If You’ve Seen One Boob, You’ve Seen ’em All

On Thursday afternoon, for moral support, I accompanied Wilma as she went to get a second opinion on her course of action regarding her breast cancer.  Remember, as you read this, please pray for her.  Do it right now.  I’ll wait.

OK, so we traveled to a large (read: super-huge) hospital in Dallas, specifically to the “Breast Center”.  You know of my fascination with all things medical.  This was really like a field trip for me.  But consider this.  We almost didn’t get to the second opinion.  You see, my mother-in-law really did not want to hurt the feelings of the doctor providing the first opinion.  Wilma, this is your life and health we’re talking about; not a chili cook-off.  She did, obviously, concede and we were on our way.  And I’m glad we were.  I had not been present at her first visit but from the descriptions I heard, a second opinion would not hurt.  I waited outside while she had her exam.  In the waiting room with me were my sister-in-law (T) and Wilma’s sister (P).  When she was ready, the three of us were summoned back to the exam room for the consult with the doctor.  I was immediately reassured by this woman, the doctor.  There was just something about her that spoke of confidence, a depth of knowledge, and an excellent bedside manner.  For the next hour, I took diligent notes on my iPad.  Lucky for her (and for you), my note-taking skills are topnotch.  Below are the actually notes from that visit with my updated notations in red.

Meeting with Doctor: September 19, 2013, [location redacted]
About 4cm area covered
Visible lymph nodes, one a bit plump on edge [plump?], might need a biopsy
Lump dr felt was large about 5 cm but doesn’t feel large lymph nodes
Needle biopsy showed invasive ductal carcinoma, grade 3 (angry looking) [ooh, angry!]
Other tests, triple negative… Division rate of tumor cells at 65%
Not a “favorable” tumor…
Lumpectomy and radiation treatments, X-ray treatment 5X a week, poss side effects including peeling like a sunburn; more serious might include scarring to lung tissue or weakening of ribs.
Mastectomy where radiation not required normally; but if tumor is larger than 5cm it might be necessary or if tumor touches edge of what they removed.
Reconstruction, like [name redacted] pulling muscle up from abdomen, might be harder because of prev c-section but not impossible OR implant with an expander.  Doctor referred to Wilma as “larger breasted,  I just threw up a little.  This option may lead to asymmetry. Again, I have vomited,  doctors would want to wait until radiation is over so as not to bring up irradiated tissue.  [Irradiated?…  Is she going to glow?  Like a superhero?  My son would LOVE that!]
Would want to do ultrasound of lymph nodes to see if suspicious and then needle biopsy.  If they are involved then would remove the lymph nodes  as well.  If not, they will do sentinel needle biopsy during the surgery.  Breast cancer likes to trav to lymph nodes so they want to know.  Would do a scan before surgery, then inject dye during surgery, use Geiger counter, this is some crazy sht.
Spec circumstance of Wilma. Nature of tumor (triple neg, kind of large). Sm tumor easier to remove with large margin of success.  Would consider chemo treatment BEFORE surgery.  Even for node pos pts, could just do sentinel node procedure.  Chemo first could make tumor smaller as well as potentially remove risk of spread to lymph nodes.  Dr says if you go to a breast cancer forum (I have personally attended three), women hate lymphadema or swelling of the arms.  Chemo would be recommended almost universally in Wilma’s case.  Dr says why not do it before surgery to increase chances of success?  She says some of the rumors [must have meant tumorswill disappear completely because of chemo,  still have to do surgery to find out but there will be a markedly better prognosis.
Opened the floor to questions from Wilma.  I want to ask her if she knows what’s she’s getting into.  Doctor just pronounced the word “been” like “bean”. I think she is Canadian and should be mistrusted. [Just a little Texas humor]
Wilma asked wouldn’t it be better to just lop it off.  Studies show not so much.  There was a study in the past where women drew straws and half got mastectomies and half lumpectomies.  Seriously?  [Again I ask, seriously?  They drew straws for this?]  Either approach can have local recurrence at the site and a triple neg tumor has a higher risk of recurrence either way.  But mastectomy doesn’t get her lesser treatment based on chemo in the long run.
Wilma asked about doing both breast at once.  Doctor said risk is higher for opposite breast cancer but not high enough to warrant double mastectomy unless genetic mutation but none present in Wilma so prob no.  Benefit of removing both boobs not strong.  Wilma’s breast are very “see-through” on the mammogram so constant monitoring will be beneficial.  Anecdote about how it took doctors took a long time to say that saving breast was ok and now patients want to chop them off.  [I actually LOL’ed at this story.  Good one, doc!]
Wilma asked how fast it is growing.  Not clear because of no inter mammogram but given that it has appeared and become so large in two years.  This also means that it is likely highly susceptible to chemo which would be good.
P [her sister] asked about time frame.  Doc said over a period of four to six months with monthly exams by medical oncologist.  Wilma just raised her arms and said “you’re the cancer place!” And laughed.  Doctor said they do this a lot here so they’re not worried about it.
Wilma asked how bad is chemo.  Hair lose, blood count could go low, some pts have nerve problems.  Team of people involved in care:surgical oncologist, medical oncologist, and radiation oncologist.  Meet with all three up front and then make a decision.
[Wilma, don’t worry, dear.  I’m suffering hair loss and I’m not taking chemo.  Plus, a fresh start to your scalp could be awesome.]
Not going to be dealing with kids on chemo days…  I can tell Wilma sad by this and she and I are both now crying but trying not to let others see.
[This was actually the toughest moment of the consult; but as doctor pointed out, this is a bump in the road so that you can be there for the kids years from now.  Still, I know how important it is for Wilma.  She always gives so much of herself, and with a smile.  My children love their Granny and this aspect will be hard on all of us.]
T [Wilma’s daughter-in-law] asked about homeopathic…  Doctor shook head and said no but that those things are adjuncts and could be used but that this is a little more serious than that. But she certainly encourages meditation, stress relief, body-mind connection…  Healthier diet always good as is healthy BMI, aerobic exercise and other lifestyle changes. Definitely not a substitute though, according to doctor. Simply no data to support that these things can combat the cancer.  They might like to know if you take any supplements for instance in a case there is a conflict.
Doctor wants to schedule ultrasound
[At this point my notes ended.  All in all, I think this was a very productive meeting from which she walked away with a sense that someone else is capably in control and that things would be OK.  And I walked away wondering how my head would look after I have to shave it in solidarity with Wilma.]

One response to “If You’ve Seen One Boob, You’ve Seen ’em All

  1. Keeping Wilma in my prayers. (She’ll get more prayers if she sends me some fried chicken – just sayin’)

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