After Surgery: Pathology and Treatment Plan.
After Surgery: Pathology and Treatment Plan.
My husband and I were sitting at a Mexican restaurant about a week after my mastectomy when I saw a missed call from my surgeon.
In her voicemail she said my lymph nodes were negative (they took three out during surgery to test for any residual cancer) and I immediately burst into tears. We had hoped and assumed that was the case, but you really don’t know until you get that confirmation.
Unfortunately, it’s very common to have to wait weeks for the full pathology to come back and often you will have to wait for an appointment with your oncologist to get the full picture. This waiting is so difficult. I was on a high hearing that my nodes were negative, but I also knew from the pathology report that my tumors had not completely disappeared (I did not achieve “PCR” or a complete pathological response to chemo). Being HER+ everything I read pointed to me needing many rounds of another chemo type drug (Kadcyla) administered through my port . I was in the process of switching to a new oncologist at a closer hospital for my future treatment and was frustrated that I couldn’t get more detailed information. I had surgery in California and the surgery center did pathology there, but Vanderbilt wanted to do their own pathology for future treatment decisions. There was some disagreement around my HER2 status (my new oncologist told me that my path pointed to being HER2 negative) which meant that I could technically avoid future treatment and go straight to removing my port. This was both exciting and difficult information to have, because when doctors disagree about your diagnosis that means you have to make some decisions on your own. I had a good conversation with my first oncologist, and he urged me to pursue treatment for the HER+ original diagnosis to cover my bases. I decided to finish out the Herceptin shots (typically these are done by infusion, but my insurance covered them as a shot in the thigh every 3 weeks), but chose not to go the more aggressive route of the Kadcyla infusion in my port. I scheduled my port removal and was so excited to move beyond that phase of treatment.
What I did not realize is that port removals (and sometimes placements) are done in-office and not in surgery. For someone who is medically squeamish this was scary for me. I asked for a prescription to help keep me calm, had my husband drive me to the appointment and it was not quite as uncomfortable as I expected. The doctor numbed the area with local anesthetic, and I looked the other way as she removed my port and stitched me back up. I think the excitement over having it removed helped me to get through that procedure. Once it was out, I healed quickly and moved to the next phase of less “active” treatment.
I would have Herceptin shots every three weeks (for a total of 17 rounds, 6 already done with chemo), be on Tamoxifen, and have Lupron shots monthly to suppress my ovaries. The first time I went to the infusion center to get my shot was at a new location. I had switched from the hospital where I got chemo to Vanderbilt which was five minutes from our house. I was so happy to have my port out and to be done with chemo that I didn’t think my shot appointments would be difficult or emotional. But the minute I sat down in that recliner (the same recliners that you receive chemo in) I felt all the old feelings of fear and sadness coming back up. There’s so much emotion involved in those chemo visits and what your body goes through, and it can be easily triggered in a doctor’s office or in a hospital setting. The nurses were so lovely and kind and gave me some privacy and space to cry and collect myself. I want to remind you if you are going through this or anyone supporting a friend, that there will be many hard moments even after it seems like we are ”done” with active treatment. Being a cancer patient changes you and affects you in ways you can’t always understand until you’ve been through each phase. There are so many hard things, and I have learned to give myself time and grace when those feelings bubble to the surface.
We spend so much time thinking about the end of chemo, and then gear up for surgery, and being done with both feels like a huge relief.
But there is a whole other phase of “survivorship” that includes appointments, follow up treatments, immunotherapy, the fear of recurrence and side effects from the ovarian suppression. Our bodies are changed forever and it can be hard to revisit the trauma of what we went through. My advice is not to jump back into “normal” life too quickly. It can take about a month per chemo session for our bodies and minds to recover and to start to come back to normal functioning. I felt the brain fog slowly start to wear off and I focused on eating well, resting, and didn’t put too much back on my plate for a few months.
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+My latest finds here.
+What I wish I knew before starting chemo.
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