Decisions. Decisions. Decisions.

Well! Another decision made. No turning back.

Kevin and I met with my surgeon this morning. I know my surgeon personally and I really trust his opinion. With my initial surgery, the margins were clear, though there was a 1 mm margin in one place. Because of that one narrow margin, the majority of the doctors in the team he meets with felt I should have additional surgery. My surgeon is of the mind that a margin is a margin is a margin and was not necessarily a proponent of additional surgery.

Today, we first ruled out having additional lymph nodes removed. My surgeon feels that the chemotherapy should have burned the lymph nodes out and, if it didn't, the radiation therapy should. Considering the long term risks association with having all of the lymph nodes removed weighed against the benefits, I quickly decided against having them removed. I'm very happy with that decision and I know it was strongly supported by my surgeon. I truly feel that having my lymph nodes removed would have made me a stronger than average candidate for lymphodema, for which there is no cure and which takes time and trouble to manage.

The next decision was not quite as clear and more difficult for my surgeon to advise on as well, but ultimately I've decided NOT to have any additional surgery. My surgeon explained that a lot of my decision regarding the additional breast surgery will be a psychological one. Some women will only have psychological relief if they have more tissue removed or the whole breast removed. I've decided, after all of my research and after talking with my surgeon, that I'm okay with having no additional surgery, trusting that the chemotherapy and the radiation will do the job and knowing that we will be carefully monitoring me with mammograms and, down the road if I choose to, some additional tests that I can access out of province or out of country.

A lot of my reading of the research suggests that the likelihood of my cancer returning either in the breast or in my bones, brain or liver is more to do with specific genetic markers or proteins that could prevent the treatments I've already had and the radiation therapy from being effective. Having additional surgery won't change that. And the genetic markers aren't tested for. So monitoring is my best bet and, if the cancer does come back, then we'll cross that bridge when we get there. I don't believe additional surgery now will be what makes the difference. Surgery or no surgery, there are no guarantees. My surgeon knows that. Kevin and I know that. It's a crap shoot really.

So, we'll skip Phase III of treatment and move straight to Phase IV, which is maximum radiation. First, though, I have to have a mole removed from the left side of my upper rib cage. My radiation oncologist felt that would be in my best interest.

It feels good to have made the decision about surgery. I was a bit of a basket case last night but felt strong this morning and I feel I've made an informed and reasonable decision that is supported by my surgeon who cares about me not just as a patient but as a family friend as well. Nobody WANTS to undergo surgery, but I wouldn't hesitate to have additional surgery if there was good reason to believe it would make a significant difference.

I'll try to improve my odds of preventing a cancer recurrence by making some lifestyle changes and I'm hoping my naturopathic doctor will be able to make several recommendations in that regard.

It would be nice to think I could be done radiation treatment by Christmas. Maybe. Maybe.

Do you like the way the hydrangeas have dried on the stem and turned a burnished bronze colour? We've cut them and have them in the house ready for arranging. Patio taught me that.

Decisions. Decisions. Decisions.