Really? Seriously?

A few years ago fellow commuters found my car irresistible and insisted on rear ending me (three times).  One time I had to have my car towed from the scene.  When the AAA driver arrived to assist, much like a doctor's office checks for insurance coverage, he asked for my card and called it in.  Of course I was current.  Giving it back he indicated that it was the first card he'd seen that had 'a member since 1979'. That card came in handy more than a few times since 1979.

Today I had a follow up visit with Dr. Mehta.  He had referred me to Dr. Goff (radiologist) and asked if I received answers to my questions. I brought Dr. Mehta up to speed.  I said that I wanted stay clear of the radiation and was mentally prepared for the mastectomy approach to treatment. I also mentioned that I had a check-in with Dr. Moore to discuss options for reconstructive surgery, who in turn referred me to Dr. Chatson.

Explaining what was discussed and the information I learned, I was strongly leaning toward mastectomy, reconstruction, reduction and tamoxifen.  Dr. Mehta recapped the 'general trend' to perform a lumpectomy with radiation but was totally understanding and supportive of my (current) preference for treatment.  I did mention about my concern about the insurance paying for the reduction.  And he, like others stated that for cancer, it's fairly common that other treatments are covered since we all have a self image that is an important factor in determining the best route to an acceptable end.

Dr. Mehta then looked at his file and said that both CT and bone scans came back favorable (no other cancers happening).  I knew this, but it was nice to hear again.  He then paused and said, however, "I've found something else".  I know that Dr. Goff had mentioned that some 'smears' showed up in the CT scan in the lungs and sliver of collapsed lung, so I was eager to hear more about this. But he said that I had an abdominal aortic aneurysm - referred to as Triple A.  What?  Really? Seriously?

Apparently it's more than 5 cm long (he gave other dimensions).  Anything that large needs to be taken care of right away.  It would be up to a vascular surgeon to determine if AAA repair should be done before the mastectomy or if can it wait. So he said that he would schedule an appointment with Dr. Pare.

Shocked by this, my mind had millions of questions circling.   Are there symptoms?  Sometimes. What can happen?  90% chance of death before getting to the hospital.  WHAT?????

Dr. Mehta said he would call my primary care and also make an appointment with Dr. Pare.

Got home and did some research.

Abdominal aortic aneurysm facts

• An aneurysm is an abnormal area of localized widening of a blood vessel.
• The aorta bulges at the site of an aneurysm like a weak spot on a worn tire.
• Aortic aneurysms are typically spindle-shaped and involve the aorta below the arteries to the kidneys.
• The most common cause of an aneurysm is arteriosclerosis.Smoking is a major risk factor.
• Abdominal aortic aneurysms often do not cause symptoms. If they do, they may cause deep boring pain in the lower back or flank. Prominent abdominal pulsations may be present.
• X-rays of the abdomen and other radiologic tests including ultrasound, CT, and MRI may be used in diagnosing and monitoring the aneurysm.
• Rupture of an aortic aneurysm is a catastrophe. (you think?)
• Repair of the aneurysm can be done by surgery or endovascular stenting.

I received a call from my Dr. Mehta's office saying that Dr. Pare's appointment was canceled and Dr. Rees (my primary) will be contacting me.

More to come.  

[Post script:  It's ironic that this cancer may have saved my life.]

Consultation with the plastic surgeon

Outside of rush hour traffic and barring rain, snow, accident and pot hole paving, I thought leaving at 1:10 PM should be enough time to get to Andover from Boston.  However, it dawned on me as I started seeing strategically placed police cars and motorcycles, that President Obama was in town.

Most of the presidential activity was going to take place at JFK/UMass, but you can never tell if the entourage might want to take a jaunt up route 93 to take advantage of the Khol's 30% off sale.  Luckily for me I got ahead of them, save the few 'creeping moses' drivers who seem to appear out of nowhere.

I did make it to Dr. Chatson's office at 2PM just in time to fill out three pages of paperwork.  Yup, all the same questions again. [Still trying to catch me in a lie.] After submitting my pop quiz, it was pointed out that I didn't have the complete telephone number for my primary care doctor.  Certainly, "I'll get that".  Taking out my phone to Google him, I was reminded that cell phones were prohibited.  Mea maxima culpa! I did know most of the number, but the last four had threes, eights or sevens.  Well she looked it up and sure 'nuff last four were 3877. Success!  I was let into the holy of holies where I was told to sit and wait.  Not too long after, a physician's assistant (Kelly) came and took my vitals.  Afterwhich, I was told to wait for the doctor.

Dr. Chatson rapped on the door and entered, introduced himself and proceeded to ask about my story.  He seemed very engaged.  First impressions: nice guy.

In general terms he began describing the types of reconstructive surgery but stopped short and said every option/patient was unique.  He then asked me to bare my chest and asked some questions as he was pressing, poking and gently pinching.  He asked me to stand in front of a mirror with him beside me.  He had a look of an artist versus a doctor.  He was quiet for a few moments then suggested we sit down to discuss the options 'as he saw it'. What he said after was very interesting.

Dr. Chatson envisioned the treatment to be multi-phased.  First, given my strong feeling not to have radiation, he said Dr. Moore would perform the mastectomy, but Dr. Chatson suggested that he assist.  He said Dr. Moore would need to remove what he needed to, but knowing what he (Chatson) needed to be left (not compromising or endangering me to further cancer related surgery) he thought that he would be able to 'set up' the next surgery.

Second, after the drain is removed and mastectomy is healed, suggested that I undergo a 'fat graft'.  Explained to me, it was like taking existing fat from my abdomen or sides (I new it would come in handy one day) sucked out and relocated to depressions caused by the mastectomy.

He said it didn't make sense to reconstruct the left breast to look like the right.  [Let's face it- I've never had a chiseled chest] At the same time, he said that he would perform a breast reduction on my right side and use some of the fat cells for the left to create symmetry.

My vain monitor went off.  It sounded like I could end up having both sides look better than today.  My question:  Since this would be the second surgery, wouldn't it be perceived as being cosmetic by the insurance company?  He thought not, but offered to write up the whole plan for Harvard Pilgrim.  He said (generally) when cancer is involved, these types of surgeries are covered.  He took some pictures (for his write up) and said he would get back to me and hopefully the insurance would cover it.

He anticipated my next question and provided a book of before and after photos of his actual patients.  Amazing. He is an artist.

Not that I relished the thought of multiple surgeries, but the end results appear to meet all the needs: mastectomy and reconstruction (both breasts for symmetry).

What a difference a day makes.  I really liked Dr. Chatson.  This appointment has made me rethink this whole thing.

I have a follow-up meeting with Dr. Mehta tomorrow.  Let's see if the genetic test results are back and what that information will do to my thinking.

Check-in with Doctor Moore

Since my last entry I had lots of time to do more research both online and in talking with family, friends and friends of friends.  As of yesterday (last evening in fact) I felt very strongly about not going lumpectomy and radiation route.  Although that small print 'it depends' is ever-present and never is left out when weighing all the options I had some questions queued up for Dr. Moore.

Given the close proximity of the cancer to my nipple, the likelihood of my losing it during a lumpectomy is high.  Not liking the radiation route eliminated the lumpectomy out of the gate. So the other option was a mastectomy (small print: provided there are clean edges and no cancer is found elsewhere no radiation, but there was still a possibility of radiation and worst case chemo - but unlikely).  A mastectomy would be disfiguring and it was my understanding that a reconstruction portion would be part of the treatment. So I was most interested in the reconstructive options.

Here's what I learned from today's conversation.

Reconstructive surgery can sometimes be undertaken during the mastectomy surgery.  However, the course of action can't be finalized until the surgeon sees the end product (mastectomy).  There are other sets of options to consider when reconstructing.  Depending on how much tissue is removed and how much is left, a skin flap can be 'made' into a nub/nipple.  There could be other options available, but it would mean a second and possibly third surgery. Apparently the discussion turned to plastic surgery to which Dr. Moore suggested that I consult a specialist in male breast reconstruction.

Information is a good thing.  So I agreed to seek yet another consultation.  Dr. Moore said he knew a few really good ones (Dr. Chatson being his first choice) but he would have to see who was available for consult  - sooner than later. We ended our call so he could make a few calls.

About a half hour later, I received a call from Dr. Moore's office asking if I could go to Dr. Chatson's office today at 2PM.  It was almost noon, but reviewing my calendar I was able to juggle some appointment and committed to the appointment.

Radiologist Consultation

Arrived at Holy Family - Methuen for my appointment with Dr. Goff, Oncology Radiologist.  I was just there a few days before, but the entire first floor was vacant.  Signage indicated that construction was in progress and various units/doctors had been relocated to other floors.

On the ground floor (which to me was down from the floor I came in - go figure), I checked in with the receptionist.  They had my folder - yay! I had to sign an authorization to bill my insurance and was told to sit and wait.

Not too long afterwards, Kelly called me and accompanied me to the examination room.  After checking my vitals she asked a few questions from her paperwork that apparently had no recorded answers.  Same types of questions I've been asked many times.  [Are they trying to catch me in a lie?]  She completed her tasks and told me the doctor would be with me in about 15 minutes.  Hmmm, that didn't bode well.  So precise.  She could have said shortly or in a few, but 15 minutes?

About an hour later Dr. Goff came in to the examination room.  [No apologies for his tardiness].  He did say that he was reviewing my chart and began to tell me as if to verify that he got things right. He asked me to explain how I discovered the mass.  After which he began to tell me that he received the results of my CT scan and Bone scan.

The bone scan was favorable - meaning no cancer was detected.  Although it was unlikely, the scan would have picked up metastasized cancer if it had spread to the bones. So they found NADA - NONE!

The CT scan was also favorable, but he did see some things in the lung.  They were inflammatory NOT CANCEROUS.  Asking what inflammatory meant, Dr. Goff said they were 'smears', possible remnants of a cold or bronchitis, but a few areas - very small.  He also said that at the bottom of one of my lungs he noticed a 'sliver' of a collapsed lung - very small, he reiterated.  I asked if I should be concerned and he said no.  [Really, why even mention it?]  Dr. Goff said he's not a surgeon and that Dr. Mehta will go over the results when I meet with him on the 31st.

Discussing the options for treatment, he did say that the lumpectomy would be accompanied by  radiation.  If that was the chosen path, he said after the surgery healed (about 3 weeks or so), radiation would start.  The initial visit is the 'set-up' where all the angles are determined.  The first treatment taking about an hour is a heavier blast (like a shock) and subsequent doses take about 15-20 minutes, for 5 1/2 weeks then an additional week of higher doses. He said there is burning (like a sunburn) and sometime blistering and peeling.  These symptoms are treated with a cortisone cream and another (don't remember) to relieve the burning.  Depending on the patient and pain, he sometimes prescribes percocet. [Not liking this].

I asked about risk from radiation exposure causing aortic cancer and he said that based on my age, the risk is low since that type of cancer takes many years to develop - if at all.  Also, the 'set-up' defines the angles to ensure the radiation is diverted away from major organs. He did say that a small portion of the lung would be exposed to this, but for the same reasons the risk is low.

He did say that a mastectomy will negate this completely - unless there were cancer cells found in the lymph node(s).  And depending on how many nodes, chemo may come into play.

Funny how simple words like: unless; but; if; and it depends can through a monkey wrench into the works.

Informative? Yes.  Some good news? Yes. More questions? You bet.

Holy Family - Scans

Congratulations Boston, you broke the record for the 'snowiest winter in recorded history'.  Now can all the prayer circles start focusing on things that matter?

Had about three inches of that rare precipitation on Sunday.  Of course the shoveling I did only made things worse because it left a sheen of black ice in its wake.  Cleaning off my car this morning I almost fell.  At one point I had the awful thought that I would slip and fall by losing traction on the ice around the perimeter of the car resulting in a broken something.  Thankfully that didn't happen.

I arrived at Holy Family about 15 minutes early for my CT scan and was given the obligatory paperwork to complete.  Really?  There was nothing asked that I hadn't already provided answers.  As I was completing the double sided form, a medical professional approached me with two capped styrofoam cups.  Quizzically, I asked what they were for.  Apparently  I needed to drink these 'contrasts' to help define the images.  [Thinking 'images' referred to the CT scan].  I was told that I needed to drink one and a half and save the last half before the scan.  In addition, I needed to have some dye injected.  Lovely.  I was given a one sheet of info on what I'd be drinking and the 'side effects' [of course].  Got right to work drinking.  Really didn't taste bad.

I was called by a different professional and led through the labyrinth to a small room with annoying flickering lights.  She said, "It's been reported many times".  Apparently it's the best they could do to remedy the annoyance.  I was asked if I ever had a reaction to iodine.  I replied that I don't recall ever having any iodine so I didn't know.  She said that she was going to give me a shunt for the injection of Iodine and later for the saline and another drug (can't remember the name) that will be used for the bone scan.  I had forgotten that I had both tests scheduled for today.  Whatever.

I got my fix of Iodine and was sent back the waiting room where I needed to wait for a few hours.  I guess the iodine and 'contrast' needed to work themselves through my system. 

There was no Internet or phone signal in that part of the hospital.  My one-sheeter indicated that it was a good idea to get up and move around.  So I took the opportunity to head outside for a signal, catch up on some email and make a few calls since these tests were going to take longer than I thought.  Also, the 'contrast' was most likely going to give me diarrhea.  Not something you want to deal with in Boston traffic. So I wanted work to know I wouldn't be in today.

Got back to the waiting room and around 11 AM,  I was called for the CT scan.  The technician placed me on the cradle and told me she was going to give me saline.  Just before the scan she gave me something she said may make me feel hot and may make me feel like I'm urinating, but I won't.  WHAT?  [How could I tell if I was or wasn't?]  Then she said not to move.  [So if I think I'm wetting myself I can't even check to see if it's real or not?]

The injection did make me feel warm and I could feel it spread through my body.  Thankfully I didn't have the urination sensation.  The scan went fast - which surprised me. I was told to grab something to eat in the cafeteria or Dunkins and be back just before noon.

By this time nature was calling.  I'll leave it at that.

Made it to the main entrance and couldn't find the cafeteria, but Dunkins was there so I had a breakfast sandwich, caught up on some email and texts and made it back to waiting room on time.

Around 12:30, I was called.  I followed the technician through what seemed like a big circle but eventually I found the scanner.  It took up the whole room.  She instructed me to lay in the cradle and gave me pillows.  She asked if I was claustrophobic.  Replying no, she said that the camera is very close and moves very slow.  "Breath regularly, but don't move', she instructed.

The 'slab' moved into place.  It did feel like I was in a coffin.  Very confining.  Tried to relax and concentrated on not moving.  I didn't realize it at first but the slab was slowly moving away from the camera.  It seemed to take about a half hour.  As I got further  away from the camera, I could see I my peripheral vision that the machine was displaying images on a small screen to my left. I couldn't turn my head so I couldn't make out too much other than a form.  Must be me, I thought.

Finally the machine stopped.  She came back in and made a few adjustments to the scanned then said she was going to scan the chest area.  Thankfully this didn't take as long.  Then she came in and said, "You are all done.'  Great.  [Just in time. My stomach gurgled.]

Since being home, nature has been calling.

They are sadists I tell you.

Follow-up with Doctor Moore

Isn't it weird when sometime you are thinking about calling someone, when they call you?

After my consultation with Dr. Mehta, I was thinking about touching base with Dr. Moore.  I called his office on the way to work Thursday morning and his answering service said the office opens at 9 AM.  It was very busy at work so I didn't get a chance to call him during business hours. However, when I got home, there was a message from him to give him a call.

I called Dr. Moore today and we chatted a bit.  Having gone through my recent crash course in biology and cancer treatment I was able (at least I thought) to articulate and participate in high level discussions about what I've learned, my options and my immediate concerns: vanity; radiation; and long-term regimen of taking a drug with concerning side effects.

I did tell him that Dr. Mehta had scheduled an appointment with the radiologist and a number of tests that I thought may prove quite useful in helping me make an informed decision.  Dr. Moore agreed with Dr. Metha's requests for the genetic (panel) test, CT and Bone scans and said all will assist him (if I select him) in his approach to treatment/surgery.

In our discussion, he did say the word 'reconstruction' which I keyed in on.  Of course human vanity would pick up on that.  "Doctor, you said reconstruction surgery, what would that entail and is it separate?"

Dr. Moore said that reconstruction surgery is very common and could be part of the surgery.  He said he's never heard of insurance not paying for it (probably because it all happens at the same time). He said that after the tissue is removed, the skin flaps are reattached and he forms a divot.  He said he could elaborate more after the test results come in and he has the best approach for treatment. He asked me to call him after I see Dr. Mehta on the 31st.

So I'm leaning toward a mastectomy with reconstructive surgery with no radiation.  Of course there are assumptions involved.

I'm getting my questions ready for Dr. Inglehart at Dana Farber.

Holy Family - Consultation # 3

What a difference a day makes.  Today started out very foggy, but ended up being warm (60 degrees) and sunny.  Lots of melting.  Uplifting!

Had an appointment with Dr. Mehta the Oncologist referred by Dr. Moore. Operationally, Dana Farber has it all over Holy Family.  When I checked in they couldn't find my name.  Found that odd. 

[Later found that I had a message left at 9:45 AM on my house voice mail indicating that Dr. Mehta had an emergency and they wanted to reschedule.  My appointment was 9:30.  I was there at 8:50.  Why call me at home after my appointment start time?]

I waited quite a long time before being called to register.  The registration process was typical and didn't take too long.  I was told to sit and I would be called.  It took almost a half hour before I was called to the examination room.  Jasmine took my vitals and had me wait for the doctor. Finally at 11, Dr. Mehta arrived.  He did apologize for his being late, but it didn't come across as being genuine.

When we finally got to business, I was hearing many of the same things I heard at Dana Farber: two options - lumpectomy or mastectomy.  The sentinel node was also explained, but things began to differ after this.


The lumpectomy 'could' spare the nipple and 'after time' the surgery will look like a small scar with depression.  However, the surgery would be done by Dr. Moore and I would need to talk to him about his being able to 'spare' the nipple.  Also, Dr. Mehta did say that 6 weeks of radiation and 5 - 10 years of Tamoxifen accompanied this option.  When I asked about the side effects of radiation, he said that white cell count goes down making one tired, explained the sunburn-like skin and the need to come five days a week for radiation treatments.  When I asked about the risk of radiation damaging my heart or causing aortic cancer.  He said they were able to deflect the radiation form major organs.  He said that he wanted me to talk to the radiologist.

The mastectomy option was the same as what I heard.  This too required  an extended need for Tamoxifen.

Dr. Mehta was pleased to hear that the BRAC tests came back negative.  He did say the he was going to order a different kind of genetic testing (he didn't say panel test as Dr Overmoyer discussed but it sounded the same).  In addition, he wants a CT scan and a Bone scan.  Apparently the CT scan on the upper torso can identify any cancerous activity/areas.  The bone scan can detect types of bone cancer.  Between the genetic testing, CT scan and Bone scan, he can have a better idea on how to treat any and all cancer and/or risks.So I now have three appointments scheduled with a follow-up with Dr. Mehta on 3/31.

Knowledge IS a dangerous thing.  I'm learning the more I know, the more I don't know.  I can't find fault with wanting more tests.  There's some solace in knowing this could be the only cancer, but knowing if there are other types or places where cancer might be planning an attack - (to me) is a good strategy.

Yesterday I was leaning toward one type of treatment, but I now need to know more.  I'm glad it's stage one and slow growing.  I do have time, but the suspense is crushing.

Dana Farber - Consultation # 2

 Les and I were discussing what we heard and looking at her notes when Dr. Overmoyer, an Oncologist at Dana Farber came in accompanied by a visiting professor from Italy.  The doctor asked if the professor could be present, to which I gladly obliged.

Doctor Overmoyer introduced herself to us and we did the same.  She had said that she talked with Dr. Inglehart, the surgeon and she had a good understanding of what we were dealing with.  She repeated facts for validation then began to explain what the interpretations of the images, medical files and initial look at the pathology meant to her.  She took a sheet of paper and as she spoke she illustrated various pieces of information.

From my understanding (which she said I had it), the cells withing the breast (both males and females) have structures (if I were a woman they would be for breast milk).  For men these structures are not needed and as cells divide and are not needed they are supposed to die off.  However they are not and they are 'growing' because the cancer I have is estrogen fed.  Estrogen receptors tell the cells to multiply.  However, there are other receptors that are correctly shut off so the cancer is slow growing.  But until the tumor itself can be sent through pathology she doesn't know if there is a rogue cell or mutate gene that causes those cells to grow faster.  If those cells grow faster they can be (released) from the (structure) cell and get into the blood.  Generally the blood is toxic to these cells and they are eventually excreted.  But if they stick or stick to nodes or organs, they can metastasize.

She said she'd be interested in the BRAC results, but thinks they might be negative (which is a good thing). [Update 3/10 afternoon - Dr Moore's office called and said these tests came back negative.  I have no BRAC gene mutation]

Once the cancer is out she needs to ensure that any other dormant cells can't be fed by estrogen.  So she said that I would need to take Tamoxifen (hormone therapy) daily for 10 years.  She did say that there is a risk for blood clots.  But she also said that that could be mitigated.  I could also elect not to take it if the risks were too great, but she said that the estrogen could cause a tumor in the other breast.  She did not recommend a double mastectomy.

Something she said gave me pause.  She asked how long I was taking spironolactone.  The strange thing is my primary care physician prescribed that a little more than a year ago.  She said that drug has been known to cause increased cell growth in men.  (I did look up the side effects and did see that: Gynecomastia (enlarged breast tissue) in men, and breast pain in women.).  She did say the she was going to reach out to him and swap it off for something else.  [It definitely makes you wonder].

Dana Farber - Consultation # 1

After checking and registering with Isaiah as well as other various check in points within Dana Farber, Leslie and I were in the waiting room waiting to be called.  Leslie had made a banana bread using ma's recipe.  While we waited we noshed and chatted.  We found humor in one of the forms I needed to complete and apparently there were people there who had similar sounding names as us.  There were a number of time I thought I was called only to find out it wasn't for me.  Of course when the did call me I didn't hear it until they spelled out my last name.  How did we not hear it the first time?

Leslie came in with me and we spoke with a woman who explained a voluntary program where my information could be used for the greater good.  I'm all for that.  Sign me up.

Not too long after, Dr. Inglehart arrived and we chatted for some time just to validate what he read and understood so far.  He did examine me.  Leslie decided it was a good time to visit the ladies room.

Les just got back when he started talking about options.  He did say that it was small a bit more than a centimeter.  He thought barring some remote findings that this could be 'cured' with one surgery.  There was a chance that the sentinel node might have cancer, but that couldn't be determined until a test can be run immediately before the surgery.  I suppose there will always be some unknown in the mix.  Initially it sounded like I had two options:
1. Mastectomy - remove the nipple, aureola, tumor, test sentinel node and determine if a subsequent surgery is needed after first is healed.
2. Lumpectomy and radiation - the position of the tumor is very close to the nipple. He thought that removing the tumor will necessitate cutting through the nipple/aureola area.  If not removed it would be discolored and misshapen.  The radiation would happen daily for six weeks.

The downside to #1 is vanity. 
Not that I take off my shirt in public, but in the summer at a pool this might become difficult to deal with.

• The uptick - this is the easiest treatment and easiest to recover from.  Other than a drain for a week or so, the healing is relatively fast - and we are done. (almost)

The downside to #2 is the affects of radiation. 
Long term exposure is like a bad sunburn. The skin gets leathery and radiation is draining.  The doctor says after six weeks of everyday dosage - your pretty much done with that.  He said the other symptoms are permanent hair loss in the at area (not that I have much there) and high risk of aortic cancer because it's on the left side and the heart is so close.  Given the history of heart disease in the family that risk scares me.  In addition, to remove the tumor so close to the nipple, the nipple won't look much like a normal nipple anymore.  (Another reason to keep the shirt on). 

• I can't see the uptick to this (at this writing)

Dr. Inglehart said that my cancer is stage 1 and completely curable.  I just need to know which options to take for treatment.  He did discuss some of the other 'things' that could come into play. How the sentinel lymph node (test) could be good (meaning there's no cancer) or bad (meaning more surgery is needed to remove more nodes after the first surgery is healed.  He did go on to say that both surgeries are fairly common and could be dome closer to home if I chose.

He gave me the number to his assistant who would schedule the surgery if I decided to have this done at Dana Farber.

My Little Sister

My little sister, Leslie has the family moniker of 'blabber fingers'.  She's the back room operations of the family and has coordinated many 'sib' (sibling) get-togethers.  Les got the blabber fingers name as a result of her blabbing some family news to the rest of the sibs (siblings and significant others).  Of course this name of endearment garnered her place as the Rhonna Barrett of the family - in a very nice way ;-) We all thank Leslie for keeping us all informed.

Once I heard about my diagnosis, I really didn't care who knew.  Not that I was looking for sympathy, but didn't want to make anyone feel uncomfortable and there could be chance that someone knows someone who knows someone that has kicked this using alternative treatment...or whatever.  Needless to say, I could remember who I told and how much.  I do know that I blasted out a short announcement to most - I've been diagnosed with cancer.  I'll keep you posted.  Kind of cruel as I think of it after the fact especially if I never followed up.  This is the primary reason for my starting this blog.  If I keep it updated, those that care to know more will have the latest.Anyway, I digress.

Because I failed to properly get back to many people, many resorted to reaching out to one another.  Well I spoke with my two brothers, my older sister, but didn't get back to Leslie or Chris (my younger brother).  Well the grapevine, thankfully was very strong cause many knew more than what I provided.  Leslie did call me a number of times, but she retires early and screens her calls.  As a result we never connected with a conversation.  Leslie was kind enough to send me a few emails and graciously offered to accompany me to Dana Farber.  I took her up on the offer.  She would be good company.  I'd get her up to speed and she could take notes and/or hear things I failed to (under the circumstances).  She took the day off from work.  I offered to drive to Boston (since it's a daily chore for me) to which she was happy.  So at 5:30 AM under the cloak of darkness we trekked into Boston and made it there in about an hour and a half.  Not bad at all for a Boston commute on a work day.  The weather turned out wonderful. The GPS got us there.  There was reduced validated parking and we were there.

Lining Up Consultations

So doctor, it's cancer you tell me.  "What am I looking at for treatment?" I asked.  "Well male breast cancer has a similar treatment as female breast cancer.  The breast and nipple are removed from the clavicle to the underarm.  Depending on the type and stage of the cancer a series of lymph nodes will need to be removed."  So what I was hearing was a radical mastectomy.  I asked if he was giving me the worst case scenario and she said no.  "This is middle of the road.  Depending on other factors some of the rib cage might need to be removed portion of the lung and arm muscle.  That's more of a worse case scenario."  He suggested that I speak with an oncologist and take a BRAC genetic test. I did scribble note of our conversation in hopes of adding them to my now growing set of folders.

Being diagnosed with Male Breast Cancer threw me for a loop.  After the initial shock, I started researching my malady on the Internet.  I learned so much in such a short period of time. But there was so much more to know. Ok. Let's start with the 'known'.

My mother and eldest sister had breast cancer and each had mastectomies.  My paternal aunt had colon cancer.  So there is a history.  I was unsure what the BRAC test would mean to me, but I'm no doctor.  What I don't know is what type and what stage.  My research brought me to the Dana Farber Cancer Institute.  Since male breast cancer is rare, I really need to see doctors that deal exclusively with this.  I sent in an online request and the following day received a call from Judy O'Brien.  What an angel.  Very supportive and a great guide.  We spoke for quite a bit and in the end she agreed that coming to Dana Farber made the most sense.  She called me back a few times to ensure that any questions I had were answered.  Shortly after I was provided via email a packet and information.  She was clear that the decision was mine to make, but it should be based on good information.  Also, I was not obliged to continue with Dana Farber if I felt I had better treatment options elsewhere.

The next day, Judy called me at work and asked if I was available to meet with the team at Dana Farber.  She was trying to arrange a series of back to back appointments and asked that I be flexible on that day, March 10th.  I agreed and proceeded to take the day off form work.  Judy reached out to me a number of times and gave me good instructions on how to get copies of my images and medical records from Holy Family. Eventually I was scheduled to see Dr. Inglehart and Dr. Overmoyer.

In the interim, Dr. Moore's staff had followed up with an Oncologist at Holy Family - Methuen.  I'm scheduled for an appointment the morning of March 11th.  I figure after having both hospitals providing their input back to back, I should be in a good place to make a decision on the treatment and which location.

The Diagnosis

Winter had hit New England with a fury.  At the end of January we had the Blizzard of 2015.  A few days later we had yet another huge storm, then another, then another.  During a brief lull in the action I drove to Holy Family - Methuen for my 'surgery'.

When I arrived at the Breast Cancer Care section of the hospital, I was getting the look like I was at the wrong place.  The receptionist looked at the 'list' and said, "You are at the right place."  Apparently they don't get too many men coming in.

Shortly after a very friendly nurse (Butler) brought me into an examination room where she explained why I was there and that I would be talking to Dr. Moore.  Apparently there was no surgery to be done that day, but there would be some more tests and images taken.  Fine with me since it was after all Friday the 13th and another major storm was due in a few days.  Not having a snow blower means that all the shoveling is done by hand.  So a reprieve from surgery came just in time.

Dr. Moore examined me and asked many questions.  He explained many things about these types of tumors and how sometimes they are benign.  He did say that in any case it should be removed.  Prior to that he needed to find out if it was cancerous and other information that will help determine the best options for treatment.  He wanted to schedule me for a core biopsy where a guided hollow needle harvests samples while watching the whole process via ultra sound.  It would be about a half hour procedure and the area would be numbed with a Novocaine.  The samples would be sent to pathology and results would be ready in three working days.  Sounded simple to me, so I scheduled the procedure for the following week.

On February 20th, I managed to park in the lot reduced by huge mounds of snow.  No major storms predicted so any soreness as a result of the biopsy will have a chance to dissipate in the event that I have to do even more shoveling.

Nurse Butler directed me to the examination room and explained what was to transpire.  Dr. Zerbey was going to perform the procedure.  After I was prepped he came in and explained what he was going to do, how it would be accomplished and how I would be affected.  Everything was understood.

The ultrasound technician set up the equipment and all four of us manged to squeeze into the room.  Given the height and size of me, the doctor had a difficult time 'setting me up' so he could do his bidding.  The nurse was propping rolled towels all around like pontoons trying to stabilize a large sea vessel at a pier.  Of course I felt like I was balancing a a tight rope to get close enough to the ultrasound, the doctor and all the hand held equipment he had to use.  Finally everything was ready.

Novocaine was first.  O M G - did that hurt.  That was the toughest part. After a few minutes it was completely numb.  The needed to make a small incision for the needle.  Didn't feel a thing.  He inserted the core and began.  He explained that the harvesting will make a snapping sound.  Fine, no pain.  I was at a perfect spot to watch it all on the display screen.  Fascinating.  So removed when you can't feel a thing.  I was told that a titanium marker was going to be inserted in the area in the event a revisit was needed, it could be found. Everything went well.  I was cleaned up and asked to have another mammogram.  No problem.  No pain.  The technician showed me a picture of the marker.  It was a small breast cancer awareness ribbon.  Interesting.  I got dressed and left with the paperwork and instructions to call Dr Moore on Wednesday.

Wednesday comes.  The results came back as cancer.

Discovery

On Thanksgiving Day 2014, we had our first real snowstorm of the season.  Not even Winter yet, the snow was heavy and wet. Muscles not normally used for shoveling were getting their first of the season work out.  Little did they know they would be getting an extended workout with the record amounts of snow at the end of January through February 2015.

The next day, this old body was sore from the shoveling but the area near my left breast was especially sore.  I thought I may have pulled a muscle.  Everyone knows the rule of thumb is - wait a few weeks and if the pain doesn't subside, then maybe you need it looked at. Time marches on.  The Holidays came and went (as well as that Thanksgiving snow) but the annoying pain remained.

After New Years I took some time to zero in on the exact location of the discomfort.  I pressed the flesh under my arm and extended across my chest.  When I neared the area of my nipple it seemed more tender.  Further examination revealed some sort of lump.  Being a young guy of 62, I have all sorts of age related 'things' on the skin and many aches and pains that you just grow accustomed.  But, this lump was new and a bit sore to the touch.  I did check the other side and didn't find anything similar.  I had an annual physical scheduled for early February, so I had planned to tell my primary care doctor my latest development.  Maybe by then it would disappear - I hoped.

February 6th came and the tenderness had not subsided.  My annual physical went well.  Then my doctor asked, "Is there anything new?"

After explaining how I discovered and what the symptoms were, he had a go at it.  "Yup, it's a lump.  We should have it looked at.  I'll have you go downstairs (Holy Family - Haverhill).  I'll send the 'orders' to registration and they'll direct you".  He also sent me for a blood test.  Which was a normal course of events.

I had been fasting since the previous evening and had no coffee, so I was groggy and really didn't want to waist the day waiting without any type of sustenance. After the blood I was quickly ushered into the mammogram room. I must add that I have a new-found respect for women who have to experience that torture.  After lots of squeezing, contortions and pictures I waited until they had a chance to view the results.  Whatever they saw made them usher me into ultra sound.  The technician explained what was going to happen and why this was taking place.  I couldn't see the screen, but I did hear some hmmm's and ooo's.  He left to get another to join in on the antiphonal sounds of oooh, and I see.  Yet another came in to join in.  Then they all left which seemed like an eternity. Finally a Doctor Saltman arrived with the entourage and she explained what they all were seeing.  She even showed me on the screen.  One of the technician flicked a switch and the image appeared to shimmer.  I asked why and she said, "It has a blood supply".  She said that it has to come out and she would report back to my primary.

Got home and soon after received a call around 4:30 PM informing me that I was being set up for surgery at Holy Family by Doctor Moore on Friday the 13th.  Really - Friday the 13th?