My surgery is March 28! That was initially a tentative date, but now it’s official!

This news came after my surgical consult today. Dr. McAuliffe went over my recent scans. She clarified that we can’t compare the ultrasound to the mammogram, just a mammogram to mammogram and ultrasound to ultrasound. She said the tumor on the original mammogram was 4 cm, and on the last one, it was 1.0 cm, which is “really good.” On the ultrasound, it was 1.3 cm, and now it’s 0.4 cm, but that might be the clip that was placed during the biopsy.

There’s uncertainty as to whether my underarm was imaged. Sometimes radiologists skip this because they think the person is getting an MRI. I can’t get an MRI due to my cochlear implant. Dr. McAuliffe will contact the radiologist and find out whether they did it. If not, I’ll have to get this done, but it won’t hold up surgery.

“Shrinking cancer concentrically is really good,” Dr. McAuliffe said. It’s no guarantee that it won’t come back, but she still thinks breast conservation is the right approach. This is also known as a lumpectomy, or the medical term, partial mastectomy. The shape of my breast will depend on how much is taken out.

She will do a sentinel lymph node biopsy as well, which will be identified by dye. If there is cancer in the lymph nodes, I might need a second surgery.

I asked about the risk of lymphedema. She said there’s a 5% chance. It doesn’t really correlate to the number of nodes removed, but typically if there’s around five removed, they put patients into the lymphedema program. But the threshold number changes.

Shortly before surgery, I will get a second marker placed in my breast – a seed that has a drop of radioactive iodine. Dr. McAuliffe will use the detector sound to guide the incision and path to the tumor. She’ll remove a cube around the clip and seed. Then a mammogram will be done – “the only painless mammogram of your life.” If removal was centered, then surgery will be done. The surgery will include a separate cut under my arm, near the hair bearing area. Internal stitches will be used with glue over the cuts.

Then I’ll have to learn to live life with my left (non-dominant) hand for two weeks. That won’t be fun!

The nurse is trying to schedule my pre-op appointment for next week, in which I get bloodwork, an EKG, and a doctor to give me clearance for surgery. If I had it at Magee, it would be a one-stop shop, but they don’t have any openings. So she’s trying another hospital in the system. If that doesn’t work, I might have to have three separate appointments and get clearance from my PCP.

Following this appointment, I had a follow up appointment with Dr. Brufsky. Usually held the last day of chemo, he wasn’t in the office that day and said to just come after my surgical consult.

I complained about still not feeling well, about having overwhelming fatigue, and no taste bud improvement. Dr. Brufsky said to give it time as I had a lot of chemo. My hemoglobin is a bit low and my body’s been through a lot. “You made it, give yourself a break,” he said. If it’s still bad at six weeks, they’ll give me a boost.

Turns out I’m special in another way… only about 1% of people have liver issues from Keytruda, and I appear to be one of them. Dr. Brufsky said we’ll just stop the Keytruda. My extensive liver tests came back negative for everything, showing it’s not an immune response, which is good. The best part? My port will be removed during my surgery, which eliminates another procedure, and makes my life easier!

I had heard that typically Dr. Brufsky likes to leave the port in for at least six months after chemo, but maybe because I responded so well to chemo, he is feeling good about not needing it later on. At any rate, I’ll see him again after my surgery to discuss the pathology.

Tuesday is the radiation consult.

Onward!