Reentry

It was nice to be a princess. I mean, the reason for my temporary royalty was rather unfortunate, but it did have its perks. I could get used to the regular delivery of neatly folded laundry to my room, drifting downstairs at my leisure to a fresh cup of coffee, and kissing my perfectly coiffed daughter farewell, her chauffeur sweeping her away for preschool drop off. But, unlike the monarchy, uncomplicated postoperative recovery is predictably finite, and for this I am obviously grateful. Today I am six weeks out from surgery. I dismissed the nanny and chauffeur about 10 days ago. And by that I mean that I told my loving parents that I could not adequately express my appreciation, but I knew they had lives to lead. I assured them that I was capable of at least basic self, child, and household care and they cautiously agreed.

Really my only hiccup was an elevated heart rate one day that landed me in the ER. Six hours, a CT scan with tingly-hot contrast, and a few thousand dollars later it was determined that I did not have a pulmonary embolism (a blood clot in the lung)— both cancer and recent surgery increase the risk for that. No one could figure out why my heart was beating much faster than normal, but at least no one said, well not out loud or to my face, that it was probably just my “nerves.” And maybe it was? But as a typical physician-patient who prides herself on utilizing emergency services only if mangled or hemorrhaging, I would have considered such a comment highly insulting. As I think most people would. (Doctors, please don’t ever say that. Ever.)

Now it is time to move forward. The results of my Oncotype test finally came back with a very low score which means NO CHEMO. And no more life-altering decisions. Step one in moving forward: make a hair appointment and procure some functioning styling tools. Now, I have never been known as a maven of hair care or manipulation (I made it well into my 30s before owning and learning to properly operate a flat iron), but lately my mop has gotten impressively neglected, even for me, due to my T. rex arm situation and the threat of impending baldness. Apparently my psyche dealt with the immensity of this last and important piece of good news by focusing in on something as frivolous as my appearance.

Admittedly my personality tends more towards melancholy skepticism than a state of joyful hope, but throwing cancer into the mix tips the scales even further. Cancer sometimes has a way of sapping the happiness out of celebratory situations. Even the smallest tumor (40mm all told, in my case) is still cancer, which is huge and ugly and scary. Even if the doctors “get it all,” the reality is not so absolute. Survivors are living statistics— lifespans measured in percentages, recurrence always a possibility. For my type of breast cancer, all the odds are in my favor. I am incredibly lucky and genuinely thankful. While I cannot and will not live in continual fear, still there remains that sliver of a chance it will come back again, which casts a sliver of a shadow over even the brightest spots, especially now when it is all so fresh.

Additionally, there is the issue of my new boobs. In this department I am also extremely lucky. Cosmetically speaking, given the circumstances, my switcheroo receives pretty high marks. I was able to get immediate implants, skipping the interminable middle step of soft tissue expanders (also known as the “iron bra”), and aside from a very minor brush with necrosis on one side, I was even able to keep my own nipples. So, I am not complaining or overly upset about it, but it is a fact that the new boobs are foreign and different and I am still adjusting to them and constantly aware of them. At this point, the pain from surgery is gone, the wounds are closed and the swelling resolved. However new just this week are intermittent zings of discomfort which are likely benign and expected symptoms of surgical nerve injury or regrowth, but are unsettling nonetheless. And, with every firing of a pectoral muscle fiber, I can feel the silicone orbs under there. Every time that happens, there is a twinge of concern that I am stretching too far or exerting too much, causing some sort of damage. So an action as simple as pumping hand soap out of the bottle or even yawning a certain way can trigger a momentary flood of thoughts and worry that, over the course of the day, is quite draining, dampening feelings of sweet relief.

All this to explain why it is that I have not screamed and shouted, high-fived and Facebook-exclaimed my way through any part of this whole affair, even with the best possible news. I know that as time passes, it will all feel less and less significant and urgent. My brain will eventually accept that the girls are here to stay and stop perceiving them as something new. Confidence in the healing process and my physical capabilities will grow. Life will go on, and as we make our way back into our routine, and maybe even make new plans and set off on new journeys, there will be less bandwidth available for all things cancer. Although I do find it a tad rude that in addition to ditching my princess crown and doing my own laundry again, I will be contending with some complex new psychophysical baggage. Sounds about right. At least I will be doing so with a fantastic, newly beach-waved balayage.

Decision Fatigue

Three and a half weeks have passed since my surgery. Most readers know, through the wonders of social media, that I am doing surprisingly well and have received good news so far. Bob is long gone and thanks to my fantastic and proactive surgeon, none of him was left behind. The silicon is taking and looking slightly more normal each day. I’m off all pain meds and, I’m just going to have to say it, I’m pooping again. I am mostly compliant with upper body movement restrictions, and I can function pretty well with T. rex arms. I have even been to the gym a few times and skirmished with the octogenarians over the recumbent bike and seated, upright leg machines. I have returned to almost normal personal hygiene and can wash my own hair, albeit testing the limits of neck flexibility. I have put on makeup and gone to restaurants.

Instead of my totally hardcore wall-sit, my mom captured me unawares, sliding down said wall to the floor. I was also unaware of the Instagram-tastic quote decal stuck to the wall over my head. #mygympicisbetterthanyours #doievenhavetoask #idefinitelydo #whatsyourexcuse #muahahaha
The amount of support and love from family and friends has been so comforting and appreciated. My mom and sister have taken turns doing the laundry and dishes and feeding, dressing and loving on my child while my dad has been on carpool, playtime and dog-walking duty. My husband was my dutiful and attentive nurse and then went back to the grind. Because, bills. Dear friends and new friends alike have brought home-cooked meals to our door and out-of-town friends have sent meal-delivery gift cards. I received an extremely generous grocery delivery gift card from a Facebook mom group, very few members of which I have ever met in person.

All of the above has been cause for a series of celebrations and generally good spirits. Cancer is now in the past tense and visible evidence of any significant change is astonishingly minimal. I do not need radiation (because my lymph nodes were cancer free), and I do not need more surgery. Can I even play the cancer card anymore?!

Well it’s cancer, and it’s not over yet.

Backing up…I didn’t understand, until personally going through it, the amount of extremely important and life-altering decisions thrust in the face of cancer patients. Yes there are algorithms and protocols, yet there is a surprising amount of nuance. In my particular case, here are some of the questions that I had to answer in a matter of 7-14 days, with professional guidance of course, but ultimately it was up to me:

  • Mastectomy or lumpectomy plus radiation?
  • Unilateral or bilateral mastectomy?
  • Before surgery, should I get a breast MRI to look for any areas of concern on the non-cancer side?
  • During surgery, should I have some lymph nodes removed and checked on the non-cancer side?
  • Reconstruction or no reconstruction?
  • What kind of reconstruction?
  • Which type of implants?

Some were easier than others to answer. And it is a luxury that I do not take for granted that my type of cancer did not dictate any of those to me. Many women aren’t so lucky. But every single question started a cascade of reading, research, grilling my support groups, listing the pros and cons, weighing the risks and benefits, deciphering emotion from evidence-based recommendations… It. Was. Exhausting. Easily my least favorite aspect of this whole cancer debacle. Yes, even worse than smelly pits.

And now here I am, seemingly at the end of my cancer journey as suddenly as it started, and my oncologist, chipper with all the good results, dealt a blow she didn’t realize by presenting me with more decisions.

Looming large is the question of whether I will need chemotherapy or not. Ten years ago there would have been no discussion of chemo for my type and grade of cancer. But now there exists a nifty test called the Oncotype DX® which determines the likelihood of chemotherapy to prevent recurrence. Low score = no chemo, high score = chemo. My oncologist informed me, however, that there is an intermediate score range wherein I might have to DECIDE whether or not to put myself on chemo to maybe decrease the odds of recurrence but to certainly feel like shit and lose my hair and maybe even fry some of my vital organs (you know— heart, lungs, what have you).

And finally, due to my cancer’s appetite for estrogen, I will be starting a medication called Tamoxifen that blocks the estrogen receptors on any silently lingering cancer cells. This is not a choice, rather a standard of care to which I will begrudgingly adhere. The side effect profile is downright rude– ranging from killer blood clots (literally) to weight gain and moodiness. HOORAY! Additionally Tamoxifen is known to have a drug interaction with a medication that I am currently taking– Zoloft. Without opening Pandora’s box of my history of waxing and waning depression dating back to my teens, know that the optimization of my current antidepressant and dose were hard-fought over the last three years and now I have to start over again.

Cue Kate spiraling into a pit of despair. More unknown, more decisions! I genuinely would rather have the four rounds of chemo than receive “intermediate” results and have to decide. But those results are completely out of my control, “outside of my hoola hoop,” to quote the wisdom of my dear friend Harmony. So, I will try my hardest to table that. As for the antidepressant, my only choice is to soldier on with a new medication and hope for the best. That’s not one of my strong suits– hoping for the best– but I commit to making the effort.

And, to be clear, I will absolutely continue to play the cancer card as I see fit.

 

All I Want for Christmas

Funny how perspectives change. Two months ago, I wanted an Apple Watch for Christmas. Six weeks ago, I wanted Bob, the lump, to be benign. And today, all I want is to not stink! I’m 2 for 3, because obviously, this is a cancer blog. But Husband gave me an Apple Watch as an early gift a few weeks ago and today, on post op day 6 (no shave day 7), which also happens to be Christmas Eve, my plastic surgeon told me I could take a shower AND wear deodorant! It’s a Christmas miracle!!!

It took two surgeons seven hours to scoop out all of my breast tissue, a few lymph nodes and hopefully every bit of cancer, and then jam hemispheres of silicon under my pectoral muscles. And the very worst part about all that, it turns out, is the inability to get fresh and clean. (A close second is narcotic-induced constipation, but we won’t go there.)

The problems: 1) not allowed to get my incisions or drain sites wet, 2) not allowed to lift my arms, 3) not allowed to wear deodorant and 4) the dreaded Jobst surgical vest. You see, this madonna-esque (but not in a good way… see previous post for pictorial evidence), hospital-issue vest-bra that I was given, manufactured by a company named Jobst (which is probably run by a Vladimir), has no redeeming characteristics… well none other than securing and protecting my brand new boobs. Due to the nature of its job, said vest fits snugly everywhere including the arm holes, and is thus constantly in contact with my pits. Additionally, it is made of that synthetic material that absorbs odors like a sponge and then time-releases a continuously musky essence. So it does not matter how many sponge baths I attempt, the cycle of stench continues.

Pain? You ask. Yes, I have had some, but it has been controlled to a tolerable level with regular low doses of narcotics. Feeling dizzy and out of sorts for days after a long anesthesia? Yep. But that’s what a newly furnished and decorated bedroom is for. (Another feat made possible by my friend Harmony who facilitated and directed the transition of our bedroom from a glorified storage unit into a soothing haven, pics to come.) A swollen, bruised, uneven and unrecognizable chest? Not knowing the final pathology and next steps, if any, in treatment? Well, that isn’t so great either, however oddly still not as bad as simmering in my own BO and feeling dirty 24/7. I feel like my hygiene and aroma should be one of the seemingly few things left within my control, which is probably why it upsets me the most.

So I nearly cried this morning when the doctor casually mentioned that I could not only take a shower and wear deodorant, but also switch to a regular, medium-compression sports bra instead of Vladimir’s torture vest from hell.

Kids get so many toys and games, some people get gadgets and electronics, others get clothes and shoes, some people even get fancy jewelry or brand new cars with big bows on top. I, however, get to take a shower. And I will bask in that shower like a bar soap commercial from the 1980s and I will be happier than everyone else in the world.

coast commercial

 

Mastectomy Time… an overly hashtagged pictograph

12/18 4:45 am #mastectomyday #bobgetstheboot #dollyparton #newdolliescomingsoon
12/18 5:15 am #waitingroom
12/18 5:30 am #pager #sadlynotthecheesecakefactory #mastectomypager
12/18 6:00 am #preop #grippysocks #onesizefitsall
12/18 6:30 am #heatedpapergown #bairhugger #canyouputmetosleepalready
12/18 6:45 am #givemestrength
12/18 4:00 pm #DONE #byebyebob #hellodollies #cometocandymountaincharlie #goodpainmeds
12/19 7:00 am POD 1 #OOBTC #sadveganbreakfasttray #atleasttheyhadsoymilk
12/19 11:00 am POD 1 #discharged #packedupandshippedout #efficiency #throughput #crazyeyes #anesthesiahangover
12/20 8:00 am POD 2 #inneedofgrooming #notallowedtoshoweryet
12/20 4:00 pm POD 2 #jobstsurgicalvest #madonnachic
12/21 POD 3 #firsttimedownstairs #clearlyifeelamazing
12/22 POD 4 #realpants #firstouting #surgicaldrainfannypack #bodyfluidchic
12/22 POD 4 #hairappointment #professionalhairwash #blowout #ifeellikeapersonagain

The Pits

So many weird things are discussed and planned before having your boobs chopped off. I’m thankful for the support groups I’ve found my way into, and for family and friends who have lovingly and extensively researched the matter, because I’m out in left field right now, and I need help. It makes sense that my neck will feel tight after surgery and that a fuzzy, lavender-scented, bunny-shaped neck pillow that can be heated or cooled will feel fantastic. Big body wedge/pillow for the bed? Sounds amazing. I sleep on my side and stomach which is obviously a no-go post-op. My sister amazonned me both a fuzzy neck bunny and a medical grade wedge, because I certainly didn’t think of any of that. I was fretting about my daughter, who turns four just days after my surgery, and in stepped my bestie Harmony, who found a winter break day camp at the YMCA and called to reserve her a spot. (Harmony just left after spending a week with me, away from her family, two weeks before Christmas. She will get her own blog post at some point because she did oh-so-much more than set up child care!) Oh yeah, I’ll have four surgical drains dangling from my chest and I haven’t given an ounce of mental energy to a solution to that, but my mom personally experienced this and came up with her own drain hack involving fashionable scarves (naturally) which she will bring and style for me.

But the most humorously perplexing issue by far has been… my PITS. That’s right. My armpits. I haaaate armpit hair. I shave daily. It itches me if I don’t. I feel dirty even when I’m not if I have any growth whatsoever. And Harmony brought to my attention that I should address this prior to surgery after which I am not allowed to lift my arms for THREE WEEKS. Simple solution: a wax. No hair for three weeks. Perfect. Or so I thought. Apparently one has to have one to two weeks of hair growth before getting a wax. I had a pre-surgery long weekend getaway at the beach with my husband and I wasn’t going to be anything other than clean shaven as I was taking my girls out for their last hurrah in a bikini… which of course had to be excessively photo-documented. (Take a moment to imagine me, usually selfie-averse, awkwardly taking pictures of my chest from every angle on the beach. Yep. I was that person. But selfies are a practiced skill and I am just not up to par.)

The Pits
Exhibit A (Who blinks while taking her own photo?!)

There was still time thankfully and I began the arduous growing-out process. And let’s just say that I don’t have cute, fluffy, popstar pit hair which was having a moment a few years ago (or is it still?). Think less euro-chic, more lumberjack. At boot camp, I felt the need to explain my pit-uation to everyone in my immediate vicinity which of course lead to a lot of breast cancer oversharing and sweaty hugs.

Ten days in, I could take it no longer and made the executive decision that it was time to make the waxing appointment. I was so excited. But just before I hit “complete” on my online booking, I paused. I hadn’t taken any time to consider the downsides of waxing. I quickly consulted one of my online support groups for guidance and my reservations were validated. I have never waxed anything before so I have no idea how my skin will react. It could be fine, but I could also come down with anything from mild irritation to a flesh-eating bacterial infection. Lymph nodes will be removed from my armpit during surgery, flesh-eating bacteria of the pits would be, well, the pits. So, I scrapped that idea and immediately shaved simultaneously bemoaning the needless ten days of axillary annoyance and the fact that I would, in fact, have to deal with itchy, hairy pits on top of having my boobs chopped off. RUDE FOREVER!!!

As has happened in a few other instances, I took this disproportionately badly. Like almost as badly as the diagnosis itself. My brain is all confused about what and how much to feel about anything these days. But, if I do end up needing chemo and/or radiation (this is still unknown and will not be known until after surgery), I suppose losing all my pit hair would be the the one perk. Gotta take those where I can get them!

So, my last day to shave my pits will be Monday December 17. In the surgical world, time is measured by the number days after the operation. (“Post op day 1” etc.) I shall amuse myself by measuring time in no-shave days. Christmas will be no-shave day 8. Oh what fun!

Living the Dream

Last night I had my first surgery-anxiety dream. I am an avid dreamer. My external environment seeps into my subconscious, conjuring dreamscapes ranging from nonsensically whimsical to startlingly real. They are almost always so vivid that I continue to experience them for minutes to hours after I wake, and in select cases, years. I had more stressful wedding dreams than I can count starting before I was even engaged, and then I had them on behalf of my sister before her nuptials this spring. I have recurring dreams about fleeing natural disasters, getting stuck upside down on rickety carnival rides, driving cars without brakes, and realizing I missed entire college courses the day of the final exam or graduation. So I’m surprised it took my dreamself this long to find her way into an operating room.

In my dream I wasn’t even the patient. I was a medical student bumbling around mucking things up. (I broke the sterile field more than once, and for those not familiar with OR culture, that is basically the dumbest thing you can do and it immediately infuriates everyone around you.) The surgical procedure on the agenda: a nose transplant. Dream-me was horrified by this. Thankfully, before it got too gory, I was jolted awake by my husband knocking over a water glass on my nightstand (as he sweetly brought me a fresh, steaming cup of coffee first thing in the morning). WHEW. Occasionally, in a dream, I have a huge forkful of the perfect chocolate cake and wake up just before it hits my tongue. It is genuinely, real-life disappointing! I love a good cake! But I do not love craniofacial surgery, or any surgery for that matter, so it was a relief to phase back into real life this morning.

The parallels were not lost on me however. In a yet undetermined amount of time, I will be having part of me removed in an operating room. A defining part of me. Maybe not a nose (things could always be worse), but defining nonetheless. I shudder when I imagine bits of me sitting in a cold, metal bowl awaiting extensive scrutiny by a pathologist whilst I saw logs in the oblivion of medical dreamland. But Bob will be in that bowl too. And my new plastic surgeon will be there to lay the groundwork for Kate’s chest 2.0, free from the grips of cancer. And gravity.

Until that happens, I’d appreciate it if my psyche could muster a few large helpings of delightfully calorie-free dreamcake thankyouverymuch.

Thanksgiving

While Bob is a cancerous sonofabitch, he did me the one courtesy of putting down his roots in a spot where I was able to find him by accident. Despite my aforementioned history of multiple breast lumps, I do not perform breast exams on myself regularly. But, I know most of my lumps and where they are and what they feel like. So this year, for Thanksgiving, I express my belated gratitude to Bob for his location, near my armpit. And that I practice at least average personal hygiene and soap my pits most days. And because of that, I discovered the evil lump while it was still small. I can’t say for sure at this point, but I’d like to think the outcome will be overall better because of it.