Penny’s Story.

Penny, a Breast reconstruction patient On January 13, 2016, I had my routine mammogram and my life changed. I had joined the Ontario Breast Screening Program the previous year and I was very good about doing my routine breast cancer tests, so I really wasn’t worried. I always had the knowledge that cancer didn’t occur in our family, so my risk factors were lower. My mammogram had been negative the year before so I believed it wouldn’t happen to me, but I was wrong.

The day after my routine mammogram, I got a phone call. The radiologist from the imaging lab wanted me to return for more images of my left breast. ‘Funny,’ I thought, it was always my right breast that had the monthly come-and-go changes related to my menstrual cycle, but it was never a concern on the routine tests.

Luckily, I had a cancellation with my work appointments and I was able to get into the lab that afternoon. I had two more views taken during another mammogram and then an ultrasound. The radiologist came in to speak to me. He said he saw a lump that he would like to have biopsied. When I left the lab I called my GP Dr. Caspers’ office and they made arrangements to see me the following morning. ‘It’s probably fine’ I thought. My sister had a breast tissue biopsy once and it wasn’t anything of concern.

In January 2016, I was a fifty-one-year-old, hard-working veterinarian. I was also very fit, strong and proud of my body. My breasts were quite nice for a woman my age and I was happy with how I looked. My work weeks averaged 60 hours, between dog and cat medicine, surgery, and my own practice of horse dentistry and chiropractic. My husband and I also had a very active family and social life.

My initial thought about the follow-up tests being suggested was that I didn’t have time for this inconvenience and interruption to my work. The day after the lab tests, I was completely booked with appointments and the re-arranging of office calls would not be easy. As I previously mentioned, I was sure I had nothing to worry about because cancer was not in my family history. I thought maybe I could wait because we have a very busy practice. I called my head veterinary technician and she told me I had to go, ‘we will make it work’ she said. Thank God I went because the whirlwind tour of dealing with breast cancer started that day.

My GP booked me in for a biopsy the following week. On January 27, 2016 we had the results and my husband and I both went in to meet with Dr. Caspers.

I will never forget the words “you have breast cancer”.

I was informed I had Invasive Lobular Carcinoma. It presented as a small mass, stage two and my lymph nodes appeared normal on the ultrasound report.

I had gone from going about my business to discussing lumpectomies and mastectomies. I was told that I needed to see a surgeon as soon as possible. My husband Bill looked like he had just been hit by a bat. I thought ‘How did this happen?. It can’t be true! I don’t have time for this.’ It had not yet occurred to me that this was life-threatening and whether or not I would be ok. I was thinking of work, commitments and everything else I had to do, and what an inconvenience this would be to my schedule.

My GP told me that 1 in 9 women end up with breast cancer and that I should prepare for things to move forward very quickly. She wasn’t joking.

After we left her office, we had to tell the kids. We have two sons and a daughter who are young adults. We also had to tell the rest of our family. We never dreamed we would be having these conversations. My daughter was scared when we told her. She cried and said “This isn’t supposed to happen to you Mom. You are the strongest person I know.”. I hugged her and thought to myself, ‘She is right, I am strong so I can do this.’  I assured her and her brothers that I would beat this thing, but I wasn’t sure. I am not the type to feel sorry for myself and I have a medical background so I knew what the whole thing meant.

I admit it shook me but I also wanted to stay strong and get going on it.

We began reading and researching breast cancer, mastectomies and reconstruction. Angelina Jolie was in the news about her own mastectomy at this time and there were excellent websites with detailed information. I formed my position, I could do this and I will look the same and live.

I saw an article in the KW Record newspaper about breast reconstruction that was being conducted at the Cambridge Memorial Hospital. The article spoke about the surgeons at The Cosmetic Surgery Clinic in Waterloo and the advancements they have made. Things looked promising.

Bill and I, along with the kids, had a consultation with a Guelph based surgeon, Dr. Bishop, in early February. He was very compassionate and thorough with us. He spent a lot of time discussing my options and follow-up. I could choose between a lumpectomy with radiation or a complete mastectomy. He told us that if I choose a mastectomy my chances of having to do chemotherapy or radiation would be greatly reduced. Being a surgeon myself, I asked him if he could start with a lumpectomy, and if he felt that things during the surgery were not looking good, proceed to a mastectomy. In my own animal surgeries I have been able to use that option, and so I was willing to empower him to do the same. He indicated that it was not an acceptable practice in these cases to change course mid-surgery and so that option was gone.

After much discussion and having my questions answered I chose to have a complete mastectomy because I did not want him telling me after the surgery that the lumpectomy was unsuccessful and the cancer was still there, growing.

At the time, he also advised against a prophylactic mastectomy of the right breast because we still weren’t sure what kind of therapy I would be facing. He didn’t want delays in getting rid of my cancer if there was a chance of post-op complications on the non-affected breast and the tests had indicated that my right breast was fine.

We discussed reconstruction surgery after recovery from the mastectomy and he mentioned he had also worked directly with the surgeons at The Cosmetic Surgery Clinic. This news was very encouraging, especially since the KW Record article had such a positive message. On February 17, 2016, I had a full mastectomy of my left breast.

My recovery went well and we received the good news that the margins were clean and my lymph nodes were negative. My family was extremely happy and we were feeling super positive that now we only had to endure the rebuild and I could resume my life and my work.

Little did I know at that time, it wasn’t going to be that simple.

I was referred to the Oncology Department at Grand River Hospital in early March 2016. I found out that they needed to run more tests, and there were likely more surgeries in my future as a preventative measure. My life really was changing. After a 3 week wait, I was relieved when test results showed that my OncoDX was a low score, which meant I would not have to go through chemotherapy. Thankfully, my CT scan and bone nuclear tests were clean, however, I was still premenopausal and my oncologist wanted to have me on a specific hormonal blocker. She recommended strongly that I have my ovaries removed due to the hormonal blocker. This meant more time off work and putting my life on hold while we went through this new challenge.

I was also anxious to have my reconstruction surgery completed and I was referred to Dr. Ma at The Cosmetic Surgery Clinic. My first meeting with Dr. Ma was in April 2016. I found her very compassionate and thorough. This was very important to me, as I needed to feel confident in every step along this journey. We discussed the procedure to install an expander implant for the left side and the best options for the right side to create the best symmetry possible. We decided a lift to the right side would be best, instead of a prophylactic mastectomy. My whirlwind tour was continuing.

During this time I was having numerous consultations with my gynaecologist and more tests, and the decision was made that I would have a complete abdominal hysterectomy and removal of my ovaries. People I know couldn’t help telling their stories of women who aged dramatically and the effects this surgery would have on my sex life.

Another fear I needed to deal with.

Dr. Ayanbadajo provided some much-needed reassurance to my concerns for a normal life, or as close to normal as could be expected, and that I would likely age gracefully. I also knew that after this surgery, I could finally have my reconstruction surgery and get back to my life.

My ovariohysterectomy was performed on June 30, 2016 and my breast reconstruction with Dr. Ma was on September 1, 2016. These surgeries went well and my pathology reports were clear of cancer! Even though I was tired and I felt different, we were happy because as my son said, we had kicked cancer.

I had to stop my horse dentistry and chiropractic, due to the upper body intensity of the job, and I worked part-time at my small animal clinic, sticking with surgery and medicine that is much less physically demanding. My support was phenomenal from the clinic owners, the staff, my clients and my family.

I had to transition from a very busy career woman to a small animal vet with modified duties. I guess my body decided it had had enough.

My recovery was going well and I was moving along with the breast expansion. Lauren at The Cosmetic Surgery Clinic was wonderful, she was so kind and caring. Even though it felt different, I was starting to feel like I looked like myself again, at least in my clothing. All was good and I would have my implant surgery and breast lift in April 2017.

As part of the program, I had a routine mammogram of my right breast and a 6 month CT scan on January 2017. All was good, no masses were seen and things seemed to be going well. In early February 2017 I met with Dr. DeCarolis, my oncologist, for a follow up physical exam. With her palpating skills, she found a very small mass in my right breast. To be thorough, she wanted to do an ultrasound of my right breast. She was sure it was nothing to worry about because my other tests were good.

We were wrong. The small mass turned out to be Invasive Lobular Carcinoma. This was terrible news and we were very shocked. My family and I were back in it again and we were truly scared. I met with Dr Bishop in his office a few days after the results. Even though the mass was very small at 6mm, we decided that I should have another complete mastectomy. Because my lymph nodes thankfully tested negative, he was quite sure I could have immediate reconstruction after the mastectomy.

Dr. Bishop and Dr. Ma coordinated the surgery with incredible speed and precision, and I had a complete mastectomy with immediate reconstruction of my right side and a permanent implant for my left side on March 31, 2017, which was my husband’s birthday.

Soon thereafter, the post-surgery pathology report results came back with more serious concerns. I learned that the mass removed was not the previously believed small size of 6mm but was, in fact, a large mass measuring 4.5cm.

The good news in all this was that the margins around the mass were clear of cancer, but I still wasn’t out of the woods for chemotherapy. I was very worried about having to do chemo and my Oncologist warned me that due to the size, it was something I should seriously consider. After three weeks, which felt much longer, my OncoDX test came back from California and measured low on the scale for my right breast and my nuclear bone scan was negative! Following an in-depth roundtable discussion by a number of oncologists and my medical team, the decision was made that I did not require chemotherapy and I am cancer free.

That was the best phone call I had received since starting on this journey and we were very relieved and appreciative of our team.

My life has changed since then but some of it has been for the better because I now know what is most important and I am very happy. I have to work less now, but I value my health more than ever.

I have been given the gift of time with my wonderful family and friends.

Dr. Ma did excellent work on both of my reconstructions and I am so appreciative. I don’t look like I did before breast cancer, but I can live with that. I’ve had a few scars since that day and I look a little uneven in the mirror but I am alive. I’m not where I was on a fitness level but I know it will come with time. I look good in my clothes and bathing suit and my husband is very supportive and happy. He says that I am still as beautiful as ever and our passion for each other is still there.

He likes to remind me that every great warrior has battle scars.

Having 5 major surgeries from February 17, 2016, to March 31, 2017, has truly made me appreciate and thankful for the incredible medical system we have here. Drs. Caspers, Bishop, Ma, DeCarolis and Ayanbadejo were all amazing, skilled and compassionate. They explained the options and took the time to listen and I will forever be thankful to them all.

Guelph General Hospital, Cambridge Memorial Hospital and Grand River Hospital all had a part in my positive outcome. The in-home care nurses were exceptional and I was so thankful for their care.

Although my second breast cancer did not show up on the mammogram, I still encourage all women to do their preventative tests, palpations and physical exams routinely. I took time in my busy schedule to have my routine mammogram January 13, 2016, and it saved my life.

If you feel something, don’t ignore it and tell your doctor, this is our best chance to beat this thing.

 

Penny

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Dr. Robert Shenker Dr. Stephanie Ma
The Cosmetic Surgery Clinic