The Binder

We wrapped up my surgical consult this morning which I think removed about 40 pounds of stress that had been resting on my shoulders. I had planned to meet with this surgeon and then evaluate if I wanted to get second opinions. I can say with confidence, after the time I spent with her, that she is the one. Not only was she medically gifted, but you could see her passion for what she does and her compassion for the whole patient approach. For those headed to this step, this appointment lasted almost three hours and consisted of the following activities.

• Review of complete medical history
• Review of your pathology reports and images (3D Mammo and Ultrasound etc)
• Physical exam on the breasts with ultrasound to confirm the mass
• Blood work for genetic testing
• Scheduling of surgical date
• Scheduling for Seed implant
• Scheduling of MRI
• Scheduling of pre-op bloodwork and guidance for pre surgery activities.
• Referrals to oncologist and radiologist

I met my Nurse Ninja and she is even more spectacular in person. She was not joking when she mentioned the binder I would receive. It is so helpful that they organize all your key documents such as test results, business cards for every person on your treatment team, diet recommendations, an key terminology you will hear. My Obsessive Compulsive Self couldn’t have organized it any better. It will become your tow along for everything and is also an important historical artifact if you ever relocate and need to transfer care. My favorite take away from the day was my Dr’s Pictionary version of “What’s Going On in your Boob?”

So the final verdict? For now, a lumpectomy for the mass. She said its tiny and they will be able to get good margins. In addition, they will make a tiny incision under the arm to do a Sentinel Lymph Node Biopsy (SLNB). A dye or radioactive tracer is injected near the tumor to identify these nodes, and the removed nodes are tested to ensure nothing has spread. Prior to the procedure I will have a bilateral contrast MRI and a procedure for a seed implant for the lumpectomy which is a radioactive or magnetic seed localization technique used to precisely mark the location of a breast tumor before surgery. This approach helps the surgeon accurately identify and remove the cancerous tissue while preserving as much healthy breast tissue as possible. Prior to surgery I should also have my genetic testing back to ensure there is no BRCA gene. Given all things look well, radiation would start after my post-surgical checkup.

A few interesting tidbits I learned during this visit. Obviously, a diet high in protein is critical all around, but you are actually instructed to drink 3 protein shakes a day for seven days prior to surgery and five days after surgery. Protein is essential in quick healing. My doctor recommended Premier Protein Shakes which come in a ton of flavors. I do normally make a protein shake with my greens every morning but snagging these are easier to grab and go for the entire day, regardless of your schedule.

Additionally, my doctor also noticed that I had a variety of diagnostic testing for digestive issues about two years back. Most of it was inconclusive but I had suffered from a variety of stomach upset, heartburn, etc. I managed to remedy some of it through dietary changes. Dr. Kaur informed me that digestive issues, particularly those related to gut microbiome dysbiosis can influence breast cancer, especially hormone receptor positive (HR+) by impacting estrogen metabolism, immune responses, and potentially effecting the efficacy of hormone therapy. This demonstrates how the gut connection is so tied to overall health. Working on healing root causes is key to recovery and cure. If nothing else, I get a little bit smarter by the day.

My final thought for the day. How in the decades of health care, have the hospital gowns not gotten any sexier? Looking like a tablecloth should not be acceptable. There is a new business idea for anyone motivated to create a fashionable line of exam ware.