[DancerDonna]

I saw my oncologist yesterday and he strongly recommends against any more lymph nodes removed unless there is successful sentinel node biopsy or if it fails, if there are any nodes that are different from the others as seen or felt: bigger, harder, dimpled, or different-looking.

It was disconcerting, thought, that my oncologist didn't remember that my second cancer is HER2 + just like my first, and also is struggling with his netbook trying to access documents. Twice, he said "IF this tumor is HER2neu +," and I kept saying, "But we KNOW that it is." There was enough from the biopsy for the lab to determine that.

Now I'm trying to find research on the best injection sites for both blue dye and radioactive substance for best identifying the sentinel node in repeat SNB. I'm not finding much, so far. So I had an idea a few minutes ago. Since Dr. Guliano developed the technique for breast cancer, maybe I can find how they're doing the injections at St. Johns in Santa Monica.

I didn't ask all the docs we saw; our questions have kept evolving as we've seen different doctors. The last doctor we saw, a surgical oncologist I was referred to by the plastic surgeon after becoming so frustrated with the breast surgeon he works with most often for DIEP, told us that he injects the radioactive substance into the nipple the afternoon before and then the blue dye into the tumor site.

I found out that the breast surgeon who operated on me five years ago always injects both into the nipple. I think the sentinel node was probably easy to find on me five years ago, before surgery, chemo, radiation, a severe breast infection, and lymphedema. The surgical oncologist said he did that hoping that one of them will show the sentinel node.

I found out today that my surgery date was changed from the date I was told when I saw the plastic surgeon. I was told by the PS's office that they were blocking out Sept. 8 because he was booked thru the first week of Sept. Then Monday is Labor Day, Tuesday his one office day, so Wed. the 8th the next day. I was disappointed I couldn't have surgery right after today because I had my third and last spinal steroid injection today. He is popular since he does SIEA, DIEP, GAP, and TUG and he seems to be one of the few docs who does in the southeast.

I saw the breast surgeon four days later than the PS and spoke of the date, tentative only because of waiting on insurance to consider the hospital in-network. I have brought up the date when I've talked to both offices by phone. Anyway, when I called today to alert the PS's office that BART testing was started on my blood yesterday (I was negative for BRCA) and asked the time of my Sept. 8 surgery, the nurse went into some office to check and then gave me a time for Sept. 10. I was shocked and asked if they ever planned to tell me they'd changed the date.

I found out it's because the breast surgeon does something different on Wed., checking on patients, I was told. But it's not an office day for patients to have appointments; however, she also does paperwork on Wed. Apparently, the PS's office still didn't know that or else thought she sometimes operated on Wed. But they changed the date and forgot to tell me.

The surgical oncologist, who was available on Sept. 8, stayed late and talked with us past 6:30 last Thursday. So did three women who work for him. I could tell his nurse was more than a little peeved when I called them as soon as I found out about the changed date. Turns out he is already booked for Sept. 10. So I guess my surgery will be with the breast surgeon.

I talked to her nurse who stays in the office and of course, no one else has ever asked about injection sites. She was answering, "the breast." She tried to find out from a nurse who was supposed to ask a radiologist. The answer she got was a site half-way between the tumor site and where my first nodes were removed from, the armpit. That surprised me, not a site I've read about. I don't know if that's really where she injects though.

The breast surgeon did try to call me, I found out when I'd logged onto my school system's email. I had specified to her nurse that I was at home, so of course, she called me at school. Which never works very well because I'm usually not in my office when I am at school.

So my next mission is to try to find out the best location or locations for injection of both dye and radioactive substance (highest success rates for repeat sentinel node biopsy) and try to get the surgeon to agree. Although it makes me a little nervous if I am her first for injection into the tumor site.

If you are aware of any relevant research or have any ideas, please post them.

DancerDonna