Phase Two – Cut it out!

Wow it’s been a long time since I’ve posted anything. I’ve composed many many posts in my head which I intend to get to before long. Posts about my existential crises, about what I got wrong about cancer in my first few posts, the cancer books I’ve found most useful and entertaining, and a list of stuff I can do while I wait out radiation and grow some hair. But those posts are for another time. I want to stick to one subject today: breast surgery. I’m going to try to be pretty detailed while it’s fresh in mind and hopefully it will help people about to go through the same thing have a better idea of what to expect.

So, here goes: I checked in for my lumpectomy (also called “partial mastectomy”) at 7 a.m. The plan was that my daughter Callahan would come with me and my husband would stay home and get our daughter Allison off to school. Then Callahan would go to her college class in the afternoon and Gunny would pick my ass up after surgery was over. Of course none of this played out quite the way we planned. Allison had a minor meltdown in the morning. She was “Sad about that thing” (That thing being the cancer and the surgery and probably the disruption to her morning routine). Daddy asked her if she wanted to help get Mommy checked in at the hospital, if that would make her feel better. It would. So we took two cars to Overlake Outpatient Surgery.

Checked in! Hat by Kiki Lewis.
Checked in! Hat by Kiki Lewis.

I got checked in and the woman looked at the schedule and told us I’d probably be ready to go home around 4 or 4:30. Well, that threw a wrench in Plan A. Plan B was Callahan would return to the hospital after her math class got out at 3:30 so Gunny could pick Allison up from after-school chess club. I kissed Gunny and the baby goodbye and Callahan and I went in the back. I lay down in the bed and the nurses asked me about allergies and what medicine I was on etc. The only thing I’m on really is magnesium. I thought my supplement days were over when Dr. Captain America deemed my hemoglobin high enough for surgery. But I got an email from him last Friday telling me to double up on my magnesium dosage for a total of 1600 milligrams per day. Here’s the deal with magnesium: it makes you poop all the poop in the world. Which is probably why, even though my appetite is back and I’m as physically idle as ever, I haven’t gained a pound since my last round of chemo. It’s like bulimia of the butt. Honestly (and here I am describing shit to you, so what else could I be but honest?) I don’t think my body remembers how to manufacture regular poo. It’s like the enzymes or whatever is responsible for shit-creation are hanging out in my guts and some sushi or hamburger appears and one of ’em says “Food, huh? Uhhh what are we supposed to do with this?” and another one (maybe wearing a tiny construction hat) takes the tiny cigar out of his mouth and jerks a thumb towards my ass and mutters, “Ehhh, just liquefy it and shoot it out the back.”

Um. Anyway, the nurses set up an IV line in my hand and take my vitals and all that. I was tired and kinda punchy and suddenly so very grateful I hadn’t gone off the deep end and insisted we cut off my boobs. Surgery is weird and scary enough…at least I wasn’t saying farewell to those murderous twins. After a while of hanging out in that room, it was time for me to go to the Breast Center (where I had the original mammograms and Turdy (the breast tumor) and Turdy Jr. (the malignant lymph node) were discovered) to get some frickin’ wires put in to guide my surgeon Dr. Superman. I was kinda hoping it would be a fun reunion with Dr. Moviestar, but no such luck. I was hoping Callahan could come in the room with me, but they wouldn’t let her. Mainly because they’d just taken delivery of this massive new machine that looks–I shit you not–like a battle mech.

Get away from her, Turdy!
Get away from her, Turdy!

About seven feet tall, it has these arms that reach out on either side of you, and these plates that flatten your tits into flesh pancakes. There was a grid with markings and the doctor, after getting my boob squashed into the right position, took a surgical pen and marked my skin at position B-10. My response? “You sank my battleship!” Then she stuck lidocaine in my boob to numb it. That stung like a mo-fo. Then she followed that up with a teeny but hollow needle and threaded a single tiny wire through. One end was right on the metal clip Dr Moviestar had dropped in when he took the core biopsy of Turdy. The other end of the wire stuck out of my boob. I looked like a hedgehog with one lonely quill. The doctor liked that idea. She also loved the hat my friend Kiki made me. Being a knitter herself, she recognized quality work. I really wanted to get a picture of my boob wire, but by the time I was reunited with my phone, I’d been gauzed and taped up. We moved into an ultrasound room for the next part: locating the clip Dr Moviestar had put in Turdy Jr in my armpit. The doc had discussed this with Dr. Supe and he’d told her that if she couldn’t find the clip, no biggie, no wire, he’d find it with the radioactive tracer. Well, she couldn’t find the clip and guess what else she couldn’t find? Turdy Jr. That 4 cm asshole was GONE. I saw for myself on the screen.

Toodle-oo motherfucker!
Toodle-oo motherfucker!

I was feeling pretty good. The wire bit was over. They wheeled me back to outpatient surgery where I waited almost an hour for Nuclear Medicine to be ready for me. Callahan was exhausted and I felt guilty for wasting her time since it wasn’t looking like she was going to get to actually see anything cool. So…I sent her home to nap before class. Because I’m a dumbass. When Nuke Med was ready for me, it turns out she COULD have come with, and the tech, Gail, had trained at the exact same program at Bellevue College that Callahan is hoping to get into. AND Gail is friends with the director of the program. So I fucked that up and feel like a stupid, stupid asshole. So, remember me telling you that I was going to have a shot of radioactive tracer in my areola? And that the tracer would flow to my lymph nodes so that Dr. Supe, during surgery could run a Geiger counter over my armpit and see which nodes were cancery and take them out?

Wrong. First up, as the doctor told me, the tracer doesn’t go to the cancery bits like a moth to a flame. It shows which lympnodes are draining from the breast as opposed to another area. These little breast dumpsters are where the cancer would spread. Okay, now I know. The other wrong stuff? It wasn’t one shot…it was FOUR. Not in the areola, but at the perimeter, where the skin changes color from regular skin to nipply color. The placement, as the doctor put it, was three, six, nine and noon. It actually didn’t hurt that bad. Gail held my hand. When the shots were over they had me hold a heat pad to my boob and massage it so that the tracer flowed to the lymph nodes more quickly. I babbled about being radioactive or become SheHulk or an X-man. They were probably glad to get me out of there.

Damn you, cancer!
Damn you, cancer!

Back in my little room it was still 45 minutes before my surgery was scheduled. I dozed a bit and screwed around on Facebook via my phone. The anesthesiologist came in to introduce himself, the nurses hooked up the IV (fluids, antibiotics, and anti-nausea stuff). Then Doc Superman came in and after I flipped him a bit of shit about the one nuke shot actually being four. He went over what he was going to do: Take out the Turdy clip in my right boob plus a little bit of surrounding tissue, then Geiger my armpit and take out up to four lymph nodes. He initialed the right breast (so, you know, he got the correct boob), and said, “See you in there, kid.”

When I had the surgery to install my medi-port back in late April, I have no memory of the actual operating room. I think the anesthesiologist started me off in the wait-around room with a sedative and I was out of it by the time they moved me. But this time, I was totally alert. The OR was big and REALLY cold. Besides the anesthesiologist there were three nurses in scrubs and masks and I started to get a little nervous. It was REAL. Then I scootched off the gurney bed onto the operating table which is ridiculously narrow! Like skinnier than a dorm room bed. Probably 2/3 the size of a twin bed. Dr. Feelgood put a sedative in my IV and an oxygen mask over my mouth and nose and…

…woke up in the recovery room. Dr. Supe told me everything went great and he’d only had to take two lymph nodes! That’s really good because the more nodes that come out, the higher the risk of this super shitty (and often permanent) swelling and pain called lymphedema. Supe asks who’s picking me up and I say my daughter. Then I look at the clock and it’s only 2:00. Callahan’s about to go to class. So I tell him my husband. Supe has the number and gives him a call.

All done!
All done!

I move to a new room that has a recliner instead of a bed and the nurse gets me a Diet Coke and Saltines. (I hadn’t eaten or drunk anything since 10:30 pm the night before and I was HANGRY). I get my phone out of my stuff and post some updates to Facebook while the nurse calls in a Percocet prescription. After a while she goes to the waiting room to look for my husband. He’s not there. They ask me to call him and I do, obviously waking him up. Dr. Supe had just told him surgery went well, but didn’t mention that he needed to come get me. So he hauls ass to pick me up, feeling terrible though it was no fault of his!

We picked up the baby from school and when she saw me in Jeep she said “MOMMY!!!” We went home and I crawled in bed and Allison gave me this picture she drew for me.

This is me waking up after surgery. The nurse is clapping and apparently we're going to eat cake.
This is me waking up after surgery. The nurse is clapping and apparently we’re going to eat cake.

Gunny picked up my prescription and a Big Mac. It tasted like heaven.

IMG_3206So now I’ve got my Percocet with a Pinktober cap and my boobs are wrapped up in an Ace bandage.

IMG_3205I can take it off and shower on Saturday (48 hours after surgery), but can’t take a bath or swim for three weeks. It’s sore, but really not too painful. The only annoyance so far (besides the sweaty funk I’m sure is brewing inside the boob burrito) is I can’t sleep on my right side. This morning I peeked under the bandage at Turdy’s gravesite. It doesn’t look too bad! My armpit is kinda numb.

Kinda grody, but I still have two boobs!
Kinda grody, but I still have two boobs!

So what’s next? On Monday or Tuesday Dr. Supe will call with the pathology results. That’s when I will find out if there is any cancer left in me. I’m feeling optimistic and am fully expecting to hear that I am cancer-free. And then, friends, we are going to PARTY.

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Chemo Round 6 – The Worst is Over!

IMG_2745Yesterday I had my sixth and final round of chemotherapy!! I’m so excited and happy and relieved. I still have a couple weeks of side-effects to deal with, but the beauty part is that when I finally start feeling better I will STAY better. I won’t come out of it just to begin again. I am convinced that this knowledge will hasten recovery.

Before I tell you the tale of this momentous day, though, I need to bring you up to speed on surgery. I met with Dr. Superman (Oh! And I’m going back and updating all these cancer blog entries with the new improved nicknames. Simply because the ones I used back in the early days before I got to know this amazing team seem disrespectful now.) Anyway, I’m going to have a lumpectomy and sentinel node biopsy on September 15. Here’s how it will go down:

  1. I will go to the breast imaging office (I hope to see Dr. Moviestar, the radiologist!) and have guide wires inserted in Turdy the breast tumor (or probably just the marker clip since we think Turdy has been demolished by the chemo) and that monster malignant lymphnode in my armpit that was twice Turdy’s size. Remember these fuckers?
    Darth Turdy
    Darth Turdy
    Son of Turdy
    Son of Turdy

    The wires will run from the clips to the outside of my body and be taped down. This will help Dr. Supe find the lil bastards (he’s amazing, but does not to my knowlege possess x-ray vision).

  2. Next, I will go to Nuclear Medicine (I’m assuming the same joint I had my MRI, PET scan, and MRI-guided biopsy on Left Boob, They will inject a radioactive tracer into my areola. Yeah, you read that right. I will NOT be asleep for this monstrous act. I’m trying not to think about it.
  3. I’ll go into surgery and hopefully be knocked the F out by the anesthesiologist. Then, Supe will run a Geiger counter wand over my armpit area and mark with a pen the places that react to the tracer. Those will be the lympnodes most likely to be cancery. He predicts 3 at most.
  4. Supe will make ONE incision, and take out the Turdy-clip in my right breast along with a small chunk of surrounding tissue. He’ll remove Turdy Jr. the lymphnode and any of his Geiger-clicky neighbors. He’ll sew me back up!
  5. All the tissue junk will be sent to Pathology for testing. To see if there is any trace of cancer that the chemo didn’t get. This may take a couple days. If there are any lingering microscopic cancer cells then Dr. Supe will need to do more surgery. I guess that’s when we’d talk mastectomy.

About three weeks after surgery I will start Radiation. I’m actually going to take part in a research study if I qualify (and to qualify I need to be cancer-free ie no lingering cancery shit). I’ll be randomly placed in one of two groups: I will either get radiation just on Right Breast, OR on Right Breast AND Armpit. I’m hoping this will assuage my guilt for opting out of the first research study I was offered (which would have me recieving hormone therapy at the same time as chemo. Ixnay on the extra side effects.) A couple things I found interesting about the details of the study was that regarding privacy, the authors of the study warn that in the future, researchers may develop some way to find out my identity just through my DNA and in that case they can’t protect my anonymity just by withholding my name. It was a little Minority Report. This was the other part that was weird but cool. They basically make it plain that this will benefit people who haven’t even been diagnosed yet.IMG_2735

Anyway, the side-effects of Round 5 were dreadful. I got so tired at one point in the middle of grocery shopping that I actually used the scooter. I took my hat off so that my fellow shoppers wouldn’t think I was a faker and that I really did deserve to ride instead of walk. Yes, I know I’m ridiculous. IMG_2634And I think I’m a shoe-in for the Turtle Club. I am most def turtley enough.

the_master_of_disguise

When I could finally eat again I only wanted sushi. My husband completely indulged me. My daughter Callahan even took me for a late night run for grocery store sushi. Remember, I’m not driving, so my sushiquest requires an accomplice.IMG_2659

LAST CHEMO!!

At one point I felt like this day would never arrive. But on the other hand I’ve been planning for it like it’s the freakin’ senior prom. First, the outfit had to be significant. It had to be Wonder Woman. I have received a lot of WW gifts both before I was ever diagnosed but mostly afterwards. My friend Megan gave me a whole fab WW care package on the last day of Kindergarten that contained a book, sunglasses, a shitload of cute socks, and this fantabulous Wonder Woman snuggie. Don’t be too jealous.IMG_2666

Let me break down the provenance of my Final Chemo Ensemble for you:

  • IMG_2777The wig courtesy of Lisa Barbato.
  • The tiara is from Gunny.
  • The t-shirt I bought myself for the gym that I haven’t set foot in since before Christmas
  • The cuffs from my book editor Marti McKenna
  • The socks (with capes!) from my former mother-in-law Kathleen

I also put a lot of thought into gifts for the team. I got Captain America my oncologist a bottle of Irish Whiskey and a copy of my Lexy Cooper: Triple Threat collection. This is what I wrote inside:IMG_2743

For Harley, my favorite front-desker I got a fancy chocolate bar, and a Starbucks card. For three of my chemo nurses and for Cap’s PA Salena I got an orchid, fancy chocolate truffles and a Toberlone bar. I was up late the night before writing thank you notes which I wept as I wrote. I won’t replicate them here but the gist was to point out how each of them specifically helped me get through chemo. I thanked Cap for always listening and never rushing me. I summed up by thanking him for more years with my family. Then I brought in two bottles of champagne for the rest of the staff. Can I just say the gifts were a big hit? Wonder Woman or turtle, they kinda love me at Overlake Medical Oncology.

IMG_2747

Me and Amy. Best friends since 1973!
Me and Amy. Best friends since 1973!

My best friend Amy came to sit with me and my baby brother Dan stopped in for an hour or so. Gunny stayed most of the time except for when he left for a bit to buy me a present. 🙂 There were lots of hugs from the staff and when I was finished with my last bag of medicine the nurses presented me with a “graduation gift” which is a bunch of magnets with encouraging words. Then I got to ring the bell and Michelle said “Congratulations on your last chemo!!!” and everyone applauded. I didn’t cry at the time, but I’m a little weepy writing this now. It was fucking GREAT.

FullSizeRender (7)
From Left to Right: Sherry, Wonder Woman, Judy, and Michelle

This isn’t the last I’ll see of this team. I’ll be in today for my Neulasta shot, and in ten days for a blood count (gotta make sure I’m okay for surgery) and then I’ll be getting maintenance infusions of Herceptin (the wonderdrug that keeps HER2+ cancers at bay) every three weeks. Don’t panic, though. The treatment only lasts 30 minutes and the only side effect is a drippy nose. GOODBYE NAUSEA!

One small wrinkle: I told Dr Cap about my elevated heart rate and that it got up to 180 one day when I was cleaning and I felt lightheaded and short of breath. (I also fudged a little because it was actually 187 according to my Apple Watch). He put in a referral for a cardiologist because we don’t want my heart throwing any kind of hissy fit during surgery. He thinks they’ll have me wear some sort of monitor for 24 hours just to track any arrhythmia. If my heart’s misbehaving then they may have me take beta blockers. But THEN, last night I got a note from Cap saying my magnesium is “even lower than your potassium” and he called in a prescription for magnesium supplements that I am to take daily ASAP. Apparently lack of magnesium can cause irregular heart beat plus a bunch of other shit (shortness of breath, high blood pressure, and nausea unrelieved by medication!) that I’ve been blaming on the chemo. SO, I’m going to be a good patient and take that shit like I’m supposed to.

Tomorrow we leave for a week at the beach house in California and I am full of happiness. Yes, I will most likely have some bad days while there, but I’ll be in the beach house bed instead of my boring old bed at home!

What To Do About the Boobs

shehulk1First of all, this round of chemo can kiss my ass. Just in the last couple of days have I been able to eat meals, and it’s time to do chemo again. As each round gets progressively shittier, I will not be surprised if the awful nausea/gross taste lasts the full three weeks between rounds. Pissed and disappointed, but not surprised.

I also have two new side effects:

1. My thumbnails are doing this.

FullSizeRender (5) FullSizeRender (4)Some chemo patients lose their nails entirely. I’m hoping that doesn’t happen, but I also thought I might be spared this side effect.

2. Neuropathy. At least I think that’s what this burning itchy feeling is on my hands. It’s not constant, thankfully, but it sometimes wakes me up at night. What freaks me out about this side effect is that it can be permanent.

So that’s the sucky stuff. Here’s the good news: In my last post I fretted about what to do with my boobs. This past week I met with my breast surgeon, Dr. Superman (formerly known as Dr. Boobcutter) and I have a lot more clarity now. He assured me that “cutting everything off” will not statistically improve my survival rate, but if it will give me peace of mind, he will do it. He also, regarding my “one boob that’s a wonder of science and one that’s had three kids” concern, told me that if I had a mastectomy on the right breast, when they did reconstruction they’d do a little perk-up on the left breast and get them as symmetrical as possible. So that made me feel better.

What the plan is, though, is to start with a lumpectomy. On examining the bad boob, Supe was unable to feel any sign of Turdy the tumor! He said he’s “thrilled” with the chemo. So all he’ll have to remove is the little metal clip that Dr. Moviestar put in when he did the original biopsy. He’ll take that plus some surrounding tissue. It will most likely be a small enough amount that while Right Boob will have a scar, it won’t be the ginormous shark bite disfigurement I was imagining.

Turdy melting

The pathologist will examine this tissue and look for any microscopic cancer cells that may have escaped. What we’re looking for are “clean margins” aka no bad cells in the tissue around where Turdy used to live. If the margins aren’t clear, then we may go back and do the mastectomy after all.

Here’s the stinky part: After Dr. Supe consulted with Dr. Cap, they decided that because I have those four bad lymph nodes under my arm, I will also need to have a sentinel node dissection. They are going to–brace yourself–inject a radioactive tracer into my areola. Yes, boys, that’s Nipple City.

sentinelHopefully, I will already be knocked out for the surgery when it’s Tracer Time? Anyway, the tracer will flow to the lymph nodes and Dr. Supe will run a wand with a Geiger counter over my armpit and see which nodes react to the tracer. Those are the nodes that he’ll remove because they are most likely to have cancer cells. It’s a better option than taking all of them out and checking each for cancer. I can’t help but wonder if a radioactive boob will trigger a metamorphosis from part-time bitch into full-time She-Hulk.

I told Dr. Supe that I wanted to do everything possible to prevent a recurrence. And he told me that with HER2+ cancer, the most critical time is the first five years. With other flavors of breast cancer I guess it can come back within 15 years, but with HER2+, as he put it, “If we go five years without a recurrence, you come back to my office and we’ll drink champagne.”

Deal.

So here’s the tentative schedule:

  • Round 4 chemo July 9
  • Round 5 July 30
  • FINAL round of chemo Aug 20!!!
  • Lumpectomy and sentinel node dissection the week of Sept 7
  • Start radiation (5x week for 5-7 weeks is standard) first week of Oct

And then? I should be done.

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