Wednesday, June 30, 2010

Today's breast surgeon visit and trying to get a shingles vaccine

Wow, a long day for sure!  And we have so much to think through before making a decision on the next steps.

Here are a few facts:

Stage 2, Grade 3, left invasive ductal carcinoma.  This is the most common form of breast cancer.  It is positive for estrogen and progesterone receptors (that is good).  There are other portions of the pathology report TBD.

We met with the breast surgeon, Dr. Christa Balanoff, and she presented the following options:

1.  Chemo first to shrink the tumor (sometimes down to almost nothing, then lumpectomy and Sentinel Node biopsy, then radiation.  In this scenario, the lumpectomy preserves the most breast tissue and gets the worst part of the treatment out of the way.  It also means I need a wig sooner rather than later. Need to think about my "new look" and I'm open to your humorous suggestions :>)

2.  Lumpectomy first and Sentinel Node biopsy, then chemo, then radiation.  In this scenario, it's a pretty big lumpectomy because they have to take enough tissue to get "clear margins" - another 3 - 5 millimeters.  I'll be lopsided, for sure, probably lose about 1/3 - 1/4 of the breast.  Hmmm...permanent reminder.

3. Total mastectomy - with or without reconstruction, then chemo, then radiation. Seems a bit radical, given the other options.  But some people just want that breast "out of here".  After all, it's trying to kill you!  So I understand why people choose that route.  But I'm thinking not...

We will have meetings in the next week or so with the oncologist and the radiologist.  Unfortunately, the tumor is just a bit too big to have the Mammosite radiation (2 times a day for 5 days).  They want it to be under 3 cm and I am right there at 3.  So radiation will probably be the normal external version - something like 33 sessions.

Also, just to be sure, I am having another ultrasound tomorrow of my left armpit lymph nodes to be sure nothing is lighting up the screen.   We have to be at Menorah's Breast Center at 7:30 a.m. - which works only because both of us aren't really sleeping well at the moment.   Let's hope they don't find anything else.  She doesn't expect anything, this is just "due diligence."

It is a lot to digest and we will take our time to plot the right course.   For now, we are leaning towards Option 1, chemo first.  Well, I really don't want chemo at all; but then, no one wants to do chemo!

Now on to the most ridiculous part of our day - trying to get my shingles vaccine.  So for those of you not familiar with this, it is recommended for anyone over 60 who's had chicken pox.  Shingles has a bad habit of erupting in people with a compromised immune system.  Chemo will put me there.  I know people (including my mom) who have suffered through this nastiness.  So, I decided to ask my doctor for the vaccine.   But our lovely government does NOT allow doctors to administer the vaccine.  They can write a script, then you take the script to the closest pharmacy, they give you the frozen live vaccine and you rush back to your doctor's office and have them inject it.  Or, you go to a Walgreen's Clinic, they charge you for an office visit (your co-pay), then the Nurse Practicioner writes the script over to their pharmacy, you wait for the pharmacy to deliver it to the NP and then she does the stick.  So, we tried the Walgreen's thing first (because we didn't know they would charge for a visit or how all this would work).  But after about an hour of messing around with their forms and their check in process and waiting and waiting... I told Rick I was done with it for the day.  So then we went over to a pharmacy that would dispense the vaccine to us, we were going to run back to the doctor's office and have them do the stick.  But it was 5:30, I kept getting the doctor's office auto-attendant and waited for about 10 minutes.    And oh, it looks like our usually fantastic insurance doesn't cover "vaccines."  Huh???  This stuff is $202!  We need to check with BCBS...maybe there is a special code that needs to be used.

We finally completely gave up, said tomorrow's another day, and went to Texas Roadhouse for bloody Mary's and dinner.


  1. Ok, lots of good info here....the best part by far is when you got to the bloody mary! Love you! Katie Fritts

  2. Gosh Michelle, what a lot of things to consider today. No wonder you're heading for some drinks!

    I had the Shingles' shot and glad I did. I did get shingles and it's not pretty. Luckily, I caught it the first day and asked the nurse's aide at work. Her mom just had it and diagnosed it for me. Mine was not extremely painful, and I was able to get better soon. My mom's shingles were all over her face near her eye. It was AWFUL and painful. She almost lost vision in her eye. I recommend everyone over 60 get a shingle's shot.

    I got the shot "after" I got shingles and was cleared up. I was told that they don't know if that will prevent me from getting it again, but I opted to get it, just in case.

  3. Hey, kiddo! Hang in there. Options are wide open, sounds like. If you have the time for a second opinion, you will likely hear the same options, but a different doctor's viewpoint of pros and cons of each one- enlightening. I would encourage second opinions. Watch the insurance stuff and be careful. Precert procedures, tests, check to make sure labs are in network, hospitals in network, keep an insurance diary- log all calls, write down dates, times, who you spoke with, let them know you are making a written note and ask them to do the same in your file. Ask for detail bills from ANY time you are admitted for a procedure or treatment, especially if it's hospital surgery. I have been charged for things that never occured. I spent a year fighting insurance on a $3500 cancer related test. Finally won, but it was huge effort.

    If you do chemo in summer, you may find a wig hot. You may be more interested in a "ball-cap" wig, or bandanas and head wraps which are cooler and more comfortable.

    Also, your insurance may have a case manager function for complex diagnoses such as cancer. They can help you navigate some of the issues you are running into, such as the shingles situation. I would call and ask about that.

    Every day, you are one day closer to being cured! Keep me posted, friend!


  4. I agree with Katie! I love the decision to call it a day and go to Texas Roadhouse for dinner and drinks! Especially after such a long exhausting day! Ted =)

  5. Thanks for sharing your blog. Humor and keeping your ever so positive outlook on things will definitely help beat this!


  6. -"Always laugh when you can, it is cheap medicine. Merriment - it is the sunny side of existence."
    ~ Lord Bryon

    Hope one these may bring a smile:
    Top 10 Reasons that Chemo-Induced Baldness is Awesome

    #10: Blonde jokes no longer apply to you.

    #9: Increased aerodynamics. (important for runners, sky divers, human

    #8: You can finally drive your convertible to work. (no more 'wind-tunnel'

    #7: You've got a blank canvas for new tattoos.

    #6: You're now ready to audition for the Blue Man Group
    #5: Time to get a new driver's license...Hair Color: Invisible. (see how
    that one goes over with the cop the next time you're pulled over)

    #4: Think of the money you'll more barber/hairdresser,
    shampoo, hairspray, dandruff medication, hair dye, etc.

    #3: Everyone knows that bald people make better lovers. (and if they
    don't, perhaps it's time that you showed them)

    #2: It distracts attention from your face. (alright, that was completely
    uncalled for, you ass)

    And the #1 reason that chemo-induced baldness is awesome:

    Bald = Sexy (just look at Bruce Willis, Vin Diesel, Natalie Portman and Britney
    Spears...ok, she's hot in a bald and crazy kind of way)

    God Bless......MQ

  7. Hey, Michelle. You presented some great options there. Like you, Number 1 sounds like the "best" choice. I know you said that you would have to "do" a wig sooner rather than later, but just think; your hair will come back sooner rather than later.

    There are so many options out there regarding wigs. My girlfriend had a difficult time and wound up getting three for different looks.

    My sister purchased one that was different from her own hair. She had curly hair, much like mine, and opted for the long, straight look. Looked good on her.

    I do have to say when their hair started coming back in, they looked magnificent in short hair. I actually told my sister she looked beautiful with the crew cut (she did!) and she stopped wearing the wig.

    Whoever MQ is, hysterical top 10 reasons. So completely true. LOL.

    Michelle, wishing you comfort and peace in whatever choice you make.