A journal of my experiences with breast cancer to inform those who are interested and to help any one else who might have just been diagnosed.

“[She] will have no fear of bad news; [her] heart is steadfast, trusting in the Lord.” Psalm 112:7

Wednesday, February 27, 2013

At the Surgeon's

"So do not fear, for I am with you;
do not be dismayed, for I am your God.
I will strengthen you and help you;
I will uphold you with my righteous right hand." 
Is. 41:10

We are back from the appointment with the surgeon. It was an interesting, but slightly confusing meeting. He reminded me a bit of Doc Martin, sans the hemophobia, in that he would ask me questions using technical medical terms of which I was not familiar. I would try to answer his questions using the terms that were given to me by the doctors in Tennessee, and he seemed dissatisfied by the answers.  He was unfamiliar with using radioactive seeds to locate the area with the tumors, but he uses frozen section evaluation of tissue during surgery to determine whether all of the cancer has been removed. Using this method, the pathology laboratory provides rapid, accurate microscopic analysis of tissue while the patient is still in surgery. In this way, surgeons know if they have achieved negative margins (removed all the cancer) while the patient is still in the operating room, eliminating the need for any further surgeries. Since that was not done in TN, he will go in at the same incision site and remove all the hardened scar tissue and a bit more around it. He cannot use the frozen section evaluations with this surgery as the hardened tissue needs a more time-consuming analysis. I have a surgery set for Monday at 10:30 at Christiana Hospital's Surgical Center for him to retrieve more tissue. In about a week we will know the results from the lab as to whether the margins are clean by at least 2 mm. If they are not, the next surgery will be a mastectomy. Please keep us in your prayers.

Tuesday, February 26, 2013

Meet The New Surgeon

“I have surely seen their affliction… and have heard their cry… for I know their sorrows; And I am come down to deliver them…” 
Exodus 3:7
Joseph M. Belgrade, M.D.
Joseph M. Belgrade, MD
Delaware Surgical Group

This is going to be a busy week for us. Tomorrow I have an appointment with the new surgeon and Friday I have an appointment with my oncologist. (We also had an appointment with Alex's new doctor on Monday and I meet with my priest on Thursday. Not really related to my health issues, but it has made for a very busy week!)
Please keep us in your prayers!

Friday, February 22, 2013

The Oncotype Results Are Back!

"The Lord is my strength and my shield; my heart trusted in Him and I am helped,,,"
Psalm 28:1, 6-7

The nurse from my oncologist office telephoned me today to say the results came back on my Oncotype test and I will not have to have Chemotherapy! I will have to have surgery, however, so my next appointments will be with a new surgeon and with the oncologist to begin the hormonal chemotherapy. I will keep you posted.

Thank you for your kind thoughts and prayers.

Thursday, February 14, 2013

Oncology Radiologist

Viroon  Donavanik, M.D.

Viroon Donavanik, M.D.

"The Lord is my strength and my shield; my heart trusted in Him and I am helped,,,"
-Psalm 28:1, 6-7

Today we met with Dr. Donavanik, the oncology radiologist. We   went to his office in Elkton, so the trip was pretty easy and it took us a little less than an hour to get there. The office was pleasant and we had nice conversation with a couple of people in the waiting room. The nurse took us back to review the information on the forms and she asked me about my treatment for my neurological condition as her mother is being treated for something similar and is not responding to the medication they are giving her (a different one than mine). It was nice to feel helpful.
As the Dr. Guarino supposed, Dr. Donavanik was not pleased with how close the margins were from my last surgery. He needs to confer with Dr.Guarino, but it looks as if Dr. Donavanik is going to refer me to a surgeon so that more tissue can be taken before he feels comfortable beginning radiation therapy. Meanwhile, we are all waiting on the results of the Oncotype to come back to see if I will need regular chemotherapy. Another option instead of the surgery is a larger dose of radiation during the radiation therapy, but we all agreed that the surgery was a preferred option.

Please keep us in your thoughts and prayers.

Friday, February 8, 2013

Michael J. Guarino, M.D; The Oncologist at the Helen F. Graham Cancer Center, Christiana, Delaware

“Peace I leave with you; my peace I give you. I do not give to you as the world gives. Do not let your hearts be troubled and do not be afraid.” ~John 14:26

It was a rainy morning when we set out to my appointment with my oncologist, Michael J. Guarino, M.D  at the Helen F. Graham Cancer Center , which is normally an hour from our house. In the rainy weather, it took a bit longer and we were a few minutes late to our appointment, which was on the third floor. Steven let me off at the door and he parked the car. I was still checking in when Steven met me at the doctor's office. We waited a few minute in the waiting room, which was a very depressing experience. There was a very heavy atmosphere of sadness, of a sense of desperation in the air. It was unnaturally quiet, reserved, a feeling that fear was everywhere. I was very glad to get out of that waiting room. Steven said he did not notice it, so perhaps I was projecting or perhaps I am overly sensitive to such things. I am not sure. I do know, however, that while we waited in the examination room for the doctor, I became very agitated, very nervous. Scared. Perhaps that was only because we waited for a very long time, and I began to think about all the things that I had put aside during the move and all that entailed. 

Dr. Guarino finally bustled in and had a wonderfully charming bedside manner. Later, over lunch, I likened him to Columbo, and Steven agreed that he seemed very much like the TV detective. He was a wonderful combination of "telling it like it is" kind of doctor and yet kind, reassuring and I felt he met us where we were. He was very reassuring, gave us a sense that he was in this with us and that he would get us through it.  He went over all the material that was sent to him from Tennessee and then he explained what it all meant, some of which I already knew, but some I didn't. The good news is that I may not have to go through the regular chemotherapy after all. He said that he has ordered a test to be done on the tumor that was taken out in TN called Oncotype DX. This is a diagnostic test that helps identify which women with early-stage, estrogen receptor-positive, lymph node-negative breast cancer are more likely to benefit from adding chemotherapy to the hormonal chemotherapy. It looks at the activity of 21 different genes in the tumor tissue that was removed and measures the chances of the woman, whose tumor it was, chances of returning and the likelihood of that woman from benefiting from chemotherapy treatment. How amazing is that? (If you are curious about it, you can find out more about it here.)

I will get the results of this test in about two weeks and it will have a recurrence score result, which is a number between 0 and 100, with the lower the score means the lower the risk that the cancer will return. If the score is low, it also means that it is a cancer that is less likely to respond to chemotherapy, so doctors will recommend treatment with hormone therapy alone. (For those of you that are praying for us, please say a special prayer that this score will come back low.)

The order of treatment will be:
  1. Maybe Regular Chemotherapy, we will know more when the test gets back.
  2. Perhaps Surgery. When a tumor is removed, some tissue surrounding it is also removed. The tumor with surrounding tissue is rolled in a special ink so that the outer edges, or margins, are clearly visible under a microscope. A pathologist checks the tissue under a microscope to see if the margins are free of cancer cells. Margins, then, refer to the distance between a tumor and the edge of the surrounding tissue that's removed along with it. Mine, although were clear of cancerous cells, were close, by 2 mm. The radiation therapist has to determine whether they are too close and I will have to have additional surgery to get more of the tissue or not. 
  3. Radiation Therapy. This will be five days a week for six weeks. Some skin burn and fatigue are the most common side effects.
  4. Hormonal Chemotherapy This will be a drug, Tamoxifen, which is a pill and is used to reduce the risk of getting a breast cancer again. It often causes menopause onset. The use of this medicine is used based on the observation that receptors for specific hormones that are needed for cell growth are on the surface of some tumor cells. Tamoxifen is an anti-estrogen and it binds to estrogen receptor site on cancer cells, blocking estrogen from going into the cancer cell, which interferes with cell growth and eventually leads to the cell dying. I will be taking this for five years.
So, now while we are waiting for the results from the Oncotype DX. test, I will see the Oncology Radiologist, Dr Danavanik on Thursday to see what he says about whether or not I need the surgery.

Please keep us in your prayers.