Recovery is a B!
I stayed overnight at the hospital, and was lucky enough to have an awesome private room at the end of a hallway on a women's only floor. So, it was nice and quiet and there was even a decent pull-out couch for Jeremy. My doctor came to check on me at about 9:30pm the day of my surgery, which means she had been at the hospital for 16+ hours. She said she'd return bright and early around 5:30am the next morning to check on me again before she began another day of surgeries. So, she basically went home for a few hours to sleep. This is another instance that gave me a new level of respect for doctors.
Before being discharged, we had a quick check on the baby's heartbeat, which was still nice and strong! Then, a nurse came in to show Jeremy and I how to take care of my drains, which would be my two new BFF's for the next week, as they would literally be attached to me 24/7. If you don't enjoy TMI, feel free to skip the next paragraph.
Drains kind of gross me out. Obviously, their purpose is to collect excess fluid drainage (mostly blood and yellowy stuff and I don't know what else, water?) You have to manually empty them into a container every so often, which is kind of like squeezing a plastic juice box. You measure and record how much fluid there is on a data sheet (as a behavior analyst, this is exciting stuff!). Then you have to squeeze your fingers along the drainage tubes to make sure that no clots are stuck along the way. But, don't pull too hard because you don't want to actually yank the drains out. I was totally not ready/willing to do this on my own, so Jeremy stepped up to the plate to take on the task as my home health nurse. Super romantic stuff! He did it without batting an eye.
Can I take a minute to talk about how clutch Jeremy has been? From the minute we were presented with this awful news, he's been exactly what I needed him to be. Not too clingy, not too distant. Juuuuusssssst right. He's helped me do all of the everyday tasks that I didn't think I'd need help doing for at least another 50 years: helping me shower/get dressed/change bandages/reach for my beloved chapstick when it fell on the floor because I couldn't lift my arm, going with me to every appointment, helping me remember which questions to ask the doctors, grocery shopping, cooking, cleaning, calling or texting all the friends and family who want updates but don't want to bother me, making sure my pillows are in the perfect formation, remembering to feed Charley, talking to Sweet Potato every day, not getting upset if I wake him up in the middle of the night because I just came across some scary statistics on the internet and am now wide awake with fear...the list goes on, but the bottom line is that we're in the middle of living out our wedding vows (..."in sickness and in health") and he is getting an A+. I don't know what I'd do without his support.
I had home health nurses visit every day, to check the incisions, drains, take vitals, etc. On the first visit, the nurse removed my bandages, which involved about a mile of ace wraps. I told her that I wasn't ready to look yet and she totally got it so I just stood there bewildered while she checked on everything. She measured the length of my incision, which is over 8 inches long. Yowza. But everything was healing properly and she scheduled another visit for the following day.
My first emotional breakdown post-surgery occurred when our AC decided to stop working the day after we got home. Ain't nobody got time for heat stroke, or for that matter, a crazy expensive home repair! So the repair guy came out and fixed it, but shortly thereafter we noticed that the thermostat was creeping up instead of down. We call the repairman back, but by that time the call was forwarded to an answering service and we'd have to wait until after 11pm. And the house was 82 degrees. So, cue the crying spell! Luckily, my parents live 5 minutes away and came to my rescue while Jeremy stayed behind, determined to finish painting the nursery while dripping sweat and waiting for sweet relief to arrive. Did I mention that he's been the one "nesting" instead of me? In the end, the AC was fixed and I was able to sleep in my bed that night :)
Jeremy's dad and his wife came to visit over the weekend. It was great to visit with them, and the guys took some time to put the crib together and fix a few random things around the house. After 5 days stuck at home, I went on my first "outing" to lunch in Tarpon Springs. I was feeling ok at first, and we decided to walk around some nearby antique shops. This is when I started to feel sore and tired, so we decided not to push it and headed home.
Follow-up with the Surgeon and Pathology Report:
Nine days post-op was my follow-up visit with the surgeon. Dr. A. was happy with how everything was healing, and decided it was time to take out the drains, which means I'd be able to drive again. The nurse came in and I was expecting this to be quite unpleasant, but I actually didn't feel a thing. In fact, most of my underarm (and the back of my upper arm) is now permanently numb; other areas feel permanently bruised. This definitely takes some getting used but I can live with it.
Now that another pathology report was completed (based on everything the doctor removed in surgery), she was able to confirm the type of cancer I have: Invasive Ductal Carcinoma, which is the most common type of breast cancer. She also noted that the tumor was 11 centimeters long and 43 lymph nodes were removed, 21 of which were positive for cancer cells. These stats really took me by surprise. I've read a lot of "survivor stories" on the internet, and also schooled myself on how stages of cancer are determined, and those numbers seemed significantly higher than anything else I had come across. Like, significantly. Most people have maybe 3-4 lymph nodes removed, with one testing positive for cancer, or maybe none positive at all. And it seems like most tumors are no more than 5cm. I know I can't believe everything I read on the internet, and every case is different, but my numbers seem like they break a record that I have no interest in breaking. But, the one piece of positivity that came out of this report is that the margins were clear. This means that the perimeter around the entire area that was removed did not show any signs of cancer cells, meaning it's less likely that cells crossed over the area into other parts of my body.
I also tested ER+, which means that my cancer cells responded to the estrogen and progesterone in my body, causing them to grow more quickly (and holy sh-- they grew quickly). The good news is that there are some hormone therapy wonder drugs out there that can address this. It involves taking a daily pill for the next 5-10 years, and is supposed to significantly decrease the recurrence rate. I tested negative for the HER-2 protein. This is a good thing, because if I were positive, I'd have to take a certain chemo drug that wouldn't be safe for the baby. My sister is HER-2 positive, and has already started her chemo (2 treatments down, 4 to go!)
So, this definitely puts me in the "Stage 3" category ("Stage 4" indicates that cancer has spread beyond the lymph nodes to other parts of the body, and thankfully, this has not been the case for me so far). FINGERS CROSSED. This is another reason why I try not to over-do the Google searching. When you look up 5-year survival rates for the different stages of breast cancer, it's a true reality check. Here's the general breakdown, according to the American Cancer Society:
Stage 0: 100%
Stage 1: 100%
Stage 2: 93%
Stage 3: 72%
Stage 4: 22%
I admit that I've struggled between trying to find a balance between being well-informed about my situation, but also not overloading myself with facts and figures that only cause me to worry. I think of my Sweet Potato and am reminded that stress and anxiety doesn't do him any good. There's something to be said about the power of positive thinking!
Thursday, August 7, 2014
Tuesday, July 29, 2014
July 29, 2014: Surgery Day!
Today is the big day! As this is my first surgery ever, ever, ever, I am a nervous ball of anxiety. Jeremy and I head to the hospital around 5:45am (in the pouring rain in his tired old SUV with broken windshield wipers), with his mom and grandma following close behind. I go through the check-in process and am suddenly extremely cold. Like teeth-chattering, can't stop shivering cold. And I almost NEVER get cold! I guess pregnant ladies don't get offered any sort of calm-the-f-down pills.
After checking in, we're taken to a holding area where Jeremy and family are taken to a waiting area while I change into a hospital gown and get an IV started (first IV ever, a lot of firsts today!). Someone comes to check my vitals, and also to get a quick check on the baby's heartbeat. Dr. A. stops by to say hello and sign my boob, I guess so there's no mistaking which one we're about to annihilate. Jeremy is then allowed to come back and visit with me until it's time to get the party started. About 45 minutes to an hour pass, and finally someone comes to wheel me back to the pre-op room. Ok, so this is the scary part, mostly because I have to give up my glasses which means I can barely see anything! Jerm later tells me that he wanted to run after me yelling, "She can't see without her glasses!" like the movie My Girl. So anyway, I give him a teary kiss goodbye and am wheeled into an elevator and then down a long hallway with all kinds of random medical equipment (at least it looks like equipment through my squinty eyes, for all I know they could have been vending machines).
I end up in a crowded room with a lot of activity going on. This must be where all the suckers are taken to wait their turn to be cut open. There are two nurses assigned to work with me and I immediately have to nervous pee so I ask to use the bathroom. They tell me where it is but I explain that I can't see well so one of them helps me shuffle along with my IV pole. She tells me to pull the emergency cord when I'm done and she'll help me walk back. Suddenly I'm an 80-year-old! But I get back into the bed and they proceed to ask questions and hook me up to monitors and sticky patches and then the anesthesiologist introduces himself and talks about which drugs he'll be using and how they're okay for the baby and he'll be sure to take good care of me and I believe him.
At some point, I'm given something in the IV that's supposed to make me drowsy. I can kind of feel it taking effect but not really. I also get a shot in the belly, something that's supposed to prevent blood clots (at least that's what I think they told me). After waiting a bit longer, it's time to be wheeled to the OR. So I'm still wide awake for all of this and all I can see are hallways covered in ugly "hospital green" tile, some people in scrubs washing their hands up to their elbows as seen on TV, and then I'm wheeled into a big room with big circular lights above (but not turned on yet) and soft music playing. They help me scoot off the bed and onto a table and prop me up on my side using a wedge. This was one of the recommendations from the perinatologist, because keeping me propped up slightly will increase blood flow to the baby. This is also why pregnant women are supposed to sleep on their side as opposed to their back. But anyway, they get the wedge in place and then I see my doctor. She starts asking me what I like to do for fun and I tell her "travel." She asks me about my favorite place, while rubbing her hands along my shoulders and collarbone. I tell her I really love Switzerland while thinking to myself, wow, I didn't expect this much small talk in the operating room. Then she tells me to think about Switzerland, as someone else slowly places a mask over my face. I was about to inquire whether I'm supposed to breathe through my mouth or my nose, but I guess it didn't matter because I don't remember a damn thing after that!
Fast forward four hours or so and I woke up to a lot of commotion around me. A nurse was making me sit up and then I heard someone yell something like, "chest x-ray, bed 4!" and everyone back away. Because I had a port placed, it's common to take an x-ray afterward to ensure it's in the right spot. They were going to skip the x-ray for me, by the perinatologist said she'd rather have me get it and have the piece of mind that the port is done right. Then I must have dozed off again for a while. I woke up again and was being wheeled somewhere and I remember asking if I was being taken to my room (I think the answer was yes?). I end up in my room and the nurse leaves. Next thing I see is Jeremy at my bedside, and my immediate response is intense vomiting. Apparently this is a common occurrence after surgery, but I'm sure it made Jeremy feel pretty terrible. The rest of my family waited in the hall until I "got it out of my system" and then came in to visit. I was still a bit out of it and couldn't see much but knew that my mom, dad, mother-in-law, and grandma were there. I was told that I'm quite hilarious on drugs and glad I could provide some entertainment for everyone. I may or may not have asked the nurse if I was receiving the same kind of drugs as Michael Jackson. According to Jeremy, Dr. A. spoke with him briefly afterward and said that everything went well and there were no surprises. The baby's heart rate was also checked at some point (I don't recall when) and that was fine as well.
So, me and Sweet Potato (our current nickname for the baby) did it! I felt like I got pummeled from all sides, but was so glad it was over with, finally! The rest of the day was a lot of napping off and on and sweet, sweet pain medication. My right eye was continuously watering and at first I thought I was just crying a lot but then realized that something must have gotten in my eye and was irritating it. It actually ended up bothering me more than the soreness from the actual surgery. I let the nurse know and she eventually got permission to give me some saline drops. Can't wait to see what the bill for that will be!
After checking in, we're taken to a holding area where Jeremy and family are taken to a waiting area while I change into a hospital gown and get an IV started (first IV ever, a lot of firsts today!). Someone comes to check my vitals, and also to get a quick check on the baby's heartbeat. Dr. A. stops by to say hello and sign my boob, I guess so there's no mistaking which one we're about to annihilate. Jeremy is then allowed to come back and visit with me until it's time to get the party started. About 45 minutes to an hour pass, and finally someone comes to wheel me back to the pre-op room. Ok, so this is the scary part, mostly because I have to give up my glasses which means I can barely see anything! Jerm later tells me that he wanted to run after me yelling, "She can't see without her glasses!" like the movie My Girl. So anyway, I give him a teary kiss goodbye and am wheeled into an elevator and then down a long hallway with all kinds of random medical equipment (at least it looks like equipment through my squinty eyes, for all I know they could have been vending machines).
I end up in a crowded room with a lot of activity going on. This must be where all the suckers are taken to wait their turn to be cut open. There are two nurses assigned to work with me and I immediately have to nervous pee so I ask to use the bathroom. They tell me where it is but I explain that I can't see well so one of them helps me shuffle along with my IV pole. She tells me to pull the emergency cord when I'm done and she'll help me walk back. Suddenly I'm an 80-year-old! But I get back into the bed and they proceed to ask questions and hook me up to monitors and sticky patches and then the anesthesiologist introduces himself and talks about which drugs he'll be using and how they're okay for the baby and he'll be sure to take good care of me and I believe him.
At some point, I'm given something in the IV that's supposed to make me drowsy. I can kind of feel it taking effect but not really. I also get a shot in the belly, something that's supposed to prevent blood clots (at least that's what I think they told me). After waiting a bit longer, it's time to be wheeled to the OR. So I'm still wide awake for all of this and all I can see are hallways covered in ugly "hospital green" tile, some people in scrubs washing their hands up to their elbows as seen on TV, and then I'm wheeled into a big room with big circular lights above (but not turned on yet) and soft music playing. They help me scoot off the bed and onto a table and prop me up on my side using a wedge. This was one of the recommendations from the perinatologist, because keeping me propped up slightly will increase blood flow to the baby. This is also why pregnant women are supposed to sleep on their side as opposed to their back. But anyway, they get the wedge in place and then I see my doctor. She starts asking me what I like to do for fun and I tell her "travel." She asks me about my favorite place, while rubbing her hands along my shoulders and collarbone. I tell her I really love Switzerland while thinking to myself, wow, I didn't expect this much small talk in the operating room. Then she tells me to think about Switzerland, as someone else slowly places a mask over my face. I was about to inquire whether I'm supposed to breathe through my mouth or my nose, but I guess it didn't matter because I don't remember a damn thing after that!
Fast forward four hours or so and I woke up to a lot of commotion around me. A nurse was making me sit up and then I heard someone yell something like, "chest x-ray, bed 4!" and everyone back away. Because I had a port placed, it's common to take an x-ray afterward to ensure it's in the right spot. They were going to skip the x-ray for me, by the perinatologist said she'd rather have me get it and have the piece of mind that the port is done right. Then I must have dozed off again for a while. I woke up again and was being wheeled somewhere and I remember asking if I was being taken to my room (I think the answer was yes?). I end up in my room and the nurse leaves. Next thing I see is Jeremy at my bedside, and my immediate response is intense vomiting. Apparently this is a common occurrence after surgery, but I'm sure it made Jeremy feel pretty terrible. The rest of my family waited in the hall until I "got it out of my system" and then came in to visit. I was still a bit out of it and couldn't see much but knew that my mom, dad, mother-in-law, and grandma were there. I was told that I'm quite hilarious on drugs and glad I could provide some entertainment for everyone. I may or may not have asked the nurse if I was receiving the same kind of drugs as Michael Jackson. According to Jeremy, Dr. A. spoke with him briefly afterward and said that everything went well and there were no surprises. The baby's heart rate was also checked at some point (I don't recall when) and that was fine as well.
So, me and Sweet Potato (our current nickname for the baby) did it! I felt like I got pummeled from all sides, but was so glad it was over with, finally! The rest of the day was a lot of napping off and on and sweet, sweet pain medication. My right eye was continuously watering and at first I thought I was just crying a lot but then realized that something must have gotten in my eye and was irritating it. It actually ended up bothering me more than the soreness from the actual surgery. I let the nurse know and she eventually got permission to give me some saline drops. Can't wait to see what the bill for that will be!
Friday, July 25, 2014
July 21-25, 2014: Ducks in a Row and IT'S A BOY!
This week I tried to work as much as possible and get everything organized so that I could take a few weeks off. It was another week of bomb-dropping my bad news to various people at work and then inevitably watching them feel sorry for me. I hate it! But I try to practice what I preach, and as a behavior analyst, that means having a positive attitude. So, I'm trying my best (insert smile here).
On Thursday (July 24), I had a pre-op appointment with Dr. A. The nurse took baseline measurements of my arms, to monitor any future occurrence of lymphedema (swelling of the arm). If a lot of lymph nodes are removed during surgery, you have an increased risk of developing lymphedema in that arm, which is a chronic condition. Sounds annoying, but I'd much rather live with a giant swollen arm instead of cancer, so...whatever.
The doctor explained details of the surgery. She'll be removing the entire breast and an as-yet undecided amount of lymph nodes. She will also be inserting a port near my collarbone, which is a device implanted under the skin and used to administer chemotherapy drugs (instead of through an IV, for example). The procedure should take 3-4 hours and I'll stay overnight. We discussed why she isn't opting to do a double mastectomy: basically, it'd just result in an increased risk of complication for me and the baby and right now we should just focus on "fixing what's broken." Also, reconstruction is an option down the road, but not right now because, again, the focus is on limiting the risk of complications as much as possible.
On Friday (July 25), Jeremy and I met with the perinatologist, Dr. R. First, we had a detailed ultrasound and after the tech heard our story (cue the crying, goosebumps, etc.) we found out we are having a BABY BOY!! She said it was "really obvious" which of course made Jeremy beam with pride, lol. So far, our sweet baby boy looks perfectly healthy and we even watched him have the hiccups (adorable). We also learned that the tech went to the elementary school Jeremy teaches at and her twin sister once went to prom with Channing Tatum. Fun facts all around!
The tech left and while we waited for the doctor, Jeremy revealed that he had a surprise. We already knew what kind of crib we wanted, and his mom found it online and bought it for us. As soon as he told me this, helloooo waterworks! Of course, he immediately thought I was upset about it, but quickly realized I was just being an emotional crazy lady again. At that moment, the tech popped back in again so I had to explain why I was crying which in turn made her cry again. Oy vey!
Dr. R. came in and talked a bit about our situation and any potential impact on the baby. I was happy to hear that she completed her residency at Johns Hopkins in Baltimore and has worked with several pregnant cancer patients (yay!) and all of them went on to have healthy babies (double yay!) She'll be in contact with Dr. A. with a few specific recommendations regarding the surgery. All of my doctors have exchanged their personal cell numbers with each other, which I thought was pretty cool. Dr. R. already consulted with the oncologist (Dr. M.) and they started to plan out a chemo schedule to try and find the optimal time for me to deliver the baby. Because blood levels change drastically at certain points during chemo, they're trying to aim for the time when my blood levels should be normal. Based on their calculations, it looks like I might be delivering around 36 weeks (late November). That's the plan for now, but I'll be getting more details after surgery when I meet with the oncologist again.
Later that night we invited my parents and mother-in-law over to let them know they're having a grandson. :)
On Thursday (July 24), I had a pre-op appointment with Dr. A. The nurse took baseline measurements of my arms, to monitor any future occurrence of lymphedema (swelling of the arm). If a lot of lymph nodes are removed during surgery, you have an increased risk of developing lymphedema in that arm, which is a chronic condition. Sounds annoying, but I'd much rather live with a giant swollen arm instead of cancer, so...whatever.
The doctor explained details of the surgery. She'll be removing the entire breast and an as-yet undecided amount of lymph nodes. She will also be inserting a port near my collarbone, which is a device implanted under the skin and used to administer chemotherapy drugs (instead of through an IV, for example). The procedure should take 3-4 hours and I'll stay overnight. We discussed why she isn't opting to do a double mastectomy: basically, it'd just result in an increased risk of complication for me and the baby and right now we should just focus on "fixing what's broken." Also, reconstruction is an option down the road, but not right now because, again, the focus is on limiting the risk of complications as much as possible.
On Friday (July 25), Jeremy and I met with the perinatologist, Dr. R. First, we had a detailed ultrasound and after the tech heard our story (cue the crying, goosebumps, etc.) we found out we are having a BABY BOY!! She said it was "really obvious" which of course made Jeremy beam with pride, lol. So far, our sweet baby boy looks perfectly healthy and we even watched him have the hiccups (adorable). We also learned that the tech went to the elementary school Jeremy teaches at and her twin sister once went to prom with Channing Tatum. Fun facts all around!
The tech left and while we waited for the doctor, Jeremy revealed that he had a surprise. We already knew what kind of crib we wanted, and his mom found it online and bought it for us. As soon as he told me this, helloooo waterworks! Of course, he immediately thought I was upset about it, but quickly realized I was just being an emotional crazy lady again. At that moment, the tech popped back in again so I had to explain why I was crying which in turn made her cry again. Oy vey!
Dr. R. came in and talked a bit about our situation and any potential impact on the baby. I was happy to hear that she completed her residency at Johns Hopkins in Baltimore and has worked with several pregnant cancer patients (yay!) and all of them went on to have healthy babies (double yay!) She'll be in contact with Dr. A. with a few specific recommendations regarding the surgery. All of my doctors have exchanged their personal cell numbers with each other, which I thought was pretty cool. Dr. R. already consulted with the oncologist (Dr. M.) and they started to plan out a chemo schedule to try and find the optimal time for me to deliver the baby. Because blood levels change drastically at certain points during chemo, they're trying to aim for the time when my blood levels should be normal. Based on their calculations, it looks like I might be delivering around 36 weeks (late November). That's the plan for now, but I'll be getting more details after surgery when I meet with the oncologist again.
Later that night we invited my parents and mother-in-law over to let them know they're having a grandson. :)
Friday, July 18, 2014
July 18, 2014: Surgery Gets Scheduled
Today I heard from Dr. A's office. The tumor review board met this morning and my case was discussed (Dr. A. and Dr. M. were both present at the meeting). The consensus was that I didn't need an MRI to proceed with the plan for a mastectomy. So, surgery is scheduled for July 29 at the hospital where Dr. A. does most of her surgeries. She also does them at a hospital much closer to home, but she specifically requested this particular hospital because they have a labor/delivery unit while the one closer to home does not. This will ensure that staff will be available to check on the baby before, during, and after surgery.
I'm glad things are moving along, but the thought of having to wait almost two more weeks for surgery is awful. Once you know that you have something so terrible growing and multiplying and basically just ruining things inside your body, you want it out YESTERDAY.
In other appointment scheduling news, my OB office has been trying all week to schedule me with the perinatologist. Apparently, they run their practice like Fort Knox and it's almost impossible to get in there. But, they had me listed as a "stat" patient, so after a lot of phone calls back and forth, I FINALLY got something scheduled for next Friday.
Oh hey, Jeremy and I have a fun and exciting cruise coming up in two days! But, even though my surgery isn't until the week after we'd return from the cruise, we decided to cancel due to several doctor appointments already scheduled for next week. And guess who didn't find it necessary to take out trip insurance?! For what it's worth, I actually looked into getting the insurance, and according to the fine print we'd only be reimbursed if one of us were actually hospitalized, so we figured the odds of that were very low. Ha! So today we called to cancel, and were told that we can "try" to get a partial refund by providing Carnival with some details about our situation. Bon voyage to a week of relaxation...
I'm glad things are moving along, but the thought of having to wait almost two more weeks for surgery is awful. Once you know that you have something so terrible growing and multiplying and basically just ruining things inside your body, you want it out YESTERDAY.
In other appointment scheduling news, my OB office has been trying all week to schedule me with the perinatologist. Apparently, they run their practice like Fort Knox and it's almost impossible to get in there. But, they had me listed as a "stat" patient, so after a lot of phone calls back and forth, I FINALLY got something scheduled for next Friday.
Oh hey, Jeremy and I have a fun and exciting cruise coming up in two days! But, even though my surgery isn't until the week after we'd return from the cruise, we decided to cancel due to several doctor appointments already scheduled for next week. And guess who didn't find it necessary to take out trip insurance?! For what it's worth, I actually looked into getting the insurance, and according to the fine print we'd only be reimbursed if one of us were actually hospitalized, so we figured the odds of that were very low. Ha! So today we called to cancel, and were told that we can "try" to get a partial refund by providing Carnival with some details about our situation. Bon voyage to a week of relaxation...
Thursday, July 17, 2014
July 17, 2014: More Diagnostic Testing and Some Good News
Back to the imaging center again today! We're getting used to the drive to/from the hospital. I'm so thankful that Jeremy's on summer break so he's able to go to all these appointments and hold my hand and tell me I'm awesome because sometimes I'm a crybaby about the whole situation. Think pregnancy hormones on steroids with a side of crack.
Anyway, I sign in today and tell them I'm there for a breast ultrasound. There's some confusion because they had me in the system for an MRI, so I had to explain why it was changed. I proceed to pay the co-pay (again), and am given paperwork. The title of the paperwork is "Preparing for your MRI" so I go up to the desk again to make sure everyone's on the same page on what exactly I'm getting done today. Sheesh.
Jeremy stays in the waiting room while I go back. I explain the confusion to the ultrasound tech to check and double-check that I'm there for the right procedure. She leaves for a while and consults with who-knows-who and when she comes back she says they're going to do a mammogram in addition to the ultrasound. Ok, fine, let's get this show on the road! I switch rooms to have the mammogram done first. I was a little nervous about this because I've heard that mammograms can be uncomfortable, not to mention it's another type of x-ray with risk to the fetus. So, another protective vest and another consent form, and another person to tell my story to, and another stranger who gets goosebumps and gets teary-eyed at how crazy the story is, and then we start the mammogram. And yes, it was a little uncomfortable but mostly because there's a giant tumor in there getting squished all around and you have to hold your breath and stand in a weird position. The non-shitty boob didn't hurt at all.
Back to the ultrasound area, where the tech did a thorough exam of both breasts. I waited a few minutes and a radiologist came in and said they got all the images they needed and I could go. He mentioned that they noted a few cysts in my other breast, but that those are totally normal and nothing needs to be done about them. But trust me when I say from now on I am on level 5 red alert for any suspicious changes!
On the way home, I get a phone call from Dr. M. (the actual doctor, not his receptionist). He explained that the results came back from yesterday's liver ultrasound and chest x-ray and everything looked clear. Great news!! He also mentioned that at some point, he might order an MRI of my back (without the contrast dye, which is safer), but he didn't see a need for it yet.
So Jeremy and I took our good piece of news for the day and ran with it.
Anyway, I sign in today and tell them I'm there for a breast ultrasound. There's some confusion because they had me in the system for an MRI, so I had to explain why it was changed. I proceed to pay the co-pay (again), and am given paperwork. The title of the paperwork is "Preparing for your MRI" so I go up to the desk again to make sure everyone's on the same page on what exactly I'm getting done today. Sheesh.
Jeremy stays in the waiting room while I go back. I explain the confusion to the ultrasound tech to check and double-check that I'm there for the right procedure. She leaves for a while and consults with who-knows-who and when she comes back she says they're going to do a mammogram in addition to the ultrasound. Ok, fine, let's get this show on the road! I switch rooms to have the mammogram done first. I was a little nervous about this because I've heard that mammograms can be uncomfortable, not to mention it's another type of x-ray with risk to the fetus. So, another protective vest and another consent form, and another person to tell my story to, and another stranger who gets goosebumps and gets teary-eyed at how crazy the story is, and then we start the mammogram. And yes, it was a little uncomfortable but mostly because there's a giant tumor in there getting squished all around and you have to hold your breath and stand in a weird position. The non-shitty boob didn't hurt at all.
Back to the ultrasound area, where the tech did a thorough exam of both breasts. I waited a few minutes and a radiologist came in and said they got all the images they needed and I could go. He mentioned that they noted a few cysts in my other breast, but that those are totally normal and nothing needs to be done about them. But trust me when I say from now on I am on level 5 red alert for any suspicious changes!
On the way home, I get a phone call from Dr. M. (the actual doctor, not his receptionist). He explained that the results came back from yesterday's liver ultrasound and chest x-ray and everything looked clear. Great news!! He also mentioned that at some point, he might order an MRI of my back (without the contrast dye, which is safer), but he didn't see a need for it yet.
So Jeremy and I took our good piece of news for the day and ran with it.
Wednesday, July 16, 2014
July 16, 2014: Diagnostic Testing
Today I was scheduled for a liver ultrasound, to rule out metastasis. It took about 20-30 minutes and I felt strangely relaxed. It turns out the technician used to work at my OB/GYN office and she was pretty nice and laid back. She didn't say much during the test, but at the end she took a quick peek at the baby and I'll never say no to that opportunity :) Then, she walked me out, and as I was leaving, she leaned in and said, "Between you and me, the liver looked fine." I know they're really not supposed to do that, but I'm so glad she did. It brought a sense of cautiously optimistic relief.
Jeremy and I headed out of the building and my phone rang. It was Dr. M's office, and the receptionist said that he also wanted me to have a chest x-ray, and if I was still at the imaging center, I could go ahead and get it right then. So, we turned around and headed back inside.
The x-ray was quick and easy, though the tech was a little confused as to why a chest x-ray would be ordered for a pregnant lady. I told him my diagnosis, and he got quiet, and then reassured me that I'd wear a protective vest and he was only taking two pictures. Of course, I had to sign a consent acknowledging the risks to the fetus, but from everything I'd read and been told by my doctors, the risks are minimal.
In the afternoon, Dr. A's office called to schedule me for an MRI tomorrow morning. Again, this was being debated among my doctors, because MRI's are typically not recommended during pregnancy, especially if contrast dye is used (which is what the doctor wanted). I went ahead with scheduling it, and figured my doctors would come to an agreement and I'd just have to trust them. This is where the issue of my safety vs. safety of the baby started to become apparent.
Later afternoon, another phone call from Dr. A's office. The radiologist would not agree to do an MRI, so it was cancelled. Instead, they decided to just order a breast ultrasound.
Sidenote: Here's a little something I learned pretty quickly about insurance. Did you know that if you have an imaging test done at a place that's located in (or adjacent to) a hospital, it'll cost much more? For me, it was a $225 difference in co-pay. And I have supposedly "good" insurance! I could've had imaging done much closer to my house, for cheaper. But at the time, I just went wherever I was told to go. Live and learn I guess.
Jeremy and I headed out of the building and my phone rang. It was Dr. M's office, and the receptionist said that he also wanted me to have a chest x-ray, and if I was still at the imaging center, I could go ahead and get it right then. So, we turned around and headed back inside.
The x-ray was quick and easy, though the tech was a little confused as to why a chest x-ray would be ordered for a pregnant lady. I told him my diagnosis, and he got quiet, and then reassured me that I'd wear a protective vest and he was only taking two pictures. Of course, I had to sign a consent acknowledging the risks to the fetus, but from everything I'd read and been told by my doctors, the risks are minimal.
In the afternoon, Dr. A's office called to schedule me for an MRI tomorrow morning. Again, this was being debated among my doctors, because MRI's are typically not recommended during pregnancy, especially if contrast dye is used (which is what the doctor wanted). I went ahead with scheduling it, and figured my doctors would come to an agreement and I'd just have to trust them. This is where the issue of my safety vs. safety of the baby started to become apparent.
Later afternoon, another phone call from Dr. A's office. The radiologist would not agree to do an MRI, so it was cancelled. Instead, they decided to just order a breast ultrasound.
Sidenote: Here's a little something I learned pretty quickly about insurance. Did you know that if you have an imaging test done at a place that's located in (or adjacent to) a hospital, it'll cost much more? For me, it was a $225 difference in co-pay. And I have supposedly "good" insurance! I could've had imaging done much closer to my house, for cheaper. But at the time, I just went wherever I was told to go. Live and learn I guess.
Tuesday, July 15, 2014
July 15, 2014: Tears, Phone Calls, and Meeting the Oncologist
Monthly Prenatal Appointment
I happened to have another prenatal appointment this morning. But about
an hour before, I got the phone call from Dr. A's office to confirm the
results of the biopsy: cancer. And just like that we were living a new reality.
Jeremy and I sat around until it was time to see my OB. She was running about 45 minutes behind, so again we
waited (I have a feeling we're going to get really good at waiting). As soon as she walked in, I started to cry and she gave me a
good, long hug. I didn't even have to say anything because she had
received the results before she even came in the room. We listened to the
baby's heartbeat (still going strong!) and discussed the risks of having
various diagnostic tests that I'd probably be getting later this week, such as
a mammogram, x-rays, and MRI. She also said that if I ended up having a
mastectomy (and it was already sounding like this would be the case), I was at
an "optimal" time in my pregnancy to undergo surgery, if there is such a thing. She also referred me to a perinatologist who specializes in
maternal/fetal medicine. I left the appointment unsure of how much
involvement Dr. T. would have in my prenatal care from this point on. So much for being a textbook pregnancy.
Phone Calls
That
afternoon, Jeremy and I headed to meet my oncologist, Dr. M. At
this point, I was supposed to see several clients in the afternoon, and I
hadn't even called to cancel yet. I couldn't bring myself to make a phone
call without getting emotional, but it was getting to the point where I had no
choice. I hadn't even announced my pregnancy to any of the families I
work with, so that was an additional bit of information I'd have to include.
I called my first parent, and through my tears I vomited a string of words, "Sorry-I-have-to-cancel-today-but-I-just-found-out-I-have-breast-cancer-and-am-on-my-way-to-the-doctor-oh-and-I'm-also-four-months-pregnant!" It just so happens that this parent, a sweet Greek woman, is a breast cancer survivor. She didn't quite understand what I had said at first, so I had to repeat myself. She then exclaimed, "Oh, honey!!! Honey! I am so sorry! You will be ok! One day this will just be a story you tell!" Her words really stuck with me and I find myself repeating that when i'm having a rough day.
I found myself dropping the bomb of bad news over and over for the next week. When I throw in the part about my sister being diagnosed the week before, that's just the icing on the shit cake. But wait, there's more! Her husband is about to have open heart surgery! This is a Nicholas Sparks type of storyline; such a shame it's not made up. A part of me wished I worked in a regular office where I could just tell the story to everyone all at once and be done with it. Thankfully, I asked my boss to contact a few parents on my behalf, which was really helpful.
I called my first parent, and through my tears I vomited a string of words, "Sorry-I-have-to-cancel-today-but-I-just-found-out-I-have-breast-cancer-and-am-on-my-way-to-the-doctor-oh-and-I'm-also-four-months-pregnant!" It just so happens that this parent, a sweet Greek woman, is a breast cancer survivor. She didn't quite understand what I had said at first, so I had to repeat myself. She then exclaimed, "Oh, honey!!! Honey! I am so sorry! You will be ok! One day this will just be a story you tell!" Her words really stuck with me and I find myself repeating that when i'm having a rough day.
I found myself dropping the bomb of bad news over and over for the next week. When I throw in the part about my sister being diagnosed the week before, that's just the icing on the shit cake. But wait, there's more! Her husband is about to have open heart surgery! This is a Nicholas Sparks type of storyline; such a shame it's not made up. A part of me wished I worked in a regular office where I could just tell the story to everyone all at once and be done with it. Thankfully, I asked my boss to contact a few parents on my behalf, which was really helpful.
Meeting the Oncologist
Ok, so we arrive at Dr. M's office and I catch a glimpse of a patient who is clearly undergoing chemo. No hair, wearing a bandana and a face mask, and looking generally tired and miserable. So of course, I start visualizing myself in the near future: bald, pregnant, and tired, with one boob. It was a Debbie Downer moment.
I am called into the exam room and have vitals taken by a nurse, along with another woman who we later realized was a student nurse. The student nurse was kind of a big gruff lady, and after they left the room, Jeremy joked, "Glad you weren't her first victim for a blood draw!" I'll get back to that in a minute...
My first impression of Dr. M. is that while he lacks the nurturing, motherly personality of my other doctors, I appreciate the fact that he (fingers crossed) knows what he's doing and will get down to business. We discussed the use of chemo during pregnancy and he handed us some journal articles about treatment outcomes. Because being diagnosed with cancer during pregnancy is uncommon, (and because it's ethically frowned upon to do research on pregnant women), the current research essentially consists of case studies lumped together and analyzed over time. The good news is that chemo can be used during the 2nd and 3rd trimester, with no known detrimental effects to the fetus. It is not recommended during the 1st trimester, however.
Dr. M. explained that the plan would be to first remove the tumor (via mastectomy), wait about a month for me to recover, and then begin rounds of chemo. At the time of this appointment, he didn't yet have my full pathology report, which would have given him specific information about which medications I'd likely need. He did a physical exam, and stated that he could feel some enlarged lymph nodes under my armpit.
He ordered an ultrasound of my liver, to determine whether the cancer had spread (metastisized). From my "official" Google research, I learned that if breast cancer is going to spread, it typically goes to the lymph nodes first, and then sometimes the liver, lungs, brain, or bones. At this point, most people would be sent for an MRI, but this turned into a source of debate among my doctors, as it's not recommended during pregnancy. I learned that at the end of the week, my case would be presented to a review committee (called the "tumor board") where other physicians essentially give their opinion. At first this freaked me out...like, awesome, they have no idea what to do with me so they're going to go ask their doctor friends. But after thinking about it, I realized that this is actually a great thing, because more physicians will be able to give their expert advice. Multiple second opinions for free! I'll get to the results of that later.
He ordered an ultrasound of my liver, to determine whether the cancer had spread (metastisized). From my "official" Google research, I learned that if breast cancer is going to spread, it typically goes to the lymph nodes first, and then sometimes the liver, lungs, brain, or bones. At this point, most people would be sent for an MRI, but this turned into a source of debate among my doctors, as it's not recommended during pregnancy. I learned that at the end of the week, my case would be presented to a review committee (called the "tumor board") where other physicians essentially give their opinion. At first this freaked me out...like, awesome, they have no idea what to do with me so they're going to go ask their doctor friends. But after thinking about it, I realized that this is actually a great thing, because more physicians will be able to give their expert advice. Multiple second opinions for free! I'll get to the results of that later.
Like Dr. A., I learned that Dr. M. has also never worked with a pregnant patient. But, he said that the treatment plan and outcome for a pregnant woman is actually very similar to a non-pregnant person of similar age, type of cancer, and stage. One difference, however, involves the type of medication used. For example, I won't be given any "newer" chemo drugs. It's safer to use the drugs that have been around the longest and therefore researched the most. Also, if I tested positive for a certain protein called HER-2, there's a specific medication that I'd need that wouldn't be safe for baby. But, at the time of this appointment, we didn't yet know whether I tested positive for this. I did know, however, know that my sister is HER-2+. She actually texted me with this info while I was waiting in the exam room, so I was able to relay this info to the doctor. He said it doesn't necessarily mean that I'd be positive as well.
During this appointment, Dr. M. ordered some labwork, and his nurses were able to do it right away. And guess who got to draw my blood? She begins by examining my arm and happily proclaiming, "Boy, she's got nice juicy veins!" For reals??! I casually mention that she should be careful what she says, because Jeremy, who was also in the room, has a reputation for passing out when he gets bloodwork done (like the firetruck and ambulance had to come and everything. He loves when I tell people about this). So I figure she'd be a little quieter, but son-of-a-biscuit, she proceeds to say it again! This time louder and with more glee! Then, she drops a tube on the floor and when it's time to unwrap the band around my upper arm, she tries to yank it with one hand while holding the vial with the other. This was enough excitement for one day, and I couldn't wait to go home and crawl under the covers.
Monday, July 14, 2014
July 14, 2014 (AKA "D-Day")
Pardon my French, but today's the day when shit
got real. Exactly one week after my sister's diagnosis, it was finally
time for me to meet the specialist, Dr. A. Jeremy and I headed to her office for
a 7:45am appointment. We tried to talk and joke like normal, but we were
both distracted. The office is beautiful and calm and we were the first
people there. Going back into the exam room, I answered all of the basic
questions for the nurse, she checked my blood pressure (which is usually good
but was high today) and then said the doctor will be in soon.
Five
or 10 minutes later, Dr. A. walked in and I immediately began to judge her.
Does she look competent? She looks kind of young...40-ish maybe?
Has she had her coffee yet? She made friendly small talk with both
of us and read over my history. I made sure she was aware of my sister's
diagnosis, which by this point we had learned is stage 2. Dr. A. commented that stage 2 breast cancer is "very treatable" and I
remember being excited to relay this comment to my sister.
She then performed a physical exam as I pointed out all areas of concern.
She didn't say much during this time, but took some measurements and
jotted a few notes. When she finished, she looked at Jeremy and I and
said something I won't ever forget.
"I am very concerned that this is malignant."
I immediately started to cry and Dr. A. gave me a hug, offered me a cup of water, and left the room. Jeremy and I had a few minutes alone to let things sink in but everything past this point was kind of a blur. All I could do was stare at the floor because looking at Jeremy resulted in uncontrollable sobs. The nurse came back with some water, said "I'm so sorry," and patted me on the arm. I suddenly felt like this was a Lifetime movie. I was in shock that the doctor could even make such a bold conclusion just based on a quick physical...how much can you really tell from that? So when she came back in the room, Jeremy decided to ask. After a brief pause, she gave us a percentage: she's 90% certain. Here's another fun fact she revealed: she's never worked with a pregnant patient before. Let's sit on that information for a while.
"I am very concerned that this is malignant."
I immediately started to cry and Dr. A. gave me a hug, offered me a cup of water, and left the room. Jeremy and I had a few minutes alone to let things sink in but everything past this point was kind of a blur. All I could do was stare at the floor because looking at Jeremy resulted in uncontrollable sobs. The nurse came back with some water, said "I'm so sorry," and patted me on the arm. I suddenly felt like this was a Lifetime movie. I was in shock that the doctor could even make such a bold conclusion just based on a quick physical...how much can you really tell from that? So when she came back in the room, Jeremy decided to ask. After a brief pause, she gave us a percentage: she's 90% certain. Here's another fun fact she revealed: she's never worked with a pregnant patient before. Let's sit on that information for a while.
She
wanted me to have a biopsy right away, and made some phone calls to get me in
at another office in the same building. But, they were all booked for the
day so she made arrangements to do the procedure in-office. We're moved
to another exam room and proceed to wait. And wait. Finally, a
nurse comes in and said they've been waiting for authorization from my health
insurance, since I have an HMO. This is where health insurance infuriates
me. I still could barely talk to or look at Jeremy, so we just sat
together in silence, continuing to stare at the floor.
After
another 30 minutes or so, the doctor returned and basically said screw the
insurance, the biopsy needs to be done now because patients come first and she
doesn't care about authorization. I really started to admire her at
that moment. Jeremy was asked to leave the room during the biopsy (which,
for anyone wondering, wasn't too bad). They used an ultrasound to help
guide where to remove tissue samples and the entire area is numbed, though I
did feel some pinching/burning at times. The most concerning part for me
was the tool that she used sounded like some sort of staple gun/hole punch
combo. She probably took about 10+ samples and it was over in 15-20 minutes.
I
went to the check-out desk and was introduced to a "nurse navigator,"
who handed me a newsletter with breast cancer information and offered help
with scheduling appointments, cancer support groups, etc. I was still in
disbelief that she's handing me all this stuff...am I even officially diagnosed
yet? This appointment had turned into a surreal 4-hour whirlwind. During
this time, I should also mention that Dr. A. contacted an oncologist, to get
some preliminary information about undergoing chemotherapy during pregnancy.
I was surprised/impressed that she already consulted with another doctor
so quickly. The receptionist set me up to meet the oncologist tomorrow afternoon.
Jeremy
and I walked outside and I tried to hold it together long enough to cross the
parking lot. But as soon as we got in the car, I lost it, so of course
Jeremy lost it, and so we just took a few minutes to be lost. All I
wanted to do was go home. I pulled myself together enough to call my mom,
but as soon as she picked up, I lost it again. It was the beginning of a
very long ride.
Monday, July 7, 2014
My Sister's Diagnosis
July 3, 2014
Coincidentally, my sister had been monitoring a lump on her right breast for the past 4-6 months, which I had no idea about until today, when she finally had a biopsy done. There's no history of breast cancer in our family. Several aunts and cousins have had biopsies done at one time or another, and all were benign. So, my sister wasn't worried too much and we compared and contrasted our situations. Her lump sounded smaller and more well-defined than mine. So now, only my husband and sister knew about my lump. My parents, God love them, are extreme worry warts, so I like to keep the drama and stress to a minimum, for their sake!
Coincidentally, my sister had been monitoring a lump on her right breast for the past 4-6 months, which I had no idea about until today, when she finally had a biopsy done. There's no history of breast cancer in our family. Several aunts and cousins have had biopsies done at one time or another, and all were benign. So, my sister wasn't worried too much and we compared and contrasted our situations. Her lump sounded smaller and more well-defined than mine. So now, only my husband and sister knew about my lump. My parents, God love them, are extreme worry warts, so I like to keep the drama and stress to a minimum, for their sake!
July 7, 2014
I got a voicemail from my mom while I was at work. I called her on the drive home and she said that my sister's biopsy results came back positive for cancer. Whoa. Nobody was expecting that. I tried to reassure her that this has happened to countless women before, there are all kinds of treatments for it, it will all work out, worrying won't fix the problem etc.
But as I hung up the phone, I began to panic. If this is happening to my sister, does that increase the odds for me? What would that mean for the baby? I suddenly felt an extreme urge to see the specialist as soon as possible. The next morning, I called her office to try and get in sooner. I didn't care what time or what office, I'd drive 500 miles and camp outside if I had to. No luck. I called again the next day, and was able to move my appointment up to July 14, 3 days sooner than originally scheduled. I'll take it! But that still left 5 excruciating days of waiting. It was at this point that I told my parents what had been going on and the worry and anxiety settled in for all of us.
I got a voicemail from my mom while I was at work. I called her on the drive home and she said that my sister's biopsy results came back positive for cancer. Whoa. Nobody was expecting that. I tried to reassure her that this has happened to countless women before, there are all kinds of treatments for it, it will all work out, worrying won't fix the problem etc.
But as I hung up the phone, I began to panic. If this is happening to my sister, does that increase the odds for me? What would that mean for the baby? I suddenly felt an extreme urge to see the specialist as soon as possible. The next morning, I called her office to try and get in sooner. I didn't care what time or what office, I'd drive 500 miles and camp outside if I had to. No luck. I called again the next day, and was able to move my appointment up to July 14, 3 days sooner than originally scheduled. I'll take it! But that still left 5 excruciating days of waiting. It was at this point that I told my parents what had been going on and the worry and anxiety settled in for all of us.
Friday, June 27, 2014
June 2014
June 2, 2014
Jeremy and I booked a 7-night Caribbean cruise! The perfect babymoon :) We'll be setting sail on July 20th. I can already taste the (virgin) pina coladas.
Jeremy and I booked a 7-night Caribbean cruise! The perfect babymoon :) We'll be setting sail on July 20th. I can already taste the (virgin) pina coladas.
June 17, 2014
My monthly prenatal appointment with Dr. T. She examined my breast, and the lump was still palpable (though I still don't like calling it a "lump" because that's not how I'd describe it). I told her that at times, I was starting to feel some minor discomfort, like if I were laying on the couch and my breast was pushed up against the cushion. I wouldn't say it was "painful," but it'd definitely get my attention. I also started noticing that my nipple was becoming more flat. She decided to refer me to a breast specialist, and gave me some general pamphlets on dealing with breast lumps/pain. I went home and began googling information (more on the pros/cons of this habit later) and read that changes in the breast are incredibly common and almost always benign. And of course, all kinds of changes take place during pregnancy that are completely normal, so again, no huge red flags have been flown. Yet.
My monthly prenatal appointment with Dr. T. She examined my breast, and the lump was still palpable (though I still don't like calling it a "lump" because that's not how I'd describe it). I told her that at times, I was starting to feel some minor discomfort, like if I were laying on the couch and my breast was pushed up against the cushion. I wouldn't say it was "painful," but it'd definitely get my attention. I also started noticing that my nipple was becoming more flat. She decided to refer me to a breast specialist, and gave me some general pamphlets on dealing with breast lumps/pain. I went home and began googling information (more on the pros/cons of this habit later) and read that changes in the breast are incredibly common and almost always benign. And of course, all kinds of changes take place during pregnancy that are completely normal, so again, no huge red flags have been flown. Yet.
Late June 2014
Now that I was referred to a specialist, it was up to me to actually call and make the appointment. Looking back, I wish I'd called ASAP. But, hindsight is 20/20 as they say and at the time, I'll admit I put it off for a little while. Honestly, it was pure laziness on my part; having to make an appointment, rearrange my work schedule, drive to an office, pay another co-pay, blah blah blah. Not to mention dealing with all of the first trimester pregnancy symptoms (I was nauseous a lot but only vomited once, hooray!).
I finally called around the end of June. This doctor has two offices: one office is 45 minutes away and the other is 5 minutes away. I despise driving, so naturally I asked for the next appointment at the nearby office. The doctor only works there once a week, so the next opening was on July 17. This was over 3 weeks away, but I patted myself on the back for finally making the call. Around this time, I started to notice at least one smaller, more pronounced "lump," best described as pea/marble sized in an area between my breast and armpit. And, my nipple continued to stay flat. But, the appointment was set, so I had some peace of mind that everything would be addressed then.
Now that I was referred to a specialist, it was up to me to actually call and make the appointment. Looking back, I wish I'd called ASAP. But, hindsight is 20/20 as they say and at the time, I'll admit I put it off for a little while. Honestly, it was pure laziness on my part; having to make an appointment, rearrange my work schedule, drive to an office, pay another co-pay, blah blah blah. Not to mention dealing with all of the first trimester pregnancy symptoms (I was nauseous a lot but only vomited once, hooray!).
I finally called around the end of June. This doctor has two offices: one office is 45 minutes away and the other is 5 minutes away. I despise driving, so naturally I asked for the next appointment at the nearby office. The doctor only works there once a week, so the next opening was on July 17. This was over 3 weeks away, but I patted myself on the back for finally making the call. Around this time, I started to notice at least one smaller, more pronounced "lump," best described as pea/marble sized in an area between my breast and armpit. And, my nipple continued to stay flat. But, the appointment was set, so I had some peace of mind that everything would be addressed then.
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