The big update

So...I am a total jerk and left you all waiting for this update. Sorry.

The smile of a long-winded jerk with big news.

We had our follow up with the surgical oncologist (Dr. Tuttle) & his entourage (Susan--Dr. Tuttle's RN, the head surgeon, Dr. S and a surgical resident, Dr. Elliot) all of which participated in my surgery from the oncology standpoint (I meet with the plastic surgeon next week). Dr. Elliot followed me in the hospital and he and I went several rounds in regards to my pain management. He lacked empathy and I flat-out told him so. Ahh, residents. At any rate, when I saw him start to come into the exam room, I jokingly said he wasn't allowed in--and thus set the stage for one of the funniest doc appts I have ever had.

They asked me how I was feeling. I looked at Susan and Dr. S (who is a female) and replied, "You two will understand this...I feel like I'm constantly wearing an underwire bra and it's the end of the day and you just want that sucker off!" Completely deadpan, Dr. Tuttle replies, "oh god, I hate that feeling!" I softly patted his hand and said, "I shouldn't have assumed...I'm sorry."

During the exam, they were looking at my blisters and remain completely stumped as to why I developed them. I replied that it's not really very comforting to hear so many "I don't know's" and "I've never seen this before's". It's not comforting when google doesn't even know the answer, btw. During this process, Dr. Elliot and I were carrying on a side convo about something when he dropped some huge medical term. "Whoa...that's not even a $5 word!", I exclaimed. "That's more like a "$10 one!" "I know," he replied, "but I feel like I need to show you I know something about medicine!" He said he wanted to put my comments as his fb status but was concerned about HIPPA...thus began my educating my doc on how HIPPA works...very odd but amusing. Dr. Tuttle, Susan and Dr. S just stood by, bemused by the whole interaction.

There was also a conversation about the difficulties of suddenly losing your ability to utilize your dominate hand for specific things, but Neil says I'm not allowed to post that conversation on the internet. Ask me about it in person though--Dr. Tuttle was so amused, he repeated it to others on my care team after our consult. I may have missed my calling as a comedian.

We finally got to the pathology report. The bad news is that the tumor was not 2x3cm (roughly 1x1 inches). In fact the MRIs were completely wrong. My tumor was much larger and closer to 3x1inches (7.7x2.6cm to be exact). That means that we absolutely made the right choice for a mastectomy as that is rather large, even after chemo. I also had a lymph node that was positive for cancer (this is actually not the surprise they expected it to be as we have been aware of this possibility since before teh definitive diagnosis in September).

The good news? There's so much! Dr. Tuttle got "wide margins" of 18mm--this means that there was quite a large amount of space between the healthy, non-cancerous tissue and the tumor. This reduces the chance that I may have to have radiation (still need to do that consult). Also, even though I had lymph node involvement, it was only in 1 of all the lymph nodes they removed (which was 9--a remarkably small number to have on one side of your body--typically, ppl have upwards of 20. Medical oddity once again).

The other piece is we received my Nottingham score. This requires a bit of explaining. The Nottingham (or Bloom-Richardson) score comes with the path report and looks at how the cells of the tumor are under a microscope. IT IS DIFFERENT FROM THE STAGING SCORE!

From here:

..."The Bloom-Richardson system is used for grading breast cancer, and has a scale of 1 - 3. A pathologist will take a sample of tissue from your tumor, and examine it under a microscope. Tumor cells that look most like normal cells are given a low grade, while those that look the most abnormal are given a high grade. High-grade tumors are fast-growing, spreading (metastatic), and aggressive. Knowing your tumor grade helps your doctor decide which treatments may be best for you.

The Tumor Grading Process

A pathologist looks at the tumor cells and checks for three microscopic features:

• degree of tumor tubule formation (percentage of cancer composed of tubular structures)
• tumor mitotic activity (rate of cell division)
• nuclear grade (cell size and uniformity)

Each feature is scored on a scale of 1 - 3.

Cell Feature Scoring

The pathologist will assign a value to each feature of the cells, based on its activity. This is how the scores may be understood:

Feature Score 1: Slow cell growth rate
Feature Score 2: Intermediate cell growth rate
Feature Score 3: Fast cell growth rate

Feature Scores Add Up to Three Grades

The score of all three features are added together for a total between 3 and 9.

Grade 1 is the least aggressive, while Grade 3 is the most aggressive type of tumor.

Tumors that are given a high grade and that contain dead cells (necrosis) are more likely to recur after treatment. High grade tumors will be treated more aggressively than low grade tumors."

Whew...sorry for the impromptu bio lesson, but I feel like it's important. Given all the info we had prior to surgery and treatment, I honestly assumed the worst. I knew my tumor was large and had progressed. We assumed it had grown quickly. I was honestly expecting the worst when it came to my Nottingham Score. Imagine my surprise when I saw the path report--I scored a 3! I feel as though I have won the lottery! This is the best possible score I could have received. I had a slow-growing, well-differentiated and NOT AGGRESSIVE type of cancer. This puts my prognosis at very, very high (there are other variables to consider, but still--this is excellent news)!

This score, combined with the wide-margins means...for all intents and purposes, I am currently cancer-free! And you are all stuck with me for a very, very long time. 

I still have some treatment to go. I will receive a dose of Herceptin every 3 weeks via infusion (minimal side effects) and will probably be adding in Perjeta due to the positive lymph node (the side effects listed are wrong--there are also minimal side effects for this drug). This will be an hour infusion every 3 weeks--a significant decrease from the 4-6 hours every week I would spend on the unit! 

I'm starting to grow my hair back as well! I wouldn't say I'm shaggy by any means, but there's some definite upward movement going on up there. I managed to retain my eyebrows and most of my eye lashes throughout both sets of treatments, but was bummed to see them drop out over the last few weeks. It turns out they were dropping out to accommodate new growth! So, I've got little, tiny eye lashes and eyebrows growing in. Not gonna lie, it looks a little goofy, but I'm glad they're coming back.

Thanks guys. I know I always end this thanking you all. But honestly! The support we have received is just so amazing. Every day at work I see how trauma can be exacerbated by stress. Neil and I are a great team already, but adversity has a way of wearing people down. We have been surrounded by wonderful friends and family who have been there with us, through all of this--we've never felt alone! Your support has made it possible for all of us (me, Neil and the boys) to weather this horrible storm. And honestly--I feel like we're going to be okay because of all of that support. So, thank you.