Back to Reality - July 25, 2020

Note: This post discusses the latest developments re: my breast cancer diagnosis. I'm writing it for my family and because I personally find it therapeutic to write about my journey. You may choose to skip this post if it has the potential to make you uncomfortable. You've been warned.

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A Short Recap

I went to see a plastic surgeon. After the last surgery, my cancer surgeon knew that this next surgery would involve a much deeper incision requiring reconstructive surgery. When I went to see the plastic surgeon, she was looking through some of the MRI images on her computer and became concerned. You could tell that she wasn’t convinced that the radiologist had read the MRI correctly. If you recall, they were surprised when they did the surgery that there was cancer in the underlying chest wall. The radiologist had determined that "Enhancement posterior to this mass, anterior to the right pectoralis musculature corresponds with a vascular structure without invasion of the right pectoralis musculature identified."

In layman's terms, this means that the radiologist felt the MRI showed a vascular structure (blood vessel) and that there had been no invasion of the chest muscle by the mucinous carcinoma. During the original surgery, it was discovered that there was extensive invasion of the skeletal muscle.

At this point, the plastic surgeon suggested that we request a second review of the MRI results by radiology. Following that review, I got a phone call from my cancer surgeon who said that, in addition to the invasion of the chest wall muscle with the carcinoma, there may also have been an invasion of the underlying rib and/or sternum. She was going to refer me to a thoracic surgeon. I will meet with him on July 28th.

Friday’s Update

My surgeon called me Friday and said that my case had been discussed in their multidisciplinary team  meeting. The following recommendations came from this meeting:

      1) They are going to have my tumor “oncotyped.” This test is designed to predict recurrence and whether chemotherapy would be a beneficial treatment.

      2) They suggested I have a CT scan to get a better look at the vessels within the breast. This has been scheduled for Monday.

3    3)  She knew I had an appointment with the thoracic surgeon on Tuesday and said she will be very interested in what he has to say. I then asked if after their meeting that they suspected that the mucinous carcinoma had “invaded” my sternum and a rib. She said it was all part of the original carcinoma when I asked her about the possibility of metastasis.

      4) The team suggested that I see a medical oncologist. I’ve already got that appointment set up for Wednesday.

So her final comment was that after they get all the information, the three surgeons will meet and come up with a surgical plan. She is still hoping to have the surgery scheduled by mid-August. It should be an interesting week.

The Getaway that Wasn't

So Bill and I decided to leave town for a few days so I wouldn't "obsess" over my current cancer diagnosis. We decided to give Bill the opportunity to ride the Ohio to Erie Trail starting in Cleveland and heading south. We had purchased books and maps but had very little time to organize this trip. I was mainly going to play a supportive role, picking Bill up at the end of each days ride and perhaps riding up from the endpoint to meet him. 

As you can see from the map on the left, the route to the Tow Path Trail Head is a combination of paved paths, on-road connections and intermittently marked bike trails. If you look at the second map (what Bill actually rode), you can see at the mile 5 flag that he missed the turn, rode south, and the backtracked to an eastern connection. This path took him far east of where he needed to go, all the way over to the Cleveland Clinic and Case Western. After racking up about 20 miles, he called me and I came and picked him up. We drove to the Trail Head on Harvard to begin again.

# 1 and # 2  Starting out from Edgewater Park on Lake Erie after the traditional "tire dip" in Lake Erie.

# 4  View of downtown Cleveland from Edgewater Park.

# 3  Actual path Bill took from Edgewater Park to East Cleveland.

# 5  Actual path Bill traveled south from Trail Head.

# 6 Tow Path Trail Head with map on Harvard Ave.

By the end of the day, Bill had ridden more than 44 miles to Boston Mills in the Cuyahoga Valley National Park. I met him there and we traveled to the B&B I had booked in Akron for the night. We tried to find a place for dinner where we were comfortable with their social distancing policies and ended up eating at Chiplotle's because of their outdoor patio. We followed this up with a butterscotch sundae at an ice cream shop that had made every effort to keep customers protected. We went back to the B&B and settled in for the night. Tomorrow would be another day.

Update: The next morning it was raining and the temperature was forecast to get up to 90. Wednesday was going to be much the same. We decided to return to Cincinnati and continue our adventure at a later date.

 

How My Husband and I Differ on Car Repairs

Bill and I looked at our calendars and realized that we actually had a week with no doctor's appointments scheduled. We both felt it would be a good time for us to get away for a couple of days to keep me from constantly checking for journal articles related to my cancer diagnosis.

Unfortunately, there were additional issues in planning this particular getaway. Covid 19 cases were escalating in Ohio and many surrounding states. Given our health factors, we had to plan a getaway that would allow us to protect ourselves from contracting the virus.

After careful consideration, we decided to take our Rad electric bikes to Cleveland and ride the Ohio to Erie Trail toward Cincinnati. I should probably clarify that Bill would be riding the trail and I would be providing car support, picking him up at the end of each day. Bill has wanted to do this for quite awhile, and we felt we could do it safely.

We would leave on Sunday and spend the night with grandchildren in Columbus. We have not been able to be in their house since March. The next morning we would go to Cleveland and do the traditional "tire dip" in Lake Erie at Edgewater Park. He would wear a mask and the trail would not be very crowded on a weekday.

But first we had to get there. It wasn't long before my passenger husband had time to figure out that I had neglected minor repairs on my car. The first clue was when water started dripping on his leg and filling the well on his side of the car. He asked me how long I knew about this, and I sheepily had to say that I had known about it since June 2019 -- only 13 months ago. Then he noticed that his phone wouldn't charge. I finally made a list of our different approach to what I considered to be minor nuisances.

So I guess I've learned my lesson (hopefully). In the next post, I'll tell you about our getaway -- not exactly how we envisioned it.

Update - July 23, 2020

As I mentioned in the previous post, the next step was to visit with a plastic surgeon because it was felt that the "next" surgery would require some reconstruction. I visited with her with my daughter on facetime. The plastic surgeon began to review some of my MRI images. She came upon the one that clearly showed the cancer from the breast tumor had invaded the chest wall. The radiologist had determined that "Enhancement posterior to this mass, anterior to the right pectoralis musculature corresponds with a vascular structure without invasion of the right pectoralis musculature identified."

In layman's terms, this means that he felt the MRI showed a vascular stucture (blood vessel) and that there had been no invasion of the chest muscle by the mucinous carcinoma. During the original surgery, the skeletal muscle has extensive invasion of the skeletal muscle, as stated in the previous blog post.

She suggested that we request a second review of the MRI results by radiology. Following that review, I got a phone call from my cancer surgeon who said that, in addition to the invasion of the chest wall muscle with the carcinoma, there may also have been an invasion of the underlying rib and/or sternum. They referred me to a thoracic surgeon. I will meet with him on July 28th.

So I am told that all three surgeons will participate in the actual surgery. I was also told, just like the last time, they really won't know how extensive the surgery will be until they actually get into the breast and determine the extent of the invasion. It all sounds a bit elaborate to me.

In light of the above, my husband and I decided to get away for a few days before the doctor appointments started up again. I'll discuss that in my next post.

Update - July 14, 2020

Two weeks ago, I had a lumpectomy on my right breast with the hope (expectation?) that they would be able to remove my 2.5 cm mucinous carcinoma. We had every reason to hope that my surgeon would be able to get clear “margins.” The next step would be 16 rounds of radiation and I would be on my way. It didn’t work out that way. The lump was removed uneventfully, and I recovered quickly. Here is a picture of me the next day after the surgery. I felt great.

Liz, Kathy, Bill and Adie

On Tuesday, the surgeon called me with the results and let me know that they were not able to get “it” all. Apparently, the tumor “invaded” the chest muscle and they would need to do additional surgery. Because of a conflict, my post-op appt. had to be delayed. She allowed me to come and pick up my full pathology reports, and her staff set up an appointment with a plastic surgeon at Christ Hospital. 

Liz and I obsessively researched everything we could over the weekend. She passed the path reports on to a few of her doctor friends in Columbus. It was beginning to sound a little scary.

When I went to see the plastic surgeon, she brought up computer images from the MRI I had on May 21^st. She got a little concerned with one of the images, let me photograph it, and then gave me her opinion. First, because of the discrepancy between the MRI synopsis and the post-surgery pathology reports, she is going to ask the radiologists for a second review. Depending on their opinion, they may want to involve a thoracic surgeon. All of this is preliminary.

So I’m going to spare you the images – under the category of “too much information.” This is the current status. There are steps to go through before I can report back.

MRI Results (May 21st) Predicted	Pathology Report (June 30th) Actu
Enhancement posterior to this mass, anterior to the right pectoralis musculature corresponds with a vascular structure without invasion of the right pectoralis musculature identified.	Excision #1 – Mucinous carcinoma -The posterior-superior margin is positive where the tumor invades the skeletal muscle.
	Excision #2 – New superior posterior margin: Skeletal muscle extensively involved by mucinous carcinoma reaching the inked margin.
	Excision #3 - New lateral posterior margin: Benign skeletal muscle, uninvolved by carcinoma.
	Excision #4 – New medial posterior margin: Skeletal muscle extensively involved by mucinous carcinoma reaching the margin.

Summary:

Skeletal Muscle: Carcinoma invades skeletal muscle.

Invasive Carcinoma Margins: Positive for invasive carcinoma.

Positive Margins: Posterior (posterosuperior)

The next step will be to wait for my surgeon to give me a call with "the plan." I don't think I'm going to like it.

June 2020

I'm writing this on July 1st -- the 42nd anniversary of me becoming a mother to Elizabeth. June was a busy month with continued doctor's appointments. Included were two Covid 19 tests, two cardiac tests, an appointment with the radiologist, a genetic counseling appointment and a "clip" placement to mark the location of the papilloma scheduled to be removed during surgery. All of this culminated with the surgery to remove the "mucinous carcinoma" on June 30th.

I hope by the time my grandchildren read this at a later date that the Covid 19 virus, which is currently decimating our country, will not be a part of their lives. Over 128,000 Americans have died and 2.7 million people have been confirmed to have contracted the virus. We have no idea how this will end and the impact it will have on schools in the fall. There are huge unemployment numbers nationwide. It almost makes my problem seem miniscule by comparison.

So yesterday was surgery. The plan was to remove the lump and one benign papilloma. Dr. Manders removed the carcinoma, and in the process of removing additional tissue, discovered some cancerous areas in the muscle behind the turmor. It was localized and she felt like she "got it all." To prevent blood clots, I had taken a lovenox injection the night before surgery. This resulted in a hematoma near the sight of the surgery where blood pooled. This initially concerned the nurses in recovery as they placed a sand bag on the area in an attempt to reduce swelling. This worked, and by the time I left the hospital it appeared that the swelling could be reduced with some additional pressure and ice.

Amazingly, I've had practically no pain. I haven't had to take any medication post-surgery and honestly feel like I haven't had surgery at this point. I'm grateful. They expect full pathology reports by Friday. I know this will be followed up with some radiation treatments in a few weeks.

I was only allowed to have one person accompany me at the hospital. Bill graciously gave the "privilege" to Liz because of her medical background. The hospitals are taking every precaution to keep patients and visitors safe. At the entrance they take your temperature, check that you have an appointment and make sure you are properly masked.

Today we had a little time to be with Liz on her birthday before she returned to Columbus. Roland called to say that all three of their kids were sent home from their summer program. Ian was running a slight temperature, Andrew was suffering from allergies, and it was decided to send Nathan home as a precaution. Schools have to be very careful during this pandemic.

As a side note, I had genetic testing on 67genes that are known to be associated with breast cancers and other types of cancers. The good news was that they found "no pathogenic variants" or harmful genetic changes in any one of the genes tested. At my age (71), it is not uncommon to get a cancer that does not have a genetic link. That is good news, and my prognosis appears to be good.

So on with the next adventure. Here's hoping that the July report will be equally positive.