u/annieswaiting

Hi, I’m 54 and was diagnosed with TNBC grade 3, ki67 90%, in late may. (Well, found lump in late may, after all the testing and biopsy, was diagnosed on july 17th.) Ultrasound said 1.5cm so when I saw MO, she said I wasn’t qualified for keynote 522 and unless it was larger in the mri or nodes were found, or if my genetic testing indicated something, it would be surgery first. We ended the appt with me stating I’d prefer neoadjuvant and she said it’s likely, based on her experience that it would be larger and I would probably have neoadjuvant. I then mentioned I was really scared of keytruda though, and we talked about a possible 4 med neoadjuvant w/o keytruda.

A few days later, I had an mri which came back with 1.7 cm. My ct also came back totally good, no nodes or Mets. And my genetic testing was clear. I met with SO, who also said “surgery first, and by golly I have a cancellation for day after tomorrow (this past Friday), otherwise it’s wait til mid September, which no pressure, but that makes me nervous.”

I had the evening to think it over. The MO called me at home to discuss it. I was freaking myself out, panicked about a quick decision and stupidly said, I thought we talked about the 4 med neoadjuvant, can’t we still just go with that plan? We talked more and she agreed we’d go that route and I’m set up for port placement and first chemo this week.

Now I can’t quit kicking myself for passing up the Friday surgery and am having horrible feeling that I’ve made the wrong decision. Like why was I even part of a decision - I don’t know what the hell I’m doing! I’ve read so much and been trying to understand all the protocols and studies and success rates, but this is over my head and the whole reason doctors get paid the big bucks, right?!

I’ve spent the weekend reading their notes, both called the tumor stage T2b. I’m guessing the MO did based on “her experience”, but the SO had all the results and saw there were no nodes and it was under 2”. (She did indicate upon physical exam she felt a 2.5 cm lump which is true - it does feel much larger than what it’s been measured.) I understand this size is a gray area, and 20% of tumors are bigger or have nodes involved, so I get the benefit of neoaduvant to try for pcr. But without keytruda, should I just have had the surgery first?

I have a second opinion with another hospital tomorrow. I’m meeting with the SO only though, as the MO has had no openings for 3 weeks.

What do I do? I tell myself if this SO says surgery first, just do it. And do it with whomever can get me in quickest. But I know I’m going to question myself if I go that route. I think my mind is playing tricks on me since my first experience with this subject matter was here where I keep reading “I wish I’d not done surgery first”. Is it just that the ones who are glad they had surgery first don’t post here because they’ve moved on in their treatment life? The doctors wouldn’t have been influenced by me right? They wouldn’t allow me to choose a path that’s not a good idea would they?

Also, who really knows more - the MO or the SO?

Sorry for such a long rambling post / I’m really tormented right now and having a hard time thinking straight. To top it all off, my person (daughter) that’s been going to appts with me just had a medical emergency with her daughter (my granddaughter), so we’re all worried about them and I am bringing my uneducated-in-any-of-this husband and it’s just too exhausting to try to talk to him about this because he’s so out of the loop. (He’s loving and supportive, but very much a just do what the first doc tells you to do type of patient. Now I’m wishing I was that type of patient too!)

Follow-up: I met with the 2nd opinion surgeon yesterday. Id been communicating with the nurse navigator so the surgeon knew I needed to make fast decisions, so she met with her MO prior to seeing me. They discussed my case and agreed neoadjuvant care was most warranted. She assured me that had I done the surgery, I wouldn’t have chosen wrong, but in my case neoadjuvant would be a “little more right”. I am relieved to have consensus and finally am at peace with moving forward. Again, I thank you all for sharing your experience.

I'm newish to bookkeeping and having a tough time wrapping my head around this. I work for a business that buys parts from retail companies to repair customer electronics. So, for instance we'll purchase a motor, wire & timer from George Electronic Supplies which I enter as an expense in a cost of goods parts account, then match the transaction a couple days later against the bank transaction. When my coworker realizes he doesn't need the wire after all, he'll return it to George, who returns the money to our bank.

We have 20 technicians and the volume of transactions with George is quite high, so I'm using SaasAnt integration to upload the expenses. I originally thought I could just upload negative expenses when the techs return parts, but I don't think that's correct. But it also seems tedious to upload as vendor credit to then go through the process of matching against the bank deposit. What should this type of transaction actually be?