No Flower Zone! :)

  Everyone who knows me, knows I LOVE FLOWERS :)  But so does our kitty Lily!  I have to stay on my toes to keep her out of petals and greenery... it's quite amusing as it seems she's 'possessed by wanting them' but I'm not going to have the energy to chase her!  so I'd like to kindly ask that no one send flowers after my surgery:)  I have a beautiful Orchid that I recently received that should keep me supplied with beautiful blooms for weeks!  If you'd like to send a note or email that would be nice... If your bent on 'sending something' ... gift cards from Safeway are good for prescriptions/groceries/flowers :):):)  Of course, no need for anyone to send anything... just knowing you are rooting for me is all I need!!

  So... now we're down to the wire and counting days.  Funny how time can be tricky... want it to hurry - it crawls... want it to slow down - it slips away... in reality, we all know it moves at the same rate, it's just how we deal with it doing its own thing.  In 3 days I'll be getting my injections for my Sentinel Node Biopsy and will be 'radioactive' for a day.  In 4 days we'll be arriving at the hospital at 5:30am to check in for my 7:30 surgery.  I would have thought at this juncture that I would want time to 'stand still'... but actually I'm more of the mind to get it over with and get on with it!  

  Thankfully all went better than I had imagined with my gyn. surgery on Wednesday and I feel quiet well.  I won't know until Monday when I call Dr. Jones' office if they found anything out of the ordinary in my pathology report and I'm not going to worry about it either... I have enough to think about.  For now I'll just call that a done deal and move on to more pressing matters.  

  As far as my bilateral mastectomy and reconstruction, I think I've read and asked all the questions I could and am going into this as informed as I could/should be.  I've been thinking of it as a situation where someone has told me 'You're going to be in a car crash.  It's certainly not going to be fatal, but you're going to get hurt and it's going to take a few months to put things right.  You'll have some pain, it won't be fun... but someday it will be over and done'.  David told me recently that I seem to be very 'matter of fact' about all of this... I don't know how else to be.  I'm trying to accept all of this and be as positive as possible... focusing on everything going as planned (with no surprises!  No More Cancer found in my pathology!) and getting beyond it.

  I'm very thankful to have met and spoken to several women, with various diagnosis of Breast Cancer, in various stages of treatment over the past couple of weeks.  I honestly feel so much better, so much more secure in my decision to have not only the breast where the Cancer was found removed... but also the other breast (which isn't clear either, due to the ALH) and my Sentinel Nodes done at the same time.  I have too many strikes against me to leave this to fate and I do not want to have the dark cloud of worrying about future Breast Cancer to hang over our lives.  

  I think the fear of the unknown is much more difficult to deal with than the reality of discomfort and adjustment... we're just about to cross the bridge between the two... 

  Thank you all for your healthy wishes, thoughts & prayers... we'll keep you posted and hopefully have good news soon!

Lisa xo

You've GOT To Be Kidding...

Have you ever noticed when you say those words... "You've got to be kidding/joking"... that whoever (or whatever the circumstance) you utter the words to (or about)... is generally anything but a 'joke'.  

With that in mind... 

I have a surgery booked for this coming Wednesday (Feb/4th) for a matter totally unrelated (I hope) to my Breast Cancer.  While going through my list of 'woes' with Dr. Okorn a couple of weeks ago, we spoke about my continuing to have unusually heavy/irregular periods and much more pain than I'd experienced in the past.  She suggested I go to see a gynecologist to discuss the possibility of having an Endometrial Ablation.  I wasn't really sure I could handle (physically or mentally) taking on any more than I already had on my plate... but the doctor told me I really should at least find out what was causing this.

  So... I'll add yet another doctor to my list... Dr. Karen Jones.  I got in to have an ultrasound done on the day of my first visit with her on Jan/21st.  During the ultrasound the technician excused herself and said she had to have a doctor check over the images to make sure she had all she needed to send back up to the Gyn.   After waiting about 5 min, she returned with a doctor to check out something she was seeing that she was unsure of on the images.  She assured me it's not an 'alien' (thankfully :p) but we still don't know what the 'area  of concern' actually is.

  I had a follow up with Dr. Jones on Jan/28th and she explained that regardless of whether it's a 'good time' to be having another surgical procedure, we really have to find out what this is.  She explained that she won't know what it is until the tissue is seen and possibly still won't know what it is until results come back from pathology (usually four days after surgery).  Most likely is a benign fibroid (which I am hoping for!).  It could also be just an unusually thick area in the wall of my uterus, a benign tumor on the inside wall or... something worse... I'll leave that for when/if I have to worry about it.  

  Before all this came up... I was anxious about my upcoming consultation with Dr. Miles (plastic surgeon) for my final meeting with her prior to my breast surgery.  My meeting with Dr. Miles is scheduled for Wed/Feb/4/10:30am... Now I have to focus my thoughts on how I can get from one side of Swedish Medical Center (after seeing Dr. Miles) to check in at Patient Registration at 11:00am for my surgery with Dr. Jones which is scheduled at 1:00pm!

  Maybe this is the Universe's way of keeping me on my toes?? Perhaps in my next life I'll come back as a Prima Ballerina :)

I've Requested an Early Valentine's Day...

As my surgery is scheduled for February/10th @ 7:30 am!  I will be having Sentinel Lymph Node Biopsies on both sides at that time as well and will have to have the dye injected the day prior.  I understand the importance of removal of these nodes to detect if any Cancer has left my breast(s) but am a little uneasy about the potential complications and/or side effects of the procedure.  I think this is one of those circumstances where I need to 'educate' myself without reading 'too much'!

  The surgery should take about 5 hours and if all goes well (which I'm sure it will!) I should be able to go home the following day (a two day stay in the hospital at the most!).  I realize that everyone is very different regarding recoup time, but I'm hoping for the 'fast track' of recovery and hope to be up and mobile within a few days!  From what Dr. Lee has told me from her experience, I will likely be more 'tired' than 'sore'.  One of the most important things for me to do will be to make sure I don't try to 'overdo' it!  Many women (after mastectomies) feel so good they forget to limit their upper body movement and end up making matters more difficult for themselves. 

  I've been reading lots of 'helpful tips' on what to do ahead of time, like moving items I use regularily from upper to lower shelves, do some extra cooking/baking the week before surgery and have things ready to thaw/heat up easily, give the apt. a good cleaning, etc., etc...  I've also gotten back on track on walking/running and am doing some Pilates here at home to get my body ready for the ordeal.  Being as fit as possible going into any surgery is a great way to help your body get ready to heal :)  I've always been a really great/fast healer... so I don't have any worries in that area!  

  I had a very nice talk with my primary doctor, Dobrina Okorn yesterday.   I had called on Tuesday in hopes of getting in to get a prescription for something to help me sleep and was told she had 'absolutely nothing' available until next week.  I requested a message be passed along to her, simply stating my name and that I would only need a few minutes of her time.  Literally seconds later, her nurse called back and set up an appointment for the following day.  I expected to have an 'in and out' visit with a prescription in my pocket and instead had her undivided attention for about 40 minutes :)  

  We talked about all that's happened since we first met on Aug/13/08.  Though that was the only time we'd actually 'seen' each other, she gets copies of all of the reports sent to her and had called on a couple of occasions to see if I was okay and if there was anything she could do for me.  After talking for a while yesterday she suggested I take a mild antidepressant as well as a mild sleep aid.  The antidepressant is something that is routinely prescribed for people having trouble sleeping and as well will hopefully help my chemicals get firing on all cylinders to help me cope emotionally with all of this.  And since I've coincidentally, seemingly ventured into the beginnings of menapause (night sweats that constantly wake me up) the sleeping meds should help me sleep through the night.  *funny I feel pained by saying I'm entering menopause... I'm slowly getting used to saying 'I have Breast Cancer'... perhaps that will get easier to say too??*

E  X  H  A  L  E... 

  Right now it is actually a relief to have a date for surgery and to feel 'a little' more comfortable about accepting that this is all happening to me.  Like most things in life, the first steps are the most difficult... 

*Deep Breath* ...

... and *E  X  H  A  L  E* .... 

  Decision making can be very nerve wracking.  I have gone through it with others and have had many struggles myself over things like: Which flight to book, what laptop to buy, get married/get divorced, start a business/end a business, what nail polish color to choose, have the lamb or the halibut, Pinot Gris or Sauvignon Blanc...  I sat down yesterday afternoon with Christine Lee (my Breast Surgeon) and started our conversation by giving her a brief overview of the past 14 months of my life and some of the other 'decisions/situations' I've been faced with (I won't bother recounting the events here... most of you reading this will know some... I gave her a 90 second snapshot of pretty much the whole 9 yards).  She sat and nodded as I spoke, her face soft and eyes caring... and then we began to speak of the matter at hand.  

  We went over the notes from Robert Resta (Geneticist) regarding my results from my BRCA1&2 tests, agreeing that although nothing definitive... a (slight) load off of my siblings and a welcome departure from having to be concerned about my Ovaries (at this time).  We also talked about the meeting David & I had with Wandra Miles (Plastic Surgeon).  Dr. Lee asked if I was going to continue to meet with other Plastic Surgeons (in hopes of finding a 'good fit' for us) and I told her that I was very comfortable with Dr. Miles and saw no reason to look further; it was only after this that she made it apparent that she trusts and enjoys working with her (even making a joke about 'if there are any problems with your surgery it will be Dr. Miles' fault... not mine' :).  I found this a very becoming quality, as she seems to go to lengths to allow me to make my own choices throughout all of this.  

  I told her that I have decided that I want to schedule surgery for a Bilateral Mastectomy with Immediate Reconstruction, with Dr. Miles placing the expanders on the same day.  She said that although she fully understood the pressure I am feeling and the level of anxiety it is causing, that she felt confident that I was making rational decisions for the right reasons and fully agreed with my choice of procedures.  I should have the date for my initial surgery within the next couple of days and hope it will be sooner than later.  Dr. Lee explained that since I'm having the Immediate Reconstruction it will make scheduling a little more complicated as not only will both of them have to be available on the same day but a larger block of time will be needed for an operating room.  Now that I have the wheels in motion and am firm in my heart and mind about the procedures... I hope they call and say it's next week!  I'd really like to get started to be closer to getting finished!  

  I was well prepared with a (long) list of questions as well as a voice recorder and will post notes later on what I learned yesterday.  For now... this is the information I received from Dr. Miles a few weeks ago... the information that caused me to go into 'meltdown' when I first read through it.  It's still by far my 'favorite read'... but gets a little easier to handle as acceptance settles in... 

TIMELINE FOR EXPANSION

1. Surgery Day: Once it is determined that you may have immediate reconstruction, placement of the breast tissue expander is done immediately following your mastectomy.  This adds approximately 1 1/2 - 2 hours to your surgery.  After surgery you are in the recovery room for about 1 hour before being transferred to your hospital room.  It is common to stay 1 - 2 days before going home.  

2. Stitch and Drain Removal: You will see Dr. Miles one week after your surgery to have your stitches removed and dressing changed.  Sometimes you will have seen your general surgeon before this and she may have changed your dressings.  Your drains will be removed by Dr. Miles ( or your surgeon) based on the amount of output.  The goal is for your output to be less than 20 - 30 cc from each drain per day before removal.  

  You will also be seen by your surgeon (or oncologist if necessary) 1 - 2 weeks after surgery to discuss your final pathology and treatment plan if needed *Let's all cross our fingers/toes that we don't have to go there*

*and another Deep Breath*

3.  Two Weeks Later: First Expansion!!  Providing that your wound is fully healed, we will begin expansion of the tissue expander.  This is done by either Dr. Miles or her nurse.  Take a Tylenol or Advil 30 minutes before your appointment.  This helps with any pressure you may feel afterward.  It is not uncommon after these expansions to feel muscle spasms in your back (especially at night) for a couple of days.  You may use your muscle relaxer medicine that Dr. Miles prescribes or your pain killers.  

4.  Weekly Expansions: You may come in once a week to be expanded or you may space these visits as far as you wish.  How many weeks this total process takes will be determined by how large you wish your breasts to be.  Generally we aim for symmetry with the unaffected breast.  Patients having both breasts being reconstructed generally have the choice of size open.  

5. Done Expanding.  After we reach our determined size, then we wait a minimum of 3 MONTHS to let the skin and muscles settle.  You can begin contemplating upon a date for your surgery to exchange your expanders for permanent implants.  We will discuss this with you at this time.  

6. Surgery To Exchange Implants:  Great Day!!  This takes about 2 1/2 - 3 hours and is an Outpatient procedure.  You can go home on the same day but also have the option to stay overnight.  Generally we do not need to put in drains for this surgery.  

7.  Stitch Removal/Dressing Change:  In 6 - 7 days we will remove your stitches and change your dressings.  Now we will have to wait while the implant 'settles down' before we can create nipples.  

8. Nipple Reconstruction:  Three months later.  Yes, 3 MONTHS.  The breasts change as the implants settle, and belly out and the breasts soften.  Now we decide on where the nipples should be.  Let's book surgery!

9.  Nipple surgery:  This takes about 1 1/2 hours and after recovery, you may go home.  It may also be done as an office procedure.  Dr. Miles will discuss this with you.

10. Stitch Removal: One week later we remove some of the stitches.  We remove the remaining stitches one week after this.  

11.  Tattoo:  Usually one or two months later, we will pigment the areolar/nipple complex.  

LET'S REVIEW:

1. Mastectomies and insertion of tissue expanders (Inpatient Surgery).

2. Two weeks later, first expansion.

3. Expansions every week until target size reached.

4. 3 Months later, exchange tissue expanders for permanent implants (Outpatient Surgery).

5. 3 Months later, nipple reconstruction surgery (Outpatient Surgery).

6. 1 - 2 Months later, tattoo nipple/areola.

7. 1 Month later, check color match.

8. DONE!! DONE!! DONE !!

TOTAL TIME: Approximately 9 to 12 Months.  

... *and another ... DEEP BREATH* ... 

The top example on this page  (taken from a random Plastic Surgeon's website) is a very 'successful' depiction of the procedures and an explanation of the progression. 

My Breast Surgeon is 'Stuck' in California...

and I'm sitting by a heater... watching the snow fly... again!

  Monday/Dec/22 was supposed to be the day that I would meet with Dr. Lee and initiate the plan to have my bilateral mastectomy and reconstruction with breast implants.   Three days before this, I sat and read through the 'Timeline For Expansions' given to me by the plastic surgeon.  I got about half way through and it struck me like a lead hammer... 'This is actually ME this is all happening to and this is going to go on for months'... I panicked!!  My brain screaming 'WE CAN'T HANDLE ALL THIS'!!!  I mean really... there must be some kind of a 'cap' or threshold on what people are supposed to be able to manage in any given period of time.  The past 14 months have had enough 'LIFE' in them... for any one couple... to have lasted 14 years! And this is just the beginning of this 'slice of life'!

  With the weather as it is and Seattle seeing the most snow/worst conditions in 10 years... public transit is a mess and I was getting ready to try to make my way to Cherry Hill on Monday morning, about 4 hours before my appointment at 3pm.  My head was a blur... I was thinking 'I'll tell her I've decided against the mastectomies... no reconstruction... no implants!  Let's just do the lumpectomy and biopsy the other area... no radiation... no drugs... no nothing.  I need to get this out of me and get back to living my life... get a job... be a productive part of this family... be 'myself' again.  Then my phone rang and I was informed that Dr. Lee was stuck in California due to weather in Seattle and wouldn't be able to see me until after the New Year.  

... 

... 

... 

*shakes head*

Okay, so I have a small nervous breakdown.  My sister Tanya tells me I should have at least one a day! 'Just hang a sign that says "Having Nervous Breakdown... Be Back When I'm Done", then let it all out, give yourself a kick in the butt and get back to looking after whatever needs to be looked after'.  Probably good advice, I'm sure the 'explosions' would be smaller if I had lots of them instead of saving them up for a 'Grand KaPow'.  

Yesterday I got a copy of the letter that Dr. Resta (the geneticist) sent to Dr. Lee with his findings on my BRCA testing.  In the letter he states that even though my results were 'normal' that with my current Cancer and my family history of Cancer that he feels it is the best course of action for me to have a mastectomy.  And again I'm reminded of the severity of the situation I'm in and that I need to do what is best for me medically... not just opt for the simplest procedure only to find myself back in a similar (or worse) situation in another year.  

I've decided that it's probably for the best that my appointment with Dr. Lee was canceled and I'm going to go 'HOME' and spend some time with my family... with my Mom.  Since my eyes well up with tears... just at typing that... I'm pretty sure it's an indication that I really need to go.  I guess there is no age limit on needing some 'Mom Time' :)

Tissue Transfers & Implants & Tattooed Nipples... Oh My!

  My friend Greg said to me a few weeks ago "I've never seen someone Blog an event so quickly"... referring to my posting about my biopsy, propped up in a comfy chair, doped up on percocet, just after we got home from the hospital.  Seems things have changed a little over the past few weeks and my rush to share my news has slowed to a crawl.  It's difficult to share something when you're really not sure what it is... or what to do with it... or who wants to hear it?! 

  There's no real 'bad news' ... well, not other than the fact that I have to deal with this at all and there's even some 'good news'.  Good news is that my genetic testing came back as 'normal' (I've always thought of 'normal' as a dryer setting!).  This means that my ovaries aren't of any concern to me now, which is a very welcome load off of my mind/plate.  Even more importantly,  this takes some pressure off of my siblings and their children.  It doesn't mean that they don't have the gene mutations... but my tests being normal takes off the glaring spotlight that it would have thrown on them had the results been different.  The whole concept of 'Genetic Testing' is just a quagmire of 'what if's and what fors'... I get that it does have a positive impact in some situations to have this information but for the most part, to me it just looks like it leads to more confusion.  

  Our first meeting with Dr. Wandra Miles (one of the Plastic Surgeons recommended by Dr. Lee, my Breast Surgeon) went well.  I'm very glad I've been doing lots of reading and educating myself on various types of reconstructive surgery, it certainly makes these conversations much easier to navigate and has us coming away feeling more confident and informed rather than overwhelmed and confused.  Before seeing her, I had decided (if possible) that I would opt for DIEP FLAP surgery, in hopes of using my own tissue and taking a more organic approach as well as eliminating the future necessity of surgeries to replace implants.  According to Dr. Miles I don't have the amount of excess tissue that would be needed to create new breasts so it looks like I will be getting implants.  There are lots of pros/cons on both sides  and if tissue transfer isn't in the stars for me... I'll have to make the most of what is.  

  The surgery itself will be skin sparing which means that they conserve all of the natural skin aside from the areola/nipple and original biopsy incision area.  (don't even ask about the areola/nipple conundrum... that seems down the road and far away to me right now... but if you're interested... Nipple & Areola Reconstruction .  And even more strange, many women opt for tattooing !  If I was going to get tattoos on my breasts... I think I'd get Daisies :)  but like I said... that's waaaaay down the road and my head is already full!  It's kind of interesting though.  When you think logically about how insignificant breast nipples are (unless you're planning to breast feed... it seems ridiculous that you'd go through surgery or tattooing to replace them?!  Here's an explanation of immediate reconstruction with tissue expanders (which is what I'm planning on doing) along with some photos that might make you think differently about 'breasts without nipples/areolas'?!

  One of the 'pros' of going with implants is that I won't have to deal with losing the loss of muscle in another area of my body.  When tissue/muscle are transferred from your abdomen, there is a risk of hernia as well as loss of core stability... I'd like to become a 'real runner' (or at least stick to a decent running regimen someday) so having my core muscles in tact is very important to me.  I got a very good 'vibe' from Dr. Miles as her primary concern (after ridding my body of Cancer) was to make sure that I understood the options to allow me to continue to enjoy activities that are important to me.... after I've had my surgery.  

  My next appointment is back with my breast surgeon, Dr. Lee on Monday/22nd.  This will be to let her know I've made my decisions on the type of procedure and reconstruction.  Since both surgeons work with patients on the same day, with the plastic surgeon coming in right after the mastectomy has been completed, everybody will have to be available on the same day.  They do this stuff everyday so I'm sure scheduling won't be an issue.  If it can happen... I'm looking at having the surgery in the first two weeks of January.  Talk about a way to start the New Year!  

  The insurance issues continue to daunt me.  Thankfully Susan (who looks after the insurance stuff for David's company) has been and continues to be very patient and helpful to me.  I think in the grand scheme of things this won't get to a point where it financially ruins us.  The onus will just remain on me to track all charges and make sure they are being processed properly.  If the information I've been getting is correct... after we satisfy the individual deductible of $2500.00 and pay the out of pocket cap of $3000.00... the insurance 'should' pay 100% of all 'eligible' expenses as long as the provider is 'in the network'.   That's great news for us... now if we can only make sure it actully works out that way!!

  And how am I? ... good question... calm & frantic... I think I spend so much time worrying about how I'm going to get back on track of being a productive part of society, that I spend little time worrying about possible complications with my surgeries.  Maybe this will be one of those things where I gain 'super-human strength' from going through all this crap and take life by the horns after this is done.   Sounds like a good scenario... you know... grey clouds and silver linings and all that jazz?!  :)

PS...  I'm considering David as an applicant for SaintHood!  We always knew we worked best as a couple under pressure.... but he's shown me a love and understanding that I had no idea was even possible.  David... ty :)

The 'Resta' The Story...

Notes from our visit with Dr. Robert Resta- Geneticist, Dec/04/08.

I still can't believe I'm saying/thinking this... but I have decided to have a bilateral mastectomy with breast reconstruction.  Dr. Resta, after having gone over my family history, agreed that this was a wise decision and the primary reason for my going ahead with the consultation with him today was not regarding the fate of my breasts, but to learn whether I should be concerned about future Ovarian Cancer and also to learn if my siblings should having genetic testing done.  

I'm very grateful to have spoken to Aunt Noreen this week who was able to give me the best information I could have to offer to the Geneticist today regarding our 'family medical history'.  

My $29.95 Sansa MP3 player paid for its worth by allowing me to use the 'voice recorder' to save the conversation we had today.  These are some of the pertinent points of information gained today.  

After asking me a litany of questions regarding my medical history and the history of my 1st & second degree relatives; he then asked and proceeded to check my hands mouth/tongue for signs of something called 'Cowden Syndrome', thankfully it's one of the things I don't have... and don't have to worry about!

He then went on to 'start at the beginning' of explaining stats/probabilities of Cancer:

* If you are born Female, in the US the lifetime risk that most women face is about 12%

* Of all of that Breast Cancer, 90% is NOT genetic

* What causes this 90%, no one knows

* At this time there are 6 specific genes that are known to be directly linked to Breast Cancer.  The most well know of these are BRCA1 & BRCA2 .  (I didn't gain any insight on the remaining 4, as Dr. Resta explained that since I did not show signs of Cowden Syndrome, which are apparently directly linked to these 'other 4', this wasn't necessarily a concern for me).  Yes... I'm confused too!!  

* We all have 2 each of the BCRA1 & BCRA2 genes, we all receive one of each from our Mother and Father.  It is 'mutations' in these specific genes that they look for.  

* In his experience, about 1:4 women with my history and having an 'early onset, diagnosed Breast Cancer' will test positive for a mutation in either the BCRA1 or BCRA2 genes, and that those numbers warrant my going ahead with the testing.  

* If I test positive my likelihood of developing a second Breast Cancer (not a recurrence of the one I'm dealing with now) would increase from 5% to 40 - 50%.  A possible, secondary Breast Cancer may not be as 'kind' as my current DCIS.  (I am more thankful every day that things aren't any worse than they are!)

* Another implication is my increased risk of Ovarian Cancer.  Average women have a 2% chance of Ovarian Cancer in their lifetime, a positive BRCA test increases the risk to 20 - 40%.  Since there is no current effective screening nor treatment for Ovarian Cancer, all women who test positive are strongly recommended to have their ovaries removed within 6 months of this finding.  

* Other concerns move on to my family members.  

* If I have a positive BRCA1 or BRCA2 my brother/sisters have a 50:50 chance of also being positive.  What this means would depend upon their gender and which gene (if either) showed the mutation.  BRCA1 has no particular risk for 'Male Cancers' but men can transmit it to their children.  If the 'parent' does NOT have the mutated gene and is not diagnosed with a Cancer, it would not be deemed necessary for their children to be tested.  

**** (A thought from Me) : What I understand all this to mean is... I am taking the responsibility on to be 'the first' in my family to have genetic testing done.  If I do not test positive for the mutation in these genes it does not mean that my siblings do not have the mutations and it would be up to them (with the knowledge of having the same family medical history as I do... and adding me as a 'sibling with Cancer') to decided whether they should be tested.  The reason for having the tests would not only to be aware if they were at increased risk of future Cancers... but also to know if their children should be tested. For instance, if a young woman (such as one of my nieces) has tested positive, her Breast Cancer screenings would begin at age 25, giving the opportunity to catch a Cancer in its earliest stages should she develop one. **** 

* If there is a  mutation in the BRCA2 gene this could effect the 'male' members of the family with higher likelihood of Male Breast Cancer (yes... sadly there is such a thing) and also higher likelihood of Prostate Cancer.  

 * If my sister is tested and is positive for the BCRA1 mutation that would mean that she has a 70% likelihood of developing a Breast Cancer in her lifetime and it would be recommended she have her ovaries removed.  Her Breast Cancer screening would elevate from just regular, annual Mammograms to MRI Breast Screening.  It would also mean that her children should be tested and if found to have mutations, should undergo additional, regular Cancer screenings.  

  Dr. Resta was also very thorough in detailing how the various insurance companies handled all of this 'genetic testing business'.  It used to be that people worried about testing 'positive' then not being able to find a company to cover them in the future.  This is no longer so, as law passed (here in the US) stating that 'insurance companies cannot refuse to cover individuals based upon genetic testing/findings'.  That's all kind of 'moot to me' because the insurance companies already don't like me because of my DCIS (I wonder if that changes in the future, after I have my breasts removed?).  

  So... we decided that I would have my blood drawn today.  It will now go to the only lab in the US that does gene testing Myriad Genetics.  A third party insurance company will be responsible for doing the due diligence with our insurance company to find out how much of the cost/if any they will cover.  Total cost of the blood screening is $3,100.  The third party will contact me if the total cost billed to me will exceed $375.00.  It would then be my decision whether or not to proceed with the screening.  (I'll let you know when/if it comes to that).  Test results general take 3 weeks.  

  To balance all of this out... as life often has a way of doing... when David & I got home from the doctor visit today... my Green Card was in the mail.  "Welcome Lisa, you are now a Permanent Resident of the United States of America" :)  

  Next step is on to see the Plastic Surgeon on Monday/Dec/15 to find out what the best type of reconstructive surgery will be for me.  We've both been doing lots of reading and right now it looks like a TRAM Flap is the best option if that is available for me.  Some of you, if you're still reading... may be thinking this all sounds like I'm dealing with this too well and that I should be *shrugs* more upset or angry or something.  Trust me, I'm plenty of everything and doing my very best to keep my head.  If anyone thinks I'm handling this any differently than I should be or making decisions they wouldn't dream of... *looks down at her shoes* ... the only way you'd ever know what you do if you were 'in my shoes'... would be to actually be 'in them'... and I hope no one I love (or anyone else for that matter) ever is...