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I have been having dreams the last few nights. They were driven by anxiety. The anxiety was driven by waiting for my genetic counseling results. The results are in! And… (drum roll) – I tested positive for the BRCA1 mutation.

Let’s start with the fact that everyone has BRCA1 and BRCA2 and all the other genes they test for. BRCA stands for breast cancer susceptibility gene. Yes, even men have these. The purpose of these particular genes is to help regulate cell growth and suppress tumors. When they are normal, the body is happy, cancer does not appear. When they are mutated, your risk of cancer increases.

BRCA1 is associated with triple negative breast cancer which is the type of cancer I have. It’s often difficult to treat, but, again. I’m lucky. I was getting screened and tested. So far all tests have shown nothing spreading beyond the breast area. It’s often not found in time. I will keep telling myself I’m lucky, even on the days when I don’t feel very lucky.

Both BRCA1 and 2 are associated with breast, ovarian and pancreatic cancer. If you have a history of any of these cancers in your family, I would highly recommend getting genetic testing done so you can determine your risk and be screened sooner.

What now? I’m not 100% sure yet other than the tatas are definitely going tata and my ovaries shall follow suit. Why? Risk of recurrence. I could opt for a lumpectomy, but I’d have to get yearly mammograms and MRIs or something. If I go with a mastectomy, the risk of recurrence goes down 90%. Not zero, but I’ll take it. 

But… your ovaries are not misbehaving! Ah, but they could. Removing them will decrease my risk of ovarian cancer by 96%. Better than 90%, closer to zero. I’ll take it. I had already opted out of fertility preservation as well. Chemotherapy most of the time will kill any chance a woman has of having children naturally without fertility treatments. Not always, but often. I am glad that these treatments are available for women who want children.

What about babies? Answer: I have two babies, they are furry and love to go on walks and take naps on the couch. I have never really had any drive to be a mother. I do love being an aunt though. I want them to grow up healthy and happy, and I want science and genetics research to keep moving forward quickly so that in the future risks can be mitigated and reduced without drastic surgical intervention.

I’m not going to lie. I love my tatas. They are glorious and have opened doors for me, mostly literally. Like, someone holds the door for me. They’ve made buying clothes tough, but when I do find the right outfits or dresses – mostly dresses – they make me look fabulous. 

I will not get implants. The news about them has not been good lately, and I don’t want a foreign object placed in my body. I already have an invasive foreign object – pretty sure cancer wasn’t there to start with. There are other options for reconstruction that I will look into, or I could wear fake tatas. It will never be the same. I’ll miss them.

My ovaries? I’ll miss them too, but mainly because I’ll go into surgical menopause. I just was looking this up to try to get the words right and found what the procedure is called: oophorectomy. That’s right. Ooph!

So, what are the odds of developing breast cancer? I am using breastcancer.org to answer this question here. They talk about ‘absolute risk’ – this is based on how many in a certain time period/age – and ‘relative risk’ – which compares risk between groups.

In the US, one in eight women will have breast cancer in their lifetimes. The younger you are, the less likely you are to develop an invasive breast cancer. Interestingly, the highest probability for this type of breast cancer appears to occur in your 40s where it jumps to 1 in 69. I’m in the 30-40 range, so my probability was 1 in 228. Crap luck, that.

Things that can increase your risk include family history and genetic mutations. If you have the BRCA1 gene, your chance of developing breast cancer by 80 is 72%. Basically, if you don’t have it by then and you have that gene, you can count yourself lucky. BRCA2 is only 69%. Much better. Kind of. (**Note: Sarcasm in use)

Luckily, the 5-year survival rate is 90%. So there’s that.

My relative risk has probably been high lately due to drinking alcohol. Or not. I did drink too much around the time that we lost our Wee Man Spencer dog in April. He had dementia, and we didn’t fully comprehend how much of our life was going into that little man until he was gone. It was jarring. Anyway, the actual overall risk if you drink two or more alcoholic beverages a day goes from 12% to 18%, so I’ll just suggest you cut down to a few days per week and not drink every day. Sound medical advice. Kidding – I am not a doctor, nor do I play one on TV.

My particular case is synchronous bilateral breast cancer (SBBC). I randomly searched and found some information on surgeons.org about this. 2.3% is the number for two tata diagnosis of invasive breast cancer. My left isn’t invasive at this time, but I’m not really interested in waiting around to find out if it wants to join the right at that particular party. The best part is that this is more likely in people with no cancer in the blood or lymphatic system. There are other things that make it more likely, but I don’t fit those because I am a unicorn. 

Survival rate is the same when both breasts are misbehaving. I guess that’s good.

Then there are recurrence rates related to types of treatment. One option is a lumpectomy. That is where they remove the area of the cancer during surgery and then check the margins to ensure no cancer has moved beyond that area. The margin refers to an area around the tumor that is removed as well. When they remove a tumor, they want to be sure they have removed the entire tumor, so they take additional tissue along with the obvious mass. Hopefully this ‘margin’ shows no signs of cancer, but if it does, the surgeon will need to remove additional tissue.

Recurrence within 10 years (back to breastcancer.org) is around 35%. If you add radiation after, Recurrence is reduced by 46%. 

Mastectomy, total removal of the breast, greatly reduces recurrence, especially if the cancer is found in the lymph nodes as well. I am holding out hope that I am not in that category and that it is only misbehaving tatas and they decided not to share with anything else in my body. It can go metastatic, meaning it has moved elsewhere in the body but it is still breast cancer. Let’s assume we caught it early enough that I can avoid that in this case. Because dwelling on ‘what ifs’ in this situation is not healthy. I need to get through this part first. Everything else can wait.

Seems about right. 

My surgeon called last night! Last night was Sunday night. Always good news when it’s a weekend call. Amiright? I’m glad I got the call. We were watching a movie – Lucky Logan – and it was funny and entertaining. Not a movie that will change your life, but that’s most movies. Sidetracked. Sorry.

Biopsy results are in! I received an apology as they had apparently been uploaded Friday night but no notification had been sent to the surgeon. Even though they’re all on the same network. And in the same building. It’s okay. I’m not upset about that. I wanted everyone to just have a good holiday weekend. I probably made the person who was checking the pathogens sad before the weekend. No one wants to go into the weekend having just discovered cancer, yours or someone else’s.

Results: Right side, additional invasive ductal carcinoma (IDC). Near the original site, not a complete surprise. Left side: Ductal carcinoma in situ (DCIS). Again, ductal – the cells in the milk ducts, carcinoma – cancer, and then a new one – in situ – meaning “in the original place.” 

Meaning? It’s non-invasive. Yippee. Still cancer. And it’s only non-invasive because it hasn’t spread beyond the milk ducts. There’s a higher risk of it coming back than the IDC because cancer totally makes sense. The chances are apparently less than 30%, but that’s much higher than, oh, say, 0%. 

I need to find out the grade of it – I was a little stunned, so failed to ask questions. I will contact them soon. And also, find out if it is hormone positive or negative. My initial diagnosis is negative, so this one is probably positive because, as I informed the surgeon last night: I’m not normal.

Decisions now. Lumpectomy with radiation drops the recurrence chance to around 15%. Still higher than the 0% I’m looking for. If it does reoccur, it’s 50/50 invasive/non-invasive. To help myself, I’ll need to maintain a healthy weight – something to work on, absolutely – and exercise regularly. This one is frustrating as I have exercised regularly more than anyone else in my family probably ever. Rant over. Limiting or avoiding alcohol – that’s fine. I’ll miss it, but not more than staying alive. I’ve got stuff to do. Eating healthy food and limiting sugar. I’ve done this for the most part. I will admit to being on a Reese’s binge at the moment, but I’m even limiting those.

Not smoking. I’ve never smoked. I grew up in a household where my parents smoked inside. No, I will not blame them because at the time everyone smoked and it was just the norm. For a long time I’ve had adverse reactions to the smell of cigarette smoke. It makes me sad, because many people in my family smoke and some of my friends smoke. I wish they’d stop.

Radiation. Not excited about this one, I must say. We are waiting on the results of genetic testing to see how prone I am to all this fun stuff. I’m honestly hoping it comes back and just tells me I’m an anomaly and there’s no current genetic reason for this. That would help me feel like maybe my relatives would be safe from all this.

I’m leaning toward just saying, ta-ta, tatas! The less I have to look over my shoulder for the rest of my life, the better.

Pros: Hiking will be easier! Won’t have to hunt for the elusive ‘bra that fits.’ No more getting punched in the boob by the dogs. I can opt for reconstruction, or not. Prosthesis are available. I could go as a Fembot for Halloween.

Fun fact: Did you know that reconstruction was not required to be covered by insurance until 1998? 

Cons: I’ll miss them. We’ve been through a lot together in 38, almost 39 years. 

So, that’s the news for today. Chances are I will still be looking at chemotherapy first, followed by surgery. Or not. Next oncology appointment is on July 16th and we should have all the pieces together by then including the genetic testing. Then we will move forward. In the meantime, we will be revamping this page a bit, make it prettier, and I’ll be working because that’s a good way to keep my mind occupied. Cheers.

I decided to split up the biopsies into two posts in case you fainted from reading about the needles in the first post. They only get bigger in the second part!

I was moved to a different room and sat on a table. They lifted me up very, very high, and prepped the under part of the table. I couldn’t see much of that apparatus from my ivory tower on top, but it is basically a mammogram machine thing but under a table. When they were ready, I lay down and my left breast hung through a hole in the table. So comfortable. At least my right one was still numb from the previous procedure because I got to lie on it for a while.

They bring the two parts of the under table mammogram machine thingy – technical term – together and use that as guidance for where to do the biopsy. They took some pictures, the doctor looked at them and the area to be… accessed… was cleaned to prepare for the procedure.

Another shot of lidocaine! I didn’t see the needle for that this time. I had in the previous procedure, but it was tiny. Then the procedure was started. The ‘large-bore needle’ used for this procedure is a 9 gauge.That means it’s bigger than the previous needle. They apparently shove more lidocaine in that hole two and I felt very little. I shouldn’t say nothing, but no pain.

The samples were taken and at one point it sounded like a drill from the dentist’s office was being used. I commented on it. There were at least three people in the room for each procedure, and they all assisted, but also to make sure I wasn’t freaking out, I think. 

The giant needle was removed and the area compressed to stop any bleeding. I then went on my side and they lowered the table and they put on the Steri-Strips and gauze. 

Next, I got to get up and move to the mammogram room and have two mammogram pictures taken on each side. Always a fun time. They didn’t squish them as hard I was told, but I couldn’t really feel anything. 

These biopsies are performed by a radiologist who has special training. Things I’m learning that I could have blissfully lived my life unaware of and been content. C’est la vie.

I behaved through all procedures. The last thing I want is to have to repeat anything or start anything over. I am nice to all the staff as they are doing their jobs and I trust that they are good at them.

The last part was with the nurse to discharge me. I was given numbers to call if I was freaked out and advised that the operator answering would not know who I was. Apparently people have gotten upset with the operator not knowing them immediately and having to look their information up and get the on-call doctor for that area to call them back. Really, people? Let’s all take a step back and just be nicer and more understanding. Okay?

No showers or swimming for 24 hours. No lifting anything over 10 pounds (lbs) for 24 hours – sorry, Arthur, you’ll have to jump up into my lap yourself – he’s 12.6 lbs. Take it easy. Ice every two hours. Sleep in your supportive bra. I didn’t ice overnight. I slept in the bra, though. Remove the gauze after 24 hours and then you can shower. Don’t remove the Steri-Strips. They will fall off on their own. Any concerns? Call. And here’s an ACE bandage in case you need to compress the area due to swelling. And some ice packs. They’re round. I was given one – asked for a second because, hey! I got two owies. 

Finally, released. The entire appointment was four hours. About half was the procedure, the rest was waiting. I did pretty well with the waiting. I’m trying to be more patient because I know there will be lots of waiting. 

The drive home took almost an hour. The drive in had taken about 45 minutes. Please pay more attention when driving, people, so that you don’t block every route out of downtown with accidents. Thanks!

Biopsies. Two. Right and left. Why? My MRI showed additional areas of concern. 

On the right, a smaller mass similar to the initial mass. It was not seen on a mammogram or the initial ultrasound. Although, to be fair, they were looking at the 2 centimeter (cm) mass. My MRI said it’s 2.1. Hence the Stage 2 now. Just .1 cm makes it sound scarier.

On the left, an irregular calcification that is kind of linear and in an area 1.6 x .7 cm. This was noted on the mammogram but only after being viewed on the MRI. The chances of it being caught with just the mammogram were maybe not great. Plus, they were concerned about the right mass and focused there.

I know you want to know what this was like. It was so fun! Kidding. The PET scan was a cakewalk. Biopsies? Less so.

They were running late. We showed up at the appointed time, and I had to wait. I was pulled into a room to do a mammogram on my left side in preparation for my stereotactic biopsy. I behaved and held my breath when requested and the pictures were fine. Then I kept waiting. I think it was around an hour and a half to two hours of waiting until we got down to business. They were running behind. I hope it wasn’t because they’d had complications with someone and needed lots of extra time.

Right biopsy. Ultrasound-guided. I was face-up on a table and a bolster placed behind my right side to elevate the area. My offenders have all decided to be on the under part of my breasts, so that’s where they needed access to. After thoroughly cleaning the area, I was numbed with lidocaine that the doctor inserted into the affected area after spending time making sure it was the correct spot. That hurt a little, but it’s just a pinch. And much better than feeling, oh, anything. 

I haven’t read the notes on this biopsy yet, but I did a little research on the size of the needles. A core biopsy needle will be 14,16, or 18 gauge. The higher the number, the smaller the needle. There is a ‘click’ as they take the samples, but she let me know so I would hopefully not jump. I didn’t jump. Trying to behave in the parts I can control and make their job easier any way I can. 

Samples were taken. Three or four, I don’t remember. I just stared at the ceiling mostly. Then, the biopsy needle was removed and pressure applied to the wound. Steri-Strips were placed over the area and then gauze was taped on. I can remove the gauze tonight before I shower – no shower for 24 hours after these procedures – but I am to leave the Steri-Strips until they fall off.

When they do a breast biopsy, they put in a little marker that is called a clip. It is titanium-based and is to mark where the site of the biopsy occurred to help mark where surgery might be needed. I have three clips, two in the right, one in the left. I am fine with this number of clips. I was fine with one. Obviously I would have preferred zero. I don’t want to collect the whole set since apparently they put different clip shapes in every site to note on my charts. Three is good, and I think all doctors currently involved would agree.

Next: Stereotactic biopsy!

I’m meeting two oncologists. One was today. He ordered a PET scan – that will be Wednesday – and we have no treatment plan because of my other areas I need biopsies on now. Also Wednesday. But he did tell me that because of my tumor size, I would be considered Stage 2. And that’s if it hasn’t spread anywhere else. That’s what the PET scan will show or hopefully not show.

Tomorrow I will meet the second one who will probably tell me the same stuff, but she’s five minutes from my house. I think he realized by the end of today I would probably end up with her. She’s close. I’m not a good candidate for a clinical trial because my main concern is neuropathy. I don’t care if my hair falls out. I don’t care if my breasts have to be removed. I don’t care about anything except being alive after all this is done, being a happy little family, and being able to keep doing what I love.

I love my work. I am a stenographer. I help people in intimate settings and at large events. I have helped amazing intelligent people in college work towards and achieve their degrees. Having a disability should never hold someone back from their dreams, no matter how large or how small. I honestly believe that many of the people I have worked with will change the world for the better, and I am humbled to have played my small part.

Neuropathy is numbness. I talked to a neighbor who survived Stage 3 esophageal cancer – treated by the oncologist I’m going to see tomorrow – and he has some numbness in his fingers and feet. He has to be careful how he walks. I know being alive is the ultimate goal, but I don’t want to have to figure out something new to love because I can’t feel my fingers and control where they go.

At the end of the day, I still don’t have a treatment plan because I need additional testing and scans. Hopefully my PET scan will just show that I have naughty, naughty breasts and that’s it. Hopefully my biopsies will show no new cancers because if I have another one, and it’s hormone positive? That would change my treatment plan a lot.

I hate waiting.

You have cancer. You’d think everyone would be freaking out and wanting to get this taken care of immediately! No. You wait. You wait for the first appointment with the people who can start to solve this. That was Monday. 

You wait for the MRI results. Those came in Tuesday while we were on the way to our pet first aid course. The course was great, and now we know how to do CPR and the Heimlich on our pets as well as find a pulse. The pulse can be found on any four-legged animal by pressing gently with the middle and ring finger on their femoral artery which is located in the crease where their hind leg meets their body. We practiced on Arthur a bit last night. He just thought he was getting belly rubs.

I digress. MRI results. Probably because I don’t want to think about it. They found another mass in my right breast. It’s smaller and was not visible on the mammogram. The initial mass is 2.1 centimeters, which puts me strongly in the chemo first/surgery later category. These things will happen either way. It’s just a matter of which is first.

Then there’s the left breast. It decided maybe to get in on the action too. They noted some calcification. What on earth is that? A calcification in the breast is usually a benign calcium deposit. Generally, nothing to worry about.

Apparently mine is maybe something to worry about. 

What does this all mean? More waiting. I have oncology appointments with two different oncologists Monday and Tuesday. I hope they agree on everything and that I get to use the one five minutes from my house since by the end of this we will be best buddies. Additional testing will happen on July 3.

The additional testing will be an ultrasound-guided biopsy on the right and a stereotactic breast biopsy on the left. The doctor will use ultrasound imaging to guide where they should insert the needle to obtain a tissue sample. I’ve also had ultrasounds on my knee and ankle. Normal women have ultrasounds to look at their babies while in the womb. I’ve decided to be abby-normal.

The stereotactic biopsy sounds a little more… yeah. I need to do more research, but currently I’ve stopped at ‘large bore needle’ – it’s probably a similar needle to the ultrasound biopsy, but I hadn’t read that part first so I’m cool with it.

They should be able to find the mass on the right at least with that and get samples. I won’t say ‘a sample’ because the first biopsy was six samples and from what I can decipher from the bit of information I have, five of those were viable to be tested.

I watched the ultrasound as they did my initial biopsy. If you’re not grossed out by medical stuff, it’s pretty fascinating. I’ve been through enough medical and nursing school now via my job that I can watch this stuff. I used to not be able to watch them prick me with a needle. Now I can. I guess that’s good.

And another mammogram. My fave. 

And then? More waiting. July 4th is a holiday in the US. I guarantee the people who read biopsies aren’t working that day. Maybe I’ll get lucky and they’ll look at them immediately, but I’m not going to hold my breath. And after talking to the nurse, she said Monday/Tuesday/Wednesday before the results and my surgeon will call me with them.

So, this pushes me into the following week before any decisions can be truly made. Fun.

Did I mention I hate waiting?

That’s what I told myself as the MRI machine clicked and fussed around me. I was facedown on a table with my boobs hanging through the table. I’d started with head Enya, but she was too peaceful for the racket going on around. Blue Men. That’s the ticket. As the sounds moved around me – real or imagined? Not sure as I’m not an MRI tech – I could pretend other Blue Men picked it up and were playing the same thing, just it had moved on to the next member of the ensemble.

And the whirring of the machine when nothing was happening? That was one Blue Man the entire time cranking an instrument that made that noise. It worked. I went through 30-35 minutes in a tube on my face with boobs dangling and my arms stretched above my head. My hands started to fall asleep near the end, but it wasn’t too bad.

That was the last test of the day. I should know what it says tomorrow when the surgeon calls. 

The first thing was a blood draw. Everyone wanted some, apparently, but my phlebotomist – a person who draws blood – was fantastic. We spent the entire 2 minutes together (okay, maybe 5) cracking jokes. I like it when people enjoy their work. Makes it easier for everyone involved.

Then on to genetic counseling. She explained how it works and we determined that it is very different than it was 10 years ago when my sister was tested and showed a negative test. You are not likely to have the genetic component, but if you are found to have it, it’s good to know. It can color your treatment decisions. 

After that was my surgical consult. At the moment, depending on what oncology says next week, all options are on the table. My cancer could be treated via lumpectomy or mastectomy. A lumpectomy – removal of the offending area only – would require radiation treatment after. A mastectomy – removal of one or both breasts – would not require radiation. Currently, I could do surgery + chemo, or chemo + surgery. Radiation would be right after surgery, whichever way it went. 

Then there are options for reconstruction. You could just opt for none, in which case a prosthesis may be used. You could opt for implants – not my idea of fun. Or there’s a procedure where they can use belly fat to reconstruct the breast if your fat is the right fat or something. The diet can wait? 

Bottom line for me: No real decision yet.

And then there was the MRI, or magnetic resonance imaging. That’s where I started and where I will end. Just imagine The Blue Man Group on a dark stage. It helps if you keep your eyes closed.

Last night I dreamt that the house lost its roof. Not that it blew away, but that the whole thing popped off and was just sitting next to it. This kept coming back in the dreams that followed. It was just laying there the whole time. Odd.

So. Many. Phone calls. As part of my treatment I had to transfer from one facility to another due to insurance. The insurance companies are fighting – I might not be covered at the facility where I was diagnosed after June 30th. Or maybe I will be. Better just to go to the new place. It’s a good place, but I already miss my patient advocate from the first place. I don’t have one yet at the new place that I am aware of.

Instead we are just getting phone calls. I tell five people my family history. Ask that all records be transferred to the new facility. I know they got them. Get a call asking for history. The history will not change. My sister had breast cancer so I was getting mammograms. She’s alive. My aunt also had breast cancer. She died too young, but older than I am. These facts will not change no matter what facility I go to.

I am going to treat the administrative part of this like a mortgage transaction. When I worked in mortgage, I did my best to make sure my customers communicated to me when they were faxing something. Email attachment is even better. I’d run to the machines and pick up my documents because if I didn’t, they might go missing. Someone would grab them or they’d end up in the shred bins.

I advise anyone going through the mortgage process to just be patient, and if they ask for documents five times, just keep sending them. I had two verifications of employment when we purchased out current home. Written by the same person, saying the same thing. Ohm. Hopefully they’ll call soon while I’m on break so I can give them my family history. Again.

PS: They called. It was additional history for genetic testing. That’s always fun because my mom was adopted and most of her records we cannot get to or just don’t know. I’ve asked my dad if he still has any of her records that they were able to get when she found her birth mother. I’m not sure how much of that is around still since she has been gone since 2008.