Adding and Subtracting Doctor’s Appointments

This week I’ve managed to remove a doctor’s appointment from my schedule, but I had to add two new ones. This is not the math I prefer to do when talking about visiting a doctor. At least the appointments I added are in my home town, so I don’t even have to drive far.

The cancelled appointment was with Dr. Li. I called in order to get my orders for bloodwork, which I had forgotten to ask for during my last Herceptin treatment. It really doesn’t matter where I get my blood drawn and tested, as long as it’s just before my appointment. I’d really prefer to do it locally than having to drive a half an hour for a five-minute needle stick. When I called to get the orders transferred, the nurse couldn’t find my appointment. That was curious. After doing a little digging, it turns out my visit to talk about Tamoxifen pushed back my three-month visit into October sometime. Great! Fewer trips to the cancer center! Except for the fact that I was planning on using the bloodwork I needed for that appointment as the bloodwork I need for my surgery on October 10th as well. The nurse just sent me the order so I can do the bloodwork when I need it.

The added doctor’s appointments were also associated with my surgery. Dr. Kang’s office called today to let me know they need medical clearance from my primary care provider before doing the exchange surgery. (Turns out, since this is essentially elective surgery, there’s a few more hoops to jump through.) Trick is, I haven’t seen my primary care provider since I was diagnosed (I figure I’m being monitored just fine without him) and the doctor I was seeing at my practice has since left. That’s OK, the nurses are still the same so they were able to hook me up. As a bonus, they can do the EKG I need before surgery at the office as well. It’s a separate appointment, since the doctor will want to see the results before giving me clearance for the surgery, but again, now I don’t have to drive across town to the Heart Institute.

So I’ve had a bit of a respite from seeing the doctor, but my schedule is filling up again as surgery looms. No problem – this is one surgery I’m whole-heartedly looking forward to.

Exchange Surgery is Scheduled!

I hope no one missed me too much these past few weeks. We went on our annual vacation to whatever city the Joint Statistical Meetings is at – Boston this year. It was great fun with lots of history, and just a few too many people for my tastes. Then it was back home and time for more doctor’s appointments.

I met with Dr. Kang on Monday to discuss my exchange surgery. It is an outpatient surgery (although it requires full anesthesia) with a pretty quick recovery time. That’ll be nice, but I still want to coordinate the surgery with my teaching schedule this year. Dr. Kang wants to wait six months after the end of radiation, to allow the skin to heal as much as possible, which means we’re talking the beginning of October. I wanted a Thursday or Friday so I wouldn’t miss any teaching days, so the earliest available date is October 10th. I got the first slot of the morning and scheduled a variety of pre-op appointments to be ready for the surgery.

I did ask a bit about the implant I’ll be getting. The room itself was full of options:

The variety of implants to choose from

The variety of implants to choose from

I reiterated that I wanted to go back to my original cup size. No more of this B-cup business, thank you very much. He’ll actually bring a couple of different sizes with him to the surgery and pick the one that provides the best symmetry with the other side. While they took out 200cc of breast tissue, he might need to put in something a bit bigger because the muscle tends to compress the implant, and sometimes the expander actually presses on the ribs enough to make a dent, so a larger size is required to get the same volume sticking out of the chest wall.

The other choice for the implant is the profile:

275cc implants - high profile on the left, medium profile on the right

275cc implants – high profile on the left, medium profile on the right. Notice the different in circumference

I’ll be getting a high profile, Mentor implant. The high profile aspect just means more of the volume goes to vertical vs. horizontal displacement. I’m guessing the medium and low profile implants are used to bolster someone’s natural breasts, instead of the complete replacement I’m getting.

Overall, I’m thrilled to have the surgery scheduled. I am so ready to get the expander out and something squishy in its place. I’m hoping with the implant it won’t hurt when I use my chest muscles like it does now. We’ll see in a few weeks!

Sore muscles

Summer is flying by, as is does so many years. I have been much busier living life and doing things around the house compared to last summer, which is great. I have noticed that I have to be careful with certain actions, or the muscles stretched across my expander hurt. They’re trying to contract and the expander underneath the muscles doesn’t compress, which leads to achiness in my chest. Just another one of those side effects they don’t tell you about ahead of time.

The worst I’ve found is a pushing motion, like when you’re scrubbing wallpaper paste off walls. I make sure to pick small sections to work on each day because I can’t do too much at a time. I also have problems laying on my stomach. I don’t usually sleep on my stomach, but I woke myself up this morning with the muscle over my expander cramping because I was sleeping on it. It adds to my reasons I’m actually looking forward to my appointment with the plastic surgeon. I so want the expander out. Now if this scab on my scar would just fall off…

Checkup with Dr. Engel’s office

Last week I had two doctor’s appointments – one with Dr. Li and one with Dr. Engel. The appointment with Dr. Li wasn’t originally on the schedule and in fact, I had to remind Dr. Li why he was talking to me when he came into the room. Dr. Engel’s appointment, on the other hand, was a routine check-up. I actually met with his nurse, Carol. After waiting for an hour and a half (she got stuck lancing an infected cyst or similar such procedure), she finally showed up in the room. I was really glad I had a good book to read.

During my appointment, Carol did her routine checks of my chest and breasts. I had to sit and put each arm on her shoulder, and then lay down with my arm over my head. I get to go every six months for three years, yearly until five years, and then I can switch to my gynecologist or family care provider to do my checks after that point. I asked what she was checking for, and she said they were just looking for irregularities.

I also asked about a knot in my back, just below the point of my shoulder-blade, to see if it was related to the surgery. She indicated it was likely related to the surgery, since it’s at the edge of the nerve that goes through your armpit and down to your fingers. I have to stretch that nerve on a regular basis. It seems to tighten up and make a line running from my pinky towards my elbow tingle. It all seems to be related, which is good because it means it’s not likely to be cancer causing the pain.

Just Say “No” to Tamoxifen

While I was at the Cancer Center on Monday for my last Herceptin infusion, I also had an appointment with Dr. Li. I had called him the previous week to discuss my nausea associated with Tamoxifen. He decided I should come in and see him to discuss. Luckily, he was able to squeak me in before my Herceptin appointment, so I didn’t have to make a special trip.

I was in a new room this time – a special one, it turns out.

An escape ladder in the corner - for just in case!

An escape ladder in the corner – for just in case!

This room had a ladder to the roof in the corner. Just in case you need to make a run from bad news? Who knows. It was amusing, though.

Dr. Li hadn’t heard of anyone feeling nauseous on Tamoxifen. I asked if there was another drug or a different formulation that I could take, but that wasn’t an option because I was pre-menopausal. There was the option to make me menopausal, through surgery or monthly injections. However, after reviewing my cancer characteristics and reminding himself that the cancer had come back <1% estrogen positive and ~20% progesterone positive, he decided it wasn’t worth it. The benefit I’d get from the treatment wouldn’t outweigh the costs of the treatment. He advised me to try the Tamoxifen again, but if I still felt nauseous, to just not take it. Now I need to decide whether or not I want to retry the Tamoxifen and take it for a few months. Do I really want to feel nauseous for that long on the possibility that it will go away and I have to take the drug for years? Such decisions…

Family portraits

One of the things we did on our Little Pink Houses of Hope vacation in Avon was get family portraits taken by a professional photographer. It was supposed to be done with the Cape Hattaras lighthouse in the background, but the weather was looking quite iffy for that day, so we moved to the fishing pier instead. Daniel Pullen is a great photographer, known especially for his surfing photos. The only problem is he works on surfing time so it would be few months before we should look for the photos.

Well, the wait is over and the pictures finally came. We actually got a CD with all the photos that were taken, and I’m quite impressed with the creativity shown in many of the family photos. Ours look much more traditional, but are still quite lovely. What do you think?

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Another Milestone!

I had my last Herceptin treatment today!! That means, I won’t have to sit in an infusion chair again!!

Last time in the chair!!

Last time in the chair!!

My nurse today was the same nurse I had for my very first infusion. When she asked how I was doing, my response was, “Awesome!” She replied, “You should be!” She apparently was aware that was my last infusion as well. I was back in the corner this time, surrounded by other people doing chemo. I felt a little bad that I was so happy when they were still going through the nonfunness of chemo.

Now, just because I’m done with infusions, doesn’t mean I’m done with going to the cancer center on a regular basis. I still need to go and get my port flushed every four to six weeks. The nurse’s comment was many people go every month just to make it easier to schedule, but I’m all about avoiding a trip to the Cancer Center as much as possible. I’ll be making those trips every six weeks, and not a day sooner.