A Year After….

It’s been a while since the last update. Amy has recovered well. She has been taking a cocktail of Tamoxifen and Zolodex (Quarterly injection) as her hormone treatment. She has good days and bad. but overall things are going great. Thanks for everyone’s concern and care. We really appreciate it.

Reconstruction

10/23/2008 – Today, Amy has her new silicone implant. She arrived at the hospital 6:30. She was admitted around 7:45. She went to the operating room around 8:30. Around 10:20 the Dr Yoon came out. Her surgery was complete. The surgery was suppose to take 1 hour and 1/2. Dr Yoon said Amy slept and didnt want to get up.

Chu-chi went into the recovery room around 12PM. Amy had some crackers and ginger ale before taking some percocet(pain killer).

We got  home around 1:40PM. Amy mainly slept. She also used her spirometer to exercise her lungs so it doesn’t collapse. She also walked around to avoid blood clots.

Overall it was very successful. At end of the day she was up and about eating dinner.

Oncologist

Dr Marcus recommended an oncologist, Dr. Chitra Rajagopal (Dr Raj). We visited Dr Raj shortly after June 20th.

After assessing the situation Dr Raj recommended Zolodex (quarterly) and Tamoxifen daily for the hormone treatment. The side effect are simliar to those of birth control. Amy will be experiencing a temporary menopause.

Dr Raj considered several factors and severity (low, medium, high):

1. Size of tumor (1 cm) – 1-2 cm is considered medium

2. Hg L/N? (0) – Low

3. ER/PR – (80%/100%) – Hormone related cancer (Low)

4. Grade – (II) – medium (based on Nottingham score) (how different is the cancer cell from normal cell)

5. Lympathic Vascular invasion (negative) – Low

6. Her 2 – (negative) – low

7. KI – 67 (24%) – medium (cell proliferation)

Oncotype Results

June 20th – We visited Dr. Marcus’s office. The oncotype result was available. 

Oncotype test is to further determine whether a breast cancer patient requires chemotherapy as treatment.

Typically, a DCIS patient does not require chemotherapy because the cancer remains in the duct and there is no danger it has escaped into the bloodstream or lymphatic system.

However, Amy has invasive breast cancer. We have determined that her cancer is not in the lymphatic system. However, there is no method to test if the cancer is in the bloodstream.

Dr. Marcus prescribed an oncotype test to further determine how aggressive is the cancer. 

 

The oncotype test came back with a score of 15. A score of 20 is intermediate range. So her score is considered low risk of recurrence. So most likely chemotherapy is not necessary!!

It is a relief.

Drain is out

6/11 Amy has been carrying a drain to capture the fluid from the mastectomy. That drain has been taken out since her daily output is less than 30CC.

This milestone allows her to stop taking antibiotics and allow her to shower once the opening for the drain heals in a couple of days. She will also start driving in a few days. although the doctor recommend in the neighborhood at first with another driver in the car for observation.

Amy will visit the plastic surgeon every week. 

Pathology Report

6/4/2008 – Dr Marcus, Amy’s Surgeon, called regarding the pathology report. The news is the best we can hope for. The lymph nodes are confirmed to be clean. The margins are clean as well. This result means Amy can avoid radiation therapy.

An oncotype test has been order to determined the type of cancer. This information to decided whether and what type of chemotherapy is needed. Hormone therapy may most likely be in the cards.

We will meet the oncologist after the oncotype results to determine the path for treatment.

Mastectomy Complete

5/27 – Met with Dr. Yoon whom went over the surgery and recovery. She discussed that she’ll draw the surgical lines pre-surgery. She will install the expander with saline and alloderm with drains.

Picked up Amy’s mom. She missed her connecting flight in San Francisco. The arrival was delayed 3 hours.

5/28 – Had dinner with Ya-shian and Julien.

5/29 – Ya-shian came over around 6:20 to take care of the kids.

7:00am Amy, Amy’s mom, chu-chi arrived at the hospital to register.

Amy was taken into the the pre-operation room. This was in the new outpatient wing which is greatly improved where she was monitored.

She came out for the sentinel biopsy where she was injected with a blue dye, iodine and gamma dye around 8am.

She went into the gamma machine around 11am to see how the injections have travelled.

Around 11:45 we met with Dr Yoon who drew the surgical lines. We also met the Anesthethiologist.

Dr Marcus was a bit behind  for lunch.

Amy went into surgery at 12:45.

Dr Marcus came out at 2:08 announcing a successful mastectomy and a negative sentinel biopsy. The news is good so far.

Dr Yoon came out at around 3:45pm announcing the initial reconstruction was complete  and amy moved to the recovery room. amy is awake and smiled. We couldn’t see Amy until 5:45 after she went into the short stay room.

The short stay room is a private room and brand new. it has a TV and restroom.

When we arrived, they just moved Amy into the room.

The nurses did very good job of moving Amy. However, they missed a few things like the foot circulator. amy noticed her foot became numb.

also, the nurse was measure blood pressure on her right arm (the affected arm). this was not recommended because it could cause lymphadema. an alert nurse informed us.

we are amazed how hard the nurse work. the shift may be more than 12 hours. most of the nurse seems reactionary because they have so much to do.

Initially Amy spent most of her time in bed and only had liquid diet. she had a low-grade fever.

the doctor recommended she used her breathing apparatus more often.

By the second day, she started having solid food for lunch. Amy was tired because she didnt have good sleep all night. The charge nurse asked Amy to walk more to avoid blood clot.

She started walking more in the morning.

Amy started getting a fever late morning.

She took a refreshing nap for a few hours. Dr Yoon was held up in traffic. She came after 5:30pm.

By then Amy was well rested and ready to leave.

Before leaving, Dr Yoon instructed us what to do prior to Monday when she will see us again to check up on Amy.

We arrived at home on 5/30 at 8. A successful surgery!

Breast Cancer – 2nd update

Updates from last post:

 

5/14 Met Dr. Huang for immediate breast reconstruction with mastectomy consultation.  Dr. Huang went over with a full range of breast reconstructive information including options, procedures, pros and cons and what most of her patient go with and why.  Pretty much have the idea that I will go with the expander and then implant at the later time.

 

5/19 Met Dr. Yoon.  She is at the office across from my children’s Ped office.  Easy access location.  It turns out that Dr. Yoon and Dr. Huang are good friends and she gave good remarks on Dr. Huang and assured me that I will be in good care with Dr. Huang.  We didn’t go through all the information that I have learned from Dr. Huang.  Instead, she explains in details of how the surgery will be, post surgery care (the drain – which scares me the most), how the expander will work on me and how often she will follow up with me after surgery.  I felt I have the most fun talk with her and felt very easy asking her to clear up some area that I’m not clear with.  Maybe it is her sincere and open-minded personality; I decided to ask Dr. Yoon to be my plastic surgeon. 

 

5/20 Today I called Dr. Marcus’s office to confirm surgery date.  It is set to be 5/29.  Starting 8 o’clock in the morning with injection, around 11 o’clock for getting ready and by 12:15 or 12:30pm is when the surgery will be under going.  Estimate 4-6 hours from this point.  I will stay one night at the hospital. 

The recovery time is estimated to be 6-8 weeks

Breast Cancer Update

The following has happened since the last post:

5/9 Amy went to Washington Radiologist in Fairfax for a second MRI. 

5/12 Amy went in for a PET Scan to detect the extent of the cancer.

5/13 The results of the MRI and PET Scan became available.

The original mass of cancer is confirmed. The new mass was also confirmed. The left breast showed benign growth. 

Decision:

Amy has decided to proceed with a mastectomy. Dr. Marcus recommended Dr. Yoon and Dr. Cathy Huang as plastic surgeons. Dr. Huang is out of network but has certification for micro surgery. She will visit the plastic surgeons for reconstruction consultation.

This will be a major surgery. But it seems like the right thing to do given the extent of the cancer growth.

The good news is that the PET Scan result showed the cancer is limited to original areas identified. It has manifested itself on the chest wall or the axilliary. Although only pathology will be the final indicator.

 

Breast Cancer

After mom’s breast cancer diagnosis 6 years ago, the last thing we expect is another diagnosis of breast cancer. This time is my wife’s turn. She has been diagnosed with Invasive Moderately Differentiated Ductile Carcinoma with associated foci of Ductile Carcinoma In Situ. The invasive tumor is about 1 cm in maximum width.

Initial diagnosis is stage 1 cancer.

Timeline:

February: Routine visit to Obstetrician. Recommeded baseline mammography (for woman 35 years or older) My wife was 36.

3/31: Mammogram taken and doctor recommended follow up Mammogram

4/7: follow up Mammogram taken. Biopsy recommended after suspicious growth detected in right breast. Left side unremarkable.

4/21: Biopsy taken

4/23: Biopsy result showed cancerous growth.

4/25: MRI taken out of ideal period.

5/1: Trip to Johns Hopkins Avon Breast Cancer Center. MRI report showed larger area of DCIS.

We met Dr. Lange, Kyle, and Deborah.

The doctor recommend suggested Lumpectomy is possible. But if a large area is taken out, it will leave little volume. 

Follow up MRI recommended to do Lumpectomy to gain accurate picture of the cancer.

Recommendation is to have MRI 7-12 days after a period started.

5/1: Period started. 

5/5: We met Dr. Marcus. She gave very clear explanation of our situation. After seeing the MRI, she recommended another MRI screening. She also recommended PET Scan.

Dr. Marcus basically gave the same information we had at Johns Hopkins. But she was clearly leaning towards mastectomy. 

5/9: scheduled repeat MRI. need doctor’s referral for insurance.