Tough day

Valerie got braces today. She looks so much older! However, she's very cute, as always. She's sore, but is handling it pretty well. It helps that Ken has been taking great care of her since she got home from school. She's had macaroni and cheese and other soft foods and a couple of ice cream treats today too.

I had a tough day today. It started out with a great meeting at work. My colleague and friend, Anne, and I brainstormed some ideas that will have OSU-wide impact, so that was fun and productive. Afterward, I went to my appointment with the Medical Oncologist.

The staff was concerned that I was there before surgery and I had to tell several people that I knew the doctor would not have a treatment plan for me before the pathology results after surgery. Once she got there, she was patient and spent a lot of time with me. Through my questions and our discussion, I learned a lot that I didn't know.

I learned that whether I need chemo is totally unrelated to whether I get a bilateral mastectomy or a lumpectomy. Likewise, whether or not I will have to take tamoxifin is also unrelated to my surgery choice. Both of those post-surgical treatments are determined by the pathology results, the results of testing the tissue after surgery. So it's possible I'll need chemo even if I get a mastectomy. And it's more than possible - it's actually likely - that I'll have to take tamoxifin either way.

I was also wrong about a couple of other things:

Doctor visits: I thought I'd have less doctor visits if I had a mastectomy because the cancer would be gone. In reality, I'll probably have more doctor visits because I'll still have all the oncology appointments but I'll also have very frequent appointments with the plastic surgeon.

Quality of Life: I thought choosing the bilateral mastectomy would allow me to skip chemo and thus all of the side effects that terrify me. I thought I'd be able to keep my hair. I thought I wouldn't get weak or sick or have to deal with all of the other terrible things that happen with chemo. Since whether I have chemo is not related to my surgical choice, this is not true. Also, choosing the mastectomy would not allow me to skip the medication, either. I'll probably have to take tamoxifin either way.

So that basically leaves just four reasons to have the mastectomy instead of the lumpectomy:

1. It's very likely that no radiation will be required after a bilateral mastectomy. However, given all the post-treatment options, radiation is by far the least terrible.
2. If I don't need radiation, the reconstruction options are much better and I'm at a much lower risk of having complications with the reconstruction.
3. And the big question mark reason - A bilateral mastectomy would reduce the risk of recurrence. I'm still so very shaky on this one. If more than half of women who were successfully treated with breast cancers never have recurrences, and I take tamoxifin which further decreases the chance of recurrence by 50%, then what is the real benefit of the bilateral mastectomy?
4. Related to #3 is the fact that this breast cancer is difficult to find and in dense breasts like mine, it's especially tricky to catch. If there is a recurrence, there is a question about whether it would be caught early enough to stop the spread to other parts of my body. 

As for the other side, reasons to have the lumpectomy instead include:

1. Shorter recovery time so I can get back to work and family activities much quicker.
2. Keep real breasts which improves body image, confidence, sensuality, and fit of my clothes.
3. Can get back into running much quicker and easier. With a year of reconstructive surgery processes, the doctor today did not expect me to want to be running while I'm uncomfortable with the stretching and other processes. I could be out of running shape for a year. I may never go back.
4. The doctor today said that the lumpectomy was a very reasonable choice. She agreed that the bilateral mastectomy was a more radical choice, but one that women sometimes choose to do all they can to fight this disease.

I talked for a long time with my friend, Eunice, after work today. She was wonderful and I am continuing to process our conversation and what she said.

I'm also meeting on Monday with a psychologist at the breast cancer treatment facility, a doctor who deals only with breast cancer patients. Since I'm still struggling with this choice, talking with someone who sees many breast cancer patients may help me figure out what is really going on with me and perhaps I'll gain some insights into what is behind my emotions.

Another friend at work, Bethany, has been a strong advocate this week too. She is helping Ken and I try to figure out what amount we should pledge for the medical flexible spending account so we can save almost 30% on our health bills beginning January 1. She also hooked me up with a Nurse Case Manager. Bethany hand-picked this case manager for me and really trusts this person. The nurse offered to help do research on options to help better understand the best course of treatment. She will also contact a well-known doctor at OSU who is known for his work with cancer, nutrition during treatment, etc. and try to get me an appointment very soon (it's difficult to get in to see him). I think Ken knows this doctor from when he worked at the Medical Center.

Soooooo . . . a very long-winded post today. I'm amazed you actually read it this far down on the page!