Because I’m starting this now, I’ll give the timeline of how we got where we are today. I plan to be wordy so just read what you want.
Monday, November 14, 2011 - annual physical. I felt good, had no concerns except that I wanted to have my hearing checked. She told me I’m at the age when they order mammograms every year, am I ok with that? I said yes. For some reason as I write this I realize I’ve always been diligent about getting the needed annual physical exams which includes mammograms and when she asked me, in my head I thought, “Of course I want a mammogram.”
Wednesday, November 23 (day before Thanksgiving) - had my mammogram. I remember the day vividly. I worked later than I intended because I had to get something done then stopped at Home Depot before arriving at my appointment a little early. It was the day before a holiday so I asked the mammographer if it helped her go home a little earlier if she got done with me earlier (my appt was for 4:00) - she said no and we discussed the holidays and travel and family.
Monday, November 28, 2011 - Got a call back from the Radiology office saying I needed to schedule a diagnostic mammogram and an ultrasound as I was driving to work that morning. A moment of panic but I asked to be scheduled as soon as they could get me in. I have been having annual mammograms since I was 39 - I’m 42 now so this is my 4th annual mammogram. I have been called back for diagnostic mammograms before so this wasn’t too alarming, but an ultrasound - this was new and a little concerning. My mom is called back for diagnostic mammograms every year because she has dense tissue so I mostly figured I had the same issue.
Thursday, December 1, 2011 - diagnostic mammogram and ultrasound appointment. They only do diagnostic mammograms between certain hours so I knew the lady sitting back in the waiting area with me was also there for a diagnostic mammogram. They have two ladies waiting near one machine. We sit with our silly capes that feel like they don’t really cover reading (or pretending to read). I smile when I think about this - I’ve done it before and it feels so funny. Anyway, I was reading on my Kindle and the mammographer (the same one that did my first mammogram) asked me if I liked it because she was debating the Nook vs. Kindle for Christmas gifts. We had this discussion. Then the other lady waiting and I talked. She is a breast cancer survivor and had felt a lump so was there to have it checked out. She told me her husband had some severe health issues and she was a traveling home nurse. She was called to do her mammogram. I said a prayer for her. A complete stranger and I connected over a similar fear. Then I went to do my mammogram - more Christmas shopping discussions. I waited again and the other lady was called for an ultrasound. The radiologist read my mammogram and decided that I too, needed an ultrasound so I was taken to the ultrasound area. The sonographer was very quiet but answered my questions. I could see the lump on her screen. Then she started to scan my armpit and I knew they weren’t going to have good news for me. The radiologist came in and repeated much of the ultrasound and told me I’d have to have a biopsy. I asked if he could do it today - he said no. I think I left sort of knowing it must be cancer because of the uneasy feeling that nobody offered any other options. Texted Doug and my mom while waiting for scheduling to let them know I had to have a biopsy.
Friday, December 2, 2011 - Had biopsy. Doug was planning to go to western Iowa to go hunting, an annual trip to meet a friend, but he cancelled his trip so he could go with me to the biopsy and help me with the girls over the weekend because I wasn’t supposed to do any lifting for a couple of days. Had the same sonographer, a different radiologist and the same mammographer. They injected numbing medicine so it didn’t hurt, but the tool they used to take the biopsy made this awful click - which sounds really mild, but it was like an air compresser “bang” when he took the sample. I did fine through the first two, but when he said he was taking a third sample, I got nervous because of the dreaded noise. Melissa has some biomedical engineering friends looking into replacing this technology - crazy that the noise was the worst part of the biopsy. This doctor also didn’t offer any explanations besides cancer. They placed a marker into the biopsy site and then took more mammograms so they could find the biopsy area in the future. Doug said the government was just tracking me… :) They said to expect biopsy results next week.
Tuesday, December 6, 2011 - Before Thanksgiving Doug and I decided that we should take a day off work and do power Christmas shopping - get it all done in one day. So I studied the calendar to find the day we should shop and December 6 called to me. We scheduled our shopping trip and arranged care for the girls. We took Emma to school that morning, took Brianna to speech and when we were dropping Brianna off at school, my doctor called. When I answered, I knew that because it was her, it wasn’t good news - if it had been her nurse, it would have been fine. She asked if I had time to talk and I said no because I was just walking Brianna into the school. I was really anxious to get Brianna into the school so I could call her back and Brianna can take her time some days - this was one of those days. I called the doctor back while we were in the car and Doug really wanted me to put it on speaker so he could hear too. She said she said a few choice words when she read the report then called me right away because she knew I’d need to get moving on taking care of it right away. The full pathology wasn’t back, but it was breast cancer. I love our doctor and was glad I changed to having my physicals with our family doctor instead of my gynecologist a few years earlier. She had her nurse make appointments for me to see an oncologist which couldn’t be scheduled until the next day. Doug and I had our moment, called our parents, sent an email or two and then decided that we should go shopping in Des Moines that day anyway. We didn’t get it all done and we got some extras, but we made huge progress. We had fun but were quite distracted.
December 7, 2011 - met with oncologist for first time. I see Dr. Erin Casey and I love her! She told us she writes everything down as she talks so we didn’t need to take notes - and then she sent her notes home with us. She took all the time we needed answering questions and explaining the process. Diagnosis: Invasive ductal carcinoma, estrogen receptor positive, progesterone receptor positive, size less than 2 cm (ultrasound had 9 mm and biopsy had 11 mm), no suspicious lymph nodes - when you get past the breast cancer diagnosis, these are all good things. She told me that breast cancer is as individual as the women on the planet so keep that in mind when I get advice from other people. She told me that there is no medical reason for me to have one type of surgery (mastectomy vs. lumpectomy) over another so the choice is completely mine. She gave me the list of reasons why I would choose one type of surgery over another and left it to me. She set up an appointment for me with a surgeon and I said I’d just like to have the appointment ASAP. Because both my parents and my daughter have had cancer, she also set me up with an appointment with a genetic counselor. I left the appointment hopeful.
December 9, 2011 - Surgical consult. Dr. Keri Nowell did an exam and agreed with Dr. Casey that either type of surgery would work for me. I told her I’d like to schedule a lumpectomy pending the results of my BRCA1/BRCA2 results. She was very nice and very passionate about her work. She spent time with us explaining each procedure. She was very confident - we left agreeing that you definitely want a surgeon that is confident!
December 12, 2011 - Met with Julie, the genetic counselor. She did a questionairre and asked me questions about my family history and when we were done discussing the results, she said it was not likely that I would have the genetic mutation BRCA1/BRCA2 that is linked to breast and ovarian cancer. She also ran a computer model based on my history and came back with a 1-4% chance that I had this mutation. She said they don’t recommend testing unless the computer model results in >10% chance. But since our insurance covered the test, I told her I’d feel better just knowing if I had it or not. The results would change my surgery decision and I’d likely also have a hysterectomy. And if I did have it, my sister and my daughters would need to be tested to know if they had it as well. So she drew blood and sent it off for testing.
I also met my Breast Health Coordinator, Mona, that day. She explained her role as a resource for me through the entire process and she gave me several contacts. What a nice service!
December 15, 2011 - met with my Radiation Oncologist, Dr. Janet Merfeld. I wanted to meet with her before my surgery so I could change my mind if I felt differently about radiation after I met with her. I have a friend that is a radiation oncologist at the University of Iowa so I had talked with her about it and she was able to answer a lot of questions for me - so I went into this meeting pretty sure I was ok with radiation. I also like her. She explained the process and side effects. She did an exam and agreed with my oncologist and surgeon that either type of surgery was ok for me. She went through what we knew to date about my cancer and guessed I would be a Stage I. She was the first doctor to tell me that she thought lumpectomy with radiation was a good choice for me - which I appreciated because up until this statement, everyone had told me it was entirely my choice - a stressful choice, indeed. I left feeling pretty good about my choice for type of surgery with radiation. Of course, my decision was still pending the results of the BRCA1/BRCA2 test.
December 20, 2011 - Results of BRCA1/BRCA2 testing. We met with Julie and she said right away when we sat down that she wouldn’t make us wait - my results were negative. I don’t have the BRCA1/BRCA2 genetic mutations!!! Yeah! When I took a deep breath, I realized I was nervous about it. So my family doesn’t have to be tested for this. Good news! And just in time for my surgery tomorrow.
December 21, 2011 -Surgery day. I was really nervous today. We spent the morning doing laundry, cleaning up the house, going for a walk and generally trying to keep my mind off of the surgery. We had to arrive 4 hours before the surgery, so 11:30 for a 3:30 surgery. They did all the admit stuff, I changed clothes, got an IV started, etc. Then I headed over to the Women’s Health Center for the pre-surgery prep. They biopsy the sentinel lymph node with every surgery so they inject radioactive dye at least 2 hours before surgery so they can see which lymph node drains the area. Since this is the first lymph node to drain the area, they test it first and if it has cancer cells, they take the rest of the lymph nodes in the arm pit. Lymph nodes are like a pearl necklace (I liked that analogy) - if the first one is clean, the rest will also be clean. I also learned that there is not a set number of lymph nodes in every person - and we are not necessarily symmetrical. I might have 8 lymph nodes in my armpit and someone else might have 14 - or I might have 14 on one side and 8 on the other. I had no idea! See - a learning experience! Anyway, my first stop was to have the dye injected. It burned going in and they didn’t give me numbing medicine for this, but it was short-lived. Then I went next door to have a needle localization. They placed that marker during my biopsy, so now the radiologist inserted a needle next to the marker so the surgeon could take out the chunk of tissue that contained that needle. Luckily they did give me numbing medicine for this procedure. Turns out it was the radiologist that also did the ultrasound and told me I’d need to have a biopsy. And the sonographer that assisted I also knew - I think we figured out it was because she had performed ultrasounds on me when I was pregnant with Brianna - and she has a sister with Down syndrome. Small world - I felt like I knew everyone! Oh, and Mona assisted as well. During the needle placement I was teary and obviously nervous, I felt out of control and that this was real - I really had cancer. It was nice that Mona was there to help calm my nerves. Once the needle was placed, I needed to have a mammogram to confirm that it was placed near the marker. Because my tumor was deep to my chest wall and far out from the center of my breast almost in my armpit, it was hard to get a good picture. The mammographer took 3 films and then they got me settled in the wheelchair again (which I was thankful for because I hadn’t eaten for a long time and was feeling weak) to wait for the radiologist to review the films. He wanted one more film - the mammographer said this time I’d have to stand on my head. I was really thankful I had numbing medicine because I am sure this would have been painful otherwise. It was very strange to have these X-rays with a needle sticking out of my chest. After the final successful film we headed back to the surgery center. Because I was so visibly nervous, the nurse said she’d talk to the doctors and get me some medicine to calm my nerves. The anaesthesiologist came to see me and asked me a ton of yes/no questions, said he’d take care of me and walked out - not the best bedside manner. But he did tell me he’d give me some Versed. I’d never had it and Brianna took it every time she had a spinal tap so I was curious if it worked, if it really does make you not remember what happens to you. The surgeon came to see me and used a Geiger counter to see if the dye had traveled to my lymph nodes which meant I was ready for surgery. Pastor Tim was there as well which I really appreciated because I was so nervous. I am a healthy person and have only had surgery for tonsils when I was in high school - a long time ago. I took Versed as they wheeled me into surgery and the only thing I vaguely remember was someone asking me to slide over. So it does work- which made me happy for Brianna. The only thing I remember about being in the recovery room was that I asked the nurse about my lymph nodes and she told me they were negative - I said, “Thank you, thank you.” Then I asked her about my lymph nodes and said a prayer of thanks. And again … and again. Poor nurse - I must have asked her, “now did you tell me my lymph nodes were negative?” a hundred times. I remember feeling like it took me forever to not feel out of it. I was nauseated when I tried to sit up so they gave me Percoset and everything started spinning and I felt more nauseated. Surgery took 1 hour and 45 minutes and it was a surgery late in the day so they said it usually does take people longer to recover with those conditions. I was one of the last people to leave for the day, I ate some soup at home and went to bed. I took pain medication for two days and slept quite a bit both days because the medicine just knocked me out. I felt MUCH better when I stopped taking it. I was able to go to church Christmas Eve with an ice pack and took it easy during our Christmas celebrations, but overall, I did pretty well.
December 29, 2011 - Pathology results didn’t come back until today because of the holidays. Good news - no lymph node involvement!!! Unfortunately, one margin was still involved so they recommended I have another surgery to excise more tissue. With a lumpectomy, I knew this was a risk and it happens that they have to go back for more tissue 1 in 3 times. Though I was disappointed, I wasn’t upset with this news and scheduled the surgery that day because the surgeon wanted to use the same incision.








