Care Managed

Returning to normal after surgery. For the most part I feel better now than I have in months. Compared to how I felt during chemo—I have no complaints. There are still restrictions on how much I can move my arms, but I’m learning to deal because I know that this is temporary and that I’ll be back to 100% soon.

As much as I am not feeling like a patient anymore, my health plan still views me as one that needs some extra monitoring. So, as of last week I have my own nurse care manager. A care manager is someone who monitors the more “complex” patients to make sure they are getting the care the need, and cynically, not costing the system too much. My first job out of grad school was at the Care Management Institute at Kaiser Permanente. Back when I was figuring out how to help KP manage their complex patients, the thought did not cross my mind that I would need this same service for breast cancer at 46. Chris is always working with his students on understanding irony. I believe we just found a good example for him to use.

One thing I’ve been able to do a lot of this week is work. As much as that might not sound like good news to some, it makes me happy to have energy and the mental wherewithal to get my work done. One wrinkle in my plan to be completely productive is Josie. We are working on her ability to sit nicely next to my desk while I work:

Unfortunately, her favorite spot is more like this:

We have some work to do.

Just Me & My JPs

Chris returned to work Thursday after an almost two-week stint of round-the-clock care of the girls and I. I required a lot more attention than Elsa and Alice for sure and Chris handled all of his responsibilities beautifully. I’m not surprised--as the nurse in Dr. D’Amore’s office said this week, “I can tell that your husband is a very competent person”. Yes he is, but we’ve known that for a long time.

Fortunately, I had lots of company after Chris went back to work. Jackie (who is in the picture above with her lovely family) came down from Oregon to see me, Arbella (cancer-free for two years, and my beacon through so much of the past six months) and Kristin all came by with food and presents and sat down with me for some much needed chit-chat. We also had a constant stream of meals from our dear Wade Thomas friends—every night someone new showed up on our doorstep with bags of food. Thank you everyone!!

So, having passed the test of those first two days without Chris, I’m quickly returning to normal which feels great. I walked the girls to school last week, and started driving yesterday (hooray!). On Monday I’ll get my JP drains out. These little suckers are supremely annoying as anyone who has had surgery can attest. We are all counting the hours until Monday’s appointment. 

“The Best and Very Highest Chance of a Complete Cure”

These are the words we heard from Bobbie Head yesterday, after she told us that my tumor was completely gone.  This is the best possible news we could receive.

We learned this week that I had what is called a “complete pathologic response” to chemotherapy—meaning there is no sign of cancer in the nodes Dr. Kelley took out on Monday, and my tumor is completely gone. About 30-40% of people have a complete pathologic response to chemo given before surgery, and these people have, as Dr. Head said, (and I like to keep telling myself), the best and very highest chance of a complete cure.

We have decided that I will do radiation—as my doctors have said, this is like an insurance policy against the cancer returning. Since radiation will not start for awhile, for now I am at home-spending lots of time with Chris, who has taken time off of work to take care of me, reading, resting and really enjoying the idea of not returning to chemo.

Yesterday was Chris’ birthday. So much was celebrated with this chocolate cake!

Game Day

Margie had surgery today, and thanks to our friend, neighbor, and fellow Wade Thomas parent Laura--also an RN at Marin General Hospital--we felt as though the whole hospital was on our side.  Our experience, start to finish, confirmed out confidence in the quality of treatment Margie is receiving.
  
Initial lab reports on lymph nodes show they are clear and haven't been affected by cancer which is good news. We will have further information and a more comprehensive idea of follow up treatments when the tumor pathology report comes back in about four to five days.

At that time we will also know how to treat the internal mammary nodes, which imaging showed cancer involvement back in August, but that post-chemo imaging couldn't see. (This doesn't rule out current microscopic cell involvement, so we will likely radiate these internal mammary nodes to ensure the best possible outcome.)

Thanks for your support, and we will follow up after the pathology report. Margie is doing great, and she'll be out of the hospital tomorrow.  

Take-Down Project, Phase II

Happy New Year! Here we are on New Year’s Day, near Tomales Bay, where we hung out with Susie and John. Unbelievably, it is as warm as it looks.

Chris and I met with Dr. Tancredi D’Amore (my plastic surgeon) and Dr. Leah Kelley (my breast cancer surgeon) this week. I’m definitely dreading the surgery, but at the same time-ready to have it behind me. 

Dr. Kelley also discussed the results of last week’s MRI and mammogram/ultrasound. The tests were to assess if any tumor and impacted lymph nodes remain. According to Dr. Kelley, the MRI showed only the clip that was placed in the tumor during this summer’s biopsy—but no tumor. The ultrasound showed a ½-centimer “shadow” where the tumor was. This is good news—it is not definitively saying the tumor is 100% gone, but given the limitations of the two tests, it is pretty much the best news that we can get at this point.

On Monday, Dr. Kelley will remove 1-2 sentinel lymph nodes to determine if the cancer has spread to the nodes, and also assess the tumor. Only after everything is biopsied will we know what we are dealing with. Of course we are feeling a lot of anxiety right now, given how much is riding on that biopsy. We are working hard on staying positive—it helps to be surrounded by our amazing family and friends. Keep those good thoughts flowing!