My energy returns and I’m stuck with the daunting task of prioritizing all the things on my to do list – all those things that I’ve been avoiding or just plain not doing because I could not concentrate, or did not have the energy. Now I’m finding myself so crazy overwhelmed with a to do list a mile long, that all I want to do is turn off my computer, pick up my laptop and watch TV … oh the vicious cycle.

And as my brain starts working again, the scope of this next surgery starts to dawn on me. Each time I get in the shower, I ask myself – am I making the right decision? What if I changed my mind and opted for breast conserving surgery (lumpectomy) … then I remember, first off, that there is still cancer in my breasts after the last surgery (that sneaky little L2 that is difficult to find on mammograms), my margins were not clear (meaning surgery to clean the margins), then if they did managed to get all the invasive stuff out, my breasts also have DCIS which is harder to find … and then I would need radiation on both sides … and when all that was done, I’d need to return every 6-months for a mammogram or MRI to ensure that the cancer hasn’t returned … I’m pretty sure that if I asked my doctors, they would all say that the bilateral mastectomy is the right decision to treat my cancer.

About 10 days after surgery I’ll get another pathology report – this time on all the breast tissue that is removed during the mastectomy. It will be this report that will help to elucidate the true extent of the cancer – or at least the post-chemotherapy extent.

What bugs me is that I know that some of the cancer reacted well to the chemo regime I was on, and some of it did not. That is so frustrating … Looking back at the pathology, they were all >95% ER+, but the progesterone positive amounts differed for each of the three tumors … here is the summary from the initial pathology:

L1:
ER+, >95%, 3+
PR+, variable 50-70%, 3+
KI-67: 38%
HER2: 2+ Indeterminate (FISH negative)
Nottingham Grade: 3

L2: (Note this was processed at a different lab than L1 and R1)
ER+, >95%, 3+
PR+, 90%, 3+
KI-67: 1-5%
HER2: Negative
Nottingham Grade: 1

R1:
ER+, >95%, 3+
PR+, 80%, 3+
HER2: 2+ Equivocal  (FISH negative)
KI-67: 8%
Nottingham Grade: 2

What strikes me when I look at this now is that the PR levels are different – in addition to the grade (or growth rate) levels. They don’t appear to re-run these tests with the surgical pathology, where I summarize the results here.

So my renewed sense of energy means that I’m getting stressed out all over again. I need to try to re-focus my energy on positive things – on moving forward. If the weather clears tomorrow, we shall focus on going for a nice walk – I want to check out the Sierra Open Space area after rain – the hills to the left of starting to look green instead of brown, so I want to see what they look like after rain. Then I need to start preparing for surgery Wednesday and my in-laws arriving Friday. Now I just need to find a little focus …