the biggest risk I took today

I was in and out of the hospital in no time flat. Norm took me in for 9:45 am, and I was out by 4:00 pm. Surgery was late to start, I got going about 1:00 pm and was waking up in the recovery room at 2:30 pm. No pain, just a little stiff in my back. I am assuming it went well, however, the normal course of events didn't go as per usual, so I feel a bit off. I saw Dr. B once before I went in the OR, but not again. I was already out to sleep before he came in, and I did not see him after the surgery either. It's funny how this disruption in my preferred pattern has me feeling off. What's worse is that I even have a pattern in my surgeries. Geesh. This is number 6 since May.

Do you want to hear something funny? Two nights ago, I felt a lump in my non-breast. This part is actually not funny, but the story has a funny ending. I am accustomed to checking for lumps and bumps, and I know what I should feel like. You may remember that this is how I found the cancer in the first place. While still at the Lake, I felt a hard lump at the bottom edge of the tissue expander. I went back and forth between that breast and the other; no, there definitely is not a corresponding lump on the left side. Not again! OK, I thought. It's pretty small, so I will have caught it in time. I'll ask Dr. B to have a look at it when he opens me up. While I did not get to the panic stage, the lump was on my mind for two days. I kept it to myself, not wanting to worry anyone. So, I'm prepped for surgery, and Dr. B comes in to make his markings on me. He says, "I bet you'll be glad to get this port out." O my gosh! I start laughing and tell him that I had thought it was a new lump. He says, "That's not the kind of thought to be having. When did you figure it out?" "Just now! I have stewed about it for the past two days."  What a goof I am. I chuckled the whole way down the hall to the OR.

As for my big risk, I must admit it. I really couldn't help myself. I played the piano this evening. It was Beethoven.

Thank you my dear friends. I'm learning.

back home

I'm going to give you the quick timeline version of my crazy week.

• Monday, May 17th. I went in for my "muscle-sparing free tram flap" surgery. It was a complete success. Here's a good article on breast reconstruction.
• Thursday, the 20th (three days early), I was discharged from hospital. The surgeon called me his star patient. I felt great. No pain at all.
• Took it easy at home for the rest of Thursday.
• Friday, Mom drove me to the store to pick up some loose-fitting sweat pants and tops. Was a bit tired, so it was a very short trip.
• Friday evening, Norm and I went to get some groceries. I didn't carry anything or overwork myself at all.
• Came home, got my jammies on, and noticed that the new tissue had changed to a dark pink colour.
• Norm took me to emergency Friday night. My surgeon was out of town, so the plastic surgeon-on-call (the same one who assisted with my surgery on Monday) came in to see me. He didn't like to looks of the tissue, so he decided to operate. At this point, the flap was still viable; the colour was not too bad, and the blood flow could still be heard with the Doppler. His thought was that too much fluid had accumulated in the breast and was causing the blood flow to become constricted. This surgery happened around 1:00 am Saturday.
• I was admitted to hospital on strict bed rest instructions. Dr. Robinson decided on a second surgery for Saturday afternoon, after having reached my own PS, Dr. Barnsley, by phone. They thought that perhaps a blood vein was twisted. Although in Lucas' blog, he says I had chest pain, there was in fact no pain at all. 
• By Sunday, it was clear that the tissue transfer was failing. Although the blood flow could still be heard, it was becoming more faint. Dr. Barnsley arrived in town and swung by the hospital to have a look at me. He would operate Tuesday to remove the tissue. It had turned a dark purple colour by now.
• I had my 4th surgery in eight days on Tuesday at 9:00 pm. 
• Was discharged Wednesday, May 26th with the plan of returning on Monday, May 31st to try a new method of reconstruction. This time, my latissimus dorsi muscle and skin from my back would be brought around front to cover a saline tissue expander in the breast area.  

I'll give a more detailed version over the next few days. I am doing fine. I have had no pain through the whole episode, so for that, I am very fortunate. I'm pretty tired today, I guess from all the anesthetic, but I'm in good spirits. I'm back to where I started last week - lop-sided! Actually I'm one step ahead, because I now have a nice flat tummy!

Thanks for all your good wishes and kind thoughts. A special thanks to the local folks who visited me in hospital, and snuck in food, good coffee, and books. A big thank you to my fellow book lover, Janik, and her pretty pink Kindle. 

Nice day today, eh? until I found out that Jackie is in the hospital again, that is.
She went in last night around 9 o'clock, and they called her surgeon to come see her. He didnt seem too concerned at first, but as her condition grew worse, he started to look closer into the cause of her discomfort. Later that night, around one o'clock, he called in a team and set up the operating room, and they re-did her surgery. Thankfully, the hospital is still open to visitors, so we are planning to go see her today.
We still do not know how for sure how long she will have to stay there this time, but I expect that she will have to stay there until monday or tuesday, at the very least.
Jackie just called, and apparently she is going to have another surgery in the next few hours, to fix a pain in her chest, most likley caused by a kinked blood vessel. Hopefully it wont take too long.

A good start to a 6 night stay...

Quote from Victoria:
-"Is it like the Spa?? I mean, do they cook and bring your food to you whenever you like?" Victoria's view of going to the hospital is obviously quite different as from mine, and many others as well. I would think that she is the only person that I know who made a joke out of the fact that Jackie gets a 6 night stay at the hospital. Anyways, I'll get on to the important stuff now.

It is 5:30, and we are about to eat dinner. I have both good and bad news to share with you, and in hopes of keeping everyone happy, I'll start with the positive :-)

Earlier today, I received a phone call from the hospital about Jackie. It was from the doctor, and he said that she did excellent during the surgery, and that she had moved on to the recovery room. Norm went to say hi, and from what he has told me, she looks, feels and is doing great.

Much as I hate to be the bearer of bad news, I must inform you that there is a severe case of the norovirus at the hospital, and there have already been over 20 cases of it. Because of this, NO VISITORS are allowed at the hospital.


Lucas

driving, driving, driving, and a walk

Our family did the "Run for the Cure" on Sunday. It was a beautiful day; we saw many people we knew, and met many new friends. I can tell you that these days, I much prefer walking to driving! With radiation sessions two hours away, I will be glad when this daily commute will be over. OK - first the pictures of Sunday's walk/run. I must add that Norm and the girls ran the 5km route, (even Evelynne) while I walked it. Oh well, there's always next year, and I'm so glad for that.

My pal Wanda

As for radiation, it's going well. I have completed 19 sessions and have 9 more to go. My last day will be the 20th of October. I am feeling a bit more tired than usual, but that could be due to the travel. My skin has only just started to turn a bit red and itchy. The doctor is pleased and so am I, and the driving isn't really that bad. It's actually kind of fun. A society called "Wheels for Wellness" picks me up every morning, drives to the clinic in Victoria , then returns me to my home in the afternoon. Most of the drivers are retired truckers or bus drivers, and many of the passengers are retired as well. Not all go to the Cancer Clinic - many are travelling to specialist appointments. At first, I didn't think I would like all the chatting, but I am enjoying it. If I don't feel like talking, I've always got my book and iPod. I've even made a friend - Bill. He's 76 and lives in Parksville. He also commutes every day, and we seem to be on the same van most days. He's having radiation in a room down the hall from me. He was away sick for all of last week, which caused me a great deal of worry. It was sure nice to open the door to the van yesterday and see him sitting there.

Last Friday, Evelynne and Rosalie came with me (they had no school). Mom drove us down and waited in the waiting room, but the girls got invited into the treatment room. They got to come inside while I was being positioned, and the techs were so good at explaining everything. While I was being zapped, Rosalie and Evelynne went to the control room to watch me on the monitor. I think they really enjoyed themselves.

That's about it for now. We're getting through each day. With Norm away in school, it is a challenge. I'm glad Mom is here this week to help out.

I'm home

It's great to be home. The hospital is not a place for resting. My roommates included a moaner, a complainer/swearer and a barfer. I was glad to accept the doctor's offer of a release when he saw me yesterday morning. He actually greeted my with, "How's the prisoner?". I left the hospital around 11:00 am Friday. Norm and I went bike shopping for Rosalie, then picked up the kids from school. We had a couple visitors stop by, threw in a frozen pizza for the kids, and went out for dinner. We ate our burgers at the beach and walked along the waterfront. We stopped by a friend's house to pick up the kids, had a nice visit and a cup of tea. It was a beautiful evening and I enjoyed myself much more than I would have, had I remained in the hospital.


I thought I would feel much worse than I do. I haven't felt nauseous, and feel no pain or discomfort (no, I'm not taking any drugs). I am so glad to be finished with the surgery. The next thing I have to get through is waiting for the pathology report. That will determine if I will have radiation or not. No radiation means we can have a great summer, radiation means we will have a good summer, but a different one.

You want to know what I think about my new body? Well, I'm OK with it. I looked down when the doctor examined me. He asked me if I were ready to see it and I nodded. When people tell you not to look down, don't listen to them. Whether you're on a tightrope across Niagara Falls or dealing with a hardship of some type, you need to "look down" so that you can assess the situation. I looked down and saw my flat chest held together by staples from my armpit to the middle of my chest. I am looking ahead to the fall, when I can have my reconstruction. For now, I'm going to fill the right side of my new bra with a "fluffy" and head to the beach. Look at me; stare at me. I'm doing it too, and what I see in that empty space is a wealth of medical knowledge, good friends, and a wonderful family.

Surgery Day

Posted for Jackie, by Norm

Well, it is gone. Jackie had her surgery today, and handled it like the superstar that she is. She was a bit late getting started, but finally went in to the operating room around 4:00. She was out of the operating room around 6:10, and awake by 6:30. When I finally got to see her around 7:30, she looked fantastic, as if this was just another ordinary day. She was assigned to a semi private room, so I went ahead to get her stuff put away. I was surprised when I entered her room to see that she had already arrived. As I neared her bed, I realized that the person in her bed had much too much hair to be Jackie, so I immediately retreated. It turns out that she was bumped down to a regular room. This is what happens as the day goes by and they need every bed that they can get. Two patients were lucky enough to get "Hallway" suites. So if you ever have to go in for surgery, and are going to stay the night, get scheduled as early as you can. The kids were all able to see her, and to see for themselves how well she had come through the surgery, before she turned in.

Would you like one lump or two?

I thought up the title to this post last night while I was stewing about the phone message from the surgeon. The receptionist had left a message for me to call the office on Wednesday, but for some reason, I missed the message and only saw it last evening. Of course, I assumed the worst. Based on what I imagined I saw on the screen while getting my mammogram, I was sure I was going to get a call saying that a new lump was found. I had it all mapped out in my head - more chemo, the PICC stays in, no swimming this summer, I'll shave my head again. OK, all settled, I have big shoulders; I can manage this too.

I thought my morning post would be to tell you my crummy news. I imagined everyone's thoughts. Well, I am happy to report that I DO NOT have new lump. I don't have any lump. In fact, there was no evidence of calcifications either. Who knows what I saw on the screen? Maybe it was scar tissue. Maybe it was someone elses' breast. I don't know. I'm doing a happy dance this morning and the tune is "I'm on my way from misery to happiness..." by the Proclaimers. Don't get me wrong - I have not been in the "misery" catergory, but today surely is a good day.

FYI: the reason the surgeon's receptionist called was to give me the date of my surgery - June 11. 41 days to go.

Surgical Pathology Report

After I left the office of Dr. Carr, I kept thinking back to his comment he made on the phone to the oncologist. He referred to me as a T2. Doesn't that mean stage 2? But he told me I was a stage 1. What's going on? I looked it up, and sure enough, T2 means stage 2. How could this be? What happened to make me go from a stage 1 to a stage 2? I couldn't get ahold of him on Friday, since he was in surgery. I even was at the hospital that day for a bone scan, but wasn't able to leave a message for him. I called my family doctor but she wasn't in either. I asked for someone in the office to call me back, but there was only one doctor and she was swamped. At least I could see the pathology report for myself. 

After driving to Ladysmith in the snow to pick up Norm, we made it back to the doctor's to pick up the report. Here is the diagnostic summary: 

• Ductal adenocarcinoma
• Tumor grade: 3/3 (8/9). 
• A. Tubule formation - 3/3
  
• B. Nuclear grade - 3/3
  
• C. Mitoses score - 2/3. 
  
• Tumor measures 1.8 cm in greatest dimension.
• DCIS associated microcalcifications present. 
• Surgical margins are negative for invasive tumor.
• Two lymph nodes are negative for tumor. 
• pT1, N0, MX

I focus on the last item - this is a rating based on the TNM staging system. The T refers to the tumor stage (1 being less than 2 cm, which I am, at 1.8 cm) N0 means there is no lymph node involvement, and MX means that the presence of distant spread (metastasis) cannot be assessed. I see a stage 1, not stage 2. I will now have to wait until Monday to find out for sure. 

The two main reasons for the recommendation of a mastectomy is the tumor grade (8/9 means a pretty fast growing little devil) and the macrocalcifications. 

Dr. Carr, revisited.

I saw Dr. Carr on Thursday, the 11th of December. He had already given me the preliminary results, which sounded promising. After he examined me to see how I am healing ("oh, you heal very well"), he made a comment about my previous day's visit to Dr Baillie, the internist. "The Holter monitor was pretty impressive, wasn't it?" Yeah, I guess so - Out of 132,577 recorded beats that day, My heart misfired on 70,627 of them. The technician who did the echo yesterday said, "your heart certainly beats to it's own drummer". Everyone's a comedian these days! Anyway, more about that in a separate post. 

Dr. Carr was not happy that I had not heard from the Cancer Clinic in Victoria yet, so while I sat with him, he called down there to speed things up. As he was describing my case to the oncologist, he summarized my history for her benefit, "Jacqueline Pallard, age 44, right partial mastectomy, T2, blah, blah, blah." He went on after hanging up with her (by the way, my appointment in Victoria is this Tuesday ay 10:30), he explained that he had consulted with the team of fellow surgeons and they are all unanimous is thinking that I will need a mastectomy after all. The pathology report came back saying that the microcalcifications are associated with DCIS - ductal carcinoma in situ. These microcalcifications are scattered throughout the breast. Do I really want the worry of cancer 5 - 10 years down the road after working so hard now to get rid of it? NO. Take it off. And while you're at it, take the other one off, too. I'll get a double mastectomy with immediate reconstruction. There is a very good reconstructive surgeon coming to Nanaimo in July who could fix me all up with a nice tummy tuck at the same time.  Dr. Carr commented on how I seem to be such a calm, level-headed person. Perhaps this is true, but I'm thinking, cancer-free and a slim figure. How can this be a bad thing? I am definitely on board for this. He ended the appointment with, I'll see you again toward the end of your chemo.  

Norm's meeting with Dr. Carr, the surgeon

Norm and I had an appointment with Dr. Carr this past Friday at 4:00 pm. When we arrived, there was no on else in the office except for his secretary. He gave her instructions to turn off the lights and that he would lock up. 

Norm and I sat with him until just after 5:00 while he answered every question we had. He showed me all me results - Invasive ductal carcinoma. Definition: invasive Ductal Carcinoma (IDC): a cancer that begins in the milk duct but grows into the normal breast tissue around it. My chest x-rays came back fine and my blood work is fine, with the exception of an elevated white blood cell count. I told him that this was the same result I received when I had blood work done because of my ankle. Dr. Carr explained that this could be because I am fighting a cold or another infection. I don't have a cold, so what's going on? 

On Thursday, I had met with Dr. Malone, an orthopedic specialist about my foot. His opinion is that I could have had a stress fracture in one area of the foot, but that now it looks a swelling and possible infection of the synovial membrane in my ankle (which apparently is not the same as arthritis). He is recommending cortisone shots, of which I am leery. I asked Dr. Carr's opinion on this, expecting a brief "yes, he's a good guy, you should do what he says, or "no, cortisone will affect you other treatments so stay away from that" , but that's not what I got. Dr. Carr, at 4:30 on a Friday afternoon, he pulled up all my previous doctor reports on his computer, including my bone scan and the CT scan. He explained what each of them meant, what he thought of my foot, all the while saying that he himself is no expert, trust Dr. Malone for he has very good reputation. I spent more time in his office talking about my foot with Dr. Carr than I did with the orthopedic doctor, and that's not even why we were there. I asked him if he thought that my breast cancer has spread to my foot. He laughed and said that he has never heard of a breast cancer metastasis in the foot. He said it's possible, but he's never seen it. OK - I had to ask. 

The rest of the time we were in the office we did talk about the cancer. He explained what would happen on Friday with the surgery, how the treatments would work, how I will feel, where I will have to go, and when I will be done. 

Friday the 21st, I have to be at the hospital at 7:00 am. I will get sent to the nuclear medicine department for an injection of radioactive dye that will track which lymph nodes are acting as the drainage for my right breast. Then I will get prepped for surgery, which will begin about 11:00 am. They will take out the lump, some surrounding tissue, and a few lymph nodes (sentinel node biopsy) to see if the cancer has spread to the lymph nodes and/or the surrounding tissue. The actual procedure will take about 40 minutes, and once I wake up and everything checks out, I can go home the same day. 

The tumour, tissue, and the lymph nodes will be examined, and from that I will get an accurate diagnosis of the stage of my cancer. I will then be referred to the BC Cancer Centre in Victoria for a consultation with an oncologist. Dr. Carr recommends that my treatment will include a 6 month course of chemotherapy (which can by administered in Nanaimo) followed by a one month course of radiation. The radiation will be the tough one, since it will be given daily for 4 weeks in Victoria. My first round of chemo will likely begin just after Christmas, and last through June. I don't know if I would a break before beginning radiation. The first couple rounds of chemo should make me feel too badly at all. I should have the results of the lumpectomy in 7 - 10 days. This will tell me whether or not I will need further surgery (mastectomy). 

I still feel pretty confident that things will turn out OK, although I do have moments when I panic about the possibilities. Thanks to everybody who has called and emailed. It's been great reconnecting with people I don't see everyday. 

surgery date

I just received a call from the receptionists with a date for the surgery. The big day is next Friday, the 21st of November. Thank goodness I will be able to be at school for the kids' science projects on the 18th. 

meeting the surgeon

On the morning of Thursday, November 6, I met Dr. Carr, my surgeon. Before I met him, I had to take our little puppy in for his vaccinations. This will become important later on, trust me. Hershey checked out at the vet and all was well with him. I dashed over to meet Dr. Carr, with Wanda waiting for me in the office. 

It was a very good meeting. I really liked him and left the office feeling so positive and informed. He explained that the mammogram showed a lump and that there is a 99% chance that it's cancer. I would know that for sure after the results of the biopsy (later that afternoon). He also pointed out that there are some calcifications that showed up in the same breast. These could be nothing, or they could be other areas that are showing signs of an early cancer. Either way, the lump has to come out. I signed a consent form for surgery, which will take place in two weeks. The lump and surrounding tissue will be examined and if the calcifications show cancer, then off comes the breast. This will be a separate surgery 2 weeks following the first. I will likely have to have both chemotherapy and radiation. 

Although the news was hard to hear, I felt good and strong because he just told it like it is. I even left the office singing. Weird, I know. The next appointment is the ultrasound and the biopsy at the hospital.