8 Feb 2011

Status report

The MRI was done at the Breast Center at McLeod Pavilion on Monday afternoon, Jan. 31. A very nice young female technician / technologist did the test which took about 30 minutes. It was a strangely configured table I had to lie on, face-down. The MRI was open at both ends, much less claustrophobic than the closed one I remember from years ago that looked like a torpedo tube.

I saw the surgeon (Dr. John Sonfield) again last Thursday. He had the MRI results, which pinpointed a 5 cm. (2 inch) area under my left arm, still consistent with breast cancer. Apparently it is pretty close to the enlarged lymph nodes. Here’s what the report said:

“3:00 position left breast there is extensive abnormal enhancement extending from anterior to posterior about 5 cm. with multifocal spiculated enhancing lesions with washout malignant type enhancement pattern. Diffuse dermal thickening in the left breast is seen with breast edema extending posteriorly including the pectoralis.”

“Conclusion: Bi-Rads category 6. Known right (left) axillary malignancy with biopsy proven pathologic lymph node. MRI demonstrates multifocal enhancing spiculated lesions in the upper outer quadrant left breast compatible with probable primary malignancy.”

Dr. Sonfield then scheduled several other tests right away, a CT scan of the chest, abdomen and pelvis (which I had at the Plaza on Friday 2/4), a whole body bone scan (at the Pavilion yesterday 2/7) and a PET scan (at the Plaza today). These are all to look for any other tumors which might have spread through the lymph system. I will return to see him Thursday Feb. 10. (He will implant a portacath for the chemotherapy, which he is sure I will need.)

I saw Dr. Bajaj yesterday afternoon (2/7). Shelby and I got there at 1:30 as instructed, amid a crowd of patients. I had to fill out new-patient forms as usual, then waited, and waited, and waited. We finally saw the doctor after 3:00. His nurse told us that he was always late, to try and be understanding about it because he takes a lot of time with his patients. We’ll be better prepared for that in the future.

Shelby didn’t want to sit in the waiting room because of cold and flu bugs going around, so we sat in the hall where a line of chairs had been placed. His office is in the same building where I used to work for Dr. King, on the 2nd floor. The building looks old and tired now. Carolina Health Care has the entire building these days, but they have just been bought out by McLeod and the name of the practice is probably going to change.

They finally called me back to the lab and drew blood for screening blood tests, which I didn’t expect. I told the nurse I felt like a pin-cushion, I’ve been stuck so many times. All are in the right arm; they won’t stick the left side due to the lymphedema there. (So far two techs, MRI and bone scan, have blown veins in my hand and arm, trying to put in an IV for contrast dye. This morning I told Carl at the PET scan lab about that, and he used a pediatric needle for the IV, which made it much easier and less painful.)

Dr. Bajaj (pronounced ba-jaj’, the final “j” is pronounced) examined me, showed me exactly where the lesion is and said he could feel it with no problem, and could feel the enlarged lymph nodes too. Now that I know where it is, I can feel it too. (Whenever I lay hands on myself, I “speak death to death and life to life” as the Lord told me to do, and visualize the bad cells shrinking and dying, becoming nothing more than food for healthy cells.)

He asked me how long I’d had the swelling, but I really didn’t know. Since I had never felt a lump, I really didn’t pay particular attention to any other changes.

He then went to the computer system (all McLeod doctors have access to it) and pulled up results from the tests I’d had so far, including the bone scan from that morning. Thankfully all were negative – nothing to indicate metastatic disease. (The CT did show gallstones and a benign liver cyst, which I’ve had for years and already knew about.) He said that was very good, but that there could still be microscopic cancer cells somewhere, which is why they recommend chemotherapy as well as surgery.

He talked to Shelby and me at length about the pathology report. This type of tumor is Stage 3, triple-negative breast cancer. Stage 3 refers to size (5 cm., about 2 inches) and the fact that the cells had invaded the nearby axillary lymph nodes. Triple-negative means there are 3 hormone-type therapies that won’t work: estrogen, progesterone, and herceptin (human growth factor). There are chemotherapies that usually will work: Adriamycin, Cytoxan and Taxotere.

Barring any odd results from the PET scan, he plans for me to start chemotherapy on February 16th, which I will have at McLeod. Before that I need an echocardiogram to be sure my heart is okay for the chemo, have the portacath implanted (done at the Day Hospital) and have Dr. Sonfield take a skin biopsy from the breast at the same time, just to be absolutely sure of the type of cancer it is and isn’t. He thinks the breast skin changes and swelling are from lymph blockage and says they are not typical for breast skin cancer, which would look red and angry. My skin looks pale pink, paler even than the other side.

The chemotherapy will be in two sections. Adriamycin / Cytoxan IV every 2 weeks, for 4 rounds (8 weeks). On day 2 I will be given Neulasta, a white cell booster. After those 4 rounds, Taxotere will be given every 3 weeks for 4 rounds (12 weeks). Following that, more films to determine the status of the tumor. If the chemo has been successful the tumor will have shrunk. Then they will schedule a mastectomy with removal of the lymph nodes, and after that, radiation therapy.

He discussed all probable and possible side effects, saying I will definitely lose all my hair in a few weeks so I need to plan for that – get a wig, head covering, hat, whatever I want. Nausea is controllable by medicines. Since the immune system will be affected I need to stay out of crowds and try to avoid colds, infections, etc. He wrote everything down and gave it to me, and also gave me printouts of all my tests so far.

There is an entire breast cancer team at McLeod, consisting of everyone who has any part in diagnosing and treating breast cancer. They meet twice a week to discuss each patient and have already discussed my case. I feel confident with their approach. Of course, I have already done a lot of reading online from major cancer centers such as Mayo Clinic and others and will continue to do so, in order to be as informed as possible and ask intelligent questions.

This has been a lot to deal with in such a short time. Shelby has gone with me both times to talk to the surgeon so she could ask any questions she might think of, and to the oncologist too. Both doctors are very friendly, outgoing, take all the time you need, and Shelby and I both like them.

Some side notes:

Carl at the PET scan lab had taken care of Tim many times in the past and I remembered him from that. He was very nice and I was glad it was him giving me the IV and test. For the scan, I had to have nothing to eat or drink for 6 hours beforehand, except for drinking 4 glasses of water up to 1 hour beforehand. The test was scheduled for 9 AM this morning and would take several hours. Radioactive glucose is given, which “clumps up” in cancerous tissue, which can’t use the glucose for food as normal tissue does. The camera picks up any place there are clumps, which would indicate metastasis.

I got up about 5:30 and drank 4 cups of hot water this morning in place of my usual coffee, read the paper, watched TV news, checked email and internet news, then took my book with me and went down to the Plaza. After getting the injection of radioactive glucose, however, Carl explained that I couldn’t read my book because I would be using my hands and arms to hold it, turn pages, etc. — which was a no-no.

They didn’t want any muscles to be used, because the glucose would go to those places and cause a false report. So while the glucose circulated throughout the body, I spent an hour in a recliner covered by a blanket, lights off, facing the window overlooking Cheves Street and the new McLeod parking deck.

I just used the time to talk to the Lord. We discussed the moon – what it’s for, why it’s necessary, what people will eventually do with it and upon it, etc. I didn’t choose this subject, exactly, but he asked me “Would you like to talk about the moon?” and so we did. I’ll have to write down all he told me about that somewhere before I forget it.

We’ve talked a lot in the last few months about space, the solar system, stars, planets, our galaxy, other galaxies, dark matter / dark energy, black holes, the universe as a whole, how everything moves and rotates and orbits around other things, etc., etc. Every now and then when I have a question he just tells me to “look it up,” and I know more about all that nowadays than I ever thought I would, but mostly I know how much there is I don’t know!

After the initial quiet hour, I was moved to the scanner in another room, which looks pretty much like the bone scan camera or CT scan camera. They are all very similar. While the bone scan camera moved extremely slowly down my whole body just one time, this camera moved slowly backward and forward three times in a period of 40 minutes, with my arms over my head for much of the time to get better pictures of my underarm area.

I tried counting off the minutes, but somewhere in the middle my throat began to tickle and I started to cough. I tried to work up enough saliva to moisten my throat and stop the tickle, which did work. They had told me to try to be as still as possible – “movement is our enemy” – so the pictures would not be blurry. I worried that they would have to start the test over, but they didn’t. It was over around 11:15. I went and picked up Shelby and we went to lunch at Western Sizzlin’, where I finally got my coffee! I dropped her back off at work, then came on home.

I drank some more coffee, turned on the TV and despite the caffeine took a little nap in my arm chair. Friday demanded a good bit of attention, but finally he went back to the bedroom for a nap of his own. (He doesn’t really like the TV noise.) He’s snoozing on his little rug here in my office right now. He doesn’t like for me to leave him alone so long at a time and tries to make up for lost time when I’m back home again.

Tomorrow I have no doctor appointments or scheduled tests, and I will probably use the time for more reading and writing. I know I should clean out closets, toss old business stuff, throw away junk off of shelves and gather up old clothes I no longer wear, but right now I am just not inclined to do any of that.


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Bette’s Journal

Bette Cox 2010

Christ is the "Big C" in my life!

That was told to me by a good friend recently, and it's so very true.

Jesus says in John 10:10, "The thief comes only to steal and kill and destroy; I have come that they may have life, and have it to the full."

I believe Jesus. I hope you do too.

I have one request of other believers reading this journal:

Agree with me that the invader will shrink, shrivel, die and disappear from my body, whatever method the Lord uses to accomplish that.

Thanks in advance.


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