The definition of complicated

This is it, we've got a meeting with the oncologist Thursday morning at 8:30am.

As we have now got all of the tests completed. This should be a meeting where treatment decisions are made!

BTW, that's 11.5 hrs and 500 km after I wind up night class at the University, nothing worse than having no control over what's happening to Pace's health nor my personal agenda... God I love my wife!

Two words, Red Bull!

Now we're getting somewhere!

Today was another day of meeting with Pace's Medical Oncologist and running about getting more tests done.

The test of the day was another Breast MRI of dual purpose. One diagnostic is to determine if the questionable lesions in her left breast are affected by the rise and fall of Estrogen and Leutenizing Hormone levels from ovulation to menstruation. While there, they also imaged the right breast to track the growth of the known cancer.

Her Medical Oncologist was able to give us partial test results, some good news and some not as good. We also got an update on the what we're up against.

• The biopsy determined there are two masses in the right breast, one is cancerous and one is not.
• The MRI and biopsy together shows the cancerous mass to be 2.5 cm in diameter
• The doctor's examination room measurements of cancerous and non cancerous masses together are 5 X 4 cm
• The cancer is a stage IIb or a IIIa
• We will find out if it a hormonal sensitive cancer later when cultures of numerous biopsies are batch tested for estrogen or progesterone receptors, but this is not terribly important right yet.
• There is definitely cancer in the lymph nodes of the right armpit and probably the left as well

He also outlined some of Pace's choices based on subsequent test results and the upcoming meeting with the surgical oncologist on the 19th.

If the left breast has pre-cancerous cells Pace faces bilateral mastectomy, meaning she loses both breasts and then gets chemotherapy. Essentially, if the suspect areas of the left breast are precancerous, and given the cancer cells are the fast growing grade III type, Pace statically faces a high rate of recurrence within 5 years in the left breast.

If the left breast is clear they can start chemotherapy to reduce the mass and conduct an operation that conserves the breast later.

More info to come on the 19th after the meeting with the surgeon and a subsequent meeting the chemotherapy oncologist on the 23rd.

Some good news it seems

We had the echogram of the intestine, stomach and liver today. Preliminary report is all clear.

More to know after the meeting with the medical oncologist tomorrow.

The Waiting is the Hardest Part

The last 7 weeks have seemed like an eternity. We're being told that's fast and we're lucky as it usually takes 3 months and we're on a second opinion.

Monday January 9th, Pace is supposed to get another MRI that will determine if the left breast has precancerous growth or if it is related to hormonal changes in the milk ducts due to ovulation. We're not betting on anything but the hope is the later.

Tuesday January 10th she gets an echogram of her liver, intestines, stomach and kidneys to be sure that no cancer has spread there.

Next Wednesday the 11th we meet with the medical oncologist, he's the chemotherapy doctor, and we should get the results of the pathology of the tumor. At that time we should know at minimum if the cancer is:

• a 1 2 or 3 grade (1 is low relatively normal, slow-growing cells, 3 is very deformed, fast-growing cells)
• what stage the cancer is at (based on the books we're in a stage 2)
• if it is progesterone or estrogen receptive (probably genetic, will have to get the wee one tested in the future)
• they'll also measure the tumor again which impacts the stage of the spread

Then on the 19th of January is the meeting with the surgeon and we'll have a course of action.

By that time we will know if we are looking at chemo then a lumpectomy, or a radical bilateral masectomy followed by chemo, regardless they're both brutal choices.

Christmas Holidays

Well a little "r & r" for the holidays is never a bad thing.

Merry Christmas, Happy Chanukkah and seasons greetings to all. Thanks for keeping us in your thoughts and prayers.

Peace from Pace, Robear and Baby V!

The Biopsy and Christmas Parties

Pace got her biopsy on the 23rd and then got on a train with the wee one to come home for my family's Christmas gathering. She didn't want to spend the Christmas party talking about her cancer and so I relayed her wishes to my brothers and sisters.

I didn't think to tell them not to hug her too hard. That was a painful oversight.

The hospital performed 2 "punch" biopsies of the tumor to grab enough cells to grow a culture, think of a straw with a claw on the end. Then they did a needle biopsy on the left breast to see if there are precancerous growths there or not.

The results of the culture should be ready for the 5th. I don't know if we have access to them at that time or not. So for now we'll spend time over the holidays with family and friends.

The 2nd opinion

There's a line in The Matrix (movie) where the Oracle say "I hate giving good people bad news but..." I wish this was a movie.

Pace got her second opinion today and the good news is she likes the doctor and he has a great relationship with one of the best oncologists at Sunnybrook. He wants to see her have her chemo and radio therapy in T.O. as Sunnybrook is now considered the best in the land.

Then the other shoe drops. He looked at her breast MRIs and is concerned. The cancer is aggressive, it's spreading and we're facing an emergency. However until we get the results of the biopsy they can't start the chemo.

Wish I could say that's all but it's not. The original doc did not order a check of Pace's liver, intestines and stomach to see if cancer had spread there. And the hits just keep on coming. It's possible that there are two other lesions in her right beast. I'm not sure if these are the odd shape of the tumor of something new. It's hard to know the questions to ask when learning this new vocabulary.

All I can do is be there for Pace when she needs me.

Getting back on track

Well the shock and anger from Wednesday’s appointment has calmed and we're working on a multi-threaded plan with the goal of getting Pace the best care possible as soon as possible and getting her back home, in the near term, to relax and get treatment.

1. Pace is getting her biopsy on Dec 22nd and they'll grow the culture over the holidays. It should be ready the first week of January. We've asked for the slide numbers so the biopsy results can be transferred easily from lab to any hospital in QC or ON.
2. We're getting copies of all documents, tests, MRI's and x-rays into a binder we can keep with us for when Pascale finally gets things transferred to Toronto.
3. Pace has been able to get in on Wed Dec 21st to see the oncologist that's treating her aunt. Hopefully we can get the chemotherapy side of things accelerated through him.
4. We're looking for referrals to good oncology docs (surgeons, radiologists and chemo) in Toronto through the family and friends network. The hope is to get her into Princess Margaret/Mount Sinai. If you know of anyone please let us know!

We've got a serious blizzard happening in Montreal today so we'll be taking the suburban train into the city for the doctor's appointment. The radio reports roads as treacherous and impassible in places. Gotta love winter...

a slow motion train wreck

Today we expected to get the results of the tests and understand our options for surgery and chemotherapy. That was not what happened.

The doctor immediately recommended a radical mastectomy because we didn't have biopsy results that would recommend a chemotherapy treatment. We thought he'd consider chemotherapy first, which can reduce the size of the tumor before surgery. However without the biopsy he wouldn't/couldn't follow that course of treatment right now.

The short story is that the doctor never ordered a biopsy of the tumor so that the lab could grow the cancer cells and determine Pace's chemotherapy options. Because the Breast MRI has reveled two suspect areas, we'll have to get a biopsy of the left breast before any surgery on one or both breasts anyways.

This development causes the schedule to slip by 2 to 4 weeks.

Due to this oversight and a bedside manner that leaves much to be desired, Pace has asked for a second opinion and I completely support her in her decision to see another doctor.

The good news is that the cancer seems confined to the breast right now, her bones, brain and blood are cancer free.

More tests and new pain for Pace

We couldn't get all of the tests done on Friday because a clerk balked at processing Pace's radiology requests. She is not a Quebec resident, period. It didn't matter that we had the inter-provincial health claim form from the hospitals accounts payable department.

It took nurses from the ambulatory clinic to came over to her and say it was authorized. The clerk had never heard of it before and there was no way she was going to let someone have a free ride on her watch. As a result we missed the window to get the lung x-ray completed.

So back we went to the hospital today. Another half day lost for 20 minutes of tests.

They've now scheduled an EEG for Wed. morning at 8:00. It's early but people have been moving mountains to help Pace get treated.

Later Wednesday morning (Dec. 15th)we meet with the oncology surgeon. After that meeting we should know where we really stand and what Pace's options. I'm glad we're getting to that stage but the area around her tumor is starting to hurt...

Whew!

The doctors at Mt. Sinai reviewed everything. The MRI photos showed no cancerous masses nor anomalies in the brain to be concerned about. That's the good news. Then again we really don't know the reason for the mini-stroke

Bottom line is they feel the epsoide was probably a TIA but then again it could be "Neurological Event."

Either way it should not hold up the yet to be scheduled operation.

Tomorrow's a big day

We get the news from the neurosurgeons and the ambulatory clinic.

We're not sure if we want them to find something or not. Most importantly we don't want to find out the Breast Cancer has spread to her brain, nor that the mini-stroke caused any brain damage.

Whatever it is we'll be better informed to get through this battle.

The Breast MRI

Pace got to Montreal yesterday and got the Breast MRI done.

First they put in a catheter and then add a liquid that shows the cancer better in the images. She said her arm got cold as the liquid flowed from the catheter into the veins and that it left an aftertaste. Then you lie down on a platform with two cut outs where the breasts go and then you get inserted into the machine for 20 minutes of imaging

Following the MRI the staff keeps you there for a half hour to make sure you have no allergic reaction.

The Elephant in the Living Room

Why is the truth often the hardest thing to talk about.

We're wired. There's so much going on and keeping an even keel is difficult at best. Near torture at other times. We're both ignoring the spectre of death that is now so much closer than we wnat to think.

Pace is scared of how fast the tumor is growing and is afraid to talk about her possible death. I'm worried that talking about my feelings of her potential death is not providing the support she needs right now.

It's a topic we have to cover soon. Especially as we're updating our wills before the operation.

* Photo by JRAWLS