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Lots of Checkups

The doctors keep checking up on me, just to make sure everything’s going fine. I know it’s going fine, but they need to check and see. I had a final checkup with Dr. Kang last week. I won’t need to see him for six more months and then we’ll have the discussion about whether we can put in the implant. Until then, I’ll just get by with a formed bra. One of these days I’ll head over to the Pennsylvania Artificial Limb and Brace Company to get my self a real prosthetic.

This week, I had some internal check-ups. A MuGA and a mammogram. I had a different technician for my mammogram, and she had a hard time getting the right position for the side-ways mammogram. She kept getting my shoulder pinched in the machine. Even less comfortable than just getting my breast squished. No results from either test, which I’m sure means they’ll be fine.

Next week, no doctor’s appointments. Hooray! I’ll have time to do some work around the house.

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Clean Mammogram

Since it’s been a year since I was diagnosed with cancer, it’s also been a year since my last mammogram. Back downtown I went. I had forgotten to check the name of the practice that does the mammograms, so I was a bit lost when I got to the professional building. I knew I was at the right building, but finding the right floor was trickier. Got it in one, though.

They were quick to call me back to get my mammogram. I barely had time to fill out all the paperwork I was supposed to before they called me to change. Everything off from the waist up, of course. At least they had decent gowns – they kind of felt like a bathrobe.

My gown for the mammogram

My gown for the mammogram

Once I was escorted to the mammogram room, it took half as long as last year, since there was no reason (or ability) to do the right side.

A mammogram machine - your breast gets squished between the clear and black panels

A mammogram machine – your breast gets squished between the clear and black panels

They do two images. The first is with the machine parallel to the floor, and the second is at a 45 degree angle, and your arm has to hold the metal bar on the gray outer circle. The technician very tenderly places your breast in between the two plates, and then starts to squish. Not painfully, but quite firmly. She stays in the room the whole time, behind a little protective station.

The technician's station

The technician’s station

Once she finished taking the photos, she headed out to the radiologist to “check the quality of the image.” Dr. Chan actually came in to the room to go over the results with me. He started out his conversation with, “I don’t know if you remember me.” Of course I do! He started the whole process, so he’s seared into my memory. Luckily, the results were much better this time around. He let me know things looked fine this time. Yeah! Won’t have to do that for another year, although I have plenty of other doctor’s appointments still on the docket.

Army of Women

logo_newI thought I’d do something a little different on this post, and talk about some breast cancer research. I can’t remember how I found the website, but the Army of Women is a clearinghouse for researchers actively seeking participants in various projects that touch on breast cancer. They are a part of the Dr. Susan Love Research Foundation, which is a “non-profit breast cancer organization, working to achieve a future without breast cancer by focusing on prevention and finding the cause”.

The basic principle of Army of Women is they provide details about research studies in which their members may want to participate. There are two options to find a study – you can look through their list of current projects, or wait until they send you an email about a project you may qualify for. If you think you fit the bill for that study and are willing to do whatever actions are necessary, there are a few more qualifying questions to answer and a researcher will contact you about specific details on the study.

I thought it was a pretty cool idea. I’m all about science, which you absolutely know if you know IRL and should guess based on the types of posts I put up here. I signed myself up as soon as I found the website. There’s even a study I qualify for: Breast Cancer Risk in Young Women Study. You have to have been diagnosed with invasive breast cancer (yes – invasive lobular carcinoma) at or before age 40 (yep, I was 39). All it takes for participation is to fill out paperwork (of course)

The paperwork sent for the project - lots of things to sign

The paperwork sent for the project – lots of things to sign

and get some blood drawn and sent back to them

The return package for my blood.

The return package for my blood.

Should be easy enough. I’m going to see if they can draw my blood while I’m at the Cancer Center this afternoon for my latest Herceptin dose. You never know what they’ll find, but hopefully they provide access to the completed research so I can see their results. We’ll see!!

Gynecology visit

Vacation is over, which means it’s back to doctor’s appointments. I think next week I have no doctor’s appointments (either for myself or for the kids), which is the first time this year I’ve gone a week without waiting in a doctor’s office somewhere. I don’t consider vacation week to count, but even so, that’s not a good record.

This week, I was off to the gynecologist. If you remember, way back at the beginning of this process, my PET scan had turned up a couple of anomalies. One was a cyst on my kidney and one was a cyst on my ovary. The last time I visited Dr. Li, he asked that I get the ovarian cyst rechecked, just to see what it was doing. I finally got around to calling the doctor. My primary care doctor couldn’t do it. I actually had to go to a gynecologist. Sure, what’s another doctor to add to the fleet of doctor’s I’ve been seeing!

The gynecologist the nurse recommended is part of OBGYN Associates, in the same office building as my plastic surgeon. It’s a huge office – both times I was there this week, there were at least 15 people in the waiting room. They give you pagers to know about when your number will be called to go back in the office. The doctor was very nice – took a quick history and then did a gynecology exam, since I was there and it had been about a year since my last exam anyways. Besides, I wanted to make the visit worthwhile, since they weren’t going to do the sonogram that I really came for that day. I needed to make another appointment for that visit.

Latest gown pattern, with a white sheet on the bottom half

Latest gown pattern, with a white sheet on the bottom half

At least I didn’t have to wait too long for the sonogram – I was back in two days for that. It was a quick wait and then in to meet the tech. You take off the bottom half of your clothes, wrap yourself in a sheet and lay on the bed with your feet in the stirrups. There was a cyst on my left ovary, but no blood flow to the mass, which implies fluid filled and not a tumor. The doctor will look at the scans and double-check, but the tech didn’t seem too nervous. Good. Even though I didn’t think it would be anything serious, any kind of doctor’s visit and test now implies a bit of nervousness.

Genetic results

The genetic counselor called me last night. I must admit, I was a little surprised to be hearing from her at 7pm. Apparently, she didn’t get all her work done during the day and she needed to bring some home with her. Whatever.

Regardless of the time, it was a short conversation. No genetic mutations showed up in the areas that they tested. This was not at all a surprising result, but it was nice to hear nonetheless. It means I don’t have to think about whether or not I want to get my ovaries out or a mastectomy on the other breast. Even with the negative result, my sisters should be getting mammograms regularly (they both have already had one since I’ve been diagnosed). My daughter should also start getting tested at 25, but since that’s about 20 years from now, I’m really not worried about recommendations for her. I’m certain that by the time she’s 25, the recommendations and the technology will have changed, and probably significantly.

I will need to call the plastic surgeon and schedule surgery on the other breast. Now that I know I won’t be losing the whole thing, I’ll need a lift so the left breast matches the perkiness of the right, fake breast. I don’t need to rush, though, since the surgery won’t happen until after radiation is over. I’ve got some time, yet.

Genetic testing

Friday morning I had a genetic counseling session. I was really worried I wouldn’t be able to make it. I was in serious pain the night before from my expansion and woke up feeling nasty from taking pain meds on an empty stomach. Luckily, a little breakfast and a nap on the couch made me feel human since it would be a couple of months to get another session.

Because I was diagnosed with cancer before I was even 40, I am a candidate for genetic testing. Before you even go in for testing, you have to do a family history – name, age and health (any cancer, reason for death) for myself, my siblings, my parents, aunts, uncles and cousins, and my grandparents and their siblings. I could guess up to my parents’ generation, but had no clue on my grandparents’ generation. After a phone call to my mother, who had some genealogy information for both sides of the family, I was able to finish the paperwork.

The genetic counseling session was a teleconference with a nurse from Magee Women’s Hospital in Pittsburgh. I really appreciated not having to drive to Pittsburgh to do the test (in fact, that might have been a deal-breaker for me). The counselor’s goal is to ensure the person getting tested understands what the test is looking for and what it means if it comes back positive or negative.

The test is solely for the BRCA1 and BRCA2 mutations, which account for less than 10% of breast cancer. The test uses two methods to test for changes in the gene – one to look for mutations in the gene, and a quantitative test to look for additions or deletions. The genes are on two separate chromosomes, and it is very unlikely that you would have both mutations. They are autosomal dominant genes (you only need one copy to get the negative effect) and affect how the cell will repair breaks in your DNA that occur on a regular basis as you go through life. If the test finds a change in the genes (a SNP) that is not the known BRCA mutation, the company keeps the information on file to see if it shows up in other genomes and would be something to pursue.

If the test comes back positive, it increases your risk of developing breast cancer (surprise, but also in the second breast in my case) in both men and women, as well as ovarian or prostate cancer, pancreatic cancer, and melanoma. Using birth control for more than six years significantly reduces (by about 60%) your risk of ovarian cancer, but there’s very poor testing for ovarian cancer so often removal of the ovaries is recommended (reducing your risk by 96%). A preventative mastectomy will reduce your risk of developing breast cancer by 90%, otherwise you start breast cancer screening at 25 with twice yearly physical exams, and yearly mammograms and MRIs.

The test itself was extremely simple – swish with Scope and spit into a tube. I couldn’t eat or drink anything an hour before the test and I had to make sure I got at least 20ml, but that was the extent of the test. Based on my family history, I’m looking at a 1% chance of having a BRCA mutation, but it’s still worth testing, mainly for family members. I’ll get the results in a couple of weeks!

Third time’s a charm

I had my third (and last, for a while I hope) breast MRI yesterday. Dr. Li ordered it to see if that last little bit of cancer is gone after three more cycle of chemo. I am trusting that it is, but I’ll find out the result when I meet with Dr. Engel, the surgeon, next week.

Yesterday was the beginning of the upswing from chemo, but I still felt a bit nauseous. This particular cycle has been a little higher in the nausea than many of the previous ones. I didn’t think anything about it, though, until I had to lay on my stomach for 20 minutes inside the MRI. Not the most comfortable of positions. Even worse, it was actually warm inside the MRI room. By the time I was done, I felt a bit light-headed. The room was all sparkly for at least five minutes. I got a glass of cold water and put my head between my knees for a minute or two and felt much better. The higher level of nausea didn’t really go away until I got home and took some meds, though.

Here’s what my MRI machine looked like:

Machine set up for breast MRI

Machine set up for breast MRI

I wanted to get a photo of the apparatus they use to capture breast tissue, but the magnets from the MRI would have fried my iPod if I had taken it into the room. This photo was taken from the door. I lay on my stomach on the bed projecting from the MRI, with my forehead cradled on a foam structure. You can just see the cutout for the right breast curving below the head support (there’s a similar hole for the left breast). Arms go over the head (see the grey rectangular pad for an arm on the upper left of the bed), and you slide into the MRI. They hook up your IV to be able to add the gadolinium for contrast, and listen to clonking and whirring for 20 minutes or so. Relax as much as possible since the MRI captures more tissue if you’re relaxed than if you’re tense.

The other item of note was the pattern for my gown – it was different from last time.

photo(15)

Not too bad, although gray really isn’t a festive color. At least we get some spots of red for cheer.