Sent: Thursday, September 12, 2002 10:52 AM
Subject: Karla Update


Hello Hello!
I know it has been awhile since I have written, but there hasnt' been alot of new news to 
report until yesterday, and I didn't want to bore you all with hum drum stuff, like all the 
aches and pains I have and how frustrated I get, but now I have good news.

I met with Dr. Rivas, my surgeon, yesterday.  He will be doing the mastectomy.  I thought I
might get lucky and have a lumpectomy, but that isn't going to happen.  The tumor is still 
too large for that.  I knew that was coming because I couldn't see one more treatment making
that significant of a change in the size of the tumor.  Dr. Rivas is the one I originally 
met with who gave me the diagnosis that it was cancer.  He then referred me to Dr. Lee, the 
oncologist, who I have been dealing with up to this point.  Anyway, I needed to meet with 
him so we can discuss my options for my surgery.  He was very pleased with the way the 
tumor had responded to the chemo.  He also said that because I don't have any skin 
discoloration like I did in the beginning, he doesn't believe that I have Inflammatory 
Breast Cancer, but that I have a VERY aggressive tumor, which means that my skin is not 
involved.  This is very good news!  I meet with Dr. Lee for my last chemo on Monday and I 
am going to ask him about this.  This is the first I have heard that my type of cancer 
could be different.  Dr. Rivas said that with IBC, the skin stays red and inflamed , even 
during the chemo, which is why they do a total mastectomy and take as much skin as possible 
and that you must wait a year to be able to do any reconstruction due to the involvement of 
the skin.  That was what I was thinking the scenario was going to be for myself for the last
3 weeks. I had talked with plastic surgeon friend of my boss, who told me this was normal 
procedure for IBC, and Dr. Lee had confirmed this at my last treatment.   I was not very 
excited at the thought of stringing this out for yet another year and walking around with a 
prosthetic.  I know I would have done it and would have had to deal with it, but it doesn't 
look like I am going to have to now.  Isn't that great?!

What will happen from here is that I will meet with Dr. Rivas again on Oct. 16th for the 
pre-op and I will have him take a skin sample then, because I want to know when I go into 
surgery what I am going to have done.  He can do it while he is doing the surgery, but I 
think I would rather know before hand.  That way I wake up with no surprises.  This will 
also determine how he will perform the surgery.  I will have more details on that later, 
if all your stomachs are up for it!  I meet with the plastic surgeon next Thursday to 
discuss my reconstruction.  And the surgery is scheduled for November 18, unless they can 
get it moved up a week.  There is a 4-6 week delay on the surgery because they have to let 
all my blood levels go back to normal and make sure I will be healthy enough for it, and 
also have time to get the Coumadin(blood thinner for my port so it doesn't get clogged) out 
of my system.  Plus,it revolves around the availabilities of the 2 doctors to be able to do
it all at the same time.  

So, I think I have covered everything up to this point.  I will have more for you after 
next week when I meet with the plastic surgeon.  Thanks again for all of you being so 
supportive.  It gives me great comfort to know you are out there.

Love ya,
KJ