Newsflash!

Dr. called to say the pathology report says no cancer left behind! Yeah! Clean margins. There is still some microcalcification and duct hyperplasia (meaning there are cells in there that are on their way to becoming cancer, but the radiation will stop that) These clean margins may mean no radiation boost to the tumor site, I find that out on May 10th. So now I have peace of mind, no tumors left behind, no cancer lurking in the margins. When the bandages come off and the swelling goes down, we'll see what aesthetic price I had to pay. This means recurrence on a local level is under control by removal and radiation and on a systemic level will be addressed by the Tamoxifen. Now I feel my prognosis is VERY good. I can take that big sigh of relief I've been holding, I'd jump for joy, but I'm still under doctor's order of no bouncing. so for now.....Yippeeeee!!!!

The 2nd surgery is behind me. It's been 3 days and I am trying to take it easy and not bounce. My devoted sister Debbie was here and as always, was a big help. Next Wednesday I have an appt with the surgeon and will learn what the pathology report says....more cancer found or no cancer found. Waiting. Meanwhile, I had 12 more paintings printed onto postcards. It is very satisfying to see these large paintings reduced to postcard size. I took them into surgery and offered them up, only one was left. My images are out in the world, living a life independent from me. :) Which is what my boys will do in a few years. In 5 years, Ezri will be 13 and Aaron 20! I'll have been on Tamoxifen for that long, praying no tumors are growing under the radar. 5 years doesn't seem that long, but so much can happen.

Looping back Around

Okay, it turns out I'm not going forward with radiation right away, it's being postponed. I'm going to repeat a step and have a 2nd surgery, by a 2nd opinion surgeon out of Walnut Creek Kaiser, on Tuesday. I decided this Friday morning. Best scenario is that she goes in again and doesn't find anymore cancer, then it will have been for naught, except my peace of mind, and hers. I couldn't let go of the close margins around the tumors they took out. The pathology report had said carcinoma "within 1 mm" of the margin. Also, if she takes out more tissue and can get wider clean margins, I might not have to have a radiation boost (7-10 zaps directly to the tumor site), which happens to be within an inch of my heart...with my lungs nearby. The fact is, radiation not only will kill cancer cells left in my breast, it also can give you cancer in nearby organs... collateral damage they like to down play. I'd still have radiation to the whole breast, and I may still need the boost, but if I don't, that alone would make this 2nd surgery worthwhile.

Choices, choices...it is ultimately my decision because it is my body and my life. It is awkward to go contrary to the recommendations of my Oakland doctors. The oncologist wrote in my chart, "the patient continues to perseverate on the close margins and not her great prognosis." Is this me focusing on the negative instead of the positive? or is it me being prudent and trusting my instincts? Dr. L feels strongly this is the right thing to do, but she is a surgeon and is used to solving problems with surgery. Could a positive attitude have kept a recurrence at bay? That is too much to ask of myself, I'd feel more confident with a 2nd viewing of the tissue in my breast. A confirmation that nothing got left behind.

A 2nd surgery means I may be lopsided, so there is the aesthetic sacrifice. But I am willing to trade it for the highest chance of avoiding a recurrence. If one has a recurrence in the same breast, radiation isn't offered a 2nd time, so mastectomy it would be. This is hard because I feel so healthy. I have to remind myself that the cancer would kill me if I don't make decisions and get treatment, and anyone who knows me, knows that I sweat out every tiny minuscule choice I have to make and then rarely let it go once I've made it.

So Debbie is coming in tomorrow afternoon to be here for me and my family, and lovely cousin Hillary will pick her up. Recovery should be faster because this surgery won't be under general anesthesia since no lymph node dissection is happening. I'm told not to dance as soon after this time, which I will heed, given the arm complication and scar tissue I now contend with.

Today was gorgeous weather. Ezri had a baseball game and Aaron joined us and it was a lovely day. Tomorrow I will pass off my work project to my boss to meet a deadline, and Tuesday will be Surrender. Unknown. Trust. Faith. Confidence. Thanks to all my friends and family whose love and prayers give me strength, really. You remind me that I'm not crazy, there is a lot to contend with in my life these days, but being around for another couple of decades will make it all worthwhile. Namaste.

Going forward

No second surgery to be done. The 2nd opinion oncologist in WC wrote me:

"I did have an opportunity to talk with Dr. O'N today (the surgeon), and the answer is that there is no more margin to be had, and she has already resected as much as she can. You should go ahead with your radiation."

I'm somewhat relieved. I really didn't want a 2nd surgery, I haven't quite healed from the first one. Any cancer left in my breast should be zapped and killed with radiation, and then if that doesn't get them, the 5 years of daily oral Tamoxifen will block the estrogen receptors on the tumor cells and not allow them to grow. My chance of a reoccurence remains at 6%, so odds are in my favor! Whew. Now I can go forward. CT scan on Friday to chart the coordinates of the beams to my breast so that they minimize radiation exposure to my heart and lungs. I assume radiation starts next week. I'll go daily for 5-7 weeks, not sure yet. Lucky for me there is valet parking. I've heard it makes you very tired and then it takes a few weeks to get your energy back. I'm open to donations of healthy soups and such to keep me going, and then it will be summertime, when the living is easy!

Comfort Zones

Hello loved ones who follow my cancer roller coaster journey:
Today I met the 2nd opinion oncologist, Dr. K, at Walnut Creek Kaiser. She confirmed and explained the low OncotypeDX score and how chemotherapy will NOT decrease chances of a reoccurence, so NO chemo for me...Yeah!! My ship has come in! My luck has turned around! Let's go to the races!
However, her concern, as was mine, are the close margins around the lumpectomy. The pathology report says "infiltrating carcinoma found within 1 mm of the medial margin and DCIS is present within 1 mm of the lateral margin." I was always trouble by the word "within." My Dr. friend had told me that margin depth is a big source of discussion and controversy in the breast cancer field and my oncologist Dr. T said she is comfortable with the "within 1". Dr. K prefers a 2 mm margin and is going to talk to my surgeon, Dr. O'N to find out if there is any more margin to be had. The medial margin is the center line, and where the tumors was taken out along my chest wall and skin, there is no more tissue to get. But maybe on the lateral side there is. We'll see what Dr. O'N says, hopefully by early next week.

Meanwhile, I see Dr. K, the Oakland oncologist tomorrow to learn about Tamoxifen. I am officially still pre-menopausal because my estrogen level is 354 and if post menopausal it would be below 30. My one ovary (unless the other is hiding) is still pumping out loads of estrogen at almost 51. (no wonder I got pregnant at 42) Monday I meet the radiation oncologist to plan that exciting holiday.

However, if a 2nd surgery is recommended, all goes on hold to scoop more out, and as much as I don't want repeat that ride, maybe my future is worth it.

Suspended

The theme was "body parts," but I had in mind painting a body being held in the cup of hands. I so want to be held, like a baby sleeping in momma's arms, supported so I can take a deep breath, let go and take a good long nap. It didn't paint out that way and instead we have a body suspended between hands, as if the energy flowing from them is what keeps the body afloat.
I feel suspended in the not knowing whether I'll have chemo or not, whether I'll have a reoccurence somewhere in my body within 5 years or not, whether I'll be able to get a job with health insurance when my cobra runs out in October or not, whether I'll have work this summer or not, whether Ezri will find a school that fits him or a soccer team that wants him or not, whether my arm will ever heal or not....and on and on. The dance gives me a place to move and breathe into all the unknowns and be with what I do know. I know have a strong chi, the life force that is still coursing through me with a creative energy that loves to be expressed through paint. I know I have a family that loves me and a community of friends that prays for me. I know I will survive and thrive and drive myself to do what needs to be done. That I will put one foot in front of the other and continue to do what I can for my boys. That I will emerge from this challenging time and see the gift that this life threatening illness offers; how to let go, move on, appreciate each moment and be grateful for all that I do have.

Feeling Lucky

The good news I was praying for has come in....my Oncotype DX score was 8. What does that mean? From the website:

The Oncotype DX test is a diagnostic test to learn more about the biological activity of the specific tumor. Along with other pieces of information, the results from the Oncotype DX test can help women and their doctors make decisions about whether or not to include chemotherapy in their treatment plan. It can also help indicate how likely it is that a woman’s cancer may return in the future (distant recurrence).

The Oncotype DX test looks at a group of 21 genes within a woman’s tumor sample—16 cancer genes and 5 control genes—to see how they are expressed, or how active they are. The results of the test are reported as a quantitative Recurrence Score^® result, which is a score between 0 and 100 that correlates with the likelihood of a woman’s chances of having her cancer return, and the likelihood that she will benefit from adding chemotherapy to her hormonal therapy. (anything below 18 is considered "low risk" for reoccurence within 10 years without chemotherapy.)

The Oncotype DX test provides information in addition to standard measurements (such as tumor size, tumor grade and lymph node status) that doctors have traditionally used to estimate how likely a woman’s cancer is to return, and to help her make treatment decisions.

My score of 8 means the average rate of distant recurrence after 5 years of Tamoxifen and 5 years after that (10 yrs total) is 6% without chemotherapy, which is a very low probability, but if I'm one of the six out of 100, then that's still no good! But if any left over tumor cells don't respond well to chemotherapy, the side effects aren't worth it. The Tamoxifin is a hormonal therapy that should inhibit tumor growth systemically. Next Thursday April 15th I'm going to get a 2nd opinion from a Kaiser oncologist in Walnut Creek, and then meet with my oncologist Eva Thomas in Oakland the following day to put it all together and get a treatment plan. Radiation is a given, likely 5 times a day for 7 weeks or so, but I think my breast needs to heal from surgery before it can begin. Tamoxifen for 5 years is also a given, but I don't know when that will start.

So I'm excited to have a low Oncotype score, but I'm not ready to jump for joy until I get a second opinion, I'm hopeful, but still waiting to exhale.

The theme from last weeks dance was the NEW body... After the chrysalis is broken. I had drawn the outline of the figure a couple of weeks before while feeling jubilant and even though my body is feeling battered and bruised, and my lymph node arm is still painful, on Wednesday afternoon, I approached the figure with that theme. The spring time is about new growth and opportunity. I was imagining pure spirit coming up from the earth to rejuvenate and heal my vehicle and allow me to carry the life force in this way a few more years...and I'm feeling lucky that with your love and support, that is what will unfold. Namaste.

Moonscape

Hello Delightful Friends,
Here is a photo of my boys in Joshua Tree. If you love rocks, and I do, it is spectacular. Our first night was a full moon and Aaron and I could walk around in a black and white world with out a flashlight, one of my favorite things in life to do! The rocks are very porous and easy to grip. Within a few minutes with little effort you can be 40' up with giant views all around. I'm thinking we should go again next spring break, anyone want to join us?