The Promise

"Your life is in our hands now and we make you the promise to give it back to you." – Mary Autry 

Today I met with my breast surgeon, Virginia Chiantella, MD (who has been practicing breast care for 29 years). Jen picked me up at 10:30am and after we got a little turned around; we finally found the right building and were there for my 11:00am appointment.

The first woman who greeted us was Mary Autry who appeared to be a nurse and “the boss,” meaning the office coordinator. I later learned that she is a two-year breast cancer survivor. She explained, “When you come to us you are a baby. You fall and crawl for awhile. Then we pick you back up and you'll walk again." She also made me the promise to give me my life back … I was so incredibly thankful for her kindness and reassurance. More than I could ever explain.

My breast surgeon, Dr. Chiantella greeted me with a hug and a “What the hell?” No doubt this woman was my cup of tea. She told me, "This is the worst you will ever be. From this moment on, you get better." My throat tightened and the tears welled up in my eyes. This woman along with my team of doctors is going to save my life. I know they are.

These are the notes Kwiatek took during my consultation:

PATHOLOGY REPORT

• The most aggressive form of breast cancer is inflammatory -- you do NOT have that. 
• The clinic that did your pathology report is CBLPath which is in New York and part of the Sloan-Kettering Cancer Center. This is the best of the best and the people are top-notch. No need to question, be concerned or second guess the report findings. 
• It appears the cancer started in the milk duct. The inside of the milk duct has a lining of cells that are all uniform in shape and appearance. Something went terribly wrong with the cells along the duct wall. They mutated and basically multiplied creating something like a “clogged pipe.” The cells broke through the milk duct wall and created a tumor. 
• Your cancer is triple negative (This isn't good or bad news, just classifies the cancer. It does mean you don't get medicine that can specifically treat these cells. Your chemotherapy "cocktail" will be more generalized.): 
• estrogen negative 
• progesterone negative 
• HER2 negative 
• Ki-67 positive: "quick spreading" 
• p53 positive: "process in the nucleolus of the cell" 
• "Invasive" means it went through the duct wall. Another word they use is "infiltrate." 
• "Differentiation" simply means that this is absolutely breast cancer. There is no question whether or not this is breast cancer. Sometimes cells will become so mutated that it's hard to decipher the type of cancer they are. 
• The lymph nodes shape had changed even though they weren't enlarged. They should look like rice grains or beans and yours were round like peas. The cancer cells in the lymph node were the same as in the cancer cells in the tumor, so we are to assume this is all one cancer and hasn’t spread further. 

THE PLAN 

• Meet with Dr. David Heyer tomorrow, who Dr. Chiantella knows very well and LOVES! Continue building my medical team and having all of them conference about my reports and images. 
• Dr. Heyer may want to do more imaging. That seems to be his standard M.O., so don’t be alarmed. He may want a CT scan, PETscan, MUGA scan, bone, etc. He likes to have ALL the possible information to treat a patient effectively. Blood work will also be necessary to ensure I am healthy and strong enough to undergo chemotherapy. 
• "I'm not worried about the chest wall,” said Dr. Chiantella. There are two types of treatment, local and systemic. Systemic is chemotherapy ... something that goes into the veins and will hit your entire body, including the chest wall. That’s the plan.
• We will hit you with systemic chemotherapy first to shrink all the cancer cells back to nothing and then talk surgery once the chemotherapy is done. There will most likely need to be surgery, but we need to focus on what's in front of us first. Tiny victories. 

GENETIC TESTING 

• Dr. Chiantella suggests genetic testing. 
• She is going to get a referral. 
• It is a blood test. 
• This will not only tell if you have the genes, but the probability for getting cancer in the right breast, a secondary cancer, like ovarian, etc. 
• You will be able to see percentages and probabilities using your DNA and family medical history and ways you can mitigate reoccurrence. 

MEDIPORT 

• Mediport scar will be next to the right breast, under the arm. The port sits on the top of the right breast. 
• Mediport surgery is scheduled for Monday, January 30 at 1:30pm 

Kwiatek took me to get lunch after my appointment. She makes sure I always get something to eat in order to keep my body strong through this process. (She knows me well.) I tried to pay for our sandwiches at Potbelly but she was quicker than I was in getting her credit card out of her wallet. I turned and looked at her and said, “The only reason you were quicker is because I have cancer.” We laughed so hard that people were looking at us. I think I’m going to be OK.