Step One of Plan - Cut the Fucker Out (sorry Mom)

I'm pretty sure my lump,
even though evil, is fabulous
and purple.  And I'm gonna
cut the fucker out.

I had an appointment to meet with Dr. Olson again on 13 Apr.  My good friend Jess went with me again.  She helped me not listen to the talk in the waiting room, which was super helpful.  We also just chatted during the TWO AND A HALF FREAKING HOURS THAT WE WAITED FOR HIM.

Funny story about Jess...the TT and their helpers always introduce themselves to the people with the patient which I think is great, because really, they are treating the whole family.  Anywho - one of the assistants came in and said, "who do we have here with you?  Lets see, daughter and mother?"

WTF?  Daughter?  First, Jess is not that young.  And second, I am not that old.

The little assistant realized her error quickly and tried to recover, but really, how do you recover from that?  Jess liked to make comments about me being the mom and my mom being the grandma all day.  Har Har Jess.

Anywho, when we finally met with Dr. Olson, he pretty much said lets do chemo and then surgery.  Oh and your MRI was clear.  And left to find my oncologist.  Seriously, did not allow for questions or anything.  Surgeons.

The reason for wanting to do chemo first is to shrink the tumor so that my boob doesn't look as bad after surgery.  They have to be able to cut the tumor plus some more around the tumor to make sure they get it all.  Mine is about an inch big so he will be removing about 3-4 inches of boob.  Look down and think about that.  And it just leaves a big ole dent.

So Dr. Blackwell comes in and we start talking about my options.  She described if we did chemo first:

• We would need to wait for the oncotype.  Recall my other post about this test.  This is the one that checks if chemo will work for me.
• The oncotype requires a certain amount of tissue.  We would be using the tissue from my biopsy which might not be enough.  There would be a chance that after we wait to see if its enough (maybe a week or more), it might not be enough.
• If enough tissue is available, we would then have to wait for the results (maybe 2 more weeks).
• The results could say that chemo wouldn't work for me.
• Dr. Olson would still need to do a surgery to biopsy the lymph nodes and Dr. Blackwell would need the final pathology report.  This biopsy is called a sentinel node biopsy.  Remember how I said part of staging is knowing if cancer is in your nodes?  Well, this is how they find that out.
• This is much better than the old school way.  The old school way they had to remove all or most of your lymph nodes around your boob.  Lymph nodes are good things to have.  They help drain and filter your lymph and keep your immune system in check.  When you don't have these, you have to be really careful about injuries (infection) and sometimes your arm can swell up big as a house.  And, I wouldn't be able to lift heavy shit anymore.  This new way allows the surgeon to just take a few lymph nodes.  Average is to take about 3.
• Even if he just removes the 3, there is a chance that my arm will swell up big as a house and that I cannot lift heavy shit.  Sigh.  Sigh.  Heavy HEAVY sigh.
• They shoot up my boob next to the tumor with radioactive dye (damn, I am getting shot up ALOT).  Then they wait to see which lymph node(s) "light up".  The theory is the one that lights up is the one that the tumor drains to and is most likely the first to get the cancer (if at all).  Supposedly they use a metal detector like thing to look for the ones that "light up".  The surgeon will then pluck out the one(s) that light up. 
• If they look and feel abnormal during surgery, the pathologist can freeze them and look for cancer right away.  If there is cancer, they will remove all of the nodes.
• The final pathology report would be available about 1-2 weeks later.  
• Then, if all is good we would do chemo.  
• There is a 1 in 10 chance chemo would make the whole damn thing disappear.  It would kill the fucker.
• There is a 1 in 3 chance chemo would make the thing smaller by up to 50%. Just a little killing.
• There is 60% chance nothing would happen

Then Dr. Blackwell described just going ahead and cutting the fucker out:

• Dr. Olson could cut the fucker out and do the sentinel node biopsy all at the same time.  One surgery.  One bout of anesthesia.  One recovery.
• I wouldn't have to wait a month to start killing the fucker.
• The oncotype would be done on the tumor itself so we would be sure to have enough sample (no additional surgery or biopsy).
• Dr. Olson would have to take more tissue out and the cosmetic result would be bad (he kept calling it a defect).
• I could always get super nice fake melons later.

We talked about all of this for quite awhile.  Dr. Blackwell wasn't even scheduled to see me, but she took the time to talk about all of this with me and Jess.  I decided that my biggest problem right now was in my head and I didn't want to wait anymore.

So I am going to cut the fucker out ASAP.

The nurse came in after that and scheduled me for first available which was 22 Apr.  I thought that was pretty soon.  I was expecting to have to wait a few weeks.  Then my mom pointed out that it was Good Friday.  I hope that the people working that day aren't bitter.  Oh well.  I will tell them all thank you for working that day.  My boob, body and especially my mind thank them.

You may be wondering why I don't have to have or that I have not chosen to have a mastectomy.  Originally when all of this started, I was just thinking lets cut both off to be safe.  I have since learned some stuff:

• Most importantly, the chances for survival are the same for lumpectomy vs. mastectomy.  
• Having my own nipples are important to me.  I've seen the fake ones and I don't think I could deal with that.  
• It is a pretty radical choice for a tumor my size.
• I've looked at mastectomy photos.  I just can't do it.
• The plastic surgeon that built my boobs after the reduction did a pretty good job.

I could have immediate reconstruction (new methods even include building boobs from tummy fat - a tummy tuck and boob job!) but that is an even longer surgery with much higher risks.

Also, I am a bit concerned about recurrence.  Lots of stories talk about people having a lumpectomy initially and then even a few months later having a recurrence and needing a mastectomy.  But Dr. Blackwell assured me that the risks of recurrence are equal in lumpectomies vs. mastectomies.  So I chose lumpectomy.

Now, there is still a chance that this plan could change (GAH FREAKING UNKNOWNS!!!).  I am still waiting on my genetic testing results.  Remember the BRAC gene mutation I talked about?  Well if I am positive for the BRAC gene, then its a double mastectomy for me.  Also, remember the "questionable spot" on my liver?  Well if that's cancer, well then we are all in for a lot of changes.  And I don't want to think about that.

I will go in on 21 Apr so that they can shoot me up with dye for a practice run at finding my lymph nodes (called mapping) and to do pre-op stuff.

*EDIT - My superwoman of a mom is coming on Wednesday to help me through all of this.  Seriously, you are never too old to need your mom.  And I've got a good one.

Keep your fingers crossed, say some good prayers, send good ju ju, think happy thoughts, rub Buddha's belly, do a rain dance, send some positive vibes or anything else you think might be helpful - lets hope that lumpectomy is all that is needed.

Hmmm.  After writing all of this I'm having a few second thoughts.