Surgery Rescheduled, and Other News

2016-08-31-14-32-48It’s been a relatively low-drama but high-stress time in our house. I’m slowly recovering from the chemotherapy, with accent on the slowly. I spent the last few weeks waiting for the results of my genetic test panel, prepping (mostly mentally) for surgery, reading about recovery, preparing my advance health care directive, and avoiding calls, emails and visits.

Yes, let me be honest: everyone wants news and I had none yet, and everyone has questions that I’m too frazzled to hear. So I kept a low profile; I apologize to my family and friends, I know they only ask because they care and I do the same when our positions are reversed. Consider this part of my self-care (my blood pressure results and disrupted sleep patterns confirm that I’ve been stressed.) However, yesterday brought some news.

Gene Genie

Cancer constellation in a circleThe genetic test panel was negative for mutation of the two genes most commonly associated with breast and ovarian cancer, BRC1 and BRC2. However, it did return positive on one of the two copies of gene MRE11A, recently linked to ovarian and breast cancer — so recently that numerical risk factors are not yet available. The genetic counsellor is going to do some additional research on the latest info and some modelling, and will call me back later today or tomorrow.

At this point, if no quantified risk factors are available and barring contrary advice from my medical team, I would go ahead with the current plan (conservative breast surgery and radiation therapy), with the recommended increased cancer screening in the future (I understand this means alternating every six months between MRI and mammogram.)

Cut Scene

I also had some blood tests done yesterday morning. Most important result: my blood coagulation rate was still too slow for surgery. As a result, my operation has been postponed to Friday next week, September 30. Since there are a bunch of pre- and post-op checks associated with it, I had a flurry of phone calls, messages, and reschedulings yesterday afternoon and this morning.

In fact, this flurry really did not help my stress situation: while I was on the phone with one department, another would call and leave me an urgent message! Add a few calls from family and friends in the mix, and me eyeing the clock for returning calls; and unrelated technical difficulties with various electronic devices in the house. By 7pm, I was ridiculously frazzled. And part of it, of course, is that I would have liked to be done ASAP with the whole surgery mess.

Not Much Thicker Than Water After All?

Getting back to that coagulation rate: I had an INR of 4.0, if you care for numbers, which means coagulating four times slower than normal. I’ve been on warfarin for three months to prevent the recurrence of blood clots. A few days before the surgery the patient stops taking warfarin and instead takes Lovenox injections. However, not only was my coagulation rte too slow yesterday, but it was the slowest it’s ever been, slower than it should even be in optimal warfarin use (the patient’s dose gets adjusted to maintain an INR of 2.0 to 3.0.)

The Anti-coagulation Clinic pharmacist doesn’t want to ramp me back up on warfarin before the surgery, so she had me take two days off from all anticoagulants, and I’ll have another blood test tomorrow morning to see if I should get back to Lovenox injections yet. After the surgery, there will definitely be some dosage adjustments.

I also received other blood test results in the evening. It looks like my white blood cell count and platelet count are inching up, but all the indicators relating to red blood cells don’t seem to have improved in five weeks. I hope to discuss this with a doctor today or tomorrow.

In Conclusion…

Things are not awful or miserable, they’re just proceeding with some inconveniences and, mostly, leaving both Edmund and I feeling anxious.