I met with the plastic surgeon…and survived

Today I met with the plastic surgeon. It wasn’t as bad as I anticipated, but it was still weird.

I was the only patient in the waiting room, and I didn’t wait long. After some brief questions and blood pressure check, the nurse went to find the doc. He was in the room within two minutes with his PA.

“I know your story and talked to the other doctors, so there’s no reason to ask a lot of questions about your situation,” he started. “Change into the gown, opening in the front, and we’ll do some measurements and photos.”

Measurements and photos? The doc and PA came back into the room. The doc had a tape measure; the PA handled some papers. “Just stand right here,” he said, unwinding the tape measure.

On both breasts, he measured the distance from my nipple to my collarbone and underside of my breast. He measured the size of my areolas and the distance from the edge of the areola to the nipple. As he measured, he called the numbers to the PA. Turns out, I’m perfectly symmetrical – for now. 🙂

Then we walked down the hall to a locked room across from the nurses’ station. It looked like a photo studio with lights and reflectors and cameras and a computer. There were two blue lines on the floor. “Just put your gown there,” the doc said pointing to a chair.

“Are these blue lines for me?” I asked. (Of course they were.)

“Um,” I said, standing on the blue lines, awkward and topless, while he logged into the computer. “I’ve never taken THESE kind of photos before…”

He laughed and said I’d get used to it. “You’re in a plastic surgeon’s office,” he said. “This is what we do. It’s not your last time…”

He snapped three photos (forward and from each side) and uploaded them to the computer. Then we walked back to the original exam room where I redressed and waited for the doc to reenter the room.

He returned with a three-tiered cart full of stuff. I asked him to walk me through all options – from mastectomy to lumpectomy reconstruction options – and he showed before and after photos of each. We started with implants (which I don’t want). He recommended the “gummy bear” implant, which is fairly new, and from my research, a lot of women like them. (Nicknamed “gummy bear” because they have a thicker consistency than other implants, almost like a gummy candy.) They do look more natural, and the doctor is one of the leading surgeons using this kind of implant. It’s also the “easiest” option – little downtime, quick surgery, little follow-up necessary. No.

We talked about total reconstruction using either a stomach muscle or a back muscle. The stomach option (and the before/after photos he showed) is intriguing. Muscle, fat, and tissue from the belly button to the hipbone is removed and shaped into a breast. Totally natural looking breasts and flat stomach – but an 8-10 week recovery and possibility of necrosis. Additionally, with the stomach, there can be only one breast reconstruction surgery. If I were to get cancer again, the stomach would be off-limits. Awkward moment: I was asking about the exact area on the stomach and the doc asked me to stand and look in the mirror. He lowered the waistband of my pants a bit to show me, then he grabbed a handful of tummy. With the other hand, he grabbed my right breast and squeezed both. “Your tummy isn’t quite as big as your breast, so we’ll have to inject fat from another area,” he said. Um, maybe.

The option using the back muscle is similar, but would require a small implant under the relocated back muscle. No.

For lumpectomy, the plastic surgeon would come into the OR after the breast surgeon removes the area around where the tumors were. Without knowing exactly how much tissue will be removed, he’ll shape, possibly reduce, and lift the breast, making it look as natural and good as possible. Since the lumpectomy will require six weeks of radiation, all other reconstruction must wait. (Radiation can cause skin changes and change in the size and shape of the breast, so it’s best to wait until the skin is healed – anywhere from four to six months after radiation is over, or in my case, right after the spring semester ends.) I’ll have a few follow ups then to make sure I’m satisfied with the size and shape (if not, fat from the tummy, butt, or thighs will be lipo’d and injected in the breast). Once the right breast is satisfactory, he’ll work on the left breast to make them symmetrical – a lift at minimum, reshaping with fat injections at most. All follow ups will be out patient, and just an hour or two each.

I asked about next steps. “Choose what’s best for you and the breast surgeon’s office will schedule with us,” he said.

By the time I got home, I knew the lumpectomy was the best option. Surgery is scheduled: July 21.

Now I’m starting to get nervous.


In other news: I went out of town for the weekend. It was the first trip I’ve taken since… I don’t know. November maybe? Not sure if I could make the drive myself, I took my mom and the kids to stay with family, about half way to my final destination. We toured a dairy farm, and I was completely fine with walking (quickly in the rain) for part of the tour. Oxygen levels seemed fine, no heavy limbs or excessive yawning. The next day, I finished the drive (another few hours) to see friends and attend a concert. It was super awesome that the band members wore breast cancer bracelets through the concert in my honor. (We went to high school with the band’s drummer, and it was coordinated through him.) I spent part of the concert sitting, but I’m okay with that. Oxygen stayed on target, and even without an afternoon nap, I was okay with the late night (although when we got back to my friend’s house, I crashed). It was a long drive back on Sunday, but I survived!

Brief update, hesitant about plastics appointment, and GREAT NEWS!

It’s been 11 days since my final chemo, and I’m  starting to feel better. I can function on a normal night’s sleep (without sleep aids like melatonin or Advil PM) and only one small, hour-long (or so) nap in the afternoon. This is in contrast to last week’s 20+ hours of sleep a day. I can walk further distances without my oxygen dropping, but there’s still a way to go to build back my stamina. Taste is coming back; bone pain is gone; the neuropathy on my right side is the same (ugh).

I’m slowly crossing off the last few tasks prior to surgery – I have a few more appointments and tests before I can schedule the surgery date.

I meet with the plastic surgeon next week. Even with a lumpectomy, there could be reconstruction and shaping necessary, but I have a mind-block about seeing a PLASTIC SURGEON. I’ve put off scheduling the consultation for weeks. While any reconstruction would be the result of a medical issue, the thought of walking into a plastic surgeon’s office just seems…icky and vain. I have images of sitting in the waiting room among supermodels seeking ginormous boobs and lip injections or the Human Barbie Doll looking for her fifth nose job and butt lift. It’s my personal mental block, and I hope the visit next week puts that to rest.

But the BEST NEWS involves the mammogram and ultrasound I had yesterday. The mammogram was fairly routine and quick. But it took more than an hour in the ultrasound room because the tech couldn’t find the tumors. She eventually called the doctor to come in. The doc COULDN’T find them either. Finally, after much searching, pulling up the images from December and April to compare “landforms” in my breast tissue, and MORE searching, the doc finally found the clips that were placed during the biopsy. The tumors are so small now that the doc couldn’t measure them. They’ve changed from football-shaped masses with tentacle-like things in all directions (December) to smaller eyeball-shaped masses with “cat eye” tails on each end (April) to small, narrow, flat masses (now). The doc explained that given the current shape, what’s left is most likely scar tissue from the biopsy and/or the breast filling in the spaces left from the tumors. But basically, the tumors (the cancer) are GONE, at least the masses aren’t “cancer-like” on the ultrasound. The masses don’t look like cancer anymore. Six months of chemo worked! Of course, we won’t know anything for sure until surgery, but the images were so positive that the tech, doc and I exchanged high fives in the ultrasound room. Can’t wait to get the thoughts of the oncologist and surgeon on this latest imagery.

Given the decrease of the tumors, I’m comfortable now with the choice to have a lumpectomy. Just have to get through the plastic surgery appointment…

Last chemo?

Today is most likely my last chemo, two infusions shy of completing the original treatment plan. I’ll still have weekly blood draws to monitor my counts, but no more visits to the Infusion Room.

Six months of chemo.

Four rounds of AC.

Three rounds of carbo.

Ten rounds of taxol.

Plus three ER visits, neutropenic fever, pneumonia, and extremely low blood counts.

Today’s doses of carbo and taxol will be reduced by 20 percent. My oxygen levels are still low and drop with even mild exertion, most likely because of anemia. Neuropathy, limited to my right hand and foot, is getting worse – going from just numb fingertips a few weeks ago to now a tingly hand and foot. The neuropathy turns to restless leg syndrome on Friday nights making it almost impossible to sleep – this is probably caused by the Benadryl given as one of the pre-meds to help fight allergic reaction to the chemo meds.

It isn’t uncommon to stop chemo before the end of treatment, especially with the amount I’ve endured. I’ve known for a while that the infusions would most likely stop before the originally prescribed 12. Mentally, I just wanted to get to 10 doses of the taxol. In my mind, that’s the magic number.

Still, I’ve been thinking “what if” – if the cancer comes back, will I regret not getting the full, original treatment plan? Would those final two doses make a difference?

The oncologist put some of those fears to rest this morning. At this point, there’s “probably” little the chemo is doing for the tumors, and the side effects (especially the neuropathy, which can become permanent if the chemo isn’t stopped in time) outnumber the benefits. Given my “young” age, the plan was to get as much of the chemo drugs as possible without creating any long-term problems.

This also means I may be able to move my scheduled mammogram and ultrasound, which could move the surgery date earlier in July, giving me more time to recover before school starts.

And yet, I’m a little scared. For six months, I’ve “known” what to expect week-to-week, day-to-day. Chemo is crazy routine in what to expect and when to expect it. Now that it’s coming to an end, the next phases have more gray areas and more decisions to make.

And I still haven’t committed to a surgical option.

Musical flashback: Moonlight Feels Right

The song played every time Mike and I ate at Joe’s Crab Shack. I never heard it anywhere else – ever – until today. 

It reminded Mike of his childhood. He said its one of the few things he associated with “happy memories” of his early life and his parents. He remembered hearing it at his parents’ softball games when he was really young. But he didn’t know the song name or the group that sang the tune. 

For his birthday one year, I researched and found it – “Moonlight Feels Right” by Starbuck. (This was pre-Shazam.) I stealthily put the song on his iPod. SURPRISE! It’s a good memory. 

But it’s an awful song. Ridiculously stereotypical 70s sound. And it was playing on the Sirius 70s On 7 channel when I was on my way to pick up the kids. I hadn’t heard the song in a long time. I smiled at the happy memory, but I couldn’t wait for it to end. 

It’s still an awful song. 

The power of the bath: making a surgery decision

I rediscovered baths this week.

As a teenager, I would spend HOURS in the tub – reading, relaxing, thinking. When I went to college, there was a tub on each floor, but it was in a glorified cleaning closet that was dark and dingy and gross. I don’t know anyone who used a tub in Justin Hall. I continued to take long baths when I came home from college on breaks.

Once I was “on my own,” baths disappeared from my life. Too much to do. Too tired. Other priorities for my time. It’s unfortunate, really, since I’ve lived in places with really nice tubs.

Our first apartment in St. Louis, when Mike was in law school, had a deep claw foot tub original to the building built in the early 1900s. That tub was so flipping deep that I almost needed steps to get in. Water up to your neck. But it was short. I think I took one bath there in four years.

Our first house had a brand new whirlpool tub. I never took a bath there. Our second house had a whirlpool tub built for two. Seriously, while resting my back on one side, I couldn’t reach the other with my legs, which meant sliding down too far. I used the bath pillow as a floatation device the two times I took a bath in that house. It’s not relaxing when you’re concentrating on not drowning.

My current house has a whirlpool tub that is just right. Not too deep, not too long. Still, in three years, I never used it until Tuesday. That’s not to say it hasn’t been USED – the kids love to take baths in there since it’s deeper than the tub in their bathroom. And it has jets! And makes bubbles!

Tuesday I had my annual physical with my primary doc. During the “well woman” portion of the visit, the doctor discovered an ingrown hair (yep, my hair is S-L-O-W-L-Y growing back!) just to the left of center *down there. * It was showing signs of infection and needed to be drained.

SIDE NOTE: Everyone has an issue with a word or two, right? One of my issues is with the word gro*n, which is technically where this problem lies. See, I can’t even type the word, let alone say it…

I’ve seen a lot of docs this year, and I’ve had a lot of tests. Some of the tests and doctor pokes have been painful, some not. But NOTHING I’ve been through hurt as much as when my primary doc injected the heart of the infection with a numbing agent. Hot diggity! That shot hurt. It was all I could do not to kick her in the head or scream.

Once numb, she drained the area and gave instruction to “rest in a warm tub, with a glass of wine and a good book.”

Doctor’s orders, right?

With kids in bed and a new book in hand (no wine since my liver is still not super happy with chemo), I turned on the faucet of the tub and climbed in. I sat there for a few minutes, starting to read the book, then got out. The tub ledge was dusty, and I couldn’t relax so I cleaned it. I read a chapter or two, then went to bed. I slept pretty well, so I decided to take a bath the next night also.

This time, the tub was clean so I could relax. The book was an easy read and perfect for the bath. I read several chapters then set the book aside. I sunk lower in the tub and let the water wash over me. I allowed my hands and arms float on the surface as I closed my eyes and breathed deeply.

I don’t know how long I stayed there, concentrating on my breathing, but I was able to identify and “solve” a couple of the things that have been bothering me lately – primarily weighing my surgery options.

I know a lot of women don’t have an option, but having the choice between lumpectomy and mastectomy is almost worse. What if I make the wrong decision? If this comes back, will I always question my decision? Why can’t someone just TELL me what to do?

I always maintained that I wanted my entire breast removed, but after meeting with the radiation oncologist (who is also the head of the cancer center), I started to rethink that. All the docs have stressed that it’s my decision, but I get the feeling that they’re recommending the “breast conservation surgery” (that’s what they call lumpectomy – defining it in those three words kinda shows which way they lean, doesn’t it?).

One of the biggest benefits to the lumpectomy would be recovery time. It’s far less invasive with almost the same success rate of removing the entire breast. At this point, I just want my energy back. I want to NOT be exhausted ALL THE TIME. I want to enjoy stuff again. I want to be able to DO stuff again. And a lumpectomy will allow me to get back to “me” faster.

Of course, there are cons also. Lumpectomy means I will undergo 4-6 weeks of daily radiation. I feel a little better about radiation after talking to the radiation oncologist. Given the size of my breasts, I (probably) will not blister and burn. Fatigue is a side effect, but the doc said women who have had chemo first don’t think the tiredness is as bad as during chemo. Radiation is only 15 minutes a day, and they will make sure I have early appointments.

I still have to meet with the plastic surgeon to understand reconstruction with lumpectomy. As much as I know my breasts have served their purpose (successfully fed two babies!) and I don’t like to think of myself as overly vain or concerned about such trivial things, I really don’t want to be misshapen or have a deep dimple on my right side.

I’ll probably HAVE to take a few more baths before I commit to a surgery plan. That warm water gives me much needed clarity and decision-making power.