The Best of all Possible News

Barbie got a call this afternoon from Dr. Gadd, the doctor who performed her lumpectomy 8 days ago.  The pathology report came back early, and all the news is good.  The cancer measured 1.6 centimeters, and all the margins around it tested negative; hopefully, they got the whole cancer.  Plus the sentinel lymph node was also negative.  This was the best possible result.  Yes, the growth was beyond the margins of the duct, but small enough to be classified as a stage 1 cancer.

Repeat: all the cancer is gone, and it has not spread to the lymph nodes.  Hooray!!!

The relief is palpable.  Barbie can now concentrate on preparations for her concert without having nagging doubts about what the pathologist’s report will say.  There will be a conference of several experts on 3/27, the Wednesday after the concert to determine what the course of treatment should be.

• Last week when Barbie was getting operated on, I went to Beth Israel to have a 4-week checkup and to get an infusion of Zometa, the medicine that promotes increased bone density.  The nurse I normally get, Mary Jane (MJ), has gotten to know Barbie and me quite well.  She was devastated to hear that Barbie had cancer too.  She immediately went somewhere, and came back with the book I Flunked My Mammogram, and gave it to me to give to Barbie.  It has lots of information about Breast Cancer, in understandable layman’s terms.  It was a perfect gift.  Thank you MJ!  I read it while waiting for Barbie to come out of the operating room.  One of the diagrams it contains presents information about the size and growth of breast cancer tumors.

We took 4 things away from studying this diagram.    

1. Barbie’s tumor, at 1.6 centimeters was around 32 doublings. 
2. At 90 days a doubling, and since the tumor only becomes detectable at 30 doublings, her tumor has only been detectable for 180 days.  180 days before her surgery was September 6^, 2012.
3. If Barbie’s mammogram was every year in June, it could have easily been a 2 centimeter tumor and likely a higher stage cancer.
4. The tumor has been growing for 8 years.  How many other tumors are growing in our bodies that are undetectable?

The next step is to deal with the concert.  Now that worries about the disease are somewhat diminished, Barbie can concentrate even more fiercely on the music.  She is very enamored of this piece.  I expect to be won over by the performance.

What happens next on the medical front will be determined by a conference with MGH experts, hopefully on March 27.  Oncologists with specialties in radiology and chemotherapy will be there, as will Dr. Gadd.  Barbie has asked if they can do an Oncotest before that time.  This test categorizes the DNA of the cancer, and determines on a scale of 1 to 10 how likely it is to return.  That group will determine her course of treatment, whether it be radiation, chemotherapy, estrogen suppressing pills, or some combination of these and other options.   But for now, it is just a huge relief to know that it is out and gone, and has not progressed to other systems.

Thank you all so much for your encouraging notes and thoughts.  We are both going to gain weight on all the delicious meals and special treats!  The best aspect of all this is learning about all the good friends we have.  It truly helps.

The Shoe on the Other Foot

You haven’t heard much from me because I am doing really well.  March 5^th (day 126) I saw Dr Levine, my hematologist/oncologist, and he declared me healthy.  I was on a 4-week checkup cycle.  He now has me on a 6-week checkup cycle.  My blood numbers all look good, my weight is up, and I have a spring in my step again.  I have to take some medicines to prevent shingles and a particularly nasty form of pneumonia, since my immune system is still coming back.  I am hunched over because of the broken bones in my back, but I am seeing a physical therapist to minimize that.  But I am running each morning and feeling really well.

On the family front, we are now proud grandparents of 2 new babies.  Bridget, wife of Brian, had Brendan on January 9, and Jess, wife of Andrew, had Emma on January 15^th.

 

That’s Brendan on the left, Emma on the right.

Here Emma is on the left, Brendan on the right.  

Now both almost 2 months old, they are wonderful little bundles to hold.  Yes, as a grandparent, you can have them when they are behaving nicely, and then give them back to more responsible parties when they get inconsolable.  My back makes it so that I cannot do prolonged walks to stifle their screams, but then usually their father takes over, and saves the day.  

The oldest grandchild, Tyler, just had a 3-year-birthday party, with a Lightning McQueen theme.  

Andrew & Brian decorated the birthday cake(s).  Lightning McQueen is on the left, Mator (a tow-truck who fixes Lightning up after he crashes) on the right.  All in all the family news is good.

So you must be wondering by now, why the blog post?  Well the reason is that Barbie has just undergone surgery for breast cancer.  She had an annual mammogram in the middle of January.  At the end of January she was called back because they wanted another look.  They took pictures with 3 different mammography machines and did an ultrasound.  Then they set up an appointment for a doctor to review the results with her.  The pathologist’s report raised all sorts of negative possibilities.  A biopsy was the only way to resolve what was happening.  She got this news the day before we left for Barbados.

A 1-week trip to Barbados was supposed to celebrate my recovery from MM.  It was wonderful to be basking in sunny climes during the week of the blizzard of 2013.  We had a busy time seeing much of the island, going on a couple of sails, putting in some serious beach time, and having a number of very nice meals.   But during all this time Barbie was constantly on her I-pad searching the internet for information about what her mammograms raised as possibilities.  The item in question was described as a spiculated mass in a duct.  Looking that up on google produced the following:

The most common presentation for breast cancer would be what is called a spiculated mass. That is a white area on the mammogram that has a star-burst appearance. It has lines, straight lines emanating from the mass, and that is very suspicious for a cancer.

Barbie had asked the doctor’s secretary for a copy of the pathologist’s report on the mammogram.  It turned out that on the second page there was something she didn’t understand, and which the doctor had not reviewed with her.  It said BI-RADS 5.  She initially assumed that was some kind of insurance classification code.  But eventually she discovered that it was a system for classifying mammogram results.  BI-RADS stands for Breast Imaging-Reporting and Data System.  It has a scale of 1 to 6 where 1 is nothing and 6 is confirmed cancer.  BI-RADS 5 is highly suggestive of malignancy – in fact the likelihood is 95% malignant.  Needless to say, that did not make her time in Barbados very relaxing.  Luckily, Nina Huber, one of the members of her chorus, who had breast cancer herself 7 years ago, took on Barbie’s case.  She strongly advised going to Mass General Hospital, and she arranged an appointment for Barbie the day after we returned from Barbados.  She even drove the mammography results into MGH, since Emerson had mailed them regular mail, and with the blizzard, they were not going to make it in time.

February 15^th, Nina drove Barbie into MGH.  Barbie met with a Dr Gadd, who confirmed the need for a biopsy.  Luckily there was an opening in the schedule, and Barbie was able to get the biopsy done later that day.  The results were positive, and surgery was scheduled for March 5^th.  This made Barbie very nervous, as she has a major concert on March 24^th.  Sounds of Stow will perform Handel’s “Jephtha”, a wonderful oratorio that she has put incredible effort into learning.  After a certain amount of hemming and hawing, having the surgery done as soon as possible won out.  Tuesday, February 26^th, Barbie & I went into MGH for prelims.  We met with Dr Gadd again, who explained the procedure: a lumpectomy of the suspicious mass and a sentinel node biopsy.  In other words, they cut out the cancerous mass (plus a margin of tissue around it), and they identify the first lymph node that drains fluid from the breast.  This is the lymph node most likely to show signs that the cancer has spread outside the breast, and they take it out for examination by a pathologist.  Barbie was top on the list to take the place of anybody who cancelled surgery that week.  None did.

So Tuesday, March 5^th, we went into MGH bright and early.  They did some basic prep work.  This involves another mammogram during which they insert a needle to identify exactly where the suspicious mass is.  Others who had undergone this process described it as incredibly painful.  Barbie made sure they numbed the area before doing this.  They also injected a blue dye and  a radioactive substance into the region of the spiculated mass.  Eventually, that dye made its way to the sentinel lymph node, and the color told them which node to take.  Sometime after 11 am Barbie went under the knife.  She had a general anesthetic, so she was blissfully unaware of anything.  When it was over the Doctor phoned me and reported that everything went according to plan.  They excised the mass in question and a reasonable margin of healthy tissue around it through an incision on the top of the left breast.  Then they made an incision in the armpit and took the sentinel node.  The doctor said she examined the lymph gland, and it looked cancer-free to her.  But we still need to wait for the pathology report to determine if there is any indication of cancer in the lymph nodes.

Barbie took quite a while to come out of the anesthesia.  When I was finally able to go into the area where family members could visit with patients, she was still somewhat groggy and quite pale.  But they got her dressed and bundled her up and allowed her to leave with me.  We got home just after 6PM, and Bridget, Brian, and Brendan were here at home for moral support.  A piano parent had provided a dinner, so Barbie was able to eat and crash in short order.

Wednesday was another day of recovery.  Barbie had a minor headache all day from the anesthesia.  Pain from the incisions themselves was alleviated by pain medications that Bridget safely metered out.  And she was able to sleep thanks to ativan (or lorazipam), a general relaxant.  Thursday she was able to be up and about much more.  She took off the immediate bandages over the operation, and the incisions looked very clean.  She is not teaching this whole next week, and the hope is that she can spend time with her music getting ready for her concert.  Luckily it also takes her mind off what she has just gone through, and the waiting period.

So we are on pins and needles until the pathology report comes back, as follow-up treatments will be determined based on those results.  Meanwhile, a director of another chorus in the area who plans to do a Handel Oratorio next fall, will fill in for Barbie at the first rehearsal on 3/16.  The hope is that Barbie will be well enough to take the podium on 3/24, but if not, this person will be able to fill in for her.  Any further surgery, radiation or chemo therapy treatments will start after the concert.

Throughout the summer and fall, we frequently remarked that it was a good thing Barbie was healthy while I was undergoing my illness.  Well, we are incredibly lucky that I am healthy while Barbie is undergoing her trial.  We certainly hope that it was caught in time, and this will just be a minor bump on the road.  Everybody assures us that they are able to do wonderful things with breast cancer now.  But cancer is potentially a deadly disease, and just a brush with it reminds you of your mortality.  I am now getting to experience what Barbie went through last October-November, watching your spouse battle a nasty disease.  Yes, you can be there for them, and yes, you can provide moral support, but ultimately it is the doctors, pathologists, anesthesiologists, and nurses who actually fight the disease.  A family member only gets to sit and wait, and hope the experts know what they are doing.

I became much more emotional during my stem cell transplant, resulting in a bad case of leaky eyes.  Barbie never lacked for tears, but now she finds herself weeping in gratitude for the miracles the medical establishment is able to do.  She weeps in gratitude for the help piano parents are providing by bringing meals.  She weeps in gratitude for the logistical help chorus members are providing in getting ready for the concert.  News of her situation has spread quickly, and everybody has been incredibly helpful.  It is great to have such a network of supporting friends.

Now is the time in this blog for instructions for what you need to do. 

First, Barbie’s condition was discovered at a routine, annual mammogram.  She is adamant that everyone continue to get their routine annual mammograms, in spite of all the current talk that they yield false positives occasionally.  Keep those appointments!  Even after Barbie’s mammogram identified the suspicious mass in the left breast, it was undetectable by manual examination.  The greatest risk factors for developing breast cancer are gender and age, not things we can dodge through life-style choices.

Second, if you do not have anything else on your calendar, come to Stow for a performance of Handel’s “Jephtha” on March 24^th at 3PM.  If Barbie is not on the podium, she will still be the driving force behind the performance.  She arranged for all the soloists, trained the chorus, and made cuts to reduce 3+ hours of music to just over 2 hours so the Sounds of Stow audience can make it through the performance.  The plot is quite dramatic, and Barbie thinks the music is quite expressive.  Come and decide for yourself.

Third, those of you who can walk or run, please consider helping me to form a team to run in the Multiple Myeloma Research Foundation Race for Research in South Boston on April 27^th.  Those of you who cannot participate, can provide moral and financial support by donating money in our names.  Pictures of races in prior years look like lots of fun, and you don’t need to be a world class runner to participate.  Check out the details at http://www.themmrf.org/teamraiser/races/1590.html.  If you are up for it, send me an email.

Lastly, do whatever you do to urge a positive outcome for Barbie.  Prayers, incense, positive vibes, or whatever works for you.  Clearly, you helped me along.  Now it is Barbie’s turn.  We are both overwhelmed with gratitude for all your caring.