Two Doctor Visits and a Twist in the Path

I saw two different doctors yesterday.  The first was just a follow-up with my cardiologist to see how my blood pressure was doing.  It was 136/82 which is amazing for me (I have been known to be as high as 200/110).  So he's not messing with my meds, and I don't have to see him for a year unless someone wants an echo down as part of my cancer treatment.  Then I'll go through him since I'm about due for one anyways, though he's fine for putting that off until after things settle down with the cancer.

My second appointment was with the new surgeon, Dr. Ahrendt, who also happens to be the head of the breast cancer surgery group.  I really liked her, and she was able to clear up a few things for us, and address some of our frustrations.

She was actually surprised that I hadn't seen any of the other doctors, and that my first appointment wasn't a group appointment.  Before I left, I not only had the appointment with the oncologist that I had made, but two other appointments were scheduled for me.

She also cleared up some confusion with our understanding of the pathology report.  While my first surgeon went over it briefly with us on the phone, it wasn't until my post-op appointment that it was gone over in any detail. The problem was that appointment wasn't with a doctor, but rather a Physicians Assistant, and things weren't presented correctly.  Jim and I were very honest with my Dr. Ahrendt about our concerns with how things have gone so far, and she seemed genuinely concerned that we had faced these frustrations.

So that part of the appointment went well.  Unfortunately, we did learn a bit more about why they were recommending a second surgery.  Where the PA had led us to believe that it was because UPMC wasn't following the new guidelines for margins, Dr. Ahrendt explained why those new guidelines didn't necessarily apply to my case.  We also discussed the fact that they had already taken a large amount of tissue in the first surgery, which makes a re-excision a poor option.  So we have decided to proceed with a mastectomy with immediate reconstruction.  We meet with the plastic surgeon next week and will be able to start to figure out exactly what reconstruction I will have.

At this point, I am very happy with the team of doctors that is being "assembled" for my treatment, and I am coming to terms with the fact that I have to have the more drastic surgery.

The other thing that we learned yesterday, was that even though the auxiliary lymph nodes were clear, the fact that I had an intra-mammary node with cancer isn't a good thing.  I have a feeling that between that and the fact that my HER 2 is equivocal,  I will need chemo.  We'll find out when we meet with the oncologist on Wednesday whether or not that will be before or after surgery.

With the mastectomy, it is unclear whether or not I'll still need radiation.  I will see the radiologist on the 23rd of September.

So lots going on, lots to digest, and lots still unknown.