Just another day

Things I’ve done in the last 24 hours:

  • Hit the wrong button on Favorites list on my phone and dialed my mom instead of B last night. Didn’t realize it was her voicemail until after I left a message. I don’t * think * I said anything weird, but embarrassing none-the-less since I used my “girlfriend voice” instead of my “daughter voice.” She rarely listens to her voicemail, so I’m REALLY hoping this one goes unnoticed.
  • Dumped out all Ethan’s drawers, emptied his closet, and raked out everything from under his bed. After realizing he hadn’t packed socks for a weekend trip and searching his room (unsuccessfully) for two pairs of No-Shows last week, I was so frustrated with the lack of organization/folding and the utter mess of clothes that don’t fit anymore that I just dumped everything in the center of the room. It’ll be a few days before things are back to normal. He handled it better than I anticipated.
  • Participated in a student interview about how I balanced life with cancer. He’s a great student who’s taking a feature writing class and chose to profile me (?) because he really respected the way I handled myself while going through chemo in the spring. It was super nice that this student thought so highly of me. I’m sure I shattered all the illusions during our hour-long discussion.
  • Filled out paperwork for a new therapist for Ethan. This one comes highly recommended by the school’s new principal. (“I’ve seen this woman work miracles with kids who’ve been traumatized!” she said.) His first appointment is Thursday evening.
  • Mourned the (re-) loss of my little toenails. I was born without nails on my little toes, and I’ve never had them – until after cancer treatments. Suddenly, post-chemo, each little toe sported a little, teeny tiny nail. Finally, I didn’t have just eight toenails to pedicure – I had 10! Like a normal person! Unfortunately, both peeled off last night. No pain, no bleeding, just no longer there. I blame having to wear “real” shoes. Thanks, Mother Nature, for the autumnal weather that forced me to trade my sandals for closed toed shoes.

What did you do today?

I’ve been Sharpie’d

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

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!

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.

Back on the chemo train

I’m feeling better than I have in weeks! After being released from the hospital on Monday, I took Tuesday to rest, and then I was back at work on Wednesday and Thursday.

Upon returning to class this week, a student gave me this "pocket angel." She carried it around with her for the last four years as she battled leukemia. "I believe these things should be passed on to those who need them," she said. "You should carry this around with you until you're better, then pass it on to someone who needs it more."

Upon returning to class this week, a student gave me this “pocket angel.” She carried this coin around with her for the last four years as she battled leukemia. “I believe these things should be passed on to those who need them,” she said. “You should carry this around with you until you’re better, then pass it on to someone who needs it more.”

The official diagnosis: pneumonia (viral) and hypoxemia (abnormally low blood oxygen level). With that diagnosis, I had my first “insurance sucks” moment when my insurance company denied the doc’s request for at-home oxygen. Low oxygen levels apparently does not mean I qualify for… oxygen? Makes total sense, right?!

I’ve managed without the oxygen just fine. I use an at-home pulseox (little device I put my finger in to determine my blood oxygen level) when I start to feel funny. From there, I can figure out what to do if my levels are too low (inhaler, deep breathing, sit down/relax, etc.) or too high. Since my levels were SO low, the docs think my oxygen levels have been low for a long time (probably since my GI problems last month) and my body has adapted to less-than-normal levels. Not good. So I feel funny when my oxygen is in the low 80s, and I feel just as funny when my oxygen is in the high 90s.

Treatment started again today. It’s the second phase of chemo. This one is supposed to be 12 weeks of “easy.” Since I’m still recovering from the fever and pneumonia, the oncologist only started one of two of the drugs for this phase (taxol), with the second one being added in a future treatment (carboplatin, which is only administered every three weeks). Some people can’t tolerate carboplatin, so it’s not a HUGE deal if I don’t get it. As the oncologist said, “The carbo is just the icing on the cake.”

Goal for this week: STAY OUT OF THE HOSPITAL!