Wednesday 24-Sep-2008
I know, I'm posting this quite late and I apologise for that.
We saw Dr. Kuisle's assistant to confirm what will happen for the surgery. First we will need to have an outpatient procedure the 1st of October. This procedure restricts the blood flow in the area of her stomach. That way, the surgeon knows which blood vessels will be feeding the tissue used for the tram flap reconstruction of the breast. Then on the 10th, we have the surgery. Mostly, we confirmed that she does not need to worry about stopping her Warfarin (blood thinners) for the outpatient procedure on the 1st. For the surgery on the 10th, she'll need to stop them a day or two prior. On the 6th of October, we'll have a followup to make sure that the procedure they did on the 1st worked the way it's supposed to.
Oh, I don't think I mentioned that Kris has opted to leave the port in since she'll be getting Herceptin treatments until Next April. It may seem strange, but, the port is in the overall more comfortable then the normal IV stick in the hand or arm... or so Kris maintains. :)
Edit: Correcting the dates. Originally I said the procedure is on the 6th, it's on the 1st. The followup is the 6th... I was remembering having to ask what hours I work on the 6th and thought that meant the procedure was then... :/
Sunday, September 28, 2008
Tuesday, September 23, 2008
Kris, Dave and the Lumps: countdown to surgery
Monday, 22-Sep-2008
Minor correction; I stated before that Kris' long term disability had gone through, it has not. Social Security has signed off on long term disability, which, again, was a shock to have happen so quickly. I think we are done with the LTD paperwork for the insurance company and are just waiting for word of approval.
Met with Dr. Jones, the surgeon. He did his usual hemming and hawing over her port wound which looks markedly better but, is not yet healed. It's enough better that we've gone without a bandage once! However, the wound was timid and immediately grabbed a bandage to hide behind the next day.
He confirmed that we are working towards the 10th of October for the date of the surgery. Well, in reality, he admitted that he does what his staff tells him to do and if we were working with them, then who was he to say otherwise for the date? He then went on to say that after the surgery, Kris would stay in the hospital for three or four days. Once that was done, we would bring her home and then it's bed rest for several days after that. My expectation has been set to set aside the following week to help Kris function... so, I've laid in an order of extra lace and servants. Oh and I plan on baking lots of bread and making soup. :)
Tomorrow (Wednesday) we go see the Plastic surgeon who will have a better timeline estimate.
Minor correction; I stated before that Kris' long term disability had gone through, it has not. Social Security has signed off on long term disability, which, again, was a shock to have happen so quickly. I think we are done with the LTD paperwork for the insurance company and are just waiting for word of approval.
Met with Dr. Jones, the surgeon. He did his usual hemming and hawing over her port wound which looks markedly better but, is not yet healed. It's enough better that we've gone without a bandage once! However, the wound was timid and immediately grabbed a bandage to hide behind the next day.
He confirmed that we are working towards the 10th of October for the date of the surgery. Well, in reality, he admitted that he does what his staff tells him to do and if we were working with them, then who was he to say otherwise for the date? He then went on to say that after the surgery, Kris would stay in the hospital for three or four days. Once that was done, we would bring her home and then it's bed rest for several days after that. My expectation has been set to set aside the following week to help Kris function... so, I've laid in an order of extra lace and servants. Oh and I plan on baking lots of bread and making soup. :)
Tomorrow (Wednesday) we go see the Plastic surgeon who will have a better timeline estimate.
Thursday, September 18, 2008
Kris, Dave and the Lumps: Correction to LTD
Friday, 19-Sep-2008
Kris corrected me in that she did get Social Security disability but has not yet been confirmed for our insurances version of Long Term Disability. Yesterday I faxed in yet another set of forms for our insurance LTD.
Kris corrected me in that she did get Social Security disability but has not yet been confirmed for our insurances version of Long Term Disability. Yesterday I faxed in yet another set of forms for our insurance LTD.
Wednesday, September 17, 2008
Kris Dave and the Lumps: Details missed
Wednesday, 17-Sep-2008
Got a reply that raised questions I had not addressed:
Kris' long term disability went through so, we are covered. Not only that but, she was approved for Social Security disability which is odd given that we were told flat out it takes a year to go through!
Chemotherapy... we thought we were done, and in a way we are, in a way we are not. Today, Kris goes in for an infusion of Herceptin. Apparently the plan was to do a year of Herceptin all along. The good news is that as these drugs go, Herceptin is 'gentle' so her hair and nails will grow back and she shouldn't have any side effects to speak of. Dr. Moran apologized because as he was telling us this he realized that he'd lead us to believe we were done with Chemotherapy. The reason is that he doesn't think of Herceptin as Chemotherapy whereas he does think of Taxotere and Xeloda (etc) as Chemotherapy. Largely this is due to the side effects of the other drug therapies and lack of side effects from Herceptin.
Kris is as well as can be expected given the news about Nikki.
General apologies for not posting for a while. It's been hectic for me of late and I will endeavor to do a better job of keeping the posts up to date.
Got a reply that raised questions I had not addressed:
Kris' long term disability went through so, we are covered. Not only that but, she was approved for Social Security disability which is odd given that we were told flat out it takes a year to go through!
Chemotherapy... we thought we were done, and in a way we are, in a way we are not. Today, Kris goes in for an infusion of Herceptin. Apparently the plan was to do a year of Herceptin all along. The good news is that as these drugs go, Herceptin is 'gentle' so her hair and nails will grow back and she shouldn't have any side effects to speak of. Dr. Moran apologized because as he was telling us this he realized that he'd lead us to believe we were done with Chemotherapy. The reason is that he doesn't think of Herceptin as Chemotherapy whereas he does think of Taxotere and Xeloda (etc) as Chemotherapy. Largely this is due to the side effects of the other drug therapies and lack of side effects from Herceptin.
Kris is as well as can be expected given the news about Nikki.
General apologies for not posting for a while. It's been hectic for me of late and I will endeavor to do a better job of keeping the posts up to date.
Kris Dave and the Lumps: Final Analysis, pre surgery
Tuesday, 16-Sep-2008
Met with Dr. Moran who had the results of the Cancer Conference. Dr. Antel had done a lot more digging and presented his information. The general consensus of the Dr.s attending was that we should not do radiation therapy in this case. The Pet and MRI scans showed good results but there was some indication of a presence of... something, which could still be cancer. We'll know more when the tissue is biopsied post surgery.
Based on this we're in the process of confirming the 10th of October as the date for the mastectomy and reconstructive surgery. We meet with the surgeons in the very near future to solidify these plans. To recap; the reconstruction is a tram flap surgery which means they will take tissue from Kris stomach to reconstruct her breast with. This also means we need to see Dr. Kuisle (the plastic surgeon) about a week in advance for an outpatient procedure which will restrict the blood flow to the tram flap tissue to a predetermined set of vessels. This is to make sure he can use those vessels during the reconstruction procedure.
According to Dr. Moran, Kris will likely go into surgery Friday the 10th, which will be 3 or 4 hours. She'll stay in the hospital likely until Sunday the 12th. I expect her to be on bed rest for a day or three after that, so, she might be ambulatory Wednesday. We'll know more after we talk with the surgeons.
Somewhat side news is that we've got some very bad news about our cats. Our youngest, Nikki who is exactly one year old, has been diagnosed with FIP (Feline Infectious Peritonitis). This disease is highly contagious and insidious in that there is no way to prevent it, nor detect it until it's full blown and it's always fatal. We will be putting Nikki down this morning and will have to watch the rest of our cats for the rest of their lives to see if they are infected. As time goes by and they are not symptomatic, the risk that they have the disease decreases. However, we can never know that they don't have it as the disease can lay dormant for years before expressing itself. Since our cats are strictly indoors and have never been socialized with other cats, the only likely source for infection is the cattery we purchased Nikki from. It's possible to have the disease transferred at a Vet, but, since Vets are aware of how devastating this disease is, they tend to be very careful and thus the odds of Nikki getting the disease from her recent visit there are very slim.
While I do not want any of you to get the impression that I don't care for our cats or that I'm being callous about this, my biggest concern is the impact of this on Kris. Stress is a known issue with triple negative breast cancer and this is the very definition of stressful.
Met with Dr. Moran who had the results of the Cancer Conference. Dr. Antel had done a lot more digging and presented his information. The general consensus of the Dr.s attending was that we should not do radiation therapy in this case. The Pet and MRI scans showed good results but there was some indication of a presence of... something, which could still be cancer. We'll know more when the tissue is biopsied post surgery.
Based on this we're in the process of confirming the 10th of October as the date for the mastectomy and reconstructive surgery. We meet with the surgeons in the very near future to solidify these plans. To recap; the reconstruction is a tram flap surgery which means they will take tissue from Kris stomach to reconstruct her breast with. This also means we need to see Dr. Kuisle (the plastic surgeon) about a week in advance for an outpatient procedure which will restrict the blood flow to the tram flap tissue to a predetermined set of vessels. This is to make sure he can use those vessels during the reconstruction procedure.
According to Dr. Moran, Kris will likely go into surgery Friday the 10th, which will be 3 or 4 hours. She'll stay in the hospital likely until Sunday the 12th. I expect her to be on bed rest for a day or three after that, so, she might be ambulatory Wednesday. We'll know more after we talk with the surgeons.
Somewhat side news is that we've got some very bad news about our cats. Our youngest, Nikki who is exactly one year old, has been diagnosed with FIP (Feline Infectious Peritonitis). This disease is highly contagious and insidious in that there is no way to prevent it, nor detect it until it's full blown and it's always fatal. We will be putting Nikki down this morning and will have to watch the rest of our cats for the rest of their lives to see if they are infected. As time goes by and they are not symptomatic, the risk that they have the disease decreases. However, we can never know that they don't have it as the disease can lay dormant for years before expressing itself. Since our cats are strictly indoors and have never been socialized with other cats, the only likely source for infection is the cattery we purchased Nikki from. It's possible to have the disease transferred at a Vet, but, since Vets are aware of how devastating this disease is, they tend to be very careful and thus the odds of Nikki getting the disease from her recent visit there are very slim.
While I do not want any of you to get the impression that I don't care for our cats or that I'm being callous about this, my biggest concern is the impact of this on Kris. Stress is a known issue with triple negative breast cancer and this is the very definition of stressful.
Sunday, September 14, 2008
Kris, Dave and the Lumps: Tests, tests and more tests
Monday, 8-Sep-2008 to Wednesday, 10-Sep-2008
Busy week. Kris went to a Pet scan and an MRI one of which had to be rescheduled at the last minute. As a reminder, the scans are to see how well the Chemo Therapy did and to see if it's feasible to go through radiation treatment as a followup. We're actually hoping that we don't have to do radiation. Partially because it's an uncomfortable treatment, partially because it implies that things haven't gone as well as they can, and in no small part because it means delaying the reconstructive surgery which means delaying putting all of this behind us.
Thursday, 11-Sep-2008
Met with Dr. Antel who is our Radiologist. He revealed that a lymph node was caught up in this mess which is not truly in the area considered to be the left breast. It's still in the left chest wall area, just not directly in what's considered to be the set of lymph nodes associated with that breast. The implications I don't like are that this means the cancer moved beyond the left breast. Dr. Antel was not actually prepared with an answer. He'd consulted with two of his colleagues he has a lot of respect for and they gave him split answers. One, with a lot of experience, stating that he'd simply not do the radiation treatment at all. The other saying that it looked to be a good idea.
He went on to explain that treating patients in whom cancer had reoccurred with a second bout of radiation was new. There is apparently a study out with about 8 years behind it wherein patients were treated to a second round of radiation and studied for one year following the treatment and the results were quite good. The Numbers are that for a first round treatment they give about 5000 rads and this reduces the chance of recurrence from 20% to 30% down to 10% to 15%... about half. With a second round treatment, they would reduce the area they would radiate so that rather than hitting the whole upper left chest area, they would hit only the breast area and go up high enough to catch the one lymph node and they would also reduce the radiation to about 4500 rads. Further, they would use an electron stream as opposed to the normal X-ray radiation. Electrons have a more shallow penetration. While he can not guarantee that Kris lungs will not be affected this time, the chances of them being affected are greatly reduced, if not eliminated. Basically Legalese for there really is no chance but, it's radiation, we can't give guarantees. The downside is that there is about a 5% chance of complications due to the radiation. Specifically, there could be tissue killed other than the cancer. This means that tests will have to be performed after the radiation and if there is dead tissue, another surgery to remove it will be required. It also means that they can't perform the reconstructive surgery since radiation treatment would effectively kill the tissue used to reconstruct the breast.
We've not yet decided what to do. In fact, Dr. Antel isn't looking for a decision yet. He's going to contact folks from the study he quoted, among others, with specific questions related to our case. He's also waiting for the local cancer board to meet and discuss our case Tuesday. Kris and I meet with Dr. Moran Tuesday to discuss what comes out of the cancer board meeting later Tuesday.
More after Tuesday...
Busy week. Kris went to a Pet scan and an MRI one of which had to be rescheduled at the last minute. As a reminder, the scans are to see how well the Chemo Therapy did and to see if it's feasible to go through radiation treatment as a followup. We're actually hoping that we don't have to do radiation. Partially because it's an uncomfortable treatment, partially because it implies that things haven't gone as well as they can, and in no small part because it means delaying the reconstructive surgery which means delaying putting all of this behind us.
Thursday, 11-Sep-2008
Met with Dr. Antel who is our Radiologist. He revealed that a lymph node was caught up in this mess which is not truly in the area considered to be the left breast. It's still in the left chest wall area, just not directly in what's considered to be the set of lymph nodes associated with that breast. The implications I don't like are that this means the cancer moved beyond the left breast. Dr. Antel was not actually prepared with an answer. He'd consulted with two of his colleagues he has a lot of respect for and they gave him split answers. One, with a lot of experience, stating that he'd simply not do the radiation treatment at all. The other saying that it looked to be a good idea.
He went on to explain that treating patients in whom cancer had reoccurred with a second bout of radiation was new. There is apparently a study out with about 8 years behind it wherein patients were treated to a second round of radiation and studied for one year following the treatment and the results were quite good. The Numbers are that for a first round treatment they give about 5000 rads and this reduces the chance of recurrence from 20% to 30% down to 10% to 15%... about half. With a second round treatment, they would reduce the area they would radiate so that rather than hitting the whole upper left chest area, they would hit only the breast area and go up high enough to catch the one lymph node and they would also reduce the radiation to about 4500 rads. Further, they would use an electron stream as opposed to the normal X-ray radiation. Electrons have a more shallow penetration. While he can not guarantee that Kris lungs will not be affected this time, the chances of them being affected are greatly reduced, if not eliminated. Basically Legalese for there really is no chance but, it's radiation, we can't give guarantees. The downside is that there is about a 5% chance of complications due to the radiation. Specifically, there could be tissue killed other than the cancer. This means that tests will have to be performed after the radiation and if there is dead tissue, another surgery to remove it will be required. It also means that they can't perform the reconstructive surgery since radiation treatment would effectively kill the tissue used to reconstruct the breast.
We've not yet decided what to do. In fact, Dr. Antel isn't looking for a decision yet. He's going to contact folks from the study he quoted, among others, with specific questions related to our case. He's also waiting for the local cancer board to meet and discuss our case Tuesday. Kris and I meet with Dr. Moran Tuesday to discuss what comes out of the cancer board meeting later Tuesday.
More after Tuesday...
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