Meeting the Surgeon

September 1, 2009

My appointment with the surgeon, Dr. Raja, was set for 10:00.  I gave my husband the choice whether to go with me or not.  I know he's not fond of medical people, and I don't really feel the need for emotional support at this time. Plus, in the future he's going to have to take some time off to help me, so if he didn't want to leave work it was fine by me.  But he wanted to go so I gave him a chore - take notes.  I figured it'd occupy him, and if the doc said anything I wanted to refer back to later, it'd be written down.

After sitting in an empty waiting room with, yes, a blaring TV (I really, really need a mini universal remote), we were called in. The doctor introduced himself to both of us,

Not knowing that over the past week I'd read 12 books on breast cancer and a zillion webpages, he started from the beginning:  the anatomy of the breast, what types of cancer form in the breast, what general treatment options there are, etc.  I didn't interrupt him to move on to more relevant conversation (like me, hello!) because my husband is extremely old-fashioned when it comes to medicine. He's of the frame of mind that whatever the doctor says goes.  The less my husband knows, the more he likes it.  He'll open his mouth like a baby bird and take a prescribed pill, not knowing what it might be or even what it's for, just because a Doctor told him to.  So, I knew he needed the basics.

And, because it was a doctor talking, he'd listen.  If it was me talking, he'd be thinking about baseball.

I, on the other hand, have been working frantically to get my PhD in breast cancer so I can confer as an equal and participate in my treatment.   I want to know everything that has, could, or might happen to each one of my individual cells. I also want to know the qualifications of the doctor, how many times he's done any procedure, and what he ate for breakfast.

Obviously, if it was Fruit Loops, I'll be forced to get a second opinion.

Dr. Raja had not gotten full pathology reports yet, so no info on estrogen/progesterone receptors, HER2/neu status, etc, which would tell me how fast-growing and aggressive it was and what kinds of treatments can be done. They'd probably come in the next day.

I expressed a strong desire for a lumpectomy over a mastectomy and he said if all my cancers were located in the same quadrant of the breast that would be possible. I already knew this, but he confirmed that radiation and a lumpectomy have the same statistical cure rate as mastectomy, so if at all possible, a  physician tries for breast conservation.

If, however, the cancer has spread through two quadrants of the breast the surgical results will not be  appealing and so mastectomy will be done.  The good news is I could have an immediate reconstruction after mastectomy, so I won't have to wake up without a breast. When we know more, he'll refer me to a plastic surgeon.  (I'm going to see if I can weasel a face-lift in too - heck, I'm already under, right?)

One of my cancers is  LCIS, (lobular carcinoma in situ) which often shows up in both breasts but is undetectable early on, so we are going to do an MRI to find out if it could be in my left one too, and also to see the extent in the right which will determine the surgical course. He warned me that MRI's often have false positives, which I'd known. so it could mean another biopsy.  Yay, more cookies and lemon water!

He did a quick exam but because of the bruising and hematoma, he couldn't get an idea of where they had done the actual biopsies, so didn't even have that visual clue.

He felt my lymph nodes and said none were swollen. He said he thought my cough was unrelated to the cancer, which was excellent news and had been my biggest worry.  He would set up a chest x-ray to be sure.

He has lots of experience doing the sentinal node biopsy so I will have that procedure at the time of surgery.  In the bad old days they just cut your armpit  (known to us BC PhD candidates as the axillary area) and scoop out tissue - then find lymph nodes to see if they have cancer cells in them.  That tells if it's spread but it has some pretty nasty side effects, including a lifetime of lymphodema.  Now they do nuclear imaging and find the first node that the lymph system from the breast drains into - the sentinal node -  and test that.  If they find no cancer cells there is a reasonable certainty it hasn't spread.  It's much less invasive and with no risk of lymphodema.

Unless, of course, they find cells in the sentinal node - then they get out the ice cream scoop.

He is going to set up a meeting with an oncologist as soon as the rest of the path reports come in, and then if I do need a a mastectomy I'll meet with a plastic surgeon too. He said I could be at stage II, which is really good news.

Curable, he said.

Best.  Word.  Ever.

He also said there was a "breast navigation program" he would hook me up with.  Frankly, it sounds more like something my husband would enjoy.  I jokingly asked them if they'd come over and clean my house and he seriously said he thought they would. 

Sweet. 

Won't know for sure until the rest of the stuff is done, but I left feeling very optimistic;  much better about the whole thing and like a weight has been lifted from my shoulders.  And, possibly won't be taken off my chest.

He sat and talked with us for a full hour.  Last time any doctor spent a whole hour with me, I was working as a bartender and was serving him drinks.

And now, more waiting.