Surgery recap and the morning after

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Surgery day started at 6:30 a.m. My mom and Lauren drove me to the hospital and stayed with me through pre-op stuff.

Around 8, I was wheeled to the Radioactive Room to have nuclear isotopes injected in my breast. These isotopes would lead the surgeon to the main lymph nodes under my arm (the sentinel nodes). If the cancer spread, there would be signs in these nodes.

I was transferred to a narrow table and told to relax. The doctor came in and explained she would inject four needles into my breast, as close to the nipple as possible. I was told it would feel like bee stings. (But BEE STINGS – in my BREAST! Ouch!)

A nurse held my hand as the doctor injected the isotopes. The first two injections were like bee stings. The third, I didn’t even feel. The fourth, though, hurt like hell. The doctor explained that I would have imaging for about the next 40 minutes, and if the isotopes weren’t moving, she’d have to inject me again four times. If THAT didn’t work, there would be a Geiger counter in the operating room that the surgeon would use to identify the sentinel nodes. A Geiger counter?! How radioactive was I going to be?

Imaging wasn’t bad. Thirty minutes for the first images, seven for the second, and four for the third. The isotopes did not move. The doctor came back in for the second set of injections. All four hurt…major pain and not “bee-like” at all. A second set of images were taken, and the isotopes moved to where they needed to be. My underarm was marked where the main nodes were located, and I was sent to the mammography center.

In the mammogram room, I sat in a chair for the imaging. The point was to find the clips from the original biopsy and mark the clips with guide wires for the surgeon. After four attempts – three of which I was standing, the tumor located near the breast wall, and farther back than the other, was found.

“Are you very squeamish?” the doctor asked.

“Um, no, I don’t think so, but no one has ever approached my breast with a nine-inch needle before,” I said.

“Don’t pass out,” she said. Since she’d have to put the wire in with me standing (the only way we could “find” the tumor) passing out was a possibility.

“One, two, three,” the doctor said and passed a needle in my breast. I was prepared for pain, but felt almost nothing. About three inches of the wire was inside, about six inches left outside my body as a guide.

The second tumor was easier to find and mark, although I was worried about the mammogram panels (the part that squeezes you) hitting the first guidewire and pushing it through my breast. When the second needle/guidewire was placed, the nurses put both under a Styrofoam cup and taped the cup to my chest. This was to “protect” the needles from movement before I was taken to surgery.

I had almost two hours before surgery, so I was taken back to my room. B was there, and having him close while I’d be in surgery made me feel better.

Surgery was about four and a half hours. The first thing I was told when I woke up was that the lymph nodes were clear – meaning no signs of cancer! Both the breast surgeon and plastic surgeon said the procedures went great, no surprises. A few hours after surgery, I was discharged and B drove me home.

Today, I’m aware, but not in much pain, on the areas of incision (a small one in the side of my breast – where the surgeon removed the tumors, a larger one under my breast and one around my areola – both part of phase one of reconstruction, and one on my side past my arm – holding a drain for any fluid build up). I’m in a surgical bra for the next seven days, only able to remove it for showering or washing it.

I know the breast is swollen, but from what I can see, I’m quite pleased. The size (compensating for the swelling) and shape are fantastic. It makes the left breast look kind of sad and floppy (reconstruction on that side won’t happen until next spring).

Overall, I slept great last night, and I feel really good today. So good, in fact, that I’m under the very watchful eyes of my mom and kids to make sure I do NOTHING today, even though I feel like I could do stuff. (They’re okay with me typing, but not lifting my computer…) I’m on restrictions for the next four weeks – primarily no lifting more than FIVE pounds, and limiting activities that increase heart rate and blood pressure. Those are going to be hard rules to follow, if I continue feeling this good.

Fingers crossed for a quick and easy recovery.

I’ve been Sharpie’d

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Surgery’s tomorrow.

I feel comfortable in my decisions. I fully trust my medical team. B will be there for me tomorrow. I feel pretty good going into the day. I just need to get through the surgery to keep on track with the treatment plan (radiation next, then reconstruction).

Today was filled with doctor appointments and pre-surgery stuff. In between the stuff relating to my surgery, Ethan had a cardiologist appointment in the afternoon. He was born with a bicuspid aortic valve, and he’s monitored every few years to make sure the valve isn’t leaking. Good news: he’s good to go for another two years.

My big appointment today was the “marking” visit with the plastic surgeon. I figured there’d be a couple of lines, like where the incision would be, but…

This was a “no pomp and circumstance” kind of appointment. Just right to the point. Change into a gown. Doc in the room right away carrying a large bin of Sharpies.

He sat on a chair, face level with my breasts and started with a thick black marker making a vertical line directly down the middle of my chest – collarbone to half way to the belly button. Then the underboob, both sides. He lifted my breast, made the line, tracing the natural curve, then dropped the breast. Flop! I’m not as perky as I was 20 years ago, but I’ve never felt so “floppy” in my life.

Next a bullseye sort of pattern on the right side. Four rings from mid-breast to nipple. He drew another vertical line from collarbone to the center of my right breast. And a vertical line from the nipple to the outside of the breast.

The doc then switched Sharpies. He picked up a red one and drew a two-inch line in between the lines making the bullseye. “This is where the surgeon can make her incision,” he said. “There’s plenty of room to work within the length of this line.”

A few more lines completed the design, then he unwrapped a sterile, orange-capped marker. With surgical scissors, he pulled out the felt tip of the marker and used the tip to retrace all the black and red lines. He labeled a few things, then we were off to the photography room again.

Seeing the image of the lines on the computer screen next to the images taken during my last appointment was weird. I hadn’t realized just how many lines he drew, and how some of them were already “running” ink across my skin.

I was ushered back to the exam room, told to change back into my clothes, and waited for the nurse to conduct the patient education session.

We talked drain maintenance, pain meds, bra requirements (24-hours a day for the surgical bra until my follow-up visit) and physical restrictions (lifting nothing over 10 pounds and not engaging in any activity that will raise my blood pressure for a month).

I had two pre-op calls to clarify my medical records and reiterate restrictions before surgery. Now I wait for 6:30 a.m., when I need to be at the hospital. Whew!

I met with the plastic surgeon…and survived

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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.

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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!

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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?

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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.