Finally some "good" news??

Well, we are about 2 1/2 hours into our 10 hour trip and I thought that perhaps I should get some of this down before my memory wears thin. We met with Dr. Gretchen Ahrendt this morning. Aside from some technical difficulties (apparently my biopsy slides never arrived and there was no sign of my mri - which was not surprising to me since they told me that it wouldn't be read until Dr. G, image examiner - that probably doesn't mean anything to you unless you are an avid TLC watcher like me, is out of town), it really went very well. She was compassionate, articulate and very receptive to any and all questions (an important quality for a patient like me...). We liked her immediately and she definitely put us both at ease. In fact, Darin wondered later how good of a surgeon she can be if she has that good of a bedside manner... ha ha.

I'm going to try to sum up everything that she said (to the best of my understanding at this point in time... ). She did a physical exam, some more measuring (which she said was hampered by the biopsy scarring) and then sat and talked with us, showing my mammogram pictures, for quite a while. She showed us the extensiveness of the microcalcification (the ductal carcinoma insitu - the stuff that is still contained within the ducts themselves) and also of the tumor itself. That total area measures somewhere over 6cm (yikes!) but she seems to feel that the area of invasive cancer is likely closer to 2cm (which would put me into the late stage 1, early stage 2 realm - however, all of this is called "clinical" staging and then there is something more diagnostic that comes along after surgery that would give a more accurate description of the true staging). But obviously that is something that she won't be able to be sure of until after surgery. As for the surgery... not as good of news... given the pervasive nature of both the insitu cancer as well as the invasive cancer (relative to the size of my post-nursing three beautiful children breasts...), there is really no choice other than a mastectomy. As well, she is doubtful that presurgical chemo would be helpful. Because, a reduction in tumor size will not mean much given that the microcalcifications, which are unlikely to be affected by the chemo, are everywhere. However, that does not rule out chemo all together since any indication of spread (i.e. cells in the sentinel lymph nodes that will be removed at the time of surgery, any positive findings on the CT/Bone Scan, etc. etc.) or even a very good potential for spread would mean that it would be necessary. Due to all of this uncertainty we are also considering a consultation with a medical oncologist prior to surgery just to get his take on the whole picture. She reiterated again that my cancer appears to be strongly both ER (estrogen) and PR (progesterone) positive - which definitely means tamoxifen - but HER2, Nu negative. (which, it seems that isn't necessarily a positive or negative thing. Are you confused yet?) We are not sure when the tamoxifen would start, i think that is something else to talk to a medical oncologist about. Then there was a long discussion about reconstruction, pros and cons to doing it in conjunction with the mastectomy - there are so many things here to think about and consider. We will be having a consultation with a plastic surgeon in the next week or so to discuss all of these issues much further. A big part of the reconstruction picture involves whether or not I will be receiving (that sounds like I won a prize or am getting a gift... not so much) radiation. But again, this is something that cannot be determined until after surgery as it is most dependant on what margins (areas around the cancerous tissue that are free of cancerous cells) they are able to achieve. Given my "leanness" (it took cancer for me to be repeatedly called "young" and "thin" - God is amazing in pointing us to things that we previously did not appreciate...), achieving good margins will be a challenge and I got the feeling that radiation should really be on my radar. However, that is something to take up with a radiation oncologist. (Is anyone's head spinning yet??) In addition to ALL of this, she did recommend that we have a consultation with a genetic counselor to check for the BRCA gene mutation and get a broader picture of what we are facing, as well as what our children will need to be made aware of when the time is right. I asked a lot of questions, Darin asked some too and by the time that we got to this point, we were both just sitting there kind of dazed. She said, "well, I think that is probably enough information for today" and set us off to make genetic counseling and plastic surgeon appointments. WHEW!

On another note... we talked to the kids (Neely was present, I'm not sure that she took too much in...) this morning at breakfast. They were asking me about why I was going to the doctor's again and if I would come home feeling as badly as I did the last time, and we just felt like it was time. The discussion was short and sweet - we did tell them that i have a disease called cancer and that i will be having a lot of doctors appointments while i work on getting better. My parents sent a couple of books (good idea mom! I hadn't thought to even look for something like that...) and we left them with Grandma to read with Dryden while we are gone (we'll see what kinds of questions he comes up with by the time that we get back... "do you think that you will have the AC or AC-T combination of chemo drugs, mom?"). Thank you so much for your prayers about this conversation, we feel that it went pretty smoothly! However, don't let up in praying for them, I have a feeling that their part in this is going to get a lot more difficult when I start to look a lot more sick...

In reading over some of my more recent posts lately, I feel like I am being pretty negative about this responsibility that God has given me. I am really not fighting Him that hard on HAVING cancer, but I'm struggling a bit on staying focused on the Him. I think that it must be a lot like Peter when he was walking on the water towards Jesus. He was fine as long as his eyes were focused on his Lord, but as soon as he looked anywhere else, he sank. I truly understand that feeling! When I start to focus on the things that I could never overcome with my own strength, I just sink into a pit of despair and sadness. But when I am looking to the Lord, whose faithfulness endures forever, I feel pretty peaceful and secure (even with cancer!! amazing, isn't it??) Last night as I sat awake thinking about a lot of these things, I came across this incredible passage which I think sums up this journey pretty well...

"Your hands made me and formed me; give me understanding to learn your commands. May those who fear you rejoice when they see me, for I have put my hope in your word. I know, O Lord, that your laws are righteous, and in faithfulness you have afflicted me. May your unfailing love be my comfort, according to your promise to your servant. Let your compassion come to me that I may live, for your law is my delight." Psalm 119:73-77