appointment with OBGYN Oncologist

Gene and I met the OBGYN Oncologist on Monday May 24, 2010. We liked  his mannerism and knowledge within the field. On Monday and Tuesday he works at Bridgeport Hospital where I will be going and the other days he works at Yale Hospital. He went over everything I mentioned in my previous blog. He talked with my OBGYN for along time about my medical before my appointment. He had most of my medical reports from all my other test and surgery's. I brought all my medical reports and I gave him a copy of my genetic findings report to add to his files. He confirmed  and gave me the options for the surgery. I told him I've decided to remove my uterus, fallopian tubes, and ovaries. He agreed this was a wise decision and since I have kids and I am over 35 years old he didn't have a problem with my decision. He feels that my numbers are increasing for CA-125 within my blood work and there is something affecting it. Its hard to know what is causing this until the surgery. He explained he has had several patients who are young with ovarian cancer and hopes I don't fall under this category. There are several other factors that can also affect my numbers to increase. There was so much information given to us that day but I believe he mentioned around a blood count of 100 is where he has seen patients who had Ovarian cancer. I am at 83 and who knows when my number will go higher but we have scheduled surgery for June 15, 2010 to stop/remove what is causing this change.  I signed some paperwork just in case when he is performing the surgery and my organs look abnormal he will take biopsies from lymph nodes that go into my legs and lymph nodes off my abdominal wall. All my organs (uterus,ovaries,and fallopian tubes) will be sent to the pathologist and we should get the results back within a week. That will be a long week to wait!!! My OBGYN will also be there to help assist through-out the surgery. My surgery will be performed  laparoscopic with help from a robotic machine. The  incisions will be on each side of my belly button but real small which will be hardly seen. The microscope and tools are inserted through this incision and the organs are discarded through the vagina. Its very interesting to watch the following video and read the information. It will only take 3-4 minutes and will explain how the machine helps so I will let you read it instead of trying to explain it all. Continues  below with more information about appointment:

info on robotic machine
http://www.yalegynoncology.com/dvs-system/da-vinci-surgical-system-safety

This site shows you what the robotic looks like:
http://www.yalegynoncology.com/dvs-system/da-vinci-surgical-system-features

Here is a video that shows how the robotic works:
http://www.yalegynoncology.com/dvs-system/procedure-multimedia

I had an  internal exam by the doctor and everything was good from this view. The day before surgery starting at 2:00 PM I will have to drink one bottle of citrate of Magnesia (which I get from the pharmacy,over the counter). This will clear out the bowels. I will have to drink clear liquids only which has no red or orange color. The nurse told me if I get a gaging reflex from the drink then to have a popsicle first to numb my throat. I am not looking forward to this part! He mentioned as a women gets older into her late 50-60's that the vagina naturally drops down. He is going to correct mine which this is called a vaginal suspension since we are preforming this surgery, I guess there are perks to this surgery, ha ha ha.Its like having a lift. There will be no activity for six weeks after. He said if I feel well and the surgery went good, I might be able to go home the same day or might just spend one night. The recovery will be 1-2 weeks without lifting anything. He explained the recovery will be a piece of cake compared to my Breast Cancer recovery. He will also give me pain pills if needed afterwards. He mentioned patients usually only need them 1-3 days afterwards.I don't remember how long the surgery will take. I will be under anesthesia during entire time. I will speak with both OBGYN's before surgery.
My OBGYN left a message today (5/26/10) and said she rearrange her appointments and confirmed she will be at my surgery. I will inform my kids about the surgery when time gets alittle closer. I don't want them to worry. I will have to wait until  after the results are back from the pathologist to know what will be are next step.(lets keep our fingers crossed that it is nothing)

OBGYN and my decesion

I placed a call to my OBGYN on Thursday May 20, 2010 to follow up. I went on with my normal day trying not to think about my blood results. It was 3:00 in the afternoon and I never received a return call back from my OB which is unusual so I called the office again. I was told she was waiting for a call back from another OBGYN Oncologist. In the evening, I went outside with my kids and was only outside for ten minutes and realized I forgot the house phone and my cell phone to take outside. O'boy..... I came inside and my OBGYN had left me a message stating she is going home for the day and to contact her at noon the next day. I called the office right away and they were closed. Lucky for caller ID. I called the number and was surprised a representative picked up the phone and was able to find her before she left to go home. She took her time and explained all the information. Remember my Oncologist had given me two names for OB Oncologist, well she spoke to the second doctor and my Oncologist spoke with the first doctor. I guess that was good so we have four doctors involved with my medical decision.
The first option is not as aggressive. I would have laproscopic surgery and take several biopsies from both of my ovaries, both of my fallopian tubes, and biopsy my uterus. At the end of this procedure I would have a washing to clear out my fluids from cavity. The downside would be if any of the biopsies are positive, I would have to go back to surgery and have that organ removed.
The more aggressive approach would to remove my ovaries, my ffallopian tubes, and uterus. This would be a full hysterectomy. The reason for this procedure is because I have alot of uncertain with my medical. My OBGYN and the OBGYN Oncologist spoke in depth about my medical and they want to give me all the options for me. There is a chance of fallopian tube cancer which is not as common but within this area it is dense and hard to detect cancer from the ultrasounds. I spoke with my OBGYN and I am not planning to have any more children. She explained you only need your uterus to have children. Another concern I might have endometriosis which would require to remove the uterus. I spoke with my doctor for along time and I don't want to live the rest of my life in fear that I might have cancer or what is wrong with me. She explained if I choose the first option that I would need to continue to have ultrasounds and blood work every few months and be monitored the rest of my life. The problem with ovarian cancer is that most of the time there is no signs of this cancer until its in a bad stage before it gives you a sign. I want to be proactive and not let this happen. There are some side effects to remove the ovaries at a early age but I would like to be around for many more years to come so I can out weigh the effects. During this conversation with my doctor I decided that I would like to have a full hysterectomy. She said she would contact the OBGYN Oncologist she spoke with and make an appointment for me to meet him and go over the options and procedure as well. He would be the main surgeon and she would also be there to assist. She spoke highly of this doctor. She works with him alot in the hospital and would trust him to perform surgery on her. After the organs are removed, they would be sent to the pathologist to be examined and help determine what I have that is activating my CA-125. I would probably stay in the hospital one night. This would also be performed laproscopic surgery Here are some of the side effects that may or may not happen:

• will go into post menopause - may have hot flashes and night sweats
• if this happens then I will have to go on a low dose of estrogen (hope not because cancer grows on estrogen but women need some estrogen in their body) this is a gray area that I will need to speak with my doctor after the surgery
• osteoporosis may occur ( again gray area and will discuss with Oncologist about possibility a shot once a year for bone density
• I will have to get off my Tamoxifen and go onto another medication because now post menopause
• possible heart disease long term- medical technology will help me here
• my good cholesterol will go down in numbers so I will have blood test to monitor
• vaginal dryness - medications/creams can be used if needed

The good outcome I will not have to deal with a monthly menstrual cycle. YEA I have to make some laughter out of all of this. My OBGYN gave me a few dates in June that she is available for surgery but would work around the main surgeon schedule.

Friday May 21, 2010 my OBGYN office called me and scheduled an appointment for Monday May 24 to meet with the OBGYN Oncologist.

Stay tune for more updates... sorry its late and I need to get to bed. There is so much information to absorb and write so I will write some more updates tomorrow. Lets pray the best for me that there is no cancer and if there is that we caught it in time before it spread!
 Ohhh forgot to add that I am healing well with my tattoo nipples/areola and I will be following up with my plastic surgeon this Thursday 5/27/10. I am happy with the results.

ultrasound/bloodwork results

May 19, 2010 I had my ultra-sound done. The results were good.  All three of my cyst were completely down to a normal size. When a women has completed her menstrual cycle the pockets of fluid should be decreased. As a women gets closer to get her menstrual cycle the next month, these pockets or cyst fill up with progesterone/estrogen fluid. The cyst that I had are normal looking cyst which don't look abnormal. I asked to speak with my OBGYN to get my blood work results but she was off on this day. The nurse said she didn't have the copy and its probably in my OBGYN's office. I text-ed my Oncologist to see if he received my results back from my blood work.
He called me this afternoon. I kinda knew something was up when I received a call from him. Wow the day started off in a positive direction and just like that my day was turned around!  He thought it was great that my cyst went away but the bad news was my blood work has gone up in numbers once again. The CA-125 is now 83 previous 55. I was in shock since my ultrasound was good. He explained that he contacted an OBGYN Oncologist and explained my situation to him. The new doctor recommended that I have biopsy done by laproscopic surgery. My previous history with breast cancer, my BRAC 2 was undetermined and my blood work is increasing is a concern. He asked  that I speak with my OBGYN tomorrow and speak with her about her decision. I text-ed my Oncologist later the same evening to get the names of the OBGYN Oncologist he would refer me too. He gave me the two names and I started my research on the Internet. I trust his opinion for the selection of doctors but I would like to also know as much as I can. I am going to speak with my OBGYN in the morning.

more test next week

I spoke with my OBGYN last Wednesday May 5, 2010 to review my test since she was on vacation. She was still concern about my CA-125 being elevated even thou the ultra-sound was good. She gave me three options: 1. have another pelvic ultrasound when I get my next menstrual cycle and get my blood withdrawn a few days prior, 2 have laproscopic surgery and remove some cells around my cyst and ovaries and have them tested for any cancer cells. If none present no surgery needed. If one of the ovary has cancer then she would remove it. 3. have both of my ovaries removed. She did inform me the medical data has shown if the ovaries are removed too early in a women's life  (unless their cancer) don't remove them because you have a greater chance to develop heart disease and Osteoporosis.
We agreed on option number 1. She explained if I get my menstrual cycle in the next few weeks then wait until the next month.

May 12, 2010 I spoke with my OBGYN to inform her that I got my menstrual  cycle and it was on a 6 week cycle.She was concern because that is a longer time than normal. This can be due to the medication I am taking. She is worried if my cycles goes another 6 weeks or later that there might be a chance that something is infecting my cells or my cysts are growing and she doesn't want to take any chances. She changed her mind and would like to me come in next week for another pelvic ultra-sound. I have an appointment on Wednesday May 19. I also have to get my blood with drawn prior to the ultra-sound so she can compare the results. I will get my blood work done on Friday or Monday.

I will keep everybody posted as soon as I get the results. Here's another roller coaster ride!!! I am hoping we get the answer soon why my CA-125 (marker for ovarian cancer) has increased. Depending on my blood work and the ultrasound that will determine our next step.

Tattoo visit

Gene and I went to Long Island, New York on Wednesday May 5, 2010 to get my nipple/areola tattooed . We had to go to the office where my plastic surgeon works for this particular procedure. It was a bad morning. It should of took us around 80 minutes and it took us forever!!! We left at 9:05 for a 11:15 appointment. The usual morning hectic commute should of been over by this time. The traffic was bumper to bumper all the way out of CT and traffic in New York as well. We barely made it there in time. The building was a beautiful  glass building. I had to go to the anesthetic office which is on a different floor then the plastic surgeons. I had a short consultation with the representative who would be doing my work to review the procedure and my medical information. She took a few pictures and went to get all the supplies ready. She expressed how well I looked. She was impressed with my plastic surgeons work. She said she has seen some bad jobs and my implants were one of the best she has seen. At this time Gene had left and would meet me in about a hour - hour half when I was finished. I had to wait another ten minutes until she returned. I was in a small room and I didn't realize we were waiting for the larger room to be available.

We decided to have a pinkish tone for me since I have light skin. She first outlined my areola area with a pencil that looked like a eyeliner. She examined my breast several times and I was wondering what she was looking at. It turned out that she was examining to see if the nipple area was even and where she had to make adjustments. She noticed that my right side was a little bit higher than my left side. She was good to notice that! I started to think about it for a minute and I forgot that would happened. I had radiation on my right side and the radiation had tighten the skin bringing this side higher. It's a slight difference that I didn't notice and with a person who doesn't have implants  they don't have the same size breast anyways. I forgot and really didn't notice it but she was examining  to make sure the job is perfect. I guess I have moved on from the past and forgot that would happened.She mixed a pink and a brown color together to achieve the color she wanted. She did this step several times to get the color she thought would look best. She would put some color on my skin (breast) to see if it matched.Once she achieved the color, she wiped off the excess and we were ready to start. I was lying down for the procedure. I was thinking to take a volume before the tattoo started to help me be calm but I forgot to bring one with me.
She started on my right side. When she first started it was painful. Oooo I thought I wasn't going to be able to make it through the procedure. She then started to chit chat with me so that helped me to be distracted. The pain did get better. I can describe the pain as a quick needle prick then stop and then again. If you can think of a clock, for some reason it hurt only around the 3:00 and 6:00 area. She said she had heard this from other patients who had this procedure as well. She explained that some of my nerves have developed and that's why I feel it in some areas and where I don't feel it the nerves haven't developed yet. It was tolerable procedure at this point. As she was coloring them in, she was surprised how my skin was responding. She can tell the color was taking right away. The procedure actually puts the needle slightly under the skin to add the color. She was about done with this side and I didn't even feel or know she colored in the nipple. I only felt a slight pressure.

She moved over to the left side. I was a little tense when she was about to begin because I don't like pain and was expecting to feel the needle pricks again. I couldn't believe it! This side was a piece of cake as far as the pain. I only felt a slight  pressure and that was it. I was so happy that the procedure was going to end with a happy experience. She did say for some reason on my left side the nipple wasn't taking the color as well but the areola was okay. She mentioned if I decide to come back in 7-10 years to have them tattoo again since the color does fade over time that I might have a  different experience. The nerves might be fully developed. We will cross that path down the road. She was done and I was able to look into the mirror before she put the gauze over the area. Wow they looked great and different. I was used to them being so light and now the area looks real. She put Bacitracin ointment on both sides and explained this need to be done twice a day for three days then covered it with a gauze. After the three days I apply Aquaphor twice a day up to two weeks total. The final color will take about two weeks to show the actual color that will remain. She also fanned out the color pass the areola area a little bit to help them have the effect as real nipples. She mentioned that I need to follow up for a two week appointment. Since I live so far away my plastic surgeon is in CT once a week for appointments and I will see her instead. She mentioned she would be excited to see how they turned out. I told her maybe my plastic surgeon can show her a picture so she knows how her final art work turned out! She asked me to call her and let her know how I think they turned out after two weeks. She mentioned if I felt I needed them darker or more color to call her and she can add some more. I think they will be good at this point.

The area we were in was beatiful. It was a warm day and I met Gene outside where he was reading a book. There were several restaurants next door so we had a nice lunch together before heading back home. The drive home was good and much better than the way there.

I am sorry for the late posting. It has been so busy on my end. I did speak with my OBGYN so check back soon for more updates. My medical life is keeping me busy at this point.

2nd pelvic ultrasound results

On Friday April 30, 2010 I had another pelvic ultrasound. I was confused again with the results. I asked her why on my last ultrasound I wasn't informed about my cyst. She explained that they are not cyst. Several individuals for example on my MRI call these pocket of fluids cyst as a general term. She performed the test and confirmed this is still the case. She measured the cyst on my left and it already had decreased in size since the MRI. The two cyst on the right were still large but seem to be getting ready to let the fluid out. This process is normal when a women goes through her menstrual cycle. Some women have the fluid filled structure and never completely go away when she gets her cycle. The progesterone is suppose to release the fluid but in some circumstance it doesn't. I had some fluid under my uterus but was okay. She suggested that I come back either next month or the following month to have another pelvic ultrasound but wants to see me between 5-10 days into menstrual period. She wants to compare the results. Each time I go, she prints out pictures. She asked me to follow up with my OBGYN doctor, same office when she is back from vacation. I am still wondering my CA-125 number has gone up. I had the correct test done so I guess I can't sweat the small stuff but will make sure I keep going to the doctors. I will follow up with my doctor this week.

My Oncologist text-ed me Friday evening and said he received a copy of the ultrasound results. He said everything looked well and he will speak with my doctor this week. It was nice that he followed up.

On Wednesday May 5, 2010 I am going to Long Island to get my areola  tattooed. I will keep everybody updated how it went.

Breast Cancer Surgeon

I already had an appointment with the Breast Cancer Surgeon the following day April 29, 2010 for a follow up. Since I have implants, I no longer get mammograms. I will see her every six months for an examination.
The nurse called me in to update my file and I mentioned to her that I had two MRI's yesterday (4/28/10) and I didn't know the results. She was able to log onto the radiology  website and print out the results for the doctor.
My surgeon examined  my lymph nodes by my throat and under my arms as well as a breast exam. Everything was well. She said the MRI's which includes liver, pancreas, uterus, cervix, abdomen and fallopian tubes was great and no concerns. According the MRI  I have two cyst one on each ovary. The left side measured 3.2 and the right side measured 3.5. She thought the doctors don't like the cyst to get bigger than 4. The  MRI showed the cyst are filled with fluid and no fatty deposits which is a good sign. She asked me to follow up with my OBGYN and see what she would like me to do. I will see her again in 6 months.
I called my OBGYN when I got home and left a message. The nurse called me back and explained  that my doctor is on vacation until 5/3/10 but she had spoken to the ultrasound doctor and she would like me to come back in the office to have a pelvic ultrasound. I questioned her since I had one a month ago and it didn't detect the cyst. She insisted that I still come in. I was concerned that my health insurance wouldn't pay for another ultrasound because  the test are close to each other but she said it would be covered. I made an appointment for the next day 4/30/10.
The same evening  4/29/10 my Oncologist called me to review the results of my MRI. I told him I saw my cancer surgeon earlier that day. The doctors are in the same building and speak often. He wasn't able to log onto the radiologist site but I told him what I have found out. He wasn't concerned with the size of the cyst but wants me to follow up with my OBGYN because he is concern with my history of breast cancer and remember my genetic test is undetermined  if I carry the gene. Since my CA-125 had risen, he would like me investigate the situation some more. He said he was reviewing my last pelvic ultrasound and it stated that I had cysts on my ovaries. Wow I was shocked and asked why did I find out through the MRI and wasn't informed from my ultrasound. He explained that sometimes if the ultrasound examiner feels that it is normal there is no mention. I was angry because I feel I should know all my medical information. He agreed that it was a good idea that I have another pelvic ultrasound the next day. He is going to talk with my OBGYN next week when she is back from vacation.(week of 5/3/10)
About a hour later my Oncologist text-ed me (he thought it was late for a phone call). He was able to log onto the website and review my MRI's. He confirmed that the cysts are benign nature cysts. The report shows that I have one cyst on my left ovary and two on my right ovary. I will have him copied in my results from the ultrasound.
Check back for my next post about the pelvic ultrasound results.