Final Fill, six month cancer check, Surgery Scheduled!

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A couple of weeks ago I had my final fill.  The surgeon over-fills the expanders, so that the final implants can lay properly and are not projecting like rockets from your chest.  The final fill was uneventful, and I’ve experienced some soreness and ill-fitting clothing ever since.  I’ve also been ridiculously tired, but I’m been tired since I came out of the first surgeries.  We schedule my implant surgery and possible fat-grafting for the end of May.

A week ago, I met with my cancer prevention nurse for my six month check.  I had my hour long internal and external pelvic ultrasound, CA-125 blood test and talked about the last six months with the nurse.  The results of my ultrasound were normal and my CA-125 was within range.  The nurse also went over the new guidelines with me.  I now will have a full body exam by a dermatologist to check for melanoma, annually.  The last thing we discussed was oophorectomy.  I still plan on surgery, but closer to age 40, so long as all of my tests continue to be normal.  New research suggests that the origin of ovarian cancer is actually the distal end of the fallopian tubes, so some surgeons are beginning to perform salpingectomies around age 35, or at the end of child-bearing, followed by oophorectomy at or after menopause.  I think this is a good option for me, but just not quite yet.

A couple of days ago I went in for my pre-op physical.  This was the same as the previous pre-op physical.  Blood draw revealed my hemoglobin to be at 8.7, which explains my extreme fatigue.  I need to get my iron up for surgery, so I have to take iron and another blood test in two weeks.  I really hope I can get the level up in time for surgery!  The doctor was quite concerned that we don’t know why I’m anemic, and after I get through surgery we will have to investigate that further.  *sigh*

Screening #2 Breast MRI

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Fall of 2014, and six months had passed since the mammogram, just as I was starting to forget all about that, I had my anxiety ramp right back up to where it was in anticipation of visiting with my cancer prevention nurse, and having my next six month screenings.  I had to block out a whole day and take sick leave to fit in all of the appointments.  First a pelvic ultrasound, just like any other pelvic ultrasound, they squirt warm goo onto your tummy and press the deodorant-stick shaped wand around your lower abdomen, clicking the buttons on a keyboard to take images and measurements.  Then, they jab the other wand up inside of you to take more images and measurements from the inside.  That was probably a half an hour appointment in one part of the hospital.

Next, I had my first breast MRI, this takes place in the radiology part of the hospital.  This appointment probably lasted about an hour or so.  First, you get to put on one of those awkward, pink gowns that barely reach down to your belly button, open to the front, of course.  Then you sit and wait until someone comes and gets you, people are walking through the hallway where you sit, awkwardly, at least in the hospital where I had this procedure done.  After being called into the room, and asked all the verification questions and if I had any questions or concerns, a technician puts an IV catheter into your arm.  They flush it with a little bit of saline to confirm placement, and you can kind of smell and taste it happen.  I don’t know why, but this happens every time I get an IV placed.  After the IV is secured, you lay on the table that will slide into the MRI machine.  This table supports the lower half of your body, while allowing your breasts to fall down into an open space.  The top half of your body is uncomfortably secured by a solid bar that supports you by your breast bone.  The technician gives you headphones and allows you to choose a radio station.  It never fails that whatever station I choose in an MRI, I will spend half of the time listening to commercials.  The technician also communicates with you through the headphones and will give you a call button to press in case you need anything.  After the table is slid into the machine, it begins making several series of clicks and thumping sounds while taking images, periodically, the technician will call into you to say, for instance, ‘This next series will take 3 minutes, please hold still.’  So during that time, you are trying your best not to move, despite the act of breathing pressing your chest up on the bar where your breast bone lies.  After all of the images are captured, they inject contrast dye into the IV and take a second set of images.  FYI, it was freezing in there, and that little gown doesn’t keep you warm.  In the future, I will ask if they can cover my body with a blanket.

When the MRI was complete, I headed to the Breast Center to meet with my cancer prevention nurse.  We discussed my health and what has transpired over the last 6 months.  She looked for updates of my medical record to see if the results were up yet from earlier in the day, but they were not.  She also performed a clinical breast exam.  A few weeks before this appointment, I had swollen lymph nodes in my right axilla, and a warm, red spot.  I had emailed the clinic and they said not to worry.  During the exam, however, my nurse felt some abnormalities in my right breast.  She said we would wait to see what the results of the MRI showed.  More waiting on pins and needles.

Lastly, I was sent for the CA-125 blood test.  Just another normal blood draw, as usual.

Red, swollen skin surface right axilla lymph nodes

Red, swollen skin surface right axilla lymph nodes

SCREENINGS?

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Understanding that my risks for cancer are increased with my BRCA mutation, I have met several times with what I like to call my Cancer Prevention Team.  This consists of my genetic counselor, who advised me about genetic testing and gave me my results; my cancer prevention nurse, who coordinates all of my screenings; and all other providers that are now involved in preventing any future cancer.

So, what exactly are these screenings?

Every six months I meet with my awesome cancer prevention nurse, at The Breast Center, at the University of Minnesota.  Together, we go over my health for the last 6 months, she performs a clinical breast exam and she sends me to the lab for a CA-125 to check for tumor biomarkers that could indicate ovarian cancer.  I then go to a clinic for a transvaginal ultrasound to check my ovaries.  Lastly, I go for breast imaging.  I switch between a mammogram, where my breast get squished in both directions, and a breast MRI where an IV is inserted into my arm and contrast medium is injected into my veins to create contrasted images of my breast tissue.

More information on CA-125: http://www.mayoclinic.org/tests-procedures/ca-125-test/basics/why-its-done/prc-20009524

Mammogram: http://www.mayoclinic.org/tests-procedures/mammogram/basics/definition/prc-20012723

Breast MRI: http://www.mayoclinic.org/tests-procedures/breast-mri/basics/definition/prc-20020473