UPDATE on Jeanie's City of Hope appointment

Sheesh! Where do I even start??? I guess I'll just preface this by saying that today wasn't what we were hoping for. We met with 3 different doctors in trying to plot a course for treatment and are overwhelmed with a lot more information than we can process right now. Thankfully, I took several pages of notes during the consultations so I wouldn't forget too much.

Basically what we know right now is that it the cancer may be more advanced, or in more spots than we had known before. Evidently the MRI showed approximately 7cm's of affected area instead of the 4-6cm's that they had initially thought. I asked the Doctor about how wide the area was and she said basically the area is anywhere from about a centimeter to several centimeters wide, in a funnel shape. At this point in the consultation, she was unsure if an oncological-plastic surgeon would still be a possibility or not, in other words she was leaning more towards mastectomy…but after meeting with Mom's main Doctor, it sounds like breast conservation might not be completely out of the question.

They basically gave the following scenarios as possible treatment options:

1. Mastectomy – with beginning the reconstruction process immediately. Reconstruction would be a slow process, but it would begin at the time of surgery with a cavity being created behind the chest wall, and they would basically pump the chamber and expand it slowly as to make room for the eventual implant. It's not like an instant process, it is slow and unfortunately painful. With a mastectomy, no radiation or medication is required afterward.
2. Segmentectomy – Basically the same thing as a lumpectomy, just removing a segment of the breast rather than the whole breast. With this method, knowing what we know now, there would have to be a lot of tissue removed. Radiation for this method would also be mandatory because the recurrence of breast cancer in such a largely affected area like my Mom has, is upwards of 30%. They would also have her take Tamoxifen for 5 years, which is an estrogen blocking agent, and again reduces the risk of recurring cancer by 50% in the affected breast, as well as keeping the other breast safe. There are of course side-affects with Tamoxifen as well. The other factor with this option is keeping everything symmetrical, so they would most likely perform a breast reduction on the unaffected breast to remove an equal amount of tissue. The recovery time would be 4-6 weeks of taking it REALLY easy.

Neither option is all that exciting, and my mother, admittedly, says she would rather run away. :) Unfortunately it was too difficult to know for sure how much of the affected area is cancerous, because they found additional calcifications even further in and don't know if that tissue too would have to be removed.

This brings us to the worst part of the day…they needed additional mammograms to make sure the MRI matched up correctly. Evidently it's more accurate to utilize both technologies to figure out what tissue should be removed. They ran a full and intense panel of mammograms on her, which wasn't too bad. Then the technician had the Doctor look at the results and the Doctor wasn't quite happy with the area that was captured. She wanted to see further back towards Mom's body. So the technician tried again, and 15 minutes later the Doctor decided that they still weren't able to see everything they needed to and wanted to try again. By the third time, I could see pain on my Moms face and she said that she was having discomfort in the area the biopsy was performed in. She also said that her skin hurt underneath her breast, and sure enough when I looked closer she was bleeding. I grabbed some tissue to dab up the blood and when the technician came in I asked if she was done and unfortunately she wasn't. I told the technician (who was SO SWEET by the way) about what happened and she was very sorry. She went and got some gauze and antibiotic ointment right away, but then had to try at another angle to get a clear picture of what they needed to see. THANKFULLY she was able to change the angle and it wasn't as painful for the last 3 images she took during the 4^th and final session.

When the technician left to go consult with the doctor about the image results, the doctor decided to come back in the room to meet with Mom (we hadn't seen this Dr before). Evidently she is who reviewed all of Moms previous test results and was familiar with her case. Basically she said that they were having a hard time getting everything they needed to see within one image, but their main concern was an area with calcifications very deep in. She said that in order to continue, Mom would need 2 more stereotactic biopsies. They want to test the tissue much further back than the first guys did at the Imaging Center in Ventura. It sure seems like they are trying to be VERY thorough, and if she chooses the segmentectomy, these tests will all make sure they get all of the cancerous tissue removed during surgery. This new doctor asked that Mom schedule the Biopsy on a day when she is working because she would like to do the biopsy herself…and felt that because she is so familiar with Moms case, that she would be the most qualified person to do it.

So, by this time it was well after 5pm and they were unable to really schedule anything more. I know that they can't do the biopsy for a week because my Mom takes one of those little "Bayer one a day" baby aspirin for her arrhythmia and that needs to be out of her system for a week before they can proceed. Until then, she will meet with 2 additional doctors, one of which is a plastic surgeon, to discuss her upcoming surgery. They will most likely reschedule her surgery, which was penciled in for Jan 23^rd, to a later date because of the need for a biopsy first.

Anyhow, I'm SO SORRY this was so lengthy, but I wanted to make sure you all knew what was going on. Thank goodness for cell phones and computers. I was able to connect to my MySpace and Facebook as well as email via my cell phone the whole time we were down there. Isn't technology wonderful?

I will send out another email as soon as we know more. We sure appreciate your thoughts, prayers and sweet messages.

Talk to you soon,

Alissa