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Competence December 20, 2013

Posted by Judy in Musings.
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The instant the nurse practitioner for the surgical oncologist walked out of the room, my FIL turns to me and says,
“Wow! She was GOOD! She knows her stuff and was more knowledgeable than many doctors I have dealt with. She. was. good!”

I agreed with him wholeheartedly. At first, I was skeptical of her. She seemed to be speaking from a script, and even when I asked questions, I felt like the answers were a bit scripted. But hubs and I kept asking questions. As they got more and more difficult, she began to squirm and I could see that she was having to go off script and really answer the questions. And you know what? She DID answer the questions. At one point, her glasses came off and her hands were tucked under her legs as she thought about a response. It was then that I was convinced that she was going to be a good fit for us.

We spent probably 45 minutes talking with her and learned several key pieces of information.

1) The tumors are smallish: 1.2 cm and 1 cm – this is good.
2) The diagnostic mammo (the original one) showed a mass that was partially obscured. This is the first time anyone told me what was on the mammogram.
3) Lobular cancers tend to grow upwards toward the armpit, and they grow with these little finger-like projections. This makes it harder to remove them with a zero margin (making sure that all of the cancer has been removed). As a result, lobular cancers often end up in mastectomies.
4) Invasive breast cancers generally spread to the lung, brain, bone or liver. This is good info to know so that later on down the line, I can pay attention to symptoms for possible recurrences.

At the end of the appointment with the NP, she informed me that my alkaline phosphatase (an enzyme in the liver) was elevated. Normal range is below 133 and mine was 153. Because my cancer is invasive, there is a chance that it has spread to other locations. The elevated liver enzyme could potentially be due to cancer cells running amok. The NP opined that it was likely pregnancy related. When pregnant, the body has extra hemoglobin, and sometimes it takes a long time for the extra cells to be excreted. These extra cells can then cause an elevation in the alkaline phosphatase. But, just to be sure, I need to have a PET scan, which will show if there are any other areas that have cancer cells. Not gonna lie .. .my heart stopped just a bit when I got this news. But then I remembered that I’m not allowing myself to get stressed out. I just committed it to prayer and moved on.

My visit with the surgical oncologist’s NP was really quite good. I also talked with the radiation oncologist, and that visit was also very good. He did a great job of explaining thing and asking to make sure I understood everything along the way. We were all quite impressed with him, as well. All in all, I was quite pleased with the apparent competence of the other members of the oncological team. The only person I have yet to meet with is the geneticist. I’m hoping our interaction with her will be equally as positive.

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