Tuesday, March 29, 2011

Claiming victory was a bit premature

Earlier this year, I went to St. Louis with Rick on a business trip and spent the day shopping in St. Charles, a little historic town along the Mississippi with cute shops and restaurants.  I came across a tshirt that said "I fought like a girl and won" and had to buy it, thinking it stated exactly how I felt about my "bout" with breast cancer.  And I wore it proudly last week on my flight from KC to Boston to visit the kids.

Well, it appears that I may have won the first round, but I didn't quite deliver the knockout punch that I thought kicked cancer's butt.  It's back.

That seroma I had was not infected, but it did contain cancer cells.  That was confirmed by Cytology last week.  Unfortunately, the lab didn't handle the specimen properly so no additional "pathology" tests could be performed.  All I know is that cancer was present. 

Today I met with the breast surgeon and asked her how I could possibly have a recurrence so soon in the same spot when we had zapped that site with 34Gy's of internal Mammosite radiation at the end of July.  That is just not supposed to happen.  All the clinical trials indicate that Mammosite is extremely effective.  The only explanation she had is that rarely, cancer cells will adhere to the biopsy hematoma site.  It is extremely rare and is why they proceed with biopsies when they are certain cancer is present.  Otherwise, biopsies would be a bad idea.  It's not supposed to happen. 

I am now an "interesting case" and she will present "me" to the tumor board next week for discussion.  How reassuring, right?

So, the plan is to have a bilateral mastectomy (BMX) with immediate reconstruction.  The procedure is called DIEP - deep inferior epigastric perforator.  The simple explanation is that the plastic surgeon takes fat from the abdomen and uses it to replace the breast tissue removed by the breast surgeon.  It is done during one 6-hour surgery.  Here's a link for more info:


So here's the current battle plan:  on Thursday I have an oncologist appointment in the morning and an MRI late in the afternoon.  The oncologist will order a PET scan, probably for Friday.  On Monday I meet with a plastic surgeon.  Assuming there are no surprises from the scan and MRI, I will have surgery within the month. 

Recovery is not easy; the first day or two are spent in the ICU so that nurses can monitor the blood supply to the grafted tissue and I will have a pain pump, then I'll be moved to a room for two or three additional days.  The first two weeks are rough, and full recovery takes about 8 weeks.

A bit of good news for my immediate family members - there was some thought that my father had breast cancer but we learned definitively that he did not; he died of lung cancer.  Apparently he had a lump removed from his breast at some point, but it was benign.  That decreases the risk that we have to worry about the BRCA gene, which indicates hereditary tendencies toward breast cancer.

Time to kick "survivor mode" into  high gear.


Thursday, March 17, 2011

Infected seroma...yuck

In early February, I noticed an area just above the site of my biopsy was getting "inflamed."  Over the past few weeks, it continued to get angry looking and increased in size.  I did a little research and determined that it was likely a seroma (think about the fluid in a blister - that's what was developing).  Most seromas resolve themselves after a while and rarely have to be aspirated, so I didn't rush off to the breast surgeon.  Plus, I already had an appointment for today so I felt that I could "wait and see" what happened.   I also knew I had an ultrasound scheduled for Monday, so this thing was going to get plenty of attention.   The technologist confirmed on Monday that it was a seroma and the radiologist recommended it be drained.  They knew I had an appointment with the breast surgeon so I was dismissed with the recommendation but no immediate action.

Now for my little adventure...my breast surgeon took a look at it this morning and determined that it was infected and I am now on Levaquin (pricey stuff!) for the next ten days. They sent me immediately back to Radiology and the radiologist withdrew two large syringes of fluid and tissue. One will be sent for culture to be sure we've got the right antibiotic at work, and the other will be sent to Cytology to look for abnormal cells. She really wanted to do a full biopsy but we agreed it was too risky because I take a daily aspirin and meloxicam. I really didn't want a repeat of the bleeding that I had from the first biopsy. She thought she could get enough tissue with the needle so I was glad that we settled on going just that far.

After the procedure, they put pressure on the site for several minutes, then took me to another room, applied antibiotic cream and a steri-strip, then wrapped my entire breast area with a tight ace bandage. And they inserted an ice pack. I have to wear the ace bandage until tomorrow. My breast surgeon advises wearing a tight sports bra for a while, to try and help close the pocket that seems to want to fill with fluid. She did say it will probably fill up again...oh yay.

I left the hospital feeling pretty good; but I didn't get very far before I started to feel the stinging as if she was still poking around with a needle. By the way, it was a big needle...the size used for blood donation. I headed to my mom's and stopped at the store for a fresh supply of extra-strength acetaminophen. I took a couple when I got to mom's and made the immediate decision that I wasn't going anywhere else except home. I stayed and had lunch with her, marched her in to get a haircut at the onsite salon, then left for the pharmacy. I picked up my prescription and now I am home, in my recliner, with a fresh ice pack.

It will all be fine, but I could certainly do without the complication. It's not the seroma from the Mammosite that's causing the trouble; it's the initial biopsy that keeps on giving.

I have to go back to the breast surgeon on March 31st and we'll see how things are going. Any other decisions are on hold until this is resolved.