Hello,
  My name is Michelle A. Schwerdtfeger. I have a husband and 2 daughters. I was 39 years old when I was diagnosed.  (almost 1 month away from my 40th birthday) I do have a great support team of friends and family, that have helped as well so my husband doesn't have to take off work every single time I need to go to the doctor. Here is my story. It will be longer being I put actual reports from the doctors findings in here as well.
     
     I have officially been diagnosed with Breast Cancer Type :  
        Metastatic
    (Stage IV ) Grade 3 Right Invasive Ductal Carcinoma that is ER 90% , PR less than 1 % and HER-2 2+
   Also, a T 4 Vertebral  body lesion on the spine. 

  Overall Size : 3.2 x 1.6 x 3.3 cm
 
    May 23rd 2018: I went into the doctor to have my yearly exam. I usually go around my birthday in July so I don't forget. I had an odd bump on my right breast so I went in a little earlier this year. I found it in the beginning of April. The family doctor  suspected something was not right. I had my 1st ever mammogram done on May 31st 2018. The mammogram came back "Highly suspicious for Malignancy."  I was then set up with an appointment on June 6th 2018 to do a core biopsy where they took out samples and left a metal marker in my site. I kinda went a little crazy waiting on results. Which seemed like it took weeks!!
  I finally received a phone call from my primary family doctor (5 days later) on June 11th 2018 at 8:14am while I was at work. The doctor had confirmed the biopsy results came back positive for breast cancer. He did not have answers for us as far as what stage ect... He said someone from the Sioux Falls Cancer Center will be contacting me that day. I immediately left work and called all my family members to notify them. I received a phone call later that day, from a nurse in Sioux Falls to set up an appointment for yet again more tests. 
              The whole next week beginning June 18th - 22nd was all scans and tests. All done in Sioux Falls, SD. I had to drive over there every morning and missed a week of work using up vacation I had saved to do things with this summer. 
       June 18th: My girlfriend Erin drove me / took me that morning. I had to be there to check in at 8 am. 
I had x-rays and a MRI done that day. 1st I went in for the MRI. Days later I got results. 
 FINDINGS:
"The breast tissue is heterogeneously dense. There is moderate diffuse background enhancement and extensive incidental enhancing lesions throughout both breasts.Right breast: In the lower outer right breast as seen on axial image 137 series 6 and sagittal image 201 series 7 there is a 2.8 x 1.9 x 2.4 cm enhancing spiculated mass. This mass begins 3.6 cm from the nipple. This mass has already undergone ultrasound-guided biopsy with clip placement. This is the patient's known malignancy.In the lower inner right breast adjacent to the chest wall and 5.1 cm from the nipple there is a 9x 10 x 12 mm enhancing mass that is very suspicious for malignancy. This finding is seen on axial image 149 and sagittal image 165.In the lower inner right breast image 134 series 6 there is a 6 x 7 mm enhancing mass 3.7 cm from the nipple. This finding is also suspicious for malignancy and is not well seen on the delayed phase imaging.There is diffuse stippled enhancement throughout the lower central right breast; for example, image 126 series 6, measuring 3.4 x 2 cm and extending from the medial to the lateral right breast, 17 mm from the nipple. This is a diffuse area of suspicious enhancement. There are additional areas of tiny foci of enhancement in the upper right breast but these are more likely diffuse incidental enhancing lesions.Left breast:There are numerous, less than 5 mm, foci of enhancement scattered throughout the left breast. This is a complex MRI pattern but no definite suspicious mass or enhancement is seen in the left breast.Lymph nodes: There is a level 1 lymph node right axilla image 37 series 6 measuring 10 x 14 mm that is suspicious. A level 2 lymph node right axilla measures 6 x 10 mm and is mildly suspicious. No definite level 3 lymph nodes are seen.There is an internal mammary chain lymph node on the right measuring 4 x 6mm image 84 series 6 as well as another lymph node in the internal mammary chain on the right measuring 5 x 6 mm image 90. Both of these are moderately suspicious. No suspicious left axillary or left internal mammary chain lymphadenopathy is seen."
      Next I went right on to the x-ray. The x-Ray results said " Heart and vessels are normal. Lung fields are considered clear. No nodules or masses seen. Hilum, mediastinum, and bones thought to be consistent with age.IMPRESSION:1. No acute disease process seen. No metastatic disease noted." 
     June 19th 2018: My husband was able to take off work to bring me to this appointment. I had another biopsy done. 14 gauge spring loaded biopsy needle was inserted. The needle was advanced to the periphery of the axillary node in the axillary position of the breast.  #3 tissue cores were obtained. Days after waiting for the results.
    FINDINGS:
"Right axillary lymph node, SAVI scout clip, core biopsy:Positive for malignancy, consistent with metastatic Invasive ductal carcinoma. In other words. Cancer! I have more cancer in another place. Great....
     June 21th 2018: My girlfriend Brenda drover/ took me to my appointments this day. They then ordered that I do a CT scan on my stomach/ pelvis. So...that's what I had done that day. Here are my results from that. That day I also had a PET scan, Echocardiogram and finally genetics testing done. 
    FINDINGS:
of the CT scan -
"Minimal dependent atelectasis in the left lower lobe. Otherwise the visualized lung bases are unremarkable.The gallbladder is present. The liver, spleen, pancreas, kidneys, and adrenal glands are unremarkable.Normal appendix is identified. There is an IUD in the uterus. The bowel loops are nondilated. There is no free fluid. Oral contrast reaches the distal colon. Rim-enhancing corpus luteum collapsing cyst in the left ovary is noted incidentally. There are no enlarged lymph nodes. There are no destructive osseous lesions.IMPRESSION:1. No CT evidence for metastatic disease."
PET scan - 
Okay we all know it's all up in my breast at this point. In my head they found some "brown" fatty tissues. I guess that's from when I was a baby? That's what they said,I don't know i'm not a doctor. They said it was normal I'm going with that. I don't want to post the whole report it's pretty extensive.(I you really want it ask me I will show it to you full.) Anyway, I'll just post the stuff they found I didn't know.   
  FINDINGS:
Musculoskeletal system. Focal areas of tracer uptake representing skeletal metastases are as follows:Lesion 1: Involving the body of sternum, best seen on image 112, demonstrates a maximum SUV of 6.71 and a mean SUV of 3.78 suspicious for metastatic disease.Lesion 2: Focal uptake involving the body of T4 with a maximum SUV of 12.62 and a mean SUV of 4.30 representing metastatic disease.1.Known right breast carcinoma, biopsy-proven in the upper outer right breast with FDG uptake as discussed above.2. Second site of involvement in the medial right breast is suspicious for malignancy by PET/CT and MRI. Correlation with ultrasound directedto this finding is recommended for possible biopsy. In addition there is a second focus of abnormal FDG uptake seen on image 115 suspicious for primary breast carcinoma with multifocal disease. This is seen in the medial right breast at the level of the nipple. Consider second-look ultrasound.3. Level I right axillary lymph node uptake representing metastatic disease.4. Skeletal metastases involving the sternum and the body of T4. Uptake in the fat planes of the head and neck, both supraclavicular fossaeand the paraspinal regions in the upper thorax, likely represent brown fat accumulation, physiologic. Continued follow-up will be required to ensure stability.5. Subtle focal area of tracer uptake in the right parasternal region worrisome for tumor involvement in a normal-sized right internal mammary chain lymph node.6. Uptake in the left ovary. Although this could represent a physiologic cyst or evolving follicle, correlation with pelvic ultrasound is recommended to exclude a more suspicious neoplastic process.
         
             So...Now they are saying it is in my spine? Is that right? What?! I doubt that.

Echocardiogram results seem normal I believe. What do I know I'm not doctor. 
 FINDINGS:
Limited study for EF evaluation.The study quality was technically good.The study was performed with the patient in normal sinus rhythm.The visually estimated ejection fraction is 55-60%. The left ventricular wall motion and contractility are within normal limits.The left ventricle is normal in size. There is no concentric left ventricular hypertrophy. A false tendon is present in the left ventricle.The right ventricle is of normal size and systolic function.The left atrial chamber size is normal.There is no evidence of a pericardial effusion.
  My genetics blood work came back with nothing. I have no genes that could have caused this upon myself. I got nothing. Which is probably a good thing considering now my daughters won't have it? But who the hell knows?
  We met with my oncologist to go over some of the results, he told me I had a spot on my back in my spine that showed up on my PET scan. He said it could be inflammation or it could be cancer. There is no way of knowing unless we do a biopsy of the spot. But, we have to know before we actually start treatments because that will determine how we approach the the regiment. Why the hell not? I've already had to other biopsies why not another one? Right? Also, I will be getting a port placed on the left side of my chest. That way I will be able to do treatments without getting poked and prodded every time I have to go in. Just add it all up. 
   June 29th 2018: My husband came with for this one. I really needed him there for this. I got a port and a biopsy at the same time! Wow! They did my back biopsy first. Flipped me over and put in my newest fashion accessory. 
   Port:
The neck evaluated with ultrasound, ultrasound image obtained. Ultrasound demonstrates the internal jugular vein to be patent. Ultrasound used to gain needle access to the internal jugular vein and document intravascular needle location. A wire passed centrally under fluoroscopic guidance and peel-away sheath placed. 3 cm skin incision made in the anterior chest 5 cm caudal to the mid-clavicle. Subcutaneous pocket established and flushed with antibiotic solution. Port connected to catheter and placed through a subcutaneous tunnel to the venous access entry site. Catheter measured, cut and placed through the peel-away sheath which was removed. Catheter tip located at the level of the right atrium. Final fluoroscopic image obtained, confirming catheter position. Port secured in the pocket with 3-0 Vicryl. Port accessed, blood freely aspirated and flushed per protocol. Incision closed with interrupted 3-0 Vicryl, Dermabond and Steri-Strips.
 Biopsy : 
PROCEDURE: Patient positioned prone. Multi planar fluoroscopic evaluation performed of the spine. The target lesion identifiedand overlying skin anesthetized with lidocaine. Under multiplanar imaging, a 13g trocar needle advanced percutaneously through the left T4 pedicle into the posterior wall of the T4 vertebra without violation of the medial wall of the pedicle.  Multiplanar Fluoroscopic images and rotational CT obtained, confirming transpedicular approach. The needle advanced to the anterior 3rd of the vertebral body to target lesion. On table rotational CT performed, multiplanar reconstruction acquired. Biopsy of the target lesions performed with Franseen needle and 16-gauge Temno. All samples submitted in formalin. Access needle removed.
FINDINGS:
 Fluoroscopy and rotational CT confirm a transpedicular approach to the T4 vertebral body, with advancement to the access needle to the left lateral margin of the anterior T4 vertebral body lesion. 
 
     So, in other words they did in fact find the cancer has spread to there as well. Hmm...That's great. Now what are my options?I have an appointment with my oncologist set up on July 6th.

 July 6th 2018: My husband came with me to this appointment. It's our oldest daughter's 17th birthday!! My appointment should only last until 11am in Sioux Falls.We can make it back early and take her out for lunch!! We are bound to get good news! I just HAS to be inflammation!! Today is going to be a good day!! I was so positive of it!!
  That WAS the plan upon meeting with the doctor. The biopsy did in fact come back positive for cancer. Well shit! Seriously?! Now what? These meeting with this dude are starting to be really depressing. Apparently, I went from in the beginning being a "Stage II with a grade 3 tumor " to who the hell even knows anymore? I seriously do not know! He has a plan we got to go with it. We were told it can be treatable but it is "Incurable" I will most likely be on medication the rest of my life. He suggested starting treatment immediately. Chemo - Taxol, Herceptin & Perjeta.  The Taxol is for Killing cancer cells. Herceptin is for the HER2 cells I have to kill them. The Perjeta is to kill the cells as well. I will have to have 12 treatments of chemo. Once a week for 12 weeks. Once that is over I will have surgery and then radiation. That's the plan!! We were like okay, we really don't have an option at this point. Do we? So, whatever you suggest and want us to do we can do it. So, I thought the nurse would be in to set up an appointment start treatments and show us where we had to go. EPIC fail!! Did I miss something? Somewhere? Did I forget to listen? Or did I just hear cancer,blah,blah,blah. Come to find out she was taking us up to the infusion center. She was like good luck! We were like... What? I'm doing this today?!! Umm.. I don't remember discussing this. Did we?I have no idea what is going on. Screw it!! It's got to be done sometime! At least I can start fighting! I haven't done anything at this point to try to cure anything. It's been a month and 1 week, how much has it grown since then? We had a very emotional cry, hugged it out and tried to compose ourselves as best as we could. I asked how long this was going to take. They told me 6 hours! 6 whole hours!! Umm...okay!?! I guess we are stuck here for the day. Glad we didn't have any other plans today. I'ts not like it is my daughter's birthday or anything. We will make the best of it and get this thing started!! Before the put the chemo in my port. (I have one of those things now) They dripped saline mixed with Decadron (it's a steroid)  Then Benadryl , Kytril (prevents nausea) then Pepcid. Then I got some of the chemo. They then gave me the Taxol. Then Herceptin. They had to wait a half hour before giving me the Perjeta. It wasn't so bad. I think the worst part was sitting in the hospital for that long! I really didn't get any side effects. I actually felt better than I have in a long time. Was I really that sick? Or is it the steroids? Who knows? All I do know is that I got past the 1st treatment! 11 more to go!! 
  July 13th 2018: Friday the 13th!! I always loved these! Strangely enough I always have a really good luck on them!My girlfriend Tracy went with me/ drove me. My 2nd round of chemo only took 2 1/2 hours. I guess it is just the 1st one that takes the longest. Who knew? I guess they are all just 2 1/2 hours now. I felt fine just like the first time. I don't seem phased by it at all? Strange. I don't know? But I do know I have 2 treatments done and over with!! I hope this trend continues!! I also had a wig appointment after chemo. You know because I'm supposed to lose my hair and all... I picked out 2 of them. I just could not make up my mind on which one i really wanted so I got them both! Down to 10 treatments to go!! 
  July 18th 2018: My mom and sister are coming to visit for the weekend on Thursday evening. That way they can come to my appointments on Friday. I have to pick up my wigs. Also get trained on how to clean and take care of them. I'm am still feeling pretty good. I really do not feel sick. Maybe I was just so sick before and I didn't realize it? Who knows? I hope this keeps up!! 
  July 20th 2018: Had another 2 1/2 hours of chemo. All is well yet again. My mom and sister came with to Sioux falls and spent the weekend with me. 1 More down!! 9 to go!! :)
  July 27th 2018: Michael and miss Audrey came to my appointments with me today. I had a bad morning my hair started to fall out immensely. I decided when I got home from Sioux Falls I am shaving my head. There's just too much hair coming out now. I had a four hour infusion this time. 
All went well. The oncologist said if I've made it this far without any side effects, I may make it the rest of the way without any. All my levels seem really good. Also, I got a release to be able to do treatments in Spencer, IA a little closer to home. Which I'm now kind of nervous about being I have been going to Sioux Falls without complications. I kind of don't want to change up my routine. It seems it's working out really well and the staff there has just been fantastic!! So, I will have one treatment next Thursday for 2 1/2 hours. ( Just the Taxol again)and see the oncologist. 8 treatments to go!! Almost halfway there! When I got home I did in fact shave my head. My girlfriend Tracy came over and said she made a promise to me I wouldn't have to do it alone. And I didn't!! My Sister Jean and my sister in-law did theirs as well. 
   Aug. 10th 2018 - I am officially half way through chemotherapy with little to no side effects!! I have 6 treatments left!! They have prescribed me Letrozole to put me into post menopause. I also had an IV of Zoledronic to strengthen my bones and hopefully prevent osteoporosis. I'm still feeling good though!! Next Friday we have an appointment with the oncologist to find out the next steps of treatment being that he wants to take me off the Taxol. Sounds like I will only need to go every 3 weeks for chemo.