Bad News: Path Reports/DR Visits

We saw Venita’s Dr. Cutter and Dr. Boob and Jim’s family doctor today.

We haven’t gone through the path reports in detail, but Dr. Cutter says (a) Lefty has 3 kinds of cancer: (1) invasive lobular carcinoma, which is what was in Righty, (2) lobular carcinoma in situ, and (3) ductal carcinoma in situ. We will put a detailed explanation in later, but “in situ” means cancer that stays within the lobe or duct and does not spread elsewhere as “invasive” cancer spreads to other tissue (in the breast or outside of the breast). The invasive cancer in Lefty is relatively small (size wise) and the breast surgeon is recommending waiting until after chemo to do Lefty’s mastectomy. Dr. Boob has to research the potential effect of trying to insert an implant in Lefty because of Venita’s left side’s intercostal neuritis.

You may recall that Dr. Cutter took 3 sentinel nodes during Righty’s mastectomy. Despite the OR-based pathothology showing no spread of the cancer, the “final” path report shows that the 1st sentinel node draining Righty had micrometastatic carcinoma, with the largest tumor cell measuring 1 mm. Of the other 2 sentinel lymph nodes, one was negative for metastatic disease and the other had tumor cell deposits, but they were too small to constitute even micrometastatic disease. Dr. Cutter said the “standard of care” would be for her to go back in and take ~15 nodes in an axillary node dissection. However, she feels the pathology results would be negative and that Venita would unnecessarily be put at risk for lymphedema.

Venita and Jim are considering asking for a second opinion on the surgeon’s recommendations on Lefty and on Righty’s axillary node dissection. We have asked Dr. Boob and will tomorrow ask Dr. Chemo for 2nd opinion recommendations.

The surgical scar from Righty’s mast is not healing properly. The scar is black, indicating necrosis (death) in the scar tissue. Dr. Boob wants to operate on Venita this Wednesday to cut out the dying scar tissue and attempt to resection the wound. Dr. Boob said “hopefully” this would be successful. He said this outcome is not unusual with a small breasted woman where there is little skin left from the mastectomy and with a smoker. (Note that although Venita is 17 days without smoking, she is a classified as a “smoker” until she has been smoke free for a year.)

Dr. Cutter will be putting in the portacath for the chemo a week from Wednesday.

Jim is having what his family doctor believes is a stress reaction. In January 2005, Jim had Synvisc shots into his knees to deal with arthritis. At the same time, the DR changed Jim’s blood pressure (BP) medicine so that it wouldn’t include a diuretic. When Jim was in FL for Phillies Baseball Spring Training in March 2005, he got a very bad skin rash (reaction to the Synvisc) and his feet and legs swelled up big time (reaction to the different BP medicine). Jim has been fighting the rash on and off since then, but a change back to his old BP medicine relieved the swelling problem. Starting last Thursday, everything blew up—rash and swelling. Today, Jim’s DR gave him a cortisone shot for the rash, asked him to take a daily diuretic, and wants to see him again on Thursday.

We'll follow up when we can, but right now we are wiped out. Call, PM, email, or respond here. Love you all!

(Note: This news posted on the FDMB here.)