Well, I had my CT Scan with no problems yesterday. Then it was off to Dr. Karp's office for surgical talk.Doug was with me and we started out meeting around 9:30am. Dr. Karp was very happy to see both the MRI and the CT Scan. They basically show almost no residual tumor. But. Since we are in the baby stages of pre-surgical chemotherapy we still need to err on the side of safety. If I had only one tumor, He would have no problems doing a simple lumpectomy followed by radiation because my nodes were positive. And he was very honest telling me and drawing for me what a lumpectomy would look like without the other small tumor that was present. He also said that he could possible do a larger lumpectomy to try and find the edges of that second tumor. IT looked like a lot of breast tissue would be taken to try to be sure that he got clean edges around both of the tumor sites. Since we did not find the second tumor until after they placed the clip, we don't have a definite point to work off for that one. He would still take all of my nodes and it would be followed by about 6 weeks of radiation. He was very willing to go back and forth on this and said that if I twisted his arm, he would do this surgery for me.
The mastectomy would be his first choice still. And I knew this from the beginning. Because of how large the first tumor was, the appearance of the second tumor about an inch away from the big one, and the three positive nodes it is the safest bet. I told him that that is exactly how I felt. He also said that I would need the radiation and the nodes removed. Then about six months after radiation, we would talk reconstruction. He did say that he would be very disappointed if the pathology all came back negative after the surgery and would expect there would be a lot of thinking "well, we could have just done a lumpectomy". I agreed that it would be a difficult thing to swallow but since we are so on the cutting edge of this pre surgical chemo, and it hasn't been long enough to define whether if it looks like there is no cancer, then there is no cancer left, I would like to be better safe than sorry later.
We talked a lot about recent studies mostly about recurrence and life expectancy. Removing the nodes still has shown to cut down on recurrence so therefore life expectancy. Radiation of the chest wall has show the same. I had another mammography for us to look at once again. Again, it showed pretty much nothing. We talked about the spot on my liver and on my lung that were still unchanged. If they were cancer, the chemo will have controlled it too. We talked about the possibility of the pathology coming back completely negative and if that were the case, could be not do radiation and get reconstruction done earlier. All these things are still possibilities. I am, however, the poster child for chemo and shrinking tumors. Basically a lot of the after surgery stuff will depend on whether he does take out anything that still has cancer cells.
Bottom line is that I am scheduled for a modified radical mastectomy with removal of my lymph nodes on April 25. Then the results tell us the rest of the schedule. If I do need radiation, we would start two to three weeks after the surgery for four to six weeks. Then we would have to wait six months for the reconstruction so that brings us into the beginning of the new year for that to happen. And, I am still thinking of getting reconstruction done in Boston but that is for a later discussion. If I don't need radiation then we could do the reconstruction much earlier - three to four weeks after surgery at the most.
The kids and I will be meeting Doug in San Diego on April 13 until the 18th for the first half of the kids vacation. I have found a ranch that does horse whispering and they are right next to the National Park that is a desert and they ride into the desert. We are definitely doing that! We'll find some more fun stuff for the rest of that week once we all return home. Then it will be time for surgery. I have to go in to get some other testing done - blood work, EKG - as well as meeting with the nurses to go over the care of the drains and the wound and recovery exercises and all that. That will probably happen after the 18th but not definitely. Doug will be gone for most of the second week of April and will be Paulo Alto before he comes down to San Diego to meet us.
I will write later about how this is all feeling, when it has sunk in a bit more and I am feeling something. Right now, I am still kinda stunned.
