It's pretty safe to say that "YES" this is my final answer!
First let me back track and give you a little run down ~ Jan. 2012, first consult appointment with plastic surgeon at UNC Cancer Center ~ end result of appointment is Lat Flap (latissimus muscle) with tissue expander on the left and mastectomy with tissue expander on the right. Scheduled a second appointment for the end of April knowing that I would be ready for surgery the end of May.
I didn't really want to have to do the Lat Flap on the left but the surgeon felt this was my only option so that is what we planned to go with. After good advice, I decided to get a second opinion...
April 19, 2012 ~ consult appt. with Dr. Claire Carman in Norfolk, VA
Wonderful doctor who agreed with and confirmed some of the previous information/decisions and yet had different views and opinions on some things as well. She also felt the best surgery for the left was the Lat Flap, so like it or not it looks like there isn't much to decide on that. She did have a differing opinion about doing the mastectomy on the right. This sort of caught me a little by surprise considering that everything I had been told up to this point leaned more toward doing the mastectomy. She had valid reasons to back up her opinion, so I decided to try to be open minded. Maybe I had made a hasty decision (seems highly possible when you are thinking in terms of life/death). Dr. Carman feels that in a lot of cases this is an unnecessary surgery that many women think will change their prognosis. It doesn't change your prognosis! In her words, "the milk is already spilled." A recurrence can happen in the same breast or tissue still present even after a mastectomy or it can occur in another part of the body (liver, lungs, bones and the brain) which is called metastasis. A metastasis is more likely to occur in another part of the body than it is the opposite breast. Another reason she felt that mastectomy surgery was not always the best way to go is because you have no feeling after this surgery. She felt that being able to feel if something wasn't "normal" was your first and best defense in catching cancer early if it happened to occur in that breast.
So I had some things to think and pray about. Nobody said that the decisions I was going to be faced with would be easy ones to make. I would say that I wish I didn't have to make them but in some way I feel that isn't fair. You see, I know God is in control and I know He has a plan for me. I also, firmly believe that all that has happened in the last year will in some way glorify Him.
April 25, 2012 ~ follow-up appts in Chapel Hill with my medical oncologist and oncology surgeon and first mammogram since cancer diagnosis. I decided to not make a final decision until I was able to talk to my doctors at this appt. and refresh my memory with the abundance of information that they had already given me. Mammogram was my first appt. I would be lying if I said it wasn't scary. At the Cancer hospital they read your films while you are still there. The radiologist said that she was satisfied with the way the films looked and as far as she was concerned I just needed to come back in 6 months. Dr. Muss (my medical oncologist) felt that if I didn't have the mastectomy surgery done on the right that I would need to be scheduled for an MRI. Not only this time but on a yearly basis into the unforeseeable future. The rest of his appt went well, other than the fact that I have to learn to live with these HOT flashes! He isn't comfortable with me taking any medication at this time to try to elevate them, so if you see me flapping my hands like I'm swatting at a bug - I'm probably just fanning myself. Poor Stewart probably won't get a good nights sleep either because I'm constantly throwing covers off because I'm sweating and then pulling them back on because the air hits the sweat and makes you cold! Dr. Demore had a lot of good information, mainly studies that showed the advantages/disadvantages to having the right side mastectomy surgery. The two that seemed most important: 1. A study that shows that you have a 95% chance of NOT getting cancer (new or recurrence) if you opt for mastectomy, and 2. A new study that shows that for women under 40yrs old there is a 5% increase in survival for women that opted for mastectomy. This is a very quick rundown of a four hour appointment!
Here's a list of the decisions that had to be made:
1. Do I do the mastectomy on the right side?
2. Do I have my surgery done in Chapel Hill or in Norfolk?
Answer to question #1: YES! I felt like I got really good information from a lot of different sources and when it comes down to it I feel like for me this is just the right thing to do. I'm sure I'll still worry but at least I will know I did everything I possibly could.
Answer to question #2: This was the hardest decision. There were a few differences in the approach and timeline for surgery from each place. According to Chapel Hill I could schedule surgery the end of May, where in Norfolk they wanted to wait until middle to end of summer. In Norfolk they wanted to do a sentinel node biopsy when they did the mastectomy surgery on the right and UNC felt that the disadvantages to doing this outweighed the advantages (a biopsy would put that arm at risk for lymph edema). Norfolk wanted to do a skin sparing mastectomy and insert a fully expanded tissue expander on the right side while the left would have to be slowly expanded (in other words, I would still be lopsided). UNC would do a total mastectomy (not keeping any of the skin) and expand the right and left side at an equal rate. When it came down to it - I'm ready to get all of this done and behind me. At UNC the surgeon and I agreed on just about every aspect of the surgery. I like the timeline. I prefer to not have the node biopsy unless pathology from the surgery shows that we need to go back and do it. I certainly prefer to go through summer with two boobs that at least appear equal. If I am opting for a mastectomy then I don't want to keep the skin or nipple, either of which cancer could pop up in. The final piece of the puzzle in deciding where to do surgery was that up to this point all of my stuff has been done at UNC, and I feel that it is better for the future monitoring of my health to keep everything in one place. I loved the doctor that I saw in Norfolk and under different circumstances I would without a doubt love for her to be my doctor. But things just didn't work out that way, and for whatever reason in the beginning I ended up at UNC and I felt like from the start that I was where I was supposed to be. And so there I will stay!
I am currently seeing a physical therapist up at the hospital that has been trained in dealing with women that have had breast cancer to get the left side ready for the upcoming surgery. Surgery is scheduled for May 31st. I am looking forward to having another part of this journey behind me!
I am an open book! If any one ever has questions about anything I post please feel free to ask. I have learned a lot over the past year, some of it the hard way, and I hope I can use my experience and what I've learned to help others! My e-mail is: angbal96@hotmail.com
God Bless, Angie
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