Back to the Surgeon

Now it’s a preop with Dr. Surgeon.

As a side note, I had asked my supervisor if she could schedule me off on Wednesdays in general because that seems to be a good day to see the various doctors. She said that she would have to give me Mondays because that works better for the schedule. I’d like to add that she hasn’t actually been to my office in several years, and I know what works better for that office than she does. Her unwillingness to give me the day I need really frosts my cookies, because it means that I take a day and a half off per week, and I need to make sure that I maintain at least 30 hours per week in order to be considered full time and maintain my health insurance. She has also told me in the past, when I’ve told her that she has scheduled me to clock-out before the office closes, that I knew what worked for the office and that she knows I’ll be working after closing. Her logic or lack of it astounds me. I’m working a check-out desk and training a new worker so that’s a whole lot of fun.

Anyway, it’s Wednesday and I’ve taken off early from work to go see Dr. Surgeon. See above.

He has to do an exam, and I have to change my top and put on that attractive paper top with the opening to the front. During the exam, he tells me that I will have to have a clip inserted. My head jerked up and I looked at his face and saw his staring out the window during his palpations, and I said “I’ve already got a clip”, and he said, “this is a different kind of clip.”

He proceeds to tell me that I have DCIS and it has to come out. Seems like an understatement.

He also said he would walk me through the procedure. It will be an outpatient surgery, but will be done at the hospital, not the outpatient center. I’ll be sedated, he’ll remove the DCIS, it will go to pathology, they’ll make sure we have clean margins, and then he will close. He said he wouldn’t close until he gets clean margins.

I mentioned to him that I had recently remembered that my first cousin’s Christmas card mentioned that she had had breast cancer TWICE but now she is cancer free. When I called her, she told me that she had DCIS, also on the left side, and that two lumpectomies were necessary to get clean margins. This made me doubt her doctors because mine has just told me that he wouldn’t close with clean margins of 2 millimeters, but more on that later. I told him that there is no history of breast cancer in my family.

Dr. Surgeon told me that 50-60 thousand women are diagnosed each year without a family history. Strangely, this doesn’t make me feel better. I would suppose that the testing has gotten so much more precise that things are being caught that wouldn’t have been previously.

Dr. Surgeon finished his spiel, and as he left the room, he slowed down with his hand on the doorknob, and looking back over his shoulder at me, he said, “We’ll hope and pray we get it all.”

I’m hearing conflicting messages.

Meeting the Oncology Radiologist

After this appointment, I have to go on to work, so Leslie wasn’t able to go with me unless we took two cars. This seems like an unnecessary complication, so I headed out alone.

I went back to the same cancer center that I was at the day prior when I met the oncologist. I haven’t been sure how to refer to the oncology radiologist. Is he a radiologist specializing in oncology? Is he an oncologist specializing in radiology? So many questions in general for this whole process.

I arrived in plenty of time and checked in with a nice lady named Angie who gave me a heap of paperwork to process. She said that my nurse would be a nice lady named Rose.

When my time came, Rose took me to the back and checked my weight and my blood pressure and my oxygen. She led me into a small consultation room with a desk and a desk chair, and a couple of chairs across from the desk. I waited a fair bit for someone to come along. I wasn’t sure what to do, so I sat there and twitched a little.

Suddenly Dr. Radiologist and Erin the Navigator entered the room. He introduced himself immediately and stationed himself behind the desk with Erin to the side. He launched into a steady stream of information, and his gaze was so direct that I couldn’t look away to make notes.

Here are some things that I gathered:

There are two types of testing that can be done to ascertain if I will benefit from radiation treatment. One is Oncotype DX and a newer one called DCISionRT (pronounced decision RT). These can help predict in percentages if this cancer will recur in 10 years, with and without radiation. So if I have a score of 20% recurrence without radiation, and 10% recurrence with radiation, it’s pretty clear that I would have radiation. The problem is that my DCIS is on the left side so it’s near the heart and left lung, and radiation could affect my heart and lung. There’s a breathing technique used during treatment where you take a deep breath and hold it for 10 seconds to help lift the DCIS away from the heart and lung.

I am not one bit interested in having radiation, but then I am also not interested in having DCIS recur. Those sneaky little cancer cells can be hiding and are undetectable by modern testing until they reach a certain age. Mine has been growing for probably 8-10 years, but it is when they are about 6 years old and have attracted calcium which attaches to them that they become shown on the mammogram as calcifications. However, calcifications can be shown on the mammogram, but it’s not DCIS, it’s just calcifications. So radiation is necessary to zap all those little hidden cancer cells.

I asked when I would be scheduled to meet again with the surgeon, and was told that the surgeon’s nurse was out sick that week and that someone would call me next week.

I’m definitely interested in having testing to find out my chances for recurrence.

I finished up with Dr. Radiologist and headed on to work.

Now I wait to hear from the surgeon.

Meeting the Oncologist

Leslie and I had an ongoing discussion.

He wanted to go with me to the oncologist. The appointment was scheduled for a mid-afternoon, about the time he usually feeds the dogs.

I said no, I could go without him. The few disruptions in the daily schedule, the better.

No you can’t, yes I can, no you can’t, yes I can.

I gave up, and he went.

****

We’re back at the new cancer center in Okatie. I was told that the oncologist’s office was on the first floor on the left by the elevator. We went in, stopped at the COVID-19 screening station immediately inside the door on the left, and went on past the elevator. That was wrong; it was a different office. Then I puzzled out that the COVID-19 screening station was set up in front of the office, almost completely obscuring the office entrance for first-timers. We made our way inside the office, where I presented my ID and insurance card and filled out more of the same paperwork.

A nice technician named Cherish walked us back to an exam room where she took another history, checked my blood pressure, and checked my oxygen levels. She left, and Dr. Oncologist and Breast Care Navigator Erin came in.

Dr. Oncologist went over what I could expect. The DCIS is estrogen and progesterone positive, meaning that their growth is fed by hormones. After the lumpectomy, there would be radiation and 5-10 years of a hormone suppressing medication, most probably Tamoxifen. Erin gave me a copy of the pathology from the stereotactic needle biopsy.

You might have caught that Dr. Oncologist never used the word “mastectomy”. I didn’t. Leslie did, and he asked the doctor is he was saying that the surgery would be a lumpectomy, not a mastectomy.

The doctor agreed that was correct. This was eye-opening, and mind-blowing, and all the other phrases for unbelievable.

Erin gave me a tote bag with an enormous handbook about breast cancer, the different types, the possible surgeries, and what to expect, along with first-hand accounts from breast cancer survivors. There was also a folder with resources and other information, regarding diet, exercise, and counseling.

I don’t remember much else about this appointment. I’m overwhelmingly relieved that a lumpectomy could be the answer.