Wednesday was a good day for us.  We had an appointment with Dr. Manders and we had a date.  Dr. Manders was pleased with Cathy's tumor response and optimistic about a successful surgery.  Like many of Cathy's doctor appointments, we were presented with many options.  With Dr. Manders's guidance, we have a plan that we feel confident is a best path if everything goes the way we hope.  We both appreciate Dr. Manders's demeanor, logic, knowledge, and communications.  All of those factors increase our confidence.  

On Thursday, November 1, Cathy will have a sentinel node biopsy in which she will be put to sleep and a blue dye and a radioactive marker will be injected into her breast.  They will follow the dye and the marker to the sentinel lymph node and remove the first 3 or 4 lymph nodes that the dye and marker encounter through a small incision under her armpit.  If lumpectomy were an option or according to an aging standard of care, frozen sections of the nodes would be analyzed under a microscope to detect the presence of cancer cells.  At that point an axillary lymph node biopsy would occur if there is cancer in the nodes with the previous standard of care.  Knowing that Cathy is going to have a bilateral mastectomy regardless of those results (because of the BRCA 1 gene mutation), Dr. Manders would prefer to send those lymph nodes out for a more detailed analysis to detect even isolated cancer cells in the lymph nodes.  This pathology takes a few days rather than a few minutes, but can determine with greater certainty the presence of cancer in her lymph nodes.  This information will determine the course of action for her mastectomy on Tuesday, November 13.

On Tuesday, November 13, Cathy will have a mastectomy.  If the lymph node pathology shows no cancer cells, this procedure will be a lengthy bilateral mastectomy followed immediately by a latissimus dorsi flap reconstruction.  This is what we're hoping and praying for.  If the pathology shows even one cancer cell, Cathy will instead have a right breast mastectomy.  She will then go through a course of radiation on the right side.  Once her tissue has recovered from radiation, she would undergo a second procedure that would begin with a left breast mastectomy followed by reconstruction on both sides.  This is the less desirable option.  Either way, cancer loses.

After the appointment, we had a nice dinner date at Enoteca Emilia in O'Bryonville.  I highly recommend this place for blog followers in the Cincinnati area.  It was a fantastic meal - the first we can remember having together without our children, or not in a hospital, or not accompanied by 250 of our closest teenage friends, in at least a year.  We shared most of our food, which included:

Shitake mushroom and arugula salad with butternut squash sformato
Garganelli pasta with mushrooms, oregano, and truffle
Lamb skewers (mostly for me) with fingerling potatoes, red onions, and rosemary
Roasted brussels sprouts with shitake mushrooms and balsamic

All the food was out of sight and it was even better to be able to celebrate the end of chemo, Cathy's birthday, and the ability to have a focused face to face conversation about whatever we wanted.  It also felt good to have some dates in place.  We've known pretty well what was going to happen to Cathy, but having firm timing makes things a little more concrete and real.  Scary and hopeful all at the same time.