Saturday, July 17, 2004
Plan for Treatment
This day was different.  This appointment was different.  I was different.  I really felt peaceful.  Whatever attitude adjustment I awoke with and the state of grace that I felt, I know was an answer to my pathetic prayer the night before.  I went into the office and it didn't scare me this time.  When the nurse took my blood pressure and pulse she was shocked that it was so good.  She told me that it is normally high on first appointments because people are so worried.  The doctor was fabulous.  She has more positive energy in her tiny body than should be legally allowed in this field of practice.  I don't know how she does it.  I left there feeling empowered for this journey.   
These are the steps and their order as we discussed them:  
1.  Sentinel Lymph Node Biopsy
2.  Chemotherapy
3.  Gene Testing
4.  Bilateral Mastectomy & Reconstruction
5.  Adjuvent Therapy (5 years of estrogen reducing drugs like Tamoxifan)  
In addition to this they will also have me scheduled for a bone scan and CAT scan to make sure there is no metastasis, or spread of the cancer elsewhere in my body.   Things can change along the way and any of these steps could be altered or there could be additional steps needed.  Either way you look at it, it is one step at a time.  
The choice for the Bilateral Mastectomy & Reconstruction is difficult to face.  Both the surgeon (who the staff at the hospital refer to as the "Booby Doctor" because he does so many of these procedures) and the oncologist gave the same recommendation.  There are so many factors contributing to the recommendation:  the type of cancer, the family history of breast cancer, my age, genetic markers of the cancer itself, and others I'm sure.  In layman's terms, here's the lowdown:   Several years ago it was believed that the best way to treat breast cancer was to remove the breast.  Ater seeing how women with mastectomies dealt with the emotional and physical issues, there was a shift to breast conserving strategies that included only removing the lump coupled with radiation and chemotherapy.  A study was then done that compared recurrence of the breast cancer in both groups of women.  The women (specific age group and type of cancer) who had mastectomies had less than 4% recurrence.  The women (specific age group and type of cancer) with the breast conserving strategies had about 28% recurrence (this number goes way up with certain factors such as family history, etc.).  Although life expectancy was the same for both groups, the recurrence of cancer was significantly differrent.  Don't quote me on this or decide to have a mastectomy without discussing this with your doctor.  I am not dispensing medical advice.  I am just sharing what I have learned based on my research and discussion with my medical team.   
When you add to the results of this study my family history (three maternal aunts and two maternal cousins) of breast cancer, the type of cancer (extensive invasive (infiltrating) lobular carcinoma, lobular carcinoma in situ), and my age, it seems to make sense.  The genetic testing, if positive, will seal the deal on this procedure.  I will admit it feels weird and the thought of losing these babies is odd.  But there is a silver lining. . .   We have come so far with reconstruction, which is done at the same time as the mastectomy using your belly fat.  Yes -- I would get new breasts and a tummy tuck just in time for my 40th birthday.  What woman wouldn't want that?  And it is covered by my insurance.  What more could I ask for in this situation?

Written by Jeannette Vagnozzi
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Name: Jeannette
Location: Southern California, USA

This is my story about being diagnosed with breast cancer at age 39. I thought I was out of the woods, but four years late it came back. This is my quest to be a two-time survivor.

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