Anyway, I finally heard back from Vanderbilt and they were very kind. The Nurse Practitioner, Katie, called to tell me what I had expected to hear (and, by the way, this woman is well on her way to being 41 weeks pregnant and I told her I did NOT want to talk to her again before the baby arrived). There was no "kick in the gut" or "punch in the stomach" just words to confirm what I already understood. This new issue is diagnosed as DCIS (or ductal carcinoma in situ). As I mentioned in a prior post, this is certainly not the worst news in and of itself. But because this 5-7 cm area of microscopic calcifications is not close enough to the tumor that has already been identified as invasive ductal carcinoma, it will require a mastectomy in order to remove both the tumor and this other area in question and also get the clean margins plus the two sentinel lymph nodes (and hope those are the only lymph nodes removed). This means that the "easier" lumpectomy surgery option is off of the table.
Once I knew this other area was indeed cancer, the question then changed to "Should I get a single- or double-mastectomy?" and "What about reconstruction?" I was worried because my surgeon was on vacation, but was relieved when she called (twice actually) to discuss what was happening and try to go over the options and ask me how I was feeling. Basically, I have decided that I will go with a single-mastectomy for now. It will still occur on May 3rd. If I elected the double-mastectomy, it would require specific insurance approval since the left side does not show any evidence of cancer. While she feels confident that they will approve the surgery to remove the left breast as well, she also said that it could take 4-5 weeks before the situation would be settled with insurance and I would be ready for surgery. She didn't feel like it would be wise to wait that long.
My surgeon also pointed out that reconstruction is not possible during the first surgery/mastectomy. The original tumor location is near the chest wall and there is a good chance that it could prove to be a challenge to get "clean margins" when removing the tumor. There is a very small separation between the tumor and the actual chest wall, so there is a very good chance that radiation cannot be avoided. Radiation is not recommended with any sort of implant (assuming that I go this route). It also means that having the left breast removed increases the chances for infection and we definitely don't want any sort of infection to occur that could delay the chemo treatments. It is important that I move forward with the chemo and radiation, especially since there is another area in question.
Once the chemo and radiation therapies are complete, I would then be just about ready for the surgery to do reconstruction. I would be able (assuming I've still decided to remove the left breast as well) to get the left one removed and then get reconstruction for both sides at the same time. It means another surgery, but it also allows me to take my time making the decision about the left side. I'm also able to get the chemo going which, while I dread it, is the way I can really start taking some pretty big hard kicks at this whole breast cancer thing. Cut off the right one and then chemo the crap out of my whole body in order to kill of those stupid cancer cells. I want the cancer out. Now.
I have been reading another blog, Anderson Family Zoo, because she was diagnosed at about the same time. I've found so much hope and inspiration through her words. And her discussion about telling the kids about "cancer" and "chemo" rather than saying that "Mommy is sick and needs medicine" was eye-opening to me. I hadn't begun to think about how they might process the "sick" and "medicine" words and potentially be scared later as a result. I've also appreciated her positive attitude. And she has addressed that this breast cancer thing is like a "job" and I can totally relate as I try to balance appointments, information, tests, plans, treatments, insurance questions, etc, on top of an already busy and hectic life with three four-year-olds. And regarding how to keep going and stay on track, I like this post here. Yes folks, cancer is "craptastic". I sort of like "craptabulous". But either way, I can just sit here and think about it and wonder how this happened (trust me, I DO wonder), or I can just do whatever I can to fight back and kick it's ass to the curb. I choose booty-kicking..
I am hoping that I got all of the details right. This isn't very interesting to most, but some people want more details and it is MUCH easier to explain it once here and refer them to the blog. It is my hope that I can one day help someone else who might have to travel this same road. But of course I really hope that one day NO ONE will have to.