I had procrastinated on making this appointment since I thought there was no need to see her again, after all, she performed the surgery and sentinel node biopsy, informed me that the cancer had not spread to the lymph nodes and I survived, what more did I need to know? As it turns out, quite a lot.
Fortunately, I had phoned her office last Thursday, the 19th and surprisingly was able to see her today, only 4 days later, including the weekend! Originally, I wanted her opinion/advice regarding possible lymphedema.
Dr. Talbert entered the room with her trademark congenial smile and the surgical report in hand, she asked how I was doing and commented that I seemed to be recovering very well. She handed the report to me as she reviewed what took place during surgery, which seemed uneventful to my mind until she said, “…there were pre-cancerous cells in your left breast. It was a very good thing that you chose to have it removed at the same time.”
Those words and time froze in my mind, “..pre-cancerous cells in your left breast…” I heard nothing else that was being said, I was stuck in that moment of, …of… fear? disbelief? gratitude? Dr. Talbert must have realized that I was dumbstruck and gave me a moment to regroup and she continued that she would like to see me six months from now for an MRI to be certain that no cancer remained to spread into the chest wall or skin. WHAT? Again, I was dumbstruck. I thought that “this” cancer was done, finito, all gone, never to be seen or feared again. Hmm, I’m learning that once you have cancer, the rest of ones life is going to be filled with vigilance.
Moving onward from cancer topics, I proceeded to ask her about lymphedema and to give me the “description” of the type of cancer I had since my relatives can tell me exactly the type of cancer they had, example, Lobular carcinoma in situ,triple negative breast cancer, Angiosarcoma, etc.. But, before I record what she explained about the type of cancer, (I’ll type in directly from the report she gave to me) let’s address the lymphedema concern.
I showed her my right arm of which I am aware that it is slightly puffy, less than it had been several days ago. I digressed as I asked her to point out from where the three lymph nodes were removed. She touched the area above where my right breast had been, close to the underarm area but still on the front side of the body and explained that those three nodes were the ones that ‘lit up’ from the nuclear injection.
Back to lymphedema, I asked if removal of the lymph nodes is associated with lymphedema, it makes sense to me that it would. She agreed that in cases where more numerous nodes are removed, the likelihood of lymphedema is much greater. Looking at my arm, she agreed that it did look slightly swollen and that she would like to send me for physical therapy but could not do that until the reconstruction phase is completed, at least up to and through the permanent implant exchange and recovery. While telling this to me, she raised one of her arms and showed me how I might relieve some of the pain by slightly raising my arm, above the heart, and gently massaging from my wrist back to my shoulder, to help encourage the fluid to drain into the larger part of the body.
One final question I posed was whether or not I could start doing more physical things, like, moving and burning our wood pile, weeding the front flower bed, vacuuming, etc.. Her eyes got HUGE and she said, “NO!” I then learned that it would actually take SIX MONTHS for my internal wounds to completely heal from the extensive surgery, even though I might be “feeling good”, if I overdo anything, I could end up back in the hospital in worse condition than when I left. Ok, that warning is good enough for me, my activities will remain to be limited to emptying the dishwasher, doing laundry and computer work.
As we closed out the visit, I wished her congratulations as she was closing her practice at this location and returning to Oklahoma University where she would return to teaching and head the new breast cancer research department. She will have an office at OU with limited patients, I, fortunately, am one of the lucky ones who can count her as my doctor!
From the report:
Right Breast, Simple Mastectomy (A):
- Invasive, Well-differentiated ductal carcinoma
- Tumor location – upper outer quadrant
- Tumor size – 1.4 x 1.1 x 1.0 centimeters
- Invasive Tumor type – Invasive Ductal Carcinoma, Usual Type
- Invasive Tumor Grade – Histologic Grade 1
- Tumor-Associated Microcalcifications – Present
- DCIS Component – Present (1/9 Slides)
- DCIS Type – Cribriform
- DCIS Nuclear Grade – Low-grade
- Necrosis – Not Identified
- Surgical Margins – Free of invasive and in situ ductal carcinoma.
- Closes Margin – Deep – 1.0 Centimeters
- Additional Margin – Superficial Skin – 1.7 Centimeters
- Ancillary Studies – Performed on Biopsy at MWR
- Estrogen Receptor – Positive (95%)
- Progesterone Receptor – Positive (80%)
- HER2-NEU By FISH – Not Amplified (1.2)
- Right Sentinel Lymph Nodes, Excision (B):
- Three begign lymph nodes negative fore metastatic carcinoma at levels (0/3)
Left Breast, Simple Mastectomy (C):
- Mild Proliferative Fibrocystic changes
- Negative for atypical hyperplasia and malignancy