Post Op with Dr. K

The drains came out today!

As I suspected, two of them were definitely ready to come out. But the third was borderline. It was putting out about 50 cc's of fluid each day. At first, Dr. K wanted to leave it in. But since we live in North County, it would be more difficult for us to get back down in a few days to have the last one removed. She gave me the option and I chose to have her take the third out.

The drains basically help my body remove fluid buildup around the wounds on the inside as they heal. There is a give and take with having one or more in longer. The longer they are in, the more the risk of infection. Frankly, it is gross to have a tube coming out of your body. But if my body isn't ready to have them out, fluid may build up internally. The remedy is to have it drained with a large needle. Gulp. That sounds gross too, doesn't it? Dr. K said they would numb the area before inserting the big needle. Then I thought back to the biopsy. That needle prick wasn't too bad. And it isn't a given that the fluid will build up. Each day that goes by, the chances decrease. Dr. K advised me to put the immediate post-surgical camisole back on and put it on tight to compress the chest to help any fluid disperse. If it did build up, she said it would be very obvious--like a breast growing. So we'll keep an eye on that for the next few days.

As far as having the drains taken out, it was not a big deal. I took 2 pain pills before we went down. My usual is just 1, except at bedtime. So I was a bit lightheaded. She had me lay down and I said a little prayer. She snipped around the sutures and it was out before I knew it. I didn't feel a thing. Then she told Eric that the tubes had been at least 6 inches inside of my body. Yikes! I'm glad I didn't know that before.

She said the scars on my chest were healing quite nicely too. My next appointment with Dr. K is in 6 months, unless something goes wrong. I'll miss her. She was a great surgeon. Anyone in San Diego with Kaiser insurance that needs surgery should request her. (Contact me and I'll give you her full name!)

She is basically handing my case off to Dr. P, the oncologist. I got a copy of my pathology report on the way out. I was trying to decipher it when I got home and comparing it to some books I have on cancer. Although Dr. K (on the fly) said it was a stage 2b, I think it is actually a stage 3a. I'm not positive, and frankly, it doesn't make a big difference what the label is.

The juicy parts of the final pathologic diagnosis:

On the left: Invasive ductal carcinoma. Histologic grade: 3 of 3 (tubules 3, mitoses 3, nuclei 2)

Invasive tumor size: 3.5 cm.

Ductal carcinoma in situ: Present

Type and pattern: Cribriform and solid with necrosis

Grade: Intermediate

Lobular carcinoma in situ: Not identified

Lymphatic vascular invasion: Present

Nipple involved: No

Multiple simultaneous invasive carcinomas: No

Associated findings: Metastatic carcinoma present in five of fifteen left axillary lymph nodes (Largest lymph node metastasis 2.5 cm; carcinoma outside of confines of node capsule focally)

TNM: T2N2a

It's the T2N2a that makes me think it is grade 3 and not 2. The T2 refers to the tumor size (between 2-5 cm), and the N2 refers to the lymph node involvement (N2 means involved nodes are fixed to one another).

We'll find out for sure about staging next week from Dr. P. But again, it doesn't really matter that much. It is what it is. God is in control regardless of the stage. He'll see me through.

My prayer requests:

• That fluid does not build up in my body now that the drains are out.
• That I'm able to get a physical therapy appointment before August 17th. Dr. K referred me to PT to learn how to avoid a swelling of the arm (lymphedema). The soonest appointment they have right now is the 17th of August.
• That I continue to heal and be able to start some exercise to get into condition for chemotherapy.
• An ongoing request is for my family. It is hard on them to have me out of commission. Pray that they be strengthened and given extra doses of grace and mercy towards one another.

Bless you all!

Pillows and Pathology

Day 5 post-op.

Pillows are my new best friends. I have them everywhere: upstairs; downstairs; in the car. The American Cancer Society sent me two small pillows that I tuck under my arms when I'm on the couch downstairs. Kaiser gave me a heart shaped pillow to use under the shoulder strap seat belt in the car. Up in my bedroom, I've got a big incline pillow that I sleep on. Then I've got 2 throw pillows that I tuck under each arm. Then a third pillow in the middle that my hands rest on.

Unexpectedly, my surgeon called yesterday to give me the results of the pathology report. I wasn't expecting to hear anything about the report until my post-op appointment on Wednesday. She said there were "no surprises." We go in tomorrow to see her and will get a copy of it for ourselves and go into it much deeper. But the bottom lines were:

• The right breast was clear of any tumors. That is good-that means my right lymph nodes will all stay in my body. With the left gone, these will be working overtime.
• The tumor on the left breast was 3.5 centimeters. It felt huge. I was afraid it was going to be much bigger.
• She got clear margins. She mentioned something about not needing radiation for this reason. I asked her if that meant I wouldn't need radiation at all, and she deferred to the oncologist, Dr. P.
• 5 of the 15 lymph nodes from the left side were positive for cancer. I already knew there was activity in the lymph nodes since the lump I felt was a lymph node. Because of the delay in surgery, I was afraid that all of the nodes would be positive. Having only 5 is an answer to the prayers that the cancer not spread.
• I asked her what "stage" of cancer I have. She had to scramble a bit and do some cross-referencing on the phone, but she said the factors in the pathology report put it at a 2b. Another answer to prayer. I was afraid it was a 3.

Eric did some research last night and there still is over a 50% chance that there are cancer cells floating around my body somewhere. I think he was kind of hoping that chemotherapy would not be necessary. He kept making comments over the past few days about how flawed the prophylactic use of chemo is when you don't really *know* there is cancer there. I've been resigned to the reality of chemo being in my future. But this 50% statistic is helping him come around to it as well.

With this news, I am feeling pretty good. I was holding out a little bit of dread and fear about the pathology report. To see just how "bad" it was going to be. It was the last unknown, at least for now. It helps to have the enemy unmasked and out in the open.

Dr. K said that if the drains were draining 50 cc or less each per day, she would be able to take them out tomorrow. Yesterday, 2 of the 3 did less than that. The third drain (the second one on the left) did 60 cc. We'll see how they do today. Overnight, they did not drain much. It usually picks up during the daytime. The drains are very uncomfortable. They itch and ache where they are coming out of my side. I'll be a very happy camper when they come out.

So now I am focused on recovering physically from surgery. I want to get back into as good of shape as I can before chemo starts. I know I won't be jumping into my Jillian workouts. But if I can do some cardio on the recumbent bike and keep my lower body strong, I'll be happy. I'll feel strong and ready to take chemo head-on.

My prayer requests today:

• That the drains be able to come out tomorrow. That means 50 cc or less each day. If there is more that they need to do, I want them to stay in. But if it is possible for them to come out tomorrow, it will help me rest better. I'll be able to find my new 'normal.'
• That it not hurt too bad when they take out the drains. I'm a little paranoid about this. I've been warned that it feels creepy. I can deal with a few seconds of creepy. I can deal with pain too. I'd just rather not.
• That I continue to be able to rest. Sleep is physical therapy. I can feel the renewal of energy and tissue when I wake up. Sleep is a godsend right now.
• Overall harmony in the house. It is hard being cooped up during the summer. Like all kids, mine bicker and have typical sibling rivalry. That raises the level of drama for everyone in the house. Eric and his mom get all worked up about it, sometimes seeming to take one side over the other. It just escalates. Eric also gets annoyed at what he sees as the kids' obsession with video games. They don't do it as much as he thinks, really. But he always seems to be coming down hard on them for it. Everyone just needs to chill out and cut each other some slack right now.

I want to thank everyone again for your prayers and support. I've received so many wonderful messages from so many of you. It is so encouraging and uplifting knowing that you all are out there with us in spirit. When this is all over, I want to throw a huge party and invite everyone to come and celebrate in pink and plaid!

Have a blessed day. God is good, all the time!