Oncology Consult – June 12, 2015

The last of the 3 big consults (surgeon, plastic surgeon and oncologist) was today Friday June 12th.  Again we had an early appointment to see Dr Sedlacek at one of the Rocky Mountain Cancer Centers. He was in the same building as Dr Schwartzberg, so it was easy to find. We already had a route from the house, knew where we were going to park.  I wondered how routine these trips would become. It’s a good that we only lived 20 minutes away and the drive was a nice 30 mph through treelined residential streets (Monaco to 13th to Claremont). Though today Chris drove via Colorado Blvd. and the traffic was thick. I worried a little about being late. I don’t know why I do that. Out of all the things to worry about, why should I give a shit if I’m a little bit late, it’s not like the the doctor is hanging around tapping fingers on the desk. You always have to wait for doctors, no matter how early or late you are.

We arrived 10 minutes before the appointment. I got the usual forms to fill out. I am terrible at filling out forms. For some reason I miss sections and boxes,  and I always (really, always) revert back to the UK date system and have to think very carefully when I put in my date of birth; month-day-year.  My brain is hardwired into remembering my date of birth as day-month-year, and that still seems a more logical way to do it.  Anyway, the people at the reception were lovely. They were so friendly and helpful, even people in the waiting room were upbeat.  I guess that’s what you do when you have cancer.

There was one older guy who was very funny. People would say hello to him in the waiting room, he must be a regular because almost everyone knew him.  We were both called at the same time and each taken to adjoining cubicles to have our weight, blood pressure, heart rate and other general details logged. He needed to have a blood sample taken and we could hear the entire dialogue. It was like a Saturday Night Life skit. he was so funny. I felt good about this practice, it had the right uplifting and positive vibe.

Dr Sedlacek was a cowboy from Nebraska; white coat, cowboy boots and bolo tie.  He was like a nice fun uncle and made us both feel very comfortable.  The meeting started with the usual topless performance. I have to say that Dr Sedlacek did the most thorough examination of my lymph nodes; it was quite reassuring, it wasn’t a routine quick test, he was really trying to feel my lymph nodes.  Since everything was balancing on whether the cancer had spread to my lymph nodes and was running wild and free in my body, I was happy he didn’t seem to find anything.

It’s weird that these consults, for me, have been less about the words the doctors have said, but more about how they have reacted and what has been relayed between the lines. His firm armpit examination said volumes to me.

So I was going to have the full Jolie (my non-scary term for a double mastectomy). He said they call it “The Full Monty!” We then went on to discuss statistics. Chris is the mathematics man, so I basically sat back and listened.  I can’t remember the exact numbers, but it was something like this;

  • Any woman in the USA has about a 16% chance of getting cancer in their lifetime, because my mother had cancer that added about 2-3% to my chances.
  • I can’t remember the percentages for recurrence after a lumpectomy or single mastectomy, but they were still in the teens.
  • If I had a double mastectomy that would reduce my chances to about 1%

In the last 20 years Dr Sedlacek had never seen a case of recurrence after a double mastectomy. He said that because they could not possibly remove every single breast cell during the mastectomy, statistically there is a chance that a single rogue cell could develop into cancer.  The good news (he said) is that if that happens I would feel a small lump on the surface of my skin.  Because breast reconstruction techniques use the pectoral muscles to hold implants, all the breast tissue is pushed to the surface. I would never need a mammogram again, but I should be aware of any small lumps or pimples on the surface. Lumps around the incisions are probably scar issue, but anywhere else should be checked out.

I think at that time I made the decision to not keep my nipples.

I asked about nipple saving. They remove the nipples and remove as much tissue from the back then put the flattened nipple skin back. Pathology will look at the removed tissue and if they find any cancer they will go back and remove the nipple skin.  He did mention that saving nipples did add another percentage to the chances of recurrence. I think at that time I made the decision to not keep my nipples. Dr Caprano had said the nipples are breast tissue with a “I can’t believe you are even considering keeping them” look. If I kept them it would just be the flattened skin, stuck back on my chest in the appropriate area.

Dr Sedlacek talked about breast reconstruction and really provided a lot more relevant information than Dr Capraro the plastic surgeon.  Dr Sedlacek summarized all the good things about reconstruction. He said my new breasts would always be perky, they could not age.  By having a double they would both be even. If you don’t save nipples, the reconstructed ones can be placed in the correct place.

At this time, the assumption is, my cancer has not spread and a double mastectomy will remove all cancer. A biopsy of the sentinal lymph notes will confirm whether the cancer has spread or not.  If the lymph nodes show the cancer has spread he may put me on a short series of chemotherapy with 5 years of tamoxifen. But that is only if the cancer has spread, and we really weren’t going in that direction. I think he said that because he had to.  We are assuming the cancer has not spread, so there would be nothing Dr Sedlacek could do for me and he would discharge me.  He wanted to see me a month after the surgery and he said he fully expected to discharge me.

Again we both left the consult relieved. I was starting to believe that I may be lucky enough to  avoid chemotherapy, radiation and Tamoxifen. We decided to go for lunch again. The sky was blue and the temperature was comfortable so we went to the same restaurant that we went to after Dr Schaertzberg’s consult.  Again we sat outside in the warm sun and ate tacos. I had a vodka tonic and tried not to cry with relief.

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