Pathology Findings Delayed

Day 7 Post-Op
I have been anxiously waiting for the pathology report from my surgery. We already knew the first critical piece of information: that the lymph nodes were negative. That test is actually done during surgery, and Dr. Kushner was able to tell Pete the results as soon as he finished his part of the operation.

The next critical piece of information would be "does analysis of the tissue removed during surgery show anything unexpected?" In my case, I think the big question was whether or not my tumors were truly non-invasive, as was predicted by the biopsy, or did detailed analysis of the larger tissue sample show micro-invasions which the biopsy did not reveal?

The third critical piece of information, and the one I have been most worried about, is the result of certain hormone receptor tests. Two out of three breast cancers are hormone receptor-positive, meaning that they rely on estrogen and/or progesterone for growth. These types of tumors can appear in other parts of the body, not just the breasts, so even with a bi-lateral mastectomy, there is a chance that I will have to have drug therapy (such as tamoxifen or aromatase inhibitor drugs) if my tumors were positive for hormone receptors. Need I say that I really don't want to have to take these drugs? The other test is for a substance called HER2, but from what I've read, that relates more to invasive cancers - at this point, I haven't learned enough about this to report as to whether or not it is a concern in my case.

So, we knew that the lab reports would take 3-4 days after surgery. I had a message from Dr. Kushner last Friday afternoon, in which he said he had my labs and "they're all good". By the time I called back, his office was closed for the day, but all weekend I was assuming that my hormone receptor tests were negative and that I didn't have to worry about adjuvant drug therapy.

BUT, after getting a copy of the pathology report faxed to me today so I could look at it myself, and leaving 2 additional messages at the doctor's office, I found out that there has been a serious fuck-up. The pathology report I received seemed to confirm that the cancer was non-invasive and that the tested lymph nodes were all negative, and I suppose that's what Dr. Kushner was referring to when he said the report was "all good".

HOWEVER, it turned out that the pathology group ASSUMED the hormone receptor test was done at the time of the biopsy. They did not bother looking at that report, where they could have read for themselves the part where it says, in summary, that the core biopsy sample was too small to perform this test, and that it would need to be done after the tumor was excised. I don't know why Dr. Kushner didn't notice himself that this test was not part of the pathology report, because we discussed my concerns about this on more than one occasion. So, THE TEST HASN'T BEEN DONE!!! The PA (Physician's Assistant) from Dr. Kushner's office who returned my calls and who contacted the lab to find out when we could expect the test results reported that they said "Thanks for pointing this out to us," to which she replied "Actually, it was the patient who noticed." She tried to get the lab to say when they would have results, but all they would commit to is "soon."

Can you tell I'm furious? Lab tests which are critical in determining what, if any, drug therapy I need following my cancer surgery were not done. They were not done because the lab assumed someone else had done them. The lab did not look at prior reports which would have told them the tests had not been done. My surgeon, in reviewing the labs, did not notice that they had not been done. When this gross omission was pointed out to the lab, all they would promise is that they would do it "soon".

No matter how good the quality of care you are receiving is, there is still a burden on the patient to get information and make sure the right things happen. That's just the way it is.

On a More Amusing Note
My personal hygiene is rather restricted these days. Fortunately, lounging about the house and taking slow little walks does not exactly work up a sweat. I cannot shower or bathe yet because I still have my drains in and have unhealed incisions. So I use baby wipes to rub down most body parts, and hydrogen peroxide to clean the underarm where the lymph nodes were removed (there's a separate incision there).

I am blessed with very thick hair which can go almost a week without washing and still look the same (which for good or bad I have virtually no control over - it just does what it wants to). But on Sunday it was time for a wash. We have a marvelous big cast-iron tub on ball feet, so it was reasonably comfortable for me to kneel over it while Pete washed my hair using the hand-held shower attachment, and he couldn't resist photographing his work: