Chronology

May 2013: Suspicious and painful lump on right breast; subsequent mammogram, ultrasound and biopsy results were benign. Aspirated cysts due to painful inflammation.

July 7, 2014: OB/GYN visit to have suspicious lump in right breast examined.

July 18, 2014: Diagnostic “3D” mammogram of both breasts. There was an additional cost of the 3D of like $40 that wasn’t covered by insurance and was considered “optional.”

July 23, 2014: Biopsy.

July 25, 2014: Diagnosed invasive ductal carcinoma. Estimated tumor size on biopsy report (referencing ultrasound) was 20mm (or 2 cm).

July 30, 2014 (a.m.): Receptor results posted to patient portal (no phone call). ER+, PR+, HER2-

July 30, 2014 (p.m.): Surgical, plastic and radiation consults at Wake Forest Baptist. Advised that lumpectomy and radiation are options and that there is no additional beneficial outcome of doing single or double mastectomy. However, if I want either of those for “psychological reasons” such as less worry in the future, then surgeon will perform it. Said I would only need chemotherapy if lymph nodes are affected and estimated that tumor is 2cm, could be larger, could be smaller if it is inflamed. Learned I am not a candidate for breast reconstruction using tissue from my stomach. Blood taken for MyRisk genetic panel. Bloodwork is normal.

August 10, 2014: Second opinion at Duke Cancer Center. Advised that chemotherapy is likely no matter lymph involvement due to being under age 35 and family history. MRI recommended due to extremely dense breast tissue and potential that tumor is larger than we think. Said my tumor is 2.3-2.4 cm, maybe bigger. If it’s bigger, I may not be a candidate for lumpectomy.

August 15, 2014: Breast MRI at Duke

August 18, 2014: The day they said I would get MRI results, but I don’t get the results

August 19, 2014: MRI results: Multiple additional “suspicious and adjacent lesions” in area spanning 7cmx3.5cmx4.2cm. Most are smaller than 0.5cm; one adjacent one is 0.9cm. No findings in left breast. Nothing encroaching on chest wall. No suspected lymph involvement. Recommend MRI-guided biopsy of lesion most distant from known tumor.

August 20, 2014: First day I might get genetic panel back, but they are running behind and now it will be September 1 at the earliest.

August 22, 2014: MRI-guided biopsy at Duke of secondary suspected lesion.

August 26, 2014: Pathology confirms secondary tumor is invasive ductal carcinoma. Approximately 0.4cm diameter, located 4cm from primary tumor. Borderline between being considered in same quadrant as primary tumor, therefore could be considered a “multicentric” breast cancer diagnosis, which can have prognostic implication. Multiple tumors in same quadrant are called multifocal.

September 2, 2014: Surgical consult at Duke for mastectomy based on new MRI-guided biopsy results. Recommendation: Single mastectomy with delayed reconstruction. Can make decision for preventative mastectomy at time of reconstruction.

September 3, 2014: Myriad MyRisk genetic results: all negative.

September 8, 2014: Unilateral mastectomy of right breast. Sentinel node biopsy: Negative.

September 16, 2014: Post-op visit. Drain removed. 2.2cm + secondary tumor = 3cm. Pathology: T2N0Mx. “Biphasic” IDC tumor with invasive lobular and neuroendocrine features. Grade 2: (Tubule-3, Nuclear-2, Mitotic-1). Negative margins. Re-examination of sentinel node: Negative. Possibility of needing radiation anyway due to rare type of tumor. Case will be discussed at weekly conference by Duke oncologists and pathologists may be asked to present findings.

September 22, 2014: Physical therapy to rehab pectoral muscle et al. from mastectomy.

September 24, 2014: Appointment with medical oncologist. Seems that my case did not go to weekly conference, but not sure. Radiation not recommended. Oncotype Dx test to be done on neuroendocrine portion of tumor simply to gain more insight on whether to consider more aggressive treatment. Current plan is four cycles of cytoxan-taxotere at three-week intervals. First cycle will be October 10. After chemo, plan is for induced menopause via monthly shots and taking an aromatase inhibitor for five years.

October 1, 2014: Physical therapy.

October 6, 2014: Oncotype Dx results: Score of 11. Medical oncologist said that although this is a low score and low risk of recurrence, he still recommends the chemotherapy treatments because the test was benchmarked based primarily on older women’s recurrence rates. He said the highest score he has seen for someone with my type of breast cancer is 38.

October 6, 2014: Physical therapy.

October 10, 2014: First chemo treatment. Allergic reaction to Taxotere.

October 17, 2014: Physical therapy

October 24, 2014: Hair begins to fall out.

October 26-28, 2014: Hospitalized due to perianal abscess. During surgical draining of abscess, two fistulas discovered but not treated.

October 31, 2014: Read CT report from abscess diagnosis on patient portal. Discover that radiologist also noted a 3.3cm mass on right adrenal gland, but no one ever mentioned this when I was in the hospital.

October 31, 2014: CANCELED DUE TO HEALING FROM ABSCESS Second scheduled chemo treatment 

October 31, 2014: Post-op visit with mastectomy surgeon at Duke.

October 31, 2014: MRI of adrenal mass at Duke

November 4, 2014: Post-op visit for abscess and drain removal at Wake Forest Baptist. Site has healed well and follow-up scheduled for one month. Possibility that two fistulas will heal on their own.

November 6, 2014: Duke sends MRI results of adrenal mass. 3.5cm x 2.5cm, benign adenoma.

November 7, 2014: Second chemo at Duke. Allergic reaction again to Taxotere. My nurse practictioner says we will have a follow-up plan for the adrenal mass before my next chemo.

November 17: Physical therapy

November 25, 2014: Third scheduled chemo treatment. No allergic reaction to Taxotere for first time (this was the first time I got Benadryl pre-infusion). Follow-up plan for adreneal mass is to work with an oncologist who specializes in breast AND adrenal, starting 6 months after chemo ends. Everyone is optimistic that it is benign, but want to run a lot of baseline tests and set up annual scan monitoring to make sure it does not grow.

December 8, 2014: Physical therapy. Declared the best mastectomy recovery ever seen by my OT. Says she may recommend horseback riding to patients, ha!

December 9, 2014: Follow-up with colorectal surgeon. Will need to follow up again in late February to discuss fistula repair.

December 19, 2014: Fourth and final chemo.

December 30, 2014: In-office draining of yet another perianal abscess formed behind fistula. Starting to regain faith in Wake Forest Baptist Hospital. My GI surgical team (including the residents) are awesome.

January 6, 2015: First injection to induce menopause at Duke. Baseline bone density scan. Sneak peak shows bone density is good. Shot was no big deal. Bloodwork is so good that I can return to chicken caretaking duty.

January 13, 2015: Follow up to see how drained abscess site is healing at Wake Forest Baptist. Pretty good. But they want to do a series of two outpatient surgeries to fix the fistula(s).

January 23, 2015: Surgery 1 (of 2) to begin repairing fistula(s) that caused absecesses. At Wake Forest Baptist. UPDATE: No fistulas found nor anything abnormal found!

February 5, 2015: First session of electro-accupuncture. Intense. Love it.

February 6, 2015: Second Zoladex.

February 12, 2015: Electro-accupuncture.

March 6, 2015: Zoladex injection again and consult with dual breast and endocrine oncologist to meet with me about my adrenal mass at Duke. Also will likely start aromatase inhibitor medication. [PLACEHOLDER]

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