And That’s A Wrap….(pretty please, fingers crossed..)

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This December will mark one year since I finished active treatment for breast cancer. But for those who have gone down this road, you know that the icing is always a few feet away from the top of the cake. I hope that the end of the year will be only the beginning…the beginning of many Merry Christmases not spent in the shadow of fear…the beginning of conquering demons one by one to make room for happiness…the beginning of a new but different life, one that is authentic and not based on “shoulds” and “laters”.

To that end, I finally decided last week to quit my job all the way. I made a half-hearted attempt at it a month earlier, promising to work as needed, keeping one foot in the door, not burning any bridges, blah…blah…blah. Well, I can see those suckers ablaze in the distance now. And you know what? The most profound sense of peace came over me the day after I did it. It’s as if I had been walking with a splinter in my foot for years, trying to ignore it; eventually, I learned to live with the annoyance. I think I’ll look back on this someday and wonder why the hell I wasted so much time doing something I hated.

Right now, I’m adrift in a way. I’m adhering to the Chinese proverb: “Be like water.” Water doesn’t try to be what it isn’t or force itself into a certain shape. It flows where an opening exists and takes whatever journey it is meant to take. Of course, water doesn’t have bills to pay or children to appease, so there’s that…I can only afford to be water for a few months. But I’m really enjoying this time; I feel a stillness inside that has been absent for so long. I dance with my daughter in the kitchen and sit in my pajamas all day when I want to.

The last piece of my breast cancer odyssey will be complete December 1, when I get my “tats”. There is a lady here in Asheville who does areola/nipple tattooing for free for breast cancer survivors. She does this to honor her mother who died of lymphoma, and it is really a special gift.

I toyed with the idea of getting flowers and vines or some deep words of wisdom to cover the scars, but in the end, I’m a fairly traditional girl. I think that most breast cancer survivors just want their bodies to look somewhat like they did before things went wrong, kind of like a reboot. I’ll be perfectly content to have regular breasts with regular areolas and nipples. They’re not ever going to be the same as they were, but I’m grateful to have them. And they’re not too shabby…

Of course, there will be fairly frequent check-ups for the next year or so. Everyone asks me what the doctors do to see if the cancer has returned. When I answer “nothing”, people look a little uncomfortable and surprised. Unless there is metastatic disease at diagnosis, there’s really nothing to “monitor”. There are blood tests for tumor markers, but these can be elevated for other reasons, so they aren’t regularly done. As a matter of fact, my tumor marker (CA 29-9) was in the normal range with Stage 3 disease. So much for that.

So what do we look for? Mainly symptoms. The most common signs of cancer recurrence are: shortness of breath, constant headaches, unexplained weight loss, and unusual pain. Naturally, survivors are always hyper vigilant when anything out of the ordinary occurs. “Could this be it?” “Why does my back hurt?”

For now, I’m happy to be alive and in good health. I’m toying with the idea of running another half marathon in February. I’m going to start the training and just see how it goes, one day at a time. I don’t want to stress out my healing body. And if I’m being totally honest, that little voice inside is saying this is probably not a great idea just yet. I’m working hard to honor that voice when it speaks. Maybe we can negotiate…

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Daily Wisdom With Dr. Boob

Photo: doodlekisses.com

Photo: doodlekisses.com

As you recall, I told you about my witty repartee with the plastic surgeon in yesterday’s boob update. At today’s post-op appointment he was in rare form.

First, I have to say that I feel so much better than when I had the tissue expanders inserted in March. I’m almost scared that I’m headed for some colossal steroid crash and burn, and this is the calm before the storm. I’m just much sleepier today, so let’s hope that this is the extent of it.

There is, however, one very odd remnant of the surgical experience. I have a fat lip. Just on the right side. Now, I work beneath the OR floor, and let me tell you, it sometimes sounds like they’re tossing midgets up there for amusement. Bam! Crash! I’d love to be a fly on the wall some days.

So, when I graced Dr. Boob’s office this morning, neatly coiffed of course, I wanted to ask him what in the world had gone on the day before.

Me: So, take a look at this lip. Do you know what happened while I was under?

Dr. Boob: You probably bit your lip next to the trach tube, that’s all. (Really! that’s all you’ve got? Quid pro quo, Dr., quid pro quo)

Me: (sure that he was off his game and it would be an easy victory today) I’m thinking that the anesthesia dude, Dr. Hopper, Harry Potter, whatever his name was, got miffed when I told him they screwed up last time. He probably smacked me around a little.

Dr. Boob: Nope. He only hit you lightly, not enough to leave a mark. I saw it.

Me: (he’s back) You mean, you saw me being physically abused and you just stood by and let it happen?

Dr. Boob: Well, I was kind of tied up doing surgery.

Me: I understand, but the least you can do is show me some sympathy now. (I put on my best puppy dog face)

Dr. Boob: (with a totally straight face) Do you know where you find sympathy in the dictionary?

Me: (feeling victory slipping away) No, where?

Dr. Boob: Somewhere between “shit” and “syphillis”.

Dammit! Quid pro quo. It puts the lotion on it’s fat lip, or it gets the hose again.

 

It’s D-Day…No Really

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If it looks like I’m slightly off-kilter in this picture, it’s merely a temporary unevenness caused by the drugs, making it somewhat difficult to stand in place without listing to one side (and to make sense, according to the number of times I’ve had to re- type words).

This morning I had surgery to exchange my breast tissue expanders for the permanent implants which will call my chest home. This will be almost the last step in a breast cancer treatment odyssey that began last March. The surgery itself lasted only an hour and a half, but I had to be there as the roosters were standing in line at Starbucks, getting coffee before crowing.

Nothing to eat or drink after midnight, blah, blah, blah. I didn’t eat, but I did have a few slugs of java and a little water. I know, I know.  Poor listening skills. I was simply trying to avoid the all-out tactical assault that was involved in starting my I.V. last time due to dehydration. I have to say that went stunningly better this go round.

I had to bring my new front-zip sports bra into the OR with me so they could bend my arms backwards and jam me into it lovingly slip me into it to hold the new cleavage down and reduce swelling. My post-op appointment is tomorrow morning, and you better believe I’ll fix my hair before I see the doctor this time.

When I came in after my last surgery, he asked “Did you even comb your hair today?” Now, mind you that I had been throwing up for the previous 24 hours due to anesthesia, and he was really lucky I made it at all. But Dr. Boob is a character, and I really love his smart-ass dry sense of humor (perhaps because I share it), so I had to take it in stride.

Here’s an example of an exchange we had yesterday:

Me: I think your medical assistant screwed up. She said something about a bilateral testicular implant.

Dr. Boob: Yes. We’re throwing that in as a promotion.

Me: (reflecting for a moment) Well, I have always felt like a man trapped in a woman’s body.

Dr. Boob: And now we’ll be making that a reality for you.

And this is how we roll on any given day. It’s a game to see who has to think longer before replying.

Right now, I’m feeling about a thousand percent better than after my last surgery, but it realize that part of that is the rather large dose of steroids they gave me through my I.V. I brought my anesthesia records with me so we could go over them and come up with a better game plan for nausea. I got Emend, like they give before chemo, and a Scopolamine patch behind the ear. So far, so good. Always be your own best advocate!

Apparently, from what I’ve read about implant reconstruction, there is a “drop and fluff” period of a few weeks, which sounds like you brought some dirty towels to the dry cleaners. What this means is that your implants will settle and look fuller as they begin to heal.

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It’s truly anyone’s guess as to what size you will end up when all is said and done, as there are so many variables of chest width, body type, height, etc. Dr. Boob told me to go by the tissue expander on the non-radiated side, so I hope that’s what I get in this odd box of Cracker Jack boobs. All I can say is that I was fitting into a 34D before surgery, and that’s the size of the sports bra you see.

I’ll post some pics as the “drop and fluff” progresses. As for now, I have to go was my hair and style my hair so I’ll be ready for tomorrow!

Houston, We Have Mosquito Bites!

mosquito bites

Well, today I’ve decided I might actually live. It was touch and go there for 48 hours. I had the beginning of my breast reconstruction surgery Wednesday at 10am, during which I had tissue expanders placed under the pectoral muscles.

Apparently my veins have gone into hiding since having chemotherapy, even though I received my meds through a port in my chest. So, needless to say, starting my IV was fun. The nurse tied a tourniquet, slapped me around a little, and gave up without a fight. “I’m not even going to try. Luckily we have someone from radiology here today training us on how to start an IV with ultrasound. I’ll have him come in.” Thank God for small favors. The IV guru arrived with trainee in tow, and he decided to let her have a go at it first. Fail. He pulled the six foot needle back out and started over. I could feel my needle-phobic husband trying his hardest not to pass out in the corner. After 20 minutes or so, we had a successful stabbing.

Next, the nurse anesthetist came in to give me some medicine to “help me relax.” This always cracks me up because, for me, this translates to “see you next Tuesday.” I don’t take medication very often, so it works fast and dirty. I barely remember getting into the operating room. After that, lights out, see ya later. I woke up after what seemed to be 5 minutes in the recovery room with the nurse trying to wake me up. The surgery had actually taken about 90 minutes.

I started to get a little queasy in the recovery room, but I was given some Zofran and all was well. Until…I rode in the car. The minute I stepped in the house, I had to rush to the bathroom to be sick. I went to bed thinking that I just needed some more rest, but it wasn’t to be. My head hurt and I vomited for the next 24 hours with an empty stomach. I couldn’t even keep water down. So, needless to say, that prescription for Vicodin sat untouched on my bedside table.

My husband called the doctor, but apparently they were having a phone issue, so the answering service kept coming on. But they never paged the doctor. Eventually, by sheer luck, the office assistant called to check on me and I got a prescription for anti-nausea meds. They are addressing the phone issue today; it’s not a good idea for the doctor to be unavailable after surgery.

Anyway, when I woke up this morning and managed to get some Tylenol and caffeine on board, I felt almost human. I went to the doctor, and after he told me that my hair was a mess (he’s a piece of work!), he took the bandage off to reveal my brand new Barbie mounds. He managed to get 180 cc’s of saline in each side during surgery. Thankfully, knock on wood, I’m not having intolerable pain thus far. A friend who had this done 5 years ago said that it felt like she had ground glass under her skin every time she moved. I can’t tell you how much I was looking forward to that. The only thing that may get irritating is the edge of the right expander, which looks like a little unicorn horn sticking out. This should fill in when he adds more saline.

Next up, I will get my stitches out April 8, and then the filling process can begin in earnest. The doctor said that the radiated side has a lot of scar tissue and is tighter, so we may have to fill every 2 weeks to allow the skin on that side to stretch and catch up.  My husband is going for something the size of cantaloupes. I’m thinking a smaller, firmer fruit will suffice.

Oh, and please remind me the next time they ask if I’ve ever had a problem with anesthesia to shout a resounding “YES!!”

 

Today Is B-Day

No, I won’t be landing on a beach in Normandy. Well, maybe, depending on how much morphine they give me. I hope it’s warmer there…

I’ll be hurrying over to the hospital in about an hour so I can wait for two hours with some other starved and dehydrated souls before surgery. Today will be the beginning of my bionic boob journey. “We can build them better, stronger…”

My tissue expanders will be inserted today and filled with 50-100 cc’s of saline. After I’ve healed for a couple weeks, I’ll go in weekly to get a “splash n go” until my mosquito bites become navel oranges.

I woke up at about 3:30 this morning with a combination of hot flashes (which I rarely get) and nerves. I think I’m more nervous about this surgery than the double mastectomy. I’ve been feeling really good lately, and I’m not looking forward to being in pain and having to take antibiotics. I have to keep telling myself that at least there’s a better consolation prize this time around.

Well, I’m off to get ready. I’ll keep you posted.

New Boobs Ahoy

mermaid-contrarian-creative

 

Well, the time has come, almost one year to the day since my breast cancer diagnosis. I feel a little giddy, like a high school girl with a hundred dollar bill at the mall. Should I get these, or, no….wait a minute, I really love the way I look in these. Do you think these make me look fat? I’m not talking about a new pair of jeans or even a daring little polka dot bikini; I’m picking out something much more fabulous and precious, a new pair of boobs.

Yes, that’s right, on March 26 I will be undergoing the first step in the series leading to my new and improved “girls”. Now, my bar is set fairly low. After all, anything would be a drastic improvement compared to the flat chest desert with the matching horizontal scars I now sport. It’s cool in a way. I look a bit like a really simplistic treasure map. I’ve followed the map; now I’m ready for the prize.

tissue expander

This first step will involve placing two plastic tissue expanders, which consist of folded plastic bags, under the pectoral muscles. (That just sounds like fun, doesn’t it?) There will be a small port placed under the skin with a tube leading to each bag. For 6 to 8 weeks, I’ll have saline injected into the bags a little at a time via the port. This will allow the skin over the chest wall, which is now flat and taut, to stretch to accommodate an implant.

Once the desired size is reached with expansion, which I’m thinking will be about a perky “C”, the expander is exchanged for a permanent implant. I’ll then have nipples created from skin elsewhere on my body, and the final artistic touch will be tattooed areolas.

This sounds like a simple process, but in reality it can be anything but. It carries the normal risks associated with surgery, such as infection and bleeding. However, when surgery is performed on radiated skin, there are additional worries. The skin may not heal properly, or it may not stretch as expected. Also, radiation causes the skin to be thinner, so cadaver skin will be used on that side to “reinforce” the implant and prevent it from breaking through.

before-after-implant

After all is said and done, I would love to have a result like the one above, which is from a plastic surgeon’s website. Hey, maybe I need to go back and get that name! Now, I’m sure that this is probably a year or more post-op to have that much fading of the scars. But all in all, it looks great to me. Ok, I might go a touch bigger, but I won’t get greedy.

The best part of all this, aside from being able to wear normal clothes again, is that I’m having the procedure the day before my daughter turns 6. I’ve already told her that we will have to go to Chuck E. Cheese a little early because Mommy is getting new boobs for her birthday!

 

Still Looking For Mr. Goodboob

80’S CANCER JAM OF THE DAY:

I’m still searching…searching for the magical sculptor who will mold from my fair, flattened silhouette into an artful bust that will make me grin when I catch a fleeting reflection of myself in a low-cut top. Apparently, my imagination and reality are having trouble lining up.

Pablo Picasso - Seated Nude

Pablo Picasso – Seated Nude (Photo credit: ahisgett)

You might remember  that I recently wrote about going on a two hour journey to meet my first plastic surgeon, henceforth known as Picasso. I drove to his office with great anticipation, heightened by the fact that his name is Jean-Pierre. How perfect! An “artiste” with a French flair. Ooh la la! (Yes, I do know that Picasso is a Spaniard, smart aleck).

Picasso’s office was very crowded and bustled with women in various stages of alteration. I waited 15 minutes in the reception area and was then called back to a room. There I waited another 45 minutes. Arrggh! I tried to be patient since I had only called the day before and they were kind enough to see me on short notice.

Finally, Picasso entered. It wasn’t lost on me that he was very attractive. Let’s see: French, a surgeon, good-looking, what else could one want? Oh, of course, he was also an Ironman triathlete. Once my adulation dimmed, Picasso started taking my history in a pleasant but very hurried fashion. He anticipated my answers and wrote them down before I could speak, frequently having to erase as I corrected him. I could tell that he was very aware of the many patients waiting in other rooms.

Picasso: “So you’ve had chemo and now you’re all done and ready to move on to reconstruction.” Scribble, scribble.

Me: “Um, no, actually I have to do radiation.”

Picasso: Erase, erase.  “Ok, so you want to get the implants in before you proceed with radiation.” Rescribble.

Me: “Well, no, my radiation oncologist would prefer that I wait to do reconstruction.”

Picasso: Erase. “Oh, I see. That’s fine if that’s what you want to do”.

Me: “Well, you tell me. What do you recommend from your experience?”

Picasso: “I think you should probably do whatever your oncology doctors recommend.”

Me: (thinking to myself) “Major copout.”

So, the bottom line I got from Picasso was this: He prefers to start with breast implant reconstruction, although he admits that there is a 1/3 failure rate after radiation. It’s an easier surgery with a shorter recovery time, and we can always go to Plan B if it fails. Plan B is to use my own tissue to create a breast, which involves up to 15 hours in the operating room and 6 weeks of downtime. He usually recommends waiting 6 months after radiation to begin, but he’s willing to start as soon as February based on some newer research showing that waiting leads to more scar tissue and less pliable skin.

Ratings for Picasso: Friendliness: B+   Office Wait: D     Explanation: A-    Patience: C

Fast forward to yesterday. I was supposed to start radiation therapy at 11:30 after days of soul searching, lost sleep, consulting the I Ching, you name it. I made my decision at midnight the night before to go forward and finally felt some peace.

Pierre-Auguste Renoir

Pierre-Auguste Renoir (Photo credit: Wikipedia)

Luckily, I had an appointment before radiation with plastic surgeon #2, who we’ll call Renoir. When I entered this office, I was greeted very warmly by a smiling gray-haired lady with a ton of Southern charm. There wasn’t another soul in the waiting room, which I tried not to take as a bad sign. I filled out my paperwork and was taken back to a room immediately.

Once I had changed into a gown, Southern Belle came back and thoroughly explained the implant procedure. She showed me a tissue expander, which would be placed under my pectoral muscle through each mastectomy scar and slowly filled with saline over several months. At that point, it would be exchanged for a permanent silicone implant. She then showed me the different implant styles. At this point, Renoir walked in.

tissue expander

Renoir was a short, dark-haired man in his 50’s with a peculiar smile. He wasn’t nearly as cute as Picasso, but I felt more at ease with him. He listened attentively. No history form, no erasing. I asked about Plan B, the foob made from my own tissue. He came over to me and squeezed my belly, trying to coax out some fat. He furrowed his brow, “Nope. Not enough skin. You won’t be a candidate for an abdominal procedure.” Back to the implant.

Renoir: “So you have to have radiation. Hmmm. Are you sure you want to do that?”

Me: Horrified that I was having to rethink this decision yet again. “What do you mean?”

Renoir: “It really damages the skin badly. Has the doctor told you the benefit from doing it?”

Me: “Well, overall, it’s a 9% increase in 10 year survival.”

Renoir: “9%? Hmmm.”

Me: Panicking now. “But..the statistic I keep going back to is reducing the risk of local recurrence from 35% to <5%. That’s pretty good.”

Renoir: Looking doubtful. “Well, you have to make that decision. I’m just telling you what I’ve seen. It really makes my job a lot harder, from a result standpoint. You can decline radiation, you know.”

Renoir then proceeded to tell me that if I were going to do radiation, it would be a lot easier for him if I got the tissue expanders in before the skin was radiated to prevent healing complications. “Oh shit! Another curveball. I’m supposed to get zapped in an hour” I thought.

Renoir: “Go talk to the radiation doc and let me know what you decide. He may not want anything under the skin during treatment.”

I left with my head spinning and my heart pounding. So much for peace. Now I was facing the prospect of major surgery and doing the radiation with painful foreign objects imbedded in my chest. Or should I do the radiation? Oh God!

Ratings for Renoir: Friendliness: A    Office Wait: A+    Explanation: B     Patience: A   Freaking Me The Hell Out: F-

Long story short: I went to the radiation office and told the super nice lady at the front desk that I had to talk to the doctor before my treatment. I told him what the plastic surgeon had said about doing surgery first, and he agreed, much to my surprise. His only condition was that the expanders would not be allowed to be filled at all until after treatment. This would cause more of my lung to be irradiated due to changing my chest wall angle. No thanks.

I have one more plastic surgery appointment before I make a final decision. Tuesday, I’ll be off to see Monet. I really want to ask him if he thinks putting these expanders in before radiation is crucial to the success of the reconstruction. That’s my bottom line. My gut is leaning toward getting through one treatment at a time and not rushing things.

What do you breast cancer warriors think about the whole dilemma? I’d love to hear your advice.