Into the Abyss

An old family friend got it right.  I don't like options, especially options with uncertainty attached.

I'm already bummed that I have to give up the rest of my precious summer of fun activities for this disease.  Now, I have to decide how I'm going to get back to doing these activities.  Yet, I have no idea how any of these options is going to turn out.  Perhaps it's uncertainty that I don't really like.

What to do?  I can go the route of no reconstruction.  What does that mean?  Living my life with one breast.  It's very hard to imagine.  Swimming, surfing, softball, basketball, etc., all my various weekly activities with just one.  But, all my muscles will be intact and I can get back to doing the things I love.

The other route isn't very cut and dry either.  My choices are to have my muscles (abdomen or back) cut and moved to my breast area, or have my existing pectoral muscle stretched over a few weeks.  I like my muscles, I use my muscles in all my activities.  But, I'll have two breasts.

Again, there are no guarantees in life.  And not know how long any of this is gonna take is driving me crazy.  With all my sports injuries I was always given a time frame of how long it would take to heal and when I could get back on the court, on the field, in the pool, etc.  But with this, there are no time frames.  There are still so many unanswered questions, will I have to do other treatments, will I get my strength back in my arm?  It's scary to thinking about what is ahead of me.

I have a lot to ponder before my next appointment.

A day at the S. Mark Taper Imaging Center.  First up an IV hook-up and an intravenous injection of Technetium 99m Medronate (basically a shot of radioactive material) for the whole body bone scan.  While this material travels through my body I get to ingest this lovely "smoothie" (pictured) for the CT Abdomen scan.  They really should not call it a "smoothie", it tastes nothing like any smoothie I have ever had, in fact tastes like chalk.  Next, I get to sit in a waiting room, IV still in my arm, for about an hour while all these lovely chemicals travel through my body.

CT Abdomen scan is up first.  Big machine, makes lots of noise, room is cold.  Next is the CT Chest scan.  They send contrasting agents through my IV for this test.  It creates this weird internal warming sensation from my head to pelvis region.  Very strange.  Both tests take about an hour to complete.  Afterwards, I am escorted to another room with another big, noisy machine for my whole body bone scan.  This takes about 45 minutes of lying completely still while the giant machine moves over my body.

After I am finished at the Imaging Center, I walk across campus to have my first meeting with the plastic surgeon.  Once again I am being inundated with a ton of information.  He briefly explained the three options for breast reconstruction available to me:  1. Breast Implant surgery which involves stretching the pectoral muscle out by filling a balloon like pouch with saline over a few weeks time, then inserting either a silicone or saline implant.  2. TRAM Flap procedure that relocates abdomen muscle and tissue up to the breast area to form a new breast.  3.  Latissimus Dorsi Flap procedure where they cut part of the latissimus dorsi muscle in your back and move it to breast area to create a pocket for an implant.

My head was spinning after all this information was spewed at me.  My biggest concern that I expressed with the doctor was my ability to be able to do all the physical activities that I enjoy, i.e. swimming, surfing, softball and basketball.  I felt like I threw him a curve ball.  Basically his answer equates to: like life, there are no guarantees to whether or not my muscles would recover 100%.

So off I go to ponder what will be the best option for me.  I am not happy.

Plan of Action

My first appointment with the breast surgeon at the Saul & Joyce Brandman Breast Center at Cedars-Sinai.  I brought my sister along for support.  And it was a good thing, the information started flowing and my head started spinning.  My sister was able to listen and ask some questions along the way.  I was pretty useless in that department.  I'm not sure I heard half of what the doctor had to say.  A treatment plan was being formulated as we spoke.

After a quick exam, we reviewed my records and looked at the mammogram films.  She told me my cancer was at least a stage II, further testing after surgery will determine exactly what stage it really is.  She then took out a tape measure and showed me how 9cm looks, basically it's a lot when you hold it up to your breast.  My two options were either a lumpectomy or a mastectomy.  With the lumpectomy comes six weeks of radiation, mandatory.  With the mastectomy, radiation or chemotherapy would be determined after they take out the tumor and surrounding calcified tissue, plus do a sentinel lymph node biopsy.  If everything is clean, I wouldn't need either.  I will have to take tamoxifen for five years because my cancer is hormone based.  If I go with the mastectomy I can do breast reconstruction or a breast prostheses, neither of which sound appealing.

Since the size of the area that needs to come out, the first decision (albeit, a sucky one) was easy.  I will go with the mastectomy.  Having told the oncologist this, she then set up a referral for a plastic surgeon to discuss my options.  Appointments for pre-op testing were made for Monday.

And so it begins.  This is really happening.

The ball gets rolling

Today I met with the general practitioner.  Basically this was a medical formality to get to the next step.  He started a chart, asked me a ton of questions about my medical history, and order blood work.  Then made the referral to the oncologist.  They sent me on my way and told me someone would be calling me in a couple of days with an appointment for the oncologist.  By the time I drove home from the doctor’s office, I had a message regarding an appointment.

I returned the call.  My referral placed me at the Saul & Joyce Brandman Breast Center at Cedars-Sinai.  They had an opening for me the following Friday.


And so the journey begins.

Hal

It's been a very emotional couple of days talking with my family.  Talking about it is the hardest part for me.  I don't like to talk about personal things like this.  I just want everything to be as normal as possible.  "I've got to look normal.  We've, all of us got to behave normally!"

To help me cope, we are calling the tumor Hal.

It is what it is

I went to the clinic to have someone official read me the results of my biopsy.

I have an invasive ductal carcinoma tumor in my left breast.  This is the most common type of breast cancer.  Invasive ductal carcinoma starts in a milk passage (duct) of the breast, breaks through the wall of the duct, and grows into the fatty tissue of the breast.  At this point, it may be able to spread to other parts of the body through the lymphatic system and bloodstream.  During surgery, the doctors will do a sentinel node biopsy to determine if the cancer has spread.

Well that just sucks.

The next step, make an appointment with a General Practitioner to get referral to see a specialist.  The first available appointment wasn’t available until May 29^th.   That is a long time to wait with no answers to what will happen next.

Yep, that sucks.

Now comes the hardest part.  Telling people that you have cancer.  You know how you feel when someone tells you bad news.  Well, having to tell someone bad news about yourself is a billion times worse.  The silence on the phone or the look in their eyes of almost immediate sadness, it creates this awful feeling in your gut.  And there is never a good time or good way to dispel the news, never.

Sucks even more.

I wanted very much not to tell people and just deal with it on my own, but all the doctors and nurses and pamphlets tell you to create a support group around you to get through everything.

I would start with telling my immediate family, this was done over the phone since they don't live in the same city as me.

Sucked.

That was about all I can handle for now.  Since I don't have any real answers to what is going to happen, I am going to keep this to myself for a bit.

You don't say

I received a call from the clinic to come in to discuss my results.  She asked if I could come on Friday.  I told her that I had to work, but I had tomorrow off.  She was going to be off, but asked me to hold while she checked the schedule to see which doctor would be available.  I told her I already had an appointment scheduled for Monday, but she was very insistent that I come in tomorrow.  I knew then that the news was not going to be good.  Basically without telling me I had cancer, she told me I had cancer.