Surgery Rescheduled

I had a video call Monday with an anesthesiology nurse. I made it clear to her that I don't want pain, and I don't want nausea. When I asked her about getting a nerve block, she said they don't do it at the South Bay location where I was scheduled to have surgery. It's a smaller cancer center in San Jose.

A few hours later I had an office visit with my surgeon and asked about getting a nerve block. She thinks it's not necessary. This may be true for some patients, but I know it's offered as an option at other hospitals for the same procedures I'm getting. Regardless, it's not offered at the South Bay center.

My surgeon wanted me to have a wire-guided localization to mark the breast area to be excised. But her nurse mentioned a newer technology called Savi Scout. From what I've read, it may or may not be more accurate, and it may or may not improve the odds of getting clear margins. It does have the advantage of not getting accidentally dislodged. It also eliminates having an uncomfortable wire sticking out of the breast for possibly hours before surgery begins. I asked my surgeon if I could switch to Savi Scout, and she agreed.

Then I asked about Lumicell. It's an imaging system that highlights tumor margins. Like Savi Scout, it improves the chance of getting clear margins. If I don't get clear margins, I will need a second surgery, and I absolutely do not want to undergo surgery again. 

It's not clear to me if I'm a candidate for Lumicell. But the surgeon said I can't have it because it's done only at the Palo Alto location. At this point she stated that because I wanted the surgery on April 6, it limits me to the South Bay location. I told her that wasn't true, that I didn't request April 6. She abruptly left, presumable to find the coordinator and reschedule my surgery. I later found out from her nurse that she prefers the Palo Alto location because it's a bigger facility with more resources.

My new surgery is date is April 14. This works out better for me because I have my second covid shot scheduled for April 11 and my next infusion for April 12. On April 13 I'll have two pre-op procedures, the Savi Scout and radioactive tracer. I will also need another very unpleasant covid test.

Another plus is that the new date gives me more time to visit with my sister and nephew who are in town to visit my dad. They won't be out of quarantine till Friday and will fly back on April 10. With my original surgery date, I would have had only three days to see them.

Surgery Second Opinion

I had a video call on Wednesday with Dr. Wong at UCSF. She recommended lumpectomy and sentinel lymph node biopsy followed by radiation. No surprises there. I was already resigned to having surgery and let Stanford know. My surgery is scheduled for April 6. 

Monday was my sixth infusion of Herceptin and Perjeta. I will get 18 infusions total.

Radiologist + Vaccine

Had a video call Wednesday with a radiologist, Dr. Salem. Most of the time was spent with the resident radiologist, Dr. Wang. The recommendation will likely be 3-5 weeks of daily radiation depending on the pathology after surgery. I will have another appointment two weeks after surgery.

I became eligible for the covid vaccine on Monday. Because of the vaccine shortage, I could not find appointments Monday and Tuesday. On Wednesday I tried looking in San Francisco and managed to get an appointment today at Moscone.

My friend Dhez joined me on the drive to SF. I didn't mind the company because driving in SF, especially downtown, stresses me out. Parking in the garage was also stressful because the parking spaces were so narrow. I drove past several available spaces till I could find one that was a bit roomier next to a partial wall.

There were hundreds of people at Moscone, but they were pretty good about keeping their distance, and the process went smoothly. The vaccine was from Pfizer. I had to sit down for 15 minutes after my shot in case of adverse reactions. From the time I entered till the time I left the building was 35 minutes.

Dhez and I ordered lunch to go and ate it at a nearby park. It was a nice and sunny day. There were lots of people out and about in SF. Too many, in fact, considering there's a pandemic. Most folks wore masks, but not all.

My arm is sore. My second shot is due in three weeks, on April 11.

Muscle Pain

The fatigue caused by my chemo is pretty much gone. I can walk up the stairs without trouble. But I noticed pain in my thighs and also in my arms. It was puzzling since I haven't been working out. I finally looked it up. Muscle pain can be a side effect of Perjeta. Either that or I have covid.

The pain is not too bad. It hurts only when I move. I try not to move.

I saw the surgeon again last Monday. She's recommending a lumpectomy. She will also have to do a sentinel lymph node biopsy. That means I will have two incisions. 

If I don't have clear margins, meaning if pathology finds cancer cells around the rim of the tissue that's removed during surgery, I will need a second surgery, and it might have to be a mastectomy. I don't want a second surgery. I don't even want a first surgery.

I managed to get an appointment at UCSF on March 24 for a second opinion. The doctor I wanted to see is not available till late April, so I settled for another doctor who trained under her.

Tumor Gone

I had an MRI, mammogram and ultrasound this week. The tests show that the tumor is gone. There is calcification and/or possibly DCIS (pre-cancer) where the tumor used to be. 

My oncologist thinks I should have surgery. There could be cancer cells remaining that the tests are not sensitive enough to catch. We didn't even discuss radiation, which like surgery, I'm hoping to avoid.

I see my breast surgeon again on Monday. She will probably recommend at least a lumpectomy followed by radiation. Both the surgery and radiation are supposed to get rid of the microscopic cancer cells, but it's not 100% guaranteed.

This afternoon I called UCSF to get a second opinion from a breast surgeon who is studying whether women are being overtreated. It will take them a couple of days to review my case, then they'll call me to set an appointment. 

When I went for my MRI on Tuesday, I thought they'd be able to use my port for the contrast dye, but they could not because I had to lie face down during the test. The nurse inserted a needle in my left arm but could not get past the valve in my vein. She tried my right arm. Same problem. Third time's the charm. She switched to a smaller butterfly needle and successfully started the IV using my hand. I thought it would really hurt but was no worse than using my arm.

Because I thought they would use my port, I applied EMLA cream to numb it up and covered it with a bandage called Tegaderm. When I removed the Tegaderm later, some of my skin came off with it. Ouch. It really stung for a couple of days. I had never had a problem with Tegaderm before. Maybe my skin came off because it has gotten so thin and dry, and I used Tegaderm two days in a row.  I'll have to remember to let the nurses know next time I go for an infusion. They also use Tegaderm on my port during my infusion, and there is another type of bandage they can use for those who are sensitive to Tegaderm.

Infusion Without Chemo

Monday I got Herceptin and Perjeta. It was the first time I got the two targeted therapy drugs by themselves without a chemo drug, so I'm just now learning what side effects they'll give me without chemo. Looks like Perjeta gives me diarrhea. I'm not looking forward to getting diarrhea every three weeks till December.

My potassium was still low on Monday, so my oncologist told me to take 40 mg of potassium pills twice a day until today when I got tested again. It's now back to normal. However, she said to take a dose every time diarrhea starts.

My WBC is also back to normal. I'll feel safer going to the farmers' market and Trader Joe's. I've been avoiding both places and all other stores.

I had been taking Prilosec for heartburn. The 14-day course ended on Monday. On Wednesday the heartburn came back. Doc said to keep taking Prilosec daily for three months. That's how long it typically takes the body to recover from the damage done to the stomach by chemo.