the same surgery as the expander exchange with the plastic surgeon, and I do not recall exactly but I think her concern was that in case I needed radiation then that could cause capsular contrapture of the final implant. However the plastic surgeon is under the impression that reconstructing a radiated breast is a lot harder then fixing one that could get capsular contracture.
.
In the afternoon I had an appointment with my plastic surgeon who was adamant in conducting the surgery before radiation during axillary dissection operation. They also expanded 100cc more, now I am totally Hooters material, can not even wear my sport tops !! I really am looking forward to the exchange where I will look a bit more normal.
.
So the next step would be to talk to the radiation oncologist to see how comfortable he is with radiating through silicone implants, then if he is cool need to run this by Dr. Chambers to push the get both done in the same operation. Although the consensus seems like I will not need radiation, but I will decide on that after the outcome of the surgery.
.
Had a personal trainer appointment for my second assessment at 7:30 to go over the 24 minute workout sequence. I was not able to do several because I want to baby my chest muscles. Does not make sense to make them stronger while at the same time I actually am tring to expand/stretch them out. But Eddie was ok in giving me alternatives whenever I could not do a machine.
.
Headed off to my first appointment of the week. With Dr. Chambers - my original surgeon. Talked about scheduling the axillary node dissection surgery, when I asked why they ( the previous group she was in) did not do it immediately after my mastectomy she said that they chose to proceed with a less agressive, less conservative approach considering my lifestyle and did not want to jeopardize me getting lymphedema. Well initially I was thinking the same way however later after talking to multiple doctors I really thought that I should get the lymph nodes out and see where I was at, and where I am at now. She will be able to request certain pathologists to review the slides to make sure that nothing is missed and I also will have an option to send the slides to a different facility to get them reviewed.
She does not want to do the axillary node dissection on the same surgery as the expander exchange with the plastic surgeon, and I do not recall exactly but I think her concern was that in case I needed radiation then that could cause capsular contrapture of the final implant. However the plastic surgeon is under the impression that reconstructing a radiated breast is a lot harder then fixing one that could get capsular contracture.
.
In the afternoon I had an appointment with my plastic surgeon who was adamant in conducting the surgery before radiation during axillary dissection operation. They also expanded 100cc more, now I am totally Hooters material, can not even wear my sport tops !! I really am looking forward to the exchange where I will look a bit more normal.
.
So the next step would be to talk to the radiation oncologist to see how comfortable he is with radiating through silicone implants, then if he is cool need to run this by Dr. Chambers to push the get both done in the same operation. Although the consensus seems like I will not need radiation, but I will decide on that after the outcome of the surgery.
Sunday, January 6, 2008
Busy Saturday Sunday - found a bike for my friend in the spice aisle of Publix !
Friday evening returning from Mimi's Cafe stopped at Publix to get
some spices that I needed. In the spice aisle ran into M from the morning cycle class while we were chatting he mentioned that he had a small size women's road bike that he could sell. I was so excited since we were going to go cycling with Z the next day and my old bike Stitch was at least 3 sizes big for her, thought she might be interested and M was able to give it to me that night for Z to test it out !
Saturday morning we went out with Z towards the airport, unfortunately since we socialized a bit too much before riding we were stuck riding in traffic. It was her 3rd time on a road bike and we did 17 miles in moderate traffic the bike was a perfect fit !
At night had the Y family over for dinner to test the flank steak marinade.
Sunday went on a 7.3 mile jog/walk with Z took close to 2 hours, I am getting slower but thats ok, as long as I can get the distance in I can work up the speed later.
Later drove up to Gainsville to check out the apartment that Sibel wants to rent with her friends next year. I want to be a college student ! The apartments were sooo nice.
When we came back home I realized that I had overdone it, wiped out on the couch watching the Desperate Housewives.
some spices that I needed. In the spice aisle ran into M from the morning cycle class while we were chatting he mentioned that he had a small size women's road bike that he could sell. I was so excited since we were going to go cycling with Z the next day and my old bike Stitch was at least 3 sizes big for her, thought she might be interested and M was able to give it to me that night for Z to test it out !
Saturday morning we went out with Z towards the airport, unfortunately since we socialized a bit too much before riding we were stuck riding in traffic. It was her 3rd time on a road bike and we did 17 miles in moderate traffic the bike was a perfect fit !
At night had the Y family over for dinner to test the flank steak marinade.
Sunday went on a 7.3 mile jog/walk with Z took close to 2 hours, I am getting slower but thats ok, as long as I can get the distance in I can work up the speed later.
Later drove up to Gainsville to check out the apartment that Sibel wants to rent with her friends next year. I want to be a college student ! The apartments were sooo nice.
When we came back home I realized that I had overdone it, wiped out on the couch watching the Desperate Housewives.
Friday, January 4, 2008
The ticker is just fine !
Went to the cardiologist today to get my results. My LVEF (Left Ventricular Ejection Fraction) was 64% compared to 67% before chemo, however she explained that this number was not exact and it would vary on a daily basis. Phew.. seems like I dodged the serious side effect of Adriamycin.. yey !!!
.
They wanted to put me on beta blockers cause I seemed to have a lot of palpitations according to the halter reading(when I asked when they mainly occurred they said throughout the day about a total of 750 of them). It is not anything worrisome but it might bother me she said, maybe thats why I keep on waking up? I told that as long as it was not something that would harm me I did not want to take any meds. Will look into natural remedies to the same effect. She also added that this could be a temporary thing because of the chemo or the stress I have been under. They want me back in 6 months just for a follow up.
.
Had to drop by Track Shack(since the Heart Center was practically acroos the Trackshack and I have a informal commitment to go to Track Shack of Orange Cycle whenever I am within a mile radius of either ;o) , and saw a lady with a 'suspicious scarf' hmm.. at the risk of being nosy I asked her in the best way that I would have liked to be approached ' Are you going through something or is your head cold ?' She started laughing and it turns out that she is being treated by my original oncologist. Asked what chemo treatment she was on she told me that she was on AC .. hmm I thought that they should have changed the protocol after all those research studies were released. The Lady ( D) has also registered to the Breast Cancer Marathon but said that she probably would not be running it but just will go as a spectator.
.
They wanted to put me on beta blockers cause I seemed to have a lot of palpitations according to the halter reading(when I asked when they mainly occurred they said throughout the day about a total of 750 of them). It is not anything worrisome but it might bother me she said, maybe thats why I keep on waking up? I told that as long as it was not something that would harm me I did not want to take any meds. Will look into natural remedies to the same effect. She also added that this could be a temporary thing because of the chemo or the stress I have been under. They want me back in 6 months just for a follow up.
.
Had to drop by Track Shack(since the Heart Center was practically acroos the Trackshack and I have a informal commitment to go to Track Shack of Orange Cycle whenever I am within a mile radius of either ;o) , and saw a lady with a 'suspicious scarf' hmm.. at the risk of being nosy I asked her in the best way that I would have liked to be approached ' Are you going through something or is your head cold ?' She started laughing and it turns out that she is being treated by my original oncologist. Asked what chemo treatment she was on she told me that she was on AC .. hmm I thought that they should have changed the protocol after all those research studies were released. The Lady ( D) has also registered to the Breast Cancer Marathon but said that she probably would not be running it but just will go as a spectator.
Thursday, January 3, 2008
Further treatment decision made
Got an early call from the Moffitt C Center doc I was impressed, he said I was the topic of several heated discussions, it appears I can even cause a turmoil when I am ill !
.
They had discussed my case and the input was given by 3 surgeons, 1 radiation oncologist and 1 oncologist.
The Radiation oncologist said that given my present state I would definitely need rads.
However this is where it gets tricky, if I get an axillary node dissection I might not get rads depending on the outcome.
I will get zapped(rads) if
2 more nodes
or
More than 20% of total nodes removed
Test positive for having/or having had (wiped out by chemo)
.
.
.
Do not get rads if:
None of the nodes show present or past sign of cancer.
.
I was really baffled/pulling my nonexistent hair out on how to put all the variables together to plan the treatment Ferit came to the rescue as the ultimate organizer.
My variables are:
1 - Getting axillary node dissection (for certain)
2 - Getting radiation (depending on the outcome of the 1st)
3 - Swapping out the expanders with silicones - surgery (together with axillary node dissection or later the later could be up to 6 months if I get radiation to let the tissue heal)
4 - My Plastic surgeon preferring to do the exchange before the radiation ( he said he has been seeing too many healing problems of doing the exchange after the radiation)
5 - The optimal time to start radiation (if needed) is 4-6 weeks from last chemo
6 - The axil node dissection can be done earliest 3 weeks after my chemo.
7 - Radiation doctor might not be comfortable with big implants and might want to deflate before radiation(which is not an option if I get the exchange with real implants at the same time with the axillary node dissection)
8 - If the exchange and the axillary node dissection can be done in the same operation have to coordinate the plastic Surgeon Pope and surgeon- chambers
9 - Finding a pathologist and getting the pathology reviewed by one that is really careful and can spot any signs of past cancer in the nodes.
So Ferit came up with the following plan :
1 - Get an appointment with Surgeon and tell her you want the axil node dissection and ask if she can in any way assist in getting the pathology assigned to a specific pathologist.
2 - Ask the Plastic surgeon to continue inflating the expanders (we had stopped because of possibility of radiation)
3 - Get the results of the axillary node dissection.
If no nodes are/were positive :
Rads are not needed continue with oncologist with hormonal treatment(tamoxifen) and continue with reconstruction at a leisurely pace have the 2nd surgery to swap out the expanders with the real implants.
.
.
If nodes are/were positive and they meet the criteria of >4 or >20% of total nodes:
Get radiation, and if needed get the expander deflated.
Wait for 6+ months then get the reconstruction.
So far everyone is under the assumption that I will not have additional nodes test + I am praying for that scenario !
Got an appointment with my surgeon for Monday 9:15
.
They had discussed my case and the input was given by 3 surgeons, 1 radiation oncologist and 1 oncologist.
The Radiation oncologist said that given my present state I would definitely need rads.
However this is where it gets tricky, if I get an axillary node dissection I might not get rads depending on the outcome.
I will get zapped(rads) if
2 more nodes
or
More than 20% of total nodes removed
Test positive for having/or having had (wiped out by chemo)
.
.
.
Do not get rads if:
None of the nodes show present or past sign of cancer.
.
I was really baffled/pulling my nonexistent hair out on how to put all the variables together to plan the treatment Ferit came to the rescue as the ultimate organizer.
My variables are:
1 - Getting axillary node dissection (for certain)
2 - Getting radiation (depending on the outcome of the 1st)
3 - Swapping out the expanders with silicones - surgery (together with axillary node dissection or later the later could be up to 6 months if I get radiation to let the tissue heal)
4 - My Plastic surgeon preferring to do the exchange before the radiation ( he said he has been seeing too many healing problems of doing the exchange after the radiation)
5 - The optimal time to start radiation (if needed) is 4-6 weeks from last chemo
6 - The axil node dissection can be done earliest 3 weeks after my chemo.
7 - Radiation doctor might not be comfortable with big implants and might want to deflate before radiation(which is not an option if I get the exchange with real implants at the same time with the axillary node dissection)
8 - If the exchange and the axillary node dissection can be done in the same operation have to coordinate the plastic Surgeon Pope and surgeon- chambers
9 - Finding a pathologist and getting the pathology reviewed by one that is really careful and can spot any signs of past cancer in the nodes.
So Ferit came up with the following plan :
1 - Get an appointment with Surgeon and tell her you want the axil node dissection and ask if she can in any way assist in getting the pathology assigned to a specific pathologist.
2 - Ask the Plastic surgeon to continue inflating the expanders (we had stopped because of possibility of radiation)
3 - Get the results of the axillary node dissection.
If no nodes are/were positive :
Rads are not needed continue with oncologist with hormonal treatment(tamoxifen) and continue with reconstruction at a leisurely pace have the 2nd surgery to swap out the expanders with the real implants.
.
.
If nodes are/were positive and they meet the criteria of >4 or >20% of total nodes:
Get radiation, and if needed get the expander deflated.
Wait for 6+ months then get the reconstruction.
So far everyone is under the assumption that I will not have additional nodes test + I am praying for that scenario !
Got an appointment with my surgeon for Monday 9:15
Tuesday, January 1, 2008
Ongoing Workout Log
October
10/16 - 1.5 miles walk 27:37 18:20 mn/mile 3.3 mph maxhr/avhr-127/117
..........time in heart rate zone: 13:36
10/17 - 2.25 miles walk 38:26 17 min/mile-3.5 mph maxhr/avhr-138/125
..........time in heart rate zone: 30:26
10/18 - First bike ride after surgery 33 minutes 5-6 miles avhr/maxhr 127/150
10/19 - 3.3 mile walk 56:00 17 min/mile-3.5 mph avhr/maxhr-121/137
..........1.5 hour Kundalini yoga
10/20 -16 miles bike ride on trail avg speed 11 mph avhr 124.
10/22 - 4.5 miles walk/jog 1:13:47 16:10 min/mile avhr/maxhr- 124/154
..........Time in Target Heart Rate zone ( 116-135): 55 minutes
10/23 - Spinning class 43:47 avhr/maxhr - 132/150
..........Time in Target Heart Rate zone ( 116-135):20 minutes
..........1.5 hour Kundalini yoga session
10/25 - chemo
10/26 - 1 mile walk 20 minutes avhr/maxhr - 114 125
..........Kundalini Yoga session.
10/30 - Spinning class 42 minutes avhr/axhr - 132/160
..........Kundalini yoga 1.5 hours
November :
11/2 - 2.8 mile walk 44 min 15:45 min/mile avhr/maxhr- 134/160
..........Kundalini yoga 1.5 hours.
11/3 - Spinning class 40 min avhr/axhr - 142/167
11/4 - 6 mile walk 1:40 mins 16:22 min/mile avhr/maxhr - 129/163
11/5 - 17.2 mile bike ride 11.7mph speed avhr/maxhr-133/147 time in zone 1:00
11/6 - Spinning class 40 minutes avhr/maxhr- 141/169
..........1.5 hour Kundalini Yoga
11/7 - 3 mile walk 48:00 mins 16min/mile avhr/maxhr - 134/
11/8 - 1 hour hot power yoga
..........Chemo #4
11/10 - 2.5 hour Kundalini Yoga(mainly meditation and breathing-breath of fire)
11/12 - 3 mile walk
11/13 - 3 mile walk
.........1 hour Kundalini Yoga
11/14 - 17.4 mile bike ride 12mph average 1:27 mins avhr:136 maxhr:151
........time in zone 47 minutes
........1.5 hour Kundalini Yoga
11/16 - 1.5 hour Kundalini Yoga
11/18 - Horrible Hundred ride- did only 26 miles 2:00 hrs 13 mph average.
........avhr/maxhr - 161/190
11/20 - according to my heart rate monitor did some kind of 44:00 minute cardio, do not recall what !! avhr/maxhr - 146/171 .. looks like spinning.
11/21 - weight training
11/22 - 1 hour indoor cycling/spinning - avhr/maxhr- 150/171
11/23 - weight training
11/24 - 41 mile bike ride with Florida Freewheelers C/D group picnic ride, 14.2 mph, 2:47:00 hrs avhr/maxhr-155/177
11/25 - 6 mile walk/jog shuffle, 1:27:00 hrs avhr/maxhr-160/184-- a bit high have to check whether my red blood cells dropped. 14:30 min/mile. 1.5 minute jog, 1 minute walk. Expanders which are looking like monster boobs might also be compressing my rib cage preventing me from breathing well.( rumor is a gals ribs cracked from the pressure of an expander)
11/26 - Weight training and 10 minute erg - left chest muscle is challenged might need to give a break.
11/28 - 1 mile run 12:40 min/mile. weight lifting
11/29 - 1st Taxol treatment chemo#5/8
December
12/5 - 1 hour lower body weight training, 1/2 mile run. Chest muscle still compromised cannot do any upper body or core.
.......1.5 hour Kundalini Yoga
12/6 - 1:08 hr bike ride, 14 mph, avhr/maxhr-158/170 17 miles
12/7 - 1 hour weight training, 1 mile run.
12/8 - 1.5 hour Kundalini Yoga
12/9 - 33 mile bike ride, avspd 15mph, avhr/maxhr -
12/10 - 1 hour weight training, lower body, 1.5 mile run
12/11 - Led the 40 minute spinning class(for the first time)avhr/maxhr-163/178
12/12 - 1/2 mile run,1000 meter erg at 2:13 pace. 1 hour weight training ( upper body, the chest muscle did not talk back I was even able to hang )
12/13 - 6/8 Chemo taxol.
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12/23 - 6 mile jog/walk. 1 min run/1+ min walk. 1:30 hours 15 min/mile -
........avhr/maxhr - 158/183.
12/24 - 53 minute spinning class avhr/maxhr - 161/178
12/26 - 51 minute spinning class avhr/maxhr - 154/174 - was able to exert myself really good this time.
12/27 - 43 minute 3 mile jog avhr 166 maxhr 172 14:20 min/mile 2 minute jog at 5 mph 1 min walk at 3 mph.
12/27 - 7/8 Chemo Taxol 1 more to go !
.
.
January
1/2 - 54 minute spinning class avhr/maxhr-151/171 - not able to exert
1/3 - 3 mile jog/walk- 1 min jog at 5mph, then walk until recover(1-2 min)
.......48 minutes 16 min/mile. Avhr/maxhr- 158/174 Treadmill - felt quite wiped out
1/5 - 1:29 hrs easy bike 12 mph 17.3 miles avhr/maxhr -151/171 -- this not sleeping
.......is really getting to me.
1/6 - 7.3 mile walk/jog 16:10 min/mile 1:58 hrs. avhr/maxhr - 151/172
.......Started with 1 min walk 1 minute jog, then the jogs got a lot longer, I am
.......glad that I was able to finish did not feel wiped out, but the knees were
.......a little weak.
1/7 - 45 minute assessment with Personal trainer, going over the machines at the
.......gym.
1/8 - instructed 50 minute spin class avhr/maxhr - 159/180
........1.5 hour Kundalini Yoga Session
1/10 - 1:24 hrs bike ride intervals about 16 miles.. avhr/maxhr - 161/191
1/11 - LAST CHEMO TAXOL yey !!!!
1/12 - 2+ mile walk with Candy- 40 minutes
.......1.5 hour Kundalini Yoga session
.
.
.
1/16 - 3 mile jog/walk with Candy 41 minutes 13:36 min/mile avhr/maxhr - 163/185
1/17 - 500 yards in the pool(first time in 6 months) my arms are tired.
.......30 minute express weight workout at the gym, 20 minutes elliptical,verytired.
1/20 - 9 mile jog/walk- 2:24 hrs 16 min/mile avhr/maxhr - 156/182
1/21 - 3.5 mile walk with Candy, 1:10 hours
.......1:30 hour bike ride from WaterFront Park at clermont on the trail with
.......rolling hills, about 16 miles. avhr/maxhr - 140/168
1/22 - Lead the 50 minute spinning class, and this time pushed myself.
.......40 minutes power yoga(downward dog pose is not aggreeing with my arm having
.......lymph nodes removed, have to find a pose modification.
1/23 - 40 minute chi kung - AM
.......40 minute light weigths - PM
1/28 - 3 mile jog/walk avhr/maxhr-168/189 -- stressful day reflecting on heart rate
1/29 - Instructed 45 minute spin class avhr/maxhr - 160/180
1/30 - 3 mile jog walk 42:00 min 14 min/mile avhr/maxhr - 153/181
.......30 min light weights pm
1/31 - 2.85 mile jog walk 41:00 min 14:24 min/mile avhr/max-142/185
Training plan for the Jacksonville Breast Cancer Half Marathon:
Week Start Date Length of long jog and/or walk
08-Oct-07 Chemo on thurs 4
15-Oct-07 4
22-Oct-07 Chemo on thurs 5
29-Oct-07 4
05-Nov-07 Chemo on thurs 6
12-Nov-07
19-Nov-07 chemo break for t-giving before going on to Taxol !
26-Nov-07 Chemo on thurs
03-Dec-07 6
10-Dec-07 Chemo on thurs
17-Dec-07 8
24-Dec-07 Chemo on thurs
31-Dec-07 6
07-Jan-08 LAST CHEMO ON THURSDAY ON THURSDAY JANUARY 10 !!!
14-Jan-08 8
21-Jan-08 10
28-Jan-08 6
04-Feb-08 4
11-Feb-08 Event on Saturday
New Years Eve
We went to N's house for the annual New Years party, I had to rest in the afternoon keeping off my feet to gather enough energy to make it through midnight. The Neulesta gave its usual shiver/fever feeling late afternoon but was gone pretty quickly. The GI problems peaked and then they poofed also !
.
Ditched the wig, found a really nice scarf at home which I had for ages but never used. Wore a black dress which became a bit too revealing for my taste considering my new expanded boobs. Hopefully they will look more natural once I get the exchange, but now I could practically apply to Hooters ! Wore heels which came off of course a couple of hours into the party the slight neuropathy of the toes dont go too well with them.
.
Once there, hit the buffett since I was ravenous as usualy the food was great, I was supposed to bring my traditional fruit salad but was not able to get it done cause I was really tired and needed to save my energy for the night, I felt bad about having time to put on make up and get dressed but not having the time to cut up the fruit salad, Ferit just would not let me.
.
N had arranged for a belly dancer who pulled everyone to the floor to join her. She had also arranged for a corner in her bedroom in front of the tv that I could just escape and relax for a while when I got tired -- that worked perfectly, 2-3 times I went there kicked off the shoes and recharged and was able to rejoin the party, after all partying 5th day of the chemo is a bit overzealous but hey it worked out even though I was not able to enjoy the margharita(did not want to drink the same day I got the Neulesta shot)
.
Annddd she had gotten all the gals red underwear.. yip ! One is supposed to have a prosperous year if one wears red underwear greeting the year.. we had quite a chuckle over this !
Saturday,Sunday, Monday at the office
Well I talked too soon,Saturday/Sunday Taxol hit me like a mac truck urghhh.. The most severe side effect I get is GI problems which is not what everyone gets and the doctor was kind of puzzled that I reported it.(ok I will admit that I realized that the more sugary stuff I eat the more GI Problems I get but that does not seem to stop me from hitting the pantry-cereal box) I do get slight tingling in fingertips and I am losing 2 toenails(I think my running shoes are not fitting me well after gaining weight my feet spread out) but those are no biggies, I would not probably have realized them as side effects if I had not read about them. I am managing the insomnia with 2 Ambiens/night I have come to peace with taking some sleep aids temporarily one week after each chemo, cause there is no way my bodies own melatonin production can fight with the poisons they are pumping in to me. Outside help is needed. Fight is not fair.
.
Saturday night watched 'Emperors club' with Kevin Kline which was really good movie, delivering a message of 'no matter how much you can try you cannot change people'
.
By now I learned to listen to my body and I can tell when the chemo is relatively washed out after each treatment. I see that with each subsequent treatment it takes longer to wash it out. When it is still in my system my upper right arm(where the lymph node removal impacted), my port incision,my expander stitches and also my scalp hurts(nonexistent pony tail in too much feel)
.
As I was laying in bed, with my nice frilly nightcap(my head gets cold, still not used to the bald feel) borrowed Ferit's reading glasses I started laughing cause I thought we were a scene from the Little Red Riding Hood. Me - the grandmother with the cap and glasses in bed, Ferit the wolf - he came in to kiss me. Sibel - Little Red Riding Hood - was going to give her bf some christmas cookies.
.
Sunday went to Crackel Barrel for breakfast, the pecan pancakes that I really like did not taste good, either my taste buds are not normal or it was a lousy batch. Then checked out Ikea(do they have a requirement to have a minimum number of crying babies present at any given moment???) and checked out Marshalls. Resting when I feel down from chemo does not seem to make a difference in the time of recovery(of course I will not go and run or bike but resuming daily normal activities seem to help) the feeling was similar to the way I felt at the last hours of my Ironman events, going on autopilot not really thinking about moving but just moving forward.
.
We were going to head to the movies but felt wiped out so rented a pay perview movie 'Mr. Brooks' while several friends of Elif invaded the house and had their own little party going on. I like the house being crowded.
.
Got a blood blister under my middle right toenail, will need to reasses workouts having impact. The muscles are feeling tired so I have given a break to weight workouts.
Was going to go swimming(have not been in the pool for 4 months now) but since my white blood cell counts were low thought I would better hold off until I get my Neulesta shot.
.
Monday felt a bit better and went to the office for the first time. Pulling into the parking lot after 4 months felt really weird, there were a couple of people at the office, since it was New Years Eve everyone who was working (or pretending to be working) was working from home. When I got in the elevator I had to think which floor I was on luckily I did remember the logon passwords for my computers. The wig really bothered me, do not know how I am going to work with it all day on Wednesday, I am considering wearing a scarf seriously. Had difficulty focusing at work, hopefully will get better.
.
Went to lunch with a friend who has been diagnosed with bc recently and tried to share some of my experiences with her those first days are really the toughest, as I told her ' until you cross the line' once you accept what you are dealing with everything else gets easier, similar to anything in life, I know it is easier said than done.
.
Later got my Neulesta shot I really did not want to get it on New Years eve because I feel like running a fever after I get it, but since my Taxol had finished at midnight they could not give it to me on Friday and the oncologist office was closed for the weekends.
.
Took the advantage of resting got far into reading 'Middlesex', a great book about several generations of Greek immigrants a definite page turner.
.
.
Saturday night watched 'Emperors club' with Kevin Kline which was really good movie, delivering a message of 'no matter how much you can try you cannot change people'
.
By now I learned to listen to my body and I can tell when the chemo is relatively washed out after each treatment. I see that with each subsequent treatment it takes longer to wash it out. When it is still in my system my upper right arm(where the lymph node removal impacted), my port incision,my expander stitches and also my scalp hurts(nonexistent pony tail in too much feel)
.
As I was laying in bed, with my nice frilly nightcap(my head gets cold, still not used to the bald feel) borrowed Ferit's reading glasses I started laughing cause I thought we were a scene from the Little Red Riding Hood. Me - the grandmother with the cap and glasses in bed, Ferit the wolf - he came in to kiss me. Sibel - Little Red Riding Hood - was going to give her bf some christmas cookies.
.
Sunday went to Crackel Barrel for breakfast, the pecan pancakes that I really like did not taste good, either my taste buds are not normal or it was a lousy batch. Then checked out Ikea(do they have a requirement to have a minimum number of crying babies present at any given moment???) and checked out Marshalls. Resting when I feel down from chemo does not seem to make a difference in the time of recovery(of course I will not go and run or bike but resuming daily normal activities seem to help) the feeling was similar to the way I felt at the last hours of my Ironman events, going on autopilot not really thinking about moving but just moving forward.
.
We were going to head to the movies but felt wiped out so rented a pay perview movie 'Mr. Brooks' while several friends of Elif invaded the house and had their own little party going on. I like the house being crowded.
.
Got a blood blister under my middle right toenail, will need to reasses workouts having impact. The muscles are feeling tired so I have given a break to weight workouts.
Was going to go swimming(have not been in the pool for 4 months now) but since my white blood cell counts were low thought I would better hold off until I get my Neulesta shot.
.
Monday felt a bit better and went to the office for the first time. Pulling into the parking lot after 4 months felt really weird, there were a couple of people at the office, since it was New Years Eve everyone who was working (or pretending to be working) was working from home. When I got in the elevator I had to think which floor I was on luckily I did remember the logon passwords for my computers. The wig really bothered me, do not know how I am going to work with it all day on Wednesday, I am considering wearing a scarf seriously. Had difficulty focusing at work, hopefully will get better.
.
Went to lunch with a friend who has been diagnosed with bc recently and tried to share some of my experiences with her those first days are really the toughest, as I told her ' until you cross the line' once you accept what you are dealing with everything else gets easier, similar to anything in life, I know it is easier said than done.
.
Later got my Neulesta shot I really did not want to get it on New Years eve because I feel like running a fever after I get it, but since my Taxol had finished at midnight they could not give it to me on Friday and the oncologist office was closed for the weekends.
.
Took the advantage of resting got far into reading 'Middlesex', a great book about several generations of Greek immigrants a definite page turner.
.
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