Family and friends,
My gentle reader will please forgive me for taking a long week before another update. It has been a long week... emptying the three surgical drains, adjusting pillows to get Julie comfortable, changing dressings, keeping her moving and trying to let her rest.
They threw us out of the hospital on Thursday, less than 24-hours there. I guess they figure:
a) Ya heal better out of the hospital, in a comfortable "at-home" setting;
b) They don't have enough staff to take really good care of you anyway, so might as well leave;
c) Cheaper for the insurance company; and/or
d) They can't give ya a really good staph infection if you're not in the hospital.
Any who, we left, and really, we probably ended up getting a lot more sleep at night. Hospitals are not what they used to be...
Julie is a tough bird; she was out shopping on Friday. She needs to walk around and keep moving, both walking and moving her arms to keep flexibility and range of motion. This is going well, although there is still considerable pain and she has to shift around to get comfortable lying down. Thank goodness (and the pharmaceutical industry) for oxycodone, Julie's newest second best friend. She is amazingly tolerant of the pain and discomfort and grotesque-ness of this surgery, as I am pretty sure had it been me, I would have been reduced to a hulking bawl-baby.
OK, so the pathology results we got today: please understand, I only play an MD on television, so I am not an expert on this...basically she was affected by two types of cancer, the highly aggressive cancer that is consistent with the inflammatory breast cancer that thrives and grows in the lymphatic system, and the slower, more persistent in situ cancer that sets up light housekeeping in the ducts of the breast, and while dangerous, is slower and offers more time for alternatives. The pathology showed that the chemo appeared to break-up the aggressive stuff into much smaller pieces than they were at the initial diagnosis. The ductal in situ was scattered thru the center in small nodules. But the good: the margins were all clear.
The lymph nodes showed tumor in 7 of the 23 that were removed, but there was no evidence that the cancer was beyond any of the dissection.
Julie's surgeon presented her case at the weekly Tumor Board Wednesday morning, a meeting for all the cancer staff to discuss and share info on patient cases. The consensus was that Julie should delay the radiation for the time being and have a second course of chemo, just to be safe and certain. It seems that the resolution of the MRI wouldn't find any tumor at the size that it would be (if there is any) right now, and that by the time any tumor grows to the size where it would be seen in 6 months from now, it would be much more resistant to the chemo. They think that this type of tumor ultimately re-surfaces about 50% of the time, but that a second chemo will further reduce the probability by another 50 to 75 %. This second chemo thus lowers the chances to around 1 in 8. So, that's the plan.
Anyone familiar with Dr. James Reason's accident causation "Swiss cheese" model knows that any additional layers of protection can only help. That is what we are hoping for.
Of course, Julie is beside herself because she really, REALLY wanted this to be over... to the extent that she had repeatedly threatened the doctor's ass with a sound kickin' if she needed more chemo after the surgery. What this does now, is throw the treatment timeline into some confusion.
We will not come back to Seattle in mid-September for radiation (so sorry, Bonnie, we were really looking forward to watching your house). Instead, we travel back to Seattle the last week of September to meet with the trio (the surgeon, the oncologist, and the radiation-ator) to start the chemo again. This gives Julie plenty of time to recover from the first chemo and the mastectomy. Our hope, and we should be able to start getting the answer to this question next week, is that once the chemo is started in Seattle that we can run the course in Juneau, and then let the radiation-ator start her nuclear magic within about three months.
To sum up:
Hospital stay way short.
No evidence that cancer went beyond the surgical site.
Need to do second chemo just to be on the safe side.
Timeline screwed up, and this probably won't be over before Christmas.
Julie pissed. And miserable.
That is about it: we fly home tomorrow, Thursday, and get to see the doggies and the house. I will keep emptying the drains and changing the dressings, and Julie will get better daily. I am not sure how soon she will be able to get back to work.
We both want to thank all the folks that came to see us these last two weeks. Your unwavering support and love continue to make all the difference. Julie is such a tough character, such a committed fighter, largely because we all stand so resolutely behind her. Bless you all.
Ken
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