Monday, February 14, 2011

On and On You Will Hike

On and on you will hike

And I know you'll hike far
And face up to your problems
Whatever they are.

from Michael to others through email - I can't summarize it any better!!!

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Kate’s bb is having some issues, so I’m sending you a quick update.

All good news today. Dr. McCready and his assistant both reporting finding no evidence of disease. Best case scenario is that cancer is gone, though this can’t be confirmed until pathology following surgery.

They recommended full mastectomy by end of March (including removal of lymph nodes), with follow-up with Dr. two weeks later. Radiation after that. Drug therapy (tamoxifen for 5 years) following that.

Meeting with radiologist following surgery. So not much more information on that.

Port-a-cath to come out around end of February. Hospital to set that up and call with appointment.

No new tests suggested, but a CT-scan will be set up to investigate what was previous “of interest” on Kate’s liver. Doctors today not much interested in that. Likeihood is whatever was there was zapped by the chemo, but the CT-scan will confirm. If it is still there post-chemo, it may be of interest.

Kate back to PMH early Wednesday this week for final pre-chemo bloodwork and meeting with chemo oncologist (Dr. Buckman this week). Andy is going to take her.

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from Kate

Tears of gladness, and elation, and pure joy. Possible? probable? God, is it too much to ask for? We live in hope, and face up to our problems whatever they are.

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Later, below, from Michael
 
It is nearly 10 pm now, Valentine's Day. Everyone is asleep, but I want to fill in some more detail. The above is the general summary. It is good news. We are pleased. We told the kids "the cancer is gone, but there is still more."
 
Strangely, perhaps, the day began with the kids coming here before school, mad that we were away all weekend without them. Both complaining that Mummy does "nothing" all day. She is sick, I said. When you have a cold, you rest, too.
 
She doesn't have a cold, Naomi said.
 
No, she has something a lot, a lot harder, I said. But it is too much for the kids to comprehend.
 
Owen was struggling tonight with "the cancer is gone" and "there will still be surgery." The process is not over, but the risk has dropped significantly. There are things of great importance that are too subtle for the kids to understand.
 
We just said, Today is a great day. Today is a happy day. We were happy and the kids soaked up that happiness, though Naomi whacked herself once in the head and twice in the shin this evening and went to bed with a dose of headache medicine and a bandage wrapped around her leg. Went to bed beside Mummy. (She began the day responding to a Valentine's from Mummy with a note saying, "I hate you," then ended the day handing Kate a note, "I love you.") We tell her constantly that we love her and encourage her all the time to express her feelings, whatever they are. Whatever can this situation be, except confusing.
 
At the hospital today, McCready's assistant (another fabulous young doctor [and, Kate said, "very handsome"]), asked how Kate was doing. Asked how the chemo was going. Said "I'm sorry to hear that" when he was told, "It's been hard."
 
Then up Kate went onto the bed and the handsome doctor examined the area. "Congratulations," he said. "It's great to have such a good response to the chemotherapy. I don't feel anything. That's really great. I don't feel any 'disease.'"
 
He went on to say everyone responds differently to chemotherapy, and for some people it's still possible to feel some of the disease. He spoke of the need to provide Kate with the full "standard of care," which means proceeding with the mastectomy "unless you feel otherwise." Kate shook her head. Full standard of care. Take it off.
 
Discussion about risks of surgery. Standard. Infection. Lymphodema. Doctor estimated risk of lymphodema at less than 50%. If it does happen, the hospital has a lymphodema clinic.
 
Discussion about new tests. No need for MRI. What about that liver thing that came up on the CT-scan last time? Will check paperwork and raise with Dr. McCready. Will go get Dr. McCready. Five minutes later, in came the world-class specialist.
 
Dr. McCready examined Kate, in front of the handsome young doctor and another handsome young intern. "I can't find anything," he said, "though that doesn't mean there's nothing underneath." He went on to say that he wouldn't expect to find anything underneath, given that the chemo had disintegrated the larger tumours. One could expect that the smaller bits had been crushed also. But one couldn't be certain until the breast is off and the biospy is done. So no absolute confirmation until two weeks after the surgery, which McCready would like to see done before the end of March.
 
Interestingly, I thought, McCready also said some women stop the chemo after the first "D" treatment. That was the hardest for Kate, yes, but she pulled through.
 
McCready said to stick around and do the paperwork for the surgery. He said he could help arrange to have the miserable port-a-cath removed early (end of February-ish). He said he would repeat the CT-scan to check up on what's going on with the liver, though in all likelihood the chemo has probably cleared it up.
 
Discussion about when to start tamoxifen. Before surgery. After surgery. After radiation.
 
Discussion about radiation. Need to meet with radiologist after surgery to work out a plan.
 
Most likey plan is start tamoxifen following radiation, but lots of time yet to sort that out.
 
Kate to see the famous Dr. Buckman this coming Wednesday in her final pre-chemo checkup. So next steps are:
  • Feb 16 - pre-chemo bloodwork and check in
  • Feb 18 - final chemo
  • End of Feb-ish - surgery to remove porta-a-cath
  • March - CT-scan
  • March - pre-surgery bloodwork and cardiogram
  • Late-March - mastectomy
  • April - consultation with radiologist
The surgery includes one night in hospital and 7-10 days of draining ooze and nurse visits to the home. And one full breast removed. (We double-checked the paperwork today to make sure they take the right [left] one.)

Our expectation is that the radiation could go from May to August, but we don't really know.

The tamoxifen treatment lasts for five years.

We plan on being around for a lot longer than that!

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